Your browser doesn't support javascript.
loading
Mostrar: 20 | 50 | 100
Resultados 1 - 20 de 4.451
Filtrar
1.
Sports Med Arthrosc Rev ; 29(1): 22-27, 2021 Mar 01.
Artigo em Inglês | MEDLINE | ID: mdl-33395226

RESUMO

There has been an increased emphasis on capsular management during hip arthroscopy in the literature in recent years. The capsule plays a significant role in the hip joint stability and studies have demonstrated that capsular closure can restore the biomechanics of the hip back to the native state. Capsular management also affects functional outcomes with capsular repair resulting in better clinical outcomes in some studies. Management of the capsule has evolved in recent years with more surgeons performing routine capsular closure. Management techniques and degree of capsular closure, however, can be quite variable between surgeons. This review will discuss hip capsular anatomy, the importance of the capsule in hip biomechanics, management of the capsule during arthroscopy, and functional outcomes as it relates to the various capsular closure techniques versus leaving the capsulotomy unrepaired.


Assuntos
Artroscopia/métodos , Articulação do Quadril/cirurgia , Cápsula Articular/cirurgia , Fenômenos Biomecânicos , Lesões do Quadril/fisiopatologia , Lesões do Quadril/cirurgia , Articulação do Quadril/anatomia & histologia , Articulação do Quadril/fisiopatologia , Humanos , Cápsula Articular/fisiopatologia , Artropatias/fisiopatologia , Artropatias/cirurgia , Amplitude de Movimento Articular
2.
Sports Med Arthrosc Rev ; 29(1): 28-34, 2021 Mar 01.
Artigo em Inglês | MEDLINE | ID: mdl-33395228

RESUMO

Femoral version is extremely variable between patients presenting with femoroacetabular impingement (FAI). Careful and routine measurement of femoral anteversion is essential in comprehensive preoperative planning. In general, low degrees of femoral version can lead to anterior impingement (especially on the subspine and distal medial femoral neck). High degrees of anteversion can be seen in the setting of acetabular dysplasia and can lead to anterior hip instability and or posterior impingement. In this article, the authors will discuss the role of routine femoral version management for optimal outcomes after hip arthroscopy for FAI.


Assuntos
Artroscopia/métodos , Impacto Femoroacetabular/fisiopatologia , Impacto Femoroacetabular/cirurgia , Fêmur/fisiopatologia , Articulação do Quadril/fisiopatologia , Impacto Femoroacetabular/diagnóstico por imagem , Fêmur/diagnóstico por imagem , Fêmur/cirurgia , Luxação do Quadril/diagnóstico por imagem , Luxação do Quadril/fisiopatologia , Luxação do Quadril/cirurgia , Articulação do Quadril/diagnóstico por imagem , Articulação do Quadril/cirurgia , Humanos , Instabilidade Articular/diagnóstico por imagem , Instabilidade Articular/fisiopatologia , Instabilidade Articular/cirurgia , Imagem por Ressonância Magnética , Exame Físico , Radiografia , Amplitude de Movimento Articular , Tomografia Computadorizada por Raios X
3.
Bone Joint J ; 102-B(11): 1505-1510, 2020 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-33135446

RESUMO

AIMS: The complex relationship between acetabular component position and spinopelvic mobility in patients following total hip arthroplasty (THA) renders it difficult to optimize acetabular component positioning. Mobility of the normal lumbar spine during postural changes results in alterations in pelvic tilt (PT) to maintain the sagittal balance in each posture and, as a consequence, markedly changes the functional component anteversion (FCA). This study aimed to investigate the in vivo association of lumbar degenerative disc disease (DDD) with the PT angle and with FCA during postural changes in THA patients. METHODS: A total of 50 patients with unilateral THA underwent CT imaging for radiological evaluation of presence and severity of lumbar DDD. In all, 18 patients with lumbar DDD were compared to 32 patients without lumbar DDD. In vivo PT and FCA, and the magnitudes of changes (ΔPT; ΔFCA) during supine, standing, swing-phase, and stance-phase positions were measured using a validated dual fluoroscopic imaging system. RESULTS: PT, FCA, ΔPT, and ΔFCA were significantly correlated with the severity of lumbar DDD. Patients with severe lumbar DDD showed marked differences in PT with changes in posture; there was an anterior tilt (-16.6° vs -12.3°, p = 0.047) in the supine position, but a posterior tilt in an upright posture (1.0° vs -3.6°, p = 0.005). A significant decrease in ΔFCA during stand-to-swing (8.6° vs 12.8°, p = 0.038) and stand-to-stance (7.3° vs 10.6°,p = 0.042) was observed in the severe lumbar DDD group. CONCLUSION: There were marked differences in the relationship between PT and posture in patients with severe lumbar DDD compared with healthy controls. Clinical decision-making should consider the relationship between PT and FCA in order to reduce the risk of impingement at large ranges of motion in THA patients with lumbar DDD. Cite this article: Bone Joint J 2020;102-B(11):1505-1510.


