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Kinsella R, Semciw AI, Hawke LJ, Stoney J, Choong PFM, Dowsey MM. Diagnostic Accuracy of Clinical Tests for Assessing Greater Trochanteric Pain Syndrome: A Systematic Review With Meta-analysis. J Orthop Sports Phys Ther 2024; 54:1-24. [PMID: 37561820 DOI: 10.2519/jospt.2023.11890] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 08/12/2023]
Abstract
OBJECTIVE: We aimed to evaluate the accuracy of clinical tests that are used to diagnose greater trochanteric pain syndrome (GTPS) in clinical practice. DESIGN: Diagnostic test accuracy systematic review with meta-analysis. LITERATURE SEARCH: MEDLINE, Embase, CINAHL, AMED, and SPORTDiscus were searched using key words mapped to diagnostic test accuracy for GTPS. STUDY SELECTION CRITERIA: Studies with published or derivable diagnostic accuracy data were included. DATA SYNTHESIS: Risk of bias was assessed using the QUADAS-2 tool, and certainty of evidence, via the Grading of Recommendations, Assessment, Development, and Evaluations (GRADE) framework. MetaDTA "R" random-effects models were used to summarize individual and pooled data including sensitivity, specificity, likelihood ratios, and pretest/posttest probabilities. RESULTS: From a database yield of 858 studies, 23 full texts were assessed. We included 6 studies for review, involving 15 tests and 272 participants (314 hips). Overall certainty of evidence ranged from very low to moderate. Meta-analysis of 6 tests revealed sequenced test clusters able to significantly shift pretest-posttest probability for or against a GTPS diagnosis. In people reporting lateral hip pain, a negative gluteal tendon (GT) palpation test followed by a negative resisted hip abduction test significantly reduced the posttest probability of GTPS from 59% to 14%. In those with a positive GT palpation test followed by a positive resisted hip abduction test, the posttest probability of GTPS significantly shifted from 59% to 96%. CONCLUSION: The value of magnetic resonance imaging for diagnosing GTPS is debated. We have identified a straightforward, clinically useful diagnostic test cluster to help confirm or refute the presence of GTPS in people reporting lateral hip pain. J Orthop Sports Phys Ther 2024;54(1):1-24. Epub 10 August 2023. doi:10.2519/jospt.2023.11890.
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Xing G, Yin J, Xu M, Zhang L. Asymptomatic Gluteal Tendinosis Does Not Adversely Affect Outcomes of Primary Total Hip Arthroplasty. J Arthroplasty 2023; 38:2638-2643. [PMID: 37286058 DOI: 10.1016/j.arth.2023.05.076] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/11/2023] [Revised: 05/24/2023] [Accepted: 05/25/2023] [Indexed: 06/09/2023] Open
Abstract
BACKGROUND The aim of this study was to compare outcomes after total hip arthroplasty (THA) in patients who have preoperative asymptomatic gluteal tendinosis (aGT) to a control group with no gluteal tendinosis (GT). METHODS A retrospective analysis was performed using data from patients who underwent THA between March 2016 and October 2020. An aGT was diagnosed using hip magnetic resonance imaging (MRI) without clinical symptoms. Patients who had aGT were matched (1:1) to patients without GT on MRI. A total of 56 aGT hips and 56 hips without GT were found using propensity-score matching. Patient-reported outcomes, intraoperative macroscopic evaluation, outcome measurements, postoperative physical examinations, complications, and revisions were compared for both groups. RESULTS When compared to preoperative outcomes, both groups demonstrated significant improvements in patients-reported outcomes at the final follow-up. There were no significant differences between both groups for preoperative scores, 2-year postoperative outcome scores, or the magnitude of improvement. Patients in the aGT group were significantly less likely to obtain the MCID for the SF-36 MCS score (50.2 versus 69.3%, P = .034). However, there were no other differences in the rates of meeting the MCID between both groups. The aGT group demonstrated significantly higher rates of partial tendon degeneration of the gluteus medius muscle. CONCLUSION Asymptomatic gluteal tendinosis patients who have osteoarthritis and undergo THA may expect favorable patients-reported outcomes at minimum 2-year follow-up. These results were comparable with those of a control group of patients without gluteal tendinosis. LEVEL OF EVIDENCE III.
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Affiliation(s)
- Guangwei Xing
- Department of Orthopedics, The Fifth Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Jinneng Yin
- Department of Internal Medicine, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Mingjie Xu
- Department of Orthopedics, The Fifth Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Ligui Zhang
- Department of Orthopedics, The Fifth Affiliated Hospital of Zhengzhou University, Zhengzhou, China
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Jawetz ST, Fox MG, Blankenbaker DG, Caracciolo JT, Frick MA, Nacey N, Said N, Sharma A, Spence S, Stensby JD, Subhas N, Tubb CC, Walker EA, Yu F, Beaman FD. ACR Appropriateness Criteria® Chronic Hip Pain: 2022 Update. J Am Coll Radiol 2023; 20:S33-S48. [PMID: 37236751 DOI: 10.1016/j.jacr.2023.02.019] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2023] [Accepted: 02/27/2023] [Indexed: 05/28/2023]
Abstract
Chronic hip pain is a frequent chief complaint for adult patients who present for evaluation in a variety of clinical practice settings. Following a targeted history and physical examination, imaging plays a vital role in elucidating the etiologies of a patient's symptoms, as a wide spectrum of pathological entities may cause chronic hip pain. Radiography is usually the appropriate initial imaging test following a clinical examination. Depending on the clinical picture, advanced cross-sectional imaging may be subsequently performed for further evaluation. This documents provides best practice for the imaging workup of chronic hip pain in patients presenting with a variety of clinical scenarios. The American College of Radiology Appropriateness Criteria are evidence-based guidelines for specific clinical conditions that are reviewed annually by a multidisciplinary expert panel. The guideline development and revision include an extensive analysis of current medical literature from peer reviewed journals and the application of well-established methodologies (RAND/UCLA Appropriateness Method and Grading of Recommendations Assessment, Development, and Evaluation or GRADE) to rate the appropriateness of imaging and treatment procedures for specific clinical scenarios. In those instances where evidence is lacking or equivocal, expert opinion may supplement the available evidence to recommend imaging or treatment.
