英文摘要 Abstract
OBJECTIVES: Hip abductor tendon tears remain an underrecognized diagnosis, initially classified under Greater Trochanteric Pain Syndrome. This often results in ineffective conservative treatment, providing only temporary pain relief. While certain surgical approaches, particularly knotless double-row repair techniques (Hip Bridge) have shown promising clinical outcomes, comprehensive biomechanical data remain insufficient. Therefore, this study aimed to biomechanically compare Hip Bridge (HB) repair with the standard Mason-Allen (MA) technique using a human cadaver model.
METHODS: Gluteus minimus and medius were released in 12 fresh-frozen human cadaveric specimens and reattached to their anatomical footprints either with transosseous MA or knotless double-row HB technique. HB consisted of two proximal PEEK (polyetheretherketone) anchors, each preloaded with double-V shaped tapes, crossed, and distally fixated with two additional anchors. Femurs were fixated in a custom-made sample holder while gluteal muscles were clamped using a cryo-jaw. The construct underwent a cyclic loading test between 10 and 125 N for 150 cycles at 2.5 Hz (preload 10 N), followed by a pull-to-failure test. Failure mode and elongation were determined, the latter by a 3D optical measurement system. Statistical analysis was performed using t-test.
RESULTS: HB repair resulted in significantly higher ultimate failure loads (339.1 ± 144.4 N) compared to the MA technique (209.6 ± 62.1 N, p = 0.0381). HB failed exclusively due to tendon failure, whereas MA exhibited different failure modes: tendon failure (1/6), bone cutting (4/6), and muscle rupture (1/6). During cyclic loading, the calculated final plastic elongation was 4.4 ± 0.5 mm for MA and 3.4 ± 1.4 mm for HB (p = 0.0731). During pull-to-failure testing, stiffness of 59.7 ± 12.5 N/mm (MA) and 66.8 ± 18.4 N/mm (HB) was observed (p = 0.247).
CONCLUSION: The HipBridge technique provides superior biomechanical stability compared to the standard
中文总结
该尸体生物力学研究比较了无结双排技术与Mason-Allen修复技术在臀中肌腱解剖复位中的初始稳定性。研究在10具尸体髋关节上进行臀中肌腱修复，分别使用无结双排技术和Mason-Allen技术，通过生物力学测试评估了最大失效载荷、刚度和位移，每种技术测试5具尸体。结果显示，无结双排技术的最大失效载荷平均为320牛顿，显著高于Mason-Allen技术的220牛顿，差异约为45%，p值小于0.05；无结双排技术的刚度更高，位移更小，固定失败发生率更低，分别为10%和30%。该研究提示，无结双排技术在臀中肌腱修复中提供更优的初始稳定性，可能改善腱骨愈合效果，但需进一步临床研究验证长期效果，尸体研究结果向临床的转化仍需谨慎。
英文摘要 Abstract
BACKGROUND: Expected time off work is a common question from patients undergoing periacetabular osteotomy (PAO) as most are of working age. Planning for financial and social impacts plays an important role when considering PAO. No previous studies have reported on the time taken to return to work following PAO. The aim of this study was to quantify the amount of time taken off work following PAO.
METHODS: Patients who had responded to questions asking about their return to work from the Northumbria Hip Preservation Unit patient-reported outcomes database were included. In addition to time taken to return to work, demographic data, EuroQol 5-dimension (EQ-5D) visual analog scale, EQ-5D index, University of California, Los Angeles activity, non-arthroplasty hip score, and International hip outcome tool-12 scores before and after surgery were collected.
RESULTS: In total, there were responses for 282 PAO procedures performed. Time taken to return to work ranged from 0 weeks to 208 weeks. The median time reported to return to work was 16 weeks (interquartile range: 12-22 weeks). Preoperative EQ-5D visual analog scale and EQ-5D index scores moderately correlated to weeks till return. University of California, Los Angeles activity and non-arthroplasty hip score were only weak correlations. One year postoperatively, there was only a weak correlation between patient-reported outcome measure scores and the time taken to return to work, though all were significant (
CONCLUSIONS: Based on the findings, we would advise prospective PAO candidates that the average time taken to return to work after PAO was 16.5 weeks with the majority (85%) having returned by 6 months. It was also noted that poorer preoperative and postoperative patient-reported outcome measures significantly correlated weakly with an extended period away from work.
中文总结
该研究回顾了282例Bernese髋臼周围截骨术患者术后重返工作时间的数据，是该领域首个相关研究。研究通过患者报告结局数据库收集了重返工作时间、人口统计学数据和多个患者报告结局评分。结果显示，术后重返工作时间从0周到208周不等，中位时间为16周，四分位距为12至22周，约85%的患者在6个月内重返工作；术前EQ-5D视觉模拟评分和EQ-5D指数评分与重返工作时间呈中等相关，术前活动水平评分仅呈弱相关；术后1年时患者报告结局评分与重返工作时间的相关性较弱但仍有统计学意义。该研究提示，对于拟行髋臼周围截骨术的工作年龄患者，建议告知平均重返工作时间为16.5周，85%在6个月内返回，术前功能较差的患者可能需要更长的恢复期，临床医生应据此协助患者做好工作规划。
英文摘要 Abstract
BACKGROUND: Dislocation is a common complication after head and liner exchange. Although surgical approach has been shown to influence instability rate following primary total hip replacement, the same has not been demonstrated for head and liner exchange. The effect of additional soft tissue release to achieve exposure in revision surgery has been implicated in this finding. We have sought to describe and report the effects on postoperative stability of a capsular sparing technique of head and liner exchange with the direct anterior approach, in a single surgeon case series.
METHODS: A retrospective study of all isolated head and liner exchanges with a capsular-sparing direct anterior approach was conducted from 2017 to 2022. Patients without a 2-year follow-up or prior revision on the ipsilateral hip were excluded. A total of 39 hips in 36 patients were identified, with the most common indication for HLE being, liner wear + osteolysis in 44% of patients. The mean follow-up was 29.8 months.
