Introduction:
Chronic hip abductor insufficiency is a rare debilitating condition. In cases refractory to conservative treatment and not amenable to direct repair an augmentation becomes necessary. ...The preferred salvage method at our institution is augmentation with the anterior third of the gluteus maximus tendon. The aim of this study is to describe the results of 8 patients, treated for painful chronic hip abductor insufficiency with gluteus maximus muscle transfer, after a minimal follow-up of 24 months including a full clinical and MRI evaluation of the hip abductors pre- and postoperatively.
Methods:
We retrospectively reviewed a consecutive series of 8 patients who were surgically managed for painful chronic hip abductor insufficiency. All patients had a Trendelenburg sign, impaired muscle strength (M ⩽ 3) as well as a complete avulsion of the hip abductors with marked fatty degeneration (⩾3). Pain levels, muscle strength, functional scores as well as a postoperative MRI was obtained after a minimal follow-up of 24 months.
Results:
The mean age of the patients was 69 years, mean follow-up was 35 (26–54) months. Pain was significantly reduced postoperatively to VAS 2.5 from VAS 5 (p = 0.046). Trendelenburg sign remained positive in all patients and hip abductor strength did not improve significantly from 2.4 to 3.1 (p = 0.19). Complete healing of the transferred tendon was confirmed by MRI in all patients at last follow-up.
Conclusions:
In the setting of painful chronic hip abductor insufficiency refractory to conservative treatment with advanced muscle degeneration without the possibility of a direct reconstruction the gluteus maximus tendon transfer significantly decreased pain. The effect on hip abductor strength and patient-reported functional outcome scores is limited. Despite the modest results it remains our preferred salvage treatment option for lack of better alternatives. Larger studies are necessary to confirm these findings.
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NUK, OILJ, SAZU, UKNU, UL, UM, UPUK
Upright standing involves small displacements of the center of mass about the base of support. These displacements are often quantified by measuring various kinematic features of the ...center-of-pressure trajectory. The plantar flexors have often been identified as the key muscles for the control of these displacements; however, studies have suggested that the hip abductor and adductors may also be important. The purpose of our study was to determine the association between the force capabilities of selected leg muscles and sway-area rate across four balance conditions in young (25 ± 4 years; 12/19 women) and older adults (71 ± 5 years; 5/19 women). Due to the marked overlap in sway-area rate between the two age groups, the data were collapsed, and individuals were assigned to groups of low- and high-sway area rates based on a k-medoid cluster analysis. The number of participants assigned to each group varied across balance conditions and a subset of older adults was always included in the low-sway group for each balance condition. The most consistent explanatory variable for the variance in sway-area rate was force control of the hip abductors and ankle dorsiflexors as indicated by the magnitude of the normalized force fluctuations (force steadiness) during a submaximal isometric contraction. The explanatory power of the regression models varied across conditions, thereby identifying specific balance conditions that should be examined further in future studies of postural control.
Developmental dysplasia of the hip (DDH) and femoroacetabular impingement (FAI) are common hip pathologies and important risk factors for osteoarthritis, yet the disease mechanisms differ. DDH ...involves deficient femoral head coverage and a shortened abductor moment arm, so this study hypothesized that the cross‐sectional area (CSA) of the gluteus medius/minimus muscle complex and the stabilizing iliocapsularis muscle would be larger in DDH versus FAI, without increased fatty infiltration. A longitudinal cohort identified prearthritic patients with DDH or FAI who underwent imaging before surgery. Patients with DDH and FAI (Cam, Pincer, or Mixed) were 1:1 matched based on age, sex, and body mass index. Magnetic resonance imaging was used to measure the gluteus medius/minimus complex and iliocapsularis in two transverse planes. Amira software was used to quantify muscle and noncontractile tissue. Paired samples t‐tests were performed to compare muscle size and composition (p < 0.05). There were no differences in the iliocapsularis muscle. Patients with DDH had significantly larger CSA of the gluteus medius/minimus complex at both transverse planes, and the noncontractile tissue proportion did not differ. The mean difference in overall muscle CSA at the anterior inferior iliac spine was 4.07 ± 7.4 cm2 (p = 0.005), with an average difference of 12.1%, and at the femoral head this was 2.40 ± 4.37 cm2 (p = 0.004), with an average difference of 20.2%. This study reports a larger CSA of the gluteus medius/minimus muscle complex in DDH compared to FAI, without a difference in noncontractile tissue, indicating increased healthy muscle in DDH.
