Incidence of Hip Pain in a Prospective Cohort of Asymptomatic Volunteers

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104

Background Femoroacetabular impingement (FAI) represents a constellation of anatomical and clinical features, but definitive diagnosis is often difficult. The high prevalence of cam deformity of the femoral head in the asymptomatic population as well as clinical factors leading to the onset of symptoms raises questions as to what other factors increase the risk of cartilage damage and hip pain.Questions/purposes The purpose was to identify any differences in anatomical parameters and squat kinematics among symptomatic, asymptomatic, and control individuals and if these parameters can determine individuals at risk of developing symptoms of cam FAI. Methods Forty-three participants (n = 43) were recruited and divided into three groups: symptomatic (12), asymptomatic (17), and control (14). Symptomatic participants presented a cam deformity (identified by an elevated alpha angle on CT images), pain symptoms, clinical signs, and were scheduled for surgery. The other recruited volunteers were blinded and unaware whether they had a cam deformity. After the CT data were assessed for an elevated alpha angle, participants with a cam deformity but who did not demonstrate any clinical signs or symptoms were considered asymptomatic, whereas participants without a cam deformity and without clinical signs or symptoms were considered healthy control subjects. For each participant, anatomical CT parameters (axial alpha angle, radial alpha angle, femoral head-neck offset, femoral neck-shaft angle, medial proximal femoral angle, femoral torsion, acetabular version) were evaluated. Functional squat parameters (maximal squat depth, pelvic range of motion) were determined using a motion capture system. A stepwise discriminant function analysis was used to determine

Section: Introductionmentioning

confidence: 99%

Patient-Specific Anatomical and Functional Parameters Provide New Insights into the Pathomechanism of Cam FAI

Lamontagne

Adamczyk

et al. 2015

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104

“…The cam deformity, characterized by an aspherical femoral head-neck junction, has been suggested as a cause of labral-chondral damage as well as an early cause for hip osteoarthritis [11,17]. Several studies suggest that a severe cam deformity, as defined by larger alpha angles, could indicate which individuals may be at risk of developing early hip pain and arthritis [1,22]. Although many symptomatic individuals with a cam morphology experienced different hip kinematics, notably during level walking [21] and maximal squatting [23,24], other individuals with a cam morphology may not experience any clinical signs or symptoms [2,12,13,19,22,33,45].…”

Section: Introductionmentioning

confidence: 99%

“…Several studies suggest that a severe cam deformity, as defined by larger alpha angles, could indicate which individuals may be at risk of developing early hip pain and arthritis [1,22]. Although many symptomatic individuals with a cam morphology experienced different hip kinematics, notably during level walking [21] and maximal squatting [23,24], other individuals with a cam morphology may not experience any clinical signs or symptoms [2,12,13,19,22,33,45]. In addition to elevated alpha angles, it was recently noted that a decreased femoral neckshaft angle might be indicative of early symptoms as well [13,33,34,45]; however, it is unclear what combined effects a large cam morphology and decreased femoral neck-shaft angle have on resultant hip stresses.…”

Section: Introductionmentioning

confidence: 99%

Increased Hip Stresses Resulting From a Cam Deformity and Decreased Femoral Neck-Shaft Angle During Level Walking

