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Context: Piriformis syndrome is often associated with muscle spasms and shortening of the piriformis muscle (PM). Physical therapy, including static stretching of the PM, is one of the treatments for this syndrome. However, the effective stretching position ofthe PM is unclear in vivo. This study aimed to determine the effective stretching positions of the PM using ultrasonic shear wave elastography. Design: Observational study. Methods: Twenty-one healthy young men (22.7 [2.41 y) participated in this study. The shear elastic modulus of the PM was measured at 12 stretching positions using shear wave elastography. Three of the 12 positions were tested with maximum internal rotation at 0°, 20°, or 40° hip adduction in 90° hip flexion. Nine of the 12 positions were tested with maximum external rotation at positions combined with 3 hip-flexion angles (70°, 90°, and 110°) and 3 hip-adduction angles (0°, 20°, and 40°). Results.' The shear elastic modulus of the PM was significantly higher in the order of 40°, 20°, and 0° of adduction and higher in external rotation than in internal rotation. The shear elastic modulus of the PM was significantly greater in combined 110° hip flexion and 40° adduction with maximum external rotation than in all other positions. Conclusion.- This study revealed that the position in which the PM was most stretched was maximum external rotation with 110° hip ftexion and 40° hip adduction. [ABSTRACT FROM AUTHOR]

Context: Excessive hip adduction and internal rotation are abnormal movements that may lead to the onset and progression of patellofemoral pain. Previous studies have reported that lower dynamic frontal plane hip joint stiffness in the gait of women is associated with the magnitude of hip adduction and internal rotation angles. However, the factors contributing to the lack of dynamic frontal plane hip joint stiffness in the gait of young women are unclear. This study aims to investigate the factors affecting dynamic frontal plane hip joint stiffness during the weight-acceptance phase of the gait of healthy young women. Design: Cross-sectional study. Methods: This study included 30 healthy women between the ages of 18 and 30 years. The pelvic width/femur length ratio was calculated by dividing the pelvic width by the femur length. Data on hip kinematics and kinetics and activation of the gluteus maximus and medius, tensor fasciae latae, and adductor longus muscles during gait were collected using a motion capture system, force plates, and surface electromyography. Stepwise multiple regression analysis was conducted to determine the extent to which each independent factor affected dynamic frontal plane hip joint stiffness. Results: In healthy young women, decreased dynamic frontal plane hip joint stiffness was associated with decreased muscle activity of the gluteus maximus during the gait, as well as greater pelvic width/femur length ratio. Conclusions: Women with a relatively great pelvic width relative to femur length may have more difficulty in producing dynamic frontal plane hip joint stiffness. However, increasing the muscle activity of the gluteus maximus may contribute to increased dynamic frontal plane hip joint stiffness. [ABSTRACT FROM AUTHOR]

Context: Hip muscle strength and hop performance limb symmetries after anterior cruciate ligament reconstruction (ACLR) are not well studied. This study aimed to determine the differences in hip abductors' (ABD) and external rotators' (ER) muscle strength measures between limbs, and the relationship between hip ABD and ER muscle strengths and hop performance limb symmetry indices (LSIs) 2 years after ACLR. Design: Cross-sectional study. Methods: Forty (level I/II) men athletes 2 years after unilateral ACLR completed 4 single-legged hop tests and involved hip ABD and ER strength testing (maximum voluntary isometric contraction [MVIC]; isokinetic peak torque [PKTQ] at 60°, 180°, and 300°/s; and isotonic peak velocity at 75% of their MVICs). Muscle strength measures were normalized to body mass, and hop performances were reported as LSIs. Paired t test was used to determine strength differences between limbs, and the Pearson correlation coefficient was used to assess the relationship between involved hip muscle strength measures and hop performance LSIs. Results: Hip ER-MVIC (involved: 60.26 [12.01], uninvolved: 63.68 [13.17] N·m/kg) and ER eccentric PKTQ at 60°/s (involved: 32.59 [9.28]; uninvolved: 35.73 [10.50] N·m/kg) were significantly different between limbs (P ≤.018). Single-hop LSI correlated with hip ER-PKTQ at 180°/s (r =.354) and 300°/s (r =.324, P ≤.041), while triple-hop LSI correlated with hip ER-MVIC (r =.320), concentric ER-PKTQ at 180°/s (r =.355), eccentric ER-PKTQ at 60°/s (r =.314), and hip ABD-PKTQ at 60°/s (r =.364) and 300°/s (r =.336, P ≤.049). Conclusions: Men athletes demonstrated symmetrical hop performance and hip muscle strengths, except for ER hip's MVIC and isokinetic eccentric peak torque at 60°/s 2 years after ACLR. Hop performance LSIs had a few, yet positive moderate relationships with involved hip ABDs and ER strength measures. This may indicate that hip ABD and ER muscle strength measures contribute to athletes' hop performances 2 years after ACLR. Post-ACLR rehabilitation programs might incorporate hip muscle strengthening training to improve athletes' functional performances. [ABSTRACT FROM AUTHOR]

Objective: The goals of this study were (i) to assess the association between hip capsule morphology and pain in patients without any other MRI abnormalities that would correlate with pain and (ii) to investigate whether hip capsule morphology in hip pain patients is different from that of controls. Methods: In this study, 76 adults with hip pain who did not show any structural abnormalities on MRI and 46 asymptomatic volunteers were included. Manual segmentation of the anterior and posterior hip capsules was performed. Total and mean anterior hip capsule area, posterior capsule area, anterior-to-posterior capsule area ratio, and medial-to-lateral area ratio in the anterior capsule were quantified. Differences between the pain and control groups were evaluated using logistic regression models. Results: Patients with hip pain showed a significantly lower anterior-to-posterior area ratio as compared with the control group (p = 0.002). The pain group's posterior hip capsule area was significantly larger than that of controls (p = 0.001). Additionally, the ratio between the medial and lateral sections of the anterior capsule was significantly lower in the pain group (p = 0.004). Conclusions: Patients with hip pain are more likely to have thicker posterior capsules and a lower ratio of the anterior-to-posterior capsule area and thinner medial anterior capsules with a lower ratio of the medial-to-lateral anterior hip capsule compartment, compared with controls. Clinical relevance statement: During MRI evaluations of patients with hip pain, morphology of the hip capsule should be assessed. This study aims to be a foundation for future analyses to identify thresholds distinguishing normal from abnormal hip capsule measurements. Key Points: • Even with modern image modalities such as MRI, one of the biggest challenges in handling hip pain patients is finding a structural link for their pain. • Hip capsule morphologies that correlated with hip pain showed a larger posterior hip capsule area and a lower anterior-to-posterior capsule area ratio, as well as a smaller medial anterior capsule area with a lower medial-to-lateral anterior hip capsule ratio. • The hip capsule morphology is correlated with hip pain in patients who do not show other morphology abnormalities in MRI and should get more attention in clinical practice. [ABSTRACT FROM AUTHOR]

Introduction: Hip osteoarthritis (OA) is one of the leading causes of disability and morbidity worldwide. It is estimated to affect 9.2% individuals globally with age over 45 years. Conventional treatment modalities have limitations and side-effects. To overcome these limitations, over the last decade, there has been an increased interest in the use of orthobiologics derived from autologous sources including platelet-rich plasma (PRP), bone-marrow aspirate concentrate (BMAC) and adipose tissue derived formulations. This review qualitatively presents the in-vitro, pre-clinical, clinical and on-going clinical studies exploring the safety and efficacy of BMAC for management of hip OA. Materials and methods: The electronic database search was done through PubMed, Embase, Web of Science, Scopus, ProQuest and Google Scholar till February 2024. The search terms used were "osteoarthritis" OR "hip osteoarthritis" OR "orthobiologics" OR "efficacy or use of orthobiologic treatment" OR "bone-marrow concentrate" OR "bone-marrow aspirate concentrate", AND "BMAC". The inclusion criteria were clinical studies of any level of evidence written in the English language, published till February 2024, evaluating the safety and efficacy of intra-articular administration of BMAC for the management of hip OA. Results: A total of 5 studies were included in this review for qualitative data synthesis. The total number of patients who participated in the study was 182, ranging from 4 to 112 in a single study. No adverse events were reported throughout the duration of the study. In addition, intra-articular administration of BMAC led to reduced pain, and improved function and overall quality of life (QoL). Conclusion: The results from this review demonstrated that administration of BMAC is safe and potentially efficacious in terms of reducing pain, improving function and overall QoL of patients with hip OA in short- and mid-term average follow-up based on the included studies. Nonetheless, more adequately powered, multi-center, prospective, double-blind, non-randomized and randomized controlled trials with long-term follow-up are warranted to establish long-term safety and efficacy of BMAC for management of hip OA and justify its routine clinical use. [ABSTRACT FROM AUTHOR]

Aim: Patients' death or adverse events appear to be associated with poor healthcare decision‐making. This might be due to an inability to have an adequate representation of the problem or of the connections among problem‐related elements. Changing how a problem is formulated can reduce biases in clinical reasoning. The purpose of this article is to explore the possible contributions of psychoneuroendocrinoimmunology (PNEI) and psychology of reasoning and decision‐making (PRDM) to support a new nursing theoretical frame. Design: Discursive paper. Method: This article discusses the main assumptions about nursing and nurses' ability to face patient's problems, suggesting a new approach that integrates knowledge from PNEI and PRDM. While PNEI explains the complexity of systems, highlighting the importance of systems connections in affecting health, PRDM underlines the importance of the informative context in creating a mental representation of the problem. Furthermore, PRDM suggests the need to pay attention to information that is not immediately explicit and its connections. Conclusion: Nursing recognizes the patient–nurse relationship as the axiom that governs care. The integration of PNEI and PRDM in nursing theoretics allows the expansion of the axiom by providing essential elements to read a new type of relationship: the relationship among information. PNEI explains the relationships between biological systems and the psyche and between the whole individual and the environment; PRDM provides tools for the nurse's analytical thinking system to correctly process information and its connections. Impact on Nursing Practice: A theoretical renewal is mandatory to improve nursing reasoning and nursing priority identification. Integrating PNEI and PRDM into nursing theoretics will modify the way professionals approach patients, reducing cognitive biases and medical errors. No Patient or Public Contribution: There was no patient or public involvement in the design or writing of this discursive article. [ABSTRACT FROM AUTHOR]

