The floating hip injury: a descriptive study and case-control analysis.

PURPOSE: A "floating hip" (FH) injury is a rare injury describing the simultaneous ipsilateral fracture of the femur and pelvis or acetabulum (P/A). We describe our experience with patients presenting with FH injuries and compare them to controls with similar P/A fractures but without femoral involvement. METHODS: Medical records and radiographs of FH patients and controls presenting to our tertiary centre between 2015 and 2020 were reviewed. Follow-up data from outpatient clinical records were also extracted. The control group were extensively matched by age, sex, body mass index, fracture classification and energy of injury. RESULTS: From 1392 recorded P/A fractures, 42 FH cases were identified (average age 39 years, 78.6% males). The most common femoral fracture was the midshaft (35.7%), followed by the neck of femur (26.2%). 90.5% of FH injuries were due to high-energy mechanisms. 64.3% of P/A fractures, and 100% of femoral fractures were managed surgically. Compared to controls, FH cases were more likely to have additional orthopaedic injuries (73.8% vs. 40.5%, p = 0.002), more total theatre admissions (mean 2.5 vs. 1.19, p < 0.001), longer hospital stays (28.3 vs. 14.9 days, p = 0.02), and a higher rates of post-op complications (53.8% vs. 20%, p = 0.025). CONCLUSIONS: We report differences in the presentation, management, and outcomes of FH injuries versus controls, even after extensive matching for confounders. These differences may inform future treatment strategies for the FH injury.

Traumatic Bifocal whereas and Ipsilateral Posterior Knee Dislocation: A Case Report.

CASE: A 19-year-old man sustained combined, ipsilateral inferior hip and posterior knee fracture-dislocations secondary to a motor vehicle collision. He underwent immediate closed reduction of the knee and delayed open reduction internal fixation but required emergent open hip reduction for an irreducible femoral head incarcerated on a pubic root fracture. At the 1-year follow-up, he demonstrated excellent functional outcome with painless and full hip and knee range of motion. CONCLUSION: Irreducible inferior femoral head dislocation in combination with a knee dislocation requires thoughtful staging and treatment but can result in satisfactory outcomes.

Correlación entre versión femoral y gravedad de displasia del desarrollo de cadera en pacientes con artrosis avanzada / Correlation between femoral version and severity of hip dysplasia in patients with advanced osteoarthritis prior to total hip arthroplasty

Antecedentes y objetivo: La displasia del desarrollo de cadera (DDC) es una dolencia que incluye un gran espectro de manifestaciones articulares, tales como alteraciones en la versión femoral y en el ángulo cérvico-diafisiario (ACD), así como una probable progresión a artrosis. El objetivo de este estudio fue buscar una correlación entre la versión femoral y la gravedad de la DDC en pacientes con artrosis. Otro objetivo planteado fue evaluar si se presentan cambios significativos en el valor del ACD a medida que la gravedad de la DDC aumenta. Materiales y método: Entre marzo de 2018 y febrero de 2019 fueron evaluados pacientes mayores de 15 años con DDC, sin cirugías de cadera previas y artrosis grave de cadera en espera de artroplastia total. Se solicitaron radiografías (Rx) de pelvis (anteroposterior) y de cadera (anteroposterior y lateral), así como tomografías axiales computadas (TAC) de cadera y rodilla de las extremidades afectadas, en las cuales se realizó la medición de versión femoral y ACD.La clasificación de Crowe fue utilizada para categorizar la gravedad de la DDC y, al igual que el ACD, fue evaluada en forma independiente por 2observadores. La versión femoral y el ACD en la TAC fueron medidos por un radiólogo especialista en enfermedad musculoesquelética. El análisis estadístico fue realizado con SPSS v. 21. Se consideró un valor significativo de p<0,05. Resultados: Los 42 pacientes que cumplieron los criterios de inclusión asistieron a la evaluación; el 76% era de género femenino, con una edad promedio de 52,7 años. De un total de 54 caderas afectadas, 45 fueron evaluadas con ambos exámenes (Rx y TAC) y 9caderas solo con Rx (uno de ellos falleció por otras causas antes de la TAC). El 48%; 16%; 7% y el 28% de las caderas fueron clasificadas en la Rx como Crowe I, II, III y IV, respectivamente, con una concordancia interobservador del 100%.(AU)