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Affiliation(s)
| | - Michael G Fox
- Panel Chair, Program Director, Diagnostic Radiology, Mayo Clinic Arizona, Phoenix, Arizona
| | - Donna G Blankenbaker
- University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin
| | - Jamie T Caracciolo
- Moffitt Cancer Center and University of South Florida Morsani College of Medicine, Tampa, Florida; MSK-RADS (Bone) Committee
| | - Matthew A Frick
- Chair of Education, Department of Radiology, Chair of Musculoskeletal Imaging, Mayo Clinic, Rochester, Minnesota
| | - Nicholas Nacey
- University of Virginia Health System, Charlottesville, Virginia
| | - Nicholas Said
- Duke University Medical Center, Durham, North Carolina
| | - Akash Sharma
- Mayo Clinic, Jacksonville, Florida; Commission on Nuclear Medicine and Molecular Imaging
| | - Susanna Spence
- University of Texas McGovern Medical School, Houston, Texas; Committee on Emergency Radiology-GSER; Member of the Board of Advisors and Board of Directors for Texas Radiological Society
| | | | | | - Creighton C Tubb
- UT Health San Antonio, San Antonio, Texas; American Academy of Orthopaedic Surgeons
| | - Eric A Walker
- Penn State Milton S. Hershey Medical Center, Hershey, Pennsylvania and Uniformed Services University of the Health Sciences, Bethesda, Maryland
| | - Florence Yu
- Section Head, Musculoskeletal Imaging, Weill Cornell Medical College, New York, New York; Primary care physician; Chair, ACR sponsored BONE-RADS Committee
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Dove JH, Lemme NJ, Modest JM, Talley-Bruns RC, Tabaddor RR, Fadale PD. A Review of Abductor Tendon Tears: The Hidden Lesion of the Hip. JBJS Rev 2022; 10:01874474-202212000-00005. [PMID: 36546777 DOI: 10.2106/jbjs.rvw.22.00133] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
» Greater trochanteric pain syndrome consists of a group of associated conditions involving the lateral hip that can be debilitating to patients, mostly women between ages 40 and 60 years. » Abductor tendon tears are becoming a more recognized cause of lateral hip pain in patients without hip osteoarthritis. » Diagnosis of this condition is critical to patient care because misdiagnosis often leads to unnecessary prolonged pain and even unnecessary procedures that address different pathologies. » Treatment strategies consists of nonoperative modalities such as nonsteroidal anti-inflammatory medications, corticosteroid injections, and physical therapy, but for refractory cases, surgical techniques including repair, augmentation, and reconstruction have been well-described in the literature providing patients with acceptable outcomes.
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Affiliation(s)
- James H Dove
- Department of Orthopedic Surgery, Warren Alpert Medical School of Brown University, Providence, Rhode Island
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Ebert JR, Fearon AM, Smith PN, Janes GC. Recommendations in the rehabilitation of patients undergoing hip abductor tendon repair: a systematic literature search and evidence based rehabilitation protocol. Arch Orthop Trauma Surg 2022; 142:3165-3182. [PMID: 33983527 DOI: 10.1007/s00402-021-03952-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/17/2020] [Accepted: 05/04/2021] [Indexed: 11/29/2022]
Abstract
INTRODUCTION Advanced hip imaging and surgical findings have demonstrated that a common cause of greater trochanteric pain syndrome (GTPS) is hip abductor tendon (HAT) tears. Traditionally, these patients have been managed non-operatively, often with temporary pain relief. More recently, there has been an increase in published work presenting the results of surgical intervention. A variety of open and endoscopic transtendinous, transosseous and/or bone anchored suture surgical techniques have been reported, with and without the use of tendon augmentation for repair reinforcement. While patient outcomes have demonstrated improvements in pain, symptoms and function, post-operative rehabilitation guidelines are often vague and underreported, providing no guidance to therapists. MATERIALS AND METHODS A systematic search of the literature was initially undertaken to identify published clinical studies on patients undergoing HAT repair, over a 3-year period up until May 2020. Following the application of strict inclusion and exclusion criteria, studies were identified and the detail relevant to rehabilitation was synthesized and presented. Published detail was combined with the authors clinical experience, with a detailed overview of rehabilitation proposed for this patient cohort. RESULTS A total of 17 studies were included, reporting varied detail on components of rehabilitation including post-operative weight bearing (WB) restrictions, the initiation of passive/active hip range of motion (ROM) and resistance exercises. A detailed rehabilitation guide is proposed. CONCLUSION In combining the current published literature on rehabilitation after HAT repair and our own clinical experience in the surgical management and post-operative rehabilitation of these patients, we present an evidence-based, structured rehabilitation protocol to better assist surgeons and therapists in treating these patients. This rehabilitation protocol has been implemented for several years through our institutions with encouraging published clinical outcomes.
