Femoroacetabular Impingement (FAI) Syndrome : the medical imaging perspective

Introduction: Sports persons, physicians, orthopods and radiologists have become increasingly aware of the extra stress that is imposed on the hip joints with excessive activity particularly when superadded weight bearing and asymmetrical variations from the normal hip joint anatomy are present leading to Femoroacetabular Impingement. Subject: Presentation of the abnormalities within the ball and socket areas of the hip joint and the resultant types of impingements, the predominant cam, the predominant pincer or mixed types femoroacetabular impingement (FAI) are discussed and illustrated. The different kind of sportspersons that are prone to FAI and the risk factors involved are discussed. Method: The main methods of investigation: The radiological techniques and radiological signs of the disease entity utilizing plain radiography and computerised transverse scanning techniques are elaborated and graphically depicted. Within the ball part of the hip joint, measurements for femoral head asphericity, that is, the Alpha (?) angle and the offset distance between the femoral head and neck are presented. With regard to pincer type FAI affecting the socket part of the hip joint, the acetabular version angle and the depth (or shallowness) of the acetabulum with their methods of quantification are discussed. Conclusion: Femoroacetabular Impingement is a syndrome which is currently more appreciated within the sports medicine field and various approaches to assessment have been devised regarding how to diagnose and quantify congenital anomalies and developmental abnormalities within both the ball and the socket regions of the hip joint.peer-reviewe

The influence of the strength of bone on the deformation of acetabular shells : a laboratory experiment in cadavers

Date of Acceptance: 24/08/2014 ©2015 The British Editorial Society of Bone & Joint Surgery. The authors would like to thank N. Taylor (3D Measurement Company) for his work with regard to data acquisition and processing of experimental data. We would also like to thank Dr A. Blain of Newcastle University for performing the statistical analysis The research was supported by the NIHR Newcastle Biomedical Research Centre. The authors P. Dold, M. Flohr and R. Preuss are employed by Ceramtec GmbH. Martin Bone received a salary from the joint fund. The author or one or more of the authors have received or will receive benefits for personal or professional use from a commercial party related directly or indirectly to the subject of this article. This article was primary edited by G. Scott and first proof edited by J. Scott.Peer reviewedPostprin

Primary stability of cementless threaded acetabular cups at first implantation and in the case of revision regarding micromotions as indicators

The primary stability of cementless total hip endoprosthesis is of vital importance for proximate, long-term osteointegration. The extent of micromotions between implant and acetabulum is an indicator of primary stability. Based on this hypothesis, different cementless hip joint endoprosthesis were studied with regard to their micromotions. The primary stability of nine different cementless threaded acetabular cups was studied in an experimental setup with blocks of rigid foam. The micromotions between implant and implant bearing were therefore evaluated under cyclic, sinusoidal exposure. The blocks of polymer foam were prepared according to the Paprosky defect classifications. The micromotions increased with the increasing degree of the defect with all acetabuli tested. Occasionally coefficients of over 200 mu m were measured. From a defect degree of 3b according to Paprosky, the implants could no longer be appropriately placed. The exterior form of the spherical implants tended to exhibit better coefficients than the conical/parabolic implants

Helminth fauna of Mt. Ontake. Part 2. Trematoda and Cestoda

I. Trematodes of mammals 1. Brachylaemus tokudai n. sp. 2. Acanthatrium ovatum Yamaguti, 1939 II. Cestodes of frogs 3. Baerietta montana n. sp. 4. Baerietta claviformis n. sp. III. Cestodes of· birds 5. Choanotaenia barbara Meggitt, 1926 IV. Cestodes of mammals 6. Hymenolepis apodemi n. sp.</p

Orthopedic management of the extremities in patients with Morquio A syndrome.

BackgroundMusculoskeletal involvement in Morquio A syndrome (mucopolysaccharidosis IVA; MPS IVA) contributes significantly to morbidity and mortality. While the spinal manifestations of the disorder have received considerable attention in the literature, there have been few reported studies to date to guide the management of the orthopedic problems associated with the lower and upper extremities.PurposeThe objective was to develop recommendations for the management of the extremities in patients with Morquio A syndrome.MethodsA group of specialists in orthopedics, pediatrics and genetics with experience in the management of Morquio A patients convened to review and discuss current clinical practices and to develop preliminary recommendations. Evidence from the literature was retrieved. Recommendations were further refined until consensus was reached.Results and conclusionsThis present article provides a detailed review and discussion of the lower and upper extremity deformities in Morquio A syndrome and presents recommendations for the assessment and treatment of these complications. Key issues, including the importance of early diagnosis and the implications of medical therapy, are also addressed. The recommendations herein represent an attempt to develop a uniform and practical approach to managing patients with Morquio A syndrome and improving their outcomes

