2025年11月 保髋进展 JCRQ 3-4

To investigate the 10-year outcomes of hip arthroscopy in femoroacetabular impingement syndrome (FAIS), comparing the impact of cam lesion location (superolateral, anterolateral, or anterior) on total hip arthroplasty (THA) conversion rates, revision rates, and patient-reported outcomes (PROs). This retrospective cohort study evaluated patients who underwent primary hip arthroscopy for FAIS between 2010 and 2013. Included patients had preoperative radiographic evidence of cam lesions and a minimum of 10 years of follow-up data. Patients were categorized by cam lesion location: superolateral, anterolateral, or anterior. Outcomes included revision rates, conversion to THA, and PROs measured with the modified Harris Hip Score (mHHS) and Non-Arthritic Hip Score (NAHS) at 10 years. Statistical analyses were performed using independent t tests, analysis of variance, Fisher exact tests, and multivariable regression. A total of 157 patients were included, with a mean follow-up of 11.66 ± 1.08 years. The cohort included 93 patients with superolateral cam lesions, 38 with anterolateral lesions, and 26 with anterior lesions. Revision rates were 0% for anterior lesions, 7.89% for anterolateral lesions, and 4.3% for superolateral lesions (P = .3806). THA conversion rates were 7.69% (anterior), 2.63% (anterolateral), and 8.6% (superolateral) (P = .3558). 10-year mHHS (superolateral: 86.7 ± 18.85; anterolateral: 85.97 ± 18.76; anterior: 90.99 ± 11.61; P = .4932) and NAHS (superolateral: 83.92 ± 19.84; anterolateral: 84.73 ± 20.83; anterior: 89.62 ± 13.27; P = .4076) were comparable across groups. Achievement of the MCID was high across all groups, with 89.2% (140/157) of patients reaching the mHHS MCID and 91.1% (143/157) reaching the NAHS MCID with no significant differences by cam lesion location for either mHHS (P = .526) or NAHS (P = .999). Multiple linear regression analysis identified greater BMI (mHHS: P = .0005; NAHS: P < .0001) and female sex (mHHS: P = .0245; NAHS: P = .0115) as predictors of worse outcomes. Logistic regression analysis found that female sex (P = .0451), elevated Tönnis grade (P = .0015), and elevated Outerbridge grade (P = .0474) were associated with increased rates of THA conversion and revision. Cam lesion location does not significantly affect revision rates, THA conversion, or long-term PROs. Factors such as BMI, sex, Outerbridge grade, and Tönnis grade are more influential on long-term outcomes. Level III, retrospective diagnostic comparative case series.

Like all diagnoses and comorbidities, patients with hip pain should be managed with individualized treatment plans. Patients with fibromyalgia undergoing hip arthroscopy are no different. Even if their absolute scores remain lower than those without fibromyalgia, these patients can achieve clinically meaningful improvements in patient-reported outcomes after treatment of femoroacetabular impingement. As orthopaedic providers, we should be aware of potential bias against patients with chronic musculoskeletal pain and critically evaluate the literature that supports clinically relevant improvement after surgical intervention. Fibromyalgia should not be viewed as a condition that excludes or increases the threshold for hip arthroscopy but rather as a factor requiring nuanced, multidisciplinary perioperative care and realistic goal-setting.

Although primary labral reconstruction for patients with femoroacetabular impingement syndrome produces favorable outcomes, there is a paucity of data regarding revision reconstruction for failed primary labral repair. Although revision labral reconstruction for failed labral repair can produce favorable results, it has been shown that it typically leads to inferior patient-perceived functional status compared with primary reconstruction. Surgeons must be prudent when evaluating the labrum intraoperatively and decide whether it stands a chance for successful repair, with a low threshold to reconstruct in the setting of compromised labral tissue and/or repair. Revision labral reconstruction in the setting of failed repair remains challenging and in need of higher-quality investigation.

To evaluate the outcomes of endoscopic sciatic neurolysis and piriformis release as treatment for piriformis syndrome with a minimum 2-year follow-up, as well as present a comprehensive approach to enhance diagnostic accuracy. Prospectively collected data were retrospectively analyzed for all patients who underwent endoscopic piriformis release and sciatic neurolysis as a treatment for piriformis syndrome between 2010 and 2021. A diagnostic algorithm was employed for surgical indications throughout this time period. Included patients had completed preoperative and a minimum of 2-year postoperative questionnaires for the following patient-reported outcome measures: modified Harris Hip Score (mHHS), Non-Arthritic Hip Score (NAHS), Hip Outcome Score-Sports Specific Subscale (HOS-SSS), and visual analog scale (VAS) for pain and patient satisfaction. The minimal clinically important difference was calculated for the mentioned patient-reported outcome and included in the analysis. A total of 18 patients with a mean follow-up time of 93.1 ± 38.2 months were included in the study. All patients experienced symptom relief postoperatively. Significant improvement was seen at latest follow-up compared to preoperative baseline for mHHS (P < .001), NAHS (P < .001), HOS-SSS (P = .019), and VAS (P < .001), as well as a high mean patient satisfaction of 8.3 ± 1.7. Furthermore, a high percentage of patients reached the calculated minimal clinically important difference for mHHS (83.3%), NAHS (77.8%), HOS-SSS (61.1%), and VAS (94.4%). Endoscopic release of the piriformis tendon and sciatic neurolysis have shown favorable outcomes, high patient satisfaction rates, and a high percentage of patients reaching clinically important thresholds, with a low rate of complications at a minimum 2-year follow-up. Level IV, retrospective case series.