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Affiliation(s)
- Jay R Ebert
- School of Human Sciences (Exercise and Sport Science), University of Western Australia, 35 Stirling Highway, Crawley, WA, 6009, Australia. .,HFRC, 117 Stirling Highway, Nedlands, WA, 6009, Australia.
| | - Angela M Fearon
- ACT, UCRISE, Faculty of Health, University of Canberra, Woden, 2617, Australia
| | - Paul N Smith
- ACT, Trauma & Orthopaedic Research Unit Canberra Hospital, Woden, 2617, Australia
| | - Gregory C Janes
- Perth Orthopaedic and Sports Medicine Centre, 31 Outram Street, West Perth, WA, 6005, Australia
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Day MA, Hancock KJ, Selley RS, Swartwout EL, Dooley M, Shamrock AG, Nwachukwu BU, Greditzer HG, Ranawat AS. Repair of gluteus medius tears with bioinductive collagen patch augmentation: initial evaluation of safety and imaging. J Hip Preserv Surg 2022; 9:185-190. [PMID: 35992027 PMCID: PMC9389905 DOI: 10.1093/jhps/hnac031] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/29/2022] [Revised: 05/08/2022] [Accepted: 06/14/2022] [Indexed: 11/30/2022] Open
Abstract
The purpose of this study was to perform an initial, prospective evaluation of imaging findings and outcomes after open surgical repair of gluteus medius tendon tears with bioinductive collagen patch augmentation. A prospective study was performed of patients with clinical and magnetic resonance imaging (MRI) evidence of symptomatic gluteus medius tears who underwent open, double-row suture anchor repair with bioinductive bovine collagen patch augmentation. Preoperative and 6-month postoperative MRIs were reviewed by a fellowship-trained musculoskeletal radiologist, and outcome scores were recorded preoperatively and 6 months postoperatively [Hip Outcome Score (HOS) Sport; HOS Activities of Daily Living (HOS ADL); Modified Harris Hip Score (mHHS) and International Hip Outcomes Tool (iHOT-33)]. Nine patients, four high-grade tears (≥50% tendon thickness) and five low-grade tears (<50% thickness) underwent surgical repair. At 6 months, 7/9 (77.8%) of tendons were qualitatively classified as completely healed on MRI, with no complications. Mean tendon thickness increased significantly: mediolateral dimension by 5.8 mm (P < 0.001), anteroposterior dimension by 4.1 mm (P = 0.02) and cross-sectional area (CSA) by 48.4 mm2 (P = 0.001). Gluteus medius and minimus CSA did not change significantly (P > 0.05). Patients demonstrated improvements in mean scores for HOS ADL, mHHS and iHOT that met defined minimum clinically important differences (P < 0.05). Open surgical repair of gluteus medius tendon tears with bioinductive collagen patch augmentation is safe and associated with increased tendon thickness on postoperative MRI. Early outcome scores are encouraging and should be evaluated after patients have completed postoperative rehabilitation to measure the whole effect of treatment.
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Affiliation(s)
- Molly A Day
- Sports Medicine Institute, Department of Orthopaedic Surgery, Hospital for Special Surgery , 535 E 70th Street, New York, NY 10021, USA
- Department of Orthopedics and Rehabilitation, University of Wisconsin , UW Health East Madison Hospital, 4602 Eastpark Blvd, Madison, WI 53718, USA
| | - Kyle J Hancock
- Sports Medicine Institute, Department of Orthopaedic Surgery, Hospital for Special Surgery , 535 E 70th Street, New York, NY 10021, USA
- Desert Orthopaedic Center , 2800 E Desert Inn Rd, Las Vegas, NV 89121, USA
| | - Ryan S Selley
- Sports Medicine Institute, Department of Orthopaedic Surgery, Hospital for Special Surgery , 535 E 70th Street, New York, NY 10021, USA
| | - Erica L Swartwout
- Sports Medicine Institute, Department of Orthopaedic Surgery, Hospital for Special Surgery , 535 E 70th Street, New York, NY 10021, USA
| | - Matthew Dooley
- Sports Medicine Institute, Department of Orthopaedic Surgery, Hospital for Special Surgery , 535 E 70th Street, New York, NY 10021, USA
| | - Alan G Shamrock
- Sports Medicine Institute, Department of Orthopaedic Surgery, Hospital for Special Surgery , 535 E 70th Street, New York, NY 10021, USA
- Department of Orthopedics and Rehabilitation, University of Iowa Hospitals & Clinics , 200 Hawkins Dr, Iowa City, IA 52242, USA
| | - Benedict U Nwachukwu
- Sports Medicine Institute, Department of Orthopaedic Surgery, Hospital for Special Surgery , 535 E 70th Street, New York, NY 10021, USA
| | - Harry G Greditzer
- Department of Radiology & Imaging, Hospital for Special Surgery , 535 E 70th Street, New York, NY 10021, USA
| | - Anil S Ranawat
- Sports Medicine Institute, Department of Orthopaedic Surgery, Hospital for Special Surgery , 535 E 70th Street, New York, NY 10021, USA
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Yang F, Maimaitimin M, Zhang X, Xu Y, Huang H, Wang J. Asymptomatic gluteal tendinosis does not influence outcome in arthroscopic treatment of femoroacetabular impingement syndrome. Knee Surg Sports Traumatol Arthrosc 2022; 30:2174-2180. [PMID: 34766190 DOI: 10.1007/s00167-021-06792-5] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/10/2021] [Accepted: 10/27/2021] [Indexed: 01/03/2023]
Abstract
PURPOSE To compare outcomes after arthroscopy in FAIS patients with preoperative asymptomatic gluteal tendinosis (GT) to a control group with no gluteal tendinosis. METHODS A retrospective analysis was performed using data from FAIS patients who had arthroscopy between 2016 and 2018. Asymptomatic GT was diagnosed using hip MRI without clinical symptoms. Patients with asymptomatic GT were 1:1 propensity-score matched to patients without GT. Patient-reported outcomes (HOS-ADL, iHOT-12, mHHS), VAS scores, radiographic measures, performed procedures, complications, and revision surgery were compared and analyzed for both groups. RESULTS A total of 105 asymptomatic GT hips and 105 hips without GT were found using propensity-score matching. When compared to preoperative levels, both groups demonstrated significant improvements in PROs and VAS scores at the final follow-up. Besides, there were no significant differences in preoperative scores, final outcome scores, or score improvements between the groups. Patients in the GT group were significantly less likely to achieve the MCID for the VAS score (72.4% vs 83.8%, p = 0.045). However, there were no other differences in the rate of meeting the PASS and MCID between the study and the control groups. CONCLUSION It was demonstrated in this study that FAIS patients with asymptomatic gluteal tendinosis can expect to experience similar good short-term patients-reported outcomes as compared with patients without gluteal tendinosis. LEVEL OF EVIDENCE III.
