2025年10月 保髋进展 JCR Q1

The clinical impact of periacetabular osteotomy (PAO) in patients with borderline hip dysplasia (BHD) remains unclear. This systematic review aims to evaluate outcomes in patients with BHD undergoing PAO. A systematic review was conducted according to PRISMA guidelines by searching PubMed, Embase, and the Cochrane Library for English-language studies reporting clinical outcomes of PAO in BHD patients. Outcomes assessed included conversion to total hip arthroplasty (THA), return-to-sport (RTS) rates and patient-reported outcome measures (PROMs) such as the modified Harris Hip Score (mHHS), Hip Outcome Score (HOS), Subjective Hip Value (SHV), Hip Disability and Osteoarthritis Outcome Score (HOOS), Short-Form Health Survey (SF-12/SF-36), International Hip Outcome Tool (iHOT-12/iHOT-33) and Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) scores. Eleven studies (2 Level III, 9 Level IV) with 657 hips met inclusion criteria. The mean patient age was 26.9 years, and follow-up was 48.1 months. The average BMI was 23.3 kg/m², and 13.0% of patients were male. mHHS improved significantly in four studies (mean: 62.6-82.9). SF-12/SF-36 physical scores improved in three studies (37.8-47.6). Two studies each showed gains in iHOT and SHV scores. The reoperation rate was 9.5%, mostly for implant irritation. THA conversion occurred in 0.2%. One study reported a 92.5% return-to-sport rate, typically within 6 months. In patients with BHD undergoing PAO, there is consistent improvement in most PROMs along with a low rate of reoperation and conversion to THA. Level IV, systematic review of Level III-IV studies.

The management of borderline hip dysplasia (BHD) remains a topic of particular interest in the hip preservation world. While periacetabular osteotomy remains the gold standard for frank dysplasia, management of mild or borderline dysplasia is more nuanced, and in many cases, isolated hip arthroscopy with capsular plication can yield favorable and durable outcomes, avoiding morbidity associated with osteotomy. However, the benefit of avoiding the morbidity of a periacetabular osteotomy should be carefully weighed against the risk of undertreating this complex pathology. Historically, BHD was defined as a lateral center-edge angle between 20° and 25°, with more recent studies using 18° as a lower threshold. Yet, a singular 2-dimensional measurement provides an incomplete picture. Labral hypertrophy, an upsloping lateral sourcil, fovea alta, ligamentum teres tears, Tönnis angle, Femoro-Epiphyseal Acetabular Roof index, vertical center anterior angle, and abnormal femoral or acetabular version are additional factors that help us understand dynamic pathoanatomy and the severity of instability. Some of these variables-including Tönnis angle >10-15°, ligamentum teres pathology, and vertical center anterior angle <18°-have been associated with failure of arthroscopy alone for BHD.

As the number of hip arthroscopy cases performed annually continues to rise, so does the number of patients requiring revision surgery. Determining the cause of failed hip arthroscopy (HA) can be challenging, with residual femoroacetabular impingement (FAI) being the most common indication for revision. While addressing impingement during primary HA is critical, factors such as articular cartilage defects, labral pathology, and capsular management also influence outcomes. To evaluate trends in revision hip arthroscopy indications at a single institution and assess whether outcomes differ by the primary indication for revision. Case series; Level of evidence, 4. A single-center hip preservation registry was reviewed to identify patients who underwent revision hip arthroscopy for FAI between 2012 and 2019. Patient demographics and primary indications for revision hip arthroscopy were determined, and patient-reported outcomes were collected preoperatively and at a mean follow-up of 5.2 years postoperatively. The most common indication for revision hip arthroscopy in the treatment of femoroacetabular impingement remains residual impingement. Capsular instability has significant consequences for function and may represent a subset of patients who demonstrate more dysfunction before and after revision arthroscopy.

Femoroacetabular impingement is a structural mismatch between the femoral head and acetabulum that can lead to labral tear, cartilage damage, and early-onset osteoarthritis. The etiology is likely multifactorial, involving both genetic and environmental risk factors, particularly engagement in high-impact lower extremity activities beginning at a young age. Diagnosis requires a triad of painful symptoms, positive clinical signs, and corroborative radiographic parameters. First-line treatment is typically conservative management with dedicated physical therapy focusing on core and hip strengthening. If conservative management is unsuccessful in providing durable symptomatic improvement, then surgery with conventional hip arthroscopy consisting of CAM/pincer resection, labral repair, and cartilage procedures as indicated can result in excellent patient reported outcomes and high rates of return to sport.

