Diagnostic Validity of the Physical Examination Maneuvers for Hip Pathology: A Systematic Review

Background: There is a number of physical examination maneuvers used to diagnose hip pathology but the diagnostic validity of these maneuvers is unclear. We conducted a systematic review to evaluate current knowledge regarding the diagnostic validity of the physical examination maneuvers for hip pathology. Methods: We conducted a literature search of the electronic databases MEDLINE, CINAHL, EMBASE, Cochrane, and SPORTDiscus. The methodological quality of each eligible study was assessed and classified according to Sackett and Haynes’ phases of diagnostic research, whereby Phase I and II studies represent proof of concept and Phase III studies are applicable to a clinical setting. Results: Eight studies were classified as phase III diagnostic studies, four of which were methodologically rigorous. In diagnosing labral tears of the hip, neither the impingement test (sensitivity=0.51-0.78, specificity=0.10-0.89) nor FABER test (sensitivity=0.60, specificity=0.75) demonstrated evidence to support the use of these tests clinically. In diagnosing gluteal tendon pathology the Trendelenburg test demonstrated some evidence for use in a clinical setting (sensitivity=0.23-0.73, specificity=0.77-0.94). Conclusion: The diagnostic validity of clinical tests to diagnose the presence or absence of hip pathology remains uncertain. The majority of studies supporting validity of these tests lacked methodological rigor, and thus cannot provide evidence to support the use of a test in clinical practice

Iliopsoas Release – A Systematic Review of Clinical Efficacy and Associated Complications

Objective: To perform a systematic review of the findings of iliopsoas release as it relates to resolution of snapping, improvement of groin pain, and associated complications. Design: Systematic review. Data Sources: Four electronic databases PubMed/MEDLINE, EMBASE, CINAHL, and Web of Science were searched, identifying all literature pertaining to surgical treatment of a snapping hip/coxa saltans, iliopsoas impingement, or iliopsoas tendinitis. A total of 818 studies were identified. Two reviewers independently screened the titles, abstracts, and full-text articles for eligibility. Eligibility Criteria: All studies published in English that reported on iliopsoas release for snapping hip/coxa saltans, iliopsoas impingement, or iliopsoas tendinitis reporting outcomes or associated complications were eligible. Results: A total of 48 articles were included in this review. Three surgical indications were identified for iliopsoas release, internal snapping hip, labral tear secondary to iliopsoas impingement, and iliopsoas tendinopathy after total hip arthroplasty. Arthroscopic techniques seemed to be superior to open techniques with regards to reoccurrence of snapping (5.1% vs 21.7%) and groin pain relief (89.1% vs 85.6%) with fewer complications (4.2% vs 21.1%) overall. Conclusions: Both open and arthroscopic iliopsoas releases have been shown to be successful treatment options regardless of the surgical indications identified in this review. Arthroscopic release demonstrated a decreased failure rate, fewer complications, and improved outcomes when compared with open procedures

Fracture of Two Moderately Cross-Linked Polyethylene Tibial Inserts in a TKR Patient

Highly cross-linked polyethylene has become the gold standard in total hip replacement for its wear resistance. Moderately crosslinked polyethylene is now available for total knee replacement (TKR), although concerns about reduced mechanical strength have prevented widespread adoption. The purpose of this report is to describe an unusual case where a patient underwent cruciate retaining TKR using a moderately crosslinked polyethylene tibial insert that went on to fracture twice in the same location across the primary and first revision surgery. The first tibial insert was 10 mm thick and was implanted for 16 months. The second tibial insert was 15 mm thick and was implanted for 11 months. Both fractured along the posterior aspect of the medial articular surface. The lack of a specific event leading to these fractures and the fact that they occurred twice in the same location in the same patient suggest that caution is still necessary regarding the introduction of crosslinked polyethylene for TKR surgery