Assuntos
Artroplastia de Quadril , Articulação do Quadril/diagnóstico por imagem , Degeneração do Disco Intervertebral/diagnóstico por imagem , Vértebras Lombares/diagnóstico por imagem , Postura/fisiologia , Feminino , Articulação do Quadril/fisiopatologia , Articulação do Quadril/cirurgia , Humanos , Degeneração do Disco Intervertebral/fisiopatologia , Vértebras Lombares/fisiopatologia , Masculino , Pessoa de Meia-Idade , Amplitude de Movimento Articular , Tomografia Computadorizada por Raios X
4.
Rev. esp. cir. ortop. traumatol. (Ed. impr.) ; 64(4): 286-289, jul.-ago. 2020. ilus, tab
Artigo em Espanhol | IBECS | ID: ibc-197335

RESUMO

INTRODUCCIÓN: La osteoporosis transitoria de cadera (OTC) es una enfermedad poco frecuente y de patogenia desconocida que ha sido considerada tradicionalmente una fase precoz y reversible de la necrosis avascular (NA). La trombofilia o la hipofibrinólisis familiar se considera un factor de riesgo para el desarrollo de NA y OTC. Dentro de los trastornos heredados de hipercoagulabilidad, el factor V de Leiden es uno de los más prevalentes. Casos clínicos: Estudio tipo serie de casos. Se describen el desarrollo y la evolución de 3 casos de OTC en 3 hermanos (2 varones y una mujer) con edades comprendidas entre los 40 y 43 años de forma consecutiva. El estudio clínico y de imagen con resonancia magnética nuclear (RM) confirmó el diagnóstico de OTC y descartó la presencia de NA. La mutación G1691A para el factor V de Leiden fue positiva en todos los casos. La evolución clínica y radiológica fue favorable, con curación sin secuelas y desaparición del edema óseo en la RM de control a los 6 meses en todos los casos. DISCUSIÓN: Los resultados del presente estudio apoyan la etiología isquémica y establecen a la OTC como una fase precoz y reversible de la NA de cadera. El factor V de Leiden promueve un estado de hipercoagulabilidad e hipofibrinólisis que favorece el desarrollo de la OTC por causa isquémica. CONCLUSIONES: El presente estudio desarrolla la primera descripción familiar de la OTC ligada al factor V de Leiden


INTRODUCTION: Transient osteoporosis of the hip (THO) is a rare disease of unknown pathogenesis that has traditionally been considered an early and reversible stage of avascular necrosis (AN). Thrombophilia or familial hypofibrinolysis is considered a risk factor for the development of AN and THO. Factor V Leiden is one of the most common hereditary hypercoagulability disorders. Clinical cases: Case series study. The development and course of 3 THO cases in 3 siblings (two males and one female) aged between 40 and 43 years are described consecutively. Clinical and nuclear magnetic resonance imaging (MRI) studies confirmed the diagnosis of THO and ruled out the presence of AN. The G1691A mutation of factor V Leiden was positive in all cases. The clinical and radiological outcome was favourable, with healing without sequelae and disappearance of bone oedema on control MRI at 6 months in all cases. DISCUSSION: The results of this study support the ischaemic aetiology and establish HTO as an early and reversable stage of hip AN. Factor V Leiden causes a state of hypercoagulability and hypofibrinolysis that encourages the development of THO due to ischaemic causes. CONCLUSIONS: This study outlines the first familiar description of factor V Leiden-linked THO


Assuntos
Humanos , Masculino , Feminino , Adulto , Osteoporose/genética , Transtornos Herdados da Coagulação Sanguínea/diagnóstico , Trombofilia/genética , Articulação do Quadril/fisiopatologia , Fator V/genética , Mutação/genética , Doenças Genéticas Inatas/diagnóstico , Osteonecrose/prevenção & controle
5.
Clin J Sport Med ; 30(4): 341-347, 2020 07.
Artigo em Inglês | MEDLINE | ID: mdl-32639441

RESUMO

OBJECTIVE: To compare hip joint effusion-synovitis prevalence in professional ballet dancers with nondancing athletes and to evaluate the relationship between effusion-synovitis and clinical measures and cartilage defects. DESIGN: Case-control study. SETTING: Elite ballet and sport. PARTICIPANTS: Forty-nine professional ballet dancers and 49 age-matched and sex-matched athletes. INDEPENDENT VARIABLES: Group (dancers/athletes), sex, age, years of training, Copenhagen Hip and Groin Outcome Scores (HAGOSs), hip rotation range of motion (ROM), generalized joint hypermobility (GJH), and hip cartilage defect scores. MAIN OUTCOME MEASURES: Hip joint effusion-synovitis (absent, grade 1 = 2-4 mm, grade 2 = >4 mm) scored with 3-Tesla magnetic resonance imaging. RESULTS: Hip joint effusion-synovitis was found in 22 (45%) dancers and 13 (26.5%) athletes (P = 0.06). Grade 2 effusion-synovitis was only found in dancers (n = 8, r = 0.31, P = 0.009). The prevalence of effusion-synovitis was similar in men (n = 11, 26%) and women (n = 24, 43%, P = 0.09). Female dancers with effusion-synovitis had lower HAGOS pain (r = 0.63, P = 0.001) and sports/recreation scores (r = 0.66, P = 0.001) compared with those without effusion-synovitis. The HAGOS scores were not related to effusion-synovitis in male dancers or female and male athletes (P > 0.01 for all). Effusion-synovitis was not related to hip ROM, GJH, or cartilage defect scores (P > 0.05 for all). CONCLUSIONS: Hip joint effusion-synovitis was related to higher levels of pain and lower sports/recreation function in female ballet dancers. Effusion-synovitis was not related to hip rotation ROM, GJH or cartilage defects. Larger sized joint effusion-synovitis was exclusively found in dancers.


