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Magnetic resonance imaging (MRI) is increasingly used in the classification and evaluation of osteoarthritis (OA). Many studies have focused on knee OA, investigating the association between MRI-detected knee structural abnormalities and knee pain. Hip OA differs from knee OA in many aspects, but little is known about the role of hip structural abnormalities in hip pain. This study aimed to systematically evaluate the association of hip abnormalities on MRI, such as cartilage defects, bone marrow lesions (BMLs), osteophytes, paralabral cysts, effusion-synovitis, and subchondral cysts, with hip pain. We searched electronic databases from inception to February 2024, to identify publications that reported data on the association between MRI features in the hip joint and hip pain. The quality of the included studies was scored using the Newcastle-Ottawa Scale (NOS). The levels of evidence were evaluated according to the Cochrane Back Review Group Method Guidelines and classified into five levels: strong, moderate, limited, conflicting, and no evidence. A total of nine studies were included, comprising five cohort studies, three cross-sectional studies, and one case-control study. Moderate level of evidence suggested a positive association of the presence and change of BMLs with the severity and progress of hip pain, and evidence for the associations between other MRI features and hip pain were limited or even conflicting. Only a few studies with small to modest sample sizes evaluated the association between hip structural changes on MRI and hip pain. BMLs may contribute to the severity and progression of hip pain. Further studies are warranted to uncover the role of hip MRI abnormalities in hip pain. The protocol for the systematic review was registered with PROSPERO (https://www.crd.york.ac.uk/PROSPERO/, CRD42023401233). [ABSTRACT FROM AUTHOR]

Introduction: Uptake of telehealth has surged, yet no previous studies have evaluated the clinimetric properties of clinician-administered performance-based tests of function, strength, and balance via telehealth in people with chronic lower limb musculoskeletal pain. This study investigated the: (i) test–retest reliability of performance-based tests via telehealth, and (ii) agreement between scores obtained via telehealth and in-person. Methods: Fifty-seven adults aged ≥45 years with chronic lower limb musculoskeletal pain underwent three testing sessions: one in-person and two via videoconferencing. Tests included 30-s chair stand, 5-m fast-paced walk, stair climb, timed up and go, step test, timed single-leg stance, and calf raises. Test–retest reliability and agreement were assessed via intraclass correlation coefficients (ICC; lower limit of 95% confidence interval (CI) ≥0.70 considered acceptable). ICCs were interpreted as poor (<0.5), moderate (0.5–0.75), good (0.75–0.9), or excellent (>0.9). Results: Test–retest reliability was good-excellent with acceptable lower CI for stair climb test, timed up and go, right leg timed single-leg stance, and calf raises (ICC = 0.84–0.91, 95% CI lower limit = 0.71–0.79). Agreement between telehealth and in-person was good-excellent with acceptable lower CI for 30-s chair stand, left leg single-leg stance, and calf raises (ICC = 0.82–0.91, 95% CI lower limit = 0.71–0.85). Discussion: Stair climb, timed up and go, right leg timed single-leg stance, and calf raise tests have acceptable reliability for use via telehealth in research and clinical practice. If re-testing via a different mode (telehealth/in-person), clinicians and researchers should consider using the 30-s chair stand test, left leg timed single-leg stance, and calf raise tests. [ABSTRACT FROM AUTHOR]

The HAGOS (Hip and Groin Outcome Score) questionnaire is a valid and reliable measure of the self-assessment of symptoms, activity limitation, participation restriction, and quality of life (Qol) of subjects with hip and/or groin pain. The aims of this study are to translate and transculturally adapt the HAGOS into Italian (HAGOS-I) and to assess its internal consistency, validity, and reliability in physically active, young, and middle-aged subjects. The translation and transcultural adaptation of (HAGOS-I) was carried out according to international guidelines. Eight-one subjects (mean age 28.19) were included in this study. All the participants completed the HAGOS-I, the Lower Extremity Functional Scale (LEFS-I), the Oxford Hip Score (OHS-I), and the Short Form 36 Health Surveys (SF-36-I). The Cronbach's α for the six HAGOS subscales ranged from 0.63 to 0.87. Statistically significant correlations were obtained between the six HAGOS-I subscales and the LEFS-I (rs = 0.44–0.68; p < 0.01). Only one HAGOS-I subscale (Participation in Physical Activities) did not reach statistical significance with the OHS-I, while the remaining five had a moderate correlation (rs = 0.40–0.60; p < 0.01). The test–retest reliability (Intraclass Correlation Coefficient) ranged from 0.57 to 0.86 for the six HAGOS-I subscales. The HAGOS-I is a valid and reliable instrument that can be used in clinical settings with young and middle-aged subjects with hip and/or groin pathologies. [ABSTRACT FROM AUTHOR]

Introduction: Individuals with acetabular dysplasia often report hip joint instability, pain, and poor hip‐related function. Periacetabular osteotomy (PAO) is a surgical procedure that aims to reposition the acetabulum to improve joint congruency and improve pain and function. We aimed to examine the influence of presurgery clinical measures on functional recovery following PAO and the associations among clinical outcomes after PAO. Methods: We screened 49 potential participants, 28 were enrolled, and 23 completed both study visits (pre‐PAO and 6 months post‐PAO). We evaluated dynamometer‐measured hip and thigh strength, loading patterns during a squat and countermovement jump (CMJ), pain intensity, and device‐measured physical activity (PA) levels (light, moderate‐to‐vigorous PA [MVPA], and daily steps). We used linear regression models to examine the influence of muscle strength (peak torque; limb symmetry index [LSI]) and loading patterns before PAO on pain intensity and PA levels in individuals 6 months following PAO. Additionally, we used Pearson correlation coefficient to examine cross‐sectional associations among all variables 6 months following PAO. Results: Lower extremity muscle strength and loading patterns during the squat and CMJ before PAO did not predict pain intensity or device‐measured PA levels in individuals 6 months following PAO (p > 0.05). Six months following PAO, higher knee extensor LSI was associated with higher time spent in MVPA (r = 0.56; p = 0.016), higher hip abductor LSI was associated with both lower pain (r = 0.50; p = 0.036) and higher involved limb loading during the squat task (r = 0.59; p = 0.010). Lastly, higher hip flexor LSI was associated with higher CMJ takeoff involved limb loading (r = 0.52; p = 0.021) and higher involved hip extensor strength was associated with higher CMJ landing involved limb loading (r = 0.56; p = 0.012). Conclusion: Six months after PAO, higher hip and thigh muscle strength and strength symmetry were associated with lower pain, higher PA levels, and greater normalized limb loading during dynamic movement tasks. [ABSTRACT FROM AUTHOR]

Neuropathy of the lateral cutaneous branch of the iliohypogastric nerve (LCBIN) may represent a differential diagnosis for greater trochanteric pain syndrome (GTPS). Ultrasound-guided neural blockade of the LCBIN may lead to diagnosis of this neuropathy. The aim of this study was to evaluate the accuracy of ultrasound-guided nerve block in cadavers and to present a first clinical case series of patients with neuropathy of the LCBIN where the workup for GTPS remained unremarkable. Ultrasound-guided nerve block led to pain relief in these patients, indicating LCBIN neuropathy. First, ultrasound-guided injections at the LCBIN were performed bilaterally in 24 fresh, non-frozen, non-embalmed body donors. Accuracy and nerve localization were validated by anatomic dissection. Second, a clinical case series of nine patients with suspected GTPS who underwent ultrasound-guided diagnostic LCBIN blockade was retrospectively analyzed. Ultrasound-guided injections at the LCBIN yielded 91.7% accuracy (95% confidence interval: 0.80–0.98). On the right side the nerve was found within a range of 3–14 cm from the anterior superior iliac spine, and within a range of 7–15 cm on the left side. This clinical case series indicates that ultrasound-guided blockade at the LCBIN provides temporary pain relief and indicates the presence of LCBIN neuropathy. Ultrasound has demonstrated high accuracy for localization and injection guidance in the examination of LCBIN. Ultrasound-guided injection of local anesthetics may help to identify LCBIN neuropathy as a differential diagnosis in patients with suspected GTPS. [ABSTRACT FROM AUTHOR]

