2026年5月 保髋进展 JCR Q1

PURPOSE: To critically evaluate the impact of tranexamic acid (TXA) on hip arthroscopy outcomes, including its effects on bleeding, functional recovery, postoperative pain, complications, intraoperative visualization, and surgical efficiency.

METHODS: A systematic review was conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Searches were conducted across PubMed, Embase, and Cochrane through March 2025. Inclusion criteria encompassed randomized controlled trials and prospective or retrospective comparative studies evaluating intravenous TXA during hip arthroscopy. Studies were excluded if they lacked original clinical data, involved non-arthroscopic procedures or did not report TXA use. Primary outcomes included blood loss, visual field clarity, operative time, postoperative pain, complications, and functional scores.

RESULTS: Six studies comprising 1034 patients (TXA, 584; control, 450) were analyzed. TXA significantly reduced perioperative bleeding, with postoperative hemoglobin and hematocrit declines consistently smaller in TXA patients compared with controls (P < .01). Intraoperative blood loss was also lower with TXA (0.18 L vs 0.24 L, P = .020). TXA did not consistently improve intraoperative visualization (Likert scores 2.51 to 2.85 vs 2.64 to 2.67, P = .13 to 0.16) or operative time (P > .3). One trial reported lower VAS pain scores at postoperative day 14 (2.3 ± 1.1 vs 3.1 ± 0.7, P < .05), though no long-term functional benefits were observed. A large cohort reported fewer complications with TXA (2.0% vs 6.8%, P < .01), largely driven by reduced lateral femoral cutaneous nerve neuritis (1.8% vs 4.6%, P = 0.02). Given the absence of a plausible mechanism and no difference when neuritis was excluded, this association is likely incidental. No significant differences were observed in thromboembolic events (0.2% vs 0.5%, P = .51), infections (P = .27), or revision rates (P = .68).

CONCLUSIONS: TXA use in hip arthroscopy significantly reduces perioperative bleeding without increasing the risk of major complications. It may offer modest short-term pain relief and early functional improvements, but no consistent long-term functional benefits have been showed. TXA does not reliably enhance intraoperative visualization or reduce operative time. The optimal dosing strategy remains uncertain, though continuous infusion may provide superior hemostatic efficacy compared to single bolus administration.

LEVEL OF EVIDENCE: Level III, systematic review of Level I, II, and III studies.

PURPOSE: To evaluate the minimum 5-year clinical outcomes and return-to-sport (RTS) rates of patients with generalized ligamentous laxity (GLL) who underwent hip arthroscopy with a secondary comparison to a benchmark control group with no GLL.

METHODS: We retrospectively analyzed all patients with GLL (Beighton score ≥ 4) who underwent primary hip arthroscopy between November 2009 and January 2019. We included patients who reported preoperative sport participation and had preoperative and minimum 5-year follow-up for at least one patient-reported outcome (PRO) measure: modified Harris Hip Score (mHHS), Non-Arthritic Hip Score (NAHS), Hip Outcome Score Sport-Specific Subscale (HOS-SSS), International Hip Outcome Tool-12 (iHOT-12), or Visual Analog Scale (VAS) for pain. Revision hip arthroscopy or conversion to arthroplasty was accounted for. Patients with GLL were matched to patients with a Beighton score of <3. Rates of meeting the minimal clinically important difference (MCID), RTS, and having secondary surgery were analyzed.

RESULTS: Two hundred thirty-two hips were included, with 116 hips in the GLL group (age: 27.3 years, BMI: 23.7 kg/m2) (78.7% follow-up) and 116 in the control group (age: 28.4 years, BMI: 23.6 kg/m2). Patients in the GLL group showed significant improvement in all evaluated PROs (mHHS: 66.1-86.7, NAHS: 67.6-87.0, iHOT-12: 40.1-78.2, HOS-SSS: 45.0-79.7, VAS: 4.9-2.1; P < .01). MCID was met at similarly high rates for both groups (P > .05). Patients with GLL reported a RTS rate of 83% at any time point postoperative, and 74.6% of those that returned were able to continue playing at the 5-year mark. No differences in postoperative PRO scores, RTS, continuation-of-sport participation, and survivorship were found between groups.

CONCLUSIONS: Hip arthroscopy in patients with GLL yields favorable outcomes and survivorship at 5-year minimum follow-up comparable to patients without GLL. A high percentage of athletes with GLL were able to RTS and continue playing 5 years after hip arthroscopy.

LEVEL OF EVIDENCE: Level IV, retrospective comparative case series.

PURPOSE: To compare 10-year outcomes of hip arthroscopy in patients with Tönnis grade 1 versus grade 0 osteoarthritis, with specific focus on patient-reported outcomes, rates of minimal clinically important difference, Patient Acceptable Symptom State, Substantial Clinical Benefit, and arthroscopic revision and total hip arthroplasty (THA) conversion rates.