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.

The extent of antero-lateral wall preservation is crucial for early osteonecrosis of the femoral head (ONFH) prognosis. This study aimed to assess the predictive value of the anterior preserved angle (APA) and lateral preserved angle (LPA) of the femoral head in postcollapse ONFH prognosis. There were 77 patients (102 hips) who had Association Research Circulation Osseous stage III A ONFH enrolled in this study, with an average follow up of 7.3 years. Hips were categorized into the favorable and poor function groups based on the Harris Hip Score and whether a conversion to total hip arthroplasty occurred during follow up. The lateral preserved angle and anterior preserved angle were measured to quantify unaffected antero-lateral femoral head regions. Univariate and multivariate analyses were conducted to identify independent factors associated with hip function status. Cutoff values of LPA and APA were determined from receiver operating characteristic curves for predicting favorable hip function, while the survival rates were assessed using Kaplan-Meier survival analysis. Ultimately, there were 49 hips in the poor function group and 52 hips in the favorable function group. Multivariate Cox regression analysis identified both LPA and APA as independent protective factors for hip function. Cutoff values were 44.6° for LPA and 41.1° for APA, respectively. The 10-year survival rates with poor joint function as the endpoint were 87.5% for LPA ≥ 44.6° and 17.6% for LPA <44.6° as well as 88.1% for APA ≥ 41.1° and 23.4% for APA < 41.1°. Similar results were obtained when considering collapse progression and secondary osteoarthritis changes as endpoints, respectively. Additionally, a satisfactory prognosis was observed when LPA ≥ 44.6° was combined with APA ≥ 41.1°. In ONFH, femoral head collapse does not necessarily indicate a poor prognosis. Specifically, cases with LPA ≥ 44.6° and APA ≥ 41.1° are expected to have a favorable prognosis, enabling long-term "survival with collapse."

Femoral head fractures are complex injuries often associated with high-energy trauma and hip dislocation. Surgical hip dislocation (SHD), particularly the Ganz trochanteric flip osteotomy, was developed to provide extensive intra-articular access while preserving the femoral head's vascular supply. However, a consolidated synthesis of its outcomes is needed. This systematic review aims to evaluate the clinical and radiological outcomes, complication profiles, and key technical considerations of SHD for the management of femoral head trauma. A systematic literature search was conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) 2020 guidelines across five databases (PubMed, Scopus, Embase, Web of Science, and Cochrane Library) on October 2, 2025. Studies reporting functional or radiological outcomes of SHD for femoral head trauma were included. The risk of bias was assessed using the ROBINS-I tool. Data on study characteristics, functional scores, and complications were extracted and synthesized narratively due to heterogeneity. Ten studies involving 267 patients were included. The majority of studies reported good to excellent functional outcomes, with mean modified Harris Hip Scores and Merle d'Aubigné scores indicating satisfactory recovery. The rate of avascular necrosis (AVN) was consistently low to moderate, ranging from 0% to 8.3% in most studies, a rate notably lower than historically reported for traditional posterior approaches. However, Pipkin type IV fractures were associated with a poor prognosis, with one study reporting an 87.5% rate of post-traumatic arthritis and a 57.1% conversion to total hip arthroplasty. Heterotopic ossification was a common but often asymptomatic finding. The comparative analysis underscored that early hip reduction (less than six hours) significantly improved outcomes. The overall risk of bias was low for all included prospective and retrospective cohort studies, while the two case series were appropriately judged to have a serious risk of bias inherent to their design. SHD is a safe and effective approach for femoral head trauma, facilitating anatomical reduction and yielding good functional outcomes with a low risk of AVN. The Ganz trochanteric flip osteotomy is the cornerstone technique. Prognosis is highly dependent on fracture type, with Pipkin IV injuries posing the greatest challenge, and the timing of surgical intervention is a critical modifiable factor for success.