Abstract Background Iliacus muscle abscess is an uncommon but potentially life-threatening condition that can present with nonspecific symptoms, posing diagnostic challenges. This case report highlights the importance of considering iliopsoas abscess in patients presenting with fever and hip pain, especially in the absence of obvious risk factors or penetrating trauma. The novelty of this case lies in its atypical presentation mimicking a respiratory viral infection and musculoskeletal injury, impeding accurate diagnosis and appropriate management. Case Presentation A previously healthy 21-year-old female who had a mechanical fall 3 weeks prior presented with fever, right hip pain, and respiratory symptoms, initially suggestive of a respiratory infection and musculoskeletal injury. However, initial investigations revealing a markedly high C-reactive protein (CRP) concentration prompted further computed tomography (CT) imaging of her abdomen and pelvis, which uncovered an iliopsoas abscess presumably stemming from antecedent trauma. Subsequent CT guided aspiration along with culture-sensitive antibiotics led to successful treatment and resolution of her symptoms. Conclusions This case emphasizes the importance of considering iliopsoas abscess as a possible differential, even in young patients without typical risk factors. Markedly elevated inflammatory markers such as CRP concentrations can serve as a vital indicator, directing attention towards the possibility of septicemia or the presence of an occult abscess, facilitating prompt imaging and accurate diagnosis.

Abstract Background The Movethehip trial investigates the effectiveness of an exercise and patient education intervention for adults with acetabular dysplasia. The intervention involves eight tailored one-to-one sessions with trained providers who employ supportive feedback tools. The present protocol reports a planned process evaluation, which aims to determine how the intervention functions by examining the implementation of the intervention (process, dose and reach), its acceptability, mechanisms of change and the influence of contextual factors. Methods Two hundred trial participants aged 18–50 years will be recruited from a University Hospital in Denmark and randomised to the intervention or control group. Approximately ten providers will deliver the intervention. The process evaluation adopts a concurrent mixed-methods design. The implementation will be assessed using self-report questionnaires (at baseline and 6-month follow-up), training records and semi-structured focus group interviews with intervention providers (n = 10) and healthcare managers (n = 4–6). The mechanisms of change will be explored through semi-structured one-to-one interviews (at baseline and 6-month follow-up) with 15–20 purposefully sampled participants and by measuring changes in health outcomes (self-reported pain, physical functioning and quality of life completed at baseline and at 3- and 6-month follow-up). Additionally, change will be measured through an explorative examination of associations between dose and change in health outcomes, applying simple linear regression models. The acceptability of the intervention and the influence of contextual factors will be explored through one-to-one participant interviews and focus group interviews with 4–6 healthcare managers. The interviews will focus on expectations, experiences, events, personal understandings and interaction with interpersonal and organisational aspects. Interview data will be analysed using theoretical thematic analyses, and findings will be merged with quantitative data and reported jointly on a theme-by-theme basis. Discussion The process evaluation conducted as part of the MovetheHip trial will illuminate how the intervention functions, and if the intervention is proven effective, the findings of the evaluation will contribute to pinpoint how the intervention may be optimised to facilitate future up-scaling and implementation. Trial registration The MovetheHip protocol was approved by the Committee on Health Research Ethics in the Central Denmark Region. ClinicalTrials, NCT04795843. Registered on 20 March 2021.

Background: Iliacus muscle abscess is an uncommon but potentially life-threatening condition that can present with nonspecific symptoms, posing diagnostic challenges. This case report highlights the importance of considering iliopsoas abscess in patients presenting with fever and hip pain, especially in the absence of obvious risk factors or penetrating trauma. The novelty of this case lies in its atypical presentation mimicking a respiratory viral infection and musculoskeletal injury, impeding accurate diagnosis and appropriate management. Case Presentation: A previously healthy 21-year-old female who had a mechanical fall 3 weeks prior presented with fever, right hip pain, and respiratory symptoms, initially suggestive of a respiratory infection and musculoskeletal injury. However, initial investigations revealing a markedly high C-reactive protein (CRP) concentration prompted further computed tomography (CT) imaging of her abdomen and pelvis, which uncovered an iliopsoas abscess presumably stemming from antecedent trauma. Subsequent CT guided aspiration along with culture-sensitive antibiotics led to successful treatment and resolution of her symptoms. Conclusions: This case emphasizes the importance of considering iliopsoas abscess as a possible differential, even in young patients without typical risk factors. Markedly elevated inflammatory markers such as CRP concentrations can serve as a vital indicator, directing attention towards the possibility of septicemia or the presence of an occult abscess, facilitating prompt imaging and accurate diagnosis. [ABSTRACT FROM AUTHOR]

Purpose: To evaluate the actual change in clinical hip pain and hip migration after operation for non-ambulatory flaccid neuromuscular (NM) scoliosis and investigate whether there is an association between hip migration and coronal/sagittal pelvic tilt (CO-PT/SA-PT). Patients and methods: This retrospective, single-center, observational study evaluated a total of 134 patients with non-ambulatory flaccid neuromuscular scoliosis who underwent surgery performed by a single surgeon between 2003 and 2020, with at least 2 years of follow-up period. Operation procedures were conducted in two stages, beginning with L5–S1 anterior release followed by posterior fixation. Radiologic parameters were measured at preoperative, immediate postoperative, and last follow-up periods with clinical hip pain and clinical hip dislocation events. Results: The significant improvements occurred in various parameters after correction surgery for NM scoliosis, containing Cobb's angle of major curve and CO-PT. However, Reimer's hip migration percentage (RMP) was increased on both side of hip (High side, 0.23 ± 0.16 to 0.28 ± 0.21; Low side, 0.20 ± 0.14 to 0.23 ± 0.18). Hip pain and dislocation events were also increased (Visual analog scale score, 2.5 ± 2.3 to 3.6 ± 2.6, P value < 0.05; dislocation, 6–12). Logistic regression analysis of the interactions between ΔRMP(High) and the change of sagittal pelvic tilt (ΔSA-PT) after correction reveals a significant negative association. (95% CI 1.003–1.045, P value = 0.0226). Conclusions: In cases of non-ambulatory flaccid NM scoliosis, clinical hip pain, and subluxation continued to deteriorate even after correction of CO-PT. There was a relationship between the decrease in SA-PT, and an increase in hip migration percentage on high side, indicating the aggravation of hip subluxation. [ABSTRACT FROM AUTHOR]

The article focuses on evaluating the effectiveness of hip arthroscopy for managing synovial chondromatosis (SC) of the hip and its impact on postoperative outcomes. Topics include the clinical and radiological manifestations of SC, the comparison of preoperative and postoperative pain and range of motion scores, and the overall efficacy of hip arthroscopy in reducing symptoms and improving hip function.

