Background: Patients with femoroacetabular impingement syndrome (FAIS) are offered hip arthroscop... more Background: Patients with femoroacetabular impingement syndrome (FAIS) are offered hip arthroscopic surgery to decrease hip pain, improve their function, and decrease development of hip osteoarthritis (OA). Nonetheless, long-term follow-up data are few. Purpose: To investigate patient-reported outcomes, clinical tests, reoperations, and radiographic status 5 years after primary hip arthroscopy in patients with FAIS. Study Design: Case series; Level of evidence, 4. Methods: A total of 60 patients (age, 36 ± 9 years; 63% female) diagnosed with FAIS were included in the study and followed for 5 years after hip arthroscopy. Follow-up included Copenhagen Hip and Groin Outcome Score (HAGOS); Hip Sports Activity Scale; and clinical tests (flexion, adduction, internal rotation [FADIR]; flexion, abduction, external rotation [FABER]; and psoas muscle/tendon major pain provocation). Radiographic evaluation included lateral joint-space width (LJSW) and Tönnis classification for hip OA. Reoperat...
Patients with femoroacetabular impingement syndrome (FAIS) experience decreased function. Consequ... more Patients with femoroacetabular impingement syndrome (FAIS) experience decreased function. Consequently, earlier studies have evaluated gait biomechanics in these patients, but a larger study evaluating gait biomechanics before and after an intervention standardising gait speed is lacking. We aimed at investigating gait kinematics and kinetics in patients with FAIS compared with pain-free controls before and 1 year after hip arthroscopic surgery. Secondary, we aimed at analysing gait pattern separately for the sexes and to investigate associations between peak kinematics and kinetics and the Copenhagen Hip and Groin Outcome Score (HAGOS). Sixty patients with FAIS and 30 pain-free controls were tested at a standardised gait speed (1.40 m/s ± 10%). Patients were tested twice: before and 1 year after surgery. Kinematics and kinetics were recorded using infrared high-speed cameras and a force plate. Participants answered HAGOS. The largest difference among groups was that gait differed between males and females. Neither before nor after surgery could we demonstrate large alterations in gait pattern between patients and pain-free controls. Male patients demonstrated associations between peak kinematics and kinetics and HAGOS Sports function. Gait pattern was only vaguely altered in patients with FAIS compared with pain-free controls before and after surgery when using at standardised gait speed. Hence, analysing gait in patients with FAIS does not seem of major importance. Nevertheless, there was an association between HAGOS Sports function and peak kinematics and kinetics in male patients, implying that there could be a clinical importance.
INTRODUCTION Lateral hip pain (LHP) due to tendon pathologies of insertion of the M. gluteus medi... more INTRODUCTION Lateral hip pain (LHP) due to tendon pathologies of insertion of the M. gluteus medius and minimus at the greater trochanter are often misdiagnosed and may lead to unrecognised disability. The purpose of this study was to evaluate pain and patient-reported outcomes in patients presenting with LHP in the context of a publicly financed healthcare system. METHODS Data were collected from September 2017 to November 2020 at a regional teaching hospital. Inclusion criteria were clinical and MRI-verified hip abductor tendon pathology. Baseline testing included pain scoring (numerical rating scale, NRS), and the following patient-reported outcome scores: Copenhagen Hip and Groin Outcome Score (HAGOS), Oxford Hip Score (OHS) and EuroQol-Visual Analogue Scale (EQ-VAS). RESULTS A total of 151 patients (94% women) with a median age of 55 years were included. The mean LHP (NRS 0-10) at rest, during activity and worst pain at any given time was 4, 7 and 9, respectively. The mean pati...
Femoroacetabular impingement syndrome (FAIS) is defined as a motion-related disorder of the hip j... more Femoroacetabular impingement syndrome (FAIS) is defined as a motion-related disorder of the hip joint, consisting of a triad of symptoms, clinical findings, and imaging findings. Hip morphology related to FAIS is developed during skeletal growth and seems to be related to sports participation. Treatment for FAIS may include physiotherapy and/or surgery, but recent evidence suggests, that surgery is more effective in improving symptoms. No literature exists on the prevention of FAIS, and prophylactic surgery is not recommended.
Lateral hip pain is a complex entity, and recent focus has been brought to pathological changes i... more Lateral hip pain is a complex entity, and recent focus has been brought to pathological changes in relation to the hip abductors as a cause of lateral hip pain. A short overview of anatomy, physiology, diagnostics and treatments of hip abductor pathologies is given in this review.