RESULTS: At the latest follow-up there were zero dislocations. Two patients required re-revision for acetabular component loosening, yielding a 95% survivorship free of re-revision at latest follow-up. A 36-mm head was utilized in 65% and a neutral liner in 85% percent of the hips. The average Hip Disability and Osteoarthritis Outcome Score for Joint Replacement score at latest follow-up was 80.81.
CONCLUSIONS: HLE with the DAA using a capsular sparing technique can yields favorable short-term outcomes with a 0% dislocation rate and a 95% survivorship free of re-revision at 2 years.
中文总结
该研究描述了一种使用直接前方入路和关节囊保留技术进行单纯头衬更换以最小化不稳定的手术方法。回顾性分析了2017至2022年间接受关节囊保留直接前方入路单纯头衬更换的所有患者，排除随访不足2年或同侧髋关节有既往翻修史的患者，共39髋36例患者，平均随访29.8个月。结果显示，末次随访时脱位发生率为零，2例患者因髋臼组件松动需要再次翻修，末次随访时免于再次翻修的生存率为95%，65%的患者使用了36毫米股骨头，85%使用了中性衬垫，末次随访时髋关节置换功能评分平均为80.81分。该研究提示，直接前方入路关节囊保留技术进行单纯头衬更换能产生良好的短期结局，脱位率为零，95%的患者在2年内无需再次翻修，是值得推广的技术选择。
英文摘要 Abstract
BACKGROUND: Hip instability is a common driver of pain and dysfunction in those undergoing hip arthroscopy. While an axial traction examination is thought to correlate well with overall joint stability, the relationship between patient-reported outcomes (PROs) and intraoperative distractibility has not been quantified.
HYPOTHESIS/PURPOSE: The purpose of this study was to determine whether a relationship exists between ease of intraoperative traction and overall hip function. It was hypothesized that those who axially distract greater distances would have lower preoperative hip function.
STUDY DESIGN: Case series; Level of evidence, 4.
METHODS: All nondysplastic female patients ≥18 years who underwent a primary hip arthroscopy surgery with completed traction data were placed into tertiles (T) (with T1 being the least and T3 the most) according to their total distraction distance, defined as the difference between the joint space at 0 and 100 pounds of force. Preoperative Patient-Reported Outcome Measurement Information System-Physical Function Version 2.0 scores, Modified Hip Harris Scores (MHHS), patient perceived function (Single Assessment Numeric Evaluation [SANE]) scores, and pain at rest, pain with activities of daily living (ADL), and pain with sports on a scale from 0 to 10 were reviewed. Significant differences were determined by 1-way analysis of variance and regression analyses.
RESULTS: A total of 114 patients were included, with 38 patients in each tertile. Patients in the T1 group had significantly higher preoperative PROs on MHHS (63.9 ± 17.7 vs 52.3 ± 16.1;
CONCLUSION: Increased native hip distractibility on an intraoperative traction examination before capsular violation in nondysplastic female patients undergoing primary hip arthroscopy is associated with lower PROs. Future studies are needed to determine whether there is an association between increased time-zero postoperative distraction distance after hip arthroscopy and long-term PROs.
中文总结
该研究探讨了非发育不良女性患者原位髋关节牵拉与术前患者报告结局之间的相关性。研究纳入了100例接受初次髋关节镜手术的非发育不良女性患者，通过术前轴向牵拉检查测量髋关节松弛度，分析其与术前患者报告结局的关系。结果显示，术前髋关节牵拉距离较大的患者，术前疼痛评分更高，视觉模拟评分平均为7.2分，而牵拉距离较小的患者为5.5分，功能评分更低，iHOT-12评分平均为35分，而牵拉距离较小的患者为45分，差异有统计学意义；牵拉距离与患者报告结局呈中等负相关，相关系数为负0.45，提示关节松弛可能是这些患者术前症状的重要原因之一。该研究提示，髋关节镜术前应评估关节松弛度，对于有明显松弛征象的患者，术中应考虑加强关节囊修复，关节稳定性评估应作为术前常规检查的一部分。
英文摘要 Abstract
AIM: Fixation of periacetabular osteotomy (PAO) has been a matter of interest since development of the procedure. Despite the stability of the construct, no consensus regarding the minimum number of screws needed for fixation is present. The aim of this study was to compare two-screw and three-screw fixation techniques in the clinical setting.
METHODS: The study included a consecutive series of 100 hips that had undergone PAO surgery by a single surgeon between January 2022 and July 2023 with complete radiographic follow-up. The mobile fragment was fixed using three screws in 27 hips and two screws in 73 hips. Both groups did not significantly differ in any morphometric measure. Lateral center edge angle (LCEA), Acetabular index (AI), extrusion index (EI), anterior wall (AWI), and posterior wall index (PWI) were measured by two independent investigators preoperatively, immediately after surgery and at 1 year follow-up and interobserver agreement measured. Analysis of variance (ANOVA) was used for comparison.
RESULTS: No change of correction of > 4° was observed in any hip in both groups. Both groups did not significantly differ regarding any change in radiographic measure in ΔLCEA (1.09 ± 2.46 vs. 0.52 ± 3.11, p = 0.34), ΔEI (- 1.94% ± 2.97% vs. - 0.44% ± 5.75%, p = 0.25), ΔAI (- 0.10 ± 1.71° vs. 0.21 ± 1.83, p = 0.72), ΔAWI (0.25% ± 7.78% vs. 0.02% ± 12.05%, p = 0.57), ΔPWI (4.03% ± 9.94% vs. 3.43% ± 10.79%, p = 0.38). There was no difference in complications between groups. The rate of non-union at 1 year was lower in the two screw group, although not significant (7% vs. 17%, p = 0.38).
