Effect of Preoperative Nutritional Status on Postoperative Functional Recovery of Hip Joint in Elderly Patients with Intertrochanteric Fractures.

Objective: The state of nutrition of senior patients with intertrochanteric fracture of femur before operation affects the patients' tolerance to the operation,the body recovery, healing of the wound and clinical prognosis. For these patients, the poor state of nutrition may lengthen the time of being in hospital, leading to poor hip recovery and clinical outcome. But currently, the relationship between functional recovery of hip joint after operation of intertrochanteric fracture in elderly patients and camp condition has not been reported. To investigate the effect of preoperative nutritional status on postoperative recovery of hip joint function in elderly patients with intertrochanteric fractures. Methods: Retrospective analysis was performed on the data of 96 elderly patients with intertrochanteric fracture of the femur treated with closed reduction PFNAfrom January 2021 to January 2022 in Dongying People's Hospital Trauma Orthopedics Department. There were 36 male patients and 60 female patients aged from 65 to 92.The patients were divided into the normal nutrition group (GNRI ≥ 92, n = 46) and the malnutrition group (GNRI < 92, n = 50). The general clinical data, time from injury to operation, intraoperative and postoperative allogeneic blood transfusion rate, postoperative complication rate, postoperative mortality 1 year, and Harris hip function score at 3, 6, 9 months and the last follow-up were compared between the two groups. Results: All patients were followed up for 9 to 15 months(mean,13.9 months) after surgery. The preoperative hemoglobin levels in the normal and malnutrition groups were 8.6-13.2 and 7.4-11.2 g/dL, respectively (P < .05). The time from injury to surgery in the normal nutrition group was significantly shorter than that in the malnutrition group (P < .01). The preoperative hemoglobin level in the normal nutrition group was significantly higher than that in the malnutrition group. The time from injury to operation in normal nutrition group and malnutrition group are respectively (1.1-5.2), (4.3-6.6)d; the intraoperative and postoperative allogeneic blood transfusion rates are respectively 47.8%(22/46), 92%(46/50);the incidence of postoperative complications are respectively 6.52%(3/46), 32%(16/50); the mortality rates within 1 year after operation are respectively 2.17%(1/46), 12%(6/50). In contrast, the postoperative allogeneic blood transfusion, postoperative complication, and postoperative complication rates in the normal nutrition group were significantly lower than those in the malnutrition group (P < .05). 3 months after surgery, the Harris hip function scores of patients in normal nutrition group and malnutrition group are respectively (75.26±4.02), (64.28±3.82); 6 months after surgery, the Harris hip function scores of them are respectively (80.42±3.86), (70.14±5.06).During the last follow-up, scores are (82.23±2.98), (72.12±4.62). At the 3, 6, and last follow-up after surgery, the Harris hip function score in the normal nutrition group was significantly higher than in the malnutrition group (P < .05). Conclusion: Preoperative malnutrition in elderly patients with intertrochanteric fracture has adverse effects on postoperative hip function recovery, and 1-year postoperative survival rate.GNRI can be used for simple screening. Early assessment of patients' nutritional status.

The effectiveness of hydrotherapy on return to play in sports following hip arthroscopic surgery: a comparative study.

BACKGROUND: The postoperative management of femoroacetabular impingement (FAI) is variable with favourable surgical outcomes. Yet there is no evidence on the efficacy of hydrotherapy in athletes undergoing hip arthroscopy for FAI. The purpose of this study was to evaluate the role and the impact of hydrotherapy on return to sports following hip arthroscopy for symptomatic FAI. METHODS: 2 cohorts of mixed level of athletes from various sports: a hydrotherapy group that followed land-based exercises in combination with hydrotherapy exercises and a control group that followed solely the same land-based exercises. Pre- and postoperative pain and hip-specific outcome scores were completed, and patient satisfaction was rated. RESULTS: A total of 88 hip arthroscopies were included with a minimum of 2 years follow-up; the hydrotherapy group comprised of 36 hips and the control group, 52 hips. There was a significant improvement in time to return to previous performance (HR 1.91, 95% CI, 1.21-3.01; p = 0.005) in the hydrotherapy group compared with the control. The hip-specific scores and patient satisfaction were considerably improved in the hydrotherapy group. CONCLUSIONS: The analysis of our data indicates that the incorporation of hydrotherapy into postoperative rehabilitation for hip arthroscopy for FAI accelerates the return of athletes to their pre-injury performance, since recovery time decreased significantly.

