The association of lumbosacral transitional vertebral anomalies with acetabular dysplasia in adult patients with hip-spine syndrome

2021 ◽  
Vol 103-B (8) ◽  
pp. 1351-1357
Author(s):  
Joshua Sun ◽  
Avneesh Chhabra ◽  
Uma Thakur ◽  
Louis Vazquez ◽  
Yin Xi ◽  
...  
Keyword(s):  
Acetabular Dysplasia ◽  
Intraclass Correlation ◽  
Final Diagnosis ◽  
Hip Pain ◽  
Pars Interarticularis ◽  
Vertebral Anomalies ◽  
Lumbosacral Transitional Vertebra ◽  
Standard Radiographs ◽  
Time Of Presentation ◽  
The Relationship

Aims Some patients presenting with hip pain and instability and underlying acetabular dysplasia (AD) do not experience resolution of symptoms after surgical management. Hip-spine syndrome is a possible underlying cause. We hypothesized that there is a higher frequency of radiological spine anomalies in patients with AD. We also assessed the relationship between radiological severity of AD and frequency of spine anomalies. Methods In a retrospective analysis of registry data, 122 hips in 122 patients who presented with hip pain and and a final diagnosis of AD were studied. Two observers analyzed hip and spine variables using standard radiographs to assess AD. The frequency of lumbosacral transitional vertebra (LSTV), along with associated Castellvi grade, pars interarticularis defect, and spinal morphological measurements were recorded and correlated with radiological severity of AD. Results Out of 122 patients, 110 (90.2%) were female and 12 (9.8%) were male. We analyzed the radiographs of 122 hips (59 (48.4%) symptomatic left hips, and 63 (51.6%) symptomatic right hips). Average age at time of presentation was 34.2 years (SD 11.2). Frequency of LSTV was high (39% to 43%), compared to historic records from the general population, with Castellvi type 3b being the most common (60% to 63%). Patients with AD have increased L4 and L5 interpedicular distance compared to published values. Frequency of pars interarticularis defect was 4%. Intraclass correlation coefficient for hip and spine variables assessed ranged from good (0.60 to 0.75) to excellent (0.75 to 1.00). Severity of AD did not demonstrate significant correlation with frequency of radiological spine anomalies. Conclusion Patients with AD have increased frequency of spinal anomalies seen on standard hip radiographs. However, there exists no correlation between radiological severity of AD and frequency of spine anomalies. In managing AD patients, clinicians should also assess spinal anomalies that are easily found on standard hip radiographs. Cite this article: Bone Joint J 2021;103-B(8):1351–1357.

Relationship Between Hip Dysplasia, Pain, and Osteoarthritis in a Cohort of Patients with Hip Symptoms

2013 ◽  
Vol 40 (9) ◽  
pp. 1583-1589 ◽  
Author(s):  
Johanne Morvan ◽  
Ronan Bouttier ◽  
Bernard Mazieres ◽  
Evelyne Verrouil ◽  
Jacques Pouchot ◽  
...  
Keyword(s):  
Anterior Margin ◽  
Hip Dysplasia ◽  
Acetabular Dysplasia ◽  
Hip Osteoarthritis ◽  
Population Based ◽  
Hip Pain ◽  
Prevalence Survey ◽  
Center Edge ◽  
Study Participants ◽  
The Relationship

