Adherence to clinical care standards and mortality after hip fracture surgery in New South Wales, 2015-2018: a retrospective population-based study.

OBJECTIVES: To determine whether adherence to hip fracture clinical care quality indicators influences mortality among people who undergo surgery after hip fracture in New South Wales, both overall and by individual indicator. STUDY DESIGN: Retrospective population-based study; analysis of linked Australian and New Zealand Hip Fracture Registry (ANZHFR), hospital admissions, residential aged care, and deaths data. SETTING, PARTICIPANTS: People aged 50 years or older with hip fractures who underwent surgery in 21 New South Wales hospitals participating in the ANZHFR, 1 January 2015 - 31 December 2018. MAIN OUTCOME MEASURES: Thirty-day (primary outcome), 120-day, and 365-day mortality (secondary outcomes) by clinical care indicator adherence level (low: none to three of six indicators achieved; moderate: four indicators achieved; high: five or six indicators achieved) and by individual indicator. RESULTS: Registry data were available for 9236 hip fractures in 9058 people aged 50 years or older during 2015-2018; the mean age of patients was 82.8 years (standard deviation, 9.3 years), 5510 patients were women (69.4%). Complete data regarding adherence to clinical care indicators were available for 7951 fractures (86.1%); adherence to these indicators was high for 5135 (64.6%), moderate for 2249 (28.3%), and low for 567 fractures (7.1%). After adjustment for age, sex, comorbidity, admission year, pre-admission walking ability, and residential status, 30-day mortality risk was lower for high (adjusted relative risk [aRR], 0.40; 95% confidence interval [CI], 0.30-0.52) and moderate indicator adherence hip fractures (aRR, 0.61; 95% CI, 0.46-0.82) than for low indicator adherence hip fractures, as was 365-day mortality (high adherence: aRR, 0.59 [95% CI, 0.51-0.68]; moderate adherence: aRR, 0.74 [95% CI, 0.63-0.86]). Orthogeriatric care (365 days: aRR, 0.78; 95% CI, 0.61-0.98) and offering mobilisation by the day after surgery (365 days: aRR, 0.74; 95% CI, 0.67-0.83) were associated with lower mortality risk at each time point. CONCLUSIONS: Clinical care for two-thirds of hip fractures attained a high level of adherence to the six quality care indicators, and short and longer term mortality was lower among people who received such care than among those who received low adherence care.

Diagnostic Accuracy of Patient History in the Diagnosis of Hip-Related Pain: A Systematic Review.

OBJECTIVE: To investigate the diagnostic accuracy of patient history associated with hip pain. DATA SOURCES: A systematic, computerized search of electronic databases (PubMed, MEDLINE, Cumulative Index of Nursing and Allied Health Literature, and Web of Science), a search of the gray literature, and review of the primary author's personal library was performed. Hip-specific search terms were combined with diagnostic accuracy and subjective or self-report history-based search terms using the Boolean operator "AND." STUDY SELECTION: This systematic review was conducted and reported according to the protocol outlined by the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. The inclusion criteria were: (1) patients with hip pain; (2) the statistical association of at least 1 patient history item was reported; (3) study designs appropriate for diagnostic accuracy; (4) adults aged ≥18 years; (5) written in English; and (6) used an acceptable reference standard for diagnosed hip pathology. Titles and abstracts of all database-captured citations were independently screened by at least 2 reviewers. DATA EXTRACTION: Two reviewers independently extracted information and data regarding author, year, study population, study design, criterion standard, and strength of association statistics associated with the subjective findings. DATA SYNTHESIS: For hip osteoarthritis (OA), a family history of OA (positive likelihood ratio [+LR], 2.13), history of knee OA (+LR, 2.06), report of groin or anterior thigh pain (+LR, 2.51-3.86), self-reported limitation in range of motion of 1 or both hips (+LR, 2.87), constant low back pain or buttock pain (+LR, 6.50), groin pain on the same side (+LR, 3.63), and a screening questionnaire (+LR, 3.87-13.29) were the most significant findings. For intra-articular hip pathology, crepitus (+LR, 3.56) was the most significant finding. CONCLUSIONS: Patient history plays a key role in differential diagnosis of hip pain and in some cases can be superior to objective tests and measures.