Efficacy of trigger point dry needling on pain and function of the hip joint: a systematic review of randomized clinical trials.

OBJECTIVE: The objective of this study was to assess the evidence for the impact of dry needling (DN) on hip pain and function. METHODS: Medline/PubMed, Embase, Scopus, Web of Science and Cochrane CENTRAL databases were searched systematically through June 2022 for randomized clinical trials (RCTs) investigating the impact of DN on hip pain and function. Version 2 of the Cochrane risk-of-bias tool for randomized trials (RoB 2) was used to assess risk of bias. Descriptive analysis was conducted to explain the outcomes and adverse events of DN in hip joint diseases. Meta-analysis was not feasible due to significant heterogeneity. RESULTS: A total of seven eligible studies (including 273 patients) were included out of 2152 screened records. Five studies were in participants with hip osteoarthritis (OA; n = 3), greater trochanteric pain syndrome (GTPS; n = 1) or piriformis syndrome (n = 1); the other two studies were conducted in healthy athletes (n = 2). Two articles assessed changes in participants' short-term visual analog scale (VAS) scores (<1 week), one of which showed that DN significantly reduced pain (P < 0.05). One-week VAS scores were analyzed in three studies, all of which demonstrated reduced scores following DN (P < 0.05). Hip range of motion (ROM) and muscle force were also improved following DN. No serious side effects were reported. CONCLUSION: DN may be safe and effective at relieving hip pain and improving hip function. DN performs significantly better than several different types of control intervention (including sham DN, no treatment, corticosteroid injections and laser). Strong evidence (high degree of certainty around the results) is lacking, and future studies should ideally use longer follow-up periods and larger sample sizes. REVIEW REGISTRATION NUMBER: CRD42022297845 (PROSPERO).

Influence of hip flexion angle on strength and gluteal muscle activities in the clinical pilates clamshell exercise.

The study aimed to investigate the presence of directional preference using the Clinical Pilates method of clamshell exercise among relatively healthy young adults, and the influence of hip flexion angles on maximum isometric strength (handheld dynamometer) and muscle activities (electromyography). The clamshell assessment involves testing in varying angles of hip flexion (0°, 30°, 60° and 90°) and 21 participants were tested. Directional preferences in the transverse and anteroposterior axes of movements were present among the participants. Gluteus medius activation was highest in the non-problem side across all hip flexion angles. In contrast, the problem side showed dysfunction of the gluteus medius, especially at the 60° hip flexion angle, 0.89 unit (ratio of maximal voluntary isometric contraction) reduction per 1 N force exerted, 95% CI -1.69 to -0.09, p = 0.031. Comparison against the non-problem side found gluteus medius activity lower on the problem side, mean difference (SD) was 26.2 (56.1), p = 0.045. Therefore, directional preference is not limited to people with injuries and can exist in healthy individuals or people who have recovered from injuries. The gluteus medius was identified to be dysfunctional on the problem side and Clinical Pilates clamshell assessment is potentially useful in assessing for motor coordination impairment.

Effects of joint loading on the development of capital femoral epiphysis morphology.

