2025年1月 保髋进展 JCR Q1 区

The new radiographic "windshield wiper sign" detects hip instability and an instability-related osteochondral defect of the anterolateral femoral head. It is visible on plain radiographs as well as on magnetic resonance imaging and during arthroscopy, in hips otherwise considered normal or borderline based on the lateral center-edge angle. In the past 2 decades, femoral acetabular impingement syndrome with labral lesions and cartilage lesions have been treated with excellent results. Recently the focus has shifted to complex cases, revision surgery, and capsular management preventing postoperative hip instability. Microinstability of the hip causes poor outcomes, but preoperatively, there has been no gold standard for radiographic assessment of hip instability. On plain radiographs, we use the lateral center-edge angle and the anterior center-edge angle, and we can also use the Femoro-Epiphyseal Acetabular Roof Index and the gothic arch angle. These signs help detect cases in which arthroscopic surgery alone would provide poor results and a concurrent osteotomy (e.g., a periacetabular osteotomy) is needed. We now understand that hip instability in hips otherwise considered normal or borderline dysplastic can be detected by the windshield wiper sign. This is important knowledge for concomitant arthroscopic combined with osteotomy because the need for cartilage therapy can be determined preoperatively.

To assess the ability of ChatGPT to answer common patient questions regarding hip arthroscopy, and to analyze the accuracy and appropriateness of its responses.

Periacetabular osteotomy (PAO) surgery presents an opportunity for shared decision-making (SDM) and may be facilitated by decision-making tools. Currently, no diagnosis or treatment-specific decision-making tools exist for this patient population. Understanding patient PAO surgery decision-making experiences and processes would enable development of a treatment-specific decision-making tool and would help hip preservation surgeons with SDM practices.

Periacetabular osteotomy (PAO) is the agreed-upon treatment for symptomatic hip dysplasia in the skeletally mature patient. Many surgeons perform hip arthroscopy to address intra-articular damage around the time of the PAO. Other surgeons believe that correcting the dysplasia with the PAO unloads the soft tissues, which negates the need for arthroscopy. Current evidence is unclear as to whether hip arthroscopy, whether concomitant or staged, is needed when performing PAO for hip dysplasia. In the United States, the chosen approach often is determined by surgeon training, comfort level, and logistical issues. Over time, the chosen approach may change, as more surgeons are trained in both open and arthroscopic hip preservation. Certainly, some patients benefit from hip arthroscopy along with PAO for labral pathology and/or femoral cam deformity.

Osteonecrosis of the femoral head (ONFH) affects at least 20,000 patients annually in the United States; however, the pathophysiology of disease progression is poorly understood. The purpose of this study was to determine the relative importance of three distinct elements and their relationship to the collapse of the femoral head as follows: (1) identifiable risk factors, (2) femoral head anatomy, and (3) the extent of the necrotic lesion.

For decades, hip preservationists have utilized intra-articular preoperative injections for diagnostic and therapeutic reasons. In the presence of typical or atypical hip pain, impingement, instability, and torsional abnormalities, hip preservationists are challenged with consistently educating ourselves and patients on interventions that can predict long-term relief. Current evidence on the predictive postoperative value of a positive injection response is mixed. Injection results can show whether the patient's symptoms are coming from the hip and to what extent, but they may not predict future outcomes. The patient is more complicated than a positive or negative injection response, and the decision for surgery should be taken in context to all clinical factors, imaging findings, and patient expectations. Proper rehabilitation is also vital. Finally, a negative injection response in a patient diagnosed with femoral acetabular impingement syndrome should not deter the decision for surgery. With the correct diagnosis and procedure, patients can do well.