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BFBNIB, FZAB, GIS, IJS, KILJ, NLZOH, NUK, OILJ, SAZU, SBCE, SBMB, UL, UM, UPUK
In the take-off motion of the high jump, huge power exerted by the lower limb is required in a very short time. Consequently, to achieve the take-off motion, improvement of power exertion ability is ...important, and most high jumpers work to achieve this. However, the components of the kinetics that contribute to high jump performance are unknown. This study investigated lower limb joint kinetics during the take-off phase of the high jump and the relationships between kinetic variables and performance. Seven male high jumpers were investigated. Their take-off motions were filmed using an infrared camera (Vicon Motion System, 250 Hz), and the ground reaction force was recorded using a force platform (Kistler, 9287C, 1000Hz). The coefficients of correlation between the vertical velocity of the center of gravity of the whole body (CG) at the moment of take-off and kinetic variables were calculated. The following results were obtained: 1. The muscles involved in hip extension play a primary role in shock absorption at the moment of touchdown. Furthermore, the muscles involved in hip abduction, knee extension and ankle plantarflexion play a significant role in lifting the body in addition to the above functions. 2. The concentric power produced by hip abductors during the take-off motion may increase vertical velocity of the CG at the moment of take-off. 3. As it has been reported that single leg exercises impact the function of hip abductors, such exercises may improve take-off motion in the high jump. These results illustrate the characteristics of take-off motion in the high jump, and these may be studied further to plan effective training aimed at improving performance.
In the take-off motion of the high jump, huge power exerted by the lower limb is required in a very short time. Consequently, to achieve the take-off motion, improvement of power exertion ability is ...important, and most high jumpers work to achieve this. However, the components of the kinetics that contribute to high jump performance are unknown. This study investigated lower limb joint kinetics during the take-off phase of the high jump and the relationships between kinetic variables and performance. Seven male high jumpers were investigated. Their take-off motions were filmed using an infrared camera (Vicon Motion System, 250 Hz), and the ground reaction force was recorded using a force platform (Kistler, 9287C, 1000Hz). The coefficients of correlation between the vertical velocity of the center of gravity of the whole body (CG) at the moment of take-off and kinetic variables were calculated. The following results were obtained: 1. The muscles involved in hip extension play a primary role in shock absorption at the moment of touchdown. Furthermore, the muscles involved in hip abduction, knee extension and ankle plantarflexion play a significant role in lifting the body in addition to the above functions. 2. The concentric power produced by hip abductors during the take-off motion may increase vertical velocity of the CG at the moment of take-off. 3. As it has been reported that single leg exercises impact the function of hip abductors, such exercises may improve take-off motion in the high jump. These results illustrate the characteristics of take-off motion in the high jump, and these may be studied further to plan effective training aimed at improving performance.
Age-related neuromuscular changes in the hip abductor-adductor muscles lead to reduced performance, especially in the rate of force development and power production. These alterations may impair ...weight transfer control and lateral balance recovery through protective stepping. This study compared the effects of eight weeks of low-dose hip abductor-adductor power and strength training on the performance of isometric maximal voluntary contractions, and lateral balance recovery at different initial weight-bearing conditions in older individuals.
Eighteen healthy older adults (71.3 (0.9) years) underwent eight weeks of low-dose hip abductor-adductor exercise training involving either power training (n = 10) or lower velocity strength training (n = 8). Outcomes were assessed for hip abductor-adductor isometric maximal voluntary contractions and lateral waist-pull balance perturbations with three initial stepping limb-load conditions (50%, 65%, or 80% body mass).
Power training increased isometric maximal voluntary contractions abductor-adductor peak torque (14%–18%, p < 0.05), rate of torque development (31%–39%, p < 0.05) and rate of neuromuscular activation (37%–81%, p < 0.05). During lateral balance recovery, power training increased the incidence of stabilizing single lateral steps at 80% body mass pre-load (by 43%, p < 0.05), reduced step lift-off time by 27 ms at 50% body mass (p < 0.05) and decreased downward momentum of the body center of mass at 80% body mass (32%, p < 0.05). Power training also increased in task hip abductor net joint torque (49%–61%, p < 0.05), power (21%–54%, p < 0.05), and abductor-adductor rate of neuromuscular activation (17%–62%, p < 0.05).
Low-dose hip abductor-adductor power training was more effective than strength training at eliciting improvements in maximal neuromuscular performance and enhanced medio-lateral balance recovery.
•Hip abductor-adductor power training was more effective than strength training.•Power training improved maximal hip abductor-adductor neuromuscular performance.•Power training enhanced weight transfer control and medio-lateral balance recovery.
