2025年12月科研进展JCRQ 3-4

Though Femoroacetabular impingement (FAI) is thought of as primarily a hip condition an increasing body of evidence has demonstrated the existence of a relationship between the hip joint and lumbopelvic spine, termed the hip-spine syndrome (HSS). This review will provide an overview of the relevant pelvic parameters, proper HSS patient evaluation, describe how lumbar pathology may mechanistically affect the hip, provide a literature review of biomechanic and outcome papers exploring the subject, and finally investigate potential interventions that can be considered in these challenging patients. Deviations from normal ranges in pelvic parameters have been shown in biomechanical studies to worsen FAI by decreasing the range of impingement free motion. The clinical relevance of this is still being determined. Patients with concomitant lumbar spine pathology may significantly improve after hip arthroscopy, though they may have a lower ceiling than comparable patients without lumbar spine pathology. Surgeons and patients should be aware of the HSS. Alterations in pelvic parameters may affect outcomes, though this still has to be determined. Patients with lumbar spine pathology and FAI can still be treated successfully with hip arthroscopy, though should be counseled appropriately.

Hip arthroscopy (HA) for femoroacetabular impingement (FAI) is increasingly performed in professional athletes, yet sport-specific return-to-sport (RTS) outcomes remain limited. To assess return-to-sport rates and postoperative outcomes after HA for FAI in a cohort of professional athletes across multiple sports. A retrospective cohort study was conducted using data from a hip preservation registry, including 128 professional athletes (157 hips) treated between 2009 and 2023. Athletes were categorized into 4 sports: baseball, basketball, football, and ice hockey. RTS was defined as athletes recording professional statistics before injury, undergoing surgery, and logging professional statistics postoperatively. Demographic, clinical, and radiographic data were analyzed, and statistical performance measurements were calculated to assess postoperative performance changes. Logistic regression was used to identify predictors of RTS. Hip arthroscopy for FAI was associated with a high overall rate of RTS in this cohort of professional athletes. RTS rates and performance outcomes were not significantly different by sport. Median changes in performance metrics across all sports were modest, suggesting that most athletes returned to a similar level of performance postoperatively. Outliers in the hockey cohort notably influenced mean performance values. Athletes undergoing revision surgery demonstrated a lower RTS rate compared with those undergoing primary procedures.

To evaluate the outcomes and return-to-sport rates of hip arthroscopy as treatment for femoroacetabular impingement syndrome (FAIS) and labral tears in competitive soccer players at mid-term follow-up, with a subanalysis of return to sport based on sex and competitive level. We retrospectively analyzed data of all patients who underwent hip arthroscopy as treatment for FAIS between February 2008 and January 2019. Included patients reported competitive soccer participation and completed preoperative and minimum 5-year postoperative questionnaires for at least one of several patient-reported outcomes-modified Harris Hip Score (mHHS), Non-arthritic Hip Score (NAHS), Hip Outcome Score-Sports Specific Subscale (HOS-SSS), International Hip Outcome Tool (iHOT-12), and visual analog scale for pain-or underwent documented revision surgery or conversion to arthroplasty. An overall return-to-sport analysis was conducted, with a subanalysis considering preoperative competitive level and sex. A total of 65 patients (74 hips) were included. Patients experienced improvements in the mHHS (67.0 to 90.4), NAHS (65.4 to 89.1), HOS-SSS (42.5 to 82.1), and iHOT-12 score (37.7 to 81.3) (P < .01 for all). Patients reached the minimal clinically important difference for the mHHS, NAHS, HOS-SSS, and iHOT-12 score at rates of 81.7%, 78.9%, 83.8%, and 92.6%, respectively. Patients met the patient acceptable symptom state for the mHHS, NAHS, HOS-SSS, and iHOT-12 score at rates of 76.1%, 76.1%, 65.7%, and 68.5%, respectively. Of the 54 patients who attempted to return to soccer at any time point, 47 (87.0%) were successful. Of these 47 patients, 32 (68.1%) continued playing soccer at 5 years postoperatively. No differences were observed when comparing return-to-soccer rates by sex or competitive level. Hip arthroscopy for FAIS and labral treatment in soccer players resulted in significant improvements in functional outcomes, with a high percentage of patients achieving important clinical thresholds. There was a high rate of return to soccer, enabling a substantial number of patients to continue playing at a minimum 5-year follow-up. Level IV, retrospective case series.