INTRODUCTION: The deleterious influence of increased mechanical forces on capital femoral epiphysis development is well established; however, the growth of the physis in the absence of such forces remains unclear. The hips of non-ambulatory cerebral palsy (CP) patients provide a weight-restricted (partial weightbearing) model which can elucidate the influence of decreased mechanical forces on the development of physis morphology, including features related to development of slipped capital femoral epiphysis (SCFE). Here we used 3D image analysis to compare the physis morphology of children with non-ambulatory CP, as a model for abnormal hip loading, with age-matched native hips. MATERIALS AND METHODS: CT images of 98 non-ambulatory CP hips (8-15 years) and 80 age-matched native control hips were used to measure height, width, and length of the tubercle, depth, width, and length of the metaphyseal fossa, and cupping height across different epiphyseal regions. The impact of age on morphology was assessed using Pearson correlations. Mixed linear model was used to compare the quantified morphological features between partial weightbearing hips and full weightbearing controls. RESULTS: In partial weightbearing hips, tubercle height and length along with fossa depth and length significantly decreased with age, while peripheral cupping height increased with age (r > 0.2, P < 0.04). Compared to normally loaded (full weightbearing) hips and across all age groups, partially weightbearing hips' epiphyseal tubercle height and length were smaller (P < .05), metaphyseal fossa depth was larger (P < .01), and posterior, inferior, and anterior peripheral cupping heights were smaller (P < .01). CONCLUSIONS: Smaller epiphyseal tubercle and peripheral cupping with greater metaphyseal fossa size in partial weightbearing hips suggests that the growing capital femoral epiphysis requires mechanical stimulus to adequately develop epiphyseal stabilizers. Deposit low prevalence and relevance of SCFE in CP, these findings highlight both the role of normal joint loading in proper physis development and how chronic abnormal loading may contribute to various pathomorphological changes of the proximal femur (i.e., capital femoral epiphysis).

Olympic fencer with femoroacetabular impingement syndrome uses active rehabilitation to avoid surgery: A case report.

INTRODUCTION: Femoroacetabular impingement (FAI) syndrome is a musculoskeletal condition characterized by hip symptoms. Conservative therapy is indicated prior to surgical intervention. However, no literature has described conservative management of FAI in detail. This report provides a detailed active rehabilitation plan for an elite athlete with FAI to guide future research and clinicians. CASE PRESENTATION: A 30-year-old male Olympic fencing athlete presented with unilateral hip pain less than 1 year prior to the Olympic Games. Radiographic imaging demonstrated bilateral cam morphology. Hip mobilizations and stretching did not provide a meaningful pain reduction. Cortisone injection was then suggested prior to the Games where surgery was suggested following the Games. MANAGEMENT AND OUTCOME: Active rehabilitative exercises targeted motor control of the lumbo-pelvic-hip complex, which led to significant pain reduction and full return to sport. Surgical intervention and cortisone injections were deemed unnecessary due to resolution of symptoms. CONCLUSION: Athletes with FAI syndrome may benefit from specific active rehabilitation exercises. Future clinical trials should explore rehabilitative exercises that address improved motor control to manage individuals with FAI syndrome.

Smaller epiphyseal tubercle in hips with slipped capital femoral epiphysis compared to the uninvolved contralateral hip.

Recent investigations suggest that physeal morphologic features have a major role in the capital femoral epiphysis stability and slipped capital femoral epiphysis (SCFE) pathology, with a smaller epiphyseal tubercle and larger peripheral cupping of the femoral epiphysis being present in hips with progressive SCFE compared to healthy controls. Yet, little is known on the causal versus remodeling nature of these associations. This study aimed to use preoperative magnetic resonance imaging (MRI) of patients with unilateral SCFE to perform a comparison of the morphology of the epiphyseal tubercle, metaphyseal fossa, and peripheral cupping in hips with SCFE versus the contralateral uninvolved hips. Preoperative MRIs from 22 unilateral SCFE patients were used to quantify the morphological features of the epiphyseal tubercle (height, width, and length), metaphyseal fossa (depth, width, and length), and peripheral cupping height in three dimension. The quantified anatomical features were compared between hips with SCFE and the contralateral uninvolved side across the whole cohort and within SCFE severity subgroups using paired t-test. We found significantly smaller epiphyseal tubercle heights (p < 0.001) across all severities of SCFE when compared to their uninvolved contralateral side. There was a marginally smaller metaphyseal fossa length (p = 0.05) in SCFE hips compared to their contralateral uninvolved hips, with mild SCFE hips specifically having smaller fossa and epiphyseal lengths (p < 0.05) than their contralateral uninvolved side. There were no side-to-side differences in any other features of the epiphyseal tubercle, metaphyseal fossa and peripheral cupping across all severities (p > 0.05). These findings suggest a potential causal role of epiphyseal tubercle in SCFE pathogenesis.

