scholarly journals Posterior wall sign (femoroacetabular impingement)

2020 ◽  
Author(s):  
Henry Knipe ◽  
Magdalena Chmiel-Nowak
Keyword(s):  
Femoroacetabular Impingement ◽  
Posterior Wall ◽  
Posterior Wall Sign

scholarly journals The Ischial Spine in Developmental Hip Dysplasia: Unraveling the Role of Acetabular Retroversion in Periacetabular Osteotomy

2020 ◽  
Vol 2020 ◽  
pp. 1-7
Author(s):  
Gerard El-Hajj ◽  
Hicham Abdel-Nour ◽  
Rami Ayoubi ◽  
Joseph Maalouly ◽  
Fouad Jabbour ◽  
...  
Keyword(s):  
Hip Dysplasia ◽  
Periacetabular Osteotomy ◽  
Posterior Wall ◽  
Acetabular Retroversion ◽  
Ischial Spine ◽  
Acetabular Version ◽  
Crossover Sign ◽  
Developmental Hip Dysplasia ◽  
Radiographic Sign ◽  
Posterior Wall Sign

Purpose. Radiological diagnosis of acetabular retroversion (AR) is based on the presence of the crossover sign (COS), the posterior wall sign (PWS), and the prominence of the ischial spine sign (PRISS). The primary purpose of the study is to analyze the clinical significance of the PRISS in a sample of dysplastic hips requiring periacetabular osteotomy (PAO) and evaluate retroversion in symptomatic hip dysplasia. Methods. In a previous paper, we reported the classic coxometric measurements of 178 patients with symptomatic hip dysplasia undergoing PAO where retroversion was noted in 42% of the cases and was not found to be a major factor in the appearance of symptoms. In the current study, we have added the retroversion signs PRISS and PWS to our analysis. Among the retroverted dysplastic hips, we studied the association of the PRISS with the hips requiring PAO. We also defined the ischial spine index (ISI) and studied its relationship to the coxometric measurements and AR. Results. In hips with AR, the operated hips were significantly associated with the PRISS compared to the nonoperated ones (χ2 = 4.847). Additionally, the ISI was able to classify acetabular version (anteverted, neutral, and retroverted acetabula). A direct correlation between the ISI and the retroversion index (RI) was found, and the highest degree of retroversion was found when the 3 signs of acetabular retroversion were concomitantly present (RI = 33.6%). Conclusion. The PRISS, a radiographic sign reflecting AR, was found to be significantly associated with dysplastic hips requiring PAO where AR was previously not considered a factor in the manifestation of symptoms and subsequent requirement for surgery. Moreover, the PRISS can also serve as an adequate radiographic sign for estimating acetabular version on pelvic radiographs.

scholarly journals Hip Stability May Influence the Development of Greater Trochanteric Pain Syndrome: A Case-Control Study of Consecutive Patients

2020 ◽  
Vol 8 (11) ◽  
pp. 232596712095869
Author(s):  
LCDR Ashton H. Goldman ◽  
ENS Vaughn Land ◽  
Matthew H. Adsit ◽  
CDR George C. Balazs
Keyword(s):  
Logistic Regression ◽  
Regression Model ◽  
Logistic Regression Model ◽  
Binary Logistic Regression ◽  
Pain Syndrome ◽  
Posterior Wall ◽  
Binary Logistic Regression Model ◽  
Greater Trochanteric Pain Syndrome ◽  
Increased Risk ◽  
Posterior Wall Sign