Three femoral stem designs without corrosion: A review of 2095 stems

© 2020 Naudie et al. Introduction: Corrosion at the head–neck interface of modular components in total hip arthroplasty (THA) has been reported as a cause of failure of modern total hip replacement implants. While this method of failure has been well described, it remains poorly understood. The purpose of this study is to review the three most commonly used uncemented femoral stems at our institution over the last fifteen years and to correlate any established risk factors with rates of revision, particularly corrosion. Methods: We reviewed 2095 patients from March 2000 to September 2015 who underwent total hip arthroplasty with one of three uncemented femoral stem designs. All stems were made of a Ti6Al4V alloy with a 12/14 taper design. We included only those stems coupled with a CoCr head and a highly crosslinked polyethylene liner. We evaluated age, gender, body mass index (BMI), femoral head size, head length, neck angle and offset and correlated these to the incidence of all cause revision, as well as revision excluding infection. Results: There were no recognized corrosion-related revisions identified. There was no association between age, BMI, gender, head length, neck angle and offset to all cause revision or revision with infection excluded (p\u3e0.05). Femoral head size less than 32mm was associated with higher all cause revision rates (OR 4.60 (95% CI 1.8, 11.8)) and when excluding infection as a reason for revision (OR 4.94 (95% CI 1.7, 14.41)). Conclusion: Over the last fifteen years, we have not identified any cases of corrosion with the three most commonly used femoral stems used at out institution. While we acknowledge that no femoral stem is immune to corrosion, certain femoral stem designs may be uniquely resistant to this mode of failure. Level of Evidence: III

Fracture of Two Moderately Cross-Linked Polyethylene Tibial Inserts in a TKR Patient

Highly cross-linked polyethylene has become the gold standard in total hip replacement for its wear resistance. Moderately crosslinked polyethylene is now available for total knee replacement (TKR), although concerns about reduced mechanical strength have prevented widespread adoption. The purpose of this report is to describe an unusual case where a patient underwent cruciate retaining TKR using a moderately crosslinked polyethylene tibial insert that went on to fracture twice in the same location across the primary and first revision surgery. The first tibial insert was 10 mm thick and was implanted for 16 months. The second tibial insert was 15 mm thick and was implanted for 11 months. Both fractured along the posterior aspect of the medial articular surface. The lack of a specific event leading to these fractures and the fact that they occurred twice in the same location in the same patient suggest that caution is still necessary regarding the introduction of crosslinked polyethylene for TKR surgery

Manufacturing, oxidation, mechanical properties and clinical performance of highly cross-linked polyethylene in total hip arthroplasty

© The Author(s) 2018. Ultra-high molecular weight polyethylene (UHMWPE) continues to be the gold standard bearing surface in total hip arthroplasty (THA) for nearly 5 decades. Highly cross-linked UHMWPE (HXLPE) was adapted for routine use in the early 2000s to reduce the revision rates related to wear, osteolysis, and aseptic loosening resulting from conventional UHMWPE wear. Since its inception, consistent evidence showing reduced wear rates and osteolysis supports the use of HXLPE in THA. High quality studies demonstrating the advantage in long term survivorship of HXLPE over conventional UHMWPE are emerging. Though retrieval studies have demonstrated evidence of in vivo oxidation and fatigue related damage at the rim of the first generation HXLPE liners, clinical significance of this remains to be seen. Second-generation sequentially annealed and vitamin E containing HXLPE liners demonstrate improved mechanical properties, resistance to oxidation, and equivalent wear rates in comparison to their first-generation counterparts, but long term success remains to be seen

Impact of surgeon’s hand and ocular dominance on right and left total knee arthroplasty alignment

Postoperative alignment is an important modifiable confounder that contributes to the longevity of total knee arthroplasty (TKA). Studies have shown that surgeon’s handedness can affect surgical performance; however, no studies have assessed the effect of surgeon’s hand or ocular dominance on TKA alignment. The purpose of this study was to evaluate the effect of surgeon’s hand and ocular dominance on coronal plane alignment in TKA. We retrospectively evaluated 138 patients who underwent sequential bilateral TKA by the same surgeon, using the Genesis II PS knee (Smith & Nephew, Memphis, TN). We assessed postoperative alignment by measuring and comparing anatomical tibiofemoral angle (TFA) bilaterally on standard postoperative knee radiographs, as well as Knee Society function and pain scores to determine any functional differences. Lastly, we evaluated whether a crossed hand-ocular dominant surgeon had greater accuracy when performing a TKA on the side opposite their hand dominance compared to uncrossed hand-ocular dominant surgeons. All surgeons were right-hand dominant and there was a significantly larger anatomical TFA on left TKAs (mean [SD], 4.6° [2.8°]) compared to right TKAs (3.8° [2.5°]) (P = 0.003). There was no significant difference between right and left Knee Society function (P = 0.09) and pain scores (P = 0.86). When comparing left TKAs, surgeons with uncrossed hand-ocular dominance (4.5°) performed with equal accuracy compared to surgeons with crossed hand-ocular dominance (4.8°) (2-tailed test = 0.597), indicating no effect of ocular dominance. In summary, hand but not ocular dominance was shown to have significant postoperative alignment effects on TKA