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Bugeja JM, Xia Y, Chandra SS, Murphy NJ, Crozier S, Hunter DJ, Fripp J, Engstrom C. Analysis of cam location characteristics in FAI syndrome patients from 3D MR images demonstrates sex-specific differences. J Orthop Res 2024; 42:385-394. [PMID: 37525546 DOI: 10.1002/jor.25674] [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: 03/01/2023] [Revised: 06/22/2023] [Accepted: 07/26/2023] [Indexed: 08/02/2023]
Abstract
Cam femoroacetabular impingement (FAI) syndrome is associated with hip osteoarthritis (OA) development. Hip shape features, derived from statistical shape modeling (SSM), are predictive for OA incidence, progression, and arthroplasty. Currently, no three-dimensional (3D) SSM studies have investigated whether there are cam shape differences between male and female patients, which may be of potential clinical relevance for FAI syndrome assessments. This study analyzed sex-specific cam location and shape in FAI syndrome patients from clinical magnetic resonance examinations (M:F 56:41, age: 16-63 years) using 3D focused shape modeling-based segmentation (CamMorph) and partial least squares regression to obtain shape features (latent variables [LVs]) of cam morphology. Two-way analysis of variance tests were used to assess cam LV data for sex and cam volume severity differences. There was no significant interaction between sex and cam volume severity for the LV data. A sex main effect was significant for LV 1 (cam size) and LV 2 (cam location) with medium to large effect sizes (p < 0.001, d > 0.75). Mean results revealed males presented with a superior-focused cam, whereas females presented with an anterior-focused cam. When stratified by cam volume, cam morphologies were located superiorly in male and anteriorly in female FAI syndrome patients with negligible, mild, or moderate cam volumes. Both male and female FAI syndrome patients with major cam volumes had a global cam distribution. In conclusion, sex-specific cam location differences are present in FAI syndrome patients with negligible, mild, and moderate cam volumes, whereas major cam volumes were globally distributed in both male and female patients.
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Affiliation(s)
- Jessica M Bugeja
- Australian e-Health Research Centre, Health and Biosecurity, Commonwealth Scientific and Industrial Research Organisation, Brisbane, QLD, Australia
| | - Ying Xia
- Australian e-Health Research Centre, Health and Biosecurity, Commonwealth Scientific and Industrial Research Organisation, Brisbane, QLD, Australia
| | - Shekhar S Chandra
- School of Information Technology and Electrical Engineering, Faculty of Engineering, Architecture and Information Technology, The University of Queensland, Brisbane, QLD, Australia
| | - Nicholas J Murphy
- Kolling Institute of Medical Research, Sydney Musculoskeletal Health, Faculty of Medicine and Health, University of Sydney, Sydney, NSW, Australia
- Department of Orthopaedic Surgery, John Hunter Hospital, Newcastle, NSW, Australia
| | - Stuart Crozier
- School of Information Technology and Electrical Engineering, Faculty of Engineering, Architecture and Information Technology, The University of Queensland, Brisbane, QLD, Australia
| | - David J Hunter
- Kolling Institute of Medical Research, Sydney Musculoskeletal Health, Faculty of Medicine and Health, University of Sydney, Sydney, NSW, Australia
- Department of Rheumatology, Royal North Shore Hospital, St Leonards, NSW, Australia
| | - Jurgen Fripp
- Australian e-Health Research Centre, Health and Biosecurity, Commonwealth Scientific and Industrial Research Organisation, Brisbane, QLD, Australia
| | - Craig Engstrom
- School of Human Movement and Nutrition Sciences, Faculty of Health and Behavioural Sciences, The University of Queensland, Brisbane, QLD, Australia
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Murphy NJ, Eyles J, Spiers L, Davidson EJ, Linklater JM, Kim YJ, Hunter DJ. Combined femoral and acetabular version and synovitis are associated with dGEMRIC scores in people with femoroacetabular impingement (FAI) syndrome. J Orthop Res 2023; 41:2484-2494. [PMID: 37032588 PMCID: PMC10946968 DOI: 10.1002/jor.25568] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/08/2022] [Revised: 03/20/2023] [Accepted: 03/29/2023] [Indexed: 04/11/2023]
Abstract
This study sought to explore, in people with symptoms, signs and imaging findings of femoroacetabular impingement (FAI syndrome): (1) whether more severe labral damage, synovitis, bone marrow lesions, or subchondral cysts assessed on magnetic resonance imaging (MRI) were associated with poorer cartilage health, and (2) whether abnormal femoral, acetabular, and/or combined femoral and acetabular versions were associated with poorer cartilage health. This cross-sectional study used baseline data from the 50 participants with FAI syndrome in the Australian FASHIoN trial (ACTRN12615001177549) with available dGEMRIC scans. Cartilage health was measured using delayed gadolinium-enhanced MRI of cartilage (dGEMRIC) score sampled at the chondrolabral junction on three midsagittal slices, at one acetabular and one femoral head region of interest on each slice, and MRI features were assessed using the Hip Osteoarthritis MRI Score. Analyses were adjusted for alpha angle and body mass index, which are known to affect dGEMRIC score. Linear regression assessed the relationship with the dGEMRIC score of (i) selected MRI features, and (ii) femoral, acetabular, and combined femoral and acetabular versions. Hips with more severe synovitis had worse dGEMRIC scores (partial η2 = 0.167, p = 0.020), whereas other MRI features were not associated. A lower combined femoral and acetabular version was associated with a better dGEMRIC score (partial η2 = 0.164, p = 0.021), whereas isolated measures of femoral and acetabular version were not associated. In conclusion, worse synovitis was associated with poorer cartilage health, suggesting synovium and cartilage may be linked to the pathogenesis of FAI syndrome. A lower combined femoral and acetabular version appears to be protective of cartilage health at the chondrolabral junction.
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Affiliation(s)
- Nicholas J. Murphy
- The University of Sydney, Sydney Musculoskeletal Health and the Kolling InstituteFaculty of Medicine and Health and the Northern Sydney Local Health DistrictSydneyAustralia
- Department of Orthopaedic SurgeryJohn Hunter HospitalNew Lambton HeightsAustralia
| | - Jillian Eyles
- The University of Sydney, Sydney Musculoskeletal Health and the Kolling InstituteFaculty of Medicine and Health and the Northern Sydney Local Health DistrictSydneyAustralia
- Department of RheumatologyRoyal North Shore HospitalSt LeonardsAustralia
| | - Libby Spiers
- Department of Physiotherapy, Centre for Health, Exercise and Sports MedicineUniversity of MelbourneMelbourneAustralia
| | - Emily J. Davidson
- Department of RadiologyRoyal Prince Alfred HospitalSydneyNew South WalesAustralia
| | | | - Young Jo Kim
- Department of Orthopedic SurgeryBoston Children's HospitalBostonMassachusettsUSA
| | - David J. Hunter
- The University of Sydney, Sydney Musculoskeletal Health and the Kolling InstituteFaculty of Medicine and Health and the Northern Sydney Local Health DistrictSydneyAustralia
- Department of RheumatologyRoyal North Shore HospitalSt LeonardsAustralia
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You M, Yang S, Li J, Chen G. Effect of Psychosocial Interventions for Individuals Who Underwent Arthroscopy in Femoroacetabular Impingement: A Randomized Controlled Trial. J Clin Med 2023; 12:jcm12113612. [PMID: 37297807 DOI: 10.3390/jcm12113612] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2023] [Revised: 03/09/2023] [Accepted: 05/10/2023] [Indexed: 06/12/2023] Open
Abstract
PURPOSE The purpose of this protocol was to discover the connection between patients with non-surgical pain or other discomfort and their psychosocial status. Cognitive behavior therapy will be used, which we verified will determine the effect and feasibility of postoperative rehabilitation processes. MATERIALS AND METHODS This study will include 200 patients ranging from 18 to 60 years old who have underwent or will undergo FAI arthroscopy in the West China Hospital Sports Medicine Center from 2023 to 2026. A standardized prospective single-center parallel-group randomized controlled trial will be used for these participants. The participants will be divided into intervention (telephone versus face-to-face versus music versus floatation) and control groups. The follow-up periods will be measured pre-operatively, as well as postoperatively at 1, 3, and 6 months. The primary outcomes will include the modified Harris Hip Score (mHHS) and the Visual Analogic Score (VAS), and the secondary outcomes will include the range of motion (ROM), the Huaxi Emotional-distress Index (HEI), and the depression, anxiety, and stress scale (DASS-21 scale). Furthermore, the Patient Health Questionnaire-9 (PHQ-9) and a Short-Form 12 (SF-12) questionnaire will also be evaluated. DISCUSSION This study will evaluate the clinical and cost-effectiveness of different types of psychosocial-therapy-based rehabilitation methods designed to improve the quality of life of FAI patients with persistent symptoms.
