The Application of Magnetic Resonance Imaging in the Early and Accurate Diagnosis of Hip Joint Avascular Necrosis.

Introduction Avascular necrosis (AVN) is characterized by the death (necrosis) of cellular bone components in the subchondral bone or epiphysis due to a lack of or an interruption of the blood supply. In routine practice, AVN is most frequently encountered in the femoral head. In this study, we aim to evaluate the application of magnetic resonance imaging (MRI) in the early and accurate diagnosis of hip joint AVN. Materials and methods This was a retrospective, cross-sectional study conducted in the Department of Radiodiagnosis of Dr. D. Y. Patil tertiary care hospital, Pimpri, Pune, India. We studied 30 patients with complaints of pain and associated limping who underwent primary radiograph analysis of the hip joint, followed by MRI. Results We assessed 30 patients (45 hip joints) using plain radiography and MRI. Of the 45 hips, we could diagnose AVN in 28 hips (62.2%) using plain radiography, but we could not diagnose it in 17 hips (37.8%), whereas we were able to diagnose AVN in all hips (100%) using MRI. Forty percent of the patients (n = 12) were on steroids, 26.7% (n = 8) were chronic alcoholics, and 16.7% (n = 5) were idiopathic. The other less common causes were a history of trauma or fracture of the neck of the femur (n = 3) and sickle cell disease (n = 2). Of the 45 hips of the 30 patients studied, 15 patients had bilateral disease affecting a total of 30 hips (66.7%), and 15 patients had unilateral disease affecting a total of 15 hips (33.4%). Of the 30 hips (bilateral disease), five (13.3%) contralateral hips were clinically occult and were incidentally diagnosed with AVN. Conclusion The assessment of AVN based solely on plain radiography can miss vital information in stages II and III (Ficat and Arlet classification). Due to its multiplanar capability, superior spatial resolution, and better tissue characterization, MRI is very sensitive and able to detect femoral head AVN early and promptly in cases that are radiograph-negative or otherwise clinically unsuspected.

A framework for three-dimensional statistical shape modeling of the proximal femur in Legg-Calvé-Perthes disease.

PURPOSE: The pathomorphology of Legg-Calvé-Perthes disease (LCPD) is a key contributor to poor long-term outcomes such as hip pain, femoroacetabular impingement, and early-onset osteoarthritis. Plain radiographs, commonly used for research and in the clinic, cannot accurately represent the full extent of LCPD deformity. The purpose of this study was to develop and evaluate a methodological framework for three-dimensional (3D) statistical shape modeling (SSM) of the proximal femur in LCPD. METHODS: We developed a framework consisting of three core steps: segmentation, surface mesh preparation, and particle-based correspondence. The framework aims to address challenges in modeling this rare condition, characterized by highly heterogeneous deformities across a wide age range and small sample sizes. We evaluated this framework by producing a SSM from clinical magnetic resonance images of 13 proximal femurs with LCPD deformity from 11 patients between the ages of six and 12 years. RESULTS: After removing differences in scale and pose, the dominant shape modes described morphological features characteristic of LCPD, including a broad and flat femoral head, high-riding greater trochanter, and reduced neck-shaft angle. The first four shape modes were chosen for the evaluation of the model's performance, together describing 87.5% of the overall cohort variance. The SSM was generalizable to unfamiliar examples with an average point-to-point reconstruction error below 1mm. We observed strong Spearman rank correlations (up to 0.79) between some shape modes, 3D measurements of femoral head asphericity, and clinical radiographic metrics. CONCLUSION: In this study, we present a framework, based on SSM, for the objective description of LCPD deformity in three dimensions. Our methods can accurately describe overall shape variation using a small number of parameters, and are a step toward a widely accepted, objective 3D quantification of LCPD deformity.

Contralateral hip joint degeneration associated with a cam-type deformity of the proximal femur in a retired chiropractor: 10-year follow-up.

