2025年08月 保髋进展 JCR Q2

BACKGROUND: Timely access for young patients who have hip dysplasia can be challenging due to health system resource limitations such as operating room access and hospital beds. This study evaluated the safety and effectiveness of same-day discharge (SDD) periacetabular osteotomy (PAO). METHODS: There were 59 consecutive patients (mean age 30 years; range, 17 to 50; 60% women) scheduled for SDD. There were 47 outpatients matched with 47 inpatients based on age and a body mass index (BMI). Outpatients had a mean age of 28 years (range, 17 to 46) and BMI of 25.6 (range, 18.9 to 37.1), compared to inpatients between 2015 and 2020 (mean age 28 years, range, 16 to 44; BMI 25.9, range, 19.4 to 34.7). All patients received general anesthesia with multimodal pain management. In the outpatient group, 46.8% had adjunct procedures, compared to 34.0% in the inpatient group. Outcomes included revisits to the emergency department, readmissions, and adverse events (using the modified Sink Dindo Classification). RESULTS: There were six outpatients (12.8%) who stayed in the hospital for more than 24 hours, with three planned and three having failed to be discharged the same day, averaging a length of stay of 10.1 hours (range, 5.7 to 23.8). The mean length of stay for inpatients was 3.03 days (range, 1.03 to 11.8). None of the unmatched patients had an SDD. Mean outpatient blood loss was 523 mL (range, 200 to 900), and surgery time was 111.9 minutes (range, 70.8 to 169.2), compared to 643 mL (range, 200 to 1,500) and 121.2 minutes (range, 75 to 259.8) for inpatients. There were two outpatients and three inpatients who returned to the emergency department within seven days. At 90 days, both groups had one readmission: a patient who had a wound dehiscence requiring irrigation and debridement and a patient who had an inferior epigastric bleed requiring embolization in outpatient and inpatient groups, respectively. CONCLUSIONS: Early experience with SDD PAOs shows comparable safety to i

BACKGROUND: Instability after total hip arthroplasty (THA) remains a challenging problem. Component revision or bearing exchange can be successful; however, constraints may be necessary. This study evaluated the results of revision THA for instability that required constrained liners (CLs) to determine whether revising or retaining the acetabular component is preferred. METHODS: This single-surgeon retrospective study included 50 consecutive patients who required a CL during acetabular revision for instability. Indications for constraint included the absence of functioning abductors and failed previous CL or dual mobility liner. A CL was used in existing cups if the cup position was deemed acceptable with a reasonable impingement-free arc of motion. If unacceptable, it was revised, or, if the internal diameter allowed, a CL was cemented into the existing cup in a "face changing" position to minimize impingement. All patients had a minimum 2-year follow-up. Recurrent instability occurred in 15 of 50 patients overall (30%). Results were analyzed, and patients were separated into the following two groups based on whether the cup/liner position was changed: group 1, cup revision or cemented CL with "face change" (FC) (n = 28), and group 2, CL implanted into existing cup without FC (n = 22). RESULTS: Group 1 had recurrent instability in four of 28 cases (14%), whereas group 2 had instability in 11 of 22 (50%) cases (P = 0.012). Cemented liners with FC failed in four of 16 cases. Cup revision had the lowest rate of recurrent instability (zero of 12) versus 15 of 38 (39%) when the cup was retained (P = 0.01). CONCLUSIONS: This study demonstrated significantly lower rates of recurrent instability when CLs can be positioned to minimize impingement, either by revising the cup or cementing the liner independent of the existing cup: a so-called "FC." Cup revision demonstrated the lowest rate of recurrent instability with predictable osteointegration at the mean 4-year follow-up

BACKGROUND: It remains unclear as to whether the clinical outcomes of periacetabular osteotomy (PAO) are influenced by the location and severity of preoperative labral injuries. This study aimed to examine the relationship between labral tear severity and clinical outcomes in patients undergoing PAO, with a focus on patient-reported outcomes and magnetic resonance imaging (MRI) assessments. METHODS: This retrospective study included 40 patients (46 hips) who had undergone PAO for developmental dysplasia of the hip between 2015 and 2022. Patients were selected based on the availability of preoperative and postoperative clinical scores and MRI data. Clinical outcomes were measured using the Harris Hip Score, the Japanese Orthopaedic Association Hip Disease Evaluation Questionnaire, and the Hip disability and Osteoarthritis Outcome Score (HOOS). Magnetic resonance imaging was used to assess labral damage, which was graded from normal to severe. RESULTS: Postoperative improvements in radiographic parameters and clinical scores were observed. Labral injuries were common, particularly in the anterior region. The presence of complicated labral injuries in the anterior region was associated with greater improvement in the Japanese Orthopaedic Association Hip Disease Evaluation Questionnaire and Hip disability and Osteoarthritis Outcome scores. In contrast, complicated labral injuries in the superior region were associated with less improvement. CONCLUSIONS: This study highlights the important effect of complicated labral injuries in the superior region on short-term clinical outcomes following PAO in patients who have dysplasia of the hip. Although PAO effectively improves acetabular coverage and alleviates symptoms, severe superior labral damage may necessitate additional intra-articular procedures such as labral suturing to optimize patient outcomes.

Reduced hip muscle strength is a common feature of individuals with femoroacetabular impingement (FAI) syndrome. However, there is limited information on the influence of pain during strength assessment. Strength deficits are evaluated by measuring the peak torque at a pre-determined or optimal angle for force production. This method disregards most of the strength waveform data, which are relevant given the dynamic nature of FAI syndrome. 148 individuals with FAI syndrome and 148 matched pain-free controls underwent isokinetic evaluation of hip abductor, adductor, external and internal rotator strength. The second waveform from three maximal efforts was analysed. Between-group comparisons were carried out with Statistical Parametric Mapping (SPM) independent sample t-tests. The FAI syndrome group was divided between individuals who reported and who did not report pain during isokinetic testing and these subgroups were compared with the pain-free controls. Results showed that individuals with FAI syndrome present deficits in hip abductor, adductor, and internal rotator torque across the entire isokinetic range of motion compared to pain-free controls. External rotator torque was impaired from 1 to 77% of the isokinetic range of motion, with no between group difference at the end-range. Pain during the isokinetic testing seems to influence range-specific and the magnitude of deficits in hip muscle torque. These findings indicate that hip muscle strength deficits in FAI syndrome affect the full isokinetic range of motion in most hip muscle groups. Assessing only peak torque underestimates the extent of these deficits, highlighting the importance of considering strength waveform data in this population.