Comparison of radiographic hip joint space in weight bearing and supine X-rays in patients with hip pathology

Abstract Background Several malreduction criteria have been proposed for ankle surgery, but the criteria of most importance for functional outcome remain undetermined. Furthermore, the acute inflammatory response in the ankle joint after fracture is hypothesized to result in osteoarthritis development, but no study has investigated the correlation between the levels of these inflammatory cytokines and post-surgical functional outcomes. We aimed to identify malreduction criteria and inflammatory cytokines associated with functional outcome after ankle surgery.MethodsDuring surgery, synovial fluid from the fractured and healthy contralateral ankles of 46 patients was collected for chemiluminescence analysis of 22 inflammatory cytokines and metabolic proteins. The quality of fracture reduction was based on 9 criteria on plain X-rays and 5 criteria on weight-bearing computed tomography (WBCT) scans. After 3 and 12 months, we recorded scores on American Orthopedic Foot and Ankle Society (AOFAS) scale, the Danish version of Foot Function Index (FFI-DK), EQ-5D-5L index score, the Kellgren Lawrence score, and joint space narrowing. ResultsTibiofibular (TF) overlap (p=0.02) and dime sign (p=0.008) correlated with FFI-DK. Tibiotalar tilt correlated positively with joint space narrowing at 3 months (p=0.01) and 12 months (p=0.03). TF widening correlated with FFI-DK (p=0.04), AOFAS (p=0.02), and EQ-5D-5L (p=0.02). No consistent correlations between synovial cytokine levels and functional outcomes were found at 12 months.ConclusionsMalreduction of TF overlap, TF widening, and tibiotalar tilt were the most important criteria for functional outcome after ankle surgery. Increased inflammatory cytokine levels after fracture did not affect functional outcome at 12 months.Trial registration: This cohort study is registered the 10th of December 2018 at ClinicalTrials.gov (NCT03769909, https://clinicaltrials.gov/ct2/show/NCT03769909), was approved by the local committee on health ethics (The Regional Committees on Health Research Ethics for Southern Denmark: J.No. S-20170139), and was reported to the National Danish Data Protection Agency (17/28505).

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Is it possible to use stress radiographs as a tool to diagnose medial meniscus posterior root tears?

Orthopaedic Journal of Sports Medicine ◽

10.1177/2325967117s00073 ◽

2017 ◽

Vol 5 (2_suppl2) ◽

pp. 2325967117S0007

Author(s):

Ali Engin Daştan ◽

Elcil Kaya Biçer ◽

Hüseyin Kaya ◽

Emin Taşkıran

Keyword(s):

Medial Meniscus ◽

Weight Bearing ◽

Joint Space Width ◽

Joint Space ◽

X Rays ◽

Meniscal Extrusion ◽

Valgus Stress ◽

Varus Stress ◽

The Difference ◽

Space Width

Aim: Medial meniscus posterior root tear (MMPRT) causes meniscal extrusion, loss of meniscus function, arthritic changes. Clinical history, physical examination and magnetic resonance imaging (MRI) findings are useful for the diagnosis of MMPRT. The aim of this study is to evaluate the utility of stress X-rays in the diagnosis of MMPRT. Methods: Twenty patients who had undergone high tibial osteotomy between March 2015 and May 2016 and whose preoperative bilateral varus and valgus stress x-rays (Telos device) along with weight bearing x-rays were available were included. These patients were grouped into two according to integrity of posterior roots of their medial menisci; there were ten patients both in the study and control groups. Lateral joint space width (LJW) on varus stress x-rays, medial joint space width (MJW) on valgus stress x-rays as well as LJW and MJW on weight bearing x-rays were measured bilaterally. Intragroup comparisons of joint space widths between index and opposite knees were performed. Differences of MJW and LJW between index and opposite knees were calculated. Differences of joint space widths between stress x-rays and weight bearing x-rays were also calculated. The changes in joint space widths between the two groups were compared. Statistical analyses were performed utilizing SPSS 18.0. Significance level was set at 0.05. Results: In MMPRT group, opening of LJ space of index knees under varus stress was greater than that of opposite knees (Index: (mean±SD) 10,27±1,17 mm, opposite: 8,61±1,37 mm; p<0,0001). In the control group the difference was not significant (Index: 9,29±2,55 mm, opposite: 9,68±1,44 mm; p=0,566). The difference in the opening of LJW (under varus stress) between index and opposite knees was significantly greater in the study group (p=0,013). The difference between LJW under weight-bearing and varus stress conditions was significantly greater in the study group. (Study: 3,64±0.217 mm, control:2,28±0,182 mm, p=0.018). Conclusions: The findings of this study showed that in patients who had MMPRTs, an increased opening in the LJW was observed under varus stress conditions. This may be relevant with the fact that when varus stress is applied, meniscal extrusion is increased in case of a MMPRT. Stress x-rays could be a useful tool in the diagnosis of MMPRTs. Further studies are needed to determine the sensitivity and specificity of this diagnostic tool.

