Can a clinical assessment predict the functional status progression in patients with femoroacetabular impingement syndrome?

BACKGROUND: Femoroacetabular impingement syndrome (FAIS) is a hip joint motion-related clinical disorder with a triad of symptoms, clinical signs, and imaging findings. However, scientific evidence is still unclear regarding the best treatment for FAIS. OBJECTIVES: To assess the value of a physical therapy evaluation in predicting the progression of functional status over the subsequent years in patients with FAIS who are candidates for hip arthroscopy surgery. METHODS: In this case-series study, patients with FAIS, candidates for hip arthroscopy surgery, underwent a standard physical therapy evaluation. Baseline data were collected between 2013 and 2019. In 2020/2021, the patients' functional status was assessed through the International Hip Outcome Tool (iHOT-33). Functional status progression was calculated as the difference between the follow-up and baseline iHOT-33 scores. A multivariate forward stepwise regression analysis was conducted to explore the relationship between baseline characteristics and the functional status progression. RESULTS: From 353 patients who completed the baseline assessment, 145 completed the iHOT-33 follow-up. The mean (±SD) follow-up time was 58.7 (27.2) months (minimum 12 and maximum 103 months). The iHOT-33 scores increased 20.7 (21.8) points on average, ranging from -39.8 to 76.9 points. Among the 15 potential predictive factors assessed in this study, only baseline iHOT-33 score (ß -0.44; -0.061, -0.27), femoral version (ß 9.03; 1.36, 16.71), and body mass index (ß -0.99; -1.98, -0.01) had the ability to predict the functional status progression. CONCLUSION: Patients with a lower baseline iHOT-33 score, lower body mass index, and normal femoral version were more likely to increase their functional status after a minimum of one year of follow-up.

Hip muscle weakness and reduced joint range of motion in patients with femoroacetabular impingement syndrome: a case-control study.

BACKGROUND: Femoroacetabular impingement (FAI) syndrome is a hip joint motion-related clinical disorder characterized by abnormal contact between the hip joint structures. Abnormal hip morphology and joint pain may impair the hip joint range of motion (ROM) and muscle function. However, FAI effects on hip joint ROM and muscle strength remain controversial. OBJECTIVES: The purpose of this study was to compare hip joint ROM and muscle strength between FAI syndrome patients and healthy controls. METHODS: Twenty FAI syndrome male patients and 20 healthy male controls (CG) matched for age (FAI=28±6 years; CG=27±5 years), body mass (FAI=81±12kg; CG=80±13kg) and height (FAI=177±6cm; CG=178±6cm), participated in the study. Hip joint ROM for flexion, internal rotation and external rotation were assessed through goniometry. Maximal isometric strength for hip flexion, extension, abduction and adduction were evaluated through hand-held dynamometry. RESULTS: Hip joint ROM was significantly lower in FAI syndrome patients compared with CG for passive flexion (-4%; effect size - ES=0.65), active internal rotation (-42%; ES=1.60), active external rotation (-28%; ES=1.46) and passive external rotation (-23%; ES=1.63). FAI patients' hip extensors (-34%; ES=1.46), hip adductors (-33%; ES=1.32), and hip flexors (-25%; ES=1.17) were weaker compared to the CG subjects. CONCLUSIONS: FAI syndrome patients presented both hip muscle weakness and reduced joint ROM compared to match CG.

Ten to fifteen-year follow-up after total hip arthroplasty with a tapered cobalt-chromium femoral component (tri-lock) inserted without cement.

BACKGROUND: Fixation of the femoral component of a total hip arthroplasty without cement has had variable results. While tapered stems appear to have consistently good results, the duration of follow-up in many series has been relatively short. The purpose of this study was to present a longer-term (ten to fifteen-year) follow-up after total hip arthroplasty with insertion of a tapered femoral component without cement. METHODS: Sixty-seven total hip arthroplasties were performed with insertion of a tapered, cobalt-chromium femoral component without cement in fifty-eight patients from 1983 to 1986. Thirteen patients (fifteen hips) died prior to the fifteen-year follow-up examination, and three patients (three hips) were lost to follow-up after ten years, leaving forty-two patients (forty-nine hips) who were followed clinically for a mean of fifteen years. Thirty-seven of the forty-nine hips were followed radiographically for fifteen years, and the remaining twelve were followed for a minimum of ten years. RESULTS: The mean preoperative Charnley score was 3.0 points for pain, 2.7 points for function, and 3.2 points for motion. At the time of the final follow-up, the mean scores were 5.6, 5.6, and 5.2 points, respectively. Although no preoperative Harris hip scores were available, the mean score at the time of the latest follow-up was 92 points (range, 78 to 100 points). There were no revisions because of isolated aseptic loosening of the femoral component (although revision because of aseptic loosening of the acetabular component led to femoral component revision in seven hips). Two femoral components showed radiographic evidence of instability. At fifteen years, the prevalence of thigh pain was 2%. No femoral component that was thought to be stable, with bone ingrowth at two years, lost fixation. CONCLUSIONS: The design features of this cobalt-chromium femoral component (i.e., the collarless, tapered, wedge fit with circumferential porous coating) are thought to be crucial to the achievement of the good-to-excellent results seen in this study.