Immediate effect of MWM adductor stretch, myofascial release, and conventional stretching in asymptomatic individuals with hip adductor tightness: A randomized controlled trial.

BACKGROUND: Hip adductors are the group of muscles that stabilize the pelvis during weight transfer in lower limbs in a gait cycle. As the full range of motion is seldomly used, this group of muscles commonly go into tightness which in turn may be a predisposing factor in development of back pain and knee pain. METHODS: 54 healthy individuals were selected after screening for bilateral hip adductor tightness by measuring hip abduction range of motion using goniometer. They were randomized to either mobilization with movement (MWM) adductor stretch, myofascial release, or conventional stretching group. All subjects were assessed pre and post intervention. Outcome measure used were hip abduction range of motion and bent knee fall out test. RESULTS: Statistically significant difference was noted between the experimental and the control group in terms of hip abduction range of motion and bent knee fall out test. CONCLUSION: Intervention showed significant results in all three groups; however, MWM adductor stretch when used in conjunction with conventional stretching has proved to be more effective than myofascial release with foam roller and conventional stretching in increasing the abduction range of motion and bent knee fall out test.

Recognition Method of Wushu Human Complex Movement Based on Bone Point Feature.

The existing recognition methods of complex human movements in Wushu have the problem of imperfect kinetic energy model, which leads to low recognition accuracy. A complex human motion recognition method based on bone point features is designed. Identify martial arts movement posture, combine the upward movement of human center of gravity trajectory, establish the kinetic energy model of joints according to the positioning results of extremity points, set the threshold of local spatial differences of human bones with the central node of hip joint as the center point, avoid overcalculation, and optimize the complex motion identification process by combining the characteristics of bone points. Experimental Results. The correct rate of different types of actions identified by this method is 90.1% and 92.7%, and the identification time is 1.2 s and 1.41 s, which shows that this method can identify actions quickly and effectively by combining the feature information of bone points.

A novel hip joint prosthesis with uni-directional articulations for reduced wear.

A novel polymer-on-metal hip joint prosthesis design that makes use of uni-directional articulations was developed and tested in this work. The new implant was tested using two polymer variants, virgin ultra-high molecular weight polyethylene (UHMWPE), and Vitamin E-infused highly crosslinked polyethylene (VEHXPE). The degrees of freedom of the ball-and-socket are reproduced by three cylindrical orthogonally-aligned articulations. This unconventional design leverages on the molecular orientation hardening mechanisms of the polyethylene and increased contact area to minimize wear. An experimental hip joint simulator was used to compare the gravimetric wear of the conventional ball-on-socket and the new implant. The new prosthesis including UHMWPE components produced a 78% reduction in wear, whereas the new prosthesis with VEHXPE components produced a 100% reduction in wear, as no measurable wear was detected. Machining marks on the acetabular cups of the new prosthesis were retained for both polyethylene variants, further demonstrating the low levels of wear exhibited by the new implants. Both polyethylene materials produced particles in the range of 0.1-1.0 µm, which are the most biologically active. Nonetheless, the extremely low wear rates are likely to induce minimal osteolysis effects. Furthermore, the novel design also offers an increase of more than 24% in the range of motion in flexion/extension when compared to a dual-mobility hip implant. A prototype of the prosthesis was implanted into a Thiel-embalmed human cadaver during a mock-surgery, which demonstrated high resistance to dislocation and the possibility of performing a figure of four position.

The Manual Therapy and Strengthening for the Hip (MASH) Trial: Protocol for a Multisite Randomized Trial of a Subgroup of Older Adults With Chronic Back and Hip Pain.