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Is Indian osteoarthritis different? Emerging scenarios of disease pattern and implications for diagnosis and treatment of osteoarthritis in India

International Journal of Research in Orthopaedics ◽

10.18203/issn.2455-4510.intjresorthop20201723 ◽

2020 ◽

Vol 6 (3) ◽

pp. 531

Author(s):

Pavankumar Kohli ◽

Hanumant Waybase ◽

Poorv Patel ◽

L. G. Naik ◽

Rajiv Colaco ◽

...

Keyword(s):

Femoral Condyle ◽

Weight Bearing ◽

Lateral Compartment ◽

Joint Space ◽

Cartilage Loss ◽

Wear Loss ◽

X Rays ◽

Femoral Cartilage ◽

Disease Pattern ◽

Cartilage Wear

Background: There are many studies to show comparative cartilage wear of medial and lateral compartment of knee. However, there are no studies in Indians that compare relative cartilage loss between femur and tibia.Methods: 44 patients with osteoarthritic knee at our center were posted for operative intervention in the form of partial or total knee arthroplasty and included in this study. Each patient had an magnetic resonance imaging (MRI) (cartogram) and weight bearing X-rays of the same knee. Intraoperative qualitative cartilage loss both femoral and tibial surfaces was observed and confirmed with preop findings of cartilage loss on X-ray or MRI.Results: The wear/loss of cartilage in 44 patients in femur is approximately twice that of tibia.Conclusions: Femoral cartilage loss is significantly more than tibia in Indians. These findings carry significance of not waiting for bone on bone arthritis to consider active treatment for Indian osteoarthritis patients. Bone on bone arthritis has so far been considered the litmus test for any intervention for osteoarthritis, even in India. Specific attention should rather be given to the femoral condyle clinically and radiologically. The authors have already described “The Dervan RIM sign” for the same purpose. The wear pattern is different from Caucasians and focus cannot be on joint space narrowing which is only with equally prevalent tibial and femoral cartilage wear.

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AB0867 INCREASED ADIPONECTIN LEVELS ARE ASSOCIATED WITH HIGHER RADIOGRAPHIC SCORES IN THE KNEE JOINT, BUT NOT IN THE HAND JOINT: THE DONG-GU STUDY

Annals of the Rheumatic Diseases ◽

10.1136/annrheumdis-2020-eular.1677 ◽

2020 ◽

Vol 79 (Suppl 1) ◽

pp. 1740.1-1740

Author(s):

J. H. Kang ◽

S. E. Choi ◽

H. Xu ◽

D. J. Park ◽

S. S. Lee

Keyword(s):