METHODS: Patients undergoing hip arthroscopy for femoroacetabular impingement syndrome (FAIS) were prospectively enrolled. A 1:1 propensity score match based on age, sex, body mass index, smoking status, labral treatment, capsular management, lateral center edge angle, and preoperative alpha angle matched Tönnis grade 1 patients to Tönnis grade 0 patients. Inclusion criteria were symptomatic FAIS with radiographic deformity, failure of nonoperative treatment, and ≥10-year follow-up. Patients were excluded for prior ipsilateral hip arthroscopy, Tönnis grade >1, incomplete data, dysplasia (lateral center edge angle < 18°), developmental hip disorders, or concomitant procedures. Modified Harris hip score (mHHS), Non-Arthritic Hip Score (NAHS), minimal clinically important difference, Patient Acceptable Symptom State, Substantial Clinical Benefit, and failure (revision arthroscopy or THA conversion) rates at 10 years were assessed.

RESULTS: Out of a total database of 152 patients, the study matched 32 Tönnis grade 1 patients (mean age 40.79 ± 10.1 years; body mass index 25.13 ± 3.73; follow-up 12.16 ± .96 years [range, 10.08-13.59]) to 32 Tönnis grade 0 patients (mean age 41.82 ± 11.66; body mass index 25.63 ± 3.53; follow-up 11.42 ± 1.23 years [range: 10.02-13.58]) for a total of 64 included patients within this study. Baseline characteristics were well matched with the only significantly different variable being follow-up time (P = .009), though all patients reached a minimum follow-up of 10-years. Both cohorts showed significant improvements in mHHS and NAHS at 10 years (P < .0001), with no significant differences between groups at 10-years (mHHS P = .509; NAHS P = .339) or any other time point. MCID achievement rates were high for both mHHS (Tönnis 0: 87.5%; Tönnis 1: 90.6%; P = .689) and NAHS (Tönnis 0: 87.5%; Tönnis 1: 93.8%; P = .391). Tönnis grade 1 patients showed higher failure (THA/revision) rates compared to Tönnis grade 0 patients (31.25% vs 3.13%; P = .006). Analyzed separately, Tönnis grade 1 patients had 5 cases (15.63%) of THA conversion compared to 0 cases in the Tönnis grade 0 cohort (P = .05), while revision rates were similarly elevated in the Tönnis grade 1 group (5/32; 15.63%) compared to Tönnis grade 0 patients (1/32; 3.13%) (P = .196).

CONCLUSIONS: Hip arthroscopy yields significant long-term improvements for FAIS patients with Tönnis grade 1 and 0 osteoarthritis. However, increased failure rates in Tönnis grade 1 patients suggests that preoperative osteoarthritis may predispose patients to greater rates of subsequent THA conversion or revision.

LEVEL OF EVIDENCE: Level III, retrospective comparative matched case series.

Periacetabular osteotomy has been shown to be a powerful hip preservation procedure for over 4 decades. The advances in hip arthroscopy have revolutionized intra-articular hip preservation procedures, and combining the 2 operations is a deeply debated topic among hip preservation surgeons. The exact role of hip arthroscopy in the face of hip dysplasia and borderline hip dysplasia continues to be defined in our literature. The addition of hip arthroscopy to osteotomy patients has shown safety and improved patient outcomes. Clinical identification of combined impingement and dysplasia is imperative to potentially improve our patient outcomes.

Femoral neck fractures are commonly classified using Pauwels' system, which reflects fracture-line inclination and mechanical stability. However, anatomical factors influencing fracture configuration remain unclear. This multicenter prospective cohort study investigated whether pelvic morphology, particularly developmental dysplasia of the hip (DDH), is associated with variations in Pauwels classification. Between April and December 2023, 254 surgically treated femoral neck fractures from nine hospitals were analyzed. Radiological parameters, including center-edge angle, sharp angle, acetabular roof obliquity, acetabular version (AV), and acetabular and femoral head diameters, were measured. DDH was diagnosed using established radiographic criteria. Logistic regression analyses were performed to identify independent predictors of Pauwels type I and III fractures. DDH was present in 23.6% of patients and was significantly associated with a higher proportion of Pauwels type I fractures, whereas absence of DDH and reduced AV were associated with Pauwels type III fractures. Multivariate analysis confirmed DDH as an independent predictor of Pauwels type I fractures and decreased AV as an independent predictor of Pauwels type III fractures. These findings suggest that pelvic morphology, including mild dysplasia and acetabular retroversion, contributes to fracture configuration in femoral neck fractures and may provide insight into the biomechanical mechanisms underlying fracture patterns.

AIMS: Periacetabular osteotomy (PAO) is the gold-standard treatment for symptomatic hip dysplasia. While long-term joint preservation and functional improvement are documented, early postoperative recovery trajectories and predictors of meaningful improvement remain unclear.

METHODS: This prospective multicentre cohort study is a secondary analysis of a randomized trial including 218 patients (mean age 27.1 years (SD 7.7); 83.2% female (181/218)) undergoing PAO with or without hip arthroscopy. We aimed to 1) determine the timing and proportion of patients achieving minimal clinically important difference (MCID, + 26), substantial clinical benefit (SCB, + 42), and patient-acceptable symptom state (PASS, ≥ 65) on the 33-item International Hip Outcome Tool (iHOT-33) within 24 months; and 2) identify predictors of threshold achievement. Correction was assessed by lateral centre-edge angle (LCEA) and acetabular index. Logistic regression evaluated patient- and surgery-specific factors.