Hip apophyseal injuries in soccer players: can MRI findings be useful to define when to return to play?

OBJECTIVE: To describe magnetic resonance imaging (MRI) findings in professional soccer players with acute apophyseal injury of the hip and to assess their relationship with return to sports. MATERIAL AND METHODS: Adolescent soccer players with diagnosis of apophyseal injury in the anterosuperior and anteroinferior iliac spine were retrospectively evaluated between 2008 and 2016. All athletes underwent hip MRI examination within 4 days after onset of clinical complaint. Images were independently analyzed by two radiologists. Medical records were reviewed to obtain clinical data. RESULTS: Mean displacement of the apophysis was 4.8 ± 4.6 mm. Bone edema was present in 82% of athletes and muscular edema in 41%. The mean time to return to sports was 37.3 ± 14.7 days. The difference between the measurements of the two radiologists was close to zero with agreement limits below 1.0 mm (p < 0.001). There was a significant correlation between displacement of the apophysis and return to sports, as well as between both and the presence of muscular edema. A displacement of the apophysis of 3.0 mm might serve as a parameter to predict return to sports/activity before 40 days, with a sensitivity of 92% and specificity of 96%, considering conservative physiotherapy treatment. CONCLUSION: Displacement of the apophysis and presence of muscular edema evaluated by MRI showed a significant correlation with return to sports in athletes with acute apophyseal injuries of the anterosuperior and anteroinferior iliac spines.

[Arthroscopic labrum reconstruction for femoroacetabular impingement syndrome: 12 cases report].

To investigate the surgical effect of hip arthroscopic labrum reconstruction. A retrospective study was performed on the clinical data of 12 patients who underwent hip arthroscopic labrum reconstruction in our department from September 2017 to February 2021 and were followed up for 5-46 months, with an average of 21.5 months. All the patients had a hip joint space of more than 2 mm, and Tonnis grade less than level Ⅱ. These 12 patients underwent arthroscopic debridement of hyperplastic synovium, femoral head and neck and/or acetabular osteoplasty, and labrum reconstruction using autograft iliotibial band or gracilis tendon. After the surgery, we conducted follow-up and data collection, recorded the satisfaction of the patients and occurrence of complications, as well as the cartilage lesion of hip joint observed under the arthroscopy. We compared the alpha angle of Dunn X-ray film, center-edge angle (CE angle) of AP X-ray film, modified Harris hip score (mHHS score), hip outcome score (HOS), international hip outcome tool 12 score (iHOT12 Score), and visual analogue scale (VAS scale) before and after the arthroscopic operation, to assess clinical symptom relief and joint function recovery. The 12 patients were followed up for 5-46 (21.5±12.8) months. The VAS scale were (5.3±2.5) and (2.5±1.4) before and after the surgery, showing significant decrease (P=0.018). The mHHS score were (60.6±22.2) and (83.1±5.8) before and after the surgery, showing significant increase (P=0.003). The patient satisfaction was high (7.8±2.0) (range: 0-10). None of the 12 patients had serious complications, revision surgery, or total hip replacement at the end of the last follow-up. Autologous tendon transplantation for reconstruction of acetabular labrum under arthroscopy can improve the clinical symptoms and joint function of patients with femoroacetabular impingement (FAI), which is a safe and effective treatment.

Hip muscle atrophy in patients with acetabular labral joint pathology.

Intra-articular hip joint pathology is a source of hip and groin pain in active individuals and is thought to be a precursor to hip osteoarthritis. Limited evidence exists to guide appropriate physiotherapy management for these patients. Identification of which hip muscles are affected may help clinicians to develop effective exercise programs. A cross-sectional observational study in a hospital setting was conducted to investigate the size of individual hip abductor, hip extensor, and hip external rotator muscles in patients with acetabular labral joint pathology compared with age and sex matched healthy subjects. Twelve participants (eight females, four males), aged 20-53 years, with a medical diagnosis of unilateral acetabular labral tear and 12 healthy participants were recruited. Magnetic resonance imaging was used to assess cross-sectional areas of the gluteus minimus, gluteus medius, upper gluteus maximus, lower gluteus maximus, piriformis, and quadratus femoris muscles bilaterally. Gluteus medius muscle cross-sectional area was significantly different between groups (P < 0.01, effect size = 0.92) with muscle size found to be smaller in the pathology group. No differences were found for the other hip muscles (P > 0.05). These findings suggest that hip muscles are not all affected equally by the presence of intra-articular hip joint pathology. Atrophy of specific hip muscles, which are important in hip joint and pelvic stability, may alter hip joint function during gait and functional tasks. Clinicians treating patients with intra-articular hip joint pathology may need to prescribe exercises targeting the specific muscles with demonstrated dysfunction. Clin. Anat. 33:538-544, 2020. © 2019 Wiley Periodicals, Inc.

