2025年1月 保髋进展 JCR Q2 区

Patients experiencing pain from femoral acetabular impingement and considering hip arthroscopy may be concerned about their timeline to resume activities they enjoy, such as golf.

Osteochondral allograft (OCA) transplantation with or without labral reconstruction is considered a hip preservation surgical treatment option for young, active patients. This study aims to report early outcomes for use of OCA and labrum allograft transplants for patients treated for symptomatic femoral head chondral damage and/or acetabular labrum deficiency after implementation of a comprehensive joint restoration approach.

Diagnosing the specific causes of young adult hip pain remains challenging due to non-specific symptoms. Fluoroscopy-guided injections are useful for confirming intra-articular hip pain and differentiating it from extra-articular pathology. When performing injections, accurate needle placement into the hip joint is critical. Traditionally, a contrast agent is used to confirm intra-articular positioning. Air arthrograms are an alternative technique that avoids adverse reactions to contrast, which may compromise interpretation of results, as well as being more cost-effective. This study presents the air arthrography technique for intra-articular hip injections, and assesses outcomes and complications in a consecutive patient cohort.

The purpose of this study was to (1) evaluate preoperative pelvic tilt utilizing the sacro-femoral-pubic (SFP) angle on standing pelvic x-rays, and (2) determine if the SFP angle changes after a unilateral or bilateral PAO.

The Journal of Hip Preservation Surgery (JHPS) is not the only place where work in the field of hip preservation can be published. Although our aim is to offer the best of the best, we are continually fascinated by work, which finds its way into journals other than our own. There is much to learn from it, and so JHPS has selected six recent and topical subjects for those who seek a summary of what is taking place in our ever-fascinating world of hip preservation. What you see here are the mildly edited abstracts of the original articles, to give them what JHPS hopes is a more readable feel. If you are pushed for time, what follows should take you no more than 10 min to read. So here goes ….

Acetabular subchondral cysts are commonly identified signs of joint degeneration and arthritis. This pathology is generally considered a relative contraindication for hip preservation surgery.

Identifying hip instability in symptomatic patients with borderline dysplasia of the hip (BDH) is of paramount importance, as it can influence both surgical decision-making and surgical outcomes. The femoroepiphyseal acetabular roof (FEAR) index is strongly affected by the hip adduction/abduction angle during the pelvic radiograph, which has not yet been considered in the recommended threshold values.

The functional hip-spine interaction is increasingly noted in hip preservation by periacetabular osteotomy (PAO), while potentially affecting the impingement-free acetabular reorientation. However, the clinically relevant sex-related differences in lumbopelvic alignment have been poorly studied. Thus, the purpose of this study was to evaluate a matched PAO patient cohort for sex-related differences in lumbopelvic alignment.

To summarize the characteristics of the top 100 most-cited publications related to hip preservation, not counting self-citation.

Triple-Osteotomy (TO) is a hip-preserving surgical technique designed to correct symptomatic hip dysplasia by achieving three-dimensional acetabular reorientation and improving femoral head coverage. This procedure has shown promising outcomes in pain reduction, functional recovery, and quality of life, particularly in young, active patients. While periacetabular-osteotomy (PAO) is another well-established method for hip preservation, the specific advantages of TO, especially in early recovery and patient-reported outcomes (PROMs), remain underexplored. This study evaluates the mid-term outcomes of TO using the iHOT33 tool to provide a comprehensive understanding of its clinical benefits.

The exponential rise in arthroscopy for femoroacetabular impingement (FAI) has led to increased revision surgery rates, although this is often an exclusion criterion from arthroscopy literature.

Mild slipped capital femoral epiphysis (SCFE) was traditionally treated with in situ pinning (ISP), a technique that stabilizes the physis but does not restore the anterior-superior femoral head offset. This residual deformity can lead to femoroacetabular impingement and early joint degeneration. Therefore, immediate arthroscopic trimming was associated to in situ pinning (ISPAT). The primary goal is to assess the clinical and radiologic outcomes of patients treated with ISPAT. Secondarily, outcomes were compared with traditional in situ pinning (ISP) and modified Dunn's procedure (MDP).

