2026年7月 保髋进展 JCR Q1

OBJECTIVE: We evaluated the effect of physiotherapist-led treatment with targeted-strengthening (STRENGTH) compared with physiotherapist-led treatment with standardised-stretching (STRETCH) on hip-related quality of life (QOL) and patient-perceived Global Rating of Change (GROC) at 6 months in people with femoroacetabular impingement (FAI) syndrome.

METHODS: Assessor-blind, limited disclosure, parallel, superiority randomised controlled trial. Participants aged 18-50 years with FAI syndrome were recruited and randomly allocated (1:1 ratio) to receive 6 months of STRENGTH or STRETCH treatment. Primary outcomes were change in (1) hip-related QOL (International Hip Outcome Tool-33 (iHOT-33, 0-100 points)); and (2) GROC-pain and GROC-function at 6 months. Secondary analysis included dichotomised GROC ('improved' and 'not improved') and hip muscle strength. Analyses were by intention to treat.

RESULTS: 154 participants (STRENGTH n=79 (53% women, mean 35 (SD 9) years); STRETCH n=75 (45% women, mean 36 (SD 9) years)) were included. There was no difference between groups for change in hip-related QOL (mean difference (95% CI) 0.2 (-5.9 to 6.3)) or patient-perceived global improvement (GROC-pain 0.2 (-0.2 to 0.7), p=0.23; GROC-function 0.3 (-0.1 to 0.6)) at 6 months. 72% of STRENGTH were improved for GROC-pain (OR 2.36 (1.15 to 4.84)) compared with 52% of STRETCH. STRENGTH had greater improvements than STRETCH in hip strength. Both groups improved in iHOT-33 over 6 months (STRENGTH 19.2 (15.7 to 22.8), STRETCH 20.8 (17.1 to 24.5) points).

CONCLUSION: There was no superior physiotherapist-led treatment to improve hip-related QOL in people with FAI syndrome, but secondary analysis indicated that targeted strengthening resulted in greater improvements in perceived pain and hip muscle strength at 6 months. Hip-related QOL improved in both groups by clinically meaningful amounts.

TRIAL REGISTRATION NUMBER: ACTRN12617001350314.

PURPOSE: To leverage a large national database to assess the association of type 1 diabetes mellitus (T1DM) with hip arthroscopy outcomes in patients with labral tears and/or femoroacetabular impingement syndrome.

METHODS: Patients who underwent hip arthroscopy for labral tears and/or femoroacetabular impingement syndrome were abstracted from the 2010 to 2023 PearlDiver M170 database. Patients with T1DM were matched 1:4 with those without T1DM based on age, sex, and Elixhauser comorbidity index. Multivariable logistic regression was used to assess the relationship between T1DM and 90-day postoperative adverse events as well as emergency department visits. Five-year conversion rates to total hip arthroplasty were assessed and compared with a log-rank test.

RESULTS: Of 69,679 patients undergoing hip arthroscopy, T1DM was identified in 951 patients (1.4%). After matching, 760 patients undergoing hip arthroscopy with T1DM were matched with 2968 patients without T1DM. Those with T1DM had significantly higher 90-day odds of any adverse events (odds ratio [OR] = 5.81), severe adverse events (OR = 2.65), minor adverse events (OR = 5.63), and emergency department visits (OR = 4.03) (P < .0001 for all). Five-year conversion to total hip arthroplasty was statistically significantly higher in the T1DM group (9.4% vs 6.4%, P = .05).

CONCLUSIONS: Patients with T1DM undergoing hip arthroscopy for labral tears and/or femoroacetabular impingement syndrome showed significantly higher rates of postoperative adverse events and emergency department visits, as well as greater rates of 5-year conversion to total hip arthroplasty compared with a matched control group without T1DM.

LEVEL OF EVIDENCE: Level III, retrospective comparative case-control study.

PURPOSE: To analyze minimum 5-year outcomes after arthroscopic treatment of femoroacetabular impingement syndrome (FAIS) utilizing the periportal capsulotomy technique for joint access without capsular closure.

METHODS: A retrospective review of a prospectively collected database of patients undergoing primary hip arthroscopy for FAIS without clinical signs of hypermobility was performed to analyze patients who underwent hip arthroscopy utilizing the periportal capsulotomy technique without capsule closure with minimum 5-year follow-up. Periportal capsulotomy was utilized for joint access, and arthroscopic labral treatment and osteochondroplasty were completed as indicated without capsular closure. Patient demographics, surgical details, and complications were recorded. Pre- and postoperatively, patients completed the modified Harris Hip Score, Hip Disability and Osteoarthritis Outcome Score (HOOS), 12-item Short-Form survey (SF-12 physical and mental components), and visual analog scale (VAS). Achievement of clinically significant outcomes (CSO) including minimal clinically important difference (MCID), patient acceptable symptom state (PASS), and substantial clinical benefit (SCB) was calculated.

RESULTS: One hundred and sixty-six hips from 161 patients (mean age, 34.1 ± 11.2; body mass index, 24.1 ± 3.6; 54% female) were included. There were no major postoperative complications including hip instability, revision arthroscopy, or conversion to total hip arthroplasty. Mean patient-reported outcome scores (PROs) were significantly improved from preoperative scores to 5-year postoperative scores (VAS, HOOS symptoms, pain, activities of daily life, sport, quality of life, and SF-12 physical component, all P < .001). Overall, 96.9% of patients achieved at least one of the CSO thresholds with 94.0% achieving MCID in at least one PROs, 86.7% meeting PASS in at least one PROs, and 80.1% achieving SCB in at least one PROs.

CONCLUSIONS: Patients undergoing arthroscopic FAIS treatment utilizing periportal capsulotomy for hip capsule management show high rates for CSO achievement at midterm 5-year follow-up.

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

PURPOSE: To systematically evaluate capsulotomy techniques through patient-reported outcome measures, rates of revision arthroscopy, conversion to total hip arthroplasty, and achievement of clinically meaningful outcomes.

METHODS: PubMed, Scopus, and Embase databases were queried in June 2024 for studies that could be used to compare capsular management strategies primarily via patient-reported outcome measures at a minimum 2-year follow-up. Inclusion criteria consisted of patients who underwent primary hip arthroscopy for the treatment of femoroacetabular impingement, minimum 2-year follow-up, and reported capsulotomy type. Based on the capsular management technique performed, groups were defined as interportal capsulotomy with closure, T-capsulotomy with complete closure, periportal capsulotomy, or puncture capsulotomy. Heterogeneity was adjusted for using metaregression models.

RESULTS: Of the 1322 unique studies identified in our search, 8 studies (1961 hips) were included. The combined puncture capsulotomy and periportal capsulotomy group (mean difference range, 21.30-32.56) performed similarly to interportal capsulotomy with closure (mean difference range, 18.33-32.00) and T-capsulotomy with complete closure (mean difference range, 20.70-23.30) groups in modified Harris Hip Score (P = .274). This continued when evaluating revision and total hip arthroplasty rates (proportion range, 0.0-0.05 and 0.0-0.01, respectively). Metaregression adjustments found baseline modified Harris Hip Score significantly influences mean differences (adjusted mean difference, -0.53 [-0.83, -0.23], P = .0006). When considering the achievement rates of minimal clinically important difference, all capsulotomy methods were similar for modified Harris Hip Score; however, minimal clinically important difference thresholds had a significant influence of -0.46 (95% confidence interval, [-0.54, -0.39], P < .0001) based on a metaregression model.

CONCLUSIONS: Periportal and puncture capsulotomy techniques did not yield statistically different outcomes compared with traditional capsulotomy techniques that use capsular closure at 2-year follow-up.

LEVEL OF EVIDENCE: Level IV, systematic review of Level II to IV studies.

PURPOSE: To evaluate return-to-sport (RTS) rates and patient-reported outcome measures (PROMs) following hip arthroscopic labral repair for femoroacetabular impingement in active basketball players with a minimum of 2-year follow-up.

METHODS: All patients who were active basketball players and underwent hip arthroscopy with labral repair for femoroacetabular impingement from 2009 to 2022 were identified. Patients were evaluated for postoperative RTS and revision surgery at a minimum 2-year follow-up. RTS was defined as resuming basketball participation, at any level. Modified Harris Hip Score (mHHS), Hip Outcome Score-Activities of Daily Living (HOS-ADL) and Sport (HOS-Sport), and surgery satisfaction were also collected.

RESULTS: Sixty-seven hips in 54 athletes (29 male, 25 female) with a mean age of 22.2 years (range 13-39 years) were included. Eighty-six (86%) were recreational or high school basketball players. There was significant improvement in all PROMs from baseline to a minimum 2-year follow-up (all P < .001). After excluding for athletes who did not RTS for nonmedical reasons, 78% of athletes returned to basketball following hip arthroscopy. Including patients who cited nonmedical reasons for not returning, the overall RTS rate was 65%. Athletes who RTS had significantly higher mHHS (P = .012), HOS-ADL (P = .006), and HOS-Sport (P = .002), as well as lower visual analog scale pain (2.2 vs 3.4, P = .037) than those who did not RTS. Calculated minimal clinically important difference values were 8.3 for mHHS, 7.2 for HOS-ADL, and 13.4 for HOS-Sport. Anchor-based patient acceptable symptom state calculations yielded thresholds of 83.5 for mHHS, 92.6 for HOS-ADL, and 79.2 for HOS-Sport-with 70%, 63%, and 67% of patients achieving these thresholds, respectively.

CONCLUSIONS: Basketball players who undergo hip arthroscopic labral repair for femoroacetabular impingement show significant improvements in PROMs with 78% RTS rate at a minimum 2-year follow-up. Although many athletes discontinued basketball for reasons unrelated to the hip, 18% cited hip issues. Basketball players who successfully return to basketball report higher PROMs than nonreturners, and cohort-specific minimal clinically important difference analysis indicates that most athletes achieve clinically meaningful improvements.

