Trunk and lower limb biomechanics during stair climbing in people with and without symptomatic femoroacetabular impingement

BackgroundFemoroacetabular impingement is a pathomechanical hip condition leading to pain and impaired physical function. It has been shown that those with femoroacetabular impingement exhibit altered gait characteristics during level walking and stair climbing, and decreased muscle force production during isometric muscle contractions. However, no studies to-date have looked at trunk kinematics or muscle activation during dynamic movements such as stair climbing in this patient population. The purpose of this study was to compare biomechanical outcomes (trunk and lower limb kinematics as well as lower limb kinetics and muscle activation) during stair climbing in those with and without symptomatic femoroacetabular impingement.MethodsTrunk, hip, knee and ankle kinematics, as well as hip, knee and ankle kinetics and muscle activity of nine lower limb muscles were collected during stair climbing for 20 people with clinical and radiographic femoroacetabular impingement and compared to 20 age- and sex-matched pain-free individuals.FindingsThose with femoroacetabular impingement ascended the stairs slower (effect size = 0.82), had significantly increased peak trunk forward flexion angles (effect size = 0.99) and external hip flexion moments (effect size = 0.94) and had decreased peak external knee flexion moments (effect size = 0.90) compared to the control group.InterpretationFindings from this study indicate that while those with and without femoroacetabular impingement exhibit many biomechanical similarities when ascending stairs, differences in trunk forward flexion and joint kinetics indicate some important differences. Further longitudinal research is required to elucidate the cause of these differences as well as the clinical relevance.     

Hip kinematics and kinetics in persons with and without cam femoroacetabular impingement during a deep squat task

BackgroundPrevious studies have indicated that hip and pelvis kinematics may be altered during functional tasks in persons with femoroacetabular impingement. The purpose of this study was to compare hip and pelvis kinematics and kinetics during a deep squat task between persons with cam femoroacetabular impingement and pain-free controls.MethodsFifteen persons with cam femoroacetabular impingement and 15 persons without cam femoroacetabular impingement performed a deep squat task. Peak hip flexion, abduction, and internal rotation, and mean hip extensor, adductor, and external rotator moments were quantified. Independent t-tests (α < 0.05) were used to evaluate between group differences.FindingsCompared to the control group, persons with cam femoroacetabular impingement demonstrated decreased peak hip internal rotation (15.2° (SD 9.5°) vs. 9.4° (SD 7.8°); P = 0.041) and decreased mean hip extensor moments (0.56 (SD 0.12) Nm/kg vs. 0.45 (SD 0.15) Nm/kg; P = 0.018). In addition persons in the cam femoroacetabular impingement group demonstrated decreased posterior pelvis tilt during squat descent compared to the control group, resulting in a more anteriorly tilted pelvis at the time peak hip flexion (12.5° (SD 17.1°) vs. 23.0° (SD 12.4°); P = 0.024).InterpretationThe decreased hip internal rotation observed in persons with cam femoroacetabular impingement may be the result of bony impingement. Furthermore, the decrease in posterior pelvis tilt may contribute to impingement by further approximating the femoral head–neck junction with the acetabulum. Additionally, decreased hip extensor moments suggest that diminished hip extensor muscle activity may contribute to decreased posterior pelvis tilt.     

Deep hip muscle activation during squatting in femoroacetabular impingement syndrome

BackgroundDeep hip muscle retraining is a common objective of non-operative management for femoroacetabular impingement (FAI) syndrome. These muscles are considered to have an important role in hip joint stabilization, however, it is unclear whether their function is altered in the presence of hip pathology. This exploratory study aimed to investigate activation patterns of the hip muscles during two squatting tasks in individuals with and without FAI syndrome.MethodsFifteen individuals with FAI syndrome (symptoms, clinical examination and imaging) and 14 age- and sex-comparable healthy controls underwent testing. Intramuscular fine-wire and surface electrodes recorded electromyographic activity of selected deep and superficial hip muscles during the squatting tasks. Activation patterns from individual muscles were compared between-groups using a wavelet-based linear mixed effects model (P < 0.05).FindingsThere were no between-group differences for squat depth or speed during descent or ascent for either task. Participants with FAI syndrome exhibited patterns of activation that differed significantly to controls across all muscles (P < 0.05) when squatting using their preferred strategy. Unlike controls, participants with FAI syndrome exhibited a pattern of activation for obturator internus during descent that was similar in amplitude to ascent, despite the contrasting contraction type (i.e. eccentric vs concentric).InterpretationIndividuals with FAI syndrome appear to implement a protective strategy as the hip descends towards the impingement position. Future studies should examine patients prospectively to establish whether these strategies are counterproductive for pathology and warrant rehabilitation.     