* OBJECTIVE: To (1) investigate the goals and expectations of participants enrolled in a clinical trial of physical therapist--led treatment for femoroacetabular impingement (FAI) syndrome and (2) explore associations between their expectations and self-reported hip burden and kinesiophobia. * DESIGN: Cross-sectional study. * METHODS: Data from 150 participants with FAI syndrome who participated in a clinical trial were analyzed. Participants described their most important treatment goal and the expectation of achieving this goal throughout physical therapy treatment. The 33-item International Hip Outcome Tool (iHOT-33) subscales were used to assess self-reported hip burden. The Tampa Scale of Kinesiophobia was used to assess kinesiophobia. Participant goals were qualitatively analyzed using content analysis. Linear regression was used to explore associations between patient expectations and the iHOT-33 and Tampa Scale of Kinesiophobia scores. * RESULTS: Participants with FAI syndrome reported goals relating to exercise (52%), improving activities of daily living quality (23%), improving physical function (15%), and reducing pain (10%). Negative expectations regarding physical therapist--led treatment were reported by 68% of the participants. Those with negative expectations reported worse scores for the iHOT-total score (mean difference = 12 points; 95% confidence interval [CI], 4 to 19) and the iHOT-symptoms (mean difference = 14 points; 95% CI, 7 to 21) and iHOT-social (mean difference = 11 points; 95% CI, 2 to 21) subscale scores, compared to those with positive expectations. Treatment expectations were not associated with the iHOT-sport and iHOT-job subscale scores and Tampa Scale of Kinesiophobia scores (P>.05). * CONCLUSION: Patients with FAI syndrome had a generally negative expectation of physical therapist--led treatment. There was a mismatch between patients' goals and current treatment approaches. Participants with FAI syndrome and negative expectations reported worse quality of life, symptoms, and social concerns compared to those with positive expectations. [ABSTRACT FROM AUTHOR]

Background: The Movethehip trial investigates the effectiveness of an exercise and patient education intervention for adults with acetabular dysplasia. The intervention involves eight tailored one-to-one sessions with trained providers who employ supportive feedback tools. The present protocol reports a planned process evaluation, which aims to determine how the intervention functions by examining the implementation of the intervention (process, dose and reach), its acceptability, mechanisms of change and the influence of contextual factors. Methods: Two hundred trial participants aged 18–50 years will be recruited from a University Hospital in Denmark and randomised to the intervention or control group. Approximately ten providers will deliver the intervention. The process evaluation adopts a concurrent mixed-methods design. The implementation will be assessed using self-report questionnaires (at baseline and 6-month follow-up), training records and semi-structured focus group interviews with intervention providers (n = 10) and healthcare managers (n = 4–6). The mechanisms of change will be explored through semi-structured one-to-one interviews (at baseline and 6-month follow-up) with 15–20 purposefully sampled participants and by measuring changes in health outcomes (self-reported pain, physical functioning and quality of life completed at baseline and at 3- and 6-month follow-up). Additionally, change will be measured through an explorative examination of associations between dose and change in health outcomes, applying simple linear regression models. The acceptability of the intervention and the influence of contextual factors will be explored through one-to-one participant interviews and focus group interviews with 4–6 healthcare managers. The interviews will focus on expectations, experiences, events, personal understandings and interaction with interpersonal and organisational aspects. Interview data will be analysed using theoretical thematic analyses, and findings will be merged with quantitative data and reported jointly on a theme-by-theme basis. Discussion: The process evaluation conducted as part of the MovetheHip trial will illuminate how the intervention functions, and if the intervention is proven effective, the findings of the evaluation will contribute to pinpoint how the intervention may be optimised to facilitate future up-scaling and implementation. Trial registration: The MovetheHip protocol was approved by the Committee on Health Research Ethics in the Central Denmark Region. ClinicalTrials, NCT04795843. Registered on 20 March 2021. [ABSTRACT FROM AUTHOR]

Females of reproductive age constitute one of the largest demographics of the hip arthroscopy population, but it is unclear as to how pregnancy planning affects decision-making regarding surgery or vice versa. The purpose of this study was to assess perceived risks to pregnancy from hip pain and/or hip arthroscopy among reproductive-age females who underwent arthroscopic treatment of femoroacetabular impingement syndrome (FAIS). A cross-sectional study was conducted involving females aged 18–44 years who underwent hip arthroscopy for the treatment of FAIS, with a single surgeon included in the study. Subjects completed a survey that assessed obstetric and gynecologic history, decision-making regarding the planning and timing of hip surgery and pregnancy, and perceived risks to pregnancy from hip pain and/or hip surgery. Subjects were classified as nulligravid (Group 1), pregnant at least once before hip surgery but never again following hip surgery (Group 2), or pregnant at least once following hip surgery (Group 3). A total of 85 patients were enrolled with a mean age of 32.3 ± 6.5 years at the time of surgery. The mean follow-up time was 51.9 ± 34.5 months. There were 39 subjects in Group 1 (45.9%), 20 in Group 2 (23.5%), and 26 in Group 3 (30.6%). About half of all subjects expressed "some" to "a lot of" concern that their hip pain could get worse during pregnancy (49.4%), and about half had "no concern" that hip arthroscopy would affect the health of their fetus/baby (54.1%). Reproductive-age females undergoing hip arthroscopy for FAIS generally consider the procedure to be safe with respect to future pregnancy outcomes. [ABSTRACT FROM AUTHOR]

Aim: To develop and validate an algorithm to rapidly distinguish transient synovitis (TS) of the hip from differential diagnoses without additional tests. Methods: This retrospective cohort study included all children admitted for nontraumatic limping in the emergency department at Lille University- Hospital between 2016 and 2020. The gold standard was a definitive diagnosis at follow- up visit. All variables associated with acute limping in children were analysed in univariate and multivariable analyses. An algorithm was then developed using recursive partitioning and validated internally on a subset of patients. Results: There were 995 patients included (mean age 5.3 years; males 63%); 337 had a TS including 210 confirmed at follow- up visit and 354 another diagnosis. After multivariable analysis, the relevant variables for distinguishing between TS and differential diagnoses were: age 3-10 years, absence of fever, absence of local inflammation, sudden onset of limping on awakening. An algorithm combining these variables was developed (n = 297) and validated internally (n = 175) for children >12 months with limping for ≤10 days, with a specificity of 98.2% and a positive likelihood ratio of 19.6. No serious differential diagnoses were missed. Conclusion: Use of this algorithm enables the diagnosis of TS without additional tests and without missing serious differential diagnoses. [ABSTRACT FROM AUTHOR]

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Acetabular dysplasia has traditionally been defined using the lateral center edge angle and treated with periacetabular osteotomy (PAO). However, the recently described Ottawa classification further quantifies dysplasia in 3-dimensional terms, categorizing Ottawa A as dysplasia due to isolated, excessive acetabular anteversion or anterior acetabular under-coverage. We sought to determine if patients who have Ottawa A dysplasia can expect similar outcomes when undergoing a PAO compared to a traditional dysplasia cohort. Patients who had undergone PAO with Ottawa A hip dysplasia were selected and compared to a control group of patients who had lateral acetabular undercoverage. The modified Harris Hip Score and International Hip Outcome Tool–33 were collected preoperatively and at various follow-up points for a final follow-up average of 2.3 years (range, 0.9 to 6.2). The 17 patients (21 hips) who had Ottawa A dysplasia were compared to a control cohort of 69 patients (88 hips). Both groups saw significant improvements in modified Harris Hip Score and International Hip Outcome Tool–33 at final follow-up, P <.001. There were no differences between groups in any of the outcome measures or rates of achieving minimal clinically important difference (MCID) or substantial clinical benefit. Rates of MCID ranged from 82.4 to 100%, and rates of achieving substantial clinical benefit ranged from 47.1 to 52.9%. In patients undergoing a PAO for Ottawa A hip dysplasia, a significant improvement in patient-reported outcomes can be expected with high rates of MCID achievement. This is not significantly different for patients undergoing PAO for more traditional dysplasia parameters. [ABSTRACT FROM AUTHOR]