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Affiliation(s)
- Fan Yang
- Beijing Key Laboratory of Sports Injuries, Department of Sports Medicine, Peking University Third Hospital, Institute of Sports Medicine of Peking University, Beijing, China
| | - Maihemuti Maimaitimin
- Beijing Key Laboratory of Sports Injuries, Department of Sports Medicine, Peking University Third Hospital, Institute of Sports Medicine of Peking University, Beijing, China
| | - Xin Zhang
- Beijing Key Laboratory of Sports Injuries, Department of Sports Medicine, Peking University Third Hospital, Institute of Sports Medicine of Peking University, Beijing, China
| | - Yan Xu
- Beijing Key Laboratory of Sports Injuries, Department of Sports Medicine, Peking University Third Hospital, Institute of Sports Medicine of Peking University, Beijing, China
| | - Hongjie Huang
- Beijing Key Laboratory of Sports Injuries, Department of Sports Medicine, Peking University Third Hospital, Institute of Sports Medicine of Peking University, Beijing, China.
| | - Jianquan Wang
- Beijing Key Laboratory of Sports Injuries, Department of Sports Medicine, Peking University Third Hospital, Institute of Sports Medicine of Peking University, Beijing, China.
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Effect of Ligament Mapping from Different Magnetic Resonance Image Quality on Joint Stability in a Personalized Dynamic Model of the Human Ankle Complex. APPLIED SCIENCES-BASEL 2022. [DOI: 10.3390/app12105087] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
Background. Mechanical models of the human ankle complex are used to study the stabilizing role of ligaments. Identification of ligament function may be improved via image-based personalized approach. The aim of this study is to compare the effect of the ligament origin and insertion site definitions obtained with different magnetic resonance imaging (MRI) modalities on the mechanical behaviour of a dynamic model of the ankle complex. Methods. MRI scans, both via 1.5 T and 3.0 T, were performed on a lower-limb specimen, free from anatomical defects, to obtain morphological information on ligament-to-bone attachment sites. This specimen was used previously to develop the dynamic model. A third ligament attachment site mapping scheme was based on anatomical dissection of the scanned specimen. Following morphological comparison of the ligament attachment sites, their effect on the mechanical behaviour of the ankle complex, expressed by three-dimensional load–displacement properties, was assessed through the model. Results. Large differences were observed in the subtalar ligament attachment sites between those obtained through the two MRI scanning modalities. The 3.0 T MRI mapping was more consistent with dissection than the 1.5 T MRI. Load–displacement curves showed similar mechanical behaviours between the three mappings in the frontal plane, but those obtained from the 3.0 T MRI mapping were closer to those obtained from dissection. Conclusions. The state-of-the-art 3.0 T MRI image analysis resulted in more realistic mapping of ligament fibre origin and insertion site definitions; corresponding load–displacement predictions from a subject-specific model of the ankle complex showed a mechanical behaviour more similar to that using direct ligament attachment observations.
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An QJ, Qin DA. "Torch fire sign" for acute calcific tendinitis of gluteus medius on MRI. Int J Surg 2022; 102:106666. [PMID: 35562004 DOI: 10.1016/j.ijsu.2022.106666] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2022] [Accepted: 05/06/2022] [Indexed: 11/25/2022]
Affiliation(s)
- Qi-Jun An
- Department of Orthopedics, Shanxi Provincial People's Hospital, Taiyuan, 030012, Shanxi, China
| | - De-An Qin
- Department of Orthopedics, Shanxi Provincial People's Hospital, Taiyuan, 030012, Shanxi, China.
