2026年2月 保髋进展 JCR Q3+Q4

BACKGROUND: Femoroacetabular impingement syndrome (FAIS) is a movement-related disorder and causing hip and/or groin pain in young active adults. Movement patterns in individuals with FAIS may be modifiable through conservative management. Identifying biomechanical differences between cohorts with asymptomatic cam morphology (FAIM) and FAIS could reveal relevant treatment targets. This study compared lower limb kinematics and kinetics between FAIS, FAIM, and healthy controls during double- (DLS) and single-leg squats (SLS).

METHODS: Whole-body motion and ground reaction forces were synchronously recorded during five DLS and five SLS. Joint angles, moments, and spatiotemporal parameters (mean squat velocity and maximum squat depth) were compared between groups using a one-way repeated measures ANOVA with statistical parametric mapping (SPM).

RESULTS: During DLS, there were no differences in hip or knee kinematics, or hip, knee, or ankle moments. The FAIM group had less ankle dorsiflexion than controls during both descent and ascent (P < .01). During SLS, the FAIM group had greater hip flexion than the FAIS group (P < .01), and the FAIS group had greater external hip rotation than controls (P < .01) and a greater hip abduction moment than the FAIM group (P < .01).

CONCLUSION: The greater demands of SLS may require those with FAIS to perform it differently to those without symptoms, regardless of the presence of cam morphology. Given all groups squatted to a similar depth, hip biomechanics - including flexion, rotation, and abduction moments - may be a more relevant target for rehabilitation.

BACKGROUND: Late diagnosis of developmental hip dysplasia (DDH) may warrant either open or closed reduction of the hip. Proximal femoral growth disturbance (PFGD) is a possible complication following these procedures.

METHODS: A systematic search of PubMed, Embase, Web of Science, The Cochrane Library and OrthoSearch from the date of inception of each database through to the 2 February 2025 was performed. The primary outcome of interest was the prevalence of clinically significant PFGD following open or closed reduction after 6 months of age. This was defined as Kalamchi-MacEwen or Bucholz-Ogden Type 2 or above.

RESULTS: The prevalence of clinically significant PFGD in patients undergoing open reduction was 12.47% (95% Confidence interval (CI): 10.39-14.69), whereas the prevalence of clinically significant PFGD in patients undergoing closed reduction was 9.53% (95% CI: 6.91-12.46). Multivariate analysis suggested that mean age at time of reduction was associated with an increase in the prevalence of PFGD in patients undergoing closed reduction (

CONCLUSION: We described the prevalence of clinically significant PFGD following closed reduction and open reduction. In both open and closed reduction groups, we observed a high relative heterogeneity (

PROSPERO REGISTRATION NO: CRD420251015622.

OBJECTIVE: Osteoarthritis (OA) is a common finding in the elderly population. Femoroacetabular Impingement (FAI)-related deformities can cause OA. Their prevalence and clinical relevance in the asymptomatic elderly population are unclear. This study aims to determine the prevalence of cam and pincer deformities in asymptomatic, non-orthopedic Caucasian patients over 60 years in computed tomography (CT) and correlate the presence of those deformities with radiological signs of OA.

DESIGN: CTs of oncological patients over 60 years without any previous history of hip pathology or pain, containing a complete scan of both hips, were included. All hips were analysed for signs of OA according to the Kellgren-Lawrence (KL) classification. The acetabular anteversion, acetabular sector angles (ASA), and alpha angles were measured in clockwise positions of the hip. All angles were modeled conditionally on KL, sex, age, and obesity using random-effects median regression.

RESULTS: One hundred ninety-five non-orthopedic patients (130 male, 65 female; mean age 70.4 years; 290 hips) were included. Signs of severe OA (KL 3/4) were found in 19.2 %. Patients over 80 years had significantly higher alpha angles at 9-11 o'clock, higher ASA at 9-12 o'clock, and a higher acetabular anteversion at the level of the acetabular roof. Individuals with advanced OA showed higher alpha angles, higher ASA, and a lower acetabular anteversion than those without/with moderate OA.

CONCLUSIONS: This study provides an estimate of the distribution of FAI-related deformities within a population of individuals over 60 years with asymptomatic hips. The prevalence of these deformities is correlated with advanced OA.

OBJECTIVE: Periacetabular osteotomy (PAO) is a well-established surgical technique that is used to enhance femoral head coverage in patients with developmental dysplasia of the hip (DDH). Although 2-dimensional radiographs remain standard for evaluating acetabular coverage, 3-dimensional (3D) computed tomography (CT)-based measurements using acetabular sector angles (ASAs) provide higher precision. This study aimed to analyze acetabular coverage through ASA parameters and to investigate the long-term clinical outcomes following PAO.

METHODS: This retrospective study included 35 hips from 29 patients who underwent PAO for DDH. Radiographic measurements comprised the T.nnis angle, Sharp angle, lateral center-edge angle (LCEA) and anterior center-edge angles (ACEA), anterior center margin angle (ACMA), extrusion index, and hip lateralization index (HLI). The CT-derived variables included acetabular version (AV), anterior ASA (AASA), posterior ASA (PASA), and horizontal ASA (HASA). Clinical outcomes were assessed by using the Harris Hip Score (HHS).