Background: Moderate to severe (grade 3-4) hip joint cartilage injury seems to impair function in... more Background: Moderate to severe (grade 3-4) hip joint cartilage injury seems to impair function in patients with femoroacetabular impingement syndrome. Purpose: To investigate whether demographic and radiographic factors were associated with moderate to severe hip joint cartilage injury. Study Design: Cross-sectional study; Level of evidence, 3. Methods: Patients were identified in the Danish Hip Arthroscopy Registry. The outcome variables were acetabular cartilage injury (modified Beck grade 0-2 vs 3-4) and femoral head cartilage injury (International Cartilage Repair Society grade 0-2 vs 3-4). Logistic regressions assessed the association with the following: age (<30 vs 30-50 years); sex; sport activity level (Hip Sports Activity Scale); alpha angle (AA) assessed as normal (AA <55°), cam (55°≤ AA <78°), or severe cam (AA ≥78°); lateral center-edge angle (LCEA) assessed as normal (25°≤ LCEA ≤ 39°), pincer (LCEA >39°), or borderline dysplasia (LCEA <25°); joint space w...
During the past decade, it has become increasingly more common to offer hip arthroscopic surgery ... more During the past decade, it has become increasingly more common to offer hip arthroscopic surgery when treating people with femoroacetabular impingement (FAI). Nevertheless, the latest reviews conclude that it still remains to be properly investigated how surgery affects the patients. Specifically, detailed information on the functional, muscular and mechanical impact of surgery in larger groups is lacking. Furthermore, the long-term outcome of the surgery is still to be investigated. In this prospective cohort study, a total of 60 patients with FAI scheduled for arthroscopic surgery will be followed and tested preoperatively, and again after 3, 6, 9 and 12 months. Assessment includes isokinetic dynamometry evaluating hip flexion and extension; evaluation of functional capacity in a three-dimensional motion laboratory; pain assessment; self-reported function, quality of life, expectation and satisfaction with the surgery; recording of previous and present sporting activities and acce...
INTRODUCTION Short-term outcome after hip arthroscopy for femoroacetabular impingement (FAI) has ... more INTRODUCTION Short-term outcome after hip arthroscopy for femoroacetabular impingement (FAI) has been reported to improve hip function and decrease pain. Only few midterm and long-term studies have been published. The objective of this study was to report midterm results in a consecutive cohort and to study the relation between cartilage lesions and the conversion rate to total hip arthroplasty (THA). METHODS Eighty-four FAI patients were followed retrospectively for 6-8 years. The conversion rate to THA, the peri-operative findings and the patient-reported outcome measures were reported. RESULTS Fifteen of 84 (18%) patients were converted to THA. The five-year hip survival rate was 83.9% (confidence interval (CI): 75.1-91.5%). The THA group was significantly older, with a mean age of 46.9 years (CI: 42.8-50.8 years) compared with 39.0 years (CI: 36.6-41.6 years) in the non-THA group (p = 0.011). In the THA group, 13 of 15 patients were 40 years or older (p = 0.005). A high-grade ac...
This review article describes the role of hip arthroscopy and the development of the technique ov... more This review article describes the role of hip arthroscopy and the development of the technique over the past decade. The refinement of this technique has led to the discovery of ''new'' diseases of the hip joint. Recently, femoro-acetabular impingement (FAI) has been proposed as a source of soft tissue dysfunction, motion loss, and early osteoarthritis in the hip. Recognition of FAI is important, as failure to address this underlying pathology may lead to early onset osteoarthritis and subsequent hip replacement. The preliminary results after hip arthroscopy are described.
Introduction Tunnelwidening in failed anterior cruciate ligament reconstruction (ACLR) can result... more Introduction Tunnelwidening in failed anterior cruciate ligament reconstruction (ACLR) can result in the staged revision procedures with a need for bone transplantation prior to revision reconstruction. Limited knowledge exist regarding to quality of different transplantation methods. The present study used CT-scanning to evaluate tunnel bone density after allogenic bone chips and bone cylinder transplantation. We hypothesized that bone chips transplantation resulted in higher bone density than bone cylinder transplantation due to possible voids between individual cylinders in the tunnels. Methods The records of 24 patients operated for 1st stage revision ACLR from April 2003 to march 2010 were included in the study. twelve patients had their tunnels transplanted with bone chips and twelve patients with bone cylinders from allogenic femoral heads. Bone chips were created by fine bone milling and cylinders were extracted by 7–8 mm core drilling. Bone density 3–4 months after transpla...