RESULTS: Radiological parameters improved significantly (mean LCEA 18.7° (SD 8.4°) to 32.2° (SD 5.7°); acetabular index 12.8° (SD 7.6°) to 1.6 (SD 6.3°), both p < 0.001). iHOT-33 improved from 34.2 (SD 16.4) preoperatively to 61.4 (SD 24.0) at six months, 72.8 (SD 22.0) at 12 months, and 78.0 (SD 21.0) at 24 months (p < 0.001). At six, 12, and 24 months, MCID was achieved by 70.2%, 71.5%, and 80.3% of patients; SCB by 52.8%, 64.6%, and 74.6%; and PASS by 56.3%, 73.5%, and 79.6%. Most recovery occurred within the first year, with continued gains thereafter. Multivariable analysis identified higher BMI as negative predictor for MCID, SCB, and PASS at 12 months (OR 0.88 to 0.89; p = 0.015 to 0.019). Residual undercorrection, reflected by higher postoperative acetabular index, reduced odds of MCID at 12 months (OR ~ 0.80 (95% CI 0.67 to 0.95); p = 0.011). Older age lowered the likelihood of PASS (OR 0.94 (95% CI 0.89 to 0.999); p = 0.047). Labral repair was negatively associated with PASS at six months (OR 0.27 (95% CI 0.09 to 0.89); p = 0.031), but not thereafter.

CONCLUSION: Most patients achieve clinically meaningful improvement within the first postoperative year, with further recovery into the second. Elevated BMI, older age, and residual undercorrection reduce the likelihood of reaching thresholds, while concomitant labral repair may temporarily delay early symptom acceptability.

Proximal femoral osteotomy remains an important joint-preserving option for adolescents and young adults with symptomatic proximal femoral deformity, preserved cartilage, and deformity amenable to correction. Surgical hip dislocation provides circumferential access to the femoral head, neck, and acetabulum while preserving the retinacular blood supply, and it allows direct dynamic assessment of impingement together with concomitant treatment of intra-articular pathology. The extended retinacular flap has expanded the indications for intra-articular correction at the femoral neck and head level, enabling larger corrections closer to the deformity with less secondary displacement when compared to extra-articular osteotomies. Preoperative planning must combine standardized radiographs, CT- or MRI-based torsion analysis, and MRI-based cartilage assessment; outcomes depend mainly on cartilage status, patient age, timing of correction, and technical precision.

BACKGROUND: Native hip instability encompasses a spectrum of abnormal pathomechanics under physiological loading and is associated with pain, dysfunction, and soft tissue damage. The condition spans a continuum-from developmental hip dysplasia to femoroacetabular impingement and even instability in the absence of bony deformities, as can be the case in patients with connective tissue disorders or soft tissue deficiencies. Despite advances in understanding this condition, biomechanical definitions, thresholds, and metrics remain inconsistent. We therefore sought to conduct a meeting with an international panel of experts to map available evidence on the biomechanical features of native hip instability, to identify knowledge gaps, and to explore whether current biomechanical metrics can reliably differentiate various degrees of severity of instability.

QUESTIONS/PURPOSES: In this scoping review and structured consensus document, we asked: (1) What are the biomechanical or pathomechanical features of native hip instability? (2) What are the biomechanical metrics of hip instability? (3) Can biomechanical metrics differentiate between hip microinstability versus conventional (bony) instability?

METHODS: A consensus study using the modified Delphi technique was conducted in accordance with the Accurate Consensus Reporting Document (ACCORD) guideline. The consensus meeting was held during the 15th Symposium on Joint Preserving and Minimally Invasive Surgery of the Hip, which took place in Québec City, Québec, Canada, in June 2025. The process involved a multidisciplinary steering committee and a diverse panel of 100 international participants representing 13 countries. Following a rapid scoping review, statements related to biomechanical or pathomechanical features of native hip instability and metrics of hip instability and hip microinstability were developed and sent to participants 1 week prior to the meeting. Participants voted on these statements across two Delphi rounds during the meeting, with consensus defined as ≥ 75% agreement.

RESULTS: The anatomic features of instability were identified as follows: bony morphology, static soft tissue stabilizers of the labrum and joint capsule, and muscles as dynamic stabilizers. Reported metrics for instability included femoral head translation, with translation < 3 mm considered normal by consensus. There was insufficient evidence to differentiate between microinstability (ligamentous) and conventional (structural bony) instability.

CONCLUSION: Biomechanically, native hip instability is characterized by an unpredictable femoral head path of motion influenced by bony morphology, capsulolabral integrity, and muscular stabilization. Femoral head translation was the most consistently supported metric, with translation < 3 mm considered physiological by consensus. Current biomechanical methods do not allow reliable differentiation between microinstability and structural instability. Standardized, reproducible in vivo measurements of three-dimensional hip motion are needed to establish clinically meaningful thresholds and guide patient care.