RESULTS: The mean patient age was 19.9 years, with a mean follow-up period of 8.7 years. Significant postoperative improvements were noted in AASA, HASA, T.nnis angle, Sharp angle, extrusion index, AV, LCEA, ACEA, acetabular depth, and HHS (all P < .05). No significant differences were observed in PASA, HLI, or ACMA. The HHS showed a negative correlation with HLI (P < .05) and a positive correlation with postoperative LCEA (P < .01). Patients with postoperative LCEA < 25Åã demonstrated superior functional outcomes compared with those with LCEA ≥ 35Åã (P = .034). Eight patients experienced complications, and 2 patients required conversion to total hip arthroplasty.

CONCLUSION: The PAO provides durable long-term results in the management of DDH. Incorporating 3D ASA analysis enhances both preoperative planning and postoperative evaluation, contributing to more precise acetabular reorientation and improved clinical assessment   Cite this article as: Güneş Z, Çağlar Ö, et al. Assessment of 3-dimensional acetabular coverage based on acetabular sector angles following periacetabular osteotomy: long-term clinical, radiological, and survivorship outcomes. Acta Orthop Traumatol Turc., 2026; 60(1), 0334, doi: 10.5152/j.aott.2026.25334.

BACKGROUND: Osteochondral defects of the hip, resulting from avascular necrosis (AVN), trauma, and femoroacetabular impingement (FAI), are challenging in management. While osteochondral autograft transplantation (OAT) has shown promising outcomes in the knee and ankle, its application in the hip is not well understood. The goal of this paper is to explore the positive predictor factors for significant increases in the Harris Hip Score (HHS) in post-operative patients.

METHODS: A systematic review and meta-analysis were performed using PubMed, CINAHL, SCOPUS, Embase, and Cochrane Central Register of Controlled Trials databases, including studies reporting pre- and post-operative HHS for hip OAT. The quality of the methodologies of this study was evaluated using the Modified Coleman Methodology Scores (MCMS). Random-effects meta-analyses explored outcome variations based on gender, follow-up duration, age, defect size, etiology, site of defect, surgical approach, and presence of complications.

RESULTS: Analysis of eleven studies (70 patients), revealed a mean HHS improvement of 32.43 points post-operatively. Superior results were associated with ipsilateral knee donor cartilage and absence of complications. The increase in score did not significantly change based on the average length of follow-up, age of participants, etiology of disease, size of the defect, or type of surgery. The mean MCMS was 44.32±12.70, which is considered poor.

CONCLUSIONS: Due to the small number of papers focusing on mosaicplasty in the hip, the positive predictor correlations found in the knee are not readily identified in the hip. It is important to gather larger-scale studies to effectively evaluate the outcomes of hip OAT procedures on the functional outcomes of patients. The current literature we have is an introduction to the potential this procedure holds for patients.

BACKGROUND: In Japan, secondary screening for developmental hip dysplasia has expanded. However, the capacity of screening programs has outpaced the availability of ultrasonography and the number of clinicians who perform and interpret examinations outside tertiary centers. Plain radiography is widely accessible; however, interpreting images in infants can be challenging. This study developed and validated a deep learning-based system to support radiographic diagnosis and test a prespecified two-step triage strategy for clinical use.

METHODS: Overall, 1188 anteroposterior pelvic radiographs of infants aged 2-12 months were retrospectively analyzed. Three non-overlapping test subsets (50 images each) represented routine screening, images without a visible femoral-head ossification center, and images from external hospitals; the remainder were used for training and internal validation. The system generates measurements and the International Hip Dysplasia Institute grades for each radiograph. All test images were independently graded by two pediatric orthopedic surgeons, and the consensus served as a categorical reference. The agreement was summarized using the intraclass correlation coefficient for measurements and quadratic-weighted kappa for grades. The triage strategy was as follows: (1) no further imaging or referral when both hips were grade 1, and (2) high-priority alert when either hip was grade ≥2 and/or the acetabular angle was at least 25°.

RESULTS: Agreement for the principal measurement between the system and each reader was 0.83-0.84 by intraclass correlation, comparable to inter-reader agreement (0.81), with small biases and acceptable limits of agreement. For grades, quadratic-weighted kappa was 0.63-0.75 across subsets, with disagreements mainly between adjacent categories. With a 25-degree cutoff, the triage strategy achieved sensitivities of 0.75-0.93 and specificities of 0.62-0.95 across subsets.

CONCLUSIONS: The system supported radiographic screening decisions across diverse images typical of this age range, achieving comparable agreement with clinicians. Therefore, a prospective multicenter evaluation with thresholds adjusted for age and location is required.

BACKGROUND: After successful treatment of developmental dysplasia of the hip (DDH) with a Pavlik harness, controversy exists about whether it's best to continue harness use for an additional "weaning" period or simply terminate treatment. The purpose of this randomized controlled trial (RCT) was to compare radiographic outcomes between patients with stable hip dysplasia who were weaned (W) or not weaned (NW) after Pavlik harness treatment.

METHODS: This was a single-center RCT of infants with stable ultrasonographic dysplasia in whom a Pavlik harness was initiated at <3 months of age. After 23 hours/day of harness treatment and normalization of ultrasound indices, patients were randomized into W or NW groups. W patients continued harness use for an additional 4 to 6 weeks, progressively decreasing daily use. Primary outcome was acetabular index (AI) on AP radiographs of the pelvis at 6 months of age. Secondary outcomes were number of hips with AI ≥ 30 degrees at 6 months (our threshold for prescribing part-time abduction bracing for residual dysplasia) and AI at 1 year of age.