Body Mass Index ◽

Knee Joint ◽

Body Mass ◽

Linear Regression Analysis ◽

Joint Space ◽

Serum Adiponectin ◽

Hand Osteoarthritis ◽

X Rays ◽

Subchondral Cyst ◽

The Relationship

Background:Several studies have evaluated the association between serum adiponectin levels and knee and hand osteoarthritis (OA), with mixed results.Objectives:The aim of this study was to investigate the relationship between OA and serum adiponectin levels according to the radiographic features of knee and hand OA.Methods:A total of 2,402 subjects were recruited from the Dong-gu Study. Baseline characteristics were collected via a questionnaire, and X-rays of knee and hand joints were scored by a semi-quantitative grading system. The relationship between serum adiponectin levels and radiographic severity was evaluated by linear regression analysis.Results:Subjects with higher tertiles of serum adiponectin were older and had a lower body mass index than those with lower tertiles. In the knee joint scores, serum adiponectin levels were positively associated with the total score (P<0.001), osteophyte score (P=0.003), and joint space narrowing (JSN) score (P<0.001) among the three tertiles after adjustment for age, sex, body mass index, smoking, alcohol consumption, education, and physical activity. In the hand joint scores, no association was found between serum adiponectin levels and the total score, osteophyte score, JSN score, subchondral cyst score, sclerosis score, erosion score, and malalignment score among the three tertiles after adjustment.Conclusion:In this study, we found that increased adiponectin levels were associated with higher radiographic scores in the knee joint, but not in the hand joint, suggesting different pathophysiologic mechanisms in the development of OA.Disclosure of Interests:None declared

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High systemic bone mineral density increases the risk of incident knee OA and joint space narrowing, but not radiographic progression of existing knee OA: the MOST study

Annals of the Rheumatic Diseases ◽

10.1136/ard.2008.099531 ◽

2009 ◽

Vol 69 (01) ◽

pp. 163-168 ◽

Cited By ~ 68

Author(s):

M C Nevitt ◽

Y Zhang ◽

M K Javaid ◽

T Neogi ◽

J R Curtis ◽

...

Keyword(s):

Bone Mineral Density ◽

Bone Mineral ◽

Joint Space Narrowing ◽

Weight Bearing ◽

Joint Space ◽

Whole Body ◽

Mineral Density ◽

Knee Oa ◽

Increased Risk

Objectives:Previous studies suggest that high systemic bone mineral density (BMD) is associated with incident knee osteoarthritis (OA) defined by osteophytes but not with joint space narrowing (JSN), and are inconsistent regarding BMD and progression of existing OA. The association of BMD with incident and progressive tibiofemoral OA was tested in a large prospective study of men and women aged 50–79 years with or at risk for knee OA.Methods:Baseline and 30-month weight-bearing posteroanterior and lateral knee radiographs were scored for Kellgren-Lawrence (K-L) grade, JSN and osteophytes. Incident OA was defined as the development of K-L grade ⩾2 at follow-up. All knees were classified for increases in grade of JSN and osteophytes from baseline. The association of gender-specific quartiles of baseline BMD with risk of incident and progressive OA was analysed using logistic regression, adjusting for covariates.Results:The mean (SD) age of 1754 subjects was 63.2 (7.8) years and body mass index was 29.9 (5.4) kg/m2. In knees without baseline OA, higher femoral neck and whole body BMD were associated with an increased risk of incident OA and increases in grade of JSN and osteophytes (p<0.01 for trends); adjusted odds were 2.3–2.9-fold greater in the highest compared with the lowest BMD quartiles. In knees with existing OA, progression was not significantly related to BMD.Conclusions:In knees without OA, higher systemic BMD was associated with a greater risk of the onset of JSN and K-L grade ⩾2. The role of systemic BMD in early knee OA pathogenesis warrants further investigation.