Biplanar radiography displays promising results in the production of subject-specific (S.specific) biomechanical models. However, the focus has predominantly centred on methodological investigations in gait analysis. Exploring the influence of such models on the analysis of high range of motion tasks linked to hip pathologies is warranted. The aim of this study is to investigate the effect of S.Specific modelling techniques on the reliability of deep squats kinematics in comparison to generic modelling. 8 able-bodied male participants attended 5 motion capture sessions conducted by 3 observers and performed 5 deep squats in each. Prior to each session a biplanar scan was acquired with the reflective-markers attached. Inverse kinematics of pelvis and thigh segments were calculated based on S.specific and Generic model definition. Agreement between the two models femoropelvic orientation in standing was assessed with Bland-Altman plots and paired t- tests. Inter-trial, inter-session, inter-observer variability and observer/trial difference and ratio were calculated for squat kinematic data derived from the two modelling approaches. Compared to the Generic model, the S.Specific model produced a calibration trial that is significantly offset into more posterior pelvis tilt (–2.8±2.7), hip extension (–2.2±3.8), hip abduction (–1.2±3.6) and external rotation (–13.8±11.4). The S.specific model produced significantly different squat kinematics in the sagittal plane of the pelvis (entire squat cycle) and hip (between 40 % and 60 % of the squat cycle). Variability analysis indicated that the error magnitude between the two models was comparable (difference<2°). The S.specific model exhibited a lower variability in the observer/trial ratio in the sagittal pelvis and hip, the frontal hip, but showed a higher variability in the transverse hip. S.specific modelling appears to introduce a calibration offset that primarily translates into an effect in the sagittal plane kinematics. However, the clinical added value of S.specific modelling in terms of reducing experimental sources of kinematic variability was limited. • Biplanar radiography was used to produce subject-specific hip and pelvis model. • S.specific model kinematics were compared to generic model kinematics. • S.specific modelling significantly offsets the calibration of the standing trial. • This offset influenced the kinematics of the Sagittal pelvis and hip kinematics. • This offset had minimum impact on the variability of deep squat kinematics. [ABSTRACT FROM AUTHOR]

Purpose: This study aimed to investigate the radiographic findings for the hip joint and hip range of motion in professional cyclists, and to determine their bone morphology and physical characteristics. The effects of physical characteristics on athletic performance were examined in terms of metabolic efficiency using simulation analysis. Methods: We performed a case–control research study on 22 hips in 11 male professional cyclists (average age 28.5, height 1.73 m, weight 77.6 kg). Thirty hips in 15 healthy male volunteers were selected as controls. As radiographic evaluations, acetabular dysplasia was assessed on standardized radiographs. During physical evaluations, the hip range of motion was examined. We used simulation analysis to investigate the metabolic efficiency in the different cycling forms. Results: The radiographic evaluations showed a significant difference in the incidence of acetabular dysplasia (p = 0.01): 59% (13/22 hips) in the pro-cyclist group versus 10% (3/30 hips) in the control group. The physical evaluations revealed significant differences in the hip internal rotation angle (p = 0.01), with greater ranges of internal rotation in the pro-cyclist group versus the control group. The simulation analyses showed that metabolism was reduced in the cycling form with hip internal rotation, especially in the lower extremities. Conclusions: Pro-cyclists showed a high frequency of acetabular dysplasia and superior hip internal rotation. According to the cycling model analyses, hip internal rotation allowed pedaling with reduced metabolic power. [ABSTRACT FROM AUTHOR]

Objective: To assess the performance of morphologic and hypointense signal changes on MRI to predict grades and types of acetabular cartilage damage in the chondrolabral transitional zone (TZ) of the hip identified at arthroscopy. Materials and methods: This retrospective single-center study reviewed conventional 3T MRI hip studies from individuals with symptomatic femoroacetabular impingement (FAI) and subsequent hip arthroscopy surgery within 6 months. Independent review was made by three radiologists for the presence of morphologic damage or a hypointense signal lesion in the TZ on MRI. Fleiss' kappa statistic was used to assess inter-reader agreement. The degree of TZ surfacing damage (modified Outerbridge grades 1–4) and presence of non-surfacing wave sign at arthroscopic surgery were collected. Relationship between sensitivity and lesion grade was examined. Results: One hundred thirty-six MRI hip studies from 40 males and 74 females were included (mean age 28.5 years, age range 13–54 years). MRI morphologic lesions had a sensitivity of 64.9–71.6% and specificity of 48.4–67.7% for arthroscopic surfacing lesions, with greater sensitivity seen for higher grade lesions. Low sensitivity was seen for wave sign lesions (34.5–51.7%). MRI hypointense signal lesions had a sensitivity of 26.3–62% and specificity of 43.8–78.0% for any lesion. Inter-reader agreement was moderate for morphologic lesions (k = 0.601) and poor for hypointense signal lesions (k = 0.097). Conclusion: Morphologic cartilage damage in the TZ on MRI had moderate sensitivity for any cartilage lesion, better sensitivity for higher grade lesions, and poor sensitivity for wave sign lesions. The diagnostic value of hypointense signal lesions was uncertain. [ABSTRACT FROM AUTHOR]

All newborns are screened for developmental dysplasia of the hip (DDH), but countries have varying screening practices. The aim of this narrative mini review is to discuss the controversies of the screening and why it seems that all screening programs are likely to have same outcome. Different screening strategies are discussed alongside with other factors influencing DDH in this review. Universal ultrasound (US) has been praised as it finds more immature hips than clinical examination, but it has not been proven to reduce the rates of late-detected DDH or surgical management. Universal US screening increases initial treatment rates, while selective US and clinical screening have similar outcomes regarding late detection rates than universal US. This can be explained by the extrinsic factor affecting the development of the hip joint after birth and thus initial screening during the early weeks cannot find these cases. Conclusion: It seems that DDH screening strategies have strengths and limitations without notable differences in the most severe outcomes (late-detected cases requiring operative treatment). Thus, it is important to acknowledge that the used screening policy is a combination of values and available resources rather than a decision based on clear evidence. [ABSTRACT FROM AUTHOR]

This research presents the results of a study about people with failed metal-on-metal hip implants, and draws on the STS concept of the technological imperative alongside research on the value of patient knowledge in clinical settings and the legitimacy of embodied stories. Popularly understood as positive and life changing, hip replacement surgery was hailed as 'the operation of the century', until a series of widespread failures of hundreds of thousands of hip implants, known collectively as metal-on-metal (MoM) hips, drew attention to the poor regulation of medical implants. This paper argues that poor regulation intersects with narratives of patients' pain, which are obstructed by surgeons and the UK regulatory body, with the effect of denying both patients' embodied experiences of implant failure, and their restitution to good health. Patient narratives about problems with their hip implant are the wellspring from which scientific evidence emerges which can indicate widespread implant failure. By obstructing these narratives the regulatory system undermines the very evidence it needs to operate effectively. [ABSTRACT FROM AUTHOR]

Background: This study aimed to evaluate the association between spinopelvic alignment parameters and hip osteoarthritis progression after spinal alignment correction surgery for adult spinal deformity, focusing on the preoperative to postoperative change in spinopelvic alignment. Methods: This retrospective study enrolled 100 adult spinal deformity patients (196 hip joints) who underwent spinal fusion surgery, after excluding four joints with previous total hip arthroplasty. Acetabular roof obliquity (ARO), center edge angle (CE) and Kellgren and Lawrence (KL) grade were measured in the hip joint. Spinopelvic alignment parameters were measured preoperatively and 1-month postoperatively and the changes (Δ) during this period were calculated. Patients were followed-up for ≥ 5 years and factors associated with KL grade progression at 5-years postoperatively were determined by logistic regression analysis. Results: In the analysis with all cases, KL grade progressed in 23 joints. Logistic regression analysis revealed age (OR: 1.098, 95% CI: 1.007–1.198, p = 0.019), ARO (OR: 1.176, 95% CI: 1.01–1.37, p = 0.026), and Δ PI (OR: 0.791, 95% CI: 0.688–0.997, p < 0.001) as parameters significantly associated with KL grade progression. On the other hand, in the analysis limited to 185 cases with 1-month postoperative KL grade of 0, KL grade progressed in 13 joints. Logistic regression analysis revealed PI-LL (OR: 1.058, 95% CI: 1.001–1.117, p = 0.04), ΔPI (OR: 0.785, 95% CI: 0.649–0.951, p < 0.001), and ΔCobb (OR: 1.127, 95% CI: 1.012–1.253, p = 0.009) as parameters significantly associated with progression. Conclusions: Both the overall and limited analyzes of this study identified preoperative to postoperative change in PI as parameters affecting the hip osteoarthritis progression after spinal fusion surgery. Decrease in PI might represent preexisting sacroiliac joint laxity. Patients with this risk factor should be carefully followed for possible hip osteoarthritis progression. [ABSTRACT FROM AUTHOR]

BACKGROUND: In the selection of minimally invasive total hip arthroplasty approaches, there is considerable debate about whether direct anterior and posterior approaches differ in postoperative gait, limb balance, and hip motor capacity, and therefore further investigation is warranted. OBJECTIVE: To assess the gait and hip ambulation ability of direct anterior and posterior approaches for primary unilateral total hip arthroplasty with a prospective randomized controlled study. METHODS: A total of 61 patients with unilateral avascular necrosis of the femoral head in Qingdao Municipal Hospital from January 2019 to June 2020 were included in the study. There were 40 males and 21 females, at a mean age of (64.83±5.52) years. All the patients were randomly divided into a direct anterior approach group (n=28) and a posterior approach group (n=33), and received initial total hip arthroplasty by direct anterior approach and posterior approach, respectively. Gait analysis (gait time-space parameters such as stride length, stride frequency, single-leg support time, and plantar pressure difference) and hip ambulation ability (standing-walking timing test and 2-minute walking test) were performed before and 1, 3 and 6 months after operation. RESULTS AND CONCLUSION: (1) With the extension of postoperative time, gait time-space parameters in both groups were gradually improved. The stride length, stride frequency, single-leg support time, and plantar pressure difference in the direct anterior approach group were significantly better than those in the posterior approach group 1 month after surgery (P < 0.01). The stride frequency, single-leg support time, and plantar pressure difference in the direct anterior approach group were significantly better than those in the posterior approach group 3 months after surgery (P < 0.05). The plantar pressure difference in the direct anterior approach group was significantly better than that in the posterior approach group 6 months after surgery (P < 0.01). (2) With the extension of postoperative time, the results of the standing-walking timing test and 2-minute walking test were gradually improved in both groups. The results of the standing-walking timing test and 2-minute walking test 1 and 3 months after operation in the direct anterior approach group were better than those in the posterior approach group (P < 0.05). (3) The results have indicated that the recovery of postoperative gait and hip ambulation ability of the two groups is inconsistent. The direct anterior approach group has some advantages in the improvement of postoperative gait and hip ambulation ability compared with the posterior approach group in the early postoperative period. [ABSTRACT FROM AUTHOR]