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

OBJECTIVE: To evaluate a 3-month post-hip arthroscopy rehabilitation program within a randomized controlled trial comparing hip arthroscopy to sham surgery for femoroacetabular impingement syndrome (HIP ARThroscopy International [HIPARTI] trial) by describing exercise adherence, type, and pain; 6-month changes in International Hip Outcome Tool-33 (iHOT-33); and physical impairments and functional performance. DESIGN: Exploratory cohort study nested in a pilot randomized controlled trial. METHODS: Participants aged 18 to 50 years with femoroacetabular impingement syndrome completed a 3-month, physical therapist-led, postsurgical rehabilitation program, self-reporting rehabilitation adherence and pain levels on the visual analog scale using weekly training diaries. Baseline to 6-month changes in quality of life (iHOT-33), physical impairment (hip strength, range of motion [ROM]), and functional performance (single-leg hop, side bridge endurance) were reported as mean (standard deviation). RESULTS: Twenty-nine people (37% female, 29.9 ± 7.9 years) participated. Hip extension, abduction, and functional exercises were performed most often. Exercise adherence analysis was limited by underreporting. Training diary data adequate to assess adherence were available for 20 participants (69%). Among those with available data, 16 (80%) met the predefined adherence target of ≥2 sessions per week, and average pain remained acceptable (<2 visual analog scale); iHOT-33 (+18.6 ± 22.5; 95% confidence interval: 10.2, 27.0) and hip flexion ROM (+6°; 95% confidence interval: 2.14, 9.60) improved significantly. Hip extension, adduction, external and internal rotation strength improvements exceeded the minimal detectable change, although they were not significant. CONCLUSION: Adherence was generally high among participants with available data, though limited by underreporting. Hip-related quality of life (iHOT-33) improved despite limited changes in physical impairments, and no improvement in functional performance. J Orthop Sports Phys Ther 2026;56(7):456-464. Epub 23 April 2026. doi:10.2519/jospt.2026.13775.

OBJECTIVE: To explore associations between hip muscle strength and symptom severity in individuals with femoroacetabular impingement (FAI) syndrome. DESIGN: Cross-sectional study. METHODS: Baseline data from 150 participants with FAI syndrome who participated in a clinical trial were analyzed. Hip abduction, adduction, flexion, extension, internal rotation, and external rotation muscle strength assessments were performed using a handheld dynamometer. Symptom severity was assessed using the International Hip Outcome Tool-33 Symptoms subscale (iHOT-Symptoms). Linear and nonlinear associations were explored using generalized linear models. RESULTS: Nonlinear associations (spline) between hip muscle strength values and iHOT-Symptoms scores were observed. Lower hip flexion (average marginal effect [AME] = 0.25, 95% confidence interval [CI] [0.12, 0.39]), abduction (AME = 0.25, 95% CI [0.11, 0.40]), and adduction (AME = 0.29, 95% CI [0.11, 0.47]) muscle strength values were associated with worse iHOT-Symptoms scores. Greater hip muscle strength was not associated with better iHOT-Symptoms scores. Hip external rotation (AME = 0.10, 95% CI [-0.01, 0.20]), internal rotation (AME = 0.10, 95% CI [0.01, 0.19]), and extension (AME = 0.02, 95% CI [-0.02, 0.07]) muscle strength values were not meaningfully associated with iHOT-Symptoms scores. CONCLUSION: Reduced hip flexion, abduction, and adduction muscle strength were associated with worse symptoms in patients with FAI syndrome, but only in individuals with hip muscle weakness. Hip external rotation, internal rotation, and extension muscle strength were not associated with symptom severity. J Orthop Sports Phys Ther 2026;56(7):465-471. Epub 2 March 2026. doi:10.2519/jospt.2026.13674.

BACKGROUND: Hip dysplasia is a common cause of hip-related pain in young adults. Hip dysplasia is frequently overlooked by clinicians, leading to delayed diagnosis and subsequent adverse outcomes, including debilitating pain, functional impairments, and poor quality of life. Diagnosing hip dysplasia is often challenging due to its variable clinical presentation, its overlap with other conditions, and the absence of standard diagnostic criteria. Despite these challenges, an emerging body of research provides valuable insight into the management of hip dysplasia. CLINICAL QUESTION: How can new and existing evidence on hip dysplasia be synthesized to support clinicians in understanding its etiopathogenesis and diagnostic approaches-including both imaging and clinical evaluation-and in improving management strategies to enable timely diagnosis and treatment of this common condition? KEY FINDINGS: Hip dysplasia presents with variable symptoms and commonly coexists with other musculoskeletal conditions. Clinical examinations should include assessment of generalized joint hypermobility, hip range of motion, symptom-reproducing tests, and extra-articular structures. Imaging remains essential but must be interpreted in the clinical context. Evidence for non-surgical management, including exercise and education, is emerging but remains limited. CLINICAL APPLICATION: Clinicians should adopt a comprehensive and structured assessment approach that integrates patient history, physical examination, and imaging findings. Awareness of coexisting conditions and alternative pain sources is critical. Early recognition may facilitate timely referral and appropriate management. In the absence of strong condition-specific evidence, clinicians should combine available research with clinical reasoning and consider outcomes beyond pain, including quality of life, physical function, and participation. J Orthop Sports Phys Ther 2026;56(7):382-398. Epub 9 April 2026. doi:10.2519/jospt.2026.13860.

PURPOSE: Femoroacetabular impingement (FAI) primarily affects young, active adults, many of whom undergo hip arthroscopy at an age when sensitivity to ionizing radiation is greatest. Routine use of computed tomography (CT) in preoperative planning remains controversial due to concerns about radiation exposure and long-term oncogenic risk. The hypothesis was that CT imaging before FAI surgery would be associated with increased risk of malignancy.

METHODS: A retrospective comparative cohort study with 1:1 propensity score matching was performed using the TriNetX Research Network. Patients undergoing hip arthroscopy with or without a preoperative CT scan were identified using Current Procedural Terminology and International Classification of Diseases, Tenth Revision codes. The primary outcome was incident malignant neoplasm diagnosis following hip arthroscopy. Secondary outcomes included benign neoplasms, endocrine disorders, blood dyscrasias, infertility, testosterone use and cardiovascular disease. Risk was compared with log-rank, and significance was set at p < 0.05.

RESULTS: After matching, 9127 patients remained in each cohort. Mean follow-up was 1345 days in the CT cohort and 1275 days in the non-CT cohort. The CT cohort had higher rates of benign neoplasms (odds ratio [OR] = 1.41, p < 0.001), malignant neoplasms (OR = 1.33, p = 0.023), and solid malignancies (OR = 1.38, p = 0.008), while haematologic malignancies occurred at similar rates. Blood dyscrasias (OR = 1.78, p < 0.001), endocrine disorders (OR = 1.47, p < 0.001) and gonadal disorders (OR = 1.28, p = 0.032) were increased in the CT cohort. There was no difference in rates of infertility or cardiovascular disease between cohorts.

CONCLUSION: In a large, propensity-matched cohort of patients undergoing hip arthroscopy for FAI, preoperative CT imaging was associated with higher long-term rates of benign and malignant pathologies, blood dyscrasias, endocrine disorders and heart disease. These findings indicate that radiation exposure in this young population may confer long-term risks which warrant judicious use of CT.

LEVEL OF EVIDENCE: Level III retrospective.

PURPOSE: To establish pooled benchmark estimates for perioperative blood loss and transfusion burden after periacetabular osteotomy (PAO) and to explore potential study-level moderators across the available literature.

METHODS: A systematic search of PubMed, Embase, Epistemonikos and CENTRAL was performed up to 30 March 2026. Prospective and retrospective primary clinical studies reporting at least one predefined perioperative blood management outcome after PAO were included. Outcomes comprised transfusion rate, units transfused, intraoperative blood loss, estimated blood loss, haemoglobin drop and postoperative haemoglobin levels. Random-effects meta-analyses of proportions and means were performed. Univariable meta-regression was used to explore study-level moderators.

RESULTS: Forty-seven studies comprising 4402 patients and 4767 hips were included. The pooled transfusion rate was 16.2% (95% confidence interval [CI] = 11.1-23.0), and the pooled mean number of transfused units was 1.94 (95% CI = 1.32-2.55). The pooled mean intraoperative blood loss was 961.8 mL (95% CI = 804.1-1119.5), and the pooled mean estimated blood loss was 809.9 mL (95% CI = 706.4-913.5). The pooled mean haemoglobin drop was 32.4 g/L (95% CI = 27.7-37.1), and the pooled mean postoperative haemoglobin level was 99.4 g/L (95% CI = 97.2-101.6). Longer operative time was significantly associated with higher intraoperative and estimated blood loss. Higher preoperative haemoglobin was associated with greater haemoglobin drop, while higher age was associated with transfusion-related outcomes.

CONCLUSION: PAO is associated with substantial perioperative blood loss and a relevant transfusion burden. These pooled estimates provide clinically useful benchmark values for perioperative blood management after PAO.

LEVEL OF EVIDENCE: Level III systematic review and meta-analysis of predominantly retrospective cohort studies.

PURPOSE: To evaluate spinopelvic mobility and rotational morphology in patients with femoroacetabular impingement (FAI)-like hip pain without classical radiographic or magnetic resonance imaging (MRI) findings.

METHODS: This retrospective comparative study included 54 patients with FAI-like hip pain without classical imaging findings (alpha angle <55°, lateral centre-edge angle 20°-40° and no significant labral/chondral pathology on conventional MRI) and 36 matched controls. Spinopelvic parameters (pelvic incidence, pelvic tilt [PT], sacral slope (SS) and anterior pelvic plane [APP]-based PT) were measured on standing and sitting lateral radiographs. Spinopelvic mobility was assessed using difference between standing and sitting pelvic tilt (ΔPT), difference between standing and sitting sacral slope (ΔSS) and difference between standing and sitting anterior pelvic plane angle (ΔAPP) tilt. Patients were classified as having rigid (ΔSS < 10°) or non-rigid (ΔSS ≥ 10°). Acetabular version, supratrochanteric femoral torsion, Visual Analogue Scale (VAS), modified Harris Hip Score and International Hip Outcome Tool-12 (iHOT-12) were evaluated.

RESULTS: Compared with controls, the patient group had significantly lower sitting PT, ΔPT (mean difference -10.0°, 95% confidence interval [CI] -12.0 to -8.0), ΔSS (-12.4°, 95% CI -15.1 to -9.7), sitting APP tilt and ΔAPP tilt (-14.4°, 95% CI -17.1 to -11.7), whereas standing APP tilt and sitting SS were significantly higher (all p < 0.01). Among patients, 34 were classified as rigid pelvis and 20 as non-rigid pelvis. The non-rigid subgroup showed higher sitting PT, ΔPT, ΔSS, sitting APP tilt and ΔAPP tilt, lower sitting SS, lower acetabular version (-3.8°, 95% CI -5.7 to -1.9; p < 0.001) and higher supratrochanteric torsion (4.4°, 95% CI 0.7-8.1; p = 0.02). Clinical scores did not differ between subgroups. ΔPT and ΔAPP tilt correlated with clinical outcome measures. In multivariable regression, ΔPT was independently associated with VAS and mHHS, whereas ΔAPP tilt was independently associated with VAS and iHOT-12.

