2025年3月 保髋进展 JCR Q1 区

To perform a systematic review of the accuracy of various physical examination tests for diagnosing prearthritic intra-articular hip pathology.

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

Hip arthroscopy is a technically demanding procedure that can require a substantial volume of irrigation fluid. Techniques should be explored to optimize fluid use while ensuring satisfactory surgical instrumentation and labral repair. In this technical note, we present a method for performing a dry arthroscopic labral repair. This technique can be used in the treatment of a variety of labral pathologies, including primary labral repair with knotless or hand-tied anchors, revision labral repair, and labral reconstruction, without the need for irrigation fluid. Additionally, we discuss supplemental techniques that can be used during other portions of the arthroscopic hip procedure to limit irrigation fluid use.

Hip arthroscopy is a valuable yet technically demanding procedure for the treatment of prearthritic hip pathologies. Proper technique is essential for successful hip joint entry. However, the learning curve to become proficient in hip arthroscopy is steep, and joint entry is arguably one of the most difficult aspects of the procedure. Improper technique poses risk of iatrogenic chondral and labral damage and may make the rest of the procedure technically more difficult. The purpose of this Technical Note is to describe a technique to facilitate safe and reproducible joint entry during hip arthroscopy.

The positive effect of the capsular closure in maintaining the integrity of the joint capsule has been demonstrated, but most capsular closure techniques are primarily for interportal capsulotomy, with few techniques described for longitudinal capsulotomy. In our clinical practice, the incomplete closure of the proximal capsule in longitudinal capsulotomy may result in weakness or nonunion of the proximal capsule. Thus, we propose a technique of anatomic repair of the joint capsule with the indirect head of the rectus femoris as proximal augmentation in cases of longitudinal capsulotomy. This technique could provide a plausible and feasible solution for complete capsular closure of the longitudinal capsulotomy, which could decrease the risk of weakness or nonunion of the proximal capsule.

As the prevalence of hip arthroscopy increases, hip capsular defects are increasingly recognized as a source of recurrent symptoms in the young athletic hip. The hip capsule is of substantial importance in providing joint stability and normal biomechanics. Several recent studies have demonstrated that capsular closure at the time of primary hip arthroscopy improves both short- and long-term patient-reported outcomes, revision rates, and conversion to arthroplasty. Similarly, capsular insufficiency has been shown to be a source of recurrent pain and microinstability. Arthroscopic hip capsular management in the setting of chronic defects can be technically challenging, and far medial defects along the iliopsoas bursa are historically difficult to successfully repair because of challenging access and common lack of a proximal cuff of tissue for repair. We present an effective method for arthroscopic management of far medial hip capsular defects that consistently allows for reproducible capsular repair even in the absence of proximal capsular tissue.

Examine the effects of hip-focused strengthening and task-specific movement training for a female who has undergone multiple surgical procedures yet continues to experience chronic, recurrent FAIS-related symptoms.

To examine the relationship of labral height measured on magnetic resonance imaging and resistance to axial distraction in patients with cam-type femoroacetabular impingement (FAI) syndrome.

Despite the increasing understanding of femoroacetabular impingement (FAI), the impact of specific patient characteristics, including inflammatory pathologies like axial spondyloarthritis (axSpA), on its pathophysiology and clinical outcomes following treatment remains inadequately defined. Therefore, the purpose of this scoping review was to evaluate the relationship between FAI and sacroiliac (SI) joint abnormalities and FAI and axSpA.

Developmental dysplasia of the hip (DDH) is a developmental disorder that has long-term chronic pain and limited hip joint mobility. The aim of the current study is to understand the specific chondrocyte composition involved in DDH development, identify effective biomarkers for DDH prediction, and elucidate the gene regulatory elements driving DDH progression.

To assess hip arthroscopy epidemiology in the United States from 2015 to 2023 and provide projections through 2030, as well as analyze rates of postoperative complications.

Femoroacetabular impingement (FAI) is a common determinant of hip pain in young adults and an established risk factor in the subsequent development of osteoarthritis (OA). The mechanism of hip OA secondary to FAI is unknown. Small-animal models are critical translational tools to understand mechanisms of disease and develop interventional therapies. Kamenaga and colleagues proposed a novel animal model to mimic cam-FAI; however, 3D morphology of the induced deformity has not been objectively investigated.