Introduction: Developmental dysplasia of the hip (DDH) is a condition which comprises a number of joint abnormalities, including modifications in femoral version and neck-shaft angle (CCD), as well as a probable progression to osteoarthritis in certain cases. The main objective of this research was to find a correlation between femoral version and severity of DDH in patients with advanced osteoarthritis prior to joint replacement, which has not been previously reported. A secondary aim was to describe the modification of CCD as the severity of DDH increases. Materials and method: Patients over the age of 15 with dysplastic hips and severe osteoarthritis prior to total hip arthroplasty were assessed between March 2018 and February 2019. Cases with any previous hip surgery were excluded. Anteroposterior pelvis X rays and femoral computed tomography (CT) were performed; femoral version was measured in CT and CCD was evaluated both in X rays (2 observers: A and B) and CT (one observer: musculoskeletal radiologist). Severity of DDH was defined by observers A and B according to Crowe classification in X rays. Statistical analysis was performed on SPSS v.21. Shapiro-Wilk test was used to confirm a normal data distribution. Intraclass correlation coefficient (ICC) determined the level of agreement between observers A and B. Pearson test assessed the correlation between femoral version and Crowe classification (positive if >0.5). Student's t test evaluated the statistical significance, which was defined as P<0.05. Results: One-year assessment; 42 patients (54 hips), 76% women. Mean age 52.7 years. 45 hips completed the imaging set, 9 hips were assessed only with X rays. 48%, 16%, 7% and 28% were classified as Crowe I, II, III and IV (100% interobserver agreement). Crowe classes were grouped as I, II/III and IV due to a low number of cases classified as II and III. Mean femoral version was 21.73°, 26.8° and 43.58°, respectively. (AU)

Correlation between femoral version and severity of hip dysplasia in patients with advanced osteoarthritis prior to total hip arthroplasty / Correlación entre versión femoral y gravedad de displasia del desarrollo de cadera en pacientes con artrosis avanzadaS

Introduction: Developmental dysplasia of the hip (DDH) is a condition which comprises a number of joint abnormalities, including modifications in femoral version and neck-shaft angle (CCD), as well as a probable progression to osteoarthritis in certain cases. The main objective of this research was to find a correlation between femoral version and severity of DDH in patients with advanced osteoarthritis prior to joint replacement, which has not been previously reported. A secondary aim was to describe the modification of CCD as the severity of DDH increases. Materials and method: Patients over the age of 15 with dysplastic hips and severe osteoarthritis prior to total hip arthroplasty were assessed between March 2018 and February 2019. Cases with any previous hip surgery were excluded. Anteroposterior pelvis X rays and femoral computed tomography (CT) were performed; femoral version was measured in CT and CCD was evaluated both in X rays (2 observers: A and B) and CT (one observer: musculoskeletal radiologist). Severity of DDH was defined by observers A and B according to Crowe classification in X rays. Statistical analysis was performed on SPSS v.21. Shapiro-Wilk test was used to confirm a normal data distribution. Intraclass correlation coefficient (ICC) determined the level of agreement between observers A and B. Pearson test assessed the correlation between femoral version and Crowe classification (positive if >0.5). Student's t test evaluated the statistical significance, which was defined as P<0.05. Results: One-year assessment; 42 patients (54 hips), 76% women. Mean age 52.7 years. 45 hips completed the imaging set, 9 hips were assessed only with X rays. 48%, 16%, 7% and 28% were classified as Crowe I, II, III and IV (100% interobserver agreement). Crowe classes were grouped as I, II/III and IV due to a low number of cases classified as II and III. Mean femoral version was 21.73°, 26.8° and 43.58°, respectively. (AU)

Antecedentes y objetivo: La displasia del desarrollo de cadera (DDC) es una dolencia que incluye un gran espectro de manifestaciones articulares, tales como alteraciones en la versión femoral y en el ángulo cérvico-diafisiario (ACD), así como una probable progresión a artrosis. El objetivo de este estudio fue buscar una correlación entre la versión femoral y la gravedad de la DDC en pacientes con artrosis. Otro objetivo planteado fue evaluar si se presentan cambios significativos en el valor del ACD a medida que la gravedad de la DDC aumenta. Materiales y método: Entre marzo de 2018 y febrero de 2019 fueron evaluados pacientes mayores de 15 años con DDC, sin cirugías de cadera previas y artrosis grave de cadera en espera de artroplastia total. Se solicitaron radiografías (Rx) de pelvis (anteroposterior) y de cadera (anteroposterior y lateral), así como tomografías axiales computadas (TAC) de cadera y rodilla de las extremidades afectadas, en las cuales se realizó la medición de versión femoral y ACD.La clasificación de Crowe fue utilizada para categorizar la gravedad de la DDC y, al igual que el ACD, fue evaluada en forma independiente por 2observadores. La versión femoral y el ACD en la TAC fueron medidos por un radiólogo especialista en enfermedad musculoesquelética. El análisis estadístico fue realizado con SPSS v. 21. Se consideró un valor significativo de p<0,05. Resultados: Los 42 pacientes que cumplieron los criterios de inclusión asistieron a la evaluación; el 76% era de género femenino, con una edad promedio de 52,7 años. De un total de 54 caderas afectadas, 45 fueron evaluadas con ambos exámenes (Rx y TAC) y 9caderas solo con Rx (uno de ellos falleció por otras causas antes de la TAC). El 48%; 16%; 7% y el 28% de las caderas fueron clasificadas en la Rx como Crowe I, II, III y IV, respectivamente, con una concordancia interobservador del 100%.(AU)

Chronic Hip Injury Has a Negative Emotional Impact on the Male Athlete With Femoroacetabular Impingement.

