2024年12月 保髋进展 JCR Q1 区

Osteonecrosis of the femoral head is a debilitating condition that can lead to cysts at the head-neck junction. Without timely intervention, the disease often progresses to femoral head collapse, ultimately necessitating hip replacement surgery. This article describes a hip preservation treatment method that involves core decompression by drilling small holes in the femoral neck and hernia sac, followed by filling femoral pits with allogeneic bone. The advantage of this technique lies in its ability to reduce intracapsular pressure, enhance blood circulation, and stabilize the femoral head, thus preventing collapse. Additionally, the blood released during core decompression nourishes the transplanted bone, further supporting its integration and effectiveness.

The number of pathologies treated successfully by hip arthroscopy continues to increase, and multiple efficacious techniques exist to perform this procedure. Hip arthroscopy performed with patients in the lateral decubitus position without a perineal post is less appreciated yet encourages increased visualization of the hip joint, improved ergonomics and maneuverability, and decreased postoperative complications. This article includes a detailed description of post-less hip arthroscopy with patient positioning in lateral decubitus.

To explore the association between obesity classification and patient-reported outcomes (PROs) in hip arthroscopy.

To systematically review and examine the current literature regarding the representation of female athletes in studies examining arthroscopic hip labral repair procedures.

Traditionally, distraction of the hip joint during hip arthroscopy has been achieved with the use of a perineal post, which acts as a counterforce. However, our knowledge of the potential complications related to the use of a perineal post continues to grow. Although pudendal neurapraxia is the most common of these potential complications, the perineal post also may cause skin tears of the perineum, erectile dysfunction and, in rare cases, permanent pudendal nerve injury. In response, several techniques for performing postless hip arthroscopy have been developed in recent years. Although some of these techniques are commercially available and some are "do-it-yourself," preliminary evidence has shown minimal risk of groin-related complications with these postless techniques. In addition to reducing complication rates, our research revealed significantly better patient-reported outcomes with postless compared with post-assisted hip arthroscopy at a minimum 1-year follow-up. Groin-related complications during hip arthroscopy are confusing and anxiety-producing to patients. Hip arthroscopy is an elective procedure, and patients do not expect to have any groin symptoms after a hip surgery. Because this is a sensitive issue, the potential for groin-related complications is rarely discussed with patients preoperatively. In addition, patients often are confused and reluctant to mention groin-related complications to their surgeon, especially if these symptoms are short-lived. Postless hip arthroscopy is a readily accessible, safe alternative to using a perineal post and should be adopted as the standard of care sooner rather than later.

The current study aimed to objectively evaluate the fit of a rectangular, tapered stem to the severely dysplastic hips on the basis of the proximal femoral anatomy and the dimensional properties of the stem. It was hypothesized that the stem size planned with accordance to the diaphyseal canal width alone can accommodate the distal femur successfully with no sizing mismatch. Forty-six patients (53 hips) suffering from secondary osteoarthritis due to hip dysplasia scheduled for total hip arthroplasty (THA) with a subtrochanteric transverse shortening osteotomy were included. All hips were Crowe type 4. All patients underwent preoperative computed tomography imaging. Height of femoral head center (HCH) was determined. Medullary canal diameter measurements at different levels were made. These were made at a level (1) 35% of HCH above the lesser trochanter (DT +35), (2) 70% of HCH below the lesser trochanter (DT -70), and (3) at the level of isthmus (Di). Medullary canal flare indices were calculated from the individual parameter ratios. Similar measurements were carried out for the different sizes of the femoral stem. The mean DT +35 was 41.9 ± 6.4 mm, the mean DT-70 was 17.3 ± 2.2 mm, and the mean Di was 12.8 ± 1.9 mm. In all femurs, the width of the isthmus was wider than that of the corresponding femoral stem isthmus. The femoral stem sizes established with respect to the diaphyseal width of the femur were all compatible with the isthmus width of the femur. Tapered and rectangular stems can accommodate the proximal femur above and below the osteotomy level in Crowe type IV hip dyplasia patients, thereby constituting a viable option as the femoral stem in this patient group with technically demanding difficulties.

