Sonography-Based Determination of Hip Joint Anterior Alpha-Angle: A Reliable and Reproducible Method

2021 ◽  
Author(s):  
Christian T. Schamberger ◽  
Stephan Stein ◽  
Gerd Gruber ◽  
Arnold J. Suda
Keyword(s):  
Hip Joint ◽  
Alpha Angle ◽  
Hip Osteoarthritis ◽  
Single Center ◽  
Diagnostic Quality ◽  
Angle Measurements ◽  
Cam Impingement ◽  
Musculoskeletal Sonography ◽  
Reproducible Method ◽  
The Mean

Abstract Purpose Femoroacetabular impingement (FAI) is a known risk factor for hip osteoarthritis. The gold standard for diagnostics is X-ray and MRI. The accuracy of hip joint alpha angle measurements obtained using sonography is equal to measurements in MRI for patients with cam impingement of the hip joint. Materials and Methods Patients with hip pain and MRI and sonography were evaluated between January 2015 and December 2019 in a single center. Musculoskeletal sonography was performed according to the DEGUM guidelines by ultrasound-certified specialists. Measurements were repeated three times by two independent investigators. Results 285 patients were screened, and 110 patients (49 females, 61 males) met the inclusion criteria. The mean age at time of investigation of 54 left and 56 right hip joints was 54.2 years. 1320 measurements were performed. The mean alpha angle was 50.7° in MRI and 50.4° in sonography with a mean difference of 0.28° (p>0.05). Conclusion Determining hip alpha angle using sonography is a safe and reproducible method. No statistically significant differences between results in MRI and sonography could be seen. Although this is a retrospective, single-center study including only Caucasian mid-Europeans and with the known limitations of ultrasound imaging, it nevertheless shows that sonography can be used as a simple, cheap, and fast technique to assess the hip alpha angle without losing diagnostic quality.

Analysis of Outcomes of Total Cementless Hip Joint Arthroplasty in the Treatment of Advanced Hip Osteoarthritis Following Childhood Perthes’ Disease

2020 ◽  
Vol 22 (5) ◽  
pp. 333-342
Author(s):  
Marek Drobniewski ◽  
Magdalena Krasińska ◽  
Andrzej Grzegorzewski ◽  
Marek Synder ◽  
Andrzej Borowski
Keyword(s):  
Hip Joint ◽  
Hip Osteoarthritis ◽  
Joint Arthroplasty ◽  
Perthes Disease ◽  
Acetabular Cup ◽  
Kaplan Meier ◽  
Long Term Follow Up ◽  
The Mean ◽  
Joint Arthroplasties

Background. The aim of this study is to analyse the outcomes of total cementless hip joint arthroplasty in the treatment of advanced hip osteoarthritis following Perthes’ disease in childhood. Material and methods. The study enrolled 56 patients (15 women and 41 men) who underwent a total of 61 hip joint arthroplasties for coxarthrosis following Perthes’ disease. The mean age of the patients at surgery was 46.7 years (range 21-67 years). The mean follow-up period was 13.7 years. Results. Pre-operative Merle d’Aubigne-Postel scores (modified by Charnley) of the study group were poor in all patients. Mean post-operative improvement was 6.7 points. The outcomes were classified as excellent in 25 cases, good in 16, satisfactory in 16 and poor in 9 cases. Poor results were always related to loosening of the acetabular cup. Heterotopic ossification was noted in 7 cases. According to the Kaplan-Meier estimator, 10 years’ survival probability was 85.24% for the whole implant and 100% for the stem. Conclusions. 1. Total cementless hip joint arthroplasty is an effective method in the treatment of advanced hip osteoarthritis following Perthes’ disease in childhood. 2. With good surgical technique and in the absence of complications, the risk of aseptic loosening is minimal. 3. Due to the patients’ young age, there may be more cases of loosening over time, requiring regular long-term follow-up.