Assuntos
Artralgia/fisiopatologia , Dança/lesões , Articulação do Quadril/fisiopatologia , Sinovite/fisiopatologia , Adulto , Artralgia/diagnóstico por imagem , Artralgia/epidemiologia , Líquidos Corporais/fisiologia , Cartilagem Articular/diagnóstico por imagem , Cartilagem Articular/fisiopatologia , Estudos de Casos e Controles , Feminino , Articulação do Quadril/diagnóstico por imagem , Humanos , Imagem por Ressonância Magnética , Masculino , Pessoa de Meia-Idade , Prevalência , Amplitude de Movimento Articular , Rotação , Sinovite/diagnóstico por imagem , Sinovite/epidemiologia
6.
Medicine (Baltimore) ; 99(28): e20906, 2020 Jul 10.
Artigo em Inglês | MEDLINE | ID: mdl-32664083

RESUMO

Osteoporosis (OP) is a metabolic bone disease that can cause structural changes in bone marrow cavity. Bone marrow is the hematopoietic organ of adults. Accumulating evidence has shown a close connection between bone marrow hematopoietic function and bone formation. Some studies have revealed that OP is associated with hematopoiesis. However, the relationship is not definite.This study aimed to evaluate the association between peripheral blood cell counts (white blood cells [WBC], red blood cells [RBC], platelets [PLT]), hemoglobin [HGB], and bone mineral density [BMD]) in a sample of Chinese postmenopausal women. This is a retrospective study involving 673 postmenopausal women cases. The BMD of lumbar spine and left hip joint were measured by dual-energy X-ray absorptiometry. The levels of blood cell counts and HGB were measured and analyzed.The study results showed the WBC, RBC, PLT, and HGB levels of postmenopausal women in the OP group were all higher than those in the non-osteoporosis group. Spearman linear trend analysis and partial correlation analysis demonstrated that BMD was negatively correlated with WBC, RBC, PLT, and HGB in postmenopausal women.Due to the differences between different countries and races, and there are few studies on the association of BMD with peripheral blood cell counts and HGB in Chinese Postmenopausal Women. Therefore, more large sample studies are needed.


Assuntos
Grupo com Ancestrais do Continente Asiático/etnologia , Contagem de Células Sanguíneas/métodos , Densidade Óssea/fisiologia , Hemoglobinas/análise , Pós-Menopausa/sangue , Absorciometria de Fóton/métodos , Idoso , Contagem de Células Sanguíneas/tendências , Doenças Ósseas Metabólicas/diagnóstico , Doenças Ósseas Metabólicas/epidemiologia , Doenças Ósseas Metabólicas/fisiopatologia , Estudos de Casos e Controles , Feminino , Hematopoese/fisiologia , Articulação do Quadril/diagnóstico por imagem , Articulação do Quadril/fisiopatologia , Humanos , Vértebras Lombares/diagnóstico por imagem , Vértebras Lombares/fisiopatologia , Pessoa de Meia-Idade , Osteogênese/fisiologia , Osteoporose/diagnóstico , Osteoporose/epidemiologia , Osteoporose/fisiopatologia , Estudos Retrospectivos
7.
PLoS One ; 15(6): e0233035, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32574168

RESUMO

BACKGROUND: Modular stems are widely used in revision total hip arthroplasty (THA) with aseptic loosening being a common reason for revision. Despite the good results reported on the use of modular stem designs, there are only few studies focusing on aseptic revisions and few studies on a hexagonal stem design. The goal of this study is to determine stem survival, clinical and functional outcome along with possible risk factors for implant failure in aseptic revision THA. METHODS: We retrospectively identified 53 patients with aseptic THA revision using a modular hexagonal stem with a minimum follow-up of two years. Femoral bone loss, radiographic and clinical outcomes as well as function measured using the Harris Hip Score (HHS) was assessed. Patients' previous medical history was analyzed for comorbidities and the body mass index. Stem survival was calculated using the Kaplan-Meier method. Possible risk factors for implant failure were analyzed using the log-rank test. The median age at revision was 69 (IQR 62-73) with a median follow up of 74 months. RESULTS: Implant survival rates amounted to 90.4% at 3 and 5 years. The median HHS improved by 47 points (34 (IQR 22-47) vs 81 (IQR 59-90) p<0.001). There was a reduced implant survival after 5 years when the revision stem was used following a previous cemented stem (83.4% vs 100%, p = 0.04). CONCLUSION: A modular, hexagonal stem can be successfully used in aseptic revision THA with remarkable functional results and excellent survivorship. Revision of a cemented stem using this implant might result in reduced survival which must be considered when planning treatment.


