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The Journal of Bone and Joint Surgery.... Dec 2019➤. Hip joint capsular ligaments (iliofemoral, ischiofemoral, and pubofemoral) play a predominant role in functional mobility and joint stability. ➤. The zona... (Review)
Review
➤. Hip joint capsular ligaments (iliofemoral, ischiofemoral, and pubofemoral) play a predominant role in functional mobility and joint stability. ➤. The zona orbicularis resists joint distraction (during neutral positions), and its aperture mechanism stabilizes the hip from adverse edge-loading (during extreme hip flexion-extension). ➤. To preserve joint function and stability, it is important to minimize capsulotomy size and avoid disrupting the zona orbicularis, preserve the femoral head size and neck length, and only repair when or as necessary without altering capsular tensions. ➤. It is not fully understood what the role of capsular tightness is in patients who have cam femoroacetabular impingement and if partial capsular release could be beneficial and/or therapeutic. ➤. During arthroplasty surgery, a femoral head implant that is nearly equivalent to the native head size with an optimal neck-length offset can optimize capsular tension and decrease dislocation risk where an intact posterior hip capsule plays a critical role in maintaining hip stability.
Topics: Arthroplasty, Replacement, Hip; Cadaver; Dissection; Female; Hip Joint; Humans; Imaging, Three-Dimensional; Joint Capsule; Joint Instability; Male; Orthopedic Procedures; Range of Motion, Articular
PubMed: 31800428
DOI: 10.2106/JBJS.19.00346 -
Advances in Therapy Nov 2016Highly prevalent among the elderly, hip osteoarthritis (OA) carries a heavy burden of disease. Guidelines for the management of hip OA are often extrapolated from knee... (Review)
Review
Highly prevalent among the elderly, hip osteoarthritis (OA) carries a heavy burden of disease. Guidelines for the management of hip OA are often extrapolated from knee OA research, despite clear differences in the etiopathogenesis and response to treatments of OA at these sites. We propose that hip OA requires specific attention separate from other OA phenotypes. Our understanding of the etiopathogenesis of hip OA has seen significant advance over the last 15 years, since Ganz and colleagues proposed femoroacetabular impingement (FAI) as an important etiological factor. This narrative review summarizes the current understanding of the etiopathogenesis of hip OA and identifies areas requiring further research. Therapeutic approaches for hip OA are considered in light of the condition's etiopathogenesis. The evidence for currently adopted management strategies is considered, especially those approaches that may have disease-modifying potential. We propose that shifting the focus of hip OA research and public health intervention to primary prevention and early detection may greatly improve the current management paradigm.
Topics: Aged; Disease Management; Femoracetabular Impingement; Hip Joint; Humans; Osteoarthritis, Hip
PubMed: 27671326
DOI: 10.1007/s12325-016-0409-3 -
The Permanente Journal 2019In this report, we deliver a concise and up-to-date review of osteonecrosis, a pathologic, painful, and often disabling condition that is believed to result from the... (Review)
Review
In this report, we deliver a concise and up-to-date review of osteonecrosis, a pathologic, painful, and often disabling condition that is believed to result from the temporary or permanent disruption of blood supply to an affected area of bone. We will discuss the epidemiology (disease distribution), pathogenesis (mechanism of development), etiology (associated risk factors, causes, and disorders), clinical manifestations (reported symptoms and physical findings), diagnosis and classification, and treatment options for hip osteonecrosis.
Topics: Arthroplasty, Replacement, Hip; Bone Transplantation; Hip Joint; Humans; Osteonecrosis; Osteotomy; Physical Therapy Modalities; Radiography
PubMed: 30939270
DOI: 10.7812/TPP/18-100 -
Clinical Journal of Sport Medicine :... Sep 2011Trochanteric bursitis (TB) is a self-limiting disorder in the majority of patients and typically responds to conservative measures. However, multiple courses of... (Review)
Review
OBJECTIVE
Trochanteric bursitis (TB) is a self-limiting disorder in the majority of patients and typically responds to conservative measures. However, multiple courses of nonoperative treatment or surgical intervention may be necessary in refractory cases. The purpose of this systematic review was to evaluate the efficacy of the treatment of TB.
DATA SOURCES
A literature search in the PubMed, MEDLINE, CINAHL, and ISI Web of Knowledge databases was performed for all English language studies up to April 2010. Terms combined in a Boolean search were greater trochanteric pain syndrome, trochanteric bursitis, trochanteric, bursitis, surgery, therapy, drug therapy, physical therapy, rehabilitation, injection, Z-plasty, Z-lengthening, aspiration, bursectomy, bursoscopy, osteotomy, and tendon repair.