BACKGROUND: Most balance disorders after total hip arthroplasty require a variety of rehabilitation methods to improve. Body weight support Tai Chi footwork can be used as a safe and effective balance training method. OBJECTIVE: To observe the effect of body weight support Tai Chi footwork on the balance function of patients after total hip arthroplasty. METHODS: Totally 74 subjects undergoing total hip arthroplasty were recruited and randomly divided into a control group (n=37) and a trial group (n=37). The control group received 30 minutes of body weight support walking training and 60 minutes of routine rehabilitation training; the trial group received 30 minutes of body weight support Tai Chi footwork training and 60 minutes of routine rehabilitation training, once a day, 5 times a week, for 12 consecutive weeks. Before the intervention, 4, 8, and 12 weeks after intervention, the Berg balance scale and the dynamic balance ability test were used to evaluate the balance function. Harris score was used to evaluate the hip joint function, and the fall risk index was used to evaluate the fall risk. RESULTS AND CONCLUSION: (1) The four observation indicators all showed significant time effects (P < 0.001). (2) Berg balance scale, Harris score and fall risk index all had an interaction effect (P < 0.001), and there was a significant inter-group difference after 12 weeks of intervention (P < 0.001), and the effect of the trial group was better than that of the control group. (3) After 12 weeks of intervention, there was an interaction and group effect in the scores of the front and left directions of the dynamic balance test (P < 0.001), and there were significant group differences in the scores of the overall, front, left and right directions (P < 0.001). (4) The results showed that after 12 weeks of intervention, the balance functions of the trial group and the control group were improved, and the improvement effect of body weight support Tai Chi footwork training was better than body weight support walking training on patients after total hip arthroplasty. [ABSTRACT FROM AUTHOR]

BACKGROUND: Total hip and knee arthroplasty is widely used in the elderly population, but there is a lack of accurate prediction methods for unplanned readmission and postoperative complications. OBJECTIVE: To investigate the effect of the Rothman index on unplanned readmission and complications in elderly patients undergoing total hip and knee arthroplasty. METHODS: A total of 153 patients who underwent elective total hip and knee arthroplasty from December 2020 to December 2022 in Ward Area One, Department of Orthopedics, The First People’s Hospital of Zunyi were selected as the study subjects. According to whether they were unplanned readmission within 90 days after discharge, they were divided into a readmission group (n=21) and a non-readmission group (n=132). The general data of all patients were collected through the electronic medical record system, including gender, age, body mass index, diabetes mellitus, hypertension, and surgical joint type. The Rothman index was evaluated according to the literature. Postoperative complications were counted. RESULTS AND CONCLUSION: (1) There was no significant difference in gender, body mass index, surgical joint type, and length of hospital stay between the readmission group and the non-readmission group (P > 0.05). There were significant differences in the number of comorbidities, age, and Rothman score between the two groups (P < 0.05). (2) The results of multivariate Logistics regression analysis showed that the number of comorbidities, age, and Rothman score were independent influencing factors for readmission 90 days after total hip and knee arthroplasty in elderly patients with hip and knee diseases (P < 0.05). (3) The results of receiver operating characteristic curve analysis exhibited that the area under the curve of the Rothman index for predicting readmission 90 days after total hip and knee arthroplasty was 0.824; the sensitivity was 80.85%; the specificity was 78.85%; the maximum Youden index was 0.597, and the optimal cutoff value was 46 points. (4) The incidence of total complications in elderly patients with Rothman < 46 was higher than that in elderly patients with Rothman ≥46 (P < 0.05). (5) It is concluded that the Rothman index can accurately predict unplanned readmission after total hip and knee arthroplasty in elderly patients with hip and knee joint diseases. Simultaneously, patients with Rothman index of less than 46 points have a higher overall risk of complications and poor joint recovery, which can be used to improve postoperative management of patients in clinical practice. [ABSTRACT FROM AUTHOR]

BACKGROUND: The distribution of the necrotic area plays an important role in hip preservation treatment. At present, there are few studies on whether the difference in the three-dimensional spatial distribution of osteonecrosis of the femoral head affects the clinical outcome of fibular support. OBJECTIVE: To explore the relationship between the spatial distribution and clinical outcome at the sites of osteonecrosis of the femoral head and fibular support using CT three-dimensional reconstruction so as to provide a basis for optimizing the applicable conditions of fibular support and improving the hip preservation effect of fibular support. METHODS: Eighty patients with osteonecrosis of the femoral head who were treated with fibular support for hip preservation from January 2010 to January 2021 were selected as the study subjects according to the inclusion criteria. They were followed up for at least 2 years. According to the clinical outcome, the patients were divided into the successful hip preservation group (n=55) and the failure hip preservation group (n=25). 3D reconstruction was performed according to the preoperative and postoperative CT images of the patients. According to the three-column theory, the femoral head was divided into outer nine areas, middle nine areas and inner nine areas (L1-9, C1-9, and M1-9) to explore the spatial distribution of necrotic area of the femoral head and fibular support area and its relationship with clinical outcome. RESULTS AND CONCLUSION: (1) Before operation, the necrotic area of the femoral head was mainly distributed in L1, L2, L4, L5, C1, C2, C4, and C5 (the upper and middle part of the anterior part of the outer ninth area and the middle part of the middle ninth area). After operation, the fibular support area was mainly distributed in L5, L6, C5, and C6 (the middle and lower part of the outer ninth area and the middle and lower part of the middle ninth area). (2) There were significant differences in the distribution of osteonecrosis of the femoral head between the successful hip preservation group and the failure hip preservation group in L8 (the posterior middle part of the outer ninth area), C3 (the anterior lower part of the middle ninth area), C6 (the lower middle part of the middle part of the inner ninth area) and M2 (the anterior middle part of the inner ninth area) (P < 0.05). There was a significant difference in the distribution of fibular support in L5 and L6 (middle and lower part of outer nine) (P < 0.05). Among them, the L8 region could be used as an independent predictor of hip preservation failure in fibular support surgery. The area under the curve of the L8 single factor prediction model was 0.698 [95%CI (0.575, 0.822)]; the sensitivity was 76%, and the specificity was 63.6%. (3) It turns out, when the necrotic area involves L8, C3, C6, and M2, especially L8, the failure of fibular support may increase, and when the fibular support involves L5 and L6, the effect of hip preservation is often not ideal. [ABSTRACT FROM AUTHOR]

This study aimed to determine differences in the hip abductor muscle activity during clam exercise at different hip flexion and femoral anteversion angles. Thirty healthy females were divided into two groups based on the femoral anteversion angle: the excessive femoral anteversion group and the normal group. Clam exercise was performed at three different hip flexion angles (60°, 45°, and 30°). Tensor fascia latae, gluteus medius, and superior portion of gluteus maximus activities were measured during the exercise, and the results were normalized to the activity during maximum voluntary isometric contraction to calculate the gluteal-to-tensor fascia latae muscle activation index. The superior portion of gluteus maximus activities at a hip flexion of 60° and 45° were greater than that at 30°. The excessive femoral anteversion group had a lower gluteal-to-tensor fascia latae muscle activation index than the normal group; the gluteal-to-tensor fascia latae muscle activation index for hip flexion at 60° was higher than that at 45°, and the gluteal-to-tensor fascia latae muscle activation index for hip flexion at 60° and 45° were higher than that at 30°. Therefore, the femoral anteversion angle and hip joint position were related to the activity of the hip abductor muscles during clam exercise. These findings may provide a rationale for instructing exercises to maximize the activity of the hip abductor muscles in individuals with an excessive femoral anteversion angle. [ABSTRACT FROM AUTHOR]

This study presents a comprehensive comparison between a marker-based motion capture system (MMC) and a video-based motion capture system (VMC) in the context of kinematic analysis using musculoskeletal models. Focusing on joint angles, the study aimed to evaluate the accuracy of VMC as a viable alternative for biomechanical research. Eighteen healthy subjects performed isolated movements with 17 joint degrees of freedom, and their kinematic data were collected using both an MMC and a VMC setup. The kinematic data were entered into the AnyBody Modelling System, which enables the calculation of joint angles. The mean absolute error (MAE) was calculated to quantify the deviations between the two systems. The results showed good agreement between VMC and MMC at several joint angles. In particular, the shoulder, hip and knee joints showed small deviations in kinematics with MAE values of 4.8∘, 6.8∘ and 3.5∘, respectively. However, the study revealed problems in tracking hand and elbow movements, resulting in higher MAE values of 13.7∘ and 27.7∘. Deviations were also higher for head and thoracic movements. Overall, VMC showed promising results for lower body and shoulder kinematics. However, the tracking of the wrist and pelvis still needs to be refined. The research results provide a basis for further investigations that promote the fusion of VMC and musculoskeletal models. [ABSTRACT FROM AUTHOR]

Background: Shift work has been identified as a risk factor for several chronic health conditions including obesity. This study evaluated the impact of a low-calorie meal replacement (MR) as a dinner substitute on body composition and metabolic parameters in shift workers with overweight and obesity. Methods: An 8-week parallel, randomized controlled trial was conducted on overweight and obese shift workers in a large hospital. An intervention group (IG) (n = 25) was provided with a low-calorie MR shake (∼200 kcal) as a replacement for dinner, every day for 8 weeks, while the control group (CG) (n = 25) continued their habitual diet. Anthropometric measurements, body composition, biochemical, and lifestyle data were assessed at the first and last visits. Analyses were done per protocol (PP) and by intention to treat (ITT). Results: Over the study duration, both groups displayed moderate changes in anthropometric measurements and body composition, although these were not statistically significant according to the PP analysis. In the ITT analysis, apart from the hip circumference (HC), all other anthropometric parameters demonstrated significant group and time interactions, suggesting the advantageous effects of the meal replacement over the study period (P < 0.05). HDL and VLDL cholesterol measures showed significant main effects, influenced by both group (P = 0.031) and time (P = 0.050) respectively. The most pronounced dietary shift in the IG was a reduction in carbohydrate consumption and an increase in protein intake. Throughout the study, the meal replacement was well-tolerated, with no adverse events reported. Conclusions: The meal replacement dietary intervention appears to offer beneficial health effects over time. Extended research is crucial to understand the broader implications of meal replacements across diverse populations. Trial registration: Australian New Zealand Clinical Trials Registry (ANZCTR): ACTRN12622000231741. Registered on 09 February 2022. https://www.anzctr.org.au/ACTRN12622000231741.aspx. [ABSTRACT FROM AUTHOR]

The article explores the significant impact of trochanteric hip fractures on elderly patients' quality of life and highlights their increasing prevalence due to global demographic shifts. It also discusses three critical concepts in managing these fractures: the tip-apex distance for implant placement, the importance of lateral trochanteric wall integrity in choosing fixation methods, and the role of anteromedial cortical support (AMCS) in fracture reduction.

