Dynamic ultrasound assessment of hip instability and anterior and posterior hip impingement

Ischiofemoral Impingement Syndrome in 2024: Updated Concepts and Imaging Methods

Ischiofemoral impingement syndrome (IFI) is a source of extra-articular pain caused by narrowing between ischium and femur in native hips. Secondary compression of quadratus femoris muscle leads to edema, tears, and deep gluteal pain. IFI is more frequent in females, with evidence pointing to a combination of hip, spine, and pelvic biomechanics and morphology leading to abnormal osseous relationships. This article provides updated concepts regarding the diagnosis, biomechanics, imaging, and treatment strategies for IFI. Moreover, IFI is emphasized as a multifactorial native hip syndrome, in contrast to ischiofemoral narrowing from secondary causes such as surgery, trauma, or masses.

Patient-Reported Outcomes Following Periacetabular Osteotomy versus Hip Arthroscopy for Borderline Acetabular Dysplasia Are Comparable: A Systematic Review

PURPOSE

The purpose of this systematic review was to compare patient populations and outcomes in studies treating borderline hip dysplasia (BHD) with either hip arthroscopy or periacetabular osteotomy (PAO). We hypothesized that studies would show significant postoperative improvement following both PAO and arthroscopy for BHD, and that subjects undergoing arthroscopy would have a higher rate of Cam morphology.

METHODS

A literature review according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines was conducted to identify studies published after 2014 that reported patient-reported outcome measures (PROMs) following hip arthroscopy or PAO for BHD. Preoperative demographics, radiographic variables, operative findings, procedures, postoperative outcomes, and complications were recorded. Forest plots were constructed of disaggregated data to identify study heterogeneity using the I2 statistic.

RESULTS

26 studies (8 PAO; 18 Arthroscopy) were included. Acetabular morphology was comparable between the PAO and arthroscopy studies while the arthroscopy studies reported higher alpha angles (range 48.3-75.3°) compared to the PAO studies (range 47.6-55°). No PAO studies reported an average alpha angle greater than 60° while this was reported in 71% of arthroscopy studies. The most common PROMs were the modified Harris Hip Score (mHHS), with average improvement ranging from 20-29 for PAO and 17.9-34.4 for arthroscopy, and the International Hip Outcome Tool-12 (iHOT-12), with mean postoperative scores ranging from 73.3-74.3 for PAO and 67.5-85.4 for arthroscopy. Postoperative PROM improvement was significant for all studies with significant heterogeneity for the mHHS (I2=0.90) and iHOT-12 (I2=0.98).

CONCLUSIONS

There was significant postoperative improvement following both PAO and modern hip arthroscopy for the surgical management of BHD with high levels of heterogeneity limiting comparability between study groups. Hip arthroscopy studies recorded higher alpha angles suggesting that cam deformities in the setting of BHD can be managed arthroscopically, however further study on optimizing indications between procedures is required.

Ultrasound Evaluation of the Hip

PURPOSE OF REVIEW

Non-arthritic hip pain is a common presentation among the general population, with many possible contributing etiologies. While radiographs, computed tomography, and magnetic resonance imaging are all within the standard diagnostic workup, ultrasonography has emerged as a facile tool given its low cost, lack of radiation, and dynamic application. This article reviews the utility of ultrasound (US) in evaluation of non-arthritic hip pain and its ability to detect pathology both statically and dynamically in comparison and as an adjunct to standard imaging modalities.

RECENT FINDINGS

Current research highlights applications of US to commonly treated hip pathologies including femoroacetabular impingement, labral tears, hip microinstability, and various other extra-articular phenomena. While static evaluation seems to add similar value to that of radiography, several novel protocols have been developed that allow for dynamic evaluation of joint biomechanics, including extent and onset of impingement and femoral head translation, that cannot be assessed with more standard imaging modalities.

Protocol and validity testing of femoroacetabular posterior translation with dynamic hip ultrasonography

OBJECTIVE

To describe femoroacetabular posterior translation (FAPT) using dynamic hip ultrasonography (DHUS), and to determine the inter- and intra-rater reliability of hip ultrasound measurements of FAPT.

