Publications by authors named "Paulien van Kampen"

26 Publications

  • Page 1 of 1

The short external rotators in the anterior approach hip arthroplasty: do the tendons heal or not? A prospective MRI study.

Hip Int 2022 Jun 28:11207000221107551. Epub 2022 Jun 28.

Department of Orthopaedic Surgery Bergman Clinics, Rijswijk, The Netherlands.

Introduction: Release of some of the short external rotator tendons may be needed in the direct anterior approach (DAA) for Total Hip Arthroplasty (THA). It is unknown if these tendons heal. The purpose of this prospective study is to examine short external rotator tendon healing after release and the associated effect on muscle volume. In addition, we examined the relation with external rotation force and patient reported outcome measures (PROMs).

Methods: In 21 DAA THA patients, preoperative MRI was compared with postoperative MRI at 6 weeks and 12 months. PROMs and rotation force of both hips were assessed. Tendon integrity and muscle volume of the obturator internus and piriformis were assessed on MRI using dedicated software.

Results: In 5 patients all tendons remained intact, in 4 patients only the conjoined tendon was released and in 12 patients both the conjoined and piriformis were released. Obturator externus remained intact in all patients. In patients with tendon release, mean volume of obturator internus and piriformis muscle decreased 27% (SD 11) and 23% (SD 16) 6 weeks after surgery, respectively. Released tendons and muscle volume loss did not recover 12 months after surgery. We found no relation between tendon release and hip rotation force or PROMs.

Conclusions: We found absent tendon healing and muscle volume loss when the conjoined or piriformis tendons were released. Although we found no relation between tendon detachment and hip force or PROMs, we have adapted our operative technique to make it more preserving for the piriformis.
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June 2022

The European Robotic Spinal Instrumentation (EUROSPIN) study: protocol for a multicentre prospective observational study of pedicle screw revision surgery after robot-guided, navigated and freehand thoracolumbar spinal fusion.

BMJ Open 2019 09 8;9(9):e030389. Epub 2019 Sep 8.

Department of Neurosurgery, Bergman Clinics Amsterdam, Amsterdam, The Netherlands.

Introduction: Robotic guidance (RG) and computer-assisted navigation (NV) have seen increased adoption in instrumented spine surgery over the last decade. Although there exists some evidence that these techniques increase radiological pedicle screw accuracy compared with conventional freehand (FH) surgery, this may not directly translate to any tangible clinical benefits, especially considering the relatively high inherent costs. As a non-randomised, expertise-based study, the European Robotic Spinal Instrumentation Study aims to create prospective multicentre evidence on the potential comparative clinical benefits of RG, NV and FH in a real-world setting.

Methods And Analysis: Patients are allocated in a non-randomised, non-blinded fashion to the RG, NV or FH arms. Adult patients that are to undergo thoracolumbar pedicle screw instrumentation for degenerative pathologies, infections, vertebral tumours or fractures are considered for inclusion. Deformity correction and surgery at more than five levels represent exclusion criteria. Follow-up takes place at 6 weeks, as well as 12 and 24 months. The primary endpoint is defined as the time to revision surgery for a malpositioned or loosened pedicle screw within the first postoperative year. Secondary endpoints include patient-reported back and leg pain, as well as Oswestry Disability Index and EuroQOL 5-dimension questionnaires. Use of analgesic medication and work status are recorded. The primary analysis, conducted on the 12-month data, is carried out according to the intention-to-treat principle. The primary endpoint is analysed using crude and adjusted Cox proportional hazards models. Patient-reported outcomes are analysed using baseline-adjusted linear mixed models. The study is monitored according to a prespecified monitoring plan.

Ethics And Dissemination: The study protocol is approved by the appropriate national and local authorities. Written informed consent is obtained from all participants. The final results will be published in an international peer-reviewed journal.

Trial Registration Number: Clinical registry NCT03398915; Pre-results, recruiting stage.
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September 2019

The Influence of Pain on the Outcome of Extracorporeal Shockwave Lithotripsy.

Curr Urol 2019 Mar;12(2):81-87

Department of Urology, Leiden University Medical Center, Leiden, The Netherlands.

Introduction: The aim of this study was to determine the predictive value of pain scores on the efficacy of extracor-poreal shockwave lithotripsy (ESWL) and to identify other predictive risk factors for treatment success.

Materials And Methods: A total of 476 patients who underwent ESWL (piezoelectric lithotripsy) for urolithiasis between September 2011 and December 2015 were identified. The primary end-point of this study was success rate, which was evaluated 4 months after ESWL. The secondary outcome was the occurrence of complications as a result of ESWL.