RESULTS: Seventy-two patients (36 W, 36 NW) met inclusion criteria. There were no differences between W and NW cohorts in age at Pavlik initiation or baseline alpha angle or percent femoral head coverage. At time of ultrasonographic normalization, there was no significant difference in mean time spent in the harness between W and NW cohorts (35.0 vs. 34.9 d, P =0.84). At 6 months, mean AI was significantly lower in the W cohort (24.8±3.9 deg.) compared with the NW cohort (26.9±3.4 deg.) ( P =0.02). Fewer braces were prescribed for residual dysplasia at 6 months in the W versus NW cohort (17% vs. 22%), but this was not statistically significant ( P =0.56). AI at 1 year of age was not significantly different between groups (W 24.6±3.4 deg.; NW 25.3±2.3 deg., P =0.84) but this likely was affected by the use of additional bracing.

CONCLUSIONS: A Pavlik weaning protocol resulted in improved AI at 6 months of age versus immediate termination of treatment. At 1 year, AI was not significantly different between W and NW cohorts, likely due to the use of additional part-time bracing in those who were dysplastic at 6 months.

LEVEL OF EVIDENCE: Level I-randomized controlled trial.

BACKGROUND: Recent animal studies have suggested that cartilage hypertrophy may occur in Legg-Calvé-Perthes disease (LCPD), potentially influencing femoral head morphology during containment treatment. We aimed to analyze cartilage hypertrophy in children with LCPD using magnetic resonance imaging (MRI) and assess its relationship with long-term femoral head outcomes.

METHODS: Fifty-five patients with unilateral LCPD who underwent conservative containment treatment were evaluated. Cartilage thickness was measured in 10 distinct regions on coronal and sagittal MRI scans obtained during the early stage of the disease. Enlargement of the femoral head due to bone or cartilaginous components was also assessed. The relationships between clinical and radiologic variables, including age and the cartilage thickness ratio, and Stulberg classification at skeletal maturity, were analyzed.

RESULTS: Femoral head enlargement was observed on the affected side compared with the normal side, primarily due to cartilage hypertrophy, whereas bony epiphyseal enlargement followed an age-dependent pattern on both sides. Cartilage hypertrophy occurred in multiple directions but was most pronounced in the lateral region. Onset age and horizontal cartilage hypertrophy emerged as independent prognostic indicators for the Stulberg classification. Severe deformities, defined as Stulberg class III or more, were observed in only 6% of children aged 7 years or younger with a cartilage thickness ratio of ≤3.7, whereas 83% of children aged 7 years or younger with a ratio >3.7 developed severe deformities.

CONCLUSION: Cartilage hypertrophy, frequently observed in early-stage LCPD, is associated with enlargement of the femoral head. The extent of horizontal hypertrophy and age at onset may serve as key prognostic indicators of femoral head deformity progression.

LEVEL OF EVIDENCE: Level III-study of nonconsecutive patients in diagnostic studies.

BACKGROUND: Developmental dysplasia of the hip (DDH) ranges from mild acetabular dysplasia to complete dislocation. Early diagnosis gives the opportunity for nonsurgical management. Delayed detection often necessitates invasive procedures. This study examined recent trends in infant hip ultrasound utilization, DDH incidence, and surgical reduction to assess whether increased imaging has translated into earlier diagnosis and reduced surgical burden.

METHODS: A retrospective cohort study was conducted using the TriNetX Network from 2013 to 2024. ICD and CPT codes identified infants undergoing hip ultrasound within the first 6 months of life. Annual incidence of ultrasound use, DDH diagnosis, and open or closed reductions in children below 5 years was calculated. Analyses were stratified by academic versus nonacademic institutions. Demographic associations with ultrasound utilization were examined using multivariable logistic regression.

RESULTS: Among 8,655,956 infants, 135,192 (1.56%) underwent hip ultrasound. Utilization in the United States declined from 0.523% in 2013 to 0.325% in 2017, then rose to 0.543% in 2024. DDH incidence decreased from 0.41% in 2013 to 0.19% in 2020, then increased to 0.28% in 2024. Academic centers reported higher ultrasound utilization and DDH incidence. Open reduction incidence remained low (0.0024% to 0.0032%) but rose slightly after 2018. Closed reductions occurred more often (0.0033% to 0.0044%) and increased modestly post-2018. Female infants had higher odds of ultrasound than males (OR: 1.72; 95% CI: 1.69-1.75; P<0.001). Black (OR: 0.56; 95% CI: 0.55-0.57; P<0.001) and Native American (OR: 0.56; 95% CI: 0.49-0.65; P<0.001) infants had lower odds of ultrasound, while Asian infants had higher odds (OR: 1.23; 95% CI: 1.20-1.27; P<0.001).

CONCLUSIONS: From 2013 to 2024, the incidence of hip ultrasound utilization and DDH diagnoses initially declined, then rose. Incidence of open and closed reduction also began rising in 2018, suggesting persistent late diagnosis or delays in care despite greater imaging availability. Standardized care pathways, timely orthopaedic referral, and equitable access to imaging are needed to promote early diagnosis that translates into successful nonoperative management.

LEVELS OF EVIDENCE: Level III-retrospective cohort.

BACKGROUND: Femoral varus osteotomy (FVO) is a common treatment for Legg-Calve-Perthes disease (LCPD). Due to concerns of decreased hip abductor strength, neck-shaft angle (NSA), and articular-trochanteric distance (ATD), concomitant greater trochanteric apophysiodesis (GTA) is often performed. While abductor strength remains a concern, no studies have quantified hip strength following FVO+GTA. The purpose of this study was to objectively quantify hip strength in patients treated with FVO+GTA using isokinetic testing and analyze contributors to abductor weakness.

