2025年09月科研进展JCRQ 3-4

Hip arthroscopy is a successful treatment option for patients with femoroacetabular impingement syndrome, with favorable reported outcomes at >10-year follow-up. Still, a minority of patients experience persistent symptoms postoperatively and potentially require reoperation, such as revision hip arthroscopy or conversion to total hip arthroplasty. There is strong evidence suggesting that patients with pre-existing osteoarthritis (Tönnis grade 2 or greater) at the time of primary surgery are at risk for inferior long-term clinical outcomes after hip arthroscopy. Higher body mass index (BMI), advanced age, and female sex have also been shown to be negatively associated with postoperative outcomes and increase the risk of reoperation in patients undergoing hip arthroscopy surgery. Of concern, nearly 42% of patients with femoroacetabular impingement syndrome undergoing hip arthroscopy in the United States are considered overweight or obese. With that being said, older age, high BMI, and female sex are not contraindications for undergoing primary hip arthroscopy. Older patients without the presence of degenerative changes can still achieve reliable outcomes after hip arthroscopy surgery. High BMI is a modifiable risk factor that can be optimized before proceeding with surgery. Female patients may be more likely to have microinstability, which can be addressed by hip capsulotomy repair. Favorable outcomes may be achieved with appropriate preoperative counseling, optimization of modifiable risk factors, and a patient-specific approach.

Accurate correction of cam or combined deformities in femoroacetabular impingement syndrome is essential because under- and over-resection can lead to complications and inferior patient-reported outcomes. Yet, consistent visualization and complete resection remain challenging, with under-resection being a leading cause of revision surgery. Computer-assisted navigation in hip arthroscopy offers the potential to improve accuracy and reduce variability. Recent studies show improved adherence to preoperative plans, reduced residual impingement, and favorable short-term functional scores. However, long-term, patient-centered outcomes remain unknown, and there is limited evidence for improved clinical outcomes compared with traditional freehand fluoroscopic techniques. Drawbacks, including longer operative time and increased system cost, may limit efficiency and raise cost-effectiveness concerns. Larger, prospective studies with extended follow-up are needed to clarify the true clinical impact of computer-assisted navigation and identify the settings in which it may provide maximal benefit.

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.

The ligamentum teres (LT) plays an important role in the general stability of the hip joint. A high prevalence of concomitant LT pathology has been noted in patients undergoing hip arthroscopy. This increased prevalence has led to the development of multiple treatment options, including reconstruction techniques using different types of grafts. The current literature on outcomes of LT reconstruction is limited. To evaluate the outcomes of LT reconstruction with tibialis anterior allograft treatment for LT tears with a minimum 2-year follow-up. Case series; Level of evidence, 4. Data were retrospectively analyzed for all patients who underwent arthroscopic LT reconstruction with a tibialis anterior allograft between 2014 and 2021. Preoperatively and a minimum of 2 years postoperatively, included patients had completed questionnaires for the following patient-reported outcome (PRO) measures: modified Harris Hip Score (mHHS), Non-Arthritic Hip Score (NAHS), Hip Outcome Score-Sports Specific Subscale (HOS-SSS), 12-item International Hip Outcome Tool (iHOT-12) score, visual analog scale (VAS) for pain score, and patient satisfaction score; or they had a documented endpoint within the study's time frame. The minimal clinically important difference (MCID) was calculated for the mentioned PROs and included in the analysis. Survivorship was also evaluated and included in the analysis. A total of 22 patients were included in the study. Significant improvement was shown in mHHS, NAHS, HOS-SSS, iHOT-12 score, and VAS pain score. A high patient satisfaction score was also observed at the latest follow-up. Furthermore, a high percentage of patients reached the calculated MCID for the mHHS, NAHS, HOS-SSS, and VAS score. Patients demonstrated 95.5% survivorship. Arthroscopic LT reconstruction with a tibialis anterior allograft, concomitant with labral repairs and osteoplasties for femoroacetabular impingement, has shown favorable outcomes, high patient satisfaction rates, and a high percentage of patients reaching clinically important thresholds, with a low rate of complications and total hip arthroplasty conversion at a minimum 2-year follow-up. Furthermore, the choice of a graft rests in the hands of the surgeon based on training, familiarity, circumstances, and resources, as the optimal graft option has yet to be elucidated.