Results: The average pain perception was reported at 5 on a scale from 0 to 10. The overall success rate of ESWL was found to be 43.9% and the success rate after the first ESWL was 35.1%. Univari-ate analysis showed no significant correlation between pain score and success of ESWL (p = 0.135). The level of intensity was correlated with pain scores (Pearson correlation -0.423, p < 0.001). Univariate analysis identified five predictive factors: sex, stone location, stone size, hydronephrosis and the use of tamsulosin. Multivariate logistic regression analysis showed that sex, stone location and size independently in-fluenced the success of ESWL (p = 0.045, p = 0.001 and p < 0.001).

Conclusion: No correlation was found between the pain scores and efficacy of ESWL. Despite this absence, pain scores during ESWL sessions remain high and additional analgesia would improve patient satisfaction.
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March 2019

Self-Warming Blanket Versus Forced-Air Warming in Primary Knee or Hip Replacement: A Randomized Controlled Non-Inferiority Study.

Asian J Anesthesiol 2018 12;56(4):128-135

Department of Orthopaedic Surgery, Leids Universitair Medisch Centrum, Leiden, the Netherlands.

Objective: After primary total knee/hip replacement (TKR or THR respectively) a prosthetic joint infection (PJI) could develop. Hypothermia could raise the risk of infection. Heating by forced-air can disrupt laminar airfl ow in the operation room (OR), potentially raising the risk of infection. We aimed to study non-inferiority of an active self-heating blanket (SHB) compared to a forced-air blanket (FAB) in preventing hypothermia.

Methods: A randomized controlled non-inferiority trial (N = 86 patients) was performed comparing a SHB versus a FAB in elective primary TKR/THR patients. Primary outcome was lowest measured temperature during surgery. Secondary outcomes were patients' core temperature before, during, and after surgery, thermal comfort visual analogue score (VAS) and complications during hospitalization.

Results: Lowest measured temperature was 35.9°C (± 0.6) in SHB and 36.1°C (± 0.5) in FAB group (p = 0.05). No signifi cant correlation was found with duration of surgery or temperature of the OR. No signifi cant difference in core temperature was found before surgery (SHB = 36.8°C [± 0.4], FAB = 36.8°C [± 0.5], p = 0.49), after induction of anaesthesia (SHB = 36.6°C [± 0.5], FAB = 36.7°C [± 0.5], p = 0.22) nor as a mean during surgery (SHB = 35.8°C [± 1.6], FAB = 36.0°C [± 1.3], p = 0.68). SHB patients were "colder" at the recovery bay, 35.8°C (± 0.6) compared to FAB patients, 36.1°C (± 0.5) (p = 0.04). Mean VAS thermal comfort was 53.3 (± 15.7) in SHB and 52.9 (± 12.3) in FAB patients. No difference in complication rate was found.

Conclusions: In this study neither kind of the warming blanket prevented perioperative hypothermia. Although a difference of 0.2°C was found between both groups at the end of TKR/THR surgery, this is most probably not clinically relevant. Complication rate in both groups was the same.
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December 2018

Validation of the Super Simple Hip score combined with the University of California, Los Angeles activity scale for younger patients.

Hip Int 2020 Mar 19;30(2):181-186. Epub 2019 Mar 19.

Bergman Clinics, Rijswijk, The Netherlands.

Introduction: Patient-reported outcome measures (PROMs) are used increasingly, but for young patients with hip complaints, traditional scoring systems have a ceiling effect that limits their usability. We developed and validated the Super Simple Hip (SUSHI) score, a PROM specifically targeted at younger patients with hip complaints. Although the SUSHI measured hip problems adequately, the responsiveness of its activity rating component was considered inadequate. Consequently, we replaced the activity rating component by the University of California, Los Angeles (UCLA) activity scale. The aim of this study was to validate the resulting new 10-item SUSHI-UCLA score.

Methods: A prospective multicentre observational cohort study was performed. Patients between 18 and 59 years, who visited the Orthopaedic Department with hip complaints, completed the SUSHI-UCLA and hip osteoarthritis outcome score (HOOS) twice before their 1st appointment, and once 16 months after.

Results: 142 patients were included (mean age 49 years; SD 8.8). The SUSHI-UCLA score correlated well with the HOOS, both before and after treatment (Spearman's rho = 0.739 and 0.847, respectively, both < 0.001). The responsiveness of both the SUSHI-UCLA score and the UCLA activity scale was high (standardised response mean = 2.51 and 1.35 respectively). The reproducibility was good (interclass correlation coefficient for agreement = 0.962). The minimal important change was 21.2. No significant floor or ceiling effect was observed.

Conclusion: The SUSHI-UCLA score is an adequate PROM to measure hip complaints in younger patients and includes a validated activity rating.
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March 2020

Risk factors for postoperative pain in the first three weeks after arthroscopic or open shoulder surgery.