METHODS: A retrospective review was conducted for 26 patients who underwent unilateral FVO+GTA at Waldenström stages 1b-3a, and hip strength testing in stages 3b-4 using an isokinetic dynamometer. The strength of the operated side was compared with the contralateral side. Clinically significant abductor weakness between the contralateral and operated side was set at ≥25% based on previous data.

RESULTS: The mean age at diagnosis was 7.7±1.2 years (range: 5.9 to 9.6) and the time from surgery to testing was 3.3±1.3 years (range: 1.8 to 6.1). While the operated side showed significant decreases in NSA ( P <0.001) and ATD ( P =0.002) compared with the contralateral side, no significant difference in the abduction strength between sides was observed with a paired t test ( P =0.15). However, when patients were grouped by those who did only home exercises (n=11, 42%) versus outpatient physiotherapy (n=15, 58%), the home exercise group showed significantly weaker abduction strength on the operated side compared with the contralateral side with a paired t test ( P =0.027), whereas the outpatient physiotherapy group was insignificant ( P =0.93). In addition, all 4 patients who had abductor weakness ≥25% on the operated side were in the home exercise group.

CONCLUSIONS: Following FVO+GTA, only 4 out of 26 patients (15%) had clinically significant abductor weakness, all of whom did only home exercises. We recommend outpatient physiotherapy after FVO+GTA to obtain more symmetrical abduction strength.

LEVEL OF EVIDENCE: Level III.

BACKGROUND: Locating the center of the nonossified femoral head on anteroposterior (AP) pelvic radiographs in children under 5 remains challenging. Hip arthrography serves as an intraoperative clinical reference in our setting, but is invasive. The agreement of magnetic resonance imaging (MRI) using bony landmarks with arthrography has not been fully established.

METHODS: Children under 5 years old with contemporaneous hip arthrograms, hip MRI, and AP pelvic radiographs were included in this retrospective study. The femoral head center was determined by the Mose concentric circle method on arthrography and MRI and proportionally projected onto a predefined coordinate system on AP pelvic radiographs. Agreement between methods for X and Y coordinates and the center-edge angle (CEA) was assessed using intraclass correlation coefficients (ICC). Intraobserver and interobserver reliability for localization and CEA measurement was assessed in a subset. In normal hips, the age-related distribution of the femoral head center was evaluated with Spearman correlation and linear regression.

RESULTS: Forty-two cases (84 hips) were analyzed; 45 normal hips (54%), median age 18 months (range: 1 to 60). In normal hips, MRI showed poor agreement with arthrography for the X coordinate (ICC=0.13), good agreement for the Y coordinate (ICC=0.89), and good agreement for CEA (ICC=0.89). Reliability was good to excellent (intraobserver ICC: 0.82 to 0.91; interobserver ICC: 0.78 to 0.89). Using arthrography-defined the femoral head centers in normal hips, the mean X-coordinate was 0%±2% of femoral neck width and showed no correlation with age (r=0.17, P=0.27). The Y coordinate showed a strong negative correlation with age (r=-0.90, P<0.001); linear model: y_coord=21.26-0.53×age (mo).

CONCLUSION: MRI can localize the femoral head center using bony landmarks in children 5 years of age or younger, but agreement with arthrography is suboptimal for the X coordinate when using this 2D bony-landmark projection approach. In normal hips, the femoral head center remains close to the femoral neck midline (small Y-coordinate) and moves distally with age.

LEVEL OF EVIDENCE: Level III-retrospective comparative study.

N/A

Pain catastrophizing and resilience have been shown to influence pain and postoperative patient reported outcomes (PROs) within orthopaedics. However, there are few studies examining the association between patient pain catastrophizing and resilience and their impact on outcomes following hip arthroscopy for femoroacetabular impingement (FAI). This systematic review aimed to identify any potential relationships. Seven studies met final inclusion criteria. A total of 231 patients were included from pain catastrophizing studies, and 196 patients were included from resilience studies. In all pain catastrophizing studies, postoperative PROs improved, and higher pain catastrophizing was associated with worse outcomes. Significant improvement was seen between pre and postoperative PROs in all resilience studies, and 2 of 3 resilience studies found lower resilience correlated with worse outcomes.

INTRODUCTION: The functionality of the hip joint is primarily determined by the anatomical relationship between acetabulum and femur. Impairment of this relationship can lead to diseases such as femoroacetabular impingement and hip osteoarthritis. In patients undergoing total hip arthroplasty, accurate placement of the acetabular and femoral components in accordance with native 3-dimensional anatomy (3D) is crucial for obtaining prosthesis stability and survival, also for preventing postoperative complications such as wear, dislocation and osteolysis. Therefore, 3D determination of native anatomical features of the hip joint is highly important.

METHODS: A total of 100 adults were randomly selected. Right femur and acetabulum were segmented using MIMICS program. 2D and 3D measurements of femoral anteversion according to posterior condylar and transepicondylar axis, acetabular anteversion, acetabular inclination and combined anteversion were determined. The differences between gender groups and the correlations of two- and three-dimensional measurement results were evaluated.

RESULTS: According to 2D and 3D measurements, statistically significant differences were observed between gender groups in all parameters except for 2D acetabular inclination. A very strong correlation was observed between 3D femoral anteversion measurements performed using the posterior condylar axis and transepicondylar axis. Our findings revealed statistically significant differences between 2D and 3D measurements in most parameters, which have clinical relevance.

