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Objective Greater trochanteric pain syndrome is a common cause of lateral hip pain. Corticosteroid injections are commonly utilized as nonsurgical interventions; however, they are not effective for all patients. This technical case report describes a method for treating greater trochanteric pain syndrome by utilizing cooled radiofrequency ablation. Methods The trochanteric branch of the nervus femoralis is identified as providing sensory innervation to the greater trochanter and its surrounding structures. We have identified fluoroscopic targets to block the nerve and perform cooled radiofrequency ablation. We present two patient cases which demonstrated significant pain relief of greater trochanteric pain syndrome with this treatment. Conclusions Cooled radiofrequency ablation of the trochanteric branch of the nervus femoralis is a potential treatment for greater trochanteric pain syndrome. This procedure provides a potential steroid-sparing interventional treatment based on reproducible fluoroscopic landmarks.

Background Various authors have successfully demonstrated that the distance from the greater trochanter to the femoral head center (GTFHC) and the distance from the lesser trochanter to the femoral head center (LTFHC) can be used as parameters to determine the recovery of the femoral head center (FHC) during hip arthroplasty. It is necessary to undertake an anatomical study concerning the correlations between the greater trochanter (GT), the lesser trochanter (LT), and the FHC using data obtained from the 3D-CT reconstruction method. Methods The study comprised 293 patients (151 males and 142 females), with an average age of 65.06 years. The femoral head diameter(FHD), the linear distance from FHC to GT (GTFHC), and the linear distance from FHC to LT(LTFHC) were all measured and recorded data. The correlation between FHD with LTFHC and GTFHC was assessed using Pearson correlation coefficients, and the ratio of LTFHC and GTFHC to FHD was calculated from this ratio. All measured parameters were compared between the left and right sides and the sexes of the participants. Results The average ratios of GTFHC/FHD and LTFHC/FHD were 0.99 and 0.95, respectively .96% of the LTFHC had absolute lateral differences of < 4 mm . 92% of the GTFHC had absolute lateral differences of < 4 mm. Conclusion LTFHC and GTFHC are reliable reference parameters for preoperative planning and reconstruction of FHC of hip arthroplasty. The ratio displayed in this research may yield insight into a practical and straightforward method for orthopedic surgeons to perform hip arthroplasty in patients with femoral neck fractures. Ratios from studies based on the same race may be desirable for future work.

Purpose Ischiofemoral impingement is considered to be an uncommon and difficult pathology to diagnose with respect to hip pain etiology. The objective was to describe the clinical results of endoscopic lesser trochanter resection via a posterior approach in patients with Ischiofemoral impingement. Methods This was a retrospective observational study of consecutive patients with Ischiofemoral impingement, who underwent endoscopic resection of the lesser trochanter via a posterior approach, between 2015 and 2018. Clinical results were evaluated using the ischiofemoral impingement test, long-stride walking test, modified Harris Hip Score (mHHS) and the Oxford scale to assess the strength of the iliopsoas muscle as well as the presence of complications. Preoperative and postoperative ischiofemoral space was measured to assess whether the resection of the lesser trochanter was adequate. Results 16 hips in 13 patients (mean age: 34.4 ± 12.1 years, 11 women) with a follow-up period between 24 and 59 months were included. Preoperative ischiofemoral space ranged from 6.4 to 22.4 mm, a measure > 17.0 mm was achieved in 15 hips without the presence of pain in IFI test and long-strides walking test. Function improved postoperatively, as reflected by a higher mean mHHS (preoperative: 44.6 ± 21.5, postoperative: 81.2 ± 15.1, p  < 0.05). After surgery, the strength of the iliopsoas muscle was not decreased compared to the preoperative measure. Three complications were reported, including two cases that required revision surgery. Conclusions Endoscopic resection of the lesser trochanter via posterior approach provides satisfactory outcomes with symptom relief and good functional results in patients with Ischiofemoral impingement. It is important to discuss the benefits and risks when offering this treatment choice. Level of Evidence Level IV