Orthop Traumatol Surg Res 2019 04 25;105(2):241-244. Epub 2019 Jan 25.

Department of Orthopedic surgery, Bergman Clinics, Rijswijk, The Netherlands.

Introduction: Shoulder surgery is a painful procedure. Adequate postoperative pain control increases patient satisfaction. The objectives of this study were to investigate postoperative pain development in shoulder surgery and to assess risk factors for high postoperative pain.

Hypothesis: Patients who undergo rotator cuff repair are more painful than patients who undergo different kinds of shoulder surgery.

Material And Methods: Four hundred and sixty five patients who underwent shoulder surgery were included in this retrospective cohort study. A linear mixed model analysis was used to compare NRS (Numeric Rating Scale) for pain between different kinds of shoulder surgery in the first three weeks postoperatively. To assess risk factors for high postoperative pain odds ratios were calculated.

Results: Pain development in the first 3 weeks differed between procedures with rotator cuff repair being the most painful procedure. Risk factors for high postoperative pain were female sex and subacromial decompression with distal clavicle resection.

Discussion: Patients who undergo rotator cuff repair are indeed more painful than patients who undergo different kinds of shoulder surgery. With identifying these differences in pain development and the risk factors for high postoperative pain after shoulder surgery, we can optimize postoperative pain treatment. However, further research is needed to support these results.

Level Of Evidence: IV, retrospective cohort study.
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April 2019

Outcome after 52 Salto Ankle Prostheses Implanted by a Single Surgeon.

Adv Orthop 2018 1;2018:2735634. Epub 2018 Aug 1.

Department of Orthopaedic Surgery, Bergman Clinics, Rijswijk, Netherlands.

While ankle arthrodesis was traditionally the gold standard method of treatment for disabling end-stage ankle arthritis, total ankle replacement (TAR) has been an acceptable alternative. The satisfaction rate of patients with TAR however differs. The purpose of our study is to investigate whether implant survival and results with special emphasis on the satisfaction rate of patients treated with a TAR implanted by a single surgeon were comparable to the literature. This was a retrospective cohort study in a teaching hospital. Data was collected from 52 patients who received a total ankle replacement (TAR) between 05/2002 and 06/2014. The mean follow-up time was 4.2 years (95% CI 3.3 - 5.0). Results showed a high satisfaction rate of 94% and 94% survival of the TAR after 5 years. We conclude that TAR with the Salto prosthesis is, in our hands, a reliable solution for end-stage ankle arthritis, with results comparable to the literature.
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August 2018

The influence of food order on postprandial glucose levels in children with type 1 diabetes.

Pediatr Diabetes 2018 06 12;19(4):809-815. Epub 2018 Mar 12.

Division of Endocrinology, Department of Pediatrics, Juliana Children's Hospital/Haga Hospital, The Hague, The Netherlands.

Objective: To evaluate the effect of the order of intake of carbohydrates, protein, and fat on postprandial glucose levels in children with type 1 diabetes (T1D). Our hypothesis was that postprandial glucose levels would be lower when fat and protein are consumed prior to carbohydrates, compared to a meal where all macronutrients are combined.

Methods: A randomized, open-label, within-subject crossover study was conducted. Twenty patients aged 7 to 17 years diagnosed with T1D for >1 year consumed 2 isocaloric meals (with similar composition) in random order. In 1 meal, the protein and fat part was consumed 15 minutes prior to the carbohydrates (test meal). In the other meal, all macronutrients were consumed together (standard meal). Capillary blood glucose measurements and continuous glucose monitoring system were used to assess multiple glucose levels during a 3-hour postprandial period.

Results: Overall, mean glucose levels were 1 mmol/L lower following the test meal compared to the standard meal (9.30 ± 3.20 vs 10.24 ± 3.35 mmol/L; P < .001). No significant difference in peak glucose was found. Glucose excursions were 1.5 and 1 mmol/L lower at 30 and 120 minutes following the test meal. A reduction in the total time period in which glucose levels exceeded 10 and 12 mmol/L of 28.7 (P = .001) and 22.3 minutes (P = .004), respectively, after the test meal was found.

Conclusions: This study shows that consumption of protein and fat prior to carbohydrates results in lower postprandial glucose levels and reduced glycemic variability in children with T1D.
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June 2018

Safety and effectiveness of selective carotid angioplasty prior to cardiac surgery: a single-centre matched case-control study.

Interact Cardiovasc Thorac Surg 2018 05;26(5):834-839

Department of Biostatistics, Haga Teaching Hospitals, Netherlands.