Hip pain in active patients with early osteoarthritis can be quite debilitating, affecting mobility, quality of life, and overall well-being. Management of this patient population is challenging because arthroplasty implants inevitably have limited life expectancy while chondral damage can mitigate the benefits of arthroscopic or open hip preservation. A multifaceted, patient-specific approach to clinical decision making is crucial in this patient population, given their higher activity level and expectations compared with older cohorts. Several advances have been made to better stratify patients into the spectrum of management, which includes nonsurgical measures; injections, including orthobiologics; arthroscopic hip preservation; open hip preservation; hip resurfacing; and total hip arthroplasty.

Femoroacetabular impingement (FAI) is a well-recognized cause of hip pain in adults. The hip-spine relationship between the femur, pelvis, and lumbosacral spine has garnered recent attention in hip arthroplasty. However, the hip-spine relationship has not been well described in patients with FAI.

Over the past decade, hip-preservation strategies have gained momentum, resulting in a notable increase in the use of hip arthroscopy for diagnostic and therapeutic interventions in hip-related pathology. In this 3-part series, the authors will aim to comprehensively review the fundamentals of hip arthroscopy in the setting of femoroacetabular impingement. This Technical Note will thoroughly review the senior authors' approach to managing the central compartment of the hip in the context of femoroacetabular impingement.

Over the past decade, hip-preservation strategies have gained momentum, resulting in a notable increase in the use of hip arthroscopy for diagnostic and therapeutic interventions in hip-related pathology. In this 3-part series, the authors will aim to comprehensively review the fundamentals of hip arthroscopy in the setting of femoroacetabular impingement. While considering the advantages and disadvantages of post versus postless hip arthroscopy, this Technical Note will review the preferred patient and portal positioning approach used by the senior authors.

Over the past decade, hip preservation strategies have gained momentum, resulting in a notable increase in the use of hip arthroscopy for diagnostic and therapeutic interventions for hip-related pathology. In this 3-part series, we aim to comprehensively review the fundamentals of hip arthroscopy in the setting of femoroacetabular impingement. This Technical Note will thoroughly review the senior authors' approach to managing the peripheral compartment of the hip in the context of femoroacetabular impingement.

Although specific techniques vary, core decompression is generally accepted as the treatment of choice for precollapse avascular necrosis (AVN) of the hip to delay or prevent progression of the disease. This can be combined with hip arthroscopy to allow visual assessment of the femoral head as well as treatment of intra-articular pathologies, which may contribute to pain and joint degeneration. We describe a technique of hip arthroscopy and concurrent core decompression using an expandable reamer and bone grafting for treatment of hip AVN. This allows for minimally invasive treatment of both bony and intra-articular soft tissue pathologies, which are often concomitantly present in hip AVN disease, while minimizing reaming of healthy femoral bone.

To (1) systematically assess which orthobiologic agents are being used in acetabular labral repairs and (2) report all available outcomes for patients undergoing operative management for labral repairs with orthobiologic agents.

To identify key molecular components within the femoroacetabular impingement hip and compare the findings between male and female patients across varying age groups.

To determine the relationship between cam morphology of the hip and ipsilateral sacroiliac motion compared to the native hip in a cadaveric model.

To determine the patient demographics and incidence of hip arthroscopy after total hip arthroplasty using the PearlDiver database.

To assess whether capsular closure during hip arthroscopy with periportal capsulotomy affects 2-year postoperative outcomes for patients with femoroacetabular impingement syndrome (FAIS) without hypermobility.