Analysis of the Results of Hip Arthroplasty with the Use of Khanuja Group 6 stems

2021 ◽  
Vol 23 (5) ◽  
pp. 361-374
Author(s):  
Marek Drobniewski ◽  
Magdalena Krasińska ◽  
Marek Synder ◽  
Andrzej Borowski
Keyword(s):  
Hip Joint ◽  
Hip Osteoarthritis ◽  
Functional Results ◽  
Joint Arthroplasty ◽  
Implantation Technique ◽  
Acetabular Cup ◽  
Replacement Surgery ◽  
Hip Replacement Surgery ◽  
The Mean

Background. Total cementless hip joint arthroplasty is universally recognized as a method of treatment of ad­vanced hip osteoarthritis. Multifaceted research by a wide group of implant specialists has led to the development of special implants that fulfill their purpose even in the most severe deformities of the hip joint. The aim of the study is to present and analyse the results of hip joint arthroplasty with the Antega anatomical stem. Materials and methods. The study enrolled 533 patients (342 women and 191 men) who underwent a total of 595 hip joint arthroplasties with the Antega anatomical stem. The mean age of the patients at surgery was 56.2 years (range: 20-87 years). The mean follow-up period was 7.3 years (range: 5-15.5 years). Results. Pre-operative Merle d’Aubigne-Postel scores (modified by Charnley) were poor in all patients. Mean post-operative improvement was 6.1 points. The outcomes were classified as excellent in 419 cases (70.4%), good in 102 cases (17.1%), satisfactory in 39 (6.6%) and poor in 34 cases. Poor results were usually associated with loosening of one of the prosthetic components. Heterotopic ossification was noted in 37 cases (6.2%). According to the Kaplan-Meier estimator, 10 years’ survival probability was 89.9% for the whole implant and 96.1% for the stem alone. Conclusions. 1. Our follow-up data (from a mean follow-up period of more than 10 years) indicate that the Antega anatomical stem affords excellent clinical and functional results. 2. With good surgical technique and in the absence of complications, the risk of aseptic loosening is minimal. 3. Modification of the Antega stem implantation technique significantly reduces the risk of so-called unexplained thigh pain, which sometimes occurs following hip replacement surgery. 4. As only medium-term follow-up data are available, there may be more cases of loosening (mainly of the acetabular cup) over time, requiring regular long-term follow-up.

scholarly journals Radiographic factors associated with hip osteoarthritis: a systematic review

2020 ◽  
Vol 7 (1) ◽  
pp. 4-13 ◽  
Author(s):  
Jacob Shapira ◽  
Jeffrey W Chen ◽  
Rishika Bheem ◽  
Ajay C Lall ◽  
Philip J Rosinsky ◽  
...  
Keyword(s):  
Systematic Review ◽  
English Language ◽  
Hip Osteoarthritis ◽  
Study Cohort ◽  
Factors Associated ◽  
Cam Impingement ◽  
Patients At Risk ◽  
The Mean ◽  
Definition Of ◽  
Cam Morphology

Abstract The purpose of this study was to outline factors that contribute to the appearance of hip osteoarthritis (OA). Secondarily, this study aims to describe radiographic factors that are associated with the progression of OA in the arthritic hip. Pubmed/MEDLINE and Embase were searched in November 2018 for radiographic risk factors for hip OA. All articles were eligible if they (i) were written in the English language and (ii) commented on OA as it relates to radiographic description, appearance or progression of OA. Demographic characteristics of the study cohort, definition of OA, baseline OA and factors for prediction or progression of OA were recorded. Nine articles were included in this review. A total of 3268 patients were analyzed across all studies. The mean age was 60.0 years (range 18–91.5). The most common descriptors for OA were dysplasia and cam impingement. Six of the nine articles found acetabular under-coverage to be associated with developing OA. Four articles found cam morphology to be an associated factor. Finally, four articles commented on the factors associated with the progression to more severe grades of OA, reporting exclusively on acetabular under-coverage, whereas only one reported on cam morphology to be associated. This systematic review found acetabular under-coverage followed by cam morphology to be strongly associated with both the development and progression of hip OA. These findings define patients at risk for developing hip OA and emphasize the importance of early awareness of future joint degeneration.

