2026年7月 保髋进展 JCR Q2

Stress-based biomechanical modeling is increasingly used to evaluate joint mechanics and support surgical planning in developmental dysplasia of the hip (DDH). This scoping review examines how such models are applied in DDH surgery, the mechanical insights they provide, and their readiness for clinical translation. A systematic search of four databases identified 21 studies published between 2007 and 2024. Finite element analysis, discrete element analysis, and analytical approaches such as HIPSTRESS were used to simulate surgical correction and assess joint mechanics. Most models were applied in the preoperative phase to guide acetabular reorientation or quantify changes in load distribution. Across studies, surgical correction was consistently associated with reductions in peak contact-based metrics (approximately 30-50%) and increases in contact area. However, these improvements did not systematically correspond to normalization of the internal mechanical state of the joint, and several studies reported persistent abnormal loading despite apparently satisfactory radiographic outcomes. Reported stress magnitudes varied widely across modeling approaches despite relatively comparable loading conditions, suggesting that differences in geometry, subject-specificity, and constitutive assumptions play a dominant role. Most studies relied on literature-based loading conditions rather than subject-specific data, introducing a potential mismatch between applied forces and anatomical representation. All findings were derived from computational models, with limited verification, sparse validation, and minimal replication across independent cohorts or modeling frameworks. In addition, most models relied on simplified assumptions, including static loading conditions and linear elastic material behavior, and did not account for time-dependent or mechanobiological processes. Although stress-based biomechanical modeling shows promise for improving the mechanical understanding and optimization of DDH correction, its clinical translation remains limited. Future work should prioritize subject-specific loading conditions, improved model validation, and integration into clinically applicable workflows.

AIMS: Comparative assessment of both hip joints in patients with slipped capital femoral epiphysis (SCFE) was performed relative to the control group.

METHODS: We created 3D CT reconstructions of the acetabulum in 27 hips with SCFE, 21 unaffected contralateral hips, and 108 hips of the age- and sex-matched non-SCFE control group. Following measurements performed using true axial CT scans were assessed: acetabular version angle (AVA°), posterior sector acetabular angle (PASA°), posterior wall angle (PWA°), and acetabular roofing percentage.

RESULTS: Based on the morphology of the posterior acetabular wall, we found three type I (closed) and 24 type II (open) hips in the SCFE group. We noticed a flattening of the posterosuperior quadrant of the acetabulum in 66.66% (18 out of 27 hips) of the hips affected by SCFE. For both SCFE (p = 0.004) and unaffected hips (p = 0.009), the AVA at the proximal hip level was significantly lower than in the control group. We observed no significant between-group differences in PASA (p > 0.05). The mean values of the PWA for the SCFE group were significantly higher than in the contralateral hip (p = 0.025) and control group (p = 0.018). None of the patients in our cohort met the criteria for hip dysplasia based on the assessed Tönnis angle (TA) and lateral centre-edge angle (LCEA).

CONCLUSIONS: Hips with SCFE tend to be flattened at the posterosuperior quadrant and have higher PWA values. PWA better defines the morphology of the posterior wall than the PASA. As the PWA angle increases, the mechanical shearing forces at the femoral physis may increase; however, this requires further research.

BACKGROUND: Hip dysplasia (HD) is a known risk factor for early morbidity in the young adult hip. HD causes a variety of pathologic changes to the hip through an asymmetrical distribution of forces. Periacetabular osteotomy (PAO) is becoming increasingly recognized as a treatment. Labral tears occur frequently in the setting of HD and there still remain questions regarding the best treatment practices for labral pathology. We sought to determine whether intraoperative labral tear size was associated with short-term patient-reported outcomes following concomitant hip arthroscopy and PAO.

METHODS: Seventy-one hips that underwent PAO with concomitant hip arthroscopy at our tertiary care hip center from February 2017 to June 2021 who had PROM follow-up time of more than one year were investigated (88.7% women and 11.3% men with mean patient age of 29.5 years). Labral tear sizes were recorded intraoperatively and sorted into three groups: < 5 mm, 5 - 10 mm, and > 10 mm. HOOS scores were collected pre- and postoperatively and were compared across the three labral tear size groups. The association between labral tear size and postoperative HOOS was evaluated while accounting for preoperative HOOS, age, sex, and BMI. The mean follow-up time was 1.57 years ± 250 days.