The management of cam morphology of FAI associated with osteoarthritis (OA) is debated. However, current surgical indications are becoming obsolete, and hip arthroscopy spreads in different settings. The present clinical trial evaluated the outcome of one-stage unilateral hip arthroscopy and contralateral total hip arthroplasty (THA) in patients with bilateral cam deformity associated with labral tears and early and advanced OA stages, respectively. The outcomes of interest were patient-reported outcome measures (PROMs) and the rate of complications. All patients who underwent one-stage THA and contralateral hip arthroscopic for symptomatic cam deformity were prospectively invited to participate in the present study. Arthroscopies were performed first with patients in a supine position on a traction bed under fluoroscopic control. Three standard portals were used. The intraarticular joint space was inspected, and the peripheral acetabular labral lesions were selectively debrided. Cam bunectomy was performed, and labral tears were debrided and repaired using bio-resorbable anchors. After arthroscopy, patients were positioned in a lateral position, and THA was performed using a minimally invasive posterolateral approach. All patients received uncemented short stems with ceramic heads and vitamin-E augmented polyethylene (GTS, Zimmer Biomet, United States or 3C, Link, Germany). All 16 patients were men, with a mean age of 41 years ±7.9. The mean length of the follow-up was 4.2 ± 1.3 years (range, 2 to 6). All patients returned to their normal daily activities within one month. PROMs were statistically significantly increased from baseline to the last follow-up in all patients. No patient experienced minor or major complications. One patient required THA five years after arthroscopy for symptomatic and radiographic progression of osteoarthritis. No other patients progressed to THA. No patient underwent revision surgery for failed arthroscopy. One-stage arthroscopy and contralateral arthroplasty are effective in managing FAI combined with early and mild to severe OA, respectively.

In patients with end-stage renal disease (ESRD), vascular calcification significantly impairs hemodialysis (HD) vascular access functionality, compromising both dialysis efficacy and long-term patency. Early risk prediction of vascular calcification facilitates timely clinical interventions to preserve vascular access integrity. A cross-sectional analysis was performed. Risk factors for vascular calcification in CKD patients were identified from the literature and Kidney Disease: Improving Global Outcomes guidelines. All variable selection and model training procedures were conducted on the training set. Univariate logistic regression was performed for all candidate variables. A nomogram was then constructed based on the final multivariate logistic model to facilitate clinical interpretation. A total of 136 HD patients were included. The predictive model, relying on arteriovenous (AV) access usage time, hip circumference, and diabetes status, is reliable and clinically actionable tool for predicting AV access calcification. Its robust performance across validation and subgroup analyses supports its potential for integration into routine clinical practice. This study developed a nomogram-based predictive model for calcification, providing a simple, cost-effective, and reliable tool for early risk assessment. Monitoring hip circumference may serve as a practical approach for identifying high-risk patients, allowing for timely intervention and improved vascular access outcomes.

Long-term results of modified Steel's triple pelvic osteotomy were evaluated to confirm if this osteotomy is indicated in the era of other redirectional osteotomies and if it can delay total hip arthroplasty (THA). In total, 317 osteotomies were performed on 225 women and 58 men between 1985 and 2012 in one institution. Thirty-four women and three men underwent bilateral surgery. Harris hip scores (HHS) and nonarthritic hip scores (nAHS) and LCE angle, Sharp-Ulmann angle and signs of acetabular version were compared. The results were statistically evaluated using a paired t-test. In total, 55 women and 21 men were contacted. Of these, 35 women and 21 men completed the questionnaires for 68 hips. The follow up ranged from 5 to 32 years (mean 18.5 years). Of the 68 hip joints, 27 had excellent or good results according to HHS and 24 for nAHS. A total of 12 patients underwent THA. Concerning the radiological evaluation, the LCE angle increased from 12° to 34° and Sharp-Ulmann angle decreased from 49° to 36°. Signs of retroversion of the acetabulum occurred in 24 patients without of necessity of surgical treatment. Non-union (five patients) represents the most frequent complication. Steel's triple pelvic osteotomy is still indicated as a safe and effective technique for preserving hip joints and delaying THA. The disadvantage of osteotomy is a relatively long-term recovery time and lower satisfaction compared to THA.