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Sun H, Huang HJ, Mamtimin M, Yang F, Duan YP, Zhang X, Wang JQ. Hip Gluteus Medius Tears Are Associated With Lower Femoral Neck-Shaft Angles and Higher Acetabular Center-Edge Angles. Arthroscopy 2022; 38:1496-1505. [PMID: 34678409 DOI: 10.1016/j.arthro.2021.10.006] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/03/2021] [Revised: 08/23/2021] [Accepted: 10/08/2021] [Indexed: 02/02/2023]
Abstract
PURPOSE 1) To assess the possible relationship between the morphology of femur or acetabulum and the gluteus medius pathology. 2) To analyze the outcome of isolated arthroscopic treatment of femoroacetabular impingement (FAI) for patients with radiographic gluteus medius tear. METHODS We performed a retrospective study of FAI patients who underwent arthroscopy between January 2016 to December 2019. Demographic data, such as sex, age, body mass index (BMI), symptom duration, were collected. Radiographic parameters, including alpha angle, lateral center-edge angle (LCEa), femur neck-shaft angle (NSa), gluteus medius pathology, were also collected. Exclusion criteria were previous hip conditions, such as osteoarthritis (Tönnis grade > 1), rheumatoid arthritis, ankylosing spondylitis, snapping hip, previous surgery on the ipsilateral hip, or incomplete data. We followed up these patients with radiographic gluteus medius tear. No surgical procedure for gluteus medius was performed. The minimum follow-up period was 13 months. Patient-reported outcomes, such as modified Harris Hip score (mHHS), visual analog scale (VAS), and patient acceptable symptom state (PASS), as well as physical examination data, including tenderness at the greater trochanter, abductor weakness, limping gait, and positive Trendelenburg sign or test, were gathered preoperatively and postoperatively. RESULTS A total of 569 hips (314, 55.2% male) were collected eventually, with a mean age of 36.5 ± 10.4 years (range: 13.0 to ∼65.0). Gluteus medius pathology was found in 209 (36.7%) hips, including 41 (7.2%) partial-thickness tears and 10 (1.8%) complete tears. The NSa of the normal, tendinosis, partial tear, and complete tear groups was 133.8 ± 4.7°, 130.6 ± 3.8°, 129.4 ± 3.9°, and 129.6 ± 3.4°, respectively (P < .001). The LCEa of each group was 31.7 ± 35.7°, 33.3 ± 6.5°, 34.9 ± 6.8°, and 33.7 ± 8.1°, respectively (P = .004). On multivariable logistic regression analysis, lower NSa and higher LCEa were identified as risk factors for developing gluteus medius pathology (P < .001). For patients with gluteus medius tear, two cases were lost to follow-up and two cases had incomplete data. The mean follow-up period of the remaining 47 hips was 29.5 ± 12.9 (range: 13 to 59) months. The mHHS improved from 54.8 ± 19.1 to 90.1 ± 6.7 points (P < .001), and VAS decreased from 6.8 ± 1.6 to 3.0 ± 1.6 points (P < .001). Forty-two cases met the threshold of PASS, with a rate of 89%. The abductor strength increased from 4.1 ± 1.00 to 4.6 ± .7 grades (P = .002). However, for patients with a completely torn gluteus medius, improvement of abductor strength was not significant statistically (3.4 ± .9 to 3.9 ± .9, P = .234). CONCLUSION There was a correlation between lower NSa/higher LCEa and gluteus medius pathology. Isolated arthroscopic treatment of FAI for patients with radiographic gluteus medius tear can gain satisfactory patient-reported outcomes. LEVEL OF EVIDENCE Therapeutic case series, IV.
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Affiliation(s)
- Hao Sun
- Department of Sports Medicine, Peking University Third Hospital, Institute of Sports Medicine of Peking University and Beijing Key Laboratory of Sports Injuries, Beijing, China
| | - Hong-Jie Huang
- Department of Sports Medicine, Peking University Third Hospital, Institute of Sports Medicine of Peking University and Beijing Key Laboratory of Sports Injuries, Beijing, China
| | - Mahmut Mamtimin
- Department of Sports Medicine, Peking University Third Hospital, Institute of Sports Medicine of Peking University and Beijing Key Laboratory of Sports Injuries, Beijing, China
| | - Fan Yang
- Department of Sports Medicine, Peking University Third Hospital, Institute of Sports Medicine of Peking University and Beijing Key Laboratory of Sports Injuries, Beijing, China
| | - Yu-Peng Duan
- Department of Sports Medicine, Peking University Third Hospital, Institute of Sports Medicine of Peking University and Beijing Key Laboratory of Sports Injuries, Beijing, China
| | - Xin Zhang
- Department of Sports Medicine, Peking University Third Hospital, Institute of Sports Medicine of Peking University and Beijing Key Laboratory of Sports Injuries, Beijing, China
| | - Jian-Quan Wang
- Department of Sports Medicine, Peking University Third Hospital, Institute of Sports Medicine of Peking University and Beijing Key Laboratory of Sports Injuries, Beijing, China.
