scholarly journals Hip joint motion does not change one year after arthroscopic osteochondroplasty in patients with femoroacetabular impingement evaluated with dynamic radiostereometry

2022 ◽  
Vol 9 (1) ◽  
Author(s):  
Lars Hansen ◽  
Sepp de Raedt ◽  
Peter Bo Jørgensen ◽  
Bjarne Mygind-Klavsen ◽  
Lone Rømer ◽  
...  
Keyword(s):  
Internal Rotation ◽  
Femoroacetabular Impingement ◽  
Hip Joint ◽  
Motion Tracking ◽  
Three Dimensional ◽  
Joint Kinematics ◽  
Bone Volume ◽  
Clinical Effects ◽  
Level Of Evidence

Abstract Purpose Dynamic radiostereometric analysis (dRSA) enables precise non-invasive three-dimensional motion-tracking of bones for assessment of joint kinematics. Hereby, the biomechanical effects of arthroscopic osteochondroplasty of the hip (ACH) can be evaluated in patients with femoroacetabular impingement (FAI). The aim was to investigate the pre- and postoperative range of motion (ROM) and the CT bone volume removed (BV) after ACH. We hypothesize increase in ROM 1 year after surgery. Methods Thirteen patients (6 female) with symptomatic FAI were included prospectively. The patient’s hips were CT-scanned and CT-bone models were created. Preoperative dRSA recordings were acquired during passive flexion to 90°, adduction, and internal rotation (FADIR). ACH was performed, CT and dRSA were repeated 3 months and 1 year postoperatively. Hip joint kinematics before, and 3 months and 1 year after ACH were compared pairwise. The bone volume removal was quantified and compared to change in ROM. Results Mean hip internal rotation, adduction and flexion were all unchanged after ACH at 1-year follow-up (p > 0.84). HAGOS scores revealed improvement of quality of life (QOL) from 32 to 60 (p = 0.02). The BV was between 406 and 1783 mm3 and did not correlate to post-operative ROM. Conclusions ACH surgery in FAI patients had no impact of ROM at 1-year follow-up. QOL improved significantly. This indicates that the positive clinical effects reported after ACH might be a result of reduced labral stress and cartilage pressure during end-range motion rather than increased ROM. Level of evidence Therapeutic prospective cohort study, level II.

Validation of a method to measure three-dimensional hip joint kinematics in subjects with femoroacetabular impingement

2019 ◽  
pp. 112070001988354
Author(s):  
Thomas R Ward ◽  
Mafruha M Hussain ◽  
Mark Pickering ◽  
Diana Perriman ◽  
Al Burns ◽  
...  
Keyword(s):  
Femoroacetabular Impingement ◽  
Hip Joint ◽  
Gold Standard ◽  
Dynamic Assessment ◽  
Three Dimensional ◽  
3D Models ◽  
Joint Kinematics ◽  
Registration Method ◽  
Kinematic Measurement ◽  
Significant Difference

Introduction: A kinematic measurement method combining dynamic motion and imaging, which captures the behaviour of the hip at terminal motion, may offer improved diagnostic accuracy and enhance our understanding of the mechanics of femoroacetabular impingement (FAI). Methods: 3 embalmed cadaveric hip/pelvis specimens with implanted Roentgen Stereophotogrammetric Analysis (RSA) beads were mounted on a custom rig and imaged with a fluoroscope in four poses to simulate a clinical impingement examination: in hip extension and in three positions: near impingement, early impingement and late impingement while simulating a flexion/adduction/internal rotation manoeuvre. Hip joint kinematics were measured using 2 methods and compared: RSA (gold standard) and a custom 3-dimensional to 2-dimensional (3D–2D) image registration method which matches 3D models developed from CT to 2D fluoroscopic images. Results: Using RSA as the gold standard, bias and precision of hip joint rotations measured using 3D–2D registration demonstrated maximums of 1.64° and 3.96°, respectively. However, if the single outlier was removed, bias and precision were 0.55° and 1.38°. Bias and precision of translations had maximums of 0.51 mm and 0.77 mm, respectively. Conclusions: This 3D to 2D registration method may offer a clinically useful solution for dynamic assessment of hip impingement. If 5-mm translation and 10° of rotation represent a clinically significant difference in hip kinematics, the method’s accuracy of approximately 1 mm displacement and 1° rotation should enable detection of significant clinical differences.