关节镜下治疗16例股骨髋臼撞击症患者的康复护理

参考国内外硬骨髋臼撞击症患者的康复护理经验,制订均衡康复程序,对16例行关节镜下髋臼和股骨头颈结合部骨成型手术的患者进行康复护理.患者能够掌握正确的功能锻炼方法,术后无并发症发生.采用改良Harris髋关节评分,术前平均62.4分,术后6个月平均92.5分.     

Persons with femoroacetabular impingement syndrome exhibit altered pelvifemoral coordination during weightbearing and non-weightbearing tasks

BackgroundPrevious studies have reported that persons with femoroacetabular impingement syndrome (FAIS) have diminished posterior tilt of the pelvis during functional tasks. It is not known how this movement impairment impacts pelvifemoral coordination during weightbearing and non-weightbearing movements.MethodsFifteen persons with a diagnosis of FAIS and 15 matched controls performed a deep squat (weightbearing) and a maximum height stepping task (non-weightbearing). Peak hip flexion, posterior pelvis tilt excursion, and the ratio of sagittal plane pelvis to femur motion during the period of pelvis posterior tilt were calculated for each task. Two factor ANOVAs were used to evaluate differences between groups and tasks.FindingsWith regards to peak hip flexion, there were no significant group differences for either task. When averaged across tasks, the FAIS group exhibited significantly less posterior tilt excursion (12.1° (SD 9.1°) vs 20.6° (SD 9.3°)) and smaller pelvifemoral ratios (0.24 (SD 0.14) vs 0.39 (SD 0.16)) compared to the control group.InterpretationPersons with FAIS exhibit altered pelvifemoral coordination regardless of weightbearing status. This finding suggests that decreased hip and/or lumbopelvic mobility may contribute to altered movement patterns at the hip.     

19例髋关节撞击综合征误诊漏诊原因分析

目的:对19例误诊或漏诊的髋关节撞击综合征病例进行总结,分析原因,提高诊断准确性,以减少误漏诊。方法:自2019年1月-2019年12月期间本院确诊的髋关节撞击综合征病例共34例,其中有19例患者就诊前在其他医院或诊所被误诊为正常、发育变异、肌肉损伤或腰椎间盘疾病。分析这19例患者X线检查的影像表现,结合病史及查体,分析误诊、漏诊原因。结果:19名患者共有32个异常髋关节,其中凸轮型6例,钳夹型4例,混合型9例,6例患者伴有髋臼唇硬化、髋臼缘骨赘、关节面囊变等继发退行性变。结论:医师们应加强对髋关节撞击综合征的学习,规范摄片,提高诊断能力,避免误诊或漏诊。     

Kinematic and kinetic analysis of the walking pattern in hemiplegic patients with foot-drop using a peroneal nerve stimulator

OBJECTIVE: To analyze the walking pattern in hemiplegic patients using a peroneal nerve stimulator to locate possible harmful mechanical effects on the musculo-skeletal system. DESIGN: Eight hemiplegic patients participated in the study. All patients had used a peroneal nerve stimulator regularly for more than two years and were able to perform unassisted walking. BACKGROUND: Peroneal nerve stimulators are widely applied for correction of foot-drop in hemiplegic patients. The stimulators do not induce normal dorsi-flexion, but a rather exaggerated dorsi-flexion and eventually eversion which might be harmful. METHODS: Three-dimensional kinematic and kinetic analyses of the walking patterns at self-selected speeds were performed with the patients walking without the stimulator and with the stimulator turned on. RESULTS: The walking speed increased on average from 0.77 (S.D., 0.83) to 0.84 (S.D., 0.11) (7.6%, P=0. 005) when the stimulator was used, however no uniform changes in the walking pattern and joint loads were observed. The total work (generation+absorption) produced by the affected leg (both with and without the peroneal nerve stimulator) was significantly lower (P=0. 005) than that of the contralateral leg. Deviations from normal power profiles were observed both on the affected and the contralateral side, and the walking efficiency was 57% lower compared to normal subjects. The estimated peak bone-on-bone forces corresponded to about 50% of what previously has been observed during normal walking at self-selected speed. CONCLUSIONS: The use of the peroneal nerve stimulator do not introduce any excessive and potential harmful mechanical loads. RELEVANCE: Applied correctly, the peroneal nerve stimulator can be used as an aid for foot-drop correction in hemiplegic patients without causing excessive wear on the joints in the lower extremity.     

