英文摘要 Abstract
Legg-Calvé-Perthes disease has been recognized for more than 100 years. It is an idiopathic osteonecrosis of the femoral head in children that follows a predictable course of bone death, revascularization, bone resorption, and eventually reossification and bone healing. The natural history is often favorable for children younger than 6 years and poor for children older than 8 to 10 years. The final outcome is determined by the shape of the healed femoral head and its congruence with the acetabulum. Treatment is aimed at preserving range of motion, maintaining containment, and limiting mechanical damage to the femoral head. Nonsurgical interventions include restricted weight-bearing, range of motion exercises, and casting or bracing treatment. Surgical interventions include osteotomies of the femur or pelvis or both to maintain containment, as well as joint distraction for containment and decreasing mechanical force. Superiority of a particular treatment strategy has been difficult to demonstrate due to relative rarity of the condition, variable natural history, and long-time horizon to predict final outcome. Recent research has focused on better imaging predictors and understanding and altering the pathophysiology subsequent to the vascular disturbance.
中文总结
Legg-Calvé-Perthes病（儿童股骨头坏死）是一种特发性股骨头骨坏死，病程经历骨坏死、再血管化、骨吸收及再骨化。6岁以下患儿预后较好，8-10岁以上预后差。治疗目标为维持活动度、保持股骨头包容性、减少机械损伤。非手术治疗包括减重、关节活动度训练及矫形支具；手术治疗包括股骨或骨盆截骨术及关节牵引。由于该病相对罕见、自然病程变异大、随访时间长，难以证明某种治疗策略的优越性。近年来研究聚焦于更优的影像学预测指标及血管损伤后病理生理干预。
英文摘要 Abstract
The Journal of Hip Preservation Surgery (JHPS) is not the only place where work in the field of hip preservation can be published. Although our aim is to offer the best of the best, we are continually fascinated by work, that finds its way into journals other than our own. There is much to learn from it, and so JHPS has selected six recent and topical subjects for those who seek a summary of what is taking place in our ever-fascinating world of hip preservation. What you see here are the mildly edited abstracts of the original articles, to give them what JHPS hopes is a more readable feel. If you are pushed for time, what follows should take you no more than 10 min to read. So here goes ….
中文总结
本文介绍J Hip Preserv Surg（JCHS）期刊精选的6篇髋关节保髋领域最新研究。JHPS编辑对原文摘要进行适度编辑，以提高可读性。这些研究来自非本刊的其他期刊，涵盖髋关节保髋手术的前沿进展，内容涉及股骨髋臼撞击症、髋关节盂唇损伤、髋关节不稳定等热点话题，旨在为从事髋关节保髋工作的临床医生提供全面、实用的研究动态概述。
英文摘要 Abstract
Hip arthroscopy has a steep learning curve with femoral osteoplasty being one of the most challenging technical aspects of the procedure. The authors discuss a methodical system of preoperative templating and intraoperative fluoroscopic evaluation to ensure adequacy of resection and correction of impingement. There have been multiple methods developed to help aid surgeons in intraoperative decision making during cam correction. Using the available techniques may help limit complications and revision arthroscopic procedures, and understanding the nuances and limitations of each method will be paramount for the success of hip arthroscopists when addressing cam morphology. Future studies comparing long-term outcomes of these various resection techniques will be important in guiding our understanding of femoroacetabular impingement management.