Background: Femoral neck system (FNS) has exhibited some drawbacks, such as non-fit of the plate with the lateral femoral cortex, postoperative pain, and the potential risk of subtrochanteric fractures. We have developed a low-profile FNS system that addresses some compatibility issues in FNS. In this study, we conducted finite element analysis on the 1-hole FNS (1 H-FNS), 2-holes FNS (2 H-FNS), and low-profile FNS (LP-FNS) and compared their biomechanical performance. Methods: After the mesh convergence analysis, we established three groups of 1 H-FNS, 2 H-FNS, and LP-FNS. The interfragmentary gap, sliding distance, shear stress, and compressive stress and the bone-implant interface compression stress, stiffness, and displacement were determined under the neutral, flexion, or extension conditions of the hip joint, respectively. The stress and displacement of the femur after the implant removal were also investigated. Results: (1) There were no obvious differences among the three FNS groups in terms of the IFM distance. However, the LP-FNS group showed less rotational angle compared with conventional FNS (neutral: 1 H-FNS, -61.64%; 2 H-FNS, -45.40%). Also, the maximum bone-implant interface compression stress was obviously decreased under the neutral, flexion, or extension conditions of the hip joint (1 H-FNS: -6.47%, -20.59%, or -4.49%; 2 H-FNS: -3.11%, 16.70%, or -7.03%; respectively). (2) After the implant removal, there was no notable difference in the maximum displacement between the three groups, but the maximum von Mises stress displayed a notable difference between LP-FNS and 1 H-FNS groups (-15.27%) except for the difference between LP-FNS and 2 H-FNS groups (-4.57%). Conclusions: The LP-FNS may not only provide the same biomechanical stabilities as the 1 H-FNS and 2 H-FNS, but also have more advantages in rotational resistance especially under the neutral condition of the hip joint, in the bone-implant interface compression stress, and after the implant removal. In addition, the 1 H-FNS and 2 H-FNS have similar biomechanical stabilities except for the maximum von Mises stress after the implant removal. The femur after the LP-FNS removal not only is subjected to relatively little stress but also minimizes stress concentration areas. Highlights: We developed a low-profile FNS of screws in sleeves and demonstrated that the LP-FNS might not only provide the same biomechanical stabilities as the 1 H-FNS and 2 H-FNS, but also have more advantages in rotational resistance especially under the neutral condition of the hip joint, in the bone-implant interface compression stress, and after the implant removal. The 1 H-FNS and 2 H-FNS groups had no notable difference in biomechanical stabilities except for the maximum von Mises stress after the implant removal. Our study, for the first time, examined the stress and displacement of the femur after the implant removal and indicated that the femur after the LP-FNS removal not only was subjected to relatively little stress but also minimized stress concentration areas compared with the femur after the 1 H-FNS or 2 H-FNS removal. [ABSTRACT FROM AUTHOR]

Hip flexion angle-moment may not be measured accurately due to the measurement posture. Maximum isometric hip flexion moment was measured while excluding the effects of postural retention function and compensatory motion. Experiment 1: Maximum isometric flexion moment of the hip joint was measured at 0∘, 30∘, 60∘, 90∘, and 105∘ in 195 participants. Experiment 2: Maximum isometric hip flexion moment of 33 participants was measured in standing and supine position at 0∘ hip flexion and in end-sitting and supine position at 105∘. Experiment 1: No interaction was observed between sex and hip angle, and hip flexion moment was minimum at 0∘ hip flexion and maximum at 105∘ hip flexion in both sexes (p< 0.01). Experiment 2: An interaction between measurement position and hip angle was observed, with maximum isometric flexion moment being greater in the supine position than in the standing position (p< 0.01). Maximum isometric hip flexion moment was greater at 105∘ than at 0∘ flexion (p< 0.01). Maximum isometric hip flexion moment showed greater joint angle-moment characteristics in deep flexion than in shallow flexion of the hip when excluding the effects of postural retention function and compensatory motion. [ABSTRACT FROM AUTHOR]

The article delves into specific nerve pathways and their role in hip joint innervation, highlighting the sensory and motor functions involved. It also discusses common clinical scenarios where knowledge of hip joint innervation is essential for accurate diagnosis and effective treatment, such as in cases of hip pain, trauma, or postoperative management.

BACKGROUD: The control of hip and ankle joint movement is important for patients with dynamic knee valgus (DKV), but few studies have used non-elastic taping (NET) to adjust alignment of the hip and ankle joints during overhead squat (OHS) simultaneously in patients with DKV. OBJECTIVE: We investigated changes in lower extremity joint kinematics and dynamic balance after the application of NET to the hip and ankle joints during OHS. METHODS: A total of 30 DKV patients participated in this study. We determined the kinematics of the hip, knee, and ankle joints, and scores on the lower quarter Y-balance test (YBT-LQ) during OHS under three conditions (non-taping, NET on hip and ankle, and sham taping). RESULTS: Hip internal rotation, knee valgus, and the ankle dorsiflexion angle were significantly lower with NET than with non- or sham taping. The hip flexion angle and scores on the YBT-LQ were significantly greater with NET than with non- or sham taping. CONCLUSIONS: The application of NET while performing a OHS is a useful method for correcting lower extremity alignment in patients with DKV, however, application of NET on the ankle should be considered. [ABSTRACT FROM AUTHOR]

General principles of cartilage repair therapies have not changed in the last years. Recommendations for cartilage repair include symptomatic ICRS grade 3 and 4 classified cartilage defects. However, what has changed in the last years is a better understanding of underlying or concomitant pathologies. Since a more precise analysis and stringent therapy of concomitant pathologies has been performed, an increase in success rates especially in formerly difficult entities could be observed. The most important concomitant pathologies in cartilage therapies of the hip-, knee- and ankle joint are axis deviations, instabilities, meniscus pathologies or prearthrotic deformities like hip dysplasia and femuroacetabular impingement syndrome. To increase the efficiency of cartilage repair procedures these pathologies should be corrected either prior to, or at latest concomitant to any cartilage repair surgery. Therefore, this article is intended to give an overview of the most important concomitant pathologies in cartilage repair of the lower extremities and their possibilities of correction. [ABSTRACT FROM AUTHOR]

Nano-finishing processes have revolutionized industrial surface therapy, providing excellent chances to improve surface integrity in various medical sectors. However, in biomedical implants, future expectations and standards for improving surface roughness will rise simultaneously with the growth in demand for artificial implants. Therefore, consistently achieving an appropriate surface finish is still challenging, especially in replacement implant parts like femoral knee, elbow, and hip joints that need a nano level of surface finish according to ISO 7206-2: 2011/AMD 1:2016 standards. This review briefly discusses the utilization of titanium and its alloys in biomedical implants due to its numerous qualities, including great corrosion resistance, superior mechanical capabilities, and excellent biocompatibility. Also, the review presents the most recent and advanced nano-finishing processes used to improve the surface quality of titanium alloys to enhance their functionality and biocompatibility. These advanced nano-finishing processes are systematically presented as mechanical, chemical, and hybrid finishing processes. The remarkable magnetic field-assisted finishing process achieved the lowest surface finish Sa (∼10 nm), an approximately ΔSa 98 % improvement. Further, this review addresses challenges and limitations in the advanced nano-finishing of titanium alloys for biomedical implant applications. [Display omitted] • Nano-finishing processes significantly improve surface quality and roughness in medical applications. • Titanium alloys are ideal for biomedical implants due to their mechanical properties and biocompatibility. • Precision surface finishing is difficult for complicated implant parts including knee, elbow, and hip joints. • The demand for artificial implants is expected to grow, driving future advancements in implant technology. [ABSTRACT FROM AUTHOR]

Study objective We report a novel block technique aimed to provide lumbosacral, abdominal, and hip analgesia: The quadro-iliac plane (QIP) block. Design A cadaveric examination that evaluates the spread of QIP block. Setting Cadaver laboratory. Patients One unembalmed cadaver. Interventions Bilateral ultrasound-guided QIP blocks on cadavers with 40 mL of methylene blue %0.5 each side. Measurements Dye spread in cadaver. Main results There was staining in the deep interfascial plane of the erector spinae muscles. Extensive staining of the interfascial plane corresponding to the posterior aspect of the quadratus lumborum muscle (QLM) was observed. There was extensive staining on the anterior surface of the QLM. There was spread of dye traversing along the transversalis fascia and significantly infiltrating retroperitoneal fat tissue. Bilateral staining of the ilioinguinal and iliohypogastric nerves was observed. On the right, there was minimal staining over the subcostal nerve. There was dye present bilaterally within the deep regions of the transverse processes. The lumbar plexus was stained on both sides. Conclusion The local anesthetic applied from a place where the QLM reaches its largest volume and the fascial plane creates a closed gap in the caudal area may exhibit a more rounded and extensive spread. Quadro-iliac plane block, involves the administration of local anesthetic to the posterior aspect of the QLM at its origin from the iliac crest. According to our cadaver study, this technique may be a promising option for alleviating acute and chronic pain in the lumbosacral, lower abdominal, and hip regions. [ABSTRACT FROM AUTHOR]

