Variation in functional pelvic tilt in patients undergoing total hip arthroplasty with acetabular dysplasia

Purpose: It is important to clarify the link between acetabular dysplasia and pelvic tilt to optimize surgical planning and postoperative outcomes. We sought to investigate functional pelvic tilt in patients undergoing total hip arthroplasty with acetabular dysplasia. Materials & Methods: From 2014 to 2020, pre-operative AP Pelvis X-rays, CT scans, and other patient-specific data such as pelvic tilt, lumbar lordotic angle, etc were collected as part of surgical planning for total hip arthroplasty. From this database, we investigated 678 female patients under the age of 50 that had undergone preoperative standing AP pelvis X-rays. Analysis was performed by investigating how many patients whose hips are dysplastic displayed anterior pelvic tilt. Anterior pelvic tilt was defined in three different positions, sitting/supine/standing. Correlation between the severity of the dysplasia and anterior pelvic tilt was also investigated. Results: Out of the 678 patients, 80.7% had a dysplastic hip. 70.7% displayed an anterior standing pelvic tilt, 89.2% displayed an anterior supine pelvic tilt, and 98.3% displayed a seated anterior pelvic tilt. An observed 81.3% of the patients who have an anterior pelvic tilt have a unilaterally or a bilaterally dysplastic hip. Out of the anterior pelvic tilt group, 63.9% were bilaterally dysplastic hip patients. Conclusion: The majority of the pre-operative patients displayed an anterior pelvic tilt in all 3 positions (standing, supine, seated). Unilaterally or bilaterally dysplastic patients were also more likely to display an anterior pelvic tilt. Within the dysplastic group, bilateral patients were more likely to display anterior pelvic tilt

The Morbidity of Greater Trochanteric Pain Syndrome is Similar to that of Hip Osteoarthritis Awaiting Total Hip Arthroplasty

Background: Greater trochanteric pain syndrome (GTPS) is characterized by chronic lateral hip pain and dysfunction. While psychosocial measures of other tendinopathies have been gaining traction, GTPS is less well studied. We sought to characterize the morbidity upon presentation of GTPS and compared it to patients with end-stage, hip osteoarthritis (OA) awaiting total hip arthroplasty (THA). Methods: This study examined patient reported outcomes measures (PROMs) on activity limitations, quality of life (QOL), pain, and level of disability, in all patients with GTPS and end-stage, pre-THA hip OA. All patients presented at a single academic medical center between October 2016 to November 2020. The PROMs were analyzed using an equivalence test and two-one-sided t-tests. Results: A total of 156 patients (193 hips) with GTPS and 300 patients (326 hips) with hip OA were investigated. Equivalence in mean UCLA Activity score between GTPS and OA groups were established with tolerance margin of ± 5. The difference in mean UCLA score was 0.002 (95% CI -0.45 to 0.43, p \u3c 0.01) between GTPS and OA patients. Equivalence in mean VAS score between GTPS and OA were established with tolerance margin of ± 10. The difference in mean VAS score was 0.35 (95% CI -0.86 to 0.16, p = 0.02). HOOSQol score was much worse in GTPS patients, placed well outside of the ± 10 tolerance margin and difference in means score was 1.72 (95% Cl -2.17 to -1.26, p = 0.99). All estimated differences were comparable with and without the adjustment for each PROM respectively, suggesting the differences (or the lack of) in the PROMs between GTPS and OA couldn’t be explained by the differences in sex, age, BMI, race, ethnicity, or smoking status. Conclusion: This cumulative evidence characterizes GTPS as painful and limiting in activities of daily living, as pre-THA hip OA, and with poorer quality of life scores than hip OA. This study validates results of other studies that have investigated PROMs between GTPS and pre-THA, hip OA patients. Clinicians and researchers should not underestimate the disease, and further research on characterizing the progression of the disease should be a priority

Piriformis syndrome: pain response outcomes following CT-guided injection and incremental value of botulinum toxin injection

