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Reliability of clinical diagnosis in intraarticular hip diseases

  • Hip
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Knee Surgery, Sports Traumatology, Arthroscopy Aims and scope

Abstract

This study investigated the ability of experienced orthopedic surgeons to agree on a diagnosis of labral tear, femoroacetabular impingement (FAI), and capsular laxity using clinical examination. Eight patients under the care of an experienced hip arthroscopist underwent independent clinical evaluations by six orthopedic surgeons who specialized in management hip pain. No attempt was made to regulate the evaluation process as surgeons performed their examination as they would in their own practice. Average subject age was 27 years (19–47 years) with five females and three males. Subjects subsequently underwent arthroscopic surgery by the treating surgeon. Surgical findings were recorded with respect to the presence or absence of a labral tear, FAI, and/or capsular laxity. The percent agreement between the surgical findings and clinical examinations were determined. Surgical findings noted four subjects had a labral tear, five FAI, and three laxity. Based on clinical examination, surgeons agreed 63, 65 and 58% of the time with the surgical diagnosis of labral tear, FAI, and capsular laxity, respectively. The level of agreement did not seem to be dependent on the size or type of labral tear. Also, the ability to detect FAI did not seem to depend on whether the lesion was a cam, pincer, combined cam/pincer or size of the cam lesion. This study offers support that clinical examination techniques used for making a diagnosis needs to be improved and standardized if they are to be useful in diagnosing specific pathologies found with arthroscopic hip surgery.

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References

  1. Beck M, Kalhor M, Leunig M, Ganz R (2005) Hip morphology influences the pattern of damage to the acetabular cartilage: femoroacetabular impingement as a cause of early osteoarthritis of the hip. J Bone Joint Surg Br 87:1012–1018

    Article  CAS  PubMed  Google Scholar 

  2. Beck M, Leunig M, Parvizi J, Boutier V, Wyss D, Ganz R (2004) Anterior femoroacetabular impingement: part II. Midterm results of surgical treatment. Clin Orthop Relat Res 418:67–73

    Article  PubMed  Google Scholar 

  3. Byrd JW, Jones KS (2004) Diagnostic accuracy of clinical assessment, magnetic resonance imaging, magnetic resonance arthrography, and intra-articular injection in hip arthroscopy patients. Am J Sports Med 32:1668–1674

    Article  PubMed  Google Scholar 

  4. Cotten A, Boutry N, Demondion X, Paret C, Dewatre F, Liesse A, Chastanet P, Fontaine C (1998) Acetabular labrum: MRI in asymptomatic volunteers. J Comput Assist Tomogr 22:1–7

    Article  CAS  PubMed  Google Scholar 

  5. Ito K, Leunig M, Ganz R (2004) Histopathologic features of the acetabular labrum in femoroacetabular impingement. Clin Orthop Relat Res 429:262–271

    Article  PubMed  Google Scholar 

  6. Jamali AA, Mladenov K, Meyer DC, Martinez A, Beck M, Ganz R, Leunig M (2007) Anteroposterior pelvic radiographs to assess acetabular retroversion: high validity of the “cross-over-sign”. J Orthop Res 25:758–765

    Article  PubMed  Google Scholar 

  7. Johnston TL, Schenker ML, Briggs KK, Philippon MJ (2008) Relationship between offset angle alpha and hip chondral injury in femoroacetabular impingement. Arthroscopy 24:669–675

    PubMed  Google Scholar 

  8. Kelly BT, Williams RJ 3rd, Philippon MJ (2003) Hip arthroscopy: current indications, treatment options, and management issues. Am J Sports Med 31:1020–1037

    PubMed  Google Scholar 

  9. Lavigne M, Parvizi J, Beck M, Siebenrock KA, Ganz R, Leunig M (2004) Anterior femoroacetabular impingement: part I. Techniques of joint preserving surgery. Clin Orthop Relat Res 418:61–66

    Article  PubMed  Google Scholar 

  10. Lecouvet FE, Vande Berg BC, Malghem J, Lebon CJ, Moysan P, Jamart J, Maldague BE (1996) MR imaging of the acetabular labrum: variations in 200 asymptomatic hips. AJR Am J Roentgenol 167:1025–1028

    CAS  PubMed  Google Scholar 

  11. Leunig M, Beck M, Kalhor M, Kim YJ, Werlen S, Ganz R (2005) Fibrocystic changes at anterosuperior femoral neck: prevalence in hips with femoroacetabular impingement. Radiology 236:237–246

    Article  PubMed  Google Scholar 

  12. Leunig M, Beck M, Woo A, Dora C, Kerboull M, Ganz R (2003) Acetabular rim degeneration: a constant finding in the aged hip. Clin Orthop Relat Res 413:201–207

    Article  PubMed  Google Scholar 

  13. Leunig M, Podeszwa D, Beck M, Werlen S, Ganz R (2004) Magnetic resonance arthrography of labral disorders in hips with dysplasia and impingement. Clin Orthop Relat Res 418:74–80