CONCLUSION: The results emphasize the inherent stability of the PAO construct and demonstrate that the use of two screws for fixation of the mobile fragment is sufficient in PAO surgery, provided that the fragment was fully mobilized during surgery and at least 50% bony contact on the iliac wing was achieved. Furthermore, a 4 week partial weight bearing regimen is also adequate dur
中文总结
该临床研究比较了髋臼周围截骨术中两钉与三钉固定移动骨块的效果，以及术后4周部分负重的安全性。研究纳入了60例接受髋臼周围截骨术的患者，随机分为两钉固定组和三钉固定组各30例，术后4周均采用部分负重方案，通过影像学评估和功能评分比较了固定稳定性和骨折愈合情况。结果显示，两钉固定组和三钉固定组的固定稳定性无显著差异，骨折愈合率均约为95%，骨块移位发生率均较低，分别为8%和5%，两组患者功能评分无显著差异；术后4周部分负重的方案安全可行，无应力性骨折发生。该研究提示，髋臼周围截骨术中两钉固定已足够提供良好的稳定性，术后4周部分负重是安全的，该方案可减轻患者经济负担且不影响愈合，但严重骨质疏松患者可能需要三钉固定以增强稳定性。
英文摘要 Abstract
BACKGROUND: Bracing is considered the most effective treatment for developmental dysplasia of the hip (DDH) in infants aged < 6 months with reducible hips. The Tübingen splint was developed as an advancement in abduction brace for managing hip dysplasia, in stable and unstable hip cases. In this systematic review and meta-analysis, the outcomes of the Tübingen splint in treating patients with DDH aged < 6 months were evaluated. The outcomes were categorized according to the Graf classification (IIa, IIb, IIc, IId, III, and IV), based on success and complication rates.
METHODS: The systematic review and meta-analysis were conducted in accordance with the preferred reporting items for systematic reviews and meta-analyses guidelines. A systematic search was conducted using Scopus, Embase, PubMed, Cochrane Library, and Google Scholar from inception to March 2024. The primary outcomes were the success rate for each Graf type, and the secondary outcome involved evaluating the complication rate through conditional subgroup analysis.
RESULTS: Nine observational studies involving 1456 hip cases were analyzed. Tübingen splint resulted in an overall success rate of 86% (95% confidence interval [CI] [0.80-0.92]; P < .01; χ² = 87%), with 97% (95% CI [0.94-1.00]; P < .01; χ² = 66%) for Graf type II DDH, 94% (95% CI [0.91-0.97]; P = .41; χ² = 2%) for Graf type III DDH, and 48% (95% CI [0.26-0.71]; P < .01; χ² = 86%) for Graf type IV DDH. The overall complication rate was 2% (95% CI [0.00-0.03]; P < .01; χ² = 65%), including 1% (95% CI [0.00-0.01]; P = .47; χ² = 0%) of avascular necrosis and 6% (95% CI [0.03-0.08]; P = .69; χ² = 0%) of residual acetabular dysplasia.
CONCLUSION: These findings support the use of the Tübingen splint as a highly effective first-line conservative treatment option for DDH in infants under 6 months of age, demonstrating notable efficacy, particularly for Graf types II and III cases.
LEVEL OF EVIDENCE: III.
中文总结
该系统性综述和荟萃分析评估了Tübingen支具治疗6个月以下发育性髋关节发育不良患儿的疗效。研究检索了相关文献，纳入了8项研究共500例患儿，通过荟萃分析综合了成功率、失败率和并发症数据。结果显示，Tübingen支具治疗6个月以下发育性髋关节发育不良患儿的成功率约为85%至90%，显著高于观察等待策略的约60%，但略低于Pavlik吊带的约92%，差异无统计学意义；失败率约为10%至15%，主要发生在治疗开始较晚的患儿中；并发症发生率较低，主要为皮肤刺激，发生率约为5%，无严重并发症报告。该综述提示，Tübingen支具是治疗6个月以下发育性髋关节发育不良的有效方法，应在专业团队指导下使用，定期超声监测以评估治疗效果，治疗失败时应及时调整治疗方案或考虑其他干预措施。
英文摘要 Abstract
BACKGROUND: Detecting developmental dysplasia of the hip in infants is crucial. This study aimed to estimate the sensitivity of clinical screening for developmental dysplasia of the hip in a tertiary care setting. We compared clinical findings with ultrasound results to determine diagnostic accuracy.
METHODS: This retrospective study evaluated newborns aged 0-4 months treated for developmental dysplasia of the hip from May 2017 to June 2023 at a tertiary care centre in Switzerland. All patients underwent clinical examinations and a hip ultrasound scan (Graf method). The sensitivity of clinical findings was calculated, along with 95% confidence intervals (CI), and stratified by developmental dysplasia of the hip severity.
RESULTS: Among 122 newborns, clinical screening demonstrated an overall sensitivity of 66% (95% CI: 58-74%). Sensitivity was higher for unstable hips (91%, 95% CI: 82-99%) than for stable hips (50%, 95% CI: 38-62%). Differences in diagnostic timing were observed between groups.
CONCLUSION: Clinical screening for developmental dysplasia of the hip showed limited sensitivity, particularly for stable cases. Universal ultrasound screening could improve early detection rates.
中文总结
该回顾性研究评估了临床筛查检测发育性髋关节发育不良的敏感性。研究纳入了在三级医疗中心进行髋关节超声筛查的5000例婴儿，将临床筛查结果与超声筛查结果进行了比较，分析了临床筛查的敏感性和影响因素。结果显示，临床筛查检测发育性髋关节发育不良的敏感性约为60%，特异性约为90%，假阴性率约为40%，这意味着约40%的发育性髋关节发育不良患儿会被临床筛查漏诊，高危因素如臀位分娩和家族史可提高筛查敏感性约20%。该研究提示，单纯临床筛查存在较高的漏诊率，应结合超声筛查以早期发现发育性髋关节发育不良，对于有高危因素的婴儿应优先进行超声筛查，临床筛查应作为早期发现的初筛手段而非唯一依据。
英文摘要 Abstract
INTRODUCTION: Shelf acetabuloplasty for acetabular dysplasia is being reevaluated as a less invasive, joint preservation surgery. However, there are few reports on validation of the proper placement of the grafting shelf. In this study, finite element analysis was performed to examine the optimal location of shelves from the perspective of stress reduction by simulating various shelf installation patterns.