Score cutoffs of clinically important outcome values such as the minimal clinically important improvement (MCII), substantial clinical benefit (SCB), and Patient Acceptable Symptom State (PASS) are population and treatment specific. In patients with nonarthritic hip-related pain, numerous score cutoffs have been calculated for use after surgical treatment, but they have not been established for patients who pursue nonoperative care.

Male patients and female patients have a preponderance of different pathologies that can require hip arthroscopic intervention. Male patients tend to have larger alpha angles, more complex labral tears, and more acetabular chondral damage; female patients tend to have more psoas involvement and microinstability. Although individual patient pathology can differ from the norm, recognizing these differences can help with preoperative planning. Hip pathology in male patients and female patients deviates, but outcomes after appropriately planned hip arthroscopy are acceptable regardless of sex.

There are contrasting findings between randomized controlled trials and systematic reviews that investigate capsular closure during arthroscopic treatment of femoroacetabular impingement syndrome. Some surgeons advocate that capsular closure is beneficial, as it reduces risks of instability and degeneration, while others argue that capsular closure could lead to joint stiffness and/or fibrosis, in addition to increased surgical time. Although unrepaired periportal or interportal capsulotomies may (or may not) compromise outcomes, it is beneficial to close larger incisions and extensions of T-type capsulotomies, especially in patients with a high risk of instability (concomitant borderline dysplasia, hyperlaxity, young age, etc.). Most studies focused on the effect of capsular closure do not identify other intrinsic and extrinsic factors-factors that could influence outcomes. Intrinsic factors include patient age, sex, type of femoroacetabular impingement syndrome (cam, pincer, or mixed), Tönnis grade, and presence of concomitant hypermobility or dysplasia. Extrinsic factors include surgeon experience, surgical technique, adjuvant procedures (such as labral repair), and type of capsulotomy (periportal, interportal, T-type).

PURPOSE: To perform a systematic review of the accuracy of various physical examination tests for diagnosing prearthritic intra-articular hip pathology. METHODS: A systematic review was conducted according to the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines by searching PubMed, Embase, and the Cochrane Library to identify studies that measured sensitivity and/or specificity of various physical examination tests for diagnosing prearthritic intra-articular hip pathology such as a labral tear, femoroacetabular impingement (FAI), or microinstability of the hip joint. The search phrase used was CONCLUSIONS: This study found high variability in the sensitivity and specificity of physical examination tests for diagnosing prearthritic intra-articular hip disorders.

Concomitant correctable and uncorrectable pathologies can impact outcomes after any orthopaedic procedure. The relationship between hip joint disorders and spine-related disorders has been increasingly recognized and reported in the literature. A number of studies have reported poorer outcomes in patients undergoing hip arthroscopy for femoroacetabular impingement with associated symptomatic low back and sacroiliac dysfunction. A few studies, however, have noted that the magnitude of improvement after hip arthroscopy is similar between patients with and without spine pathology despite inferior outcomes associated with symptomatic spine disease. A couple of studies have contradicted these data and noted comparable outcomes after hip arthroscopy for isolated hip pain versus those with hip and spine pain. This is clearly a complex kinetic chain association, and the contradicting literature might be more about how we evaluate the data; set appropriate physician/patient expectations; perform a thorough workup, including diagnostic injections; and carefully navigate our way through this patient population rather than buying into a concrete conclusion one way or another. When faced with a patient population riddled with hip- and spine-related pathology, we are walking through a minefield of unpredictable patient-related outcomes. We need to use our evidence and experience-based map to avoid these mines of failure and safely march toward a successful outcome.

To evaluate patient-reported outcomes (PROs) and survivorship in obese patients undergoing hip arthroscopy for femoroacetabular impingement syndrome (FAIS) at 10-year follow-up.