Femoral neck fractures, pose significant risks of AVN and non-union. Recent studies suggest that adding capsulotomy to CRIF could reduce complications by alleviating intracapsular pressure and enhancing femoral head vascularity. This study aims to assess the efficacy of capsulotomy combined with CRIF in reducing the incidence of AVN and non-union in Garden III femoral neck fractures compared to CRIF alone.

To report the association between os acetabuli and relevant radiologic measurements in a series of surgically treated hip preservation patients.

Present recommendations in the literature advocate for a return to sport (RTS) between 5- and 10 months following hip arthroscopy for femoroacetabular impingement (FAI). We have adopted the International Society of Hip Preservation protocol with modifications for the rehabilitation of our patients. The aim of the present study was to examine the time to RTS with this rehabilitation approach after hip arthroscopy for FAI. It was hypothesized that most athletes will RTS by 5 months post-surgery without any adverse effects. Patients undergoing hip arthroscopy for FAI were prospectively followed with preoperative and postoperative Patient Reported Outcome Measures including: Modified Harris Hip Score (mHHS) and Copenhagen Hip and Groin Outcome Score (HAGOS). Preinjury sports and competition level, postoperative RTS rate, time, and level, complications, and revision surgeries were recorded. A total of 56 patients were identified for inclusion (36.6 ± 14.1 years old at date of surgery, 34 females and 22 males). There were 35 recreational athletes and 21 competitive-level athletes (10 in high-demand sports and 11 in moderate-demand sports). In all, 44 patients (79%) returned to sport at 5.3 ± 3.5 months postoperatively. Of the 12 patients who did not RTS, 5 (42%) did not return for reasons other than their hip. Neither HAGOS (

The Journal of Hip Preservation Surgery (JHPS) is not the only place where work in the field of hip preservation can be published. Although our aim is to offer the best of the best, we are continually fascinated by work, which finds its way into journals other than our own. There is much to learn from it, and so JHPS has selected six recent and topical subjects for those who seek a summary of what is taking place in our ever-fascinating world of hip preservation. What you see here are the mildly edited abstracts of the original articles, to give them what JHPS hopes is a more readable feel. If you are pushed for time, what follows should take you no more than 10 min to read. So here goes.

Osteochondral lesions of the femoral head in young patients are a rare but challenging clinical problem. Fresh osteochondral allograft (OCA) transplantation has been proposed as one potential treatment option that may improve function and delay hip arthroplasty. However, there is a paucity of published data. The purpose of this study was to assess allograft survivorship and patient-reported outcomes in patients undergoing OCA transplantation for osteochondral lesions of the femoral head.

Arthroscopic hip surgery for femoroacetabular impingement syndrome (FAIS) has high rates of return to sport; however, patient return to long-distance running is unclear.

Editorial commentary on hip preservation registries. No abstract available.

Hip preservation surgeons are increasingly using commercially available 3D motion analysis software to investigate areas of impingement and quantify femoral head coverage. Variations in functional pelvic tilt will affect the position of the acetabular rim and projected femoral head coverage, but currently the majority of available software standardizes sagittal rotation to the anterior pelvic plane (APP). The study hypothesis was that the APP does not correlate well with patient-specific pelvic position.

Cartilage lesions of the hip are frequently encountered in the setting of multiple concomitant hip pathologies. For patients with symptoms refractory to comprehensive nonoperative management, numerous surgical treatments are available. To date, the ideal management strategy for hip chondral defects remains controversial, with patients best suited by an individualized approach accounting for the lesion being treated as well as any potentially modifiable underlying factors such as femoroacetabular impingement or dysplasia. Studies on the treatment of hip chondral defects continue to be published at a seemingly exponential rate, highlighting the evolution of treatment strategies for these patients.

Pathology involving the acetabular fossa is often identified during hip arthroscopy, with many of the descriptive classification systems focusing on the ligamentum teres (LT). Recently, a novel grading system for ligamentous-fossa-foveolar complex (LFFC) lesions was introduced for open hip preservation surgery that included evaluation of the cotyloid fossa and perifoveal cartilage.

Hip preservation surgery with vascularized iliac bone flap transplantation is currently an important method for treating patients with early-stage femoral head necrosis and collapse. However, if hip preservation fails, total hip arthroplasty (THA) is the only treatment option. This study aimed to compare the clinical efficacy and complications of direct anterior (DAA) and posterior (PA) approaches for subsequent THA in patients with failed hip preservation.