Background: Greater trochanteric pain syndrome (GTPS) is thought to relate primarily to tendinosis/tendinopathy of the hip abductors. Previous studies have suggested that certain anatomic factors may predispose one to development of the condition. Hypothesis: It was hypothesized that intrinsic acetabular bony stability of the hip is related to the development of GTPS. Study Design: Cross-sectional study; Level of evidence, 3. Methods: A total of 198 consecutive patients diagnosed with GTPS were compared with 198 consecutive patients without clinical evidence of GTPS. Electronic health records of the included patients were examined; data recorded included patient age, sex, race, and body mass index (BMI). Standing anteroposterior radiographs were evaluated by 2 blinded examiners who measured the Tönnis angle, lateral center-edge angle (LCEA), and acetabular depth/width ratio (ADW) and assessed for the presence of a posterior wall sign. The number of dysplastic measures was recorded for each patient based on published norms. Associations between radiographic and patient variables versus the presence or absence of GTPS were determined. Factors with univariate associations where P < .20 were included in a binary logistic regression model to identify independent predictors of the presence of GTPS. Results: There was no difference between groups in terms of age, BMI, or race. There were significantly more women than men in the GTPS group (71% vs 30%; P < .001). Intraclass correlation coefficients were good for the LCEA (0.82) and Tönnis angle (0.82) and poor (0.08) for the ADW. Kappa was moderate for the presence of a posterior wall sign (0.51). An increased Tönnis angle, decreased ADW, and ADW <0.25 were significantly associated with the presence of GTPS. The binary logistic regression model identified an increased Tönnis angle ( P < .010) and female sex ( P < .001) as independent risk factors for GTPS. Conclusion: Based on this preliminary retrospective study, decreased intrinsic acetabular bony stability of the hip may be associated with an increased risk of GTPS.

Radiographic Hip Anatomy Correlates With Range of Motion and Symptoms in National Hockey League Players

2017 ◽  
Vol 45 (7) ◽  
pp. 1633-1639 ◽  
Author(s):  
Christopher M. Larson ◽  
James R. Ross ◽  
Andrew W. Kuhn ◽  
Donnie Fuller ◽  
David M. Rowley ◽  
...  
Keyword(s):  
Range Of Motion ◽  
External Rotation ◽  
Intraclass Correlation ◽  
Alpha Angle ◽  
Posterior Wall ◽  
Crossover Sign ◽  
Good Reliability ◽  
Hip Anatomy ◽  
Hip Abduction ◽  
Posterior Wall Sign

Background: Hip disorders in athletes have been increasingly recognized. Purpose: To characterize radiographic hip anatomy for National Hockey League (NHL) players and correlate it with hip range of motion and hip symptoms and/or surgery. Study Design: Cross-sectional study; Level of evidence, 3. Methods: Fifty-nine professional hockey players (118 hips) with 1 NHL organization (mean age, 24.2 years; range, 18-36) prospectively underwent history and physician examination by 2 independent orthopaedic surgeons. Current or previous groin and/or hip pain or surgery was noted. Anteroposterior (AP) pelvis and bilateral Dunn lateral radiographs were obtained for all players with assessment of hip morphology by 2 blinded independent orthopaedic surgeons. Results: Good to very good reliability of radiographic assessments was noted (intraclass correlation coefficients = 0.749-0.958). Sixty-four percent of athletes had a positive crossover sign, while 86% and 60% had a positive posterior wall sign and a prominent ischial spine sign, respectively. Twenty-one percent of hips demonstrated dysplastic acetabular features (lateral center edge angle <25°). Eighty-five percent and 89% of hips demonstrated cam-type morphology based on alpha angle (>50° Dunn lateral) and head-neck offset, respectively. Good to very good reliability was noted for ROM assessments (intraclass correlation coefficient >0.69). Mean hip flexion was 107.4º ± 6.7º, and mean hip internal rotation was 26.1º ± 6.6º. Thirty-one percent of hips had a history of hip-related pain and/or surgery. Higher AP, Dunn lateral, and maximal alpha angles correlated with decreased hip internal rotation ( P = .004). Greater AP alpha angle correlated with decreased hip extension/abduction ( P = .025), and greater Dunn lateral and maximal alpha angle correlated with decreased hip flexion/abduction ( P = .001). A positive posterior wall sign correlated with increased straight hip abduction, while other radiographic acetabular parameters were not predictive of range of motion. Only decreased hip external rotation and total arc of motion correlated with an increased risk for current or prior hip symptoms or surgery ( P < .001). Conclusion: Hip anatomy in NHL players is characterized by highly prevalent cam-type morphology (>85%) and acetabular retroversion (>60%). In addition, acetabular dysplasia (21%) was relatively common. Greater cam-type morphology correlated with decreased hip range of motion, and a positive crossover sign correlated with increased hip abduction. Decreased hip external rotation and total arc of motion were predictive of hip-related pain and/or surgery.

scholarly journals Prevalence of radiographic markers of femoroacetabular impingement in asymptomatic adults