Objectives: Reducing the rate of postoperative stroke after cardiac surgery remains challenging, especially in patients with occlusive cerebrovascular disease. Angioplasty in all patients with high-grade carotid artery stenosis has not been shown to be effective in reducing the post-surgical stroke rate. In this study, we present the initial results of a different approach using selective carotid angioplasty only in patients with poor intracranial collaterals.

Methods: We conducted a single-centre study to assess the safety of this procedure. The postangioplasty complication rate of the study group was compared to that of patients who were scheduled for symptomatic carotid artery angioplasty. To determine the effectiveness of this procedure, the post-cardiac surgery complication rate of the study group was compared with that of the matched case controls.

Results: Twenty-two patients were treated with selective carotid angioplasty without developing persistent major neurological complications. All patients except 1 patient subsequently underwent surgery without developing persistent major neurological disabilities. Two patients died of cardiogenic shock within 30 days.

Conclusions: Selective carotid angioplasty prior to cardiac surgery in patients with a presumed high risk of stroke was relatively safe and effective in this study group. Although this strategy does not prevent stroke in these high-risk patients, data suggest that this approach shifts the postoperative type of stroke from a severe haemodynamic stroke towards a minor embolic stroke with favourable neurological outcomes. Larger studies are needed to determine whether this strategy can effectively eliminate the occurrence of haemodynamic stroke after cardiac surgery.
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May 2018

Impact of the Haga Braincare Strategy on the burden of haemodynamic and embolic strokes related to cardiac surgery.

Interact Cardiovasc Thorac Surg 2017 11;25(5):765-771

Haga Academy, Haga Teaching Hospitals, The Hague, Netherlands.

Objectives: This study prospectively evaluates the impact of the Haga Braincare Strategy (HBS) on the occurrence of haemodynamic and embolic stroke in a cohort of patients who underwent coronay artery bypass grafting (CABG), valve replacement of a combination of both types of surgery between 2012 and 2015 at the Haga Teaching Hospitals.

Methods: The HBS is a dual strategy based on a preoperative vascular work-up of the cerebral circulation by transcranial Doppler and a perioperative monitoring of the cerebral circulation by cerebral oximetry. Duplex of the carotid arteries and/or computed tomography angiography prior to surgery was performed in high-risk patients. Patients with severe carotid artery stenosis were scheduled for carotid angioplasty prior to surgery or waived from surgery.

Results: A total of 1065 patients were included. Poor cerebral haemodynamics were identified by transcranial Doppler in 2.1% of patients (n = 22). Based on the HBS, 3 patients were waived from surgery, 4 received preoperative carotid angioplasty followed by cardiac surgery and the remaining patients were operated while being monitored with bilateral cerebral oximetry sensors. In all, 2.2% of the study group experienced a stroke (n = 23), of which none were classified as haemodynamic. Most of the remaining presumed embolic strokes showed a minor to moderate stroke severity.

Conclusions: In this single-centre prospective follow-up study, surveillance of cerebral perfusion by the HBS eliminated the occurrence of haemodynamic stroke while most of the residual strokes had a good to favourable prognosis.
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November 2017

Ultrasound guided Needling vs Radial Shockwave Therapy in calcific tendinitis of the shoulder: A prospective randomized trial.

J Orthop 2017 Dec 1;14(4):466-469. Epub 2017 Aug 1.

HagaZiekenhuis, Department of Orthopaedic Surgery, Sportlaan 600, 2566 MJ The Hague, The Netherlands.

Purpose: Ultrasound Needling(UN) and Radial Shockwave(RSWT) aim to dissolve deposits in Shoulder Calcific tendinitis.

Methods: RCT in 25 patients to compare short term effectiveness. Outcome measures were pain and functional outcome at 6 weeks and 1 year and decrease of deposits after 6 weeks.

Results: UN decreased deposit more than RSWT(P = 0.029). After 6 weeks, Constant, NRS and Oxford improved more in UN. After 1 year, there was no significant difference in NRS(p = 0.45) or Oxford(p = 0.32).

Conclusion: Compared to RSWT, UN resulted in lower pain and faster resorption of calcifications after 6 weeks. No significant differences were found after 1 year.
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December 2017

Epinephrine Diluted Saline-Irrigation Fluid in Arthroscopic Shoulder Surgery: A Significant Improvement of Clarity of Visual Field and Shortening of Total Operation Time. A Randomized Controlled Trial.

Arthroscopy 2016 Mar;32(3):436-44

Haga ziekenhuis, The Hague, The Netherlands.

Purpose: To determine the influence of epinephrine saline irrigation in therapeutic shoulder arthroscopy procedures on the clarity of arthroscopic view. Three subgroups were analyzed; (1) Bankart/SLAP repairs; (2) rotator cuff repairs; and (3) subacromial procedures without rotator cuff repair. Secondary objectives were to evaluate the influence on total operating time and potential cardiovascular adverse reactions.