OBJECTIVE: Chronic low back pain (CLBP) is a disabling and costly condition for older adults that is difficult to properly classify and treat. In a cohort study, a subgroup of older adults with CLBP who had elevated hip pain and hip muscle weakness was identified; this subgroup differentiated itself by being at higher risk for future mobility decline. The primary purpose of this clinical trial is to evaluate whether a hip-focused low back pain (LBP) treatment provides better disability and physical performance outcomes for this at-risk group compared with a spine-focused LBP treatment. METHODS: This study is a multisite, single-blinded, randomized controlled, parallel arm, Phase II trial conducted across 3 clinical research sites. A total of 180 people aged between 60 and 85 years with CLBP and hip pain are being recruited. Participants undergo a comprehensive baseline assessment and are randomized into 1 of 2 intervention arms: hip-focused or spine-focused. They are treated twice weekly by a licensed physical therapist for 8 weeks and undergo follow-up assessments at 8 weeks and 6 months after randomization. Primary outcome measures include the Quebec Low Back Disability Scale and the 10-Meter Walk Test, which are measures of self-report and performance-based physical function, respectively. IMPACT: This multicenter, randomized clinical trial will determine whether a hip-focused or spine-focused physical therapist intervention results in improved disability and physical performance for a subgroup of older adults with CLBP and hip pain who are at increased risk of mobility decline. This trial will help further the development of effective interventions for this subgroup of older adults with CLBP.

Long-Term Results of Alumina Ceramic-On-Ceramic Bearings in Cementless Total Hip Arthroplasty: A 20-Year Minimum Follow-Up.

BACKGROUND: Alumina ceramic-on-ceramic bearings are used in total hip arthroplasty (THA) because of their wear-resistant and inert properties. In this study, we assessed the clinical and radiographic outcomes of patients undergoing primary cementless ceramic-on-ceramic THA at a minimum follow-up of 20 years. METHODS: A series of 301 consecutive primary THAs in 283 patients were assessed. Clinically, patients were assessed with the modified Harris Hip Score (HHS) and pain questionnaires. Anteroposterior radiographs of the pelvis and lateral radiographs of the hip were used to radiologically assess the implant. Patients were classified as lost to follow-up if they could not be contacted on multiple occasions or did not wish to participate further in this study. RESULTS: At twenty years after operation, 60 patients had died of a cause unrelated to surgery, 16 had experienced complications requiring reoperation, and 100 hips had both clinical assessments and radiographs at a minimum of 20 years of follow-up. The average HHS improved from 56.1 (range: 17-89) before THA to 92.5 (range: 63-100) at the latest follow-up. The classification of the HHS was good or excellent in 96.4% of patients. Only 1.8% of patients still had moderate residual pain at the thigh or groin. Radiographically, all patients demonstrated bony ingrowth but no clinical symptoms of loosening. The overall survival rate of the implants was 94.2% at 20 years with revision for any reason as the end point. CONCLUSION: Long-Term follow-up in our series showed excellent implant survival, excellent functional outcomes, and minimal late complications. There was no significant radiographic evidence of failure at a minimum of 20 years after THA. LEVEL OF EVIDENCE: Therapeutic Level IV.

Uncemented total hip arthroplasty using alumina ceramic bearings at a minimum of 14 years of follow-up.

INTRODUCTION: The effectiveness of modern ceramic bearings has been well established in reducing the osteolysis associated with wear of the bearing surfaces in total hip arthroplasty (THA). However, there are limited mid- to long-term follow-up data for complications associated with ceramic bearings. MATERIALS AND METHODS: This case series analyzed 124 consecutive primary uncemented THAs in 108 patients with a mean age of 61 years using alumina ceramic-on-alumina ceramic bearing couples. Seventy THAs (56%) were evaluated at a minimum 14 years of follow-up; the mean follow-up period was 16 ± 1 years (14-20 years). Kaplan-Meier survivorship was determined with revision surgery for any reason as the end point. Complications were recorded focusing on osteolysis, ceramic fracture, and abnormal sounds until the final follow-up. Clinical data were scored according to the Merle d'Aubigne and Postel hip score at 14 years after THA. RESULTS: The survivorship was 93.5% (95% CI 86.7-97.0%) at 14-years postoperatively. Five patients (4.0%) underwent revision surgery due to instability or infection before 1-year postoperatively. Two patients (1.6%) underwent revision surgery due to ceramic liner fracture at 9- and 12-years postoperatively, respectively. There was no radiographic evidence of osteolysis. A total of 27 complications occurred: dislocations (n = 7/124), squeaking sounds (n = 3/124), clicking sounds (n = 6/124), ceramic liner fractures (n = 2/124), periprosthetic fractures (n = 4/124), deep infections (n = 2/124), transient sciatic nerve palsy (n = 2/124), and femoral stem breakage (n = 1/124). The Merle d'Aubigne and Postel hip score was 16.8 ± 1.4 points. CONCLUSIONS: The survivorship analysis demonstrates the uncemented THA using alumina ceramic bearings may provide favorable clinical outcome and can offer minimal wear at a minimum 14-year follow-up. Revision surgery was mostly required due to instability and infection in the short-term, and implant breakage in the mid- to long-term.