RESULTS: Across all patients, the mean preoperative HOOS was 66.9 ± 14.5, and the mean postoperative HOOS was 77.8 ± 16.3. Statistically significant improvement was observed in the <5 mm and 5-10 mm groups (p<0.001) but not in the >10 mm group (p=0.310). Mean postoperative HOOS values in the <5 mm, 5-10mm, and >10 mm labral tear groups were 84.3 ± 13.7, 76.9 ± 16.6, and 69.2 ± 16.1, respectively. Larger labral tear size was associated with worse postoperative HOOS (p=0.004).

CONCLUSION: Among patients undergoing concomitant hip arthroscopy and PAO, larger intraoperative labral tear size was associated with worse short-term postoperative HOOS. However, larger labral tears were also associated with older age and worse markers of intra-articular disease, suggesting that tear size may reflect more advanced disease rather than independently determine outcome.

BACKGROUND: Evidence on nonoperative treatment for Legg-Calvé-Perthes disease remains limited by heterogeneity in treatment exposure, including variable combinations of observation, physiotherapy, bracing, casting, activity restriction, and weight-bearing restriction. We evaluated radiographic outcomes and risk factors after a protocol-defined prolonged cast-based abduction containment regimen, thereby establishing benchmark outcome estimates for this specific nonoperative pathway.

METHODS: This single-center retrospective cohort study included children with Legg-Calvé-Perthes disease treated with the institutional protocol between 2009 and 2022 and followed radiographically to healing. The protocol consisted of continuous cast-based abduction containment and strict non-weight-bearing until radiographic healing. The primary outcome was an adverse radiographic result at healing, defined as modified Stulberg grade III to V. Hip-level associations were evaluated using generalized estimating equations with an independence working correlation structure and patient-clustered robust standard errors to account for correlation between bilateral hips.

RESULTS: A total of 398 children with 427 hips were included; 110 hips (25.8%) had an adverse radiographic outcome. Adverse outcome rates increased across age groups: 15.8% in children younger than 6 years, 24.1% in children aged 6 to < 8 years, and 39.8% in children aged 8 years or older. In the primary multivariable model, compared with children younger than 6 years, the odds of adverse outcome were higher in children aged 6 to < 8 years (OR 2.16, 95% CI 1.13 to 4.15; p = 0.020) and in those aged 8 years or older (OR 5.69, 95% CI 2.77 to 11.71; p < 0.001). Compared with Herring A/B hips, Herring B/C hips (OR 2.19, 95% CI 1.07 to 4.49; p = 0.032) and Herring C hips (OR 10.28, 95% CI 5.50 to 19.22; p < 0.001) had higher odds of adverse outcome. Sensitivity analyses showed the same overall pattern.

CONCLUSIONS: Within this defined nonoperative pathway, older age at diagnosis and greater Herring lateral pillar involvement were associated with a higher risk of adverse radiographic outcome at healing. These protocol-specific estimates provide a reference for prognostic counselling within this treatment pathway and a benchmark for future comparative studies of nonoperative strategies.

TRIAL REGISTRATION: Chinese Clinical Trial Registry, ChiCTR2600120879, 20 March 2026, retrospectively registered.

PURPOSE: To identify independent risk factors for conversion to total hip arthroplasty (THA) after hip arthroscopy for femoroacetabular impingement syndrome (FAIS) in a large European single-centre cohort with minimum five-year follow-up, and to further evaluate the Hip Arthroscopy Risk (HAR) Index. We hypothesised that HAR Index ≥ 3, Tönnis grade 2, and Outerbridge grade 4 would be independently associated with THA conversion at five years.

METHODS: This retrospective cohort study included 827 consecutive hips undergoing primary hip arthroscopy for FAIS between January 2007 and April 2021, with minimum five-year follow-up. The primary endpoint was THA conversion within 60 months. Kaplan-Meier analysis and multivariable Cox regression were performed. Predictors included Tönnis grade, Outerbridge grade, ALAD grade, HAR Index, age, sex, and body mass index.

RESULTS: A total of 86 hips (10.4%) were converted to THA within five years (overall survivorship 89.6%). Conversion rates increased with Tönnis grade: 1.0% (grade 0), 7.7% (grade 1), and 36.2% (grade 2) (P < 0.001). Outerbridge grade 4 was associated with a 33.3% conversion rate versus 2.3% for grades 0-1 (P < 0.001). The HAR Index showed a dose-response from 0.3% (HAR 0) to 66.7% (HAR 4). Two pre-specified multivariable Cox models were constructed to address multicollinearity between the HAR Index and its component variables. Model 1 (composite model): HAR Index ≥ 3 (HR 8.30; 95% CI, 4.84-14.26), Outerbridge grade 4 (HR 6.32; 95% CI, 3.29-12.14), and Outerbridge grade 2-3 (HR 3.16; 95% CI, 1.48-6.73) were independent predictors (C-index 0.853; all P ≤ .003). Model 2 (component model): Tönnis grade 2-3 (HR 19.41; 95% CI, 6.03-62.53), Tönnis grade 1 (HR 7.09; 95% CI, 2.18-23.06), Outerbridge grade 4 (HR 2.16; 95% CI, 1.06-4.37), and age 50-60 years (HR 5.49; 95% CI, 2.47-12.17) were independent predictors (C-index 0.885; all P ≤ .033).