Characterized by microcirculatory disorder and oxidative stress microenvironment, the repair of bone defect after hip preservation therapy (such as core decompression) for osteonecrosis of the femoral head (ONFH) remains a clinical challenge. Thus, an ideal bone scaffold for treating ONFH should not only promote bone and vessel formation but also alleviate hypoxia and oxidative stress.

To determine if the setting of administration (home vs clinic) results in significant differences in patient scores from questionnaires assessing hip and general physical function in a hip preservation patient population.

To determine the reliability of sagittal radiographic variables across multiple positions and radiographic views and to correlate measures obtained on anteroposterior (AP) radiographs to lateral pelvis imaging.

To explore a possible correlation between sitting versus standing hip pain and a primary diagnosis of femoroacetabular impingement syndrome (FAIS) versus hip dysplasia.

Association Research Circulation Osseous (ARCO) stage III is the last chance for joint preservation in patients with osteonecrosis of the femoral head (ONFH). As the femoral head has collapsed at this stage, existing hip-preserving surgical treatments show limited success. We aimed to introduce a new surgical technique called partial femoral head replacement for the treatment of ARCO III femoral head necrosis and to evaluate its safety and efficacy.

The Journal of Hip Preservation Surgery (JHPS) is not the only place where work in the field of hip preservation can be published. Although our aim is to offer the best of the best, we are continually fascinated by work, which finds its way into journals other than our own. There is much to learn from it, and so JHPS has selected six recent and topical subjects for those who seek a summary of what is taking place in our ever-fascinating world of hip preservation.

The alpha angle is a radiological measurement that has been proposed for the detection of cam morphology in patients suspected of femoroacetabular impingement syndrome (FAIS). After analysing published articles on FAIS, it is apparent that different types of circles are used in the measurement of alpha angles. To determine the interobserver and intraobserver reliability of alpha angle values measured using different types of circles on a 45° Dunn lateral radiograph in patients with symptomatic FAIS. The 45° Dunn lateral radiographs of the operated hips of patients who underwent hip preservation surgery in Dokuz Eylül University Hospital between 2014 and 2017 were evaluated retrospectively. Alpha angles were measured manually with transparent goniometers using three different circle types: thin full circle, thin-dashed circle, and thick full circle, and eye estimation without circle insertion. Measurements were made separately by an orthopaedist and a radiologist. A second measurement was made by the radiologist 1 month later for intraobserver reliability. Interobserver reliability for the thin full circle, thin-dashed circle, thick circle, and eye estimation (ICC = 0.645, 0.525, 0.494, and 0.588, respectively). Intraobserver reliability for the thin, thin-dashed, thick line, and eye estimation (ICC= 0.626, 0.681, 0.681, and 0.462 respectively). Interobserver difference of mean values of alpha angles for thin full, thin-dashed, thick full, and eye estimation were 2.7°, 0.9°, 1.1°, and 2.3°, respectively. Intraobserver differences between measurements were 1.5°, 0.9°, 0°, and 1.6°, respectively. Our study demonstrated that interobserver reliability is highest when measurements are made using a thin full circle.

Understanding the minimal clinically important difference (MCID) for a given procedure and its associated patient-reported outcome measures (PROMs) are critical for evaluating success in orthopedic surgery. The MCIDs for the International Hip Outcome Tool (iHOT-33) and Modified Harris Hip Score (mHHS) have been defined for open proximal hamstring repair (OPHR); however, the speed and reliability at which patients achieve these are unknown. A retrospective review of prospectively collected data from our institution's hip preservation registry was performed, examining pre-operative and 6-, 12-, and 24 months post-operative mHHS and iHOT-33 scores. The percentage of patients achieving MCID at each time point was determined, and factors associated with achieving MCID were assessed. A total of 37 patients were included in this analysis (

To systematically review the literature on delays in diagnosis or treatment of hip preservation patients.

Femoroacetabular impingement (FAI) can cause hip pain and osteoarthritis in patients. Importantly, 3-dimensional (3D) bone models in dynamic hip impingement simulations can enable a patient-specific diagnosis of FAI. The manual segmentation of bone models is time-consuming; therefore, automatic segmentation should be investigated.

To investigate whether the use of a three-dimensional (3D) printed model, compared to conventional imaging, resulted in better corrections of osseous deformities following femoral acetabular impingement syndrome (FAIS) hip arthroscopy by comparing radiographic outcomes.