Total hip arthroplasty (THA) and hip resurfacing arthroplasty (HRA) are established treatments for hip osteoarthritis. Recent advancements have introduced short-stem THA, which offers potential advantages in terms of bone preservation and biomechanical restauration. None of previous studies compared these three surgical interventions. The aim of this network meta-analysis (NMA) is to compare HRA, short stem and standard stem in THA in terms of: (1) complications rate (global, infection and dislocation rate), (2) clinical outcomes (WOMAC, Harris Hip Score (HHS), Oxford Hip Score (OHS), Forgotten Joint Score (FJS), Postel Merle Aubigné Score (PMA) and SF-36) at short- and mid-term, (3) procedure-related variables (operative time, pain at day one and length of stay). A systematic literature review was conducted using multiple electronic databases (Medline, Central and Embase) to identify comparative studies evaluating at least two of the three surgical interventions. Studies were included if they reported one of our outcomes. Data synthesis was performed using a Bayesian NMA. A total of 72 studies including, 793 593 patients (mean age 54.7 years), met the inclusion criteria. The most common comparison was standard-stem THA/ HRA (94,4% of the studies). The NMA did not identify differences for the rate of global complications between short stem THA/standard-stem THA (risk ratio (RR) 1.52 [95% CI 0.41-5.96]), HRA/standard-stem THA (RR 1.17 [95% CI 0.85-1.66]) and HRA/short-stem THA (RR 0.77 [95% CI 0.20-2.95]). Regarding infection and dislocation, standard THA had a higher rate of infection (risk ratio 2.14 [95% CI 1.33-5.44]) and of dislocation (risk ratio 13.45 [95% CI 3.37-98.21]) compared to HRA. For functional outcomes at short term, no differences were observed between HRA and standard-stem THA for WOMAC (Mean Difference (MD) -0.01 [95% CI -0.51 to 0.40]), HHS (MD 0.05 [95% CI -3.26 to 3.45]), PMA (MD -0.13 [95% CI -0.94 to 0.71]) and FJS (MD -1.64 [95% CI -9.04-5.45]). For functional outcomes at mid-term, no differences were observed between HRA and standard-stem THA for WOMAC (MD -0.07 [95% CI -1.13 to 1.05]), HHS (MD -0.02 [95% CI -1.55 to 1.36]), PMA (MD -0.03 [95% CI -0.60 to 0.49]) and SF-36 (MD 0.11 [95% CI -3.37 to 3.61]). No difference was observed for comparison of short-stem THA/standard-stem THA and HRA/short-stem THA for clinical outcomes.The surgical time was shorter for HRA compared to short-stem THA (MD-34.05 [95% CI -53.25 to -13.28]) and standard-stem THA (MD -16.25 [95% CI -24.84 to -7.53]). No difference was observed between HRA and standard-stem THA for VAS at day one (MD 0.22 [95% CI -1.90 to 2.13]) and for the length of stay (MD 0.48 [95% CI -0.27 to 1.34]). HRA demonstrated had lower infection and dislocation rate compared to standard THA. HRA also offers a shorter operative time. However, no difference was observed for functional outcome between the three technics. These findings support the notion that the choice of technique should be tailored to patient-specific characteristics, highlighting the potential shift towards personalized hip arthroplasty. III; Network meta-analysis.

Bilateral hip symptoms are a common finding in patients with femoroacetabular impingement (FAI). There is a paucity of literature regarding midterm outcomes in patients undergoing staged bilateral hip arthroscopy. The purpose was to present and compare minimum 5-year outcomes between patients who underwent bilateral hip arthroscopic surgery for FAI to a propensity score-matched benchmark control group of patients who underwent unilateral hip arthroscopy and to investigate the effect of time between staged bilateral procedures. It was hypothesized that patients who underwent bilateral hip arthroscopy would demonstrate similar functional outcomes and complication rates compared with those who underwent unilateral surgery. Cohort study; Level of evidence, 3. Data from patients who underwent primary hip arthroscopy from June 2008 to October 2018 were retrospectively collected. Patients who underwent bilateral hip arthroscopy with a minimum 5-year follow-up, including modified Harris Hip Score, Nonarthritic Hip Score, Hip Outcome Score-Sports-Specific Subscale (HOS-SSS), visual analog scale for pain, and patient satisfaction scores, were included. The bilateral group was propensity score matched 1:1 to a control group that underwent unilateral hip arthroscopy based on age, sex, and body mass index. Patients who underwent unilateral and bilateral hip arthroscopy for FAI showed significant and comparable improvements at a minimum 5-year follow-up. Bilateral-presenting patients who underwent staged procedures ≤9 weeks apart met clinically significant thresholds at a higher rate compared with bilateral-presenting patients who had their procedures spaced >9 weeks apart.

