2026年8月 保髋进展 JCR Q1

BACKGROUND: Developmental dysplasia of the hip remains a preventable yet underdiagnosed condition. Conventional screening strategies that rely on physical examination demonstrate limited sensitivity and fail to achieve comprehensive population coverage. Although universal ultrasound screening has shown promise, evidence supporting scalable, sustainable, and nurse-led community-based implementation models within real-world public health systems remains limited.

OBJECTIVE: To evaluate a nurse-led community-based ultrasound hip screening program integrated into routine maternal and child health services in Japan using the Reach, Effectiveness, Adoption, Implementation, Maintenance framework.

DESIGN: A prospective cohort study with a mixed-methods design.

SETTINGS: Three rural Japanese municipalities (February 2024 to August 2025).

PARTICIPANTS: Public health nurses, midwives, infants, and their caregivers who underwent routine newborn home visits or child-rearing consultations in the participating municipalities.

METHODS: The existing maternal and child health services evaluated across the following dimensions: Reach (coverage rate); Effectiveness (the proportion and mean age of infants referred early to medical institutions, and caregiver-reported outcomes following referral); Adoption (nurse adoption rate); Implementation (the proportion of ultrasound images meeting Graf's criteria, examination time, operational challenges, and cost); and Maintenance (continuation and policy integration). Ultrasound images were uploaded to a secure encrypted cloud server and interpreted remotely by Graf-certified pediatric orthopedic surgeons, with structured feedback provided to nurses throughout the implementation process.

RESULTS: A total of 818 examinations were performed in 349 infants. The estimated coverage rate was 95.6%, indicating a near-universal range. Standard-plane images meeting Graf's criteria were obtained in 85.8% of examinations. Non-Type I hips accounted for 8.7% of cases, and 7.0% of infants were referred for further evaluation. Of these referred infants, 97.6% visited medical institutions, 54.8% required continued follow-up, and 4.8% required treatment. Adoption was high, with 95.5% of trained nurses conducting screenings. Implementation challenges included infant positioning, data-upload errors, and limited digital integration; however, interprofessional feedback from orthopedic surgeons improved technical performance. Ultrasound visualization enhanced caregiver understanding and facilitated timely adherence to referral recommendations. All municipalities continued screening, demonstrating strong maintenance.

CONCLUSIONS: Nurse-led ultrasound hip screening can be feasibly integrated into routine maternal and child healthcare systems. This model enables early identification of suspected developmental dysplasia of the hip without clinical signs, and offers an equitable approach in resource-limited settings from a precision public health nursing perspective.

REGISTRATION: University Hospital Medical Information Network Clinical Trial Registry; UMIN000051929 (https://center6.umin.ac.jp/cgi-open-bin/ctr/ctr_his_list.cgi?recptno=R000059248). Registration date: September 16, 2023. Start of recruitment: November 01, 2023.

SOCIAL MEDIA ABSTRACT: Nurse-led community ultrasound hip screening achieved 95.6% coverage, and 8.7% of the screened infants had a suspected dislocation or hip dysplasia.

Osteonecrosis of the femoral head (ONFH) is traditionally framed as structural failure after interrupted blood supply, yet this linear model does not explain why patients with similar radiographic stage may show markedly different pain trajectories, collapse kinetics, and hip-preservation outcomes. We propose that ONFH is better interpreted as an osteoimmune microenvironmental failure sustained by a self-reinforcing loop: ongoing cell-death input, maladaptive inflammatory reprogramming, bone-marrow niche dysfunction, and mechanical destabilization. In this framework, early sterile inflammation may support debris clearance, but persistent danger signaling can shift the lesion border into chronic, repair-incompetent inflammation. The marrow niche then transitions from a regenerative interface to a maladaptive state characterized by impaired stromal osteogenesis, endothelial dysfunction, uncoupled remodeling, and reduced load tolerance. To translate this model clinically, we organize intervention into three coordinated axes: entry blockade, niche reprogramming, and reconstruction. We further propose a dynamic decision path integrating stage, risk-factor burden, and niche activity, with serial imaging, biomarker trajectories, and functional outcomes guiding escalation.

Image-guided hip injections are widely used for osteoarthritis, femoroacetabular impingement syndrome, and extra-articular hip pathology. Corticosteroids have traditionally dominated this space, despite increasing concern regarding joint safety. I argue that injectable nonsteroidal anti-inflammatory drugs, particularly ketorolac, represent a clinically effective and potentially safer alternative to corticosteroids for selected hip conditions. This commentary integrates comparative effectiveness data with recent randomized and observational safety literature, including randomized controlled trial evidence supporting corticosteroid efficacy, to frame a risk-balanced clinical decision model. When symptom relief is comparable, the injectate with fewer catastrophic downside risks should be preferred. Current evidence supports ketorolac as a reasonable and often preferable, first-line option for ultrasound-guided hip injections in appropriately selected patients.