Morphological Variations of the Femural Head and Acetabulum: Femoro-Acetabular Impingement and Dysplasia as Possible Initiators of Cartilage Degeneration

2007 ◽  
Author(s):  
Salman Chegini ◽  
Martin Beck ◽  
Stephen J. Ferguson
Keyword(s):  
Finite Element ◽  
Femoral Head ◽  
Hip Joint ◽  
Hip Dysplasia ◽  
Alpha Angle ◽  
Three Dimensional ◽  
Hip Osteoarthritis ◽  
Element Model ◽  
Cartilage Degeneration ◽  
Scientific Basis

Morphological deviations of the acetabulum and femoral head may lead to hip dysplasia or femoro-acetabular impingement. Hip dysplasia and femoro-acetabular impingement (FAI), a pathological contact of the femoral neck with the acetabular rim during motion, have been proposed as potential factors in the development of hip osteoarthritis. The effects of these two kinds of disorders on the mechanical environment of the hip joint are analyzed and compared. One of the morphological measures of the acetabulum is the angle of Wiberg (CE angle), which defines dysplastic, normal or over-covered joints. The morphological measure defined for femoral head deviations in orthopedic literature is the alpha (α) angle [1]. A three-dimensional finite element model of the hip joint has been developed. Changing the CE angle, and alpha angle, normal and pathological joint geometries have been simulated with idealized CAD-generated models, and the results of finite element analyses have been compared for different load and motion cases. Internal contact pressures and cartilage stresses were calculated for each case. The results provide an understanding of normal and pathological joint function, as well as a scientific basis for the corrective operations which are already being utilized. Also, this study verifies femoro-acetabular impingement as one of the potential initiators of cartilage degeneration in the hip.

Digital volumetric measurements based on 3D scans of the lower limb: A valid and reproducible method for evaluation in lymphedema therapy. (Preprint)

2019 ◽  
Author(s):  
Daniel Schiltz ◽  
Natalie Kiermeier ◽  
Dominik Eibl ◽  
Christoph Koch ◽  
Karolina Müller ◽  
...  
Keyword(s):  
Lower Limb ◽  
Lower Leg ◽  
T Test ◽  
Volume Changes ◽  
Quick Method ◽  
Reproducible Method ◽  
The Mean ◽  
3D Scans ◽  
Paired T Test ◽  
Volumetric Measurements

BACKGROUND Exact quantification of volumetric changes of the extremities is difficult. There are several direct and indirect methods to assess extremity volume. As water displacement volumetry is rarely viable in a clinical setting and circumference measurements are prone to errors due to poor reproducibility and high inter- and intra-observer variability, an objective and easily reproducible method is indispensable. OBJECTIVE The aim of this study was to establish a standardized method based on 3D scans with defined caudal and cranial landmarks of the lower leg which allows for measurements of exactly the same body area. Furthermore, this study tests the method in terms of reproducibility and evaluates volume changes after surgical therapy in patients suffering from lymphedema. METHODS 3D-scans of the lower limb were performed with a mobile 3D-scanner. Volumetric calculation was done digitally. “Repeatability“ and “Inter-observer reliability” of digital volumetry were tested. Furthermore, the method was applied on 31 patients suffering from chronic lymphedema. ANOVA (analyses of variance) was conducted to compare the digital volumetric measurements. To assess the sensitivity to changes in digital volumetry, the mean volume of 31 patients before and 3 months after therapy were compared by a paired t-Test. RESULTS Calculations of repeatability of the volume based on 20 3D-scans of the same lower leg showed a mean volume of 2,488 ± 0,011 liters (range: 2,470 – 2,510). The mean volume of the 7 measurements of the 3 examiners did not differ significantly (F(2,18) = 1,579, p = .233). The paired t-Test showed a significant mean volume decrease of 375ml (95% CI = 245/505ml) between pre and post treatment (t (30) =5,892, p < .001). CONCLUSIONS 3D-Volumetry is a noninvasive, easy and quick method to assess volume changes of the lower leg. Other than the costs, it is reproducible and precise and therefore ideal for evolution of therapy in lymphedema.