Women with type 2 diabetes have an increased risk of bone fragility and fractures. Experimental models suggest that dipeptidyl peptidase-4 inhibitors (DPP4-Is) may have protective effects on bone, but clinical data remain limited, and randomized trials targeting bone Outcomes are lacking. This study aimed to evaluate the efficacy and safety of 52 weeks of oral sitagliptin treatment in improving bone Outcomes in women with type 2 diabetes. This multicenter, phase III, superiority, double-blind, randomized, placebo-controlled trial enrolled 132 women with type 2 diabetes in monotherapy with metformin and stable glycemic control. Participants were recruited from diabetes Outpatient clinics at Sapienza University of Rome, Italy, and were randomly assigned to receive sitagliptin or placebo for 52 weeks. The main outcome was a change in bone mineral density (BMD) and bone turnover biomarkers. Both intention-to-treat (ITT) and per-protocol (PP) analyses were conducted. Treatment with sitagliptin preserved the total proximal femur BMD T score over 52 weeks (estimated mean difference: - 0.02; 95% confidence interval: - 0.07; 0.03; p = 0.46), whereas the placebo group showed a significant reduction (estimated mean difference: - 0.13; 95% confidence interval: - 0.19; - 0.07; p < 0.0001). The between-group difference was significant in favor of sitagliptin (estimated mean difference: 0.11; 95% confidence interval: 0.03; 0.19; p = 0.0063). No significant differences were detected in other skeletal sites or bone turnover markers. PP analysis confirmed the results obtained in the ITT analysis. Compared with the placebo, sitagliptin significantly reduced the levels of inflammatory mediators involved in bone metabolism. No within- or between-group differences in glucose control at 52 weeks were reported. No serious adverse events were reported; five mild to moderate adverse events occurred and were equally distributed between the two groups. Sitagliptin treatment was associated with preservation of total hip T score in women with type 2 diabetes, without consistent effects on other bone sites or turnover markers. These findings suggest a potential additional benefit of sitagliptin beyond blood glucose control and warrant confirmation in longer-term studies, also including populations at higher fracture risk. EudraCT number: 2018-000859-40 (registered 15 March 2018); ClinicalTrials.gov identifier: NCT06770894 (retrospectively registered).

Hip arthroscopy has become an increasingly common and effective surgical technique for the diagnosis and treatment of various intra-articular hip disorders. While generally considered safe and minimally invasive, the procedure is not without risks. The increasing volume and complexity of hip arthroscopies has led to a rise in reported complications, highlighting the importance of understanding potential adverse events and their management. This Current Concepts Review aims to summarize the types, causes, and management strategies of complications associated with hip arthroscopy, emphasizing the importance of early recognition and evidence-based intervention to minimize morbidity based on the authors' experience and the available literature. Complications can be broadly categorized into neurovascular injuries, iatrogenic chondral and labral damage, fluid extravasation, deep vein thrombosis, and heterotopic ossification. Neuropraxia-particularly involving the pudendal and lateral femoral cutaneous nerves-is among the most common adverse events, often related to traction use and duration. Iatrogenic damage during portal placement or instrumentation is also significant, necessitating precise surgical technique and anatomical knowledge. Fluid extravasation, though rare, can result in abdominal compartment syndrome and requires prompt diagnosis. Effective management includes preventive measures such as appropriate patient positioning, limited traction time, and vigilant intraoperative monitoring. Though complications in hip arthroscopy are relatively uncommon, their potential impact necessitates a thorough understanding of risk factors, preventive strategies, and prompt intervention protocols. Improved surgical techniques, enhanced imaging modalities, and comprehensive training programs are essential for minimizing adverse outcomes and improving patient safety in hip arthroscopy.

Periacetabular osteotomy (PAO) treats developmental dysplasia of the hip (DDH) by reducing load on the hip and improving joint function. Untreated DDH affects lower extremity alignment and alters knee morphology, with valgus alignment more pronounced in hip osteoarthritis secondary to DDH. While PAO may influence knee mechanics, its association with subchondral bone density in the tibiofemoral joint remains unclear. (1) To what degree is PAO associated with changes in the distribution of subchondral bone density in the knees of patients with DDH? (2) Is PAO associated with altered subchondral bone density distribution in patients with DDH such that they more closely resemble a control cohort of patients? We conducted a retrospective chart review to evaluate the association of PAO with knees in female patients with DDH. From January 2015 to December 2021, 69 patients (≤ 49 years of age, center-edge angle ≤ 25°) underwent PAO. Of these, 38% (26) of patients were included after excluding patients for bilateral operations, lack of follow-up, or incomplete CT data. A power analysis required at least 20 hips per group based on the past study. For comparison, we reviewed 63 patients undergoing joint-preserving surgery for idiopathic osteonecrosis from January 2014 to December 2024, with 32% (20) of female patients meeting criteria (unilateral hip necrosis only) for the control group. PAO resulted in sufficient acetabular coverage and improved clinical scores in patients. Importantly, no change in lower limb alignment was observed postoperatively. The distribution and quantification of subchondral bone density in the proximal tibial articular surface were measured using CT osteoabsorptiometry (CT-OAM). This was achieved by assessing radiodensity variations in Hounsfield units (HUs) and mapping these as two-dimensional visualizations. The high-density area within these regions was defined as the top 20% of HUs. The medial and lateral tibial compartments were divided into three subregions of equal width in the coronal direction: lateral-lateral, lateral-central, lateral-medial, medial-medial, medial-central, and medial-lateral. Each subregion percentage represented by the high-density area was calculated (percentage of high-density area). Our primary study goal was to evaluate the association of PAO with changes in subchondral bone density distribution in the knees of patients with DDH. To achieve this, we utilized CT-OAM to map subchondral bone density patterns before and after surgery. Our secondary study goal was to determine whether PAO results in a subchondral bone density distribution in patients with DDH that more closely resembles that of a control cohort without DDH. For this goal, we analyzed radiographic and CT data to identify changes in high-density areas across tibial plateaus and compared preoperative and postoperative results within the PAO group and between the PAO and control groups. Preoperatively, the mean ± SD percentage of high-density area of the medial region was lower in the PAO group compared with the control group (control versus PAO preoperative 61% ± 12% versus 50% ± 20%; p = 0.02). After PAO, the percentage of high-density area of the medial region increased (preoperative versus postoperative 50% ± 20% versus 58% ± 19%; p = 0.003) and was not different from the control group postoperatively (control versus PAO postoperative 61% ± 12% versus 58% ± 19%; p = 0.16). Our findings suggest that DDH may cause a lateral shift in knee loading distribution. PAO appears to modify this loading pattern, based on subchondral bone density, making it more similar to one in a control cohort of knees. However, long-term follow-up studies are necessary to confirm whether early changes in subchondral bone density because of PAO are associated with subsequent knee degeneration. Level III, therapeutic study.