Both running performance and injury have been associated with running kinematics. Plyometric training improves run performance and reduces injury risk in court-sport and field-sport athletes. The aim of this study was to assess longitudinal changes in kinematics in novice runners before and after a typical beginners' running program, compared with those who perform a plyometric intervention before running. Fifty-seven novice female runners were assigned to the control group (8 weeks walking +8 weeks running) or the intervention group (8 weeks strength or plyometric training +8 weeks running). Kinematics were assessed at baseline, 8 weeks, and 16 weeks. Joint angles throughout the stride of those who completed the training (n = 21) were compared between groups and assessment time points using a statistical parametric mapping 2-way analysis of variance, with group and study time point as independent variables. There was no interaction effect of group and study time point (p > 0.05), indicating that both training programs had similar effects on running kinematics. There was a main effect of time for sagittal plane knee and hip kinematics (p < 0.001); after training, subjects ran with a more extended leg, particularly during swing. Programs of 8 weeks of preparatory training, followed by 8 weeks of running, resulted in altered sagittal plane biomechanics, which have previously been related to improved running economy. A greater volume of plyometric, run training or concurrent plyometric and run training may be required to elicit changes in running form associated with lower injury risk. [ABSTRACT FROM AUTHOR]

Avascular Necrosis (AVN) is a pathological condition characterised by a reduction in the blood supply to the subchondral bone, leading to the degenerative condition of the bone, marked by the death of cellular components of the bone. It is also known as osteonecrosis. The epiphysis of long bones at weight-bearing joints is typically affected. All of these conditions have a poor prognosis. In Ayurveda, it corresponds to Asthivahastrotodushtivikara (musculoskeletal disorder) as there is kshaya (necrosis) of asthi (bone) and Majja (bone marrow) dhatu (major structural components of the body). In modern medicine, AVN is managed by the use of corticosteroids and many surgical procedures such as drilling, insertion of prosthetics, or bone grafts. Therefore, Ayurveda provides a conservative line of treatment based on the principle of Asthi-majjagatkashaya (decalcification of bone) caused by abhighatajanyavataprakopa (trauma). A case of AVN with the right femoral head was treated with shaman (oral medications), Sodhana (bio-purification), and bruhmana (rejuvenation) procedures. The therapy provided significant improvements in pain and range of movement of the hip joint, based on the patient's signs and symptoms before and after treatment. Conservative treatment can give outstanding results, improve the quality of life, halt disease progression, and help manage AVN by tissue regeneration without harmful effects. [ABSTRACT FROM AUTHOR]

Purpose: This study aimed to investigate the distance and correlation between the anatomy of the anterior side of the hip joint and the femoral nerve. Methods: Using ten fresh-frozen cadavers with twenty hip joints. We dissected and marked the femoral nerve in the inguinal area. Employing the direct anterior approach, we identified and marked study points, including the superior and inferior points of the anterior rim of the acetabulum, ¼ point, half point, and ¾ point along an imagined line connecting the formers, the inferomedial and mid aspect of the femoral neck, and the soft spot. Coronal plane measurements gauged the distance between these points and the femoral nerve. The collected data were analyzed to assess the distance and correlation. Results: In the coronal plane, the median distance between the inferior point of the anterior rim of the acetabulum and the femoral nerve was 0 millimeters (interquartile range [IQR] 0–0). Likewise, the median distance between the mid aspect of the medial side of the femoral neck and the femoral nerve was 0 millimeters (IQR 0–0). Additionally, the mean distance between the soft spot and the femoral nerve was 1.18 cm (SD 0.63). Conclusion: Surgeons approaching the hip joint via the direct anterior approach should be cautious at the inferior point of the anterior rim of the acetabulum and the mid aspect of the femoral neck. The soft spot at the anterior rim of the acetabulum remains safe from direct injury when surgeons use the correct technique during anterior retractor insertion. [ABSTRACT FROM AUTHOR]

Neurofibromatosis is an autosomal-dominant multi-system disease affecting the nervous, integumentary, ocular, and musculoskeletal systems. In the small number of reported cases, the cause was either atraumatic or an intra-articular neurofibroma. Only a couple of articles in medical literature have reported synovial and capsular hemangioma originating within the hip joint. In this article, we present a rare case of pathological hip dislocation in a neurofibromatosis patient secondary to capsular hemangioma that would be reported for the first time in medical literature. We present the case of a 20-year-old female, resident of Karachi, who presented to the outpatient clinic with pain in the left hip join and inability to bear weight on left leg for 1 week. Diagnosed as a case of posterior hip dislocation after physical examination and imaging, her dislocation was reduced by the Allis method. This maneuver, however, was unsuccessful. Ultimately, the joint was reduced with open reduction via Steinmann pin because post-reduction hip joint was unstable to be contained into the acetabulum; therefore, Steinmann pin was used. The biopsy specimen taken from joint capsule and femoral neck during the surgery revealed cavernous hemangioma within the capsule. Hence, the etiology of posterior hip dislocation was attributed to the presence of capsular hemangioma within the hip joint. The surgery proved successful. The patient had remarkable recovery. The Steinmann pin was removed at 6 weeks, full weight-bearing started at 3 months, and range of motion extended from 0 to 90 degrees at 1 year with imaging studies showing a normally placed hip joint. The presented case reports an unusual etiology of a rare pathology occurring in association with a common genetic disease. It focuses on the importance of thorough examination and extensive relevant investigations in patients presenting with rare pathologies. These practices not only expedite the diagnosis and treatment of such patients, but can also reveal unusual etiologies responsible for uncommon pathologies. This case would help widen the differential diagnosis and treatment strategies of the physicians while dealing with neurofibromatosis patients with pathological hip dislocation. Level of Evidence This is a case report having Level of Evidence 4 in accordance with the levels developed by the Centre of Evidence Based Medicine (CEBM) for treatment. [ABSTRACT FROM AUTHOR]

Purpose: Idiopathic chondrolysis of the hip is characterized by the loss of the articular cartilage of the hip joint with spectrum ranging from full recovery to fibrous ankylosis. Study assessed outcomes following intra-articular steroid injections, joint manipulation and traction immobilization. Methods: Retrospective (2012–2021) review of 41 cases treated for idiopathic chondrolysis of hip, assessed pre-operatively and post-operatively (minimum 2-year follow-up) using Children's Hospital Oakland Hip Evaluation Score (CHOHES), visual analogue scale (VAS) and range of motion measurements. Results: Twenty-five patients (62%) achieved painless mobility, 6 (14%) had hip stiffness without pain and 10 (24%) had painful and stiff hips at final follow-up. They had a mean age of 12.49 ± 2.4 years and a mean follow-up duration of 33.15 ± 13.1 months. Range of motion improved significantly (p < 0.05). VAS improved to 3.93 ± 1.3 from 7.8 ± 0.7. CHOHES improved from 29.12 ± 9.9 to 56.37 ± 17.6. Conclusion: Intra-articular steroid injection, manipulation and traction immobilization may effectively treat idiopathic chondrolysis of the hip by enhancing patient function and reducing the need for further surgical intervention. [ABSTRACT FROM AUTHOR]

Purpose: This study is aimed at determining the rates and predictors of re-operation and re-admission in children with septic arthritis treated at an institution without routine clinical practice guidelines. Methods: This is a retrospective cohort study of patients less than 18 years old who underwent surgery for septic arthritis between January 1, 2009, and January 1, 2019, at a single tertiary-care paediatric institution. Uni- and multivariate analysis was performed to identify any risk factors associated with re-operation or unplanned visits to the emergency department after hospital admission compared to patients who had an uncomplicated post-operative course. Results: One hundred and forty-four patients were included. The mean age was five years (range 1 month–17 years), and the most commonly affected joint was the hip. The re-admission rate was 1% (n = 2), and the re-operation rate was 8% (n = 12). Twenty percent of patients (n = 29) had unplanned presentations to the emergency department (ED) after discharge. Discharge CRP level was not significantly higher in patients with unplanned presentations to the ED or re-operation. Positive joint fluid culture and infection of any other joint than the hip increased the likelihood of re-operation. Patients who had septic arthritis of the hip were more likely to have an unplanned ED presentation. Conclusions: Rates of re-admission and re-operation were similar to literature despite lack of a standardized treatment pathway or discharge protocol. Outcomes of pediatric septic arthritis did not correlate with discharge CRP level. There was a high rate of unplanned ED visits after discharge. [ABSTRACT FROM AUTHOR]

Purpose: Hip vessel examination provides key information on many hip-related pediatric diseases, and it has an important role in the evaluation of femoral head (FH) blood supply and diagnosis of avascular necrosis (AVN). The aim of this study was to investigate the feasibility of MR-enhanced high-resolution three-dimensional water-selective cartilage (3D-WATSc) sequence in visualizing the vessels of the hip joint in children. Patients and methods: Children with hip disease were randomly enrolled prospectively at our hospital from January 2021 to August 2022. We performed our institution's hip MRI protocol and enhanced high-resolution 3D-WATSc sequence. The 3D-WATSc images were reconstructed and analyzed, and images of the normal hip were categorized into grades 0–3. The abnormal hip images were compared with those of the normal side using the χ2 test. Results: Twenty-four patients with unilateral hip abnormalities were included in this study. The cartilaginous vascular canal and ossification centre vessels of normal FHs were observed in 18 patients (75%) and met the grade 3 standard. An abnormal cartilaginous canal was observed in 16 patients (67%); meanwhile, 18 patients (75%) had abnormal extrachondral vessels. Comparison of high-resolution 3D-WATSc images with those of the normal side provided effective abnormal vascular information in 95.8% of patients. Conclusions: Enhanced high-resolution 3D-WATSc can visualize the blood vessels of the hip in children. This may provide a new method for the vascular study of various pediatric hip diseases. [ABSTRACT FROM AUTHOR]