Utilization of Physical Therapy Prior to Consultation for Hip Preservation Surgery.

Background: Comprehensive conservative care prior to arthroscopic hip surgery is recommended, but not all patients pursue a course of physical therapy (PT) prior to consulting a hip surgeon. The purpose of this study is to investigate the incidence and type of PT administered to patients with hip pain prior to consulting a hip surgeon. Methods: We conducted a single-center, questionnaire-driven study at a young adult hip preservation clinic that exclusively treats patients with hip pain. Thirty (88%) of thirty-four consecutive new patients answered the 15-item questionnaire. The questionnaire was designed to inquire about the reason for the visit, type of formal PT received (hip strengthening, leg strengthening etc.), and additional treatments received prior to the visit (electric stimulation, narcotics etc.). Descriptive statistics were utilized to quantify the reason for visit, PT prior to the visit, and type of exercises performed during physical therapy. Results: Overall, 21 (70%) patients received physical therapy prior to consulting with a hip surgeon. Of those who received PT, 91% (n=19) did hip strengthening exercises, 76% (n=16) did focused hip stretching exercises, 62% (n=13) did leg strengthening exercises, 57% (n=12) did joint mobilization exercises, and 52% (n=11) did focused core strengthening exercises. Only 48% (n=10) reported improvement in symptoms with PT. Of those who received additional treatments, 77% (n=20) took anti-inflammatory medications regularly, 50% (n=13) underwent electric stimulation, 31% (n=8) had chiropractic manipulation, 19% (n=5) underwent soft tissue mobilization, 15% (n=4) received steroid injections, and 12% (n=3) were prescribed narcotics for hip pain. Conclusion: The present study offers insight into the incidence and type of formal PT patients with hip pain receive before consulting a hip surgeon. Treatment methods during PT visits are variable, which makes determining outcomes of conservative care difficult to assess in this population.Level of Evidence: IV.

[Focused extracorporeal shock wave therapy with centrifugal exercise for the treatment of greater trochanteric pain syndrome].

OBJECTIVE: To explore the clinical efficacy of focused extracorporeal shock wave therapy with centrifugal exercise in the treatment of greater trochanteric pain syndrome. METHODS: From September 2017 to June 2019, 53 eligible cases of greater trochanteric pain syndrome were randomly divided into observation group (29 cases) and control group (24 cases). In observation group, there were 8 males and 21 females, aged from 38 to 62 years old with an average of (49.96±6.39) years old; the course of disease ranged from 6 to 13 months with an average of (8.58±1.99) months;treated with focused extracorporeal shock wave therapy with centrifugal exercise. In control group, there were 5 males and 19 females, aged from 39 to 62 years old with an average of (52.79±5.86) years old;the course of disease ranged from 6 to 14 months with an average of (9.04±2.51) months;treated with centrifugal exercise alone. Visual analogue scale (VAS) and hip Harris score were measured before ESWT treatment and at 1, 2, and 6 months to evaluate relieve degree of pain and functional recovery of hip joint, respectively. RESULTS: At 1 month after treatment, there were no significant differences in VAS, hip Harris score and treatment success rate (all P>0.05). At 2 months after treatment, VAS score in observation group (3.20±0.81) was lower than that of control group (3.87±0.61, P=0.002), there were no significant differences in hip Harris score score between observation group (81.93±2.43) and control group (82.12±2.34, P=0.770), the treatment success rate in observation group (58.62%, 17 / 29) was higher than that of control group (29.16%, 7 / 24) (P=0.032). At 6 months after treatment, VAS score in observationgroup (2.24±0.68) was lower than that of control group (3.12±0.53, P<0.001), hip Harris score score in observation group(85.10±1.75) was higher than that of control group (83.66±1.78)(P=0.005), there were no significant differences in treatment success rate between observation group (82.75%, 24 / 29) and control group (62.50%, 15 / 24)(P=0.096). CONCLUSION: In treatment of greater trochanteric pain syndrome, focused extracorporeal shock wave therapy with centrifugal exercise could significantly relieve symptoms of lateral hip pain, improve functional recovery of hip joint with good safety. This treatment strategy is worthy of application and promotion in clinical practice.