CONCLUSIONS: Patients with FAI-like hip pain without classical imaging findings demonstrated reduced spinopelvic mobility. Rotational morphology may represent an additional biomechanical contributor, although its clinical relevance remains uncertain. Assessment of these parameters may provide additional information in selected patients with persistent symptoms and inconclusive imaging findings.

LEVEL OF EVIDENCE: Level III retrospective comparative study.

PURPOSE: Hip arthroscopy (HAS) is technically demanding, and surgeon's experience may influence outcomes. However, the magnitude and domain-specific effects of the learning curve remain unclear.

METHODS: A systematic review and meta-analysis were conducted according to Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) and registered in PROSPERO (CRD420251185937). PubMed/MEDLINE, Embase and Scopus were searched through 31 December 2025 for studies comparing early versus late experience phases in HAS. Random-effects meta-analyses (Sidik-Jonkman estimator with Hartung-Knapp adjustment) were performed for operative and traction time, patient-reported outcomes, complications, revision arthroscopy and conversion to total hip arthroplasty (THA). Risk of bias was assessed using ROBINS-I and certainty of evidence using Grading of Recommendations, Assessment, Development and Evaluation (GRADE).

RESULTS: Eighteen studies (2624 procedures; 1291 early and 1333 late cases) were included. Late cases showed significantly shorter operative time (-31.77 min; 95% confidence interval [CI] -51.40 to -12.14) and traction time (-15.67 min; 95% CI -25.42 to -5.92), with substantial heterogeneity. Functional outcomes favoured late experience, including higher improvement in minimal clinically important difference units (0.58; 95% CI 0.17 to 0.99) and modest gains in modified Harris Hip Score (2.78 points; 95% CI 0.16 to 5.41) and Non-Arthritic Hip Score (8.41 points; 95% CI 1.99 to 14.83). Complication rates and revision arthroscopy did not differ significantly, whereas conversion to THA was lower in late cases (odds ratio [OR] 0.10; 95% CI 0.01 to 0.98). Most studies were at moderate to serious risk of bias, and certainty of evidence was low to very low.

CONCLUSION: Surgeon experience in HAS is associated with improved operative efficiency and modest functional gains, while safety outcomes remain largely unchanged. The lower THA conversion rate in late cases may reflect improved patient selection and decision-making, although confidence is limited by study design and heterogeneity.

LEVEL OF EVIDENCE: Level III systematic review and meta-analysis of predominantly retrospective cohort studies.

BACKGROUND: Femoroacetabular impingement (FAI) is a common cause of hip pain, often treated with arthroscopy. The optimal approach among unilateral, staged bilateral, and simultaneous bilateral procedures remains unclear due to limited comparative data.

PURPOSE: To compare clinical outcomes and complication rates among simultaneous bilateral, staged bilateral, and unilateral hip arthroscopy in patients with FAI syndrome.

STUDY DESIGN: Systematic review and Meta-analysis; Level of evidence, 3.

METHODS: A systematic review and meta-analysis were conducted in accordance with PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines. The PubMed, Scopus, and Ovid MEDLINE databases were searched through April 2025. Eligible comparative studies included patients with FAI undergoing hip arthroscopy via unilateral, simultaneous bilateral, or staged bilateral approaches and reported outcomes such as patient-reported scores, complications, and revision or conversion to total hip arthroplasty (THA).

RESULTS: Nine studies with a total of 4040 hips were included. All surgical approaches showed significant improvements in pain and functional outcome scores. There were no statistically significant differences in postoperative visual analog scale score, Modified Harris Hip Score, Non-Arthritic Hip Score, International Hip Outcome Tool-12 score, rates of revision surgery, or conversion to THA among the 3 groups. Meta-analyses confirmed similar outcomes between staged and unilateral groups. Although 1 study reported a lower THA conversion rate in the simultaneous group, findings were inconsistent across the literature.

CONCLUSION: Simultaneous bilateral, staged bilateral, and unilateral hip arthroscopy offer comparable short- to midterm outcomes and complication rates in FAI patients. Simultaneous bilateral arthroscopy may represent a safe and efficient option for appropriately selected patients. Surgical approaches should be individualized based on patient symptoms, goals, and risk profile.

REGISTRATION: PROSPERO (CRD420251039957).

BACKGROUND: Femoroacetabular impingement (FAI) morphology is common in asymptomatic adults. Spinopelvic alignment modulates hip mechanics and influences hip range of motion. Specific spinopelvic parameters, such as pelvic incidence and dynamic parameters, have been inconsistently associated with FAI. Yet, their specific influence on FAI morphology and symptomatology remains uncertain.

PURPOSE: To determine how morphologic, postural, and dynamic spinopelvic parameters differ according to FAI morphology (cam, pincer) and symptomatology.

STUDY DESIGN: Meta-analysis; Level of evidence, 3.

METHODS: PubMed, EMBASE, and Scopus were searched from inception to December 23, 2024. Studies reporting spinopelvic parameters in symptomatic or asymptomatic FAI compared with controls were included. Two reviewers independently screened, extracted data, and rated methodological quality (Newcastle-Ottawa Scale [NOS]). Fixed- or random-effects meta-analyses of mean differences were stratified by parameter, FAI type, and concept (morphology vs symptomatology).

RESULTS: A total of 41 studies (n = 3750; 1343 symptomatic, 821 asymptomatic FAI; 1586 controls; median NOS 6/9) were included. Symptomatic cam hips had higher pelvic incidence (PI) than asymptomatic cam hips (mean difference [MD], 4.94° [95% CI, -0.10 to 9.98]; P = .05). Pincer morphology was linked to lower PI versus controls (MD, -5.13° [95% CI, -8.70 to -1.57]; P < .01). No significant differences emerged for pelvic tilt or sacral slope. Cam FAI exhibited reduced posterior pelvic excursion in late-phase squat (MD, -5.23° [95% CI, -7.17 to -3.30]; P < .01) and a modest global excursion increase during gait (MD, 0.38° [95% CI, 0.05 to 0.72]; P = .03).

CONCLUSION: Low PI was linked to pincer morphology, suggesting a primary prevention target during development. Cam hips with higher PI were predisposed to symptoms. Symptomatic cam FAI also showed diminished pelvic rollback and increased anterior pelvic tilt, identifying kinematic targets for conservative management. Finally, dynamic spinopelvic characteristics more consistently demonstrated significant differences than static ones and may be more clinically pertinent in FAI research.

BACKGROUND: Hip arthroscopy is increasingly used for femoroacetabular impingement, but outcomes may be influenced by coexisting spine pathology due to altered spinopelvic mechanics. Understanding this relationship is critical for patient counseling and surgical planning.

PURPOSE: To systematically review and meta-analyze the effect of preexisting spine pathology on patient-reported outcomes, revision hip arthroscopy, and conversion to arthroplasty after hip arthroscopy.

STUDY DESIGN: Systematic review and meta-analysis; Level of evidence, 3.

METHODS: A comprehensive literature search of PubMed, Ovid MEDLINE, and Scopus through July 2025 identified studies comparing hip arthroscopy outcomes between patients with and without spine pathology. Inclusion criteria were comparative studies reporting patient-reported outcomes or postoperative complications. Data extraction included demographic characteristics, type of spine pathology, surgical details, and outcomes. The Modified Coleman Methodology Score (MCMS) assessed study quality. Pooled mean difference (MD) and odds ratio (OR) with 95% CI were calculated using random- or fixed-effects models depending on heterogeneity.

RESULTS: Fourteen studies (4462 hips) were included, with 948 patients having spine pathology. Meta-analysis demonstrated statistically significantly inferior outcomes in the spine pathology group for the modified Harris Hip Score (MD, -6.71; P = .001), Hip Outcome Score-Activities of Daily Living (MD, -6.13; P = .004), Hip Outcome Score-Sports Subscale (MD, -10.45; P = .0002), Non-Arthritic Hip Score (MD, -7.16; P = .04), and International Hip Outcome Tool (MD, -9.17; P = .04) but not for visual analog scale scores for pain (P = .28). Patients with spine pathology also had higher rates of revision hip arthroscopy (OR, 2.56; P = .04) and conversion to arthroplasty (OR, 1.46; P = .01).

CONCLUSION: Patients with preexisting spinal pathology had statistically significantly worse patient-reported outcomes after hip arthroscopy compared with patients without spinal pathology as well as higher rates of revision arthroscopy and conversion to arthroplasty.

BACKGROUND: An accurate measurement of femoral version is essential for diagnosing version abnormalities, determining the need for a surgical intervention, and establishing the extent of correction required. However, in the literature, numerous measurement techniques have been described.

PURPOSE: To (1) evaluate the differences among 4 different 2- and 3-dimensional (2D and 3D, respectively) techniques for measuring femoral version, (2) assess the effect of femoral version on differences between measurement techniques, and (3) examine the accuracy of an automated method in determining femoral version using commonly employed techniques.

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

METHODS: A total of 100 patients who underwent hip preservation surgery at a single academic center were analyzed (measured and segmented). Pelvic computed tomography was used to measure femoral version using 4 established methods: 2 were 2D axial techniques (Murphy and Reikeras), and 2 were 3D reconstructions (Sugano and Lee). Overall, 4 assessors performed the axial measurements. Measurements were performed relative to the posterior condylar axis (PCA) and transepicondylar axis (TEA). Discrepancies in femoral version between different techniques and interobserver correlations were determined. Linear regression equations to convert femoral version values between methods were established. Using these equations, we calculated the range for each method to be 10° to 25° as per the Murphy method, described as "normative" in the literature.

RESULTS: All 2D measurements demonstrated excellent interobserver reliability (interclass correlation coefficients = 0.93-0.97). The mean femoral version according to the 4 methods varied from 3.4°± 9.6° (Lee; lowest) to 23.2°± 11.2° (Murphy; highest). Distally, the TEA exhibited an external rotation of 5.2°± 1.6° relative to the PCA. Linear regression equations showed a strong correlation (R2 > 0.8) for converting femoral version values between methods. The normative range, derived from these equations, varied from 10° to 25° (Murphy) to -7° to 5° (Lee). Excellent correlations were identified between the manual 2D and automatic 3D methods for both distal (TEA: ρ = 0.942, P < .001; PCA: ρ = 0.984, P < .001) and proximal (Reikeras: ρ = 0.924, P < .001; Murphy: ρ = 0.965, P < .001) femoral measurements.

CONCLUSION: Femoral version measurements varied significantly between methods, with more proximal reference axes yielding lower values. Despite high reproducibility, the methods differed in mean values, emphasizing the importance of method-specific normal ranges. While 2D methods are common, 3D imaging, supported by quick and user-friendly software, serves as a more detailed and practical assessment.

