2026年1月 保髋进展 JCR Q3+Q4

Dysplasia is a recognized risk factor for osteoarthritis (OA) of the hip, early diagnosis of dysplasia is important to provide opportunities for surgical interventions aimed at reducing the risk of hip OA. We have developed a pipeline for semi-automated classification of dysplasia using 3D surface models obtained from volumetric CT scans of patients' hips and a minimal set of four clinically annotated landmarks on the acetabular rim (the most proximal, distal, anterior and posterior aspects), combining the framework of the Gaussian process latent variable model with diffeomorphism to create a statistical shape model (SSM), which we termed the Gaussian process diffeomorphic SSM (GPDSSM). We used 192 CT scans, 100 for model training and 92 for testing. The GPDSSM effectively distinguishes dysplastic samples from controls while also highlighting regions of the underlying surface that show dysplastic variations. As well as improving classification accuracy compared to angle-based methods (AUC 96.2% vs 91.2%), the GPDSSM can save time for clinicians by removing the need to manually measure angles and interpreting 2D scans for possible markers of dysplasia.

BACKGROUND: Hip dysplasia and cam morphology are both common causes of hip pain in pediatric patients. However, there is limited literature on how the presence of hip dysplasia may affect the prevalence of cam morphology.

OBJECTIVE: This study aims to assess if hip dysplasia in pediatric patients has a similar prevalence and location of cam morphology compared with non-dysplastic hips.

MATERIALS AND METHODS: This retrospective study assessed pediatric patients with hip pain from April 2012 to June 2024. Data collection was based on chart review and imaging consensus review of all hip MRIs conducted by two musculoskeletal radiologists and a pediatric orthopedic surgeon. Data included were the presence of hip dysplasia, defined as a lateral center-edge angle (LCEA) <18°, cam morphology, and their location. Chi-square and Fisher's exact test were used with p-values for significance set to 0.05.

RESULTS: From our study cohort of 118 hips in 107 patients (mean age 15.3. years, 66% female, 81 hips underwent surgery), there were 64 cam morphology hips present. Cam morphology was present in 55.6% of dysplastic hips and 53.7% of non-dysplastic hips (p = 0.849). Cam morphology was most commonly located anterosuperior femoral head-neck in 70% of dysplastic hips and 65.9% in non-dysplastic hips (p = 0.747).

CONCLUSION: Cam morphology is frequently identified in pediatric patients with hip pain. The prevalence and location of cam morphology is not affected by the presence of co-existing hip dysplasia. During imaging work-up and treatment planning, it is important to recognize that a high proportion of pediatric hip dysplasia patients may have a co-existing cam morphology.

BACKGROUND: Hip distraction is essential for hip arthroscopy and other orthopaedic surgeries, but high traction forces often lead to complications like nerve injury and soft tissue impairment. Patients with total knee arthroplasties (TKAs) may face increased risk due to altered joint mechanics; however, the impact of specific TKA configurations on knee behavior during distraction is poorly understood.

METHODS: A validated finite element model of the pelvis and lower extremity was developed from patient CT and MRI data. Three configurations were modeled: bi-cruciate retaining (BCR), posterior-cruciate retaining (PCR; lacking ACL), and posterior-stabilized (PS; lacking both cruciates). Hip distraction was simulated with axial traction forces (100-500 N) applied to the distal tibia/fibula with the pelvis fixed proximally. Knee and hip joint displacement and ligament strains were evaluated.

FINDINGS: The BCR model demonstrated the highest knee stiffness. ACL removal (PCR) reduced stiffness more compared to PCL removal. While the amount of hip distraction was consistent across models, PCR and PS knees experienced excessive knee distraction (>12 mm) and ligament strains exceeding 20% before achieving 10 mm of hip distraction. Conversely, the BCR model remained under 10 mm of knee distraction and 15% strain at equivalent hip distraction levels.

INTERPRETATION: Finite element analysis revealed that PCR and PS configurations exhibit knee instability, exceeding soft tissue injury thresholds (>20% strain) within standard clinical traction ranges (250-350 N). The ACL contributed greater to knee complex stiffness in axial traction compared to the PCL. Standard traction forces may pose an iatrogenic risk to PCR and PS patients, suggesting a need for TKA-specific distraction protocols to prevent soft tissue failure.

PURPOSE: The Hip Worries Inventory (HWI) is an 11-item questionnaire developed to assess parental concerns related to developmental dysplasia of the hip (DDH) in early infancy. This study aimed to translate the HWI into Dutch and evaluate its psychometric properties.

METHODS: The HWI was translated using a standardized forward-backward translation process. Psychometric evaluation followed COnsensus-based Standards for the selection of health Measurement INstruments (COSMIN) guidelines and included assessments of readability, interpretability, responsiveness, reliability and content validity. Parents of infants aged 3-13 months diagnosed with DDH and managed with active surveillance or abduction bracing with a Pavlik harness were included.

RESULTS: The Dutch version of the HWI was completed by 59 parents prior to treatment and by 50 of them during treatment. In addition, 56 parents completed the questionnaire twice around their child's first birthday. The Dutch HWI demonstrated good readability (Flesch Reading Ease Score = 84.1) and adequate interpretability (mean score 21.53, standard deviation 6.11). Responsiveness was supported by confirmation of 89% of the predefined hypotheses. Internal consistency was good (Cronbach's α = 0.77-0.79) and test-retest reliability was excellent (Intraclass Correlation Coefficient = 0.95; 95% Confidence interval 0.91-0.97). Content validity assessment identified concerns regarding the relevance of items 3-6 for non-brace treatment, the sequencing of items, the use of negatively worded items and the absence of items addressing practical and informational needs.

CONCLUSIONS: The Dutch HWI is a promising instrument for assessing parental concerns related to DDH in early infancy. However, limitations in content validity highlight the need for refinement, incorporating input from parents, caregivers and healthcare professionals to enhance content validity and clinical applicability.

PURPOSE: Developmental dysplasia of the hip (DDH) requires timely, guideline-concordant decisions to prevent long-term morbidity. ChatGPT-5.0 may support clinicians-especially where pediatric orthopedic expertise is limited, but their reliability across typical and discordant presentations is uncertain. This scenario-based validation study evaluated the accuracy of ChatGPT-5.0's management recommendations for DDH using 30 structured clinical cases and compared these outputs against AAOS (2022) and AAP (2016) guidelines.

METHODS: Scenario-based validation using 30 unique cases: 20 concordant (aligned clinical and imaging findings) spanning Graf and acetabular index-based ages, and 10 mismatch scenarios with correct examinations but intentionally erroneous radiology. The primary outcome was guideline-concordant accuracy, categorized as correct, partially correct, undertreatment, overtreatment, or incorrect. Secondary outcomes included the effect of error-aware prompts and multilingual consistency.

RESULTS: In concordant scenarios, guided ChatGPT achieved 100% correct, while non-logged-in ChatGPT achieved 95% with one overtreatment. In mismatch scenarios, guided ChatGPT frequently tends toward overtreatment and failing to recommend repeat ultrasound or urgent pediatric orthopedic consultation. Non-logged-in ChatGPT performed better in mismatch cases but similarly under-emphasized remeasurement/consultation. Error-aware prompts did not materially alter recommendations in either environment. Swahili queries produced outputs clinically identical to English responses.

CONCLUSIONS: ChatGPT-5.0 provides reliable, guideline-concordant guidance for DDH when clinical and radiologic data are concordant, supporting potential use as a decision aid in settings without immediate pediatric orthopedic access. Safe clinical implementation requires human oversight and integration of guideline-based safety checks to prevent mismanagement in ambiguous cases.

