2025年1月 保髋进展 JCR Q4 区

To explore the application effect of grid locator in hip arthroscopy for the treatment of femoral acetabular impingement (FAI).

Developmental dysplasia of the hip (DDH) is a complex static-dynamic condition resulting in chronic joint instability and osteoarthritis. Borderline acetabular dysplasia refers to slightly abnormal patterns in the acetabular shape and coverage that are not within the dysplastic range. However, they can predispose to mechanical dysfunction and hip instability. Diagnosis and treatment remain controversial topics in hip preservation, with little current comparative literature to guide accurate diagnosis and treatment decision-making. Historically, the diagnosis of borderline DDH relied on assessments of the acetabular anatomy on anteroposterior pelvic radiography, most commonly the lateral central-edge angle (LCEA), with normal values ranging from 20 to 25° or, in some more recent studies, 18 to 25°. Surgical treatment decision-making debates the use of isolated hip arthroscopy or periacetabular osteotomy, considering the difficulty in determining a fundamental mechanical diagnosis (instability versus femoroacetabular impingement) in subjects with borderline DDH. Therefore, for effective surgical decision-making, the evaluation of additional bone anatomy characteristics, instability, and patients' features is essential.

Objective: To explore the application effects of the proximal anterior-distal anterolateral accessory (PA-DALA) in hip arthroscopy for treating common hip diseases. Methods: A retrospective analysis was conducted on the clinical data of patients who underwent hip arthroscopic surgery at the Chinese People's Liberation Army General Hospital from January 2018 to December 2023. The diseases included femoral acetabular impingement syndrome (FAI), ankylosing spondylitis (AS), synovial chondromatosis (SC), and pigmented villonodular synovitis (PVNS). Based on the different surgical approaches, the patients were divided into two groups: the control group underwent the conventional distal anterolateral approach (DALA) commonly used in hip arthroscopy, while the observation group received the PA-DALA approach. Results: A total of 102 patients with effective follow-up are included in the study. The observation group demonstrated a greater advantage in alleviating postoperative pain. The anchor placement success rate was 100% in the observation group vs 91.18% in the control group (P=0.049). Conclusions: The PA-DALA approach can fulfill the requirements for establishing surgical approaches in hip arthroscopy for common hip diseases. Compared with the conventional DALA approach, the PA-DALA approach enhances the safety and success rate of anchor placement.

Osteochondritis dissecans (OCD) of the femoral head accounts for approximately 2% of all OCD cases. Most of the OCD lesions affecting the femoral head are secondary to pathologies concerning the femoral component of the hip joint, such as Legg-Calvé-Perthes (LCP) disease. Although there are reports of OCD secondary to hip dysplasia, to our knowledge, there is no report of bilateral OCD lesions being treated successfully with bilateral triple pelvic osteotomies (PAO) in a pediatric patient.

Osteonecrosis of the femoral head (ONFH) is a chronic, debilitating affliction of the hip, with a high incidence in the employable population, thus posing a significant social and economic burden. To date, total hip arthroplasty (THA) remains the only successful treatment for the late stages of ONFH. Various joint-preserving surgical options have been described for early ONFH, with varying success rates. The study aimed to analyze the functional and radiological outcomes of core decompression (CD) combined with bone marrow aspirate concentrate (BMAC) injection for early ONFH.

peritrochanteric syndrome, also known as greater trochanteric pain syndrome, affects 10-25% of the population, resulting in pain and functional impairment in the lateral hip region. This condition is often associated with significant long-term disabilities.

Osteonecrosis of the femoral head (ONFH) is a challenging orthopedic condition that often leads to progressive joint destruction and disability. This study aims to simplfy the surgical tehniques and idealize the position of bone grafting for the repair of ONFH, and its preliminary clinical results were reported.​ METHODS: Anatomical studies were first conducted on four fresh frozen cadaveric specimens (8 hips). Arterial perfusion was performed to precisely investigate the medial femoral circumferential vessels supplying to the posterior greater intertrochanter. Based on the anatomical findings, vascularised posterior inter-trochanteric bone graft and the corresponding surgical instruments were meticulously designed to ensure accurate creation of the decompression tunnel and precise fitting of the bone graft​From August 2018 to August 2021, a total of 20 patients (24 hips) underwent the medial femoral circumferential vascularized posterior intertrochanteric bone grafting procedure at our institution. Clinical data, imaging findings, ARCO staging, and Harris hip scores were systematically collected. Intraoperative parameters, including operative time and blood loss, were also recorded. Postoperatively, patients were followed up for at least two years. Hip preservation failure was defined as a decrease in the Harris score, radiographic progression of ONFH, or the necessity for THA.​ RESULTS: The cadaveric study revealed that the deep branch of the medial femoral circumflex artery (MFCA) consistently gave rise to 2-3 branches supplying the posterior intertrochanteric bone. The first branch originated from the superior margin of the quadratus femoris attachment, and the remaining two branches were located beneath the quadratus femoris. The branches supplying the posterior intertrochanteric bone are carefully dissected and preserved, a 4-5cm long, 1.5-16 cm thick and deep bone graft is cut, which is used to improve the vascularization and mechanical stability within the osteonecrosis.​There are 20 patients (24 hips) prospectively enrolled, including 15 male patients (19 hips). The average postoperative followup duration was 24.2 ± 5.6 months. Four patients had to undergo THA due to disease progression, while the remaining 20 hips continued to be monitored. The final mean postoperative Harris hip score (HHS) was 75.1 ± 13.7. Among the 24 hips, 20 did not require THA, resulting in a hip preservation rate of 83%. Based on comprehensive evaluations of clinical function, symptoms, and radiographic findings, 71% of the hips were considered to have achieved successful hip preservation.​ CONCLUSIONS: The modified vascularized posterior intertrochanteric bone grafting is a simple yet effective hip - preserving surgical technique. It enables precise placement of the vascularized bone graft directly under the subchondral bone, and the good blood supply of the graft significantly promotes bone repair. This technique provides a simple，reliable and ideal graft position to repair the ONFH, the clinical outcomes seem to be related to the degree of femoral head collapse, with less favorable results associated with more severe collapse, its long term efficacy needs studied further.

Background and Objectives: Artificial intelligence-driven large language models such as ChatGPT increasingly influence patient education in surgical fields. This study evaluates the quality and accuracy of ChatGPT-3.5-generated responses to patient questions regarding femoroacetabular impingement syndrome (FAIS) and hip arthroscopy (HAS). Materials and Methods: In this descriptive observational study, ChatGPT-3.5 generated and answered 20 representative patient questions about FAIS and HAS. Each response was independently evaluated by two fellowship-trained orthopedic surgeons across four domains: relevance, accuracy, clarity, and completeness, using a five-point Likert scale. Results: Mean ratings across all domains ranged from 4.85 ± 0.24 to 5.00 ± 0.00. Relevance achieved a perfect mean score of 5.00, while accuracy and clarity each obtained 4.98 ± 0.11. Completeness demonstrated the lowest scores (4.85 ± 0.24). No factually incorrect or unsafe information was identified. Conclusions: ChatGPT-3.5 demonstrates significant potential as a supplementary patient education tool in hip preservation surgery. While its responses were consistently accurate and easy to understand, their occasional lack of detail indicates that further validation is required before generalizing these results to real-world patient interactions.

To determine the clinical outcomes of hip arthroscopy for anterior inferior iliac spine subspine impingement (SSI).