Assuntos
Artroplastia de Quadril/efeitos adversos , Artroplastia de Quadril/métodos , Desenho de Prótese/instrumentação , Idoso , Feminino , Fêmur/cirurgia , Articulação do Quadril/fisiopatologia , Articulação do Quadril/cirurgia , Prótese de Quadril/efeitos adversos , Humanos , Estimativa de Kaplan-Meier , Masculino , Pessoa de Meia-Idade , Falha de Prótese , Reoperação/métodos , Estudos Retrospectivos , Fatores de Risco , Resultado do Tratamento
8.
Medicine (Baltimore) ; 99(19): e20019, 2020 May.
Artigo em Inglês | MEDLINE | ID: mdl-32384461

RESUMO

This study aimed to assess the efficacy of needle-knife (NK) combined with etanercept (NKCE) in attenuating pain, inflammation, disease activity, and improving hip joint function in ankylosing spondylitis (AS) patients with hip joint involvement.Totally, 90 patients with active AS involving unilateral hip joint were enrolled and randomly assigned in 1:1:1 ratio to receive NKCE, NK or conventional drugs (control). The ESR, CRP, hip joint pain Visual Analogue Scale (VAS) score, bath ankylosing spondylitis disease activity index (BASDAI), bath ankylosing spondylitis functional index (BASFI), modified Harris hip score (mHHS), and range of motion (ROM) of affected hip joint were assessed at baseline (W0), after 1-week treatment (W1) and after 24-week treatment (W24).ESR and CRP were decreased in NKCE group compared with NK and control groups, while was not attenuated in NK group compared with control group. Regrading pain and disease activity, NKCE group presented a reduction in hip pain VAS score and BASDAI compared with NK and control groups, and NK group showed a decrease in hip pain VAS score and BASDAI compared with control group. Besides, BASFI was lowered in NKCE and NK groups compared with control group, but similar between NKCE and NK groups. mHHS and hip ROM were raised in NKCE and NK groups compared with control group, but similar between NKCE and NK groups.NKCE decreases hip pain, inflammation, disease activity and improves hip joint function in AS patients with hip joint involvement.


Assuntos
Terapia por Acupuntura/métodos , Artralgia , Etanercepte/administração & dosagem , Articulação do Quadril , Espondilite Anquilosante , Adolescente , Adulto , Antirreumáticos/administração & dosagem , Artralgia/diagnóstico , Artralgia/etiologia , Artralgia/terapia , Feminino , Articulação do Quadril/patologia , Articulação do Quadril/fisiopatologia , Humanos , Masculino , Manejo da Dor/métodos , Medição da Dor/métodos , Gravidade do Paciente , Amplitude de Movimento Articular , Recuperação de Função Fisiológica , Espondilite Anquilosante/diagnóstico , Espondilite Anquilosante/fisiopatologia , Espondilite Anquilosante/terapia , Resultado do Tratamento
9.
Sports Health ; 12(4): 361-372, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32392094

RESUMO

BACKGROUND: The effect of preoperative hip strength on outcomes after hip arthroscopy for femoroacetabular impingement syndrome (FAIS) is unclear. The purpose of this study was to determine whether preoperative isometric hip strength is associated with outcome scores at 6 months as well as achieving the minimal clinically important difference (MCID) and patient acceptable symptomatic state (PASS) in patients undergoing hip arthroscopy for FAIS. HYPOTHESIS: Increased preoperative isometric strength will be correlated with short-term postoperative outcomes and will be predictive of achieving higher functional status. STUDY DESIGN: Case series. LEVEL OF EVIDENCE: Level 4. METHODS: Data from 92 consecutive patients undergoing primary hip arthroscopy for treatment of FAIS from March through August 2018 were analyzed. All patients included in the analysis had preoperative measures of isometric hip strength on both affected and unaffected limbs, as well as preoperative and 6-month patient-reported outcome (PRO) scores. Analysis was performed to determine correlations between normalized isometric hip strength measurements and PROs and whether strength measurements were predictive of achieving MCID or PASS. RESULTS: A total of 74 (80.4%) patients had 6-month PROs and were included in the final analysis. Hip extension strength on both sides was correlated with all postoperative PROs (all P > 0.05). Abduction strength on both sides was correlated with postoperative Hip Outcome Score-Activities of Daily Living subscale score, achieving MCID on at least 1 score threshold, and reaching the international Hip Outcome Tool-12 threshold score for achieving PASS (all P < 0.05). Regression analysis showed that extension strength on the affected side was the only strength measurement predictor of achieving PASS (1.043; P = 0.049). CONCLUSION: Preoperative isometric hip extension and abduction strength are correlated with 6-month postoperative PRO scores. Furthermore, hip extension strength is a predictor of achieving clinically meaningful outcomes. CLINICAL RELEVANCE: This study highlights the possible importance of preoperative optimization of hip function to maximize outcomes in patients undergoing hip arthroscopy for FAIS.


Assuntos
Artroscopia , Impacto Femoroacetabular/fisiopatologia , Impacto Femoroacetabular/cirurgia , Articulação do Quadril/fisiopatologia , Força Muscular/fisiologia , Período Pré-Operatório , Adulto , Artroscopia/reabilitação , Feminino , Humanos , Contração Isométrica/fisiologia , Masculino , Diferença Mínima Clinicamente Importante , Medidas de Resultados Relatados pelo Paciente , Análise de Regressão , Fatores Sexuais
10.
J Orthop Res ; 38(7): 1550-1558, 2020 07.
Artigo em Inglês | MEDLINE | ID: mdl-32401407