中文总结
髋关节镜手术学习曲线陡峭，股骨骨软骨成形术（Femoral Osteoplasty）是最具挑战性的技术环节之一。本文系统介绍了术前模板测量和术中透视评估的方法论体系，以确保cam畸形切除的充分性和撞击征的矫正效果。目前已开发多种术中决策辅助技术来指导cam畸形矫正，合理运用这些技术有助于减少并发症和二次关节镜翻修手术。充分理解各种技术的细微差别和局限性，对髋关节镜医生的长期成功至关重要。未来需要比较不同切除技术在长期疗效方面的差异，以指导股骨髋臼撞击症的治疗决策。
英文摘要 Abstract
Lifestyle interventions for weight loss might exacerbate age-related bone loss and osteoporosis. However, there is limited knowledge about their effects on bone quality. We examined whether lifestyle intervention can preserve or enhance bone quality, despite reductions in bone mineral density. Of 138 participants assessed for eligibility in person between Nov 9, 2017, and Nov 8, 2021, 120 were included in this study (mean age 71·4 years [SD 4·6]; 63 [53%] male and 57 [47%] female). At 12 months, weight loss was greater in the intensive lifestyle group than in the healthy lifestyle group (-11·6 kg [SE 0·5] vs -1·2 kg [0·5]). No group differences were noted in the change in distal tibia cortical thickness between the intensive lifestyle group (-0·013 mm [SE 0·026]) and the healthy lifestyle group (-0·002 mm [0·025]; between-group difference 0·027 [95% CI -0·066 to 0·120], p=0·40). The change in hip failure load at 12 months did not differ between the intensive lifestyle group (13 N [SE 25]) and the healthy lifestyle group (3 N [26]; between-group difference -6.9 N [95% CI -108 to 95], p=0·89). Exercise-related adverse events in the intensive lifestyle group included a small number of musculoskeletal events (falls [one participant], neck pain [two], and foot, shoulder, back, and leg pain [one each]). Lifestyle intervention preserved bone quality in older adults with obesity during weight loss. Further research is needed to determine whether lifestyle interventions can reduce fracture risk in older adults with obesity. National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK) and US Department of Veterans Affairs.
中文总结
减重生活方式干预可能加重年龄相关的骨量丢失和骨质疏松，但对其骨质量影响的研究有限。本研究纳入120例肥胖老年人（平均71岁），比较强化生活方式干预与健康生活方式干预12个月后的效果。强化干预组减重11.6 kg vs 对照组1.2 kg，两组胫骨远端皮质厚度和髋关节失败载荷变化无显著差异。强化干预组有少量运动相关不良事件（跌倒1例、颈痛2例等）。结论：生活方式干预可在减重的同时维持骨质量，但尚需更多研究确定其能否降低骨折风险。
英文摘要 Abstract
Although total hip arthroplasty (THA) post-periacetabular osteotomy (PAO) has yielded excellent short-term and mid-term outcomes, long-term implant survivorship remains unclear. This study aimed to evaluate the long-term (minimum 10 year) outcomes of THA post-PAO and assist in determining surgical indications and planning for THA post-PAO. This study included 50 hips that underwent THA post-PAO, with a minimum follow-up of 10 years. Propensity score-matching based on age, sex, and Crowe type was used to establish the PAO and control groups. The mean age at the time of THA for the PAO and control groups was 56 (95.7% women) and 56 (91.7% women) years, respectively. There were 11 hips (22%) diagnosed with developmental dysplasia of the hip during childhood and treated conservatively. Key parameters assessed included the Harris Hip Score, complications, horizontal and vertical distances between the teardrop and femoral head center, radiolucent lines (RLLs), and loosening on radiographs. Subgroup analysis was performed to compare outcomes between the elevated and anatomical groups. At the latest follow-up, the PAO group exhibited significantly lower Harris Hip Score than the control group (86.7 ± 9.4 versus 90.3 ± 5.7; P = 0.021). Radiographic analysis revealed RLLs in four (8.0%) and three (6.0%) cases in the PAO and control groups, respectively, without significant differences. Loosening cases were not observed in either group. Acetabular cups were located more superiorly in the PAO group than in the control group (26.1 ± 7.3 versus 22.8 ± 6.4; P = 0.020). Subgroup analysis indicated no significant difference in RLLs between the elevated and anatomical groups (5.5 versus 9.4%; P = 0.62). Although the functional outcomes of THA post-PAO were inferior to those of primary THA, implant survivorship was comparable between the two groups. In cases with large preoperative bone defects, the acetabular component was placed more superiorly in the PAO group, which did not appear to affect long-term (10 year) implant survivorship.