Relationship of Dynamic Balance Impairment with Pain-Related and Psychosocial Measures in Primary Care Patients with Chronic Greater Trochanteric Pain Syndrome.

OBJECTIVE: Subjects with greater trochanteric pain syndrome (GTPS) show an altered physical function while performing static and dynamic tasks. Pain and psychosocial factors are also variables that influence the outcomes of these patients. Thus, the aim of this study was to evaluate the relationship between dynamic balance, pain-related measures, and psychosocial measures in subjects with chronic GTPS. DESIGN: Descriptive cross-sectional study. SETTING: Primary health care center. SUBJECTS: Fifty-one subjects with greater trochanteric pain syndrome were recruited. METHODS: Dynamic balance was evaluated using the Y-Balance Test (YBT), and a self-reported test battery was used to assess the following aspects: pain catastrophizing (Pain Catastrophizing Scale [PCS]), kinesiophobia (Tampa Scale of Kinesiophobia [TSK-11]), pain intensity (visual analog scale [VAS]), disability (Western Ontario and McMaster Universities Osteoarthritis Index [WOMAC]), and self-efficacy (Chronic Pain Self-Efficacy Scale [CPSS]). RESULTS: Correlation analysis showed that YBT was negatively associated with the VAS average, the helplessness subscale of the PCS, and the pain and function subscales and total score of the WOMAC. YBT was positively associated with the pain subscale of the CPSS. The scores of the YBT forward movement were predicted by the VAS average (38.1% of variance) in addition to the WOMAC total score (34.2% of variance) and TSK-11 total score (43.8% of variance). CONCLUSIONS: The findings of this study suggest that kinesiophobia, pain, and physical function are related to dynamic balance in subjects with GTPS. Thus, when diagnosing and planning the treatment of patients with GTPS, psychosocial and physical function factors should be taken into account, in addition to pain management.

Pain Expansion and Severity Reflect Central Sensitization in Primary Care Patients with Greater Trochanteric Pain Syndrome.

OBJECTIVES: The aims of this study were twofold: 1) to evaluate the differences in pain sensitivity of patients with greater trochanteric pain syndrome (GTPS) and 2) to examine the association between pain expansion, pain severity, and pain-related central sensitization somatosensory variables in patients with GTPS. STUDY DESIGN: A cross-sectional study. SETTING: Primary health care centers. SUBJECTS: The sample consisted of 49 participants with a mean age of 48.28 ± 8.13 years and included eight males (16.3%) and 41 females (83.7%). METHODS: Conditioned pain modulation (CPM), pain location, temporal summation, pressure pain detection threshold (PPDT), and pain intensity were recorded. Pain severity was determined with the Graded Chronic Pain Scale (GCPS). RESULTS: Several participants (34.7%) showed a negative conditioned pain modulation and a statistically significant negative moderate correlation (P < 0.05; r = -0.316) between conditioned pain modulation and right view percentage of pain location. Temporal summation at the major trochanter showed a statistically significant low negative correlation (P < 0.05; r = -0.298). The GCPS exhibited a statistically significant moderately positive correlation (P < 0.01; r = 0.467) with the PPDT at the trochanter and a significant correlation with the postero-superior iliac spine (P < 0.01; r = 0.515) and epicondyle (P < 0.01; r = 0.566). CONCLUSIONS: Patients with GTPS presented altered CPM, a relationship with more pain areas associated with negative CPM, and a positive association between pain severity and mechanical hyperalgesia at remote sites. Thus, physicians could apply these outcome measurements to assess primary care patients with GTPS and determine the central sensitization presence to prescribe adequate multimodal treatment approaches.

