Total Hip Arthroplasty in 2017 - Current Concepts and Recent Advances.

Total hip arthroplasty (THA) is one of the most successful interventions not only in orthopedics but also in modern medicine. Since its first implantation in the 1950s, improvements in surgical technique, technology, and postoperative rehabilitation have greatly increased the effectiveness and success of this procedure

Treatment strategies for ischiofemoral impingement: a systematic review

Abstract: Purpose: There has been relatively little information about the treatment for ischiofemoral impingement (IFI) because of its rarity as well as the uncertainty of diagnosis. The aim of this study was to provide the reader with the available treatment strategies and their related outcomes for IFI based on the best available evidence, whilst highlighting classically accepted ways of treatment as well as relatively new surgical and non-surgical techniques. Methods: A systematic review of the literature from Medline, Embase, AMED, Cochrane and Google Scholar was undertaken since inception to December 2017 following the PRISMA guidelines. Clinical outcome studies, prospective/retrospective case series and case reports that described the treatment outcome for IFI were included. Animal or cadaveric studies, trial protocols, diagnostic studies without any description of treatments, technical notes without any results, and review articles were excluded. Results: This systematic review found 17 relevant papers. No comparative studies were included in the final records for qualitative assessment, which means all the studies were case series and case reports. Eight studies (47.1%) utilised non-surgical treatment including injection and prolotherapy, followed by endoscopic surgery (5 studies, 29.4%) then open surgery (4 studies, 23.5%). Mean age of the participants was 41 years (11–72 years). The mean follow-up was 8.4 months distributed from 2 weeks to 2.3 years. No complications or adverse effects were found from the systematic review. Conclusion: Several treatment strategies have been reported for IFI, and most of them have good short- to medium-term outcomes with a low rate of complications. However, there are no comparative studies to assess the superiority of one technique over another, thus further research with randomised controlled trials is required in this arena. This study explores the wide variety and categories of different treatments used for IFI to guide physicians and shed light on what can be done for this challenging cohort of patients. Level of evidence: III

The history of femoroacetabular impingement.

AIMS: Femoroacetabular impingement (FAI) describes abnormal bony contact of the proximal femur against the acetabulum. The term was first coined in 1999; however what is often overlooked is that descriptions of the morphology have existed in the literature for centuries. The aim of this paper is to delineate its origins and provide further clarity on FAI to shape future research. METHODS: A non-systematic search on PubMed was performed using keywords such as "impingement" or "tilt deformity" to find early anatomical descriptions of FAI. Relevant references from these primary studies were then followed up. RESULTS: Although FAI has existed for almost 5,000 years, the anatomical study by Henle in 1855 was the first to describe it in the literature. The relevance of the deformity was not appreciated at the time but this triggered the development of further anatomical studies. Parallel to this, Poland performed the first surgical correction of FAI in 1898 and subsequently, descriptions of similar procedures followed. In 1965, Murray outlined radiological evidence of idiopathic cam-type deformities and highlighted its significance. This led to a renewed focus on FAI and eventually, Ganz et al released their seminal paper that has become the foundation of our current understanding of FAI. Since then, there has been an exponential rise in published literature but finding a consensus, especially in the diagnosis of FAI, has proven to be difficult. CONCLUSION: Current research on FAI heavily focuses on new data, but old evidence does exist and studying it could be equally as important in clarifying the aetiology and classification of FAI.Cite this article: Bone Joint Res 2020;9(9):572-577

Is restricted hip movement a risk factor for anterior cruciate ligament injury?

Restricted hip movement along with femoroacetabular impingement (FAI) has been reported to be an important risk factor in anterior cruciate ligament (ACL) injury. We performed a literature review assessing the evidence that FAI, or restricted hip movement, contributes to the likelihood of sustaining an ACL injury to provide an evidence-based and comprehensive update on the relationship between these pathologies. Studies were divided into three categories: clinical studies, radiological studies and cadaveric studies. Clinical studies primarily assessed the limitations to hip movement in patients with ACL injury, and numerous studies of this kind have demonstrated a relationship between restricted movement and ACL injury. Radiological studies have been able to demonstrate a higher number of bony hip abnormalities in patients with ACL injury. However, due to variable results within these studies, it is unclear which kinds of bony abnormality are specifically associated with an increased risk of ACL injury. Cadaveric studies have demonstrated that peak ACL relative strain was inversely related to the range of internal rotation of the femur, thus providing a potential mechanism for this relationship. In conclusion, clinical and radiological studies have established a correlation between restricted hip and ACL injury, but have been unable to demonstrate an increased risk of future ACL injury in individuals with restricted hip movement. Future prospective cohort studies are necessary to confirm this. Additionally, these findings highlight the need for a thorough clinical assessment of the hip when assessing patients with an ACL injury

LABRAL TEARS IN YOUNG SEXUALLY ACTIVE WOMEN: AN EVALUATION OF PATIENT SATISFACTION AFTER HIP ARTHROSCOPY

Summary: Labral tears in young sexually active women: An evaluation of patient satisfaction after Hip Arthroscop

Arthroscopic excision of heterotopic ossification in the rectus femoris muscle causing extra-articular anterior hip impingement.