The Journal of Hip Preservation Surgery (JHPS) is not the only place where work in the field of hip preservation can be published. Although our aim is to offer the best of the best, we are continually fascinated by work, that finds its way into journals other than our own. There is much to learn from it, and so JHPS has selected six recent and topical subjects for those who seek a summary of what is taking place in our ever-fascinating world of hip preservation. What you see here are the mildly edited abstracts of the original articles, to give them what JHPS hopes is a more readable feel. If you are pushed for time, what follows should take you no more than 10 min to read. So here goes ….

Correct quantification of femoral version (FV) is crucial for femoroacetabular impingement (FAI) patients for diagnosis and for surgical planning. However, different measurement methods for FV and different normal values are confusing. The study aimed to investigate differences in FV measurement methods and to review normal FV. This retrospective comparative study investigated a total of 84 hips for FV measurement: 48 hips (asymptomatic patients) and 36 hips (asymptomatic volunteers) without hip pain. The 48 patients underwent computed tomography (CT) for another reason (mean age 63 ± 11 years) and most (39 hips, 81%) were male patients. The 36 hips reported no hip pain at the time of magnetic resonance imaging (MRI) (mean age 27 ± 7 years, 20 female patients, 56%). FV was measured on CT or MRI included pelvis and knee) and with the Murphy method. Mean FV for 48 hips was 22° (range 5-34°), and for 36 hips, it was 24° (7-44°). No significant differences were found between the two groups. For 39 male patients with CT scans, the mean FV was 21° (6-34°) and was significantly (

Determining which patients with acetabular dysplasia will benefit most from periacetabular osteotomy (PAO) can be challenging. Intra-articular corticosteroid injection (CSI) is often used for therapeutic and diagnostic purposes in various hip pathologies. This study aims to assess the relationship between self-reported preoperative CSI pain relief and postoperative pain relief after PAO. The case log of a single hip-preservation surgeon was queried from 2013 onward for patients who underwent PAO with preoperative intra-articular CSI. Patients were asked, 'overall, what percent improved are your symptoms from 0-100%?' following preoperative CSI and again at each postoperative visit. A successful postoperative pain outcome was defined as pain relief ≥75% compared to preoperative symptoms at the approximate 6 month postoperative visit. A total of 76 hips met inclusion criteria. Average self-reported relief from preoperative intra-articular CSI was 70 ± 35%. Mean postoperative pain relief was 88 ± 18%. Analysis showed a positive but weak correlation between preoperative CSI response and postoperative relief (0.278,

The study aimed to evaluate the accuracy, comprehensiveness, and readability of responses generated by ChatGPT 4.0 to 30 common patient questions about the Bernese periacetabular osteotomy (PAO).

To compare the clinical efficacy of rotational osteotomy at the base of femoral neck and iliac bone flap transfer with ascending branch of lateral femoral circumflex artery(vascularized iliac bone flap transfer) in the treatment of ARCO III stage, CJFH-L type osteonecrosis of femoral head.

Safe surgical dislocation has revolutionised hip preservation surgery by allowing complete access to the proximal femur while minimising the risk of avascular necrosis. However, despite meticulous technique, intraoperative injury to the superior retinacular vessels (SRV), the primary blood supply to the femoral head, can still occur, potentially compromising outcomes.

Periacetabular osteotomy has evolved from a procedure limited to developmental dysplasia of the hip into a versatile joint-preserving surgery for a wide range of acetabular pathomorphologies. Large-scale studies have demonstrated its effectiveness in improving pain, function and quality of life, with long-term survival rates approaching 68% at 20 years, though modern refinements likely yield even better results. Apart from a precise technical execution, its success depends on patient selection: while patients over 40 years old were once considered contraindications, recent evidence shows that outcomes are more closely tied to the absence of preexisting arthritis than to age. Indications have expanded to acetabular retroversion and borderline dysplasia and advances in imaging and technique, such as limited soft-tissue dissection and refined pubic cuts, have improved safety and recovery. Furthermore, technical innovations like augmented reality promise to further enhance surgical precision in the future.