Prevalence of femoroacetabular impingement in asymptomatic contralateral hips in patients with unilateral idiopathic osteoarthritis

Radiographic findings of femoroace tabular impingement in the contralateral asymptomatic hip of patients who had undergone total hip arthroplasty because of primary osteoarthritis (n = 44) were compared with controls (n = 40). The centre-edge angle and caput-collum-diaphyseal angle were measured and the presence of crossover sign and a prominent ischial spine noted on anteroposterior radiographs of the pelvis. The α-angle and offset ratio were measured on cross-table lateral radiographs of the hip. The centre-edge angle and offset ratio were significantly lower and the α-angle significantly higher in the study group compared with controls. While the number of cases with an abnormal centre-edge angle was similar in both groups, the numbers with an α-angle > 50° and the number with an offset ratio ≤ 15 were significantly higher in the study group. It was concluded that morphological anomalies associated with femoroacetabular impingement are seen more frequently in the asymptomatic contralateral hip of patients who have undergone hip replacement for primary osteoarthritis than in controls.     

The pelvifemoral rhythm in cam-type femoroacetabular impingement

Background

There is growing evidence that femoroacetabular impingement is a potentially important risk factor for the development of early idiopathic osteoarthritis in the nondysplastic hip. Understanding of affected joint kinematics is a basic prerequisite in the evaluation of mechanical disorders in a clinical and research oriented setting. The aim of the present study was to compare pelvifemoral kinematics between subjects diagnosed with femoroacetabular impingement and healthy controls.

Methods

The authors collected motion data of the femur and pelvis on a total of 43 hips – 19 cam impingement hips and 24 healthy controls – using a validated electromagnetic tracking device. The pelvifemoral rhythm in supine position was defined during both active and passive hip flexion and statistically compared between both groups.

Findings

A significant increase in posterior pelvic rotation was observed during active hip flexion in the femoroacetabular impingement group compared with the control group (P < 0.001). During passive hip flexion, however, posterior pelvic rotation between the impingement group and the controls did not differ significantly (P = 0.628).

Interpretation

Posterior pelvic rotation during active high-end hip flexion is increased in femoroacetabular impingement, indicating the presence of an active compensational mechanism that decreases the extent of harmful joint conflict during high-flexion activities.     

Kinematic and kinetic modifications in walking pattern of hip osteoarthritis patients induced by intra-articular injections of hyaluronic acid

Background

A growing body of evidence points to the efficacy of intra-articular injections of hyaluronic acid, in dealing with pain and function in hip osteoarthritis. To date, however, no data exist as to this treatment's effect on walking pattern.

Methods

We performed a prospective, open study in order to verify, in a group of 20 hip osteoarthritis patients (12 men, 8 women, mean age 60.5, range 47–73), the clinical effects of 3 intra-articular injections of 2 ml of hyaluronic acid in the hip (1/week) in terms of pain and function at 1 (T1), 3 (T2) and 6-month (T3) follow-ups, as well as changes in the kinematics and kinetics of gait at 6-month follow-up.

Findings

Pain as measured with visual analog scale significantly dropped after this procedure (P < 0.0001). A significant improvement was noted regarding stiffness (P = 0.005) and disability (P = 0.04), as measured by the Western Ontario and McMaster Universities osteoarthritis index. As regards gait analysis, patients at T3 walked with higher cadence (P = 0.004) and stride length (P = 0.02) compared to T0. Moreover, a significant increase for the pelvic tilt at heel contact (P = 0.0004) and for hip flexion–extension moment at loading response sub-phases of gait cycle (P = 0.02) was noted at T3.

Interpretation

In line with current literature, our patients display clinical improvement 6 months after intra-articular injections of hyaluronic acid, accompanied by changes in walking pattern, as measured by instrumental gait analysis. The kinematic and kinetic changes observed may be the consequence of the therapeutic effect of intra-articular injections of hyaluronic acid.     

