Cell therapy for cartilage defects of the hip.

BACKGROUND: Chondral injuries are commonly related to poor clinical outcome, but recent data showed some improvements in function and pain after hip arthroscopy. Cell-based therapies represent an appealing alternative strategy for cartilage regeneration, and interesting results have been recently reported after intra-articular injections of mesenchymal stem cells (MSCs). The results of hip arthroscopy for femoroacetabular impingement (FAI) and intra-articular injections of autologous expanded bone marrow - MSCs (BM-MSCs) are reported in this retrospective study. MATERIALS AND METHODS: Twenty patients (29 hips) received hip arthroscopy for FAI and focal cartilage injuries or mild to moderate osteoarthrosis (OA). Three intra-articular injections of 20×106 BM-MSCs were injected from 4 to 6 weeks postoperative. The modified Harris Hip score (mHHS), the WOMAC score, the VAIL score and VAS score were administered to all patients. RESULTS: The mean age of the patients was 51.8 years, and the mean follow-up was 24 months. The median preoperative mHHS, WOMAC and VAIL scores were 64.3, 73 and 56.5 respectively, and they increased to 91, 97 and 83 at final follow up (p<0.05). The VAS score also improved from a median of 6 to 2. Four patients received a THA (13% of the hips) at the median of 9 months post intervention (range 6-36 months). Six patients referred pain after the injection of MSCs, which improved with oral pain killers. No major complications were reported. CONCLUSION: BM-MSCc injections in combination with hip arthroscopy may improve the quality of life and functional score in patient with FAI and cartilage injuries which are still not candidate to a THA. LEVEL OF EVIDENCE: IV case series.

Arthroscopic release of iliopsoas tendon in patients with femoro-acetabular impingement: clinical results at mid-term follow-up.

BACKGROUND: The iliopsoas tendon is a recognized cause of extra-articular hip pain, and tenotomy has been described as an effective treatment in patients who do not respond to conservative treatments. Endoscopic release showed higher success rate, lower recurrence, fewer complications compared to open surgery. The aim of the study is to report the results at a mean of 4 years follow-up of a series of patients affected by femoroacetabular impingement (FAI) and an associated iliopsoas tendinopathy, treated with hip arthroscopy and transcapsular tendon release. METHODS: Fifteen patients were retrospectively reviewed. Assessment of radiographic signs of FAI was performed, the alpha angle, the femoral head-neck offset and the lateral center edge angle (LCEA) were collected. Osteoarthritis was assessed from the AP pelvic and graded according to the Tönnis classification. Modified Harris Hip Score (mHHS), VAIL score and VAS score were administered to all patients before surgery, at follow-up at 1 year (T1) and final follow-up (T2). RESULTS: We found a statistical significant improvement in functional scores (mHHS and VAIL score) from the baseline to T2. According to VAS score, a statistical significant improvement was also found from T0 to T2, from a median of 5.5 (range 3-7) to 0 (range 0-5) (P<0.001). Two patients referred a recurrence of pain one year after surgery who were treated conservatively. No other complications have been reported. CONCLUSION: Iliopsoas tendinopathy can be associated to FAI in some patients, and failure in diagnosing and treating may be the reason of poor results and a revision surgery. Arthroscopic iliopsoas tendon release seems to produce good clinical outcome, reducing pain and the rate of a revision surgeries. Level of evidence: IV case series.

Arthroscopic treatment of femoroacetabular impingement in patients older than 60 years.

BACKGROUND: The indications of hip arthroscopy increased over the past decade. Although mostly recommended for treatment of femoroacetabular impingement (FAI) in young patients, well-selected older patients (> 60 years old) may benefit from this surgery. However, the role of hip arthroscopy for the management of older patients is controversial. The aim of the study is to evaluate the clinical outcomes of a series of patients aged 60 years and older who underwent hip arthroscopy for FAI at mid-term follow-up. MATERIALS AND METHODS: Sixty-year-old patients and older, with a joint space greater than 2 mm, and a grade I and II hip osteoarthrosis (OA) according Tönnis scale were included into the study. Twenty-three patients (28 hips) met the inclusion criteria. The T-Student test was used to detect for differences between variables (p<0.05). RESULTS: The mean age of the patients was 63.4 years, and the mean follow-up was 4.4 years (2-9 years). We found an improvement in mHHS and VAS score from the baseline to the final follow-up in 87% of patients (p<0.05). Three patients (13%) were submitted to a THA at a mean of 12 months, while the survivorship rate at the final follow-up was 75%. No major complications have been reported. CONCLUSION: Arthroscopic treatment of FAI in patients over 60 years old, with no signs of advanced osteoarthrosis, showed a significant improvement of functional score and pain in most of cases, and it can be consider a reasonable option in well selected patients. Level of evidence: IV case series.

[Femoroacetabular impingement as a cause of inguinal pain]. / Pinzamiento femoroacetabular: Conceptos básicos en una nueva causa de dolor inguinal.