PURPOSE: To evaluate the impact of hip arthroscopy for femoroacetabular impingement (FAI) on both the physical and mental components of the 36-Item Short Form (SF-36) and assess how changes in health status compare with improvements in physical function and ability to continue to play (CTP) 2 years after surgery. METHOD: Data collected prospectively from male athletes undergoing primary arthroscopic correction of FAI between November 2008 and October 2016 were analyzed. Physical (PCS) and mental (MCS) component scores of the SF-36 were assessed preoperatively and 2 years postoperatively. The minimal clinical important difference (MCID) was calculated using an anchor-based percentage of possible improvement technique, and the proportion of athletes achieving MCID was established. Logistic regression analysis was used to identify predictors of achieving MCID. CTP was assessed at 2-year follow-up. RESULTS: 486 cases were included, age 25.9 ± 5.6 years. Median PCS improved from baseline 69.4 (51.9 to 85.0) to 91.9 (81.9 to 97.5) at 2 years (P < .001). Median MCS remained unchanged-preoperative, 88 (76 to 92); postoperative, 88 (80 to 96)-although the difference in the distribution of scores was statistically significant (P < .001). Calculated MCID was 60.1% (PCS) and 58.1% (MCS). Mean improvement was significantly higher for PCS compared with MCS (17.4 versus 3.7, P < .001) The proportion of cases achieving MCID was 56.9% and 28.7% for PCS and MCS, respectively, and the difference was statistically significant (P < .001). Lower Tonnis grade (odds ratio [OR] 0.601, 95% confidence interval [CI] 0.377 to 0.958; P = .032) and symptom duration <2 years (OR 0.624, 95% CI 0.406 to 0.960; P = .032) were predictive of achieving PCS MCID. Higher preoperative scores decreased the odds of achieving MCID (OR 0.965, 95% CI 0.955 to 0.975; P < .001; OR 0.972, 95% CI 0.958 to 0.986; P < .001 for PCS and MCS, respectively). 77.3% continued to play their main preinjury sport. Where CTP was not achieved, a significantly higher proportion of cases failed to meet MCID for the MCS compared with PCS (85% versus 60%, P < .001). CONCLUSION: Arthroscopic management of sports-related FAI results in excellent overall clinical outcome and high levels of satisfaction and CTP at 2 years. Chronic hip injury has a significant negative effect on the physical and mental well-being of athletes; corrective surgery may restore physical function but is more limited in its ability to improve mental health status in this athletic cohort. LEVEL OF EVIDENCE: IV, therapeutic case series.

Hip pain and its correlation with cam morphology in young skiers-a minimum of 5 years follow-up.

BACKGROUND: There is conflicting evidence regarding the association between cam morphological changes and hip pain, and it remains unclear who with cam morphology will develop hip pain and who will not. This study aimed to investigate the correlation between cam morphology, hip pain, and activity level at a 5-year follow-up in young Alpine and Mogul skiers. METHOD: All students (n = 76) at Åre Ski National Sports High School were invited and accepted participation in this prospective study at baseline. Magnetic resonance imaging (MRI) of both hips was conducted to evaluate the presence of cam morphology (α-angle ≥ 55°) and its size alongside the reporting of hip pain, type, and frequency of training by the Back and hip questionnaire, at baseline. After 5 years, the skiers were invited to complete a shortened version of the same questionnaire. RESULTS: A total of 60 skiers (80%) completed the follow-up questionnaire, of which 53 had concomitant MRI data. Cam morphology was present in 25 skiers (47.2%, 39 hips). Hip pain at baseline and at follow-up was reported in 17 (28.3%) and 22 (36.7%) skiers, respectively. No correlations were found between the activity level, the frequency, and the size of cam morphology and hip pain, except for the right hip α-angle at 1 o'clock and hip pain in skiers with cam morphology at baseline (rs = 0.49; P = 0.03) and at follow-up (rs = 0.47; P = 0.04). A total of 73.3% skiers had retired, of which 48% reported this was due to injuries. CONCLUSION: Hip pain was not shown to be correlated, or had a low correlation, with activity level and the presence and size of cam morphology in young skiers on a 5-year follow-up. Based on these results, cam morphology or activity level did not affect hip pain to develop during 5 years of follow-up in young skiers. Furthermore, this study highlights that almost 75% of young elite skiers had retired from their elite career with almost 50% reporting that this was due to injuries sustained from skiing.

