Aims. Overall sagittal flexion is restricted in patients who have undergone both lumbar fusion and total hip arthroplasty (THA). However, it is not evident to what extent this movement is restricted in these patients and how this influences quality of life (QoL). The purpose of this study was to determine the extent to which hip-lumbar mobility is decreased in these patients, and how this affects their QoL score. Methods. Patients who underwent primary THA at our hospital between January 2010 and March 2021 were considered (n = 976). Among them, 44 patients who underwent lumbar fusion were included as cases, and 44 THA patients without lumbar disease matched by age, sex, and BMI as Control T. Among those who underwent lumbar fusion, 44 patients without hip abnormalities matched by age, sex, and BMI to the cases were considered as Control F. Outcome and spinopelvic parameters were measured radiologically in extension and flexed-seated positions. Hip, lumbar, and hip-lumbar mobility were calculated as parameter changes between positions. Results. There were 20 male and 112 female patients in the case and control groups, with a mean age of 77 years (5 to 94) and a mean BMI of 24 kg/m. 2. (15 to 34). QoL score and hip-lumbar mobility were reduced in cases compared to Control T and F, and were further reduced as the number of fused levels increased. Hip-lumbar mobility was associated with reduction in activity-related QoL, mostly for those activities requiring sagittal flexion. Conclusion. This study confirmed that hip-lumbar mobility is a factor that influences activity, most of all those requiring overall sagittal flexion. Clinicians should focus on hip-lumbar mobility and counteract disability by suggesting appropriate assistive devices. Cite this article: Bone Joint J 2025;107-B(1):34–41

Abstract. Purpose The aim of this study was investigate the relationship between version and torsional abnormalities of the acetabulum, femur and tibia in patients with symptomatic FAI. Methods A systematic review was performed according to PRISMA guidelines using the EMBASE, MEDLINE, PubMed and Cochrane databases. Original research articles evaluating the described version and torsional parameters in FAI were included. The MINORS criteria was used to appraise study quality and risk of bias. Mean version and torsion values were displayed using forest plot and the estimated proportion of hips displaying abnormalities in version/torsion were calculated. Results. A total of 1206 articles were identified from the initial search, with 43 articles, involving 8,861 hips, meeting the inclusion criteria. All studies evaluating femoral or acetabular version in FAI reported ‘normal’ mean version values (10. 0. to 25. 0. ). However, distribution analysis revealed that an estimated 31% and 51% of patients with FAI displayed abnormal central acetabular and femoral version respectively. Conclusion. Up to 51% of patients presenting with symptomatic FAI show an abnormal femoral version, whilst up to 31% demonstrate abnormal acetabular version. This high percentage of version abnormalities highlights the importance of evaluating these parameters routinely during assessment of patients with FAI, in order to guide clinical decision making

Aims

To clarify the mid-term results of transposition osteotomy of the acetabulum (TOA), a type of spherical periacetabular osteotomy, combined with structural allograft bone grafting for severe hip dysplasia.

The life expectancy of patients with Down syndrome has increased significantly in recent years. Hip abnormalities occur in children with this syndrome but little is known about their natural history in later life. In 65 adults with Down syndrome we found hip abnormalities in 28%, and this was statistically correlated with walking ability. A subgroup of 18 patients was followed by serial examination; this showed that hip instability occurred in adulthood and became worse with time. In some patients, hip instability started after skeletal maturity