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Affiliation(s)
- Mingke You
- Department of Orthopedics, Orthopedic Research Institute, West China Hospital, Sichuan University, Chengdu 610041, China
| | - Shuoyao Yang
- Department of Orthopedics, Orthopedic Research Institute, West China Hospital, Sichuan University, Chengdu 610041, China
| | - Jian Li
- Department of Orthopedics, Orthopedic Research Institute, West China Hospital, Sichuan University, Chengdu 610041, China
| | - Gang Chen
- Department of Orthopedics, Orthopedic Research Institute, West China Hospital, Sichuan University, Chengdu 610041, China
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Thirumaran AJ, Murphy NJ, Eyles JP, Linklater J, Reichenbach S, Schmaranzer F, Lerch TD, Venkatesha V, Heller G, O'Donnell J, Hunter DJ. Do patients with femoroacetabular impingement syndrome who undergo hip arthroscopy display improved alpha angle (magnetic resonance imaging) and radiographic hip morphology? Int J Rheum Dis 2023; 26:354-359. [PMID: 36502534 PMCID: PMC10946938 DOI: 10.1111/1756-185x.14530] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2022] [Revised: 11/14/2022] [Accepted: 11/26/2022] [Indexed: 12/14/2022]
Abstract
AIMS To compare (a) the change in radiological bony morphology between participants with femoroacetabular impingement (FAI) syndrome who underwent arthroscopic hip surgery compared to physiotherapist-led non-surgical care and (b) the change in radiological bony morphology between participants with FAI syndrome who underwent arthroscopic hip surgery involving cam resection or acetabular rim trimming or combined cam resection and acetabular rim trimming. METHODS Maximum alpha angle measurements on magnetic resonance imaging and Hip2 Norm standardized hip measurements on radiographs were recorded at baseline and at 12 months postoperatively. One-way analysis of covariance and independent T tests were conducted between participants who underwent arthroscopic hip surgery and physiotherapist-led non-surgical care. Independent T tests and analysis of variance were conducted between participants who underwent the 3 different arthroscopic hip procedures. RESULTS Arthroscopic hip surgery resulted in significant improvements to mean alpha angle measurements (decreased from 70.8° to 62.1°) (P value < .001, 95% CI -11.776, -4.772), lateral center edge angle (LCEA) (P value = .030, 95% CI -3.403, -0.180) and extrusion index (P value = 0.002, 95% CI 0.882, 3.968) compared to physiotherapist-led management. Mean maximum 1-year postoperative alpha angle was 59.0° (P value = .003, 95% CI 4.845, 18.768) for participants who underwent isolated cam resection. Measurements comparing the 3 different arthroscopic hip procedures only differed in total femoral head coverage (F[2,37] = 3.470, P = .042). CONCLUSION Arthroscopic hip surgery resulted in statistically significant improvements to LCEA, extrusion index and alpha angle as compared to physiotherapist-led management. Measured outcomes between participants who underwent cam resection and/or acetabular rim trimming only differed in total femoral head coverage.
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Affiliation(s)
| | - Nicholas J Murphy
- Sydney Musculoskeletal Health, Kolling Institute of Medical ResearchUniversity of SydneyCamperdownNew South WalesAustralia
- Department of Orthopedic SurgeryJohn Hunter HospitalNew LambtonNew South WalesAustralia
| | - Jillian Peta Eyles
- Sydney Musculoskeletal Health, Kolling Institute of Medical ResearchUniversity of SydneyCamperdownNew South WalesAustralia
- Department of RheumatologyRoyal North Shore HospitalSydneyNew South WalesAustralia
| | - James M. Linklater
- Department of Musculoskeletal ImagingCastlereagh ImagingSt LeonardsNew South WalesAustralia
| | - Stephan Reichenbach
- Institute of Social and Preventive MedicineUniversity of BernBernSwitzerland
- Department of Rheumatology, Immunology and AllergologyUniversity Hospital and University of BernBernSwitzerland
- Department of Diagnostic, Interventional and Pediatric Radiology, InselspitalBern University Hospital, University of BernBernSwitzerland
| | - Florian Schmaranzer
- Department of Diagnostic, Interventional and Pediatric Radiology, InselspitalBern University Hospital, University of BernBernSwitzerland
| | - Till D. Lerch
- Department of Diagnostic, Interventional and Pediatric Radiology, InselspitalBern University Hospital, University of BernBernSwitzerland
| | - Venkatesha Venkatesha
- Northern Sydney Local Health District ExecutiveRoyal North Shore HospitalSt LeonardsNew South WalesAustralia
| | - Gillian Heller
- Department of Statistics, Faculty of Science and EngineeringMacquarie UniversitySydneyNew South WalesAustralia
| | - John O'Donnell
- Hip Arthroscopy AustraliaMelbourneVictoriaAustralia
- St Vincent's Private HospitalMelbourneVictoriaAustralia
| | - David J. Hunter
- Sydney Musculoskeletal Health, Kolling Institute of Medical ResearchUniversity of SydneyCamperdownNew South WalesAustralia
- Department of RheumatologyRoyal North Shore HospitalSydneyNew South WalesAustralia
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5
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Murphy NJ, Diamond LE, Bennell KL, Burns A, Dickenson E, Eyles J, Fary C, Grieve SM, Griffin DR, Kim YJ, Linklater JM, Lloyd DG, Molnar R, O'Connell RL, O'Donnell J, Randhawa S, J Singh P, Spiers L, Tran P, Wrigley T, Hunter DJ. Which hip morphology measures and patient factors are associated with age of onset and symptom severity in femoroacetabular impingement syndrome? Hip Int 2023; 33:102-111. [PMID: 34424780 DOI: 10.1177/11207000211038550] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
BACKGROUND Bony morphology is central to the pathomechanism of femoroacetabular impingement syndrome (FAIS), however isolated radiographic measures poorly predict symptom onset and severity. More comprehensive morphology measurement considered together with patient factors may better predict symptom presentation. This study aimed to determine the morphological parameter(s) and patient factor(s) associated with symptom age of onset and severity in FAIS. METHODS 99 participants (age 32.9 ± 10.5 years; body mass index (BMI 24.3 ± 3.1 kg/m2; 42% females) diagnosed with FAIS received standardised plain radiographs and magnetic resonance scans. Alpha angle in four radial planes (superior to anterior), acetabular version (AV), femoral torsion, lateral centre-edge, anterior centre-edge (ACEA) and femoral neck-shaft angles were measured. Age of symptom onset (age at presentation minus duration of symptoms), international Hip Outcome Tool-33 (iHOT-33) and modified UCLA activity scores were recorded. Backward stepwise regression assessed morphological parameters and patient factors (age, sex, BMI, symptom duration, annual income, private/public healthcare system accessed) to determine variables independently associated with onset age and iHOT-33 score. RESULTS Earlier symptom onset was associated with larger superoanterior alpha angle (p = 0.007), smaller AV (p = 0.023), lower BMI (p = 0.010) and public healthcare system access (p = 0.041) (r2 = 0.320). Worse iHOT-33 score was associated with smaller ACEA (p = 0.034), female sex (p = 0.040), worse modified UCLA activity score (p = 0.010) and public healthcare system access (p < 0.001) (r2 = 0.340). CONCLUSIONS Age of symptom onset was chiefly predicted by femoral and acetabular bony morphology measures, whereas symptom severity predominantly by patient factors. Factors measured explained a small amount of variance in the data; additional unmeasured factors may be more influential.