Introduction: Management of trochanteric fractures in revision hip surgery has a high incidence of non-union and complications. Fixation devices are often bulky, prone to breakage, and necessitate reoperation. This study describes a novel soft tissue and bony abductor repair that reduces the forces on bony fragments without the need for prominent metalwork. Methods: This novel surgical technique involves fixation of the abductor mechanism with polyester and polyethylene sutures that are woven through the abductors and secured to the femoral shaft with a proprietary suture cerclage tape with cerclage wire supplementation in select cases. All patients undergoing fixation were retrospectively reviewed with a minimum follow-up period of 12 months. Outcomes relating to dislocation, reoperation, fracture union and the incidence of symptomatic Trendelenburg gait were recorded. Results: A total of 17 patients underwent this novel intervention. There were no dislocations or reoperations for prominent metalwork at the last follow-up. One patient had evidence of greater trochanter (GT) non-union, and three had GT displacement of over 3 mm. Eight (47.1%) patients were independently mobile and seven (41.2%) were mobile with only one walking aid. No patients required plate or bolt fixation. Conclusions: GT fractures and abductor deficiency are difficult to manage, with most reported methods utilising bulky metalwork to treat a soft tissue injury. We describe a novel combined soft tissue and bony fixation without the need for excessive metalwork. Our pilot study demonstrates satisfactory outcomes of this intervention that are technically reproducible and more appropriately addresses the deforming forces involved with a low complication profile.

The accuracy of the trochanter‐based three‐dimensional method enables clinically acceptable estimation of the femoral head center (FC) even in patients with developmental dysplasia of the hip and may serve as a useful adjunct for planning of total hip arthroplasty when the native FC is difficult to identify.

Leg length discrepancy (LLD), offset, and anatomical abnormalities such as a high-riding greater trochanter are key factors that may influence the outcomes of total hip arthroplasty (THA). Understanding how these factors affect patient-reported outcomes (PROs) is crucial for optimizing surgical techniques and improving patient satisfaction. This study investigated whether preoperative and postoperative LLD, offset, and a preoperative high-riding greater trochanter influence PROs in unilateral THA. A questionnaire survey was conducted targeting 1,010 individuals who underwent primary THA. Of the 652 respondents (62%), 203 with healthy contralateral sides were included. PROs were assessed using the Forgotten Joint Score-12 (FJS-12), Oxford Hip Score (OHS), and Visual Analogue Scale (VAS)-Satisfaction. Anteroposterior radiographs taken before and one week after surgery were used to measure LLD, femoral offset, acetabular offset, global offset, and articular trochanteric distance (ATD). A high-riding greater trochanter was defined as an ATD < 0 mm. Multivariable analyses revealed that a longer leg on the surgical side postoperatively ( P  = 0.0004) and a preoperative high-riding greater trochanter ( P  = 0.01) were negative factors for FJS-12. Older age ( P  = 0.0004) and higher body mass index ( P  = 0.04) were negative factors for OHS. Male sex negatively affected VAS-Satisfaction ( P  = 0.04). This study is the first to reveal that a longer postoperative leg on the surgical side and the presence of a high-riding greater trochanter leads to a decrease in the FJS-12 score independently. Therefore, to improve joint stability, it may be more beneficial to increase offset rather than extend leg length.

ObjectiveTo utilize hip MRI 3D models for demonstration of location and frequency of impingement during simulated range-of-motion in ischiofemoral impingement (IFI) compared to non-IFI hips.Materials and methodsSixteen hips (N = 7 IFI, 9 non-IFI) from 8 females were examined with high-resolution MRI. We performed image segmentation and generated 3D bone models and simulated hip range-of-motion and impingement. We examined the frequency and location of bone contact in early external rotation and early extension (0–20°), isolated maximum external rotation, and isolated maximum extension. Frequency and location of impingement at varied combinations of external rotation and extension and areas of simulated bone impingement at early external rotation and extension were compared between IFI and non-IFI.ResultsHigher frequency of bony impingement occurred more often in IFI hips at each simulated range-of-motion combination (P < 0.05). Impingement involved the lesser trochanter more often in IFI hips (P < 0.001) and occurred at early degrees of external rotation and extension. In isolated maximum external rotation, only the greater trochanter, intertrochanteric area, or both combined were involved, in 14%, 57%, and 29% in IFI hips. In isolated maximum extension, the lesser trochanter, intertrochanteric area, or both combined were involved in 71%, 14%, and 14% in IFI hips. The simulated area of bone impingement was significantly higher in IFI hips (P = 0.02).ConclusionHip MRI 3D models are feasible for simulated range-of-motion and show a higher frequency of extra-articular impingement at early stages of external rotation and extension in IFI compared to non-IFI hips.

