2025年3月 保髋进展 JCR Q3 区

CAM morphology of the hip is a disorder of abnormal morphology of the femoral head-neck junction associated with loss of the osseous sphericity of the femoral head. Several radiological measurements exist to detect CAM morphology of the hip.

For years, physical examination (PE) findings (e.g., Barlow, Ortolani tests, and abduction limitation) have been used as the primary screening method in the early diagnosis of developmental dysplasia of the hip (DDH). There are a limited number of studies in the literature that evaluate the agreement of PE findings and dynamic sonographic evaluation. Our aim was to evaluate the correlation between dynamic sonographic hip types and physical examination findings in infants with DDH.

The aim of this study was to examine the knowledge levels and awareness of family physicians about Developmental Dysplasia of the Hip (DDH) and the Nationwide Newborn Hip Screening Program in Turkey.

Purpose Developmental dysplasia of the hip (DDH) is a precursor of secondary osteoarthritis, with borderline DDH (BDDH) often overlooked. This study explores three-dimensional (3D) proximal femoral morphology in DDH and BDDH and examines their distinctions from normal hips (NH), emphasizing new correlations between femoral parameters and hip instability. Methods We retrospectively analyzed 130 hips from 120 patients categorized as DDH (lateral center-edge angle (LCEA) < 20°), BDDH (20°-25°), or NH (>25°). Detailed 3D analyses using advanced CT imaging measured unique femoral parameters such as femoral neck anteversion (FAV), lesser trochanter version (LTV), and femoral head morphology. Statistical methods assessed differences among groups and identified novel correlations. Results The study confirmed that DDH is associated with increased FAV and decreased LTV, alongside reduced femoral head-lesser trochanter distance (FH-LT) and an elliptical femoral head. BDDH displayed intermediate morphological changes, highlighting its biomechanical significance. Correlations revealed new insights into the relationship between hip morphology and clinical symptoms. Discussion External rotational abnormalities, such as increased FAV and decreased LTV, may predispose DDH patients to ischiofemoral impingement, psoas bursitis, and joint degeneration. The shortened FH-LT and elliptical femoral head further contribute to instability and early osteoarthritis. These findings underscore the role of 3D proximal femoral morphology in DDH biomechanics and clinical symptoms. Conclusion This study extends previous research by identifying previously unreported associations between proximal femoral abnormalities and hip biomechanics in DDH and BDDH. These findings inform diagnostic and therapeutic strategies for early intervention.

Background Intraoperative nerve monitoring (IONM) plays a crucial role in preventing peripheral nerve injury during total hip arthroplasty (THA). However, its efficacy in THA remains controversial. This study aimed to evaluate the efficacy of IONM in preventing peripheral nerve injury during THA. Methods This study retrospectively included 79 hips in 72 patients (primary THA: 43 hips; revision THA: 36 hips) with risk factors for intraoperative nerve injury who underwent motor evoked potential (MEP) monitoring combined with THA between July 2011 and March 2019. A concerning MEP change was defined as a decrease to <30%. The frequency and cause of the MEP change and the presence of postoperative neurological symptoms were investigated. Results Motor evoked potential changes were detected in five of the 79 hips (6.3%). In one of these cases, the potential amplitude did not recover, and transient postoperative muscle weakness was observed due to the delayed detection of MEP changes. In the remaining cases, the potential change was quickly detected by IONM, including the regular-interval monitoring method, without any subsequent postoperative muscle weakness. Conclusions Intraoperative nerve monitoring effectively prevented peripheral nerve injury during THA, particularly in patients with developmental dysplasia of the hip (DDH) or a history of hip surgery. To prevent irreversible postoperative neuropathy, regular interval nerve monitoring, and free-run electromyography should be considered routine techniques in THA for patients with DDH or a history of hip surgery.

Inflammatory femoroacetabular impingement (FAI) is a cam lesion caused by inflammation and is characterized by a distinct bone deformity. To date, no reports have described bone deformities resulting from juxta-articular osteoid osteomas that resemble those seen in inflammatory FAI. We report a case of a 15-year-old girl who presented with right hip pain, hip arthritis, and a cam deformity at the femoral head-neck junction. Computed tomography revealed a bone translucency with internal calcification, suggestive of a nidus, at the medial cortex of the right femoral neck. Based on these findings, we diagnosed inflammatory FAI caused by juxta-articular osteoid osteoma. Following resection, her pain resolved rapidly. This is a rare reported case of juxta-articular osteoid osteoma causing inflammatory FAI. Understanding the characteristics of inflammatory FAI can aid in distinguishing between inflammation and FAI as the source of pain.

Hip dysplasia (HD) is a prevalent cause of non-traumatic hip pain, which may result in osteoarthritis. Radiological measurements of HD exhibit variability based on reader and imaging modality, why it is important to know the agreement between different measurement methods.