Hip passive stiffness is associated with hip kinematics during single-leg squat.

INTRODUCTION: Single-leg squat (SLS) is a test commonly used to assess lower limb function in rehabilitation. Increased hip adduction and internal rotation (IR) is associated with dynamic knee valgus, which is related to hip and knee overload. Proximal and distal factors, such as hip passive stiffness, poor hip muscle strength and excessive foot misalignment may influence hip movement. However, previous studies focus on how proximal and distal factors affected knee joint movement and did not reported the influence on hip joint. OBJECTIVE: This study investigated the association of hip external rotators (ER) strength, hip passive stiffness and shank-forefoot alignment (SFA) with hip adduction and IR during SLS. DESIGN: Cross-sectional study. METHOD: Forty-six health participants of both sexes (23.47 ± 4.29 years, 60.40 ± 11.28 kg, 1.67 ± 8.9 m) had SFA, hip ER torque, hip passive stiffness and hip kinematics assessed. Multiple linear regressions were performed to identify the factors which associated with mean and peak hip adduction and IR movement during SLS. RESULTS: Only hip passive stiffness was associated with mean (R2 = 0.164; Confidence Interval (CI) 95% = [-0.250, -0.048]; p = 0.005) and peak (R2 = 0.116; CI 95% = [-0.223, -0.210]; p = 0.019) hip IR movement. CONCLUSION: Hip passive stiffness was associated with mean and peak hip IR movement during the SLS. These results suggest that individuals with reduced hip passive stiffness may demonstrate increased hip IR movement during SLS.

The effect of magnetic therapy and moderate aerobic exercise on osteoporotic patients: A randomized clinical study.

BACKGROUND: Osteoporosis is a frequent musculoskeletal condition with significant complications that would be a global health problem and one of the major causes of mortality and morbidity. OBJECTIVES: The current study aimed to ascertain the impact of pulsed magnetic therapy, aerobic exercise, and a combination of both modalities on osteoporotic female patients postthyroidectomy. METHODS: Between May 2018 and September 2019, 45 female patients with osteoporosis were included in the randomized clinical study, their age ranged from 40 to 50 years, had thyroidectomy for at least 6 months ago, and had an inactive lifestyle for at least the previous 6 months. Patients were assigned randomly into 3 equal groups. Group A (magnetic therapy group): received routine medical treatment (bisphosphonates, calcium, and vitamin D) in addition to pulsed magnetic therapy on the hip region for 12 weeks (3 sessions/week). Group B (exercise group): received routine medical treatment plus moderate-intensity aerobic exercise for 12 weeks (3 sessions/week). Group C (combined magnetic therapy and exercise therapy group): received routine medical treatment plus pulsed magnetic therapy and moderate-intensity aerobic exercise for 12 weeks (3 sessions/week). The 3 groups were assessed for bone mineral density (BMD) at baseline by dual-energy x-ray absorptiometry and after 12 weeks of treatment. RESULTS: The results showed that within-group analysis a statistically significant increase was reveled (P < .05) for BMD in the 3 studied groups. Comparing the results among the 3 tested groups revealed a significant increase (P < .05) in posttesting mean values of BMD in group (C) compared to group (A) and group (B). No significant statistical difference in BMD means values between the 2 groups (A) and (B) after testing was detected. CONCLUSION: Combination of both pulsed magnetic therapy and moderate-intensity aerobic exercise showed significant improvement in BMD at the hip region than using any of the 2 modalities alone.

A Kinematic Comparison Between Sit-to-Stand Movements and Individual Cycles of the 5-Cycle Sit-to-Stand Test.