Developmental dysplasia of the hip (DDH) is a common congenital pediatric orthopedic malformation that often requires open reduction combined with pelvic osteotomy, resulting in severe postoperative pain. Pediatric patients under 2 years old have immature anatomical and physiological characteristics, high sensitivity to opioid analgesics, and an inability to subjectively express pain, which makes perioperative analgesia and anesthesia management a major clinical challenge. Traditional opioid-based analgesic regimens carry a high risk of adverse reactions such as respiratory depression and restlessness, which hinder postoperative recovery. This case reports the optimized perioperative anesthesia and analgesia management strategy for a 19-month-old female infant (12 kg, ASA Ⅰ) with right DDH undergoing open hip reduction and pelvic osteotomy, and preliminarily explores the clinical application value, efficacy and safety of ultrasound-guided type Ⅱ QLB in infant DDH surgery. A composite anesthesia strategy of general anesthesia combined with ultrasound-guided type Ⅱ QLB (0.2% ropivacaine, 0.5 mL/kg, total 6 mL) was adopted, with optimized perioperative management including precise airway selection, targeted vital sign monitoring, and multimodal postoperative analgesia (PCIA+on-demand oral acetaminophen). Pain was evaluated using the FLACC behavioral scale, and vital signs and adverse reactions were closely monitored postoperatively. The infant's 24-hour postoperative FLACC scores were all ≤2 points without the need for rescue analgesics, with significantly reduced opioid consumption (intraoperative sufentanil 6

PURPOSE: This study compares PROMs between patients who underwent hip arthroscopy prior to hip resurfacing arthroplasty (HRA) to a matched cohort of HRA patients without prior arthroscopy.

METHODS: A retrospective cohort study was performed of patients who underwent a HRA from 2016 to 2021 with minimum 2-year follow-up. Patients with prior arthroscopy were matched 1:3 with controls on age, sex, BMI, and ASA classification. Subjects completed HOOS JR, FJS, SANE, and PROMIS for physical function, pain intensity, and pain interference. The Mann-Whitney U test was used for intergroup mean comparisons and Fisher's exact test for categorical variables.

RESULTS: 20 patients with prior hip arthroscopy were matched to 60 controls (mean age: 47.1 ± 7.2 years; BMI: 29.5 ± 4.2, 96% male). Patients who underwent hip arthroscopy prior to HRA reported significantly greater pain (33.8 vs. 13.2, p = 0.011), poorer FJS (46.6 vs. 70.5, p = 0.030), physical function (43.7 vs. 50.9, p = 0.018), SANE rating (59.9 vs. 82.6, p = 0.005), and satisfaction (66.1 vs. 88.1, p = 0.006) after HRA. 11 patients (55.0%) stated that their hip resurfacing procedure met their expectations compared to 52 patients (86.7%) in the control group.

CONCLUSIONS: Patients who underwent hip arthroscopy prior to HRA have an association with significantly worse patient-reported outcome metrics, poor postoperative satisfaction, and higher postoperative pain.

PURPOSE: This study aimed to evaluate the minimum 10-year outcomes of total hip arthroplasty (THA) using the CentPillar-TMZF, a curved anatomic stem developed based on anatomical data from Japanese patients including those with hip dysplasia.

METHODS: Among 331 consecutive THA procedures, the CentPillar-TMZF was implanted in 80 primary THAs (24 %) following standardized selection criteria based on preoperative CT data. X-rays taken at the 10-year follow-up were assessed to evaluate stem fixation and the degree of stress shielding. Kaplan-Meier survivorship was calculated, with revision for any reason as the endpoint.

RESULTS: Seventy-three of the 80 hips (91 %) were followed for 10 years or until revision surgery. In all hips followed more than 10 years, stem fixation was classified as bone-ingrown stable with first- or second-degree stress shielding. The survivorship rate, with revision as the endpoint, was 98 % (95 % CI 90 %-99 %) at 10 years. Before the 10-year follow-up, one patient required revision due to a periprosthetic fracture, and another required revision for dislocation.

CONCLUSION: In THA using CentPillar-TMZF, no aseptic loosening was observed until postoperative 10 years in patients whose femoral medullary canal shape was preoperatively determined to be compatible based on CT evaluation.

BACKGROUND: Epidemiological characteristics of Hip osteoarthritis (OA) continue to change due to population aging and emerging disease concepts, such as femoroacetabular impingement (FAI) and subchondral insufficiency fracture of the femoral head (SIF). This study aimed to analyze the current etiologies of hip OA in Japan and identify characteristics associated with each etiology.

METHODS: A multicenter cross-sectional study was conducted in 2022 at 12 major Japanese hospitals, including 1197 patients (1515 hips) newly diagnosed with hip OA. Etiologies were classified into nine categories based on patient background and imaging findings: hip dysplasia, primary OA, FAI, SIF, rapidly destructive coxopathy (RDC), trauma, Legg-Calvé-Perthes disease (LCPD), slipped capital femoral epiphysis (SCFE), and skeletal dysplasia.

RESULTS: The etiologies included hip dysplasia (74.4 %), primary OA (13.4 %), FAI (4.8 %), SIF (3.4 %), RDC (1.3 %), trauma (1.3 %), LCPD (0.9 %), SCFE (0.1 %), and skeletal dysplasia (0.1 %). Patients in their 70s comprised the largest group, with a predominance of female patients across all ages. The proportion of hip dysplasia decreased in the elderly patients, whereas primary OA and SIF increased. Hip dysplasia was more common in female than male (78.2 % vs. 55.2 %), whereas FAI was more frequent in male (17.9 % vs. 2.2 %). The Japanese Orthopaedic Association hip scores were highest for FAI and lowest for SIF. Kellgren-Lawrence (KL) grade ≥3 was more common in primary OA (82.0 %) and hip dysplasia (76.7 %) than in FAI (57.7 %) and SIF (66.7 %).

CONCLUSIONS: Hip dysplasia remains the predominant cause of hip OA in Japan. Age-specific analyses revealed that FAI was more common in younger patients, while primary OA and SIF were prevalent in older patients. Patients with hip dysplasia and primary OA often presented with advanced KL grades, while SIF was associated with the poorest clinical scores. These findings may inform diagnostic and treatment approaches based on predominant etiologies.

BACKGROUND: This study aimed to compare the clinical and radiological outcomes of patients who underwent autograft application following standard transverse osteotomy supported by two cobalt-chrome cables with those who did not use autografts to support the osteotomy line in Crowe type IV Developmental Dysplasia of the Hip (DDH).

METHODS: Sixty-nine patients (78 hips) with Crowe type IV DDH underwent a transverse subtrochanteric shortening osteotomy. In Group 1, 42 hips had their osteotomy site supported with an autograft harvested from the shortening osteotomy. Conversely, Group 2 consisted of 36 hips in which graft application was not performed, and fixation of the osteotomy site was solely achieved by employing the femoral stem. Clinical outcome measures included limb length discrepancy, pain (visual analog score), and functional Harris Hip Score (HHS). For radiological evaluation, bone healing of the femoral osteotomy site was assessed using the radiographic union score for tibial (mRUST) classification, and stabilization of components was evaluated according to the Engh classification.

RESULTS: There were no significant differences in age, body mass index, follow-up duration, preoperative and postoperative LLD, VAS score, and HHS values. No statistically significant difference was identified between the Engh classification. Significant differences between the groups were detected in the mRUST classification (p = 0.020). The mean value of the group not utilizing autograft (11,89 ± 1,83) was higher than that of the group using autografts (10,95 ± 1,59). There was no statistically significant relationship between complications between the groups (p = 0.981).

CONCLUSION: Performing of THA in Crowe type IV DDH, the press-fit application of the femoral component, without additional implantation or grafting, have shown comparable and satisfactory outcomes.

INTRODUCTION: Legg-Calvé-Perthes disease (LCPD) often causes residual deformities, typically manifesting as an ellipsoidal femoral head shape. This condition arises from initial bone collapse and necrosis, inhibiting growth at the anterosuperior femoral head and resulting in asymmetric growth. The aim of this study is to assess the effectiveness of selective hemiepiphysiodesis in improving femoral head sphericity in patients with LCPD with previous onset of ovalization.