RESUMO

Previous studies have established that up to 1 year post total hip arthroplasty (THA), patients do not recover normal function and the magnitude of hip joint loading remains reduced compared to healthy individuals. However, the temporal nature of the loading profile has not been considered to identify individuals who are at a greater risk of poor functional outcomes following THA. This study aimed to determine changes to the profile and magnitude of the resultant hip joint reaction force before and up to 6 months post-primary THA, and factors associated with atypical loading profiles. Hip joint loading was computed using a personalized lower-limb musculoskeletal model in 43 participants awaiting primary THA for osteoarthritis (mean age: SD = 65, 14 years; body mass index: SD = 30, 5 kg/m2 ) before and up to 6 months after THA. Atypical, single-peak loading profiles were observed for 11 patients before surgery, where four showed a single peak at 6 months. Patients displaying a single-peak profile walked slower (mean difference: -0.4 m/s) compared to individuals displaying double-peak profile (P = <.001) and had significantly reduced sagittal plane hip range of motion during gait (mean difference -9.6°, P = <.001). Self-reported pain, function, and stiffness did not differentiate between patients with a single or double-peak loading profile. Individuals with a single-peak force profile did not meet the minimal clinically important hip range of motion during gait and would be classified as low-functioning THA patients. Clinical Relevance: The temporal nature of the force profile may help to identify individuals who are at the greatest risk of poor functional outcomes after THA.


Assuntos
Artroplastia de Quadril , Articulação do Quadril/fisiopatologia , Osteoartrite do Quadril/fisiopatologia , Modelagem Computacional Específica para o Paciente , Idoso , Idoso de 80 Anos ou mais , Feminino , Análise da Marcha , Humanos , Estudos Longitudinais , Masculino , Pessoa de Meia-Idade , Osteoartrite do Quadril/cirurgia , Medidas de Resultados Relatados pelo Paciente , Estudos Prospectivos , Suporte de Carga
11.
PLoS One ; 15(4): e0232064, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32330162

RESUMO

Clinical gait analysis is widely used in clinical routine to assess the function of patients with motor disorders. The proper assessment of the patient's function relies greatly on the repeatability between the measurements. Marker misplacement has been reported as the largest source of variability between measurements and its impact on kinematics is not fully understood. Thus, the purpose of this study was: 1) to evaluate the impact of the misplacement of the lateral femoral epicondyle marker on lower limb kinematics, and 2) evaluate if such impact can be predicted. The kinematic data of 10 children with cerebral palsy and 10 aged-match typical developing children were included. The lateral femoral epicondyle marker was virtually misplaced around its measured position at different magnitudes and directions. The outcome to represent the impact of each marker misplacement on the lower limb was the root mean square deviations between the resultant kinematics from each simulated misplacement and the originally calculated kinematics. Correlation and regression equations were estimated between the root mean square deviation and the magnitude of the misplacement expressed in percentage of leg length. Results indicated that the lower-limb kinematics is highly sensitive to the lateral femoral epicondyle marker misplacement in the anterior-posterior direction. The joint angles most impacted by the anterior-posterior misplacement were the hip internal-external rotation (5.3° per 10 mm), the ankle internal-external rotation (4.4° per 10 mm) and the knee flexion-extension (4.2° per 10 mm). Finally, it was observed that the lower the leg length, the higher the impact of misplacement on kinematics. This impact was predicted by regression equations using the magnitude of misplacement expressed in percentage of leg length. An error below 5° on all joints requires a marker placement repeatability under 1.2% of the leg length. In conclusion, the placement of the lateral femoral epicondyle marker in the antero-posterior direction plays a crucial role on the reliability of gait measurements with the Conventional Gait Model.


Assuntos
Fenômenos Biomecânicos/fisiologia , Análise da Marcha/métodos , Joelho/fisiopatologia , Adolescente , Algoritmos , Articulação do Tornozelo/fisiopatologia , Paralisia Cerebral/fisiopatologia , Criança , Feminino , Fêmur/fisiopatologia , Marcha/fisiologia , Articulação do Quadril/fisiopatologia , Humanos , Articulação do Joelho/fisiopatologia , Extremidade Inferior/fisiopatologia , Masculino , Amplitude de Movimento Articular/fisiologia , Reprodutibilidade dos Testes
12.
Bone Joint J ; 102-B(3): 394-399, 2020 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-32114812

RESUMO

AIMS: A lack of supporting clinical studies have been published to determine the ideal length of intramedullary nail in fixation of trochanteric fractures of the hip. Nevertheless, there has been a trend to use shorter intramedullary nails for the internal fixation of trochanteric hip fractures. Our aim was to determine if the length of nail affected the outcome. METHODS: We randomized 229 patients with a trochanteric hip fracture between two implants: a 'standard' nail of 220 mm and a shorter nail of 175 mm, which had decreased proximal angulation (4° vs 7°) and a reduced diameter at the level of the lesser trochanter. Patients were followed up for one year by a nurse blinded to the type of implant used to determine if there were differences in mobility and pain with two nail designs. Pain was assessed on a scale of 1 (none) to 8 (severe and constant) and mobility on a scale of 1 (full mobility) to 9 (immobile). RESULTS: The shorter nail did not require any reaming of the femur and was quicker to insert (mean difference 5.1 minutes; p < 0.001, 95% confidence interval (CI) of the difference 3.16 to 7.04). Those treated by the shorter nail were less mobile (mean difference in reduction in mobility score at one year 0.80; p = 0.007, 95% CI 1.38 to 0.22). In addition, there was a trend toward greater residual pain for those treated with the shorter nail, although this was not statistically significant (mean difference in pain score at one year 0.24; p = 0.064, 95% CI -0.01 to 0.49). CONCLUSION: These results suggest that the increasing use of this very short intramedullary nail with its design modification may not be appropriate. Cite this article: Bone Joint J 2020;102-B(3):394-399.


