scholarly journals Recent advances and future trends in hip arthroscopy

2020 ◽  
Vol 1 ◽  
pp. 81-89
Author(s):  
James Zhang ◽  
Matthew Pettit ◽  
Karadi Hari Sunil Kumar ◽  
Vikas Khanduja
Keyword(s):  
Hip Joint ◽  
Hip Arthroscopy ◽  
Psychological State ◽  
Labral Repair ◽  
Patient Specific ◽  
Cartilage Defects ◽  
Invasive Technique ◽  
Navigation Surgery ◽  
Long Term Outcome ◽  
Wide Range

Hip arthroscopy (HA) is a well-established minimally invasive technique used to treat a wide range of conditions. Technological innovations have expanded the scope of HA and improved its outcomes. Several authors have described post-less arthroscopy to overcome the risk associated with the use of the perineal post for obtaining distraction of the hip joint. Instrument refinement has improved the efficacy of labral repair and reconstruction. Several treatment strategies are available for articular cartilage defects including ACI, MACI, and mosaicplasty, to name a few. Some authors have suggested that ligamentum teres reconstruction is helpful in young active patients with femoroacetabular impingement experiencing subluxation of the hip joint. The incorporation of new technology and patient-specific approaches represents a new way to improve HA outcomes. Virtual reality simulation training is the key to overcoming the steep learning curve associated with HA and to achieve high standards early in a surgeon’s career. Computer-based navigation surgery may be the key to accurately resecting the cam deformity and reducing the rate of revision surgery due to inaccurate resection at the index procedure. Assessment and optimization of the baseline psychological state and effective pre-habilitation may also improve outcome measures. Adequate stratification of the pathology and assessment of baseline patient characteristics influences the long-term outcome following the HA.

scholarly journals Autologous matrix-induced chondrogenesis and bone marrow aspirate concentrate compared with microfracture for arthroscopic treatment of femoroacetabular impingement and chondral lesions of the hip: bridging the osteoarthritis gap and facilitating enhanced recovery

2020 ◽  
Author(s):  
Anshul S Sobti ◽  
Kwaku W Baryeh ◽  
Rex Woolf ◽  
Rishi Chana
Keyword(s):  
Bone Marrow ◽  
Femoroacetabular Impingement ◽  
Hip Arthroscopy ◽  
Bone Marrow Aspirate ◽  
Enhanced Recovery ◽  
Arthroscopic Surgery ◽  
Labral Repair ◽  
Cartilage Defects ◽  
Survivorship Analysis ◽  
Biological Reconstruction

Abstract In an attempt to bridge the osteoarthritis (OA) gap, this study compared biological reconstruction with traditional microfracture (MF) techniques in patients with femoroacetabular impingement and focal cartilage defects. Cohorts of two groups were investigated; age, gender and Tonnis grade matched comparison for outcomes between MF and newer biological reconstruction techniques hip arthroscopy surgery using autologous matrix-induced chondrogenesis and bone marrow aspirate combination. Outcomes investigated were pre-op and post-op mean iHOT-12 scores up to 18 months after surgery with a Kaplan–Meier survivorship analysis. Of 111 patients, 46 patients underwent MF and 65 biological reconstruction hip arthroscopy including cam/pincer osteoplasty and labral repair surgery. Age range was 20–69, mean age 45 years for both groups, Tonnis grading was as follows: Grade 0: 26% versus 30%, Grade 1: 52% versus 47% and Grade 2: 22% versus 23% in MF and biological reconstruction groups, respectively. The mean post-operative iHOT-12 score differences between MF and biological reconstruction were significant at 1-year minimum follow-up (P = 0.01, SD 2.8). Biological reconstruction allowed for an enhanced recovery protocol. The MF group had a 67.4% survivorship for conversion to hip replacement at 18 months (32.6% failure rate for any reason) and biological reconstruction had 100% survivorship at 18 months post-operatively with no failures for any reason. This study provides further support to the evidence base for biological reconstructive techniques as superior to MF in combination with joint preservation arthroscopic surgery, even in the face of focal cartilage defects and offers both surgeons and patients a potential bridging of the OA gap.