METHODS: We compared 71 hips undergoing prophylactic selective hemiepiphysiodesis (surgical group) against 86 hips managed nonsurgically (control group). Radiographic evaluations were performed at 3 time points (3 y after disease onset, 5 y after disease onset, and skeletal maturity) to assess disease progression and intervention effects, measuring the ellipsoidal index (EI), the Reimer migration index (RMI), and the articulotrochanteric distance (ATD), with classifications according to the Herring scale and final sphericity assessments.

RESULTS: Both cohorts were initially comparable in terms of age at onset, sex, and degree of deformity, showing similar EI, Herring classifications, and RMI ( P >0.05). At T2, significant improvements were observed in the EI, RMI, and ATD in the surgical group compared with the control group. At skeletal maturity, the surgical group demonstrated significantly improved sphericity across all 3 indices ( P <0.05), confirming the effectiveness of selective hemiepiphysiodesis in halting and partially reversing the ovalization process. The sphericity deviation score was significantly lower in the operated group (28±12) compared with the control group (43±28), the EI improved to 1.68±0.25 in the operated group from 2.11±0.33 in the controls, and the RMI showed a marked improvement (24.0±8.1) compared with controls (32.4±7.3).

CONCLUSIONS: Growth modulation by selective hemiepiphysiodesis effectively disrupts the progression of femoral head ovalization and enhances sphericity. This intervention presents a viable option for mitigating the ellipsoidal process in patients with LCPD, suggesting a significant potential to improve long-term outcomes by addressing early signs of deformity.

LEVEL OF EVIDENCE: Level III-retrospective cohort study.

BACKGROUND: Axial imaging is typically obtained following operative reduction of developmental dysplasia of the hip (DDH) to confirm a concentric reduction. Although the utility of axial imaging has been studied following the index reduction, its value following spica cast exchange remains unclear.

METHODS: This single-center study included all children 2 years or younger with idiopathic DDH who underwent closed or open reduction between 2012 and 2023. Patients with concurrent osteotomies or dysplasia secondary to syndromic/neuromuscular causes were excluded. Institutional protocol during this period consisted of 3 months of immobilization with a spica cast exchange at 6 weeks for all closed or medial open reductions. Axial imaging (CT or MRI) was typically obtained after both the index procedure and cast exchange to confirm reduction. A retrospective review was conducted to assess how often axial imaging directly altered clinical management, defined as an unplanned return to the operating room or a documented change in management based on imaging findings per the treating surgeon's notes. Minimum follow-up was 1 year. Descriptive statistics were used to summarize patient characteristics and arthrogram findings.

RESULTS: The cohort included 91 patients (124 hips): 92 (74%) hips underwent closed reduction, and 32 (26%) underwent open reduction. The median age at index reduction was 7.7 months, with 52% (n=47/91) above 6 months old. Of those with preoperative radiographs (n=98), most hips were IHDI grade 3 (29%, n=27) or 4 (39%, n=38). Axial imaging changed management in 3% of hips after the index reduction (4/92 closed reductions, 0/32 open reductions). Among 124 hips receiving axial imaging at cast exchange (92=MRI, 32=CT), only 1 hip was dislocated (<1%). Analysis of a separate cohort of 12 hips that did not receive axial imaging at cast exchange suggests that an adequate arthrogram (no medial dye pool and deep concentric reduction) is sufficient to confirm reduction.

CONCLUSIONS: Axial imaging at the time of spica cast exchange rarely alters clinical management and should not be routinely obtained unless otherwise indicated by a concerning intraoperative arthrogram.

LEVEL OF EVIDENCE: Level IV-retrospective case series.

BACKGROUND: Identifying patients at the highest risk of developmental dysplasia of the hip (DDH) is critical to the success of an efficient selective screening program. Defining and evaluating risk factors is, therefore, vital. This study was designed to analyze the relationship between classic risk factors and rates of DDH in a contemporary United States-based population.

METHODS: All patients presenting before 12 months of age to a single tertiary care pediatric hospital's orthopaedic department for DDH screening, with explicit medical record documentation of DDH risk factors from 2018 to 2022 were included. Classic risk factors were defined as breech presentation, female sex, firstborn status, and family history of hip dysplasia. Ultrasounds and radiographs obtained at initial presentation were reviewed to determine Graf and IHDI classifications. Reasons for referral for DDH screening were obtained from the chart review.

RESULTS: One thousand two hundred twenty-six patients were eligible for the study. The probability of having DDH increased as the number of risk factors present for DDH increased ( P <0.001). Female sex and firstborn status were found to be independent risk factors for DDH. Females were 2.5 times more likely to have DDH than males ( P <0.001). Firstborn children were 1.3 times more likely to have DDH than subsequent birth-order children ( P =0.048). There was no difference in the proportion of DDH in breech presenting patients compared with non-breech ( P =0.511) or in subjects with a family history of DDH ( P =0.16).

CONCLUSIONS: The primary risk factor for DDH in this contemporary cohort was female sex. Female patients without any other risk factors for DDH had a 25.2% rate of DDH, significantly higher than the estimated population incidence. Fifteen percent of these patients had no notable physical exam findings consistent with DDH. Given the high rate of DDH in female patients in the absence of notable physical exam findings, universal ultrasound screening for females at the age of 6 weeks should be considered.

LEVEL OF EVIDENCE: Level IV.

PURPOSE: To evaluate the results of arthroscopic treatment for femoroacetabular impingement syndrome (FAIS) with concomitant labrum ossification (LO) using patient-reported outcome measures (PROMs). The hypothesis was that at 2-year follow-up, an improvement in PROMs would be observed.

METHODS: A group of 24 patients (28 hips) with FAIS and LO findings were eligible for inclusion. In total 14 patients (18 hips) were included in the final PROMs analysis. The International Hip Outcome Tool short version (iHOT-12) was the primary outcome. The Copenhagen Hip and Groin Outcome Score (HAGOS), the European Quality of Life-5 Dimensions Questionnaire (EQ-5D), the EQ-visual analogue scale (EQ VAS), the Hip Sports Activity Scale for physical activity level, the VAS for overall hip function and a single question regarding overall satisfaction with the surgery were the secondary outcomes.

RESULTS: At 2-year follow-up 6 out of 24 (25%) patients had undergone total hip arthroplasty (THA). Comparing PROMs preoperatively with 2-years follow-up for the group of patients that did not undergo THA (

CONCLUSION: Patients with FAIS and LO who had not undergone THA at 2-year follow-up following arthroscopic treatment showed improved outcomes regarding patient-reported outcomes. Level of evidence: Case series, level IV.

The alpha angle is commonly used to quantify cam-type morphologies in hips. However, the threshold values that define a pathological alpha angle remains disputed. To identify the threshold values for the alpha angle measured on X-ray, computed tomography (CT), and magnetic resonance imaging (MRI) in asymptomatic individuals in different radiological modalities. Using the Preferred Reporting Items for Systematic reviews and Meta-Analysis guidelines and checklist, a literature search was conducted in May 2024 by two independent reviewers. The PubMed, Embase, Cochrane, and CINAHL databases were searched using the following search terms: ('Alpha angle') AND (('FAI') OR 'femoroacetabular impingement') AND ((((Imaging) OR CT) OR MRI) OR X ray). Of the studies identified, those measuring the alpha angle using either X-ray, CT, or MRI in an asymptomatic population were included. Study population and, if stated, demographics like gender, ethnicity, and activity level were then compiled using Excel as well as number of individuals and hips, imaging modality and view, method of evaluating symptoms, mean alpha angle, and 95% reference interval. Twenty-five articles were included in the review. Threshold values varied depending on what radiological method was used, with thresholds for X-ray ranging from 61.0° to 122.9°, thresholds for CT ranging from 50.0° to 95.3°, and thresholds for MRI ranging from 52.7° to 103.5°. According to current literature, threshold values indicating increased risk of FAI syndrome vary physiologically and depend on imaging view and modality. Therefore, no single cut-off reliably defines cam morphology and measurements should be interpreted within their clinical context.