scholarly journals IDENTIFICATION OF FACTORS ASSOCIATED WITH DISEASE PROGRESSION IN THE CONTRALATERAL HIP OF PATIENTS WITH SYMPTOMATIC FEMOROACETABULAR IMPINGEMENT

2021 ◽  
Vol 9 (7_suppl3) ◽  
pp. 2325967121S0014
Author(s):  
Adam Khan ◽  
Craig R. Louer ◽  
Wahid Abu-Amer ◽  
Gail Pashos ◽  
Cecilia Pascual Garrido ◽  
...  
Keyword(s):  
Disease Progression ◽  
Femoroacetabular Impingement ◽  
External Rotation ◽  
Univariate Analysis ◽  
Alpha Angle ◽  
Hip Osteoarthritis ◽  
Symptom Development ◽  
Ucla Activity Score ◽  
Center Edge ◽  
Imaging Characteristics

Introduction: Femoroacetabular Impingement (FAI) is one of the most common causes of hip osteoarthritis. Nevertheless, the factors contributing to symptom development and FAI disease progression are poorly understood. Hypothesis/Purpose: The purpose of this study was to (1) investigate rates of initial and subsequent symptom development in the contralateral hip of patients with FAI, and (2) identify predictors of disease progression (symptom development) in the contralateral hip. Methods: This prospective study included a minimum 5 year follow-up of the contralateral hip in 179 patients undergoing FAI surgery. Symptoms (moderate pain) were monitored over the study course. Univariate analysis compared patient and FAI imaging characteristics of patients developing symptoms to those who remained asymptomatic. Results: 146 patients (146 hips, 81.5%) were included (min 5 year, mean 6.7 years). Thirty-nine (26%) presented with symptoms in the contralateral hip while 34 (23%) developed symptoms. Head-neck offset ratio (HNOR) on AP pelvis radiographs was significantly lower among hips that developed symptoms (0.164 vs. 0.153 p=0.025). Maximum alpha angle (p=0.413), lateral center edge angle (p=0.704), and crossover sign (p=0.115) were not predictive of symptoms. Patients with a UCLA activity score greater than 9 were less likely to develop symptoms (14% vs. 46%, p=0.081), but this was not statistically significant. The total arc of rotation in extension (35.740 vs 45.140, p=0.012) and 900 of flexion (40.00 vs 50.800, p=0.009) as well as external rotation at 900 of flexion (28.940 vs 36.590, p=0.020) were decreased in hips developing symptoms. Internal Rotation in flexion was not significantly decreased in symptomatic patients (11.060 vs 14.20, p=0.113). Conclusions: We identified unique radiographic and physical exam findings that are associated with symptom development in patients with FAI. Specifically, decreased hip rotation arc and decreased HNOR were strongly associated with disease progression and may represent important factors for future risk modeling in FAI patients.

scholarly journals SOFT TISSUE CAM IMPINGEMENT IN ADOLESCENTS: MRI REVEALS IMPINGEMENT LESIONS UNDERAPPRECIATED ON X-RAY

2021 ◽  
Vol 9 (7_suppl3) ◽  
pp. 2325967121S0006
Author(s):  
Benjamin L. Johnson ◽  
Hamza Alizai ◽  
Montanez Ben ◽  
K. John Wagner ◽  
Tyler Youngman ◽  
...  
Keyword(s):  
Soft Tissue ◽  
Femoral Head ◽  
Plain Radiograph ◽  
Alpha Angle ◽  
Duration Of Symptoms ◽  
X Ray ◽  
Insidious Onset ◽  
Adolescent Patients ◽  
Cam Impingement ◽  
Soft Impingement