Developmental dysplasia of the hip (DDH) with complete dislocation (grade ≥III) in older patients often requires open reduction. However, achieving long-term stability remains challenging. This study introduces and evaluates a novel surgical technique, intraosseous tunneling and ligamentodesis of the ligamentum teres (LT), conceived to enhance postoperative hip stability while preserving the ligament's anatomic course. Pediatric patients with grade ≥III DDH, as classified by the International Hip Dysplasia Institute (IHDI), underwent open reduction using a novel ligamentum teres ligamentodesis technique to enhance joint stability. The ligament was detached, sutured, and tunneled intraosseously from the fovea to the greater trochanter, then anchored to the periosteum. Postoperative evaluation included gait status, pain, hip range of motion, reluxation, residual dysplasia, avascular necrosis (AVN), physeal bars, growth arrest, complications, and need for reintervention. Nineteen hips in 16 patients (14 females, 2 males) with a median age of 24 months underwent LT intraosseous ligamentodesis combined with femoral and pelvic osteotomies. At a median follow-up of 23 months, all patients were pain-free, had normal gait, and no functional limitations, except for one case of persistent limping and one hip with mild limitation of abduction. Radiographically, all hips achieved satisfactory outcomes with IHDI type I, and severing grades I (80%) and II (20%). No cases of redislocation, dysplasia, infection, physeal bars, or growth arrest were observed. Two hips (10.5%) developed asymptomatic AVN. The ligamentum teres intraosseous ligamentodesis ("Teretization") is a safe and technically feasible adjunct to open reduction in severe DDH, demonstrating favorable mid-term outcomes with no redislocations and low complication rates. These findings support its potential role in enhancing hip stability without jeopardizing femoral head physis and vascularity. Level IV-therapeutic case series. This study evaluates a novel surgical technique in a series of patients with congenital hip dislocation without a control group.

To compare patient-reported outcomes in patients with femoral retroversion (<5° of femoral anteversion) treated with either isolated hip arthroscopy (HA), femoral derotation osteotomy (FDO), or a combined procedure. Patients treated between 2013 and 2019 were identified from an institutional hip preservation registry. Inclusion criteria were age 14 to 60 years, femoral version <5° as measured on preoperative computed tomography, and a minimum 1-year follow-up. Patients underwent isolated HA, isolated FDO, or combined HA + FDO. The primary outcome was improvement in the modified Harris Hip Score. Secondary outcomes included hip range of motion, postoperative complications, revision surgery rates, and achievement of minimum clinically important difference (MCID), substantial clinical benefit, and patient acceptable symptomatic state (PASS). A total of 82 patients met the inclusion criteria. The combined HA + FDO group had the greatest improvement in modified Harris Hip Score, followed by the FDO group, then the HA group (P = .001). A significantly higher proportion of FDO patients achieved the MCID (95%) compared to HA patients (67%) (P = .03). PASS was also more frequently achieved in the FDO and combined groups (90% and 78%, respectively) compared to HA (48%) (P = .004). No patients required conversion to total hip arthroplasty. In patients with femoral retroversion, treatment with FDO, either alone or combined with HA, resulted in greater improvements in functional outcomes and higher rates of MCID and PASS compared to isolated hip arthroscopy. Level III, retrospective comparative case series.

Although multiple studies have examined the efficacy of muscle-sparing techniques in reducing dislocation after posterior approach THA, their findings are limited by small sample sizes and short follow-up durations, and to our knowledge, none have specifically evaluated outcomes in high-risk patients. This study compared the overall and 90-day dislocation risks of the previously described external rotator preservation (ERP) and standard posterior approach THA in high-risk patients. We retrospectively reviewed patients who underwent THA between January 2008 and December 2022 at three tertiary centers, including those who had osteonecrosis of the femoral head (ONFH), inflammatory arthritis (IA), or a history of lumbar spinal fusion. Patients who underwent the ERP approach were identified from medical records and matched 1:1 to controls (standard posterior approach) by age, sex, body mass index, American Society of Anesthesiologists score, year of surgery, and surgical indication, yielding 501 patients per group. Binary logistic regressions were used to compare overall and 90-day dislocation risk. Kaplan-Meier analysis evaluated revision due to dislocation and all-cause revision. Surgical complications, Harris Hip Score (HHS), and postoperative radiographic parameters were compared. The mean follow-up was 10.7 years. The ERP group showed lower overall (odds ratio, 0.25; P < 0.001) and 90-day dislocation risks (odds ratio, 0.20; P = 0.002). Subgroup analyses revealed reduced dislocation risks in the ONFH and IA patients, with no difference in the lumbar spinal fusion subgroup. The estimated 10-year survivorship free from both revision for dislocation (P = 0.302) and any revision (P = 0.739) was similar. Other complications, the latest Harris Hip Score, and radiographic parameters were comparable. The ERP approach for THA demonstrated lower overall and 90-day dislocation rates compared to the standard posterior approach in patients at high risk of dislocation without compromising long-term outcomes. The ERP may serve as an effective option for performing posterior approach THA in ONFH and IA patients. Level III, retrospective cohort study.