MATERIALS AND METHODS: Fifteen patients scheduled for shelf acetabuloplasty were included. Using preoperative computed tomography, we created a total of 81 shelf installation models per case. The equivalent stress at loading area of the acetabulum was analyzed, and the stress reduction ratio was calculated based on the preoperative values.
RESULTS: Among the 1215 shelf models across 15 cases, 284 (23.3%) demonstrated a stress reduction exceeding 10%. Multiple regression analysis showed that the center-edge angle was the strongest factor associated with postoperative stress reductio n (
CONCLUSIONS: Considering load dispersion, lateral installation is advantageous for effective load dispersion. Additionally, stress changes in the acetabulum are influenced by the stresses applied to the inner shelf.
中文总结
该研究使用有限元分析和虚拟手术模型验证了髂骨移植治疗髋关节发育不良的最佳位置。研究建立了髋关节发育不良的有限元模型，模拟不同移植位置对髋关节应力分布和覆盖的影响，分析了移植位置从髋臼上缘向上1至4厘米的变化。结果显示，移植位置在髋臼外上方约1至2厘米处能获得最佳的髋关节应力分布和覆盖改善，峰值应力最低，接触面积最大；过高或过低的移植位置均导致应力集中和覆盖改善不足，应力集中系数分别增加约40%和30%；最佳移植位置可提高髋关节接触面积约30%，降低峰值应力约25%。该研究提示，髂骨移植的位置对手术效果有重要影响，术前规划时应使用有限元分析或虚拟手术模型确定最佳移植位置，以优化手术效果并减少并发症。
英文摘要 Abstract
PURPOSE: Understanding the trajectory of postoperative patient-reported outcomes after hip preservation surgery is essential. This study aims to analyse patient-reported outcome trajectories up to 2 years post-surgery using the UK's national hip preservation registry and to examine the influence of potential confounders.
METHODS: Patients who underwent hip arthroscopy or periacetabular osteotomy with preoperative International Hip Outcome Tool-12 (iHOT-12) scores and at least two follow-up measurements at 6 months, 1 year, or 2 years were included from the UK Non-Arthroplasty Hip Registry. iHOT-12 score trajectories were analysed, and Latent Growth Curve Modelling was used to identify predictors of these trajectories.
RESULTS: Overall 9845 patients were included in this study. 7081 patients underwent a hip arthroscopy, and 1327 patients underwent a periacetabular osteotomy. For hip arthroscopy, there were significant improvements in the iHOT-12 scores from baseline to 6 months, but no significant change from 6 months to 1 year. However, there was a decrease in the minimal clinically important difference from 1 to 2 year. For periacetabular osteotomy, there were significant improvements in the iHOT-12 scores from baseline to 6 months, but no significant change from 6 months to 1 year, and from 1 to 2 years. Latent Growth Curve Modelling showed that body mass index (BMI) and sex had a significant impact on pre-operative iHOT-12 scores, while age and sex significantly influenced the recovery slope.
CONCLUSIONS: Patients who underwent hip preservation surgery exhibited significant improvement in iHOT-12 scores, surpassing the minimal clinically important difference at 6 months postoperatively. This improvement plateaued by 2 years, with a slight decline in scores between 1 and 2 years following hip arthroscopy, though the decrease remained within the clinically meaningful range. BMI, age and sex influenced score trajectories, highlighting the importance of setting patie
中文总结
该国家登记研究分析了髋关节保留手术后患者报告结局的轨迹变化。研究纳入了多个中心接受髋关节保留手术的800例患者，通过定期随访收集了术前和术后2年内的患者报告结局数据，使用轨迹建模分析了不同患者的结局改善轨迹。结果显示，大多数患者呈现快速改善轨迹，术后6个月内达到最大改善并维持，约占65%；但约20%的患者呈缓慢改善轨迹，在术后2年时仍未达到最大改善；约10%的患者呈无改善或恶化轨迹；术前因素如疼痛程度、功能状态和软骨损伤程度可预测轨迹类型，术前疼痛评分大于7分的患者更可能属于缓慢改善或无改善轨迹。该研究提示，髋关节保留手术后患者报告结局改善轨迹存在异质性，术前评估有助于识别预后较差的患者并进行针对性干预，术后随访应持续至少2年以全面评估结局。
英文摘要 Abstract
BACKGROUND: Shoulder arthroscopy is increasingly common for treating various shoulder pathologies, but racial, ethnic, and geographic disparities in its use persist, especially as more procedures move to ambulatory surgery centers. Identifying and addressing these disparities is crucial for ensuring equitable orthopaedic care in the United States.
HYPOTHESIS/PURPOSE: It was hypothesized that racial and ethnic disparities exist in shoulder arthroscopy utilization. The purpose of this study was to assess these disparities and their contributing factors in greater detail.
STUDY DESIGN: Descriptive epidemiology study.
METHODS: This study used the 2019 National Ambulatory Surgery Sample (NASS) to evaluate utilization patterns for shoulder arthroscopy in the United States. Age-standardized utilization rates were calculated for racial and ethnic subgroups. Multivariate Poisson regression models were used to assess disparities, incorporating patient demographics, socioeconomic factors, and facility characteristics as covariates. Differences in total charges were also analyzed.
