Suka M, Yoshida K.
The national burden of musculoskeletal pain in Japan: Projections to the year 2055.
Clin J Pain. 2009 May;25(4):313-9. doi: 10.1097/AJP.0b013e31818c00c5.
Abstract/Text
OBJECTIVES: To project the national burdens of low back, hip, and knee pains in Japan from 2005 to 2055 in terms of quality adjusted life years (QALYs).
METHODS: The age- and sex-specific prevalence rates of low back, hip, and knee pains in the questionnaire survey (3048 men and 1885 women) were multiplied by the corresponding age- and sex-specific Japanese population projections. The losses of QALYs associated with low back, hip, and knee pains were calculated as the projected numbers of men and women with pain at each site multiplied by the corresponding sex-specific mean differences of EQ-5D scores between those who reported pain at each site and those who reported no musculoskeletal pain in the questionnaire survey.
RESULTS: Among a total of 87.9 million Japanese people aged 30 years or older in 2005, 21.4 million (24.3%), 3.2 million (3.7%), and 9.1 million (10.4%) were estimated to have low back, hip, and knee pains, respectively. The prevalence rates of low back, hip, and knee pains will gradually increase in subsequent years, reaching 26.5%, 4.4%, and 12.9%, respectively by 2055. Consequently, the losses of QALYs associated with low back, hip, and knee pains per 1000 population will increase from 17.2, 3.8, and 8.9, respectively in 2005 to 18.8, 4.5, and 11.2, respectively by 2055.
DISCUSSION: Due to population aging, the national burden of musculoskeletal pain in Japan is projected to increase in the next 50 years. Musculoskeletal pain has not been counted among national healthcare priorities. However, the control of musculoskeletal pain should not be bypassed to improve QOL and extend healthy life expectancy.
Swezey RL.
Overdiagnosed sciatica and stenosis, underdiagnosed hip arthritis.
Orthopedics. 2003 Feb;26(2):173-4; discussion 174. doi: 10.3928/0147-7447-20030201-20.
Abstract/Text
A retrospective analysis of 43 consecutive patients with hip osteoarthritis was performed. Twenty-four patients had previously been diagnosed with hip osteoarthritis, and 19 were treated solely for coexistent spine-related disorders without recognition of hip osteoarthritis. Four of 19 patients had previous spinal surgery for sciatica or spinal stenosis, 6 of 19 had epidural injections, 17 of 19 had magnetic resonance imaging or computed tomography, and 3 of 19 had electrodiagnostic studies.
Nakamura J, Oinuma K, Ohtori S, Watanabe A, Shigemura T, Sasho T, Saito M, Suzuki M, Takahashi K, Kishida S.
Distribution of hip pain in osteoarthritis patients secondary to developmental dysplasia of the hip.
Mod Rheumatol. 2013 Jan;23(1):119-24. doi: 10.1007/s10165-012-0638-5. Epub 2012 Apr 11.
Abstract/Text
OBJECTIVES: Our aim was to clarify the distribution of hip pain in patients with osteoarthritis of the hip secondary to developmental dysplasia of the hip (DDH).
METHODS: We retrospectively studied 443 hips in 369 patients with osteoarthritis secondary to DDH; mean age was 61 years, and follow-up rate was 84 %. Hip pain was defined as preoperative pain that was relieved 3 months after total hip arthroplasty.
RESULTS: Distribution of pain originating in the hip was 89 % (393 hips) to the groin, 38 % (170 hips) to the buttock, 33 % (144 hips) to the anterior thigh, 29 % (130 hips) to the knee, 27 % (118 hips) to the greater trochanter, 17 % (76 hips) to the low back, and 8 % (34 hips) to the lower leg. When the groin, buttock, and greater trochanter were combined as the hip region, 95 % (421 hips) of pain was located in the hip region. On the other hand, when the anterior thigh, knee, lower leg, and low back were combined as the referral region, 55 % (242 hips) showed referred pain.
CONCLUSIONS: We suggest that rheumatologists be aware of hip disease masquerading as knee pain or low back pain.
Steindler A: Mechanics of normal and pathological locomotion in man. Springfield: Charles C Thomas, 1935.
Byrd JW, Jones KS.
Diagnostic accuracy of clinical assessment, magnetic resonance imaging, magnetic resonance arthrography, and intra-articular injection in hip arthroscopy patients.
Am J Sports Med. 2004 Oct-Nov;32(7):1668-74. doi: 10.1177/0363546504266480.
Abstract/Text
BACKGROUND: Hip arthroscopy has defined elusive causes of hip pain.
HYPOTHESIS/PURPOSE: It is postulated that the reliability of various investigative methods is inconsistent. The purpose of this study is to evaluate the diagnostic accuracy of these methods.
STUDY DESIGN: Retrospective review of prospectively collected data.