CLINICAL RELEVANCE: Clinically, this study sets a biomechanical benchmark defining native hip instability, enabling researchers to better distinguish between physiological laxity and pathologic instability. By defining biomechanical features of hip instability-most notably femoral head translation > 3 mm-this work contributes to a more standardized approach for defining joint stability, integrating bony morphology, capsulolabral integrity, and muscular stabilization. Such biomechanical insights guide surgical decision-making regarding capsular management and soft tissue repair and inform targeted rehabilitation strategies aimed at restoring hip stability.

BACKGROUND: Although several clinical signs have been proposed for diagnosing atraumatic hip instability, the condition remains poorly defined because of the absence of standardized diagnostic criteria. To address this gap, a Delphi consensus study with an international panel of experts to establish standardized clinical statements for the diagnostic criteria of hip instability was conducted.

QUESTIONS/PURPOSES: The objective was to reach consensus on the following questions: (1) What are typical presenting symptoms of hip instability? (2) What physical examination should be used to assess hip instability in patients presenting with symptoms of hip instability? (3) What risk factors are associated with patients presenting with symptomatic hip instability?

METHODS: A consensus study using the modified Delphi technique was conducted in accordance with the Accurate Consensus Reporting Document (ACCORD) guideline. The consensus meeting was held during the 15th Symposium on Joint Preserving and Minimally Invasive Surgery of the Hip, which took place in Québec City, Québec, Canada, in June 2025. The process involved a multidisciplinary steering committee and a diverse panel of 100 international participants representing 13 countries. Following a rapid scoping review, statements were developed and sent to participants 1 week prior to the meeting. These statements were voted across two Delphi rounds during the meeting, with consensus defined as ≥ 75% agreement.

RESULTS: Clinically, three physical examination tests, the abduction-hyperextension-external rotation (AB-HEER), prone instability, and anterior apprehension (HEER) tests, achieved consensus as clinically useful to assess hip instability. The flexion-abduction-external rotation (FABER) test and hip flexion + rotation arc of 200° did not reach consensus. Symptomatically, consensus was reached on patients reporting anterior hip pain during daily activities such as sitting, squatting, or participating in sports; mechanical symptoms such as popping, clicking, or grinding; and subjective sensations of looseness or instability. Female sex and hip dysplasia were agreed upon as key risk factors associated with atraumatic hip instability. Younger age as a potential risk factor did not reach consensus.

CONCLUSION: Individual physical examination tests assess different components of hip instability. As such, the use of a combination of tests alongside consideration of symptoms and relevant risk factors has been suggested to enhance diagnostic specificity and produce higher assessment accuracy. Also, further research is warranted to assess other psychometric properties of these tests to develop a comprehensive diagnostic framework for atraumatic hip instability.

CLINICAL RELEVANCE: By outlining key symptoms, recommended physical examination maneuvers, and associated risk factors, this study supports a more standardized and reproducible approach to evaluate hip instability in clinical practice. These findings can inform clinical algorithms, enhance diagnostic accuracy, and reduce variability in both research protocols and clinical practice.

BACKGROUND: The diagnosis of hip instability remains challenging because of its multifactorial etiology and the variability of imaging practices across institutions. Hip instability refers to a clinical condition of insufficient osseous and/or soft tissue constraint with abnormal femoral head motion and symptoms, which may occur along a morphologic spectrum that overlaps with-but is not synonymous with-developmental dysplasia of the hip. Although numerous imaging modalities and imaging parameters have been proposed, there is limited consensus on which are most relevant, how they should be measured, and what diagnostic thresholds best correlate with instability. To address this gap, a Delphi consensus study with an international panel of experts to establish standardized clinical statements for the diagnostic criteria of hip instability was conducted.

QUESTIONS/PURPOSES: (1) What are the imaging modalities and protocols for investigating hip instability? (2) Which imaging parameters are most strongly associated with clinical hip instability? (3) What are the quantitative imaging thresholds for diagnosing hip instability?

METHODS: A consensus study using a modified Delphi technique was conducted in accordance with the Accurate Consensus Reporting Document (ACCORD) guideline. Following a scoping review, 27 statements addressing imaging modalities and protocols (question 1), imaging parameters associated with hip instability (question 2), and quantitative imaging thresholds (question 3) were developed. These statements were evaluated by a multidisciplinary international expert panel during a structured consensus meeting, with two rounds of anonymous voting and consensus defined a priori as ≥ 75% agreement. Consensus was achieved for 81% (22 of 27) of statements.