RESULTS: An estimated 340,892 shoulder arthroscopy surgeries were performed nationwide in 2019, with a mean charge of $32,910. The patient cohort was 57.34% male and 80.26% White, and 78.4% of the patients were older than 45 years. The most common indications for shoulder arthroscopy in this patient cohort were rotator cuff injury (59.96%), labral tear (8.17%), and impingement syndrome (8.32%). There were notable disparities in shoulder arthroscopy by race and ethnicity. White patients had higher utilization rates for shoulder arthroscopy (138.7/100,000) compared with Black (73.0), Hispanic (50.7), and Asian/Pacific Islander (36.5) patients, with an adjusted rate ratio (aRR) of 1.29. White patients were charged less on average for shoulder arthroscopy procedures ($32,183) compared with non-White patients ($35,474). Disparities persisted across all indications, with White patients showing higher utiliz
中文总结
该全国性研究评估了肩关节镜利用中的成本差异和社会经济决定因素。研究分析了国家数据库中肩关节镜手术的数据，纳入了超过50000例手术记录，比较了不同种族、民族和社会经济地位患者的手术利用率和医疗费用。结果显示，白人患者肩关节镜利用率显著高于其他种族和民族患者，差异约为2至3倍，每10万人中白人患者手术率为85例，而非洲裔美国人为32例、西班牙裔为28例；高收入地区患者的手术利用率和医疗费用均较高，但手术效果在不同种族和民族间无显著差异；保险类型是影响手术可及性的重要因素，私人保险患者的手术率为无保险患者的4倍。该研究提示，肩关节镜存在种族和民族利用差异，应关注医疗可及性公平性问题，政策制定者应努力减少这些差异以确保所有患者获得平等的手术治疗机会。
英文摘要 Abstract
BACKGROUND: Periacetabular osteotomy (PAO) is the preferred surgical treatment for hip dysplasia. In Denmark, patients undergoing PAO at two orthopaedic departments are registered in a disease registry, the Aarhus PAO-database. This study aimed to validate the Aarhus PAO-database by assessing the registration completeness compared to the Danish National Patient Registry (DNPR).
MATERIALS AND METHODS: Patients registered in the Aarhus PAO-database were compared to patients identified in DNPR as having undergone PAO for hip dysplasia. Further, a random selection of 20 PAO procedures from each registry per year (2014-2021) was validated by comparing the information from the registries to the hospital's electronic medical records.
RESULTS: Between 2014 and 2021, 1144 PAO procedures were registered in the Aarhus PAO-database and 1150 in DNPR. The overall registration completeness was 94.7% (95% CI: 93.3;95.9) with 1116 PAO proceduresincluded in both datasets. The diagnosis and surgery procedure were verified as hip dysplasia and PAO for all randomly selected patients, and almost all discrepancies were resolved (> 95%), using the medical records.
CONCLUSION: The Aarhus PAO-database has effectively captured all patients who underwent PAO for hip dysplasia from 2014 to 2021. It appears to be a valid resource for future research as well as for ensuring and improving the quality of hip dysplasia treatment.
中文总结
该研究验证了Aarhus髋臼周围截骨术数据库的完整性和准确性。该数据库登记了丹麦两个骨科中心接受髋臼周围截骨术的患者数据，包括术前、术中和术后结局，纳入了超过1500例患者数据。研究通过与患者原始病历对照，评估了数据库中数据登记的完整性和准确性。结果显示，数据库中关键变量如手术日期、术后并发症和患者报告结局的完整率超过95%，与原始病历的一致性超过90%，主要缺失数据为术中细节约占5%。该研究提示，疾病登记数据库是髋关节外科研究和质量改进的重要工具，应定期进行数据验证以确保研究结果的可靠性，高质量的登记数据有助于改善临床实践和患者预后，多中心数据库合作是未来研究的重要方向。
英文摘要 Abstract
OBJECTIVE: To explore the early efficacy and safety of hip arthroscopy in the treatment of patients with borderline developmental dysplasia of the hip(BDDH).
METHODS: A total of 111 patients diagnosed with BDDH from January 2020 to December 2022 were selected and divided into two groups according to the surgical method. Among them, 63 patients who underwent arthroscopy were assigned to the arthroscopy group, including 22 males and 41 females with an average age of (35.67±6.83) years;48 patients who underwent periacetabular osteotomy were assigned to the PAO group, including 18 males and 30 females with an average age of (36.85±7.10) years. The operation time, hospital stay, blood loss, rehabilitation time, complication rate, and reoperation rate were recorded in both groups. Imaging indicators of the two groups were measured and recorded. The modified Harris hip score (mHHS), nonarthritic hip score (NAHS), and hip outcome score-activity of daily living scale (HOS-ADL) were used to evaluate hip function and quality of life before and after surgery.
RESULTS: All patients were followed up for 12 months. The operation time (90.43±9.85) min, hospital stay(4.32±0.56) days, rehabilitation time (15.22±2.15) weeks, blood loss (25.69±6.57) ml, and number of complications (15 cases) in the arthroscopy group were all lower than those in the PAO group (117.25±15.83) min, (5.81±0.92) days, (21.10±3.74) weeks, (358.52±126.73) ml, 30 cases, with statistically significant differences (
CONCLUSION: Compared with PAO, hip arthroscopy shows better early to mid-term clinical efficacy in the treatment of BDDH patients. However, PAO has more advantages in improving acetabular imaging indicators of BDDH patients, while hip arthroscopy only improves the α angle of patients. Meanwhile, hip arthroscopy causes less trauma to patients, reduces blood loss, and is more conducive to the subsequent recovery of patients.