During the past few years, the hip capsule has seen a growing interest from arthroscopic hip surg... more During the past few years, the hip capsule has seen a growing interest from arthroscopic hip surgeons, and evidence has shown that the capsule is an important structure that hip surgeons have to take into account when performing hip arthroscopy. Whether it is in conjunction with femoro-acetabular impingement syndrome (FAIS) surgery or in patients with laxity and/or microinstability of the hip joint, the hip capsule is an important structure. This chapter will highlight some of the recent findings and suggestions for hip capsular management during arthroscopic hip surgery.
This review summarises the present knowledge of diagnosing and treating hip joint pain. The resul... more This review summarises the present knowledge of diagnosing and treating hip joint pain. The results of joint preserving surgery are good in symptomatic patients with hip dysplasia, acetabular retroversion or impingement (cam or pincer) without signs of osteoarthritis. Confirmation of intraarticular pathology as the cause of symptoms is established clinically, and the pathology can in many cases be visualised by a standing, standardised radiograph of the pelvis, which is the basis for admission to the relevant orthopaedic department. We present an algorithm for this. Dysplasia and retroversion can be treated by periacetabular osteotomy and impingement by arthroscopic procedures.
This chapter updates main topics in hip arthroscopy. Since chondrolabral injury has been proposed... more This chapter updates main topics in hip arthroscopy. Since chondrolabral injury has been proposed the beginning of hip osteoarthritis, other new entities play a role in the painful hip. Actually, if we want to improve long-term clinical results, we should establish better indications for surgical treatment rather than surgical technical modifications. Different options to manage chondrolabral lesions are described in this chapter, and labral reconstruction is a very popular option nowadays. Capsular management is also a hot topic that will be discussed, and its relationship with hip instability is an interesting debate. The importance of cam deformity resection and modern therapies to treat cartilage defects are other problems directly related to osteoarthritis progression in the hip.
Os acetabuli (Os) or acetabular rimfractures are often seen in femoroacetabular impingement patie... more Os acetabuli (Os) or acetabular rimfractures are often seen in femoroacetabular impingement patients and can result in groin pain. When seen in symptomatic patients, the question is whether to remove them or to fixate the loose fragment to the acetabular rim. This depends on acetabular coverage and the extent of the Os. If removal of the Os might lead to hip dysplasia and instability, fixation of the Os should be the goal. This technical article describes the author's technique in fixating the Os with a suture-bridge technique.
Background: Patients with femoroacetabular impingement syndrome (FAIS) are offered hip arthroscop... more Background: Patients with femoroacetabular impingement syndrome (FAIS) are offered hip arthroscopic surgery to decrease hip pain, improve their function, and decrease development of hip osteoarthritis (OA). Nonetheless, long-term follow-up data are few. Purpose: To investigate patient-reported outcomes, clinical tests, reoperations, and radiographic status 5 years after primary hip arthroscopy in patients with FAIS. Study Design: Case series; Level of evidence, 4. Methods: A total of 60 patients (age, 36 ± 9 years; 63% female) diagnosed with FAIS were included in the study and followed for 5 years after hip arthroscopy. Follow-up included Copenhagen Hip and Groin Outcome Score (HAGOS); Hip Sports Activity Scale; and clinical tests (flexion, adduction, internal rotation [FADIR]; flexion, abduction, external rotation [FABER]; and psoas muscle/tendon major pain provocation). Radiographic evaluation included lateral joint-space width (LJSW) and Tönnis classification for hip OA. Reoperat...
Patients with femoroacetabular impingement syndrome (FAIS) experience decreased function. Consequ... more Patients with femoroacetabular impingement syndrome (FAIS) experience decreased function. Consequently, earlier studies have evaluated gait biomechanics in these patients, but a larger study evaluating gait biomechanics before and after an intervention standardising gait speed is lacking. We aimed at investigating gait kinematics and kinetics in patients with FAIS compared with pain-free controls before and 1 year after hip arthroscopic surgery. Secondary, we aimed at analysing gait pattern separately for the sexes and to investigate associations between peak kinematics and kinetics and the Copenhagen Hip and Groin Outcome Score (HAGOS). Sixty patients with FAIS and 30 pain-free controls were tested at a standardised gait speed (1.40 m/s ± 10%). Patients were tested twice: before and 1 year after surgery. Kinematics and kinetics were recorded using infrared high-speed cameras and a force plate. Participants answered HAGOS. The largest difference among groups was that gait differed between males and females. Neither before nor after surgery could we demonstrate large alterations in gait pattern between patients and pain-free controls. Male patients demonstrated associations between peak kinematics and kinetics and HAGOS Sports function. Gait pattern was only vaguely altered in patients with FAIS compared with pain-free controls before and after surgery when using at standardised gait speed. Hence, analysing gait in patients with FAIS does not seem of major importance. Nevertheless, there was an association between HAGOS Sports function and peak kinematics and kinetics in male patients, implying that there could be a clinical importance.
