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Hip osteoarthritis may be caused by increased or abnormal intra-articular forces, which are known to be related to structural articular cartilage damage. Femoral torsional deformities have previously been correlated with hip pain and labral damage, and they may contribute to the onset of hip osteoarthritis by exacerbating the effects of existing pathoanatomies, such as cam and pincer morphologies. A comprehensive understanding of the influence of femoral morphotypes on hip joint loading requires subject-specific morphometric and biomechanical data on the movement characteristics of individuals exhibiting varying degrees of femoral torsion. The aim of this study was to evaluate hip kinematics and kinetics as well as muscle and joint loads during gait in a group of adult subjects presenting a heterogeneous range of femoral torsion by means of personalized musculoskeletal models. Thirty-seven healthy volunteers underwent a 3D gait analysis at a self-selected walking speed. Femoral torsion was evaluated with low-dosage biplanar radiography. The collected motion capture data were used as input for an inverse dynamics analysis. Personalized musculoskeletal models were created by including femoral geometries that matched each subject’s radiographically measured femoral torsion. Correlations between femoral torsion and hip kinematics and kinetics, hip contact forces (HCFs), and muscle forces were analyzed. Within the investigated cohort, higher femoral antetorsion led to significantly higher anteromedial HCFs during gait (medial during loaded stance phase and anterior during swing phase). Most of the loads during gait are transmitted through the anterior/superolateral quadrant of the acetabulum. Correlations with hip kinematics and muscle forces were also observed. Femoral antetorsion, through altered kinematic strategies and different muscle activations and forces, may therefore lead to altered joint mechanics and pose a risk for articular damage. The method proposed in this study, which accounts for both morphological and kinematic characteristics, might help in identifying in a clinical setting patients who, as a consequence of altered femoral torsional alignment, present more severe functional impairments and altered joint mechanics and are therefore at a higher risk for cartilage damage and early onset of hip osteoarthritis., Frontiers in Bioengineering and Biotechnology, 9, ISSN:2296-4185

© Author(s) (or their employer(s)) 2020. No commercial re-use. See rights and permissions. Published by BMJ. The 1st International Hip-related Pain Research Network meeting discussed four prioritised themes concerning hip-related pain in young to middle-aged adults: (1) diagnosis and classification of hip-related pain; (2) patient-reported outcome measures for hip-related pain; (3) measurement of physical capacity for hip-related pain; (4) physiotherapist-led treatment for hip-related pain. Thirty-eight expert researchers and clinicians working in the field of hip-related pain attended the meeting. This manuscript relates to the theme of physiotherapist-led treatments for hip-related pain. A systematic review on the efficacy of physiotherapist-led interventions for hip-related pain (published separately) was conducted and found that strong evidence for physiotherapist-led treatments was lacking. Prior to the meeting, draft consensus recommendations for consideration in the meeting were also developed based on the systematic review. The draft consensus recommendations were presented to all of the meeting participants via email, at least 1 week prior to the meeting. At the meeting, these recommendations were discussed, revised and voted on. Six recommendations for clinical practice and five recommendations for research were included and all gained consensus. Recommendations for clinical practice were that (i) Exercise-based treatments are recommended for people with hip-related pain. (ii) Exercise-based treatment should be at least 3 months duration. (iii) Physiotherapist-led rehabilitation after hip surgery should be undertaken. (iv) Patient-reported outcome measures, measures of physical impairment and measures of psychosocial factors should be used to monitor response to treatment. (v) Physical activity (that may include sport) is recommended for people with hip-related pain. (vi) Clinicians should discuss patient expectations, use shared-decision making and provide education. Recommendations for research were (i) Reporting of exercise programmes: Exercise descriptors such as load magnitude, number of repetitions and sets, duration of whole programme, duration of contractile element of exercise, duration of one repetition, time under tension, rest between repetitions, range of motion through which the exercise is performed, and rest between exercise sessions should be reported. (ii) Research should investigate the optimal frequency, intensity, time, type, volume and progression of exercise therapy. (iii) Research should examine the effect of patient education in people with hip-related pain. (iv) Research should investigate the effect of other treatments used in people with hip-related pain (for example: manual therapy, medications, injections). (v) Research should examine the impact of comorbidities and social determinants on treatment effectiveness in people with hip-related pain. Clinicians and researchers working with young to middle-aged active adults with hip-related pain may use these consensus recommendations to guide, develop, test and implement individualised, evidence-based physiotherapist-led rehabilitation programmes.