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Affiliation(s)
- Nicholas J Murphy
- Kolling Institute of Medical Research, Institute of Bone and Joint Research, University of Sydney, St Leonards, NSW, Australia.,Department of Orthopaedic Surgery, John Hunter Hospital, Australia
| | - Laura E Diamond
- Griffith Centre of Biomedical and Rehabilitation Engineering (GCORE), Menzies Health Institute Queensland, School of Allied Health Sciences, Griffith University, Australia
| | - Kim L Bennell
- Centre for Health, Exercise and Sports Medicine, Department of Physiotherapy, University of Melbourne, Australia
| | | | - Edward Dickenson
- Warwick Medical School, University of Warwick, Coventry, UK and University Hospitals of Coventry and Warwickshire NHS Trust, Coventry, UK
| | - Jillian Eyles
- Kolling Institute of Medical Research, Institute of Bone and Joint Research, University of Sydney, St Leonards, NSW, Australia.,Department of Rheumatology, Royal North Shore Hospital, Australia
| | - Camdon Fary
- Department of Orthopaedic Surgery, Western Health, Melbourne, Australia.,Australian Institute for Musculoskeletal Science (AIMSS), The University of Melbourne and Western Health, St Albans, Melbourne, Australia
| | - Stuart M Grieve
- Sydney Translational Imaging Laboratory, Charles Perkins Centre, University of Sydney, Camperdown, Australia.,Department of Radiology, Royal Prince Alfred Hospital, Camperdown, Australia
| | - Damian R Griffin
- Warwick Medical School, University of Warwick, Coventry, UK and University Hospitals of Coventry and Warwickshire NHS Trust, Coventry, UK
| | - Young Jo Kim
- Department of Orthopaedic Surgery, Boston Children's Hospital, Boston, USA
| | - James M Linklater
- Department of Musculoskeletal Imaging, Castlereagh Sports Imaging Centre, St Leonards, Australia
| | - David G Lloyd
- Griffith Centre of Biomedical and Rehabilitation Engineering (GCORE), Menzies Health Institute Queensland, School of Allied Health Sciences, Griffith University, Australia
| | - Robert Molnar
- Sydney Orthopaedic Trauma and Reconstructive Surgery, Sydney, Australia
| | - Rachel L O'Connell
- Department of Rheumatology, Royal North Shore Hospital, Australia.,NHMRC Clinical Trials Centre, University of Sydney, Camperdown, Australia
| | - John O'Donnell
- Hip Arthroscopy Australia, Richmond, Australia.,St Vincent's Private Hospital, East Melbourne, Australia
| | - Sunny Randhawa
- Macquarie University Hospital, Macquarie University, Sydney, Australia
| | - Parminder J Singh
- Hip Arthroscopy Australia, Richmond, Australia.,Maroondah Hospital, Eastern Health, Davey Drive, Ringwood East, Melbourne, Australia
| | - Libby Spiers
- Centre for Health, Exercise and Sports Medicine, Department of Physiotherapy, University of Melbourne, Australia
| | - Phong Tran
- Department of Orthopaedic Surgery, Western Health, Melbourne, Australia.,Australian Institute for Musculoskeletal Science (AIMSS), The University of Melbourne and Western Health, St Albans, Melbourne, Australia
| | - Tim Wrigley
- Centre for Health, Exercise and Sports Medicine, Department of Physiotherapy, University of Melbourne, Australia
| | - David J Hunter
- Kolling Institute of Medical Research, Institute of Bone and Joint Research, University of Sydney, St Leonards, NSW, Australia.,Department of Rheumatology, Royal North Shore Hospital, Australia
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6
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Murphy NJ, Eyles J, Spiers L, Davidson E, Kim YJ, Linklater JM, Afacan O, Bennell KL, Burns A, Diamond LE, Dickenson E, Fary C, Foster NE, Fripp J, Grieve SM, Griffin DR, Heller G, Molnar R, Neubert A, O'Donnell J, O'Sullivan M, Randhawa S, Reichenbach S, Singh P, Tran P, Hunter DJ. Moderators, Mediators, and Prognostic Indicators of Treatment With Hip Arthroscopy or Physical Therapy for Femoroacetabular Impingement Syndrome: Secondary Analyses From the Australian FASHIoN Trial. Am J Sports Med 2023; 51:141-154. [PMID: 36427015 DOI: 10.1177/03635465221136547] [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] [Indexed: 11/27/2022]
Abstract
BACKGROUND Although randomized controlled trials comparing hip arthroscopy with physical therapy for the treatment of femoroacetabular impingement (FAI) syndrome have emerged, no studies have investigated potential moderators or mediators of change in hip-related quality of life. PURPOSE To explore potential moderators, mediators, and prognostic indicators of the effect of hip arthroscopy and physical therapy on change in 33-item international Hip Outcome Tool (iHOT-33) score for FAI syndrome. STUDY DESIGN Cohort study; Level of evidence, 2. METHODS Overall, 99 participants were recruited from the clinics of orthopaedic surgeons and randomly allocated to treatment with hip arthroscopy or physical therapy. Change in iHOT-33 score from baseline to 12 months was the dependent outcome for analyses of moderators, mediators, and prognostic indicators. Variables investigated as potential moderators/prognostic indicators were demographic variables, symptom duration, alpha angle, lateral center-edge angle (LCEA), Hip Osteoarthritis MRI Scoring System (HOAMS) for selected magnetic resonance imaging (MRI) features, and delayed gadolinium-enhanced MRI of cartilage (dGEMRIC) score. Potential mediators investigated were change in chosen bony morphology measures, HOAMS, and dGEMRIC score from baseline to 12 months. For hip arthroscopy, intraoperative procedures performed (femoral ostectomy ± acetabular ostectomy ± labral repair ± ligamentum teres debridement) and quality of surgery graded by a blinded surgical review panel were investigated for potential association with iHOT-33 change. For physical therapy, fidelity to the physical therapy program was investigated for potential association with iHOT-33 change. RESULTS A total of 81 participants were included in the final moderator/prognostic indicator analysis and 85 participants in the final mediator analysis after exclusion of those with missing data. No significant moderators or mediators of change in iHOT-33 score from baseline to 12 months were identified. Patients with smaller baseline LCEA (β = -0.82; P = .034), access to private health care (β = 12.91; P = .013), and worse baseline iHOT-33 score (β = -0.48; P < .001) had greater iHOT-33 improvement from baseline to 12 months, irrespective of treatment allocation, and thus were prognostic indicators of treatment response. Unsatisfactory treatment fidelity was associated with worse treatment response (β = -24.27; P = .013) for physical therapy. The quality of surgery and procedures performed were not associated with iHOT-33 change for hip arthroscopy (P = .460-.665 and P = .096-.824, respectively). CONCLUSION No moderators or mediators of change in hip-related quality of life were identified for treatment of FAI syndrome with hip arthroscopy or physical therapy in these exploratory analyses. Patients who accessed the Australian private health care system, had smaller LCEAs, and had worse baseline iHOT-33 scores, experienced greater iHOT-33 improvement, irrespective of treatment allocation.