Focal femoral head degeneration can lead to loss of structural support of the femoral head and eventual collapse. Formerly, total hip arthroplasty (THA) was the only definitive means available to restore function and mitigate pain. Osteochondral allograft transplantation (OATS) of the femoral head can be used to potentially prevent or delay THA, and the aim of this study is to analyse outcomes of patients who have undergone OATS procedures. An OATS procedure involves vessel-sparing hip dislocation to achieve global femoral head exposure, removal of damaged cartilage and subchondral bone, and press-fit implantation of a fresh femoral head allograft. Eleven patients have undergone OATS at our institution, and we collected retrospective data and Patient-Reported Outcome Measurement Information System (PROMIS) data. All eleven patients demonstrated focal femoral head degeneration. Six patients underwent simultaneous PAO for concomitant structural instability. Postoperatively, patients returned to weight bearing by an average of 9.8 ± 5.6 weeks and physical activities in 9.9 ± 2.9 months. Four patients had unrelated health conditions limiting physical activity involvement. One patient had undergone THA, 6 years postoperatively. Five patients provided updated follow-up metrics, demonstrating significant improvement in average physical function PROMIS scores (

This case series aims to share our experience with arthroscopic circumferential allograft labral reconstruction (CLR) as a part of the treatment for femoroacetabular impingement (FAI) syndrome in 34 nonarthritic hips of patients aged 60 and older. Twenty-nine patients had a minimum follow-up of 36 months (ranging from 3 to 10 years), with one case converting to total hip arthroplasty. Five patients were lost to follow-up. Significant improvements were observed across all patient-reported outcomes used at the last follow-up. Modified Harris Hip Scores improved by a mean of 40 points (

Periacetabular osteotomy (PAO) is performed to relieve symptomatic acetabular dysplasia by reorienting the acetabulum to provide adequate femoral head coverage. Due to an increased risk for complications in obese patients, some surgeons consider obesity as a contraindication for surgery. We theorize obese patients will have similar reductions in their pain levels and improvement in radiographic parameters despite an increased risk for postoperative complications. We performed a retrospective review of all patients who underwent a PAO in the last 12 years by the principal investigator. The incidence of complications, change in visual analogue scale (VAS) scores at 6 months follow up, and change in lateral centre edge angles (LCEAs) were then compared between obese patients and non-obese patient cohorts. Forty-eight hips in 41 patients were analysed. Fifteen hips were of obese patients at time of operation and 33 hips were of non-obese patients. The number of complications in the obesity group was statistically significant with a

This study compared the effects of pericapsular nerve group (PENG) block and supra-inguinal fascia iliaca compartment block (FICB) on quadriceps strength, postoperative analgesia, and functional scores following hip arthroscopy (HA) for patient complaining of femoroacetabular impingement (FAI) under general anaesthesia. A prospective, randomized, and controlled trial recruited a total of 48 patients who had either PENG group or supra-inguinal FICB as a pain management modality. The primary outcomes were the postoperative quadriceps muscle power, and the secondary outcomes included pain scores, opioid consumption, and functional scores; the modified Harris hip score (mHHS) and international hip outcome tool-12 (iHOT-12) score. All patients in PENG group were capable of performing a straight leg raise with hip flexion of >15°. In contrast, two patients in FICB group had postoperative falls and six patients (25%) were unable to perform a straight leg raise at 24 h postoperatively. At the time of admission to the post-anaesthesia care unit and at 6, 12, and 24 h postoperatively, peak visual analogue scale (VAS) scores at rest were 6, 5, 4, and 4, respectively, in PENG group and 8, 7, 6, and 5, respectively, in FICB group (

INTRODUCTION: Developmental dysplasia of the hip is a condition characterized by loose joints or dislocated hips due to malformations of the hip joint in newborns and young children. Understanding the prevalence and awareness of this condition can help in early detection and treatment hence promoting better health outcomes and improved quality of life of the children.

METHODS: This cross-sectional study involved a total of 401 adults living in Northern Saudi Arabia. The data were collected using structured online questionnaires, then cleaned, coded, and analyzed using SPSS version 27 to drive key insights.

RESULTS: The study found a 4% prevalence of developmental dysplasia of the hip among children. About 61 participants (15.2%) demonstrated good awareness while the majority of them 360 (84.8%) had poor awareness regarding DDH. The most common source of knowledge was internet and social media (109, 45.2%). The risk factors for DDH correctly reported were breech presentation (139, 34.7%) and female gender (108, 26.9%) while the complications were walking problems (256, 63.8%) and chronic hip pain (214, 53.4%). Statistically significant association was found between place of residence, age and the awareness level of DDH (p=0.006; p<0.001). Furthermore, knowing someone with DDH was a significant predictor of good awareness of the condition (AOR = 2.90; 95% CI = 1.807 - 4.650; p<0.001).

CONCLUSION: The study found inadequate awareness of developmental dysplasia of the hip among the population; with residents of Arar and participants aged more than 45 years demonstrating better awareness of DDH. The study identified significant gaps in knowledge and awareness of the risk factors, treatment and complications of DDH. These findings highlight the need for targeted awareness and education programs on the need for early detection and treatment of the condition to prevent complications and improve quality of life of children.

INTRODUCTION: Spiron short-stem hip arthroplasty for the treatment of avascular necrosis of the femoral head (AVNFH) in young patients preserves the bones, resulting in favorable and easy conditions when the hip is replaced again. The purpose of this study is to describe several anatomical features of the hip joint in adult Vietnamese people and to assess the efficacy of Spiron short-shaft hip arthroplasty.

METHODS: 129 healthy hips and 64 hips of 46 AVNFH patients underwent Spiron short-stem arthroplasty and were followed up from Jan-2012 - Dec-2022. Patients were performed digital X-rays to determine anatomical parameters in order to select the proper joint size. Patients' clinical outcomes and complications were evaluated at 12, 36, and 48 months after arthroplasty.

RESULTS: Among the 46 patients, only 4.4% were women. The patients had an average age of 40.6 years and a mean preoperative Harris score of 45.9. AVNFH patients' anatomical indices were all lower than those of healthy people. After 48 months of arthroplasty, severe pain symptoms decreased from 71.9% to 3.1%, walking limitation decreased from 59.4% to 4.7%, and Harris score good and excellent (80-100 points) increased from 0.0% to 78.2%. Complications included 1.6% wound infection and 3.1% acetabular displacement after 48 months. Other complications, such as lateral popliteal nerve injury, decreased from 6.3% (12 months) to 1.6% after 48 months, while bone loss and periarticular lumina increased from 3.1% (12 months) to 18.8-21.9% (48 months). After 48 months, 12.5% of patients underwent re-arthroplasty.

CONCLUSION: Although Spiron short-stem hip arthroplasty for young Vietnamese patients has significantly improved clinical symptoms and bone preservation, the rate of complications and re-arthroplasty remains relatively high due to the skill and surgical indication selection of surgeons. Therefore, surgeons need to receive careful and closely monitored training in the Spiron hip arthroplasty technique.

BACKGROUND: Femoroacetabular impingement syndrome (FAIS) is a major cause of chronic hip pain and early osteoarthritis. Surgical correction, traditionally via open surgical dislocation and increasingly via hip arthroscopy, aims to restore hip function by correcting bony morphology. While both techniques address cam and pincer lesions, the long-term implications of the surgical approach and specific impingement morphology on five-year structural outcomes, including hip instability, osteoarthritis (OA) progression, and conversion to total hip arthroplasty (THA), remain poorly defined.