CONCLUSIONS: A very strong correlation between femoral anteversion measurements obtained using the transepicondylar and posterior condylar axes supports the intraoperative use of the transepicondylar axis reliably. We believe the data obtained from our study will contribute to understand the 3-dimensional native anatomy of the hip joint.

BACKGROUND: Hip arthroscopy (HAS) is widely used to treat femoroacetabular impingement syndrome (FAIS), and many patients rely on online resources for medical information. Large language models (LLMs) such as ChatGPT have shown potential as supplementary educational tools in orthopedics; however, existing evaluations are limited to earlier model generations with variable accuracy and completeness. This study aimed to evaluate the accuracy, clarity, relevance, and completeness of ChatGPT-5 responses to common patient questions regarding FAIS and HAS.

METHODS: ChatGPT-5 was used to generate 25 frequently asked patient questions and corresponding answers related to hip preservation. Two fellowship-trained hip preservation surgeons independently evaluated each response using a five-point Likert scale across four predefined domains: relevance, accuracy, clarity, and completeness. Descriptive statistics were calculated as mean ± standard deviation for each domain. Inter-rater reliability was assessed using a two-way random-effects intraclass correlation coefficient with absolute agreement (ICC [2, 1]) and complemented by exact agreement percentages.

RESULTS: All responses received excellent scores, with mean values ranging from 4.84 ± 0.27 (completeness) to 5.00 ± 0.00 (relevance). Accuracy (4.97 ± 0.08) and clarity (4.91 ± 0.17) were near-perfect. ICC values demonstrated moderate to excellent agreement (0.70-0.81), complemented by high exact agreement rates (84-100%). No answer contained factually incorrect, misleading, or unsafe information. Minor reductions in completeness were attributable to occasional brevity rather than substantive omissions.

CONCLUSION: ChatGPT-5 generated highly accurate, clear, and clinically appropriate patient-oriented explanations regarding FAIS and HAS, showing clear improvement compared with earlier ChatGPT versions. Although ChatGPT-5 represents a marked advancement in AI-based patient education, its use should be regarded as a complementary educational tool rather than a replacement for professional orthopedic counseling.

BACKGROUND: Hip surveillance guidelines have been introduced by the Australian (AusACPDM, 2008) and American Academy for Cerebral Palsy and Developmental Medicine (AACPDM, 2016) to screen for hip displacement in children with cerebral palsy (CP). Whether these guidelines are associated with changes in surgical management remains unknown. This study compares trends in hip osteotomy rates among children with CP in the United States using a national database before and after the publication of national hip surveillance guidelines.

METHODS: International Classification of Diseases (ICD-9)-CM and ICD-10-CM codes were used to identify hospital admissions for hip osteotomies in children <20 years old with CP from the Healthcare Cost and Utilization Project (HCUP) Kids' Inpatient Database (KID) from 1997 to 2019. Cases without an admission month were excluded. National estimates of CP-related hospital cases, osteotomy (acetabular, proximal femoral) rates, and hip dislocations were calculated using weighted variables provided by HCUP. The average monthly osteotomy rates were compared using one-way analysis of variance (ANOVA) for the periods before and after guideline establishments. Baseline patient characteristics were also analyzed using either chi-squared tests or one-way ANOVA.

RESULTS: From 1997 to 2019, 318,367 weighted CP admissions were recorded, demonstrating a 44% increase in the annual incidence of CP hospitalizations. Baseline patient characteristics for the periods January 1997 to December 2006 (preAusACPDM), January 2009 to September 2016 (post-AusACPDM, pre-AACPDM), and October 2016 to December 2019 (post-AACPDM) indicates that mean age and length-of-stay (LOS) increased significantly in the post-AACPDM period relative to the two prior time periods (

CONCLUSIONS: Reconstructive hip surgery rates declined among children with CP treated in U.S. community hospitals represented in the KID database, temporally coinciding with publication of national hip surveillance guidelines. These findings demonstrate an association rather than a causal relationship and may reflect variation in guideline adoption, shifts in care to tertiary referral centers, or evolving surgical practices.

KEY CONCEPTS: (1)Hip surveillance guidelines are screening tools for children with cerebral palsy.(2)Early detection of hip subluxation is crucial for timely orthopaedic interventions.(3)Children with cerebral palsy are undergoing hip osteotomies at older ages with longer stays in recent years.(4)Barriers may exist that prevent adherence to hip surveillance guidelines.(5)Formal guideline implementation may be necessary to improve timely interventions and outcomes.

LEVEL OF EVIDENCE: IV.

Developmental dysplasia of the hip (DDH) is among the most common congenital musculoskeletal disorders and may lead to early hip osteoarthritis if left untreated. Modified Pemberton acetabuloplasty is an established, growth-preserving osteotomy technique for surgical correction in childhood. However, robust clinical long-term outcomes with follow-up periods exceeding two decades have not yet been published. The aim of this study was to retrospectively evaluate functional and patient-reported outcomes after an average follow-up of 25.6 years.In this monocentric retrospective cohort study, 63 patients (92 hips) were included from an original cohort of 331 patients with 507 operated hips who had undergone modified Pemberton acetabuloplasty between 1990 and 1995. In 2018, clinical follow-up was performed in 54 patients; all participants completed standardised questionnaires, including the Harris Hip Score (HHS), WOMAC, and EQ-5D. Data analysis was descriptive.The mean follow-up period was 25.6 years. The average HHS was 95.8 points, the mean WOMAC index 7.2 points, and the EQ-5D-VAS 89.3/100. A total of 81% of patients were free of symptoms, and 83.3% achieved excellent functional results. Overall, 96.8% rated the surgical outcome as good or very good, and 92% would choose to undergo the procedure again. No patient required total hip arthroplasty. No major postoperative complications occurred.Modified Pemberton acetabuloplasty demonstrates stable functional outcomes, low symptom levels, and high health-related quality of life more than 25 years after surgery. The very high patient satisfaction and the absence of secondary procedures underscore the long-term clinical effectiveness of this growth-preserving technique.