Hip arthroscopy: a unique inferomedial approach to bullet removal.

Most arthroscopic approaches allow for inspection of the lateral part of the hip joint, but visualization of the medial part is difficult. This article describes the removal of a bullet lodged in the right femoral head of a 33-year-old man. By using an inferomedial arthroscopic approach, we avoided a formal arthrotomy and the disadvantages of other arthroscopic approaches, which include the need for alternate portals, the need for traction, and the risk of both articular cartilage and acetabular labrum damage. The authors believe that this case demonstrates the effective use of the inferomedial arthroscopic approach as an alternative method for removing foreign bodies.

VALGUSING INTERTROCHANTERIC OSTEOTOMY FOR THE TREATMENT OF FEMORAL NECK NON-UNIONS: REPORT OF 32 CASES.

UNLABELLED: The purpose of the present study was to review the results of femoral neck non-unions treatment with valgusing intertrochanteric osteotomy. METHODS: Between 1988 and 2003 we treaded thirty two femoral neck non-unions with valgusing osteotomy and fixation. The mean follow-up time was 9.8 years and the mean age was 41.7 years. RESULTS: Twenty eight (87.4%) of the thirty two valgusing osteotomies evolved to femoral neck union, while four cases (12.6%) evolved to total hip arthroplasty. Eight cases evolved to partial osteonecrosis. CONCLUSIONS: The valgusing intertrochanteric osteotomy for treating femoral neck non-unions achieved consolidation in 87.4% (28/32). However, only 56.2% (18/32) achieved full recovery of hip function.

Relationship between surgical volume and early outcomes of total hip arthroplasty: do results continue to get better?

This retrospective study explored the relationship between the volume of total hip arthroplasties (THA) and postoperative mortality and early complications from a single institution. One thousand hip arthroplasties in 932 patients were identified during a 1-year period, which included 786 primary and 214 revision hip arthroplasties. The postoperative 6-month combined medical and orthopedic complication rate for primary and revision THA was 7.9% and 16.5%, respectively. The 6-month mortality rate for the overall group was 0.5% (5 deaths), for the primary hips was 0.4% (3 deaths), and for the revision hip was 0.9% (2 deaths). The mortality and complication rates of many surgical procedures, including joint arthroplasties, are inversely related to hospital and surgical volume. The reduction in complication rate, however, approaches a plateau and does not improve regardless of an increase in the surgical and hospital volume.

Complications associated with reimplantation after girdlestone arthroplasty.

Complications associated with reimplantation of a total hip arthroplasty after resection or Girdlestone arthroplasty for treatment of an infected hip are not well-documented. Forty-four hips in 44 patients with a minimum 2-year followup (range, 2-9 years) from the time of reimplantation total hip arthroplasty were evaluated retrospectively. The average Harris hip score changed from 40 preoperatively to 78 at the latest followup. One patient had persistent infection requiring rerevision surgery, and another patient had rerevision surgery for recurrent dislocation. Complications related to the prosthesis consisted of dislocations in five patients (11.4%), recurrent infection in one patient (2.3%), trochanteric nonunion in four patients (9.1%), hematoma in one patient, heterotopic ossification in one patient, and postoperative wound drainage in one patient. Resection arthroplasty of the hip is highly effective in eradicating infection. In the current series, 97.7% of patients were free of infection at the latest followup. However, with an 11.4% dislocation rate and 39% of patients having a persistent limp, alternative approaches need to be evaluated which might reduce these complications.

Osteotomia valgizante para pseudartrose do colo do fêmur: relato de 32 casos / Valgusing intertrochanteric osteotomy for the treatment of femoral neck non-unions: report of 32 cases

Objetivo: Avaliar a consolidação pós-osteotomia osteotomia valgizante do fêmur no tratamento do pseudartrose do colo femoral. Método: Durante 15 anos (1988-2003), 32 casos de pseudartrosedo colo do fêmur foram tratados com osteotomia valgizante e fixação. O seguimento médio dos casos foi de 9,8 anos e a média de idade dos pacientes foi de 41,7 anos. Resultados: Dos 32casos quatro evoluíram para prótese total do quadril e 28 evoluíram para consolidação (87,4%). Oito casos evoluíram necrose parcial. Conclusão: A osteotomia valgizante é altamente eficazpara obtenção da consolidação na pseudartrose do colo do fêmur 87,4% (28/32) A recuperação integral da função do quadril só foi obtida em 56,2% (18/32).