CONCLUSIONS: Tönnis grade, Outerbridge grade, age, and the HAR Index were independently associated with THA conversion within five years. A HAR Index ≥ 3 may help guide patient selection and preoperative counselling. External validation is required.

PURPOSE: To characterise recovery trajectories across nine patient-reported outcomes (PROs) during the first twelve months after hip arthroscopy for femoroacetabular impingement syndrome (FAIS), and to determine whether six-month assessment serves as a representative endpoint.

METHODS: Retrospective analysis of a prospective database (2007-2025). Patients undergoing primary hip arthroscopy for FAIS completed nine PROs pre-operatively and at three, six, and twelve months. Linear mixed-effects models adjusted for age, BMI, sex, morphology, cartilage grade, and labral treatment were the primary analysis; Holm correction controlled the family-wise error rate. MCID and PASS achievement with 95% Wilson CIs were secondary outcomes.

RESULTS: Included were 1,095 hips (44.2% CAM; 52.9% combined; mean age 38.2 ± 12.7 years; 63.3% male). The largest gains occurred at three months (mHHS: Δ + 14.6, 95% CI + 12.8 to + 16.5; iHOT-33: Δ + 20.9, + 18.2 to + 23.5; both p < 0.001). Further improvement occurred through six months. After Holm correction, no instrument showed statistically significant change from six to twelve months (all p-adj > 0.05; effect sizes d = 0.05-0.12). MCID achievement rose from three to six months (mHHS: 57.9% to 69.4%; HOS Sport: 52.9% to 68.2%), with minimal further gain at twelve months.

CONCLUSION: Recovery follows a biphasic pattern: the largest gains occur within three months, with further improvement through six months. After Holm correction, no PRO changed significantly from six to twelve months. Six-month assessment is a pragmatic endpoint for pain, daily-living function, and overall hip scores. HOS Sport and SF-36 PCS warrant twelve-month evaluation in athletes and studies using these as primary endpoints.

To develop an artificial intelligence-based radiographic screening system for hip dysplasia and to evaluate its diagnostic performance and clinical utility. Seventy-three patients with hip dysplasia who underwent unilateral periacetabular osteotomy and 29 asymptomatic volunteers were included. Radiographs from patients with hip dysplasia were divided into training (n = 40), validation (n = 7), and testing (n = 26) datasets, whereas radiographs from volunteers were used exclusively for testing. The artificial intelligence system detects and segments anatomical landmarks on pelvic radiographs, quantifies parameters reflecting anterior, posterior, and lateral acetabular coverage, and determines whether a patient has hip dysplasia based on these measurements. It comprises two deep learning models: DeepLabCut and U-Net, which can effectively learn anatomical structures from relatively small training data. Ground-truth measurements were obtained from repeated assessments by a hip surgeon and a non-hip surgeon, and hip dysplasia status was independently determined by two hip surgeons in blinded assessments. Agreement with the ground-truth was assessed using intraclass correlation coefficients, and screening performance was compared with that of general orthopaedic residents using the test images. Agreement with the ground-truth was good to excellent [intraclass correlation coefficient: 0.70-0.95]. The system showed the best overall screening performance (sensitivity, 0.96 vs. 0.44-0.97; specificity, 0.92 vs. 0.16-0.92; area under the curve, 0.94 vs. 0.57-0.76; F-measure, 0.96 vs. 0.60-0.81) compared with the residents. Our artificial intelligence-based screening system may serve as a primary care-oriented radiographic screening and referral-support tool for clinicians, including non-specialists, despite being trained on a limited dataset.

INTRODUCTION: Whether iliofemoral ligament-preserving hip arthroscopy facilitates recovery of gait speed-an indicator of functional recovery following hip arthroscopy in patients with femoroacetabular impingement-remains unclear. We investigated whether gait speed improved after iliofemoral ligament-preserving hip arthroscopy and examined whether pelvic jerk, defined as the time derivative of acceleration and assessed using inertial sensors at 1 month postoperatively (1M), was associated with gait speed at 6 months (6M).