scholarly journals Para-acetabular Radiopaque Densities in Patients With Femoroacetabular Impingement: A Retrospective Assessment of Prevalence and Characteristics

2020 ◽  
Vol 8 (1) ◽  
pp. 232596711989233
Author(s):  
Guillaume D. Dumont ◽  
Travis J. Menge ◽  
Adam J. Money ◽  
Philip Carmon
Keyword(s):  
Computed Tomography ◽  
Femoroacetabular Impingement ◽  
Hip Arthroscopy ◽  
Alpha Angle ◽  
Labral Tear ◽  
Labral Repair ◽  
Patient Specific ◽  
Treatment Technique ◽  
Systemic Inflammatory Disease ◽  
Fai Syndrome

Background: Femoroacetabular impingement (FAI) syndrome is a common source of hip pain associated with chondrolabral injury. There is a subset of patients with FAI syndrome who present with radiopaque densities (RODs) adjacent to the acetabular rim. Purpose: To evaluate the prevalence, characteristics, and patient-specific factors associated with RODs adjacent to the acetabulum in patients treated with hip arthroscopy for symptomatic FAI. Study Design: Case series; Level of evidence, 4. Methods: Between November 2014 and March 2018, a total of 296 patients who underwent hip arthroscopy for FAI with a labral tear were reviewed retrospectively. Patient-specific variables were collected, including age, sex, lateral center-edge angle (LCEA), and alpha angle. Imaging (computed tomography) and surgical reports were reviewed for the location and characteristics of RODs, as well as subsequent labral treatment technique. Patients were excluded if they were treated for extra-articular hip pathology, had a revision procedure, or had a diagnosis other than FAI with a labral tear. No patient was excluded for any history of systemic inflammatory disease. Binary logistic regression was used to compare age, LCEA, and alpha angle for patients with or without radiopaque fragments. An alpha level of 0.05 was used to indicate statistical significance. Results: A total of 204 patients met inclusion criteria; 33 patients (16.2%; 16 males, 17 females) had para-acetabular RODs. There were no statistically significant differences in age ( P = .82), sex ( P = .92), LCEA ( P = .24), or alpha angle ( P = .10) among patients with or without an ROD. Of the 33 patients, 29 (87.9%) had fragments in the anterosuperior quadrant. Overall, 31 patients (93.9%) were treated with labral repair in addition to correction of the underlying bony impingement, while 2 patients (6.1%) underwent focal labral debridement owing to poor labral tissue quality around the RODs. Twenty-five patients (76%) had identifiable RODs, which were excised at the time of surgery. The mean (± SD) ROD size measured on axial and coronal computed tomography imaging was 6.3 ± 5.5 mm and 4 ± 4.5 mm, respectively. Conclusion: Age, sex, LCEA, and alpha angle were not predictive of the presence of para-acetabular RODs. Approximately one-sixth of all patients with FAI had RODs identified on computed tomography, which were typically located at the anterosuperior acetabulum. The majority of hips with para-acetabular RODs were amenable to labral repair. The relative prevalence and lack of predictive patient-specific indicators for these fragments suggest that a high degree of suspicion is necessary when evaluating patients with FAI.

Impairment Tutorial: Rating Tears of the Acetabular Labrum

2006 ◽  
Vol 11 (6) ◽  
pp. 4-7
Author(s):  
Charles N. Brooks ◽  
Richard E. Strain ◽  
James B. Talmage
Keyword(s):  
Magnetic Resonance ◽  
Hip Arthroscopy ◽  
Age Groups ◽  
Limited Range ◽  
Labral Repair ◽  
X Rays ◽  
Joint Stability ◽  
Acetabular Labrum ◽  
Complete Excision ◽  
Limited Range Of Motion