BACKGROUND: Ice hockey places high demands on the hip, predisposing athletes to femoroacetabular impingement (FAI), although long-term outcomes after hip arthroscopy remain poorly defined.

PURPOSE: To evaluate the outcomes and return-to-sport (RTS) rates of ice hockey players undergoing hip arthroscopy for femoroacetabular impingement syndrome (FAIS) and labral pathology at short-, mid-, and long-term follow-up (2, 5, and 10 years), with a secondary subanalysis of RTS durability.

STUDY DESIGN: Case series; Level of evidence, 4.

METHODS: Prospectively collected data on ice hockey players who underwent hip arthroscopy between 2008 and 2020 were reviewed. Included patients reported ice hockey participation within 1 year from the surgery and completed preoperative and minimum 2-year postoperative questionnaires for at least 1 of the following patient-reported outcomes (PROs): modified Harris Hip Score (mHHS), Non-Arthritic Hip Score (NAHS), Hip Outcome Score-Sports Specific Subscale (HOS-SSS), International Hip Outcome Tool (iHOT-12), visual analog scale (VAS). Clinically relevant thresholds and secondary procedures were recorded. RTS analysis was based on the number of patients who attempted RTS at 2-, 5-, and 10-year points.

RESULTS: A total of 72 hockey players were included, with a mean age of 31.3 ± 13.6 years and mean follow-up of 80.2 ± 41.7 months. Significant improvements were observed across all PROs from pre- to postoperative assessments (P < .001). At latest follow-up, thresholds for the minimal clinically important difference were achieved by 74.2% of participants for mHHS, 66.7% for NAHS, 95% for iHOT-12, 68.8% for HOS-SSS, and 76.8% for VAS. On the Patient Acceptable Symptom State anchor question, 86.2% of hockey players responded "yes" at the latest follow-up. Revision arthroscopy was performed in 6 patients (8.3%), and conversion to total hip arthroplasty occurred in 2 patients (2.8%). Of the 61 athletes who attempted RTS, 53 (86.9%) returned to hockey. At 2-year follow-up, 51 of the athletes (83.6%) were still active. At 5-year follow-up, 75.7% continued to play hockey. At 10 years, 57% continued to play. Among the patients who returned to sport, 74.5% returned to play at the same or a higher competitive level.

CONCLUSION: Hip arthroscopy for FAIS and labral pathology in hockey players resulted in significant functional improvement and high midterm RTS rates. Importantly, most athletes who returned to play were able to compete at the same or a higher level compared with preoperative status, reinforcing the potential for functional durability of well-performed hip arthroscopy in this athletic cohort.

BACKGROUND: Workers' compensation (WC) patients often experience inferior outcomes compared with non-workers' compensation (non-WC) patients after orthopaedic procedures. Long-term outcomes for contemporary hip arthroscopy in this group remain unclear.

PURPOSE: To compare patient-reported outcomes (PROs), achievement of clinically significant outcomes, and reoperation-free survival between WC and non-WC patients undergoing hip arthroscopy for labral tear/femoroacetabular impingement syndrome at a minimum 10-year follow-up.

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

METHODS: Patients who underwent hip arthroscopy between January 2012 and February 2015 with ≥10-year follow-up were included. WC patients were propensity-score matched with non-WC patients on age, sex, and body mass index. PROs were assessed preoperatively and at 2-, 5-, and 10-year postoperatively, including Hip Outcome Score-Activities of Daily Living (HOS-ADL), Hip Outcome Score-Sport-specific (HOS-SS), Modified Harris Hip Score (mHHS), 12-item International Hip Outcome Tool (iHOT-12), and visual analog scale (VAS) for pain and satisfaction. Achievement of minimal clinically important difference (MCID), patient acceptable symptom state (PASS), and reoperation rates were compared.

RESULTS: A total of 37 WC hips were matched with 108 non-WC hips. Both cohorts demonstrated significant improvements in all PROs from baseline (P < .001). Preoperatively, WC patients had lower HOS-ADL (46.9 vs 63.5; P < .001) and mHHS scores (47.4 vs 57.3; P = .004), but similar HOS-SS and VAS-Pain scores (P≥ .076). At 2 years, WC patients reported lower HOS-ADL, HOS-SS, mHHS, and iHOT-12 scores (P≤ .047). At 5 years, HOS-ADL and HOS-SS remained lower in WC patients (P≤ .004), whereas other PROs were comparable (P≥ .160). At 10 years, no significant between-group differences persisted (P≥ .057). WC patients achieved higher MCID rates for HOS-ADL (94.7% vs 68.8%; P = .021) and mHHS (87% vs 62%; P = .038), with comparable MCID and PASS rates for other PROs. Both cohorts demonstrated similar reoperation-free survivorship (P = .383). Overall, 33 WC patients (91.7%) returned to work at a mean time of 8.7 ± 5.2 months postoperatively.

CONCLUSION: At a minimum 10-year follow-up, WC patients demonstrated sustained improvement and outcomes comparable to non-WC patients after primary hip arthroscopy. Although WC status is associated with inferior preoperative and early postoperative outcomes, long-term symptom resolution, functional improvement, and joint preservation can be expected in appropriately selected patients treated with contemporary hip arthroscopy techniques.

BACKGROUND: The periportal capsulotomy for hip arthroscopy minimizes iliofemoral ligament violation compared to T- and interportal capsulotomies, theoretically reducing the risk of postoperative instability secondary to capsular insufficiency.

PURPOSE/HYPOTHESIS: The purpose of this study was to compare patient-reported outcomes (PROs) and revision rates between women without dysplasia who underwent an interportal versus a periportal capsulotomy approach for the treatment of femoroacetabular impingement syndrome (FAIS). It was hypothesized that women without dysplasia would achieve better outcomes and a lower revision rate through a periportal approach.

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

METHODS: Consecutive female patients with normal acetabular coverage (lateral center-edge angle >25° and ≤40°) who underwent primary hip arthroscopy with complete capsular closure by a single surgeon for the treatment of FAIS between February 2020 and November 2022 were prospectively added to a database and their records retrospectively reviewed. An interportal capsulotomy was utilized in all patients before June 2021, and periportal capsulotomies were utilized thereafter. Femoral osteoplasty was performed in all patients, and a labral repair was performed when indicated. PROs were collected preoperatively and at a 2-year minimum follow-up, including pain scores at rest and activities of daily living (range, 0-10), single assessment numeric evaluation (SANE) scores, and Patient-Reported Outcomes Measurement Information System-Physical Function (PROMIS-PF) scores. Minimal clinically important differences (MCIDs) were calculated using the distribution method. PROs, MCID achievement rates, and revision rates were compared between capsulotomy types.

RESULTS: In total, 105 women without dysplasia (41 interportal, 64 periportal) were included. There were no differences in baseline demographic or radiographic characteristics between groups. Follow-up time was longer in the interportal group compared to the periportal group (3.52 ± 1.04 years vs 2.67 ± 0.62 years; P < .001). The periportal group had greater improvements in SANE (30.0 ± 20.2 vs 17.3 ± 21.3; P = .004) and PROMIS-PF (13.7 ± 9.61 vs 7.62 ± 9.04; P = .003) scores compared to the interportal group. The periportal group also had higher rates of MCID achievement with SANE (87% vs 69%; P = .037) and PROMIS-PF (90% vs 68%; P = .018) scores compared to the interportal group. Overall, the 2-year revision rate was 12% for the interportal group and 4.7% for the periportal group (P = .26). All patients who required additional surgery underwent revision hip arthroscopy for instability.

CONCLUSION: In female patients without hip dysplasia who underwent primary hip arthroscopy for the treatment of FAIS, periportal capsulotomies with complete capsular closure provided higher rates of clinically meaningful improvements in subjective outcomes of SANE and PROMIS-PF scores compared to an interportal capsulotomy with complete closure at 2 years postoperatively.

BACKGROUND: Acetabular overcoverage (pincer morphology) has been suggested to be both a source of pain and dysfunction and potentially protective against osteoarthritic change.

PURPOSE: To compare the minimum 5-year clinical outcomes of patients undergoing primary hip arthroscopic labral repair with a lateral center edge angle (LCEA) of ≥40° as compared with nondysplastic controls with an LCEA of 25° to 40°.

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

METHODS: A retrospective review was performed to identify all patients who underwent primary hip arthroscopic labral repair between 2009 and 2019 at a single academic institution. Patients with an LCEA of ≥40° (pincer) were propensity-matched to nondysplastic controls with an LCEA of 25° to 40° on a 1-to-2 basis by sex, age, body mass index, and surgery year. Patient-reported outcome measures (PROMs)-including visual analog scale, Tegner activity score, modified Harris Hip Score, International Hip Outcome Tool (iHOT-12), and Hip Outcome Score were analyzed-as were reoperations and conversions to total hip arthroplasty (THA).

RESULTS: A total of 55 patients with pincer morphology (preoperative LCEA: 41.9°± 2.1°) were matched to 110 nondysplastic controls (LCEA: 31.2°± 4.1°), resulting in a total of 165 hips in 163 patients (67% women, mean age: 37.7 ± 9 years). Pincer patients were corrected to a mean postoperative LCEA of 38.7°± 4.1º (P < .001), with 22 pincer patients having residual overcoverage; namely, a postoperative LCEA ≥40° (range, 40°-45.8°). There were no differences between cohorts regarding intraoperative characteristics-including femoral and acetabular Outerbridge grade-as well as capsulotomy type and the presence of capsular repair (P≥ .210). At a mean 8-year follow-up (range, 5.1-13.2), there was no difference in any postoperative PROMs between pincers and controls (P≥ .215) and no difference in PROMs between patients with residual overcoverage and pincer patients with a postoperatively normalized LCEA (P≥ .291). At final follow-up, 4 patients in the pincer cohort (7%) and 21 controls (19%) converted to THA (P = .046).

CONCLUSION: Patients with lateral acetabular overcoverage demonstrated similar and satisfactory postoperative PROMs at a minimum 5-year follow-up compared with propensity-matched nondysplastic controls, regardless of whether the LCEA was corrected to <40°. Of note, nondysplastic controls demonstrated a higher rate of conversion to THA, suggesting a potentially chondroprotective role for acetabular overcoverage.

BACKGROUND: Patients with femoroacetabular impingement syndrome (FAIS) experiencing >2 years of pain before hip arthroscopy have been linked with worse short-term and midterm outcomes.