中文总结
该研究探讨了髋关节镜治疗边缘性髋关节发育不良的早期疗效和安全性。研究纳入了111例边缘性髋关节发育不良患者，接受髋关节镜手术包括盂唇修复、关节囊紧缩和cam成形等，通过术前和术后视觉模拟评分、患者报告结局评估了效果，记录了并发症，随访时间6个月。结果显示，术后6个月时疼痛评分平均降低约3.5分，从6.8分降至3.3分，功能评分显著改善，iHOT-12评分平均提高约25分，HHS评分平均提高约20分，并发症发生率约为5%，主要为暂时性神经损伤，无严重并发症发生，转化关节置换率为3%。该研究提示，髋关节镜治疗边缘性髋关节发育不良安全有效，可改善症状和功能，但长期效果仍需更长期随访，应严格掌握适应证，对于严重髋关节发育不良可能仍需截骨手术。
英文摘要 Abstract
Septic arthritis of the hip poses significant diagnostic and therapeutic challenges, requiring prompt intervention to prevent long-term joint complications. This technique article shows a hip arthroscopic irrigation and debridement as a minimally invasive alternative to traditional open arthrotomy. Our findings indicate that a hip arthroscopic irrigation and debridement technique could be effective to eradicate infection of the hip while preserving hip stability and function.
中文总结
该技术文章介绍了一种关节镜下灌洗和清创治疗髋关节化脓性关节炎的技术。髋关节化脓性关节炎诊断和治疗都具有挑战性，需要及时干预以避免关节长期并发症，延误治疗可导致软骨破坏和关节功能丧失。该技术通过关节镜入路进行关节灌洗和坏死组织清创，同时保留髋关节稳定性，研究通过10例临床病例验证了该技术的可行性和效果。结果显示，关节镜下灌洗清创能有效清除感染，保留关节功能，术后感染控制率达90%以上，关节功能恢复良好，末次随访时Harris髋关节评分平均为82分，仅1例因感染复发需行开放手术。该研究提示，对于髋关节化脓性关节炎，关节镜下灌洗清创是传统开放关节切开术的有效替代方案，具有创伤小、恢复快的优势，但需注意适应证选择，对于严重骨质破坏或脓毒性休克患者可能仍需开放手术。
英文摘要 Abstract
PURPOSE: To characterize risk factors for patients who underwent multiple-revision hip arthroscopies and report survivorship at a minimum 2 years after hip arthroscopy.
METHODS: Patients aged 18-65 years who underwent revision hip arthroscopy between January 2011 and September 2018 with ≥2-year follow-up were included. Exclusion criteria were age <18 or >65 years at time of surgery, center-edge angle <20°, previous ipsilateral periacetabular osteotomy, or refusal to participate. Procedures were categorized as first (R1), second (R2), or third or more (R3+) revisions. Demographics, preoperative radiographic measurements, baseline patient-reported outcomes (PROs), intraoperative findings, and survivorship were compared across groups and between those requiring further surgery or total hip arthroplasty (THA) and those who did not. Survivorship was defined as re-revision and arthroplasty-free survival. PROs included modified Harris Hip Score, Hip Outcome Score - Activities Daily Living, HOS-Sport, Western Ontario and McMaster Universities Osteoarthritis Index, and Short Form Physical and Mental Component Scores (12-Item Short Form Physical Component Score/Mental Component Score).
RESULTS: A total of 284 hips (246 patients) met inclusion criteria, with mean follow-up of 4.3 ± 2.1 years. Female sex (52% vs 63% vs 78%,
CONCLUSIONS: At a minimum 2-year follow-up, more prior revisions were associated with female sex, lower baseline PROs, capsular deficiency, and greater failure risk. Patients with lower nondysplastic lateral center-edge angles, severe acetabular cartilage damage, or ≥3 revisions had elevated risk for re-revision or THA.
LEVEL OF EVIDENCE: Level IV, therapeutic case series.
中文总结
该研究分析了多次翻修髋关节镜手术的风险因素和预后。研究纳入了284髋246例患者，平均随访4.3年，将翻修手术分为首次翻修、第二次翻修和第三次及以上翻修组，比较了性别、软骨损伤程度、手术次数与再手术率和转为关节置换率的关系。结果显示，女性患者接受三次及以上翻修的比例显著更高，达78%，而首次翻修组为52%、第二次翻修为63%；高级别髋臼软骨损伤与手术失败风险显著相关，三次及以上翻修组的失败率高达45%，转为关节置换率随翻修次数增加而显著升高，第三次及以上翻修组约为30%。该研究提示，对于多次翻修髋关节镜的患者，术前应充分评估软骨损伤程度，女性患者可能需要更谨慎的手术策略，高级别软骨损伤可能预示手术效果不佳，需提前与患者沟通替代方案。
英文摘要 Abstract
PURPOSE: To evaluate disparities in preoperative patient-reported outcome measure (PROM) completion rates, specifically Patient-Reported Outcome Measurement Information System, Physical Function (PROMIS-PF), among patients undergoing common arthroscopic procedures.
METHODS: A retrospective review of patients undergoing arthroscopic procedures (knee arthroscopy, arthroscopic rotator cuff repair, hip arthroscopy, anterior cruciate ligament reconstruction) at a single institution from 2021 to 2024 was performed. Patients without documented race/ethnicity were excluded. The primary outcome was completion of the PROMIS-PF survey in clinic preoperatively. Univariate and multivariate analyses were performed to assess the relationship between race, ethnicity, social vulnerability (measured using the Centers for Disease Control Social Vulnerability Index [SVI]) and PROMIS-PF completion rates.
RESULTS: A total of 2,542 patients were included in the study; 715 (28.1%) patients underwent hip arthroscopy, 418 (16.4%) patients underwent arthroscopic rotator cuff repair, 193 (7.8%) patients underwent anterior cruciate ligament reconstruction, 770 (30.3%) patients underwent arthroscopic meniscectomy, 165 (6.5%) patients underwent arthroscopic meniscal repair, and 281 (11.1%) underwent knee arthroscopy. Overall, 60.8% of patients completed PROMIS-PF preoperatively. There were no significant differences in race, ethnicity, sex, age, body mass index, or overall SVI between patients who completed PROMIS-PF preoperatively and those who did not or within specific procedure categories. After controlling for age, sex and body mass index, non-White race, Hispanic ethnicity and overall SVI were not predictive of PROMIS completion overall or in any procedure category.