Paralabral cysts in the acetabulum often occur in the setting of labral tears. While labral tears are commonly identified in femoroacetabular impingement syndrome, developmental dysplasia of the hip is also a cause of chondrolabral pathology. Our understanding of paralabral cysts has encouraged addressing the concomitant labral pathology, as this has been shown to result in cyst resolution. However, recent evidence suggests in the setting of hip dysplasia, addressing the bony pathology of the acetabulum with an isolated acetabular reorientation osteotomy allows for cyst resolution and significant improvement in clinical outcomes despite persistent labral tears postoperatively. While further investigation is needed to delineate the effects of persistent labral tears after isolated periacetabular osteotomy, addressing the acetabular undercoverage remains critical in the treatment of these patients.

In all aspects of orthopaedic surgery, restoring native patient anatomy has shown improved outcomes in comparison to nonanatomic reconstructions. Particular attention has been paid to the hip capsule, as the complex of the iliofemoral, pubofemoral, and ischiofemoral ligaments, as well as the zona orbicularis and iliocapsularis, all play an essential role in hip stability, mechanics, and maintenance of intra-articular pressures. An anatomic approach toward hip arthroscopy also includes labral repair or reconstruction with preservation of the chondrolabral junction and cam resection. Multiple recent studies have revealed improved patient-reported outcomes at long-term (>10-year) follow-up, as well as reduced revision rates and less progression to total hip replacement with complete capsular repairs compared to incomplete closure or no capsular management following hip arthroscopy. We perform an interportal capsulotomy with labral-sided capsular traction sutures for the central compartment, followed by the T-capsulotomy along the femoral neck with femoral-sided traction sutures for the peripheral compartment. At the end of every case, we ensure an anatomic complete capsular closure of the entire T-capsulotomy using a combination of self-retrieving suture guns and curved self-suture passers, often tying 7 or more sutures.

Developmental dysplasia of the hip (DDH) can cause pain and premature osteoarthritis. The risk factors and timing for disease progression in adolescents and young adults have not been fully defined. This study aimed to determine the prevalence of and risk factors for contralateral hip pain and surgery after periacetabular osteotomy (PAO) on a dysplastic hip.

Hip resurfacing arthroplasty (HRA) is recommended for younger patients seeking higher levels of activity. However, femoroacetabular cup impingement (FACI) between the femoral neck and acetabular prosthesis remains a concern. This study aimed to determine the incidence, risk factors, and prognostic consequences of FACI after HRA.

Acetabular cartilage delamination (ACD) can result in focal chondral defects, increasing contact stresses and contributing to osteoarthritis. This is commonly associated with femoroacetabular impingement, particularly with cam deformities due to shearing of the cam on the acetabulum. Additionally, ACD associated with labral tears or chondrolabral separation, when untreated, can compromise labral repair outcomes. ACD is often missed on preoperative magnetic resonance imaging and magnetic resonance arthrography, which show a sensitivity of <80%. Thus, given the ubiquity of ACD in patients undergoing femoroacetabular impingement surgery, a single-stage treatment option is essential. Acetabular shape, depth, and constraint, coupled with the thinness of acetabular cartilage, make treatment technically difficult, particularly arthroscopically. Treatment generally falls within 3 categories: repair, repair with augmentation, or cell-based cartilage transplantation. Currently, we most commonly employ primary repair and incorporate the cartilage flap into the labral repair.

This study aimed to evaluate the accuracy of ChatGPT in answering patient questions about femoroacetabular impingement (FAI) and arthroscopic hip surgery, comparing the performance of versions ChatGPT-3.5 (free) and ChatGPT-4 (paid).

Historically, for hip procedures, the Hip Outcome Score (HOS) and the International Hip Outcome Tool 12 (iHOT-12) have been commonly usedas instruments for patient-reported outcome measures (PROMs). However, these tools are often influenced by other factors, such as concurrent illnesses, making more standardized tools a preferable choice. Patient-Reported Outcomes Measurement Information System-25 (PROMIS-25) is a standardized, validated PROMs metric that has correlated well with several other anatomy-specific PROMs tools. In this study, we aim to assess and compare the correlations between iHOT-12 and HOS with PROMIS-25 in adult and pediatric hip preservation patients.