INTRODUCTION Lateral hip pain (LHP) due to tendon pathologies of insertion of the M. gluteus medi... more INTRODUCTION Lateral hip pain (LHP) due to tendon pathologies of insertion of the M. gluteus medius and minimus at the greater trochanter are often misdiagnosed and may lead to unrecognised disability. The purpose of this study was to evaluate pain and patient-reported outcomes in patients presenting with LHP in the context of a publicly financed healthcare system. METHODS Data were collected from September 2017 to November 2020 at a regional teaching hospital. Inclusion criteria were clinical and MRI-verified hip abductor tendon pathology. Baseline testing included pain scoring (numerical rating scale, NRS), and the following patient-reported outcome scores: Copenhagen Hip and Groin Outcome Score (HAGOS), Oxford Hip Score (OHS) and EuroQol-Visual Analogue Scale (EQ-VAS). RESULTS A total of 151 patients (94% women) with a median age of 55 years were included. The mean LHP (NRS 0-10) at rest, during activity and worst pain at any given time was 4, 7 and 9, respectively. The mean pati...
Femoroacetabular impingement syndrome (FAIS) is defined as a motion-related disorder of the hip j... more Femoroacetabular impingement syndrome (FAIS) is defined as a motion-related disorder of the hip joint, consisting of a triad of symptoms, clinical findings, and imaging findings. Hip morphology related to FAIS is developed during skeletal growth and seems to be related to sports participation. Treatment for FAIS may include physiotherapy and/or surgery, but recent evidence suggests, that surgery is more effective in improving symptoms. No literature exists on the prevention of FAIS, and prophylactic surgery is not recommended.
Lateral hip pain is a complex entity, and recent focus has been brought to pathological changes i... more Lateral hip pain is a complex entity, and recent focus has been brought to pathological changes in relation to the hip abductors as a cause of lateral hip pain. A short overview of anatomy, physiology, diagnostics and treatments of hip abductor pathologies is given in this review.
Background: Moderate to severe (grade 3-4) hip joint cartilage injury seems to impair function in... more Background: Moderate to severe (grade 3-4) hip joint cartilage injury seems to impair function in patients with femoroacetabular impingement syndrome. Purpose: To investigate whether demographic and radiographic factors were associated with moderate to severe hip joint cartilage injury. Study Design: Cross-sectional study; Level of evidence, 3. Methods: Patients were identified in the Danish Hip Arthroscopy Registry. The outcome variables were acetabular cartilage injury (modified Beck grade 0-2 vs 3-4) and femoral head cartilage injury (International Cartilage Repair Society grade 0-2 vs 3-4). Logistic regressions assessed the association with the following: age (<30 vs 30-50 years); sex; sport activity level (Hip Sports Activity Scale); alpha angle (AA) assessed as normal (AA <55°), cam (55°≤ AA <78°), or severe cam (AA ≥78°); lateral center-edge angle (LCEA) assessed as normal (25°≤ LCEA ≤ 39°), pincer (LCEA >39°), or borderline dysplasia (LCEA <25°); joint space w...
During the past decade, it has become increasingly more common to offer hip arthroscopic surgery ... more During the past decade, it has become increasingly more common to offer hip arthroscopic surgery when treating people with femoroacetabular impingement (FAI). Nevertheless, the latest reviews conclude that it still remains to be properly investigated how surgery affects the patients. Specifically, detailed information on the functional, muscular and mechanical impact of surgery in larger groups is lacking. Furthermore, the long-term outcome of the surgery is still to be investigated. In this prospective cohort study, a total of 60 patients with FAI scheduled for arthroscopic surgery will be followed and tested preoperatively, and again after 3, 6, 9 and 12 months. Assessment includes isokinetic dynamometry evaluating hip flexion and extension; evaluation of functional capacity in a three-dimensional motion laboratory; pain assessment; self-reported function, quality of life, expectation and satisfaction with the surgery; recording of previous and present sporting activities and acce...