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Andronic O, Rahm S, Fritz B, Singh S, Sutter R, Zingg PO. External snapping hip syndrome is associated with an increased femoral offset. EUROPEAN JOURNAL OF ORTHOPAEDIC SURGERY AND TRAUMATOLOGY 2021; 32:1481-1489. [PMID: 34550475 PMCID: PMC9587962 DOI: 10.1007/s00590-021-03123-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/12/2021] [Accepted: 09/13/2021] [Indexed: 11/15/2022]
Abstract
Background External snapping hip syndrome (ESH) is postulated to be one of the causes of greater trochanteric pain syndrome, which also includes greater trochanteric bursitis and tendinopathy or tears of the hip abductor mechanism. However, it was not yet described what kind of bony morphology can cause the snapping and whether symptomatic and asymptomatic individuals have different imaging features. Purpose It was the purpose of this study to look for predisposing morphological factors for ESH and to differentiate between painful and asymptomatic snapping. Methods A consecutive cohort with ESH and available magnetic resonance imaging (MRI) between 2014 and 2019 was identified. The control group consisted of patients that underwent corrective osteotomies around the knee for mechanical axis correction and never complained of hip symptoms nor had undergone previous hip procedures. The following parameters were blindly assessed for determination of risk factors for ESH: CCD (corpus collum diaphysis) angle; femoral and global offset; femoral antetorsion; functional femoral antetorsion; translation of the greater trochanter (GT); posterior tilt of the GT; pelvic width/anterior pelvic length; intertrochanteric width. Hip and pelvic offset indexes were calculated as ratios of femoral/global offset and intertrochanteric/pelvic width, respectively. For the comparison of symptomatic and asymptomatic snapping, the following soft-tissue signs were investigated: presence of trochanteric bursitis or gluteal tendinopathy; presence of surface bony irregularities on trochanter major and ITB (Iliotibial band) thickness. Results A total of 31 hips with ESH were identified. The control group (n = 29) consisted of patients matched on both age (± 1) and gender. Multiple regression analysis determined an increased hip offset index to be independent predictor of ESH (r = + 0.283, p = 0.025), most likely due to the higher femoral offset in the ESH group (p = 0.031). Pearson correlation analysis could not identify any significant secondary factors. No differences were found between painful and asymptomatic snapping on MRI. Conclusions A high hip offset index was found as an independent predictor for external snapping hip in our cohort, mainly due to increased femoral offset. No imaging soft-tissue related differences could be outlined between symptomatic and asymptomatic external snapping. Level of evidence III This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00590.
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Affiliation(s)
- Octavian Andronic
- Department of Orthopaedics, Balgrist University Hospital, University of Zurich, Forchstrasse 340, 8008, Zurich, Switzerland.
| | - Stefan Rahm
- Department of Orthopaedics, Balgrist University Hospital, University of Zurich, Forchstrasse 340, 8008, Zurich, Switzerland
| | - Benjamin Fritz
- Department of Radiology, Balgrist University Hospital, University of Zurich, Forchstrasse 340, 8008, Zurich, Switzerland
| | - Sarvpreet Singh
- Department of Orthopaedics, Balgrist University Hospital, University of Zurich, Forchstrasse 340, 8008, Zurich, Switzerland
| | - Reto Sutter
- Department of Radiology, Balgrist University Hospital, University of Zurich, Forchstrasse 340, 8008, Zurich, Switzerland
| | - Patrick O Zingg
- Department of Orthopaedics, Balgrist University Hospital, University of Zurich, Forchstrasse 340, 8008, Zurich, Switzerland
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12
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Mittlmeier T. [Tendon injuries of the hip and thigh]. Unfallchirurg 2021; 124:517-518. [PMID: 34232345 DOI: 10.1007/s00113-021-01036-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/27/2021] [Indexed: 11/25/2022]
Affiliation(s)
- Thomas Mittlmeier
- Klinik und Poliklinik für Unfall‑, Hand- und Wiederherstellungschirurgie, Universitätsmedizin Rostock, Operatives Zentrum, Schillingallee 35, 18057, Rostock, Deutschland.
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13
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Rosinsky PJ, Diulus SC, Walsh JP, Meghpara MB, Shapira J, Maldonado DR, Lall AC, Kyin C, Domb BG. Development of a Predictive Algorithm for Symptomatic Hip Abductor Tears in Patients Undergoing Primary Hip Arthroscopy. Am J Sports Med 2021; 49:497-504. [PMID: 33405942 DOI: 10.1177/0363546520980461] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
BACKGROUND Patients presenting with lateral hip pain may pose a difficult diagnostic challenge, as pain can be due to various causes. PURPOSE/HYPOTHESIS The purpose was to identify risk factors and predictors for symptomatic hip abductor tears in a cohort of patients undergoing primary hip arthroscopy for femoroacetabular impingement syndrome. We hypothesized that body mass index (BMI), female sex, age, and presence of chondral damage would be significant predictors of hip abductor pathologies. STUDY DESIGN Cohort study (diagnosis); Level of evidence, 3. METHODS Data were prospectively collected and retrospectively reviewed. Patients were included if they underwent primary hip arthroscopy between March 2009 and December 2019. Patients with Tönnis grade >1, previous hip conditions, incomplete radiographic data, or open procedures were excluded. All demographic variables, intraoperative measurements, and radiographic measurements were assessed using a bivariate analysis. A stepwise logistic regression was used to determine predictive variables. RESULTS In total, 255 hips with a hip abductor tear that underwent hip arthroscopy and 2106 hips without a tear that underwent hip arthroscopy were included. The stepwise logistic regression successfully created a predictive model using age, sex, BMI, lateral joint space, and alpha angle as variables. The efficiency of the predictive model was 90.7%, with an area under the curve of 0.894. The odds of having a hip abductor tear were 7.41 times higher in females (odds ratio [OR], 7.41; 95% CI, 4.61-11.9). Each additional year of age was associated with a 13.7% (OR, 1.137; 95% CI, 1.12-1.16) increase in the odds of having a tear. Similarly, with each 1-unit increase in BMI, the odds of having a tear increased by 3.4% (OR, 1.034; 95% CI, 1.01-1.06). CONCLUSION This study successfully created a predictive model that identified female sex (OR, 7.41), increasing age (OR, 1.137 for each year), and increased BMI (OR, 1.034 for each unit of BMI) as significant independent predictors of the presence of hip abductor tears in patients undergoing hip arthroscopy for femoroacetabular impingement syndrome. This model can be used in support of physical examination and imaging suggestive of hip abductor pathology to preoperatively identify the probability of a symptomatic hip abductor tear in these patients.
