Aims. Professional dancers represent a unique patient population in the setting of hip arthroplasty, given the high degree of hip strength and mobility required by their profession. We sought to determine the clinical outcomes and ability to return to professional dance after total hip arthroplasty (THA) or hip resurfacing arthroplasty (HRA). Methods. Active professional dancers who underwent primary THA or HRA at a single institution with minimum one-year follow-up were included in the study. Primary outcomes included the rate of return to professional dance, three patient-reported outcome measures (PROMs) (modified Harris Hip Score (mHHS), Hip disability and Osteoarthritis Outcome Score for Joint Replacement (HOOS-JR), and Lower Extremity Activity Scale (LEAS)), and postoperative complications. Results. A total of 49 hips in 39 patients (mean age 56 years (SD 13); 80% female (n = 39)) were included. Mean follow-up was 4.9 years (SD 5.1). Of these 49 hips, 37 THAs and 12 HRAs were performed. In all, 96% of hips returned to professional dance activities postoperatively. With regard to PROMs, there were statistically significant improvements in mHHS, HOOS-JR, and LEAS from baseline to ≥ one year postoperatively. There were complications in 7/49 hips postoperatively (14%), five of which required revision surgery (10%). There were no revisions for instability after the index procedure. Two complications (5.4%) occurred in hips that underwent THA compared with five (42%) after HRA (p = 0.007), though the difference by procedure was not significantly different when including only contemporary implant designs (p = 0.334). Conclusion. Active professional dancers experienced significant improvements in functional outcome scores after THA or HRA, with a 96% rate of return to professional dance. However, the revision rate at short- to mid-term follow-up highlights the challenges of performing hip arthroplasty in this demanding patient population. Further investigation is required to determine the results of THA versus HRA using contemporary implant designs in these patients. Cite this article: Bone Joint J 2024;106-B(3 Supple A):17–23

Injuries to the hamstring muscle complex are common in athletes, accounting for between 12% and 26% of all injuries sustained during sporting activities. Acute hamstring injuries often occur during sports that involve repetitive kicking or high-speed sprinting, such as American football, soccer, rugby, and athletics. They are also common in watersports, including waterskiing and surfing. Hamstring injuries can be career-threatening in elite athletes and are associated with an estimated risk of recurrence in between 14% and 63% of patients. The variability in prognosis and treatment of the different injury patterns highlights the importance of prompt diagnosis with magnetic resonance imaging (MRI) in order to classify injuries accurately and plan the appropriate management.

Low-grade hamstring injuries may be treated with nonoperative measures including pain relief, eccentric lengthening exercises, and a graduated return to sport-specific activities. Nonoperative management is associated with highly variable times for convalescence and return to a pre-injury level of sporting function. Nonoperative management of high-grade hamstring injuries is associated with poor return to baseline function, residual muscle weakness and a high-risk of recurrence. Proximal hamstring avulsion injuries, high-grade musculotendinous tears, and chronic injuries with persistent weakness or functional compromise require surgical repair to enable return to a pre-injury level of sporting function and minimize the risk of recurrent injury.

This article reviews the optimal diagnostic imaging methods and common classification systems used to guide the treatment of hamstring injuries. In addition, the indications and outcomes for both nonoperative and operative treatment are analyzed to provide an evidence-based management framework for these patients.

Cite this article: Bone Joint J 2020;102-B(10):1281–1288.

Aims

This study presents the long-term survivorship, risk factors for prosthesis survival, and an assessment of the long-term effects of changes in surgical technique in a large series of patients treated by metal-on-metal (MoM) hip resurfacing arthroplasty (HRA).

A retrospective review of the medical records, radiological studies, operative reports, and physiotherapy charts was done for 11 consecutive elite dancers (7 [64%] women and 4 [36%] men) who underwent arthroscopic treatment for anterior ankle impingement syndrome during a 9-year period (1990–1999). The procedures were performed by a single surgeon (DJR) at one hospital (Hospital for Joint Diseases). There were 14 arthroscopic procedures (12 initial and 2 repeat) involving the right ankle in 8 (57%) and the left ankle in 6 (43%). Average age (± standard deviation) at surgery was 28 ± 6 years (age range, 20–41 years). There were 6 (55%) professional dancers, 4 (36%) pre-professional dance students, and 1 (9%) professional dance teacher; all were primarily ballet dancers, but three concurrently performed modern dance. In 6 (50%) ankles, soft tissue impingement only (hypertrophic synovitis or impinging distal fascicle of the inferior band of the anterior tibiofibular ligament) was noted, and in 6 (50%) ankles, a bony spur was also present on the anterior lip of the tibia and/or dorsal aspect of the talar neck. Resection of bony spurs and excision of hypertrophic soft tissue and synovium was performed arthroscopically. Nine (82%) of the 11 patients returned to dance after an average period of 7 weeks (range, 6 to 11 weeks). There were no wound infections or neuromas. One ankle with soft tissue impingement developed postoperative stiffness despite physical therapy, and underwent repeat arthroscopy 4 months after the initial procedure for excision of adhesions and scar tissue; this dancer subsequently returned to competitive dance. Another ankle had a second arthroscopic debridement for recurrent spur formation, 9 years after the first arthroscopic excision; this dancer retired from dance performance after the first arthroscopy because of concurrent knee and back problems, but he continued at a lower activity level as a dance teacher. In summary, arthroscopic debridement was effective in the management of anterior ankle impingement in dancers