Extra-articular Debridement of Hip Joint for Management of Anterior Hip Pain.
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ABSTRACT:
SUBMITTER: Kaya M
PROVIDER: S-EPMC6019961 | biostudies-literature |
REPOSITORIES: biostudies-literature
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Project description:BackgroundPeriarticular pain after total hip arthroplasty (THA) can significantly impair the postoperative functionality. Extra-articular impingement between the greater trochanter and the anterior inferior iliac spine is presented as a cause of refractive pain after THA.MethodsTwenty patients were treated for refractive periarticular pain and limited internal rotation between January 2014 and April 2016. All patients underwent a positive chair rise test, pelvic inclination test, and Marcainisation test. Patients were treated with bone resection of the anterior part of the greater trochanter with or without component revision.ResultsAt a mean follow-up of 20 months, all functional outcomes had improved significantly. All patients were willing to undergo the surgery again. Sixteen (80%) indicated the result as very good, 3 (15%) as good, and one (5%) as poor. Two patients developed a postoperative heterotopic ossification that required resection.ConclusionsExtra-articular impingement should be considered as a possible cause of refractive groin pain after THA. Bony resection through the Hueter interval provides immediate pain relief with improved functional outcomes 1 year after surgery.
| S-EPMC7567039 | biostudies-literature
Project description:Anterolateral rotational instability may persist after anterior cruciate ligament (ACL) reconstruction for a variety of reasons including damage to lateral or posterolateral structures, injury to the meniscus, disruption of anterolateral soft tissue structures, or increased tibial slope. In the setting of revision or primary ACL reconstruction with persistent anterolateral laxity, despite repair or reconstruction of other injured structures or in the setting of increased tibial slope, a lateral extra-articular tenodesis procedure can be used to augment an ACL reconstruction to aid in restoring anterolateral rotational stability and to upload the ACL reconstruction graft. This article details our technique for performing a modified Lemaire lateral extra-articular tenodesis using iliotibial band autograft as an adjunct to ACL reconstruction.
| S-EPMC6823830 | biostudies-literature
Project description:Intra-articular malignant lesions of the hip present significant challenges. Resection often requires large resection of the acetabular bone and pelvic columns. Concurrent reconstruction options after intra-articular hip tumors are challenging and may necessitate the use of techniques and implants with uncertain long-term survivorship. We present a case of an intra-articular hip malignancy with extra-articular resection and preservation of the acetabular columns with reconstruction using a cementless acetabular shell fixed with screws.
| S-EPMC6287234 | biostudies-literature
Project description:An increasing concern has been given to the rotation stability of the knee in the setting of an anterior cruciate ligament (ACL) reconstruction. This growing interest stems from a better understanding of the rotational stability of the knee afforded by the identification of the anterolateral ligament. Previously, a residual abnormal pivot-shift test had been found after an anatomic single-band reconstruction of the ACL because of a lack of rotational stability, which may lead to the development of osteoarthritis. Residual instability affects function, especially in high-demand athletes who perform many flexion-rotation movements during sporting activity. The purpose of this Technical Note is to describe our preferred method of intra-articular ACL reconstruction using a hamstring tendon autograft in combination with an extra-articular iliotibial band tenodesis for reinforcement of rotational stability.
| S-EPMC5709921 | biostudies-literature
Project description:BackgroundDynamic 3-dimensional (3D) simulation of hip impingement enables better understanding of complex hip deformities in young adult patients with femoroacetabular impingement (FAI). Deep learning algorithms may improve magnetic resonance imaging (MRI) segmentation.Purpose(1) To evaluate the accuracy of 3D models created using convolutional neural networks (CNNs) for fully automatic MRI bone segmentation of the hip joint, (2) to correlate hip range of motion (ROM) between manual and automatic segmentation, and (3) to compare location of hip impingement in 3D models created using automatic bone segmentation in patients with FAI.Study designCohort study (diagnosis); Level of evidence, 3.MethodsThe authors retrospectively reviewed 31 hip MRI scans from 26 symptomatic patients (mean age, 27 years) with hip pain due to FAI. All patients had matched computed tomography (CT) and MRI scans of the pelvis and the knee. CT- and MRI-based osseous 3D models of the hip joint of the same patients were compared (MRI: T1 volumetric interpolated breath-hold examination high-resolution sequence; 0.8 mm3 isovoxel). CNNs were used to develop fully automatic bone segmentation of the hip joint, and the 3D models created using this method were compared with manual segmentation of CT- and MRI-based 3D models. Impingement-free ROM and location of hip impingement were calculated using previously validated collision detection software.ResultsThe difference between the CT- and MRI-based 3D models was <1 mm, and the difference between fully automatic and manual segmentation of MRI-based 3D models was <1 mm. The correlation of automatic and manual MRI-based 3D models was excellent and significant for impingement-free ROM (r = 0.995; P < .001), flexion (r = 0.953; P < .001), and internal rotation at 90° of flexion (r = 0.982; P < .001). The correlation for impingement-free flexion between automatic MRI-based 3D models and CT-based 3D models was 0.953 (P < .001). The location of impingement was not significantly different between manual and automatic segmentation of MRI-based 3D models, and the location of extra-articular hip impingement was not different between CT- and MRI-based 3D models.ConclusionCNN can potentially be used in clinical practice to provide rapid and accurate 3D MRI hip joint models for young patients. The created models can be used for simulation of impingement during diagnosis of intra- and extra-articular hip impingement to enable radiation-free and patient-specific surgical planning for hip arthroscopy and open hip preservation surgery.