METHODS: Five parameters were assessed in 40 patients: clinical assessment, high-resolution magnetic resonance imaging, magnetic resonance imaging with gadolinium arthrography, intra-articular bupivacaine injection, and arthroscopy. Using arthroscopy as the definitive diagnosis, the other parameters were evaluated for reliability.
RESULTS: Hip abnormality was clinically suspected in all cases with 98% accuracy (1 false positive). However, the nature of the abnormality was identified in only 13 cases with 92% accuracy. Magnetic resonance imaging variously demonstrated direct or indirect evidence of abnormality but overall demonstrated a 42% false-negative and a 10% false-positive interpretation. Magnetic resonance arthrography demonstrated an 8% false-negative and 20% false-positive interpretation. Response to the intra-articular injection of anesthetic was 90% accurate (3 false-negative and 1 false-positive responses) for detecting the presence of intra-articular abnormality.
CONCLUSIONS: In this series, clinical assessment accurately determined the existence of intra-articular abnormality but was poor at defining its nature. Magnetic resonance arthrography was much more sensitive than magnetic resonance imaging at detecting various lesions but had twice as many false-positive interpretations. Response to an intra-articular injection of anesthetic was a 90% reliable indicator of intra-articular abnormality.
浦部昌夫，島田和幸，川合眞一：今日の治療薬（2013年版）. 南江堂, 2013.
日本整形外科学会診療ガイドライン委員会, 変形性股関節症診療ガイドライン策定委員会編. 変形性股関節症診療ガイドライン2024 改訂第3版. 南江堂, 2024.
日本整形外科学会診療ガイドライン委員会, 特発性大腿骨頭壊死症診療ガイドライン策定委員会編：特発性大腿骨頭壊死症診療ガイドライン 2019. 南江堂, 2019.
Burnett RS, Della Rocca GJ, Prather H, Curry M, Maloney WJ, Clohisy JC.
Clinical presentation of patients with tears of the acetabular labrum.
J Bone Joint Surg Am. 2006 Jul;88(7):1448-57. doi: 10.2106/JBJS.D.02806.
Abstract/Text
BACKGROUND: The clinical presentation of a labral tear of the acetabulum may be variable, and the diagnosis is often delayed. We sought to define the clinical characteristics associated with symptomatic acetabular labral tears by reviewing a group of patients who had an arthroscopically confirmed diagnosis.
METHODS: We retrospectively reviewed the records for sixty-six consecutive patients (sixty-six hips) who had a documented labral tear that had been confirmed with hip arthroscopy. We had prospectively recorded demographic factors, symptoms, physical examination findings, previous treatments, functional limitations, the manner of onset, the duration of symptoms until the diagnosis of the labral tear, other diagnoses offered by health-care providers, and other surgical procedures that these patients had undergone. Radiographic abnormalities and magnetic resonance arthrography findings were also recorded.
RESULTS: The study group included forty-seven female patients (71%) and nineteen male patients (29%) with a mean age of thirty-eight years. The initial presentation was insidious in forty patients, was associated with a low-energy acute injury in twenty, and was associated with major trauma in six. Moderate to severe pain was reported by fifty-seven patients (86%), with groin pain predominating (sixty-one patients; 92%). Sixty patients (91%) had activity-related pain (p < 0.0001), and forty-seven patients (71%) had night pain (p = 0.0006). On examination, twenty-six patients (39%) had a limp, twenty-five (38%) had a positive Trendelenburg sign, and sixty-three (95%) had a positive impingement sign. The mean time from the onset of symptoms to the diagnosis of a labral tear was twenty-one months. A mean of 3.3 health-care providers had been seen by the patients prior to the definitive diagnosis. Surgery on another anatomic site had been recommended for eleven patients (17%), and four had undergone an unsuccessful operative procedure prior to the diagnosis of the labral tear. At an average of 16.4 months after hip arthroscopy, fifty-nine patients (89%) reported clinical improvement in comparison with the preoperative status.
CONCLUSIONS: The clinical presentation of a patient who has a labral tear may vary, and the correct diagnosis may not be considered initially. In young, active patients with a predominant complaint of groin pain with or without a history of trauma, the diagnosis of a labral tear should be suspected and investigated as radiographs and the history may be nonspecific for this diagnosis.
LEVEL OF EVIDENCE: Diagnostic Level IV. See Instructions to Authors for a complete description of levels of evidence.
上野良三：変形性股関節症に対する各種治療法の比較検討. 3．X線像からの評価. 日整会誌 1971;45: 826-828.
Yamamoto T, Bullough PG.
Subchondral insufficiency fracture of the femoral head: a differential diagnosis in acute onset of coxarthrosis in the elderly.
Arthritis Rheum. 1999 Dec;42(12):2719-23. doi: 10.1002/1529-0131(199912)42:12<2719::AID-ANR31>3.0.CO;2-X.
Abstract/Text
OBJECTIVE: To document subchondral insufficiency fracture (SIF) of the femoral head and investigate its frequency.