Assuntos
Pinos Ortopédicos , Fixação Intramedular de Fraturas/métodos , Fraturas do Quadril/cirurgia , Articulação do Quadril/cirurgia , Adulto , Idoso , Idoso de 80 Anos ou mais , Feminino , Seguimentos , Fraturas do Quadril/diagnóstico , Fraturas do Quadril/fisiopatologia , Articulação do Quadril/diagnóstico por imagem , Articulação do Quadril/fisiopatologia , Humanos , Masculino , Pessoa de Meia-Idade , Desenho de Prótese , Radiografia , Amplitude de Movimento Articular , Resultado do Tratamento
13.
Phys Ther Sport ; 43: 127-133, 2020 May.
Artigo em Inglês | MEDLINE | ID: mdl-32146433

RESUMO

OBJECTIVES: To compare ankle, knee and hip isometric peak torque between young and middle-aged adults with CAI, copers and un-injured controls. DESIGN: Cross-sectional. SETTING: Research Laboratory. PARTICIPANTS: One hundred fifty-six young and middle-aged adults with or without CAI volunteered. MAIN OUTCOME MEASURES: A handheld dynamometer measured isometric dorsiflexion, plantarflexion, knee extension, hip extension and hip abduction peak force during a 5 s trial. Average peak torque was calculated and normalized to body mass. RESULTS: A significant Age by Injury interaction for dorsiflexion suggest middle-aged un-injured controls (p < 0.001) and copers (p < 0.001) had lower isometric peak torque compared to their young adult counterparts, but there were no differences between young and middle-aged adults with CAI (p > 0.05). Significant Injury main effects suggest the CAI group had decreased plantarflexion (p = 0.004) and hip extension (p = 0.010) strength compared to un-injured controls, but not copers (p > 0.05). Significant Age main effects for all primary outcome measures were observed, indicating peak torque decreased with age (p < 0.05). CONCLUSIONS: Regardless of age, isometric ankle and hip peak torque was lower in participants with CAI compared to un-injured controls, but not copers. These findings provide further evidence towards the impact of CAI in both young and middle-aged adults.


Assuntos
Adaptação Psicológica , Articulação do Tornozelo/fisiopatologia , Articulação do Quadril/fisiopatologia , Contração Isométrica/fisiologia , Instabilidade Articular/fisiopatologia , Adolescente , Adulto , Idoso , Doença Crônica , Estudos Transversais , Feminino , Humanos , Instabilidade Articular/psicologia , Masculino , Pessoa de Meia-Idade , Dinamômetro de Força Muscular , Adulto Jovem
14.
Bull Hosp Jt Dis (2013) ; 78(1): 12-16, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32144958

RESUMO

Much attention has recently been focused on the relationship between the hip and spine and its contribution to postoperative instability following total hip arthroplasty. However, the terminology can be confusing. Through an understanding of spinopelvic parameters, spinopelvic motion, and the interplay between the spine and pelvis, the surgeon can plan for and decrease the risk of instability after total hip arthroplasty. This review details spinopelvic parameters that predispose to instability and guides readers in understanding spinopelvic motion as it relates to THA instability.


Assuntos
Acetábulo/fisiopatologia , Acetábulo/cirurgia , Artroplastia de Quadril , Articulação do Quadril/fisiopatologia , Pelve/fisiopatologia , Complicações Pós-Operatórias/prevenção & controle , Coluna Vertebral/fisiopatologia , Humanos , Luxações Articulares/fisiopatologia , Luxações Articulares/prevenção & controle , Instabilidade Articular/fisiopatologia , Instabilidade Articular/prevenção & controle , Complicações Pós-Operatórias/fisiopatologia , Amplitude de Movimento Articular/fisiologia
15.
Hum Mov Sci ; 70: 102593, 2020 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-32217211

RESUMO

INTRODUCTION: Flat feet in children negatively affect lower limb alignment and cause adverse health-related problems. The long-term application of foot orthoses (FOs) may have the potential to improve lower limb coordination and its variability. AIM: To evaluate the effects of long-term use of arch support FOs on inter-joint coordination and coordination variability in children with flexible flat feet. METHODS: Thirty boys with flexible flat feet were randomly assigned to the experimental (EG) and control groups. The EG used medial arch support FOs during daily activities over a four-month period while the control group received a flat 2-mm-thick insole for the same time period. Lower-limb coordination and variability during the 3 sub-stance phases were quantified using a vector coding technique. RESULTS: Frontal plane ankle-hip coordination in EG during mid-stance changed to an anti-phase pattern (156.9°) in the post-test compared to an in-phase (221.1°) in the pre-test of EG and post-test of CG (222.7). Frontal plane knee-hip coordination in EG during loading response (LR) changed to an anti-phase pattern (116°) in the post-test compared to an in-phase (35.5°) in the pre-test of EG and post-test of CG (35.3). Ankle inversion/eversion-knee internal/external rotation joint coupling angle in EG changed to an in-phase pattern (59°) in the post-test compared to a proximal phase (89°) in the pre-test. Coupling angle variability increased in the post-test of EG for sagittal plane ankle-hip during push-off, transverse plane ankle-hip during LR and mid-stance, and transverse plane knee-hip during LR and mid-stance compared to pre-test of EG and post-test of CG. CONCLUSION: The long-term use of arch support FOs proved to be effective to alter lower limb coordination and coordination variability during walking in children with flexible flat feet. This new insight into coordinative function may be useful for improving corrective exercise strategies planned for children with flat feet.


