Hip dysplasia hiding in plain sight: A retrospective analysis of radiology reports.

INTRODUCTION: Timely recognition of dysplastic hip morphology is critical to facilitate appropriate management before significant joint damage has developed. It is likely that radiologist under reporting contributes to delays in diagnosis. This study aimed to assess how often adult hip dysplasia goes undetected in radiological reports and to identify clinical and radiological variables that impact the likelihood of detection of dysplasia by radiologists. METHODS: Referral details and radiology reports of patients who underwent periacetabular osteotomy by a single surgeon for symptomatic hip dysplasia between 1 January 2016 and 30 June 2020 were reviewed. Four assessors measured the lateral centre edge angle from the pelvic radiograph performed at time of referral. Film quality and other radiographic parameters were also assessed. RESULTS: Sixty-eight patients were included, 84% were female and the median age was 28.1 years. Dysplasia was not documented in the radiology report in 49% of cases. Dysplasia was more likely to be reported with no history of injury, an aspherical femoral head, lower lateral centre edge angle, higher acetabular index, increased femoral head shaft angle, higher femoro-epiphyseal acetabular roof index, or if there was disruption of Shenton's line, with the first three variables being independent predictors of radiologist detection. CONCLUSION: Hip dysplasia should be considered in all adolescents/young adults presenting with hip pain. Causes of radiologist under reporting are likely multifactorial. Clinical information can cause cognitive biases and result in selective looking. A systematic approach to pelvis radiographs should include assessment of acetabular coverage and active search for evidence of femoral head migration.

The posterior crescent sign on MRI and MR arthrography: is it a marker of hip dysplasia and instability?

OBJECTIVE: To evaluate the prevalence of the 'posterior crescent sign' in symptomatic patients referred for MRI/MR arthrogram of the hip and identify any correlation with imaging features of joint pathology. MATERIALS AND METHODS: Retrospective imaging assessment of a cohort of 1462 hips, from 1380 included MR examinations (82 bilateral) retrieved from a search of all examinations in patients 16-50 years old from June 2018 to June 2021, with median age 45.8 years (range 17.8-50.0) and 936 hips (64%) in women. Radiographic and MR findings related to hip dysplasia, femoroacetabular impingement and osteoarthritis were assessed. RESULTS: Fifty-one hips (3.5%) were positive for the posterior crescent sign, median age of 45.8 years (range 17.8-50.0) and 29 (58%) in women. Radiographic findings included the following: mean lateral centre edge angle (LCEA) 22.2° (± 7.8°) with LCEA < 20° in 15 (31%) and LCEA 20-25° in 17 (35%) and mean acetabular index (AI) of 13.1° (± 5.8°) with AI > 13° in 22 (45%). MR findings included the following: mean anterior acetabular sector angle (AASA) 54.3° (± 9.8°), mean posterior acetabular sector angle (PASA) 92.7° (± 7.0°), labral tear at 3-4 o'clock in 20 (39%), high-grade acetabular chondral loss in 42 (83%) and ligamentum teres abnormality in 20 (39%). CONCLUSION: The posterior crescent sign occurs in 3.5% of symptomatic young and middle-aged adults on MR. It is associated with overt and borderline hip dysplasia and other findings of hip instability. It is also associated with osteoarthritis in some cases and should be interpreted with caution in these patients.

Assessment of the iliocapsularis muscle on magnetic resonance imaging.