INTRODUCTION Short-term outcome after hip arthroscopy for femoroacetabular impingement (FAI) has ... more INTRODUCTION Short-term outcome after hip arthroscopy for femoroacetabular impingement (FAI) has been reported to improve hip function and decrease pain. Only few midterm and long-term studies have been published. The objective of this study was to report midterm results in a consecutive cohort and to study the relation between cartilage lesions and the conversion rate to total hip arthroplasty (THA). METHODS Eighty-four FAI patients were followed retrospectively for 6-8 years. The conversion rate to THA, the peri-operative findings and the patient-reported outcome measures were reported. RESULTS Fifteen of 84 (18%) patients were converted to THA. The five-year hip survival rate was 83.9% (confidence interval (CI): 75.1-91.5%). The THA group was significantly older, with a mean age of 46.9 years (CI: 42.8-50.8 years) compared with 39.0 years (CI: 36.6-41.6 years) in the non-THA group (p = 0.011). In the THA group, 13 of 15 patients were 40 years or older (p = 0.005). A high-grade ac...
This review article describes the role of hip arthroscopy and the development of the technique ov... more This review article describes the role of hip arthroscopy and the development of the technique over the past decade. The refinement of this technique has led to the discovery of ''new'' diseases of the hip joint. Recently, femoro-acetabular impingement (FAI) has been proposed as a source of soft tissue dysfunction, motion loss, and early osteoarthritis in the hip. Recognition of FAI is important, as failure to address this underlying pathology may lead to early onset osteoarthritis and subsequent hip replacement. The preliminary results after hip arthroscopy are described.
Introduction Tunnelwidening in failed anterior cruciate ligament reconstruction (ACLR) can result... more Introduction Tunnelwidening in failed anterior cruciate ligament reconstruction (ACLR) can result in the staged revision procedures with a need for bone transplantation prior to revision reconstruction. Limited knowledge exist regarding to quality of different transplantation methods. The present study used CT-scanning to evaluate tunnel bone density after allogenic bone chips and bone cylinder transplantation. We hypothesized that bone chips transplantation resulted in higher bone density than bone cylinder transplantation due to possible voids between individual cylinders in the tunnels. Methods The records of 24 patients operated for 1st stage revision ACLR from April 2003 to march 2010 were included in the study. twelve patients had their tunnels transplanted with bone chips and twelve patients with bone cylinders from allogenic femoral heads. Bone chips were created by fine bone milling and cylinders were extracted by 7–8 mm core drilling. Bone density 3–4 months after transpla...
During the past few years, the hip capsule has seen a growing interest from arthroscopic hip surg... more During the past few years, the hip capsule has seen a growing interest from arthroscopic hip surgeons, and evidence has shown that the capsule is an important structure that hip surgeons have to take into account when performing hip arthroscopy. Whether it is in conjunction with femoro-acetabular impingement syndrome (FAIS) surgery or in patients with laxity and/or microinstability of the hip joint, the hip capsule is an important structure. This chapter will highlight some of the recent findings and suggestions for hip capsular management during arthroscopic hip surgery.
This review summarises the present knowledge of diagnosing and treating hip joint pain. The resul... more This review summarises the present knowledge of diagnosing and treating hip joint pain. The results of joint preserving surgery are good in symptomatic patients with hip dysplasia, acetabular retroversion or impingement (cam or pincer) without signs of osteoarthritis. Confirmation of intraarticular pathology as the cause of symptoms is established clinically, and the pathology can in many cases be visualised by a standing, standardised radiograph of the pelvis, which is the basis for admission to the relevant orthopaedic department. We present an algorithm for this. Dysplasia and retroversion can be treated by periacetabular osteotomy and impingement by arthroscopic procedures.
This chapter updates main topics in hip arthroscopy. Since chondrolabral injury has been proposed... more This chapter updates main topics in hip arthroscopy. Since chondrolabral injury has been proposed the beginning of hip osteoarthritis, other new entities play a role in the painful hip. Actually, if we want to improve long-term clinical results, we should establish better indications for surgical treatment rather than surgical technical modifications. Different options to manage chondrolabral lesions are described in this chapter, and labral reconstruction is a very popular option nowadays. Capsular management is also a hot topic that will be discussed, and its relationship with hip instability is an interesting debate. The importance of cam deformity resection and modern therapies to treat cartilage defects are other problems directly related to osteoarthritis progression in the hip.
Os acetabuli (Os) or acetabular rimfractures are often seen in femoroacetabular impingement patie... more Os acetabuli (Os) or acetabular rimfractures are often seen in femoroacetabular impingement patients and can result in groin pain. When seen in symptomatic patients, the question is whether to remove them or to fixate the loose fragment to the acetabular rim. This depends on acetabular coverage and the extent of the Os. If removal of the Os might lead to hip dysplasia and instability, fixation of the Os should be the goal. This technical article describes the author's technique in fixating the Os with a suture-bridge technique.
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