Purpose: The purpose of the present study was to review the results of femoral neck non-unions treatment with valgusing intertrochanteric osteotomy. Methods: Between 1988 and 2003 we treaded thirty two femoral neck non-unions with valgusing osteotomy and fixation. The mean follow-up time was 9.8 years and the mean age was 41.7 years. Results: Twenty eight (87.4%)of the thirty two valgusing osteotomies evolved to femoral neck union, while four cases (12.6%) evolved to total hip arthroplasty. Eight cases evolved to partial osteonecrosis. Conclusions: Thevalgusing intertrochanteric osteotomy for treating femoral neck non-unions achieved consolidation in 87.4% (28/32). However, only 56.2% (18/32) achieved full recovery of hip function.

Acetábulo rosqueado CO-10 revestido com hidroxiapatita: seguimento de sete a 13 anos em pacientes com idade superior a 64 anos / Hydroxyapatite-coated CO-10 type threaded acetabulum: seven to thirteen year follow-up in patients older than 64

Objetivo: Avaliar a fixação do acetábulo rosqueado CO10 em pacientes acima de 64 anos de idade nos quais a capacidade de osteointegração é diminuída. Métodos: Foram utilizados padrões radiográficos (densidade óssea, remodelação, linhas de radioluscência, desgaste do polietileno, inclinação acetabular, migração acetabular e osteólise) com acetábulo rosqueado CO-10 em 35 pacientes (44 quadris operados) em seguimento mínimo de 84 meses e máximo de 161 (média de 108 meses). Resultados: Os autores identificaram: aumento de densidade óssea em 68,3% dos casos, remodelação óssea em 22,7%, linhas de radioluscência em 45,4%, desgaste do polietileno em 97,7%, inclinação acetabular média de 44,6º, migração acetabular em 6,8% e osteólise em 50% dos casos. Conclusão: Em relação à estabilidade, o acetábulo CO-10 foi considerado como fixo em 93,2% dos casos.

Impacto femoroacetabular: uma das condições precursoras da osteoartrose do quadril / Femoroacetabular impingement: a harbinger condition of hip joint osteoarthrosis

A osteoartrose (OA) do quadril é classicamente dividida em dois tipos principais: primárias ou "idiopáticas" e secundárias. Os mecanismos responsáveis pela OA primária da articulação coxofemoral permaneceram desconhecidos por muitos anos. Trabalhos realizados pela equipe do Dr. Reinhold Ganz, em Berna, na Suiça, apontam evidências clínicas sugestivas de que o impacto femoroacetabular (IFA) seja fator etiológico de alterações degenerativas precoces que progridem para OA, sendo, dessa forma, responsáveis por grande parte daquelas outrora classificadas como idiopáticas. Por meio de extensa revisão de literatura, os autores apresentam a terminologia, os mecanismos, a anatomia patológica, os métodos diagnósticos e o tratamento da IFA. Salientam a existência de indícios que permitem, com tratamento precoce, evitar o desencadeamento ou desacelerar a progressão da OA do quadril.

Mielomeningocele / Myelomeningocele

Dentro do espectro de defeitos de fechamento do tubo neural, a mielomeningocele é a principal responsável pelas repercussöes do aparelho locomotor. Säo revisados conceitos fundamentais, métodos diagnóstico, medidas terapêuticas gerais e alguns fatores relacionados com o prognóstico, dentro do campo da ortopedia

Lombalgia / Low back pain

Dor lombar é um sintoma bastante comum que pode ter sua origem em vários tecidos adjacentes a coluna vertebral. O presente trabalho revisa alguns aspectos genéricos da história, exame físico, radiologia e tratamento desse problema. Caracteriza tambéem o síndrome lombar agudo e crônico e os diferentes diagnósticos que devem ser considerados.

Dor nos membros inferiores / Pain in the lower limbs

Os autores revisam as principais causas de dor nos membros inferiores enfocando os aspectos clínicos que contribuem para o diagnóstico diferencial entre os quadros oriundos dos sistemas músculos-esquelético, nervoso e vascular.

Antepé cavo congênito: correçäo cirúrgica segundo a técnica de Rosman: relato de case / Congenital cavus forefoot: surgical correction according the Rosman Technique: report of caso

Os autores apresentam um caso de antepé cavo congênito provocado por sinostose entre o quarto e quinto metatarsianos, anomalia óssea que caracteriza esta rara entidade. A técnica cirúrgica para correçäo da deformindade, segundo Michael Rosman é mostrada, assim como o resultado obtido