Cam-type deformities of the proximal femur have long been associated with femoroacetabular impingement (FAI); an orthopedic condition recognized in the etiology of early osteoarthritis (OA) in the non-dysplastic adult hip. However, the optimal clinical management (including the long-term prognosis) of patients with cam-type deformities with or without FAI symptoms remains uncertain. In this imaging case review (ICR), we present the 10-year follow-up of a retired chiropractor with bilateral cam-type femoral deformities who initially underwent total right hip joint arthroplasty for advanced hip joint OA, and subsequently developed advanced hip joint OA on the contralateral side.

Examen du cas par imagerieDégénérescence controlatérale de l'articulation de la hanche associée à une déformation en came du fémur proximal chez un chiropraticien à la retraite: Suivi sur 10 ansLes déformations de type came du fémur proximal ont longtemps été associées à un conflit fémoro-acétabulaire (CFA); une affection orthopédique reconnue dans l'étiologie de l'arthrose précoce de la hanche adulte non dysplasique. Cependant, la gestion clinique optimale (notamment le pronostic à long terme) des patients présentant des déformations de type came avec ou sans symptômes du syndrome du conflit fémoro-acétabulaire (CFA) avec ou sans facteur rhumatoïde reste incertaine. Dans cet examen de cas par imagerie (ECI), nous présentons le suivi sur 10 ans d'un chiropraticien à la retraite avec des déformations fémorales bilatérales de type came qui a initialement subi une arthroplastie totale de l'articulation de la hanche droite pour l'arthrose de l'articulation de la hanche avancée, et a développé par la suite une arthrose de l'articulation de la hanche avancée du côté controlatéral.

Hip-related functional limitations in individuals with idiopathic scoliosis: a controlled trial.

BACKGROUND: Since scoliosis is a three-dimensional deformity, it causes some movement limitations in the spine and related joints. However, functional limitations associated with scoliosis-related hip joint involvement are the subject of research. AIMS: This study aims to investigate the physical characteristics and functional limitations associated with idiopathic scoliosis (IS), focusing on hip joint. METHODS: Demographic characteristics, scoliosis-specific assessments and hip joint active range of motion (RoM), lumbar mobility (Modified Schober test), lumbopelvic stability (Single leg squat test-SLS), hip joint position sense, lower extremity balance (Y-balance test) and lower extremity functionality (Lower extremity functional scale-LEFS) were evaluated. RESULTS: The study included 120 individuals, with 86 in the scoliosis group (mean age: 15.7 ± 3.4 years) and 34 in the control group (mean age: 16.1 ± 4.8 years). The scoliosis group exhibited limited RoM of the hip joint in flexion, extension, right abduction, adduction, internal rotation, and left external rotation compared to controls (p < 0.001). Lumbar mobility was decreased (p < 0.001). In the joint position sense test, the mean difference for right flexion was and for left flexion. Bilateral decreased SLS test performances (p < 0.001) and Y-balance test performance (p < 0.05) in individuals with IS. LEFS scores were statistically different but not clinically different between groups (p < 0.05). CONCLUSION: Individuals with IS show decreased hip mobility, lumbopelvic stability, hip joint position sense, and balance compared to healthy peers; however, these limitations do not have a clinical impact on daily living activities.

Risk factors for deep vein thrombosis of the lower extremity after total hip arthroplasty.

OBJECTIVE: To investigate the risk factors for deep vein thrombosis (DVT) following total hip arthroplasty (THA). METHODS: Patients who underwent THA in the Department of Joint Surgery at the Sixth Affiliated Hospital of Xinjiang Medical University from September 2020 to December 2022 were retrospectively selected based on inclusion criteria. They were divided into the DVT group (n = 65) and the non-DVT group (n = 397) according to the occurrence of postoperative DVT. The following variables were reviewed for both groups: age, sex, Body Mass Index (BMI), affected limb, previous history (smoking and drinking), diabetes, hypertension, operation time, total cholesterol, triglycerides, fibrinogen, hemoglobin, albumin, platelets, D-dimer, International Normalized Ratio (INR), and fibrin degradation products. Univariate analysis was conducted on these factors, and those with statistical significance were further analyzed using a binary logistic regression model to assess their correlation with DVT after THA. RESULTS: A total of 462 patients were included in the study, with the DVT group representing approximately 14% and the non-DVT group approximately 86%. The DVT group had an average age of 67.27 ± 4.10 years, while the non-DVT group had an average age of 66.72 ± 8.69 years. Univariate analysis revealed significant differences in diabetes mellitus, preoperative fibrinogen, preoperative D-dimer, preoperative INR, and preoperative and postoperative fibrin degradation products between the DVT and non-DVT groups. Binary logistic regression analysis identified diabetes mellitus, elevated preoperative fibrinogen, preoperative D-dimer, and preoperative INR (p < 0.05) as risk factors for DVT after THA. CONCLUSION: This study found that diabetes mellitus, elevated preoperative fibrinogen, preoperative D-dimer, and preoperative INR are independent risk factors for DVT following THA. Surgeons should thoroughly assess these risk factors, implement timely and effective interventions, and guide patients to engage in functional exercises as early as possible to reduce the incidence of DVT, thereby improving the outcomes of THA and improving patient quality of life.