The Effectiveness of Exercise on Recovery and Clinical Outcomes in Patients With Soft Tissue Injuries of the Hip, Thigh, or Knee: A Systematic Review by the Ontario Protocol for Traffic Injury Management (OPTIMa) Collaboration.

OBJECTIVE: The purpose of this systematic review was to determine the effectiveness of exercise for the management of soft tissue injuries of the hip, thigh, and knee. METHODS: We conducted a systematic review and searched MEDLINE, EMBASE, PsycINFO, the Cochrane Central Register of Controlled Trials, and CINAHL Plus with Full Text from January 1, 1990, to April 8, 2015, for randomized controlled trials (RCTs), cohort studies, and case-control studies evaluating the effect of exercise on pain intensity, self-rated recovery, functional recovery, health-related quality of life, psychological outcomes, and adverse events. Random pairs of independent reviewers screened titles and abstracts and assessed risk of bias using the Scottish Intercollegiate Guidelines Network criteria. Best evidence synthesis methodology was used. RESULTS: We screened 9494 citations. Eight RCTs were critically appraised, and 3 had low risk of bias and were included in our synthesis. One RCT found statistically significant improvements in pain and function favoring clinic-based progressive combined exercises over a "wait and see" approach for patellofemoral pain syndrome. A second RCT suggests that supervised closed kinetic chain exercises may lead to greater symptom improvement than open chain exercises for patellofemoral pain syndrome. One RCT suggests that clinic-based group exercises may be more effective than multimodal physiotherapy in male athletes with persistent groin pain. CONCLUSION: We found limited high-quality evidence to support the use of exercise for the management of soft tissue injuries of the lower extremity. The evidence suggests that clinic-based exercise programs may benefit patients with patellofemoral pain syndrome and persistent groin pain. Further high-quality research is needed.

Usefulness of MR arthrography of the hip with leg traction in the evaluation of ligamentum teres injuries.

PURPOSE: To retrospectively evaluate the diagnostic accuracy of magnetic resonance (MR) arthrography of the hip with leg traction in the evaluation of ligamentum teres lesions and to evaluate whether there is increased articular distraction, possibly indicating secondary instability, in hips with ligamentum teres injuries. MATERIALS AND METHODS: Institutional review board approval and informed consent were obtained for this retrospective study. MR arthrograms of the hip with leg traction of 184 consecutive patients, including 108 men (mean age, 32.6 years; range, 19-53 years) and 76 women (mean age, 38.5 years; range, 18-56 years), who underwent hip arthroscopy were assessed for the presence of ligamentum teres lesions. The MR arthrographic findings were independently assessed by two radiologists who were blinded to the arthroscopic results. The inclusion criteria stipulated no previous surgery, arthroscopy within 1 month after MR arthrography, and availability of a detailed surgical report with ligamentum teres findings. The arthroscopy findings served as the reference standard. Sensitivity, specificity, accuracy, and K statistics for interobserver and intraobserver agreement were calculated. RESULTS: At arthroscopy, 32 ligamentum teres injuries were found. The ligamentum teres was normal in 152 (82.6%) patients and had suffered low-grade partial tears in 15 (8.1%) patients, high-grade partial tears in 10 (5.4%) patients, and complete ruptures in 7 (3.8%) patients. MR arthrography with axial traction demonstrated moderate sensitivity and high specificity for both low-grade (62/93%) and high-grade (66/96%) partial tears. Grouping low- and high-grade partial tears increased the diagnostic performance of MR arthrography, yielding a sensitivity of 87% and a specificity of 95%. For complete ligamentum teres tears, MR arthrography with leg traction demonstrated high sensitivity (92%) and specificity (98%). Articular distraction was significantly increased in patients with complete ruptures of the ligamentum teres (p = 0.001). CONCLUSION: MR arthrography with leg traction offers accurate diagnosis of ligamentum teres injuries. Patients with complete tears of the ligamentum teres exhibit increased articular distraction that may indicate secondary hip instability.

Diagnosis of an Occult Hip Fracture by Point-of-Care Ultrasound.