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TRANSIENT SYNOVITIS OF THE HIP JOINT IN CHILDREN

PEDIATRICS ◽

10.1542/peds.24.6.1042 ◽

1959 ◽

Vol 24 (6) ◽

pp. 1042-1049 ◽

Cited By ~ 1

Author(s):

Alexander Spock

Keyword(s):

Hip Joint ◽

Streptococcal Infection ◽

Weight Bearing ◽

Bed Rest ◽

Transient Synovitis ◽

Treatment Results ◽

B Virus ◽

Coxsackie B Virus ◽

Roentgenographic Examination ◽

Coxsackie B

A clinical review of 47 eases of transient synovitis of the hip joint occurring in patients less than 14 years of age is presented. Evidence from clinical, bacteriologic and serologic data is presented to show that in four patients acute streptococcal infection was associated with the development of transient synovitis. In one other patient clinical and serologic data disclosed a similar parallelism with an infection by the Coxsackie B virus. These findings suggest that these agents may be among those etiologically responsible for this syndrome. An obese or stocky physique probably predisposes a child to this disease. Patients with transient synovitis do not have any diagnostic abnormalities which can be detected by roentgenographic examination. Prevention of weight bearing by bed rest until the patient is completely asymptomatic provides the best form of therapy, and failure to follow such treatment results in prolongation of the illness. Antibiotics do not appear to influence the course of the disease. Three patients in this series developed Legg-Perthes disease within an interval of 3 to 17 months after convalescing from transient synovitis of the hip.

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Assessment of Acetabulum Deformity During Preoperative Planning for Hip Arthroplasty

Traumatology and Orthopedics of Russia ◽

10.21823/2311-2905-2019-25-3-153-164 ◽

2019 ◽

Vol 25 (3) ◽

pp. 153-164

Author(s):

D. V. Martynenko ◽

V. P. Voloshin ◽

L. A. Sherman ◽

K. V. Shevyrev ◽

S. A. Oshkukov ◽

...

Keyword(s):

Acetabular Component ◽

Hip Joint ◽

Preoperative Planning ◽

Bone Defects ◽

Lateral Side ◽

X Rays ◽

Two Dimensional ◽

Acetabular Coverage ◽

Anatomical Features ◽

Medial Side

Purpose of the study — to improve the two-dimensional planning of total hip joint arthroplasty to ensure precise positioning of the acetabular component in the deformed acetabulum. Materials and methods. Features of roentgenological anatomy of acetabulum and its coverage were studied on 1058 hip joint x-rays in the AP view in accordance with the procedure developed by the authors to define acetabular square — the site of standard positioning of a spherical femoral head in the acetabulum or of a hemispherical acetabular component. The method consisted of identifying the apex of “teardrop” figure; the most lateral points of the pelvic terminal line and roof of the acetabulum; superior part of the acetabular cavity; medial and inferior points of acetabular coverage, and building the sides of acetabular square — medial, inferior, lateral and superior boundary lines. Connection of “teardrop” apex and lateral point of the pelvic terminal line formed the medial side of acetabular square, and a perpendicular to that line drawn through the “teardrop” apex to its inferior side. The lateral side was drawn either through the intersection of the ascending diagonal line — bisector from the top of the “teardrop” figure with the contour of the acetabulum roof, or was a part of the projection of the most lateral point of the acetabular roof on the inferior side of the square. The superior side was a perpendicular connecting the intersection of the ascending diagonal and lateral bounding lines with the medial side of the acetabular square. The area of the deformed acetabular cavity located outside of the acetabular square was assessed as the acetabular defect. Results. Method of defining the acetabular square allowed to identify types of ratios between acetabular cavity and acetabular coverage in transverse (9 types) and longitudinal (7 types) direction. Combination of transverse ratio of acetabular cavity and coverage with longitudinal type allowed to define the options of acetabular deformities in two-dimensional view. The authors identified 25 types of acetabular deformities. Bone defects of acetabular walls were of the major importance among all anatomical features. Cranial defect of acetabulum was observed in 450 cases, medial wall defect — in 38 cases, defect including cranial and medial areas — in 7 cases. Conclusion. The method suggested by the authors to determine acetabular square and acetabular deformity variations allows to screen the anatomical features of the acetabulum during two-dimensional preoperative planning and to make an informed decision on the need to use other planning techniques. The type of acetabular deformity identified during preoperative planning allows to elaborate the indications for replacement of acetabular bone defects and/or resection of acetabular osteophytes.