| S-EPMC8685729 | biostudies-literature
Project description:PurposeThe purpose of this study was to determine the accuracy of electronic hip pain drawing to diagnose intra-articular source of pain in nonarthritic hips, defined by response to an intra-articular injection.MethodsA retrospective assessment was performed in consecutive patients who had an intra-articular injection completed within a 1-year period. Patients were classified as responders or nonresponders to intra-articular hip injection. A positive injection was defined as greater than 50% hip pain relief within 2 hours after injection. Electronic pain drawings collected before injection were then evaluated according to the hip region marked by the patients.ResultsEighty-three patients were studied after applying inclusion and exclusion criteria. Anterior hip pain on drawing had a sensitivity of 0.69, specificity of 0.68, positive predictive value (PPV) of 0.86, and negative predictive value (NPV) of 0.44 for intraarticular source of pain. Posterior hip pain on drawing had a sensitivity of 0.59, specificity of 0.23, PPV of 0.68, and NPV of 0.17 for intra-articular source of pain. Lateral hip pain on drawing had a sensitivity of 0.62, specificity of 0.50, PPV of 0.78, and NPV of 0.32 for intraarticular source of pain.ConclusionAnterior hip pain on electronic drawing has a sensitivity of 0.69 and specificity of 0.68 for intra-articular source of pain in nonarthritic hips. Lateral and posterior hip pain on electronic pain drawings are not reliable to rule out intra-articular hip disease.Level of evidenceLevel III, case-control study.
| S-EPMC9971901 | biostudies-literature
Project description:BackgroundIt is still controversial whether the combination of anterior cruciate ligament (ACL) reconstruction and extra-articular reconstruction (EAR) have good clinical efficacy. This meta-analysis aims systematically to compare the clinical effectiveness of ACL reconstruction and combined reconstruction.MethodsElectronic databases, including Medline/PubMed, Embase and the Cochrane Library, were systematically searched to identify targeted studies. A meta-analysis were performed to pool the outcome estimates of interest, such as the Lysholm, International Knee Documentation Committee (IKDC) and Tegner scores and the results from the KT-1000/2000 arthrometer test, the Lachman test and the pivot shift test.ResultsTwelve studies involving 1146 knees were identified. Compared with single ACL reconstruction, combined reconstruction had better results for a pivot shift of grade 1 (relative ratio [RR] = 0.88, 95% CI: 0.83-0.94) and grade 2 (RR = 0.95, 95% CI: 0.91-0.99) rather than grade 3 (RR = 0.98, 95% CI: 0.90-1.06) and no statistically significant difference for both Lachman grade 1 (RR = 0.96, 95% CI: 0.89-1.05) and grade 2 (RR = 0.96, 95% CI: 0.90-1.03). Combined reconstruction resulted in significant improvements on the instrumented joint laxity test when considering a failure standard of more than 5 mm (a side-to-side arthrometric difference) (RR = 0.94, 95% CI: 0.89-0.98) rather than 3 mm (RR = 0.94, 95% CI: 0.86-1.03). Moreover, combined reconstruction increased the IKDC score at the 12-month (weighted mean difference [WMD] = - 6.38, 95% CI: - 9.66 to - 3.10), 24-month (WMD = - 5.60, 95% CI: - 8.54 to - 2.66) and 36-month follow-ups (WMD = - 4.71, 95% CI: - 7.59 to - 1.83) and the Tegner score at the 36-month follow-up (WMD = - 0.53, 95% CI: - 0.97 to - 0.09), but it did not increase the Lysholm score at the 36-month follow-up (WMD = - 0.84, 95% CI: - 2.02 to 0.34).ConclusionWith the advances in reconstruction techniques, combined reconstructions were found to be effective in improving rotational stability and to lead to good functional scores. However, obviously, the combined reconstruction technique is more time-consuming and requires an additional incision, which is not suitable for all ACL-deficient patients. Therefore, programs should be personalized and customized for the specific situation of each patient.