Lubricin in experimental and naturally occurring osteoarthritis: a systematic review.

OBJECTIVE: Lubricin is increasingly being evaluated as an outcome measure in studies investigating post-traumatic and naturally occurring osteoarthritis. However, there are discrepancies in results, making it unclear as to whether lubricin is increased, decreased or unchanged in osteoarthritis. The purpose of this study was to review all papers that measured lubricin in joint injury or osteoarthritis in order to draw conclusions about lubricin regulation in joint disease. DESIGN: A systematic search of the Pubmed, Web of Knowledge, and EBSCOhost databases for papers was performed. Inclusion criteria were in vivo studies that measured lubricin in humans or animals with joint injury, that investigated lubricin supplementation in osteoarthritic joints, or that described the phenotype of a lubricin knock-out model. A methodological assessment was performed. RESULTS: Sixty-two studies were included, of which thirty-eight measured endogenous lubricin in joint injury or osteoarthritis. Nineteen papers found an increase or no change in lubricin and nineteen reported a decrease. Papers that reported a decrease in lubricin were cited four times more often than those that reported an increase. Fifteen papers described lubricin supplementation, and all reported a beneficial effect. Eleven papers described lubricin knock-out models. CONCLUSIONS: The human literature reveals similar distributions of papers reporting increased lubricin as compared to decreased lubricin in osteoarthritis. The animal literature is dominated by reports of decreased lubricin in the rat anterior cruciate ligament transection model, whereas studies in large animal models report increased lubricin. Intra-articular lubricin supplementation may be beneficial regardless of whether lubricin increases or decreases in OA.

25-hydroxyvitamin D levels in the early healing of osteoporotic hip fracture and their relationship with clinical outcome / Niveles de 25-hidroxivitamina D en la fase precoz de la fractura osteoporótica de cadera y su relación con los resultados clínicos

INTRODUCTION: vitamin D is involved in recovery after an osteoporotic hip fracture (OHF). Previous studies have reported decreased serum vitamin D levels during fracture healing. OBJECTIVES: our aim was to evaluate: a) serum 25-hydroxyvitamin D3 (25OHD3) levels in patients with OHF at hospital admission and 8 days post-admission, and b) the relationship between 25OHD levels and clinical outcomes. METHODS: a prospective study including 66 patients aged over 65 years hospitalized for OHF. We gathered data on baseline demographic characteristics, medical history, Mini Mental State (MMS) assessment, Activities of Daily Living (ADL) results, nutritional assessment, and type of fracture and surgery. Laboratory results were collected on bone biomarkers, albumin, 25OHD3, and IL6. Clinical outcomes included length of stay, complications, and mortality. In the statistical analysis, a t-test was used for continuous variables and a chi-square test for qualitative variables. Linear regression models were used for the multivariate analysis, adjusted for covariates. RESULTS: our study population had low serum vitamin D levels at admission, with a mean [(standard error of the mean (SEM)] of 12.04 (1.03) ng/mL. Both 25OHD3 and interleukin 6 (IL-6) levels significantly declined (p < 0.001) during the early post-fracture phase. A greater decline in 25OHD3 levels was significantly associated with longer hospital stay (p = 0.042, multivariate analysis). Serum 25OHD3 levels were also associated with cognitive status as assessed using the MMS exam. CONCLUSIONS: 25OHD3 levels were reduced in OHF patients at admission, and significantly decreased during the first 8 days post-admission. 25OHD3 levels were associated with MMS-assessed cognitive status. A greater decline in serum 25OHD3 was associated with a longer hospital stay

INTRODUCCIÓN: la vitamina D se ha relacionado con la recuperación tras la fractura osteoporótica de cadera (FOC). Estudios previos muestran un descenso de los niveles de vitamina D en la fase precoz tras la fractura. OBJETIVOS: evaluar: a) los niveles séricos de 25-hidroxivitamina D3 (25OHD3) al ingreso y a los 8 días del ingreso en hospitalizados por FOC; b) la relación de los niveles de 25OHD3 con los resultados clínicos, así como con el nivel cognitivo y funcional. MÉTODOS: estudio prospectivo de 66 pacientes (> 65 años) ingresados por FOC. Se estudiaron las características demográficas, los antecedentes personales, la valoración nutricional, el test Mini Mental State (MMS), el cuestionario Activities of Daily Living (ADL), el tipo de fractura y de cirugía, y parámetros bioquímicos del metabolismo óseo, la 25OHD3, la albúmina y la interleuquina 6. Como resultados clínicos se analizaron: estancia hospitalaria, complicaciones y mortalidad durante el ingreso. El análisis estadístico consistió en: a) prueba de la t para las variables continuas y χ2 para las cualitativas; b) análisis multivariable utilizando modelos de regresión lineal ajustados según el análisis de la covarianza. RESULTADOS: la población estudiada muestra niveles bajos de 25OHD3 al ingreso: media [± error estándar de la media (EEM)] = 12,04 (1,03) ng/mL. Durante el ingreso, 25OHD3 e interleuquina 6 decrecen significativamente (p < 0,001). El descenso de 25OHD3 se asocia con la estancia hospitalaria (p = 0,042 en análisis multivariable). Los valores disminuidos de 25OHD3 se asocian a un bajo nivel cognitivo (p = 0,042). CONCLUSIONES: los pacientes ingresados por fractura osteoporótica de cadera tienen niveles bajos de 25OHD3 que decrecen significativamente tras 8 días de ingreso. El descenso de 25OHD3 se asocia significativamente a la estancia hospitalaria. Los niveles disminuidos de 25OHD3 se asocian a un peor estado cognitivo evaluado mediante el MMS