The aim of this study was to assess the reliability of Delta angle (DA) as a parameter of microinstability compared to established radiographic instability parameters. It was assessed whether the morphology of the Ligamentum teres (LT) was affected by DA, established instability parameters. Further, the correlation between clinical status and microinstability parameters was assessed.

Traditionally, hip arthroscopy has been performed with a perineal post, although risks associated with the use of a post include pudendal nerve injury, sexual dysfunction, and other soft tissue complications. Recently, some hip preservation specialists have switched to postless hip arthroscopy techniques to minimize these complications.

To evaluate the clinical efficacy of pedicled vascularized iliac bone graft transfer (PVIBGT) in treating osteonecrosis of the femoral head (ONFH) at Association Research Circulation Osseous (ARCO) stages II-IIIB, to assess postoperative revascularization using standardized dynamic contrast-enhanced magnetic resonance imaging (DCE-MRI) and CT perfusion imaging (CTP), and to identify independent predictors of surgical success through multivariate analysis.

The diagnostic accuracy of magnetic resonance imaging (MRI) and magnetic resonance arthrography (MRA) for detecting labral tears is well established in femoroacetabular impingement but remains unclear in dysplastic hips undergoing hip arthroscopy (HA) combined with periacetabular osteotomy (PAO).

In cases of large, irreparable gluteus medius (GM) tears, gluteus maximus tendon transfer has emerged as a viable treatment option. The purpose of this study is to evaluate the short- to mid-term outcomes of gluteus maximus transfer as a treatment for irreparable GM tears in the native hip.

Subjective interpretation of magnetic resonance imaging (MRI) findings in the setting of early hip osteoarthritis can be challenging with little agreement between surgeons. While arthroplasty is rarely indicated for patients with preserved joint space, it may be the preferred surgical option when advanced imaging reveals severe intra-articular pathology. The purpose of this study was to evaluate a semiquantitative MRI-based scoring system in patients undergoing surgery for hip pain without advanced radiographic joint space loss. Consecutive patients with hip pain refractory to conservative measures and without severe radiographic hip osteoarthritis [Tönnis grade 0-1, Joint Space Width (JSW)> 3 mm] who received primary total hip arthroplasty with a preoperative MRI were included. This cohort was propensity-matched by Tönnis grade and JSW, as well as age, gender, and BMI, to patients undergoing hip preservation surgery. Preoperative MRIs were evaluated according to the Scoring Hip Osteoarthritis with MRI (SHOMRI) grading system. SHOMRI scores were compared between the arthroplasty and hip preservation cohorts with threshold values calculated to evaluate associations with treatment pathways. Patients undergoing arthroplasty had significantly greater SHOMRI total scores as well as cartilage component scores. Threshold values for the cartilage component SHOMRI score were significantly associated with the designated surgical treatments between the two groups (

To perform a systematic review that identifies the percentage of arthroscopic hip surgery publications that obtain postoperative plain radiographs (and type, and when) and the accuracy of the osseous corrections performed. A systematic review was conducted utilizing PRISMA guidelines. Arthroscopic hip preservation surgery publications were included over a 20-year publication eligibility period. Synthetic reviews were excluded. Studies reporting accuracy of correction based on intra-operative fluoroscopic and/or dynamic arthroscopic examination alone, but without postoperative plain radiographs, were excluded. Publications were screened for the presence, type, and timing of postoperative radiographs and measurements performed quantifying femoral head-neck junction sphericity. Descriptive statistics and logistic and multivariate regression analyses were performed. Two-hundred fifty-six publications (29 381 hips; 14 692 female; mean age range 14.8-65.8 years). The most common surgical indication was labral tear (13 112 hips [44.7% of hips]). There was an inverse correlation between publication year and obtaining postoperative radiographs (

The femoral neck axis (FNA) is an important reference in femoral neck rotational osteotomy, which is a hip preservation procedure. The purpose of this study was to propose a method for determining the FNA with high accuracy and reliability and to evaluate the effect of FNA determination accuracy on the stress and strain distribution in the proximal femur. Femoral computed tomography data from 50 patients were reconstructed, and the FNA was fitted by the centroid iterative method. The fitting accuracy was evaluated in terms of the distance between the femoral head centre and the FNA. The reliability was assessed by intraclass correlation coefficient (ICC). Stress-strain distributions of the native femur model and rotational osteotomy models with accurate FNA and deviated FNA were simulated by finite element analysis and digital image correlation methods. The distance between the femoral head centre and the FNA was 1.24 ± 0.35 mm. The intra- and interobserver reliability was high, with ICC values of 0.960 and 0.924, respectively. The maximum von Mises stress was 25.76 MPa, 50.82 MPa, and 93.24 MPa for the native femur model, accurate FNA model, and deviated FNA model, respectively. The finite element strain distributions were linearly correlated with digital image correlation results. The centroid iterative method for FNA fitting has high accuracy and reliability. Accurate determination of the FNA reduces stress concentration in the proximal femur and decreases the risk of subsequent fracture and non-union of the osteotomy surface.

