The Etiology and Treatment of Hip Pain in the Young Adult

Peters, Christopher L.; Erickson, Jill

doi:10.2106/jbjs.f.00631

Cited by 23 publications

(9 citation statements)

References 20 publications

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“…8,9,12,13 Usual management strategies for cartilage flaps include cartilage resection and subchondral microfracture and acetabular rim-trimming with labral advancement. 18,24,25 Intuitively, the capacity to preserve native cartilage would be preferable, as formation of fibrocartilage can be unpredictable, and a zone completely devoid of cartilage leads to eccentric wear and progression of arthritis. As such, the purpose of this study was to determine if the acetabular cartilage flap still has viable chondrocytes and, if so, what type of cartilage is present, permitting us to hypothesize the possible success of cartilage refixation.…”

Section: Discussionmentioning

confidence: 99%

Viability assessment of the chondral flap in patients with cam-type femoroacetabular impingement: a preliminary report

2014

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Background: Delaminated acetabular cartilage is a common finding in patients undergoing surgical dislocation or hip arthroscopy in the treatment of cam-type femoroacetabular impingement. Current treatment involves resection of the free cartilage flap with or without acetabular rim trimming. The viability of the delaminated cartilage flap is not known. We sought to examine if the acetabular cartilage still has viable cartilage cells and, if so, what type of cartilage is present. Methods:We examined the delaminated cartilage flaps from patients undergoing surgical dislocation and osteochondroplasty for symptomatic cam-type impingement. We performed hematoxylin and eosin staining and histological analysis using light microscopy to determine cartilage viability and cartilage type. Results:We examined 12 delaminated cartilage flaps from 11 patients (10 men, 1 woman, average age 30.1 yr). Ninety percent chondrocyte viability was confirmed in 11 of 12 flaps. Six of 12 flaps were composed predominantly of hyaline cartilage, 4 were a mixed population of fibrocartilage and hyaline cartilage and 2 were predominantly fibrocartilage. Conclusion:Our findings suggest that the delaminated cartilage flap in patients with femoroacetabular impingement may retain a large amount of viable chondrocytes. Development of surgical techniques focusing on refixation of this flap as an alternative to excision and microfracture should be considered.

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Section: Discussionmentioning

confidence: 99%

Viability assessment of the chondral flap in patients with cam-type femoroacetabular impingement: a preliminary report

2014

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“…All patients were diagnosed with FAI and presented with hip pain exacerbated with flexion activities such as sitting, squatting, or certain work-specific maneuvers. The impingement test, performed at 90°of flexion with internal rotation and adduction of the femur, produced pain in all patients [26,31,35]. Clinical results were graded using the mHHS obtained during routine office visits by the resident, fellow, or physician assistant responsible for that visit.…”

Section: Methodsmentioning

confidence: 99%

Does the Nature of Chondrolabral Injury Affect the Results of Open Surgery for Femoroacetabular Impingement?

Peters

Anderson

Díaz-Ledezma

et al. 2015

Clinical Orthopaedics &Amp; Related Research

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Background The degree to which patient characteristics, clinical outcomes, and the nature, severity, and corresponding treatment of chondrolabral injury in femoroacetabular impingement (FAI) is associated with failure after surgery is incompletely understood. Conclusions We were unable to identify an increased risk of poor outcomes based on sex, body mass index, or severity of chondrolabral lesions. We did find an increased risk of poorer outcomes associated with age. Labral refixation was associated with a decrease in the risk of failure indicating that treatment methodology, rather than the nature of the chondrolabral injury, may be associated with clinical failure. Future studies will be needed to help determine optimal treatment strategies for chondrolabral injuries. Level of Evidence Level IV, therapeutic study.

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“…24,38 The results of a recent randomized controlled trial provide evidence for the addition of soft tissue manual therapy to reduce muscle-related pain. 42 Untreated myofascial trigger points may cause persistent or chronic pain.…”

Section: Visit 6 Dischargementioning

confidence: 99%

The Use of Manual Therapy Post–Hip Arthroscopy When an Exercise-Based Therapy Approach Has Failed: A Case Report

LeBeau

Nho²

2014

J Orthop Sports Phys Ther

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A number of publications describe postoperative rehabilitation following hip arthroscopic procedures. 7,12,13,17,47,50 Manual therapy for the treatment of joint stiffness is often mentioned but not well described in these publications. While Hoeksma et al, 21 MacDonald et al, 33 and Howard and Levitsky 23 have all demonstrated significant improvements in hip range of motion (ROM), pain ratings, and Harris hip scores 22 when using a manual physical therapy approach to treat hip osteoarthritis, to the authors' knowledge, there are no published case reports or clinical trials demonstrating the effectiveness of manual therapy in patients following labral/FAI repair.The purpose of this case report was to describe a multimodal manual therapy approach used with a patient who had undergone labral repair with FAI decompression and initially responded poorly to an exercise-based treatment approach postsurgery. The approach described consisted of a combination of soft tissue and joint mobilization, trigger point dry needling, and specific neuromuscular rehabilitation to restore hip function, reduce pain, and improve functional outcomes. CASE DESCRIPTIONT he patient was a 30-year-old female surgical resident specializing in the ear, nose, and throat. She reported a 2-year history of anterior lateral hip pain with insidious onset. The patient denied having a history of low back pain or lumbar radiculopathy prior to onset of her hip pain. The diagnosis of labral tear was made by the third orthopaedic surgeon she had consulted. Magnetic resonance arthrography and fluoroscopy indicated a labral tear in the anterior superior aspect of the hip, with a focal cam lesion and reactive pincer lesion. After a lack of improvement with conservative care that consisted of activity modification and steroid injections, the patient underwent arthroscopic surgery for labral repair, acetabular trimming, and femoral osteochondroplasty.Postsurgical management for the first 3 weeks consisted of reduced weight bearing, bracing, and hip ROM exercises. Twenty days postsurgery, the patient returned to her highly demanding occupation, which required prolonged standing and walking with limited rest. At that time, she discontinued the use of her brace and progressed to a cane for ambulation.Upon her return to work, the patient reported an exacerbation of hip pain with the increased activity level. The physical therapy interventions she received at that time appeared to deviate from published protocols by progressing resistance exercise too quickly and not sufficiently addressing soft tissue and joint mobility deficits. She reported increased pain during and after physical therapy treatment. At her 6-week follow-up postsurgery, the surgeon noted being concerned about her elevated pain levels and limited recovery. Additional therapy was prescribed to address soft tissue tightness as a potential cause of her symptoms. The patient continued to perform her demanding duties as a surgical resident and to experience elevated pain levels, gait abnormalities, and...

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The Etiology and Treatment of Hip Pain in the Young Adult

Cited by 23 publications

References 20 publications

Viability assessment of the chondral flap in patients with cam-type femoroacetabular impingement: a preliminary report

Viability assessment of the chondral flap in patients with cam-type femoroacetabular impingement: a preliminary report

Does the Nature of Chondrolabral Injury Affect the Results of Open Surgery for Femoroacetabular Impingement?

The Use of Manual Therapy Post–Hip Arthroscopy When an Exercise-Based Therapy Approach Has Failed: A Case Report

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