METHODS: We conducted a retrospective cohort study using the TriNetX US Collaborative Network, analyzing de-identified electronic medical records from 2,725 patients (2,321 arthroscopic, 404 open) who underwent FAIS correction between 2003 and 2023 with a minimum five-year follow-up. Patients were grouped by surgical approach (Arthroscopic vs. Open) and morphology (Cam-only vs. Pincer-only vs. Mixed). Primary outcomes were five-year cumulative incidence and time-to-event incidence (Hazard Ratio, HR) of hip instability/dislocation, hip OA, and THA conversion.

RESULTS: In patients with mixed FAIS morphology, the arthroscopic approach was associated with a significantly lower risk of instability/dislocation (3.7% vs. 11.6%; HR 0.393, p<0.001) compared to the open approach. Conversely, the open approach demonstrated a lower incidence of hip OA (4.6% vs. 7.8%; HR 2.320, p=0.001 favoring open). Although the overall five-year THA incidence was equal (2.4%), arthroscopy had a significantly higher hazard of conversion (HR 6.112, p=0.004). Subgroup analysis found no statistically significant difference in instability, OA, or THA rates between cam and pincer morphologies within either the arthroscopic or open cohort.

CONCLUSION: Surgical approach significantly impacts five-year structural outcomes in FAIS correction. Arthroscopy offers superior early joint stability, but the open approach may be associated with a more protective effect against long-term OA progression. Impingement morphology (cam vs. pincer) did not independently influence these five-year outcomes. These findings support a trade-off between approaches and highlight the need for tailored surgical selection to optimize joint preservation.

BACKGROUND: The progression of avascular necrosis to the point of femoral head collapse necessitates total hip arthroplasty surgery as a treatment intevention. Despite its widespread use, this surgical procedure is often associated with a notable incidence of failure and various postoperative complications. This study aimed to evaluate the outcomes of cementless total hip arthroplasty (CTHA) in Vietnamese patients diagnosed with late-stage avascular necrosis of the femoral head (AVNFH).

METHODS: From Sep 2011 to Dec 2021, 150 patients were diagnosed with unilateral AVNFH at stages IV, V, and VI at the 108 Military Central Hospital. These patients underwent laboratory tests, CTHA, and assessments of hip function at three intervals: before surgical procedure, 12 months after surgery, and 48 months post-surgery.

RESULTS: Among the 150 patients with AVNFH, the femurs were classified as type B (80.7%), type A (10%), and type C (9.3%). Of these patients, 62.0% had articular head diameters of 32mm, while 38.0% had diameters of 36mm. The bearing surface pairings used in hip arthroplasty included 63.3% metal-polyethylene and 36.7% ceramic-ceramic. Regarding implant size, 86.7% used size 10-13 femoral stems, 6.0% used size 9, and 7.4% used size 14-15. In-hospital following surgery, there were no reports of thrombosis, deep infection, femoral fracture, or acetabular fracture. Meanwhile, 80% of cases had the acetabulum positioned in an intermediate alignment, whereas 4.0% and 16.0% were in varus and valgus positions, respectively. Patients with AVNFH in stages IV, V, and VI showed significant improvement in mobility, with pain levels decreasing to 0.0% and Harriss Hip scores increasing to approximately 85 points. At 12 months postoperatively, 16.0%, 52.0%, 21.2%, and 16.7% of patients exhibited bone platforms, bone welds, radiolucent lines, and calcar osteolysis, respectively. These figures increased to 23.0%, 89.3%, 27.3%, and 30.7%, respectively, after 48 months. Complications at 12 months included 2.0% superficial infection, 0.7% deep infection, and prosthetic joint loosening. At 48 months, patients experienced deep infection, hip dislocation, and prosthetic joint loosening, each occurring in 1.3% of cases.

CONCLUSION: With the posterior approach, CTHA for Vietnamese patients with AVNFH stages IV, V, and VI demonstrated favorable and promising outcomes. Intraoperative complications were minor, and no significant issues were observed during the 12- and 48-month postoperative follow-up periods.

BAC KGROUND: Total hip arthroplasty (THA) is a rare procedure in pediatric patients. Although it shows excellent results in adults, the presence of growth plates, the limited longevity of implants, and the hip-spine biomechanics involved during growth make the outcomes of THA in children uncertain.

OBJECTIVE: We hypothesized that THA yields satisfactory results for children suffering from unmanageable pain due to hip joint osteoarthrosis.

METHODS AND SETTINGS: 27 patients aged <18 years who underwent THA for hip joint osteoarthritis at our hospital between 2015 and 2022 were retrospectively included. Primary outcomes included two clinical scales: the Postel Merle d'Aubigné (PMA) and Oxford scale. Secondary outcomes included chronic pain relief and complications.

RESULTS: Mean age at surgery was 13.7± 1.7 years (min11, max 17). The mean follow-up was 5.4±2.4 years (min 3, max 10). Etiology of osteoarthrosis was slipped capital femoral epiphysis (n=13), idiopathic hip chondrolysis (n=4), femoral neck fracture (n=3), developmental hip dysplasia (n=3), hip joint infection (n=2), aseptic osteonecrosis secondary to drepanocytosis (n=1), and Legg-Calvé-Perthes disease (n=1). The average Oxford score was 43.2±4.8, and the mean PMA score was 15.9±0.6. Pain relief was achieved in 96.3% of patients. Six patients had major complications (22.2%), with three (11.1%) requiring unplanned surgeries.

LIMITATIONS: The main limitations were a small sample size and the absence of a control group.

CONCLUSION: To date, no study has specifically evaluated THA clinical outcomes in children with non-inflammatory hip joint osteoarthritis. This study demonstrates satisfactory outcomes following THA in children with hip joint osteoarthritis. THA should be considered a viable option for selected pediatric patients.

The study objective was to evaluate the relationship between the first hip ultrasound (HUS) result and developmental dysplasia of the hip (DDH) diagnosis in preterm infants. Additionally, we report the types of treatment for preterm infants diagnosed with DDH.This is a retrospective chart review of infants born between January 1, 2009, and December 31, 2018, at <37 weeks of gestation who had HUS in the first year of life. Positive predictive value (PPV), negative predictive value (NPV), sensitivity, and specificity for abnormal and normal HUS results were calculated.From 2,397 infants analyzed, 71 (3%) infants were diagnosed with DDH. The majority (

BACKGROUND: Femoroacetabular impingement (FAI) morphology is defined by anatomical variants that may predispose to mechanical conflict between the bony structures of the acetabulum and proximal femur with underlying bony incongruence leading to damage of adjacent tissues. Repetitive abnormal contact in this region can contribute to the formation of herniation pits (HPs) in the anterosuperior femoral head-neck junction, which may exacerbate symptoms and complicate surgical management of FAI.

CASE REPORT: This case report describes a 55-year-old male who underwent arthroscopic osteochondroplasty for mixed-type FAI morphology, combined with resection of a large HP and subsequent cavity filling using allogenic bone graft. Importantly, even though he did not have classic acetabular overcoverage, focal acetabular retroversion resulted in mechanical impingement when combined with anatomical variation of the femoral head-neck junction and patient's activity patterns. The postoperative course was uneventful, and graft incorporation was confirmed during the three-year follow-up.

CONCLUSIONS: This case highlights the anatomical and surgical interplay between osseous morphology, soft-tissue integrity, and joint biomechanics in the setting of FAI. Importantly, the various FAI morphologies should be considered anatomical variants that, when combined with specific movement patterns or loading conditions, may predispose to impingement and subsequent clinical symptoms. Additionally, this case demonstrates that allogenic bone grafts used to fill the herniation pit cavity can successfully incorporate into the surrounding bone, even in the anterosuperior femoral neck - a region known for relatively limited vascular supply.

