Clinical Outcomes Analysis of Conservative and Surgical Treatment of Patients With Clinical Indications of Prearthritic, Intra-articular Hip Disorders

Section, Physical Medicine and Rehabilitation, Department of Orthopaedic Surgery, Washington University School of Medicine, St. Louis, MO 63110, USA.
PM&R (Impact Factor: 1.53). 05/2012; 4(7):479-87. DOI: 10.1016/j.pmrj.2012.03.012
Source: PubMed


To describe outcomes of the conservative treatment of patients who had the clinical presentation of a prearthritic, intra-articular hip disorder, including acetabular labral tears, developmental hip dysplasia, and femoroacetabular impingement.
Prospective observational clinical outcomes study.
Outpatient orthopedic clinic at a tertiary university hospital.
Patients presenting with prearthritic, intra-articular hip disorders were recruited. Fifty-eight consecutive patients were enrolled; 6 were lost to follow-up, and 52 subjects completed the study.
Patients were recruited on the basis of symptoms, distribution of pain, and the findings of a physical examination. Radiographic measurements of the hip were obtained for all subjects to describe the presence or absence and extent of deformity and/or osteoarthritis. All subjects completed a directed course of conservative treatment. After 3 months of conservative care, subjects with continued limitations, reduction of symptoms with a diagnostic intra-articular hip injection, and a surgically amenable lesion found on a magnetic resonance arthrogram proceeded to surgery.
Numeric Pain Score (0-10), Short Form-12, Modified Harris Hip Score, Western Ontario and McMaster Universities Osteoarthritis Index, Nonarthritic Hip Score, Baecke Questionnaire of Habitual Activity, and patient choice to have surgery.
Fifty-eight patients (9 men and 49 women) with a mean age of 35 ± 11 years (range, 18-50 years) enrolled in the study. Fifty-two subjects completed the study. Twenty-three subjects (44%) reported satisfaction with conservative care. Twenty-nine subjects (56%) chose to have surgery. Both groups demonstrated equally significant improvement (P value ranges: P = .03 to P = .0001) in all outcome measures from baseline to 1-year follow-up. Subjects who chose surgery had higher baseline activity scores compared with the conservative treatment group (P = .02).
All subjects with signs and symptoms of prearthritic, intra-articular hip disorders who were treated with conservative treatment alone and with conservative treatment followed by surgery demonstrated significant improvement in pain and functioning from baseline to 1 year. Forty-four percent of patients improved with conservative care alone, and 56% chose to have surgery after receiving conservative care. Persons with more active lifestyles were more likely to choose surgery. These data suggest that a trial of conservative management for persons with prearthritic, intra-articular hip disorders should be considered before engaging in surgical intervention.

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Available from: Heidi Prather, Jan 12, 2015
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    • "Recently there has been additional attention placed on improving the precision of hip motion and decreasing anterior hip joint stresses (Hunt et al., 2007; Yazbek et al., 2011; Hunt et al., 2012), but details of these interventions have not been well described or supported by research. Therefore, the purpose of this case report is to describe a movement system examination, diagnosis, and treatment for a professional ballet dancer with a suspected acetabular labral tear. "
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    ABSTRACT: Dancers are at risk for developing groin pain that is due to acetabular labral tears. Although surgical management of labral tears has been reported extensively, conservative management has been poorly described. This case report describes the examination, diagnosis, and treatment of groin pain in a professional ballet dancer with a suspected acetabular labral tear. Treatment focused on decreasing anterior hip joint stresses and improving the precision of hip motion through correction of alignment and movement impairments noted during functional activities and dance. Successful outcomes included a reduction in pain and return to professional ballet dancing. Copyright © 2015 Elsevier Ltd. All rights reserved.
    Manual Therapy 02/2015; 20(4). DOI:10.1016/j.math.2015.01.015 · 1.71 Impact Factor
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    • "The patients are instructed to maintain the trunk in line with the pelvis. The patients are also instructed to avoid hip and knee extension beyond neutral during gait (Hunt et al., 2012). Specifically, patients are instructed to 'flex the knee' and 'roll over' the foot more in the late stance phase of gait than they do naturally. "
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    ABSTRACT: Anterior hip pain is common in young, active adults. Clinically, we have noted that patients with anterior hip pain often walk in a swayback posture, and that their pain is reduced when the posture is corrected. The purpose of this study was to investigate a potential mechanism for the reduction in pain by testing the effect of posture on movement patterns and internal moments during gait in healthy subjects. Fifteen subjects were instructed to walk while maintaining three postures: 1) natural, 2) swayback, and 3) forward flexed. Kinematic and force data were collected using a motion capture system and a force plate. Walking in the swayback posture resulted in a higher peak hip extension angle, hip flexor moment and hip flexion angular impulse compared to natural posture. In contrast, walking in a forward flexed posture resulted in a decreased hip extension angle and decreased hip flexion angular impulse. Based on these results, walking in a swayback posture may result in increased forces required of the anterior hip structures, potentially contributing to anterior hip pain. This study provides a potential biomechanical mechanism for clinical observations that posture correction in patients with hip pain is beneficial.
    Manual Therapy 09/2014; 20(1). DOI:10.1016/j.math.2014.08.007 · 1.71 Impact Factor
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    ABSTRACT: : To educate the obstetrics community regarding postpartum labral tears, an avoidable and treatable potential complication of pregnancy in the postpartum period. : From 2009 to 2011, 10 women presented to the second author's office with persistent hip pain that had begun during pregnancy or during delivery. These 10 postpartum women presented with signs and symptoms of labral tears, which were subsequently confirmed with arthroscopy and surgically repaired. : Each patient experienced relief of symptoms within 4 months after the procedure. All patients were satisfied with surgery, and all patients had improvement in modified Harris hip score. The average preoperative modified Harris hip score was 53.1 and the average postoperative modified Harris hip score was 84.3 (P<.001). : An acetabular labral tear should be considered part of the differential diagnosis for hip pain in postpartum women. Additionally, freeing the distal lower extremity to externally rotate during labor may prevent an acute labral tear. When nonoperative management fails, surgery may lead to positive outcomes. : II.
    Obstetrics and Gynecology 11/2012; 120(5):1093-8. DOI:10.1097/AOG.0b013e31826fbcc8 · 5.18 Impact Factor
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