METHODS: The study was based on a retrospective review of 464 removed femoral heads (from 419 patients) with both radiologic and histologic evidence of subchondral collapse. Gross photographs, specimen radiographs, and histologic sections were reevaluated in all cases. Available clinical notes and imaging studies were also reviewed.
RESULTS: Ten cases previously diagnosed as osteonecrosis were reinterpreted as SIF on a histopathologic basis. All of these patients were women over 65 years old (average age 75) with osteopenia. The initial symptom was acute onset of hip pain. Radiologically, a subchondral collapse, mainly in the superolateral segment of the femoral head, was noted. Magnetic resonance imaging, available in 3 cases, showed diffuse low intensity on T1-weighted images and high intensity on T2-weighted or fat-suppressed images. Bone scintigraphy, available in 4 cases, showed increased uptake in the femoral head. Histopathologically, a 1.0-2.5-cm long linear whitish gray zone, comprising fracture callus and granulation tissue, was found beneath the subchondral bone end plate. There was no evidence of antecedent osteonecrosis.
CONCLUSION: The results of this study indicate that SIF should be included in the differential diagnosis of acute onset of coxarthrosis in the elderly.
Postel M, Kerboull M.
Total prosthetic replacement in rapidly destructive arthrosis of the hip joint.
Clin Orthop Relat Res. 1970 Sep-Oct;72:138-44.
Abstract/Text
Clohisy JC, Knaus ER, Hunt DM, Lesher JM, Harris-Hayes M, Prather H.
Clinical presentation of patients with symptomatic anterior hip impingement.
Clin Orthop Relat Res. 2009 Mar;467(3):638-44. doi: 10.1007/s11999-008-0680-y. Epub 2009 Jan 7.
Abstract/Text
Femoroacetabular impingement (FAI) is considered a cause of labrochondral disease and secondary osteoarthritis. Nevertheless, the clinical syndrome associated with FAI is not fully characterized. We determined the clinical history, functional status, activity status, and physical examination findings that characterize FAI. We prospectively evaluated 51 patients (52 hips) with symptomatic FAI. Evaluation of the clinical history, physical exam, and previous treatments was performed. Patients completed demographic and validated hip questionnaires (Baecke et al., SF-12, Modified Harris hip, and UCLA activity score). The average patient age was 35 years and 57% were male. Symptom onset was commonly insidious (65%) and activity-related. Pain occurred predominantly in the groin (83%). The mean time from symptom onset to definitive diagnosis was 3.1 years. Patients were evaluated by an average 4.2 healthcare providers prior to diagnosis and inaccurate diagnoses were common. Thirteen percent had unsuccessful surgery at another anatomic site. On exam, 88% of the hips were painful with the anterior impingement test. Hip flexion and internal rotation in flexion were limited to an average 97 degrees and 9 degrees, respectively. The patients were relatively active, yet demonstrated restrictions of function and overall health. These data may facilitate diagnosis of this disorder.
Ganz R, Parvizi J, Beck M, Leunig M, Nötzli H, Siebenrock KA.
Femoroacetabular impingement: a cause for osteoarthritis of the hip.
Clin Orthop Relat Res. 2003 Dec;(417):112-20. doi: 10.1097/01.blo.0000096804.78689.c2.
Abstract/Text
A multitude of factors including biochemical, genetic, and acquired abnormalities may contribute to osteoarthritis of the hip. Although the pathomechanism of degenerative process affecting the dysplastic hip is well understood, the exact pathogenesis for idiopathic osteoarthritis has not been established. Based on clinical experience, with more than 600 surgical dislocations of the hip, allowing in situ inspection of the damage pattern and the dynamic proof of its origin, we propose femoroacetabular impingement as a mechanism for the development of early osteoarthritis for most nondysplastic hips. The concept focuses more on motion than on axial loading of the hip. Distinct clinical, radiographic, and intraoperative parameters can be used to confirm the diagnosis of this entity with timely delivery of treatment. Surgical treatment of femoroacetabular impingement focuses on improving the clearance for hip motion and alleviation of femoral abutment against the acetabular rim. It is proposed that early surgical intervention for treatment of femoroacetabular impingement, besides providing relief of symptoms, may decelerate the progression of the degenerative process for this group of young patients.
Tannast M, Siebenrock KA, Anderson SE.
Femoroacetabular impingement: radiographic diagnosis--what the radiologist should know.
AJR Am J Roentgenol. 2007 Jun;188(6):1540-52. doi: 10.2214/AJR.06.0921.
Abstract/Text
OBJECTIVE: The purpose of this article is to show the important radiographic criteria that indicate the two types of femoroacetabular impingement: pincer and cam impingement. In addition, potential pitfalls in pelvic imaging concerning femoroacetabular impingement are shown.
CONCLUSION: Femoroacetabular impingement is a major cause for early "primary" osteoarthritis of the hip. It can easily be recognized on conventional radiographs of the pelvis and the proximal femur.