Hip preservation remains a significant surgical challenge in adolescent and young adult patient with unilateral developmental dysplasia of hip (DDH). We compared the clinical and radiographic results of modified Colonna capsular arthroplasty in unilateral DDH patients.

Patients electively undergo the treatment of symptomatic acetabular dysplasia by periacetabular osteotomy (PAO). Increasing evidence suggests that a patient's perception of success following orthopaedic surgery is influenced by their preoperative expectations. In response, the Hip Preservation Surgery Expectations Survey (HPSES) was developed to quantify improvement expected and received in domains of pain, function, and psychological well-being. This instrument has not yet been evaluated in a hip preservation sample postoperatively, consistent with a paucity in the literature regarding patient-derived goals. Therefore, the purpose of this study was to describe the fulfilment of expectations following PAO through the HPSES and collection of preoperative personal goals. Preoperatively and at 1-year, 80 participants undergoing PAO (mean age 27.5 ± 9.2 years, 98.8% female) completed the HPSES and/or personal goals surveys. A proportion was calculated as the amount of improvement received versus the amount of improvement expected. The average expectations proportional score was 0.97 with 51.6% achieving a proportional score ≥ 1.0. The average goals proportional score was 0.91 with 50.0% achieving a proportional score ≥ 1.0. Expectations and goals related to day-to-day function, social activity, routine exercise, and relieving stress and anxiety were met most often and correlated to improvement and satisfaction scores. Goals related to high-level physical activity and pregnancy were met less often. Higher preoperative expectations and less attainable goals were associated with lower fulfilment. The appraisal and management of appropriate and realistic goals hold considerable value in achieving patient-perceived satisfaction. PAO is successful in fulfilling expectations related to routine function, social activity, and psychological well-being.

The supraacetabular fossa (SAF) is a bony fossa in the acetabular roof's load-bearing region. Its role in acetabular development and hip morphology remains unclear, with potential implications for hip preservation procedures. We aimed to (i) determine the prevalence of SAF by age, (ii) measure its dimensions in patients with hip pain undergoing magnetic resonance (MR) arthrogram, and (iii) assess associations between SAF and acetabular or femoral morphologies. We performed a retrospective analysis of patients with hip pain who underwent MR arthrograms. SAF were classified as type 1 (unfilled) or type 2 (cartilage-filled), and its dimensions measured. Acetabular and femoral morphology were assessed on radiographs, and hips were categorized into 13 morphology groups. 697 hips from 615 patients were included. SAF was present in 10.9% (76/697) of hips, with affected patients being younger (24.3 ± 7.6 years) than those without SAF (31.8 ± 11.2 years,

While total hip arthroplasty (THA) is an effective treatment option when indicated, young, active individuals are not ideal candidates. Biologic hip preservation (BHP) using femoral head osteochondral and acetabulum labrum allograft transplantation provides a potential alternative. This study was designed to test the hypothesis that BHP would result in superior hip joint function compared to THA in a 'young adult' preclinical canine model. With Institutional Animal Care and Use Committee Approval, canine femoral heads and acetabular labrums were aseptically recovered for subsequent transplantation. Ten purpose-bred hounds were randomly assigned to undergo either BHP or THA (

The spectrum of hip pathology treated by hip preservation surgery ranges from femoroacetabular impingement to hip dysplasia. Borderline hip dysplasia (BHD) represents a challenging diagnosis where the surgical indication is not always clear. BHD is a complex pathology which presents challenges in surgical decision-making between hip arthroscopy and open surgery, specifically periacetabular osteotomy. Research has shown efficacy for both isolated hip arthroscopy and/or periacetabular osteotomy as a treatment option in the appropriately selected patients.