Osteonecrosis of the femoral head (ONFH) primarily affects young adults, leading to femoral head collapse and secondary osteoarthritis. Treatments include joint-preserving surgery, which has been performed preferentially, especially for young adults, and joint arthroplasty, i.e., total hip arthroplasty (THA). Although advancements in implant materials have markedly improved performance, there are few data regarding implant survival and clinical outcomes in younger patients. This study aimed to assess long-term implant survival of more than 120 months and clinical outcomes in young ONFH patients undergoing primary THA. This retrospective single-center study assessed 99 joints in 66 ONFH patients who underwent primary THA between 1997 and 2019. Patients were categorized according to age at the time of THA: group A, aged less than 30 years (20 joints) and group B, aged 30 years or more (79 joints). The mean age was 43 years, and 36 patients were men. The mean follow-up duration was 128.1 months. Clinical and radiographic characteristics were compared. The median Japanese Orthopaedic Association score at the final follow-up was 100 in both groups (P = 0.41). Major complications occurred in 13 joints: one in group A and 12 in group B (P = 0.46). Overall implant survival rate was 100% at 60 months, 98% at 120 months, and 94% at 180 months. When considering aseptic loosening as the endpoint, the 180-month survival rate was 100%. No significant differences in survival rate were found between the groups with either endpoint (P = 1.00, P = 0.67). Our results showed THA was a safe, effective treatment for young ONFH patients, with demonstrated efficacy over 120 months. Advances in implants and revision techniques support THA as a viable treatment, even as an initial treatment for young ONFH patients. Future research should assess longer follow-up with larger cohorts and standardized surgical methods.

Slope-reducing high tibial osteotomies (SR-HTOs) correct posterior tibial slope (PTS) abnormalities in patients with anterior knee instability, as in cases of anterior cruciate ligament (ACL) deficiency. The SR-HTO techniques, including infra-tubercle and retro-tubercle approaches, provide distinct benefits: retro-tubercle techniques help preserve patellofemoral joint mechanics, while infra-tubercle techniques are effective in mitigating iatrogenic varus. However, there is limited comparative literature available. This study compares the PTS correction precision, frontal plane alignment changes, patellar height (PH) alterations and complications between both SR-HTO techniques. A retrospective matched cohort study including 62 patients who underwent SR-HTO with ACL revision surgery between 2020 and 2023 was conducted. Of the 62 patients included, 40 (64.5%) were male and 22 (35.5%) were female. The mean follow-up period was 23.4 ± 7.7 months (range: 12-45 months). The cohort was subdivided into infra-tubercle (n = 29) and retro-tubercle (n = 33) groups. Preoperative and post-operative radiographic assessments included hip-knee-ankle angle (HKA), medial proximal tibial angle (MPTA), proximal tibial slope (PTS) and PH indices. Functional outcomes were measured using the simple knee value (SKV) score. Complications such as hinge fractures, ACL re-rupture and hardware removal were recorded. Both techniques achieved similar mean slope correction with post-operative PTS in infra-tubercle: 9.2 ± 1.1° (range: 5-13.8°) versus retro-tubercle: 9.1 ± 1.3° (range: 5-14°). This has been reduced from a preoperative PTS in the infra-tubercle group of 14.2 ± 1.7° (range: 11.5-17°) versus retro-tubercle group: 14 ± 1.8° (range: 11-17.5°). Infra-tubercle osteotomy showed greater precision to pre-operative plans, with a deviation of 1.2 ± 1.1° (range: 0.0-3.6°) versus 1.8 ± 1.3° (range: 0.0-3.4°) in the retro-tubercle group (p = 0.02). Retro-tubercle SR-HTO induced greater coronal changes compared to infra-tubercle SR-HTO, ΔHKA: 1.4 ± 1.6° (range: 0-5°) versus 0.8 ± 0.8° (range: 0-2.8°) (p = 0.05); ΔMPTA: 1.6 ± 1.6° (range: 0-5.7°) versus 0.9 ± 0.7° (range: 0-2.8°) (p = 0.03). There was no intergroup difference in PH changes using either Caton-Deschamps or Schroter indices (p = 0.2). SKV improvement was greater in the infra-tubercle group compared to the retro-tubercle group, 28.7 ± 10.4 (range: 10.0-55.7) versus 20.7 ± 12.3 (range: -9.2 to 48.4) (p = 0.008). Complications were similar, with no hinge fractures and identical ACL re-rupture rates of 3.4%. Hardware removal was higher in the infra-tubercle group compared to the retro-tubercle group, 24.1% versus 9.1% (p = 0.2). Infra-tubercle SR-HTO demonstrated greater correction accuracy and better preservation of frontal plane alignment and functional outcomes compared to the retro-tubercle technique, although the observed differences were modest. Both techniques maintained PH and exhibited comparable safety profiles. Infra-tubercle SR-HTO may offer a reliable alternative, particularly in ACL-deficient knees where precise slope correction is desired. Level III, retrospective comparative study.