BACKGROUND: Hip fractures are common injuries, particularly among elderly patients. Although plain radiographs are the initial imaging modality of choice, approximately 10% of hip fractures are not radiographically evident. Failure to diagnose a hip fracture in the emergency department may result in delayed diagnosis and potentially devastating consequences. CASE REPORT: We report the case of an 81-year-old woman with right hip pain after a fall. Although plain radiographs of the right hip and femur were negative for fracture, point-of-care ultrasound of the right hip demonstrated a cortical disruption in the femur consistent with a fracture. Given the clinical and ultrasound findings, computed tomography of the bony pelvis and proximal femurs was performed, which confirmed an oblique complex fracture of the right femur through the greater and lesser trochanters. WHY SHOULD AN EMERGENCY PHYSICIAN BE AWARE OF THIS?: Point-of-care ultrasound, in conjunction with clinical suspicion, may help identify patients who require more advanced imaging to identify occult hip fractures.

Hip Sideline Emergencies and Hip Injuries in Elite Athletes.

PURPOSE OF REVIEW: Hip injuries in elite athletes are an increasingly recognized problem and range from chronic overuse injuries, such as adductor strains and labral tears, to acute traumatic injuries such as hip dislocations. In this article, we review common hip pathology experienced by elite athletes and sideline management of emergent hip injuries. RECENT FINDINGS: Elite athletes are subject to unique physical and mental stresses and therefore must be evaluated and treated in a unique manner. Hip and groin injuries account for approximately 6% of sport injuries overall and 3-15% of all injuries in professional sports. Hip sideline emergencies were rare but can include hip dislocations, subluxations, and avulsion fractures. Hip and groin injuries represent an important subset of injuries which can greatly impact an athlete's ability to perform. Understanding the physiology and types of hip/groin injuries, which athletes are prone to injuries, the impact on recovery time, recurrence risk, and the potential need for surgery aid sports medicine physicians in decision-making.

Association between Hip/Groin Pain and Hip ROM and Strength in Elite Female Soccer Players.

Background/Objectives: Hip strength and range of motion have been compared in soccer players with and without hip and groin pain but only in male footballers or gender-combined samples. In female soccer players, the biomechanics contributing to this injury remain poorly understood compared to other sporting injuries. The aim of the present study is to investigate whether differences exist in adductor and abductor isometric test values and hip joint range of motion between elite female soccer players with longstanding groin pain and injury-free controls. Methods: Ten female elite soccer players with current longstanding hip and groin pain and twenty-five injury-free controls from the same teams were included in the study. Hip adductor and abductor isometric strength were evaluated with a hand-held dynamometer. A bent knee fall-out test was also utilized to examine the hip joint range of motion. Results: A significant difference in abductor isometric test values was observed between the control group (2.29 ± 0.53 N/Kg) and the hip and groin pain group (2.77 ± 0.48 N/Kg; p = 0.018). Furthermore, the injured group showed a decreased adductor/abductor ratio compared to the control group (1.00 ± 0.33 vs. 1.27 ± 0.26; p = 0.013). No differences were observed in the bent knee fall-out test (p = 0.285). Conclusions: Female elite soccer players with current longstanding hip and groin pain exhibited higher abductor isometric strength and lower adductor/abductor ratio compared to non-injured women players. There were no differences in the BKFO test between groups.

Imaging of common hip pathologies in runners.

Running is an increasingly popular sport and form of exercise. Because of the importance of the hip in the biomechanics involved with running, forming the primary connection between the axial and appendicular skeleton of the lower extremities, accurate diagnosis and reporting of hip pathology are vital for appropriate management. This review provides an overview of the most common hip pathologies and injuries encountered in runners. Radiologic studies, primarily conventional radiography and magnetic resonance imaging (MRI) provide useful diagnostic information and should be used in combination with clinical findings to help guide therapeutic management.

Two case reports of adult traumatic inferior hip dislocations following road traffic accidents without complications.

Inferior dislocation of the hip is the rarest type of hip dislocation, mainly occurring from high-energy incidents, mostly from road traffic accidents or sports. It is generally an injury among adults. Case presentation: A 17-year-old male sustained injuries as a pedestrian, and a 30-year-old male sustained a traffic accident as a motorcycle rider. Both patients complained of severe pain in the hip, decreasing range of motion, and the inability to weight bearing. In both, the affected hip joint was fixed in 90° flexion, abduction, and external rotation, and the leg was slightly shorter than the other limb. An X-ray showed the inferior dislocation of the right hip and left hip, respectively, without any sign of fracture. We reduced both dislocations closely after sedation without any complications during follow-ups. Conclusion: This injury should be treated as an emergency, and reduction performed as soon as possible, within 6 h. It can be managed usually with closed reduction under general anesthesia. Close follow-up is necessary to prevent its complications, including avascular necrosis, associated fractures, neurovascular compromise, and articular cartilage injuries.