| S-EPMC7325370 | biostudies-literature
Project description:ObjectivesIt is currently poorly known how different structural and compositional components in human articular cartilage are related to their specific functional properties at different stages of osteoarthritis (OA). The objective of this study was to characterize the structure-function relationships of articular cartilage obtained from osteoarthritic human hip joints.MethodsArticular cartilage samples with their subchondral bone (n = 15) were harvested during hip replacement surgeries from human femoral necks. Stress-relaxation tests, Mankin scoring, spectroscopic and microscopic methods were used to determine the biomechanical properties, OA grade, and the composition and structure of the samples. In order to obtain the mechanical material parameters for the samples, a fibril-reinforced poroviscoelastic model was fitted to the experimental data obtained from the stress-relaxation experiments.ResultsThe strain-dependent collagen network modulus (E(f)(ε)) and the collagen orientation angle exhibited a negative linear correlation (r = -0.65, P < 0.01), while the permeability strain-dependency factor (M) and the collagen content exhibited a positive linear correlation (r = 0.56, P < 0.05). The nonfibrillar matrix modulus (E(nf)) also exhibited a positive linear correlation with the proteoglycan content (r = 0.54, P < 0.05).ConclusionThe study suggests that increased collagen orientation angle during OA primarily impairs the collagen network and the tensile stiffness of cartilage in a strain-dependent manner, while the decreased collagen content in OA facilitates fluid flow out of the tissue especially at high compressive strains. Thus, the results provide interesting and important information of the structure-function relationships of human hip joint cartilage and mechanisms during the progression of OA.
| S-EPMC3627049 | biostudies-literature
Project description:PurposeTo identify the risk of anterior cruciate ligament (ACL) femoral tunnel penetration with the use of a staple for lateral extra-articular tenodesis (LET) graft fixation and to determine whether this varied between 2 different techniques for ACL femoral tunnel drilling.MethodsTwenty paired, fresh-frozen, cadaver knees underwent ACL reconstruction with a LET. Left and right knees were randomized to ACL reconstruction with femoral tunnel creation by use of either a rigid guide pin and reamer through the accessory anteromedial portal or by the use of a flexible guide pin and reamer through the anteromedial portal. Immediately after tunnel creation, the LET was performed and fixated with a small Richard's staple. Fluoroscopy was used to obtain a lateral view of the knee to determine staple position, and visualization of the ACL femoral tunnel was performed with the arthroscope to investigate penetration of the staple into the femoral tunnel. The Fisher exact test was conducted to determine whether there was any difference in tunnel penetration between tunnel creation techniques.ResultsThe staple was noted to penetrate the ACL femoral tunnel in 8 of 20 (40%) extremities. When stratified by tunnel creation technique, the Richards staple violated 5 of 10 (50%) of the tunnels made via the rigid reaming technique compared with 3 of 10 (30%) of those created with a flexible guide pin and reamer (P = .65).ConclusionsA high incidence of femoral tunnel violation is seen with lateral extra-articular tenodesis staple fixation.Level of evidenceLevel IV, controlled laboratory study.Clinical relevanceThe risk of penetrating the ACL femoral tunnel with a staple for LET graft fixation is not well understood. Yet, the integrity of the femoral tunnel is important for the success of ACL reconstruction. Surgeons can use the information in this study to consider adjustments to operative technique, sequence, or fixation devices used when performing ACL reconstruction with concomitant LET to avoid the potential for disruption of ACL graft fixation.
| S-EPMC9971869 | biostudies-literature
Project description:For patients who have anterior hip pain evaluated by Patrick's test and tenderness at Scarpa's triangle, we perform periarticular debridement based on the hypothesis that extra-articular pathologies are responsible for the hip pain. The purpose of this study was to categorize the endoscopic extra-articular findings and to evaluate the clinical significance of periarticular pathologies in anterior hip pain.Arthroscopic findings of 77 patients who underwent periarthritic debridement were evaluated. As extra-articular pathologies, injuries of the direct head and reflective head of the rectus femoris muscle were evaluated. A thin layer of fat tissue normally exists on the anterior inferior iliac spine (AIIS), the attachment site of the direct head of the rectus femoris muscle. The macroscopic appearance of the fat pad on the AIIS was categorized as normal, blood vessel-rich adipose tissue or adipose tissue with fibrosis or scar formation and histologically confirmed. Adhesion of gluteal muscles to the joint capsule was also evaluated.Of the 77 patients, 75 had rupture of the direct head of the rectus femoris. In contrast, rupture of the reflective head was extremely rare. Seven patients had a normal fat pad on the AIIS, 11 had blood vessel-rich adipose tissue and 55 had adipose tissue with fibrosis. Fat tissue was completely replaced by fibrous scar tissue in another 4 patients. In 64 patients, adhesion between the anterior joint capsule and gluteus muscles was marked. Groin pain disappeared soon after the operation even when labral tears were not repaired and all patients returned to daily life and sports activities within 2 weeks after operation.Rectus femoris tendinosis, fibrosis of the AIIS fat pad, and adhesion of gluteal and rectus femoris muscles are common extra-articular pathologies in patients with anterior hip pain. Management of only these lesions induces rapid relief of anterior hip pain even in the absence of labral tear repair. My observations suggest that it is desirable to be aware of the presence of periarticular pathologies as a cause of groin pain.
| S-EPMC5764340 | biostudies-literature