This study compared the Pericapsular Nerve Group (PENG) block combined with the Lateral Femoral Cutaneous Nerve (LFCN) block to the anterior Quadratus Lumborum Block (QLB) in patients undergoing Total Hip Arthroplasty (THA). In this prospective, double-blind trial, 80 adults scheduled for THA under spinal anesthesia were randomized to receive either an anterior QLB (n = 40) with 30 mL of 0.25% bupivacaine or a combined PENG + LFCN block (n = 40) using 25 mL of 0.25% bupivacaine for PENG and 5 mL for LFCN. The primary outcome was cumulative 24 hour postoperative intravenous morphine consumption. Secondary outcomes included pain scores, quadriceps strength, patient satisfaction and side effects. No significant differences were observed between the groups in morphine consumption or pain scores during the first 12 hours (p > 0.05). At 24 hours, the PENG + LFCN group demonstrated significantly lower morphine consumption (p = 0.027) and resting VAS scores (p < 0.001). Quadriceps weakness occurred in 15% (6/40) of anterior QLB patients at 6 hours (p = 0.026), whereas no weakness was observed in the PENG + LFCN group within 24 hours. Patient satisfaction and the incidence of complications were comparable between the groups. Both anterior QLB and PENG + LFCN blocks provide effective analgesia for up to 12 hours post-THA. However, the PENG + LFCN combination offers prolonged analgesia, reduced opioid requirements and better preservation of quadriceps strength.

Hip arthroscopy is a successful treatment option for patients with femoroacetabular impingement syndrome, with favorable reported outcomes at >10-year follow-up. Still, a minority of patients experience persistent symptoms postoperatively and potentially require reoperation, such as revision hip arthroscopy or conversion to total hip arthroplasty. There is strong evidence suggesting that patients with pre-existing osteoarthritis (Tönnis grade 2 or greater) at the time of primary surgery are at risk for inferior long-term clinical outcomes after hip arthroscopy. Higher body mass index (BMI), advanced age, and female sex have also been shown to be negatively associated with postoperative outcomes and increase the risk of reoperation in patients undergoing hip arthroscopy surgery. Of concern, nearly 42% of patients with femoroacetabular impingement syndrome undergoing hip arthroscopy in the United States are considered overweight or obese. With that being said, older age, high BMI, and female sex are not contraindications for undergoing primary hip arthroscopy. Older patients without the presence of degenerative changes can still achieve reliable outcomes after hip arthroscopy surgery. High BMI is a modifiable risk factor that can be optimized before proceeding with surgery. Female patients may be more likely to have microinstability, which can be addressed by hip capsulotomy repair. Favorable outcomes may be achieved with appropriate preoperative counseling, optimization of modifiable risk factors, and a patient-specific approach.

