Latest Research
October 2023
Changes in Sports Activity After Periacetabular Osteotomy: A Qualitative and Quantitative Analysis
Leopold et al 2023
Background:
Patients undergoing periacetabular osteotomy (PAO) for symptomatic developmental dysplasia of the hip are usually young and active with high functional demands. Those who participate in sports seek surgical therapy to resume or maintain sports activities. There is little evidence regarding the postoperative level of activity and the extent to which sports activity changes after PAO both qualitatively and quantitatively.
Purpose:
The aim of this study was to determine the change in activity level as measured using the University of California Los Angeles (UCLA) activity score and the changes in qualitative and quantitative sports activity.
Study Design:
Case series; Level of evidence, 4.
Methods:
This was a retrospective analysis of prospectively collected data of 123 hips in 111 patients who underwent PAO for developmental dysplasia of the hip between January 2015 and June 2017. UCLA activity score, International Hip Outcome Tool 12, and Subjective Hip Value, as well as practiced sports, frequency and duration of sports activity, and time to return to sports, were assessed. Eventual changes in practiced sports and reasons for those changes were recorded.
Results:
Of the participating patients, 85% were female and 15% were male. The mean patient age at the time of surgery was 27.7 ± 7.3 years. Mean follow-up was 63 ± 10 months. UCLA score (5.08 ± 2.44 vs 6.95 ± 1.74; P < .001), International Hip Outcome Tool 12 (41.4 ± 22.2 vs 72.6 ± 22.9; P < .001), and Subjective Hip Value (42.8 ± 24.3 vs 80.4 ± 17.8; P < .001) increased significantly from pre- to postoperatively. Significantly more patients participated in low-impact sports postoperatively (31.7% vs 52%; P = .001). Participation in high-impact sports decreased (42.3% vs 36.6%; P = .361). The overall sports activity rate increased significantly (78.8% vs 90.8%; P = .008). Quantitatively, sports frequency in times per week (P < .001) as well as length of exercise per time (P = .007) increased significantly. A total of 52 patients (42%) changed sports activities postoperatively. Of these, 35 (28.4%) reported having stopped previously practiced sports after surgery, while 17 (13.8%) reported having started new sports. Reasons for starting and stopping certain sports varied and included hip- and non–hip related ones. In only 2 cases was physician’s advice given as a reason for changing the sport.
Conclusion:
Patients can improve their sports activity both qualitatively and quantitatively after PAO. However, a relevant proportion of patients adjusts their sports activities for a variety of hip-related and non–hip related reasons.
October 2023
Football Players With Hip Dysplasia: The Relationship Between Muscle Strength, Functional Performance, Self-reported Sport and Recreation, Cartilage Defects, and Sex. A Cross-sectional Study. O'Brien 2023
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: Football Players With Hip Dysplasia: The Relationship Between Muscle Strength, Functional Performance, Self-reported Sport and Recreation, Cartilage Defects, and Sex. A Cross-sectional Study
Latest Research
What we have been reading this month- October 2018
This week we have been reading an interesting journal in Osteoarthritis and Cartilage by Vafaeian et al, 2017. It is titled: Finite element analysis of mechanical behaviour of human dysplastic hip joints: a systematic review.
This systematic review highlights a few key facts:
- DDH is present in 1-3/1000 live births.
- DDH accounts for one-third of hip replacement surgeries in patients under 60 years old.
- DDH which is left untreated can lead to the following symptoms: mechanical instability, muscle imbalance, limited mobility, subluxation, abnormal joint loading which can cause increased cartilage shearing and development of osteoarthritis.
- The earlier DDH is addressed the less likely the joint is to degenerate and develop osteoarthritis.
- The labrum plays a key role in hip stability in the normal hip. In the dysplastic hip the mechanical contribution of the labrum has been found to be between 2-11 times greater.
- Therefore in dysplastic hips there is increased load and shearing forces on the labrum, which eventually results in anterosuperior tearing of the labrum. Labral symptoms can be one of the first issues that a patient experiences- which leads to a diagnosis of hip dysplasia.
- There is evidence of increased stress on the lateral acetabular roof, which is often where the first signs of osteoarthritis occur and sclerosis is often noted on x-ray.
Latest Research
Cam Deformity and Acetabular Dysplasia as Risk Factors for Hip Osteoarthritis//November 2018
A paper by Saberi-Hosnijeh et al, 2016 looking at acetabular dysplasia and cam deformity as risk factors for developing hip osteoarthritis has highlighted the following:
- Recent studies have supported the hypothesis that mild acetabular dysplasia is associated with an increased risk of incidence of hip OA.
- In dysplasia, the femoral head articulates with a specific small area of the shallow acetabulum. Therefore, the joint stresses are localised to a more focal small area on both the femur and the acetabulum. The cumulation of these joint stresses and increased shearing forces results in articular surface contact stress above a critical threshold, therefore causing joint degeneration and early onset of OA.
- A few studies have also found a significant association between cam deformity and the risk of developing hip OA. Which has then lead to a total hip replacement (THR) being required within 2–20 years of follow‐up.
- Cam impingement is characterised by excess bone formation at the anterolateral head–neck junction creating a nonspherical femoral head known as a cam deformity.
- The cam deformity on the femoral head articulates earlier with the acetabulum during flexion and internal rotation of the hip and results in the cam being forced into the acetabulum. This leads to structural damage of the acetabular rim, resulting in labral tears and cartilage delamination. This damage may gradually lead to hip OA.
- A significant association between acetabular dysplasia and development of OA was only seen in the female group. This could be due to differences in alignment of the lower extremity in women compared with men, which results in changes to dynamic and mechanical joint loading of the hip. Women often have abnormal underlying joint laxity, estrogen metabolism, and pregnancy‐associated pelvic instability which might explain the difference.