Subspine impingement is an extra-articular hip impingement syndrome that usually occurs when there is abnormal contact between an enlarged or malorientated anterior inferior iliac spine (AIIS) and the distal anterior femoral neck in straight flexion of the hip. We present the case of a 13-year-old boy with a history of left groin pain and loss of range of movement of the hip for over six months following an avulsion fracture of the AIIS during a game of rugby. He was diagnosed with subspine impingement secondary to a large lesion of heterotopic ossification in the rectus femoris; this was dissected and extracted from the muscle in toto arthroscopically. This case highlights the importance of heterotopic ossification after injury as an important cause for subspine impingement in the young adult hip. This is the first report and describes subspine impingement secondary to a large lesion of heterotopic ossification

Outcomes Following Total Hip Arthroplasty: A Review of the Registry Data.

While total hip arthroplasty remains one of the most reliable procedures with excellent, cost-effective outcomes, there remains controversy in the choice of implant in terms of method of fixation, bearing surface, and size of the femoral head, especially in the younger population. This review looks at the possible information base that surgeons can explore before choosing the implant that they are comfortable with. It also looks at the findings of various registries, which readers can use in the process of informed consent. We have provided certain recommendations with specific reference to the method of fixation, bearing surface, and head size that can be backed by the available registry data. However, the information provided should be used only after considering local, financial, and patient-specific issues that surgeons encounter on a daily basis during their practice

Standardising muscle strength measurement protocols in femoroacetabular impingement: RE: Kierkegaard, S., Mechlenburg, I., Lund, B., Søballe, K., & Dalgas, U. (2017). Impaired hip muscle strength in patients with femoroacetabular impingement syndrome. Journal of Science and Medicine in Sport.

We read with interest the article entitled “Impaired hip muscle strength in patients with femoroacetabular impingement syndrome” Kierkegaard et al. It is certainly an interesting article and shows reduced muscle strength in the affected as well as the unaffected hips in those suffering with femoroacetabular impingement (FAI)

Medial synovial fold cyst in the hip leading to pectineofoveal impingement.

Pectineofoveal impingement is a relatively rare condition, which can cause hip or groin pain along with mechanical symptoms of clicking in the young adult. We present the case of a 13-year-old girl who was referred to us with left hip pain, which had been affecting her for over six months along with mechanical symptoms of clicking. Following appropriate clinical examination and investigations the patient underwent arthroscopic surgery of her hip. At arthroscopy, a cyst was identified on the medial synovial fold, which was abutting against the zona orbicularis leading to pectineofoveal impingement. The cyst was decompressed and the synovial fold excised arthroscopically. Following arthroscopic intervention, the patient did extremely well and remains asymptomatic at the last follow-up (7 months following the procedure). The case highlights the importance of the medial synovial fold pathology as an important cause for pain and mechanical symptoms in the young adult hip

What Is the Risk Posed to the Lateral Femoral Cutaneous Nerve During the Use of the Anterior Portal of Supine Hip Arthroscopy and the Minimally Invasive Anterior Approach for Total Hip Arthroplasty?

PURPOSE: To determine: (1) What is the proximity of the lateral femoral cutaneous nerve (LFCN) to the anterior portal (AP) used in supine hip arthroscopy? (2) What is the proximity of the LCFN to the incision in the minimally invasive anterior approach (MIAA) for total hip arthroplasty? (3) What effect does lateralizing the AP have on the likelihood of nerve injury? (4) What branching patterns are observable in the LFCN? METHODS: Forty-five hemipelves were dissected. The LFCN was identified and its path dissected. The positions of the nerve in relation to the AP and the MIAA incision were measured. RESULTS: The AP intersected with 38% of nerves. In the remainder, the LFCN was located 5.7 ± 4.5 mm from the portal's edge. In addition, 44% of nerves crossed the incision of the MIAA. Of those that did not, the average minimum distance from the incision was 14.4 ± 7.0 mm. We found a significant reduction in risk if the AP is moved medially by 5 mm or laterally by 15 mm (P = .0054 and P = .0002). The LFCN showed considerable variation with 4 branching variants. CONCLUSIONS: These results show that the LFCN is at high risk during supine hip arthroscopy and the MIAA, emphasizing the need for meticulous dissection. We suggest that relocation of the AP 5 mm medially or 15 mm laterally will reduce the risk to the LFCN. CLINICAL RELEVANCE: These findings should aid surgeons in minimizing the risk to the LCFN during hip arthroscopy and the minimally invasive anterior approach to the hip