Purpose: The purpose of the study was to determine which of the ankle, knee or hip joint is the most important contributor to horizontal velocity during maximal sprint running. Furthermore, it was undertaken to quantify the fraction of propulsive power and work produced at each of the three joints. Methods: Seven athletes of national class served as subjects for the study. One running cycle of each subject was recorded by four video cameras (240 f/s) and a recessed force platform. Inverse dynamics in 3D was calculated as well as an angle between joint moment and angular velocity to express propulsive power and propulsive joint work. Results: Previous studies indicating the hip joint being the most important joint could not be confirmed by the present results due to large inter-individual differences for the hip joint. Averaged across all subjects, 64% of the normalized positive ankle joint work and 71% of the knee joint work were propulsive, while for the hip joint, four athletes showed 0%, one athlete 8%, and two athletes 96% and 97% propulsive work, respectively. For the whole leg, the propulsive fraction was 70% of the total positive work (range 40–87%). Normalized propulsive work was significantly correlated with maximal running velocity. Conclusion: The whole leg should be considered as one functional unit in which one or more of the joints may dominate generation of propulsive joint work. [ABSTRACT FROM AUTHOR]

Background: Hip dislocations, constituting 2-5 percent of all joint dislocations, predominantly present as posterior dislocations. Bilateral hip dislocations are rare, accounting for 1.25% of cases. Associated fractures often involve the proximal femur and acetabulum. Case Report: A 60-year-old man with no prior hip trauma history sustained bilateral hip dislocations after a 6-meter fall. Initial assessments and a hip computed tomography (CT) scan confirmed posterior dislocation of the right hip and anterior dislocation of the left hip. The patient underwent a successful closed pelvic reduction operation four hours post-injury, as confirmed by a post-reduction CT scan. Conclusion: The study, encompassing 11 relevant studies and 208 patients, predominantly men (81%), revealed that asymmetrical bilateral hip dislocations were exceptionally rare (0.01-0.02 percent). Contrary to expectations, this study challenges the presumed stronger association of traffic accidents with bilateral dislocations, presenting a statistically significant association between the type of dislocation and trauma mechanism. Associated fractures, such as acetabulum fractures in unilateral cases and posterior edge fractures in bilateral cases, varied. Avascular necrosis (AVN), a common complication, was not observed in the current case, where reduction occurred within the critical 6-hour timeframe. This report contributes valuable insights into the characteristics and associations of asymmetric bilateral hip dislocations, emphasizing the importance of prompt intervention to mitigate complications. Further research is needed to validate these findings and explore underlying patterns in this rare clinical scenario. [ABSTRACT FROM AUTHOR]

Purpose: This report presents the long-term results of the hip joint reconstruction in patients with spastic hip disease through open reduction, proximal femur varus derotation osteotomy, and Dega transiliac osteotomy. Methods: We analyzed retrospectively patients diagnosed with a spastic form of bilateral cerebral palsy with painful hip subluxation or dislocation. All patients underwent the same surgical procedure. The minimum follow-up time was 15 years. The study group comprised 15 patients (22 hips), classified with the Gross Motor Function Classification System as levels IV and V. The hip joint range of motion and anteroposterior X-ray examination at the final follow-up visit were compared with pre-operative data. The pain level was evaluated using the Visual Analogue Scale (VAS), and the femoral head shape was assessed using the Rutz classification. The patients' caregivers answered questions regarding pain during sitting, personal hygiene activities, and at rest. The caregivers' satisfaction with the treatment was also assessed with the Caregiver Priorities and Child Health Index of Life with Disabilities questionnaire. Results: We observed a significant reduction of the hip joint pain and improvement in both radiological hip stability parameters and range of motion at the final follow-up visit. Based on the Rutz classification, one hip remained type B, while the other joints became type A. Reduced pain was reported in all three positions, with the most pronounced improvement during sitting and personal hygiene activities. Interestingly, patients with unilateral hip reconstruction were more prone to pain after reconstruction than those operated bilaterally. Conclusion: Primary reconstruction of the painful hip joint neurogenic dislocation results in a stable joint reduction, pain decrease, and improved quality of life in patients with cerebral palsy. Level of evidence: IV case series. [ABSTRACT FROM AUTHOR]

Background: The indirect head of the rectus femoris (IHRF) tendon has been used as an autograft for segmental labral reconstruction. However, the biomechanical properties and anatomic characteristics of the IHRF, as they relate to surgical applications, have yet to be investigated. Purpose: To (1) quantitatively and qualitatively describe the anatomy of IHRF and its relationship with surrounding arthroscopically relevant landmarks; (2) detail radiographic findings pertinent to IHRF; (3) biomechanically assess segmental labral reconstruction with IHRF, including restoration of the suction seal and contact pressures in comparison with iliotibial band (ITB) reconstruction; and (4) assess potential donor-site morbidity caused by graft harvesting. Study Design: Descriptive laboratory study. Methods: A cadaveric study was performed using 8 fresh-frozen human cadaveric full pelvises and 7 hemipelvises. Three-dimensional anatomic measurements were collected using a 3-dimensional coordinate digitizer. Radiographic analysis was accomplished by securing radiopaque markers of different sizes to the evaluated anatomic structures of the assigned hip.Suction seal and contact pressure testing were performed over 3 trials on 6 pelvises under 4 different testing conditions for each specimen: intact, labral tear, segmental labral reconstruction with ITB, and segmental labral reconstruction with IHRF. After IHRF tendon harvest, each full pelvis had both the intact and contralateral hip tested under tension along its anatomic direction to assess potential site morbidity, such as tendon failure or bony avulsion. Results: The centroid and posterior apex of the indirect rectus femoris attachment are respectively located 10.3 ± 2.6 mm and 21.0 ± 6.5 mm posteriorly, 2.5 ± 7.8 mm and 0.7 ± 8.0 mm superiorly, and 5.0 ± 2.8 mm and 22.2 ± 4.4 mm laterally to the 12:30 labral position. Radiographically, the mean distance of the IHRF to the following landmarks was determined as follows: anterior inferior iliac spine (8.8 ± 2.5 mm), direct head of the rectus femoris (8.0 ± 3.9 mm), 12-o'clock labral position (14.1 ± 2.8 mm), and 3-o'clock labral position (36.5 ± 4.4 mm). During suction seal testing, both the ITB and the IHRF reconstruction groups had significantly lower peak loads and lower energy to peak loads compared with both intact and tear groups (P =.01 to.02 for all comparisons). There were no significant differences between the reconstruction groups for peak loads, energy, and displacement at peak load. In 60° of flexion, there were no differences in normalized contact pressure and contact area between ITB or IHRF reconstruction groups (P >.99). There were no significant differences between intact and harvested specimen groups in donor-site morbidity testing. Conclusion: The IHRF tendon is within close anatomic proximity to arthroscopic acetabular landmarks. In the cadaveric model, harvesting of the IHRF tendon as an autograft does not lead to significant donor-site morbidity in the remaining tendon. Segmental labral reconstruction performed with the IHRF tendon exhibits similar biomechanical outcomes compared with that performed with ITB. Clinical Relevance: This study demonstrates the viability of segmental labral reconstruction with an IHRF tendon and provides a detailed anatomic description of the tendon in the context of an arthroscopic labral reconstruction. Clinicians can use this information during the selection of a graft and as a guide during an arthroscopic graft harvest. [ABSTRACT FROM AUTHOR]

Background: In patients with femoroacetabular impingement (FAI), mental health has been implicated in both symptom severity and postoperative outcomes. However, there are limited data regarding the independent influences of baseline mental health and hip pathology on patient-reported outcomes over time after hip arthroscopy. Purpose: To evaluate the association between mental health and structural hip pathology with pain, hip function, and quality of life (QOL). Study Design: Cohort study; Level of evidence, 3. Methods: Patient records from a single surgeon's hip outcomes registry were retrospectively reviewed. Mental health was evaluated using the Patient-Reported Outcomes Measurement Information System Anxiety and Depression scores. Pain was evaluated with the Single Assessment Numeric Evaluation score for Activities of Daily Living (SANE-ADL), while hip-related QOL was evaluated with the 12-item International Hip Outcome Tool (iHOT-12). Hip function was assessed with the Hip Outcome Score (HOS) Sport-Specific (SS) and ADL subscales. Separate mixed models were used to predict pain, QOL, and hip function, including hip pathology measures (size of labral tear, grade of chondral damage, preoperative alpha angle), anxiety, depression, and time as fixed effects and individuals as a random effect. Results: A total of 312 patients were included in this study. The preoperative alpha angle, degree of intraoperative cartilage damage, and size of the labral tear were not associated with pain or QOL (P >.05 for all). However, higher levels of anxiety and depression were significantly associated with lower SANE-ADL scores (estimate ± SE) (anxiety: –0.59 ± 0.07, P <.0001; depression: –0.64 ± 0.08, P <.0001), iHOT-12 scores (anxiety: –0.72 ± 0.07, P <.0001; depression: –0.72 ± 0.08, P <.0001), HOS-SS scores (anxiety: –0.68 ± 0.09, P <.0001; depression: –0.57 ± 0.10, P <.0001), and HOS-ADL scores (anxiety: –0.43 ± 0.05, P <.0001; depression: –0.43 ± 0.06, P <.0001). Conclusion: Patients had similar improvements in pain scores, QOL, and hip function after hip arthroscopy for FAI irrespective of their degree of hip pathology. Additionally, preoperative symptoms of anxiety and depression symptoms were associated with greater pain, decreased QOL, and worse hip function both pre- and postoperatively, independent of the degree of hip pathology. This suggests that efforts to directly address symptoms of anxiety and depression may improve outcomes after hip arthroscopy. [ABSTRACT FROM AUTHOR]

