An Algorithmic Approach to Mechanical Hip Pain

Poultsides, Lazaros; Bedi, Asheesh; Kelly, Bryan T.

doi:10.1007/s11420-012-9304-x

Cited by 56 publications

(24 citation statements)

References 120 publications

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“…During routine clinical practice, the diagnosis of SSI must be made based on clinical findings such as limitation of range of motion and pain elicited by maximal flexion and/or palpation over the AIIS. 5,18 The use of CT helps to recognize other parameters such as the morphology of the AIIS; however, in many cases, these findings are not conclusive and it is recommended to perform dynamic studies that allow evaluation of the possible zones of conflict in the hip. 7 The 3D dynamic study is a tool that allows one to perform a directed intervention, with the goal of avoiding the appearance of residual pain and reinterventions associated with the impingement of the AIIS.…”

Section: Discussionmentioning

confidence: 99%

“…3,4 Although there is not a specific validated test to make the diagnosis of SSI, the presence of pain during maximal flexion is considered suggestive of SSI. 5 Underdiagnosis of SSI may result in residual impingement, even after arthroscopic management of FAI. 6 Currently, there are complementary studies such as computed tomography (CT) with 3-dimensional (3D) dynamic reconstruction that can guide us toward a specific treatment, avoiding negative and unexpected results in the postoperative period.…”

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confidence: 99%

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Functional Results of Arthroscopic Treatment in Patients With Femoroacetabular and Subspine Impingement Diagnosed With a 3-Dimensional Dynamic Study

Aguilera-Bohórquez¹,

Ramirez

Cantor

2020

Arthroscopy, Sports Medicine, and Rehabilitation

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To describe the functional results of arthroscopic treatment in patients with femoroacetabular impingement (FAI) and subspine impingement (SSI) evaluated with a 3-dimensional (3D) dynamic study. Methods: This was a retrospective observational study of patients with a diagnosis of FAI and SSI, evaluated with a 3D dynamic computed tomography scan with Move Forward software, who underwent hip arthroscopy between February 2015 and December 2017. Measurements of the alpha angle, femoral anteversion, acetabular anteversion, lateral center-edge angle, and Tönnis angle were extracted from the 3D dynamic study. Functionality was evaluated using the Western Ontario McMaster Universities Osteoarthritis Index before and 12 months after surgery. Results: We analyzed 22 hips in 17 patients (9 female and 8 male patients) with an average age of 34.6 AE 14.3 years. Of the 22 hips, 15 had cam morphology, 6 had mixed morphology, and 1 had pincer morphology. Of the hips, 11 had a type I spine, 10 had type II, and 1 had type III. The average alpha angle, Tönnis angle, femoral anteversion, and acetabular anteversion were 61.9 AE 11.1 , 2.5 AE 6.4 , 8.8 AE 6.8 , and 15.1 AE 7.1 , respectively. The median lateral center-edge angle was 38.1 (interquartile range, 32.6-43.5). At 1-year follow-up, a decrease in the Western Ontario McMaster Universities Osteoarthritis Index score (P ¼ .001) and an increase in the flexion angle (P < .001) were observed. No cases needed posterior surgical revision because of persistent pain. Conclusions: Arthroscopic treatment provides symptom relief and good functional results in patients with FAI and SSI. Level of Evidence: Level IV, therapeutic case series.

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Section: Discussionmentioning

confidence: 99%

mentioning

confidence: 99%

Functional Results of Arthroscopic Treatment in Patients With Femoroacetabular and Subspine Impingement Diagnosed With a 3-Dimensional Dynamic Study

Aguilera-Bohórquez¹,

Ramirez

Cantor

2020

Arthroscopy, Sports Medicine, and Rehabilitation

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“…On physical examination, a palpably prominent AIIS and limited passive hip flexion with end range of motion anterior hip pain are useful clinical indicators of AIIS-related EAHI. The subspine impingement test 15 has been described, and it consists of passive hip flexion with the hip in neutral rotation. A history of anterior hip pain that is reproduced with this test is highly suggestive of subspine impingement.…”

Section: Methodsmentioning

confidence: 99%

Outcomes for Arthroscopic Treatment of Anterior Inferior Iliac Spine (Subspine) Hip Impingement