MATERIALS AND METHODS: Eighteen patients who underwent primary hip arthroscopy for femoroacetabular impingement were included. Gait speed and pelvic jerk were assessed during a 10-m walk at a self-selected speed, using an inertial sensor positioned at the third lumbar level. Peak pelvic jerks during the 1st and 2nd halves of the stance phase (1st - and 2nd -peak pelvic jerks) were calculated. Measurements were obtained preoperatively and at 1M and 6M. Gait parameters were compared across time points using a linear mixed model. Bayesian regression was used to compare the observed change in gait speed from preoperatively to 6M with previously reported values. Associations between gait variables at 1M and gait speed at 6M were also examined.

RESULTS: Gait speed was significantly higher at 6M than that pre surgery (preoperative, 1.15 [95% confidence interval, 1.08-1.21] m/s, 6M, 1.24 [95% confidence interval, 1.17-1.30] m/s, P = 0.013). Bayesian analysis indicated that the improved gait speed (posterior mean, 0.09 m/s; 95% credible interval, 0.04-0.14) was comparable with previously reported values. The 2nd -peak pelvic jerk at 1M was significantly associated with gait speed at 6M (β = 0.63, P = 0.02).

CONCLUSIONS: Iliofemoral ligament-preserving hip arthroscopy was associated with a significant improvement in gait speed at 6M. Early postoperative gait kinematics during the latter half of the stance phase, reflected by the 2nd -peak pelvic jerk, may be associated with subsequent gait speed recovery.

INTRODUCTION: A transitional "grey-zone" exists between typical locations of classical trapezoidal anterior wall and large-fragment posterior wall acetabular fractures. Part of this grey zone is the superior acetabular dome, which is commonly involved in acetabular fracture patterns, especially in geriatric patients. The aim of this study was to characterize isolated acetabular superior wall fractures and to assess their relevance as a distinct fracture pattern.

METHODS: A retrospective analysis of pelvic fracture databases from three tertiary trauma centers was performed. Acetabular fractures with superior dome involvement were screened, and cases with isolated superior articular involvement were included. Overall, seven patients were identified. Clinical and radiological data were analyzed regarding fracture morphology, associated fracture characteristics (including dislocation, comminution, marginal impaction, intra-articular fragments, and femoral head injury), concomitant pelvic ring injuries, treatment, and clinical outcomes.

RESULTS: Isolated superior wall acetabular fractures occurred following both high-energy and low-energy mechanisms, including simple falls. The mean age was 48 years and four of seven patients were male. Hip dislocation or subluxation was observed in four cases (anterior-superior or purely superior). Surgical treatment was performed in six cases, predominantly using anterior approaches (mainly the iliofemoral approach) with screw and/or plate fixation. Outcomes were frequently unfavorable, with relevant joint degeneration or persistent symptoms, likely related to substantial articular damage of the superior weight-bearing zone.

CONCLUSION: Acetabular superior wall fractures present a distinct fracture pattern that differs from classical anterior and posterior wall fractures and is less commonly observed. These injuries involve the superior weight-bearing dome and are frequently associated with comminution and substantial articular damage of both the acetabulum and femoral head. Even in cases with restored joint congruence, outcomes appear inferior, underscoring the clinical relevance of this fracture entity.

BACKGROUND: Developmental dysplastic hip disease is common in childhood, and clinical maneuvers (e.g., Ortolani and Barlow) detect only subluxation or dislocation. Sound transmission has been proven useful in the diagnosis of this disease.

OBJECTIVE: to calculate the validity and repeatability of electromagnetic acoustic wave transmitter-receiver device for the clinical diagnosis of hip dysplasia in newborns.

DESIGN: This was a cross-sectional study of newborns at Guanajuato General Hospital whose parents agreed to participate.

METHODS: One hundred newborns, between 4 and 27 days of extrauterine life, underwent sound transmission testing with the punctual sound emitter-receiver device placed separately on each hip on three occasions by two examiners. Hip ultrasound was performed using the Graf technique as the gold standard. Validity (sensitivity, specificity, and predictive values) and Cohen's Kappa were calculated to determine the reliability of the device.

RESULTS: Of the 200 hips, 15 right and 18 left hips were diagnosed with dysplasia using the Graf technique ultrasound; a validity greater than 90% was obtained in the three measurements. Repeatability with intra-observer Kappa values were 0.76 for the right hip and 0.82 for the left hip, while inter-observer Kappa values were 0.90 for the right hip and 0.81 for the left hip.