Background: After posterior cruciate ligament reconstruction (PCLR), functional deficits at the knee can persist. It remains unclear if neighboring joints compensate for the knee during demanding activities of daily living. Purpose: To assess long-term alterations in lower limb mechanics in patients after PCLR. Study Design: Descriptive laboratory study. Methods: A total of 28 patients who had undergone single-bundle unilateral isolated or combined PCLR performed stair navigation, squat, sit-to-stand, and stand-to-sit tasks at 8.2 ± 2.2 years after surgery. Motion capture and force plates were used to collect kinematic and kinetic data. Then, 3-dimensional hip, knee, and ankle kinematic data of the reconstructed limb were compared with those of the contralateral limb using statistical parametric mapping. Results: Side-to-side differences at the knee were primarily found during upward-driven movements at 8 years after surgery. The reconstructed knee exhibited lower internal rotation during the initial loading phase of stair ascent versus the contralateral knee (P =.005). During the sit-to-stand task, higher flexion angles during the midcycle (P =.017) and lower external rotation angles (P =.049) were found in the reconstructed knee; sagittal knee (P =.001) and hip (P =.016) moments were lower in the reconstructed limb than the contralateral limb. In downward-driven movements, side-to-side differences were minimal at the knee but prominent at the ankle and hip: during stair descent, the reconstructed ankle exhibited lower dorsiflexion and lower external rotation during the midcycle versus the contralateral ankle (P =.006 and P =.040, respectively). Frontal hip moments in the reconstructed limb were higher than those in the contralateral limb during the stand-to-sit task (P =.010); during squats, sagittal hip angles in the reconstructed limb were higher than those in the contralateral limb (P <.001). Conclusion: Patients after PCLR exhibited compensations at the hip and ankle during downward-driven movements, such as stair descent, squats, and stand-to-sit. Conversely, residual long-term side-to-side differences at the knee were detected during upward-driven movements such as stair ascent and sit-to-stand. Clinical Relevance: After PCLR, side-to-side differences in biomechanical function were activity-dependent and occurred either at the knee or neighboring joints. When referring to the contralateral limb to assess knee function in the reconstructed limb, concentric, upward-driven movements should be prioritized. Compensations at the hip and ankle during downward-driven movements lead to biases in long-term functional assessments. [ABSTRACT FROM AUTHOR]

Background: The morphology of coxa profunda remains inadequately understood. However, knowledge about the characteristics of the acetabulum in coxa profunda can help to predict pelvic morphology in three dimensions based on radiographic findings, as well as help to diagnose and predict hip pathologies. Therefore, this study aimed to investigate the relationship between the morphological characteristics of the pelvis and coxa profunda. Methods: We conducted a retrospective analysis including women who had undergone unilateral total hip arthroplasty. Only those with normal hip joint morphology on the opposite side, as evidenced by anteroposterior pelvic radiography showing a distance of ≥ 2 mm between the ilioischial line and acetabular floor, were included. Five parameters related to acetabular anteversion, thickness, and the position of the ilioischial line were measured using axial computed tomography at the central hip joint. The coxa profunda group (n = 39) and control group (n = 34) were compared. Results: The mean acetabular anteversion angle was 12.5° ± 4° in the control group and 22.3° ± 5.6° in the coxa profunda group. The mean thickness from the acetabular fossa to the medial wall was 7.5 ± 1.7 mm in the control group and 3.9 ± 1.2 mm in the coxa profunda group. Furthermore, the bony region representing the ilioischial line was positioned more posteriorly in the coxa profunda group than it was in the control group. Conclusion: Our findings suggest that coxa profunda in women is associated with anterior acetabular dysplasia and a thin acetabulum, in contrast to previous interpretations of excessive coverage. This insight suggests a conversion of coxa profunda from a finding of pincer-type femoroacetabular impingement to a finding of acetabular dysplasia, a revelation that also draws attention to cup positioning for total hip arthroplasty. [ABSTRACT FROM AUTHOR]

Background: Patient outcomes following low-trauma hip fracture are suboptimal resulting in increased healthcare costs and poor functional outcomes at 1 year. Providing early and intensive in-hospital physiotherapy could help improve patient outcomes and reduce costs following hip fracture surgery. The HIP fracture Supplemental Therapy to Enhance Recovery (HIPSTER) trial will compare usual care physiotherapy to intensive in-hospital physiotherapy for patients following hip fracture surgery. The complex environments in which the intervention is implemented present unique contextual challenges that may impact intervention effectiveness. This study aims to complete a process evaluation to identify barriers and facilitators to implementation and explore the patient, carer and clinician experience of intensive therapy following hip fracture surgery. Methods and analysis: The process evaluation is embedded within a two-arm randomised, controlled, assessor-blinded trial recruiting 620 participants from eight Australian hospitals who have had surgery for a hip fracture sustained via a low-trauma injury. A theory-based mixed method process evaluation will be completed in tandem with the HIPSTER trial. Patient and carer semi-structured interviews will be completed at 6 weeks following hip fracture surgery. The clinician experience will be explored through online surveys completed pre- and post-implementation of intensive therapy and mapped to domains of the Theoretical Domains Framework (TDF). Translation and behaviour change success will be assessed using the Reach Effectiveness-Adoption Implementation Maintenance (RE-AIM) framework and a combination of qualitative and quantitative data collection methods. These data will assist with the development of an Implementation Toolkit aiding future translation into practice. Discussion: The embedded process evaluation will help understand the interplay between the implementation context and the intensive therapy intervention following surgery for low-trauma hip fracture. Understanding these mechanisms, if effective, will assist with transferability into other contexts and wider translation into practice. Trial registration: ACTRN 12622001442796. [ABSTRACT FROM AUTHOR]

Falls in older individuals are a serious health issue in super-aged societies. The stepping reaction is an important postural strategy for preventing falls. This study aimed to reveal the characteristics of lateral stepping in response to mechanical disturbance by means of an analysis of the hip joint kinematics in the stepping leg and head stability during crossover steps. The participants included 11 healthy older and 13 younger individuals. An electromagnet-controlled disturbance-loading device induced crossover steps due to lateral disturbance. Responses were measured using a motion capture system and force plates. The righting reaction of the head was quantified by lateral displacement (sway), neck joint kinematics (angle displacement, angular velocity), and neck joint moment during crossover stepping. Moreover, the relationship between the neck lateral bending moment and angular velocity of hip flexion/adduction of the stepping leg was examined. The lateral head sway was significantly larger in the older participants (1.13±0.7 m/s2) than in the younger individuals (0.54±0.3 m/s2); whereas, the angle displacement (older -14.1±7.1 degree, young -8.3±4.5 degree) and angular velocity (older 9.9±6.6 degree/s, 41.2±27.7 degree/s) of the head were significantly lower in the older than in the younger participants. In both groups, the moment of neck lateral bending exhibited a significant negative correlation with the hip flexion angular velocity of the stepping leg. Correlation analysis also showed a significant negative correlation between the neck lateral bending moment and hip adduction angular velocity only in the older group (r = 0.71, p<0.01). In conclusion, older individuals increased instability in the lateral direction of the head and decreased righting angle displacement and angular velocity of the head during crossover steps. The correlation between neck moment and hip flexion/adduction angular velocity suggested a decrease in step speed due to increased neck muscle tone, which could be influenced by vestibulospinal reflexes. [ABSTRACT FROM AUTHOR]

Background: Hip arthroscopy with initial access to the peripheral compartment could reduce the risk of iatrogenic injury to the labrum and cartilage; furthermore, it avoids the need for large capsulotomies with separate portals for peripheral and central (intra-articular) arthroscopy. Clinical results of the peripheral-compartment-first technique remain sparse, in contrast to those of conventional hip arthroscopy starting in the intra-articular central compartment. The purpose of this study was to assess outcome of hip arthroscopy with the peripheral-compartment-first technique, including complication rates, revision rates and patient-reported outcome scores. Materials and methods: This outcome study included 704 hips with femoroacetabular impingement. All arthroscopies were performed using the peripheral-compartment-first technique. A joint replacement registry and the institutional database were used to assess the revision and complication rates, while patient-reported outcome measures were used to assess functional outcomes and patient satisfaction. Results: In total, 704 hips (615 patients) were followed up for a mean of 6.2 years (range 1 to 9 years). The mean age of the patients was 32.1 ± 9.2 years. During the follow-up period, 26 of 704 (3.7%) hips underwent total hip arthroplasty (THA) after a mean of 1.8 ± 1.2 years, and 18 of the 704 (2.6%) hips required revision hip arthroscopy after a mean of 1.2 ± 2.1 years. 9.8% of the hips had an unsatisfactory patient-reported outcome at final follow-up. Conclusions: The results for the peripheral-compartment-first technique were promising. We recommend a well-conducted randomized controlled clinical trial to guide future therapeutic recommendations regarding the most favorable hip arthroscopy technique. Level of evidence: Level IV, therapeutic study. Trial registration: This study was registered at ClinicalTrials.gov (U.S. National Library of Medicine; ID: NCT05310240). [ABSTRACT FROM AUTHOR]

BACKGROUND: At present, postoperative timing or subjective criteria by clinicians are commonly employed to determine the return-to-sport timing for patients undergoing anterior cruciate ligament reconstruction. Unfortunately, these criteria do not adequately consider the biomechanical deficits in patients following anterior cruciate ligament reconstruction. OBJECTIVE: To explore the lower extremity kinematic and kinetic characteristics of athletes after anterior cruciate ligament reconstruction during bilateral vertical jumping. METHODS: Twenty athletes undergoing anterior cruciate ligament reconstruction and twenty healthy athletes, aged 20-24 years, were recruited in Wuhan Sports University from December 2021 to December 2022. All the 40 subjects underwent a bilateral vertical jumping test. The kinematic and dynamic characteristics of the lower limbs at propulsion phase, initial landing time and peak vertical ground reaction force moment. RESULTS AND CONCLUSION: At the initial landing time, the athletes undergoing anterior cruciate ligament reconstruction showed higher hip flexion angle (P=0.031) and lower ankle plantar flexion angle (P=0.018) on the operated side compared with the healthy athletes. At the peak vertical ground reaction force moment, the athletes undergoing anterior cruciate ligament reconstruction had higher hip flexion angle (P=0.016), lower hip abduction angle (P=0.019), lower knee flexion angle (P=0.025), higher knee external rotation angle (P=0.030), and higher ankle external rotation angle (P=0.042) on the operated side compared with the healthy athletes. At the peak vertical ground reaction force moment, the athletes undergoing anterior cruciate ligament reconstruction showed lower knee extension moment (P=0.036), lower knee internal rotation moment (P=0.016), lower hip abduction moment (P=0.004), higher hip extension moment (P=0.040), and higher hip external rotation moment (P=0.005) on the operated side compared with the healthy athletes. To conclude, the athletes undergoing anterior cruciate ligament reconstruction exhibit a stiff landing pattern, in which the knee load on the operated side tends to shift to the hip joint, and show inadequate control of lower limb rotational stability. Therefore, detection and correction of abnormal biomechanical characteristics should be part of the rehabilitation after anterior cruciate ligament reconstruction. [ABSTRACT FROM AUTHOR]