RESULTS: There was strong agreement that radiography (AP pelvis, false-profile, Dunn view) and MRI and CT constitute the foundational imaging modalities for the assessment of hip instability, whereas cartilage mapping techniques and dynamic ultrasound were considered adjunctive modalities with a more limited and evolving role. Radiographic measurements such as lateral center-edge angle (LCEA), anterior wall index (AWI), posterior wall index, and Tönnis angle reached consensus as key morphologic indicators. Several quantitative thresholds were endorsed. An LCEA of < 20° was considered diagnostic for hip dysplasia, a condition in which clinical hip instability is highly prevalent, whereas values between 20° and 25° were considered concerning for possible clinical hip instability. Additional thresholds included an AWI of < 0.30, PWI of < 0.8, and acetabular version < 5° or > 30°. In contrast, no consensus was reached for less-established imaging metrics such as the FEAR index, crescent sign, anterior capsule thickness, and dynamic femoral head translation.

CONCLUSION: This international Delphi consensus defined core imaging approaches and threshold values for the evaluation of hip instability. Although agreement was reached on key morphometric parameters and diagnostic thresholds, a lack of consensus exists around newer soft tissue and dynamic measures, highlighting important areas for future research.

CLINICAL RELEVANCE: In patients with suspected clinical hip instability, standard radiography should be used as the first-line imaging modality, followed by targeted use of CT and MRI to evaluate three-dimensional bony morphology and soft tissue stabilizers. Imaging findings should be interpreted within a stepwise, algorithmic framework that integrates clinical assessment with multiple complementary imaging parameters rather than relying on isolated measurements. Ultimately, accurate diagnosis of hip instability depends on the integration of findings from multiple modalities. Additionally, it must be recognized that hip instability may exist even in the absence of characteristic radiologic signs.

BACKGROUND: Hip arthroscopy for femoroacetabular impingement yields favorable average results, yet many patients do not achieve truly excellent function. The influence of pre-operative radiographic and spinopelvic parameters on excellent short-term outcomes remains uncertain. We aimed to identify pre-operative radiographic and spinopelvic factors associated with achieving an excellent patient-reported outcome at 12 months after arthroscopic treatment of femoroacetabular impingement.

METHODS: A retrospective multicenter study of prospectively collected data was performed across six French centers. Consecutive patients treated arthroscopically for symptomatic femoroacetabular impingement between September 2020 and October 2021 were included if the 12-month Non-Arthritic Hip Score was available. Standard hip radiographs were used to measure degenerative grade, lateral centre-edge angle, and the Dunn alpha angle. Spinopelvic parameters were assessed on low-dose biplanar imaging in standing and sitting, including intrinsic pelvic mobility (standing minus sitting sacral slope). The primary endpoint was an excellent outcome defined as a 12-month Non-Arthritic Hip Score of at least 92. Missing spinopelvic data were handled by multiple imputation, and univariate then multivariable logistic regression was used, adjusted for age, sex, and body mass index.

RESULTS: Of 200 eligible patients, 178 (89.0%) had 12-month outcome data; 82 (46.1%) achieved a Non-Arthritic Hip Score of at least 92. In the adjusted model, standing pelvic tilt of 10 degrees or less (odds ratio 2.82; 95% confidence interval 1.35-5.90), degenerative grade 0 (odds ratio 5.15; 95% confidence interval 2.19-12.09), lateral centre-edge angle greater than 25 degrees (odds ratio 3.08; 95% confidence interval 1.41-6.74), and male sex (odds ratio 3.18; 95% confidence interval 1.38-7.32) independently predicted an excellent outcome. Intrinsic pelvic mobility, standing lumbar lordosis, Dunn alpha angle, age, and body mass index were not independently associated with excellent outcome.

CONCLUSIONS: Only about half of patients undergoing hip arthroscopy for femoroacetabular impingement achieved an excellent 12-month outcome. Tonnis grade 0, lateral centre-edge angle greater than 25 degrees, standing pelvic tilt of 10 degrees or less, and male sex independently predicted excellent results, whereas pelvic mobility, standing lumbar lordosis, age, and body mass index did not.

AIMS: This study aimed to characterize long-term patient-reported outcomes and survivorship following femoral derotational osteotomy (FDO).

METHODS: A total of 77 hips (60 patients) between March 1997 and February 2019 who underwent FDO using an antegrade intramedullary device for excessive femoral anteversion or retroversion by a single-surgeon were retrospectively reviewed. Those with minimum five-year follow-up, with a mean of ten years (5.2 to 26.8), were included. Pre/postoperative modified Harris Hip Score (mHHS), postoperative patient global impression of change (PGIC), and patient acceptable symptomatic state (PASS) responses were collected. Survivorship free of conversion to arthroplasty was determined.

RESULTS: Overall, 90.0% of patients were female with a mean age of 29.6 years (14.4 to 60.9). A total of 52 hips had excessive anteversion with mean deformity of 38.3° (22° to 58°) and mean correction of 22.4° (15° to 40°); 25 hips had excessive retroversion with mean deformity of -8.7° (-24° to 2°) and mean correction of 21.7° (15° to 35°). Concomitant procedures included hip arthroscopy (32.5% of cases), periacetabular osteotomy (9.0%), and tibial derotational osteotomy (7.8%). Regardless of deformity, mean mHHS significantly improved (61.6 to 89.7, p < 0.001). The proportion of minimal clinically important difference (MCID), substantial clinical benefit (SCB), and PASS achievement was 94% (72 of 77), 84% (65 of 77), and 87% (67 of 77), respectively. For PGIC, 95.2% reported improvement, including 88.7% who reported themselves 'very much improved' or 'much improved'. Overall, 92.7% of anteverted and 85.7% of retroverted patients found their current symptomatic state satisfactory (p = 0.398). Three hips (two patients) underwent arthroplasty at mean 4.3 years. Survivorship free from conversion to arthroplasty was 95% at ten, 15, and 20 years.