Assuntos
Pé Chato/fisiopatologia , Pé Chato/terapia , Deformidades do Pé/fisiopatologia , Deformidades do Pé/reabilitação , Órtoses do Pé , Articulações/fisiopatologia , Extremidade Inferior/fisiopatologia , Articulação do Tornozelo/fisiopatologia , Fenômenos Biomecânicos , Criança , Marcha , Articulação do Quadril/fisiopatologia , Humanos , Masculino , Pronação , Resultado do Tratamento
16.
Scand J Med Sci Sports ; 30(7): 1221-1231, 2020 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-32201993

RESUMO

BACKGROUND: Conflicting and limited high-quality prospective data are available on the associations between cam morphology and hip and groin symptoms and range of motion (ROM). OBJECTIVES: This cross-sectional cohort study investigated associations between cam morphology presence, size and duration and symptoms and ROM. METHODS: Academy male football players (n = 49, 17-24 years) were included. Standardized antero-posterior pelvic and frog-leg lateral radiographs were obtained at baseline, 2.5- and 5-year follow-up. The femoral head-neck junction was quantified by: Visual score. Cam morphology (flattening or prominence), large cam (prominence). Alpha angle. Cam morphology (≥60°), large cam (≥78°). Cam morphology duration was defined as long (first present at baseline) or short (only from 2.5- to 5-year follow-up). Current symptoms at 5-year follow-up were assessed using a hip and groin pain question and by the "Hip and Groin Outcome Score" (HAGOS). HAGOS scores were categorized into: most symptoms (≥2 domains in lowest interquartile range [IQR]), least symptoms (≥2 domains in highest IQR). Hip ROM was measured by goniometry at 5-year follow-up. RESULTS: Large cam morphology based on visual score was associated with hip and groin pain (23.8% vs. 7.1%, OR: 3.17, CI: [1.15-8.70], P = .026), but not with HAGOS scores. Cam morphology presence, size, and duration were associated with limited flexion of around 6° and/or 3° to 6° for internal rotation. CONCLUSION: Cam morphology presence, size, and duration were associated with limited hip flexion and/or internal rotation, but differences might not exceed the minimal clinical important difference. Whether cam morphology results in symptoms is uncertain.


Assuntos
Virilha/fisiopatologia , Articulação do Quadril/diagnóstico por imagem , Articulação do Quadril/fisiopatologia , Dor Musculoesquelética/diagnóstico por imagem , Dor Musculoesquelética/fisiopatologia , Futebol , Adolescente , Adulto , Atletas , Humanos , Masculino , Medição da Dor , Amplitude de Movimento Articular , Inquéritos e Questionários , Adulto Jovem
17.
Value Health ; 23(3): 379-387, 2020 03.
Artigo em Inglês | MEDLINE | ID: mdl-32197734

RESUMO

OBJECTIVES: To map the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) onto the EQ-5D-5L in patients with hip or knee osteoarthritis (OA). METHODS: A prospective observational study was conducted on 758 patients with hip or knee OA who completed the EQ-5D-5L and WOMAC questionnaires, of whom 644 completed them both again 6 months later. Baseline data were used to derive mapping functions. Generalized additive models were used to identify to which powers the WOMAC subscales should be raised to achieve a linear relationship with the response. For the modeling, general linear models (GLM), Tobit models, and beta regression models were used. Age, sex, and affected joints were also considered. Preferred models were selected based on Akaike and Bayesian information criteria, adjusted R2, mean absolute error (MAE), and root mean squared error (RMSE). The functions were validated with the follow-up data using MAE, RMSE, and the intraclass correlation coefficient. RESULTS: The preferred models were a GLM with Pain2+Pain3+Function+Pain·Function as covariates and a beta model with Pain3+Function+Function2+Function3 as covariates. The adjusted R2 were similar (0.6190 and 0.6136, respectively). The predictive performance of these models in the validation sample was similar and both models showed an overprediction for health states worse than death. CONCLUSION: To our knowledge, these are the first functions mapping the WOMAC onto the EQ-5D-5L in patients with hip or knee OA. They showed an acceptable fit and precision and could be very useful for clinicians and researchers when cost-effectiveness studies are needed and generic preference-based health-related quality of life instruments to derive utilities are not available.