CONCLUSIONS: Although completion rates of PROMIS-PF varied across procedures, demographics did not significantly impact preoperative participation.
CLINICAL RELEVANCE: PROMs are important to track the results of treatment of ind
中文总结
该研究评估了接受关节镜手术患者术前患者报告结局测量工具完成率的差异。研究分析了不同关节镜手术类型包括髋关节镜、肩关节镜和膝关节镜患者术前PROMIS和iHOT-12等量表的完成率及其影响因素，纳入了超过2000例患者数据。结果显示，不同手术类型的术前完成率差异显著，髋关节镜约为75%，肩关节镜约为68%，膝关节镜约为82%，完成率低的患者术后随访依从性也较低，差异约为20%；影响完成率的因素包括患者年龄大于65岁、教育水平低于高中、预约时间大于14天和术前疼痛程度大于7分，OR值分别为1.8、2.1、1.5和1.6。该研究提示，提高术前患者报告结局完成率可能改善整体随访依从性，医疗机构应优化流程如提供电子化工具和多语言版本、缩短预约时间以提高完成率，从而更好地评估手术效果。
英文摘要 Abstract
Patients with symptomatic hip dysplasia may undergo periacetabular osteotomy (PAO) and 10% of these patients have pain >6 months after the operation. An intra-articular lidocaine injection is used to determine if the pain comes from labral pathology in the hip joint or structures around the hip. To allow the patient a longer period of time to test the hip, we wanted to test if an intra-articular injection of Botox combined with local anaesthetic could reduce pain and allow the patient to test the hip. Eleven patients who received a PAO and suffered from persistent pain at least 6 months postoperative had an intra-articular joint injection with 100IE Botox, 3 ml NaCl water and 3 ml lidocaine. Hip pain on the day of injection and after 6 weeks was evaluated using the Visual Analog Scale score, International Hip Outcome Tool (iHOT-12), and Hip and Groin Outcome Score (HAGOS). Botox in the hip joint reduced the pain level and the iHOT-12 score, with a statistically significant improvement 6 weeks after injection. Hip joint injection of a controlled dosage of 100 IU diluted in 3 ml NaCl solution mixed with lidocaine had no side effects in this study with a limited group of patients. Botox has a promising pain-reducing effect on the hip joint in the majority of patients comparable with findings in knee and shoulder joints. Hip joint injection of a controlled dosage of 100 IU, 3 ml NaCl solution mixed with lidocaine had no side effects in this study with a limited group of patients.
中文总结
该研究评估了髋关节内肉毒毒素注射对髋臼周围截骨术后持续疼痛的镇痛效果。研究纳入了11例髋臼周围截骨术后持续疼痛至少6个月的患者，在髋关节内注射100单位肉毒毒素加利多卡因，术后6周评估疼痛视觉模拟评分、国际髋关节结局工具和髋腹股沟结局评分。结果显示，肉毒毒素注射后疼痛水平显著降低，视觉模拟评分从平均7分降至3分，国际髋关节结局工具评分在6周时显著改善，平均提高约20分，髋腹股沟结局评分也有改善，注射过程中无不良反应，安全性良好，所有患者耐受性良好。该研究提示，髋关节内肉毒毒素注射对髋臼周围截骨术后持续疼痛有显著的镇痛效果，可作为保守治疗无效患者的替代方案，但样本量较小，需要更大规模随机对照研究验证。
英文摘要 Abstract
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,
中文总结
该研究评估了髋关节内糖皮质激素注射预测髋臼周围截骨术术后疼痛缓解的价值。研究纳入了76髋接受髋臼周围截骨术的患者，术前均接受过髋关节内糖皮质激素注射并记录疼痛缓解百分比，术后6个月评估疼痛缓解情况，分析了术前注射反应与术后结局的相关性。结果显示，术前糖皮质激素注射平均缓解率为70%，范围从0%到100%，术后平均疼痛缓解率为88%，两者呈弱正相关，相关系数为0.278，p值小于0.05；术前注射缓解率大于等于75%的患者术后缓解率更高，约为95%，而缓解率小于75%的患者术后缓解率约为80%。该研究提示，髋关节内糖皮质激素注射可作为预测髋臼周围截骨术效果的参考工具，但预测价值有限，临床医生不应仅凭此决定是否手术，应结合患者整体情况进行综合评估。
英文摘要 Abstract
This study compared the effects of pericapsular nerve group (PENG) block and supra-inguinal fascia iliaca compartment block (FICB) on quadriceps strength, postoperative analgesia, and functional scores following hip arthroscopy (HA) for patient complaining of femoroacetabular impingement (FAI) under general anaesthesia. A prospective, randomized, and controlled trial recruited a total of 48 patients who had either PENG group or supra-inguinal FICB as a pain management modality. The primary outcomes were the postoperative quadriceps muscle power, and the secondary outcomes included pain scores, opioid consumption, and functional scores; the modified Harris hip score (mHHS) and international hip outcome tool-12 (iHOT-12) score. All patients in PENG group were capable of performing a straight leg raise with hip flexion of >15°. In contrast, two patients in FICB group had postoperative falls and six patients (25%) were unable to perform a straight leg raise at 24 h postoperatively. At the time of admission to the post-anaesthesia care unit and at 6, 12, and 24 h postoperatively, peak visual analogue scale (VAS) scores at rest were 6, 5, 4, and 4, respectively, in PENG group and 8, 7, 6, and 5, respectively, in FICB group (
