A home-based exercise and activity modification program in patients with acetabular retroversion and excessive anterior pelvic tilt
Publikation: Bidrag til tidsskrift › Konferenceabstrakt i tidsskrift › Forskning › fagfællebedømt
INTRODUCTION: Acetabular retroversion (AR) is a variant of hip dysplasia,1 enhancing the risk of pincer-morphology femoroacetabular impingement syndrome (FAIS).2 FAIS is associated with pain,3 reduced level of function,4 decreased health-related quality of life,5 and early development of hip osteoarthritis (OA).6, 7 Symptoms may be exacerbated by anterior pelvic tilt (APT)8 as it functionally increases anterosuperior femoral head cover.1, 9, 10 Currently, the standard treatment for symptomatic AR is an invasive anteverting periacetabular osteotomy.11 Exercise aiming at reducing APT may be a less-invasive alternative treatment strategy. However, the impact of a targeted exercise intervention in patients with symptomatic AR, and excessive APT is unknown.
RESEARCH QUESTION: What is the change in patient-reported symptoms and pelvic tilt in patients with AR and excessive APT of an 8-week targeted progressive home-based exercise intervention compared with a prior control period?
METHODS: The sample size was n=36 patients (age 18-40 years) not eligible for surgery, with radiographic signs of AR on an anterior/posterior radiograph in standing position. Patients were recruited from Odense University Hospital outpatient clinic (Denmark) from November 2018 to December 2019. Exclusion criteria were; pelvic-tilt-ratio greater than 0.512 (the height of the obturator foramen divided by the height of the lesser pelvis) indicating posterior pelvic tilt, radiographic sign of hip OA, related surgery, and a body mass index (BMI) above 35. The intervention consisted of education, activity modification, stretching for posterior pelvic tilt mobility, strengthening muscles for tilting the pelvis posteriorly, improving body core stability, and pelvic movement control three times per week. The primary outcome was change in the Copenhagen Hip and Groin Outcome Score (HAGOS) pain subscale. Secondary outcomes included change in pelvic tilt in standing position measured by EOS® scanning, as the angle between a horizontal line and a line connecting the upper border of the symphysis with the sacral promontory.13
RESULTS: Forty-two patients (39 women) (median [interquartile range], 20.5 [19 – 25 years] were included. Three patients were lost to follow-up. Between-period mean change scores were 5.2 points (95% confidence interval [CI]: [-0.3 – 10.6]), for the HAGOS-PAIN subscale and -1.6 degrees [-3.9 – 0.7] of anterior pelvic tilt.
DISCUSSION: No statistical or clinically relevant changes in self-reported hip-related pain and APT were found. However, post-hoc responder analysis revealed that patients with moderate pain at baseline benefited from exercise. Patients had an excessive APT of 74° ±8 (mean ±SD) at baseline, which is 14° more than the defined neutral pelvic tilt.13 The current study is limited by a short and unsupervised training period, and measuring static pelvic tilt only. Future results from three-dimensional gait analysis will provide answers to whether patients' ability to dynamically tilt their pelvis posteriorly has changed.
REFERENCES:
1. Reynolds D, Lucas J, Klaue K. Retroversion of the acetabulum. A cause of hip pain. J Bone Joint Surg Br. 1999;81(2):281-8.
2. Siebenrock KA, Schoeniger R, Ganz R. Anterior femoro-acetabular impingement due to acetabular retroversion. Treatment with periacetabular osteotomy. J Bone Joint Surg Am. 2003;85(2):278-86.
3. Langlais F, Lambotte JC, Lannou R, Gedouin JE, Belot N, Thomazeau H, et al. Hip pain from impingement and dysplasia in patients aged 20-50 years. Workup and role for reconstruction. Joint Bone Spine. 2006;73(6):614-23.
4. Rylander JH, Shu B, Andriacchi TP, Safran MR. Preoperative and postoperative sagittal plane hip kinematics in patients with femoroacetabular impingement during level walking. Am J Sports Med. 2011;39 Suppl:36S-42S.