Reliability and agreement of manual and automated morphological radiographic hip measurements.

Objective: To determine the reliability and agreement of manual and automated morphological measurements, and agreement in morphological diagnoses. Methods: Thirty pelvic radiographs were randomly selected from the World COACH consortium. Manual and automated measurements of acetabular depth-width ratio (ADR), modified acetabular index (mAI), alpha angle (AA), Wiberg center edge angle (WCEA), lateral center edge angle (LCEA), extrusion index (EI), neck-shaft angle (NSA), and triangular index ratio (TIR) were performed. Bland-Altman plots and intraclass correlation coefficients (ICCs) were used to test reliability. Agreement in diagnosing acetabular dysplasia, pincer and cam morphology by manual and automated measurements was assessed using percentage agreement. Visualizations of all measurements were scored by a radiologist. Results: The Bland-Altman plots showed no to small mean differences between automated and manual measurements for all measurements except for ADR. Intraobserver ICCs of manual measurements ranged from 0.26 (95%-CI 0-0.57) for TIR to 0.95 (95%-CI 0.87-0.98) for LCEA. Interobserver ICCs of manual measurements ranged from 0.43 (95%-CI 0.10-0.68) for AA to 0.95 (95%-CI 0.86-0.98) for LCEA. Intermethod ICCs ranged from 0.46 (95%-CI 0.12-0.70) for AA to 0.89 (95%-CI 0.78-0.94) for LCEA. Radiographic diagnostic agreement ranged from 47% to 100% for the manual observers and 63%-96% for the automated method as assessed by the radiologist. Conclusion: The automated algorithm performed equally well compared to manual measurement by trained observers, attesting to its reliability and efficiency in rapidly computing morphological measurements. This validated method can aid clinical practice and accelerate hip osteoarthritis research.

[Usefulness of Copper Filter Addition and Potential for Dose Reduction in Hip-joint Radiography].

PURPOSE: In this study, we evaluated image quality and radiation dose reduction when a Copper (Cu) filter was added to hip joint X-ray imaging. METHODS: We measured effective energy without (0 mm) and with (0.1/0.2 mm) Cu-added filter at 70 kV, and we calculated soft tissue-bone contrast and signal-difference-to-noise-ratio (SDNR) under constant entrance surface dose. After that, we estimated the dose reduction rate. RESULTS: The effective energy was 32.07 keV for 0 mm Cu, 37.59 keV for 0.1 mm Cu, and 40.91 keV for 0.2 mm Cu. As the thickness of the Cu-added filter was increased, contrast decreased, but SDNR increased. The dose reduction rate in bone calculated measuring SDNR was 34% for 0.1 mm Cu and 47% for 0.2 mm Cu in max. CONCLUSION: It was suggested that adding Cu filter to hip-joint X-ray imaging could reduce entrance surface dose while maintaining the image quality based on SDNR.

Three-dimensional assessment of subchondral arc and hip joint coverage angles in the asymptomatic young adult hip.

