Hip Dysplasia Pathology and assessment Alan Rankin MSc, BSc (Hons) Physiotherapist
A confused picture!
Hip joint
Muscle Groin pain
Infection Hernia
SIJ Medical Lumbar
2014 Doha Consensus on groin definitions
24 experts – systematic literature review
Groin injuries in Club football
Male footballers 4-19%
Female footballers 2-14%
72 studies33 different diagnostic terms
Consent on classification of groin pain
Defined clinical entities
2014 Doha Consensus on groin definitions
Hip related pain
Other cause of pain in athletes
10% of all groin region problems are hip related. Reiman (2014)
Catching Locking Clicking Giving-way
HistoryOnset Nature Location
Funnel approach to examination
Faber test
Fadir test
Hip ROM
Palpation
Test reliability?
Radiology to confirm
Literature poor on testing accuracy Doha (2014), Reiman (2014) Subjective exam56-90% accurate Objective exam30% accurate Reiman (2014)
Dysplasia is a radiological diagnosis and not clinical
Radiological findings point to impingement + - OA
What is it?! Unknown cause congenital defect Loder (2011)
Depth of the socket is the centreedge angle (C-E angle).
Normal C-E angle is 25° or more
Implications for women's football?
Most common cause of hip arthritis in young women. Hip Dysplasia Institute (2016)
75-80% patients were female. (Loder 2011)
Secondary OA commonly related to Dysplasia Loder (2011)
Dose-response relationshipFrequency of training in young age- development of future problems. Tak et al (2014)
Abnormal joint alignment is a risk factor to labrum. Saw and Villar (2004)
More frequent due to increasing football demands?
What now then?!
Early referral to experienced hip surgeon
Relatively good outcomes of surgery and back to pre injury status (Doha 2014)
Periacetabular osteotomy (POA) Move acetabulum to cover more of the femoral head
Pre
Improve the biomechanics of the hip joint
Post
Reduce the high stresses that start to cause damage
Principles post -op
Movement Strength Core Proprioception Function
Stage 1
Mental wellbeing
Mobile with e/c’sapprox. 6 weeks. Then full weight as able
Early range of movement and strength exercises ROM > 85% Contralateral
Specific exercises
Stage 2 Aim for hip strength to be 6075% compared to opposite
Full weight bearing and minimal pain
Normal gait pattern
Strength, Proprioception and core exercises No ballistic or forced stretching No treadmill use Avoid hip flexor/joint inflammation
Stage 3
Gradual move from Physio to sports scientist
Take home Good prognosis in football High chance of surgery
Not common in football Suspect the hip!
Sixth Hip Conference. Warwick Orthopaedics Sports Surgery
St George’s Park, Burton-on-Trent, Staffordshire.
Of Interest 27th-28th June 2016
www2.warwick.ac.uk/fac/med/research/csri/ orthopaedics/about_us/welcome/
Thank you!!
www.footballmedic.co.uk www.damiangriffin.org www.hipdysplasia.org