单侧髋3.0 T MRI在髋关节撞击综合征患者中的应用价值

目的探讨单侧髋3.0 T MRI在髋关节撞击综合征(femoroacetabular impingement,FAI)中盂唇损伤的诊断价值。材料与方法回顾性分析本院2015年1月至2017年6月共60例经关节镜证实为FAI的患者术前MRI图像资料,并与关节镜进行比较。结果 MRI对髋臼前上唇损伤的灵敏度、特异度、准确率、阳性预测值、阴性预测值分别为78.9%、100%、80%、100%、20%。对于唇旁囊肿、股骨头囊肿、圆韧带损伤、股骨颈疝窝诊断的符合率均为100%,而对于软骨损伤诊断的符合率为8.3%。结论单侧髋3.0 T MRI对FAI患者髋臼唇损伤有较高的诊断价值。     

Sports hernia and femoroacetabular impingement in athletes: A systematic review

AIM: To investigate the association between sports hernias and femoroacetabular impingement(FAI) in athletes.METHODS: Pub Med, MEDLINE, CINAHL, Embase, Cochrane Controlled Trials Register, and Google Scholar databases were electronically searched for articles relating to sports hernia, athletic pubalgia, groin pain, long-standing adductor-related groin pain, Gilmore groin, adductor pain syndrome, and FAI. The initial search identified 196 studies, of which only articles reporting on the association of sports hernia and FAI or laparoscopic treatment of sports hernia were selected for systematic review. Finally, 24 studies were reviewed to evaluate the prevalence of FAI in cases of sports hernia and examine treatment outcomes and evidence for a common underlying pathogenic mechanism.RESULTS: FAI has been reported in as few as 12% to as high as 94% of patients with sports hernias, athletic pubalgia or adductor-related groin pain. Cam-type impingement is proposed to lead to increased symphyseal motion with overload on the surrounding extra-articular structures and muscle, which can result in the development of sports hernia and athletic pubalgia. Laparoscopic repair of sports hernias, via either the transabdominal preperitoneal or extraperitoneal approach, has a high success rate and earlier recovery of full sports activity compared to open surgery or conservative treatment. For patients with FAI and sports hernia, the surgical management of both pathologies is more effective than sports pubalgia treatment or hip arthroscopy alone(89% vs 33% of cases). As sports hernias and FAI are typically treated by general and orthopedic surgeons, respectively, a multidisciplinary approach for diagnosis and treatment is recommended for optimal treatment of patients with these injuries.CONCLUSION: The restriction in range of motion due to FAI likely contributes to sports hernias; therefore, surgical treatment of both pathologies represents an optimal therapy.     

Kinematic, kinetic and metabolic parameters of treadmill versus overground walking in healthy older adults

Background

Although treadmill and overground walking appear to be biomechanically similar in healthy, young adults it is not known whether this can be generalized to older subjects or if the metabolic demands are correspondingly comparable.

Methods

Ten healthy adults between 50 and 73 years of age walked at the same speed overground and on a treadmill. Temporal parameters, angular kinematics and vertical ground reaction forces were recorded during walking once subjects were in steady state as determined from their heart rate and oxygen uptake.

Findings

Step, stride and joint angular kinematics were similar for both modes of walking with the exception of the maximum hip flexion and knee extension which were more pronounced with treadmill or overground walking, respectively but in both instances differed by less than 3°. Vertical ground reaction force profiles were similar although the peak associated with push-off was 5.5% smaller with treadmill walking. The metabolic requirements of treadmill walking were about 23% higher than that associated with overground walking.

Interpretation

While treadmill and overground walking are biomechanically similar, the metabolic cost of treadmill walking is higher. Clinically this may be important when using a treadmill for gait retraining in patient populations as it may lead to premature fatigue or undesirable physiologic challenge.     

关节镜治疗髋关节撞击综合征的短期临床疗效

目的 探讨关节镜治疗髋关节撞击综合征(FAI)的短期临床疗效.方法 选取该院2015年8月-2017年8月行髋关节镜治疗的FAI患者30例.其中,男18例,女12例;年龄26～59岁,平均33.85岁.术前髋关节活动度评估:外展(30.75±6.74)°,髋关节屈曲90°位内旋(14.84±8.22)°,屈曲(95.2...     

