Clinical Trial: Soft Tissue Pathology in Hip Dysplasia Before and After Periacetabular Osteotomy
Study Status: Completed
Recruit Status: Unknown status
Study Type: Observational
Official Title: Soft Tissue Pathology in 100 Patients With Hip Dysplasia Before and After Periacetabular Osteotomy
Brief Summary:
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.
Detailed Summary:
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.
Original Primary Outcome: Same as current
Current Secondary Outcome:
- Isometric hip muscle strength using a dynamometer [ Time Frame: Prior to surgery and one year after surgery ]Isometric hip muscle strength of the hip flexors, hip abductors, hip adductors and hip extensors using a dynamometer
- Subjective visual analogue scale (VAS) [ Time Frame: Prior to surgery and one year after surgery ]Subjective visual analogue scale (VAS) at rest and during hip muscle strength tests.
- Pain location registered on a pain-drawing [ Time Frame: Prior to surgery and one year after surgery ]In an anatomical picture of a human body the patients records pain areas on the drawing.
- Presence of internal snapping hip (examined with a standardized examination test) [ Time Frame: Prior to surgery and one year after surgery ]Presence of internal snapping hip examined with a standardized examination test.
- Presence of lumbar and thoracic back pathology [ Time Frame: Prior to surgery and one year after surgery ]Presence of lumbar and thoracic back pathology is examined with the reliable Spine Springing Tests of the spinous process and processus transversi and of the sacrum.
- Conjoint tendon pathology [ Time Frame: Prior to surgery and one year after surgery ]Conjoint tendon pathology is examined with palpation of the pubic tubercle and ultrasonography of the pubic tubercle.
Original Secondary Outcome: Same as current
Information By: University of Aarhus
Dates:
Date Received: April 2, 2014
Date Started: April 2014
Date Completion: March 2017
Last Updated: February 29, 2016
Last Verified: March 2014