中文总结
PAO术后全髋关节置换术（THA）的远期疗效尚未明确。本研究纳入50例PAO后THA患者，最短随访10年，以倾向评分匹配建立PAO组与对照组。PAO组末次随访Harris髋关节评分显著低于对照组（86.7 vs 90.3），但两组放射学透亮线发生率及假体松动率无显著差异。PAO组髋臼杯位置更偏上方。两组假体10年生存率相当。结论：PAO后THA功能结局略差于初次THA，但假体生存率相近；对于术前骨缺损较大的病例，髋臼组件置入位置偏上，但未影响10年假体生存率。
英文摘要 Abstract
The new Tri-Lock bone -preserving stem with a collarless proximal-coated tapered-wedge design was compared with a classic well-proven collarless proximal-coated long and round-tapered design. Our primary aim was to compare femoral stem fixation (subsidence) of the Tri-Lock stem with the classic Summit stem, and secondarily to compare the change in periprosthetic bone mineral density (BMD) and PROMS between stem groups. In a patient-blinded randomized controlled trial, 52 patients at mean age 60 (SD 6) received cementless Tri-Lock (n = 26) or Summit (n = 26) femoral stems with a cementless Pinnacle cup, a cross-linked polyethylene liner, and a CoCr head. Patients were followed for 5 years with radiostereometric analysis (RSA), dual-energy X-ray absorptiometry (DXA), and patient-reported outcome measures (PROMs). We measured mean (CI) values of migration and periprosthetic bone mineral density and calculated between group differences. At 2-year follow-up, the mean difference in subsidence was 0.14 mm (95% confidence interval [CI] -0.27 to 0.56) and below the chosen minimal clinically important difference of 0.6 mm. At 5-year follow-up, for the Tri-Lock and Summit stems, the mean subsidence was 0.38 (CI 0.04-0.72) and 0.24 (CI 0.09-0.57), and the mean retroversion was 1.68° (CI 0.80-2.55) and 1.53° (CI 0.68-2.37), respectively. There was initial periprosthetic BMD loss for both stems. At 5-year follow-up, the mean metaphyseal bone loss was minimal for the Tri-Lock stem (zone 1: -2.8% vs -11.5%) while the Summit stem preserved the medial diaphyseal bone better (zone 6: -7.1% vs -13.6%). At the medial stem tip, BMD was increased with the Summit stem (zone 5: +3.4% vs -1.5%). At 5-year follow-up, median EQ5D was 1 in both groups and median Oxford Hip Score was 47 (Tri-Lock) and 45 (Summit) with no statistical significant differences between groups. The Tri-Lock and the Summit stems displayed similar migration until mid-term follow-up. At 3 months both stems had lost metaphyseal periprosthetic bone mineral density (BMD). During the following years, the new design regained more metaphyseal BMD. Contrarily, the long and round-tapered stem design regained or even increased diaphyseal BMD. PROM scores improved beyond the reference level for both groups.
中文总结
Tri-Lock骨保留股骨柄（锥形楔形设计）与经典Summit柄（长圆形锥形设计）在52例患者中比较，随访5年。两组股骨柄下沉量相似（均在0.6 mm最小临床重要差异以下）。早期两种柄均有近端骨密度丢失，但Tri-Lock设计5年后恢复了更多干骺端骨密度，而Summit柄在保持骨干骨密度方面更优（Zone 6: -7.1% vs -13.6%）。两组患者报告结局指标均改善至参考水平以上。结论：两种柄中期移位相似，新Tri-Lock设计干骺端骨保留更优，而Summit柄骨干骨密度保留更好。
英文摘要 Abstract
Routine capsular closure after hip arthroscopy remains controversial. The hip capsule is important for hip stability, but this can sometimes heal after a small periportal or intraportal capsulotomy without closure. Although reliable healing of intraportal capsulotomies can be achieved with capsular closure, multiple systematic reviews show improved outcomes and less revision surgery after capsular closure. In my practice, I do an interportal capsulotomy in all patients, and I close or plicate the capsule.