Introduction. The deformity in osteoarthritis (OA) of the knee has been evaluated mainly in the frontal plane two dimensional X-ray using femorotibial angle. Although the presence of underlying rotational deformity in the varus knee and coexisting hip abnormality in the valgus knee have been suggested, three dimensional (3D) deformities in the varus and valgus knee were still unknown. We evaluated the 3D deformities of the varus and valgus knee using 3D bone models. Methods. Preoperative computed tomography (CT) scans of twenty seven OA knees (fifteen varus and twelve valgus) undergoing total knee arthroplasty were assessed in this study. CT scans of each patient's femur and tibia, with a 2 mm interval, obtained before surgery. We created the 3D digital model of the femur and tibia using visualization and modeling software developed in our institution. The femoral coordinate system was calculated by the 3D mechanical axis and clinical transepicondylar axis and the tibial coordinate system was calculated by the 3D mechanical axis and Akagi's line. The 3D deformities of the knee were determined by the relative position of the femorotibial coordinate system, and described by the tibial position relative to the femur. The anteversion of the femoral neck were calculated to evaluate the relationship between the valgus knee and hip region. Results. The 3D deformities of the varus knee were 12.1±5.5°varus (5.4 to 22.6°), 6.8±6.3°flexion (1.7 to 21.7°) and 6.5±6.1 °external rotation (−1.2 to 23.2°). The flexion and external rotational deformities were larger in knees with increased varus deformities. The 3D deformities of the valgus knee were 10.2±4.2°valgus (0.6 to 15.0°), 9.5±8.8°flexion (−5.2 to 23.7°) and 2.3±7.3°external rotation (−9.4 to 16.1°). Although there were no tendency about the 3D deformities in the valgus knee, the anteversion of the femoral neck in the valgus knees was 31.9°compared with 10.8°in the varus knees. Conclusion. The varus deformity in OA of the knee is associated with significant flexion and external rotational deformity. In contrast, the valgus deformity has a biomechanical background originating from the anteversion of the femoral neck

Few epidemiological studies from Asian countries have addressed this issue and reported that FAI is less prevalent in Asian population. The purpose of this study was to determine the prevalence of radiographic hip abnormalities associated with FAI in asymptomatic Korean volunteers. The authors hypothesized that the prevalence of FAI in Korean population would not be less than that in western population. Two hundred asymptomatic volunteers with no prior hip surgery or childhood hip problems underwent three-view plain radiography (pelvis anteroposterior (AP) view, Sugioka view, and 45° Dunn view) of both hips. Cam lesions were defined as the presence of the following signs on each views: pistol-grip deformity, osseous bump at the femoral head-neck junction, flattening of the femoral head-neck offset, or alpha angle >50°. Pincer lesions were determined by radiographic signs, including crossover sign, posterior wall deficient sign, or lateral center-edge (CE) angle >40°. Only positive cases agreed by both observers were defined as true FAI-related deformities. There were 146 male and 254 female hips, with a mean age of 34.7 years. On pelvis AP view, the prevalence of pistol grip deformity, bump, flattening, and alpha angle >50° was 1.3% (male 3.4%, female 0%), 0.8% (male 2.1%, female 0%), 0.8% (male 2.1%, female 0%), and 1.0% (male 2.7%, female 0%), respectively. On Sugioka view, the prevalence of bump, flattening, and alpha angle >50° was 9.8% (male 14.4%, female 7.1%), 13.5% (male 20.5%, female 9.4%), and 14.0% (male 26.7%, female 6.7%), respectively. On 45° Dunn view, the prevalence of bump, flattening, and alpha angle >50° was 8.0% (male 14.4%, female 4.3%), 17.5% (male 27.4%, female 11.8%), and 27.5% (male 44.5%, female 17.7%), respectively. The prevalence of cam lesion which was identified on at least one radiograph was 42.5% (male 62.3%, female 31.1%). The prevalence of cam lesion which was identified on ≥2 radiographs was 19.3% (male 30.8%, female 12.6%). The prevalence of cam type FAI (at least one cam lesion) was 2.0% (male 5.5%, female 0%) on pelvis AP view, 25.8% (male 37.0%, female 19.3%) on Sugioka view, and 35.8% (male 55.5%, female 24.4%) on 45° Dunn view. On pelvis AP view, the prevalence of crossover sign, posterior wall sign, and CE angle >40° was 20.0% (male 23.3%, female 18.1%), 20.8% (male 22.6%, female 19.7%), and 2.0% (male 2.7%, female 1.6%), respectively. The prevalence of pincer type of FAI (at least one pincer lesion) was 23.0% (male 27.4%, female 20.5%). In asymptomatic Korean volunteers, the prevalence of cam type FAI was low on AP pelvis radiographs, whereas the prevalence of cam type FAI on Sugioka and 45° Dunn view was found to be comparable to that previously reported in Western populations. The prevalence of pincer type FAI in asymptomatic Korean volunteers was also comparable that in Western populations and was similar in both gender. Considering the high prevalence of FAI morphologic features on plain radiographs in asymptomatic Korean populations, it is also important to determine whether FAI is a cause of hip pain when considering surgery in Asian patients