[Bilateral Dislocation of the Hip Joints after a Car Accident?] / Bilaterálna traumatická luxácia bedrových klbov po autonehode?

The authors describe a case report of a 5-year-old foreign girl with a rare bilateral hip dislocation after a car accident. Young surgeons at the emergency department performed an unsuccessful closed reduction. Since the clinical and ultrasound screening of DDH of all newborns in the Slovak Republic is carried out until the age of 4-6 weeks, the treatment of dislocated hips starts early and the late diagnosed dislocations occur rarely. The aim of the study is to point at differences in DDH screening all over Europe resulting in an increased risk of misdiagnosed patients. Key words:hip dislocation, childhood, trauma, DDH, screening.

Prevalence of and Risk Factors for Total Hip and Knee Replacement in Retired National Football League Athletes.

BACKGROUND: Osteoarthritis is a substantial cause of disability. Joint replacement prevalence relates to the burden of severe osteoarthritis, and identifying risk factors for end-stage disease may indicate intervention opportunities. American football has high youth and elite participation, and determining risk factors for severe osteoarthritis may support future morbidity prevention. PURPOSE: To (1) determine the prevalence of hip and knee replacement in retired National Football League (NFL) athletes, (2) examine risk factors for replacement, and (3) identify the association between knee injuries and knee replacement. STUDY DESIGN: Case-control study; Level of evidence, 3. METHODS: Retired NFL athletes who participated in a general health survey were included. This historical cohort included those playing between 1929 and 2001. The association between self-reported playing or injury history, and replacement after retirement, was assessed with prevalence ratios (PRs). Models were adjusted for potential confounders of age and weight. RESULTS: Data for 2432 retired male NFL players (69.3% response rate) who had participated in football for a mean 15.2 years were included, in which 277 players reported replacement after retirement (11.4%). More participants reported knee replacement (7.7%) than hip replacement (4.6%). The majority of participants reported previous severe knee injury (53%), and the most prevalent was meniscal tear (32.2%). In multivariable models, age (10-year increase, PR, 2.23; 95% CI, 1.99-2.51), current weight (PR, 1.10; 95% CI, 1.06-1.14), and reporting 1 (PR, 1.78; 95% CI, 1.14-2.77), 2 (PR, 1.91; 95% CI, 1.16-3.15), or ≥3 knee injuries (PR, 3.44; 95% CI, 2.33-5.09) were associated with knee replacement. Age (10-year increase, PR, 1.86; 95% CI, 1.59-2.18), linemen (PR, 1.62; 95% CI, 1.03-2.55), and reporting 1 (PR, 1.72; 95% CI, 1.05-2.80), 2 (PR, 2.77 95% CI, 1.58-4.84), or ≥3 (PR, 2.44; 95% CI, 1.52-3.91) hip injuries were associated with hip replacement. Each reported knee injury type was cross-sectionally associated with replacement after retirement (P < .05). CONCLUSION: Knee replacement was more prevalent than hip replacement. Risk factors differed between the hip and the knee, with age and severe joint injury associated with hip and knee replacement, weight with knee replacement, and playing position associated with hip replacement. Joint injury and weight management may be prevention opportunities to reduce morbidity and end-stage osteoarthritis in this population.

Ipsilateral hip pain and femoral shaft fractures: is there any relationship?