CONCLUSION: Sound transmission using this clinical device complements the evaluation of the hips of newborns.

Narrowing of the ischiofemoral space leading to the entrapment of neurovascular structures is the pathologic basis of ischiofemoral impingement (IFI). In our clinical practice, we encountered a patient with secondary IFI because of an osteochondroma in the lesser trochanter region, presenting with typical posterior hip pain. Traditional surgical methods typically involve lesion resection through a posterolateral approach to the hip, with only a few patients reported using hip arthroscopy. We present a modified posterior hip arthroscopic technique for resecting an osteochondroma near the lesser trochanter. This technique allows for rapid access to the lesion site and provides clear visualization of the sciatic nerve under arthroscopy, facilitating safe and thorough lesion resection.Level of evidence V, Case Study.

AIM: To evaluate the radiological outcomes of femoral head osteonecrosis (FHO) in children with sickle cell disease (SCD), comparing non-operative treatment (bisphosphonates) and head-preserving surgical interventions-core decompression with bone marrow aspirate concentrate (CD-BMAC) and proximal femur reorientation osteotomy (PFRO)-by analyzing changes in Steinberg stage before treatment to final follow-up.

METHODS: Retrospective review of 28 hips from 17 pediatric SCD patients treated between 2010 and 2024, analyzed patient demographics, disease stage, treatment modalities, disease progression, and follow-up duration; and compared pre-collapse and post-collapse stages.

RESULTS: Among 75 hips with FHO in 51 children, 61 (81%) were non-traumatic. Of the 28 hips (13 pre-collapse, 15 post-collapse) in 17 children (mean age 11.6 years; 58.8% male), the average interval from SCD diagnosis to FHO onset was 78.8 months (Standard deviation-36.6). Treatments included bisphosphonates (11 hips), CD-BMAC (5), and PFRO (6). After excluding salvage procedures and lost follow-up, 20 hips were available for the final outcome analysis. At final follow-up (mean 30.7 months), FHO improved or remained stable in 15 hips (75%), while it progressed by at least 1 Steinberg stage in 5 hips (25%). In pre-collapse hips, no further disease progression was seen. In post-collapse cases, progression was noted in three of five bisphosphonate-treated hips and two CD-BMAC-treated hips; PFRO-treated hips showed no progression. Two hips developed arthritis.

CONCLUSION: Bisphosphonates, CD-BMAC, and PFRO prevent disease progression in pre-collapse hips. In post-collapse hips, PFRO showed no further progression, while CD-BMAC and bisphosphonates showed mixed results.

SIGNIFICANCE OF STUDY: Early radiological screening and intervention before femoral head collapse is critical to preserving joint anatomy.

LEVEL OF EVIDENCE: Level IV.

CONTEXT: Individuals with chronic hip-related groin pain display impaired dynamic postural control as measured by the modified star excursion balance test; however, the kinematics and kinetics displayed have not been reported in chronic hip-related groin pain populations. Hip joint kinematics during various tasks differ between males and females with chronic hip-related groin pain; however, few studies have reported trunk kinematics or hip joint loading. We were curious if sex differences exist in trunk, hip, and pelvis kinematics and hip joint loading during the modified star excursion balance test among those with chronic hip-related groin pain.

DESIGN: Cross-sectional.

METHODS: Patients with chronic hip-related groin pain performed 3 trials of the modified star excursion balance test, reaching in anterior, posteromedial, and posterolateral directions. We used a motion capture system and force plates to capture hip, pelvis, and trunk kinematic and kinetic data. Variables of interest included reach distance, normalized by leg length, and sagittal and frontal plane hip, pelvis, and trunk kinematics and hip joint kinetics at the time of max reach. We used independent t tests or Wilcoxon rank sum tests to assess between-group differences.

RESULTS: Compared with males (n = 11, age = 28 years, body mass index = 25.0 kg/m2), females (n = 17, age = 25 years, body mass index = 22.1 kg/m2) displayed larger hip adduction angle during anterior (12.6° vs 6.1°, P = .048) and posteromedial (1.5° vs -4.6°, P = .043) directions, larger contralateral pelvic drop angle during anterior direction (-1.7° vs 2.3°, P = .014), smaller trunk flexion angle during posteromedial direction (25.8° vs 34.8°, P = .045), and smaller hip flexion moment during posterolateral direction (0.56 vs 0.87 N·m/kg, P = .021). Females and males displayed similar reach distances.

CONCLUSION: Movement strategies differ between sexes, with females displaying more hip adduction motion, more contralateral pelvic drop, less trunk flexion motion, and smaller hip flexion moments.