Aims

Cam and pincer morphologies are potential precursors to hip osteoarthritis and important contributors to non-arthritic hip pain. However, only some hips with these pathomorphologies develop symptoms and joint degeneration, and it is not clear why. Anterior impingement between the femoral head-neck contour and acetabular rim in positions of hip flexion combined with rotation is a proposed pathomechanism in these hips, but this has not been studied in active postures. Our aim was to assess the anterior impingement pathomechanism in both active and passive postures with high hip flexion that are thought to provoke impingement.

During the preoperative examination, surgeons determine whether a patient, with a degenerative hip, is a candidate for total hip arthroplasty (THA). Although research studies have been conducted to investigate in vivo kinematics of degenerative hips using fluoroscopy, surgeons do not have assessment tools they can use in their practice to further understand patient assessment. Ideally, if a surgeon could have a theoretical tool that efficiently allows for predictive post-operative assessment after virtual surgery and implantation, they would have a better understanding of joint conditions before surgery. The objectives of this study were (1) to use a validated forward solution hip model to theoretically predict the in vivo kinematics of degenerative hip joints, gaining a better understanding joint conditions leading to THA and (2) compare the predicted kinematic patterns with those derived using fluoroscopy for each subject. A theoretical model, previously evaluated using THA kinematics and telemetry, was used for this study, incorporating numerous muscles and ligaments, including the quadriceps, hamstring, gluteus, iliopsoas, tensor fasciae latae, an adductor muscle groups, and hip capsular ligaments. Ten subjects having a pre-operative degenerative hip were asked to perform gait while under surveillance using a mobile fluoroscopy unit. The hip joint kinematics for ten subjects were initially assessed using in vivo fluoroscopy, and then compared to the predicted kinematics determined using the model. Further evaluations were then conducted varying implanted component position to assess variability. The fluoroscopic evaluation revealed that 33% of the degenerative hips experienced abnormal hip kinematics known as “hip separation” where the femoral head slides within the acetabulum, resulting in a decrease in contact area. Interestingly, the mathematical model produced similar kinematic profiles, where the femoral head was sliding within the acetabulum (Figure 1). During swing phase, it was determined that this femoral head sliding (FHS) is caused by hip capsular laxity resulting in reducing joint tension. At the point of maximum velocity of the foot, the momentum of the lower leg becomes too great for capsule to properly constrain the hip, leading to the femoral component pistoning outwards. During stance phase, kinematics of degenerative hips were similar to kinematics of a THA subject with mal-positioning of the acetabular cup. Further evaluation revealed that if the cup was placed at a position other than its native, anatomical center, abnormal forces and torques acting within the joint lead to the femoral component sliding within the acetabular cup. It was hypothesized that in degenerative hips, similar to THA, the altered center of rotation is a leading influence of FHS (Figure 2). The theoretical model has now been validated for subjects having a THA and degenerative subjects. The model has successfully derived kinematic patterns similar to subjects evaluated using fluoroscopy. The results in this study revealed that altering the native joint center is the most influential factor leading to FHS, or more commonly known as hip separation. A new module for the mathematical model is being implemented to simulate virtual surgery so that the surgery can pre- operatively plan and then simulate post-operative results