Methods: The design of the study was a prospective, randomized, double-blind controlled trial. A total of 101 patients were included. Pressure pump-controlled regular saline irrigation fluid was used in the control group. In the epinephrine group, epinephrine (0.33 mg/L) was added to the saline-irrigation fluid. Visual clarity was rated by a Numeric Rating Scale. Total operation time, total use of irrigation fluid, increases in pump pressure, heart rate, blood pressure, and electrocautery use were registered.

Results: Visual clarity (P = .002) was significantly better and total operating time (P = .008) significantly shorter in the epinephrine group. Total irrigation fluid used was significantly lower in the epinephrine group (P = .001). The greatest effect on visual clarity and shortening of operation time up to 15 minutes was seen in Bankart and SLAP repairs. No significant effect of the addition of epinephrine on heart rate and blood pressure was observed.

Conclusions: The addition of epinephrine (0.33 mg/L) to irrigation fluid significantly improves visual clarity in most common types of therapeutic shoulder arthroscopy. A significant reduction in total operating time and use of irrigation fluid was observed. The greatest effect on visual clarity and shortening of operation time was seen in Bankart and SLAP group. Therefore, one of our initial hypotheses that the greatest effect would be observed in subacromial and rotator cuff repair procedures was not supported by the data presented. No cardiovascular adverse reactions were seen.

Level Of Evidence: Level 1, Randomized controlled trial.
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March 2016

Combining femoral and acetabular parameters in femoroacetabular impingement: the omega surface.

Med Biol Eng Comput 2015 Nov 7;53(11):1239-46. Epub 2015 Oct 7.

Departments of Orthopaedic Surgery, Haga Hospital, The Hague, The Netherlands.

The concept of femoroacetabular impingement (FAI) proposes the development of hip osteoarthritis through motion-induced damage to the acetabular cartilage and labrum. Thus, dynamic interaction of the proximal femur and acetabulum is the crux of FAI. Several types of FAI can be distinguished, but FAI classification is mostly done with separate parameters for acetabular and femoral morphology on planar images, without direct representation of the femoroacetabular interaction. Five main parameters influence impingement between the proximal femur and the acetabular rim: alpha and center edge angles, acetabular and femoral version, and neck-shaft angle. We attempted to integrate these five parameters in order to reflect their interaction and derive a signal comprehensive parameter, the omega surface, to characterize the severity of FAI. The omega surface is a CT-based delineation of the femoral head surface that represents the area for impingement-free motion. The omega surface is determined with dedicated software (Articulis™) and can be determined for various positions of the hip joint. We determined the omega surface in a pilot study for five different hip morphotypes and found the omega surface was smaller in FAI morphotypes than in a normal hip. Furthermore, the omega surface was smaller in symptomatic versus control subjects with FAI morphotypes. The omega surface may therefore help in improved differentiation between symptomatic and asymptomatic FAI hips.
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November 2015

Short-Term Clinical Outcome of Hemiarthroplasty Versus Arthrodesis for End-Stage Hallux Rigidus.

J Foot Ankle Surg 2015 Sep-Oct;54(5):848-51. Epub 2015 May 23.

Research Coordinator, Department of Orthopaedic Surgery, Medical Centre Haaglanden, The Hague, The Netherlands. Electronic address:

Few data are available to compare the outcomes of first metatarsophalangeal joint (MTPJ) hemiarthroplasty and arthrodesis. We included 46 patients who had undergone BioPro(®) first MTPJ hemiarthroplasty and 132 who had undergone arthrodesis, with a minimum follow-up duration of 12 months. The primary outcome was patient satisfaction, which was determined using binominal questions. The Foot and Ankle Outcome Score, Foot Function Index, and Numerical Rating Scale for pain and limitations questionnaires were also used. The secondary outcome was treatment failure. No differences were found in the satisfaction rate (p = .54) after a median period of 38.4 (range 12 to 96) months and 39.8 (range 12 to 96) months in the hemiarthroplasty and arthrodesis patients, respectively. Furthermore, no differences were found in the failure rates (p = .93) or the interval to failure (p = .32).The results of the present study showed no significant differences in the short-term clinical outcomes and failure rates for BioPro(®) first MTPJ hemiarthroplasty and arthrodesis. Prospective comparative studies are required to determine whether BioPro(®) first MTPJ hemiarthroplasty is a good alternative for first MTPJ arthrodesis in the long term.
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May 2016

Can combining femoral and acetabular morphology parameters improve the characterization of femoroacetabular impingement?