The hip is a complex load-bearing joint susceptible to both acute traumatic and chronic overuse injuries. Traumatic injuries, such as acute fractures, dislocations, apophyseal avulsions, and muscle tears, typically follow high-energy events. In contrast, overuse injuries, for example, femoroacetabular impingement, stress fractures, labral degeneration, and greater trochanteric pain syndrome, arise gradually from repetitive mechanical overload. Early and accurate diagnosis requires a multimodal imaging approach: radiographs for baseline assessment, computed tomography for detailed osseous injury and alignment, magnetic resonance imaging and magnetic resonance arthrography for chondrolabral and soft tissue pathology, and ultrasound for dynamic evaluation of tendinous disorders. Understanding the mechanism, location, and severity of hip injuries is essential to guide prognosis, management, and prevention. This review provides a structured overview of traumatic and overuse hip injuries, highlighting imaging features that enable timely detection, precise characterization, and tailored interventions to optimize functional outcomes.

INTRODUCTION: Due to demographic shifts and an increasing proportion of older adults at higher fracture risk, the overall burden of proximal femur fractures has risen significantly in recent years, placing a burden on patients and healthcare systems. Despite extensive research on hip fracture epidemiology and treatment, the specific influences of femoral and acetabular parameters on fracture localisation remain underexplored. This study evaluates the impact of these parameters on proximal femur fracture localisation.

MATERIALS AND METHODS: This retrospective cohort study analysed data from 400 patients with proximal femur fractures, including medial and lateral femoral neck fractures (FNFs), pertrochanteric, and subtrochanteric fractures, treated at a university hospital between 2010 and 2022. Radiographic measurements of femoral head size and other morphological parameters were conducted using pre-operative pelvic radiographs. Statistical analyses included multivariate logistic regression.

RESULTS: A larger head-radius vertical (HRV) was associated with an increased risk of lateral FNFs (OR 1.11;

CONCLUSIONS: The study identified key variables associated with proximal femur fracture localisation. Morphological parameters such as HRV, FHEI, canal width, and LCEA, as well as BMI for subtrochanteric fractures, significantly influence fracture localisation, highlighting their importance for personalised risk assessment and preventive strategies.

BACKGROUND: Periacetabular osteotomy (PAO) is a well-established surgical treatment of symptomatic developmental dysplasia of the hip in young patients by improving the lateral centre-edge angle (LCEA) and the acetabular index (AI). Hence, the correction of the acetabular fragment is a hallmark of the PAO procedure.

PURPOSE: To evaluate the efficacy of fluoroscopy-guided visual estimation of the correction of the fragment during PAO.

METHODS: 49 patients undergoing PAO were enrolled. The surgeons (3) were asked to visual assess the perioperative LCEA and AI. Perioperative assessments were compared with perioperative and postoperative measurements. Interobserver variation was assessed by regression analysis. Bland-Altman analysis was used to determine correlation between visual assessment and measurements.

RESULTS: Mean correction of the LCEA was 11.1° (-4-23.5°) and the average AI correction was -10.7° (-20- 4°). The interobserver agreement was high for LCEA (R

CONCLUSIONS: Perioperative visual estimation is on average sufficient for assessing the postoperative correction of LCEA and AI in PAO. Outliers are however observed.

PURPOSE: Understanding the trajectory of recovery after hip arthroscopy is valuable to help manage expectations and recognise patients at risk for delayed recovery. The purpose of this study was to determine the recovery profile of function, pain, and activity level up to 2 years after hip arthroscopy.

METHODS: Patients from a single centre's orthopaedic registry who underwent hip arthroscopy were identified. Function, pain, and activity level were measured using Patient-Reported Outcomes Measurement Information System (PROMIS) Physical Function (PF), PROMIS Pain Interference (PI), a numeric pain scale (NPS), and Tegner Activity Scale (TAS) up to 2 years postoperatively. Nonlinear growth models were used to estimate the effect of recovery time on each outcome.

RESULTS: Of 92 patients identified, 64 (70%) were followed up to 2 years. There was significant improvement in all outcome measures at 2 years. The time to 50% recovery for PROMIS PF, PROMIS PI, and TAS was 11.0, 6.7, and 18.5 weeks, respectively. The time, in weeks, to full recovery of PROMIS PF, PROMIS PI, and TAS was estimated at 17.0, 37.4, and 28.8 respectively. NPS declined at a rate of -0.22 points per week, plateauing by 12 weeks.

CONCLUSIONS: Physical function and activity levels plateau at 4 and 7 months respectively, while pain recovery is more variable. These results can help guide discussions with patients regarding recovery after hip arthroscopy and provide benchmarks for identifying patients who could benefit from changes in postoperative protocol.

PURPOSE: To examine the effects of superior lateralisation of the centre of rotation and femoral offset shortening on the gluteus medius in developmental dysplasia of the hip (DDH), and the impact of biomechanical restoration by total hip arthroplasty (THA).

METHODS: Horizontal (femoral, acetabular, and combined offset) and vertical (centre height, leg length) radiographic parameters, as well as gluteus medius radiodensity measured by computed tomography, were evaluated preoperatively and 1 year postoperatively in 100 hips (87 patients). Patients were grouped by whether radiodensity improved postoperatively. Correlations between parameter changes and radiodensity were analysed.

RESULTS: In advanced osteoarthritis, radiodensity deterioration correlated with femoral offset shortening (

CONCLUSIONS: Gluteus medius fatty infiltration improved mainly with leg lengthening, but insufficient combined offset limited this recovery.

BACKGROUND: Ipsilateral fractures and dislocations involving the hip, distal femur, and patella are rare and pose significant management challenges.

CASE PRESENTATION: We present a unique case of a 50-year-old male who sustained a posterior hip dislocation with femoral head fracture, medial femoral condyle fracture, and rotational patellar dislocation incarcerated between the femoral condyles following a high-energy roadside accident. The patient presented with limb deformity and a knee wound within 30 min post-injury. Initial closed reduction attempts failed, and surgical intervention under spinal anaesthesia achieved hip reduction via the Allis manoeuvre, open fixation of the distal femur fracture, and patellar relocation.

OUTCOME: Postoperative recovery was uneventful, with satisfactory joint function at five months. However, at 20 months, the patient developed avascular necrosis with osteoarthritic changes for which total hip replacement was advised.

CONCLUSION: This case highlights the importance of prompt diagnosis and coordinated surgical management of complex lower-limb trauma.

This study aimed to quantify the effect of double pelvic osteotomy (DPO) on dorsal acetabular rim angle (DARA) in a clinical cohort of dogs.Retrospective study.The DARA was measured on computed tomographic (CT) studies of 27 client-owned dogs that underwent DPO due to hip dysplasia. The change in DARA was determined for 30-, 25- and 20-degree preangled-locking DPO plates. The preoperative DARA was compared to the immediate postoperative DARA, and where available, the postoperative DARA was compared to short- and long-term DARA measurements.27 dogs underwent DPO, resulting in 49 hips available for analysis. The median preoperative DARA was 16.3 degrees (Q1-Q3, 12.3-22.2) and 17.6 degrees (Q1-Q3, 12.42-1.0) for right and left hip, respectively. The median postoperative DARA was -4.5 degrees (Q1-Q3, [-8.8]-[-1.3]) for the right hip and -4.1 degrees (Q1-Q3, [-7.6] to 5.8) for the left hip. The median change in DARA was 23.4 degrees (Q1-Q3, 17.5-26.15), 16.7 degrees (Q1-Q3, 12.2-20) and 15 degrees (Q1-Q3, 14.1-15.2) for a 30-, 25- and 20-degree plate, respectively. Short-term follow-up CT was available for 16 dogs (30 hips) at a median of 48 days (Q1-Q3, 45-57 days) and long-term follow-up CT was available for 12 dogs (22 hips) at a median of 386 days (Q1-Q3, 325-557). The postoperative DARA and short- and long-term DARA measurements did not change significantly (

OBJECTIVE: To introduce a novel acetabular biplanar calibration (ABC) method to improve the accuracy of hip arthroscopic portal establishment.

STUDY DESIGN: An observational study. Place and Duration of the Study: Department of Orthopaedic Surgery, Chongqing Orthopaedic Hospital of Traditional Chinese Medicine, Chongqing, China, from January to December 2024.