Background If interplanetary travel is to be successful over the coming decades, it is essential that countermeasures to minimize deterioration of the musculoskeletal system are as effective as possible, given the increased duration of spaceflight associated with such missions. The aim of this review, therefore, is to determine the magnitude of deconditioning of the musculoskeletal system during prolonged spaceflight and recommend possible methods to enhance the existing countermeasures. Methods A literature search was conducted using PubMed, Ovid and Scopus databases. 5541 studies were identified prior to the removal of duplicates and the application of the following inclusion criteria: (1) group means and standard deviations for pre- and post-spaceflight for measures of strength, muscle mass or bone density were reported (or provided by the corresponding author when requested via e-mail), (2) exercise-based countermeasures were included, (3) the population of the studies were human, (4) muscle function was assessed and (5) spaceflight rather than simulated spaceflight was used. The methodological quality of the included studies was evaluated using a modified Physiotherapy Evidence Database (PEDro) scale for quality, with publication bias assessed using a failsafe N (Rosenthal method), and consistency of studies analysed using I 2 as a test of heterogeneity. Secondary analysis of studies included Hedges’ g effect sizes, and between-study differences were estimated using a random-effects model. Results A total of 11 studies were included in the meta-analyses. Heterogeneity of the completed meta-analyses was conducted revealing homogeneity for bone mineral density (BMD) and spinal muscle size (Tau 2  < 0.001; I 2  = 0.00%, p  > 0.05), although a high level of heterogeneity was noted for lower body force production (Tau 2  = 1.546; I 2  = 76.03%, p  < 0.001) and lower body muscle mass (Tau 2  = 1.386; I 2  = 74.38%, p  < 0.001). The estimated variance (≤ -0.306) for each of the meta-analyses was significant ( p  ≤ 0.033), for BMD (− 0.48 to − 0.53, p  < 0.001), lower body force production (− 1.75, p  < 0.001) and lower body muscle size (− 1.98, p  < 0.001). Spaceflight results in small reductions in BMD of the femur (Hedges g  = − 0.49 [− 0.69 to – 0.28]), trochanter (Hedges g  = − 0.53 [− 0.77 to – 0.29]), and lumbo-pelvic region (Hedges g  = − 0.48 [− 0.73 to – 0.23]), but large decreases in lower limb force production (Hedges g  = − 1.75 [− 2.50 to – 0.99]) and lower limb muscle size (Hedges g  = − 1.98 [− 2.72 to – 1.23]). Conclusions Current exercise countermeasures result in small reductions in BMD during long-duration spaceflight. In contrast, such exercise protocols do not alleviate the reductions in muscle function or muscle size, which may be attributable to the low to moderate loads reported by crewmembers and the interference effect associated with concurrent training. It is recommended that higher-load resistance exercise and the use of high-intensity interval training should be investigated, to determine if such modifications to the reported training practices result in more effective countermeasures to the deleterious effect of long-duration spaceflight on the muscular system.

Background/Objectives: Femoral anteversion (FA) is the angle between the femoral neck axis (FNA) and the posterior condylar axis (PCA). Surgeons generally estimate intraoperative femoral stem anteversion visually relative to the PCA, but this method can be challenging even for experienced surgeons. This study aimed to find an anatomical proximal landmark within a CT coordinate system for intraoperative estimation of femoral stem anteversion. Methods: Seventy patients were included. The anterior lesser trochanter line (ALTL) was defined as the line passing through two tangent points: one between the rounded part of the lesser trochanter and the medial edge of the anterior lesser trochanter cortex, and the other between the anterior cortex of the femur and the lateral edge of the anterior lesser trochanter cortex at the level of the lesser trochanter tip. The following angles were measured and analyzed: Angle 1 (angle between the FNA and the ALTL), Angle 2 (angle between the ALTL and the PCA), and Angle 3 (angle between the FNA and the PCA [FA]). Results: In all measurements, the inter-observer and intra-observer intraclass correlation coefficients exceeded 0.81. Angle 1 negatively correlated with Angle 2 (r = −0.79, p < 0.01), whereas Angle 1 positively correlated with Angle 3 (r = 0.70, p < 0.01). Conclusions: We found a consistent relationship between the ALTL and FA, and the ALTL may serve as a proximal landmark for intraoperative estimation of femoral stem anteversion during anterior or anterolateral approaches.