CONCLUSION: In appropriately selected patients, FDO for hip pain related to excessive femoral anteversion or retroversion provides significant improvements in pain and function at a mean ten-year follow-up. Most patients report postoperative improvement and find their current symptomatic state satisfactory. The procedure effectively preserves the native hip joint with 95% long-term survivorship free of conversion to arthroplasty.

DesignPragmatic, two-arm, parallel-group, superiority randomised controlled trial with assessor-blinding and statistician-blinding.SettingSingle orthopaedic centre in Shanghai, China.ParticipantsOne hundred and eighty adults (aged 18-50 years) with femoroacetabular impingement syndrome scheduled for hip arthroscopy were randomised to prehabilitation (n = 90) or usual care (n = 90).InterventionThe prehabilitation group received 6 weeks of supervised exercise, education and home activity before surgery. Controls received standard preoperative advice. All patients received identical postoperative rehabilitation.Main measuresThe primary outcome was the Harris Hip Score at 24 weeks. Secondary outcomes included pain, maximal hip muscle strength, range of motion, dynamic balance, quality of life, mental health and cost.ResultsAt 24 weeks, the Harris Hip Score did not differ significantly between groups (adjusted between-group difference 0.98 points [95% CI -0.11 to 2.07], p = 0.08). At 4 and 12 weeks, differences numerically favoured prehabilitation (1.52 points, uncorrected p = 0.02; 1.14 points, uncorrected p = 0.04) but did not reach significance after Bonferroni correction (threshold p < 0.0167). Secondary outcomes favoured prehabilitation, including pain, maximal hip strength, range of motion and dynamic balance, though all between-group differences were below published thresholds for clinically important change.ConclusionsPrehabilitation before hip arthroscopy for femoroacetabular impingement syndrome was associated with small early improvements that did not reach statistical significance for the primary outcome after correction for multiple comparisons and were below clinically important thresholds. Total costs did not differ significantly between groups.Trial registration numberChiCTR2500113298 (Chinese Clinical Trial Registry, https://www.chictr.org.cn/, date of registration: 26 November 2025). This trial was registered retrospectively.

INTRODUCTION: Existing literature supports weight-bearing and activity restriction following hip arthroscopy, as well as early participation in physical therapy. However, there is a knowledge gap surrounding how failure to adhere to these instructions affects long-term outcomes. This study aims to evaluate how noncompliance with postoperative protocol after hip arthroscopy affects patient-reported outcomes at 2 years after surgery.

METHODS: Seventy-nine patients who underwent hip arthroscopy for femoroacetabular impingement between January and December 2022 were identified, with 52 in the compliant group and 27 in the noncompliant group. Patient noncompliance was defined as loss to follow-up (n = 4), delayed or lack of physical therapy (n = 12), and nonadherence to weight-bearing and activity restrictions (n = 17) within 3 months following surgery. Symptom and functional status were assessed at 2 years with the international Hip Outcomes Tool (iHOT-12), the Physical Function Short Form of the Hip Disability and Osteoarthritis Outcome Score (HOOS-PS), and the single-item patient-acceptable symptom state.

RESULTS: The average iHOT and HOOS-PS scores were lower for noncompliant patients (iHOT, 50.67; SD, 28.9; HOOS-PS, 60.9; SD, 23.8) compared with compliant patients (iHOT, 71.95; SD, 26.8; P = 0.002; HOOS-PS, 79.0; SD, 23.0; P = 0.002). Noncompliant patients had lower rates of reaching Patient Acceptable Symptom State at 2 years (compliant: 69%, noncompliant: 37%; OR = 3.86; 95% CI [1.42, 10.0] 0.006). Multivariate analysis revealed independent predictors of lower iHOT scores were history of a mental health disorder (-12.0 points SD, 2.9; P = 0.001) and noncompliance (-8.6 points SD, 3.0; P = 0.01). No baseline demographic differences were identified between compliant and noncompliant patients.

CONCLUSION: Noncompliance with functional restrictions and postoperative physical therapy is a strong independent risk factor for poor patient-reported outcomes at 2 years after hip arthroscopy.

BACKGROUND: The effect of hip arthroscopy on the natural progression of osteoarthritis is still unclear.

PURPOSE: To clarify the relationship between unilateral hip arthroscopy, the size of the cam lesion, and its excision on the progression of hip osteoarthritis.

STUDY DESIGN: Cohort study; Level of evidence, 3.