Criteria for Return to Play After Hip Arthroscopy in the Treatment of Femoroacetabular Impingement: A Systematic Review

2021 ◽  
pp. 036354652110389
Author(s):  
Martin S. Davey ◽  
Eoghan T. Hurley ◽  
Matthew G. Davey ◽  
Jordan W. Fried ◽  
Andrew J. Hughes ◽  
...  
Keyword(s):  
Systematic Review ◽  
Femoroacetabular Impingement ◽  
Hip Arthroscopy ◽  
Operative Management ◽  
Return To Play ◽  
Return To Sports ◽  
Level Of Evidence ◽  
The Mean

Background: Femoroacetabular impingement (FAI) is a common pathology in athletes that often requires operative management in the form of hip arthroscopy. Purpose: To systematically review the rates and level of return to play (RTP) and the criteria used for RTP after hip arthroscopy for FAI in athletes. Study Design: Systematic review; Level of evidence, 4. Methods: A systematic review of the literature, based on the PRISMA guidelines, was performed using PubMed, Embase, and Scopus databases. Studies reporting outcomes after the use of hip arthroscopy for FAI were included. Outcomes analyzed were RTP rate, RTP level, and criteria used for RTP. Statistical analysis was performed using SPSS software. Results: Our review found 130 studies, which included 14,069 patients (14,517 hips) and had a mean methodological quality of evidence (MQOE) of 40.4 (range, 5-67). The majority of patients were female (53.7%), the mean patient age was 30.4 years (range, 15-47 years), and the mean follow-up was 29.7 months (range, 6-75 months). A total of 81 studies reported RTP rates, with an overall RTP rate of 85.4% over a mean period of 6.6 months. Additionally, 49 studies reported the rate of RTP at preinjury level as 72.6%. Specific RTP criteria were reported in 97 studies (77.2%), with time being the most commonly reported item, which was reported in 80 studies (69.2%). A total of 45 studies (57.9%) advised RTP at 3 to 6 months after hip arthroscopy. Conclusion: The overall rate of reported RTP was high after hip arthroscopy for FAI. However, more than one-fourth of athletes who returned to sports did not return at their preinjury level. Development of validated rehabilitation criteria for safe return to sports after hip arthroscopy for FAI could potentially improve clinical outcomes while also increasing rates of RTP at preinjury levels.

scholarly journals Treatment of cam-type femoroacetabular impingement

Joints ◽  
2015 ◽  
Vol 03 (02) ◽  
pp. 67-71 ◽  
Author(s):  
Gennaro Fiorentino ◽  
Alberto Fontanarosa ◽  
Riccardo Cepparulo ◽  
Alberto Guardoli ◽  
Luca Berni ◽  
...  
Keyword(s):  
Femoroacetabular Impingement ◽  
Hip Arthroscopy ◽  
Alpha Angle ◽  
Case Series ◽  
Arthroscopic Treatment ◽  
Correct Selection ◽  
Harris Hip Score ◽  
Radiographic Examination ◽  
Level Of Evidence

Purpose: the aim of this study was to evaluate preliminary clinical and radiographic results of arthroscopic treatment of cam-type femoroacetabular impingement (FAI). Methods: thirty-eight patients underwent hip arthroscopy for cam-type FAI between 2009 and 2012. Preoperative assessment was based on clinical examination, modified Harris Hip Score (mHHS) and radiographic examination with anteroposterior pelvis, frogleg and Lequesne views. The patients’ clinical conditions at follow-up were assessed using the mHHS administered as a telephone survey. Radiographic outcome measurements evaluated pre and postoperatively were the alpha angle and femoral head-neck offset. Results: the patients were clinically evaluated at a mean follow-up of 36 months. Radiographic follow-up was performed at an average of 12.7 months. Thirty of the 38 patients (79%) were satisfied with the results of the arthroscopic procedure. A total of nine patients subsequently underwent a total hip replacement. All 30 patients who declared themselves satisfied recorded an mHHS increase; in particular, the mHHS increased from a mean of 52.9 preoperatively (range: 27.5-82.5) to a mean of 85.6 postoperatively (range: 45.1-100.1). Three significant differences between the two groups of patients (satisfied and not satisfied) were recorded: mean age, alpha angle and BMI were all significantly greater in the patients who were not satisfied with the treatment. Conclusions: a crucial aspect in order to obtain good clinical outcomes of arthroscopic treatment of camtype impingement is correct selection of patients who are likely to benefit from this kind of surgery. Hip arthroscopy should be avoided in patients aged over 50 years with risk factors for early osteoarthritis (high BMI and a significantly increased alpha angle). Level of evidence: Level IV, therapeutic case series.