METHODOLOGY: This study included patients with femoroacetabular impingement syndrome or acetabular labral tear. Pelvic morphology was measured from preoperative radiographs. The ABC method involved placing metallic markers on the coronal (Landmark A) and sagittal (Landmark B) planes around the operative hip and measuring the distances from the anterior superior iliac spine (ASIS) to the two markers. The establishment of anterolateral (AL), mid-anterior (MA), and distal anterolateral accessory (DALA) portals was based on the above landmarks and confirmed by fluoroscopy. The accuracy rates of these portal placements were calculated as percentages, respectively.

RESULTS: A total of nine patients were included. The puncture target on the coronal plane was 3.06 ± 0.39 cm distal and 2.97 ± 0.42 cm medial to the ASIS. The puncture target on the sagittal plane was 2.88 ± 0.38 cm distal and 8.13 ± 1.25 cm lateral to the ASIS. The accuracy rates of establishing the AL, MA, and DALA portals using the ABC method were 77.8% (7/9), 88.9% (8/9), and 77.8% (7/9), respectively.

CONCLUSION: The ABC method appears to be a promising avenue for improving the accuracy of hip arthroscopic portal-establishment, with reduced reliance on femoral positioning. It can also be used for frequent arthroscopic instrument navigation. Future research with larger samples, multicentre studies, and the integration of advanced imaging technologies is needed to validate its reliability and effectiveness fully.

KEY WORDS: Hip arthroplasty, Landmark, Portal establishment.

BACKGROUND: Neglected hip dislocation in adult is relatively a rare entity but not so uncommon in the developing world due to many factors including lack of awareness, poor socioeconomic status, illiteracy, poor transportation, distant location from towns, lack of well-equipped hospitals, and skilled medical personnel. Its management becomes challenging as close reduction becomes almost impossible and there are increased chances of avascular necrosis (AVN) of the femoral head and so arthritis of hip joints later on. There is no clear-cut management protocol available in the literature regarding it. Some orthopedician prefer open reduction of hip joint and some prefer total hip arthroplasty (THA).

CASE CHARACTERISTICS: In our series of 3 cases, One patient who had neglected hip dislocation of 2 months duration without AVN changes in magnetic resonance imaging (MRI) underwent open reduction, whereas another two cases with neglected hip dislocation of more than 3 months durations (12 months and 6 months) undergone primary THA.

CONCLUSION: Primary THA should be done in neglected hip dislocation of duration more than 3 months but the open reduction of the hip joint can be tried if the duration of dislocation is <3 months without AVN changes of the femoral head in MRI.

CONTEXTE:: La luxation négligée de la hanche chez l’adulte est une entité relativement rare mais pas si rare dans les pays en développement en raison de nombreux facteurs, notamment le manque de sensibilization, le faible statut socioéconomique, l’analphabétisme, les transports médiocres, l’éloignement des villes, and le manque d’hôpitaux bien équipés et de personnel médical qualifié. Sa gestion devient difficile car une réduction étroite devient presque impossible et il existe des risques accrus de nécrose avasculaire de la tête fémorale et donc d’arthrite des articulations de la hanche plus tard. Il n’existe pas de protocole de gestion clair disponible dans la littérature à ce sujet. Certains orthopédistes préfèrent la réduction ouverte de l’articulation de la hanche et d’autres préfèrent l’arthroplastie totale de la hanche (ATH).

CARACTÉRISTIQUES DU CAS:: Dans notre série de 3 cas, 1 patient qui avait une luxation négligée de la hanche d’une durée de 2 mois sans modifications de l’AVN à l’IRM a subi une réduction ouverte tandis que 2 autres cas de luxation négligée de la hanche d’une durée de plus de 3 mois (12 mois et 6 mois) ont subi une arthroplastie totale de la hanche primaire.

CONCLUSION:: Une arthroplastie totale de la hanche (ATH) primaire doit être réalisée en cas de luxation négligée de la hanche d’une durée supérieure à 3 mois, mais une réduction ouverte de l’articulation de la hanche peut être tentée si la durée de la luxation est inférieure à 3 mois sans modifications de l’AVN de la tête fémorale à l’imagerie par résonance magnétique (IRM).

Total hip arthroplasty (THA) is a transformative procedure in addressing hip arthritis. However, managing acetabular defects remains challenging, particularly in neglected developmental dysplasia of the hip cases due to altered hip anatomy. A middle-aged female presented with bilateral hip arthritis secondary to dysplasia. She was planned for staged bilateral THA. Intraoperatively, we noted a shallow acetabulum with a posterior superolateral defect and significant uncoverage of the cup. The defect was reconstructed using autologous femoral head graft and screws fixation along with contracture releases. Postoperative bilateral outcome scores showed significant improvement at 6 months and 2 years, with neutral limb length discrepancy. Follow-up radiographs showed successful graft integration and implant stability. This technique offers the advantages of biological integration, improved implant stability, enhanced joint survivorship, and improved quality of life. In situations, where acetabular augments are unavailable or cannot be used owing to financial constraints, this technique proved to be an effective method.

L’arthroplastie totale de la hanche (PTH) est une intervention révolutionnaire dans le traitement de l’arthrose de la hanche. Cependant, la prise en charge des lésions acétabulaires reste complexe, notamment dans les cas de dysplasie développementale négligée de la hanche due à une altération anatomique de la hanche. Il s’agit d’une femme d’âge moyen présentant une arthrite bilatérale sévère secondaire à une dysplasie. Une PTH bilatérale progressive a été envisagée. En peropératoire, nous avons constaté un acétabulum peu profond avec une lésion postéro-supérolatérale et une importante découverte de la cupule. La lésion a été reconstruite par greffe autologue de tête fémorale et fixation par vis, ainsi que par libération des contractures. Les scores de résultats bilatéraux postopératoires ont montré une amélioration significative à 6 mois et 2 ans, avec une inégalité de longueur des membres neutre. Les radiographies de suivi ont montré une intégration réussie du greffon et une stabilité de l’implant. Cette technique offre les avantages de l’intégration biologique, d’une meilleure stabilité de l’implant, d’une meilleure survie articulaire et d’une meilleure qualité de vie. Dans les situations où les prothèses acétabulaires ne sont pas disponibles ou ne peuvent être utilisées en raison de contraintes financières, cette technique s’est avérée efficace.

OBJECTIVES: Clarify the distinctive characteristics of avascular necrosis of the femoral head (AVNFH) in relation to coronavirus disease 19 (COVID-19) and report the successive individuals who were identified with the condition after recovering from COVID-19.

MATERIALS AND METHODS: From August 2023 to July 2024, we examined 24 successive patients (35 hips) prospectively who received an AVNFH diagnosis after recovering from COVID-19. Twenty patients were on corticosteroids for the treatment of COVID-19. The staging of AVNFH was decided by plain radiographs and magnetic resonance imaging. An association between the stage with the dosage of steroids and the comorbidities was evaluated.

RESULTS: After COVID-19, hip symptoms took a mean of 6.13 months to manifest. In Methylprednisolone equivalent, the average steroid dosage was 713.2 mg. For those on steroid medication, the mean time for COVID-19 before hip complaints was 5.95 months. It was discovered that the mean COVID-19 period before the onset of hip symptoms was 7.125 months for individuals without comorbidities and 3 months for those with both diabetes and hypertension.

CONCLUSION: There has been an increase in AVN during the pandemic. This rise is probably because patients with COVID-19 pneumonia were receiving severe doses of corticosteroids. There is also an increase in severity and decrease in the duration of COVID-19 before hip symptoms in patients with comorbidities like diabetes. Given the minimal total amount of steroids taken by our patients, it is possible that vasculitis-associated COVID-19 contributes to the pathophysiology of AVN of the femur head.

OBJECTIFS:: Clarifier les caractéristiques distinctives de la nécrose avasculaire de la tête fémorale (AVNFH) en relation avec le coronavirus Maladie 19 (Covid-19) et signalez les personnes successives qui ont été identifiées avec la maladie après avoir récupéré de Covid-19.

