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Top Banner Graphic - 1 of 12 - acetabular dysplasia, exercise

Welcome to my 12 Top Hip Papers series of miniblogs from 2022, starting with this one on elevated posterior acetabular edge loading in hip dysplasia. Some of you might have joined me for my 12 Top Hip papers series last year. Those were papers from over the years that have contributed strongly to our understanding of hip conditions and/or the assessment or management of hip pain or injury. If you haven't already downloaded your free ebook of those 12 papers, you can do it by clicking HERE.

This year, I'll be focussing on interesting hip papers published in 2022. I am aiming to provide an overview of how the research has moved the hip space forward this year. I have prepared infographics and key learnings for each paper. Quick but info-packed reads for this busy time of year.

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Let's kick off day one then, with this paper that found elevated posterior acetabular edge loading in hip dysplasia during deep squatting. 

Banner Graphic 2 - 1 of 12 - acetabular dysplasia, exercise

1 of 12 Top Hip Papers of 2022 : Elevated loading at the posterior acetabular edge of dysplastic hips during double leg squat

Often we think most about the impact of acetabular dysplasia on loads imposed on the anterior or lateral acetabulum, but those with posterior undercoverage of the femoral head can also be at risk of high posterior joint loads, posterior instability and buttock pain. This hip paper was first published online in January, 2022. Song and colleagues investigated posterior acetabular edge loading in dysplasia during a squat. Here's some key information about what they did, what they found, and the clinical implications.

Study Aim:

  • To use subject specific musculoskeletal models to estimate acetabular edge loading during double‐legged squatting in hips of those with developmental dysplasia of the hip compared to healthy controls.

What was done:

  • 3D pelvic and femoral bony anatomy from X-rays and MRI's and movement data was collected from a 3D kinematic system (Vicon) during squatting.
  • This data was used within an Open Sim musculoskeletal model to estimate hip joint reaction forces and acetabular edge loading for 10 patients with hip pain and dysplasia and 10 healthy controls.
  • Between-group differences were examined.
Key Findings - 1 of 12 - acetabular dysplasia, exercise

Clinical Implications:

The clinical implication from these findings is that for those with dysplasia, we need to consider posterior joint loading in functional tasks and rehab or gym exercises. Lumbopelvic and trunk position will have a large impact on these loads. Overemphasis on lumbar lordosis/anterior pelvic tilt or excessive trunk forward lean may increase these already high loads.

For those with posterior undercoverage of the femoral head - global undercoverage or acetabular retroversion resulting in focal posterior undercoverage - higher posterior edge loads and for some, posterior instability, may result in development of deep buttock pain. Consider how you might reduced posterior edge loading and provide more local muscle support for the posterior joint.

The main takeaways of this paper are:

i) Be aware of the posterior impact of dysplasia

ii) Consider the impact of pelvic position during a squat


Key Findings:

  • Posterior acetabular edge loading in hip dysplasia was significantly higher in squatting compared with healthy controls:
    • Healthy control group = 1.8 x bodyweight
    • Acetabular dysplasia group = 2.6 x bodyweight

Posterior edge loading was substantially higher for those with dysplasia, in this task that is carried out regularly during everyday life and gym or rehabilitative exercises.

There is often a focus on anterior or antero-lateral loads in those with dysplasia, which are of course important, but don't forget the posterior joint for those with global or focal posterior undercoverage.


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I hope you enjoyed the infographic and key learnings from Day 1 of my 12 Top Hip Papers of 2022. There are 11 more papers to come, so stay tuned and return to the blog page each day to see what other top papers and infographics I have for you!

Missed paper 2? Click above to read it!

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About Dr Alison Grimaldi

Dr Alison Grimaldi is a physiotherapist, researcher and educator with over 30 years of clinical experience. She has completed a Bachelor of Physiotherapy, a Masters of Sports Physiotherapy and a PhD, with her doctorate topic in the hip region. Dr Grimaldi is Practice Principal of PhysioTec Physiotherapy in Brisbane, a Fellow of the Australian College of Physiotherapy and an Adjunct Senior Research Fellow at the University of Queensland. She runs a global Hip Academy and has presented over 100 workshops around the world.