INTRODUCTION: Morphologic features of Iliocapsularis (IC) may aid clinical decision-making in the symptomatic hip. The relationship between IC muscle size and underlying hip pathology is emerging; however, research is limited in the imaging literature. The purpose of this study was to determine the reliability and reproducibility of measurements of the IC muscle and its MRI appearances. It also looked for any association between IC dimension and axial levels, side, gender and bony features of hip instability. METHODS: Retrospective study of 37 MRI scans were assessed by four observers. MRI axial T1 images were used to define the IC anatomy, measure the IC and rectus femoris at the femoral head centre (FHC) and adjacent levels and calculate the iliocapsularis-to-rectus femoris (IR) ratio. Measurements were repeated at least 2 weeks later. Radiographic assessment of the lateral centre edge angle, acetabular index and femoral neck-shaft angle were also conducted. RESULTS: The IC was always present, but was well-defined in only 4% of cases with fair agreement. The intraclass correlation coefficient for reliability and reproducibility was the highest for IC width 0.94 (0.91-0.96). No significant correlation was identified between the IR ratio and radiographic parameters. CONCLUSION: Iliocapsularis is visible and reliably measured on MRI despite observers considering the muscle to be not well-defined. Despite gender differences in muscle size, the IR ratio was unchanged. There is a significant difference in the IR ratio above and below the FHC; therefore, clinicians need to be aware of how this may impact the clinical use when utilising the IR ratio.

Microinstability of the hip: a systematic review of the imaging findings.

OBJECTIVES: To undertake a systematic review of the morphologic features associated with hip microinstability and determine whether there are suggestive or diagnostic imaging findings. METHODS: Four electronic databases were searched up to September 2019 to identify original research reporting morphologic features in individuals with either a clinical diagnosis of hip microinstability (instability without overt subluxation/dislocation) or those with symptomatic laxity demonstrated on imaging (increased femoral head translation/distraction or capsular volume). Studies focussing on individuals with pre-existing hip conditions (including definite dysplasia (lateral centre edge angle < 20°), significant trauma, previous dislocation or surgery were excluded. Methodological quality was assessed by the Quality Assessment of Diagnostic Accuracy Studies 2 tool. RESULTS: Twenty-two studies met inclusion criteria (clinical diagnosis of microinstability n = 15 and demonstration of laxity n = 7). Imaging information gathered from the studies includes radiographs (n = 14), MRI (n = 6), MR arthrography (n = 4), CT (n = 1) and intraoperative examination. Most studies exhibited design features associated with an overall high or unclear risk of bias. Some dysplastic features are associated with microinstability or laxity reference measures; however, microinstability is frequently diagnosed in those with a lateral centre edge angle > 25°. Other associated imaging findings reported include impingement morphology, anterior labral tearing, femoral head chondral injury, ligamentum teres tears and capsular attenuation. CONCLUSIONS: The current literature does not provide strong evidence for imaging features diagnostic of microinstability. In the appropriate clinical context, dysplastic morphology, anterior labral tears and ligamentum teres tears may be suggestive of this condition although further research is needed to confirm this. PROSPERO REGISTRATION: CRD42019122406.

Persistent or recurrent symptoms after arthroscopic surgery for femoroacetabular impingement: A review of imaging findings.

Hip arthroscopy is one of the most rapidly growing and evolving orthopaedic subspecialties. With the recent dramatic increase in the volume of hip arthroscopy performed there has been an increase in the number of symptomatic patients following arthroscopy for femoroacetabular impingement. Imaging has a key role in determining the need for revision surgery and in preoperative planning. Although the revision rate for hip arthroscopy is 3-9%, little has been published about the imaging findings associated with unsatisfactory treatment outcomes. This review discusses the significance of pre-existing osteoarthritis and underlying hip dysplasia and describes the causes of persistent symptoms. Recent literature on extra articular impingement and causes of microinstability are presented. Post-operative appearances are described focussing on the clinically relevant imaging findings. The challenges of evaluating the labrum after repair and specific findings associated with anchor failure and iatrogenic chondrolabral injury are discussed. The purpose of this article is to review the causes of unsatisfactory treatment outcomes after hip arthroscopy, role of imaging and indications for revision arthroscopy.

Lost productivity due to premature mortality in developed and emerging countries: an application to smoking cessation.