Femoroacetabular impingement (FAI) is a pathomechanical process of the hip joint, which could lead to hip pain and functional disability. Aim of this thesis was to investigate hip muscle function in patients with a symptomatic FAI. Hip muscle function was first investigated before patients underwent any surgical treatment for managing FAI. It was shown that they present with reduced hip muscle strength (i.e., muscle weakness), probably due to hip muscle inhibition. Nevertheless, hip muscle weakness was not associated with exaggerated hip muscle fatigue. Hip muscle strength recovery was then evaluated in a series of patients after hip arthroscopy to treat FAI. These patients demonstrated a good recovery for all hip muscle groups, except for hip flexors. The case of a professional ice hockey player who underwent bilateral hip open surgeries for treating bilateral FAI was also documented. This report showed that iliotibial band dehiscence could occur after hip open surgery, thereby preventing hip abductor strength increase during rehabilitation and delaying the return to sport. In addition, the assessment of the rate of force development scaling factor for the hip muscles was evaluated in a group of healthy adults. This parameter seems to be promising for the evaluation of hip muscle inhibition. The testing protocol was feasible and reproducible for hip adductors, external rotators and flexors. Taken as a whole, these findings show that patients with symptomatic FAI demonstrate an impaired hip muscle function, which is however mainly resolved after surgical treatment., Le conflit fémoro-acétabulaire (femoroacetabular impingement, FAI) est une pathologie mécanique de la hanche qui peut causer des douleurs et limitations fonctionnelles. Le but de cette thèse était d’étudier la fonction musculaire au niveau de la hanche chez des patients présentant un FAI symptomatique. La fonction musculaire de la hanche a été évaluée, dans un premier temps, chez des patients avant qu’ils ne subissent une opération. Ces patients démontraient un déficit de force qui pourrait être expliqué par de l’inhibition musculaire. Cependant, ce déficit de force n’était pas associé à une plus grande fatigabilité musculaire. Dans un deuxième temps, les altérations de force musculaire ont été évaluées chez des patients ayant subi une arthroscopie de la hanche. Après l’opération, les patients récupéraient un niveau de force normal au niveau de tous les groupes musculaires de la hanche excepté les fléchisseurs. Le cas d’un joueur de hockey sur glace ayant subi une chirurgie ouverte aux deux hanches pour traiter un FAI bilatéral a aussi été décrit. On a démontré que la déhiscence de la bandelette iléo-tibiale pouvait survenir après chirurgie, empêcher l’augmentation de force musculaire des abducteurs de la hanche, et retarder la reprise du sport. Enfin, un protocole d’évaluation du taux de développement de la force normalisé, variable permettant d’estimer l’inhibition musculaire de la hanche, a été proposé chez des sujets sains. La fiabilité et reproductibilité des résultats ont été montrées au niveau des adducteurs, rotateurs externes, et fléchisseurs de la hanche. Ces résultats montrent que ces patients ont une fonction musculaire altérée au niveau de la hanche, qui est toutefois récupéré après une opération.

International audience; Introduction: The aim of this study was to evaluate test feasibility, validity, and reproducibility of the rate of force development scaling factor (RFD-SF) for the hip muscles. Methods: Feasibility was assessed as the testing compliance, validity as the ability to compute the RFD-SF from a linear regression, and reproducibility with a test-retest design in 20 healthy subjects. Reliability and agreement (reproducibility) were evaluated using intraclass correlation coefficient (ICC3,1) and percent standard error of measurement (SEM), respectively. Results: The RFD-SF testing protocol was completed successfully by all subjects, although the analysis had to be modified for hip rotators. Reliability was high (ICC3,1>0.70) for all muscles except hip abductors (ICC3,1=0.69) and internal rotators (ICC3,1=0.58). Agreement was high for all muscles (SEM

Background The need for valid and reproducible questionnaires to routinely assess the physical activity level of patients after total knee arthroplasty (TKA) is of particular concern in clinical settings. Aims of this study were to evaluate the validity and reproducibility of the physical activity scale for the elderly (PASE) questionnaire in TKA patients, with a particular view on gender differences. Methods A total of 50 elderly patients (25 women and 25 men aged 70 ± 6 years) following primary unilateral TKA were recruited. The reproducibility was evaluated by administering the PASE questionnaire during two occasions separated by 7 days. The construct (criterion) validity was investigated by comparing the physical activity level reported by patients in the PASE questionnaire to that measured by accelerometry. Reproducibility was evaluated using intraclass correlation coefficients (ICC3,1) for reliability and standard error of measurement (SEM) and smallest detectable change (SDC) for agreement, while validity was investigated with Pearson correlation coefficients. Results Reliability of the PASE total score was acceptable for men (ICC = 0.77) but not for women (ICC = 0.58). Its agreement was low for both men and women, as witnessed by high SEM (32% and 35%, respectively) and SDC (89% and 97%, respectively). Construct validity of the PASE total score was low in both men (r = 0.45) and women (r = 0.06). Conclusions The PASE questionnaire has several validity and reproducibility shortcomings, therefore its use is not recommended for the assessment of physical activity level in patients after TKA, particularly in women., BMC Musculoskeletal Disorders, 15, ISSN:1471-2474