Patients with femoroacetabular impingement syndrome (FAIS) present with ongoing symptoms in a painful hip. Insightful patients or family members often express concern about similar pathology, and associated risk of arthritis, in their less or asymptomatic hip, and recent research shows that patients with increased alpha angles are associated with more advanced cartilage damage, particularly in males. The ultimate question, for surgeons and patients, is: Can we predict chondral pathology based on preoperative variables alone, and should we intervene prior to symptoms? Yet, FAIS is multifactorial, not simply anatomic, and cam-type FAI can have a high prevalence in asymptomatic hips in some populations. Thus, today, prophylactic hip preservation surgery cannot be generally recommended, but in the future, an individualized treatment algorithm may result in precise prediction of which patients might benefit from earliest intervention to help reduce the incidence of premature hip osteoarthritis. In the interim, when timely intervention is in the best interest of the patient, insurance denials that delay indicated surgery must not be tolerated. One of the most rewarding and unique aspects of managing FAIS is that we have the opportunity to both treat ongoing hip symptoms and mitigate future pathology, sometimes even in the contralateral hip.

this study focused on the mixed-type deformities of acetabular retroversion (AR) and developmental dysplasia of the hip (DDH) deformity and aimed to ascertain the changes in pelvic tilt from a supine to a standing position in these cases and identify potential underlying mechanisms.

To determine staged hip arthroscopy and periacetabular osteotomy (PAO) mid-term outcomes in active patients aged 45 years and older compared with a younger group.

To evaluate the safety, reliability, and effectiveness of bioceramic rods (BR) in treating osteonecrosis of the femoral head (ONFH), compared with other treatments such as core decompression and autologous bone grafting.

Staged or combined hip arthroscopy/periacetabular osteotomy has typically been reserved for the younger patient with coexisting hip dysplasia and labral pathology and/or cam-type femoroacetabular impingement. In carefully selected patients with little to no arthritis over the age of 45, results are similar to a younger cohort of patients. Hip-preserving procedures intend to preserve the hip from getting arthritis, and if a patient does not have arthritis, consideration should be given to hip preservation surgery despite a more advanced age.

The dynamic alignment of the lumbar spine, pelvis and femur is increasingly studied in hip preservation surgery. However, the interaction between lumbopelvic alignment, acetabular and femoral morphology and its influence on patients' preoperative symptom burden remains poorly understood. The aim of this study was to evaluate whether lumbopelvic malalignment affects osseous hip morphology and exacerbates preoperative patient-reported joint functionality in patients undergoing periacetabular osteotomy (PAO).

Sex has been associated with different pathologic characteristics in painful hips undergoing hip arthroscopic surgery.

To determine the effectiveness of administering intravenous (IV) tranexamic acid (TXA) on altering visual field clarity (VFC) during arthroscopic hip preservation surgery for patients with femoroacetabular impingement syndrome (FAIS).

The utility of patient-reported outcome measures (PROMs) has been well established, but their interpretation relies on population-specific definitions of meaningful improvement. As such, the minimum clinically important difference (MCID), substantial clinical benefit (SCB), and patient-acceptable symptom state (PASS) thresholds have become prominent metrics in the orthopaedic evidence to ascribe clinical relevance to numeric PROM scores. Studies assessing outcomes of periacetabular osteotomy (PAO) relative to the MCID and PASS have previously evaluated patients against thresholds defined for hip arthroscopy for the treatment of femoroacetabular impingement or distribution-based MCID calculations. These scores may not accurately reflect the status or expectations of patients with a different symptom profile undergoing open hip preservation surgery.

Hip arthroscopy is a valuable tool through which intra- and extra-articular hip pathologies may be addressed, with the goal of improving pain and function while preventing osteoarthritis progression. Little data are available regarding the effect of social determinants of health on hip arthroscopy outcomes.

To use a nationwide administrative database (PearlDiver) to investigate whether patients with generalized anxiety disorder (GAD) undergoing primary hip arthroscopy for femoral acetabular impingement syndrome (FAIS) have (1) higher rates of medical complications, (2) higher readmission rates, and (3) higher costs of care as compared with patients without GAD.