The primary objective of this study was to develop a custom algorithm to assess three-dimensional (3D) acetabular coverage of the femoral head based on surface models generated from computed tomography (CT) imaging. The secondary objective was to apply this algorithm to asymptomatic young adult hip joints to assess the regional 3D acetabular coverage variability and understand how these novel 3D metrics relate to traditional two-dimensional (2D) radiographic measurements of coverage. The algorithm developed automatically identifies the lateral- and medial-most edges of the acetabular lunate at one-degree intervals around the acetabular rim based on local radius of curvature. The acetabular edges and the center of a best-fit sphere to the femoral head are then used to compute the mean 3D subchondral arc angles and hip joint coverage angles in five acetabular octants. This algorithm was applied to hip models generated from pelvis/hip CT imaging or abdomen/pelvis CT angiograms of 50 patients between 17 and 25 years of age who had no history of congenital or developmental hip pathology, neuromuscular conditions, or bilateral pelvic and/or femoral fractures. Corresponding 2D acetabular coverage measures of lateral center edge angle (LCEA) and acetabular arc angle (AAA) were assessed on the patients' clinical or digitally reconstructed radiographs. The 3D subchondral arc angle in the superior region (58.0 [54.6-64.8] degrees) was significantly higher (p < 0.001) than all other acetabular subregions. The 3D hip joint coverage angle in the superior region (26.2 [20.7-28.5] degrees) was also significantly higher (p < 0.001) than all other acetabular subregions. 3D superior hip joint coverage angle demonstrated the strongest correlation with 2D LCEA (r = 0.649, p < 0.001), while 3D superior-anterior subchondral arc angle demonstrated the strongest correlation with 2D AAA (r = 0.718, p < 0.001). The 3D coverage metrics in the remaining acetabular regions did not strongly correlate with typical 2D radiographic measures. The discrepancy between standard 2D measures of radiographic acetabular coverage and actual 3D coverage identified on advanced imaging indicates potential discord between anatomic coverage and the standard clinical measures of coverage on 2D imaging. As 2D measurement of acetabular coverage is increasingly used to guide surgical decision-making to address acetabular deformities, this work would suggest that 3D measures of acetabular coverage may be important to help discriminate local coverage deficiencies, avoid inconsistencies resulting from differences in radiographic measurement techniques, and provide a better understanding of acetabular coverage in the hip joint, potentially altering surgical planning and guiding surgical technique.

Methods for three-dimensional characterization of the acetabulum prior to pelvic reorientation osteotomy: a scoping review.

Periacetabular osteotomy is the gold standard treatment for acetabular dysplasia. The great variability of acetabular dysplasia requires a personalized preoperative planning improved by 3D reconstruction and computer-assisted surgery. To plan the displacement of the acetabular fragment by a pelvic osteotomy, it is necessary to define a reference plane and a method to characterize 3D acetabular orientation. A scoping review was performed on PubMed to search for articles with a method to characterize the acetabulum of native hips in a 3D reference frame. Ninety-eight articles out of 3815 reports were included. Three reproducible reference planes were identified: the anterior pelvic plane, the Standardization and Terminology Committee plane used in gait analysis, and the sacral base plane. The different methods for 3D analysis of the acetabulum were divided in four groups: global orientation, triplanar measurements, segmentation, and surface coverage of the femoral head. Two methods were found appropriate for reorientation osteotomies: the global orientation by a vector method and the triplanar method. The global orientation method relies on the creation of a vector from the acetabular rim, from the acetabular surface or from successive planes. Normalization of the global acetabular vector would correct acetabular dysplasia by a single alignment maneuver on an ideal vector. The triplanar method, based on angle measurements at the center of the femoral head, would involve correction of anomalies by considering axial, frontal, and sagittal planes. Although not directly fit for reorientation, the two others would help to candidate patients and verify both planning and postoperative result.

The Influence of Hip-Strengthening Program on Patients with Chronic Ankle Instability.