Objective.The relationship between acetabular dysplasia (HD) and hip osteoarthritis (OA) remains unclear, especially for mild forms of dysplasia. Our objectives were to estimate the prevalence of HD in a population-based sample with symptoms and to evaluate potential associations linking HD, hip OA, and hip pain.Methods.Individuals 40 to 75 years of age with symptoms in 1 or both hips were recruited during a multiregional prevalence survey. All study participants underwent examination and radiographs. Radiographs were evaluated using Kellgren-Lawrence staging (with stages ≥ 2 indicating hip OA) and HD measures [center-edge (CE) angle, acetabular inclination angle (HTE), acetabular depth (AD), and vertical center-anterior margin angle].Results.We studied both hips of 842 individuals (1684 hips), among whom 203 had hip OA. Compared to left hips, right hips had significantly smaller CE angles and significantly greater AD and HTE values (p ≤ 0.001). Overall, the prevalence of HD ranged from 7.6% to 22.2% of the hips depending on the measure used. The prevalence of HD was higher in individuals with hip OA, with significant differences for abnormal HTE (19.1% vs 11.4%; p < 0.0001) and abnormal CE (11.3% vs 7.5%; p = 0.04). By logistic regression, only abnormal HTE remained associated with OA. Same-side hip pain was not statistically more common in individuals with HD after stratification on OA status (p = 0.12).Conclusion.Our study confirms the relationship between OA and HD, particularly as defined based on the HTE angle.

scholarly journals Bilateral Destructive Hip Disease from Untreated Juvenile Idiopathic Arthritis

2019 ◽  
Vol 2019 ◽  
pp. 1-6
Author(s):  
Arash Calafi ◽  
Alton W. Skaggs ◽  
Trevor J. Shelton ◽  
Brian M. Haus
Keyword(s):  
Juvenile Idiopathic Arthritis ◽  
Case Report ◽  
Femoral Head ◽  
Pediatric Patient ◽  
Acetabular Dysplasia ◽  
Pediatric Patients ◽  
Similar Case ◽  
Hip Pain ◽  
Complete Destruction ◽  
Hip Disease

We report a novel case of a pediatric patient with bilateral hip destruction from untreated Juvenile idiopathic arthritis (JIA). She was presented at the age of 9 with hip pain associated with bilateral acetabular dysplasia and a dislocated left femoral head. Only 1.5 years later, the patient developed complete destruction of the left femoral head and dislocated right femoral head. The authors have not identified literature describing a similar case report of bilateral femoral head destruction resulting from Persistent Oligoarticular JIA. Pediatric patients presenting with rapidly evolving destructive process should be evaluated for rheumatologic, infectious, and spinal etiologies.

Reliability and Relevance of Radiographic Measures of Metatarsus Primus Elevatus and Arch Alignment in Individuals with Midfoot Arthritis and Controls

2013 ◽  
Vol 103 (5) ◽  
pp. 347-354 ◽  
Author(s):  
Smita Rao ◽  
Katie Bell
Keyword(s):  
Inclination Angle ◽  
Intraclass Correlation ◽  
Positive Association ◽  
Group Differences ◽  
Control Group ◽  
Arch Height ◽  
First Metatarsal ◽  
Compressive Stresses ◽  
Metatarsal Angle ◽  
The Relationship

Background: Low arch alignment and metatarsus primus elevatus (MPE) have been postulated to increase dorsal compressive stresses in the joints of the medial column of the foot and to contribute to the development of degenerative changes. The primary purposes of this study were 1) to examine the relationship between radiographic measures of arch alignment and MPE and 2) to assess arch alignment and MPE in individuals with midfoot arthritis and in asymptomatic controls. The secondary aim was to examine the reliability of radiographic measures of arch alignment and MPE. Methods: Radiographic measures of arch height and MPE were quantified on 28 individuals with midfoot arthritis and 22 individuals in a control group. Reliability was assessed using the intraclass correlation coefficient (ICC). The Pearson product moment correlation (r) was used to assess the relationship between arch alignment and MPE. Between-group differences were assessed using a two-sample t test (α = 0.05). Results: Good to excellent reliability was noted for measures of arch height (ICC[2,3] = 0.919–0.994) as well as MPE (ICC[2,3] = 0.891–0.882). A modest positive association was noted between normalized cortical elevation and normalized navicular height (r = 0.274, P = .030) and calcaneal inclination angle (r = 0.263, P = .035). Individuals with midfoot arthritis demonstrated lower arch alignment, reflected in a significantly higher calcaneal–first metatarsal angle (P = .002), lower calcaneal inclination angle (P = .004), and lower normalized navicular height (P &lt; .001) compared with controls. No evidence was found to support between-group differences in lateral intermetatarsal angle (P = .495) and normalized cortical elevation (P = .146). Conclusions: These findings provide objective data establishing the reliability of measures of MPE and arch alignment and their potential clinical significance. (J Am Podiatr Med Assoc 103(5): 347–354, 2013)