Periacetabular osteotomy (PAO) can treat pain, dysfunction, and decreased activity secondary to hip dysplasia. Patients' pre- and postoperative activity can be measured using the University of California Los Angeles (UCLA) activity score, a validated questionnaire. Understanding return to and maintenance of activity at long-term follow-up after PAO is a priority for active patients.

To (1) compare 5-year survivorship (avoiding repeat hip arthroscopy (HA)/total hip replacement conversion) between those undergoing routine capsular repair compared with where no repair was performed; (2) compare patient-reported outcome measures (PROMs) and achievability of metrics of clinically important improvement between these groups; and (3) evaluate the moderating influence of age and sex on outcomes.

The management of borderline hip dysplasia (BHD) remains a topic of particular interest in the hip preservation world. While periacetabular osteotomy remains the gold standard for frank dysplasia, management of mild or borderline dysplasia is more nuanced, and in many cases, isolated hip arthroscopy with capsular plication can yield favorable and durable outcomes, avoiding morbidity associated with osteotomy. However, the benefit of avoiding the morbidity of a periacetabular osteotomy should be carefully weighed against the risk of undertreating this complex pathology. Historically, BHD was defined as a lateral center-edge angle between 20° and 25°, with more recent studies using 18° as a lower threshold. Yet, a singular 2-dimensional measurement provides an incomplete picture. Labral hypertrophy, an upsloping lateral sourcil, fovea alta, ligamentum teres tears, Tönnis angle, Femoro-Epiphyseal Acetabular Roof index, vertical center anterior angle, and abnormal femoral or acetabular version are additional factors that help us understand dynamic pathoanatomy and the severity of instability. Some of these variables-including Tönnis angle >10-15°, ligamentum teres pathology, and vertical center anterior angle <18°-have been associated with failure of arthroscopy alone for BHD.

Central acetabular stenosis (CAS), defined as an osteophyte within the acetabular fossa, is associated with higher rates of femoral head chondral damage and, when left untreated, inferior short-term outcomes after hip arthroscopic surgery. Central acetabular decompression (CAD) is an arthroscopic technique to resect the osteophyte and resurface the acetabular fossa to improve contact mechanics of the femoral head.

Hip decompression (HD) has shown promising outcomes for osteonecrosis of the femoral head (ONFH), particularly in early stages. Prompt intervention may delay progression to total hip arthroplasty (THA). This study evaluated outcomes of HD with elevation of the collapsed segment in patients who had advanced stages of ONFH, specifically those who had segmental collapse of the femoral head.

Multiple drilling techniques, a minimally invasive variation of core decompression, have shown promise for joint preservation in early-stage osteonecrosis of the femoral head (ONFH). However, long-term outcomes remain insufficiently reported. This study extends the follow-up period to 30 years, aiming to deliver a thorough evaluation of the sustained effectiveness and potential limitations of multiple drilling in the management of ONFH.

This study aimed to collect tissue overlying a CAM deformity for subsequent cell culture and chondrocyte expression as a proof of concept of clinical feasibility for autologous cell-based cartilage restoration in the hip.

Osteonecrosis of the femoral head (ONFH) can cause pain, diminished function, and eventual articular collapse, disproportionately impacting younger patients. Core decompression (CD) is used to halt or at least delay postcollapse disease in patients who suffer from ONFH, but it can have variable outcomes. Orthobiologics are cellular therapies, growth factors, and biomaterial substances obtained from human cells and tissue that promote biological healing and have recently gained attention in the treatment of osteonecrosis. In this review, the role of orthobiologics in the treatment of osteonecrosis is discussed.