MATÉRIAUX ET MÉTHODES:: D’août 2023 à juillet 2024, nous avons examiné 24 patients successifs (35 hanches) prospectivement qui ont reçu un Diagnostic AVNFH après avoir récupéré de Covid-19. Vingt patients étaient sous corticostéroïdes pour le traitement du Covid-19. La mise en scène de AVNFH a été décidé par des radiographies simples et une imagerie par résonance magnétique. Une association entre la scène avec le dosage des stéroïdes et Les comorbidités ont été évaluées.

RÉSULTATS:: Après Covid-19, les symptômes de la hanche ont pris une moyenne de 6,13 mois à manifester. En méthylprednisolone Équivalent, la dose de stéroïde moyenne était de 713,2 mg. Pour les personnes sous des médicaments stéroïdes, le temps moyen pour Covid-19 avant les plaintes de la hanche était de 5,95 mois. Il a été découvert que la période de Covid-19 moyenne avant le début des symptômes de la hanche était de 7,125 mois pour les individus Sans comorbidités et 3 mois pour ceux qui atteint du diabète et de l’hypertension.

CONCLUSION:: il y a eu une augmentation de l’AVN pendant la pandémie. Cette augmentation est probablement parce que les patients atteints de pneumonie Covid-19 recevaient des doses graves de corticostéroïdes. Il y a aussi Une augmentation de la gravité et de la diminution de la durée du Covid-19 avant les symptômes de la hanche chez les patients atteints de comorbidités comme le diabète. Compte tenu du Quantité totale minimale de stéroïdes prises par nos patients, il est possible que le Covid-19 associé à la vascularite contribue à la physiopathologie de Avn de la tête du fémur.

BACKGROUND: Slipped capital femoral epiphysis (SCFE) requires surgical treatment. In German-speaking countries, dynamic in-situ fixation is commonly used for mild SCFE lenta. Various implants are available for this purpose.

OBJECTIVE: High complication rates have been reported for the removal of titanium gliding screws. In this retrospective study, we analyzed the complications in the treatment of SCFE, particularly focusing on the removal of sliding screws made of stainless steel and K‑wires.

MATERIALS AND METHODS: A total of 111 patients with SCFE were treated, including 96 fixations using stainless steel sliding screws, 93 wire pinning procedures, and 69 hips treated with a combination of both techniques. Additionally, 43 Imhäuser osteotomies were performed. Complications arising from these treatments were analyzed.

RESULTS: In 14 patients, 23 complications were observed. Avascular necrosis of the femoral head occurred in three cases. Two patients sustained a fracture of the proximal femur. One patient presented with soft tissue irritation following fixation with both sliding screws and K‑wires. Infections occurred in three patients. Due to implant misplacement or breakage, 6 patients required a total of 12 revision surgeries. Two patients developed postoperative hematomas, which were surgically evacuated. No complications were observed related to implant removal.

DISCUSSION: The issues described in the literature regarding the removal of titanium screws were not observed with stainless steel screws. This difference can be attributed to material properties: titanium screws have lower torsional strength and require higher torque for removal.

ZUSAMMENFASSUNG: HINTERGRUND: Epiphyseolysis capitis femoris (ECF) erfordert eine operative Behandlung. Im deutschsprachigen Raum erfolgt bei der milden Form ECF lenta eine dynamische In-situ-Fixierung. Verschiedene Implantate stehen zu Verfügung.

ZIEL DER ARBEIT: Bei der Materialentfernung (ME) von Gleitschrauben aus Titan werden hohe Komplikationsraten beschrieben. In dieser retrospektiven Studie analysieren wir die Komplikationen bei der Behandlung der ECF, insbesondere bei der Metallentfernung von Gleitschrauben aus Stahl und K‑Drähten.

MATERIAL UND METHODEN: Bei 111 Patienten mit ECF erfolgten insgesamt 96 Fixierungen mittels Gleitschraube aus Stahl, 93 Drahtspickungen und 69 Hüften wurden mit einer Kombination beider Verfahren versorgt. Zusätzlich erfolgten 43 Imhäuser-Osteotomien. Die Komplikationen, die bei dieser Behandlung aufgetreten sind, wurden analysiert.

ERGEBNISSE: Bei 14 Patienten wurden 23 Komplikationen beobachtet. In 3 Fällen kam es zu einer avaskulären Nekrose des Femurkopfes. 2 Patienten zogen sich eine proximale Femurfraktur zu. Ein Patient stellte sich nach Fixierung mittels Gleitschraube und Kirschner-Drähten mit einer Weichteilirritation vor. Bei 3 Patienten traten Infektionen auf. Aufgrund einer Fehllage oder eines Bruchs des Implantates wurden 6 Patienten insgesamt 12-mal revidiert. Bei 2 Patienten bildete sich postoperativ ein Hämatom, das operativ evakuiert wurde. In Bezug auf ME stellten wir keine Komplikationen fest.

DISKUSSION: Die in der Literatur beschriebene Problematik bei der ME von Titanschrauben konnten wir bei den Stahlschrauben nicht feststellen. Der Unterschied ist auf die Materialeigenschaften zurückzuführen. Titanschrauben verfügen über eine niedrigere Torsionsstärke und es ist ein höheres Drehmoment für die Entfernung notwendig.

PURPOSE OF THE STUDY: Reconstruction of acetabular posterior wall fractures is challenging. This study evaluates the use of iliac crest graft to reconstruct the posterior wall of the acetabulum.

MATERIAL AND METHODS: The study population included all patients with high-grade acetabular posterior wall fractures who were treated with acetabular posterior wall reconstruction using iliac strut graft. In this study, patients with high-grade acetabular posterior wall fracture (based on Letournel and Judet's classification of acetabular fracture equivalent to grade 2 or 3 and based on AO type A1 classification) were treated with acetabular posterior wall reconstruction using iliac strut patients over 70 years old and under 18 years old were excluded from the study.

RESULTS: In this study, 14 patients, 10 men and 4 women, with posterior acetabular wall fractures were treated using the acetabular posterior wall reconstruction method using iliac strut graft. The average age of these patients was 60 years. One patient had evidence of avascular necrosis after 6 months. In all 8 patients, the radiological results showed that the femoral head did not completely match the acetabulum after the operation. The condition of the 48-year-old patient was good to excellent. Three patients under 50 years of age without post-traumatic osteoarthritis at the time of reconstruction had good clinical results and good radiological results. Patients with post-traumatic osteoarthritis at the time of reconstruction had poor clinical and radiological results and sometimes required THA.

CONCLUSIONS: The results of this study show that reconstruction of the posterior wall of the acetabulum with iliac crest graft is a suitable option for children or adult patients without post-traumatic osteoarthritis at the time of reconstruction. Mid-term follow-up showed good to excellent clinical results. However, this method is not recommended for adult patients with post-traumatic osteoarthritis during reconstruction. Such patients are likely to require THA.

Neglected DDH can cause degenerative changes to the hip joint that could result in subsequent hip pain and disability. The best treatment for these patients is total hip arthroplasty (THA) with artificial joint prosthesis implantation. Acetabular fractures in dysplastic hips with THA are uniquely complex, being more unstable, difficult to assess radiographically due to implant interference, and often atypical in pattern. Management is highly challenging, as treatment decisions must balance surgical risks with prosthetic stability and patient factors, making the successful conservative recovery in this case both rare and notable. This case report presents a case of a 42-year-old female patient with neglected DDH who underwent bilateral total hip replacement complicated by a spontaneous acetabular fracture. Radiographs revealed a nondisplaced, spontaneous acetabular fracture in the superior region. Based on the timing and implant stability, the injury was classified as a Pascarella Type 2A. Due to the clinical context and surgical complexity in dysplastic hips with prior THA, the patient was treated conservatively consisting of protected weight-bearing, rehabilitation, and close follow-up, with full improvement.