Femoro-acetabular impingement is an anatomical disturbance of the hip, caused by a deformity of the acetabulum, femur or both that causes an abnormal contact between both structures during certain movements. Its prevalence is 10 to 15% and causes chronic inguinal pain. It can be confused with several other causes of inguinal pain such as hernias, facet syndromes, a renal colic, etc. Patients with this condition are usually young individuals with inguinal pain that may appear after a minor trauma. During examination, pain may be elicited by infernal rotation and abduction movements of hip, flexed in 90 degrees . Plain hip X ray is the most commonly used diagnostic method. Non-steroidal anti-inflammatory drugs and physical therapy can be used to alleviate pain, but the definitive treatment is surgical.

Pinzamiento femoroacetabular: Conceptos básicos en una nueva causa de dolor inguinal: [revisión] / Femoroacetabular impingement as a cause of inguinal pain: [review]

Femoro-acetabular impingement is an anatomical disturbance of the hip, caused by a deformity of the acetabulum, femur or both that causes an abnormal contact between both structures during certain movements. Its prevalence is 10 to 15 percent and causes chronic inguinal pain. It can be confused with several other causes of inguinal pain such as hernias, facet syndromes, a renal colic, etc. Patients with this condition are usually young individuals with inguinal pain that may appear after a minor trauma. During examination, pain may be elicited by infernal rotation and abduction movements of hip, flexed in 90°. Plain hip X ray is the most commonly used diagnostic method. Non-steroidal anti-inflammatory drugs and physical therapy can be used to alleviate pain, but the definitive treatment is surgical.

Arthroscopic Treatment of Femoroacetabular Impingement in Patients over 60 Years Old: Preliminary Report of a Pilot Study.

The objective was to evaluate short-term outcomes of patients of more than 60 years old, who underwent arthroscopic treatment for femoroacetabular impingement (FAI). The study design was a nonrandomized controlled clinical trial; this was a prospective study in 15 patients (15 hips) over 60 years old. Inclusion criteria were symptomatic FAI, no prior surgeries of the affected hip, and osteoarthritis Tonnis classification grade I or II. Exclusion criteria were multiple or large (≥5 mm) chondral defects or subchondral bone cysts in the acetabulum or the femoral head seen on magnetic resonance imaging (MRI). Radiographs and MRI arthrograms were used for the imaging assessment in all cases. Procedures performed arthroscopically included labrum resection, acetabuloplasty, and femoral osteoplasty in all cases. The Harris Hip Score was applied preoperatively and 2 years postoperatively. At 2 years postoperatively, the average increase in the Harris Hip Score was 21 points (mainly pain reduction) from a mean preoperative score of 66 points to a mean postoperative score of 87 points; this difference was significant (P < 0.05). Three cases (20%) had poor outcomes and required a total hip replacement during the first year after the surgery. Poor results were associated with Tonnis grade II osteoarthritis and Outerbridge grade III or IV chondral defects. Arthroscopic treatment of FAI of patients over 60 years old showed a significant Harris Hip Score increase as a result of excellent and good short-term clinical results in most of the patients of our study. Nevertheless, despite strict selection criteria for very well-selected patients, we observed an early failure rate of up to 20%.

Anterior and Posterior Femoral Head-Neck Offset Ratio in the Cam Impingement.

PURPOSE: The purpose of this study was to determine if the anterior-posterior offset ratio is altered in patients with symptomatic cam impingement. STUDY DESIGN: Preoperative radiographs of 15 symptomatic patients with isolated cam-type impingement diagnosed by physical examination and magnetic resonance imaging arthrogram (MRIA) and confirmed by hip arthroscopy findings were assessed. Fifteen asymptomatic volunteers made up the control group. The anterior offset (AO), posterior offset (PO), and AO/PO ratio were calculated. RESULTS: The mean ± SD AO/PO ratio was 0.56 ± 0.1 for the symptomatic group and 0.9 ± 0.2 for the asymptomatic group. This difference was statistically significant. Intra- and interobserver correlation factor for calculating the AO/PO ratio was 0.8 and 0.5, respectively, and differences were not statistically different. CONCLUSIONS: The AO/PO ratio in this study was a useful radiological parameter for the assessment of patients with a cam-type impingement.