Sagittal plane alignment affects hips with conditions such as femoroacetabular impingement and hip dysplasia. Increasing anterior pelvic tilt (pelvis rocking forward) improves femoral head coverage in patients with dysplasia. Increasing posterior pelvic tilt improves internal rotation in patients with femoroacetabular impingement. Physical therapy may functionally decrease anterior pelvic tilt, allowing the hip joint further range of motion before impinging and, thus, alleviating symptoms.

Femoroacetabular impingement syndrome (FAIS) is a motion-related hip disorder characterised by altered hip-joint morphology and symptoms. Recent consensus statements have provided guidance on the diagnosis and management of FAIS but given the knowledge gaps in translating research into practice, it is unclear at what level this is being utilised by primary contact physiotherapists. This study undertook a cross-sectional multi-centre international survey to describe contemporary physiotherapy practice for the diagnosis and management of femoroacetabular impingement syndrome (FAIS). An online survey comprising 32 questions based around current consensus recommendations for the diagnosis and management of FAIS, was developed. The survey was distributed to six English-speaking countries (Australia, Canada, Ireland, New Zealand, South Africa and the United Kingdom) where physiotherapists work as primary contact practitioners. Questions were answered with a 5-point Likert scale. To describe the 'most commonly' utilised tools for diagnosis and management, the two highest ranked responses ('always' and 'often') were combined for analysis and presented as a percentage of total respondents. Four hundred and twenty-nine (72%) of eligible respondents were included. Respondents varied across the six countries, 58% were female, and most worked in private practice (70%). When diagnosing FAIS, patient-reported signs/symptoms (90%), functional tests (88%), special tests (87%), and strength assessments (70%) were 'most commonly' used, while imaging (60%) and balance assessment (33%) were less frequently implemented. Most respondents employed strengthening exercises (97%) and education (96%) in their management of FAIS, and some utilised range of motion/stretching (62%), and manual therapy (62%). Half of the respondents (52%) use patient-reported outcome measures to assess treatment effectiveness. Our findings of physiotherapy diagnosis and management of FAIS from six countries broadly aligns with contemporary expert recommendations. Physiotherapy diagnosis of FAIS in practice is guided by patient-reported symptoms, and functional and special tests. Central to physiotherapy management is exercise and advice/education. Other modalities are less frequently utilised. Not applicable.

There is disagreement regarding use of hip orthoses after arthroscopic surgery for femoroacetabular impingement syndrome (FAIS). Few data exist on the postoperative effect of bracing in this context. It was hypothesized that at 6 weeks after arthroscopic surgery for FAIS, patients wearing a brace would have significantly lower mean Numerical Pain Ranking Scale (NPRS) score compared with those who did not wear a brace. Secondary goals included comparison of additional patient-reported outcome measures, physical examination findings, complications, and use of medications or injections at 6 weeks and 6 months postoperatively. Randomized controlled trial; Level of evidence 1,Methods:An intention-to-treat randomized controlled trial for treatment superiority was performed. Inclusion criteria were patients aged 14 to 60 years undergoing arthroscopic osteoplasty and labral repair for FAIS. Patients who would not be able to undergo follow-up in clinic or who did not speak English were excluded. Patients were randomized to brace and no-brace groups at their preoperative appointment. Braces were worn full-time for 3 weeks postoperatively and then weaned. Surgeries were performed by a single surgeon who was not aware of brace assignment. Patients completed NPRS, Hip disability Osteoarthritis Outcome Score (HOOS), and Veterans Rand 12 (VR-12) assessment at regular intervals with a primary endpoint of 6 weeks after surgery. The study was designed to have 80% power to detect a clinically meaningful difference in NPRS of 1.2 points (32 patients per group). In this randomized controlled trial, patients who wore a hip brace after FAIS surgery did not experience less pain (mean NPRS) at 6 weeks postoperatively compared with patients who did not wear a brace. Clinicaltrials.gov NCT04599296.