PURPOSE: To examine the effect of preoperative pain duration on patient-reported outcomes (PROs), clinically significant outcomes, and reoperation rates in patients undergoing primary hip arthroscopy for FAIS.

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

METHODS: A prospectively maintained surgical repository was reviewed to select patients who underwent primary hip arthroscopy for FAIS between January 2012 and October 2014 with 10-year follow-up. Patients who reported pain ≥2 years before surgery were propensity score matched 1:1 to patients reporting preoperative pain <2 years by age, sex, and body mass index (BMI). PRO scores collected included those for the Hip Outcome Score-Activities of Daily Living (HOS-ADL), Hip Outcome Score-Sports Subscale (HOS-SS), modified Harris Hip Score (mHHS), and visual analog scale (VAS) for pain and satisfaction. Achievement rates of the minimal clinically important difference and patient acceptable symptom state were compared. Reoperation-free survivorship was compared with Kaplan-Meier analysis.

RESULTS: A total of 164 patients who had a symptom duration ≥2 years (mean age, 35.9 ± 11.7 years; 64.0% female; mean BMI, 25.3 ± 5.2 kg/m2) were successfully matched to 164 patients who had a symptom duration <2 years (mean age, 35.8 ± 11.9 years; 64.6% female; mean BMI, 25.3 ± 4.7 kg/m2). Patient characteristics were similar between groups. Preoperative and 2-year PRO scores were similar between groups. At 10 years, the prolonged pain group had worse mHHS (P = .027), higher VAS pain (P = .002), and lower VAS satisfaction (P = .002) scores than the short pain group. The prolonged pain group also had significantly lower achievement rates of the minimal clinically important difference for the HOS-ADL (P = .024) and HOS-SS (P = .039) and lower achievement rates of the patient acceptable symptom state for the VAS pain (P = .006) and at least 1 PRO measure (P = .041). Reoperation-free survivorship did not differ between groups (P = .11).

CONCLUSION: Patients with pain ≥2 years before undergoing primary hip arthroscopy for FAIS significantly improved at 10 years but experienced worse function, pain, satisfaction, and achievement of clinically significant outcomes, with similar survivorship, compared to a matched group of patients with preoperative pain <2 years.

BACKGROUND: The rates of hip arthroscopy are increasing worldwide for femoroacetabular impingement syndrome (FAIS). There is a lack of literature examining outcomes of modern nonoperative treatment of patients with FAIS.

PURPOSE: To develop and assess the effectiveness of a pelvic tilt-focused exercise program for nonoperative management for patients with FAIS.

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

METHODS: Eligible patients included those aged 16 to 55 years who met radiographic and clinical criteria for FAIS. Enrolled patients participated in a 10-minute standardized pelvic tilt-focused home exercise program (HipFit10) at least 4 times per week over 6 months. Self-reported adherence was tracked weekly. Patient-reported outcomes were collected at baseline and 3 and 6 months. The International Hip Outcome Tool-33 (iHOT-33) score was measured at baseline and 3 and 6 months, with the primary outcome being the iHOT-33 change score between baseline and 6 months. Secondary outcomes included the Hip Outcome Score-Activities of Daily Living (HOS-ADL), pain visual analog scale (pain VAS) score, crossover to surgical management, and complications.

RESULTS: A total of 214 patients were enrolled between August 2020 and October 2021. The mean age was 34.2 ± 10.2 years, and 121 (57%) patients were female. Within the study period, 19 of 214 (9%) patients dropped out or were lost to follow-up. By 6 months, 153 of 195 (78%) patients completed the intervention and elected to avoid surgery, and 42 of 195 (22%) patients signed up for or underwent surgery. The final iHOT-33 score was completed by 192 of 195 (98%) participants with mean improvement from baseline to 6 months of 11.7 (95% CI, 9.2 to 14.1; P < .001). By 6 months, 103 of 192 (54%) participants achieved the iHOT-33 minimal clinically important difference of 6.8. Significant improvements also were seen in the iHOT-33 score from baseline to 3 months (mean difference [MD], 7.6; 95% CI, 5.7 to 9.6) and from 3 months to 6 months (MD, 3.7; 95% CI, 1.8 to 5.6), as well as in the HOS-ADL (0-3 months: MD, 2.65; 95% CI, 0.8 to 4.4) and pain VAS score (0-3 months: MD, -7.7 [95% CI, -4.8 to -10.5]; 3-6 months: MD, -3.5 [95% CI, -0.6 to -6.3]). No adverse events were reported.

CONCLUSION: In this study of patients with FAIS, pelvic tilt-focused physical therapy was utilized to improve patient function with 78% avoiding surgery. These results suggest the HipFit10 program is a safe and effective nonoperative option for patients with FAIS.

BACKGROUND: Debate exists on which functional position (supine or standing) should form the basis of radiographic assessment of the native acetabulum. Pelvic tilt (PT) differs between positions influencing radiographic acetabular assessment. This study aims to (1) quantify PT changes from supine to standing amongst volunteers and patients; (2) assess changes in acetabular parameters between the postures; and (3) determine whether changes in acetabular parameters differ according to acetabular morphotype.

METHODS: This is a prospective, consecutive, cohort study of 105 asymptomatic volunteers (53% male; mean age 36.5 ± 13.6 years; body mass index [BMI] 25.0 ± 2.0 kg/m2) and 437 patients presenting to a hip preservation clinic without osteoarthritis (Tonnis ≤1) (40% male; mean age 35.7 ± 8.6 years; BMI 25.0 ± 2.0 kg/m2). All underwent standardized supine and standing anteroposterior pelvic radiographs. PT change was quantified using the sacrofemoral-pubic (SFP) angle. Acetabular morphology was evaluated in detail to characterize morphotype according to the Ottawa classification (lateral dysplasia, anterior dysplasia, posterior dysplasia), pincer or "normal." Changes between supine and standing were compared between cohorts and morphotypes.

RESULTS: The mean SFP decreased by -3.7° (IC95% 4.0-3.5) from supine to standing. Acetabular measurements demonstrated no differences in change between volunteers and symptomatic patients when transitioning between supine to standing. Measurements of lateral coverage changed minimally between supine (volunteers: 30.7° ± 6.1°; symptomatics: 27.3° ± 8.3°) and standing (volunteers: 30.3° ± 5.7°; symptomatics: 26.1° ± 8.1°), whereas measurements reflecting anteroposterior coverage changed significantly (ΔAWI volunteers: -0.10 ± 0.08 and symptomatics: -0.09 ± 0.07; p < 0.001 and ΔPWI volunteers: 0.09 ± 0.08 and symptomatics: 0.09 ± 0.07; p < 0.001). Patients with anterior dysplasia demonstrated smaller ΔSFP (-1.5° ± 2.5° vs. -3.7° ± 2.9°; p = 0.004) compared with the rest of the cohort. By contrast, posterior dysplasia showed greater ΔSFP (-4.5° ± 2.7° vs. -3.6° ± 2.9°; p = 0.128) than the rest.

CONCLUSIONS: Groups demonstrated comparable changes in PT and acetabular parameters between positions. The magnitude and direction of change was associated with acetabular morphology uncoupling compensatory mechanisms. Standing radiographs may be preferred to supine, as they account for compensatory mechanisms.

LEVEL OF EVIDENCE: Level II, diagnostic. See Instructions for Authors for a complete description of levels of evidence.

BACKGROUND: Legg-Calvé-Perthes disease (LCPD) is idiopathic osteonecrosis of the femoral head. The effects of proximal femoral varus osteotomy (PFVO) on femoral head revascularization are unknown. We evaluated whether patients with early-stage LCPD treated with PFVO had a higher revascularization rate than those receiving nonoperative treatment with serial perfusion magnetic resonance imaging (pMRI).

METHODS: Forty-nine patients (49 hips) in early-stage LCPD with ≥2 pMRIs treated nonoperatively (n = 22) or with PFVO (n = 27) were retrospectively analyzed. The mean age of diagnosis was 8.2 ± 1.7 years (range: 5.3-12.2), median pMRI of 3 (IQR:2-4; range: 2-6), and Waldenström stage I (n = 37) or IIa (n = 12). The revascularization rate (%/month) was assessed in 4-month intervals. Time to Waldenström stage IIIb and full weight-bearing status (FWB) were compared.

RESULTS: Baseline characteristics (age, initial perfusion, Waldenström stage) were similar between groups. Perfusion was higher in the PFVO group at 4 to 8 (56 ± 20 vs. 80 ± 12%, p = 0.001) and 12 to 16 months (68 ± 25 vs. 91 ± 7%, p = 0.02) follow-ups. The PFVO group had significantly higher revascularization rates at 3 intervals: 4 to 8 (4.2 ± 2.7 vs. 7.0 ± 2.1%/month, p = 0.006), 8 to 12 (3.4 ± 1.7 vs. 6.1 ± 1.5%/month, p = 0.004), and 12 to 16 months (2.5 ± 1.3 vs. 4.9 ± 1.1%/month, p = 0.002). The PFVO group had a shorter time to Waldenström stage IIIb (22.7 ± 8.7 vs. 17.1 ± 6.9 months, p = 0.02) and was associated with earlier FWB (18.8 ± 6.5 vs. 13.1 ± 4.7 months, p = 0.008).

CONCLUSIONS: The PFVO group had faster revascularization and a shorter time to the late-reossification stage.

SIGNIFICANCE: This study is the first to investigate the effects of PFVO on revascularization rate using serial pMRI. These findings provide novel insight into the biologic effect of PFVO on femoral head revascularization.

LEVEL OF EVIDENCE: Level IV, therapeutic. See Instructions for Authors for a complete description of levels of evidence.

INTRODUCTION: Hip arthroscopy has been established as a successful management for femoroacetabular impingement (FAI) syndrome. Patient-reported outcome measures (PROMs) are frequently used to assess treatment results in patients. However, clinically important outcome values have recently been calculated to better understand and interpret PROMs and define successful treatment. This systematic review aimed to investigate the minimal clinically important difference (MCID), patient-acceptable state (PASS), substantial clinical benefit (SCB), and minimally detectable change (MIC) of the most commonly used PROMs for assessing patients who have undergone arthroscopic surgery for FAI.

MATERIAL AND METHODS: This study was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses: the 2020 PRISMA statement. In October 2025, the following databases were accessed: PubMed, Web of Science, and Embase. All clinical studies investigating tools to assess the clinical relevance of PROMs used to evaluate patients who have undergone arthroscopic surgery for FAI were accessed. Only studies that assessed the minimal MCID, PASS, SCB, and/or MIC were considered.