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Affiliation(s)
- Nicholas J Murphy
- Kolling Institute of Medical Research, Sydney Musculoskeletal Health, University of Sydney, St Leonards, Australia; Department of Orthopaedic Surgery, John Hunter Hospital, Newcastle, Australia
| | - Jillian Eyles
- Kolling Institute of Medical Research, Sydney Musculoskeletal Health, University of Sydney, St Leonards, Australia; Department of Rheumatology, Royal North Shore Hospital, St Leonards, Australia
| | - Libby Spiers
- Centre for Health, Exercise and Sports Medicine, Department of Physical Therapy, University of Melbourne, Parkville, Australia
| | - Emily Davidson
- Department of Radiology, Royal Prince Alfred Hospital, Sydney, Australia
| | - Young Jo Kim
- Department of Orthopedic Surgery, Boston Children's Hospital, Boston, Massachusetts, USA
| | | | - Onur Afacan
- Department of Radiology, Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Kim L Bennell
- Centre for Health, Exercise and Sports Medicine, Department of Physical Therapy, University of Melbourne, Parkville, Australia
| | | | - Laura E Diamond
- Griffith Centre of Biomedical and Rehabilitation Engineering, Menzies Health Institute Queensland, School of Allied Health Sciences, Griffith University, Gold Coast, Australia
| | - Edward Dickenson
- Warwick Medical School, University of Warwick, and University Hospitals of Coventry and Warwickshire NHS Trust, Coventry, UK
| | - Camdon Fary
- Department of Orthopaedic Surgery, Western Health, Melbourne, Australia; Australian Institute for Musculoskeletal Science, The University of Melbourne and Western Health, St Albans, Australia
| | - Nadine E Foster
- STARS Research and Education Alliance, Surgical Treatment and Rehabilitation Service, The University of Queensland and Metro North Hospital and Health Service, Brisbane, Australia; Primary Care Centre Versus Arthritis, School of Medicine, Keele University, Keele, UK
| | - Jurgen Fripp
- The Australian e-Health Research Centre, CSIRO Health and Biosecurity, Brisbane, Australia
| | - Stuart M Grieve
- Department of Radiology, Royal Prince Alfred Hospital, Sydney, Australia; Imaging and Phenotyping Laboratory, Charles Perkins Centre, University of Sydney, Camperdown, Australia; Sydney Medical School and School of Health Sciences, Faculty of Medicine and Health, University of Sydney, Camperdown, Australia
| | - Damian R Griffin
- Warwick Medical School, University of Warwick, and University Hospitals of Coventry and Warwickshire NHS Trust, Coventry, UK
| | - Gillian Heller
- Department of Rheumatology, Royal North Shore Hospital, St Leonards, Australia; NHMRC Clinical Trials Centre, University of Sydney, Camperdown, Australia
| | - Robert Molnar
- Sydney Orthopaedic Trauma and Reconstructive Surgery, Sydney, Australia
| | - Ales Neubert
- The Australian e-Health Research Centre, CSIRO Health and Biosecurity, Brisbane, Australia
| | - John O'Donnell
- Hip Arthroscopy Australia, Richmond, Australia; St Vincent's Private Hospital, East Melbourne, Australia
| | - Michael O'Sullivan
- North Sydney Orthopaedic and Sports Medicine Centre, North Sydney, Australia
| | - Sunny Randhawa
- Macquarie University Hospital, Macquarie University, Sydney, Australia
| | - Stephan Reichenbach
- Institute of Social and Preventive Medicine, University of Bern, Bern, Switzerland; Department of Rheumatology, Immunology and Allergology, University Hospital and University of Bern, Switzerland; Department Diagnostic, Interventional and Paediatric Radiology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Parminder Singh
- Hip Arthroscopy Australia, Richmond, Australia; Maroondah Hospital, Eastern Health, Ringwood East, Australia
| | - Phong Tran
- Australian Institute for Musculoskeletal Science, The University of Melbourne and Western Health, St Albans, Australia; STARS Research and Education Alliance, Surgical Treatment and Rehabilitation Service, The University of Queensland and Metro North Hospital and Health Service, Brisbane, Australia
| | - David J Hunter
- Kolling Institute of Medical Research, Sydney Musculoskeletal Health, University of Sydney, St Leonards, Australia; Department of Rheumatology, Royal North Shore Hospital, St Leonards, Australia.,Investigation performed at the University of Sydney, Camperdown, Australia, and University of Melbourne, Melbourne, Australia
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7
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Conservative Physiotherapy Treatment of Femoroacetabular Impingement. ACTA MEDICA BULGARICA 2022. [DOI: 10.2478/amb-2022-0030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
Abstract
The femoro-acetabular impingement (FAI) syndrome is a motion-related disorder of the hip joint with premature contact between the acetabulum and the proximal femur. It is a relatively new clinical entity and no strict treatment protocols and guidelines have been established yet. Furthermore, patients are often misdiagnosed and not properly treated. We report a clinical case of a young adult female patient presenting with a bilateral FAI-CAM type deformity during the last 2 years. An individual progressive global elastic resistant training program was established which involved stimulation to all affected muscle groups using Pilates concept. Hip-specific and functional lower limb strengthening targeted the deep hip external rotators, abductors and flexors in the transverse, frontal, and sagittal planes. Improving the dynamic stability and Core stability was the main aim of the challenging physiotherapy treatment in this case. A good functional result was registered at 6 months follow up. All therapeutic activities were performed in a pain free range of motion which was of paramount importance for achieving excellent patient compliance and successful outcome respectively. The applied treatment strategy demonstrated to be reliable and could be a helpful tool in the armamentarium of contemporary physiotherapy when dealing with the FAI group of patients.
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8
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Grant TM, Diamond LE, Pizzolato C, Savage TN, Bennell K, Dickenson EJ, Eyles J, Foster NE, Hall M, Hunter DJ, Lloyd DG, Molnar R, Murphy NJ, O'Donnell J, Singh P, Spiers L, Tran P, Saxby DJ. Comparison of Walking Biomechanics After Physical Therapist-Led Care or Hip Arthroscopy for Femoroacetabular Impingement Syndrome: A Secondary Analysis From a Randomized Controlled Trial. Am J Sports Med 2022; 50:3198-3209. [PMID: 36177759 DOI: 10.1177/03635465221120388] [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] [Indexed: 01/31/2023]
Abstract
BACKGROUND Femoroacetabular impingement syndrome is characterized by chondrolabral damage and hip pain. The specific biomechanics used by people with femoroacetabular impingement syndrome during daily activities may exacerbate their symptoms. Femoroacetabular impingement syndrome can be treated nonoperatively or surgically; however, differential treatment effects on walking biomechanics have not been examined. PURPOSE To compare the 12-month effects of physical therapist-led care or arthroscopy on trunk, pelvis, and hip kinematics as well as hip moments during walking. STUDY DESIGN Secondary analysis of multi-centre, pragmatic, two-arm superiority randomized controlled trial subsample; Level of evidence, 1. METHODS A subsample of 43 participants from the Australian Full randomised controlled trial of Arthroscopic Surgery for Hip Impingement versus best cONventional (FASHIoN trial) underwent gait analysis and completed the International Hip Outcome Tool (iHOT-33) at both baseline and 12 months after random allocation to physical therapist-led care (personalized hip therapy; n = 22; mean age 35; 41% female) or arthroscopy (n = 21; mean age 36; 48% female). Changes in trunk, pelvis, and hip biomechanics were compared between treatment groups across the gait cycle using statistical parametric mapping. Associations between changes in iHOT-33 and changes in hip kinematics across 3 planes of motion were examined. RESULTS As compared with the arthroscopy group, the personalized hip therapy group increased its peak hip adduction moments (mean difference = 0.35 N·m/body weight·height [%] [95% CI, 0.05-0.65]; effect size = 0.72; P = .02). Hip adduction moments in the arthroscopy group were unchanged in response to treatment. No other between-group differences were detected. Improvements in iHOT-33 were not associated with changes in hip kinematics. CONCLUSION Peak hip adduction moments were increased in the personalized hip therapy group and unchanged in the arthroscopy group. No biomechanical changes favoring arthroscopy were detected, suggesting that personalized hip therapy elicits greater changes in hip moments during walking at 12-month follow-up. Twelve-month changes in hip-related quality of life were not associated with changes in hip kinematics.