PURPOSEPiriformis syndrome is a common pain condition affecting the buttock and posterior hip with or without radiation to the leg, and management of the condition involves many treatments. In this study, we hypothesize that a CT-guided injection with botulinum toxin is more effective in providing pain relief than a CT-guided injection without Botox.METHODSOverall, 97 consecutive patients with piriformis syndrome presented for a CT-guided injection of the piriformis muscle and perineural injection of the sciatic nerve. After the injection, the patients received a visual analog scale pain log to record their pain level until the follow-up appointment. P values of less than 0.2 were considered as confounder and adjusted by inverse probability of treatment weighting (IPTW) via propensity score. The effect of botulinum toxin on 48-hour response and duration of response was tested using weighted chi-square test and weighted Kaplan-Meier analysis.RESULTSThere was a total of 97 patients in the study, and 111 injections, as some patients had bilateral injections. Patients in the Botox group had more 48-hour response than patients in the non-botulinum toxin group (P < 0.001 with IPTW, P = 0.005 without IPTW). Median pain-free survival was 30 days for Botox group and 1 day for non-Botox group (P = 0.059 with IPTW, P = 0.10 without IPTW).CONCLUSIONCT-guided injections with botulinum toxin for patients with piriformis syndrome are more likely to lead to a positive response and a longer duration of response than patients who receive a CT-guided injection without botulinum toxin. We hope that this study facilitates future prospective randomized blind trials for patients with suspected piriformis syndrome

Outcomes Following Total Hip Arthroplasty for Hip Dysplasia in Older Adults. Are They Comparable to Those with Osteoarthritis?

Background: Total hip arthroplasty (THA) for the treatment of hip dysplasia, which disproportionately impacts the younger population, has been shown to be an effective intervention to restore functionality and improve quality of life. However, it is unclear whether these outcomes can be just as beneficial in treating hip dysplasia when it presents in older patients. Therefore, we sought to investigate and compare the pre-and postoperative outcomes of THA for hip dysplasia in older adults to those with end-stage osteoarthritis (OA). Methods: A prospectively collected database from a single institution was queried from September 1st, 2016 to October 31st, 2021 to identify 323 unilateral THA patients age 50 years or older and separated into 2 groups given a primary diagnosis of hip dysplasia (n = 90 patients) or osteoarthritis (n = 233 patients). Preoperative and minimum 1-year postoperative outcomes were then compared using the Hip Outcome Score (HOS), Hip Disability and Osteoarthritis Outcome Score (HOOS), University of California-Los Angeles (UCLA) activity score, Pain Catastrophizing Score (PCS), and the Depression Anxiety Stress Scale (DASS). Results: The outcomes between the groups showed no significant differences in their pre-and postoperative HOOS (P = 0.22 and P = 0.63 respectively), DASS Anxiety (P = 0.81 and P = 0.29 respectively), and the DASS Stress Score (P = 0.17 and P = 0.28 respectively). Patients with hip dysplasia reported significantly better preoperative (10.1 vs 12.9, P P = 0.01) DASS Depression Scores but scored significantly lower in the pre-operative HOS (35.4 vs 42.2, P P = 0.02), but no significant difference was seen postoperatively (4.6 vs 5.0, P = 0.11). The PCS noted no significant differences preoperatively (23.2 vs 21.0, P = 0.12). However, the hip dysplasia group has significantly better postoperative scores (6.6 vs 10.0, P = 0.02). Conclusion: Our investigation demonstrates THA as an excellent surgical option for treating hip dysplasia when presenting in older adults and can yield comparable outcomes as those noted in THA performed for OA in older adults

MR Neurography: Pitfalls in Imaging and Interpretation

MR imaging of peripheral nerves, typically referred to as MR neurography, is a rapidly evolving technique that currently is drawing huge attention, both in research and in clinical settings. Both training and experience are necessary to detect the sometimes subtle findings and to avoid misinterpretation of abnormalities. This review article is intended to help radiologists with image evaluation and interpretation. Typical pitfalls are discussed as well as strategies to avoid them

Magnetic resonance neurography: diffusion tensor imaging and future directions

Magnetic resonance (MR) neurography has progressed in the past 2 decades because of rapid technological developments in both hardware and software. In addition to improvements in high-resolution anatomic pulse sequences, functional techniques are becoming feasible. This article presents the current state-of-the-art three-dimensional anatomic techniques, discusses the advantages of functional techniques being exploited, and portrays novel contrast types and molecular techniques that are under development and promise a bright future for this rapidly evolving technique

Upper limb peripheral neuropathy in sickle cell anemia: MR neurography appearances

Sickle cell anemia is an inherited disorder with many systemic complications. Peripheral neuropathy related to this disorder has been sparsely reported. We report an interesting case of upper limb peripheral neuropathy from sickle cell disease with emphasis on MR neurography appearances and electrophysiology correlation