RESULTS: The methodological quality of the 21 included studies was assessed, and the overall risk of bias was found to be low-to-moderate. The main characteristics of the included studies were analyzed and summarized. In addition, we determined the MCID, PASS, SCB, and MIC of the hip injury and osteoarthritis outcome score (HOOS), short form 36 (SF-36), modified Harris hip score (mHHS), nonarthritic hip score (NASH), Copenhagen hip and groin outcome score (HAGOS), hip outcome score (HOS), international hip outcome tool-12 (iHOT-12), international hip outcome tool-33 (iHOT-33), University of California, Los Angeles Score (UCLA), visual analogue scale (VAS), and Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) scores for arthroscopic hip surgery.

CONCLUSIONS: This systematic review provides clinically important outcome values, such as the MCID, PASS, SCB, and MIC, for the most commonly used PROMs in arthroscopic hip surgery, based on data from 21 studies involving 5687 patients. The calculated values for the MCID, PASS, SCB, and MIC could be helpful for future clinical trials investigating the outcomes of hip arthroscopy in patients with FAI. However, given the heterogeneity of the included studies, their predominantly nonrandomized designs, and differences in PROMs, follow-up intervals, and calculation methods, these findings should be interpreted with caution. Level of evidence Level IV, systematic review.

BACKGROUND: Ultrasound at 2 to 6 weeks of age is routine clinical practice in neonates at high risk; however, developmental dysplasia of the hip (DDH) may develop after a normal screening examination. There is a current lack of consensus regarding the use and most appropriate timing of subsequent imaging.

QUESTIONS/PURPOSES: (1) What proportion of neonates with a breech presentation who had a normal screening ultrasound result for DDH developed DDH at 6-month follow-up? (2) Are patient factors (sex and concomitant congenital muscular torticollis) associated with an increased odds of late-developing DDH?

METHODS: Between January 1, 2016 and July 1, 2025, a total of 367 infants with breech presentation were evaluated by the pediatric orthopaedic service for the possibility of DDH. During that time, we recommended screening ultrasound at 6 weeks of age. The American Academy of Pediatrics and the American Academy of Orthopaedic Surgeons guidelines advise ultrasound at 2 to 6 weeks of age in infants with normal clinical examinations but elevated risks, including breech presentation. Seventy-six percent (280 of 367) of patients had a 6-week ultrasound performed; the mean ± SD age at imaging was 7.1 ± 2.0 weeks. Of those, 87% (243) were normal (defined as an alpha angle of ≥ 60° and femoral head coverage of ≥ 50%). During the study period, we recommended a follow-up ultrasound or plain radiograph at 6 months for all patients with normal ultrasound results. Of the 243 patients with normal ultrasound results, 57% (139) had a 6-month AP pelvis radiograph at a mean age of 6.7 ± 0.8 months. Binary logistic regression with a Firth correction was used to assess the odds of late-developing DDH by sex and concomitant congenital muscular torticollis.

RESULTS: The presence of late-developing DDH was 9% (13 of 139; 11 patients with acetabular dysplasia, 2 patients with hip dislocation). Eight of 13 patients were treated with abduction orthosis, two with closed reduction and spica casting, and three were monitored with serial radiographs. In regression analysis, female sex was associated with greater odds of late-developing DDH compared with male sex (OR 5 [95% confidence interval (CI) 1.2 to 48.0]; p = 0.03). Congenital muscular torticollis was not associated with increased odds of late-developing DDH (OR 3 [95% CI 0.9 to 10.0]; p = 0.06).

CONCLUSION: These findings demonstrate that hip dysplasia can develop after birth, which supports its developmental rather than purely congenital origin. Clinicians should consider routine follow-up imaging at approximately 6 months for infants with breech presentation, even after a normal screening ultrasound result. This approach may be particularly important in female infants, who exhibited higher odds of late-developing DDH in our cohort. However, given the modest sample size and the restriction to newborns with breech presentation, these results cannot be generalized to universal follow-up imaging for all screened populations. Targeted monitoring of higher-risk groups may allow earlier diagnosis and treatment while avoiding unnecessary imaging. The timing of follow-up radiographs and the appropriate endpoint for surveillance after a normal ultrasound result remain to be established.

LEVEL OF EVIDENCE: Level III, diagnostic study.

OBJECTIVE: To conduct a systematic review to evaluate the measurement properties of clinical tests reportedly used in the assessment of patients with hip-related pain.

DATA SOURCES: PubMed, Embase, Cochrane, SportDiscus, Web of Science, and Scopus. Searches covered all records available up to July 31, 2024, and were updated on July 1, 2025.

STUDY SELECTION: Studies assessing at least one measurement property (eg, reliability, measurement error, responsiveness, convergent validity, or discriminative validity) of functional, strength, or range of motion (ROM) tests in individuals diagnosed with hip-related pain were included.

DATA EXTRACTION: Data were extracted from the included studies using a custom data extraction form. The Consensus-based Standards for the selection of health Measurement INstruments risk of bias checklist was used to assess the risk of bias, and certainty of evidence was assessed by the modified Grading of Recommendations Assessment, Development and Evaluation. Data extraction, risk of bias, and certainty of evidence assessment were performed independently by two authors.

DATA SYNTHESIS: Thirteen studies exploring the measurement properties of 39 clinical measures used in the assessment of 637 individuals with hip-related pain were included. Single-leg squat and step-down tests demonstrated sufficient reliability and discriminative validity. Muscle strength assessments using handheld dynamometry and isokinetic dynamometry had sufficient reliability and convergent validity, respectively. The active hip flexion ROM test demonstrated sufficient convergent and discriminative validity.

CONCLUSIONS: Evaluating movement quality during single-leg squat and step-down tasks, handheld dynamometry and isokinetic hip muscle strength, and active hip flexion ROM is recommended in people with hip-related pain, with findings mostly reliable and demonstrating sufficient convergent and discriminative validity. More studies are needed to make stronger recommendations on which clinical tests should be used for the assessment of individuals with hip-related pain.

BACKGROUND: The long-term durability of total hip arthroplasty remains challenging in young patients with osteonecrosis of the femoral head (ONFH), necessitating effective hip-preserving strategies. However, existing techniques are diverse but lack a unifying principle for precise treatment selection. Reconstruction of the anterolateral pillar of the femoral head may be a promising guideline.

MAIN BODY: The anterolateral pillar encompasses approximately one-third of the anterior and lateral femoral head anatomically, whereas the functional pillar denotes this region corresponding to the lateral third of acetabular weight-bearing portion. Its structural integrity is critical for risk stratification and prognosis. Centering on this concept of the biomechanical significance of anterolateral pillar of the femoral head, this review discusses the current classification systems and reclassifies hip-preserving techniques. Among intra-femoral head strategies involving in anterolateral pillar reconstruction, pharmacological agent and core decompression with bio-augmentation provide no direct structural support and largely depend on the residual bone stock in the femoral head. Implant-based approaches, including bone and biomaterial grafting, hinge not only on implant properties but also on whether these can achieve targeted mechanical support to the anterolateral pillar. Extra-femoral head reconstruction procedures, particularly proximal femoral or acetabular osteotomy, restore function by transferring viable bone into weight-bearing areas or optimizing acetabular coverage through anatomical reconfiguration, thereby indirectly reconstructing the pillar's load-bearing role.

CONCLUSIONS: Establishing direct or indirect reconstruction of the anterolateral pillar as a unifying principle can standardize precision-based treatment for ONFH. Optimal clinical outcomes are further enhanced when orthopedic surgeons select reconstruction strategies tailored to their surgical expertise.

BACKGROUND: Femoral version (FV) affects hip biomechanics and postoperative outcomes in developmental dysplasia of the hip (DDH) as well as femoroacetabular impingement (FAI). However, its assessment depends on advanced imaging modalities such as CT and MRI with limited clinical utility for cost-effective screening of FV. This study aimed to implement and test the diagnostic accuracy of the lesser trochanter index (LTI) as an indicator for increased femoral FV on pelvic radiographs in patients with symptomatic DDH and FAI.

METHODS: This prospective, diagnostic cohort study included symptomatic patients with DDH (n = 194 patients) and FAI (n = 22 patients) undergoing hip preservation surgery. Patients underwent a standardized protocol of anteroposterior pelvic radiographs and magnetic resonance imaging (MRI) of the pelvis, hip and lower extremity. FV was measured in accordance to the Murphy method. The lesser trochanter morphology on pelvic radiographs was used to calculate the lesser trochanter index (LTI). It was predefined as positive to detect increased FV (>25/30° Murphy) with a cut-off value of > 1.5.

RESULTS: A total of 409 hips in 216 patients were included. Patients with DDH were significant older (30.7 vs. 25.5, p = 0.008), were more frequently female (77.3% vs. 34.8, p < 0.001) and had a significant higher femoral version compared to FAI (28 vs. 21.8, p = 0.013). The LTI > 1.5 showed a high sensitivity (25°/30° FV - 90.9/93.1%), but a low specifity (25°/30° FV - 20.3/18.9%) to detect increased FV. The negative predictive value remained moderate (25°/30° FV - 65.5/81%), while the LTI has only a weak positive predictive value (25°/30° FV - 57.5/42.7%).

CONCLUSION: The LTI represents a clinical useful and widely available indicator of increased FV and can optimize the use of subsequent MRI and CT assessment. However, due to its moderate diagnostic accuracy, the LTI is more a rule- out test, than a diagnostic marker of increased FV and cannot replace advanced imaging modalities.

AIMS: There is a paucity in the literature regarding functional outcomes of revision periacetabular osteotomy (R-PAO) after failure of previous redirectional pelvic osteotomy in a mature skeleton. This study aimed to compare the surgical and patient-reported outcome measures (PROM) between R-PAO and primary PAO.

METHODS: Patients undergoing R-PAO (n = 13) and primary PAO (n = 39) were matched in a 1:3 ratio for age, sex, and surgical date with a minimum follow-up of one year. PROM assessment included scores for pain, joint function (Modified Harris Hip Score -mHHS; International Hip outcome tool-12 -iHOT12), and activity level (University of California Los Angeles activity scale -UCLA). Postoperative outcomes were compared between the groups using independent-samples t-tests and Mann-Whitney U test. Multivariable linear regression was used to identify predictors of postoperative outcome improvement.