Between 1992 and 1997, we undertook a prospective, targeted clinical and ultrasonographic hip screening programme to assess the relationship between ultrasonographic abnormalities of the hip and clinical limitation of hip abduction. A total of 5.9% (2 of 34) of neonatal dislocatable hips and 87.5% (7 of 8) of ‘late’ dislocated hips seen after the age of six months, presented with unilateral limitation of hip abduction. All major (Graf type III) and 44.5% of minor (Graf type II) dysplastic hips presented with this sign. Statistically, bilateral limitation of hip abduction was not a useful clinical indicator of underlying hip abnormality because of its poor sensitivity, but unilateral limitation of abduction of the hip was a highly specific (90%) and reasonably sensitive sign (70%). It was more sensitive than the neonatal Ortolani manoeuvre, which has been considered to be the method of choice. It was, however, not sensitive enough to be of value as a routine screening test in developmental dysplasia of the hip. We consider unilateral limitation of hip abduction to be an important clinical sign and its presence in an infant over the age of three to four months makes further investigation essential

1. A scheme was started in 1960 with the object of ensuring that the hips of all babies born in the North-Eastern Region of Scotland were examined shortly after birth. 2. 1,671 children with suspected abnormalities have been seen during the ensuing ten years, and the findings are discussed. 3. Clinical examination is essential. Radiographic examination of the newborn is not necessary and may be misleading, but it does prove that some hips with limited abduction but no instability are in fact dislocated. 4. Treatment is not started when the diagnosis is made shortly after birth. The children are re-examined at three weeks, when spontaneous recovery has occurred in about half. The others, whether they show instability or only limitation of abduction of the hips, are treated in a simple splint until they are three months old. Any residual stiffness is an indication for further splintage. 5. The first radiographs are taken when the children are three months old, and no child is discharged until the radiographs show that the upper femoral epiphyses have appeared and are in normal position. 6. We appreciate that we are treating some children who would have recovered spontaneously, but we do not know how to distinguish them. There is no evidence that splintage harms a hip. 7. Eighty-six children (5 per cent of the total) needed operation usually because the diagnosis was missed at birth. 8. Children with familial joint laxity or genu recurvatum should be examined especially carefully for associated hip abnormality. 9. The incidence of abnormality of the hips at birth is about one in fifty live births

Aims

The prevalence of combined abnormalities of femoral torsion (FT) and tibial torsion (TT) is unknown in patients with femoroacetabular impingement (FAI) and hip dysplasia. This study aimed to determine the prevalence of combined abnormalities of FT and TT, and which subgroups are associated with combined abnormalities of FT and TT.

Introduction: Infants referred under the Hip Screening Programme undergo both a clinical and ultrasonic assessment of hip stability. The majority are reviewed for repeat clinical assessment and X-ray of the hips before a diagnosis of DDH will be excluded. If we could safely rely on the ultrasound findings, then the number of children routinely reviewed with a hip radiograph could be reduced. As a result, many children would avoid the unnecessary and potentially harmful exposure to radiation. In addition, the burden on both the Orthopaedic Outpatients Department and the Radiology Department could be eased. Objective: The aim of the study was to assess the sensitivity of the ultrasound screening programme for DDH over a four year period. Study Design: A retrospective review of the 501 infants referred for hip screening between January 1997 and December 2000. Results: 28 patients were treated for DDH during the period of January 1997 to December 2000. Thirteen patients (46.4%) of those treated for DDH were referred via the Hip Screening Programme after their initial baby check by the paediatricians showed that they had a risk factor. The risk factors include Family History, Breech Deliver, and clinical instability. The remaining fifteen patients (53.6%) were referred via GP’s, Health Visitors and Paediatricians, following abnormal clinical findings ranging from ‘clicky hip’, abnormal skin creases, and decreased hip abduction at follow up baby checks. The average age of the infant in this group was 5.5 months. These 15 were diagnosed with X-ray only. All patients (501 patients) referred via the Hip screening programme underwent an ultrasound scan of both hips initially, and a pelvic X-ray 4–6 months after this. We identified 5 cases where the ultrasound had originally been interpreted as normal, yet the infant developed DDH as diagnosed by a later X–ray. Five infants (38.5%) of the thirteen diagnosed with DDH via the screening programme is unacceptable. These five infants could easily have been missed until they were a lot older, and subsequently their prognoses would have been worse. Three (20%) of the fifteen patients diagnosed with DDH which were not referred via the Hip Screening Programme had an identifiable risk factor at birth, yet were not sent for orthopaedic review and ultrasound examination via the Screening Programme. Conclusion: Normal ultrasound scan does not exclude a subsequent diagnosis of Developmental Dysplasia of the hip. X-ray is still considered the gold standard in assessing a child’s hips. Both the performance and interpretation of the hip ultrasound is skill with a steep learning curve and, for the meantime, will have to go hand in hand with pelvic X-rays in diagnosing DDH