To compare patient populations and outcomes in studies treating borderline hip dysplasia (BHD) with either hip arthroscopy or periacetabular osteotomy (PAO).

To evaluate the effect of depth and location of femoral osteoplasty or the use of remplissage on the suction seal in a sheep hip model.

There remains ongoing controversy regarding the optimal treatment strategy of hip dysplasia, with some advocating for the addition of hip arthroscopy to periacetabular osteotomy (PAO) to address concomitant labral tears. The purpose of this systematic review was to compare the clinical outcomes, complications, and joint preservation of PAO and PAO with hip arthroscopy.

To determine the optimal treatment decision for capsular management after primary hip arthroscopy for femoroacetabular impingement syndrome.

This article has been withdrawn from Arthroscopy due to an error on the part of the Publisher. The article was intended for publication in Arthroscopy, Sports Medicine and Rehabilitation (where it is still published) but was mistakenly also published in Arthroscopy. The Publisher apologizes for any inconvenience this may cause, and would also like to make clear that there was no fault on the part of the article's author, and no fault with the article itself. The withdrawal has taken place simply to ensure that the publication record is correct. The full Elsevier Policy on Article Withdrawal can be found at https://www.elsevier.com/about/policies/article-withdrawal.

Physicians caring for athletes must provide accurate prognoses for return to sport (RTS). Regarding hip arthroscopy, the number of athletes being indicated for surgery is increasing, and the athletes are trending younger. Recent research shows that almost 90% of college athletes RTS after hip arthroscopy. The procedure is career-prolonging, rather than career-ending surgery. Finally, RTS is not equivalent to "performance," i.e., RTS at the same level or greater.

The purpose of this study was to explore the impact of social deprivation on preoperative characteristics and postoperative outcomes following hip arthroscopy (HA) for femoroacetabular impingement syndrome (FAIS).

The aim of this study is to assess agreement between retrospectively and prospectively collected patient-reported outcome measures (PROMs) following hip arthroscopy for femoroacetabular impingement syndrome (FAIS).

The essential component of managing femoroacetabular impingement involves restoration of the original labral function. Circumferential labral reconstruction (CLR) has shown positive results. However, biomechanical studies of CLR are limited and have not established the efficacy of the modern knotless all-suture anchor (ASA) pull-through technique.

This study aimed to determine the acetabular position to optimize hip biomechanics after transposition osteotomy of the acetabulum (TOA), a specific form of periacetabular osteotomy, in patients with hip dysplasia.

The objective of this study was to conduct a cost-utility analysis of osteochondroplasty with or without labral repair compared to arthroscopic lavage with or without labral repair for femoroacetabular impingement (FAI) from a Canadian public payer perspective.

Femoroacetabular impingement (FAI) is a cause of hip pain and can lead to hip osteoarthritis. Radiological measurements obtained from radiographs or magnetic resonance imaging (MRI) are normally used for FAI diagnosis, but they require time-consuming manual interaction, which limits accuracy and reproducibility. This study compares standard radiologic measurements against radiomics features automatically extracted from MRI for the identification of FAI patients versus healthy subjects. Three-dimensional Dixon MRI of the pelvis were retrospectively collected for 10 patients with confirmed FAI and acquired for 10 healthy subjects. The femur and acetabulum were segmented bilaterally and associated radiomics features were extracted from the four MRI contrasts of the Dixon sequence (water-only, fat-only, in-phase, and out-of-phase). A radiologist collected 21 radiological measurements typically used in FAI. The Gini importance was used to define 9 subsets with the most predictive radiomics features and one subset for the most diagnostically relevant radiological measurements. For each subset, 100 Random Forest machine learning models were trained with different data splits and fivefold cross-validation to classify healthy subjects versus FAI patients. The average performance among the 100 models was computed for each subset and compared against the performance of the radiological measurements. One model trained using the radiomics features datasets yielded 100% accuracy in the detection of FAI, whereas all other radiomics features exceeded 80% accuracy. Radiological measurements yielded 74% accuracy, consistent with previous work. The results of this preliminary work highlight for the first time the potential of radiomics for fully automated FAI diagnosis.