Background: The presence of femoroacetabular impingement (FAI) in adolescents has been established. However, the existence of a non-ossified CAM lesion in adolescent femoracetabular impingement (FAI) is not well described. Hypthesis/Purpose: The purpose of this study is to evaluate the presence of a non-ossified or soft CAM lesion in adolescent patients with FAI. Methods: A review of a prospective cohort of patients with symptomatic FAI in an institutional registry was performed. Subjects were included if they had an MRI and lateral x-ray of the hip (45o Dunn, Cross Table, or frog) at a baseline visit. On MRI, evaluation of the anterolateral femoral head was evaluated using radial, coronal, sagittal, or axial oblique sequences. When a soft CAM lesion was identified (all found between 2-5 o’clock), an alpha angle was performed on MRI and plain radiograph. The cohort of soft CAM lesions was reviewed and differences between radiographic and MRI alpha angles were assessed using a paired T-Test. Results: Thirty-one (9.3%) of 332 hips (mean age 16.4 yrs, range 13.66-19.59 yrs; 83.9% F) were identified with a soft impinging lesion at the femoral head-neck junction on MRI. The most common primary sport was track & field (4), the average duration of symptoms was 92.4 weeks and a majority with insidious onset (77.4%). The average alpha angle on MRI was greater than on x-ray [63.53 ± 7.94o vs 51.25 ± 7.92o; p<0.05]. All subjects with soft CAM lesions demonstrated soft tissue consistent with extension of the physis (n=1),thickening of the peri-chondral ring (n=22), or thickening of the periosteum (n=8). Twenty-two of these patients (71%) with soft impingement underwent hip preservation surgery (n=13 labral repairs) with improvements in clinical outcome. Conclusion: In adolescent patients with symptomatic hip impingement, MRI may be useful to identify soft CAM lesions (non-ossified) that are under-represented on x-ray.

Frequency, Predictors, and Outcome of Seizures in Patients With Myelomeningocele: Single-Center Retrospective Cohort Study

2021 ◽  
pp. 088307382110531
Author(s):  
Cemal Karakas ◽  
Emin Fidan ◽  
Kapil Arya ◽  
Troy Webber ◽  
Joan B. Cracco
Keyword(s):  
Good Prognosis ◽  
Cortical Atrophy ◽  
Seizure Freedom ◽  
Single Center ◽  
Seizure Onset ◽  
Shunt Procedure ◽  
History Of ◽  
The Mean

To determine the frequency, predictors, and outcomes of seizures in patients with myelomeningocele, we retrospectively analyzed the data from patients with myelomeningocele followed longitudinally at a single center from 1975 to 2013. We identified a total of 122 patients (61% female). The mean follow-up duration was 11.1 years (minimum-maximum = 0-34.5 years, SD = 8.8, median = 9.1 years). A total of 108 (88.5%) patients had hydrocephalus, and 98 (90.7%) of those patients required a ventriculoperitoneal shunt procedure. Twenty-four (19.7%) patients manifested with seizures, 23 of whom had hydrocephalus. The average age of seizure onset was 4.8 years (median 2 years of age). Falx dysgenesis ( P = .004), lumbar myelomeningocele ( P = .007), and cortical atrophy ( P = .028) were significantly associated with epileptic seizure development. The average seizure-free period at the last follow-up in patients with a history of myelomeningocele and seizures was 8.1 years. We conclude that myelomeningocele patients with seizures have an overall good prognosis with considerable long-term seizure freedom.

scholarly journals Quantitative diffusion tensor MRI-based fiber tracking of human skeletal muscle

