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 hip dysplasia are typically young and active individuals with high functional performance demands. Those involved in sports often pursue surgical therapy to resume or maintain their sports activities. However, there is limited evidence regarding the postoperative level of activity and the extent to which sports activity changes, both qualitatively and quantitatively, following PAO.
Purpose:
The aim of this study was to assess changes in activity level using the University of California Los Angeles (UCLA) activity score, along with the qualitative and quantitative sports activity changes postoperatively.
Study Design:
Case series; Level of evidence, 4.
Methods:
This retrospective analysis reviewed prospectively collected data from 123 hips in 111 patients who underwent PAO for developmental dysplasia of the hip between January 2015 and June 2017. The UCLA activity score, International Hip Outcome Tool 12, and Subjective Hip Value were evaluated, alongside practiced sports, frequency and duration of sports activity, as well as the time taken to return to sports. Changes in practiced sports and the reasons behind these changes were documented.
Results:
Among the patients, 85% were female and 15% were male, with a mean age of 27.7 ± 7.3 years at the time of surgery. The average follow-up duration was 63 ± 10 months. Significant increases were recorded in the 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) from pre- to postoperatively, indicating improved muscle strength and functional performance. A greater number of patients participated in low-impact sports postoperatively (31.7% vs 52%; P = .001), while participation in high-impact sports decreased (42.3% vs 36.6%; P = .361). The overall sports activity rate significantly increased (78.8% vs 90.8%; P = .008). Quantitatively, both the frequency of sports activity per week (P < .001) and the duration of exercise sessions (P = .007) increased significantly. Of the patients, 52 (42%) changed their sports activities postoperatively; 35 (28.4%) reported stopping previously practiced sports, while 17 (13.8%) began new sports. The reasons for starting or stopping certain sports varied, encompassing both hip-related and non-hip-related factors; in only two instances was physician advice cited as a reason for changing sports.
Conclusion:
Patients can experience improvements in sports activity both qualitatively and quantitatively after periacetabular osteotomy. Nevertheless, a significant proportion of patients may adjust their sports activities for various reasons related to hip dysplasia and other factors.
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 sports activity changes 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 sports activity changes were 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 having cartilage defects showing a polynomial (convex) relationship (β = 36.59; 95% CI: 12.74, 60.45), while those without cartilage defects had no significant 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, titled: Finite element analysis of mechanical behaviour of human dysplastic hip joints: a systematic review.
This systematic review highlights a few key facts about hip dysplasia (DDH):
DDH is present in 1-3/1000 live births.
DDH accounts for one-third of hip replacement surgeries in patients under 60 years old.
When left untreated, DDH can lead to symptoms such as mechanical instability, muscle imbalance, limited mobility, subluxation, and abnormal joint loading, which can cause increased cartilage shearing and the development of osteoarthritis.
The earlier DDH is addressed, the less likely the joint is to degenerate and develop osteoarthritis, which ultimately preserves functional performance.
The labrum plays a key role in hip stability in a normal hip, but in dysplastic hips, the mechanical contribution of the labrum has been found to be between 2-11 times greater.
This increased load and shearing forces on the labrum in dysplastic hips can lead to anterosuperior tearing of the labrum. Labral symptoms are often among the first issues a patient experiences, which can lead to a diagnosis of hip dysplasia.
There is also evidence of increased stress on the lateral acetabular roof, which is frequently where the first signs of osteoarthritis occur, and sclerosis is often noted on x-ray.
Moreover, changes in sports activity may also affect muscle strength and functional performance, making early intervention crucial. Additionally, a periacetabular osteotomy can be considered to improve outcomes in those with significant hip dysplasia.
Latest Research
Cam Deformity and Acetabular Dysplasia as Risk Factors for Hip Osteoarthritis//November 2018
A paper by Saberi-Hosnijeh et al, 2016 examining hip dysplasia, specifically 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, which can significantly impact functional performance. In cases of dysplasia, the femoral head articulates with a specific small area of the shallow acetabulum, leading to localized joint stresses on both the femur and the acetabulum. The cumulation of these joint stresses, combined with increased shearing forces, results in articular surface contact stress exceeding a critical threshold, ultimately 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 been linked to the need for total hip replacement (THR) within 2–20 years of follow‐up. Cam impingement is characterized 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, resulting in the cam being forced into the acetabulum. This leads to structural damage of the acetabular rim, resulting in labral tears and cartilage delamination, which may gradually contribute to the development of hip OA.
Interestingly, a significant association between acetabular dysplasia and the development of OA was only observed in the female group. This difference could be attributed to variations in alignment of the lower extremity between women and men, affecting dynamic and mechanical joint loading of the hip. Women often exhibit abnormal underlying joint laxity and changes in muscle strength, along with factors like estrogen metabolism and pregnancy‐associated pelvic instability, which might explain the observed differences in sports activity changes and the risk of developing hip OA. Periacetabular osteotomy may be considered in managing these conditions to enhance functional performance.