构建Cam型髋关节撞击综合征有限元模型及力学分析

背景：Cam型髋关节撞击综合征可使关节承受力学过载并最终导致髋关节骨关节炎,然而其诱发骨关节炎的相关力学机制仍不清楚。 目的：运用三维有限元的方法,分析Cam型髋关节撞击综合征的关节内力学环境,进一步了解其病理力学特点。 方法：采用正常髋关节CT数据,利用Mimics和Hypermesh软件准确构建正常髋关节和Cam型髋关节撞击综合征三维有限元模型。在LS-DYNA 软件中,模拟坐下、起立时的力学加载条件,对正常髋关节和Cam型髋关节撞击综合征髋关节的软骨接触力学进行分析。 结果与结论：基于CT数据准确构建了包含关节软骨的正常髋关节和Cam型髋关节撞击综合征髋关节三维有限元力学分析模型。坐下、起立加载过程中,正常髋关节在最大屈髋位时峰值接触压力分别为4.43,4.59 MPa;而Cam型髋关节撞击综合征髋关节分别为14.96,14.86 MPa,髋臼缘前上方出现过高压力和应力集中。提示髋臼软骨过高的接触压力可能是Cam型髋关节撞击综合征导致骨关节炎的力学机制。     

Short term outcomes of hip arthroscopy on hip joint mechanics and cartilage health in patients with femoroacetabular impingement syndrome

BackgroundFemoroacetabular acetabular impingement syndrome consists of abnormal hip joint morphology resulting in painful hip joint impingement. Hip arthroscopy corrects the abnormal morphology and reduces clinical symptoms associated with femoroacetabular impingement syndrome yet the effects of hip arthroscopy on gait mechanics and cartilage health are not well understood.MethodsTen femoroacetabular impingement syndrome patients and 10 matched asymptomatic controls underwent gait analysis consisting of three-dimensional hip joint kinematics and kinetics. Femoroacetabular impingement syndrome patients underwent gait analysis and quantitative magnetic resonance imaging of the surgical hip joint before and seven months post-surgery. Patient reported outcomes were obtained from all study participants and were used to quantify hip joint pain, function and quality of life.FindingsPrior to surgery, femoroacetabular impingement syndrome patients demonstrated hip joint kinematics or kinetics as the control group. After surgery, femoroacetabular impingement syndrome patients exhibited improved patient reported outcomes, similar hip joint kinematic patterns, increased hip flexion and decreased hip extension moment impulses within the surgical limb. The femoroacetabular impingement syndrome patients that ambulated with increased HFMI post-surgery demonstrated a decrease in femoral cartilage T1ρ and T2 values.InterpretationFemoroacetabular impingement syndrome patients exhibited improved clinical symptoms yet ambulated with altered sagittal plane hip joint loading after hip arthroscopy. Increased hip flexion moment impulse post-surgery was associated with improved cartilage health within the surgical limb. These study findings suggest that sagittal plane hip joint loading at short-term follow-up after hip arthroscopy is associated with cartilage health and may be an important biomechanical parameter in post-operative rehabilitation programs.     

体外冲击波疗法治疗股骨髋臼撞击综合征的临床疗效观察

目的:探讨体外冲击波疗法治疗股骨髋臼撞击综合征(FAI)的临床疗效。方法:2013年5月~2015年8月我院采用保守疗法治疗44例FAI患者,其中23例采用体外冲击波疗法(观察组),21例口服塞来昔布胶囊(对照组)。两组患者性别、年龄、侧别、病程及治疗前VAS评分、HHS评分及髋关节活动度比较,差异均无统计学意义(P0.05)。对两组治疗前后VAS评分、HHS评分和髋关节活动度进行统计学比较。结果:所有患者均获得随访,其中观察组随访时间为12~16周,平均(13.96±1.58)周;对照组随访时间为12~15周,平均(13.29±1.15)周。末次随访时,两组VAS评分和HHS评分显著优于治疗前,差异有统计学意义(P0.05);治疗后,两组间VAS评分比较,差异有统计学意义(P0.05),但两组间HHS评分比较,差异无统计学意义(P0.05)。末次随访时,两组髋关节活动度与治疗前比较无明显改善,差异均无统计学意义(P0.05);两组间比较差异无统计学意义(P0.05)。结论:体外冲击波疗法治疗FAI能够缓解髋关节疼痛,改善髋关节功能,但无法提高髋关节活动度,在缓解疼痛方面不如口服塞来昔布胶囊明显。