Background and Objectives: Repetitive ankle sprains lead to mechanical instability of the ankle. Patients with chronic ankle instability may experience decreased muscle strength and limited postural control. This study investigated the effects of a hip-strengthening exercise program on muscle strength, balance, and function in patients with chronic ankle instability. Materials and Methods: A total of 30 patients participated in the study and were randomly assigned to the two groups. Among the 30 participants, 14 were assigned to the hip joint-strengthening exercise group and 16 to the control group. The experimental group underwent a hip-strengthening exercise program and received training for 40 min per session twice a week for four weeks. The control group received the same frequency, duration, and number of sessions. Measurements were performed before and after the training period to assess changes in hip strength, balance, and function. Results: In the within-group and between-group comparisons, both groups showed significant differences in hip joint strength, static balance, dynamic balance, and function (FAAM; foot and ankle ability measures) (p < 0.05). Statistically significant differences were observed in the time × group interaction effects among the hip abductors and external rotation in hip joint strength, path length in static balance, posterolateral and posteromedial in dynamic balance, and FAAM-ADL and FAAM-SPORT functions (p < 0.05). Conclusions: Accordingly, this study confirmed that hip joint-strengthening exercises have a positive effect on the strength, balance, and function of patients with chronic ankle instability, and we believe that hip joint-strengthening exercises will be recommended as an effective intervention method for patients suffering from chronic ankle instability.

Importance of hip capsular repair in total hip arthroplasty (THA) via the posterior lateral approach: a five year retrospective cohort study.

PURPOSE: This study aims to assess the impact of repairing the hip joint capsule during posterior-lateral approach total hip arthroplasty (THA) on postoperative hip joint function and late dislocation incidence. METHODS: A retrospective cohort study included 413 patients, divided into experimental (hip joint capsule repair, n = 204) and control (hip joint capsule excision, n = 209) groups. Patients were followed for five years, evaluating postoperative hip range of motion (ROM), dislocation rate, VAS and HHS scores, inflammatory and coagulation markers, hospitalization, blood loss, and body composition. Statistical analysis included the Student's t-test, Chi-square test, and logistic regression for dislocation risk factors. RESULTS: Joint capsule repair improved postoperative hip flexion and extension within six months and at two years postoperatively, internal and external rotation within three months, and abduction and adduction throughout the entire follow-up period (P < 0.05). Capsular repair also reduced early and late dislocation rates (P < 0.05). Significant differences in HHS and VAS scores, inflammatory and coagulation indicators, hospitalization, blood loss, and body composition were noted (P < 0.05). Multivariate logistic regression indicated hip joint repair, rheumatoid arthritis, epilepsy, and sarcopenia as dislocation risk factors (P < 0.05). CONCLUSIONS: Capsular repair during posterior-lateral THA improves postoperative hip function and mobility while reducing dislocation rates, blood loss, pain, inflammation, and economic burden. Patients with rheumatoid arthritis, epilepsy, or sarcopenia require individualized planning and enhanced postoperative care to minimize complications.

[Modified gluteus maximus transfer for hip abductor deficiency]. / Modifizierter Gluteus-maximus-Transfer zur Therapie der glutealen Insuffizienz.

OBJECTIVE: Transfer of the gluteus maximus with refixation at the greater trochanter for treatment of abductor deficiency. INDICATIONS: Symptomatic abductor deficiency with atrophy and fatty degeneration of the gluteal muscles > 50% (grade 3 by quartile) with good strength of the gluteus maximus. CONTRAINDICATIONS: Low atrophy or fatty degeneration of less than 50% of the gluteal muscles, limited strength of the gluteus maximus, infection. SURGICAL TECHNIQUE: First, the fascia lata is incised dorsally to the tensor fascia latae muscle, with the incision extending approximately 1.5 cm proximal to the iliac crest. A second incision divides the gluteus maximus muscle longitudinally along the muscle fibers and continues towards the fascia lata distal to the greater trochanter. These incisions result in a triangular muscle flap, which is elevated and divided into anterior and posterior portions. The posterior flap is positioned ventrally over the femoral neck and fixed to the anterior capsule and the anterior edge of the greater trochanter. The anterior flap is placed directly on the proximal femur. For this purpose, a groove is prepared in the area of the proximal femur using a spherical burr to freshen up the future footprint. The anterior flap is positioned from the tip of the greater trochanter towards the insertion of the vastus lateralis muscle. Subsequently, the anterior flap is fixed to the created groove with transosseous sutures and positioned under the elevated vastus lateralis muscle in 15° abduction of the leg. To provide additional stabilization to the tendinous part of the anterior flap, a screw is inserted distally to the greater trochanter. The vastus lateralis muscle is attached to the distal tip of the anterior flap, and the remaining gluteus maximus muscle is sutured to the fascia lata to cover the anterior flap. Additionally, a flap of the tensor fascia latae muscle can be mobilized and adapted to the reconstruction. Layered wound closure is performed. RESULTS: The technique of a gluteus maximus transfer represents a method for the treatment of chronic abductor deficiencies and improves abduction function as well as the gait pattern in short-term follow-ups. Fifteen patients (mean age at time of surgery 62 years) had after a mean follow-up of 2.5 years. The modified Harris Hip Score (mHHS) improved from 48 points preoperatively to 60 points at follow-up. Preoperatively, 100% had a positive Trendelenburg sign; at follow-up, this was about 50%.