Females of reproductive age constitute one of the largest demographics of the hip arthroscopy population, but it is unclear as to how pregnancy planning affects decision-making regarding surgery or vice versa. The purpose of this study was to assess perceived risks to pregnancy from hip pain and/or hip arthroscopy among reproductive-age females who underwent arthroscopic treatment of femoroacetabular impingement syndrome (FAIS). A cross-sectional study was conducted involving females aged 18–44 years who underwent hip arthroscopy for the treatment of FAIS, with a single surgeon included in the study. Subjects completed a survey that assessed obstetric and gynecologic history, decision-making regarding the planning and timing of hip surgery and pregnancy, and perceived risks to pregnancy from hip pain and/or hip surgery. Subjects were classified as nulligravid (Group 1), pregnant at least once before hip surgery but never again following hip surgery (Group 2), or pregnant at least once following hip surgery (Group 3). A total of 85 patients were enrolled with a mean age of 32.3 ± 6.5 years at the time of surgery. The mean follow-up time was 51.9 ± 34.5 months. There were 39 subjects in Group 1 (45.9%), 20 in Group 2 (23.5%), and 26 in Group 3 (30.6%). About half of all subjects expressed “some” to “a lot of” concern that their hip pain could get worse during pregnancy (49.4%), and about half had “no concern” that hip arthroscopy would affect the health of their fetus/baby (54.1%). Reproductive-age females undergoing hip arthroscopy for FAIS generally consider the procedure to be safe with respect to future pregnancy outcomes.

Abstract Background Clinicians and public health professionals have allocated resources to curb opioid over-prescription and address psychological needs among patients with musculoskeletal pain. However, associations between psychological distress, risk of surgery, and opioid prescribing among those with hip pathologies remain unclear. Methods Using a retrospective cohort study design, we identified patients that were evaluated for hip pain from January 13, 2020 to October 27, 2021. Patients’ surgical histories and postoperative opioid prescriptions were extracted via chart review. Risk of hip surgery within one year of evaluation was analyzed using multivariable logistic regression. Multivariable linear regression was employed to predict average morphine milligram equivalents (MME) per day of opioid prescriptions within the first 30 days after surgery. Candidate predictors included age, gender, race, ethnicity, employment, insurance type, hip function and quality of life on the International Hip Outcome Tool (iHOT-12), and psychological distress phenotype using the OSPRO Yellow Flag (OSPRO-YF) Assessment Tool. Results Of the 672 patients, n = 350 (52.1%) underwent orthopaedic surgery for hip pain. In multivariable analysis, younger patients, those with TRICARE/other government insurance, and those with a high psychological distress phenotype had higher odds of surgery. After adding iHOT-12 scores, younger patients and lower iHOT-12 scores were associated with higher odds of surgery, while Black/African American patients had lower odds of surgery. In multivariable analysis of average MME, patients with periacetabular osteotomy (PAO) received opioid prescriptions with significantly higher average MME than those with other procedures, and surgery type was the only significant predictor. Post-hoc analysis excluding PAO found higher average MME for patients undergoing hip arthroscopy (compared to arthroplasty or other non-PAO procedures) and significantly lower average MME for patients with public insurance (Medicare/Medicaid) compared to those with private insurance. Among those only undergoing arthroscopy, older age and having public insurance were associated with opioid prescriptions with lower average MME. Neither iHOT-12 scores nor OSPRO-YF phenotype assignment were significant predictors of postoperative mean MME. Conclusions Psychological distress characteristics are modifiable targets for rehabilitation programs, but their use as prognostic factors for risk of orthopaedic surgery and opioid prescribing in patients with hip pain appears limited when considered alongside other commonly collected clinical information such as age, insurance, type of surgery pursued, and iHOT-12 scores.

Background: Clinicians and public health professionals have allocated resources to curb opioid over-prescription and address psychological needs among patients with musculoskeletal pain. However, associations between psychological distress, risk of surgery, and opioid prescribing among those with hip pathologies remain unclear. Methods: Using a retrospective cohort study design, we identified patients that were evaluated for hip pain from January 13, 2020 to October 27, 2021. Patients' surgical histories and postoperative opioid prescriptions were extracted via chart review. Risk of hip surgery within one year of evaluation was analyzed using multivariable logistic regression. Multivariable linear regression was employed to predict average morphine milligram equivalents (MME) per day of opioid prescriptions within the first 30 days after surgery. Candidate predictors included age, gender, race, ethnicity, employment, insurance type, hip function and quality of life on the International Hip Outcome Tool (iHOT-12), and psychological distress phenotype using the OSPRO Yellow Flag (OSPRO-YF) Assessment Tool. Results: Of the 672 patients, n = 350 (52.1%) underwent orthopaedic surgery for hip pain. In multivariable analysis, younger patients, those with TRICARE/other government insurance, and those with a high psychological distress phenotype had higher odds of surgery. After adding iHOT-12 scores, younger patients and lower iHOT-12 scores were associated with higher odds of surgery, while Black/African American patients had lower odds of surgery. In multivariable analysis of average MME, patients with periacetabular osteotomy (PAO) received opioid prescriptions with significantly higher average MME than those with other procedures, and surgery type was the only significant predictor. Post-hoc analysis excluding PAO found higher average MME for patients undergoing hip arthroscopy (compared to arthroplasty or other non-PAO procedures) and significantly lower average MME for patients with public insurance (Medicare/Medicaid) compared to those with private insurance. Among those only undergoing arthroscopy, older age and having public insurance were associated with opioid prescriptions with lower average MME. Neither iHOT-12 scores nor OSPRO-YF phenotype assignment were significant predictors of postoperative mean MME. Conclusions: Psychological distress characteristics are modifiable targets for rehabilitation programs, but their use as prognostic factors for risk of orthopaedic surgery and opioid prescribing in patients with hip pain appears limited when considered alongside other commonly collected clinical information such as age, insurance, type of surgery pursued, and iHOT-12 scores. [ABSTRACT FROM AUTHOR]

Femoroacetabular Impingement (FAI) syndrome represents a prevalent aetiology of hip discomfort observed among both adolescent and adult populations. It is initially managed conservatively with oral anti-inflammatories and physiotherapy; some patients proceed to receiving an intra-articular (IA) hip injection, but ultimately, the gold-standard treatment is hip arthroscopy. Systematic Review. To systematically investigate the relationship between response to IA anaesthetic or steroid hip injections and arthroscopy outcomes for FAI syndrome. A systematic search of PubMed, Medline, CINAHL, SCOPUS, and Cochrane was conducted in line with the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-analyses) guidelines. Seven studies (Level II-IV) were identified that met our inclusion and exclusion criteria. These studies collectively included 637 patients, demonstrating an average age of 37.5 years (and a range of 14–72 years). Two of the seven studies reported a statistically significant positive correlation between response to IA injections and arthroscopy outcomes. The remaining five studies found that although a positive IA injection response increased the odds of a good outcome post arthroscopy (defined across various studies as a post-operative modified Harris Hip score of >70 points, >79 points or an improvement by 8 or more points), this correlation was not statistically significant. IA hip injections can be a useful prognostic tool, though they are not a consistently reliable predictor of which patients will have good arthroscopic outcomes. [ABSTRACT FROM AUTHOR]