BACKGROUND: High-energy traumas are common occurrences worldwide. The rate of overlooked neck fractures in polytrauma cases is also high. Previous studies have shown that articular hip pathologies, particularly neck fractures, are associated with fractures of the femoral shaft. This study sets out to describe cases of intra-articular hip pathology following traumatic femoral shaft fracture. Thus, the present study aims to investigate the relationship between ipsilateral hip pain and femoral shaft fractures. METHODS: Patients who were diagnosed with a fracture of the femur shaft and who were operated on (intramedullary fixation or plate) were included in this study. Patients with pathologic fractures, femoral neck fractures, femoral intertrochanteric fractures, or pelvic fractures were excluded. Patients with at least six months of follow-up and who were capable of independent walking without support were grouped according to AO/OTA fracture classification. Patients were questioned for deep anterior groin pain, and physical examination tests and hip imaging (X-ray and MR arthrography) were performed by calling patients with the indicated complaints. RESULTS: The presence of labral tears were noted in two patients. The incidence of osseous bump of the femoral neck identified by MR arthrography (MRA) was found in three of 16 hips. Assessment of the presence of gluteal tendinosis or tear and herniation pit identified three of 16 hips. The presence of osteophytes was noted in one patient. MRA identified three of 16 hips with more than one type of intra-articular pathology. Two patients with an osseous bump of the femoral neck were also diagnosed with additional hip pathology as herniation pit. CONCLUSION: Anterior groin pain in patients with a history of femoral shaft fracture is not always related to implants. Orthopedic surgeons should become suspicious in cases of intra-articular hip pathology in patients who have persistent hip pain after severe lower extremity trauma.

The role of preoperative vascular imaging and embolisation for the surgical resection of bilateral hip heterotopic ossification.

The surgical excision of heterotopic ossification can provide improved function for patients; however, complications can include damage to nearby vessels and nerves, blood loss and recurrence. In the preoperative planning for excision, our case report describes the combination of CT angiography, preoperative embolisation of involved vascular structures and the use of intraoperative vascular surgery for dissection around key structures to aid in the reduction of morbidity in these patients.

Open reduction capsular arthroplasty using a modified Codivilla-Hey Groves-Colonna procedure augmented with tensor fascia lata graft, supported by Ilizarov hinged external fixator in a patient with chronic traumatic posterior hip dislocation.

Untreated traumatic hip dislocation is a rare condition in children. Capsular arthroplasty is a previously abandoned surgical technique in dealing with developmental dysplasia of the hips but not described in traumatic dislocations. We present a 2-year follow-up of a 7-year-old boy who sustained chronic traumatic posterior hip dislocation treated as a first case in published literature combining a modified version of the Codivilla-Hey Groves-Colonna procedure, using tensor fascia lata graft and application of a hinged Ilizarov frame. The patient is currently independent on all activities of daily living.

Compressive Femoral Mononeuropathy Secondary to Acetabular Labral Tear Associated With Paralabral Ganglion Cyst of an Osteoarthritic Hip: A Case Report.

CASE: A 61-year-old man presented with a 5-year history of left hip pain and a 6-month history of left groin swelling associated with hypoesthesia and proximal muscle weakness. Radiograph of the left hip showed degenerative joint disease. Magnetic resonance imaging revealed a large, anteriorly displaced paralabral cyst of the left hip joint. Neurophysiologic studies were corroborative of left femoral mononeuropathy. Complete excision of the cyst along with total hip replacement were performed. At 4-year follow-up, there was complete remission with resolution of symptoms. CONCLUSIONS: Our experience emphasizes the importance of identifying and addressing the underlying primary pathologic disease for a satisfactory functional outcome.

Prevalencia de lesiones del labrum y del cartílago articular de la cadera en imagen por resonancia magnética simple 3 T de futbolistas profesionales asintomáticos / Prevalence of labrum and articular cartilage injuries of the hip on 3T magnetic resonance imaging of asymptomatic elite soccer players

Objetivo: Establecer la prevalencia de lesiones del labrum y el cartílago articular de la cadera en futbolistas profesionales asintomáticos y explorar la asociación con hallazgos en las pruebas de imagen de choque femoroacetabular (CFA). Métodos: Estudio de corte transversal que evaluó por imagen de resonancia magnética en 3 tesla (IRM 3 T) un total de 84 caderas en jugadores de fútbol profesional, con edades entre los 18 y 31 años. Se identificaron las lesiones del labrum y las del cartílago acetabular y femoral. Pruebas estadísticas específicas fueron utilizadas para establecer la relación entre las alteraciones anatómicas de CFA y la presencia de lesiones condrolabrales. Resultados: La prevalencia de CFA fue del 25%, siendo el tipo cam el más predominante con 22,5%. Para las lesiones del labrum existe una prevalencia de 33,8%, de las cuales el 18,8% fueron para degeneración intrasustancial y 2,5% para rotura completa. Las características anatómicas de la cadera según el tipo de CFA están asociadas con lesiones del cartílago femoral p < 0,001, lesiones de la unión condrolabral p = 0,042 y lesión combinada (presencia de lesión del labrum o cartílago o acetabular o femoral o unión condro-labral) p < 0,001. Conclusión: Existe una alta prevalencia de lesiones asintomáticas del labrum y del cartílago articular de la cadera en futbolistas profesionales, las cuales se asocian a las características anatómicas de CFA de cadera