Nwachukwu

Chang

Fields

et al. 2017

Orthopaedic Journal of Sports Medicine

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Background:Femoroacetabular hip impingement (FAI) is now well recognized; however, anterior inferior iliac spine (AIIS; or subspine) impingement is a form of hip impingement that is underrecognized and can be an important source of hip disability and functional limitation.Purpose:To investigate the outcomes after arthroscopic treatment of AIIS/subspine-related hip impingement in the absence of FAI surgery.Study Design:Case series; Level of evidence, 4.Methods:A prospective institutional hip preservation registry was reviewed to identify patients who underwent arthroscopic AIIS decompression without concurrent treatment of FAI. Primary outcome tools captured in the registry included the modified Harris Hip Score (mHHS), the Hip Outcome Score (HOS), and the International Hip Outcome Tool–33 (iHOT-33). Patients with minimum 1-year follow-up were included. Meaningful outcome improvement was determined per minimal clinically important difference (MCID). Statistical analyses were primarily descriptive.Results:Thirty-three patients with a mean follow-up of 19.1 months (range, 12-44 months) were identified. All patients were female, with a mean ± SD age of 26.1 ± 10.3 years. All patients were found to have an associated labral tear, and the mean acetabular version was increased at 2 and 3 o’clock (14.5° and 19.8°, respectively). Mean preoperative outcome scores on the mHHS, HOS ADL (activities of daily living), HOS sport, and iHOT-33 were 57.2 ± 15.3, 66.9 ± 18.8, 43.9 ± 23.6, and 33.5 ± 18.3, respectively. At final available follow-up, mean scores on these outcome measures were 79.5 ± 19.0, 86.8 ± 15.8, 70.4 ± 32.8, and 65.0 ± 31.0, respectively. By the 1-year follow-up, MCID had been achieved in the majority of patients across all 4 tools.Conclusion:There is a paucity of outcomes evidence on AIIS/subspine-related hip impingement. This study demonstrates that isolated subspine impingement can be a cause of hip disability, even in the absence of FAI. Patients with isolated subspine impingement are more likely to be women and to present with low patient-reported outcome scores. However, meaningful outcome improvement can be achieved with arthroscopic AIIS decompression.

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“…They often present with a myriad of vague clinical symptoms and there rarely is a pathognomonic finding. When faced with differentiating the diagnosis of an athlete's hip/groin pain, it is often helpful to use the layered approach concept, described by Poultsides et al [13]. This concept defines layer 1 as the osteochondral layer, which delineates the individual's joint congruence and osteoarticular kinematics.…”

Section: Clinical Examinationmentioning

confidence: 99%

Hip and Groin Injuries in Baseball Players

Mlynarek

Coleman

2018

Curr Rev Musculoskelet Med

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(a) Limitations in throwing velocity, pitch control, and bat swing speed may be secondary to decreased mobility and strength within the proximal kinetic chain, which must harness power from the lower extremities and core. (b) Approximately 5.5% of all baseball injuries per year involve the hip/groin and may lead to a significant amount of time spent on the disabled list. Injuries involving the hip and groin are relatively common in baseball players. Our knowledge of the mechanics of overhead throwing continues to evolve, as does our understanding of the contribution of power from the lower extremities and core. It is paramount that the team physician be able to accurately diagnose and treat injuries involving the hip/groin, as they may lead to significant disability and inability to return to elite levels of play. This review focuses on hip- and groin-related injuries in the baseball player, including femoroacetabular impingement, core muscle injury, and osteitis pubis.

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An Algorithmic Approach to Mechanical Hip Pain

Abstract: Background: As our understanding of hip pathology evolves, the focus is shifting toward earlier

Cited by 56 publications

References 120 publications

Functional Results of Arthroscopic Treatment in Patients With Femoroacetabular and Subspine Impingement Diagnosed With a 3-Dimensional Dynamic Study

Functional Results of Arthroscopic Treatment in Patients With Femoroacetabular and Subspine Impingement Diagnosed With a 3-Dimensional Dynamic Study

Outcomes for Arthroscopic Treatment of Anterior Inferior Iliac Spine (Subspine) Hip Impingement

Hip and Groin Injuries in Baseball Players

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