This study presents a rare case of unilateral slipped capital femoral epiphysis treated surgically in a 5-year-old boy with cerebral palsy who was born at 27 weeks' gestation and developed grade III intraventricular haemorrhage and periventricular leucomalacia and was on antiepileptic drugs, including valproic acid and levetiracetam for >3 years. The patient had no history of endocrine, renal, and significant familial diseases. [ABSTRACT FROM AUTHOR]

Background: The COVID-19 pandemic has presented numerous challenges to the global healthcare system and emerging evidence suggests a potential link between COVID-19 treatment, specifically steroid therapy, and the development of avascular necrosis (AVN) of the hip. This review aims to provide a comprehensive overview of recent studies and case reports investigating the relationship between COVID-19, corticosteroid therapy, and the development of AVN. Understanding the nuances of AVN in the context of COVID-19 is crucial for healthcare professionals to navigate treatment decisions and mitigate potential complications. Materials and Methods: The Preferred Reporting Items for Systematic Reviews and a Meta-Analysis (PRISMA) were used in the systematic review until 1 September 2023. The full texts of the remaining twenty-three (n = 23) articles were independently reviewed by the authors of this review. Conclusions: The association between steroid therapy for COVID-19 and the development of hip AVN is a noteworthy concern even though no relationship is evident between the duration of treatment, cumulative dosage of medication, maximum daily dosage received, and presence of AVN. Further research with larger cohorts and long-term follow up is needed to better understand the causative relationship and optimal management strategies for hip AVN in the context of COVID-19 and steroid therapy. [ABSTRACT FROM AUTHOR]

Background: The clinical presentation of neuroblastoma can widely vary but can include orthopaedic related complaints. Case details: We present two cases of neuroblastoma diagnosis after an initial presentation of an orthopaedic complaint of limp and hip pain. Both cases varied on laboratory markers and warning symptoms, leading to delays in final diagnosis. Conclusion: These cases demonstrate the importance of orthopaedic surgeons including neuroblastoma in the differential diagnosis of hip pain and limp.

Background. While primary cardiac tumors occur rarely, it is observed that cardiac metastases are almost 20 times more common. These are, however, observed during autopsy and seldom missed in living patients. Patients with cardiac metastases present commonly with dyspnea on exertion or pleuritic chest pain. Most common site of intracardiac metastases is right atrium. Case presentation. Here we present a case of a 21-year-old male who presented for a routine check-up to the cardiac outpatient department for assessment of fitness for chemotherapy. He was a known case of right hip chondrosarcoma for 2 years, being treated with Ayurvedic medications. He had no symptoms related to the respiratory or cardiac system. He was afebrile during the examination, however, was restricted to a bed due to the pain in his right hip. On evaluation, the patient was diagnosed with a right ventricular thrombus extending to the pulmonary artery (PA) causing an impending pulmonary embolism. On opening the right atrium and PA, we found a loose, whitish-grey mass, adherent to the right ventricular papillary muscle, entangling the chordae. The tricuspid valve leaflets were also found to be tethered to this mass. The mass was found to extend to the PA beyond the leaflets, however, the leaflets were free of the tissue. The mass was extracted piece-meal through right atrium and PA approach. Histopathology revealed metastatic chondrosarcoma tissue. Conclusion. Cardiac metastases of chondrosarcoma are a rare condition, and can be often asymptomatic. Such patients often present with dyspnea, and imaging may not be able to rightly identify the cause. A high index of suspicion is necessary in patients with a known current or prior malignancy before committing to surgical intervention.

Abstract Background The “International Hip Outcome Tool 12” (iHOT12) is a self-administered patient-reported outcome tool for measuring health-related quality of life and physical functioning in young and active patients with hip pathology. Since the iHOT12 has become widely used, we sought to translate and validate it for Hebrew-speaking populations. The aims of this study were: (1) To translate and culturally adapt the iHOT12 into Hebrew using established guidelines. (2) To test the new Hebrew version for validity, and (3) reliability. Methods The iHOT12 was translated and culturally adapted from English to Hebrew (iHOT12-H) according to the COSAMIN guidelines. For validity, the iHOT12-H and Western Ontario and McMaster universities osteoarthritis index (WOMAC) were completed by 200 patients with hip pathology. Exploratory factor analysis was used to assess structural validity. Subsequently, 51 patients repeated the iHOT12-H within a 2-week interval. Intraclass Correlation Coefficient (ICC), Cronbach alpha, and Standard Error of Measurement (SEM) were calculated to assess reliability. Results Construct validity: iHOT12-H correlated strongly to the WOMAC scores (r = -0.82, P

With the growing number of primary arthroscopies performed, patients requiring revision hip arthroscopies for various issues is high including postoperative adhesion formation, a source of pain, mechanical symptoms, range of motion limitation, stiffness, and microinstability. Adhesions are a consequence of biological pathways that have been stimulated by injury or surgical interventions leading to an increased healing response. Preventative efforts have included surgical adjuncts during/after primary hip arthroscopy, biologic augmentation, and postoperative rehabilitation. Treatment options for adhesion formation includes surgical lysis of adhesions with or without placement of biologic membranes aimed at inhibiting adhesion reformation as well as systemic medications to further reduce the risk. Postoperative rehabilitation exercises have also been demonstrated to prevent adhesions as a result of hip arthroscopy. Ongoing clinical trials are further investigating pathways and prevention of adhesion formation.

The HAGOS (Hip and Groin Outcome Score) questionnaire is a valid and reliable measure of the self-assessment of symptoms, activity limitation, participation restriction, and quality of life (Qol) of subjects with hip and/or groin pain. The aims of this study are to translate and transculturally adapt the HAGOS into Italian (HAGOS-I) and to assess its internal consistency, validity, and reliability in physically active, young, and middle-aged subjects. The translation and transcultural adaptation of (HAGOS-I) was carried out according to international guidelines. Eight-one subjects (mean age 28.19) were included in this study. All the participants completed the HAGOS-I, the Lower Extremity Functional Scale (LEFS-I), the Oxford Hip Score (OHS-I), and the Short Form 36 Health Surveys (SF-36-I). The Cronbach’s α for the six HAGOS subscales ranged from 0.63 to 0.87. Statistically significant correlations were obtained between the six HAGOS-I subscales and the LEFS-I (rs = 0.44–0.68; p < 0.01). Only one HAGOS-I subscale (Participation in Physical Activities) did not reach statistical significance with the OHS-I, while the remaining five had a moderate correlation (rs = 0.40–0.60; p < 0.01). The test–retest reliability (Intraclass Correlation Coefficient) ranged from 0.57 to 0.86 for the six HAGOS-I subscales. The HAGOS-I is a valid and reliable instrument that can be used in clinical settings with young and middle-aged subjects with hip and/or groin pathologies.