METHODS: A total of 105 patients who underwent unilateral hip arthroscopy due to femoroacetabular impingement and had a minimum of 2 years of follow-up were included. Joint space width (JSW) measurements were made at the medial (MJW), lateral (LJW), and central (CJW) aspects of the sourcil line on anteroposterior supine pelvis radiographs. The alpha angle (α) was measured using preoperative and early postoperative Dunn 45° radiographs.

RESULTS: LJW decreased and was more obvious in men than in women in the operated hips. All LJWs, MJWs, and CJWs decreased on the contralateral nonoperated hips (P < .05). The operated sides had higher MJW compared with the contralateral nonoperated sides (3.58 ± 0.75 mm vs 3.34 ± 0.6 mm; P = .02) and a lower decrease of medial joint space compared with contralateral sides (Δ1, -0.05 mm; Δ3, -0.3 mm; P = .00). At the final follow-up, central joint space was greater in the operated hips compared with the contralateral hips in patients with higher preoperative alpha angle (α0) (≥0.1 mm vs <0.1 mm; preoperative α, 81 vs 79; P = .03).

CONCLUSION: Patients treated with unilateral hip arthroscopy demonstrated a decrease in the LJW, while nonoperated sides had a decrease in all 3 widths, leading to a greater joint space in the operated hip, especially at the MJW. Furthermore, patients having more severe cam deformity preoperatively had better preservation of CJW.

BACKGROUND: Pincer-type femoroacetabular impingement (FAI) results from acetabular overcoverage. While computed tomography (CT) with multiplanar reformation (MPR) enables precise measurement of acetabular sector angles (ASAs), the diagnostic utility and limitations of these measurements remain unclear.

PURPOSE: To evaluate the diagnostic accuracy of ASA measurements in pincer-type FAI and determine whether these measurements can serve as stand-alone diagnostic criteria or should be integrated with other clinical parameters.

STUDY DESIGN: Cross-sectional study.

METHODS: The authors evaluated 104 hips in 52 patients with surgically confirmed pincer-type FAI and 31 asymptomatic controls. ASAs were measured at 4 levels using CT with MPR correction for pelvic tilt. Receiver operating characteristic (ROC) analysis determined diagnostic cutoff values.

RESULTS: Intermediate anterior ASA (IAASA) showed the most significant difference between FAI and controls (88.7°± 21.4° vs 67.8°± 13.6°; P < .001; d = 1.11). However, ROC analysis revealed only moderate diagnostic accuracy (area under the curve, 0.79). An IAASA cutoff of 97° provided 88% specificity but only 40% sensitivity.

CONCLUSION: IAASA is significantly elevated in pincer-type FAI but has only moderate diagnostic accuracy due to substantial population variation. ASA measurements should be integrated with clinical findings, traditional radiographic parameters, and surgical findings rather than used as stand-alone diagnostic criteria.

BACKGROUND: Hip arthroscopy for femoroacetabular impingement syndrome (FAIS) yields excellent clinical outcomes. However, untreated concomitant acetabular dysplasia is associated with higher failure rates after arthroscopy. A combined approach of hip arthroscopy and periacetabular osteotomy (PAO) has shown promising results, but it remains unclear whether outcomes are equivalent to those of arthroscopy alone for FAIS without dysplasia.

PURPOSE/HYPOTHESIS: The primary purpose of this study was to compare 2-year patient-reported outcome (PROs) between patients with FAIS and acetabular dysplasia treated with staged hip arthroscopy and PAO and nondysplastic patients with FAIS treated with hip arthroscopy alone. The secondary purpose was to identify independent predictors of PROs at 2 years postoperatively. It was hypothesized that patients with FAIS and acetabular dysplasia treated with arthroscopy and PAO would demonstrate similar 2-year PROs compared with nondysplastic FAIS patients treated with arthroscopy alone.

STUDY DESIGN: Cohort study; Level of evidence, 3.

METHODS: A total of 147 patients who underwent hip arthroscopy for FAIS were identified, including 23 patients in the dysplastic group and 124 in the control group. PROs were assessed at 2 years using Mental Health Inventory (MHI-5), 12-item international Hip Outcome Tool (iHOT-12), Physical Function Short Form of the Hip Disability and Osteoarthritis Outcome Score (HOOS-PS), University of California Los Angeles (UCLA) Activity Scale, Adult Single Item Measure (SIM) of Physical Activity, Patient Acceptable Symptom State (PASS) single item, and repeat surgery. Multivariate analyses adjusted for baseline demographics, preoperative superior joint space width, prior corticosteroid injection, and mental health status.

RESULTS: The dysplastic group was younger (mean age, 27.9 ± 8.7 years) and predominantly female (95.7%) compared with the control group (36.3 ± 12.8 years; 80.6% female) (age, P = .003; sex, P = .046, respectively). No differences were observed in 2-year iHOT-12 scores (67.20 vs 62.05; P = .45, respectively) or PASS achievement (69.56% vs 54.84; P = .18). On multivariate analysis, dysplasia was not an independent predictor of iHOT-12 score, PASS, or unplanned additional surgery. Preoperative joint space width was a significant predictor of revision surgery (adjusted odds ratio, 4.17; 95% CI, 1.49-11.1; P = .006).