2007 ◽  
Vol 103 (2) ◽  
pp. 673-681 ◽  
Author(s):  
Drew A. Lansdown ◽  
Zhaohua Ding ◽  
Megan Wadington ◽  
Jennifer L. Hornberger ◽  
Bruce M. Damon
Keyword(s):  
Muscle Fiber ◽  
Diffusion Tensor ◽  
Fiber Tracking ◽  
Laboratory Frame ◽  
Mean Value ◽  
Pennation Angle ◽  
Frame Of Reference ◽  
Fiber Tracts ◽  
Angle Measurements ◽  
The Mean

Diffusion-tensor magnetic resonance imaging (DT-MRI) offers great potential for understanding structure-function relationships in human skeletal muscles. The purposes of this study were to demonstrate the feasibility of using in vivo human DT-MRI fiber tracking data for making pennation angle measurements and to test the hypothesis that heterogeneity in the orientation of the tibialis anterior (TA) muscle's aponeurosis would lead to heterogeneity in pennation angle. Eight healthy subjects (5 male) were studied. T1-weighted anatomical MRI and DT-MRI data were acquired of the TA muscle. Fibers were tracked from the TA's aponeurosis by following the principal eigenvector. The orientations of the aponeurosis and muscle fiber tracts in the laboratory frame of reference and the orientation of the fiber tracts with respect to the aponeurosis [i.e., the pennation angle (θ)] were determined. The muscle fiber orientations, when expressed relative to the laboratory frame of reference, did not change as functions of superior-to-inferior position. The sagittal and coronal orientations of the aponeurosis did not change in practically significant manners either, but the aponeurosis′ axial orientation changed by ∼40°. As a result, the mean value for θ decreased from 16.3 (SD 6.9) to 11.4° (SD 5.0) along the muscle's superior-to-inferior direction. The mean value of θ was greater in the deep than in the superficial compartment. We conclude that pennation angle measurements of human muscle made using DT-MRI muscle fiber tracking are feasible and reveal that in the foot-head direction, there is heterogeneity in the pennation properties of the human TA muscle.

scholarly journals Cementless one-stage bilateral total hip arthroplasty in osteoarthritis patients: functional outcomes and complications

2017 ◽  
Vol 9 (2) ◽  
Author(s):  
Afshin Taheriazam ◽  
Amin Saeidinia
Keyword(s):  
Total Hip Arthroplasty ◽  
Hip Arthroplasty ◽  
Functional Outcomes ◽  
Hip Osteoarthritis ◽  
Harris Hip Score ◽  
Superficial Infection ◽  
Total Hip ◽  
One Stage ◽  
The Mean ◽  
Hardinge Approach

Total hip arthroplasty (THA) is one of the successful and cost-benefit surgical treatments. One-stage bilateral THA (BTHA) has a large number of advantages, although there are concerns about the higher complications in this procedure. Aim of our study was to evaluate the complications and outcomes of cementless one-stage BTHA in osteoarthritis patients. A total of 147 patients from 2009 till 2012, underwent one-stage BTHA in Milad and Erfan hospitals, Tehran, Iran. A prospective analysis of the functional outcomes and complications of one-stage BTHA through Hardinge approach in patients with osteoarthritis was performed. We evaluated all patients clinically and radiologically with serial followups. A clinical hip score based upon the modified Harris Hip Score (MHHS) was performed preoperatively and again postoperatively. During the period of study 89 men (60.5%) and 58 women (39.4%) with a mean age of 54.67±7.08 years at the time of presentation were recruited. The mean surgical time was 2.8±0.25 hrs. The mean hospital stay was 3.83±0.65 days. Hemoglobin level decreased significantly after operation (P=0.038). There was two deep venous thromboses, one superficial infection and one temporal proneal palsy but no pulmonary embolism, dislocation, periprosthetic fracture or heterotrophic ossification. The mean preoperative MHHS score was 41.64±5.42 in patients. MHHS score improved to 89.26±4.68 in the last followup (P=0.0001). Our results recommended the use of cementless one-stage BTHA through Hardinge approach in patients with bilateral hip osteoarthritis.

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