OBJECTIVE: The 5-cycle sit-to-stand (5XSTS) test is frequently used to test physical function for different clinical populations, with time to complete as the measured outcome. This study evaluated the similarity of kinematics between a single cycle of the STS movement and individual cycles of the 5XSTS test. METHODS: Lower extremity, pelvis, and thorax kinematic data were monitored as 20 participants (aged 18-40) completed 5 trials of the STS movement and 1 trial of the 5XSTS test. Correlations and root mean squared differences assessed the temporal and spatial similarities in kinematic patterns of sagittal plane joint angles at the ankles, knees, hips, and spine between single cycles of the STS movement and individual cycles of the 5XSTS test. Peak joint angles were obtained along with discrete angles at the start, seat off, and end of the movement. RESULTS: Temporal and spatial similarity of kinematics for the ankles and hips were reduced over cycles 2 to 5 of the 5XSTS. Increased hip flexion was observed at the start of cycles 2 to 5 of the 5XSTS test. Increased knee and hip flexion were observed at the end of cycles 1 to 4 of the 5XSTS test. CONCLUSIONS: Temporal patterns of sagittal plane joint angles captured in the first cycle of the 5XSTS represented those adopted for an isolated STS movement. Different initial conditions for cycles 2 to 5 of the 5XSTS 58 may have reduced temporal and spatial similarity of sagittal plane joint angles of the ankles and hips.

Activation of the gluteus maximus, gluteus medius and tensor fascia lata muscles during hip internal and external rotation exercises at three hip flexion postures.

BACKGROUND: Hip internal and external rotation exercises are usually performed in clinical practice. However, given the synergies required to stabilize the hip in the frontal plane, it is not clear how the activation of target muscles will differ between the two exercise directions. OBJECTIVE: I) Compare the activation of the upper and lower fibers of gluteus maximus (GMax), gluteus medius (GMed) and tensor fascia lata muscles between the hip internal and external rotation exercises; ii) Compare the maximal isometric force between hip internal and external rotation exercises and; iii) Assess the effect of varying hip flexion angles on muscle activation and maximal isometric force. STUDY DESIGN: A cross sectional study. METHODS: Electromyography and force production of twenty-one participants were measured during maximum isometric hip internal and external rotation in three postures: 0°, 45° and 90° of hip flexion. RESULTS: MANOVA results showed a larger activation of the GMed, tensor fascia lata and upper GMax (p < .001) for hip internal rotation compared to external rotation regardless of hip flexion angle. For the lower GMax, the same was observed when the hip was kept at 90° of flexion. Maximal isometric force during hip external rotation was greater than during hip internal rotation at 0° posture, and lower at 90° posture (p < .001). CONCLUSION: The gluteus and the tensor fascia lata muscles were substantially recruited during the hip internal rotation exercise, and barely recruited during the hip external rotation exercise. Hip flexion influences the myoeletric activity and isometric force production during the internal rotation exercise.

Dry needling trigger points around knee and hip joints improves function in patients with mild to moderate knee osteoarthritis.

INTRODUCTION: Dry needling may be an effective method to alleviate pain and improve range of motion. Controversial results have been found in previous studies using dry needling in knee problems. So, the aim of current study is to exert dry needling technique on unilateral muscles around the hip and knee joints and evaluate its effects on knee osteoarthritic patients. METHOD: For this double-blind randomized clinical trial, 40 female patients with mild to moderate knee osteoarthritis (aged 45-70 years old) were recruited. They entered the study if they had any trigger points around the hip or knee joints of the examined side and randomized into two groups. Pain, sensitivity of trigger points, balance and function measured by visual analogue scale, algometer, Y-balance test, timed up and go, self-paced walk tests beside KOOS questionnaire respectively before and after intervention. The intervention group received 3 sessions of dry needling on marked trigger points while the sham group received sham treatment consisting of only the plastic cover of a needle. Both groups reexamined 2 weeks after primary evaluation. RESULTS: Comparing results before and after implementing dry needling revealed significant improvements in all measured variables in treatment group whereas, pain and timed up and go increased and peak pain pressure decreased in sham group. Between group comparison revealed significant differences in all variables. CONCLUSION: Using 3 sessions of dry needling can increase functional activity, sensitivity and balance and decrease pain in patients with knee osteoarthritis in short term.