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GEOZS, IJS, IMTLJ, KILJ, KISLJ, NLZOH, NUK, OILJ, PNG, SAZU, SBCE, SBJE, UL, UM, UPUK, ZRSKP
Understanding the physiological variables that contribute to a functional task provides important information for trainers and clinicians to improve functional performance. The hip abductors and ...adductors muscles appear to be important in determining the performance of some functional tasks; however, little is known about the relationship of the hip abductor/adductors muscle strength, activation, and size with functional performance. This study aimed to investigate the relationship of maximum torque, rate of torque development (RTD), rate of activation (RoA), and muscle thickness of the hip abductors tensor fascia latae (TFL) and gluteus medius (GM) and adductor magnus muscle with the Four Square Step Test (FSST) and the two-leg hop test in healthy young adults. Twenty participants (five males) attended one testing session that involved ultrasound image acquisition, maximal isometric voluntary contractions (hip abduction and hip adduction) while surface electromyography (EMG) was recorded, and two functional tests (FSST and two-leg side hop test). Bivariate correlations were performed between maximum voluntary torque (MVT), RTD at 50, 100, 200, and 300ms, RoA at 0–50, 0–100, 0–200, and 0–300, and muscle thickness with the dynamic stability tests. For the hip abduction, MVT (
r
=−0.455,
p
=0.044) and RTD
300
(
r
=−0.494,
p
=0.027) was correlated with the FSST. GM RoA
50
(
r
=−0.481,
p
=0.032) and RoA
100
(
r
=−0.459,
p
=0.042) were significantly correlated with the two-leg side hop test. For the hip adduction, there was a significant correlation between the FSST and RTD
300
(
r
=−0.500,
p
=0.025), while the two-leg side hop test was correlated with RTD
200
(
r
=0.446,
p
=0.049) and RTD
300
(
r
=0.594,
p
=0.006). Overall, the ability of the hip abductor and adductor muscles to produce torque quickly, GM rapid activation, and hip abductor MVT is important for better performance on the FSST and two-leg hop tests. However, muscle size appears not to influence the same tests.
We here present a case of chondrosarcoma of the diaphysis of the femur with extensive involvement of the length of the bone and with the pathological fracture at the mid-shaft level. Total femur ...replacement was done in this case with a bipolar head and repair of abductors and hip flexors to the implanted prosthesis.
An elderly female in her late 60s presented to the trauma department with sudden onset pain and inability to bear weight on her left lower limb following a trivial slip and fall. The Radiographs revealed a pathological spiral mid-shaft displaced fracture of the femur with an extensive mixed lesion throughout the femur. Magnetic Resonance imaging revealed involvement of more than 90% of the femur with lesion extension into the quadriceps and hamstrings. Histopathology confirmed grade-II conventional chondrosarcoma. Metastatic work-up showed no distant spread. Wide-local resection and total femur endo-prosthetic reconstruction were done. No recurrence or infection was evident at the 18-month follow-up. In elderly non-metastatic pathological fractures, limb salvage with endo-prosthetic reconstruction can be a preferred treatment.
This case is unique in describing a rare presentation of chondrosarcoma of the diaphysis of the femur, which eventually landed in a pathological fracture. The fracture may increase the tumour's aggressiveness, but wide-margin resection should be the mainstay treatment for primary or recurrent chondrosarcoma, irrespective of pathological fracture.
In well-indicated cases (no distant spread – N0M0 disease), Total Femur Replacement (TFR) is an excellent option for limb salvage in tumours with extensive involvement of the femur.
•This is an interesting case demonstrating an unusual origin of conventional chondrosarcoma from the diaphyseal location in the femur of an elderly female.•The lesion involved almost the entire femur length, sparing only the proximal and distal ends.•The disease manifested with a pathological fracture straightway at the first presentation, though dull aching pain persisted in the thigh region for three months, which was ignored by the patient.•The case explains the importance of limb salvage in chondrosarcoma with wide local margins; a pathological fracture does not affect prognosis.•This case describes Total Femur Replacement (TFR) as the best reconstructive option for limb salvage in tumours with extensive involvement of the femur, especially in elderly age groups, in well-indicated cases (no distant spread – N0M0 disease).
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GEOZS, IJS, IMTLJ, KILJ, KISLJ, NLZOH, NUK, OILJ, PNG, SAZU, SBCE, SBJE, UILJ, UL, UM, UPUK, ZAGLJ, ZRSKP
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