Tratamiento artroscopico del pellizcamiento femoroacetabular: tecnica quirurgica y resultados preliminares / Arthroscopic treatment of femoroacetabular impingement: surgical technique and early results

La articulacion de la cadera puede ser origen de dolor y limitacion funcional. Entre otros diagnosticos se encuentra el pellizcamiento femoroacetabular. El diagnostico de pellizcamiento de cadera se ha visto asociado a rotura del labrum y artrosis precoz. El tratamiento de esta patologia puede incluir cirugia. El procedimiento a realizar depende del tipo de pellizcamiento y lesiones asociadas. Los distintos procedimiento quirurgicos han sido reportados por via abierta. Al igual que en otras articulaciones, la via artroscopica presenta ventajas relativas haciendola una opcion atractiva por su menor indice de complicaciones. Una de las limitantes de la artroscopia es la dificultad tecnica que esta plantea. Nuestro grupo ha realizado 60 artroscopias de cadera para el tratamiento del pellizcamiento femoroacetabular con la tecnica aqui descrita. Se han obtenido buenos a excelentes resultados en 91,6 por ciento de los casos (55/60), en un seguimiento a corto plazo. A pesar de las dificultades tecnicas y complicaciones inherentes al procedimiento, la via artroscopica se presenta como una buena alternativa de tratamiento de los pellizcamientos femoroacetabulares pudiendo hacerse desinsercion del labrum, acetabuloplastia, re-insercion y bumpectomia cuando es necesario.

Tratamiento artroscopico del pellizcamiento femoroacetabular: tecnica quirurgica y resultados preliminares / Arthroscopic treatment of femoroacetabular impingement: surgical technique and early results

La articulacion de la cadera puede ser origen de dolor y limitacion funcional. Entre otros diagnosticos se encuentra el pellizcamiento femoroacetabular. El diagnostico de pellizcamiento de cadera se ha visto asociado a rotura del labrum y artrosis precoz. El tratamiento de esta patologia puede incluir cirugia. El procedimiento a realizar depende del tipo de pellizcamiento y lesiones asociadas. Los distintos procedimiento quirurgicos han sido reportados por via abierta. Al igual que en otras articulaciones, la via artroscopica presenta ventajas relativas haciendola una opcion atractiva por su menor indice de complicaciones. Una de las limitantes de la artroscopia es la dificultad tecnica que esta plantea. Nuestro grupo ha realizado 60 artroscopias de cadera para el tratamiento del pellizcamiento femoroacetabular con la tecnica aqui descrita. Se han obtenido buenos a excelentes resultados en 91,6 por ciento de los casos (55/60), en un seguimiento a corto plazo. A pesar de las dificultades tecnicas y complicaciones inherentes al procedimiento, la via artroscopica se presenta como una buena alternativa de tratamiento de los pellizcamientos femoroacetabulares pudiendo hacerse desinsercion del labrum, acetabuloplastia, re-insercion y bumpectomia cuando es necesario.(AU)

Tratamiento artroscopico del pellizcamiento femoroacetabular: tecnica quirurgica y resultados preliminares / Arthroscopic treatment of femoroacetabular impingement: surgical technique and early results

La articulacion de la cadera puede ser origen de dolor y limitacion funcional. Entre otros diagnosticos se encuentra el pellizcamiento femoroacetabular. El diagnostico de pellizcamiento de cadera se ha visto asociado a rotura del labrum y artrosis precoz. El tratamiento de esta patologia puede incluir cirugia. El procedimiento a realizar depende del tipo de pellizcamiento y lesiones asociadas. Los distintos procedimiento quirurgicos han sido reportados por via abierta. Al igual que en otras articulaciones, la via artroscopica presenta ventajas relativas haciendola una opcion atractiva por su menor indice de complicaciones. Una de las limitantes de la artroscopia es la dificultad tecnica que esta plantea. Nuestro grupo ha realizado 60 artroscopias de cadera para el tratamiento del pellizcamiento femoroacetabular con la tecnica aqui descrita. Se han obtenido buenos a excelentes resultados en 91,6 por ciento de los casos (55/60), en un seguimiento a corto plazo. A pesar de las dificultades tecnicas y complicaciones inherentes al procedimiento, la via artroscopica se presenta como una buena alternativa de tratamiento de los pellizcamientos femoroacetabulares pudiendo hacerse desinsercion del labrum, acetabuloplastia, re-insercion y bumpectomia cuando es necesario

alpha2-Adrenoceptors control the release of noradrenaline but not neuropeptide Y from perivascular nerve terminals.

Neuropeptide Y (NPY) and noradrenaline (NA) are co-transmitters at many sympathetic synapses, but it is not yet clear if their release is independently regulated. To address this question, we quantified the electrically evoked release of these co-transmitters from perivascular nerve terminals to the mesenteric circulation in control and drug-treated rats. 6-Hydroxydopamine reduced the tissue content and the electrically evoked release of ir-NPY and NA as well as the rise in perfusion pressure. A 0.001 mg/kg reserpine reduced the content of ir-NPY and NA, but did not modify their release nor altered the rise in perfusion pressure elicited by the electrical stimuli. However, 0.1mg/kg reserpine reduced both the content and release of NA but decreased only the content but not the release of ir-NPY; the rise in perfusion pressure was halved. Clonidine did not affect the release of ir-NPY while it lowered the outflow of NA, not altering the rise in perfusion pressure elicited by the electrical stimuli. Yohimbine, did not modify the release of ir-NPY but increased the NA outflow, it antagonized the clonidine effect. Therefore, presynaptic alpha2-adrenoceptors modulate the release of NA but not NPY, implying separate regulatory mechanisms.