Recent studies have used femoroacetabular impingement (FAI) as a model for hip osteoarthritis, however, the cellular mechanisms underlying disease progression remain unclear. Pulvinar abnormalities within the cotyloid fossa are common findings during hip preservation surgery and total hip arthroplasty (THA). The purpose of this study was to compare histologic inflammation and gene expression of pulvinar synovial tissue in patients with FAI and patients with hip osteoarthritis secondary to FAI (FAI-OA). Patients undergoing hip arthroscopy for FAI and THA for osteoarthritis with FAI morphology (FAI-OA) were included. Macroscopic evaluation of the pulvinar for the FAI cohort was classified through the ligamentum-fossa-fovea complex (LFFC) grading system. RNA was isolated for reverse transcription-polymerase chain reaction to evaluate the expression of inflammatory genes. Synovial samples were graded according to the histologic synovitis scoring system. Twenty-nine patients were included in the study (17 FAI and 12 FAI-OA). FAI patients had a lower pulvinar synovial score (2.3 ± 1.1) compared to FAI-OA patients undergoing THA (3.6 ± 1.7; p = 0.04). Macroscopic pulvinar inflammation in the FAI cohort according to the LFFC classification was associated with worsening histologic synovitis (r = 0.82; p < 0.001). There were no differences in gene expression between the FAI and FAI-OA cohorts, while there was increased expression of IL1β, TGF-β1, and PPARγ in subjects without significant pulvinar synovitis. Increased catabolic gene expression by the pulvinar tissue of patients without histologic synovitis earlier in the disease process may promote the development of worsening synovitis and contribute to articular cartilage degeneration. STATEMENT OF CLINICAL SIGNIFICANCE: Understanding the role of the pulvinar tissue within the hip, both macroscopically and biochemically, can help surgeons understand the complexities of the presentation and progression of osteoarthritis.

Femoroacetabular impingement (FAI) results from overcoverage of the acetabulum or excess bone on the femoral head-neck junction, which may cause pain or discomfort with repetitive hip flexion. Previous studies have reported adaptations in squat mechanics in individuals with FAI compared with controls, but to our knowledge, there has been little research exploring pre- to postoperative deviations in adolescents.

Fixation of periacetabular osteotomy (PAO) has been a matter of interest since development of the procedure. Despite the stability of the construct, no consensus regarding the minimum number of screws needed for fixation is present. The aim of this study was to compare two-screw and three-screw fixation techniques in the clinical setting.

Understanding the trajectory of postoperative patient-reported outcomes after hip preservation surgery is essential. This study aims to analyse patient-reported outcome trajectories up to 2 years post-surgery using the UK's national hip preservation registry and to examine the influence of potential confounders.

Minimum joint space width (mJSW) is a useful quantitative metric of osteoarthritis progression in the hip, particularly as a continuous variable compared to more common categorical classification systems. The purpose of this study was to develop an automated algorithm for measuring mJSW in native hips on antero-posterior pelvis radiographs.

Mounting evidence suggests that patient response to intra-articular injection may not predict clinical response to arthroscopy in the setting of femoroacetabular impingement syndrome (FAIS), as once believed. However, the hip preservation community should not take this to mean that diagnostic injections lack value in establishing a diagnosis of FAIS and distinguishing it from extra-articular hip conditions. Like other diagnostic tools, intra-articular injection is not a stand-alone test intended to definitively determine proper treatment. All diagnostic tools, to include elements as basic as assessment of pain location and provocative examination maneuvers, have shown poor specificity in predicting response to arthroscopy for FAIS when evaluated in isolation. Intra-articular injections, as with all other tools of the orthopaedic surgeon, must be considered in light of the entire evaluation of the patient.

Hip arthroscopy has been shown to consistently result in significant improvements in pain, function, and quality of life for athletes diagnosed with femoroacetabular impingement syndrome. This outcome is similarly observed in studies focusing specifically on soccer players, a group notably associated with femoroacetabular impingement syndrome because of the physical demands of the sport. Although most athletes return to their sport, interpreting return-to-sport (RTS) data requires caution. Definitions vary widely, used tools and methods to measure RTS are poor and too generalized, performance levels and metrics often are overlooked, and additional important factors contributing to RTS, such as psychological readiness, are frequently ignored. Reported RTS rates may therefore not reflect sustained performance at a preinjury level. Moreover, failure to RTS may not always directly suggest athletes' dissatisfaction from surgery. These nuances matter. Moving forward, RTS reporting should evolve to capture the quality of return, integrating validated definitions, performance metrics, and transparency about limitations. In addition, we should acknowledge that in some cases reporting on less-favorable RTS data after a surgical intervention does mean it is not successful. Only by doing so can the orthopaedic community provide athletes with accurate, realistic guidance about outcomes after hip-preservation surgery. The critical message is that hip arthroscopy reliably improves pain and function, but RTS is not always what it seems.