Aims

Complex total hip arthroplasty (THA) with subtrochanteric shortening osteotomy is necessary in conditions other than developmental dysplasia of the hip (DDH) and septic arthritis sequelae with significant proximal femur migration. Our aim was to evaluate the hip centre restoration with THAs in these hips.

Aims

This paper aims to review the evidence for patient-related factors associated with less favourable outcomes following hip arthroscopy.

Hip arthroscopy is particularly attractive in children as it confers advantages over arthrotomy or open surgery, such as shorter recovery time and earlier return to activity. Developments in surgical technique and arthroscopic instrumentation have enabled extension of arthroscopy of the hip to this age group. Potential challenges in paediatric and adolescent hip arthroscopy include variability in size, normal developmental change from childhood to adolescence, and conditions specific to children and adolescents and their various consequences. Treatable disorders include the sequelae of traumatic and sports-related hip joint injuries, Legg–Calve–Perthes’ disease and slipped capital femoral epiphysis, and the arthritic and septic hip. Intra-articular abnormalities are rarely isolated and are often associated with underlying morphological changes. This review presents the current concepts of hip arthroscopy in the paediatric and adolescent patient, covering clinical assessment and investigation, indications and results of the experience to date, as well as technical challenges and future directions

Aims. The aim of this study was to review the value of accepting referrals for children with ‘clicky hips’ in a selective screening programme for hip dysplasia. Patients and Methods. A single-centre prospective database of all referrals to the hip clinic was examined to identify indication for referrals, diagnosis, and treatment. All patients referred received a standardized ultrasound scan and clinical examination by an orthopaedic consultant. Results. There were 5716 children referred to the orthopaedic hip clinic between 1 June 2014 and 26 September 2018. In all, 1754 children (30.1%) were referred due to ‘clicky hip’ with no additional risk factors or indications for ultrasound scan. A total of 123 children (7.1%) referred with ‘clicky hip’ and no additional risk factors or examination findings had an abnormal initial hip ultrasound, including 16 children (0.9%) with dysplastic hips. Of the 141 children who required treatment in a Pavlik harness during the study period, 23 (16%) had been referred with a ‘clicky hip’ and no additional risk factors or examination findings, including six children with Graf 3 or 4 hips. Conclusion. There is significant value in reviewing children with an isolated ‘clicky hip’. Many children who require treatment are referred to the orthopaedic service as ‘clicky hip’ with no additional risk factors. In a pragmatic pathway with a diverse population of clinicians performing baby checks, ‘clicky hip’ is an important indication for referral and should not be discarded. Cite this article: Bone Joint J 2019;101-B:635–638