Abstract The primary function of the acetabular labrum, like that of the glenoid, is to deepen the socket and improve joint stability. Tears of the acetabular labrum are common in older adults but occur in all age groups and with equal frequency in males and females. The AMA Guides to the Evaluation of Permanent Impairment (AMA Guides), Fifth Edition, is silent about rating tears, partial or complete excision, or repair of the acetabular labrum. Provocative tests to detect acetabular labrum tears involve hip flexion and rotation; all rely on production of pain in the groin (typically), clicking, and/or locking with passive or active hip motions. Diagnostic tests or procedures rely on x-rays, conventional arthrography, computerized tomography, magnetic resonance imaging (MRI), magnetic resonance arthrography (MRA), and hip arthroscopy. Hip arthroscopy is the gold standard for diagnosis but is the most invasive and most likely to result in complications, and MRA is about three times more sensitive and accurate in detecting acetabular labral tears than MRI alone. Surgical treatment for acetabular labrum tears usually consists of arthroscopic debridement; results tend to be better in younger patients. In general, an acetabular labral tear, partial labrectomy, or labral repair warrants a rating of 2% lower extremity impairment. Evaluators should avoid double dipping (eg, using both a Diagnosis-related estimates and limited range-of-motion tests).

Application of the Innovative and Non-Invasive Technique, Molecular Music Therapy (MMT), Bio-Frequency Therapy, for the Treatment of a Wide Range of Disorders and Pathologies, with Consequent Verification of Molecular Parameters by Using Bi-Digital O-Ring Test (BDORT)

2020 ◽  
Vol 44 (3) ◽  
pp. 177-189
Author(s):  
Momir Dunjic ◽  
Stefano Turini ◽  
Dejan Krstic ◽  
Katarina Dunjic ◽  
Marija Dunjic ◽  
...  
Keyword(s):  
Amino Acid ◽  
Music Therapy ◽  
Amino Acid Sequences ◽  
Sirtuin 1 ◽  
Ring Test ◽  
Invasive Technique ◽  
Specific Gene ◽  
Radiofrequency Therapy ◽  
Wide Range ◽  
Clinical Pictures

Radiofrequency therapy is an unconventional method, already applied for some time, with numerous results in numerous clinical pictures. Our group has developed a software, later called SONGENPROT-SOLARIS, capable of directly converting nucleotide sequences (DNA and/or RNA) and amino acid sequences (polypeptides and proteins) into musical sequences, based on mathematic matrices, designed by the French physicist and musician Joel Sternheimer, which allows to associate a musical note with a nucleotide or an amino acid. Innovation in our software is that, in the algorithm that defines it, a variant is directly implemented that allows the reproduction of sounds, phase-shifted by 30 Hz, between one ear and another reproducing the phenomenon of Binaural Tones, capable of induce a specific brain activity and also the release of particles called solitons. Thanks to this software we have developed a technique called MMT (Molecular Music Therapy) and currently, we are in the phase of applying the technique on a cohort of 91 patients, with a high spectrum of clinical pictures, examining the same, using the technique Bi-Digital-ORing-Test (BDORT), before and after treatment with MMT. Aim of project is to stimulate the expression of a specific gene (the same genetic sequence that the patient listens to, translated into music), only through the use of sound sequences. We have concentrated our attention on three main molecules: Sirtuin-1, Telomers and TP-53. The results obtained with BDORT, after treatment with MMT, showed a significant increase in the values of the three molecules, on all the examined patients, demonstrating the operative efficacy of the technique and the its applicability to numerous diseases. In order to confirm the data obtained by BDORT, we propose, with the help of an accredited laboratory, to perform epigenetic tests on the three parameters listed above, paving the way to understanding how frequencies can influence gene expression.