Clin Orthop Relat Res 2015 Apr;473(4):1396-403

Department of Orthopaedic Surgery, Haga Hospital, Sportlaan 600, 2566 MJ, The Hague, The Netherlands,

Background: Femoroacetabular impingement (FAI) presupposes a dynamic interaction of the proximal femur and acetabulum producing clinical symptoms and chondrolabral damage. Currently, FAI classification is based on alpha angle and center-edge angle measurements in a single plane. However, acetabular and femoral version and neck-shaft angle also influence FAI. Furthermore, each of these parameters has a reciprocal interaction with the others; for example, a shallow acetabulum delays impingement of the femoral head with the acetabular rim.

Questions/purposes: We introduce the new parameter "omega zone," which combines five parameters into one: the alpha and center-edge angles, acetabular and femoral version, and neck-shaft angle. We sought to determine whether the omega zone could differentiate patients with FAI from (1) normal control subjects (alpha < 55°), but also from (2) control subjects with elevated alpha angles (≥ 55°).

Methods: We evaluated CT data of 20 hips of male patients with symptomatic cam-type FAI and of 35 male hips extracted from 110 anonymized CT scans for vascular diagnosis. We excluded hips with osteoarthritis, developmental dysplasia, or coxa profunda (center-edge angle 20°-45° on AP pelvic view or corresponding coronal CT views). With dedicated software, femoral and pelvic orientation was standardized; we tested the omega zone in four hip positions in three distinct groups: patients with cam-type FAI (alpha > 60°) and control subjects with normal (< 55°) and high alpha angles (≥ 55°).

Results: The omega zone was smaller in patients with cam-type FAI than normal control subjects (alpha angle < 55°) at 60° and 90° of flexion (mean, 12%; 95% confidence interval [CI], 7-17; p = 0.008; Cohen's d = 9%; 95% CI, 4-13; p = 0.003). Furthermore, the omega zone was smaller in all positions in patients with cam-type FAI than control subjects with high alpha angles (0° p = 0.017, 30° p = 0.004, 60° p = 0.004, 90° p = 0.007). In contrast, the omega zone did not differ between control subjects with normal or high alpha angles. In all hips, the omega zone decreased with flexion, corresponding to a decrease in remaining impingement-free motion with flexion.

Conclusions: The omega zone visualizes and quantifies the interaction of the proximal femur and acetabulum. The omega zone differed between patients with cam-type FAI and control subjects with high alpha angles (≥ 55°), who could not be distinguished based on alpha angle alone. For hip-preserving surgery, it can help surgeons decide whether to address the femur, the acetabulum, or both.
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April 2015

What ape proximal femora tell us about femoroacetabular impingement: a comparison.

Clin Orthop Relat Res 2015 Apr;473(4):1204-11

Department of Orthopaedic Surgery, Haga Hospital, Sportlaan 600, 2566 MJ, The Hague, The Netherlands.

Background: Human hip morphology is variable, and some variations (or hip morphotypes) such as coxa profunda and coxa recta (cam-type hip) are associated with femoroacetabular impingement and the development of osteoarthrosis. Currently, however, this variability is unexplained. A broader perspective with background information on the morphology of the proximal femur of nonhuman apes is lacking. Specifically, no studies exist of nonhuman ape femora that quantify concavity and its variability.

Questions/purposes: We hypothesized that, when compared with modern humans, the nonhuman apes would show (1) greater proximal femoral concavity; (2) less variability in concavity; and (3) less sexual dimorphism in proximal femoral morphology.

Methods: Using identical methods, we compared 10 morphological parameters in 375 human femora that are part of the Hamann-Todd collection at the Cleveland Museum of Natural History with 210 nonhuman ape femora that are part of the collection of the Royal Museum for Central Africa, Tervuren, Belgium, and the Muséum National d'Histoire Naturelle, Paris, France.

Results: The nonhuman apes have larger proximal femoral concavity than modern humans. This morphology is almost uniform without large variability or large differences neither between species nor between sexes.

Conclusions: Variability is seen in human but not in nonhuman ape proximal femoral morphology. An evolutionary explanation can be that proximal femoral concavity is more important for the nonhuman apes, for example for climbing, than for modern humans, where a lack of concavity may be related to high loading of the hip, for example in running.
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April 2015

Where is the neck? Alpha angle measurement revisited.

Acta Orthop 2014 Apr;85(2):147-51

Departments of Orthopaedic Surgery , Haga Hospital, the Hague , the Netherlands .

Background And Purpose: The alpha angle is the most used measurement to classify concavity of the femoral head-neck junction. It is not only used for treatment decisions for hip impingement, but also in cohort studies relating hip morphology and osteoarthritis. Alpha angle measurement requires identification of the femoral neck axis, the definition of which may vary between studies. The original "3-point method" uses 1 single point to construct the femoral neck axis, whereas the "anatomic method" uses multiple points and attempts to define the true anatomic neck axis. Depending on the method used, the alpha angle may or may not account for other morphological characteristics such as head-neck offset.