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Normal radiological unossified hip joint space and femoral head size development during growth in 675 children and adolescents

Clinical Anatomy ◽

10.1002/ca.22807 ◽

2016 ◽

Vol 30 (2) ◽

pp. 267-275 ◽

Cited By ~ 1

Author(s):

Veronika Wegener ◽

Gabriele Jorysz ◽

Andreas Arnoldi ◽

Sandra Utzschneider ◽

Bernd Wegener ◽

...

Keyword(s):

Femoral Head ◽

Children And Adolescents ◽

Hip Joint ◽

Joint Space ◽

Head Size ◽

Femoral Head Size

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Labyrinthectomy decreases bone mineral density in the femoral metaphysis in rats

Journal of Vestibular Research ◽

10.3233/ves-2004-14501 ◽

2004 ◽

Vol 14 (5) ◽

pp. 361-365

Author(s):

Régis Levasseur ◽

Jean Pierre Sabatier ◽

Olivier Etard ◽

Pierre Denise ◽

Annie Reber

Keyword(s):

Bone Mineral Density ◽

Bone Mineral ◽

Weight Bearing ◽

Whole Body ◽

X Rays ◽

Mineral Density ◽

Femoral Metaphysis ◽

Significant Difference ◽

Distal Femoral Metaphysis ◽

Vestibular Influence

To determine whether the vestibular system could influence bone remodeling in rats, we measured bone mineral density with dual energy X-rays absorptiometry before and 30 days after bilateral labyrinthectomy. Comparatively to intact control rats, labyrinthectomized animals showed a reduced bone mineral density in distal femoral metaphysis (p = 0.007): the variations between D0 and D30 were +3.0% for controls and -13.9% for labyrinthectomized rats. No significant difference between the 2 groups was observed in the whole body mineral density. These results suggest that the peripheral vestibular apparatus is a modulator of bone mass and more specifically in weight bearing bone. We discuss possible mechanisms of this vestibular influence probably mediated by the sympathetic nervous system.

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Computer-Aided System Application Value for Assessing Hip Development

Frontiers in Physiology ◽

10.3389/fphys.2020.587161 ◽

2020 ◽

Vol 11 ◽

Author(s):

Yaoxian Jiang ◽

Guangyao Yang ◽

Yuan Liang ◽

Qin Shi ◽

Boqi Cui ◽

...

Keyword(s):

Hip Joint ◽

Detection System ◽

Pearson Correlation ◽

Correlation Coefficients ◽

Diagnostic Efficiency ◽

X Rays ◽

Computer Aided Detection ◽

Sharp Angle ◽

Center Edge ◽

Computer Aided

PurposeA computer-aided system was used to semiautomatically measure Tönnis angle, Sharp angle, and center-edge (CE) angle using contours of the hip bones to establish an auxiliary measurement model for developmental screening or diagnosis of hip joint disorders.MethodsWe retrospectively analyzed bilateral hip x-rays for 124 patients (41 men and 83 women aged 20–70 years) who presented at the Affiliated Zhongshan Hospital of Dalian University in 2017 and 2018. All images were imported into a computer-aided detection system. After manually outlining hip bone contours, Tönnis angle, Sharp angle, and CE angle marker lines were automatically extracted, and the angles were measured and recorded. An imaging physician also manually measured all angles and recorded hip development, and Pearson correlation coefficients were used to compare computer-aided system measurements with imaging physician measurements. Accuracy for different angles was calculated, and the area under the receiver operating characteristic (AUROC) curve was used to represent the diagnostic efficiency of the computer-aided system.ResultsFor Tönnis angle, Sharp angle, and CE angle, correlation coefficients were 0.902, 0.887, and 0.902, respectively; the accuracies of the computer-aided detection system were 89.1, 93.1, and 82.3%; and the AUROC curve values were 0.940, 0.956, and 0.948.ConclusionThe measurements of Tönnis angle, Sharp angle, and CE angle using the semiautomatic system were highly correlated with the measurements of the imaging physician and can be used to assess hip joint development with high accuracy and diagnostic efficiency.

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