Infographic. Consensus recommendations on the classification, definition and diagnostic criteria of hip-related pain in young and middle-aged active adults from the International Hip-related Pain Research Network, Zurich 2018

Combined Anteversion in Healthy Hips: Should there be a single implant alignment target in total hip arthroplasty?

BACKGROUND

The ideal anteversion at which the acetabular and femoral components for a total hip arthroplasty (THA) should be implanted is still a subject of debate. One alignment philosophy being explored is restoration of individual constitutional femoral and acetabular anteversion. This study aimed to measure combined anteversion in a healthy hip population and understand the expected phenotypes and ranges for constitutional hip alignment.

METHODS

Computed tomography (CT) scans of 338 healthy hips were analysed using an advanced modelling and analysis software that automatically maps landmarks consistently across all scans. Four distinct methods for measuring the acetabular and femoral versions were employed, each derived from different landmark placements. Acetabular and femoral versions were classified as either normal (10° - 20°), increased (> 20°), or decreased (<10°), resulting in nine potential hip phenotypes, and the prevalence of each in the healthy population was determined.

RESULTS

Femoral and acetabular version angles varied depending on the number of points used to measure them. There was wide variability in acetabular and femoral anteversion angles, ranging from 6° to 26° acetabular anteversion, and from 5° retroversion to 32° femoral anteversion. Only 29% of hips were found to have constitutional combined anteversion between 20° and 40°, withacetabular version between 10° - 20° and femoral version between 10° - 20°.

CONCLUSIONS

There is increasing interest in individualised implant alignment for THA, since studies have shown the Lewinnek "safe zone" does not guarantee hip stability. The results found in this study suggest that a single target for implant alignment may not be optimal for recreating a patient's constitutional hip alignment. Further research should consider how changes in combined anteversion during THA implant placement can impact patient outcomes.

What are participant beliefs regarding physical therapy led treatment? A qualitative study of people living with femoroacetabular impingement syndrome

BACKGROUND

Physical therapist-led treatment programs are recommended for patients with femoroacetabular impingement (FAI) syndrome. Views of people with FAI syndrome regarding such interventions are currently unknown, including perceptions of potential barriers and facilitators to participation and adherence to exercise programs.

OBJECTIVES

To explore participant perceptions of physical therapist-led programs for FAI syndrome, including barriers and facilitators for accessing physical therapy, and adhering to a rehabilitation program.

METHODS

Our qualitative study used semi-structured interviews to explore the perceptions of patients with FAI syndrome undertaking physical therapy-led treatment, where treatment was ceased due to Coronavirus Disease 2019 (COVID-19). The interview topic guide was informed by the Theoretical Domain Framework. Interviews were transcribed verbatim and data categories were developed using inductive thematic analysis. Themes were discussed between researchers until consensus was reached.

RESULTS

Fourteen participants (mean age: 30 years) with a range of physical activity backgrounds undertook interviews. We identified four key themes, 1) Patients believed their hip pain was caused by structural damage worsened through exercise; 2) Barriers and facilitators on the feasibility of physical therapist-led programs; 3) Participants held beliefs regarding the importance of adjunct treatments to exercise; and 4) Impact of FAI syndrome on physical activity participation.

CONCLUSION

People with FAI syndrome believe they have structural damage which leads to their hip pain and are often afraid to exercise due to fear of causing more damage to their hip. Our findings suggest that people with FAI syndrome want clear education about exercise, imaging, and expectations of cost and duration of treatment.

Consensus statement on concussion in sport: the 6th International Conference on Concussion in Sport-Amsterdam, October 2022

For over two decades, the Concussion in Sport Group has held meetings and developed five international statements on concussion in sport. This 6th statement summarises the processes and outcomes of the 6th International Conference on Concussion in Sport held in Amsterdam on 27-30 October 2022 and should be read in conjunction with the (1) methodology paper that outlines the consensus process in detail and (2) 10 systematic reviews that informed the conference outcomes. Over 3½ years, author groups conducted systematic reviews of predetermined priority topics relevant to concussion in sport. The format of the conference, expert panel meetings and workshops to revise or develop new clinical assessment tools, as described in the methodology paper, evolved from previous consensus meetings with several new components. Apart from this consensus statement, the conference process yielded revised tools including the Concussion Recognition Tool-6 (CRT6) and Sport Concussion Assessment Tool-6 (SCAT6, Child SCAT6), as well as a new tool, the Sport Concussion Office Assessment Tool-6 (SCOAT6, Child SCOAT6). This consensus process also integrated new features including a focus on the para athlete, the athlete's perspective, concussion-specific medical ethics and matters related to both athlete retirement and the potential long-term effects of SRC, including neurodegenerative disease. This statement summarises evidence-informed principles of concussion prevention, assessment and management, and emphasises those areas requiring more research.

Improving function in people with hip-related pain: a systematic review and meta-analysis of physiotherapist-led interventions for hip-related pain

OBJECTIVE

To report the effectiveness of physiotherapist-led interventions in improving pain and function in young and middle-aged adults with hip-related pain.

DESIGN

Systematic review and meta-analysis.

DATA SOURCES

A comprehensive, reproducible search strategy was performed on five databases in May 2019. Reference lists and grey literature were also searched.

ELIGIBILITY CRITERIA FOR SELECTING STUDIES

Population: people aged ≥18 years with hip-related pain (with or without a diagnosis of femoroacetabular impingement syndrome).

INTERVENTION(S)

physiotherapist-led interventions for hip pain. Comparators: sham treatment, no treatment or other treatment (eg, hip arthroscopic surgery).

OUTCOMES

primary outcomes included patient-reported hip pain and function. Secondary outcomes included physical function measures.

RESULTS

1722 papers were identified. After exclusion criteria were applied, 14 studies were included for analysis. They had varied risk of bias. There were no full-scale placebo-controlled randomised controlled trials (RCTs) of physiotherapist-led treatment. Pooled effects ranged from moderate effects (0.67 (95% CI 0.07 to 1.26)) favouring physiotherapist-led intervention over no treatment post-arthroscopy, to weak effects (-0.32 (95% CI 0.57 to 0.07)) favouring hip arthroscopy over physiotherapist-led treatment.

CONCLUSION

Physiotherapist-led interventions might improve pain and function in young and middle-aged adults with hip-related pain, however full-scale high-quality RCT studies are required.

PROSPERO REGISTRATION NUMBER

CRD42018089088.