Methods: We compared 2 methods of alpha angle measurement (termed "anatomic" and "3-point") in 59 cadaver femora and 83 cross-table lateral radiographs of asymptomatic subjects. Results were compared using Bland-Altman plots.

Results: Discrepancies of up to 13 degrees were seen between the methods. The 3-point method had an "equalizing effect" by disregarding femoral head position relative to the neck: in femora with high alpha angle, it resulted in lower values than anatomic measurement, and vice versa in femora with low alpha angles. Using the anatomic method, we derived a reference interval for the alpha angle in normal hips in the general population of 30-66 degrees.

Interpretation: We recommend the anatomic method because it also reflects the position of the femoral head on the neck. Consensus and standardization of technique of alpha angle measurement is warranted, not only for planar measurements but also for CT or MRI-based measurements.
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April 2014

Coxa recta, coxa profunda and abductor ratio: hip morphology variants compared in an arthroplasty and control population.

Hip Int 2013 May-Jun;23(3):287-92. Epub 2013 Feb 14.

Department of Orthopaedics, Haga Hospital, Den Haag, Zuid-Holland 2566MJ, The Netherlands.

Morphology variants of the hip such as coxa recta (aspherical femoral head and/or reduced head-neck concavity) or coxa profunda (overcoverage, or "deep" socket) are associated with cam and pincer impingement respectively, and may ultimately lead to coxarthrosis. Several population studies have documented the prevalence of hip morphotypes, but few studies have examined this prevalence in total hip arthroplasty (THA) patients, or persons without hip symptoms or signs.
We reviewed whether coxa recta and profunda morphotypes were more prevalent in THA patients compared to normal controls. Further, we explored differences in hip abductor mechanism related to hip morphology.
We examined 113 THA patients and 83 normal controls with anteroposterior pelvic and lateral hip 
radiographs. Coxa recta and profunda were classified with alpha and lateral CE-angle, respectively. The abductor ratio (AR) was measured on AP pelvic radiographs.
Both coxa recta and profunda were more prevalent in THA patients than normal controls (coxa recta: male 42% vs 8%, female 15% vs 5%, respectively and coxa profunda: male 20% vs 1%, female 19% vs 6% respectively). AR was higher in females than males, both in THA patients (1.66 vs 1.47) and normal controls (1.68 vs 1.57). Coxa profunda was associated with a lower AR (1.54 vs 1.61).
The higher prevalence of coxa recta and profunda in arthroplasty patients supports the theory of a role of these morphotypes in the development of coxarthrosis. The higher AR in females signifies the need for increased abductor work. Coxa profunda may be an adaptation to lower the AR.
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February 2014

Mammal hip morphology and function: coxa recta and coxa rotunda.

Anat Rec (Hoboken) 2013 Feb 10;296(2):250-6. Epub 2012 Dec 10.

Department of Orthopedic Surgery, HAGA Hospital, The Hague, The Netherlands.

Using 15 parameters, we provide a systematic description of mammal proximal femoral morphology. We established two types of proximal femoral morphology, termed coxa recta and coxa rotunda, characterized by low versus high concavity of the head-neck junction. Concavity is a measure of the sphericity of the femoral head as it meets the femoral neck that can be quantified by angular measurements. We asked whether the parameter of concavity corresponds with the classification of mammal proximal femoral morphology based on coalesced versus separate ossification patterns and locomotor patterns. Statistical analysis demonstrated a distinction between coxa recta and coxa rotunda with significant differences between the two groups in all but 3 of the 15 parameters examined. We found the most discriminating measurement between mammal hips to be the concavity of the posterior head-neck junction (beta angle). Coxa recta (small concavity) and coxa rotunda (large concavity) relate to the ossification pattern seen in proximal femoral development, and species-specific patterns of locomotion. We interpret the two hip types to reflect optimization for strength (recta) versus mobility (rotunda). Conceptually, both hip types can be recognized in humans, where coxa recta can be related to the development of osteoarthritis.
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February 2013

[Shoulder surgery using only regional anaesthesia].

Ned Tijdschr Geneeskd 2011 ;155(38):A3406

HagaZiekenhuis, locatie Sportlaan, Afd. Orthopedie, Den Haag, the Netherlands.

Effective intra-operative anaesthesia and peri-operative analgesia are important aspects of patient care in orthopaedic surgery. The interscalene regional anaesthetic block technique, performed with the patient lying in a lateral decubitus position, is new for arthroscopic shoulder surgery conducted in the Netherlands. The combination of the interscalene block (without general anaesthesia) and the lateral decubitus position results in better peri-operative conditions for the patient. Better analgesia, increased patient satisfaction and fewer complications in comparison to general anaesthesia have been reported for these types of surgery.
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December 2011

SUSHI: the Super Simple Hip score for younger patients.