scholarly journals MaioRegen Osteochondral Substitute for the Treatment of Knee Defects: A Systematic Review of the Literature

2019 ◽  
Vol 8 (6) ◽  
pp. 783 ◽  
Author(s):  
Riccardo D’Ambrosi ◽  
Federico Valli ◽  
Paola De Luca ◽  
Nicola Ursino ◽  
Federico Usuelli
Keyword(s):  
Systematic Review ◽  
Clinical Improvement ◽  
Three Dimensional ◽  
Lesion Size ◽  
Review Of The Literature ◽  
Level Of Evidence ◽  
Significant Clinical Improvement ◽  
Almost All ◽  
Femoral Condyles

Background: This study aims to investigate the clinical and radiological efficacy of three-dimensional acellular scaffolds (MaioRegen) in restoring osteochondral knee defects. Methods: MEDLINE, Scopus, CINAHL, Embase, and Cochrane Databases were searched for articles in which patients were treated with MaioRegen for osteochondral knee defects. Results: A total of 471 patients were included in the study (mean age 34.07 ± 5.28 years). The treatment involved 500 lesions divided as follows: 202 (40.4%) medial femoral condyles, 107 (21.4%) lateral femoral condyles, 28 (5.6%) tibial plateaus, 46 (9.2%) trochleas, 74 (14.8%) patellas, and 43 (8.6%) unspecified femoral condyles. Mean lesion size was 3.6 ± 0.85 cm2. Only four studies reported a follow-up longer than 24 months. Significant clinical improvement has been reported in almost all studies with further improvement up to 5 years after surgery. A total of 59 complications were reported of which 52 (11.1%) experienced minor complications and 7 (1.48%) major complications. A total of 16 (3.39%) failures were reported. Conclusion: This systematic review describes the current available evidence for the treatment of osteochondral knee defects with MaioRegen Osteochondral substitute reporting promising satisfactory and reliable results at mid-term follow-up. A low rate of complications and failure was reported, confirming the safety of this scaffold. Considering the low level of evidence of the study included in the review, this data does not support the superiority of the Maioregen in terms of clinical improvement at follow-up compared to conservative treatment or other cartilage techniques.

Sports and Recreation Activity of Patients with Femoroacetabular Impingement before and after Arthroscopic Osteoplasty

2009 ◽  
Vol 37 (5) ◽  
pp. 917-922 ◽  
Author(s):  
Alexander Brunner ◽  
Monika Horisberger ◽  
Richard F. Herzog
Keyword(s):  
Clinical Outcome ◽  
Pain Score ◽  
Femoroacetabular Impingement ◽  
Case Series ◽  
Level Of Evidence ◽  
Level Of Activity ◽  
First Occurrence ◽  
And Function ◽  
Sports Activities

Background Hip arthroscopy represents a new and minimally invasive method of treating patients with femoroacetabular impingement (FAI). However, participation in popular sports after this procedure has not yet been analyzed. Hypotheses Arthroscopic treatment of FAI increases the level of popular sports activities, and this level of activity correlates with the clinical outcome in terms of pain and function. Study Design Case series; Level of evidence, 4. Methods Fifty-three patients (41 male, 12 female) were evaluated preoperatively and after a mean follow-up of 2.4 years (range, 2-3.2 years) after arthroscopic osteoplasty for cam and mixed FAI. Evaluation included the type and level of sports activities (sports frequency score [SFS]) as well as clinical outcome in terms of pain (VAS) and function (nonarthritic hip score [NAHS]). Results Forty-five of the 53 patients had regularly participated in popular sports until the first occurrence of FAI symptoms. Preoperatively, only 4 of these 45 patients had maintained their accustomed level of activity. At the final follow-up, 31 patients had returned to their full accustomed level of activity. None of the patients who had not been active in sports before the first occurrence of symptoms of FAI (n = 8) had begun participation in sports after arthroscopic osteoplasty. The SFS significantly increased from 0.78 to 1.84 (P < .001), and the mean VAS pain score significantly improved from 5.7 (range, 1-9) to 1.5 (range, 0-6) points (P < .001). The NAHS improved from 54.4 (range, 28.75-92.5) to 85.7 (range, 47.5-100) (P < .001). There was no significant correlation between SFS and NAHS (r = .051, P = .35), as well as between SFS and VAS pain score (r = .159, P = .140) preoperatively, but a significant correlation was seen at the time of the last postoperative follow-up (SFS/NAHS: r = .392, P = .003; SFS/VAS: r = .242, P = .049). The 3 most frequent sports activities postoperatively were biking, hiking, and fitness. Conclusion Arthroscopic osteoplasty can significantly improve the rate and level of popular sports activities in patients with FAI. The level of postoperative sports activity directly correlates with the clinical outcome in terms of pain and function.