Acetabular posterior column screws via an anterior approach.

Screw fixation of acetabular column fractures is a well-established alternative option to plate fixation providing comparable biomechanical strength and requiring less surgical exposure. For displaced acetabular fractures involving both columns open reduction and plate fixation of one column in combination with a column-crossing screw fixation of the opposite column via a single approach is a viable treatment option. Preoperative planning of posterior column screws (PCS) via an anterior approach is mandatory to assess the eligibility of the fracture for this technique and to plan the entry point and the screw trajectory. The intraoperative application requires fluoroscopic guidance using several views. A single view showing an extraarticular screw position is adequate to rule out hip joint penetration. The fluoroscopic assessment of cortical perforation of the posterior column requires several oblique views such as lateral oblique views, obturator oblique views and axial views of the posterior column or alternatively intraoperative CT scans. The application of PCS via an anterior approach is a technically demanding procedure, that allows for a relevant reduction of approach-related morbidity, surgical time and blood loss by using a single approach.

Effect of Comprehensive Rehabilitation Training Based on Balance Function on Postoperative Recovery and Function of Hip Fracture in the Elderly: A Systematic Review and Meta-Analysis.

Introduction: In China, the proportion of the elderly population is gradually increasing, followed by the increasing medical demands of elderly patients. Hip fracture is a common fracture in the elderly. The elderly are prone to serious postoperative complications, resulting in failure to restore normal hip function, which seriously affects patients' quality of life and further increases their mortality rate. Thus, hip fracture represents a remarkable public health issue within the realm of geriatric medical care. Significance: This study systematically evaluated the impact of comprehensive rehabilitation training, with a focus on balance function, on elderly individuals with hip fractures' postoperative recovery and functional outcomes. Result: Results showed a significant difference in BBS scores favoring comprehensive rehabilitation training based on balance function over conventional intervention. Similarly, AM-PAC scores favored the balance-focused training. TUTG meta-analysis indicated its adoption in comprehensive rehabilitation training. FIM scores showed improvement with balance-focused training. Harris score meta-analysis also favored this approach. A funnel plot analysis revealed potential publication bias, likely due to study heterogeneity and limited publications. Conclusions: In conclusion, comprehensive rehabilitation training centered around balance function displayed clinical efficacy in enhancing postoperative hip joint function in elderly hip fracture patients. This approach improved balance, coordination, and posture control, facilitating lower limb function recovery and overall prognosis. It holds promise as a valuable treatment approach.

Are hip joint imaging findings associated with symptoms and early hip osteoarthritis features in elite male Australian Football League draftees?

1) describe intra-articular features (prevalence and severity) and bony hip morphology (prevalence and size) in elite male Australia Football League (AFL) draftees; 2) examine the relationship between bony hip morphology (cam and pincer morphology) and intra-articular features (cartilage defects and labral tears); and 3) examine the relationship between intra-articular features, bony hip morphology, and the Copenhagen Hip and Groin Outcome Score (HAGOS). Cross-sectional study. 58 male AFL draftees underwent 3-tesla hip MRI. Alpha angle determined cam morphology and acetabular depth defined pincer morphology. For each hip, intra-articular features were scored semi-quantitatively. All players completed the HAGOS to determine hip/groin symptoms and sports function. Logistic regression determined whether bony hip morphology was associated with labral tears and cartilage defects. Mann-Whitney U tests evaluated the difference in HAGOS subscale scores between football players with and without intra-articular features and bony hip morphology. Cam and pincer morphology were evident in 20% and 19% of hips, respectively. Nearly half of hips (41%) had a labral tear, with only 14% having a cartilage defect. Greater alpha angle was associated with the presence of labral tears (OR 1.14, 95%CI 1.07 to 1.21, p < 0.001) but not cartilage defects. Hip imaging findings were not associated with lower (worse) HAGOS scores. Hip joint imaging findings were common in elite male AFL draftees but not associated with worse pain, symptoms, or sport function. Cam morphology may contribute to the development of labral tears in male AFL draftees.