An abundance of literature exists assessing outcomes of revision total hip arthroplasty (THA) using diaphyseal-engaging stems; however, there is little research into the use of primary-style femoral stems in revision THA. Primary stems may have benefits, including cost reduction, maintenance of proximal bone stock, and ease of potential future reconstructions. The purpose of this study was to evaluate the aseptic survival rate of revision THAs using primary femoral stems. A review of our registry was performed to identify patients from 2010 to 2020 who underwent all-cause revision THA utilizing a primary metaphyseal-engaging stem for femoral reconstruction. Patients who had a history of previous revision THA or those treated with cement or bone graft augmentation were excluded. There were seven patients excluded due to a lack of 2-year follow-up. Implant survival, complications requiring revision surgery, and ambulatory status at final follow-up were documented. There were 78 patients who met the final inclusion criteria. The mean follow-up was 5.2 years (range, 2.0 to 10.0). The most common indications for index revision were aseptic loosening (44%) or infection (34%). Prerevision Paprosky classification of the femur was Type I in 41 patients (52%), Type II in 37 patients (47%), and Type IIIA in one patient (1%). Overall, 13 patients (16.5%) required rerevision, five for periprosthetic fracture, six for instability, and two for recurrent infection. Of those, seven of 13 required femoral component revision. When excluding recurrent infections, the aseptic femoral component survivorship for the cohort was 94%. There were three patients who sustained a fracture requiring stem rerevision. A Vancouver B1 fracture was sustained > 2 years postoperatively, and two Vancouver B2 fractures were sustained within 6 months postoperatively. There were no femoral rerevisions for aseptic loosening. Primary metaphyseal-engaging femoral stems provide reliable fixation during revision THA in patients who have preserved proximal metaphyseal bone, with similar complication rates to those previously reported in the literature for revision THA.

Most of the current evidence for short femoral stems in total hip arthroplasty (THA) is related to uncemented fixation. This study aims to summarise the existing evidence on the use of short cemented stems in THA, with a focus on overall implant survival, clinical outcomes, radiographic findings, and complication rates. A systematic literature review was conducted following the PRISMA guidelines. 12 articles met the inclusion criteria. The risk of bias was assessed through the Methodological Index for Non-Randomized Studies (MINORS) score. With a total of 5294 total hip replacement performed, the mean follow-up was 13.5 years. The most reported complications were dislocation, periprosthetic fracture, and infections; several studies reported varus and valgus stem malalignment. All the included studies demonstrated improved clinical outcomes. Short cemented stems are a reliable option for Dorr type A femurs, as well as for hypoplastic and small femurs. Their advantages include preservation of metaphyseal bone, easier insertion, and easier removal in case of revision. Varus and valgus stem-position should be studied as risk factors for failure. Despite small follow-up available, and considering different stem type and length, cemented short stems implants are a safe and effective option for THA.

Medial open-wedge high tibial osteotomy (MOWHTO) is an effective treatment for medial compartment knee osteoarthritis. However, there is no consensus regarding the optimal management of the pes anserinus during the procedure. This study aimed to investigate the effects of pes anserinus release on radiological healing, alignment correction, and functional outcomes after MOWHTO. This retrospective cohort study included 73 patients who underwent MOWHTO with locking plate fixation. Patients were divided into two groups based on surgical preference: pes anserinus release (n = 35) and non-release (n = 38). Functional outcomes were assessed using the Knee injury and Osteoarthritis Outcome Score (KOOS) at baseline, six months, and 12 months. Radiographic parameters included the hip-knee-ankle (HKA) angle, medial proximal tibial angle (mMPTA), tibial slope, and time to bone union. Complications were also documented. Both groups were comparable in demographic characteristics and preoperative alignment. The non-release group achieved bone union significantly earlier (median 4.0 vs. 5.0 months, p = 0.019). There were no significant differences in HKA angle, mMPTA or tibial slope between the groups. At six months, KOOS scores were significantly higher in the non-release group (p < 0.001); however, by 12 months, both groups demonstrated similar functional outcomes. No major complications or nonunions were observed in either group. Preserving the pes anserinus during MOWHTO does not compromise alignment correction and may enhance early bone healing and functional recovery. Routine release of the pes anserinus may be unnecessary, and its preservation could offer clinical benefits during the early postoperative period. Further prospective, randomized studies are needed to validate these findings.