scholarly journals Pincer deformities and mild acetabular dysplasia: the relationship between acetabular coverage and development of hip OA in the nationwide prospective check cohort

2013 ◽  
Vol 21 ◽  
pp. S52-S53
Author(s):  
R. Agricola ◽  
M.P. Heijboer ◽  
S.M. Bierma-Zeinstra ◽  
J.A. Verhaar ◽  
H. Weinans ◽  
...  
Keyword(s):  
Acetabular Dysplasia ◽  
Acetabular Coverage ◽  
The Relationship

MECHANICAL STRESS MAY CAUSE THE TEAR OF THE LABRUM IN ACETABULAR DYSPLASIA

2004 ◽  
Vol 08 (01) ◽  
pp. 35-41
Author(s):  
Hirotaka Sano ◽  
Norikazu Yamada ◽  
Shingo Maeda
Keyword(s):  
Stress Concentration ◽  
Mechanical Stress ◽  
Acetabular Dysplasia ◽  
The Body ◽  
Von Mises Stress ◽  
Center Edge ◽  
Dimensional Finite Element ◽  
Von Mises ◽  
Distal Border ◽  
The Relationship

In the current study, using the arthrogram, we developed two-dimensional finite element (FE) models of the human hip joint. To clarify the relationship between the stress distribution and the degree of acetabular dysplasia, three FE models were established and analyzed. The models varied only in the degree of the bony covering of the femoral head; i.e. the center-edge (CE) angle=20, 10, 0 degrees. An edge load (x=0 N, y=600 N) was then applied on the distal border of the femur to simulate the bearing of the body weight. In the CE=20 degree model, no definite stress concentration was seen at the site of the labrum. On the other hand, the stress concentration was seen from the attachment of the labrum to the superior aspect of the acetabulum in the CE=0 degree model. The site of stress concentration clearly corresponded to the lesions where the acetabular rim pathologies were seen in the clinical practice. Moreover, we found that the Von Mises stress increases dramatically with decreasing the CE angle at the attachment of the labrum. In the dysplastic hip, the mechanical stress increases significantly at the supero-lateral aspect of the acetabulum, which eventually leads to the tearing or detachment of the labrum.

scholarly journals The Analysis of Cognitive Moral in Bridging the Gap Between Internal Marketing and B2B Salespeople Performance

2021 ◽  
Vol 10 (5) ◽  
pp. 12
Author(s):  
. Ribhan ◽  
Albet Maydiantoro
Keyword(s):  
Intraclass Correlation ◽  
Sales Force ◽  
Internal Marketing ◽  
Marketing Theory ◽  
Hierarchical Linear Modelling ◽  
Behavioural Performance ◽  
Marketing Variables ◽  
Performance Results ◽  
Outcome Performance ◽  
The Relationship

This study seeks to confirm and analyse the effect of cross-level cognitive morals on internal marketing and business sales force performance (i.e. behavioural performance and outcome performance). The concepts of relationship marketing and marketing theory of ethics underpin the relationship among variables. This study adopted a quantitative approach through a survey of 460 respondents from 13 company services and manufacturers. Internal marketing variables were measured at the unit level and tested using interrater agreement and the intraclass correlation. In contrast, the cognitive moral variables, behavioural performance, and sales force performance results were measured individually. Hierarchical linear modelling (HLM) was used to test the effect of the cross-level research variables. The results showed that internal marketing empirically supports cognitive morals. However, the effect of internal marketing does not support the two-dimensional performances of the sales force. Theoretically, the contributions, internal marketing and cognitive morals have shown the relationship between marketing and marketing theory of ethics.   Received: 28 April 2021 / Accepted: 15 July 2021 / Published: 5 September 2021

scholarly journals Physiological Compensation for Advanced Bolus Location at Swallow Onset: A Retrospective Analysis in Healthy Seniors