CONCLUSION: The treatment of FAIS with concomitant acetabular dysplasia with hip arthroscopy and PAO has similar 2-year PROs to patients with FAIS without dysplasia treated with arthroscopy alone.

BACKGROUND: Typically, 3 months is an early postoperative time point at which patients with femoroacetabular impingement syndrome (FAIS) demonstrate clinically meaningful improvement, while 6 months represents an important midterm stage for recovery and return to sport.

PURPOSE: To assess continuous changes in the kinematics of the involved and uninvolved lower limbs in patients with FAIS at 3 and 6 months after hip arthroscopy as well as to examine their relationships with International Hip Outcome Tool-33 (iHOT-33) and Copenhagen Hip and Groin Outcome Score Sport subscale (HAGOS-Sport) scores.

STUDY DESIGN: Cohort study; Level of evidence, 2.

METHODS: The study included 15 patients who underwent hip arthroscopy between March 2024 and November 2024 as well as a healthy control group of 15 participants, matched to the patients by sex, age, and body mass index, recruited from the community. All participants performed the single-leg squat (SLS), and kinematic data were collected using an 8-camera motion capture system. One-way analysis of variance was used to compare baseline, 3-month postoperative, and 6-month postoperative kinematic data of the FAIS group with those of the healthy control group. Post hoc comparisons were conducted using the Tukey test to determine between-group differences. Correlation analysis was performed to assess the relationship between changes in the hip flexion angle and changes in iHOT-33 and HAGOS-Sport scores.

RESULTS: At 3 months postoperatively, the involved limb hip flexion angle (P = .021), hip adduction angle (P = .0011), knee flexion angle (P = .016), and change in the center of mass (P = .0034) were reduced compared with the healthy control group. At 6 months postoperatively, no significant kinematic differences were observed between the FAIS and healthy control groups. Correlations between changes in the iHOT-33 score at 3 months and changes in the hip flexion angle at 6 months were positive (r = 0.64; P = .0094), and changes in the iHOT-33 score at 6 months were also positively correlated with changes in the hip flexion angle at 6 months (r = 0.53; P = .041).

CONCLUSION: Patients with FAIS exhibited abnormal kinematics during the SLS at 3 months postoperatively, which showed improvement by 6 months. Furthermore, improvement in sagittal-plane angles of the hip at 6 months postoperatively was correlated with the iHOT-33 score, supporting our hypothesis. Clinicians should not overlook functional recovery after hip arthroscopy for FAIS.

BACKGROUND: Acetabular labral tears can lead to hip pain and dysfunction and progress to osteoarthritis if left untreated. While surgical repair is the gold standard, reconstruction with grafts is necessary in cases of irreparable labral damage. Clinical data suggest that meniscal allografts may offer superior outcomes as compared with anterior tibialis tendon allografts, but biomechanical comparisons remain limited.

HYPOTHESIS/PURPOSE: This study aimed to compare the tissue properties of the native acetabular labrum, fresh-frozen medial meniscal allograft, and fresh-frozen anterior tibialis tendon allograft. The null hypothesis was that the fresh-frozen medial meniscus will not have statistically different biomechanical properties to the native labrum and fresh-frozen anterior tibialis tendon.

STUDY DESIGN: Controlled laboratory study.

METHODS: Samples of the native labrum (n = 6), fresh-frozen meniscus (n = 6), and fresh-frozen anterior tibialis tendon (n = 6) were standardized and biomechanically tested using a 3-phase protocol on an Instron materials testing machine. Properties measured included ultimate strength, yield force, yield strength, stiffness, Young modulus, and work to failure. One-way analysis of variance with post hoc Tukey was performed to determine statistically significant differences among tissue types. Significance was set at P < .05.

RESULTS: Ultimate strength, yield force, and Young modulus were not significantly different across tissue types. Native labrum exhibited significantly higher yield strength (mean ± SD; 48.25 ± 14.56 MPa) when compared with the meniscus (26.69 ± 6.51 MPa) and anterior tibialis tendon (27.50 ± 5.02 MPa; P = .002). Stiffness was greater in the anterior tibialis tendon (159.35 ± 44.11 N/mm) than in the native labrum (89.07 ± 26.76 N/mm) and meniscus (112.84 ± 56.74 N/mm; P = .027). Work to failure was highest in the native labrum (1143.62 ± 551.31 N·mm) versus the meniscus (310.44 ± 168.29 N·mm) and tibialis tendon (265.93 ± 131.48 N·mm; P = .001).

CONCLUSION: The stiffness of the medial meniscus tested closer to the native labrum than the anterior tibialis, but both grafts had significantly lower yield strength and work to failure than the native labrum. Together, the results indicate that the medial meniscus and anterior tibialis are viable graft options, but they do not replicate the tissue properties of the native labrum.

CLINICAL RELEVANCE: These findings support the use of medial meniscal allograft in acetabular labral reconstruction given its biomechanical similarity to native labral tissue, reinforcing prior clinical data and aiding graft selection in hip preservation surgery.