Necrotizing fasciitis (NF) is a life-threatening soft tissue infection, typically caused by preexisting conditions such as trauma, complicated intraabdominal infections, or even small wounds. However, it is very rare for NF to occur as a result of perforated colon cancer (CC). Diagnosis primarily relies on clinical findings, imaging, and laboratory tests. Early diagnosis and treatment are crucial for patient survival. In this study, we present a case of an 82-year-old female a known case of CC diagnosed 1 month ago. She presented with hip pain persisting for 10 days duration, along with skin changes over the proximal anterolateral aspect of the thigh. The patient was diagnosed with NF associated with an iliopsoas abscess caused by perforated CC that was managed with surgical debridement, left hemicolectomy, and end colostomy along with broad-spectrum antibiotics. [ABSTRACT FROM AUTHOR]

Background: The "International Hip Outcome Tool 12" (iHOT12) is a self-administered patient-reported outcome tool for measuring health-related quality of life and physical functioning in young and active patients with hip pathology. Since the iHOT12 has become widely used, we sought to translate and validate it for Hebrew-speaking populations. The aims of this study were: (1) To translate and culturally adapt the iHOT12 into Hebrew using established guidelines. (2) To test the new Hebrew version for validity, and (3) reliability. Methods: The iHOT12 was translated and culturally adapted from English to Hebrew (iHOT12-H) according to the COSAMIN guidelines. For validity, the iHOT12-H and Western Ontario and McMaster universities osteoarthritis index (WOMAC) were completed by 200 patients with hip pathology. Exploratory factor analysis was used to assess structural validity. Subsequently, 51 patients repeated the iHOT12-H within a 2-week interval. Intraclass Correlation Coefficient (ICC), Cronbach alpha, and Standard Error of Measurement (SEM) were calculated to assess reliability. Results: Construct validity: iHOT12-H correlated strongly to the WOMAC scores (r = -0.82, P < 0.001, Spearman). Factor analysis revealed a two-factor structure. Cronbach's alpha was 0.953 confirming internal consistency to be highly satisfactory. Test–retest correlation of the iHOT12-H was excellent with an ICC = 0.956 (95% CI 0.924–0.974). There was no floor or ceiling effect. Conclusion: The iHOT12 Hebrew version has excellent reliability, good construct validity and can be used as a measurement tool for physical functioning and quality of life in young, physically active patients with hip pathology. This study will serve Israeli researchers in evaluating treatment effectiveness for these patients. Moreover, it will also enable multinational cooperation in the study of hip pathology. Highlights: • The International Hip Outcome Tool 12 was translated into Hebrew (iHOT12-H). • The iHOT12-H showed comparable psychometric properties to the original version. • The iHOT12-H is a valid and reliable questionnaire for people with hip-related pain. [ABSTRACT FROM AUTHOR]

Hip fracture is a common injury and represents a major health problem with an increasing incidence. In older adults, opioids such as oxycodone are often preferred to other analgesics such as tramadol because of a lower risk of delirium. Different parameters, such as inhibition of cytochrome P450 (CYP450) 2D6 and/or 3A4, can potentially lead to pharmacokinetic variations of oxycodone representing a risk of adverse drugs effects or lack of drug response. There is a risk of drug–drug interactions involving CYP450 in older adults due to the high prevalence of polypharmacy. This study sought to identify patient characteristics that influence oxycodone administration. A single-center observational study included 355 patients with a hip fracture hospitalized in a geriatric postoperative unit. Composite endpoint based on form, duration, and timing to intake separated patients into three groups: "no oxycodone", "low oxycodone ", and "high oxycodone ". CYP450 interactions were studied based on a composite variable defining the most involved CYP450 pathways between CYP2D6 and CYP3A4. CYP450 interactions with CYP2D6 pathway involved were associated with the risk of "high oxycodone" [odds ratio adjusted on age and the type of hip fracture (OR*) 4.52, 95% confidence interval (CI) 1.39–16.83, p = 0.02)], as well as serum albumin levels (OR* 1.09, 95% CI 1.02–1.17, p = 0.01). Cognitive impairment was negatively associated with the risk of "high oxycodone" (OR* 0.38, 95% CI 0.18–0.77, p = 0.02). This study showed an association between CYP2D6 interactions and higher oxycodone consumption indirectly reflecting the existence of uncontrolled postoperative pain. [ABSTRACT FROM AUTHOR]

* OBJECTIVES: To compare the effects of diagnostic labels and their explanations on people's beliefs about managing hip pain. *DESIGN: Online randomized controlled trial involving 626 participants. * METHODS: Participants aged >45 years with and without hip pain considered a hypothetical scenario (initial doctor consultation for hip pain). They were randomized to receive a diagnostic label and explanation of (1) hip osteoarthritis, (2) persistent hip pain, or (3) hip degeneration. Primary outcomes were the beliefs (1) exercise would damage the hip and (2) surgery is necessary at some stage (scales, 0 = definitely would not/ unnecessary, 10 = definitely would/necessary). Secondary outcomes included beliefs about other treatments and care providers. * RESULTS: Compared to hip degeneration, participants who were allocated to hip osteoarthritis and persistent hip pain believed exercise was less damaging (mean difference -1.3 [95% CI: -1.9, -0.7] and -1.8 [-2.3, -1.2], respectively) and surgery less necessary (-1.5 [-2.1, -1.0] and -2.2 [-2.7, -1.6], respectively). Compared to hip osteoarthritis, participants who were allocated to persistent hip pain believed surgery was less necessary (-0.7 [-1.2, -0.1]), but not that exercise was less damaging (-0.5 [-1.1, 0.1]). Compared to hip degeneration, participants who were allocated to hip osteoarthritis and persistent hip pain were less concerned about their hip and believed exercise and care from an exercise and sports physician, rheumatologist, or physiotherapist would be more helpful, and care from an orthopaedic surgeon less helpful. * CONCLUSIONS: People who were allocated a diagnostic label and explanation of hip osteoarthritis or persistent hip pain believed exercise was less damaging and surgery less necessary for a hip problem than hip degeneration. [ABSTRACT FROM AUTHOR]

Abstract Background Greater Trochanteric Pain Syndrome (GTPS) is a common chronic musculoskeletal condition that may affect physical function, quality of life and sleep. The Victorian Institute of Sport Assessment-Gluteal questionnaire (VISA-G) has been developed as a Patient-Reported Outcome Measurement (PROM) to address pain, everyday activities, physical activities, and difficulty with weight bearing activities. The aim of the study was to test the reliability, validity and floor and ceiling effects of the Norwegian version of the VISA-G (VISA-G-Norwegian) in a population with GTPS in a specialist health care setting. Methods This psychometric evaluation of the VISA-G-Norwegian questionnaire were conducted with a prospective observational design. The VISA-G was translated into Norwegian following recommended guidelines. A subgroup repeated the VISA-G-Norwegian a week after the initial submission. For the reliability, the Intraclass Correlation Coefficient (ICC2.1), Standard Error of the Measurement (SEM) and the Smallest Detectable Change (SDC95%) were calculated. Internal consistency was measured using a Cronbach´s alpha. Floor and ceiling effects were evaluated, and construct validity was assessed with three a priori hypotheses. Results 78 participants were included in the study of which 47 stable participants undertook the test-retest reliability arm of the study. The ICC2.1 for the total score was 0.85 (95% CI 0.68, 0.92), SEM was 6.6 points and SDC95% 18.4 points. Cronbach`s alpha was 0.77 (95% CI 0.69, 0.84). No floor or ceiling effects were found in the total score, but ceiling effect was found in three of the eight items. For construct validity, one of the three hypotheses were confirmed. VISA-G-Norwegian correlated to the modified Harris Hip Score (mHHS), Oswestry Disability Questionnaire (ODI) and Numeric Pain Rating Scale (NPRS), 0.64, -0.75 and − 0.63 respectively. Conclusion The VISA-G-Norwegian has acceptable reliability and validity, despite ceiling effect of individual items. The large SDC95% should be considered when measuring change in similar cohorts with GTPS. For a potential future version, it would be recommended to consider response options for questions with ceiling effect and the comprehensibility of question eight. Trial registration Registered at ClinicalTrials.gov the 28/02/2020 (NCT04289922).