Why did you do this work?In developmental dysplasia of the hip (DDH), the ball and socket hip joint develops abnormally and is prone to dislocation (figure 1). Newborn and Infant Physical Examination (NIPE) is adopted in primary care at 6–8 weeks with selective ultrasound screening following positive clinical DDH screening, incorporating Barlow and Ortolani manoeuvres to identify DDH.This review assesses and evaluates current selective DDH screening against universal (all patients) ultrasound screening of hips. The review also explores methods to minimise delayed diagnosis due to false negative results from current clinical DDH screening.What did you do?Published literature databases, including Science Direct and British Journal of General Practice, were searched until 13/01/2024. Data was obtained from two single centre studies: retrospective cohort study over 14 years from 01/01/1999–31/12/2013 and observational cohort study over 15 years from 01/01/1996–31/12/2010.What did you find?The observational cohort study1 of 70,071 patients demonstrated 16.7% sensitivity and 3.5% positive predictive value for clinical DDH screening, which was low and considered false negative cases. 30 patients presented late with irreducible hip dislocation following negative DDH screening, requiring invasive procedures (table 1).The retrospective cohort study2 contained 164 patients with negative DDH screening and 32 had abnormal hip ultrasounds, where 16 patients required Pavlik Harness (figure 2) and 2 underwent invasive procedures. Breech position at birth was a major risk factor for false negative DDH screening (table 2). A key limitation of the retrospective study was potential to over-diagnose DDH following universal ultrasound screening, leading to higher rates of false positive cases.Both studies indicated Ortolani and Barlow manoeuvres (figure 3) to be a poor sole screening tool due to low sensitivity and false negative cases requiring invasive procedures.What does it mean?Limitations were identified for current DDH screening in NIPE at 6 to 8 weeks, recommending altering to a later time or further DDH screening at developmental milestones. Additions to the current DDH screening could improve specificity and sensitivity of NIPE, such as incorporating observations for asymmetrical skin creases (figure 4), reduced range of motion, Galaezzi’s sign (figure 5) and Klisic’s sign (figure 6) in clinical DDH screening to minimise delayed diagnosis.Abstract 8120 Figure 1Comparison of normal against DDH affected ball and socket hip joint[Image Omitted. See PDF.]Abstract 8120 Figure 2A pavlik harness, commonly used to treat DDH and is worn for up to 12 weeks[Image Omitted. See PDF.]Abstract 8120 Figure 3Barlow and Ortolani manoeuvres. Positive results include palpable instability or audible clicking at the hip[Image Omitted. See PDF.]Abstract 8120 Figure 4Illustration depicts A with normal gluteal creases but asymmetrical thigh creases, whereas B has an asymmetrical gluteal crease[Image Omitted. See PDF.]Abstract 8120 Figure 5Galaezzi’s sign, showing abnormal height difference between thighs[Image Omitted. See PDF.]Abstract 8120 Figure 6Klisic’s sign can be tested when placing fingers at anterior superior iliac spine and greater trochanter, then lining them up. Positive results line up away from umbilicus[Image Omitted. See PDF.]Abstract 8120 Table 1This contingency table has been taken from the observational cohort study (Davies, Talbot and Paton, 2020) in order to depict the performance of the 6 to 8 week DDH screening[Image Omitted. See PDF.]Abstract 8120 Table 2This univariate analysis with odds ratio (OR) table has been taken from the observational cohort study (Davies, Talbot and Paton, 2020)[Image Omitted. See PDF.]ReferencesRonnie Davies, Christopher Talbot, Robin Paton. Evaluation of primary care 6- to 8-week hip check for diagnosis of developmental dysplasia of the hip: a 15-year observational cohort study. 2020. DOI: 10.3399/bjgp20X708269Si Heng Sharon Tan, Joel Xue Yi Lim, Andrew Kean Seng Lim, James Hoi Po Hui. Risk factors for a false negative ortolani and barlow examination in developmental dysplasia of the hip. 2023. DOI: 10.1016/j.otsr.2023.103796