RESULTS: Patients undergoing R-PAO had significantly worse preoperative joint function (mHHS 34.91 to 57.28, p < 0.001; iHot-12 33.17 to 46.22, p = 0.005) and activity level (UCLA 4.38 to 6.34, p = 0.004) compared to primary PAO. While achieving similar functional improvement (Δpre - post, p > 0.05) comparing both groups, postoperative mHHS (70.21 to 86.81, p = 0.002) and pain score (3.46 to 1.92, p = 0.010) remained significantly worse after R-PAO. Multivariable linear regression analysis revealed that preserved preoperative joint function (iHot-12 ß = 0.795, p < 0.001; mHHS ß = 0.696, p < 0.001) and activity level (UCLA ß = 0.360, p < 0.001), a lower BMI (iHot-12 ß = -2.011, p = 0.002; UCLA ß = -0.120, p = 0.041), and a sufficient postoperative anterior wall coverage (iHot-12 ß = 0.849, p < 0.001) are predictors of improved postoperative outcomes in both R-PAO and primary PAO.

CONCLUSION: The failure of hip-preserving pelvic osteotomies in skeletally mature patients results in a substantial symptom burden and functional impairment. R-PAO represents a considerable treatment strategy that preserves the native hip joint and function, but postoperative outcomes after R-PAO remain inferior to those of primary PAO, due to the worse preoperative joint function.

AIMS: Pavlik harness (brace) treatment is the cornerstone of management for infants with developmental dysplasia of the hip (DDH). However, there is wide variation in how the harness is discontinued, with some clinicians stopping immediately and others using gradual reduction ('weaning'), reflecting the absence of high-quality comparative evidence. WINDY (Weaning in INfant hip Dysplasia) is a multicentre randomized feasibility trial comparing a standardized weaning regimen with immediate cessation. The primary aim is to determine whether a definitive multicentre randomized controlled trial (RCT) is feasible. Secondary aims are to assess parental engagement, evaluate the acceptability and measurement properties of the Evaluation Measure for BRACe Experience (EMBRACE), and explore whether routinely collected Smart4NIPE data can be used for trial outcomes.

METHODS: WINDY is a multicentre, parallel-group feasibility RCT with 1:1 allocation, stratified by site. Infants treated with a Pavlik harness who demonstrate ultrasound normalization (hip centred; α angle ≥ 60°) are eligible. Following consent, infants are randomized to either four weeks of night-time-only harness wear (minimum 10 hours per night) or immediate cessation. Follow-up is 12 weeks and aligned with routine care. Parents complete electronic questionnaires, including EMBRACE, at baseline, two, four, and six weeks post-randomization. Feasibility outcomes include recruitment, proportion randomized, parental engagement, and compliance. EMBRACE measurement properties and the feasibility of using routinely collected national data will also be assessed.

DISCUSSION: This study will determine key feasibility parameters for a definitive multicentre RCT comparing harness weaning with immediate cessation in DDH, including recruitment, intervention acceptability, and parent-reported data completion. It will also provide further evaluation of the EMBRACE measure to support family-centred outcomes and assess whether routinely collected Smart4NIPE data can be used for trial outcome capture. As a feasibility study, analyses will be descriptive and will inform the design and delivery of a future definitive trial.

Background/Objectives: In patients with femoroacetabular impingement syndrome (FAI), the efficacy and safety of platelet-rich plasma (PRP) as an auxiliary treatment for femoroacetabular impingement syndrome (FAI) remain controversial. The study aimed to evaluate the safety and clinical effectiveness of arthroscopy combined with PRP compared with arthroscopy alone for the treatment of patients with FAI. Methods: In this retrospective study, patients who underwent hip arthroscopy for the treatment of FAI between January 2019 and January 2022 were included and divided into two groups: (1) arthroscopy group (A) and (2) arthroscopy combined with PRP group (AP). During the 2-year follow-up, Visual Analog Scale (VAS) pain scores, modified Harris Hip Score (mHHS), International Hip Outcome Tool-12 (iHOT-12), Hip Outcome Score-Activities of Daily Living (HOS-ADL), Hip Outcome Score-Sport-Specific (HOS-SSS), 12-Item Short Form Physical Composite Summary and Mental Composite Summary (SF-12 PCS and MCS), medical related expenses were recorded. Minimal clinically important difference (MCID) and patient-acceptable symptom state (PASS) comparison for mHHS, HOS-ADL, and HOS-SSS scores between the two groups. VAS, mHHS, iHOT-12, HOS-ADL, HOS-SSS score, and changing trends were described pre-operation and one month, six months, one year, and two years after the operation. Results: A total of 107 FAI patients were included; 55 patients were in Group A, 52 patients in Group AP. The overall mean ± SD was 39.1 ± 12.6 years (arthroscopy group, (A): 18 females, arthroscopy combined with PRP group, (AP): 13 females). There were no significant differences in the general data between the two groups (p > 0.05). Except for the auxiliary tools subscale of the mHHS (p > 0.05), both groups showed statistically significant improvements at one year (p < 0.01) and two years (p < 0.01) after surgery than pre-operation in VAS, mHHS, iHOT-12, HOS-ADL, and HOS-SSS. The scores after two years of treatment were further improved compared with one year (p < 0.01). There were no differences between the two groups at one year and two years postoperatively in VAS, mHHS, iHOT-12, HOS-ADL, and HOS-SSS scores (p > 0.05). No differences in the achievement of MCID and PASS for mHHS, HOS-ADL, and HOS-SSS (p > 0.05). A significant difference in SF-12 PCS and MCS was observed between the two groups preoperatively and two years after the operation (p < 0.01). The Group AP had significantly higher scores at two years (p < 0.01) after surgery than the Group A in the SF-12 MCS. There was no significant difference in SF-12 MCS distribution (>46.5, 36-46.5, ≤36) (χ2 = 0.198, p > 0.01). The AP group had significantly higher indirect and absenteeism expenses in the year of surgery than Group A (p < 0.01). Conclusions: For patients with FAI, compared with arthroscopy alone, arthroscopy combined with PRP can significantly improve SF-12 MCS two years after therapy; however, there was no significant improvement in clinical results, and indirect treatment costs were higher. Arthroscopy combined with PRP has no obvious advantage and cannot be recommended as the first choice.

PURPOSE: Hip labral reconstruction survival refers to the durability of the reconstructed labrum, typically measured by the rate of freedom from revision surgery or conversion to total hip arthroplasty (THA) over time. This systematic review aimed to identify and combine prognostic factors, particularly those related to cartilage status, graft characteristics, and osteoarthritis, that are associated with functional outcomes and long-term survivorship after hip labral reconstruction.

METHODS: Clinical studies reporting prognostic/exposure factors (e.g., cartilage status, osteoarthritis severity and graft/technique variables) and postoperative outcomes in adult patients undergoing hip labrum reconstruction were searched in PubMed and Scopus databases up to December, 2025. Two reviewers performed the search, data extraction, and risk of bias assessment using ROBINS-I. Random-effects meta-analyses and meta-regressions were performed when ≥2 studies provided comparable data.

RESULTS: Thirty-two studies (2252 hips) were included. Patient-reported outcomes showed significant improvement across cohorts after reconstruction, but survival not requiring arthroplasty varied depending on joint status and technique. In a random-effects meta-analysis, the pooled THA conversion rate was 8.8% (95% CI: 6.7%-11.5%). In meta-regression, a higher prevalence of high-grade acetabular cartilage damage was associated with increased THA conversion (univariate p = 0.035; β = 0.0269, p = 0.0165 after adjusting for follow-up time), and longer follow-up time independently increased the risk of conversion (β = 0.0300/month, p = 0.0082). In exploratory subgroup analyses, circumferential reconstruction was associated with greater PROM recovery and a lower pooled THA conversion rate than segmental techniques, and allografts were associated with a lower pooled THA conversion rate than autografts; these comparisons are confounded by surgeon experience, institutional volume, and indication, and should be regarded as hypothesis-generating only.

CONCLUSION: Outcomes after hip labral reconstruction appear to be associated with preoperative joint status, particularly cartilage damage and radiographic osteoarthritis. These findings are derived from study-level analyses and should not be interpreted as evidence of independent or causal effects. Apparent differences between graft types and reconstruction configurations are exploratory and likely reflect underlying confounding rather than true treatment effects. Capsular management and concomitant cartilage procedures were not consistently associated with differences in clinical outcomes or THA conversion.

LEVEL OF EVIDENCE: Level IV, systematic review and meta-analysis of Level IV-III studies. Systematic review registration: This systematic review was prospectively registered with the International Prospective Register of Systematic Reviews (PROSPERO). Registration number: CRD420251273992. Available at: https://www.crd.york.ac.uk/PROSPERO/view/CRD420251273992.

PURPOSE: To evaluate the association between tranexamic acid (TXA) use, autologous predonation and perioperative blood management outcomes after periacetabular osteotomy (PAO) using an arm-based multilevel meta-analytic framework.

METHODS: A systematic search of PubMed, Embase, Epistemonikos and the Cochrane Central Register of Controlled Trials (CENTRAL) was performed up to 30 March 2026. Prospective and retrospective primary clinical studies reporting perioperative blood management outcomes after PAO were included. Comparisons between TXA and non-TXA arms, as well as predonation and no-predonation arms, were performed using arm-based multilevel random-effects meta-analysis.

RESULTS: Forty-three studies comprising 4315 patients and 4674 hips were included. TXA use was associated with lower estimated blood loss (mean difference [MD] -185.6 mL, 95% confidence interval [CI]: -341.1 to -30.1), lower intraoperative blood loss (MD: -299.4 mL, 95% CI: -392.2 to -206.6), fewer transfused units (MD: -0.67, 95% CI: -0.89 to -0.45) and a lower transfusion rate (OR: 0.14, 95% CI: 0.056-0.338). No significant differences were observed for haemoglobin-related outcomes, complications, reoperations or conversion to total hip arthroplasty. Autologous predonation was not associated with reductions in blood loss or transfusion-related outcomes and was associated with lower postoperative haemoglobin levels (MD: -5.5 g/L, 95% CI: -9.0 to -1.9). The certainty of evidence ranged from low to very low, and substantial heterogeneity was observed across most analyses.

CONCLUSION: TXA use was associated with reduced blood loss and transfusion requirements after PAO, whereas autologous predonation was not associated with measurable clinical benefit. Given the substantial heterogeneity and low certainty of evidence, these findings should be interpreted cautiously.

LEVEL OF EVIDENCE: Level III, systematic review and meta-analysis of predominantly retrospective cohort studies.

PURPOSE: The prevalence and clinical consequences of falls in the early post-operative period after hip arthroscopy for femoroacetabular impingement syndrome (FAIS) remain unknown. The purpose of this study was to determine the prevalence of and risk factors for postoperative falls within 90 days of surgery in patients who undergo hip arthroscopy for FAIS and determine whether falls within 90 days are associated with increased risk of early revision surgery.