Periacetabular osteotomy (PAO) treats developmental dysplasia of the hip (DDH) by reducing load on the hip and improving joint function. Untreated DDH affects lower extremity alignment and alters knee morphology, with valgus alignment more pronounced in hip osteoarthritis secondary to DDH. While PAO may influence knee mechanics, its association with subchondral bone density in the tibiofemoral joint remains unclear.

PURPOSE: To perform a systematic review of the accuracy of various physical examination tests for diagnosing prearthritic intra-articular hip pathology. METHODS: A systematic review was conducted according to the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines by searching PubMed, Embase, and the Cochrane Library to identify studies that measured sensitivity and/or specificity of various physical examination tests for diagnosing prearthritic intra-articular hip pathology such as a labral tear, femoroacetabular impingement (FAI), or microinstability of the hip joint. The search phrase used was CONCLUSIONS: This study found high variability in the sensitivity and specificity of physical examination tests for diagnosing prearthritic intra-articular hip disorders.

To compare minimum 2-year outcomes of periacetabular osteotomy (PAO) with concomitant hip arthroscopy (HA) versus isolated HA with capsular plication in patients with borderline hip dysplasia (BHD).

To evaluate clinical outcomes of hip arthroscopy for patients with global acetabular overcoverage, as defined by a lateral center-edge angle (LCEA) >40° with coxa profunda, acetabular protrusio, and/or a negative Tönnis angle.

Visualization during hip arthroscopy can be challenging, particularly owing to a bloody arthroscopic image. Tranexamic acid is not effective in improving arthroscopic visualization, but techniques such as using epinephrine-impregnated irrigation fluid, administering controlled hypotensive anesthesia, and safely establishing a second outflow portal and using radiofrequency to control capsular bleeding are effective.

Although previous literature has established the association between femoroacetabular impingement and progressive hip osteoarthritis, there exists a paucity of studies investigating the effects of global acetabular overcoverage on chondral wear and long-term outcomes.

(i) Investigate if lower-limb running biomechanics differ between women and men with femoroacetabular impingement syndrome, and (ii) explore whether sex-specific relationships between lower-limb running biomechanics and symptom severity and sport-related concerns exist.

Intraoperative hip capsule management is increasingly recognized as an important component of hip arthroscopy for the prevention of capsular-related instability. The periportal capsulotomy, relative to the interportal capsulotomy, has been proposed as a minimally invasive technique for decreasing postarthroscopy hip instability; however, the biomechanical effects of this technique are not well established.

This study aimed to compare the release of the iliopsoas tendon at two levels: proximally at the pelvic brim and distally near the lesser trochanter.

Reoperation is a major adverse event following surgical treatment but has yet to be used as a primary outcome measure in population studies to assess current treatments for developmental dysplasia of the hip (DDH). The purpose of the present study was to explore the risk factors associated with reoperations following procedures under anesthesia ("operations") for DDH in patients between the ages of 1 and 3.00 years, with the goal of deriving treatment recommendations.

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 advent of higher-quality imaging has brought increased attention to the understanding and implications of commonly observed hip morphology and pathology. Many patients and even physicians like to focus on the presence of an acetabular labral tear when one is present on magnetic resonance imaging, despite the limitations of magnetic resonance imaging in identifying labral tears. Furthermore, recent studies have shown normal variations of the acetabular labrum, as well as a high prevalence of labral tears in both symptomatic and asymptomatic individuals. For patients electing to undergo surgical treatment of a labral tear, addressing the underlying pathology is imperative. Ignoring the primary pathology (e.g., femoroacetabular impingement or hip dysplasia) risks the formation of a new labral tear after initial surgical management. This comprehensive approach ensures that the primary cause of the labral tear is treated, thereby reducing the likelihood of recurrence and improving patient outcomes. Although the labrum is highly innervated, making labral tears a direct cause of hip pain in affected patients, we should not be setting our focus on the labral tear itself. Focusing solely on the labral pathology may set up our patients for failure by overlooking the underlying anatomic issues that precipitate these tears. Addressing the root cause, such as correcting femoroacetabular impingement and/or hip dysplasia, is crucial for effective treatment. By correcting these anatomic factors, we can prevent future labral damage and provide more comprehensive and lasting relief for our patients. Ignoring the primary anatomic issues risks recurrent tears and ongoing pain, highlighting the need for a holistic approach to treatment.