Screw fixation and hemiarthroplasty are commonly used surgical options for treating undisplaced femoral neck fractures in the elderly. While fixation preserves the native joint, arthroplasty offers immediate mechanical stability. The optimal treatment remains controversial. A systematic review and meta-analysis was conducted across PubMed, Scopus, Cochrane Library, and Google Scholar through June 2025. Twelve studies (including randomised controlled trials and observational cohorts) encompassing 2190 patients treated with screw fixation and 2606 with hemiarthroplasty were included. Outcomes assessed included intraoperative blood loss, transfusion rates, operation time, hospital stay, pain scores, Harris Hip Score, complication and reoperation rates, and mortality at 1 month and 1 year. Screw fixation was associated with significantly less intraoperative blood loss (MD =  - 162.79 mL), shorter surgery time (MD =  - 31.68 min), and reduced transfusion requirements (RR = 0.30). Hospital stay was shorter by 3.5 days on average. Pain scores at final follow-up were similar between groups (p = 0.55), while Harris Hip Scores were slightly higher with fixation (MD = 2.09), though of questionable clinical relevance. However, fixation carried a markedly higher risk of reoperation (RR = 3.54) and complications such as non-union and osteonecrosis. Mortality at 1 month and 1 year trended lower in the fixation group but did not reach statistical significance. Screw fixation provides notable perioperative advantages and comparable long-term functional outcomes in select elderly patients with undisplaced femoral neck fractures. However, it is offset by a significantly higher risk of failure and reoperation. Hemiarthroplasty, while more invasive, ensures greater mechanical reliability and lower revision rates. Treatment decisions should be individualized based on patient frailty, fracture characteristics, and mobility goals.

To evaluate clinical outcomes and accuracy of patient-specific cutting guides (PSCGs) in double-level knee osteotomy (DLO) patients over a minimum 24-month follow-up. This single-center retrospective case series included consecutive patients who underwent DLO using PSCGs from December 2016 to May 2022. Inclusion criteria comprised symptomatic knee osteoarthritis with varus/valgus malalignment, planned double-level correction, and a minimum 24-month follow-up. Primary outcomes were functional improvement (Western Ontario and McMaster Universities Osteoarthritis Index [WOMAC] scores) and complications; secondary outcomes included alignment accuracy (hip-knee-ankle, medial proximal tibial angle, lateral distal femoral angle, joint line obliquity, joint line convergence angle) and patient satisfaction. The WOMAC scores and achievements of minimal clinically important difference (MCID) and patient acceptable symptom state (PASS) were compared between patients with and without postoperative effusion-synovitis. Statistical analysis used the Mann-Whitney U test for alignment accuracy and paired t tests for functional outcomes. Among 31 patients (35 knees), there was a mean 36.2-month follow-up (range, 24-91 months). Patients' average age was 59.3 ± 5.14 years with a body mass index of 22.1 ± 1.8. Hip-knee-ankle improved from 163.9° to 181.1°, medial proximal tibial angle from 83.9° to 91.5°, lateral distal femoral angle from 94.7° to 85.7°, and joint line convergence angle from 5.6° to 2.4° (all preoperative to postoperative P < .05). Postoperative values showed no significant difference versus planned values (all P > .05). Preoperative joint line obliquity (4.71° ± 2.12°) significantly improved to 2.31° ± 2.02° postoperatively (P = .019), with no significant difference from the target (2.10° ± 1.53°, P = .526). WOMAC total scores decreased from 41.6 to 22.4 (P < .001), with 100% achieving the MCID. PASS rates varied: WOMAC pain (85.3%), stiffness (67.6%), physical function (94.1%), and total (79.4%). Complications included 2 femoral and 1 tibial hinge fractures, plus 6 venous thromboses (all resolved with rivaroxaban). Patient satisfaction was high (26/31 highly satisfied). DLO with PSCGs achieved consistent alignment with preoperative plans, preserved physiological joint line orientation, and sustained functional improvements over 36.2 months. All patients met the MCID for WOMAC total scores, with 94.1% attaining PASS in physical function and 85.3% in pain subdomains at a minimum 24-month follow-up. Level IV, retrospective case series.

Pipkin fractures are rare, complex hip injuries typically caused by high-energy trauma. Surgical management must balance adequate exposure with preservation of femoral head vascularity. We evaluated outcomes of surgical hip dislocation with absorbable screw fixation for Pipkin fractures. We retrospectively reviewed 10 patients with Pipkin fractures treated by surgical hip dislocation and absorbable screw fixation at Foshan Traditional Chinese Medicine Hospital from December 2018 to March 2023. Demographics, Pipkin classification, and injured limb were recorded. All patients had at least 2 years of follow-up. Outcomes included fracture healing time, Modified Harris Hip Score (MHHS), and modified Merle d'Aubigné score. Complications, including avascular necrosis (AVN) and post-traumatic osteoarthritis (PTOA), were documented. At final follow-up, the mean MHHS was 90.3 ± 6.8. Functional results were excellent in 7 patients, good in 2, and fair in 1 (excellent-to-good rate, 90%). Modified Merle d'Aubigné scores paralleled the MHHS. One patient with a Pipkin type III fracture developed AVN; no other major complications were observed. Patients with Pipkin types I and II achieved better functional recovery than those with types III and IV. In treating Pipkin fractures, surgical hip dislocation provides adequate exposure while preserving femoral head vascularity. Bioabsorbable screws achieve stable fixation through their thread design and axial compression, supporting fracture healing. This technique shows promise as a treatment strategy for complex femoral head fractures.