2019 ◽  
Vol 62 (12) ◽  
pp. 4351-4355 ◽  
Author(s):  
Erica G. Herzberg ◽  
Danielle Brates ◽  
Sonja M. Molfenter
Keyword(s):  
Intraclass Correlation ◽  
Barium Swallow ◽  
Bolus Volume ◽  
Posterior Angle ◽  
Linear Mixed Effects ◽  
Main Effect ◽  
Laryngeal Vestibule ◽  
Post Hoc ◽  
Main Effects ◽  
The Relationship

Purpose Previous work has established that advanced bolus location at swallow onset (BLSO) alone is not correlated with an increased swallowing safety risk in healthy seniors. The primary goal of this retrospective study was to examine whether healthy seniors systematically alter their laryngeal vestibule closure reaction time (LVCrt) to maintain a safe swallow in the context of advanced BLSO. The secondary goal was to determine if longer LVCrt distinguished Penetration–Aspiration Scale (PAS; Rosenbek, Robbins, Roecker, Coyle, & Wood, 1996) scores of 1 versus 2. Method Videofluoroscopy studies from 43 healthy seniors (21 men, 22 women; M age = 76.7 years, SD = 7.2) were analyzed. LVCrt was calculated for 3 × 5 ml and 3 × 20 ml thin liquid barium boluses per participant. PAS and BLSO (Modified Barium Swallow Impairment Profile Component 6) were scored for all swallows. Reliability (intraclass correlation coefficient > .75) was established on all measures. A linear mixed-effects regression was run to examine the effect of PAS and BLSO on LVCrt while controlling for bolus volume and repeated swallow trial. Results There was a main effect of BLSO ( F = 4.6, p = .004) and PAS ( F = 29.3, p < .001) on LVCrt. Post hoc pairwise comparisons revealed that LVCrt was significantly faster in BLSO scores of 3 (pyriforms) compared to scores of both 0 (posterior angle of the ramus) and 1 (valleculae). Significantly prolonged LVCrt was observed in PAS scores of 2 in comparison to 1. No significant main effects of bolus volume or trial, or interactions, were observed. Conclusions Our findings suggest that healthy seniors compensate for advanced BLSO by increasing their LVCrt. Furthermore, faster LVCrt was shown to distinguish PAS scores of 1 versus 2. Additional work should explore the relationship between LVCrt, BLSO, and PAS scores in dysphagic populations, specifically those with known sensory impairments.

scholarly journals Therapeutic Plasma Exchange (PLEX) in Thrombotic Microangiopathy (TMA): Experiences of an Inner-City Hospital over a Decade

Blood ◽  
2019 ◽  
Vol 134 (Supplement_1) ◽  
pp. 3691-3691
Author(s):  
Aakash Putta ◽  
Hafeez Shaka ◽  
Shristi Upadhyay Banskota ◽  
Sunny R K Singh ◽  
Sindhu Malapati ◽  
...  
Keyword(s):  
Inner City ◽  
Validation Studies ◽  
Patient Population ◽  
Final Diagnosis ◽  
Safety Net ◽  
Inclusion Criteria ◽  
Safety Net Hospital ◽  
Study Population ◽  
Time Of Presentation