STUDY SELECTION
All studies directly involving the treatment of TB were reviewed by 2 authors and selected for further analysis. Expert opinion and review articles were excluded, as well as case series with fewer than 5 patients. Twenty-four articles were identified. According to the system described by Wright et al, 2 studies, each with multiple arms, qualified as level I evidence, 1 as level II, 1 as level III, and the rest as level IV. More than 950 cases were included.
DATA EXTRACTION
The authors extracted data regarding the type of intervention, level of evidence, mean age of patients, patient gender, number of hips in the study, symptom duration before the study, mean number of injections before the study, prior hip surgeries, patient satisfaction, length of follow-up, baseline scores, and follow-up scores for the visual analog scale (VAS) and Harris Hip Scores (HHS).
DATA SYNTHESIS
Symptom resolution and the ability to return to activity ranged from 49% to 100% with corticosteroid injection as the primary treatment modality with and without multimodal conservative therapy. Two comparative studies (levels II and III) found low-energy shock-wave therapy (SWT) to be superior to other nonoperative modalities. Multiple surgical options for persistent TB have been reported, including bursectomy (n = 2), longitudinal release of the iliotibial band (n = 2), proximal or distal Z-plasty (n = 4), osteotomy (n = 1), and repair of gluteus medius tears (n = 4).
CONCLUSIONS
Efficacy among surgical techniques varied depending on the clinical outcome measure, but all were superior to corticosteroid therapy and physical therapy according to the VAS and HHS in both comparison studies and between studies. This systematic review found that traditional nonoperative treatment helped most patients, SWT was a good alternative, and surgery was effective in refractory cases.
Topics: Adrenal Cortex Hormones; Bursitis; Combined Modality Therapy; Hip Joint; Humans; Physical Therapy Modalities; Treatment Outcome
PubMed: 21814140
DOI: 10.1097/JSM.0b013e318221299c -
Arthritis & Rheumatology (Hoboken, N.J.) Jan 2015
Review
Topics: Arthroscopy; Disease Management; Femoracetabular Impingement; Hip Joint; Humans; Physical Therapy Modalities; Prevalence; Radiography
PubMed: 25308887
DOI: 10.1002/art.38887 -
Der Radiologe Mar 2022Instability and impingement of the hip are the main pathomechanisms that can lead to chondrolabral damage, painful restriction of motion and early hip osteoarthritis due... (Review)
Review
Instability and impingement of the hip are the main pathomechanisms that can lead to chondrolabral damage, painful restriction of motion and early hip osteoarthritis due to increased mechanical stress, even in young patients. The goals of joint-preserving hip surgery are correction of the osseous deformities and chondrolabral damage as well as restoration of joint function. A prerequisite for successful surgery is the identification of the underlying hip pathologies, which can also occur in combination. Dedicated radiographic and magnetic resonance (MR) imaging of osseous morphology and the internal degenerative joint lesions play an essential role for the treatment indications and surgical treatment planning. This article provides a concise overview of the prevalence, pathomechanisms and indicated treatment of hip deformities as well as detailed recommendations on the specific radiological clarification.
Topics: Arthroscopy; Femoracetabular Impingement; Hip Joint; Humans; Magnetic Resonance Imaging; Osteoarthritis, Hip
PubMed: 35238995
DOI: 10.1007/s00117-022-00973-0 -
Clinical Orthopaedics and Related... May 2019
Topics: Arthroplasty, Replacement, Hip; Clinical Decision-Making; Congresses as Topic; Hip Joint; Humans; Osteotomy; Patient Selection; Referral and Consultation
PubMed: 30998627
DOI: 10.1097/CORR.0000000000000759 -
Lakartidningen Apr 2023
Topics: Child; Humans; Epiphyses, Slipped; Hip Joint
PubMed: 37039299
DOI: No ID Found -
RoFo : Fortschritte Auf Dem Gebiete Der... Jul 2015The assessment of bone healing and loosening of endoprosthesis material was long the primary indication for postoperative projection radiography and CT imaging of the... (Review)
Review
UNLABELLED
The assessment of bone healing and loosening of endoprosthesis material was long the primary indication for postoperative projection radiography and CT imaging of the hip joint following trauma and endoprosthesis implantation. With the increasing number of joint-preserving surgery, e. g. of surgical hip luxation and hip arthroscopy for the treatment of femoroacetabular impingement (FAI), high-resolution imaging of intra-articular pathologies before and after surgery has become increasingly important. In this review article, diagnostic imaging of the hip joint is presented following common trauma surgery and orthopedic surgery interventions. The imaging modalities of projection radiography, CT and MRI including direct MR-arthrography are discussed with regard to their diagnostic capability in the postoperative assessment of the hip joint. Among others topics, imaging is discussed following hip arthroplasty, following surgical hip luxation and arthroscopic interventions for the treatment of FAI, as well as following core decompression for avascular necrosis of the femoral head. Moreover, orthopedic interventions of the hip joint in children and adolescents are presented and the dedicated reporting of postoperative imaging is outlined.