Concurrent ipsilateral fractures of acetabular posterior wall and femoral shaft associated with posterior hip dislocation: A case report and literature review of a rare injury.

INTRODUCTION: A floating hip injury involving the acetabulum and femur, often complicated by hip dislocation, necessitates a timely and appropriate management strategy to preserve the extremity and patient well-being. CASE PRESENTATION: We present a case of a 20-year-old male with concurrent fractures of the acetabular posterior wall, a comminuted femoral shaft, and posterior hip dislocation. Reduction of the dislocated hip posed a challenge due to the femoral shaft fracture. We successfully employed an innovative technique, using pins proximal and distal to the shaft fracture in conjunction with a temporary external fixator, later replaced by an interlocking nail after hip reduction. Subsequently, we addressed the acetabular fracture through a posterior hip approach, enabling the patient to regain full weight-bearing capacity within a few months. DISCUSSION: In managing concurrent injuries in a floating hip, particularly when a femoral shaft fracture is involved, innovative approaches, such as the one described in this study, are crucial for timely hip reduction. Following hip reduction, a series of surgeries are required to address the multiple lower extremity injuries, prioritizing those with the highest risk of adverse events and neurovascular complications. CONCLUSION: Urgent procedures for multiple fractures in orthopedic trauma surgery are pivotal for the best long-term outcomes. Prioritizing these urgent procedures, even through unconventional transient methods when conventional means are unavailable, can prevent long-term complications such as avascular necrosis. Effective and timely management is paramount for optimal patient recovery.

Reliability and validity of common hip adduction strength measures: The ForceFrame strength testing system versus the sphygmomanometer.

OBJECTIVES: The criterion validity of the sphygmomanometer was evaluated, relative to the Force Frame strength testing system. Test-retest reliability was assessed for both hip adduction and abduction strength. DESIGN: Test-retest reliability study and criterion validity study. PARTICIPANTS: 50 asymptomatic, field-sport athletes. MAIN OUTCOME MEASURES: Maximal isometric hip adduction and abduction strength were measured. Interclass correlation coefficient(ICC2,1) with confidence intervals were calculated to evaluate reliability of peak strength values. A Pearson product-moment correlation coefficient(r) was calculated to examine criterion validity of the sphygmomanometer as a measure of force when compared to the ForceFrame. RESULTS: Intra-rater reliability for bilateral adduction testing using both ForceFrame and sphygmomanometer values revealed good-excellent reliability for both the 0° (ICC2.1 = 0.87-0.90) and 45° (ICC2.1 = 0.81-0.91) positions. ForceFrame values revealed good-excellent reliability for 0° abduction position and 45° abduction position. A good-moderate relationship (Pearson's r = 0.63) for 0° adduction position, and poor relationship (Pearson's r = 0.40) for 45° adduction position, were found between adduction squeeze values on ForceFrame and sphygmomanometer. CONCLUSION: Excellent reliability in hip adduction squeeze strength testing for both modes. However, there exists a 'good to moderate'-'fair' relationship between the Force Frame and sphygmomanometer.

Examination of Matching Methods, Sparse Effects, and Limitations in a Nationwide Database Study on Alzheimer's Disease.

Akada et al. conducted a nationwide database study on patients with Alzheimer's disease, examining risk factors and outcomes over 3 years. A significant association emerged between decreased daily activities and hip fractures. However, the odds ratio was 1.95 (with p = 0.020) may be inaccurate in men, considering the wide 95% confidence interval (1.12-3.51). Possible influencing factors include an inappropriate outcome variable, sparse-data bias, collinear covariates, and comorbidities. Moreover, exact propensity-score matching would be more efficient than nested matching. Limitations include potential recall bias in measuring daily activities and limited applicability of cause-effect relationships in a national database study.