Die entwicklungsbedingte Hüftdysplasie zählt zu den häufigsten angeborenen Erkrankungen des Bewegungsapparates und kann unbehandelt zur frühzeitigen Koxarthrose führen. Die modifizierte Pemberton-Azetabuloplastik stellt als wachstumserhaltende Korrekturosteotomie ein etabliertes Verfahren zur operativen Behandlung im Kindesalter dar. Belastbare klinische Langzeitergebnisse mit Nachbeobachtungszeiträumen von über 2 Jahrzehnten fehlen jedoch bislang. Ziel der vorliegenden Studie war die retrospektive Analyse des funktionellen und subjektiven Outcomes nach durchschnittlich 25,6 Jahren.In dieser monozentrischen, retrospektiven Kohortenstudie wurden aus einem ursprünglichen Kollektiv von 331 Patient*innen mit insgesamt 507 operierten Hüftgelenken, die zwischen 1990 und 1995 mittels modifizierter Pemberton-Azetabuloplastik behandelt worden waren, insgesamt 63 Patient*innen (92 Hüftgelenke) eingeschlossen. 2018 erfolgte eine klinische Nachuntersuchung bei 54 Patient*innen; bei allen lag ein vollständig ausgefüllter Fragebogen mit HHS-, WOMAC- und EQ-5D-Index vor. Die Auswertung erfolgte deskriptiv.Die mittlere Nachbeobachtungszeit betrug 25,6 Jahre. Der durchschnittliche Harris Hip Score lag bei 95,8 Punkten, der WOMAC-Index bei 7,2 Punkten und der EQ-5D-VAS bei 89,3/100. 81% der Patient*innen waren beschwerdefrei, 83,3% erzielten ein sehr gutes funktionelles Ergebnis. 96,8% bewerteten das Operationsergebnis als gut bis sehr gut, 92% würden sich retrospektiv erneut für den Eingriff entscheiden. Kein Fall erforderte eine Hüfttotalendoprothese. Schwere postoperative Komplikationen traten nicht auf.Die modifizierte Pemberton-Azetabuloplastik zeigt auch nach über 25 Jahren stabile funktionelle Ergebnisse, geringe Beschwerden und eine hohe gesundheitsbezogene Lebensqualität. Die sehr hohe Patientenzufriedenheit und das Fehlen von Folgeeingriffen unterstreichen die langfristige klinische Effektivität dieses wachstumsschonenden Verfahrens.

AIM: To compare the effectiveness and safety of selective arterial perfusion (SAP) combined with core decompression (CD) versus CD alone for treating osteonecrosis of the femoral head (ONFH) at association research circulation osseous (ARCO) stages 1-2.

METHODS: Overall, 102 individuals (involving 130 hips) diagnosed with nontraumatic ONFH at ARCO stages 1-2 and admitted into Beijing Jishuitan Hospital Guizhou Hospital (Guizhou Orthopedic Hospital) between January 2021 and December 2023 were enrolled in this retrospective study. They were assigned to two groups based on the treatment protocol: the experimental group (56 patients, 72 hips) treated with SAP combined with CD, and the control group (46 patients, 58 hips) receiving CD only. Both groups were supplemented with conventional treatment: oral aescuven forte (1 tablet/time, 2 times/day for 12 weeks), extracorporeal shock wave therapy (once per week for 4 weeks), nerve block (lateral femoral cutaneous nerve block for visual analogue scale (VAS) >5 points), and rehabilitation training (30 minutes/day, 5 days/week for 12 weeks). All participants were followed up for 12 months, with key outcomes such as effective rate, femoral head collapse rate, lesion size, bone marrow edema grading, VAS score, harris hip score (HHS) score, and complication rate recorded.

RESULTS: No statistically significant differences in baseline data (age, gender, disease duration, ARCO staging, etiology, etc.) were identified between the two groups (

CONCLUSIONS: At 12 months of follow-up, compared with CD alone, SAP combined with CD demonstrated better clinical performance in nontraumatic ONFH patients at ARCO stages 1-2, accompanied by a higher effective rate, lower femoral head collapse rate, more significant reductions in lesion size and improved hip joint function, while maintaining a comparable safety profile. This combined regimen provides a valuable option for hip-preservation treatment in early-stage ONFH, with potential clinical implications for optimizing minimally invasive intervention strategies.

Congenital hip dislocation represents the most severe form of developmental dysplasia of the hip (DDH) and, if left untreated, it leads to permanent functional impairment. Since the nationwide implementation of ultrasound screening in Germany in 1996, the condition can be detected and managed early on. The primary goal of treatment is a stable concentric reduction of the femoral head to allow normal acetabular development. In irreducible hips, operative reduction and additional corrective osteotomies may be required. Early diagnosis, standardized treatment protocols, and close follow-up are essential to achieve optimal long-term outcomes.