Imaging evaluation of hip capsule disorders: a comprehensive review.

The hip capsule and capsular ligaments play crucial roles in providing hip stability and mobility. Their role in hip pathologies is being increasingly recognized, underscoring the need for thorough imaging evaluation, which is better performed through MRI-arthrography. Various diseases affect the hip capsule directly or indirectly. Improper mechanical loading, as seen in conditions such as femoroacetabular impingement or chondrolabral pathology, can induce capsule thickening, whereas thinning and laxity of the capsule are characteristics of microinstability. Inflammatory conditions, including adhesive capsulitis of the hip, crystal deposition disease, polymyalgia rheumatica, and infections, also lead to capsular changes. Traumatic events, particularly posterior hip dislocations, cause capsule ligament disruption and may lead to hip macroinstability. Friction syndromes can lead to capsular edema due to impingement of the adjacent capsule. Hip arthroscopy can result in various postoperative findings ranging from fibrotic adhesions to focal or extensive capsule discontinuation. Although the significance of hip capsule thickness and morphology in the pathogenesis of hip diseases remains unclear, radiologists must recognize capsule alterations on imaging evaluation. These insights can aid clinicians in accurately diagnosing and effectively managing patients with hip conditions.

Preoperative SSRI use increases perioperative transfusion need in patients undergoing surgical procedures on the hip joint.

PURPOSE: Selective serotonin reuptake inhibitors (SSRIs) are commonly prescribed for psychiatric conditions. Previous studies have shown that SSRIs can increase bleeding risk by affecting platelet aggregation. However, their impact on perioperative outcomes in hip surgery remains uncertain. This case-control study examines the link between preoperative SSRI use and perioperative transfusion requirements in hip surgery patients. METHODS: Data from the M161Ortho dataset of Pearl Diver patient records database were utilized. Patients who underwent hip joint surgery between 2010 and 2022 and had documented preoperative SSRI use within one month prior to surgery were included. Patients with coagulopathy disorders or coagulopathy medication use were excluded. Perioperative transfusion need was defined as receiving red blood cell or whole blood transfusions on the same date or within 10 days following the surgery. RESULTS: A total of 75,374 patients with preoperative SSRI use were matched with an equal number of non-SSRI users. Preoperative SSRI use was associated with an increased risk of requiring perioperative transfusion (5.7% vs. 5.1%, P < 0.001). Subgroup analysis demonstrated increased transfusion risk in patients undergoing pinning (2.6% vs. 1.8%, P = 0.02), open reduction with internal fixation (ORIF) (8.9% vs. 8.2%, P = 0.007), and total hip arthroplasty (THA) (3.8% vs. 3.4%, P < 0.001), but no significant difference was observed in patients undergoing hemiarthroplasty. CONCLUSION: Clinicians should be aware of the potential risk of increased perioperative transfusion requirements in hip surgery patients using SSRIs, especially during pinning, ORIF, and THA procedures. It is essential to consider this when managing patients on SSRIs before hip surgery.

Morphometric Assessment of the Hip Joint in a Functional Dysplastic Rabbit Model.

The present study investigates the morphometric changes in the hip joint in a surgically induced rabbit model of hip dysplasia through the sectioning of the ligamentum capitis femoris and pelvic limb immobilization. A total of seventeen rabbits were evaluated using radiographic and computed tomographic imaging to measure the following parameters: the femoral angles of anteversion and inclination, length and width indexes of the neck of the femur, and acetabular depth and ventroversion. Significant differences in femoral anteversion angle and acetabular depth were observed, particularly in the group of hip instability surgery with pelvic limb immobilization. The results have shown the influence of hip joint instability in the promotion of femoral anteversion and acetabular shallowing. These findings provide a foundation for future research on naturally occurring or experimentally induced hip dysplasia in rabbits and underscore the model's potential for studying the biomechanical and developmental aspects of hip joint disorders.

