Soft Tissue Pathology in 100 Patients With Hip Dysplasia Before and After Periacetabular Osteotomy
试验速览
- 阶段
- 不适用
- 状态
- 已完成
- 入组人数
- 100
- 试验地点
- 2
- 主要终点
- Soft tissue pathology in the hip region (xamined with the Clinical Entities Approach)
研究概览
简要总结
Introduction: The lack of congruence between the acetabulum and femoral head in hip dysplasia compromise the passive stability of the hip joint resulting in increased stress on the acetabular labrum, joint capsule and the muscles acting close to the hip joint. Soft tissue injury is present in hip dysplasia, and pathology of the iliopsoas muscle has been found in 18-50%. To our knowledge, no studies have systematically examined the prevalence of soft tissue pathology in hip dysplasia.
The overall aim of this research project is to examine soft tissue pathology in 100 patients with hip dysplasia prior to and one year after Periacetabular osteotomy (PAO).
Methods: Soft tissue pathology will be examined in a prospective cohort study on 100 patients with hip dysplasia prior to and one year after surgery. Pathology will be examined using ultrasonography and the Clinical Entities Approach that focus on pathology of the iliopsoas, adductors, rectus abdominis, gluteus medius and hamstrings. Furthermore, hip muscle strength is tested with a dynamometer, hip related health is measured with the Copenhagen Hip and Groin Outcome Score (HAGOS) and physical activity is measured with triaxial accelerometers during a period of 7 days.
Perspective: Is it possible to demonstrate pathology of the hip muscles and tendons applying clinical tests, muscle strength tests, and ultrasonography, as it has been found in sports-active people with groin pain, it will make sense to plan and test a specific training program focusing on the pathological soft tissue pathology.
详细描述
Introduction
In hip dysplasia the acetabulum presents as shallow and oblique with insufficient coverage of the femoral head. Deformity of the femoral neck and head is common with bilateral affection in 54%. The lack of congruence between the acetabulum and femoral head compromise the passive stability of the hip joint resulting in increased increased stress on the acetabular labrum, joint capsule and the muscles acting close to the hip joint. The increased stress on soft tissue results in acetabular labrum injury in 49-94% of the patients with hip dysplasia scheduled for joint preserving surgery. Left untreated hip dysplasia may lead to development of early osteoarthritis; however, the osteoarthritic process can be prevented or delayed with the Periacetabular osteotomy (PAO).
Soft tissue injury is present in hip dysplasia, and pathology of the iliopsoas muscle has been found in 18-50%. The muscles acting close to the hip joint including the deep fibers of the iliopsoas and the iliocapsularis muscle are together with the acetabular labrum and joint capsule able to increase the dynamic stabilisation of the femoral head in the dysplastic and shallow acetabulum. The hip joint is beside the iliopsoas further stabilised by the adductors and the gluteus medius muscle. Sustained hip pain and immobilisation has a negative impact on the iliopsoas, psoas and the hip adductors in terms of atrophy and decreased hip muscle strength. In an experimental study design it was found that decreased force contribution from the gluteal muscles during hip extension and the iliopsoas muscle during hip flexion resulted in an increase in the anterior hip joint force. The increased anterior hip joint force may contribute to anterior hip pain, subtle hip instability and the development of anterior acetabular labral tears.
Patients with hip dysplasia are less physical active prior to PAO mainly due to groin pain. A decreased physical activity level is likely to have a negative impact on the muscles acting close to the hip joint with a possible increased risk of sustaining further acetabular labrum injury and/or overuse related to soft tissue pathology. After surgery, the risk of overuse related soft tissue pathology might be further increased due to surgery impact on muscles and tendons. If it is possible to demonstrate pathology of the hip muscles and tendons applying clinical tests, muscle strength tests, and ultrasonography, as it has been found in sports-active people with groin pain, it will make sense to plan and test a specific training program focusing on the pathological soft tissue pathology.
The overall aim of this research project is to examine soft tissue pathology in 100 patients with hip dysplasia prior to and one year after PAO.
研究设计
- 研究类型
- Observational
- 观察模型
- Cohort
- 时间视角
- Prospective
入排标准
- 性别
- All
- 接受健康志愿者
- 否
入选标准
- •Diagnosis of hip dysplasia with a Wiberg´s Center-Edge (CE) angle <25 degrees, and planned PAO surgery at Aarhus University Hospital
排除标准
- •Osteoarthritis grade ≥2 using Tönnis' classification
- •Other hip conditions as Calvé Perthes and epiphysiolysis
- •Surgery due to discus disease and spondylodesis and joint preserving and alloplastic surgery at the hip, knee or angle region
- •Neurological and/or rheumatological conditions affecting the function of the hip joint
- •Tenotomy of the iliopsoas tendon
- •Cross-over sign (retroversion of the acetabulum)
结局指标
主要结局
Soft tissue pathology in the hip region (xamined with the Clinical Entities Approach)
时间窗: Prior to surgery and one year after surgery
Soft tissue pathology will be examined with the Clinical Entities Approach examining pathology of the iliopsoas, adductors, rectus abdominis, gluteus medius and hamstrings using a standardized and reliable examination protocol
Hip related self-reports of health (Copenhagen Hip and Groin Outcome Score (HAGOS)
时间窗: Prior to surgery and one year after surgery
Hip related health measured with the reliable Copenhagen Hip and Groin Outcome Score (HAGOS) validated on patients with groin pain.
Soft tissue pathology of the hip region using a standardized ultrasonography protocol
时间窗: Prior to surgery and one year after surgery
Soft tissue pathology of the iliopsoas, adductors, rectus abdominis, gluteus medius and hamstrings is examined using a standardized ultrasonography protocol.
Physical activity during a period of 7 days (measured with triaxial accelerometers)
时间窗: Prior to surgery and one year after surgery
Physical activity is measured with triaxial accelerometers during a period of 7 days on the following categories: rest, standing, walking, sit to stand (STS), cycling and running.
次要结局
- Pain location registered on a pain-drawing(Prior to surgery and one year after surgery)
- Conjoint tendon pathology(Prior to surgery and one year after surgery)
- Isometric hip muscle strength using a dynamometer(Prior to surgery and one year after surgery)
- Presence of internal snapping hip (examined with a standardized examination test)(Prior to surgery and one year after surgery)
- Presence of lumbar and thoracic back pathology(Prior to surgery and one year after surgery)
- Subjective visual analogue scale (VAS)(Prior to surgery and one year after surgery)