Introduction: There are multiple mechanisms of occurrence of TMA. Some of the etiologies are associated with high morbidity and mortality, but there are very subtle differences in presentation. A high index of suspicion is recommended for thrombotic thrombocytopenic purpura (TTP) due to the time sensitive nature of treatment initiation and poor outcomes associated with delay in treatment. Due to this, treatment with PLEX is often initiated empirically before diagnostic test results are available. We aim to report the management and outcomes of TMA along with the predictive value of the PLASMIC score in our patient population, over a 10-year period in an inner-city safety net hospital. Methods: This is a single center observational study including patients who underwent PLEX for a diagnosis of TMA, due to concern for TTP between January 2009 and May 2019 at an inner-city safety net hospital. Patients were identified from blood bank records and data was collected by review of electronic medical record. We excluded patients &lt;18 years old and who received PLEX for indications other than that described previously. Data was collected until death or last follow-up. Statistical analysis was done using STATA. Results: A total of 40 patients met the inclusion criteria. Of these, 57.5% (n=23) were male, 17.5% (n=7) had a known malignancy and 15% (n=6) had human immunodeficiency virus infection. Study population was predominantly African American and Hispanic- comprising 75% (n=30) and 17.5% respectively- which differentiates our study from other validation studies for the PLASMIC score. Symptoms at presentation to emergency department, time to initiation of PLEX from presentation, and lab parameters before and after PLEX are shown in the attached table. ADAMTS13 activity level is available in 65% (n=26) patients, 57.7% of which were sent before initiation of PLEX. Average number of PLEX sessions during the admission was 9.4 (range: 2-30). As part of treatment, 85% (n=34) received steroids and 17.5% (n=7) received hemodialysis. 5 patients received rituximab and 2 received eculizumab. Final diagnoses included TTP in 62.5% (n=25), complement mediated TMA in 5% (n=2), drug induced TMA in 10% (n=4), TMA from sepsis or rheumatological condition in 15% (n=6), bone marrow suppression due to chemotherapy in 5% (n=2) and unsure in 2.5% (n=1). Average length of stay was 22.2 days (range: 6-85 days). Of the total 40 patients, 7.5% (n=3) died on the same admission, 10% (n=4) died after discharge and 3 were readmitted for repeat PLEX. Duration of follow-up after discharge ranged from 9 to 3319 days (mean 1102.6 days). We retrospectively estimated the PLASMIC score at the time of presentation for all the patients. Amongst the patients eventually diagnosed with TTP, 50% had a PLASMIC score of &gt;5 and 70.83% had a score ≥5 at the time of presentation. Among non-TTP TMA, 25% had a score of &gt;5 and 62.5% had a score ≥5. The sensitivity, specificity and positive predictive value of PLASMIC score for prediction of final diagnosis of TTP was calculated for all patients who met inclusion criteria and is shown in the attached table. Of those who underwent PLEX in the setting of TMA for the concern of TTP, only about a third were started on PLEX within 24 hours. Conclusion:Among our study population, only about a third were started on PLEX within 24 hours which is concerning and highlights the need for quality improvement initiatives to increase provider awareness and decrease time to PLEX. Final diagnosis of TTP was made in 62.5% of the patients but notably, the performance of PLASMIC score in our patient population was inferior compared to prior validation studies. One possible explanation for this could be the difference in baseline patient demographics, with our patients belonging mostly to minority groups. There is a need for further studies with derivation and validation cohorts in this patient population to derive a scoring system that is more predictive. Table Disclosures No relevant conflicts of interest to declare.

scholarly journals THE RELATIONSHIP BETWEEN GLOBAL AND DAILY LEVELS OF PAIN AND RELIGIOUS COPING

2019 ◽  
Vol 3 (Supplement_1) ◽  
pp. S524-S524
Author(s):  
Katherine L Cheesman ◽  
Brian Cox ◽  
Dylan M Smith ◽  
Patricia A Parmelee
Keyword(s):  
Religious Coping ◽  
Intraclass Correlation ◽  
Coping Behaviors ◽  
Phone Calls ◽  
Daily Diary Methodology ◽  
And Coping ◽  
The Relationship ◽  
Racial Ethnic ◽  
Daily Pain