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Affiliation(s)
| | | | - Claudio Pizzolato
- Griffith Centre of Biomedical and Rehabilitation Engineering, Griffith University, Gold Coast, Australia
| | - Trevor N Savage
- Griffith Centre of Biomedical and Rehabilitation Engineering, Griffith University, Gold Coast, Australia; and Sydney Musculoskeletal Health, Kolling Institute of Medical Research, The University of Sydney, Sydney, Australia
| | - Kim Bennell
- Centre for Health, Exercise and Sports Medicine, Department of Physiotherapy, University of Melbourne, Melbourne, Australia
| | - Edward J Dickenson
- University of Warwick, Coventry, UK, and University Hospitals of Coventry and Warwickshire NHS Trust, Coventry, UK
| | - Jillian Eyles
- Sydney Musculoskeletal Health, Kolling Institute of Medical Research, The University of Sydney, Sydney, Australia; and Department of Rheumatology, Royal North Shore Hospital, St Leonards, Australia
| | - Nadine E Foster
- Primary Care Centre Versus Arthritis, School of Medicine, Keele University, Keele, UK; and STARS Education and Research Alliance, Surgical, Treatment and Rehabilitation Service, The University of Queensland and Metro North Health, Queensland, Australia
| | - Michelle Hall
- Centre for Health, Exercise and Sports Medicine, Department of Physiotherapy, University of Melbourne, Melbourne, Australia
| | - David J Hunter
- Sydney Musculoskeletal Health, Kolling Institute of Medical Research, The University of Sydney, Sydney, Australia; and Department of Rheumatology, Royal North Shore Hospital, St Leonards, Australia
| | - David G Lloyd
- Griffith Centre of Biomedical and Rehabilitation Engineering, Griffith University, Gold Coast, Australia
| | - Robert Molnar
- Department of Orthopaedic Surgery, St George Hospital, Kogarah, Australia; and Sydney Orthopaedic and Reconstructive Surgery, Sydney, Australia
| | - Nicholas J Murphy
- Sydney Musculoskeletal Health, Kolling Institute of Medical Research, The University of Sydney, Sydney, Australia; and Department of Orthopaedic Surgery, John Hunter Hospital, Newcastle, Australia
| | - John O'Donnell
- Hip Arthroscopy Australia, Richmond, Australia; and School of Health Sciences, Swinburne University of Technology, Melbourne, Australia
| | - Parminder Singh
- Hip Arthroscopy Australia, Richmond, Australia; and Maroondah Hospital, Eastern Health, Melbourne, Australia
| | - Libby Spiers
- Centre for Health, Exercise and Sports Medicine, Department of Physiotherapy, University of Melbourne, Melbourne, Australia
| | - Phong Tran
- Department of Orthopaedic Surgery, Western Health, Melbourne, Australia; and Australian Institute for Musculoskeletal Science, University of Melbourne and Western Health, St Albans, Australia
| | - David J Saxby
- Griffith Centre of Biomedical and Rehabilitation Engineering, Griffith University, Gold Coast, Australia.,Investigation performed at Griffith University, Southport, Queensland, Australia
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9
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Automated 3D Analysis of Clinical Magnetic Resonance Images Demonstrates Significant Reductions in Cam Morphology Following Arthroscopic Intervention in Contrast to Physiotherapy. Arthrosc Sports Med Rehabil 2022; 4:e1353-e1362. [PMID: 36033193 PMCID: PMC9402425 DOI: 10.1016/j.asmr.2022.04.020] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2021] [Accepted: 04/19/2022] [Indexed: 11/25/2022] Open
Abstract
Purpose To obtain automated measurements of cam volume, surface area, and height from baseline (preintervention) and 12-month magnetic resonance (MR) images acquired from male and female patients allocated to physiotherapy (PT) or arthroscopic surgery (AS) management for femoroacetabular impingement (FAI) in the Australian FASHIoN trial. Methods An automated segmentation pipeline (CamMorph) was used to obtain cam morphology data from three-dimensional (3D) MR hip examinations in FAI patients classified with mild, moderate, or major cam volumes. Pairwise comparisons between baseline and 12-month cam volume, surface area, and height data were performed within the PT and AS patient groups using paired t-tests or Wilcoxon signed-rank tests. Results A total of 43 patients were included with 15 PT patients (9 males, 6 females) and 28 AS patients (18 males, 10 females) for premanagement and postmanagement cam morphology assessments. Within the PT male and female patient groups, there were no significant differences between baseline and 12-month mean cam volume (male: 1269 vs 1288 mm3, t[16] = −0.39; female: 545 vs 550 mm,3t[10] = −0.78), surface area (male: 1525 vs 1491 mm2, t[16] = 0.92; female: 885 vs 925 mm,2t[10] = −0.78), maximum height (male: 4.36 vs 4.32 mm, t[16] = 0.34; female: 3.05 vs 2.96 mm, t[10] = 1.05) and average height (male: 2.18 vs 2.18 mm, t[16] = 0.22; female: 1.4 vs 1.43 mm, t[10] = −0.38). In contrast, within the AS male and female patient groups, there were significant differences between baseline and 12-month cam volume (male: 1343 vs 718 mm3, W = 0.0; female: 499 vs 240 mm3, t[18] = 2.89), surface area (male: 1520 vs 1031 mm2, t(34) = 6.48; female: 782 vs 483 mm2, t(18) = 3.02), maximum-height (male: 4.3 vs 3.42 mm, W = 13.5; female: 2.85 vs 2.24 mm, t(18) = 3.04) and average height (male: 2.17 vs 1.52 mm, W = 3.0; female: 1.4 vs 0.94 mm, W = 3.0). In AS patients, 3D bone models provided good visualization of cam bone mass removal postostectomy. Conclusions Automated measurement of cam morphology from baseline (preintervention) and 12-month MR images demonstrated that the cam volume, surface area, maximum-height, and average height were significantly smaller in AS patients following ostectomy, whereas there were no significant differences in these cam measures in PT patients from the Australian FASHIoN study. Level of Evidence Level II, cohort study.
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10
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Hunter DJ, Eyles J, Murphy NJ, Spiers L, Burns A, Davidson E, Dickenson E, Fary C, Foster NE, Fripp J, Griffin DR, Hall M, Kim YJ, Linklater JM, Molnar R, Neubert A, O'Connell RL, O'Donnell J, O'Sullivan M, Randhawa S, Reichenbach S, Schmaranzer F, Singh P, Tran P, Wilson D, Zhang H, Bennell KL. Multi-centre randomised controlled trial comparing arthroscopic hip surgery to physiotherapist-led care for femoroacetabular impingement (FAI) syndrome on hip cartilage metabolism: the Australian FASHIoN trial. BMC Musculoskelet Disord 2021; 22:697. [PMID: 34399702 PMCID: PMC8369620 DOI: 10.1186/s12891-021-04576-z] [Citation(s) in RCA: 25] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/02/2021] [Accepted: 08/04/2021] [Indexed: 11/29/2022] Open
Abstract
Background Arthroscopic surgery for femoroacetabular impingement syndrome (FAI) is known to lead to self-reported symptom improvement. In the context of surgical interventions with known contextual effects and no true sham comparator trials, it is important to ascertain outcomes that are less susceptible to placebo effects. The primary aim of this trial was to determine if study participants with FAI who have hip arthroscopy demonstrate greater improvements in delayed gadolinium-enhanced magnetic resonance imaging (MRI) of cartilage (dGEMRIC) index between baseline and 12 months, compared to participants who undergo physiotherapist-led management. Methods Multi-centre, pragmatic, two-arm superiority randomised controlled trial comparing physiotherapist-led management to hip arthroscopy for FAI. FAI participants were recruited from participating orthopaedic surgeons clinics, and randomly allocated to receive either physiotherapist-led conservative care or surgery. The surgical intervention was arthroscopic FAI surgery. The physiotherapist-led conservative management was an individualised physiotherapy program, named Personalised Hip Therapy (PHT). The primary outcome measure was change in dGEMRIC score between baseline and 12 months. Secondary outcomes included a range of patient-reported outcomes and structural measures relevant to FAI pathoanatomy and hip osteoarthritis development. Interventions were compared by intention-to-treat analysis. Results Ninety-nine participants were recruited, of mean age 33 years and 58% male. Primary outcome data were available for 53 participants (27 in surgical group, 26 in PHT). The adjusted group difference in change at 12 months in dGEMRIC was -59 ms (95%CI − 137.9 to - 19.6) (p = 0.14) favouring PHT. Hip-related quality of life (iHOT-33) showed improvements in both groups with the adjusted between-group difference at 12 months showing a statistically and clinically important improvement in arthroscopy of 14 units (95% CI 5.6 to 23.9) (p = 0.003). Conclusion The primary outcome of dGEMRIC showed no statistically significant difference between PHT and arthroscopic hip surgery at 12 months of follow-up. Patients treated with surgery reported greater benefits in symptoms at 12 months compared to PHT, but these benefits are not explained by better hip cartilage metabolism. Trial registration details Australia New Zealand Clinical Trials Registry reference: ACTRN12615001177549. Trial registered 2/11/2015. Supplementary Information The online version contains supplementary material available at 10.1186/s12891-021-04576-z.
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Affiliation(s)
- David J Hunter
- Institute of Bone and Joint Research, Kolling Institute of Medical Research, University of Sydney, Camperdown, Australia. .,Department of Rheumatology, Royal North Shore Hospital, Sydney, Australia.