BackgroundHip dysplasia (HD) involves abnormal acetabular development, resulting in reduced femoral head coverage, labral tears, and cartilage injury. Machine learning (AI) advancements have enabled reproducible radiographic measurements for HD, such as lateral center edge angle (LCEA), Tonnis, and extrusion index. Moreover, incorporating 3D magnetic resonance imaging (MRI) alongside 2D MRI enhances diagnostic capabilities.PurposeTo correlate advanced MRI-assessed labral and cartilage injuries with validated AI-generated radiographic measurements.Material and MethodsThis study enrolled 139 patients (age range = 16-68 years) with HD, comprising a total of 156 hips. All patients had 2D and 3D MRI scans, four-view X-rays, and AI-generated radiographic measurements using a commercial AI program that utilized bony landmarks to generate measurements. Labral reconstructions were obtained for each hip, and a multi-reader study was conducted. Inter-reader (ICC) analysis and Spearman correlations were calculated.ResultsThe predominant location for the largest labral tear was anterosuperior (133/156, 90%), and paralabral cysts were observed in 53/156 (34%) cases. No statistically significant correlations were found between the length of labral tears and radiographic measurements. However, statistically significant correlations were observed between paralabral cysts and femoral head coverage, extrusion index, LCEA, and Tonnis measurements.ConclusionAI-generated radiographic measurements in HD exhibited weak correlations with advanced MRI findings, likely due to the condition's complex pathophysiology.

The Tönnis classification is widely used to quantify the severity of developmental dysplasia of the hip (DDH) based on the epiphyseal ossification center, while the International Hip Dysplasia Institute (IHDI) has proposed an alternative system. However, the pathological morphology associated with these classifications remains inadequately defined.

Adolescent hip dysplasia represents a unique challenge for pediatric orthopaedic surgeons. The disease spectrum is broad and the complications of untreated disease can be severe. The purpose of this review is to provide a framework for understanding and treating adolescent hip dysplasia and when to consider nonoperative versus operative interventions.

BackgroundHip joint (HJ) pain, which may be caused by lumbar disease, is a common complaint.PurposeTo investigate the prevalence and specific correlations between various HJ diseases and lumbar spine magnetic resonance imaging (MRI) findings in patients with HJ pain.Material and MethodsPatients with the chief complaint of HJ pain who had both HJ MRI and lumbar MRI were retrospectively included. According to the existence of HJ disease, patients were divided into the following groups: non-HJ disease; osteoarthritis (OA); femoroacetabular impingement (FAI); ischiofemoral impingement (IFI); greater trochanter pain syndrome (GTPS); and other diseases. The prevalence of major lumbar MRI findings was compared. Correlations between HJ disease and major lumbar MR findings were explored.ResultsA total of 585 patients were included, of which 566 (96.8%) had major findings on lumbar MRI. The HJ disease group was more likely to be female and had more spondylolisthesis, while the non-HJ disease group had more low back or leg pain. The OA group was older and correlated with lumbar spinal stenosis (contingency coefficient = 0.164) and spondylolisthesis (contingency coefficient = 0.095). The FAI group was younger, had more male patients, and correlated with lumbosacral transitional vertebrae (contingency coefficient = 0.122). The IFI group was older, had more female patients, and correlated with facet joint osteoarthritis (contingency coefficient = 0.168). The GTPS group was older, had more female patients, and correlated with spondylolisthesis (contingency coefficient = 0.097).ConclusionMajor lumbar MRI findings were frequently observed in patients with hip pain, even in patients without HJ disease. Specific lumbar MRI finding correlated with different HJ disease.

Determining the optimal osteotomy length for patients with unilateral Crowe-IV developmental dysplasia of the hip undergoing subtrochanteric osteotomy remains challenging due to the significant variability in pelvic and spinal alignment. Incorrect osteotomy length, compounded by pelvic or spinal tilt, can adversely affect postoperative gait and long-term outcomes. Therefore, this study could introduce a method to calculate the osteotomy length for patients with unilateral Crowe-IV developmental dysplasia of the hip, correcting spinal and pelvic tilt, and improving patient gait.

To describe what is known about hip problems in individuals with developmental central hypotonia.

The pathomorphology of Legg-Calvé-Perthes disease (LCPD) is a key contributor to poor long-term outcomes such as hip pain, femoroacetabular impingement, and early-onset osteoarthritis. Plain radiographs, commonly used for research and in the clinic, cannot accurately represent the full extent of LCPD deformity. The purpose of this study was to develop and evaluate a methodological framework for three-dimensional (3D) statistical shape modeling (SSM) of the proximal femur in LCPD.

 The aim of this study was to determine the effect of double pelvic osteotomy (DPO) on dorsolateral subluxation (DLS) of the femoral head in a weight-bearing position.

The hip capsule and capsular ligaments play crucial roles in providing hip stability and mobility. Their role in hip pathologies is being increasingly recognized, underscoring the need for thorough imaging evaluation, which is better performed through MRI-arthrography. Various diseases affect the hip capsule directly or indirectly. Improper mechanical loading, as seen in conditions such as femoroacetabular impingement or chondrolabral pathology, can induce capsule thickening, whereas thinning and laxity of the capsule are characteristics of microinstability. Inflammatory conditions, including adhesive capsulitis of the hip, crystal deposition disease, polymyalgia rheumatica, and infections, also lead to capsular changes. Traumatic events, particularly posterior hip dislocations, cause capsule ligament disruption and may lead to hip macroinstability. Friction syndromes can lead to capsular edema due to impingement of the adjacent capsule. Hip arthroscopy can result in various postoperative findings ranging from fibrotic adhesions to focal or extensive capsule discontinuation. Although the significance of hip capsule thickness and morphology in the pathogenesis of hip diseases remains unclear, radiologists must recognize capsule alterations on imaging evaluation. These insights can aid clinicians in accurately diagnosing and effectively managing patients with hip conditions.