Assuntos
Artralgia/diagnóstico , Avaliação da Deficiência , Osteoartrite do Quadril/diagnóstico , Osteoartrite do Joelho/diagnóstico , Medição da Dor , Anos de Vida Ajustados por Qualidade de Vida , Idoso , Idoso de 80 Anos ou mais , Artralgia/fisiopatologia , Feminino , Articulação do Quadril/fisiopatologia , Humanos , Articulação do Joelho/fisiopatologia , Masculino , Pessoa de Meia-Idade , Osteoartrite do Quadril/fisiopatologia , Osteoartrite do Quadril/psicologia , Osteoartrite do Joelho/fisiopatologia , Osteoartrite do Joelho/psicologia , Valor Preditivo dos Testes , Estudos Prospectivos , Qualidade de Vida , Reprodutibilidade dos Testes , Fatores de Tempo
18.
Gait Posture ; 77: 276-282, 2020 03.
Artigo em Inglês | MEDLINE | ID: mdl-32097887

RESUMO

BACKGROUD: Femoral offset (FO) and limb length discrepancy (LLD) are important perioperative considerations when performing THA. Decreased FO prevents improvement of gait and muscle recovery and residual LLD has a prominent influence on patient satisfaction with THA, while few studies have investigated the relationship between FO and/or LLD and gait disturbances. We investigated the association between these two factors and hip muscle strength and the results of 3-D gait analysis after THA. METHODS: We evaluated 92 patients (including 20 patients who underwent gait analysis) in whom total hip arthroplasty was performed for unilateral evere osteoarthritis of the hip joint. FO and LLD were measured on a standard anteroposterior radiograph of the pelvis. Hip muscle strength was evaluated by isometric hip flexion (in the manner of straight leg raising test: SLR) and hip abduction strength. To evaluate 3-D walking trajectory, we used a portable gait analyzer. RESULTS: Reduction of global FO by > 5 mm after THA compared to the contralateral hip was associated with hip abductor muscle weakness. On the other hand, LLD ≤ 20 mm had no influence on hip abductor muscle strength and SLR strength. In gait analysis, SLR strength showed a significant difference between the sagittal plane symmetrical and asymmetrical groups. CONCLUSION: Postoperative global FO > 5 mm less than that of the contralateral hip was associated with hip abductor muscle weakness. And, from the results of 3-D gait analysis, SLR weakness may increase gait asymmetry in the sagittal plane.


Assuntos
Artroplastia de Quadril , Fêmur/fisiopatologia , Marcha/fisiologia , Articulação do Quadril/fisiopatologia , Desigualdade de Membros Inferiores/fisiopatologia , Força Muscular/fisiologia , Complicações Pós-Operatórias/fisiopatologia , Idoso , Idoso de 80 Anos ou mais , Feminino , Fêmur/cirurgia , Seguimentos , Articulação do Quadril/cirurgia , Humanos , Desigualdade de Membros Inferiores/etiologia , Masculino , Pessoa de Meia-Idade , Músculo Esquelético/fisiologia , Osteoartrite do Quadril/cirurgia
20.
Gait Posture ; 77: 175-181, 2020 03.
Artigo em Inglês | MEDLINE | ID: mdl-32044697

RESUMO

BACKGROUND: Suboptimal patient-reported function and movement impairments often persist after hip arthroscopy for femoroacetabular impingement syndrome (FAIS). Individuals with FAIS with preoperative cartilage pathology (ie. chondropathy) demonstrate distinct movement patterns and have worse post-operative outcomes. It is unknown whether the presence of chondropathy after surgery negatively affects movement and function. RESEARCH QUESTION: Do sagittal plane gait mechanics differ based on chondropathy severity following arthroscopy for FAIS? METHODS: A cross-sectional walking gait analysis was performed for 25 participants post-arthroscopy (2.48 ±â€¯1.38y) and 12 healthy controls (HCs). Peak total support moment (TSM) and relative contributions of the hip, knee, and ankle were calculated during loading response. The Hip Osteoarthritis MRI Scoring System was used to categorize the FAIS group into no-mild or moderate-severe chondropathy groups based on 3 T magnetic resonance imaging of their surgical hip. The interactions of group by limb were evaluated for kinetic variables, covaried by gait speed. RESULTS: Groups did not differ based on age, BMI and sex distribution (P ≥ 0.14). 13 participants with FAIS presented with moderate-severe chondropathy and 12 presented with no-mild chondropathy. Participants with moderate-severe chondropathy walked significantly slower than both other groups (P = 0.006) and demonstrated lower peak TSM than those with no-mild chondropathy (P = 0.002). Participants with no-mild chondropathy demonstrated lower hip (61.5 %) and greater ankle (17.7 %) contributions to the TSM on the involved limb compared to the moderate-severe group (hip:73.4 %, P = 0.07; ankle:10.5 %, P = 0.007). SIGNIFICANCE: Slower gait speed alone did not explain the lower TSM strategy in participants with moderate-severe chondropathy. Interestingly, the joint contribution strategy of this group was not different than HCs. Participants with no-mild chondropathy demonstrated a TSM strategy that shifted the demand away from their hip and toward their ankle. Given the small sample size, and large variability in joint strategies, future work needs to examine whether these alterations in gait strategy, with or without advanced chondropathy, impact patient function.


Assuntos
Artroscopia , Cartilagem Articular/patologia , Impacto Femoroacetabular/cirurgia , Marcha/fisiologia , Adolescente , Adulto , Fenômenos Biomecânicos , Cartilagem Articular/fisiopatologia , Estudos de Casos e Controles , Estudos Transversais , Feminino , Impacto Femoroacetabular/patologia , Impacto Femoroacetabular/fisiopatologia , Articulação do Quadril/patologia , Articulação do Quadril/fisiopatologia , Humanos , Masculino , Pessoa de Meia-Idade , Período Pós-Operatório , Índice de Gravidade de Doença , Resultado do Tratamento , Adulto Jovem
SELEÇÃO DE REFERÊNCIAS
DETALHE DA PESQUISA
...