Abstract Objective: This research examines associations between global and daily levels of pain and the use of religious coping strategies among African American (AA) and non-Hispanic White (NHW) older adults with physician-confirmed knee osteoarthritis (OA). Methods: As part of a larger study of racial/ethnic differences in everyday quality of life with OA, 125 persons over the age of 50 completed a global measure of religious coping using the Brief RCOPE. Daily variability in pain and coping was assessed using a daily diary methodology consisting of 4 daily phone calls over 7 days. Hypotheses: Demographic characteristics (sex, race) were expected to predict religious coping at both the global and daily levels. Specifically, we expected women and AAs would use more religious coping than their male and NHW counterparts. Further, daily levels of pain were predicted to correlate with daily levels of coping. Results: AAs were found to engage in significantly more religious coping behaviors than NHWs at the global, but not daily, level. An intraclass correlation coefficient of .316 indicated sufficient within-person variability for the use of multi-level modeling to determine the association of daily pain and religious coping. Within individuals, pain was significantly lower on days when religious coping was not used. Implications: Results contribute to a growing understanding of how individuals use their religious beliefs to cope with daily pain and perhaps, to the formulation of more targeted therapies for individuals living with chronic illness. (Supported by R01-AG041655 D. Smith and P. Parmelee, PIs.)

scholarly journals Risk Factors for Long-term Hip Osteoarthritis in Patients With Femoroacetabular Impingement Without Surgical Intervention

2020 ◽  
Vol 48 (12) ◽  
pp. 2881-2886
Author(s):  
Heath P. Melugin ◽  
Rena F. Hale ◽  
Jun Zhou ◽  
Matthew LaPrade ◽  
Christopher Bernard ◽  
...  
Keyword(s):  
Risk Factors ◽  
Femoroacetabular Impingement ◽  
Mixed Type ◽  
Surgical Intervention ◽  
Significant Risk ◽  
Hip Osteoarthritis ◽  
Hip Pain ◽  
Male Sex ◽  
Time Of Presentation

Background: Femoroacetabular impingement (FAI) is a common cause of hip pain and a known risk factor for hip osteoarthritis (OA) and total hip arthroplasty (THA) at a young age. Unfortunately, little is known about the specific factors associated with an increased risk of OA. Purpose: To (1) report the overall rate of symptomatic hip OA and/or THA in patients with FAI without surgical intervention and (2) identify radiographic features and patient characteristics associated with hip OA. Study Design: Case-control study; Level of evidence, 3. Methods: A geographic database was used to identify all patients with hip pain and radiographs between 2000 and 2016. Chart review was performed to identify patients with FAI. Patient medical records were reviewed to obtain demographic information, clinical history, physical examination findings, imaging details, and treatment details. Kaplan-Meier analysis was used to determine the rate of hip OA. Univariate and multivariate proportional hazard regression models were performed to determine risk factors for OA. Results: The study included 952 patients (649 female; 303 male; 1104 total hips) with FAI. The majority of hips had mixed type (n = 785; 71.1%), 211 (19.1%) had pincer type, and 108 (9.8%) had cam type. Mean age at time of presentation was 27.6 ± 8.7 years. Mean follow-up time was 24.7 ± 12.5 years. The rate of OA was 13.5%. THA was performed in 4% of patients. Male sex, body mass index (BMI) greater than 29, and increased age were risk factors for OA (male sex: hazard ratio [HR], 2.28; P < .01; BMI >29: HR, 2.11; P < .01; per year of increased age: HR, 1.11; P < .01.). Smoking and diabetes mellitus were not significant risk factors. No radiographic morphological features were found to be significant risk factors for OA. Conclusion: At mean follow-up of 24.7 years, 14% of hips had symptomatic OA and 4% underwent THA. BMI greater than 29, male sex, and increased age at the time of presentation with hip pain were risk factors for hip OA. The cohort consisted of a large percentage of mixed-type FAI morphologies, and no specific radiographic risk factors for OA were identified.

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