MATERIALS AND METHODS

The study design was a feasibility study of 13 healthy young adults (26 hips) using test-retest analysis. The data was collected prospectively over a 2-week time period. Three DHUS measurements (posterior neutral (PN), flexion, adduction, and internal rotation (PFADIR), and stand and load (PStand) were measured by four independent raters (2 senior who divided the cohort, 1 intermediate, 1 junior) at two time points for bilateral hips of each participant. Reliability was assessed by calculating the intraclass correlation coefficient (ICC) along with 95% confidence intervals (CIs) for each rater and across all raters.

RESULTS

A total of 468 US scans were completed. The mean age of the cohort was 25.7 years (SD 5.1 years) and 54% were female. The inter-rater reliability was excellent for PFADIR (ICC 0.85 95% CI 0.76-0.91), good for PN (ICC 0.69 95% CI 0.5-0.81), and good for PStand (ICC 0.72 95% CI 0.55-0.83). The intra-rater reliability for all raters was good for PFADIR (ICC 0.60 95% CI 0.44-0.73), fair for PN (ICC 0.42 95% CI 0.21-0.59), and fair for PStand (ICC 0.42 95% CI 0.22-0.59).

CONCLUSION

This is the first study to present a protocol using dynamic ultrasonography to measure FAPT. DHUS measure for FAPT was shown to be reliable across raters with varying levels of ultrasound experience.

Current status of dynamic musculoskeletal ultrasound for application to treatment of orthopedic diseases

In recent years, dynamic musculoskeletal ultrasound (DMUS) technology has demonstrated great potential in the diagnosis and treatment of orthopedic diseases. As a non-invasive, real-time imaging technique, it provides a dynamic view of joints and soft tissues, offering crucial insight for evaluating muscle injuries and bone damage caused by motion. This article comprehensively reviews the latest research in the field of DMUS, discussing its significant roles in managing orthopedic diseases and enhancing clinical practice. The application of DMUS is wide-ranging, including but not limited to the diagnosis of tendon injuries, ligament tears, arthritis, and soft tissue diseases. Additionally, DMUS has significant value in monitoring treatment progress and evaluating post-operative recovery. Furthermore, we discuss the use of DMUS for improving the accuracy and effectiveness of orthopedic surgeries. DMUS can provide high-quality diagnostic and therapeutic services for patients without a need for expensive equipment or complex procedures. Despite its promising outlook in orthopedics, broader clinical adoption remains limited by factors such as the steep learning curve associated with its use, the demand for specialized skills in interpreting high-quality images, and the need for extensive clinical validation. Future research should focus on standardizing operational procedures, improving the automation of image analysis, and validating its application in different orthopedic diseases through clinical trials.

Hip microinstability and its association with femoroacetabular impingement: A scoping review

Introduction

Hip microinstability has become a recognized cause of non-arthritic hip pain and disability in young patients. However, its pathophysiology remains unclear. We want to (1) present an overview of the evidence of hip microinstability and of its association with femoroacetabular impingement (FAI), (2) map out the type of evidence available, and (3) make recommendations for future research.

Methods

A deductive analysis and extraction method was used to extract information. In addition, diagnostic accuracy statistics were extracted or calculated.

Results

Of the 2,808 identified records, 123 were eligible for inclusion. Different definitions for microinstability exist. A standardized terminology and clear diagnostic criteria are lacking. FAI and microinstability may be associated and may aggravate each other. Conservative treatment strategies for FAI and microinstability are similar. The reported prevalence of microinstability in combination with FAI ranges from 21% to 42% in adults undergoing hip arthroscopy or magnetic resonance arthrography (MRA) of the hip.

Conclusion

Hip microinstability and FAI may be associated, occur together, or exacerbate each other. To better address this topic, a standardized terminology for microinstability is essential. Achieving consensus on physical examination and diagnosis is also necessary. Initial efforts to establish uniform diagnostic criteria have been made, but further work is needed. Specifically, randomized controlled trials are required to evaluate the effectiveness of training programmes aimed at reducing symptoms in individuals with microinstability, with or without FAI. Such studies will enable clinicians to manage microinstability with greater confidence within this context.