2014 ◽  
Vol 41 (1) ◽  
pp. 36-42 ◽  
Author(s):  
Rodrigo Benedet Scheidt ◽  
Carlos Roberto Galia ◽  
Cristiano Valter Diesel ◽  
Ricardo Rosito ◽  
Carlos Alberto De Souza Macedo
Keyword(s):  
Internal Rotation ◽  
Femoroacetabular Impingement ◽  
Alpha Angle ◽  
Posterior Wall ◽  
Cross Sectional Study ◽  
Cross Sectional ◽  
Radiographic Findings ◽  
Asymptomatic Patients ◽  
Asymptomatic Volunteers ◽  
Hip Internal Rotation

OBJECTIVE: to determine the prevalence of radiographic signs of femoroacetabular impingement (FAI) in asymptomatic adults and correlate them with data from physical examinations. METHODS: We conducted a cross-sectional study with 82 asymptomatic volunteers, 164 hips, between 40 and 60 years of age, selected by convenience. They were submitted to anamnesis and clinical examination of the hip, anteroposterior (AP) pelvis radiographs with three incidences, Dunn 45° and Lequesne false profile of each hip, to measure the variables. We measured the alpha angle, anterior offset of the femoral neck, cervical diaphyseal angle, CE angle of Wiberg, acetabular index, Sharp angle, and the crossing, ischial spine and posterior wall signs. RESULTS: our sample consisted of 66% women, mean age of 50.4 years. The average alpha angle was 45.10°, SD=8.6. One quarter of the hips showed alpha angle greater than or equal to 50°; among men the prevalence was 34%, and among women, 11%. We found indicative radiographic signs of femoroacetabular impingement in 42.6% of hips, whether femoral or acetabular, and the increased alpha angle was related to the decrease in hip internal rotation (p<0.001). CONCLUSION: the radiographic findings of femoroacetabular impingement in asymptomatic patients were frequent in the studied sample. The increase in alpha angle was associated with decreased internal rotation.

scholarly journals Treatment Algorithm for Patients with Non-arthritic Hip Pain, Suspect for an Intraarticular Pathology

2016 ◽  
Vol 10 (1) ◽  
pp. 404-411 ◽  
Author(s):  
R. Wejnold Jørgensen ◽  
C. Dippmann ◽  
L. Dahl ◽  
J. Stürup
Keyword(s):  
Hip Dysplasia ◽  
Periacetabular Osteotomy ◽  
Treatment Algorithm ◽  
Posterior Wall ◽  
Hip Pain ◽  
Acetabular Retroversion ◽  
Ischial Spine ◽  
Radiographic Findings ◽  
Posterior Wall Sign ◽  
The Right

Background: The amount of patients referred with longstanding, non-arthritic hip pain is increasing, as are the treatment options. Left untreated hip dysplasia, acetabular retroversion and femoroacetabular impingement (FAI) may lead to osteoarthritis (OA). Finding the right treatment option for the right patient can be challenging in patients with non-arthritic hip pain. Purpose: The purpose of this study was to categorize the radiographic findings seen in patients with longstanding hip pain, suspect for an intraarticular pathology, and provide a treatment algorithm allocating a specific treatment option for each clinical condition. Material and Methods: A review of the literature was performed using Public Medline searches of MeSH terms combined with synonyms for femoroacetabular impingement, acetabular retroversion, periacetabular osteotomy and hip arthroscopy. Results: Radiographic findings associated with acetabular retroversion described in the literature were the crossover sign, the posterior wall sign and the ischial spine sign, while Wiberg’s lateral center-edge angle (CE-angle) together with Leqeusne’s acetabular index indicate hip dysplasia. A Tönnis index >2 indicates osteoarthritis, however unsatisfying results are documented following joint preserving surgery with a Tönnis index >1. Furthermore, ischial spine sign in combination with the posterior wall sign indicates total acetabular retroversion prone to periacetabular osteotomy in contrast to focal retroversion prone to hip arthroscopy. These findings were used creating a treatment algorithm for intraarticular pathologies in patients with longstanding hip pain. Conclusion: Based on the radiographic findings, the algorithm presented in this study can be a helpful tool in the decision-making for the treatment of patients with non-arthritic hip pain, suspect for intraarticular pathologies.