中文总结
髋关节镜术后常规关闭关节囊仍存争议。髋关节囊对髋关节稳定性至关重要，尽管小切口经皮或经腔隙切开术后囊有时可愈合，但多项系统综述表明，关节囊关闭可改善疗效并减少翻修手术率。本文作者对所有患者均采用经腔隙关节囊切开术，并关闭或折叠关节囊。研究表明，虽然部分患者即使不关闭关节囊也能愈合，但现有证据主流仍支持关闭，尤其是存在不稳定风险因素时。精确的关节囊修复结合合理康复计划，是获得良好预后的关键。
英文摘要 Abstract
Osteonecrosis of the femoral head (ONFH) can cause pain, diminished function, and eventual articular collapse, disproportionately impacting younger patients. Core decompression (CD) is used to halt or at least delay postcollapse disease in patients who suffer from ONFH, but it can have variable outcomes. Orthobiologics are cellular therapies, growth factors, and biomaterial substances obtained from human cells and tissue that promote biological healing and have recently gained attention in the treatment of osteonecrosis. In this review, the role of orthobiologics in the treatment of osteonecrosis is discussed. We reviewed the existing literature regarding orthobiologics in the treatment of precollapse ONFH. A total of 11 studies were included, consisting of six randomized controlled trials and five retrospective reviews. The included literature was obtained through a PubMed query of all studies from 1990 to 2024 that evaluated the role of ancillary cell-based therapies in the treatment of precollapse ONFH. Level IV and non-human studies were not included. There were seven studies that supported the use of orthobiologics as an augmentation strategy to CD in terms of radiographic outcomes (i.e., prevention of femoral head collapse), clinical symptoms, or conversion to total hip arthroplasty. There were four studies (one retrospective review and three randomized controlled trials) that found no clinical or radiographic difference in collapse progression in patients who received CD versus CD along with an orthobiologic augmentation strategy. In summary, further adequately powered, multicenter, blinded, randomized controlled trials are necessary. In addition, many of the studies had other limitations, including a large variability in mesenchymal cell content and standardization. Although the current literature regarding orthobiologic augmentation in the treatment of precollapse ONFH appears promising, further investigation is necessary to conclude its efficacy.
中文总结
股骨头坏死（ONFH）好发于年轻患者，可导致疼痛、功能障碍及关节面塌陷。髓芯减压术（CD）可延缓塌陷发生，但效果不稳定。再生医学中的骨科生物制剂（orthobiologics）近年来受到关注。本综述纳入11项研究评估细胞治疗联合CD治疗塌陷前期ONFH的疗效：7项研究显示生物制剂可改善影像学结局、减轻症状或减少全髋置换；4项研究未发现显著差异。结论：现有证据支持再生医学联合CD治疗ONFH有一定前景，但尚需更大型、多中心、盲法的随机对照试验进一步验证其确切疗效。
英文摘要 Abstract
Femoroacetabular impingement (FAI) causes hip pain and osteoarthritis (OA). However, its prevalence and characteristics in the Japanese population remain unclear. Therefore, this large-scale nationwide epidemiological study aimed to determine the current aetiologies of hip disorders in Japan, focusing on the prevalence and clinical features of primary FAI. A total of 2402 patients presenting with groin pain were prospectively enrolled from 16 hip-specialised institutions across Japan. Diagnoses were based on standardised clinical and radiographic evaluations, including the Japanese Hip Society criteria for primary FAI. Centralised radiographic assessment was also conducted using dedicated measurement software. Secondary OA due to hip dysplasia was the most common diagnosis (52.9 %), followed by primary OA (16.8 %), osteonecrosis of the femoral head (8.5 %), and primary FAI (6.2 %). Patients with FAI were predominantly younger males. Cam-type FAI was the most frequently identified FAI subtype. Centralised radiographic assessment revealed discrepancies compared with institutional diagnoses, in which 12.8 % of patients initially diagnosed with FAI showed signs of advanced OA, the percentage of hips with a lateral center-edge angle <25° was higher in the centralised measurements (13.8 % vs. 6.4 %; P < 0.001), and the percentage of hips with an alpha angle ≥55° was reduced (40.3 % vs. 67.7 %; P = 0.0393). This nationwide study identified secondary OA due to hip dysplasia as the most common (52.9 %), with primary FAI identified in 6.2 % of cases, predominantly affecting younger males with cam-type morphology. Standardised radiographic assessment revealed an underdiagnosis of hip dysplasia and OA and a potential overdiagnosis of cam-type FAI, emphasising the need for accurate diagnosis to guide appropriate treatment decisions.