KEY POINTS
• Consolidation of osteotomies and position of implants should be assessed in postoperative imaging. • MRI is useful for confirming correct articulation after treatment of congenital hip dislocation. • Radiologically assessable complications after total hip replacement are inlay wear, loosening, dislocation, periarticular ossifications and infection. • MRI can detect and classify pseudotumours in cases of metal-metal pairing after total hip replacement.
Topics: Adult; Child; Female; Hip Injuries; Hip Joint; Humans; Joint Diseases; Magnetic Resonance Imaging; Male; Postoperative Care; Tomography, X-Ray Computed; Treatment Outcome
PubMed: 25750113
DOI: 10.1055/s-0034-1399232 -
The American Journal of Sports Medicine Feb 2019Surgical management of cam femoroacetabular impingement (FAI) aims to preserve the native hip and restore joint function, although it is unclear how the capsulotomy, cam...
BACKGROUND
Surgical management of cam femoroacetabular impingement (FAI) aims to preserve the native hip and restore joint function, although it is unclear how the capsulotomy, cam deformity, and capsular repair influence joint mechanics to balance functional mobility.
PURPOSE
To examine the contributions of the capsule and cam deformity to hip joint mechanics. Using in vitro, cadaveric methods, we examined the individual effects of the surgical capsulotomy, cam resection, and capsular repair on passive range of motion and resistance of applied torque.
STUDY DESIGN
Descriptive laboratory study.
METHODS
Twelve cadaveric hips with cam deformities were skeletonized to the capsule and mounted onto a robotic testing platform. The robot positioned each intact hip in multiple testing positions: (1) extension, (2) neutral 0°, (3) flexion 30°, (4) flexion 90°, (5) flexion-adduction and internal rotation (FADIR), and (6) flexion-abduction and external rotation. Then the robot performed applicable internal and external rotations, recording the neutral path of motion until a 5-N·m of torque was reached in each rotational direction. Each hip then underwent a series of surgical stages (T-capsulotomy, cam resection, capsular repair) and was retested to reach 5 N·m of internal and external torque again after each stage. During the capsulotomy and cam resection stages, the initial intact hip's recorded path of motion was replayed to measure changes in resisted torque.
RESULTS
Regarding changes in motion, external rotation increased substantially after capsulotomies, but internal rotation only further increased at flexion 90° (change +32%, P = .001, d = 0.58) and FADIR (change +33%, P < .001, d = 0.51) after cam resections. Capsular repair provided marginal restraint for internal rotation but restrained the external rotation compared with the capsulotomy stage. Regarding changes in torque, both internal and external torque resistance decreased after capsulotomy. Compared with the capsulotomy stage, cam resection further reduced internal torque resistance during flexion 90° (change -45%, P < .001, d = 0.98) and FADIR (change -37%, P = .003, d = 1.0), where the cam deformity accounted for 21% of the intact hip's torsional resistance in flexion 90° and 27% in FADIR.
CONCLUSION
Although the capsule played a predominant role in joint constraint, the cam deformity provided 21% to 27% of the intact hip's resistance to torsional load in flexion and internal rotation. Resecting the cam deformity would remove this loading on the chondrolabral junction.
CLINICAL RELEVANCE
These findings are the first to quantify the contribution of the cam deformity to resisting hip joint torsional loads and thus quantify the reduced loading on the chondrolabral complex that can be achieved after cam resection.
Topics: Biomechanical Phenomena; Cadaver; Femoracetabular Impingement; Hip Joint; Humans; Joint Capsule; Male; Middle Aged; Movement; Range of Motion, Articular; Robotics; Rotation; Torque
PubMed: 30596529
DOI: 10.1177/0363546518815159