scholarly journals DIFFERENCES IN RADIOGRAPHIC MEASUREMENTS ON STANDING VERSUS SUPINE PELVIC RADIOGRAPHS

2020 ◽  
Vol 8 (4_suppl3) ◽  
pp. 2325967120S0016
Author(s):  
Andrea M. Spiker ◽  
Ryan M. Graf ◽  
Sean P. Duminie ◽  
Stephanie A. Kliethermes ◽  
David C. Goodspeed
Keyword(s):  
Clinical Importance ◽  
Posterior Wall ◽  
Joint Space ◽  
Ischial Spine ◽  
Crossover Sign ◽  
Acetabular Inclination ◽  
Pelvic Radiographs ◽  
Center Edge ◽  
Radiographic Measurements ◽  
Posterior Wall Sign

Background: Accurate pelvic radiographic measurements is of clear clinical importance, as these measurements can drive the indications for surgery, the surgical approach utilized, and/or the degree of correction during hip preservation surgery. Currently, there are a large number of measurements available and reported on the literature when referencing anterior-posterior (AP) pelvic radiographs. However, there is no standardization of whether these pelvic radiographs are obtained in the standing or supine position. Hypothesis/Purpose: Standing vs. Supine radiographs, obtained in the same patient, will result in different value for standard radiographic measurements used in making hip pathology diagnoses. Methods: All new patients who presented for evaluation of hip pain between September 2016 and July 2018 were retrospectively reviewed. Inclusion criteria included age 18-50, no prior hip surgery/injury, and both standing and supine AP pelvis radiographs dated within 2 years of each other. Measurements were obtained on 26 radiographs (52 hips), blinded to patient demographics and standing versus supine radiograph. Measurements included minimum joint space, lateral center edge angle (LCEA), acetabular depth, acetabular inclination, Tönnis Grade, crossover sign, posterior wall sign, ischial spine sign. Results: Standing films resulted in significantly lower LCEA and acetabular depth measurements, and higher acetabular inclination. Supine measurements for crossover sign were 5.69 times more likely to be positive than standing measurements. Similarly, supine measurements for ischial spine were 7.93 times more likely to be positive (see Table 1). Conclusion: Based on our study, supine films are almost 6 times more likely to give a positive crossover sign and almost 8 times more likely to give a positive ischial spine sign than a standing film in the same patient. Additionally, LCEA, acetabular depth will be lower and acetabular inclination will be higher on standing films. As such, our recommendation is to obtain standing AP pelvis radiographs to obtain the most accurate pelvic radiographic measurements in hip preservation patients. Tables: [Table: see text]

Primary Peritoneal Serous Psammocarcinoma: a Case Report

2015 ◽  
Vol 24 (2) ◽  
pp. 253-256 ◽  
Author(s):  
Răzvan Dan Togănel ◽  
Ioan Şimon ◽  
Adriana Zolog ◽  
Răzvan Simescu ◽  
Angela Cozma ◽  
...  
Keyword(s):  
Adjuvant Chemotherapy ◽  
Posterior Wall ◽  
Ca 125 ◽  
Low Grade ◽  
Abdominal Girth ◽  
Treatment Protocols ◽  
Standardized Treatment ◽  
Pelvic Peritonectomy ◽  
Optimal Debulking ◽  
Douglas Pouch

Background: Psammocarcinomas (PCas) are rare epithelial tumors, usually originating in the ovaries or the peritoneum. These tumors are morphologically characterized by extensive psammomatous calcifications, invasiveness and low-grade cytological features.Case report: We present the case of a 54-year-old woman who was referred to our department with an umbilical tumor and increasing abdominal girth. The patient had had an umbilical hernia for more than 20 years. The CA 125 level was normal. The CT scan showed small peritoneal nodules at the level of the Douglas pouch, including the posterior wall of the uterus, and the entire colon, as well as large nodules located on the caecum and the sigmoid colon. We performed partial enterectomy, total colectomy with ileo-rectal anastomosis, omentectomy, total histerectomy and bilateral adnexectomy, pelvic peritonectomy of the Douglas pouch. Pathology findings were consistent with F.I.G.O. stage IIIC peritoneal PCa. The patient received adjuvant chemotherapy with Taxol and Carboplatin. To date, twelve months after surgery, the follow-up shows no evidence of disease.Conclusion: Standardized treatment protocols are hindered by the rarity of the PCas. However, literature concludes that optimal debulking is mandatory, whereas the efficacy of adjuvant chemotherapy remains to be elucidated.

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