Objective: To establish the prevalence of lesions of the labrum and articular cartilage of the hip in asymptomatic elite soccer players by performing 3T magnetic resonance imaging. Methods: Eighty-four asymptomatic hips of 42 professional soccer players were evaluated. Male subjects older than 18 years were included. Cam and pincer deformity were defined as an alpha angle greater than 55 degrees and a lateral centre edge angle greater than 39 degrees, respectively. Labral injuries were classified with the Czerny classification and cartilage damage was classified with the Outerbridge classification. Specific statistical tests were used to establish the relationship between anatomical variances of the hip and the presence of chondral and labral injuries. Results: FAI morphology prevalence was 25%. Abnormalities such as cam (22.5%) and labral injuries (33.8%) were found. Those cases with reported labral injury were predominantly intrasubstance damage (18.8%). Anatomical features of FAI were found to be related to lesions of the femoral cartilage (P<.001), chondrolabral damage (P=.042), or both injuries (P<.001). Conclusion: Asymptomatic labral or cartilaginous injuries of the hip were reported in 25% of the included professional soccer players. These injuries were associated with anatomical features of FAI

Use of ceramic-on-ceramic bearing in total hip arthroplasty for posttraumatic arthritis of the hip.

PURPOSE: We aimed to evaluate (1) the intraoperative parameters, (2) cup position, (3) complications, (4) long-term results, and (5) the survivorship of cementless total hip arthroplastys (THAs) with use of ceramic bearings in patients with a history of acetabular fracture. METHODS: We compared 57 THAs in patients, who were treated due to previous acetabular fracture (posttraumatic group), with 57 propensity score-matched THAs in patients, who were operated due to femoral head osteonecrosis (osteonecrotic group), at a minimum of 5-year follow-up. RESULTS: The operation time was longer ( p = 0.008), and the volume of transfusion was larger ( p = 0.0.23) in the posttraumatic group. The cup abduction (39.4° ± 6.0° vs. 39.7°±4.8°) and anteversion (24.7° ± 8.0° vs. 26.7°±7.7°) were similar between the two groups. There was one dislocation in the posttraumatic group. There was no ceramic fracture in either group. One posttraumatic patient underwent excision of exuberant heterotrophic ossification at 3 years after the arthroplasty. The mean University of California, Los Angeles activity improved from 3.6 to 4.9 points in the posttraumatic group and 3.5 to 5.2 points in the osteonecrotic group. All acetabular cups and femoral stems had bone-ingrown stability. When reoperation for any reason was used as the end point, the 10-year survival rate was 98.3% (95% CI: 95.0-100) in the posttraumatic group and 100% in the osteonecrotic group. CONCLUSION: In our study, posttraumatic patients had longer operation time and larger volume of transfusion than osteonecrotic patients. However, medium-term results and survivorship were similar with those of osteonecrotic patients.

Prevalence of labrum and articular cartilage injuries of the hip on 3T magnetic resonance imaging of asymptomatic elite soccer players. / Prevalencia de lesiones del labrum y del cartílago articular de la cadera en imagen por resonancia magnética simple 3 T de futbolistas profesionales asintomáticos.

OBJECTIVE: To establish the prevalence of lesions of the labrum and articular cartilage of the hip in asymptomatic elite soccer players by performing 3T magnetic resonance imaging. METHODS: Eighty-four asymptomatic hips of 42 professional soccer players were evaluated. Male subjects older than 18 years were included. Cam and pincer deformity were defined as an alpha angle greater than 55 degrees and a lateral centre edge angle greater than 39 degrees, respectively. Labral injuries were classified with the Czerny classification and cartilage damage was classified with the Outerbridge classification. Specific statistical tests were used to establish the relationship between anatomical variances of the hip and the presence of chondral and labral injuries. RESULTS: FAI morphology prevalence was 25%. Abnormalities such as cam (22.5%) and labral injuries (33.8%) were found. Those cases with reported labral injury were predominantly intrasubstance damage (18.8%). Anatomical features of FAI were found to be related to lesions of the femoral cartilage (P<.001), chondrolabral damage (P=.042), or both injuries (P<.001). CONCLUSION: Asymptomatic labral or cartilaginous injuries of the hip were reported in 25% of the included professional soccer players. These injuries were associated with anatomical features of FAI.

Relationship Between PROMIS Computer Adaptive Tests and Legacy Hip Measures Among Patients Presenting to a Tertiary Care Hip Preservation Center.