5. Clohisy JC, Baca G, Beaule PE, Kim YJ, Larson CM, Millis MB, et al. Descriptive epidemiology of femoroacetabular impingement: a North American cohort of patients undergoing surgery. Am J Sports Med. 2013;41(6):1348-56.
6. Ganz R, Parvizi J, Beck M, Leunig M, Notzli H, Siebenrock KA. Femoroacetabular impingement: a cause for osteoarthritis of the hip. Clin Orthop Relat Res. 2003(417):112-20.
7. Giori NJ, Trousdale RT. Acetabular retroversion is associated with osteoarthritis of the hip. Clin Orthop Relat Res. 2003(417):263-9.
8. Riviere C, Hardijzer A, Lazennec JY, Beaule P, Muirhead-Allwood S, Cobb J. Spine-hip relations add understandings to the pathophysiology of femoro-acetabular impingement: A systematic review. Orthop Traumatol Surg Res. 2017;103(4):549-57.
9. Dandachli W, Ul Islam S, Richards R, Hall-Craggs M, Witt J. The influence of pelvic tilt on acetabular orientation and cover: a three-dimensional computerised tomography analysis. Hip Int. 2013;23(1):87-92.
10. Ross JR, Nepple JJ, Philippon MJ, Kelly BT, Larson CM, Bedi A. Effect of Changes in Pelvic Tilt on Range of Motion to Impingement and Radiographic Parameters of Acetabular Morphologic Characteristics. Am J Sports Med. 2014.
11. Siebenrock KA, Schaller C, Tannast M, Keel M, Buchler L. Anteverting periacetabular osteotomy for symptomatic acetabular retroversion: results at ten years. J Bone Joint Surg Am. 2014;96(21):1785-92.
12. Schwarz T, Benditz A, Springorum HR, Matussek J, Heers G, Weber M, et al. Assessment of pelvic tilt in anteroposterior radiographs by means of tilt ratios. Arch Orthop Trauma Surg. 2018.
13. Tannast M, Murphy SB, Langlotz F, Anderson SE, Siebenrock KA. Estimation of pelvic tilt on anteroposterior X-rays--a comparison of six parameters. Skeletal Radiol. 2006;35(3):149-55.
RESEARCH QUESTION: What is the change in patient-reported symptoms and pelvic tilt in patients with AR and excessive APT of an 8-week targeted progressive home-based exercise intervention compared with a prior control period?
METHODS: The sample size was n=36 patients (age 18-40 years) not eligible for surgery, with radiographic signs of AR on an anterior/posterior radiograph in standing position. Patients were recruited from Odense University Hospital outpatient clinic (Denmark) from November 2018 to December 2019. Exclusion criteria were; pelvic-tilt-ratio greater than 0.512 (the height of the obturator foramen divided by the height of the lesser pelvis) indicating posterior pelvic tilt, radiographic sign of hip OA, related surgery, and a body mass index (BMI) above 35. The intervention consisted of education, activity modification, stretching for posterior pelvic tilt mobility, strengthening muscles for tilting the pelvis posteriorly, improving body core stability, and pelvic movement control three times per week. The primary outcome was change in the Copenhagen Hip and Groin Outcome Score (HAGOS) pain subscale. Secondary outcomes included change in pelvic tilt in standing position measured by EOS® scanning, as the angle between a horizontal line and a line connecting the upper border of the symphysis with the sacral promontory.13
RESULTS: Forty-two patients (39 women) (median [interquartile range], 20.5 [19 – 25 years] were included. Three patients were lost to follow-up. Between-period mean change scores were 5.2 points (95% confidence interval [CI]: [-0.3 – 10.6]), for the HAGOS-PAIN subscale and -1.6 degrees [-3.9 – 0.7] of anterior pelvic tilt.
DISCUSSION: No statistical or clinically relevant changes in self-reported hip-related pain and APT were found. However, post-hoc responder analysis revealed that patients with moderate pain at baseline benefited from exercise. Patients had an excessive APT of 74° ±8 (mean ±SD) at baseline, which is 14° more than the defined neutral pelvic tilt.13 The current study is limited by a short and unsupervised training period, and measuring static pelvic tilt only. Future results from three-dimensional gait analysis will provide answers to whether patients' ability to dynamically tilt their pelvis posteriorly has changed.