BACKGROUND: Researchers and policy makers have determined that accounting for productivity costs, or "indirect costs," may be as important as including direct medical expenditures when evaluating the societal value of health interventions. These costs are also important when estimating the global burden of disease. The estimation of indirect costs is commonly done on a country-specific basis. However, there are few studies that evaluate indirect costs across countries using a consistent methodology. METHODS: Using the human capital approach, we developed a model that estimates productivity costs as the present value of lifetime earnings (PVLE) lost due to premature mortality. Applying this methodology, the model estimates productivity costs for 29 selected countries, both developed and emerging. We also provide an illustration of how the inclusion of productivity costs contributes to an analysis of the societal burden of smoking. A sensitivity analysis is undertaken to assess productivity costs on the basis of the friction cost approach. RESULTS: PVLE estimates were higher for certain subpopulations, such as men, younger people, and people in developed countries. In the case study, productivity cost estimates from our model showed that productivity loss was a substantial share of the total cost burden of premature mortality due to smoking, accounting for over 75 % of total lifetime costs in the United States and 67 % of total lifetime costs in Brazil. Productivity costs were much lower using the friction cost approach among those of working age. CONCLUSIONS: Our PVLE model is a novel tool allowing researchers to incorporate the value of lost productivity due to premature mortality into economic analyses of treatments for diseases or health interventions. We provide PVLE estimates for a number of emerging and developed countries. Including productivity costs in a health economics study allows for a more comprehensive analysis, and, as demonstrated by our illustration, can have important effects on the results and conclusions.

The impact of symptoms and impairments on overall health in US national health data.

OBJECTIVE: To assess the effects on overall self-rated health of the broad range of symptoms and impairments that are routinely asked about in national surveys. DATA: We use data from adults in the nationally representative Medical Expenditure Panel Survey (MEPS) 2002 with validation in an independent sample from MEPS 2000. METHODS: Regression analysis is used to relate impairments and symptoms to a 100-point self-rating of general health status. The effect of each impairment and symptom on health-related quality of life (HRQOL) is estimated from regression coefficients, accounting for interactions between them. RESULTS: Impairments and symptoms most strongly associated with overall health include pain, self-care limitations, and having little or no energy. The most prevalent are moderate pain, severe anxiety, moderate depressive symptoms, and low energy. Effects are stable across different waves of MEPS, and questions cover a broader range of impairments and symptoms than existing health measurement instruments. CONCLUSIONS: This method makes use of the rich detail on impairments and symptoms in existing national data, quantifying their independent effects on overall health. Given the ongoing availability of these data and the shortcomings of traditional utility methods, it would be valuable to compare existing HRQOL measures to other methods, such as the one presented herein, for use in tracking population health over time.

The value of medical interventions for lung cancer in the elderly: results from SEER-CMHSF.

BACKGROUND: Lung cancer is the leading source of cancer mortality and spending. However, the value of spending on the treatment of lung cancer has not been conclusively demonstrated. The authors evaluated the value of medical care between 1983 and 1997 for nonsmall cell lung cancer in the elderly US population. METHODS: The authors used Surveillance, Epidemiology, and End Results (SEER) data to calculate life expectancy after diagnosis over the period 1983 to 1997. Direct costs for nonsmall cell lung cancer detection and treatment were determined by using Part A and Part B reimbursements from the Continuous Medicare History Sample File (CMHSF) data. The CMHSF and SEER data were linked to calculate lifetime treatment costs over the time period of interest. RESULTS: Life expectancy improved minimally, with an average increase of approximately 0.60 months. Total lifetime lung cancer spending rose by approximately $20,157 per patient in real, ie, adjusted for inflation, 2000 dollars from the early 1980s to the mid-1990s, for a cost-effectiveness ratio of $403,142 per life year (LY). The cost-effectiveness ratio was $143,614 for localized cancer, $145,861 for regional cancer, and $1,190,322 for metastatic cancer. CONCLUSIONS: The cost-effectiveness ratio for nonsmall cell lung cancer was higher than traditional thresholds used to define cost-effective care. The most favorable results were for persons diagnosed with early stage cancer. These results suggested caution when encouraging more intensive care for lung cancer patients without first considering the tradeoffs with the costs of this therapy and its potential effects on mortality and/or quality of life.