A 2-year minimum follow-up period has generally been preferred in orthopaedic studies. This minimum standard aids comparisons across the literature and helps to ensure methodologic rigor. However, in some situations, these minimum durations are not required to answer specific research questions and strictly enforcing these requirements poses unnecessary barriers to research by adding cost and complexity, increasing the risk of loss to follow-up and potentially restricting early dissemination of clinically important findings. There can be situations when variability in these minimum time frames might be appropriate, depending on the research question, diagnosis, treatment, and primary outcome measure. Therefore, we encourage authors to include a statement in their manuscript justifying their chosen follow-up period. In many cases, this may default to the established minimum standard. However, we include examples of procedures (rotator cuff repair, shoulder stabilization, superior capsule reconstruction, shoulder arthroplasty, anterior cruciate ligament reconstruction, partial meniscectomy, meniscus repair, platelet-rich plasma injection, microfracture for osteochondral lesions of the talus, and arthroscopic hip preservation surgery) in which the literature has shown when clinical outcomes plateau. In some cases, this confirms the need to adhere to the established minimum follow-up of 2 years, but in other scenarios, clinical outcomes plateau much earlier. Therefore, authors evaluating patient-reported outcome measures may justify shorter durations of minimum follow-up in some settings.

Femoral retroversion is increasingly recognized as a contributor to hip pain, impingement, and inferior outcomes after hip preservation surgery. Although its natural history remains incompletely defined, biomechanical studies show that retroversion decreases impingement-free range of motion and alters labral contact. Clinical outcomes following hip arthroscopy in retroverted hips have been mixed. Recent comparative studies have reported that femoral derotational osteotomy, either alone or combined with hip arthroscopy, can outperform hip arthroscopy alone in terms of patient-reported outcomes in patients with <5° of femoral anteversion.

To compare patient-reported outcomes in patients with femoral retroversion (<5° of femoral anteversion) treated with either isolated hip arthroscopy (HA), femoral derotation osteotomy (FDO), or a combined procedure.

Editorial on the intersection of hip preservation and sports medicine. No abstract available.

As the number of hip arthroscopy cases performed annually continues to rise, so does the number of patients requiring revision surgery. Determining the cause of failed hip arthroscopy (HA) can be challenging, with residual femoroacetabular impingement (FAI) being the most common indication for revision. While addressing impingement during primary HA is critical, factors such as articular cartilage defects, labral pathology, and capsular management also influence outcomes.

Postoperative stress fractures following periacetabular osteotomy (PAO) can prolong the healing process, with some cases resulting in nonunion. The purpose of this study was to characterize the incidence of stress fracture following PAO in a cohort of patients who underwent bilateral PAO and identify the subsequent risk of second-side stress fracture if there had been a stress fracture on the first side.

Previous studies on the outcomes of hip arthroscopy in patients with global acetabular overcoverage and focal lateral acetabular overcoverage have been limited by short- and intermediate-term follow-up periods and inconsistent radiographic criteria in defining these specific subpopulations with femoroacetabular impingement syndrome (FAIS).

Hip arthroscopy (HA) for femoroacetabular impingement (FAI) is increasingly performed in professional athletes, yet sport-specific return-to-sport (RTS) outcomes remain limited.

Although periacetabular osteotomy (PAO) is a commonly used procedure with generally good intermediate and long-term outcomes, complications such as stress fractures of the ischium or pubis have been reported. A limited number of studies have investigated stress fracture after PAO, but the results lack consensus and do not thoroughly explore lifestyle factors or patient-reported outcome measures (PROMs).