TY - JOUR
T1 - Healthy Hip Joints Have Different Macroscopic and Microscopic Capsular Nerve Architecture Compared With Hips With Osteoarthritis, Femoroacetabular Impingement Syndrome, and Developmental Dysplasia of the Hip
T2 - A Systematic Review
AU - Meheux, Carlos J.
AU - Hirase, Takashi
AU - Dong, David
AU - Clyburn, Terry A.
AU - Harris, Joshua D.
N1 - Funding Information:
T.A.C. reports AAOS: board or committee member; Conformis: research support; stock or stock options; Nimbic Systems: IP royalties. J.D.H. reports AAOS: board or committee member; American Orthopaedic Society for Sports Medicine: board or committee member; Arthroscopy: editorial or governing board; Arthroscopy Association of North America: board or committee member; Arthrex/Medinc of Texas: research support; DePuy, A Johnson & Johnson Company: research support; Frontiers In Surgery: editorial or governing board; NIA Magellan: paid consultant; SLACK Incorporated: publishing royalties, financial or material support; Smith & Nephew: paid presenter or speaker, paid consultant, research support; Ossur: paid speaker. Full ICMJE author disclosure forms are available for this article online, as supplementary material. The authors report the following potential conflicts of interest or sources of funding:
Publisher Copyright:
© 2020 Arthroscopy Association of North America
Copyright:
Copyright 2021 Elsevier B.V., All rights reserved.
PY - 2021/2
Y1 - 2021/2
N2 - Purpose: To perform a systematic review to identify macroscopic and microscopic patterns and differences in hip capsule innervation between normal hips and hips with osteoarthritis (OA), femoroacetabular impingement (FAI) syndrome, and developmental dysplasia of the hip (DDH). Methods: A systematic review was performed using Preferred Reporting Items for Systematic reviews and Meta-Analyses guidelines. Multiple databases were searched for both clinical and basic science laboratory studies on hip capsule innervation. Non-innervation capsule and non-human animal studies were excluded. Macroscopic and microscopic differences in capsular innervation between normal hips, and hips with OA, FAI, and DDH were analyzed. Methodological quality assessment of all studies included in this review was completed using the Methodological Index for Non-randomized Studies. Results: Ten articles were analyzed (263 specimens; 211 patients, 52 cadavers; mean Methodological Index for Non-randomized Studies 10/16). The hip capsule is innervated by the sciatic and superior gluteal nerves posterosuperiorly, nerve to quadratus femoris and inferior gluteal nerve posteroinferiorly, and femoral and obturator nerves anteriorly. The anterior-superior capsule between 1:00 and 2:30 o'clock on a right hip is a safe internervous zone. The superolateral capsule has the greatest density of mechanoreceptors and sensory fibers. OA is associated with a greater expression of nerve fibers compared with normal hips but does not correlate with pain or disability. No significant differences were found in nerve fiber expression among patients with DDH, FAI, or normal hips. A negative correlation is seen with aging and pain fiber expression. Conclusions: The hip capsule has a complex macroscopic and microscopic innervation pattern with varying nerve fiber expression from at least 6 separate peripheral nerves. OA is associated with a greater expression of nerve fibers, although nerve fiber expression does not correlate with painful pathology. Level of Evidence: IV, Systematic review of level I-IV studies.
AB - Purpose: To perform a systematic review to identify macroscopic and microscopic patterns and differences in hip capsule innervation between normal hips and hips with osteoarthritis (OA), femoroacetabular impingement (FAI) syndrome, and developmental dysplasia of the hip (DDH). Methods: A systematic review was performed using Preferred Reporting Items for Systematic reviews and Meta-Analyses guidelines. Multiple databases were searched for both clinical and basic science laboratory studies on hip capsule innervation. Non-innervation capsule and non-human animal studies were excluded. Macroscopic and microscopic differences in capsular innervation between normal hips, and hips with OA, FAI, and DDH were analyzed. Methodological quality assessment of all studies included in this review was completed using the Methodological Index for Non-randomized Studies. Results: Ten articles were analyzed (263 specimens; 211 patients, 52 cadavers; mean Methodological Index for Non-randomized Studies 10/16). The hip capsule is innervated by the sciatic and superior gluteal nerves posterosuperiorly, nerve to quadratus femoris and inferior gluteal nerve posteroinferiorly, and femoral and obturator nerves anteriorly. The anterior-superior capsule between 1:00 and 2:30 o'clock on a right hip is a safe internervous zone. The superolateral capsule has the greatest density of mechanoreceptors and sensory fibers. OA is associated with a greater expression of nerve fibers compared with normal hips but does not correlate with pain or disability. No significant differences were found in nerve fiber expression among patients with DDH, FAI, or normal hips. A negative correlation is seen with aging and pain fiber expression. Conclusions: The hip capsule has a complex macroscopic and microscopic innervation pattern with varying nerve fiber expression from at least 6 separate peripheral nerves. OA is associated with a greater expression of nerve fibers, although nerve fiber expression does not correlate with painful pathology. Level of Evidence: IV, Systematic review of level I-IV studies.
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U2 - 10.1016/j.asmr.2020.08.015
DO - 10.1016/j.asmr.2020.08.015
M3 - Review article
C2 - 33615274
VL - 3
SP - e269-e276
JO - Arthroscopy, sports medicine, and rehabilitation
JF - Arthroscopy, sports medicine, and rehabilitation
SN - 2666-061X
IS - 1
ER -