scholarly journals Use of Biologics as an Adjunct Therapy to Arthroscopic Surgery for the Treatment of Femoroacetabular Impingement: A Systematic Review

2019 ◽  
Vol 7 (12) ◽  
pp. 232596711989067
Author(s):  
Patrick G. Robinson ◽  
Iain R. Murray ◽  
Julian Maempel ◽  
Conor S. Rankin ◽  
David Hamilton ◽  
...  
Keyword(s):  
Systematic Review ◽  
Femoroacetabular Impingement ◽  
Hip Arthroscopy ◽  
Platelet Rich Plasma ◽  
Arthroscopic Surgery ◽  
Acid Growth ◽  
Level Of Evidence ◽  
Associated Lesions ◽  
Chondrocyte Implantation

Background: There has been a recent increase in the use of biologics in hip arthroscopy to assist in the management of femoroacetabular impingement (FAI). Purpose: To analyze the current use of biologics for the treatment of FAI and its associated lesions. Study Design: Systematic review; Level of evidence, 4. Methods: A search of the PubMed, Medline, and EMBASE databases was performed in March 2019 with use of the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines. The criterion for inclusion was observational, published research articles studying the therapeutic use of biologics as an adjuvant therapy during arthroscopic surgery for FAI; treatments included bone marrow aspirate concentrate, mesenchymal stem cells (MSCs), platelet-rich plasma (PRP), hyaluronic acid, growth factors, and autologous chondrocyte implantation (ACI) or autologous matrix-induced chondrogenesis (AMIC). Results: There were 9 studies that met the inclusion criteria, and a total of 674 patients were included across all studies. FAI was studied in all articles. Further, 7 studies (78%) also analyzed chondral injuries, and 3 studies also analyzed labral tears (33%). ACI or AMIC was used in 56% of studies and showed superior functional outcomes at short- and midterm follow-up versus debridement or microfracture. PRP did not improve the outcome of labral repairs at short-term follow-up. Conclusion: The current literature regarding biologic adjuncts in hip arthroscopy is varied in quality, with only one level 1 study. The use of ACI/AMIC for medium-sized chondral lesions showed promising results in individual studies; however, these were of lower quality. To enable comparisons among future studies, investigators must ensure accuracy in the reporting of biologic preparations and formulations used and homogeneity in the type and severity of lesion treated.

Femoroacetabular Impingement Patients With Decreased Femoral Version Have Different Impingement Locations and Intra- and Extraarticular Anterior Subspine FAI on 3D-CT–Based Impingement Simulation: Implications for Hip Arthroscopy

2019 ◽  
Vol 47 (13) ◽  
pp. 3120-3132 ◽  
Author(s):  
Till D. Lerch ◽  
Adam Boschung ◽  
Inga A.S. Todorski ◽  
Simon D. Steppacher ◽  
Florian Schmaranzer ◽  
...  
Keyword(s):  
Range Of Motion ◽  
Internal Rotation ◽  
Femoroacetabular Impingement ◽  
Hip Arthroscopy ◽  
Control Group ◽  
Level Of Evidence ◽  
Cross Sectional ◽  
Hip Impingement ◽  
Femoral Version ◽  
Asymptomatic Control