Die kongenitale Hüftluxation ist die schwerste Form der kongenitalen Hüftdysplasie und führt unbehandelt zu bleibenden Funktionseinschränkungen. Durch das seit 1996 etablierte Hüftscreening mittels Ultraschall kann sie frühzeitig erkannt und behandelt werden. Ziel ist die stabile Rezentrierung des Hüftkopfs und die physiologische Pfannenentwicklung. Bei irreponiblen Hüften sind operative Repositionen, gegebenenfalls in Kombination mit knöchernen Korrekturen erforderlich. Frühdiagnostik, standardisierte Therapie und engmaschige Kontrollen sichern die besten Langzeitergebnisse.

BACKGROUND: Pediatric hip disorders differ from those seen in adults.

OBJECTIVE: To present the incidence, aetiology, pathogenesis, diagnosis, and treatment of the most common pediatric hip disorders.

MATERIAL AND METHODS: Review of fundamental studies, research articles, and expert recommendations on the topic.

RESULTS: The management of the most common pediatric hip disorders is largely consensual. Timely diagnosis and treatment of septic arthritis of the hip and slipped capital femoral epiphysis are of particular urgency.

CONCLUSIONS: Due to the complexity of these conditions, affected patients should be managed in collaboration with specialists in pediatric orthopedics.

ZUSAMMENFASSUNG: HINTERGRUND: Pädiatrische Hüfterkrankungen unterscheiden sich von denen der Erwachsenen.

FRAGESTELLUNG: Darstellung der Inzidenz, Ätiologie, Pathogenese, Diagnostik und Therapie der häufigsten pädiatrischen Hüfterkrankungen.

MATERIAL UND METHODE: Überblick über Grundlagenarbeiten, Studien und Expertenempfehlungen zum Thema.

ERGEBNISSE: Der Umgang mit den häufigsten pädiatrischen Hüfterkrankungen ist weitgehend konsensual. Besonders dringlich ist die rechtzeitige Diagnostik und Therapie von septischer Koxarthritis und Epiphyseolysis capitis femoris.

SCHLUSSFOLGERUNGEN: Die Begleitung der betroffenen Patient:innen sollte aufgrund der Komplexität der Erkrankungen in Zusammenarbeit mit Spezialist:innen aus dem Bereich der Kinder- und Jugendorthopädie erfolgen.

INTRODUCTION: Arthroscopic and mini-open surgery are both valid options for managing symptomatic femoroacetabular impingement (FAI). The current systematic review compared the clinical outcomes of arthroscopic surgery versus mini-open surgery for femoroacetabular impingement. The primary outcomes assessed included patient-reported outcome measures (PROMs) and the incidence of complications.

MATERIAL AND METHODS: This systematic review followed the PRISMA statement. The Web of Science, PubMed, and Embase were accessed in June 2025 without additional filters or temporal constraints. All clinical studies concerning the surgical management of FAI were considered. Only investigations on arthroscopy or a mini-open surgical approach and those directly comparing the two techniques were included. Only studies with at least 6 months of follow-up were considered. The PROMs of interest were the visual analogue scale (VAS) and the modified Harris Hip Score (mHHS). Data on the reoperation rate and progression to total hip arthroplasty were collected. The mean difference (MD) and odds ratio (OR) measures were used for the comparisons.

RESULTS: Data from 233 clinical studies (54,272 patients) were retrieved. The mean follow-up duration was 33.9 ± 22.7 months. The mean age was 35.0 ± 5.2 years and the mean body mass index (BMI) was 25.1 ± 2.1 kg/m

CONCLUSION: Mini-open and arthroscopic surgery for symptomatic FAI achieve similar clinical outcomes and comparable complication rates at approximately 34 months follow-up. The mini-open approach was associated with a lower risk of reoperation. Future research should focus on long-term follow-up and standardized outcome measures to refine the understanding of these surgical options and enhance patient care.

ZUSAMMENFASSUNG: EINLEITUNG: Sowohl arthroskopische als auch minimal-invasive Operationen sind geeignete Optionen zur Behandlung eines symptomatischen femoroazetabulären Impingements (FAI). Die vorliegende systematische Übersicht vergleicht die klinischen Ergebnisse arthroskopischer mit denen minimal-invasiver FAI-Operationen. Zu den primären Endpunkten gehörten Patient-Reported Outcome Measures (PROMs) und die Häufigkeit von Komplikationen.

MATERIAL UND METHODEN: Diese systematische Übersicht erfolgte gemäß der PRISMA-Erklärung. Im Juni 2025 wurden die Datenbanken Web of Science, PubMed und Embase ohne zusätzliche Filter oder zeitliche Einschränkungen durchsucht. Alle klinischen Studien zur chirurgischen Behandlung von FAI wurden berücksichtigt. Es wurden nur Untersuchungen zu arthroskopischen oder mini-offenen chirurgischen Verfahren einbezogen sowie solche, die beide Techniken direkt miteinander verglichen. Es wurden nur Studien mit einer Nachbeobachtungszeit von mindestens 6 Monaten berücksichtigt. Die relevanten PROMs waren die visuelle Analogskala (VAS) und der modifizierte Harris Hip Score (mHHS). Es wurden Daten zur Reoperationsrate und zum Fortschreiten bis zur Hüfttotalendoprothese erhoben. Für die Vergleiche wurden die mittlere Differenz (MD) und die Odds-Ratio (OR) verwendet.