    Article  PubMed  Google Scholar 

  14. Martin RL, Enseki KR, Draovitch P, Trapuzzano T, Philippon MJ (2006) Acetabular labral tears of the hip: examination and diagnostic challenges. J Orthop Sports Phys Ther 36:503–515

    PubMed  Google Scholar 

  15. Martin RL, Irrgang JJ, Sekiya JK (2008) The diagnostic accuracy of a clinical examination in determining intra-articular hip pain for potential hip arthroscopy candidates. Arthroscopy 24:1013–1018

    Article  PubMed  Google Scholar 

  16. Martin RL, Sekiya JK (2008) The interrater reliability of 4 clinical tests used to assess individuals with musculoskeletal hip pain. J Orthop Sports Phys Ther 38:71–77

    PubMed  Google Scholar 

  17. McCarthy JC, Busconi B (1995) The role of hip arthroscopy in the diagnosis and treatment of hip disease. Orthopedics 18:753–756

    CAS  PubMed  Google Scholar 

  18. McCarthy JC, Noble PC, Schuck MR, Wright J, Lee J (2001) The watershed labral lesion: its relationship to early arthritis of the hip. J Arthroplasty 16:81–87

    Article  CAS  PubMed  Google Scholar 

  19. Mitchell B, McCrory P, Brukner P, O’Donnell J, Colson E, Howells R (2003) Hip joint pathology: clinical presentation and correlation between magnetic resonance arthrography, ultrasound, and arthroscopic findings in 25 consecutive cases. Clin J Sport Med 13:152–156

    Article  PubMed  Google Scholar 

  20. Philippon M, Schenker M, Briggs K, Kuppersmith D (2007) Femoroacetabular impingement in 45 professional athletes: associated pathologies and return to sport following arthroscopic decompression. Knee Surg Sports Traumatol Arthrosc 15:1041–1047

    Article  PubMed  Google Scholar 

  21. Philippon MJ (2001) The role of arthroscopic thermal capsulorrhaphy in the hip. Clin Sports Med 20:817–829

    Article  CAS  PubMed  Google Scholar 

  22. Philippon MJ (2006) New frontiers in hip arthroscopy: the role of arthroscopic hip labral repair and capsulorrhaphy in the treatment of hip disorders. Instr Course Lect 55:309–316

    PubMed  Google Scholar 

  23. Philippon MJ, Schenker ML (2005) Athletic hip injuries and capsualr laxity. Oper Tech Orthop 15:261–266

    Article  Google Scholar 

  24. Philippon MJ, Stubbs AJ, Schenker ML, Maxwell RB, Ganz R, Leunig M (2007) Arthroscopic management of femoroacetabular impingement: osteoplasty technique and literature review. Am J Sports Med 35:1571–1580

    Article  PubMed  Google Scholar 

  25. Schenker ML, Martin RL, Weiland DE, Philippon MJ (2005) Current trends in hip arthroscopy: a review of injury diagnosis, techniques and outcome scoring. Curr Opin Orthop 16:89–94

    Article  Google Scholar 

  26. Seldes RM, Tan V, Hunt J, Katz M, Winiarsky R, Fitzgerald RH Jr (2001) Anatomy, histologic features, and vascularity of the adult acetabular labrum. Clin Orthop Relat Res 382:232–240

    Article  PubMed  Google Scholar 

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Acknowledgments

Multi-Center Arthroscopy of the Hip Outcomes Research Network (MAHORN) has received a grant from Smith and Nephew.

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Authors and Affiliations

  1. Center for Sports Medicine-University of Pittsburgh Medical Center, Department of Physical Therapy, Duquesne University, 114 Rangos School of Health Sciences, Pittsburgh, PA, 15282, USA

    RobRoy L. Martin

  2. Hospital for Special Surgery, New York, NY, 10021, USA

    Bryan T. Kelly

  3. Schulthess Clinic, Lengghalde 2, 8008, Zürich, Switzerland

    Michael Leunig

  4. Oklahoma Sports Science and Orthopaedics, Oklahoma City, OK, 73118, USA

    Hal D. Martin

  5. University of Calgary, Calgary, AB, T2N 4N1, Canada

    Nicholas G. Mohtadi

  6. Steadman-Hawkins Research Foundation, Vail, CO, 81657, USA

    Marc J. Philippon

  7. MedSport—Department of Orthopaedic Surgery, University of Michigan, Ann Arbor, MI, 48106, USA

    Jon K. Sekiya

  8. Stanford University, Stanford, CA, 94305, USA

    Marc R. Safran

Authors
  1. RobRoy L. Martin
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  2. Bryan T. Kelly
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  3. Michael Leunig
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  4. Hal D. Martin
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  5. Nicholas G. Mohtadi
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  6. Marc J. Philippon
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  7. Jon K. Sekiya
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  8. Marc R. Safran
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Correspondence to RobRoy L. Martin.

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Martin, R.L., Kelly, B.T., Leunig, M. et al. Reliability of clinical diagnosis in intraarticular hip diseases. Knee Surg Sports Traumatol Arthrosc 18, 685–690 (2010). https://doi.org/10.1007/s00167-009-1024-5

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  • DOI: https://doi.org/10.1007/s00167-009-1024-5

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