Mantovani

Lamontagne

et al. 2017

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Background It is still unclear why many individuals with a cam morphology of the hip do not experience pain. It was recently reported that a decreased femoral neck-shaft angle may also be associated with hip symptoms. However, the effects that different femoral neck-shaft angles have on hip stresses in symptomatic and asymptomatic individuals with cam morphology remain unclear.Questions/purposes We examined the effects of the cam morphology and femoral neck-shaft angle on hip stresses during walking by asking: (1) Are there differences in hip stress characteristics among symptomatic patients with cam morphology, asymptomatic individuals with cam morphology, and individuals without cam morphology? (2) What are the effects of high and low femoral neck-shaft angles on hip stresses? Methods Six participants were selected, from a larger cohort, and their cam morphology and femoral neck-shaft angle parameters were measured from CT data. Two participants were included in one of three groups: (1) symptomatic with cam morphology; (2) asymptomatic with a cam morphology; and (3) asymptomatic control with no cam morphology with one participant having the highest femoral neck-shaft angle and the other participant having the lowest in each subgroup. Subject-specific finite element models were reconstructed and simulated during the stance phase, near pushoff, to examine maximum shear stresses on the acetabular cartilage and labrum. Results The symptomatic group with cam morphology indicated high peak stresses (6.3-9.5 MPa) compared with the asymptomatic (5.9-7.0 MPa) and control groups (3.8-4.0 MPa). Differences in femoral neck-shaft angle influenced both symptomatic and asymptomatic groups; participants with the lowest femoral neck-shaft angles had higher peak stresses in their respective subgroups. There were no differences among control models. Conclusions Our study suggests that the hips of individuals with a cam morphology and varus femoral neck angle may be subjected to higher mechanical stresses than those with a normal femoral neck angle. Clinical Relevance Individuals with a cam morphology and decreased femoral neck-shaft angle are likely to experience severe hip stresses. Although asymptomatic

“…Body pain diagrams, which have been used for more than 20 years in musculoskeletal pain research, provide a rapid and inexpensive way to measure the extent, distribution, and location of pain [14,18,21,24,28]. Widespread pain has been recognized as a poor prognostic factor in diseases such as rheumatoid arthritis, cancer, and chronic low back pain, and a poor prognostic factor for outcome of TKA [18,28].…”

Section: Introductionmentioning

confidence: 99%

Is There an Association Between Whole-body Pain With Osteoarthritis-related Knee Pain, Pain Catastrophizing, and Mental Health?

Dave

Selzer

Losina

et al. 2015

Background Greater levels of self-reported pain, pain catastrophizing, and depression have been shown to be associated with persistent pain and functional limitation after surgeries such as TKA. It would be useful for clinicians to be able to measure these factors efficiently. Questions/purposes We asked: (1) What is the association of whole-body pain with osteoarthritis (OA)-related knee pain, function, pain catastrophizing, and mental health? (2) What is the sensitivity and specificity for different cutoffs for body pain diagram region categories in relation to pain catastrophizing? Methods Patients (n = 267) with knee OA undergoing elective TKA at one academic center and two community orthopaedic centers were enrolled before surgery in a prospective cohort study. Questionnaires included the WOMAC Pain and Function Scales, Pain Catastrophizing Scale (PCS), Mental Health Inventory-5 (MHI-5), and a pain body diagram. The diagram documents pain in 19 anatomic areas. Based on the distribution of the anatomic areas, we established six different body regions. Our analyses excluded the index (surgically treated) knee. Linear regression was used to evaluate the association between the total number of nonindex painful sites on the whole-body pain diagram and measures of OA-related pain and function, mental health, and pain catastrophizing. Generalized linear regression was used to evaluate the association between the number of painful nonindex body regions (categorized as 0; 1-2; or 3-6) with our measures of interest. All models were adjusted for age, sex, and number of comorbid conditions. The cohort included 63% females and the mean age was 66 years (SD, 9 years). With removal of the index knee, the median pain diagram score was 2 (25 th , 75 th percentiles, 1, 4) with a range of 0 to 15. The median number of painful body regions was 2 (25 th , 75 th percentiles, 1, 3). Results After adjusting for age, sex, and number of comorbid conditions, we found modest associations between painful body region categories and mean scores for WOMAC physical function (r = 0.22, p \ 0.001), WOMAC pain (r = 0.20, p = 0.001), MHI-5 (r = À0.31, p\ 0.001), and PCS (r = 0.27, p \ 0.001). A nonindex body pain region score greater than 0 had 100% (95% CI, 75%-100%) sensitivity for a pain catastrophizing score greater than 30 but a specificity of just 23% (95% CI, 18%-29%) . A score of 3 or greater had greater specificity (73%; 95% CI, 66%-79%) but lower sensitivity (53%; 95% CI, 27%-78%). Conclusions We found modest associations between the number of painful sites on a whole-body pain diagram and the number of painful body regions and measures of OArelated pain, function, pain catastrophizing, and mental health. Patients with higher self-reported body pain region scores might benefit from further evaluation for depression and pain catastrophizing. Level of Evidence Level III, therapeutic study.