ERGEBNISSE: Daten aus 233 klinischen Studien (54.272 Patienten) wurden ausgewertet. Die durchschnittliche Nachbeobachtungsdauer betrug 33,9 ± 22,7 Monate. Das Durchschnittsalter lag bei 35,0 ± 5,2 Jahren und der durchschnittliche Body-Mass-Index (BMI) bei 25,1 ± 2,1 kg/m

SCHLUSSFOLGERUNG: Mini-offene und arthroskopische Operationen bei symptomatischem FAI erzielen nach einer Nachbeobachtungszeit von etwa 34 Monaten ähnliche klinische Ergebnisse und vergleichbare Komplikationsraten. Der mini-offene Ansatz war mit einem geringeren Risiko einer erneuten Operation verbunden. Zukünftige Forschungsarbeiten sollten sich auf die Langzeitnachbeobachtung und standardisierte Messinstrumente konzentrieren, um die Kenntnisse dieser chirurgischen Optionen zu verfeinern und die Patientenversorgung zu verbessern.

BACKGROUND: Hip disorders in childhood and adolescence require precise imaging to prevent maldevelopment, deformities, and early osteoarthritis.

ULTRASOUND: Ultrasound is the primary first-line modality: radiation-free, dynamic, and indispensable in infancy. It provides detailed assessment of cartilaginous and soft-tissue structures and is essential in developmental dysplasia of the hip (DDH) to evaluate maturation and femoral head centration. It also enables rapid detection of joint effusions in transient synovitis or septic arthritis, as well as inflammatory changes in juvenile idiopathic arthritis (JIA). In addition, ultrasound offers useful early clues in Legg-Calvé-Perthes disease and slipped capital femoral epiphysis (SCFE).

RADIOGRAPHY: From about 6 months of age, radiography becomes central to evaluating the bony anatomy. Standard projections such as the anteroposterior pelvic view and the frog-leg lateral view allow reliable assessment of acetabular morphology, femoral head position, and head-neck geometry.

MAGNETIC RESONANCE IMAGING: Magnetic resonance imaging (MRI) is the most comprehensive cross-sectional technique. It expands diagnostic capabilities in Perthes disease, SCFE, inflammatory conditions, and tumors, and provides detailed visualization of cartilage, the labrum, bone marrow edema, and torsional alignment. Modern fast sequences enable short, focused examinations in young children, often without the need for sedation.

COMPUTED TOMOGRAPHY: Computed tomography (CT) is reserved for specific indications and is valuable for analyzing complex osseous structures.

ZUSAMMENFASSUNG: HINTERGRUND: Hüftbeschwerden im Kindes- und Jugendalter erfordern eine präzise bildgebende Diagnostik, um Fehlentwicklungen, Deformitäten und Arthrosen zu vermeiden.

SONOGRAPHIE: Die Sonographie ist die wichtigste Erstuntersuchung: strahlenfrei, dynamisch und besonders im Säuglingsalter unverzichtbar. Sie ermöglicht die Beurteilung knorpeliger und weichteiliger Strukturen, etwa bei der entwicklungsbedingten Hüftdysplasie (DDH) zur Einschätzung der Reifung und Hüftkopfzentrierung. Zudem erlaubt sie die rasche Detektion von Ergüssen bei Coxitis fugax oder septischer Koxitis sowie entzündlichen Veränderungen bei juveniler idiopathischer Arthritis (JIA). Auch bei Morbus Perthes und Epiphyseolysis capitis femoris (SCFE) liefert sie wichtige Frühhinweise. RöNTGEN: Das Röntgen stellt ab dem 6. Lebensmonat den zentralen Pfeiler der knöchernen Diagnostik dar. Standardaufnahmen wie die Beckenübersicht (a. p.-Strahlengang) und die Lauenstein-Aufnahme erlauben die Beurteilung von Pfannenform, Hüftkopfzentrierung und Kopf-Hals-Geometrie.

MAGNETRESONANZTOMOGRAPHIE: Die Magnetresonanztomographie (MRT) stellt die wichtigste Schnittbildgebungstechnik dar. Sie erlaubt die erweiterte Diagnostik bei Morbus Perthes, SCFE, entzündlichen Veränderungen und Tumoren wie auch die Beurteilung von Knorpel, Labrum, Knochenmarködemen und Torsionsverhältnissen. Schnelle Sequenztechniken ermöglichen bei Kleinkindern kurze fokussierte Untersuchungen ohne Narkose.

COMPUTERTOMOGRAPHIE: Die Computertomographie (CT) bleibt speziellen Fragestellungen vorbehalten und kann hochauflösende Darstellungen komplexer knöcherner Strukturen beitragen.

INTRODUCTION AND IMPORTANCE: Although developmental dysplasia of the hip (DDH) patients aged over 80 years are occasionally encountered in Japan, most of them have severe deformity with complete dislocation and have not received any treatment in childhood. Therefore, surgical treatment for such patients remains extremely challenging, and few detailed reports have described postoperative muscle recovery and rehabilitation outcomes in this age group.

CASE PRESENTATION: The patient was a woman in her 80s who had bilateral Crowe IV DDH dislocated into the gluteal muscles without a history of DDH treatment. She experienced walking difficulties due to aging and had elements of sarcopenia. One-stage bilateral total hip arthroplasty (THA) with shortening of the subtrochanteric osteotomy was performed.

CLINICAL DISCUSSION: The gluteal and knee extensor muscles in THA with shortening subtrochanteric osteotomy for Crowe IV dysplasia in old-old patients differ from those in conventional long-term outcomes; consequently, physical and gait performance did not reach the cutoff values for fall risk at several points.

CONCLUSION: Long-term intervention that considers multidisciplinary aspects is necessary for postoperative rehabilitation for one-stage bilateral THA with shortening subtrochanteric osteotomy in old-old patients with sarcopenia.