Devyani Hunt

Clinical presentation of symptomatic acetabular dysplasia in skeletally mature patients.

BACKGROUND Acetabular dysplasia is recognized as a cause of early degenerative hip osteoarthritis. The purpose of this study was to prospectively determine the early clinical presentation of symptomatic acetabular dysplasia in skeletally mature patients. METHODS Fifty-seven consecutive skeletally mature patients with a total of sixty-five symptomatic hips were diagnosed with symptomatic acetabular dysplasia on the basis of the history, physical examination, and radiographs. These fifty-seven patients were enrolled in this study and were followed prospectively for a minimum of twenty-four months postoperatively. RESULTS The study group included forty-one female patients (72%) and sixteen male patients (28%) with a mean age of twenty-four years. All were treated with a periacetabular osteotomy and were followed for a minimum of twenty-four months. The initial presentation was insidious in 97% of the hips, and the majority (77%) of the hips were associated with moderate-to-severe pain on a daily basis. Pain was most commonly localized to the groin (72%) and/or the lateral aspect of the hip (66%). Activity-related hip pain was common (88%), and activity restriction frequently diminished hip pain (in 75% of the cases). On examination, thirty-one hips (48%) were associated with a limp; twenty-five (38%), with a positive Trendelenburg sign; and sixty-three (97%), with a positive impingement sign. The mean time from the onset of symptoms to the diagnosis of hip dysplasia was 61.5 months. The mean number of health-care providers seen prior to the definitive diagnosis was 3.3. The mean Harris hip score improved from 66.4 points preoperatively to 91.7 points at a mean of 29.2 months after the periacetabular osteotomy. CONCLUSIONS The diagnosis of symptomatic acetabular dysplasia is commonly delayed, and procedures other than a pelvic reconstructive osteotomy are frequently recommended. The diagnosis of developmental dysplasia of the hip should be suspected and investigated when a skeletally mature, young, active patient has a predominant complaint of insidious activity-related groin pain and/or lateral hip pain. LEVEL OF EVIDENCE Prognostic Level IV. See Instructions to Authors for a complete description of levels of evidence.

Clinical Outcomes Analysis of Conservative and Surgical Treatment of Patients With Clinical Indications of Prearthritic, Intra-articular Hip Disorders

To describe outcomes of the conservative treatment of patients who had the clinical presentation of a prearthritic, intra‐articular hip disorder, including acetabular labral tears, developmental hip dysplasia, and femoroacetabular impingement.

Reliability and agreement of hip range of motion and provocative physical examination tests in asymptomatic volunteers.

To: (1) report passive hip range of motion (ROM) in asymptomatic young adults, (2) report the intratester and intertester reliability of hip ROM measurements among testers of multiple disciplines, and (3) report the results of provocative hip tests and tester agreement.

Review of Anatomy, Evaluation, and Treatment of Musculoskeletal Pelvic Floor Pain in Women

The purpose of this review is 2‐fold. The first is to provide a review for physiatrists already providing care for women with musculoskeletal pelvic floor pain and a resource for physiatrists who are interested in expanding their practice to include this patient population. The second is to describe how musculoskeletal dysfunctions involving the pelvic floor can be approached by the physiatrist using the same principles used to evaluate and treat others dysfunctions in the musculoskeletal system. This discussion clarifies that evaluation and treatment of pelvic floor pain of musculoskeletal origin is within the scope of practice for physiatrists. The authors review the anatomy of the pelvic floor, including the bony pelvis and joints, muscle and fascia, and the peripheral and autonomic nervous systems. Pertinent history and physical examination findings are described. The review concludes with a discussion of differential diagnosis and treatment of musculoskeletal pelvic floor pain in women. Improved recognition of pelvic floor dysfunction by healthcare providers will reduce impairment and disability for women with pelvic floor pain. A physiatrist is in the unique position to treat the musculoskeletal causes of this condition because it requires an expert grasp of anatomy, function, and the linked relationship between the spine and pelvis. Further research regarding musculoskeletal causes and treatment of pelvic floor pain will help validate these concepts and improve awareness and care for women limited by this condition.