Aim: We wanted to ascertain if clinical examination confers any additional benefit to secondary/targeted ultrasound screening of neonatal hips. Materials/Methods: Of the 30585 births (over a 6 year period) in the population served by our hospital, 2742 babies (8.96percent) were referred to the Hip Screening Clinic by the neonatologists and general practitioners. They were examined clinically and by US scans by the specialist consultants. The findings were documented prospectively. Of these, 1862 hips were normal on clinical examination, 841 hips tense (clinical examination inconclusive). Results: 233 hips were identified as abnormal by the US scans (Graf method). 106 (45percent) of these were normal on clinical examination. In 88 of the hips with abnormal US scans (38percent), clinical examination could not be performed reliably as the babies were tense. None of the hips identified as abnormal on clinical examination were normal on US scans. Conclusion/Discussion: US scanning of hips in at-risk babies by an experienced paediatric radiologist will identify all the abnormal hips. This will release the paediatric orthopaedic surgeon from routine clinical examination of all these babies. This time can be utilised for running other clinics. Babies found to have abnormal hips on US scanning may be seen by the orthopaedic surgeon for treatment and follow-up. Parents of babies with normal hip US scans may be reassured by a nurse practitioner or a paediatric physiotherapist. This should lead to better utilisation of resources and cost savings

Aim: We wanted to ascertain if clinical examination confers any additional benefit to secondary/targeted ultrasound screening of neonatal hips. Materials and Methods: Of the 30585 births (from 1997–2002) in the population served by our hospital, 2742 babies (8.96 percent) were referred to the Hip Screening Clinic by the neonatologists and general practitioners. They were examined clinically and by US scans by the specialist consultants. The findings were documented prospectively. Of these, 1862 hips were normal on clinical examination, 841 hips tense (clinical examination inconclusive). Results: 233 hips were identified as abnormal by the US scans (Graf method). 106 (45 percent) of these were normal on clinical examination. In 88 of the hips with abnormal US scans (38 percent), clinical examination could not be performed reliably as the babies were tense. None of the hips identified as abnormal on clinical examination were normal on US scans. Conclusion/Discussion: US scanning of hips in at-risk babies by an experienced paediatric radiologist will identify all the abnormal hips. This will release the paediatric orthopaedic surgeon from routine clinical examination of all these babies. This time can be utilised for running other clinics. Babies found to have abnormal hips on US scanning may be seen by the orthopaedic surgeon for treatment and follow-up. Parents of babies with normal hip US scans may be reassured by a nurse practitioner or a paediatric physiotherapist. This should lead to better utilisation of resources and cost savings

Aims

The significance of the ‘clicky hip’ in neonatal and infant examination remains controversial with recent conflicting papers reigniting the debate. We aimed to quantify rates of developmental dysplasia of the hip (DDH) in babies referred with ‘clicky hips’ to our dedicated DDH clinic.

Femoroacetabular impingement causes pain in the hip in young adults and may predispose to the development of osteoarthritis. Genetic factors are important in the aetiology of osteoarthritis of the hip and may have a role in that of femoroacetabular impingement. We compared 96 siblings of 64 patients treated for primary impingement with a spouse control group of 77 individuals. All the subjects were screened clinically and radiologically using a standardised protocol for the presence of cam and pincer deformities and osteoarthritis. The siblings of those patients with a cam deformity had a relative risk of 2.8 of having the same deformity (66 of 160 siblings hips versus 23 of 154 control hips, p < 0.00001). The siblings of those patients with a pincer deformity had a relative risk of 2.0 of having the same deformity (43 of 116 sibling hips versus 29 of 154 control hips, p = 0.001). Bilateral deformity occurred more often in the siblings (42 of 96 siblings versus 13 of 77 control subjects, relative risk 2.6, p = 0.0002). The prevalence of clinical features in those hips with abnormal morphology was also greater in the sibling group compared with the control group (41 of 109 sibling hips versus 7 of 46 control hips, relative risk 2.5, p = 0.007). In 11 sibling hips there was grade-2 osteoarthritis according to Kellgren and Lawrence versus none in the control group (p = 0.002). Genetic influences are important in the aetiology of primary femoroacetabular impingement. This risk appears to be manifested through not only abnormal joint morphology, but also through other factors which may modulate progression of the disease