Anatomical Features in Inguinal-Pubic-Adductor Area That May Contribute to Gender Difference in Susceptibility to Groin Pain Syndrome.

Groin pain syndrome (GPS) is often a diagnostic challenge for sport physicians. Despite this diagnostic difficulty, the incidence of GPS in athletes is relatively high, afflicting 10-20% of the total sports population. In the literature, a certain number of studies demonstrate an important gender-based difference in the incidence of GPS in both sexes, with a ratio of female:male athletes clearly in favor of the female gender being relatively less prone to GPS. Indeed, some anatomical differences between the two sexes seem to represent a protective factor against the onset of GPS in women, although the current literature still needs to clarify the validity of these findings. It is the aim of this systematic review to examine all the anatomical differences between men and women that may be responsible for the difference in the onset of GPS in the two sexes.

Longitudinal Assessment of Clinical Outcomes After Arthroscopic Treatment for Hip Synovial Chondromatosis and the Effect of Residual Loose Bodies: Minimum 4-Year and 8-Year Follow-up.

BACKGROUND: Arthroscopic treatment is recommended for hip synovial chondromatosis. However, evidence regarding long-term clinical outcomes is limited. PURPOSE: To evaluate long-term patient-reported outcomes (PROs) and survival, and to determine the potential effect of residual loose bodies, as evaluated by immediate postoperative computed tomography (CT), on clinical outcomes. STUDY DESIGN: Case series; Level of evidence, 4. METHODS: A consecutive cohort of patients undergoing arthroscopic treatment and diagnosed with synovial chondromatosis between March 2010 and May 2015 were included in the study. Preoperative radiography, CT, and magnetic resonance imaging were performed. Preoperative, midterm (minimum of 4 years), and long-term (minimum of 8 years) PROs were collected for visual analog scale for pain, modified Harris Hip Score (mHHS), Non-Arthritic Hip Score (NAHS), and 12-item international Hip Outcome Tool (iHOT-12). The percentages achieving minimal clinically important difference (MCID) were calculated. PROs and survival were compared between patients with and without residual loose bodies evident on immediate postoperative CT scan. RESULTS: A total of 28 patients (20% of patients were lost to follow-up) were included in the study with a mean follow-up period of 104.9 months (range, 96-139 months). PROs including visual analog scale for pain (preoperative, 3.8 ± 1.2; midterm, 0.9 ± 1.7; long-term, 0.8 ± 1.4), mHHS (preoperative, 66.4 ± 14.4; midterm, 92.8 ± 12.3; long-term, 93.5 ± 10.5), NAHS (preoperative, 45.2 ± 16.2; midterm, 81.8 ± 15.3; long-term, 83.1 ± 12.9), and iHOT-12 (preoperative, 48.4 ± 15.6; midterm, 69.3 ± 11.7; long-term, 72.7 ± 11.4) were improved at both midterm and long-term follow-up (all with P < .001). In total, 27 (96.4%), 28 (100%), and 26 (92.9%) patients achieved MCID for mHHS, NAHS and iHOT-12, respectively, at the long-term follow-up. No significant difference was found in any of the PROs and the rate of achieving MCID between midterm and long-term follow-up (all with P > .05). One patient (3.6%) underwent revision surgery. Among the 23 patients who had loose bodies on preoperative CT or radiographs, 14 patients (60.9%) with residual loose bodies evident on immediate postoperative CT demonstrated lower NAHS (P = .045) and iHOT-12 (P = .037) scores but a comparable survival (P > .05) at long-term follow-up compared with those who did not have loose bodies. CONCLUSION: Arthroscopic treatment for hip synovial chondromatosis achieved satisfactory long-term clinical outcomes with strong survival. Most patients maintained or improved their overall functional status between midterm and long-term follow-up. Furthermore, patients with residual loose bodies had less favorable clinical outcomes, although the survival rate was comparable.