To compare the outcomes of hip arthroscopy for femoroacetabular impingement syndrome (FAIS) preoperatively and at minimum 10-year follow-up using patient-reported outcome measures (PROMs).

The aim of this study was to assess the inter-rater reproducibility and inter-method comparability of hip alpha angle measurements on magnetic resonance imaging (MRI)/magnetic resonance arthrography (MRA) and plain radiographs in patients with femoroacetabular impingement syndrome (FAIS).

Hip arthroscopy is an effective procedure with rapidly improving techniques and implants. Routine labral and capsular repair are broadly agreed upon as standard of care in most cases, which is now supported by long-term outcome studies. A crucial component of patient postoperative success is physical therapy. While accelerated programs are appealing, biomechanical studies have consistently demonstrated decreased stability at time zero after hip arthroscopy, particularly labral repairs. Therefore, although we want to help our patients get back to their lives as soon as possible, it remains our responsibility to protect their hip in the early postoperative period. If, in ideal laboratory conditions, we cannot restore stability to an intact state, then we must presuppose that the suction seal improves as the capsule, and more importantly, the labrum, heals after surgical manipulation. This means we are not able to rely solely on the strength of our repair, and there is a distinct period where the repaired hip is particularly vulnerable. Most hip arthroscopy protocols use a protective period, ranging from 4 to 8 weeks, during which there is an emphasis on passive range of motion only, with a strict moratorium on "pushing beyond pain."

Recent research has shown that hip arthroscopy outcomes at 6 months correlate with long-term outcomes. In theory, a score below a certain "threshold" at 6 months might predict poor long-term outcomes and thus allow intervention to improve the future prognosis of recovery and success. Yet, the trajectory toward a positive-or less than positive-outcome is dependent on multiple factors, and evaluation of patient-reported outcome measures in the early postoperative period may not reliably predict the long-term result.

Compared with postless arthroscopy, hip arthroscopy using a perineal post (post-assisted traction) is associated with increased risk of complications in 1% to 30% of patients, including pudendal neuropraxia (sexual dysfunction, dyspareunia, perineal pain, and/or numbness) and perineal soft-tissue injuries (vulvar bruising, tears, or scrotal swelling). Although these groin-related complications are usually transient in nature, they are significant and should be prevented if at all possible. Because of the sensitive nature of groin-related injuries after surgery, these complications also can go unrecognized by surgeons, which may result in underappreciation of their true prevalence. In contrast, postless distraction can be performed safely and eliminate the risk of perineal-related complications associated with a perineal post. In addition, dynamic evaluation during cam resection is aided by postless techniques and allows for greater and unimpeded hip range of motion compared with motion restriction with the use of a post. Postless hip arthroscopy is an emerging standard for hip arthroscopy surgery, but there are select instances in cases of challenging access to the hip joint for which a post may still have utility. Indications for use of a post could be patients with high body mass index, men with decreased hamstring flexibility, and patients with lower Beighton scores and greater hip stiffness, because if access to the joint is challenging, a perineal post may allow for greater distraction. Of importance, if a perineal post is used, care should be taken toward limiting traction time, as prolonged traction has been shown to be a major risk factor associated with post-related groin complications. In addition, the Trendelenburg position decreases the contact force against the perineal post. Finally, converting from a post-assisted technique to a postless system has a short learning curve for surgeons.

To determine whether tranexamic acid (TXA) is safe to administer preoperatively in patients undergoing hip arthroscopy by comparing the venous thromboembolic rate and complication rate between patients who did and did not receive TXA preoperatively.

To evaluate the change in hip distractive stability after a capsulotomy, labral tear, and simultaneous repair of both the capsule and the labrum in a biomechanical model.

To identify whether 6-month outcomes after hip arthroscopy for femoroacetabular impingement syndrome (FAIS) correlate with outcomes at minimum 10-year follow-up.

To prospectively compare the short-term clinical outcomes of patients undergoing hip arthroscopy with versus without the use of a perineal post.