Background: It remains unclear whether decreased femoral version (FV) causes anterior intra- or extra-articular femoroacetabular impingement (FAI). Therefore, we evaluated symptomatic hips with decreased FV, with and without cam and pincer FAI, by using computed tomography (CT)–based virtual 3-dimensional (3D) impingement simulation and compared this group with patients with normal FV and with asymptomatic hips. Purpose: To investigate (1) the osseous range of motion, (2) the osseous femoral and acetabular impingement zones, and (3) whether hip impingement is extra- or intra-articular in symptomatic hips with FAI. Study Design: Cross-sectional study; Level of evidence, 3. Methods: An institutional review board–approved, retrospective comparative analysis was performed on a total of 84 hips in 68 participants. Of these, 37 hips in 24 symptomatic patients with FAI had decreased FV. These hips were compared with 21 hips of 18 symptomatic patients with anterior FAI with normal FV (10°-25°) and 26 asymptomatic hips with no FAI and normal FV. All patients with FAI were symptomatic and had anterior hip pain and a positive anterior impingement test. They underwent pelvic CT scans to measure FV. Decreased FV was defined as FV less than 5°. The 37 hips with decreased FV presented both with and without cam and pincer FAI. All 84 hips were evaluated by use of CT-based 3D models and a validated 3D range of motion and impingement simulation. Asymptomatic hips were contralateral normal hips imaged in patients undergoing total hip arthroplasty. Results: Hips with FAI combined with decreased FV had a significantly ( P < .001) lower mean flexion (114°± 8° vs 125°± 13°) and internal rotation (IR) at 90° of flexion (18°± 6° vs 32°± 9°, P < .001) compared with the asymptomatic control group. Symptomatic patients with FAI and normal FV had flexion of 120°± 16° and IR at 90° of flexion of 23°± 15°. In a subgroup analysis, we found a significantly ( P < .001) lower IR in 90° of flexion in hips with FV less than 5° combined with mixed-type FAI compared with hips with FV less than 5° without a cam- or pincer-type deformity. The maximal acetabular impingement zone for hips with decreased FV was located at the 2-o’clock position and ranged from 1 to 3 o’clock. In hips with decreased FV, most of the impingement locations were intra-articular but 32% of hips had combined intra- and extra-articular FAI in internal rotation in 90° of flexion. During the flexion-adduction-IR test performed in 10° and 20° of adduction, extra-articular subspine FAI had significantly ( P < .001) higher prevalence (68% and 84%) in hips with decreased FV compared with normal hips. Conclusion: Hips with FAI and decreased FV had less flexion and internal rotation in 90° of flexion compared with the asymptomatic control group. The majority of hip impingement due to low FV was intra-articular, but one-third of samples had combined intra- and extra-articular subspine FAI. Anterior extra- and intra-articular hip impingement can be present in patients who have FAI with decreased FV. This could be important for patients undergoing hip arthroscopy.

scholarly journals In Vivo Pelvic and Hip Joint Kinematics in Patients With Cam Femoroacetabular Impingement Syndrome: A Dual Fluoroscopy Study

2019 ◽  
Vol 38 (4) ◽  
pp. 823-833 ◽  
Author(s):  
Penny R. Atkins ◽  
Niccolo M. Fiorentino ◽  
Joseph A. Hartle ◽  
Stephen K. Aoki ◽  
Christopher L. Peters ◽  
...  
Keyword(s):  
Femoroacetabular Impingement ◽  
Hip Joint ◽  
Joint Kinematics ◽  
Impingement Syndrome ◽  
Femoroacetabular Impingement Syndrome

Objective QbTest and subjective evaluation of stimulant treatment in adult attention deficit-hyperactivity disorder

2015 ◽  
Vol 30 (1) ◽  
pp. 179-185 ◽  
Author(s):  
D. Bijlenga ◽  
M. Jasperse ◽  
S.K. Gehlhaar ◽  
J.J. Sandra Kooij
Keyword(s):  
Motion Tracking ◽  
Rating Scale ◽  
Tracking System ◽  
Subjective Evaluation ◽  
Objective Measure ◽  
Clinical Effects ◽  
Stimulant Treatment ◽  
Medication Effects ◽  
Motion Tracking System

AbstractPurpose:To evaluate the QbTest as an objective measure versus self-reported ADHD Rating Scale (ADHD-RS) before and during stimulant treatment in adults with ADHD.Patients and methods:We used the subjective ADHD Rating Scale (ADHD-RS), and the objective computerized QbTest, which is a 20-minute unconditional identical pairs test that measures attention, impulsivity, and also hyperactivity using a motion-tracking system. Patients were assessed before (baseline) and during medical treatment with stimulants (follow-up) in an observational study design.Results:Data of n = 145 patients at baseline and n = 82 patients at follow-up were analyzed. There were significant symptom reductions on all symptom domains, but correlations between the tests were weak. Improvement on the QbTest was independent of the patient's age, gender, educational level, ADHD subtype, co-morbid disorders, and use of other medications. Patients with worst QbTest results at baseline showed most improvement at follow-up. The QbTest was more sensitive to medication effects than the ADHD-RS. QbTest objectified clinical significant medication effect in 54% of patients who subjectively did not report any clinical effects.Discussion:Symptoms dimensions of objective and subjective tests refer to different psychological constructs.Conclusion:The QbTest is a valuable addition to existing subjective measures to assess medication effects in ADHD patients who have difficulties reporting treatment effects.

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