A CT-free protocol to treat osteoid osteoma of the hip region in childhood and adolescence by percutaneous drilling and by hip arthroscopy

2021 ◽  
pp. 112070002199626
Author(s):  
Oliver Eberhardt ◽  
Thekla von Kalle ◽  
Rebecca Matthis ◽  
Richard Doepner ◽  
Thomas Wirth ◽  
...  
Keyword(s):  
Radiofrequency Ablation ◽  
Minimally Invasive ◽  
Hip Joint ◽  
Hip Arthroscopy ◽  
Standard Form ◽  
Childhood And Adolescence ◽  
Ct Guided ◽  
Contrast Enhanced ◽  
Mri Guided ◽  
Mri Diagnostics

Introduction: It is often difficult to clinically and radiologically diagnose intra-articular osteoid osteomas and osteoid osteomas of the hip joint. Treatment can also be difficult due to complex locational relationships. CT-guided radiofrequency ablation is currently the standard form of treatment. In this paper we report on a minimally-invasive concept for treating osteoid osteomas near the hip joint in children and adolescents which does not involve using computed tomography. Material and method: 10 patients with an average age of 12.1 years underwent treatment for osteoid osteomas in the hip joint region. The diagnosis was made using a contrast-enhanced MRI. The osteoid osteomas were marked percutaneously using x-ray and MRI guidance. MRI-guided drilling/curettage was performed in 4 cases and arthroscopic resection in 6 cases. Results: All lesions were successfully treated using the MRI-guided method. All patients were free of pain after the treatment. There was no instance of recurrence during the follow-up period, which averaged 10 months. The effective dose for marking the lesion was between 0.0186 mSv and 0.342 mSV (mean 0.084 mSV). Conclusions: Our MRI diagnostics protocol, the MRI-guided drilling and the minimally invasive hip arthroscopy represent an alternative to CT-guided radiofrequency ablation in the treatment of osteoid osteomas. Radiation exposure can thereby be significantly reduced. Hip arthroscopy can also be used to treat secondary pathologies such as femoroacetabular impingement.

scholarly journals Allocation of Anchors During Labral Repair: A Multicenter Cohort Analysis of Labral Treatment in Hip Arthroscopy

2021 ◽  
Vol 9 (2) ◽  
pp. 232596712098198
Author(s):  
Ryan P. McGovern ◽  
John J. Christoforetti ◽  
Benjamin R. Kivlan ◽  
Shane J. Nho ◽  
Andrew B. Wolff ◽  
...  
Keyword(s):  
Hip Arthroscopy ◽  
Cohort Analysis ◽  
Arthroscopic Surgery ◽  
Labral Repair ◽  
Fixation Method ◽  
Entire Group ◽  
Acetabular Labrum ◽  
Level Of Evidence ◽  
Multicenter Cohort ◽  
Tear Size

Background: While previous studies have established several techniques for suture anchor repair of the acetabular labrum to bone during arthroscopic surgery, the current literature lacks evidence defining the appropriate number of suture anchors required to effectively restore the function of the labral tissue. Purpose/Hypothesis: To define the location and size of labral tears identified during hip arthroscopy for acetabular labral treatment in a large multicenter cohort. The secondary purpose was to differentiate the number of anchors used during arthroscopic labral repair. The hypothesis was that the location and size of the labral tear as well as the number of anchors identified would provide a range of fixation density per acetabular region and fixation method to be used as a guide in performing arthroscopic repair. Study Design: Cross-sectional study; Level of evidence, 3. Methods: We used a multicenter registry of prospectively collected hip arthroscopy cases to find patients who underwent arthroscopic labral repair by 1 of 7 orthopaedic surgeons between January 2015 and January 2017. The tear location and number of anchors used during repair were described using the clockface method, where 3 o’clock denoted the anterior extent of the tear and 9 o’clock the posterior extent, regardless of sidedness (left or right). Tear size was denoted as the number of “hours” spanned per clockface arc. Chi-square and univariate analyses of variance were performed to evaluate the data for both the entire group and among surgical centers. Results: A total of 1978 hips underwent arthroscopic treatment of the acetabular labrum; the most common tear size had a 3-hour span (n = 820; 41.5%). Of these hips, 1645 received labral repair, with most common repair location at the 12- to 3-o’clock position (n = 537; 32.6%). The surgeons varied in number of anchors per repair according to labral size ( P < .001 for all), using 1 to 1.6 anchors for 1-hour tears, 1.7 to 2.4 anchors for 2-hour tears, 2.1 to 3.2 anchors for 3-hour tears, and 2.2 to 4.1 for 4-hour tears. Conclusion: Variation existed in the number of anchor implants per tear size. When labral repair involved a mean clockface arc >2 hours, at least 2 anchor points were fixated.