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Affiliation(s)
| | | | | | - Mitchell B Meghpara
- American Hip Institute Research Foundation, Chicago, Illinois, USA.,AMITA Health St Alexius Medical Center, Hoffman Estates, Illinois, USA
| | - Jacob Shapira
- American Hip Institute Research Foundation, Chicago, Illinois, USA
| | | | - Ajay C Lall
- American Hip Institute Research Foundation, Chicago, Illinois, USA.,American Hip Institute, Chicago, Illinois, USA
| | - Cynthia Kyin
- American Hip Institute Research Foundation, Chicago, Illinois, USA
| | - Benjamin G Domb
- American Hip Institute Research Foundation, Chicago, Illinois, USA.,American Hip Institute, Chicago, Illinois, USA
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14
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Rosinsky PJ, Bheem R, Meghpara MB, Haden M, Shapira J, Maldonado DR, Lall AC, Domb BG. Asymptomatic Gluteal Tendinopathies Negatively Impact Outcomes of Total Hip Arthroplasty: A Propensity Score-Matched Study. J Arthroplasty 2021; 36:242-249. [PMID: 32828621 DOI: 10.1016/j.arth.2020.07.063] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/08/2020] [Revised: 07/22/2020] [Accepted: 07/24/2020] [Indexed: 02/02/2023] Open
Abstract
BACKGROUND The purpose of this study is to compare outcomes after total hip arthroplasty (THA) in patients with preoperative asymptomatic gluteus medius and minimus (GMM) pathology to a control group with no GMM pathology. METHODS Patients undergoing THA for osteoarthritis between August 2012 and March 2018 were retrospectively reviewed. Asymptomatic GMM pathology was considered as the presence of gluteal tendinopathy diagnosed by magnetic resonance imaging (MRI) without the following clinical symptoms: Trendelenburg gait or test, abductor weakness, and lateral thigh tenderness. Patients with asymptomatic GMM pathology were matched (1:1) to patients without GMM pathology on MRI. Two-year data were collected on patient-reported outcomes including Harris Hip Score, Forgotten Joint Score, pain, and satisfaction. Postoperative clinical examination, radiographic measures, complications, and revisions for both groups were reviewed. RESULTS Fifty cases of asymptomatic GMM pathology were successfully matched to 50 hips without GMM pathology on MRI. Patients with asymptomatic GMM pathology demonstrated significantly worse outcomes regarding 2-year Harris Hip Score (86.24 vs 92.39, P = .04), VAS for pain (1.82 vs 0.98, P = .05), and patient satisfaction (7.69 vs 9.16, P = .002). The study group exhibited significantly higher rates of lateral hip pain postoperatively. Two cases (4%) in the control group underwent a revision THA and 4 cases (8%) in the study group underwent revision THA. CONCLUSION In patients undergoing THA for osteoarthritis, those with asymptomatic GMM pathology experience inferior 2-year postoperative patient-reported outcomes compared to a matched group. This finding should raise awareness surrounding this important pathology's negative impact on surgical outcomes, thus warranting increased vigilance, and possibly justifying concomitant treatment, even in cases of asymptomatic GMM tears. LEVEL OF EVIDENCE Level III - Retrospective comparative prognostic study.
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Affiliation(s)
| | - Rishika Bheem
- American Hip Institute Research Foundation, Des Plaines, IL
| | - Mitchell B Meghpara
- American Hip Institute Research Foundation, Des Plaines, IL; AMITA Health St. Alexius Medical Center, Hoffman Estates, IL
| | - Marshall Haden
- University of Illinois at Chicago College of Medicine, Chicago, IL
| | - Jacob Shapira
- American Hip Institute Research Foundation, Des Plaines, IL
| | | | - Ajay C Lall
- American Hip Institute Research Foundation, Des Plaines, IL; AMITA Health St. Alexius Medical Center, Hoffman Estates, IL; American Hip Institute, Des Plaines, IL
| | - Benjamin G Domb
- American Hip Institute Research Foundation, Des Plaines, IL; AMITA Health St. Alexius Medical Center, Hoffman Estates, IL; American Hip Institute, Des Plaines, IL
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15
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Meghpara MB, Yelton MJ, Annin S, Shapira J, Rosinsky PJ, Maldonado DR, Lall AC, Domb BG. Mid-Term Outcomes of Endoscopic Gluteus Medius Repair With Concomitant Arthroscopic Labral Treatment: A Propensity-Matched Controlled Study. Arthroscopy 2020; 36:2856-2865. [PMID: 32730896 DOI: 10.1016/j.arthro.2020.07.020] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/22/2020] [Revised: 07/10/2020] [Accepted: 07/16/2020] [Indexed: 02/02/2023]
Abstract