| | - Jillian Eyles
- Institute of Bone and Joint Research, Kolling Institute of Medical Research, University of Sydney, Camperdown, Australia.,Department of Rheumatology, Royal North Shore Hospital, Sydney, Australia
| | - Nicholas J Murphy
- Institute of Bone and Joint Research, Kolling Institute of Medical Research, University of Sydney, Camperdown, Australia.,Department of Orthopaedic Surgery, Gosford and Wyong Hospitals, Gosford, New South Wales, Australia
| | - Libby Spiers
- Department of Physiotherapy, Centre for Health, Exercise and Sports Medicine, University of Melbourne, Parkville, Australia
| | | | - Emily Davidson
- Department of Radiology, Royal Prince Alfred Hospital, Sydney, New South Wales, 2035, Australia
| | - Edward Dickenson
- Warwick Medical School, University of Warwick, Coventry, UK.,University Hospitals of Coventry and Warwickshire NHS Trust, Coventry, UK
| | - Camdon Fary
- Department of Orthopaedic Surgery, Western Health, Melbourne, Australia.,Australian Institute for Musculoskeletal Science (AIMSS), The University of Melbourne and Western Health, St. Albans, VIC, Australia
| | - Nadine E Foster
- STARS Education and Research Alliance, School of Health and Rehabilitation Sciences, University of Queensland, St Lucia, Australia.,Primary Care Centre Versus Arthritis, School of Medicine, Keele University, Newcastle upon Tyne, UK
| | - Jurgen Fripp
- The Australian e-Health Research Centre, CSIRO Health and Biosecurity, Brisbane, Australia
| | | | - Michelle Hall
- Department of Physiotherapy, Centre for Health, Exercise and Sports Medicine, University of Melbourne, Parkville, Australia
| | - Young Jo Kim
- Department of Orthopedic Surgery, Boston Children's Hospital, 300 Longwood Avenue, Boston, MA, 02115, USA
| | - James M Linklater
- Department of Musculoskeletal Imaging, Castlereagh Imaging, St Leonards, New South Wales, Australia
| | - Robert Molnar
- Sydney Orthopaedic Trauma & Reconstructive Surgery, Sydney, New South Wales, Australia
| | - Ales Neubert
- The Australian e-Health Research Centre, CSIRO Health and Biosecurity, Brisbane, Australia
| | - Rachel L O'Connell
- Institute of Bone and Joint Research, Kolling Institute of Medical Research, University of Sydney, Camperdown, Australia.,NHMRC Clinical Trials Centre, University of Sydney, Camperdown, Australia
| | - John O'Donnell
- Hip Arthroscopy Australia, 21 Erin St, Richmond, Victoria, Australia.,St Vincent's Private Hospital, 159 Grey St, East Melbourne, Victoria, Australia
| | - Michael O'Sullivan
- North Sydney Orthopaedic and Sports Medicine Centre, North Sydney, New South Wales, Australia
| | - Sunny Randhawa
- Macquarie University Hospital, 3 Technology Pl, Macquarie University, Macquarie Park, NSW, 2109, Australia
| | - Stephan Reichenbach
- Institute of Social and Preventive Medicine, University of Bern, Bern, Switzerland.,Department of Rheumatology, Immunology and Allergology, University Hospital and University of Bern, Bern, Switzerland.,Department Diagnostic, Interventional and Paediatric Radiology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Florian Schmaranzer
- Department Diagnostic, Interventional and Paediatric Radiology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Parminder Singh
- Hip Arthroscopy Australia, 21 Erin St, Richmond, Victoria, Australia.,Maroondah Hospital, Eastern Health, Davey Drive, Ringwood East, Melbourne, Victoria, 3135, Australia
| | - Phong Tran
- Department of Orthopaedic Surgery, Western Health, Melbourne, Australia.,Australian Institute for Musculoskeletal Science (AIMSS), The University of Melbourne and Western Health, St. Albans, VIC, Australia
| | - David Wilson
- Department of Orthopaedics, Center for Hip Health and Mobility, University of British Columbia, Vancouver, BC, Canada
| | - Honglin Zhang
- Department of Orthopaedics, Center for Hip Health and Mobility, University of British Columbia, Vancouver, BC, Canada
| | - Kim L Bennell
- Department of Physiotherapy, Centre for Health, Exercise and Sports Medicine, University of Melbourne, Parkville, Australia
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11
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Mok TN, He QY, Teng Q, Sin TH, Wang HJ, Zha ZG, Zheng XF, Pan JH, Hou HG, Li JR. Arthroscopic Hip Surgery versus Conservative Therapy on Femoroacetabular Impingement Syndrome: A Meta-Analysis of RCTs. Orthop Surg 2021; 13:1755-1764. [PMID: 34351052 PMCID: PMC8523765 DOI: 10.1111/os.13099] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/12/2021] [Revised: 04/21/2021] [Accepted: 05/17/2021] [Indexed: 12/29/2022] Open
Abstract
To determine the outcome and differences between arthroscopic hip surgery and conservative therapy in patients suffering from femoroacetabular impingement syndrome, we searched articles from PubMed, Embase, Cochrane, Web of Science and Clinicaltrials.gov using a Boolean search algorithm. Only randomized controlled trials comparing arthroscopic hip surgery and conservative therapy were included in this meta‐analysis of femoroacetabular impingement syndrome management. Two authors determined eligibility, extracted the needed data and assessed the risk of bias of eligible studies independently. Then we meta‐analyzed three articles to assess pooled estimate size (ES) and 95% confidence interval for Hip Outcome Score of activities of daily living (HOS ADL subscale), Hip Outcome Score sport (HOS sports subscale) and International Hip Outcome Tool (iHOT‐33) analyses were performed by using STATA version 14.0 MP (STATA, College Station, TX, USA) with the principal summary measures are mean between group difference, sample size, and standard deviation. We collected 52 articles in total after removing duplicates and screened by titles and abstracts. A total of three RCTs were included finally. There was definite evidence of additional benefit of arthroscopic hip surgery against conservative therapy in the field of improving quality of life (three trials, 575 participants, ES = 2.109, 95% CI: 1.373 to 2.845, I2 = 42.8%, P = 0.000) and activity of daily living (two trials, 262 participants, ES = 9.220, 95% CI: 5.931 to 12.508, I2 = 16.5%, P = 0.000). However, no significant difference could be seen in sports function improvement (two trials, ES = 7.562, 95% CI: −2.957 to 18.082, I2 = 60.1%, P = 0.159). In conclusion, this meta‐analysis suggests that arthroscopic hip surgery provided essential benefit compared with conservative therapy in improving activity of daily living and quality of life.
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Affiliation(s)
- Tsz-Ngai Mok
- First Affiliated Hospital of Jinan University, Guangzhou, China
| | - Qi-Yu He
- Pediatric Cardiac Surgery Center, National Center for Cardiovascular Disease and Fuwai Hospital, Chinese Academy of Medical Sciences, Peking Union Medical, Beijing, China
| | - Qiang Teng
- First Affiliated Hospital of Jinan University, Guangzhou, China
| | - Tat-Hang Sin
- First Affiliated Hospital of Jinan University, Guangzhou, China.,International School, Jinan University, Guangzhou, China
| | - Hua-Jun Wang
- First Affiliated Hospital of Jinan University, Guangzhou, China
| | | | - Xiao-Fei Zheng
- First Affiliated Hospital of Jinan University, Guangzhou, China
| | - Jing-Hua Pan
- First Affiliated Hospital of Jinan University, Guangzhou, China
| | - Hui-Ge Hou
- First Affiliated Hospital of Jinan University, Guangzhou, China
| | - Jie-Ruo Li
- First Affiliated Hospital of Jinan University, Guangzhou, China
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12
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Abstract
Advances in hip preservation surgery have to lead to increased utilization of hip arthroscopy. With this, there has also been a growth in the understanding of various hip conditions, therefore, leading to an increase in hip conditions amenable to arthroscopic intervention. The acetabular hip labrum has been at the forefront of arthroscopic advances in the hip. The labrum is important for hip stability, provision of the suction seal, and joint proprioception. Given the labrum's central role in hip biomechanics, there is increasing emphasis on labral preservation in the form of debridement and repair. In revision settings, advanced techniques such as labral augmentation and reconstruction may play a role in the management of labral pathology. Appropriate management of the hip labrum at the time of surgery can be an important mediator of the outcome. As such, an understanding of the evolving evidence base and surgical indications and techniques are integral to the treatment and management of labral pathology.