Benefits of Exercise During Pregnancy

There is a direct link between healthy mothers and healthy infants. Exercise and appropriate nutrition are important contributors to maternal physical and psychological health. The benefits and potential risks of exercise during pregnancy have gained even more attention, with a number of studies having been published after the 2002 American College of Obstetrics and Gynecologists guidelines. A review of the literature was conducted by using PubMed, Scopus, and Embase to assess the literature regarding the benefits of exercise during pregnancy. The search revealed 219 publications, which the authors then narrowed to 125 publications. The purpose of this review is to briefly summarize the known benefits of exercise to the mother, fetus, and newborn.

Early Intra-Articular Hip Disease Presenting With Posterior Pelvic and Groin Pain

To determine whether posterior pelvic pain is associated with intra‐articular hip abnormalities (labral tears and early degenerative changes) in patients with minimal‐to‐no radiographic abnormalities.

Activity Tolerance After Periacetabular Osteotomy

Background: Periacetabular osteotomy is a well-described surgical intervention for symptomatic acetabular deformities in skeletally mature patients. Data regarding return to athletic activity or sport after this procedure are still limited. Purpose: To evaluate the ability of patients to return to preoperative levels of activity after periacetabular osteotomy. Study Design: Case series; Level of evidence, 4. Methods: This is a retrospective review of active patients treated with periacetabular osteotomy for acetabular deformity correction. Patients were identified as those with preoperative University of California–Los Angeles activity levels ≥7. Patient demographics, operative data, radiographic measures, and clinical outcomes were documented prospectively. The University of California–Los Angeles activity score, Harris Hip Score, Hip Dysfunction and Osteoarthritis Outcome Score, and Western Ontario and McMaster Universities Osteoarthritis Index were used to measure clinical outcomes, and details regarding activity and satisfaction were analyzed. Results: This study included 36 patients (39 hips; 15 males and 21 females) whose average age was 25 years (range, 15-45 years) and whose average body mass index was 24 ± 3.5 kg/m2. Mean follow-up was 33 months (range, 18-59 months). Preoperatively, the average lateral center edge angle, anterior center edge angle, and acetabular index were 10°, 14°, and 21°, respectively; 92% of patients had a Tönnis osteoarthritis grade of 0 or 1. One patient failed hip preservation surgery and went on to total hip arthroplasty 27 months after periacetabular osteotomy. Of the remaining patients, 71% reported an increase or no change in activity level postoperatively. The University of California–Los Angeles score was also unchanged (9.2 vs 8.8, P = .157), and the Harris Hip Score (63 vs 87, P < .001), Hip Dysfunction and Osteoarthritis Outcome Score–Quality of Life (38 vs 71, P < .001), and Western Ontario and McMaster Universities Osteoarthritis Index (71 vs 92, P < .001) results improved from preoperative levels. There was a 97% rate of satisfaction with the surgery. Four patients (11%) reported hip pain as the primary factor limiting postoperative activity. Conclusion: The majority (71%) of active patients with hip dysplasia return to presurgical or higher activity levels after open hip preservation surgery with the periacetabular osteotomy.

Managing Hip Pain in the Athlete

Hip and groin pain is commonly experienced by athletes. The differential diagnosis should include both intra-articular and extra-articular sources for pain and dysfunction. A comprehensive history and physical examination can guide the evaluation of hip pain and the potential need for further diagnostics. Treatment of athletes with hip disorders includes education, addressing activities of daily living, pain-modulating medications or modalities, exercise and sports modification, and therapeutic exercise. Surgical techniques for prearthritic hip disorders are expanding and can offer appropriate patients a successful return to athletic endeavors when conservative measures are not effective.

Inter-rater Reliability of Three Musculoskeletal Physical Examination Techniques Used to Assess Motion in Three Planes While Standing

The objective of the study was to measure the reliability between examiners of 3 basic maneuvers of the Total Body Functional Profile physical examination test. The hypothesis was musculoskeletal health care providers of different disciplines could reliably use the 3 basic maneuvers as part of the musculoskeletal physical examination.

Anxiety and Insomnia in Young and Middle-Aged Adult Hip Pain Patients With and Without Femoroacetabular Impingement and Developmental Hip Dysplasia

In young and middle‐aged adults with and without hip deformity, hip pain receives treatment focused primarily related to hip structure. Because this hip pain may be chronic, these patients develop other coexisting, modifiable disorders related to pain that may go undiagnosed in this young and active population, including insomnia and anxiety.