Hip Int 2011 May-Jun;21(3):361-6. Epub 2011 Jun 8.

Haga Hospital,The Hague - Netherlands.

We describe the development of a simple patient-based score for young patients with hip problems which concentrates on activities that are difficult for someone with a hip problem and includes an activity rating scale that measures the highest level of physical activity reached during the past year. We compared the super simple hip score (SUSHI) with the more extensive hip osteoarthritis outcome score (HOOS) and evaluated the validity, sensitivity to change and floor and ceiling effects of the SUSHI score. We found that the SUSHI score is an adequate score to measure hip problems and that this score was preferred to the HOOS score by patients.
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June 2016

A method to identify talent: visual search and locomotion behavior in young football players.

Hum Mov Sci 2010 Oct 21;29(5):764-76. Epub 2010 Aug 21.

Institute MOVE, Faculty of Human Movement Sciences, VU University Amsterdam, The Netherlands.

The present study examined differences in visual search and locomotor behavior among a group of skilled 10-12 year-old football players. The participants watched video clips of a 4-to-4 position game, presented on a large screen. The participants were asked to take part in the game by choosing the best position for the reception of the ball passed by one of the players in the clip. Participants' visual search and locomotor behavior were collected continuously throughout the presentation of the clip. A within-group comparison was made based upon the participants' interception score, i.e., more at the correct position. The findings show that the high-score group looked more to the ball area, while the players in the low-score group concentrated on the receiving player and on the hips/upper-body region of the passing player. The players in the high-score group covered a significantly greater distance compared to the low-score group. It was concluded that differences in visual search and locomotion behavior can be used as indicators for identifying talented junior football players.
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October 2010

Planning of an interceptive movement in children.

Neurosci Lett 2010 Apr 21;473(2):110-4. Epub 2010 Feb 21.

Institute for Biomedical Research into Human Movement and Health, Manchester Metropolitan University, UK.

In the present study, we examined the spatio-temporal organization of the walking and reaching behaviour during an interception task in younger (6-9 years old) and older (10-13 years old) children. To this end, eighteen children had to walk towards an interception point to grasp a moving ball under three visual manipulation conditions. Walking and reaching behaviour were analysed during a condition allowing full vision of the ball trajectory and during two conditions in which vision towards the ball was partly occluded (enhanced planning requirement). The velocity of the ball was adapted to 50 or 70% of the maximum walking velocity of the participant. Results revealed that both younger and older children show a less accurate performance when the ball trajectory was occluded, while the walking profile and timing of the reach was not influenced by the occlusion manipulations. The findings seem to suggest that both groups were less accurate when the necessity of planning was enhanced.
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April 2010

Children's use of the bearing angle in interceptive actions.

J Mot Behav 2008 Jan;40(1):18-28

Institute for Biophysical and Clinical Research Into Human Movement, Manchester Metropolitan University, Alsager, Cheshire, England.

The authors investigated the effect of ball velocity and walking direction on children's adherence to the constant bearing angle (CBA) strategy. Children (N = 20) approached a moving ball to manually intercept it at a predefined target area. Results revealed that 10- to 12-year-olds adhered more than 5- to 7-year-olds to the CBA strategy. Younger children deviated more than older children from smaller angles of approach and lower ball velocities. The present findings suggest that younger children have difficulty adjusting to task requirements because they fail to couple walking velocity with ball velocity. The improvement seen with increasing age suggests that compliance with the CBA strategy may be attributed to older children's enhanced coincidence anticipation.
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January 2008

Postural adjustments and bearing angle use in interceptive actions.

Exp Brain Res 2006 May 10;171(1):47-55. Epub 2006 Jan 10.

Institute for Biophysical and Clinical Research into Human Movement, Manchester Metropolitan University, Hassall Road, Alsager, ST7 2HL Cheshire, UK.

The experiment investigates the effect of ball velocity and walking direction on the adherence to the bearing angle (BA) strategy in adults. Adult participants (N=12) approached a moving ball in order to manually intercept it at a predefined target area. Results revealed that during locomotion the BA strategy was implemented, but on reaching the point of interception, this strategy broke down and the BA strategy of the wrist compensated for the movement requirements relative to the ball velocity and approach angle. Larger deviations from the BA occurred when the angle of approach was decreased and when the ball velocity increased. When the BA strategy was adhered to, postural adjustments were reduced. Increased movements occurred in a proximal-distal direction with an increasing approach angle and a faster ball velocity.
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May 2006