Hang Qian,1 Xu Wang,1 Pengbo Wang,1 Guangyang Zhang,1 Jun Liu,1 Xiaoqian Dang,1 Jianbin Guo,2 Ruiyu Liu1 1Department of Orthopedics, The Second Affiliated Hospital, Xi’an Jiaotong University, Xi’an, People’s Republic of China; 2Department of Orthopedics, Honghui Hospital, Xi’an Jiaotong University, Xi’an, People’s Republic of ChinaCorrespondence: Ruiyu Liu, Department of Orthopaedics, The Second Affiliated Hospital, Xi’an Jiaotong University, No. 157, Xiwu Road, Xi’an, Shaanxi, 710004, People’s Republic of China, Email liuryu@126.comObjective: Hip ankylosis is a prevalent condition in patients with Ankylosing spondylitis (AS) that can significantly impact their psychological well-being. This study aimed to investigate the impact of Total Hip Arthroplasty (THA) on anxiety and depression among AS patients.Methods: 62 AS patients undergoing primary THA were recruited and separated into two groups based on preoperative hip motion. The 40 patients with hip mobility of 0° were assigned to group A, and others were assigned to group NA. Self-rating Anxiety Scale (SAS), Self-rating Depression scale (SDS), Harris hip scores (HHS) and 36-Item Short Form Survey (SF-36) were obtained one week before and there, six and twelve months after THA.Results: The study found that AS patients in group A had significantly higher levels of anxiety and depression (SAS score = 75.05± 2.79, SDS index score = 0.74± 0.02) compared to group B (SAS score = 54.58± 3.35, SDS index score= 0.64± 0.03, P=0.01). However, both groups showed significant improvements in anxiety and depression scores from there to twelve months after THA (P< 0.001). Correlation analyses revealed that the improvement in group NA was associated with hip pain relief (p< 0.001), while the improvement in group A was related to joint function, disease duration, age at THA and spine imaging lesions (p< 0.001).Conclusion: Some degree of anxiety and depression was present in both groups of AS patients. Levels of depression and anxiety were higher in patients with combined hip ankylosis. And their improvement was associated with improved hip function and quality of life after THA. Hip pain relief played a significant role in patients without hip joint ankylosis. The impact of the degree of lesion on spinal imaging on psychological status needs to be considered in both groups.Keywords: ankylosing spondylitis, depression and anxiety, hip pain, hip joint range of motion, hip ankylosing

Abstract Background Patient-reported outcomes are commonly used to assess patient symptoms. The effect of specific hip pathology on relationships between perceived and objectively measured symptoms remains unclear. The purpose of this study was to evaluate differences of function and pain in patients with FAIS and DDH, to assess the correlation between perceived and objective function, and to determine the influence of pain on measures of function. Methods This prospective cross-sectional study included 35 pre-operative patients (60% female) with femoroacetabular impingement syndrome (FAIS) and 37 pre-operative patients (92% female) with developmental dysplasia of the hip (DDH). Objectively measured function (6-min walk [6MWT], single leg hop [SLHT], Biodex sway [BST], hip abduction strength [HABST], and STAR excursion balance reach [STAR] tests), patient-reported function (UCLA Activity, Hip Outcome Score [HOS], Short Form 12 [SF-12], and Hip Disability and Osteoarthritis Outcome Score [HOOS]), and patient-reported pain (HOOS Pain, visual analogue scale (VAS), and a pain location scale) were collected during a pre-surgical clinic visit. Between-group comparisons of patient scores were performed using Wilcoxon Rank-Sum tests. Within-group correlations were analyzed using Spearman’s rank correlation coefficients. Statistical correlation strength was defined as low (r = ± 0.1–0.3), moderate (r = ± 0.3–0.5) and strong (r > ± 0.5). Results Patients with DDH reported greater pain and lower function compared to patients with FAIS. 6MWT distance was moderately-to-strongly correlated with a number of patient-reported measures of function (FAIS: r = 0.37 to 0.62, DDH: r = 0.36 to 0.55). Additionally, in patients with DDH, SLHT distance was well correlated with patient reported function (r = 0.37 to 0.60). Correlations between patient-reported pain and objectively measured function were sparse in both patient groups. In patients with FAIS, only 6MWT distance and HOOS Pain (r = -0.53) were significantly correlated. In patients with DDH, 6MWT distance was significantly correlated with VAS Average (r = -0.52) and Best (r = -0.53) pain. Conclusion Pain is greater and function is lower in patients with DDH compared to patients with FAIS. Moreover, the relationship between pain and function differs between patient groups. Understanding these differences is valuable for informing treatment decisions. We recommend these insights be incorporated within the clinical continuum of care, particularly during evaluation and selection of surgical and therapeutic interventions.

The scientific review presents the treatment of coxarthrosis of various stages by the radiofrequency denervations technique. Full-text articles were searched in open electronic databases PubMed, eLibrary, CyberLeninka for the maximum possible time interval for the time interval from 1990 to 2023. Fifteen scientific articles were selected, in which 302 patients were treated with 489 radiofrequency denervations of the hip joint. The authors provide information about the state of the problem with special attention to the characteristics of various denervation protocols and justification of the choice of target points for exposure from the standpoint of anatomy and innervation of the hip joint. RCD is a modern, interventional, and effective solution to the main symptom, which is pain, according to numerous studies. The introduction of targeted effects on the articular branches of the locking and femoral nerves by radiofrequency denervation into the work of a practitioner can increase the period of remission of exacerbation of coxarthrosis and shorten the period of disability with a high level of intervention safety for the patient. Conducting further research on the role of radiofrequency denervation in coxarthrosis is critical.

Background and purpose: We aimed to evaluate the long-term predictive value of radiographic abnormality and/or hip pain assessed 5 years following primary total hip arthroplasty (THA) and the occurrence of revision for aseptic loosening between 5 and 25 years postoperatively. Patients and methods: We included all primary THAs performed between 1996 and 2011 (same uncemented cup, polyethylene-ceramic bearing, 28 mm head, cemented stem) and prospectively enrolled in the institutional registry, for whom baseline and follow-up radiographs were available. At 5 years radiographically we assessed femoral osteolysis and/or stem migration. Pain was evaluated with the Harris Hip pain subscore. Kaplan–Meier survival and Cox regression analyses were performed. Results: 1,317 primary THAs were included. 25 THAs (2%) were revised for aseptic stem loosening. Any abnormal radiographic sign at 5 years was present in 191 THAs (14%). Occasional hip pain was reported by 20% and slight to severe pain by 12% of patients at 5 years. In patients < 60 years, 10 of the 12 later revised for aseptic stem loosening had abnormal radiographs at 5 years vs. 5 of the 13 later revised in those ≥ 60 years. Hazard ratios (HR) were 34 (95% confidence interval [CI] 7–155) in younger vs. 4 (CI 1–11) in the older group. HR for association of hip pain at 5 years with future revision was 3 (CI 1–5). Conclusion: The presence of abnormal radiographic signs 5 years after THA was strongly associated with later revision for aseptic stem loosening, especially in patients < 60 years. The association between pain at 5 years and future revision was much weaker.

