Femoro-Acetabular Impingement (FAI) is a hip joint disease which affects and impairs the range of hip motion during performing activities of daily living, jogging, walking, or climbing stairs due to the bony abnormalities of the joint. Ballet dancers and athletes (e.g. gymnasts and hockey players) put their hips at the risk of FAI by extremely moving the hip mainly by excessively rotating the joint. In this research, we introduce a visualization system which helps surgeons to analyze the range of hip motions as well as to have a better communication with patients. These goals are achieved by presenting three dimensional (3D) visualizations of motion envelope by examining the maximum possible rotation of the digital hip bones. Our computer simulation system estimates, analyzes and visualizes the maximum hip range of motion (ROM) for the constructed 3D bone models that are extracted from Magnetic Resonance Images (MRI) after segmenting the bones. These tasks are accomplished by first calculating Hip Joint Center (HJC) which is center of rotation of femoral head on the 3D segmented MRI models followed by simulating hip motions with examining impingement between the femur and the acetabulum using our collision detection system. In our collision detection system, surfaces of femoral head and acetabulum bones are sampled in the spherical coordinates based on rasterization and interpolation. Then, the distance between the femoral head and acetabulum are computed to prevent impingement between them. The maximum motion degree of femur bone within depression of acetabulum in every direction during the digital simulation shows the ROMs of the inputted MRI of the hip joint. Six primary plane motions (flexion/extension, abduction/adduction and internal/external rotation) as well as various combinations of these motions (maximum rotation of the hip between every two rotational movements) and successive movements (maximum rotational movement of the hip per another rotational movement) are simulated and analyzed along with 3D visualization of estimated range of these motions. Generally, the ROM differs by some factors such as age, gender, ethnicity, and geographic location. For instance, newborns up to age two have considerably greater motion in hip flexion and hip abduction than adults. Our system by 3D visualization of motion envelope will provide a platform to understand quicker and better the effect of bony morphology of the hip joint on the possible ROM. We also examine the long-standing question about moving center of rotation related to ROM. We found out the ROM becomes bigger especially when the center moves outward to the direction of acetabulum axis. This thesis does not consider the effect of muscle and other surrounding connective tissue on the hip ROM since they can be altered significantly by physical training to show the potential of maximum ROM. For example a ballerina has a bigger ROM leading a bigger motion envelope compared with non-dancers. Hence we visualize the range of joint motions and their envelopes that are obtained from the osseous anatomy of the hip joint. The osseous anatomy of the joint is the most fundamental and permanent factor of ROM which indicates the maximum motion that the joint can achieve if the muscle and other connective tissues are perfectly trained.

Femoro-Acetabular Impingement (FAI) is a hip joint disease which affects and impairs the range of hip motion during performing activities of daily living, jogging, walking, or climbing stairs due to the bony abnormalities of the joint. Ballet dancers and athletes (e.g. gymnasts and hockey players) put their hips at the risk of FAI by extremely moving the hip mainly by excessively rotating the joint. In this research, we introduce a visualization system which helps surgeons to analyze the range of hip motions as well as to have a better communication with patients. These goals are achieved by presenting three dimensional (3D) visualizations of motion envelope by examining the maximum possible rotation of the digital hip bones. Our computer simulation system estimates, analyzes and visualizes the maximum hip range of motion (ROM) for the constructed 3D bone models that are extracted from Magnetic Resonance Images (MRI) after segmenting the bones. These tasks are accomplished by first calculating Hip Joint Center (HJC) which is center of rotation of femoral head on the 3D segmented MRI models followed by simulating hip motions with examining impingement between the femur and the acetabulum using our collision detection system. In our collision detection system, surfaces of femoral head and acetabulum bones are sampled in the spherical coordinates based on rasterization and interpolation. Then, the distance between the femoral head and acetabulum are computed to prevent impingement between them. The maximum motion degree of femur bone within depression of acetabulum in every direction during the digital simulation shows the ROMs of the inputted MRI of the hip joint. Six primary plane motions (flexion/extension, abduction/adduction and internal/external rotation) as well as various combinations of these motions (maximum rotation of the hip between every two rotational movements) and successive movements (maximum rotational movement of the hip per another rotational movement) are simulated and analyzed along with 3D visualization of estimated range of these motions. Generally, the ROM differs by some factors such as age, gender, ethnicity, and geographic location. For instance, newborns up to age two have considerably greater motion in hip flexion and hip abduction than adults. Our system by 3D visualization of motion envelope will provide a platform to understand quicker and better the effect of bony morphology of the hip joint on the possible ROM. We also examine the long-standing question about moving center of rotation related to ROM. We found out the ROM becomes bigger especially when the center moves outward to the direction of acetabulum axis. This thesis does not consider the effect of muscle and other surrounding connective tissue on the hip ROM since they can be altered significantly by physical training to show the potential of maximum ROM. For example a ballerina has a bigger ROM leading a bigger motion envelope compared with non-dancers. Hence we visualize the range of joint motions and their envelopes that are obtained from the osseous anatomy of the hip joint. The osseous anatomy of the joint is the most fundamental and permanent factor of ROM which indicates the maximum motion that the joint can achieve if the muscle and other connective tissues are perfectly trained.