中文总结
本研究为日本全国性流行病学研究，纳入16家髋关节专科中心2402例腹股沟痛患者，评估股骨髋臼撞击症（FAI）的患病率和临床特征。结果：继发性髋关节发育不良占52.9%为首位，原发性骨关节炎16.8%，股骨头坏死8.5%，原发性FAI仅占6.2%。FAI患者以年轻男性为主，cam型最常见。集中影像学评估发现：12.8%初诊为FAI的患者实际已有晚期OA，发育不良漏诊率高（外侧CE角<25°从6.4%升至13.8%），cam型FAI存在过度诊断（alpha角≥55°从67.7%降至40.3%）。结论：需重视标准化影像学评估以减少漏诊和过度诊断。
英文摘要 Abstract
Early diagnosis of femoroacetabular impingement syndrome (FAIS) is essential. This systematic review aimed to identify biomarkers useful for diagnosing FAIS and predicting its progression to hip osteoarthritis. Our hypothesis was that there are biomarkers that are useful for the diagnosis and/or prognosis of FAIS. Our research questions were: (1) which biomarkers support diagnosis or screening of FAIS? and (2) which biomarkers predict disease progression? A systematic review using the PRISMA guidelines was conducted to investigate the relationship between biomarkers and FAIS. The diagnosis of FAIS was based on the criteria used in each original study, typically involving clinical symptoms and radiographic evidence of CAM or pincer morphology. The protocol for the review has been published in PROSPERO. Literature search was performed using three databases: Embase, MEDLINE and Cochrane Library. The initial search yielded 683 articles of which 16 articles were included for final analysis. Data from a total of 2134 participants were analysed. Sixty-eight unique biomarkers associated with FAIS were identified and measured. Diagnostically, 19 biomarkers were identified, of which 12 could significantly detect a difference between patients with FAIS and healthy controls. Forty-two biomarkers predicting the association of FAIS with hip osteoarthritis or late FAIS were identified, of which 16 biomarkers were statistically significant. Only 4-aminobutyrate aminotransferase promoter (ABAT) and peroxisome proliferator-activated receptor gamma (PPARγ) were associated with both diagnosis and prognosis. Biomarkers may support the diagnosis and monitoring disease progression in patients with FAIS. Twelve biomarkers may detect early changes, and 16 may predict progression to osteoarthritis. Further refinement is required to identify those most useful in clinical practice. ABAT and PPARγ may be linked to both diagnosis and progression. While primarily preclinical, these findings may improve diagnostic accuracy, reduce overtreatment and aid decisions regarding joint preservation strategies. Level III.
中文总结
早期诊断股骨髋臼撞击综合征（FAIS）至关重要。本系统综述纳入16项研究共2134例参与者，识别出68种生物标志物，其中19种可辅助FAIS诊断（12种有统计学意义），42种可预测疾病进展（16种有统计学意义）。仅ABAT和PPARγ两种标志物同时与诊断和预后相关。这些发现可能提高诊断准确性，减少过度治疗，并有助于制定保髋治疗策略。但目前主要为临床前数据，需进一步优化以确定最适合临床应用的标志物。
英文摘要 Abstract
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. 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. Case series; Level of evidence, 4. 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. 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
髋关节不稳定是髋关节镜术后疼痛和功能障碍的常见原因。本研究探讨术中牵引下髋关节自然松弛度与术前患者报告结局指标（PROs）的关系。将非发育不良女性患者按牵引距离分为三组（从低到高）。结果显示：牵引距离越大（提示关节松弛度越高）的患者，其术前PROMIS-Physical Function 2.0评分、改良Harris髋关节评分、患者感知功能（SANE评分）均较低，静息痛和活动痛也更高。结论：非发育不良女性患者术前髋关节松弛度与功能结局呈负相关，未来研究需进一步探讨术后即刻松弛度变化与远期疗效的关系。