REFERENCES:
1. Reynolds D, Lucas J, Klaue K. Retroversion of the acetabulum. A cause of hip pain. J Bone Joint Surg Br. 1999;81(2):281-8.
2. Siebenrock KA, Schoeniger R, Ganz R. Anterior femoro-acetabular impingement due to acetabular retroversion. Treatment with periacetabular osteotomy. J Bone Joint Surg Am. 2003;85(2):278-86.
3. Langlais F, Lambotte JC, Lannou R, Gedouin JE, Belot N, Thomazeau H, et al. Hip pain from impingement and dysplasia in patients aged 20-50 years. Workup and role for reconstruction. Joint Bone Spine. 2006;73(6):614-23.
4. Rylander JH, Shu B, Andriacchi TP, Safran MR. Preoperative and postoperative sagittal plane hip kinematics in patients with femoroacetabular impingement during level walking. Am J Sports Med. 2011;39 Suppl:36S-42S.
5. Clohisy JC, Baca G, Beaule PE, Kim YJ, Larson CM, Millis MB, et al. Descriptive epidemiology of femoroacetabular impingement: a North American cohort of patients undergoing surgery. Am J Sports Med. 2013;41(6):1348-56.
6. Ganz R, Parvizi J, Beck M, Leunig M, Notzli H, Siebenrock KA. Femoroacetabular impingement: a cause for osteoarthritis of the hip. Clin Orthop Relat Res. 2003(417):112-20.
7. Giori NJ, Trousdale RT. Acetabular retroversion is associated with osteoarthritis of the hip. Clin Orthop Relat Res. 2003(417):263-9.
8. Riviere C, Hardijzer A, Lazennec JY, Beaule P, Muirhead-Allwood S, Cobb J. Spine-hip relations add understandings to the pathophysiology of femoro-acetabular impingement: A systematic review. Orthop Traumatol Surg Res. 2017;103(4):549-57.
9. Dandachli W, Ul Islam S, Richards R, Hall-Craggs M, Witt J. The influence of pelvic tilt on acetabular orientation and cover: a three-dimensional computerised tomography analysis. Hip Int. 2013;23(1):87-92.
10. Ross JR, Nepple JJ, Philippon MJ, Kelly BT, Larson CM, Bedi A. Effect of Changes in Pelvic Tilt on Range of Motion to Impingement and Radiographic Parameters of Acetabular Morphologic Characteristics. Am J Sports Med. 2014.
11. Siebenrock KA, Schaller C, Tannast M, Keel M, Buchler L. Anteverting periacetabular osteotomy for symptomatic acetabular retroversion: results at ten years. J Bone Joint Surg Am. 2014;96(21):1785-92.
12. Schwarz T, Benditz A, Springorum HR, Matussek J, Heers G, Weber M, et al. Assessment of pelvic tilt in anteroposterior radiographs by means of tilt ratios. Arch Orthop Trauma Surg. 2018.
13. Tannast M, Murphy SB, Langlotz F, Anderson SE, Siebenrock KA. Estimation of pelvic tilt on anteroposterior X-rays--a comparison of six parameters. Skeletal Radiol. 2006;35(3):149-55.
Originalsprog | Engelsk |
---|---|
Tidsskrift | Gait & Posture |
Vol/bind | 81 |
Udgave nummer | Suppl. 1 |
Sider (fra-til) | 52-53 |
ISSN | 0966-6362 |
DOI | |
Status | Udgivet - 23 sep. 2020 |
Eksternt udgivet | Ja |
Begivenhed | ESMAC Virtual Meeting 2020 - Varighed: 17 sep. 2020 → 17 sep. 2020 |
Konference
Konference | ESMAC Virtual Meeting 2020 |
---|---|
Periode | 17/09/2020 → 17/09/2020 |
ID: 252060773