Background: The early introduction of physiotherapy significantly shortens the time required for a patient to regain full mobility after hip arthroplasty. Obtaining the expected result is determined by cooperation with a physiotherapist and the patient's involvement in the rehabilitation process. The aim of this study was to assess the quality of life, life satisfaction, and motor ability of patients after hip arthroplasty. Methods: This study included 147 patients who underwent hip arthroplasty at the Orthopedic and Trauma Department. The research material was collected using questionnaires, and the study used the Barthel Index (BI), Harris Hip Score (HHS), Visual Analogue Scale (VAS), Acceptance of Illness Scale (AIS), and Quality of Life Assessment Questionnaire (WHOQOL-BREF). In the studied group of patients, the Excia cementless endoprosthesis was primarily used (69.39%), as well as the Metha Short Hip prosthesis (15.65%), AM hip prosthesis (10.20%), and bipolar hip prosthesis (4.76%). Results: The analyzed group of patients included 95 women (64.63%) and 52 men (35.37%); the average age was 67 years. Six weeks after hip arthroplasty, mild disability occurred in 53.74% of the patients, while the remaining 46.26% had no disability, and 95.24% of the patients achieved a high level of acceptance of the disease and quality of life. Conclusions: Early improvement after hip replacement surgery contributes to eliminating the disability of the hip joint in the following areas: pain sensation, functionality, lack of deformation, and range of motion. Each subsequent stage of treatment increased the level of acceptance of the disease in the study group. The applied surgical treatment increased satisfaction with overall health and quality of life. [ABSTRACT FROM AUTHOR]

Metabolic syndrome poses a significant health challenge worldwide, prompting the need for comprehensive strategies integrating physical activity monitoring and energy expenditure. Wearable sensor devices have been used both for energy intake and energy expenditure (EE) estimation. Traditionally, sensors are attached to the hip or wrist. The primary aim of this research is to investigate the use of an eyeglass-mounted wearable energy intake sensor (Automatic Ingestion Monitor v2, AIM-2) for simultaneous recognition of physical activity (PAR) and estimation of steady-state EE as compared to a traditional hip-worn device. Study data were collected from six participants performing six structured activities, with the reference EE measured using indirect calorimetry (COSMED K5) and reported as metabolic equivalents of tasks (METs). Next, a novel deep convolutional neural network-based multitasking model (Multitasking-CNN) was developed for PAR and EE estimation. The Multitasking-CNN was trained with a two-step progressive training approach for higher accuracy, where in the first step the model for PAR was trained, and in the second step the model was fine-tuned for EE estimation. Finally, the performance of Multitasking-CNN on AIM-2 attached to eyeglasses was compared to the ActiGraph GT9X (AG) attached to the right hip. On the AIM-2 data, Multitasking-CNN achieved a maximum of 95% testing accuracy of PAR, a minimum of 0.59 METs mean square error (MSE), and 11% mean absolute percentage error (MAPE) in EE estimation. Conversely, on AG data, the Multitasking-CNN model achieved a maximum of 82% testing accuracy in PAR, a minimum of 0.73 METs MSE, and 13% MAPE in EE estimation. These results suggest the feasibility of using an eyeglass-mounted sensor for both PAR and EE estimation. [ABSTRACT FROM AUTHOR]

Exploring high strength materials with a higher concentration of reinforcements in the alloy proves to be a challenging task. This research has explored magnesium-based composites (AZ31B alloy) with tungsten carbide reinforcements, enhancing strength for medical joint replacements via league championship optimisation. The primary objective is to enhance medical joint replacement biomaterials employing magnesium-based composites, emphasising the AZ31B alloy with tungsten carbide reinforcements. The stir casting method is utilised in the manufacture of magnesium matrix composites (MMCs), including varied percentages of tungsten carbide (WC). The mechanical characteristics, such as micro-hardness, tensile strength, and yield strength, have been assessed and compared with computational simulations. The wear studies have been carried out to analyse the tribological behaviour of the composites. Additionally, this study investigates the prediction of stress and the distribution of forces inside bone and joint structures, therefore offering significant contributions to the field of biomedical research. This research contemplates the use of magnesium-based MMCs for the discovery of biomaterials suitable for medical joint replacement. The study focuses on the magnesium alloy AZ31B, with particles ranging in size from 40 to 60 microns used as the matrix material. Moreover, the outcomes have revealed that when combined with MMCs based on AZ31B-magnesium matrix, the WC particle emerges as highly effective reinforcements for the fabrication of lightweight, high-strength biomedical composites. This study uses the league championship optimisation (LCO) approach to identify critical variables impacting the synthesis of Mg MMCs from an AZ31B-based magnesium alloy. The scanning electron microscopy (SEM) images are meticulously analysed to depict the dispersion of WC particulates and the interface among the magnesium (Mg) matrix and WC reinforcement. The SEM analysis has explored the mechanisms underlying particle pull-out, the characteristics of inter-particle zones, and the influence of the AZ31B matrix on the enhancement of the mechanical characteristics of the composites. The application of finite element analysis (FEA) is being used in order to make predictions regarding the distribution of stress and the interactions of forces within the model of the hip joint. This study has compared the physico-mechanical and tribological characteristics of WC to distinct combinations of 0%, 5%, 10% and 15%, and its impact on the performance improvements. SEM analysis has confirmed the findings' improved strength and hardness, particularly when 10%–15% of WC was incorporated. Following the incorporation of 10% of WC particles within Mg-alloy matrix, the outcomes of the study has exhibited enhanced strength and hardness, which furthermore has been evident by utilising SEM analysis. Using ANSYS, structural deformation and stress levels are predicted, along with strength characteristics such as additional hardness of 71 HRC, tensile strength of 140–150 MPa, and yield strength closer to 100–110 MPa. The simulations yield significant insights into the behaviour of the joint under various loading conditions, thus enhancing the study's significance in biomedical environments. [ABSTRACT FROM AUTHOR]

Summary: We ascertained the fracture risk factors stratified by vertebral and non-vertebral sites in rheumatoid arthritis (RA) females. Bone/muscle features, but not disease activity, were the main markers for fractures in this long-standing RA population: low trabecular bone score (TBS) for vertebral fracture and decreased appendicular muscle mass for non-vertebral fracture. Purpose: To assess risk factors for fractures, including clinical, laboratory and dual energy X-ray absorptiometry (DXA) parameters (bone mass, trabecular bone score—TBS, muscle mass) in women with established rheumatoid arthritis (RA). Methods: Three hundred females with RA (ACR, 2010) were studied. Clinical data were obtained by questionnaire and disease activity by composite indices (DAS28, CDAI, SDAI), C-reactive protein (CRP) and erythrocyte sedimentation rate (ESR). Bone mineral density (BMD), TBS, body composition and Vertebral Fracture Assessment (VFA) were performed by DXA. Logistic regression models were constructed to identify factors independently associated with vertebral (VF) and non-vertebral fractures (NVF), separately. Results: Through rigorous eligibility criteria, a total of 265 women were yielded for final data analysis (median age, 55 [22–86] years; mean disease duration, 16.2 years). Prevalence of VF and NVF were 30.6% and 17.4%, respectively. In multivariate analyzes, TBS (OR = 1.6, 95%CI = 1.09–2.36, p = 0.017), CRP (OR = 1.54, 95%CI = 1.15–2.08, p = 0.004), and parathormone (OR = 1.24, 95%CI = 1.05–1.45, p = 0.009) were risk factors for VF, whereas low appendicular muscle mass (OR = 2.71; 95%CI = 1.01–7,28; p = 0.048), body mass index (BMI) (OR = 0.90, 95%CI = 0.82–0.99; p = 0.025), ESR (OR = 1.18, 95%CI = 1.01–1,38, p = 0,038) and hip BMD (OR = 1.82, 95%CI = 1.10–3.03, p = 0.02) were associated with NVF. Conclusion: In women with long-term RA, markers of fractures differed between distinct skeletal sites (vertebral and non-vertebral). The magnitude of association of bone/muscle parameters with fracture (TBS for VF and appendicular muscle mass for NVF) was greater than that of the association between RA activity and fracture. TBS seems to have greater discriminative power than BMD to identify subjects with VF in long-standing RA. [ABSTRACT FROM AUTHOR]

Background: The ultrasound-guided viscosupplementation of the hip joint with hyaluronic acid (HA) is considered a standard procedure among the conservative treatments for hip arthritis. The aim of this study was to evaluate the clinical benefit and the incidence of adverse events of the technique in an observational study at one year follow up. Methods: We evaluated a consecutive series of 85 patients with a diagnosis of symptomatic arthritis who underwent intra-articular ultrasound-guided hyaluronic acid injections. The scales used for evaluation were modified Harris Hip Score (mHHS), WOMAC (Western Ontario and McMaster University), and Hip Outcome Score (HOS) with subscale Sport (HOSs), for pain the Visual Analogic Scale (VAS). The patients were classified according to Tonnis' radiological classification of arthritis (range 0–3): 20 patients (grade 0), 32 (grade 1), 18 (grade 2), 15 (grade 3). Results: At last follow up, all the scales increased: mHHS from 59.35 to 82.1, HOS from 69.45 to 78.53, HOss from 47.4 to 58.11, VAS from 6.09 to 3.97, WOMAC from 33.2 to 31.5 (p < 0.05 for all the parameters); the results were elaborated with GraphPad Prism v5.0 (Prism Software La Jolla, CA, USA) using Wilcoxon's test. A total of 13 patients out of 85 needed arthroplasty, all classified as Tonnis grade 3. No serious adverse events were noted due to the procedure. Conclusions: Based on our findings, indication for the use of hyaluronic acid is limited to patients with mild to moderate arthritis. Patients in advanced arthritis refusing replacement surgery and asking for this treatment should be informed about the poor results of the technique even in the short term. [ABSTRACT FROM AUTHOR]