Snapping hip caused by a venous hemangioma of the gluteus maximus muscle: a case report

<p>Abstract</p> <p>Introduction</p> <p>Snapping hip, or coxa saltans, is defined as a clinical condition where a usually painful, audible snap occurs during hip flexion and extension. Its causes can be divided into external, internal or intra-articular origin. Accurate diagnosis is a prerequisite to successful treatment. We report a rare cause of snapping hip which is different from any previously reported cases.</p> <p>Case presentation</p> <p>A 23-year-old man presented to us with right hip pain of more than 10 years duration. Atrophy of the right gluteus maximus with snapping and tenderness were also noted. The imaging study revealed a focal intramuscular lesion in the lateral portion of the right gluteus maximus muscle. Surgery was performed and pathological examination concluded this mass to be a venous hemangioma.</p> <p>Conclusion</p> <p>Intramuscular hemangioma, though rare, should be considered in the differential diagnosis of a snapping hip even though muscle fibrosis is most frequently encountered.</p

Acetabular retroversion: Diagnosis and treatment

Acetabular retroversion (AR) consists of a malorientation of the acetabulum in the sagittal plane. AR is associated with changes in load transmission across the hip, being a risk factor for early osteoarthrosis. The pathophysiological basis of AR is an anterior acetabular hyper-coverage and an overall pelvic rotation.The delay or the non-diagnosis of AR could have an impact in the overall management of femoroacetabular impingement (FAI). AR is a subtype of (focal) pincer deformity.The objective of this review was to clarify the pathophysiological, diagnosis and treatment fundaments inherent to AR, using a current literature review.Radiographic evaluation is paramount in AR: the cross-over, the posterior wall and ischial spine signs are classic radiographic signs of AR. However, computed tomography (CT) evaluation permits a three-dimensional characterization of the deformity, being more reliable in its recognition.Acetabular rim trimming (ART) and periacetabular osteotomy (PAO) are the best described surgical options for the treatment of AR.The clinical outcomes of both techniques are dependent on the correct characterization of existing lesions and adequate selection of patients. Cite this article: EFORT Open Rev 2018;3:595-603. DOI: 10.1302/2058-5241.3.180015

Patient-Reported Outcome questionnaires for hip arthroscopy: a systematic review of the psychometric evidence

Abstract Background Hip arthroscopies are often used in the treatment of intra-articular hip injuries. Patient-reported outcomes (PRO) are an important parameter in evaluating treatment. It is unclear which PRO questionnaires are specifically available for hip arthroscopy patients. The aim of this systematic review was to investigate which PRO questionnaires are valid and reliable in the evaluation of patients undergoing hip arthroscopy. Methods A search was conducted in Pubmed, Medline, CINAHL, the Cochrane Library, Pedro, EMBASE and Web of Science from 1931 to October 2010. Studies assessing the quality of PRO questionnaires in the evaluation of patients undergoing hip arthroscopy were included. The quality of the questionnaires was evaluated by the psychometric properties of the outcome measures. The quality of the articles investigating the questionnaires was assessed by the COSMIN list. Results Five articles identified three questionnaires; the Modified Harris Hip Score (MHHS), the Nonarthritic Hip Score (NAHS) and the Hip Outcome Score (HOS). The NAHS scored best on the content validity, whereas the HOS scored best on agreement, internal consistency, reliability and responsiveness. The quality of the articles describing the HOS scored highest. The NAHS is the best quality questionnaire. The articles describing the HOS are the best quality articles. Conclusions This systematic review shows that there is no conclusive evidence for the use of a single patient-reported outcome questionnaire in the evaluation of patients undergoing hip arthroscopy. Based on available psychometric evidence we recommend using a combination of the NAHS and the HOS for patients undergoing hip arthroscopy.</p

Femoral neck fractures after arthroscopic femoral neck osteochondroplasty for femoroacetabular impingement

PURPOSE: The objective of this study was to evaluate the rate, associated risk factors and outcome of insufficiency femoral neck fractures following arthroscopic femoral neck osteochondroplasty for femoroacetabular impingement. METHODS: Between 2005 and 2009, a consecutive series of 376 arthroscopic femoral osteochondroplasties for femoroacetabular impingement were performed and analysed. Seven postoperative fractures were found and comprise the fracture group. The amount of femoral head-neck bone resected as assessed on follow-up cross table lateral views, as well as age, gender, height, weight and BMI, was compared between the fracture group and the entire collective. Subjective outcome was recorded using the WOMAC score. RESULTS: Seven fractures (1.9 %) were identified. All occurred in males at an average of 4.4 weeks postoperatively and were considered insufficiency fractures. The fracture group had a significantly higher mean age (p = 0.01) and height (p = 0.013). Within the fracture group, alpha angles were lower (p = 0.009) and resection depth ratios were higher (p < 0.001). The femoral offset was significantly higher (p = 0.016) in the fracture group and in male patients (p < 0.001). The cut-off value for resection depth ratio on cross table lateral radiograph was 18 % of the femoral head radius. After a mean follow-up of 20 months, an inferior WOMAC (p = 0.030) was recorded in the fracture group. CONCLUSION: Femoral neck insufficiency fractures were identified in 1.9 % of our arthroscopic femoral osteochondroplasty cases. Significant new pain following a period of satisfactory recovery after arthroscopic femoral neck osteochondroplasty should alert the surgeon to the possibility of this complication. If a resection depth ratio of more than 18 % is recognized on the postoperative cross table lateral view, particularly in male patients with a high femoral head-shaft offset, the risk of postoperative insufficiency fracture is increased. This study not only defines the complication rate, but also identifies associated risk factors and determines the influence on the postoperative subjective short-term result. Important information for both the patient and orthopaedic surgeon is provided and may have a direct consequence on the postoperative protocol. LEVEL OF EVIDENCE: IV