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13
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Trunk, pelvis and lower limb walking biomechanics are similarly altered in those with femoroacetabular impingement syndrome regardless of cam morphology size. Gait Posture 2021; 83:26-34. [PMID: 33069126 DOI: 10.1016/j.gaitpost.2020.10.002] [Citation(s) in RCA: 23] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/07/2020] [Revised: 09/15/2020] [Accepted: 10/06/2020] [Indexed: 02/02/2023]
Abstract
BACKGROUND Studies of walking in those with femoroacetabular impingement syndrome have found altered pelvis and hip biomechanics. But a whole body, time-contiuous, assessment of biomechanical parameters has not been reported. Additionally, larger cam morphology has been associated with more pain, faster progression to end-stage osteoarthritis and increased cartilage damage but differences in walking biomechanics between large compared to small cam morphologies have not been assessed. RESEARCH QUESTION Are trunk, pelvis and lower limb biomechanics different between healthy pain-free controls and individuals with FAI syndrome and are those biomechanics different between those with larger, compared to smaller, cam morphologies? METHODS Twenty four pain-free controls were compared against 41 participants with FAI syndrome who were stratified into two groups according to their maximum alpha angle. Participants underwent three-dimensional motion capture during walking. Trunk, pelvis, and lower limb biomechanics were compared between groups using statistical parametric mapping corrected for walking speed and pain. RESULTS Compared to pain-free controls, participants with FAI syndrome walked with more trunk anterior tilt (mean difference 7.6°, p < 0.001) as well as less pelvic rise (3°, p < 0.001), hip abduction (-4.6°, p < 0.05) and external rotation (-6.5°, p < 0.05). They also had lower hip flexion (-0.06Nm⋅kg-1, p < 0.05), abduction (-0.07Nm⋅kg-1, p < 0.05) and ankle plantarflexion moments (-0.19Nm⋅kg-1, p < 0.001). These biomechanical differences occurred throughout the gait cycle. There were no differences in walking biomechanics according to cam morphology size. SIGNIFICANCE Results do not support the hypothesis that larger cam morphology is associated with larger differences in walking biomechanics but did demonstrate general differences in trunk, pelvis and lower limb biomechanics between those with FAI sydrome and pain-free controls. Altered external biomechanics are likely the result of complex sensory-motor strategy resulting from pain inhibition or impingement avoidance. Future studies should examine internal loading in those with FAI sydnrome.
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14
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Abstract
Femoroacetabular impingement (FAI) syndrome is one of the most rapidly evolving etiologies of hip pain. The 2016 Warwick Agreement consensus statement defined FAI syndrome as a triad of symptoms, signs, and radiographic findings. Cam morphology is more likely in athletes and is associated with repetitive hip loading in maximal flexion during adolescence. Much less is known about the development of pincer morphology. Physical therapy improves pain and function, justifying a trial before pursuing surgery. Musculoskeletal injections are utilized for FAI syndrome, but the evidence is limited. Arthroscopic surgery for FAI syndrome can correct the morphological changes and address the underlying soft tissue injuries. Recent studies evaluated reliable indicators of surgical outcomes, the most reliable of which is the presurgical presence of osteoarthritis. Recent studies demonstrate the efficacy of surgery, but with the risk of complication and no guarantee of a return to the same level of sport.
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Affiliation(s)
- Steven D Trigg
- National Capital Consortium Military Primary Care Sports Medicine Fellowship, Uniformed Services University of Health Sciences, Bethesda, MD
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15
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Wright AA, Tarara DT, Gisselman AS, Dischiavi SL. Do currently prescribed exercises reflect contributing pathomechanics associated with femoroacetabular impingement syndrome? A scoping review. Phys Ther Sport 2020; 47:127-133. [PMID: 33276232 DOI: 10.1016/j.ptsp.2020.11.034] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2020] [Revised: 11/19/2020] [Accepted: 11/20/2020] [Indexed: 10/22/2022]
Abstract
OBJECTIVE Research reports limited, mixed evidence on the effectiveness of physiotherapy management in the treatment of femoroacetabular impingement (FAI) syndrome. The purpose of this review was to (1) identify what therapeutic exercises are being utilized in the non-surgical management of patients with FAI syndrome; (2) map the extent to which reported exercises reflect contributory pathomechanics associated with FAI syndrome. DESIGN Scoping Review. METHODS MEDLINE, PubMed, CINAHL, SPORTDiscus, and PEDRO electronic databases were searched for studies that implemented a non-surgical, exercise-based treatment approach in patients with FAI syndrome. Exercises were extracted and analyzed according to elements recognized as contributing to the pathomechanics associated with FAI syndrome. RESULTS 24 studies fulfilled the inclusion criteria. 453 exercises were extracted. Uniplanar exercises accounted for 338/453 or 74.6% of all reported exercises whereas triplanar exercises accounted for 21/453 or 4.6% of all exercises. Non-weight bearing exercises accounted for 220/453 or 48.6% of all exercises. CONCLUSION The majority of therapeutic exercises were classified as sagittal, uniplanar exercises, utilizing a concentric exercise approach. These findings highlight that exercises utilizing triplanar, eccentric hip control, in a single limb weightbearing position are considerably underrepresented.
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Affiliation(s)
- Alexis A Wright
- Department of Public Health and Community Medicine, School of Medicine, Tufts University, 136 Harrison Ave, Boston, MA, 02111, USA.
| | - Daniel T Tarara
- Department of Exercise Science, High Point University, One University Pkwy. High Point, NC, 27268, USA
| | | | - Steven L Dischiavi
- Department of Physical Therapy, High Point University, One University Pkwy. High Point, NC, 27268, USA
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16
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Lall AC, Walsh JP, Maldonado DR, Pinto LE, Ashberg LJ, Lodhia P, Radha S, Correia APR, Domb BG, Perez-Carro L, Marín-Peña O, Griffin DR. Teamwork in hip preservation: the ISHA 2019 Annual Scientific Meeting. J Hip Preserv Surg 2020; 7:2-21. [PMID: 33072394 PMCID: PMC7546541 DOI: 10.1093/jhps/hnaa037] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Hip preservation surgery is now an established part of orthopedic surgery and sports medicine. This report describes the key findings of the 11th Annual Scientific Meeting of International Society for Hip Arthroscopy-the International Hip Preservation Society-in Madrid, Spain from 16 to 19 October 2019. Lectures, seminars and debates explored the most up-to-date and expert views on a wide variety of subjects, including: diagnostic problems in groin pain, buttock pain and low back pain; surgical techniques in acetabular dysplasia, hip instability, femoroacetabular impingement syndrome, labral repair and reconstruction, cartilage defects, adolescent hips and gluteus medius and hamstring tears; and new ideas about femoral torsion, hip-spine syndrome, hip capsule surgery, impact of particular sports on hip injuries, registries, robotics and training for hip preservation specialists. Surgeons, sports physicians, radiologists and physiotherapists looking after young people with hip problems have an increasingly sophisticated armoury of ideas and techniques with which to help their patients. The concept of hip preservation has developed incredibly fast over the last decade; now it is clear that the best results can only be achieved by a multidisciplinary team working together. The 2020s will be the decade of 'Teamwork in Hip Preservation'.
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Affiliation(s)
- Ajay C Lall
- American Hip Institute Research Foundation, 999 E Touhy Ave Ste 450, Des Plaines, IL 60018, USA.,American Hip Institute, 999 E Touhy Ave Ste 450, Des Plaines, IL 60018, USA
| | - John P Walsh
- American Hip Institute Research Foundation, 999 E Touhy Ave Ste 450, Des Plaines, IL 60018, USA.,Des Moines University, Desert Orthopaedic Center, 2800 E, Desert Inn Rd, Las Vegas, NV 89121, USA
| | - David R Maldonado
- American Hip Institute Research Foundation, 999 E Touhy Ave Ste 450, Des Plaines, IL 60018, USA
| | - Leonardo E Pinto
- Centro Medico Decente La Trinidad (Trinity Medical Center), Av. Principal de El Hatillo, Caracas 1080, Metropolitan District of Caracas, Venezuela
| | - Lyall J Ashberg
- Atlantis Orthopaedics, 4560 Lantana Rd Suite 100, Lake Worth, Atlantis, FL 33463, USA
| | - Parth Lodhia
- Footbridge Centre for Integrated Orthopaedic Care, 181 Keefer Pl #221, Vancouver, BC V6B 6C1, Canada
| | - Sarkhell Radha
- Croydon University Hospital, 530 London Rd, Thornton Heath CR7 7YE, London, UK
| | | | - Benjamin G Domb
- American Hip Institute Research Foundation, 999 E Touhy Ave Ste 450, Des Plaines, IL 60018, USA.,American Hip Institute, 999 E Touhy Ave Ste 450, Des Plaines, IL 60018, USA
| | - Luis Perez-Carro
- Hospital Clinica Mompia, Av. de los Condes, s/n, 39108 Mompía, Cantabria, Spain
| | - Oliver Marín-Peña
- University Hospital Infanta Leonor, Av. Gran Vía del Este, 80, 28031 Madrid, Spain and
| | - Damian R Griffin
- Warwick Medical School, University of Warwick and University Hospitals of Coventry and Warwickshire, Coventry CV4 7AL, UK
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17
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Gatz M, Driessen A, Eschweiler J, Tingart M, Migliorini F. Arthroscopic surgery versus physiotherapy for femoroacetabular impingement: a meta-analysis study. EUROPEAN JOURNAL OF ORTHOPAEDIC SURGERY AND TRAUMATOLOGY 2020; 30:1151-1162. [PMID: 32382825 PMCID: PMC7505824 DOI: 10.1007/s00590-020-02675-6] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/08/2020] [Accepted: 04/21/2020] [Indexed: 12/01/2022]
Abstract
INTRODUCTION Femoroacetabular impingement (FAI) is thought to play an important role in the development of hip osteoarthritis. However, there is no consensus about the optimal treatment options, since non-operative therapy such as physiotherapy and surgical treatment such as arthroscopic hip surgery can both improve symptoms. Therefore, the aim of the present meta-analysis was to compare the outcomes between two different treatment regimes; physiotherapy versus arthroscopic treatment for FAI. METHODS The present meta-analysis was carried out according to the PRISMA guidelines. In November 2019, the main online databases were accessed. All the randomized clinical trials (RCTs) comparing surgical arthroscopic treatment versus physiotherapy for FAI were considered for inclusion. Only articles reporting quantitative data under the outcomes of interest were included. For the all analysis, we used Review Manager Software. Data from 644 patients were analysed. RESULTS Data from 644 patients were evaluated with a mean follow-up of 14.67 ± 8.3 months. The unpaired t test detected an optimal baseline comparability in terms of side, gender, years, duration of symptoms and BMI (p = 0.08-0.9). The VAS subscale of the score EQ-5D and the mean iHOT33 reported favourable values in the arthroscopic group (p = 0.03 and p < 0.0001, respectively). Similar findings were evidenced in the iHOT33 subgroup 6-months (p = 0.70) and 12-months (p = 0.0002). The HOS score, the ADL (p < 0.0001) and the sport (p = 0.0003) subscales reported both greater values in the arthroscopic group. No statistical significance was found concerning the risk to incur in further total hip arthroplasty (p = 0.72). CONCLUSION Based on only three high-quality RCTs, arthroscopic hip surgery is an effective therapeutic treatment for FAI revealing superior results than a non-surgical approach with physiotherapy.