scholarly journals Stem cell therapies and benefaction of somatic cell nuclear transfer cloning in COVID-19 era

2021 ◽  
Vol 12 (1) ◽  
Author(s):  
Birbal Singh ◽  
Gorakh Mal ◽  
Vinod Verma ◽  
Ruchi Tiwari ◽  
Muhammad Imran Khan ◽  
...  
Keyword(s):  
Stem Cells ◽  
Stem Cell ◽  
Regenerative Medicine ◽  
Somatic Cell ◽  
Somatic Cell Nuclear Transfer ◽  
Nuclear Transfer ◽  
Drug Testing ◽  
Human Interaction ◽  
Patient Specific ◽  
Wide Range

Abstract Background The global health emergency of COVID-19 has necessitated the development of multiple therapeutic modalities including vaccinations, antivirals, anti-inflammatory, and cytoimmunotherapies, etc. COVID-19 patients suffer from damage to various organs and vascular structures, so they present multiple health crises. Mesenchymal stem cells (MSCs) are of interest to treat acute respiratory distress syndrome (ARDS) caused by SARS-CoV-2 infection. Main body Stem cell-based therapies have been verified for prospective benefits in copious preclinical and clinical studies. MSCs confer potential benefits to develop various cell types and organoids for studying virus-human interaction, drug testing, regenerative medicine, and immunomodulatory effects in COVID-19 patients. Apart from paving the ways to augment stem cell research and therapies, somatic cell nuclear transfer (SCNT) holds unique ability for a wide range of health applications such as patient-specific or isogenic cells for regenerative medicine and breeding transgenic animals for biomedical applications. Being a potent cell genome-reprogramming tool, the SCNT has increased prominence of recombinant therapeutics and cellular medicine in the current era of COVID-19. As SCNT is used to generate patient-specific stem cells, it avoids dependence on embryos to obtain stem cells. Conclusions The nuclear transfer cloning, being an ideal tool to generate cloned embryos, and the embryonic stem cells will boost drug testing and cellular medicine in COVID-19.

scholarly journals Towards a methodology for the characterisation of the fabric of wet clays using X-ray scattering

2019 ◽  
Vol 92 ◽  
pp. 01005
Author(s):  
Georgios Birmpilis ◽  
Reza Ahmadi-Naghadeh ◽  
Jelke Dijkstra
Keyword(s):  
Materials Science ◽  
Measurement Techniques ◽  
Invasive Technique ◽  
Colloidal Systems ◽  
Characteristic Distance ◽  
X Ray ◽  
Hydrophobic Coating ◽  
X Ray Scattering ◽  
Wide Range ◽  
Ray Scattering

X-ray scattering is a promising non-invasive technique to study evolving nano- and micromechanics in clays. This study discusses the experimental considerations and a successful method to enable X-ray scattering to study clay samples at two extreme stages of consolidation. It is shown that the proposed sample environment comprising flat capillaries with a hydrophobic coating can be used for a wide range of voids ratios ranging from a clay suspension to consolidated clay samples, that are cut from larger specimens of reconstituted or natural clay. The initial X-ray scattering results using a laboratory instrument indicate that valuable information on, in principal evolving, clay fabric can be measured. Features such as characteristic distance between structural units and particle orientations are obtained for a slurry and a consolidated sample of kaolinite. Combined with other promising measurement techniques from Materials Science the proposed method will help advance the contemporary understanding on the behaviour of dense colloidal systems of clay, as it does not require detrimental sample preparation

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