Study Design Cross-sectional study. Objectives To evaluate intrarater and interrater agreement among physical therapists with different clinical experience in performing a visual rating of movement-pattern quality of patients with femoroacetabular impingement (FAI) syndrome using a semi-quantitative scale. Background Visual rating of movement patterns in patients with FAI syndrome is of interest, because poor control of dynamic hip motion is frequently noted. Methods A video camera was used to record the performance of 34 patients with FAI syndrome performing single-limb standing, squat, frontal lunge, hop lunge, bridge, and plank. Visual rating of movement, as recorded on video, was performed by a highly experienced, a moderately experienced, and a novice physical therapist on 2 occasions using a semi-quantitative scale. Hip abductor strength was assessed using dynamometry, and hip pain and function were assessed with a patient-reported questionnaire. Intrarater and interrater agreement among physical therapists was evaluated using Gwet's agreement coefficient 1. Construct validity was evaluated as the association between physical therapists' rating and patients' hip abductor strength, pain, and function. Results Good intrarater and interrater agreement was observed in the highly experienced and moderately experienced physical therapists when rating single-limb standing, bridge, and plank. Poor to moderate intrarater and interrater agreement was found when they rated squat, frontal lunge, and hop lunge. Poor performers, as rated by the highly experienced physical therapist only, demonstrated lower hip abductor strength (P

Objectives To investigate sex-specific differences in hip muscle strength asymmetries, and associations between hip abductor and flexor strength asymmetries, hip morphology and symptoms in patients with femoroacetabular impingement syndrome (FAIS). Design Cross-sectional study. Setting Clinical setting. Participants Thirty-four patients with FAIS (21 women, 13 men). Main outcome measures Side-to-side strength asymmetries of hip adductor, abductor, internal and external rotator, flexor and extensor muscles were assessed using dynamometry, while hip pain during contractions was evaluated with a visual analogue scale. Hip morphology was assessed on anteroposterior pelvic radiographs and magnetic resonance arthrography images. Hip symptoms were evaluated using the Oxford Hip Score (OHS). Results Women presented larger hip flexor strength asymmetries than men. In women, hip abductor asymmetries correlated with the OHS and with hip pain during muscle contraction. Hip flexor asymmetries correlated with the alpha angle in men. Conclusion Patients with FAIS demonstrated sex-specific hip muscle strength asymmetries and associations with the underlying hip symptoms and morphology. Women showed larger hip flexor strength asymmetries than men, and their hip abductor strength asymmetries were associated with hip symptoms. In contrast, hip flexor strength asymmetries in men were associated with the severity of the underlying cam morphology.

OBJECTIVE To investigate the responsiveness to exercise therapy of patients with femoroacetabular impingement syndrome (FAIS), and to investigate differences in hip function, strength, and morphology between responders versus nonresponders. METHODS Patients with FAIS underwent 12 weeks of semi-standardized and progressive exercise therapy. A good therapy outcome (responders) versus a poor therapy outcome (nonresponders) was determined at week 18 with the Global Treatment Outcome questionnaire for hip pain. Hip function was evaluated using the Hip Outcome Score (HOS) activities of daily living (ADL) and Sport at baseline, and at weeks 6, 12, and 18. Hip muscle strength and dynamic pelvic control were evaluated using dynamometry and video analysis, respectively, at baseline, week 12, and week 18. Hip morphology was evaluated with imaging at baseline. RESULTS Thirty-one patients (mean age 24 years) were included. Sixteen patients (52%) were responsive and 15 patients (48%) were not responsive to exercise therapy. Only responders improved HOS ADL and HOS Sport by 10 points (95% confidence interval [95% CI] 7, 14; P < 0.001) and by 20 points (95% CI 15, 25; P < 0.001), respectively, and hip abductor strength by 0.27 Nm/kg (95% CI 0.18, 0.36; P < 0.001). The prevalence of patients showing good dynamic pelvic control only increased in responders (44%; P = 0.029). The prevalence of severe cam morphology was higher in nonresponders than in responders (40% versus 6%; P = 0.037). CONCLUSION Half of patients with FAIS benefit from exercise therapy in the short term. Responsiveness to hip abductor strength and dynamic pelvic control improvements is associated with a good therapy outcome, whereas the presence of severe cam morphology is associated with a poor therapy outcome.

Objectives Aim of this study was to evaluate the flexion-adduction-internal rotation (FADIR) test accuracy for screening cam and pincer morphology in youth male ice hockey players without diagnosed hip disorders. Design Cross-sectional study. Methods Seventy-four ice hockey players with a mean age of 16 years (range: 13–20 years) were assessed unilaterally. The presence of cam and pincer morphology was evaluated using the FADIR test and magnetic resonance imaging (MRI) (reference standard). Positive FADIR test consisted of groin pain during the maneuver, while positive MRI findings consisted of (1) pure cam, pure pincer or combined morphology and acetabular labral alterations, or (2) pure cam or combined morphology and acetabular labral alterations. Sensitivity, specificity, positive and negative likelihood ratios, and positive and negative predictive values were calculated. Results For pure cam, pure pincer or combined morphology as positive MRI findings, the FADIR test demonstrated a sensitivity of 41%, specificity of 47%, positive likelihood ratio of 0.78, negative likelihood ratio of 1.24, positive predictive value of 19% and negative predictive value of 73%. For pure cam or combined morphology as positive MRI findings, the FADIR test showed a sensitivity of 60%, specificity of 52%, positive likelihood ratio of 1.24, negative likelihood ratio of 0.78, positive predictive value of 16% and negative predictive value of 89%. Conclusions The FADIR test is inadequate for screening cam and pincer morphology in youth ice hockey players without diagnosed hip disorders because of the large number of false positive test outcomes.