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Titel på arbejdetMuscle-tendon pain and outcome of hip-preserving surgery in patients with hip dysplasia: Prospective investigations applying clinical examinations, ultrasonography, patient-reported outcome and measurements of physical activity (one-year follow-up study)
NavnJulie Sandell Jacobsen
Afdeling / StedDepartment of Clinical medicine
UniversitetAarhus University
  • Hip and knee surgery
Abstract / Summary

Hip dysplasia is considered a joint disease where pain presents secondary to intraarticular
lesions. Yet, previous studies indicate that this understanding may be
insufficient, and it has been suggested that extra-articular structures such as muscles
and tendons may play a role in relation to the development of pain in hip dysplasia.
However, muscle-tendon pain and structural abnormalities have not been
investigated in patients with hip dysplasia, and there is a lack of studies reporting
outcome of periacetabular osteotomy (PAO) with outcome measures considered
relevant for the typical young and active patient.

A prospective case series study was conducted in 100 patients with hip dysplasia
with follow-up 1 year after PAO. PAO outcome was investigated, applying the
Copenhagen Hip and Groin Outcome Score (HAGOS), accelerometer-based
measures of physical activity and standardised clinical examinations. Clinical
examinations were used to identify muscle-tendon pain in specific anatomical
regions (i.e. clinical entities). Moreover, prior to PAO, structural abnormalities in hip
tendons were identified with standardised ultrasonographic examinations, while hip
muscle strength was assessed with a handheld dynamometer.

Prior to PAO, the majority of patients experienced muscle-tendon pain, primarily
affecting the iliopsoas (56%; CI 46 - 66) and hip abductors (42%; CI 32 - 52). Muscle-tendon
pain was negatively associated with patient-reported outcome (PRO) and hip
muscle strength, and abnormal ultrasonographic findings were identified in the
corresponding painful structures. However, only weak to moderate correlations
between abnormal ultrasonographic findings and clinically identified pain were
found for the iliopsoas and hip abductors. One year after PAO, the proportion of
patients with muscle-tendon pain had fallen by 39% points, while patients reported
moderate to very high improvements across all subscales of the HAGOS. However,
for patient-reported participation in physical activity and physical function in sport/
recreation, about half of patients reported change scores lower than the minimally
important change, indicating that these patients did not experience clinically relevant
improvements after PAO. Moreover, despite considerable improvement in patient-reported
physical activity, no changes in accelerometer-based physical activity were

Muscle-tendon pain and structural abnormalities were common in hip dysplasia;
and 1 year after PAO, muscle-tendon pain decreased parallel with improvements in
PRO. However, the level of daily physical activity did not change after PAO. Based
on these results, hip dysplasia appears to be a joint disease that is associated with
muscle-tendon pain and structural abnormalities in muscle-tendon tissue.