North American Species of the Genus Hydrochoreutes (Acarina: Pionidae)

Excerpt: Members of the water mite genus Hydrochoreutes have a Holarctic distribution. They are found in lakes, ponds, and sluggish streams, but usually only in small numbers and therefore long series of specimens are difficult to obtain. Two species, ungulatus (Koch) and krameri Piersig, have a widespread range in Europe and Siberia and the latter species is also known from Algeria. Marshall (1937) reported ungulatus from Maine, Michigan, Wisconsin and California. However, the present author has seen no specimens from North America which can be assigned to the latter species and the illustrations in Marshall\u27s paper are definitely not those of ungulatus. Therefore. there are no authentic records of the latter species in the New World. Cook (1956) named a new species, intermedius, from North America. Both the description and illustrations are inadequate for the latter and it is treated along with four new species in this paper

Periportal Capsulotomy: A Technique for Limited Violation of the Hip Capsule During Arthroscopy for Femoroacetabular Impingement.

Hip arthroscopy has become the standard treatment for symptomatic femoroacetabular impingement as patients have shown good outcomes and high satisfaction with this intervention. However, capsular management to gain access for intra-articular procedures remains greatly debated. Capsular closure is advocated particularly in the setting of interportal or T-capsulotomy to avoid complications of instability or nonhealing capsule. We introduce a technique for capsular management through a limited periportal capsulotomy during arthroscopic treatment of femoroacetabular impingement. In using dilation of the anterolateral and mid-anterior portals without completion of a full interportal capsulotomy, the stabilizing iliofemoral ligament is preserved. We have found that periportal capsulotomy provides safe and sufficient access to the hip joint without necessitating capsular closure

Operative treatment for pincer type femoroacetabular impingement:a case report

Femoroacetabular impingement (FAI) is a condition characterized by the impingement of the femur and acetabulum. In Japan, this disorder has become recognized gradually. Here we report a rare case of surgically treated FAI, associated with an osseous protrusion on the acetabulum of a 30-year-old female. Plain computed tomography (CT) and reconstructive 3D-CT images clearly demonstrated an anterolateral bony protrusion. Hip arthroscopy showed no degeneration of the cartilage on either the femoral or acetabular side, but degeneration at the edge of labrum was observed in the region of the bony protrusion. The complete removal of the bony protrusion under hip arthroscopy was thus considered impracticable, and a small skin incision was therefore made anteriorly to approach the acetabulum. The Short-Form 36-Item Health Survey (SF-36) revealed improvement in all scores.</p

Accuracy of magnetic resonance studies in the detection of chondral and labral lesions in femoroacetabular impingement : systematic review and meta-analysis

Background: Several types of Magnetic resonance imaging (MRI) are commonly used in imaging of femoroacetabular impingement (FAI), however till now there are no clear protocols and recommendations for each type. The aim of this meta-analysis is to detect the accuracy of conventional magnetic resonance imaging (cMRI), direct magnetic resonance arthrography (dMRA) and indirect magnetic resonance arthrography (iMRA) in the diagnosis of chondral and labral lesions in femoroacetabular impingement (FAI). Methods: A literature search was finalized on the 17th of May 2016 to collect all studies identifying the accuracy of cMRI, dMRA and iMRA in diagnosing chondral and labral lesions associated with FAI using surgical results (arthroscopic or open) as a reference test. Pooled sensitivity and specificity with 95% confidence intervals using a random-effects meta-analysis for MRI, dMRA and iMRA were calculated also area under receiver operating characteristic (ROC) curve (AUC) was retrieved whenever possible where AUC is equivocal to diagnostic accuracy. Results: The search yielded 192 publications which were reviewed according inclusion and exclusion criteria then 21 studies fulfilled the eligibility criteria for the qualitative analysis with a total number of 828 cases, lastly 12 studies were included in the quantitative meta-analysis. Meta-analysis showed that as regard labral lesions the pooled sensitivity, specificity and AUC for cMRI were 0.864, 0.833 and 0.88 and for dMRA were 0.91, 0.58 and 0.92. While in chondral lesions the pooled sensitivity, specificity and AUC for cMRI were 0.76, 0.72 and 0.75 and for dMRA were 0.75, 0.79 and 0.83, while for iMRA were sensitivity of 0.722 and specificity of 0.917. Conclusions: The present meta-analysis showed that the diagnostic test accuracy was superior for dMRA when compared with cMRI for detection of labral and chondral lesions. The diagnostic test accuracy was superior for labral lesions when compared with chondral lesions in both cMRI and dMRA. Promising results are obtained concerning iMRA but further studies still needed to fully assess its diagnostic accuracy