Periacetabular osteotomy (PAO) is a common treatment for prearthritic hip dysplasia. The goal of this investigation was to determine if computationally assessed hip contact mechanics are associated with joint failure at minimum 10-year follow-up. One hundred patients with hip dysplasia (125 hips) completed patient-reported outcomes an average of 13.8 years (range 10.0-18.0 years) after PAO. 63/125 hips were classified as having failed: 26 converted to total hip arthroplasty (THA) and 37 with significant disability indicated by modified Harris Hip Score (mHHS) ≤ 70. Differences in discrete element analysis-computed contact mechanics were compared between (1) preserved and failed hips, (2) preserved hips and hips that failed by THA, and (3) preserved hips and hips that failed by mHHS ≤ 70. Failed hips had significantly higher preoperative contact stress and exposure metrics (p < 0.001-0.009) than preserved hips. Failed hips also had significantly higher postoperative peak contact stress (p = 0.018), higher mean contact stress (p < 0.001), and smaller contact area (p = 0.044). When assessed based on type of failure, hips that failed by THA had significantly higher postoperative contact stress and exposure metrics than preserved hips (p < 0.001-0.020). In hips that failed by mHHS ≤ 70, mean postoperative contact stress exposure was significantly higher compared to preserved hips (p = 0.043). Despite improved radiographic measures of dysplasia after PAO, pathologic joint contact mechanics can persist and predict treatment failure at minimum 10 years after surgery. Operative and nonoperative techniques specifically intended to reduce harmful contact mechanics in dysplastic hips may have the potential to further improve clinical outcomes after PAO.

The acetabular version is crucial for hip function, and its accurate assessment is necessary for treating patients with hip disorders. Current studies reveal discrepancies in the precision of quantitative radiographic measurements versus CT measurements, but there is a lack of focused analysis on anteverted versus retroverted hips. This study aims to fill this gap by directly comparing the reliability of these two methods in assessing varied hip configurations.

Hip arthroscopy has one of the steepest learning curves of any orthopaedic surgery and has been reported to require upwards of more than 100 times the number of cases required to become efficient compared with other surgeries. Thus, hip arthroscopy deserves special attention regarding training, as it is technically challenging. Recent research shows that both immersive virtual reality (with a headset) and nonimmersive virtual reality (with a 2-year subscription, a high-definition touchscreen display, a benchtop hip manikin with pre-established arthroscopic portals, and magnetized arthroscopic instruments for tactile feedback) result in similar acquisition of procedural knowledge and technical skills, but immersive virtual reality is 132-fold less costly. Both types of virtual reality offer haptics, which replicate the "feel" of performing a hip arthroscopy, and both versions are far less costly than a cadaver lab, or the lost opportunity costs incurred with an additional year of fellowship training. Although virtual reality will never replace performing an actual surgery on an actual patient, it is shown to diminish the hip arthroscopy learning curve and is well worth the investment.

Adequate pain control and early mobilization are critical in the postoperative period after periacetabular osteotomy (PAO). Regional anesthesia can reduce postoperative pain, but certain techniques can increase the risk of postoperative motor block and delayed functional recovery. Continuous lumbar epidurals can provide excellent analgesia but also create challenges with early ambulation. Recently, suprainguinal fascia iliaca (SIFI) single-shot blocks have been shown to provide effective analgesia in PAO patients. The goal of this study was to compare opioid use, time to achieve inpatient physical therapy (PT) goals, and length of stay (LOS) between a cohort of patients receiving SIFI blocks and a cohort of patients receiving epidural analgesia (EA).

To (1) compare the efficacy of immersive virtual reality (iVR) to nonimmersive virtual reality (non-iVR) training in hip arthroscopy on procedural and knowledge-based skills acquisition and (2) evaluate the relative cost of each platform.