Background & Objectives: Hip pain has different etiologies in adults and children. MRI is the method of choice in characterizing the various disorders and assessing the full extent of osseous, chondral and soft tissue abnormality of the hip joint. This study was aimed to evaluate the diagnostic value of MRI in assessment of painful hip joint. Methodology: This prospective study included 60 patients with painful hip joint. The following MR sequences were performed to all patients: Coronal T1, T2 & STIR WIs, axial T1&T2WIs, axial T1WI and sagittal T1WI after contrast injection. Patient's history, local examination of the diseased hip and laboratory investigations were performed. Results: The most common pathology for which MRI hip advised was avascular necrosis (AVN) (40%), followed by septic arthritis (20%). Male to female ratio was 2.3:1, their ages ranged from 10 months to 76 years with a mean age of 40 years. In this study most common presentation was pain in hip joint (97%) followed by restricted movement (92%). In the study most common MRI finding of AVN was bone marrow edema (78%) of the lesions followed by joint effusion 63% and Double line sign (58%). In present study, stage 4 with secondary osteoarthritis was the most common stage of AVN present in 43% of the lesions followed by stage 3 31%. The frequency of MRI findings in septic joints was synovial enhancement (91%), joint effusions (91%), erosive bone destruction (67%). In the study most common changes of osteoarthritis is joint space reduction noted in 38% of hips studied. Conclusion: MRI of the hip joint is an informative, diagnostic, and accurate for the assessment of hip pain and sufficient imaging modality for delineation of different hip joint pathology. [ABSTRACT FROM AUTHOR]

Background. Avascular necrosis of the hip (AVNH) is a debilitating osteoarticular disease that has variable risk factors, but not a very specific pathogenetic pathway. Many management options were proposed and studied for AVNH treatment, but with limited or inconsistent results, as there is not a current treatment guideline. The specific symptoms of AVNH are pain and reduced range of motion of the hip, usually painful rotations of the hip and sometimes an affected walk. In some cases, patients can present with non-specific or atypical symptoms, which can make the diagnostic difficult. The golden standard imaging for AVNH diagnostic is magnetic resonance, but simple radiography can be sufficient in many cases. Case presentation. We report a case of a 62 years old male, without significant personal pathological history or alcohol or other substances abuse, with no chronic treatment, with a confirmed arthritis of both knees. The patient presented with mechanical pain of the left shoulder and both knees, with no present or past symptoms of the hips. The patient was evaluated by a rehabilitation medicine specialist and a painful and limited range of motion of the left hip was found. Blood works and radiological investigations were done, which confirmed the diagnostic of an avascular necrosis of the left hip, arthritis of both hips and left shoulder. Conclusions. This case, of a generally healthy male, with no toxic behavior and no symptoms at the hip region, but with clear signs of an affected left hip at clinical examination is a particular one by correlation with an atypical presentation of an avascular left hip necrosis, which emphasizes the crucial importance of a detailed and complete physical examination of a patient, even in the case of poor or none symptomatology. [ABSTRACT FROM AUTHOR]

* OBJECTIVE: In symptomatic football players with hip dysplasia, we aimed to explore the relationships between self-reported sport and recreation ability and (1) hip muscle strength, (2) functional performance, and investigate if these relationships were modified by sex or cartilage defects. * METHODS: In this cross-sectional study, football players (n = 50) with longstanding (>6 months) hip and/or groin pain, a positive flexion/adduction/internal rotation test, and a lateral-center-edge angle <25° were included. Hip muscle strength and functional performance were assessed. Self-reported sport and recreation ability was quantified using the sports and recreational subscales from the International Hip Outcome Tool-33 (iHOT-Sport) and the Copenhagen Hip and Groin Outcome Score (HAGOS-Sport). Relationships were evaluated using regression models with sex and cartilage defects as potential effect modifiers. * RESULTS: There was a positive linear relationship between the one-leg-rise test and the iHOT-Sport subscale (β = 0.61; 95% CI: 0.09, 1.14). A polynomial (concave) relationship was found between peak eccentric adduction strength and the HAGOS-Sport subscale (β = -30.88; 95% CI: -57.78, -3.99). Cartilage defects modified the relationship between peak isometric adduction strength and HAGOS-Sport, with those with cartilage defects having a polynomial (convex) relationship (β = 36.59; 95% CI: 12.74, 60.45), and those without cartilage defects having no relationship. * CONCLUSION: One-leg-rise performance and adduction strength were associated with selfreported sport and recreation ability, indicating a possible relationship between physical function, hip joint structure, and sport and recreation ability in football players with hip dysplasia. [ABSTRACT FROM AUTHOR]

Background: Greater Trochanteric Pain Syndrome (GTPS) is a common chronic musculoskeletal condition that may affect physical function, quality of life and sleep. The Victorian Institute of Sport Assessment-Gluteal questionnaire (VISA-G) has been developed as a Patient-Reported Outcome Measurement (PROM) to address pain, everyday activities, physical activities, and difficulty with weight bearing activities. The aim of the study was to test the reliability, validity and floor and ceiling effects of the Norwegian version of the VISA-G (VISA-G-Norwegian) in a population with GTPS in a specialist health care setting. Methods: This psychometric evaluation of the VISA-G-Norwegian questionnaire were conducted with a prospective observational design. The VISA-G was translated into Norwegian following recommended guidelines. A subgroup repeated the VISA-G-Norwegian a week after the initial submission. For the reliability, the Intraclass Correlation Coefficient (ICC2.1), Standard Error of the Measurement (SEM) and the Smallest Detectable Change (SDC95%) were calculated. Internal consistency was measured using a Cronbach´s alpha. Floor and ceiling effects were evaluated, and construct validity was assessed with three a priori hypotheses. Results: 78 participants were included in the study of which 47 stable participants undertook the test-retest reliability arm of the study. The ICC2.1 for the total score was 0.85 (95% CI 0.68, 0.92), SEM was 6.6 points and SDC95% 18.4 points. Cronbach's alpha was 0.77 (95% CI 0.69, 0.84). No floor or ceiling effects were found in the total score, but ceiling effect was found in three of the eight items. For construct validity, one of the three hypotheses were confirmed. VISA-G-Norwegian correlated to the modified Harris Hip Score (mHHS), Oswestry Disability Questionnaire (ODI) and Numeric Pain Rating Scale (NPRS), 0.64, -0.75 and − 0.63 respectively. Conclusion: The VISA-G-Norwegian has acceptable reliability and validity, despite ceiling effect of individual items. The large SDC95% should be considered when measuring change in similar cohorts with GTPS. For a potential future version, it would be recommended to consider response options for questions with ceiling effect and the comprehensibility of question eight. Trial registration: Registered at ClinicalTrials.gov the 28/02/2020 (NCT04289922). [ABSTRACT FROM AUTHOR]

Objectives: Greater trochanteric pain syndrome (GTPS) is one of the causes of lateral hip pain. We aimed to determine the significance of certain anatomical parameters related to GTPS in imaging tests. Methods: Data of patients who were treated with glucocorticoid injection for trochanteric bursitis in our clinic between July 2019 and July 2022 for GTPS were analyzed. The control group was constituted of patients without GTPS but with hip and spinal problems who had pelvic computerized tomography (CT) images and undergone robotic-assisted knee arthroplasty. Standard anteroposterior pelvic radiograms, pelvic CTs, or magnetic resonance images were evaluated for anatomical parameters. Results: Among anatomical parameters, acetabular anteversion, length of trochanter major, and abductor index were significantly different between the patients with and without GTPS. Although mean age was different between the GTPS and control patient groups, age was not found to be correlated with any anatomical parameter. Abductor lever arm length (p = 0.001) and abductor index (p = 0.009) were found to be correlated. Conclusions: The length of trochanter major and abductor index were shown to be predisposing anatomical parameters for GTPS. [ABSTRACT FROM AUTHOR]