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Affiliation(s)
- Matthias Gatz
- Department of Orthopaedic Surgery, RWTH Aachen University Clinic, Pauwelsstraße 30, 52074, Aachen, Germany.
| | - Arne Driessen
- Department of Orthopaedic Surgery, RWTH Aachen University Clinic, Pauwelsstraße 30, 52074, Aachen, Germany
| | - Jörg Eschweiler
- Department of Orthopaedic Surgery, RWTH Aachen University Clinic, Pauwelsstraße 30, 52074, Aachen, Germany
| | - Markus Tingart
- Department of Orthopaedic Surgery, RWTH Aachen University Clinic, Pauwelsstraße 30, 52074, Aachen, Germany
| | - Filippo Migliorini
- Department of Orthopaedic Surgery, RWTH Aachen University Clinic, Pauwelsstraße 30, 52074, Aachen, Germany
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Casartelli NC, Bizzini M, Maffiuletti NA, Sutter R, Pfirrmann CW, Leunig M, Naal FD. Exercise Therapy for the Management of Femoroacetabular Impingement Syndrome: Preliminary Results of Clinical Responsiveness. Arthritis Care Res (Hoboken) 2019; 71:1074-1083. [PMID: 30133164 DOI: 10.1002/acr.23728] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2018] [Accepted: 08/14/2018] [Indexed: 11/12/2022]
Abstract
OBJECTIVE To investigate the responsiveness to exercise therapy of patients with femoroacetabular impingement syndrome (FAIS), and to investigate differences in hip function, strength, and morphology between responders versus nonresponders. METHODS Patients with FAIS underwent 12 weeks of semi-standardized and progressive exercise therapy. A good therapy outcome (responders) versus a poor therapy outcome (nonresponders) was determined at week 18 with the Global Treatment Outcome questionnaire for hip pain. Hip function was evaluated using the Hip Outcome Score (HOS) activities of daily living (ADL) and Sport at baseline, and at weeks 6, 12, and 18. Hip muscle strength and dynamic pelvic control were evaluated using dynamometry and video analysis, respectively, at baseline, week 12, and week 18. Hip morphology was evaluated with imaging at baseline. RESULTS Thirty-one patients (mean age 24 years) were included. Sixteen patients (52%) were responsive and 15 patients (48%) were not responsive to exercise therapy. Only responders improved HOS ADL and HOS Sport by 10 points (95% confidence interval [95% CI] 7, 14; P < 0.001) and by 20 points (95% CI 15, 25; P < 0.001), respectively, and hip abductor strength by 0.27 Nm/kg (95% CI 0.18, 0.36; P < 0.001). The prevalence of patients showing good dynamic pelvic control only increased in responders (44%; P = 0.029). The prevalence of severe cam morphology was higher in nonresponders than in responders (40% versus 6%; P = 0.037). CONCLUSION Half of patients with FAIS benefit from exercise therapy in the short term. Responsiveness to hip abductor strength and dynamic pelvic control improvements is associated with a good therapy outcome, whereas the presence of severe cam morphology is associated with a poor therapy outcome.
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Affiliation(s)
- Nicola C Casartelli
- Schulthess Clinic and Laboratory of Exercise and Health, Swiss Federal Institute of Technology, Zurich, Switzerland
| | | | | | - Reto Sutter
- Orthopaedic University Hospital Balgrist and University of Zurich, Zurich, Switzerland
| | - Christian W Pfirrmann
- Orthopaedic University Hospital Balgrist and University of Zurich, Zurich, Switzerland
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Richardson RS, Lothe K, Sturridge S. Is surgery effective in patients with femoroacetabular impingement syndrome? BMJ 2019; 365:l1359. [PMID: 31000520 DOI: 10.1136/bmj.l1359] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Christensen JC, Marland JD, Miller CJ, Horton BS, Whiting DR, West HS. Trajectory of clinical outcomes following hip arthroscopy in female subgroup populations. J Hip Preserv Surg 2019; 6:25-32. [PMID: 31069092 PMCID: PMC6501448 DOI: 10.1093/jhps/hnz011] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/23/2018] [Revised: 01/21/2019] [Accepted: 02/03/2019] [Indexed: 01/03/2023] Open
Abstract
To describe the recovery trajectory in a group of relatively older borderline dysplastic female femoroacetabular impingement syndrome (FAIS) patients following arthroscopic surgery, to determine if outcomes in this group differs from females with different age and bony morphology characteristics. Four subgroups were created to define (i) older females (>35 years), borderline dysplastic (lateral center edge angle [LCEA] ≤ 25 degrees) and anterior wall index (AWI) deficient (AWI ≤ 0.40) (older, borderline dysplastic, anterior wall deficient [ODD, reference]); (ii) younger (≤35 years), borderline dysplastic (LCEA ≤ 25 degrees) and deficient anterior wall (AWI ≤ 0.40) (younger, borderline dysplastic, anterior wall deficient [YDD]); (iii) older (>35 years), non-dysplastic (LCEA > 25 degrees) and non-deficient anterior wall (AWI > 0.40) (older, non-dysplastic, non-deficient anterior wall [ONN]); and (iv) younger (≤35 years), non-dysplastic (LCEA > 25 degrees) and non-deficient anterior wall (AWI > 0.40) (younger, non-dysplastic, non-deficient anterior wall [YNN]). One hundred and seventy-three female patients were included. Comparing mean scores, the ODD group reported significantly lower International Hip Outcome Tool (iHOT-12) change scores compared with the ONN group [23.58 ± 9.73; P = 0.03] at 12 months. ODD group also demonstrated significantly lower iHOT-12 change scores compared with the ONN (27.62 ± 8.22; P < 0.01) and YNN (25.39 ± 7.68; P < 0.01) groups at 24 months. Relatively older females with borderline dysplasia and anterior acetabular wall deficiencies had poorer iHOT-12 outcomes at both 12 and 24 months post-operatively compared with other female subgroups. In the absence of hip dysplasia and anterior wall deficiencies, superior iHOT-12 outcomes were observed in both older and younger females post-operatively.
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Affiliation(s)
- Jesse C Christensen
- Intermountain Healthcare, Murray, UT, USA.,Department of Physical Medicine and Rehabilitation, University of Colorado, 13001 East 17th Place, Aurora, CO, USA.,Eastern Colorado Geriatric Research Education and Clinical Center, Aurora, CO, USA
| | | | - Caitlin J Miller
- Intermountain Healthcare, Murray, UT, USA.,Department of Physical Therapy and Athletic Training, University of Utah, Salt Lake City, UT, USA
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