2025年07月 保髋进展 JCR Q1

PURPOSE: To evaluate the labrum status and paralabral cysts on preoperative and postoperative magnetic resonance imaging (MRI) in patients with developmental dysplasia of the hip (DDH) who underwent periacetabular osteotomy (PAO). METHODS: A retrospective review was conducted using prospectively collected data from patients who had undergone primary PAO between June 1, 2021, and May 30, 2022. Inclusion criteria were an age range of 16 to 55 years and a minimum follow-up of 2 years. MRI was used to evaluate the preoperative and postoperative conditions of the labrum and the presence of paralabral cysts. Furthermore, the correlations between the presence of paralabral cysts and demographic and radiographic variables were investigated. Additionally, patient-reported outcomes (PROs), minimal clinically important difference, and complications were reported during the final follow-up evaluation. RESULTS: A total of 23 patients were included in the final analysis, with an average follow-up of 26.6 ± 3.4 months (range, 24-32 months). All patients diagnosed with symptomatic DDH exhibited labrum tears. MRI scans revealed paralabral cysts in 10 of 24 (41.6%) patients, with a significant correlation noted between the presence of cysts and preoperative lateral center-edge angle (ρ = -0.649; P = .001), anterior center-edge angle (ρ = -0.637; P = .001), Tönnis angle (ρ = 0.593; P = .002) and age (ρ = -0.444; P = .034). Postoperative MRI scans at 1 year showed resolution of all paralabral cysts, while labral tears were found to persist. At the end of the follow-up period, most patients improved considerably in PROs compared with preoperative values. The probabilities of achieving the minimal clinically important difference were 91.3% on the Hip Outcome Score-Activities of Daily Living, 78.2% on the Hip Outcome Score-Sports Subscale, 91.3% on the modified Harris Hip Score, 73.9% on the International Hip Outcome Tool 12-component form, and 69.6% on the visual analog scale pain scale.

PURPOSE: 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. METHODS: All patients aged 45 years and older who underwent staged arthroscopy and PAO between 2015 and 2021 were retrospectively analyzed and compared with a case-matched control group of younger patients. All patients underwent at least 6 months of nonoperative management prior to surgery. Prior to PAO, all patients underwent hip arthroscopy to address any intra-articular pathology. The experimental group consisted of patients with dysplasia aged 45 years and older without significant osteoarthritis who underwent PAO and reported patient-reported outcomes for a minimum of 1 year postoperatively. Patient-reported outcomes were quantified using the International Hip Outcome Tool 12 (iHOT-12) score and Non-arthritic Hip Score (NAHS). RESULTS: The cohort consisted of 35 patients (44 hips) with a mean age of 49.4 ± 3.8 years. The lateral center-edge angle significantly improved from preoperatively (20.1° ± 4.5°) to postoperatively (33.2° ± 3.2°, P < .001). The mean follow-up period in the PAO cohort aged 45 years and older was 2.80 years (standard deviation, 1.3 years) postoperatively. Patients reported significant improvements in the iHOT-12 score (36.6 ± 14.1 preoperatively vs 81.2 ± 21.0 at latest follow-up, P < .001) and NAHS (59.2 ± 15.5 preoperatively vs 87.4 ± 13.1 at latest follow-up, P < .001). The older cohort did not report significantly different iHOT-12 scores compared with the control group at any point, and age did not significantly affect either outcome score (P > .05). CONCLUSIONS: Patients aged 45 years and older reported a statistically significant improvement in hip function and pain after staged hip arthroscopy and PAO, with outcome scores comparable to a younger cohort. Our findings show that appropriately selected older patients with dysplasia without significant pre-existing h

PURPOSE: To report minimum 2-year follow-up patient-reported outcomes (PROs), clinical benefit, and survivorship in patients who underwent concomitant hip arthroscopy and periacetabular osteotomy (PAO) for the surgical treatment of the developmental dysplasia of the hip (DDH). METHODS: Prospectively collected data were retrospectively reviewed for patients who underwent hip arthroscopy with concomitant PAO between December 2015 and September 2022. Patients with baseline and minimum 2-year PROs were included. Exclusion criteria included those who underwent an isolated PAO or had a history of ipsilateral prior surgery. The PROs collected were Hip Outcome Score-Activities of Daily Living (HOS-ADL) and Hip Outcome Score-Sport-Specific Subscale (HOS-SSS). The minimal clinically important difference (MCID) was reported. Survivorship was defined as nonconversion to total hip arthroplasty (THA). RESULTS: Thirty patients were included (29 females and 1 male). The average age at the time of surgery was 27.48 ± 8.57 years, and the average body mass index was 23.97 ± 4.05. Further, 86.67%, 73.33%, and 100% underwent labral treatment, femoroplasty, and capsular closure, respectively. The preoperative lateral center-edge angle increased from 17.07° ± 4.40 to 33.24° ± 3.40 postoperatively (P < .001). At a minimum of 2-year follow-up, all PROs significantly improved from baseline (P < .001): HOS-ADL improved from 62.68 ± 16.18 to 91.66 ± 15.13, HOS-SSS from 38.96 ± 21.39 to 86.82 ± 19.56. Moreover, 90% and 93.33% achieved MCID for the HOS-ADL and HOS-SSS, respectively. No conversions to THA were reported. CONCLUSIONS: At a minimum 2-year follow-up, the surgical management of DDH with PAO and concomitant hip arthroscopy demonstrated significant improvement in all PROs collected, with a high achievement rate for the MCID, and survivorship of 100%. These results suggest that, at short-term follow-up, this surgical approach seems to be safe and effective. LEVEL OF EVIDENCE: Level IV, r

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.

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.

PURPOSE: To report preoperative and intraoperative variables as well as patient-reported outcome measures (PROMs) of patients receiving either isolated periacetabular osteotomy (PAO) or combined hip arthroscopy with PAO (PAOHS) for the surgical management of acetabular dysplasia. METHODS: A review of the literature according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses was conducted to identify studies published between January 2014 and March 2025 that reported PROMs for combined arthroscopic hip surgery with PAO (PAOHS) or isolated PAO. Patient demographics, radiographic variables, surgical data, as well as postoperative PROMs and complications were recorded. Forest plots were used to identify heterogeneity using the I RESULTS: In total, 29 studies (13 PAOHS; 18 PAO) with 3,809 patients were included in the review. Rates of intra-articular pathology for the PAOHS studies ranged from 68% to 100%. Level of evidence ranged from I-IV. The most common PROMs used by both the PAO and PAOHS studies were the modified Harris Hip Score (53% vs 70%) and the International Hip Outcome Tool-12 (26% vs 40%), whereas other outcome scores were used more infrequently between the 2 groups. Postoperative PROM improvement was significant for all studies with significant heterogeneity for the modified Harris Hip Score (I CONCLUSIONS: Although there was sustained PROM improvement for both the PAO and PAOHS, there was significant heterogeneity and little comparability between the 2 groups of studies, limiting potential conclusions regarding the efficacy of intra-articular intervention despite high levels of intra-articular pathology identified in the PAOHS studies. LEVEL OF EVIDENCE: Level IV, systematic review of Level I to IV studies.