PURPOSE To report mid-term outcomes of patients who underwent endoscopic gluteus medius (GM) repair with arthroscopic labral treatment and to compare them with a control cohort of patients who underwent arthroscopic labral treatment without an endoscopic GM repair. METHODS Data were prospectively collected and retrospectively reviewed for all patients who underwent primary hip arthroscopy between February 2008 and August 2013. Patients were included if they underwent arthroscopic labral treatment, endoscopic GM repair, and had preoperative with minimum 5-year follow-up for the following patient-reported outcomes: modified Harris Hip Score (mHHS), Nonarthritic Hip Score (NAHS), and Hip Outcome Score-Sports Specific Subscale (HOS-SSS). Propensity score matching was used to create a control cohort of patients who underwent primary arthroscopic labral treatment without GM repair. RESULTS There were a total of 46 patients with GM repair eligible for the current study, of whom 43 (93.5%) had 5-year follow-up. The average follow-up time was 73.4 months. At minimum 5-year follow-up, all PROs significantly improved (P < .001). Among the entire GM repair cohort, rates for achieving the patient acceptable symptomatic state (PASS) for mHHS, HOS-SSS, and international Hip Outcome Tool (iHOT-12) were 74.4%, 51.9%, and 71.8%, respectively. Rates for reaching a minimal clinically important difference for mHHS, NAHS, and HOS-SSS were 79.5%, 89.7%, and 73.1%, respectively. When the GM repair cohort was matched, there were 37 cases in the GM repair cohort and 78 in the control cohort. The GM repair cohort outcomes compared satisfactorily to the control cohort for mHHS (82.3 vs 82.6), NAHS (81.9 vs 82.3), and HOS-SSS (66.3 vs 67.5). Rates of achieving minimal clinically important difference and PASS for mHHS, NAHS, HOS-SSS, and iHOT-12 were also favorable. CONCLUSIONS Endoscopic GM repair with arthroscopic labral treatment results in safe, durable, and significant improvement in PROs at a minimum 5-year follow-up. The outcomes compared favorably with a control cohort without GM tears. LEVEL OF EVIDENCE III, retrospective comparative study.
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Affiliation(s)
- Mitchell B Meghpara
- American Hip Institute Research Foundation, Des Plaines; AMITA Health St. Alexius Medical Center, Hoffman Estates, IIlinois, U.S.A
| | | | - Shawn Annin
- American Hip Institute Research Foundation, Des Plaines
| | - Jacob Shapira
- American Hip Institute Research Foundation, Des Plaines
| | | | | | - Ajay C Lall
- American Hip Institute, Des Plaines; American Hip Institute Research Foundation, Des Plaines
| | - Benjamin G Domb
- American Hip Institute, Des Plaines; American Hip Institute Research Foundation, Des Plaines.
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Worlicek M, Messmer B, Grifka J, Renkawitz T, Weber M. Restoration of leg length and offset correlates with trochanteric pain syndrome in total hip arthroplasty. Sci Rep 2020; 10:7107. [PMID: 32345993 PMCID: PMC7188889 DOI: 10.1038/s41598-020-62531-9] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2019] [Accepted: 03/13/2020] [Indexed: 02/06/2023] Open
Abstract
Persistent pain around the greater trochanter is a common complication after total hip arthroplasty. Restoration of biomechanics such as leg length, femoral und acetabular offset is crucial in THA. The purpose of this study was to evaluate postoperative differences of these parameters after THA and to analyze their association to greater trochanteric pain syndrome. Furthermore, we aimed to evaluate the clinical relevance of trochanteric pain syndrome compared to patient reported outcome measures. 3D-CT scans of 90 patients were analyzed after minimalinvasive total hip arthroplasty and leg length, femoral and acetabular offset differences were measured. Clinical evaluation was performed three years after THA regarding the presence of trochanteric pain syndrome and using outcome measures. Furthermore, the patients' expectation were evaluated. Patients with trochanteric pain syndrome showed a higher absolute discrepancy of combined leg length, femoral and acetabular offset restoration compared to the non-operated contralateral side with 11.8 ± 6.0 mm than patients without symptoms in the trochanteric region with 7.8 ± 5.3 mm (p = 0.01). Patients with an absolute deviation of the combined parameters of more than 5 mm complained more frequently about trochanteric symptoms (29.2%, 19/65) than patients with a biomechanical restoration within 5 mm compared to the non-affected contralateral side (8.0%, 2/25, p = 0.03). Clinical outcome measured three years after THA was significantly lower in patients with trochanteric symptoms than without trochanteric pain (p < 0.03). Similarly, fulfillment of patient expectations as measured by THR-Survey was lower in the patients with trochanteric pain (p < 0.005). An exact combined restoration of leg length, acetabular and femoral offset reduces significantly postoperative trochanteric pain syndrome and improves the clinical outcome of the patients.
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Affiliation(s)
- Michael Worlicek
- University of Regensburg, Department of Trauma Surgery, University Medical Center, Regensburg, Germany. .,University of Regensburg, Department of Orthopedic Surgery, Asklepios Medical Center, Bad Abbach, Germany.
| | - Benedikt Messmer
- University of Regensburg, Department of Orthopedic Surgery, Asklepios Medical Center, Bad Abbach, Germany
| | - Joachim Grifka
- University of Regensburg, Department of Orthopedic Surgery, Asklepios Medical Center, Bad Abbach, Germany
| | - Tobias Renkawitz
- University of Regensburg, Department of Orthopedic Surgery, Asklepios Medical Center, Bad Abbach, Germany
| | - Markus Weber
- University of Regensburg, Department of Orthopedic Surgery, Asklepios Medical Center, Bad Abbach, Germany
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