BACKGROUND: Legacy hip outcome measures may be burdensome to patients and sometimes yield floor or ceiling effects. Patient-Reported Outcomes Measurement Information System (PROMIS) computer adaptive tests (CATs) allow for low-burden data capture and limited ceiling and floor effects. PURPOSE/HYPOTHESIS: The purpose of this study was to determine whether the PROMIS CAT domains demonstrate correlation against commonly used legacy patient-reported outcome measures in a population of patients presenting to a tertiary care hip preservation center. The authors hypothesized the following: (1) PROMIS CAT scores based on physical function (PF), pain interference (PIF), pain behavior, and pain intensity would show strong correlation with the following legacy scores: modified Harris Hip Score (mHHS), International Hip Outcome Tool-12 (iHOT-12), Hip Outcome Score (HOS) Sports and Activities of Daily Living subscales, and Veterans RAND-6D (VR-6D) utility measure. (2) The mental and physical health portions of the VR-6D legacy measure would show weak correlation with mental- and psychosocial-specific PROMIS elements-depression, anxiety, fatigue, sleep, and ability to participate in social roles and activities. (3) All PROMIS measures would exhibit fewer floor and ceiling effects than legacy scores. STUDY DESIGN: Cohort study (diagnosis); Level of evidence, 3. METHODS: Prospective data were collected on 125 patients in the hip preservation clinics. Enrollees completed legacy scores (visual analog scale for pain, mHHS, iHOT-12, HOS, and VR-6D) and PROMIS CAT questionnaires (PF, PIF, pain behavior, anxiety, depression, sleep, social roles and activities, pain intensity, fatigue). Spearman rank correlations were calculated, with rs values of 0 to 0.3 indicating negligible correlation; 0.3 to 0.5, weak correlation; 0.5 to 0.7, moderately strong correlation; and >0.7, strong correlation. Floor and ceiling effects were evaluated. RESULTS: As anticipated, the PF-CAT yielded strong correlations with the iHOT-12, mHHS, HOS-Sports, HOS-Activities of Daily Living, and VR-6D, with rs values of 0.76, 0.71, 0.81, 0.87, and 0.71, respectively. The PIF-CAT was the only pain score to show moderately strong to strong correlation with all 14 patient-reported outcome measures. A strong correlation was observed between the VR-6D and the social roles and activities CAT ( rs = 0.73). The depression CAT had a significant floor effect at 19%. No additional floor or ceiling effect was present for any other legacy or PROMIS measure. CONCLUSION: The PF-CAT shows strong correlation with legacy patient-reported outcome scores among patients presenting to a tertiary care hip preservation center. The PIF-CAT also correlates strongly with legacy and PROMIS measures evaluating physical and mental well-being. PROMIS measures are less burdensome and demonstrate no floor or ceiling effects, making them a potential alternative to legacy patient-reported outcome measures for the hip.

Role of Hip Injury and Giving Way in Pain Exacerbation in Hip Osteoarthritis: An Internet-Based Case-Crossover Study.

OBJECTIVE: To evaluate the association between hip injury/giving way and hip pain exacerbations in patients with symptomatic hip osteoarthritis (OA). METHODS: We conducted an internet-based case-crossover study to assess hip injury and giving way for hip pain exacerbation. Eligible participants with symptomatic hip OA were followed up for 90 days and asked to complete online questionnaires at baseline and 10-day intervals (control periods). They also logged on to the study web site to complete questionnaires for an episode of a hip pain exacerbation (case periods) defined as an increase of 2 points in pain intensity compared with the baseline rating on a numeric rating scale (range 0-10). The relationship of hip injury and giving way to the risk of pain exacerbation was examined using conditional logistic regression. RESULTS: Of 252 patients recruited into the study, we included 133 patients (53%) who provided data from both case and control periods. Hip injury during the last 7 days increased the risk of hip pain exacerbation (odds ratio [OR] 2.74 [95% confidence interval (95% CI) 1.62-4.62]). The hip giving way during the last 2 days was associated with an increased risk of hip pain exacerbation (OR 2.10 [95% CI 1.30-3.39]) and showed a significant relationship between the number of hip giving way events and the risk of hip pain exacerbations (P < 0.001). CONCLUSION: Hip injury and episodes of the hip giving way were significantly related to pain exacerbation in patients with symptomatic hip OA. Methods to prevent exposure to injury may help to reduce the burden of pain in patients with hip OA.

Imaging of the limping child.

Limping is a challenging symptom in the pediatric patient as the diagnosis can range from traumatic, malformative, infectious/inflammatory and neoplastic diseases. In this paper, we propose a schematic imaging algorithm to the limping child in three different age groups (Toddler: 1-3years, child: 4-10 years; adolescent: 11-16 years) based on presence of signs of infection, any specific localization of pain, and history of trauma. In this setting, the most common imaging pitfalls are also summarised. Finally, a literature review of the main differential causes of limping in the pediatric patient is reported.