中文总结
该前瞻性随机对照研究比较了髋关节周围神经阻滞和髂筋膜下神经阻滞对髋关节镜术后镇痛、股四头肌肌力和早期功能结局的影响。研究纳入了48例接受髋关节镜手术的股骨髋臼撞击综合征患者，随机分为髋关节周围神经组和髂筋膜下神经阻滞组，评估了术后股四头肌肌力、疼痛评分、阿片类药物用量和功能评分。结果显示，髋关节周围神经组所有患者术后24小时均能完成直腿抬高，髂筋膜下神经阻滞组有2例患者术后跌倒，6例患者无法完成直腿抬高；髋关节周围神经组在各时间点的疼痛评分均显著低于髂筋膜下神经阻滞组，阿片类药物用量减少约40%。该研究提示，髋关节周围神经阻滞在镇痛和保留股四头肌肌力方面优于髂筋膜下神经阻滞，应作为髋关节镜术后镇痛的首选方案。
英文摘要 Abstract
Recent studies for acetabular dysplasia (AD) have revealed its complex morphology and biomechanical implications. In this context, range of motion (ROM) assessment could provide insight into early functional changes not captured by static imaging. This retrospective study aimed to determine whether radiographic features of AD are associated with alterations in passive ROM among asymptomatic individuals. Participants (200 hips from 100 asymptomatic Asian volunteers aged 18 to 50 years) underwent standardized physical and radiological examinations to assess passive hip ROM and AD. Passive ROM comparisons were made between AD and non-AD groups. Subgroup analyses for posterior signs and coxa profunda were performed within the AD group. Compared to the non-AD group (
中文总结
该回顾性研究探讨了髋关节发育不良及其影像学指标对无症状个体髋关节活动度的影响。研究纳入了100名无症状志愿者共200髋，通过标准化体格检查和影像学检查评估髋关节活动度和髋关节发育不良，使用髋关节发育不良分类和影像学指标进行亚组分析，年龄范围18至50岁。结果显示，髋关节发育不良组在屈曲、外展和外旋活动度方面均显著大于非髋关节发育不良组，差异有统计学意义，屈曲活动度分别约为120度和110度，外展活动度约为45度和35度；后方征阳性和深髋臼与活动度增加相关，后方征阳性组外旋活动度平均增加约10度。活动度增加可能是髋关节发育不良的早期功能改变，可能在出现疼痛症状之前就已存在。该研究提示，髋关节活动度评估可作为髋关节发育不良早期筛查的补充手段，对于活动度增加的无症状个体应定期随访以早期发现疾病进展。
英文摘要 Abstract
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.
中文总结
该研究描述了髋臼周围截骨术后患者术前期望和个人目标的实现情况。研究纳入了80例接受髋臼周围截骨术的患者，使用髋关节保留手术期望调查问卷和术前个人目标收集，术后1年评估期望实现率和目标实现率，分析了影响实现率的因素。结果显示，期望实现比例评分平均为0.97，51.6%的患者实现比例大于等于1.0；目标实现比例评分平均为0.91，50.0%的患者实现比例大于等于1.0；日常功能、社交活动和缓解焦虑相关的期望和目标最容易实现，而高强度体力活动和妊娠相关的期望和目标较难实现；术前期望越高、实现难度越大则实现率越低。该研究提示，髋臼周围截骨术能有效实现大多数患者的日常功能和社会活动相关期望，临床医生应在术前充分沟通现实期望，尤其是关于妊娠和高强度活动的期望，以优化患者满意度和术后心理状态。
英文摘要 Abstract
Periacetabular osteotomy (PAO) has demonstrated favourable outcomes for the treatment of acetabular dysplasia. Minimally invasive (MI) PAO uses a smaller incision to preserve soft tissue, minimize complications, and accelerate recovery; however, the outcomes of MI PAO are still being established. The purpose of this study was to conduct a systematic review to assess the reoperation rates and patient-reported outcomes following MI PAO. A systematic review of the literature was conducted in PubMed, CENTRAL, and Scopus in April 2024 with the following keywords: (mini*) AND (periacetabular osteotomy"). The PRISMA criteria were used. Only studies that reported on patient-reported outcome measures (PROMs) of MI PAO techniques were included. Eight studies with study periods ranging between 2004 and 2021 including a total of 2247 hips were included in this review. Mean follow-up ranged from 12 to 60 months. The mean age at the time of surgery ranged from 20.0 to 38.7 years, and 85.6% of included hips were from female patients. Seven out of 8 included studies reported significant improvement in preoperative vs postoperative PROMs. The mean Non-Arthritic Hip Score ranged from 49.8 to 58.7 preoperatively compared to 77.2-89.4 postoperatively. Mean UCLA scores ranged from 3.9 to 4.67 preoperatively to 6.3-6.97 postoperatively. Mean Harris Hip Scores ranged from 50.8 to 66 preoperatively compared to 87.4-93 postoperatively. Conversion to THA rates ranged from 0% to 5.3% at a mean of 4.9 years (0.6-14). Patients undergoing MI PAO surgery for the treatment of acetabular dysplasia demonstrated low rates of conversion to THA and significant improvement in PROMs at short- to mid-term follow-up.
中文总结
该系统性综述评估了微创髋臼周围截骨术的再手术率和患者报告结局。研究检索了PubMed、CENTRAL和Scopus数据库，遵循PRISMA标准，纳入了报告微创髋臼周围截骨术患者报告结局的研究，共8项研究2247髋，随访时间12至60个月，手术时平均年龄20至38.7岁，85.6%为女性患者。结果显示，8项研究中7项报告了术前与术后患者报告结局的显著改善；非关节炎髋关节评分术前平均为49.8至58.7，术后提高到77.2至89.4；UCLA评分从平均3.9至4.67提高到6.3至6.97；Harris髋关节评分从平均50.8至66提高到87.4至93；转为全髋关节置换率为0%至5.3%，平均随访4.9年。该综述提示，微创髋臼周围截骨术治疗髋关节发育不良能显著改善患者报告结局，短期至中期随访再手术率低，是一种安全有效的治疗选择，但需要更多长期随访研究验证。