METHODS: Consecutive patients who underwent primary hip arthroscopy for FAIS were included. Falls were defined by ground impact by body parts other than the feet, and near-falls were defined as sudden, forceful and unanticipated loading of the operative extremity without impact. Bivariate and multivariate analyses were conducted to identify associations between demographic or clinical factors and fall occurrence as well as revision surgery within 1 year.

RESULTS: A total of 192 patients met inclusion criteria (median age 36.7 years, interquartile range [IQR] 23.4, 46.5; 72% female). Of these, 33 patients (17%) experienced a postoperative fall or near-fall (21 falls, 12 near-falls). Median time to fall was 16.5 days (IQR 8.3-44.5). Fall/near-fall patients had significantly higher rates of revision surgery within 1 year compared to controls (27% vs. 4%, p < 0.001; odds ratio [OR] = 9.4, 95% confidence interval [CI] 3.1-30.5). Fall/near-fall events were associated with worse baseline physical function (Physical Function Short Form of the Hip Disability and Osteoarthritis Outcome Score [HOOS-PS], p = 0.047), lower mental health scores (Mental Health Inventory-5 [MHI-5], p = 0.04) and lower activity levels (University of California, Los Angeles [UCLA] score, p = 0.03). Hearing or visual impairment (OR = 6.6, 95% CI 1.9-23.3, p = 0.004) and higher HOOS-PS score (OR = 1.1, 95% CI 1.1-1.3, p = 0.02) were significant predictors of postoperative falls/near-falls.

CONCLUSION: Falls and near-falls within 90 days after hip arthroscopy were associated with higher rates of revision hip arthroscopy. Surgeons should counsel patients, particularly those with sensory impairments, regarding postoperative fall prevention and emphasize prompt reporting of any fall/near-fall events. Future studies are needed to determine whether reducing postoperative falls can decrease revision rates.

LEVEL OF EVIDENCE: Level III.

PURPOSE: Periacetabular osteotomy (PAO) is an established joint-preserving procedure for the treatment of developmental dysplasia of the hip (DDH). As PAO is typically concentrated in specialized centres, many patients travel considerable distances for treatment. The purpose of this study was to evaluate the influence of travel distance on short-term outcomes following PAO.

METHODS: This prospective registry study included 296 hips undergoing PAO for DDH between January 2022 and May 2025 by a single experienced surgeon. Travel distance was determined using driving distance, and hips were stratified into two groups: ≤80.5 and >80.5 km from the treating centre. Radiographic parameters, patient-reported outcome measures (PROMs) and rates of achieving the Patient Acceptable Symptom State (PASS) and Minimal Clinically Important Difference (MCID) for the modified Harris Hip Score (mHHS) and international Hip Outcome Tool-12 (iHOT-12) were analysed.

RESULTS: A total of 126 hips (43%) resided ≤80.5 km and 170 hips (57%) >80.5 km from the treating centre. Hips of patients travelling longer distances demonstrated a lower preoperative lateral centre-edge angle (p = 0.005) and a higher extrusion index (p = 0.034). No significant differences were observed in demographics, comorbidities, concomitant procedures or preoperative PROMs. All PROMs improved significantly in both groups (all p < 0.05). Postoperative PROMs, magnitude of improvement, PASS and MCID achievement rates and complication rates did not differ significantly between groups. Travel distance was not an independent predictor of postoperative outcomes in multivariable regression analyses.

CONCLUSION: Travel distance to a specialized hip preservation centre does not influence short-term outcomes following PAO. Comparable functional outcomes and complication rates can be achieved irrespective of travel distance, supporting the feasibility of centralized PAO care in specialized high-volume centres.

LEVEL OF EVIDENCE: Level III.

PURPOSE: The aim of the study was to identify potential biomarkers of pre-arthritic condition and early osteoarthritis (OA) in patients with femoroacetabular impingement (FAI), by analysing clinical data and quantifying inflammatory molecules, typically involved in OA pathology, in body fluids.

METHODS: FAI patients undergoing hip arthroscopy were enroled after providing written informed consent. Demographic data (age, sex, body mass index [BMI]) were collected, together with radiographic grading of hip degeneration (Tönnis scale) and intra-articular pathology grading (Outerbridge classification). Cartilage degradation markers and immunomodulating molecules were quantified by commercially available sandwich-enzyme-linked assay and multiplex bead-based sandwich immunoassay kits.

RESULTS: Forty-nine patients were enroled, 38 synovial fluids (SFs) and urine samples were available. Median age 32 years ± 8.35 standard deviation (SD); median BMI 24 kg/m2 ± 4.89 SD. Higher BMI corresponded to acetabular chondropathy and was associated with increased C-telopeptide fragments of Type II collagen (CTX-II) release in both SFs and urine. Radiological and intra-operative scores showed moderate-to-strong positive correlation with synovial CTX-II and slight-to-strong positive correlation with vascular endothelial growth factor (VEGF). CTX-II and Cartilage Oligomeric Matrix Protein (COMP) in SFs were positively correlated, showing a high-to-moderate positive correlation with VEGF. VEGF demonstrated a high-to-moderate positive correlation with interleukin (IL)-6 and IL-8. IL1-β correlates moderately positively with IL-8, MIP-3β and TNF-α, which in turn is linked to the release of 6kine, MIP-3β and RANTES. Except for IL-8, all chemokines showed a similar release pattern, suggesting a synergistic and continuous inflammatory mechanism.

CONCLUSIONS: A higher BMI was associated with increased CTX-II in both body fluids, suggesting a potential link between metabolic status and early cartilage degradation in FAI patients. Radiographic and intraoperative indicators of joint degeneration were also associated with selected synovial biomarkers (CTX-II, VEGF, IL-6, IL-8). These findings suggest that synovial and urinary biomarkers may represent candidate markers of early joint degeneration in FAI, useful for clinical evaluation of FAI patients at risk of progression toward OA.

LEVEL OF EVIDENCE: Level IV, case series with no comparison group.

INTRODUCTION: Slipped capital femoral epiphysis (SCFE) is a condition requiring surgical fixation on a semiurgent basis. Although recent studies have evaluated the safety of outpatient SCFE management, none have examined cost in this population. Furthermore, it is unclear what percent of in situ SCFE fixation is done on an outpatient basis nationally.

METHODS: A retrospective chart review of patients treated between the years 2015 to 2024 was conducted at a large tertiary-care children's health system. Patients undergoing in situ fixation for stable SCFE and a minimum 90 days follow-up were included. Demographics, outcomes, and charges were compared between patients treated as outpatients or inpatients. A review of the national PearlDiver database was performed to determine frequency of inpatient versus outpatient settings for this procedure.

RESULTS: A total of 95 patients with stable SCFE were included. The mean age was 11.6 ± 1.9 years. Thirty patients were admitted through the emergency department, 19 of which underwent admission, surgery, and discharge on the same day. In total, 65 patients were scheduled as outpatients from clinic, 58 of which were true outpatient procedures. There was no difference in 90-day complications between groups. There was, however, a significant difference in patient charges for scheduled outpatients versus ED admissions ($10,052.40 vs $13,285.14; P = 0.001). In addition, scheduled outpatient surgery was less expensive than treatment through the ED, even if fixation and discharge occurred the same day ($9,669.90 vs $11,585.78; P = 0.041). On a national level, outpatient SCFE management is more frequent than inpatient management ( P = 0.0016).

CONCLUSION: This study suggests that stable SCFE can safely be an outpatient procedure with significant cost savings. A national trend toward outpatient SCFE management is evident, mirroring general healthcare trends.

BACKGROUND: There is a paucity of literature investigating the effect of preoperative opioid use on outcomes after hip arthroscopy.

PURPOSE: To evaluate the short-term outcomes and the recovery curve of patients undergoing hip arthroscopy for femoroacetabular impingement (FAI) and labral tears who reported preoperative opioid use and to compare these results to a control group of patients without preoperative opioid use.

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

METHODS: We retrospectively analyzed data for patients who underwent primary hip arthroscopy for FAI and labral tears between 2009 and 2021. Patients were included if they reported daily opioid-based pain management within 1 year of surgery (preoperative opioid [PO] group) and had completed preoperative and postoperative patient-reported outcome (PRO) measures at 2-year follow-up. Patients were propensity score matched in a 1:1 ratio to a control group based on sex, age, body mass index, acetabular Outerbridge grade, and labral and capsular treatment. Analysis included comparisons of PROs at 3 months, 1 year, and 2 years as well as clinical thresholds and secondary surgery.

RESULTS: A total of 236 patients in the PO group were matched to 236 control cases. The PO group demonstrated significant improvements on all PRO measures at 2-year follow-up. Compared to the control group, the PO group had lower preoperative scores for the modified Harris Hip Score (mHHS), Non-Arthritic Hip Score (NAHS), and Hip Outcome Score-Sports-Specific Subscale (HOS-SSS) and experienced a prolonged recovery, as indicated by lower mHHS and HOS-SSS scores at 3 months and lower mHHS, HOS-SSS and NAHS scores at 1 year. However, by 2-year follow-up, the PO group achieved comparable scores for the mHHS, NAHS, HOS-SSS, and visual analog scale (VAS). Despite these improvements, the PO group reported lower patient satisfaction compared to the control group (6.3 vs 8.7, respectively; P = .03), reaching the PASS for the VAS at a lower rate (P = .03). No significant differences were observed for secondary surgery rates.

CONCLUSION: Hip arthroscopy for the treatment of FAI and labral tears in patients using daily opioid-based pain control resulted in significant short-term improvements in PROs. Compared to a control group, these patients experienced a prolonged recovery process but ultimately achieved comparable functional outcomes at 2-year follow-up. Despite these improvements, they reported lower patient satisfaction and met the PASS for the VAS at a lower rate.

The hip capsule is a dense, fibrous structure that plays a crucial role in providing hip stability. Its biomechanical function is tied to its complex anatomy, which includes the iliofemoral, pubofemoral, and ischiofemoral ligaments, along with the circumferential fibers of the zona orbicularis. Anatomic and biomechanical studies with advanced imaging and arthroscopic techniques have provided better understanding of the capsular morphology and its contribution to hip stability. Additionally, these studies provide insight into how capsulotomy and subsequent capsular management at the time of hip arthroscopy can potentially influence postoperative outcomes. Growing clinical evidence supports capsular preservation and repair at the time of primary hip arthroscopy and demonstrates the potential negative outcomes of capsular deficiency, such as pain, dysfunction, and instability. This review provides a comprehensive overview of the gross, arthroscopic, radiologic, and biomechanical anatomy of the hip capsule.