Title: The evaluation of surgical treatment of the hip in the diagnosis of femor- acetabular impingement syndrome. Objectives: The main objective of this work is to evaluate the effect of the surgery of the hip in diagnosis of femor-acetabular hip impingement. Methods: In our work we have cooperated with 103 patients who have been operated on hip with the diagnosis of femor-acetabular hip impingement (FAI). We used standardized questionnaires of WOMAC and NAHS, which assesses functional self- care, limitations in motion and painfulness. Patients completed questionnaires twice. For the first time before surgery and second time at least one year after the surgery. The specimens of questionnaire are attached in the Annex. Results: We found out that postoperative condition is significantly different from the preoperative state in terms of improved self-care, increased range of motion and reduction of painfulness. Keywords: Femor-acetabular impingement, hip surgery, WOMAC, NAHS

Femoral acetabular impingement (FAI) is a bony hip condition that often results in tears to the acetabular labrum. Patients with FAI experience pain, decreased function, and quality of life. FAI and its’ sequela are treated definitively with hip arthroscopy. Hip arthroscopy is being performed with increasing frequency, and while most patients respond favorably, a subset of 10-20% of patients have suboptimal outcomes. Previous research suggests that mental status may be a primary driver in the way patients with FAI respond to and feel pain. Measures of mental status include the presence of mood disorders and psychosocial patient reported outcomes (PROs). Psychosocial constructs that have yet to be examined in patients with FAI include self-efficacy, kinesophobia, and pain catastrophizing. The Pain Self-Efficacy Questionnaire (PSEQ) gauges an individual’s confidence, or self-efficacy, in their ability to complete tasks despite their current pain. Previous research has established that a patient’s self-efficacy is an important determinant of long-term success following orthopedic surgery. Kinesophobia, measured via the Tampa Scale for Kinesiophobia (TSK), is a measure of movement-related fear. In contrast to self-efficacy, fear of movement has been identified as a predictor of early success following orthopedic surgery. Lastly, pain catastrophizing is a set of maladaptive behaviors including ruminating on pain, feeling helpless to overcome painful situations, and magnifying the circumstances surrounding the painful experience. Catastrophizing behaviors, measured via the Pain Catastrophizing Scale (PCS), have been repeatedly linked to increased pain and decreased functionality in a variety of orthopedic populations. To date, the relationship between these psychosocial variables and pain has not been examined in patients with FAI. The primary aim of this dissertation was to evaluate the role of psychosocial factors on pre and postoperative pain in patients with FAI undergoing hip arthroscopy. To accomplish this aim we performed a series of three studies. The first study was a retrospective chart review to determine the prevalence of mental health disorders and compare preoperative clinical presentation between patients with and without mental health disorders. The second was a cross-sectional study designed to determine if any psychosocial variables could predict preoperative hip pain. The final study utilized a longitudinal, cohort design. Patients were tested preoperatively and at 12-weeks postoperative. The primary outcomes measured were self-efficacy, kinesiophobia, pain catastrophizing, and hip pain at rest and during activity measured via a visual analog scale (VAS). The purpose of this study was to determine the effect of preoperative psychosocial variables on postoperative pain, and to determine if these variables were predictive of persistent postoperative pain three months following hip arthroscopy. Based on the results from these studies we can conclude the following: 1) Mental health disorders are more common in patients with FAI than other orthopedic populations, and self-reported pain and function are worse in this subset of patients, but neither symptom chronicity nor the severity of joint deformity differs; 2) Low self-efficacy is predictive of worse preoperative pain in patients with FAI; and 3) Patients with high preoperative pain catastrophizing or low self-efficacy are more likely to have increased postoperative pain. Low preoperative self-efficacy is predictive of persistent hip pain during activity three months following hip arthroscopy, while low self-efficacy and mental health disorders are predictive of persistent hip pain at rest. Future studies are necessary to develop and implement interventions targeting low self-efficacy and elevated catastrophizing in patients undergoing hip arthroscopy to improve patient outcomes for this high-risk group.