PURPOSE: To compare patient outcomes following ultrasound-guided nonsteroidal anti-inflammatory drug injections (NSI) versus corticosteroid injections (CSI) for osteoarthritis (OA), femoroacetabular impingement syndrome (FAIS), and extra-articular tendinopathy (ET) of the hip.

METHODS: A retrospective analysis of a single-institutional database of patients undergoing ultrasound-guided injections for hip pathology with NSI (ketorolac) and CSI (dexamethasone) between October 2022 and November 2024 was performed. Patients were separated into 3 groups based on hip pathology: OA, FAIS, and ET. Exclusion criteria included avascular necrosis, fracture, inflammatory arthritis, a history of prior hip injections, and patients with less than 6 months of follow-up or incomplete follow-up. Outcomes including pre-injection pain scores, post-injection pain scores, patient-reported improvement, effect onset, effect duration, and side effects were analyzed.

RESULTS: Ninety hips from 89 patients were included with minimum 6-month follow-up (mean 14.2 ± 6.7 months). No significant demographic differences existed between NSI (n = 45) and CSI (n = 45) groups. FAIS patients were younger than patients with other hip pathologies (42.6 years FAIS, 50.8 ET, 58.8 OA, P < .01). On multivariate analysis, NSI was correlated with a significantly greater decrease in pain score after injection when compared with CSI (P = .035). There was no difference in pain relief based on hip pathology, but female patients were more likely to show improvement compared with male patients. In patients with reported pain relief from injections, there was no significant difference in overall reported percentage improvement (47% ± 33% NSI, 39% ± 35% CSI, P = .33), duration of effect (93 d ± 124 d NSI, 128 d ± 165 d steroid, P = .35), or effect onset time (3.3 d ± 4.6 d NSI, 11.1 d ± 33.8 d CSI, P = .22).

CONCLUSIONS: Ultrasound-guided injections for hip OA, FAIS, and ET with ketorolac may provide greater pain relief with a similar duration of action compared with corticosteroids.

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

PURPOSE: To evaluate the patient-reported outcome measures (PROMs) of hip arthroscopy (HA) in patients with concomitant low back pain and lumbar spine pathology (LSP) compared with those without back concerns at a minimum of 5 year follow-up and determine the prevalence of low back pain (LBP) and LSP in Asian patients with femoroacetabular impingement syndrome (FAIS).

METHODS: Patients with FAIS, who underwent primary HA for FAIS with labral repair by a single surgeon between July 2017 and October 2019 with minimum 5-year follow-up, were identified. Patients were placed into 3 groups based on presence of preoperative LBP and LSP. These groups included: group LBP (with LBP), group Both (with LBP and LSP), and group None (neither diagnosis). The presence of concomitant LSP was identified using preoperative imaging with a pathologic lumbar spine diagnosis. All patients included in the study were asked to complete the Harris Hip Score (HHS) and Visual Analog Scale (VAS). All patients enrolled in the study were asked to fill out this survey preoperatively, at 3 months postoperatively, and latest follow-up. Satisfaction ratings were collected. Patient-reported outcomes (PROs) were compared between groups, postoperative with preoperative, along with revision arthroscopy, and conversion to total hip arthroplasty (THA).

RESULTS: The groups were similar in age (46.2 ± 14.4 years, 46.0 ± 15.5 vs 43.9 ± 13.8, P = .16), sex (55.4% female, 58.2% vs 55.4%,P = .91), and body mass index (23.4 ± 2.2 kg/m2, 23.6 ± 2.5 vs 23.1 ± 2.2, P = .93). Comparing HHS and VAS between groups, no significant differences were observed preoperatively and at 5-year follow-up (P ≥ 0.057). Postoperative PROs significantly improved compared with preoperative PROs in all groups at 5-year follow-up (P < .0001). The LBP, Both, and None groups showed comparable rates of any patient acceptable symptomatic state (PASS) (89.1%, 88.1% vs 90.1%, P = .86) at 5-year follow-up. No significant differences in the rates of revision or THA conversion were identified between groups (P = .45). The prevalence of LBP and LSP was 28.9% and 11.5% in the cohort, respectively.

CONCLUSIONS: The patients with LBP and/or LSP undergoing HA achieved comparable PROs, achievement of PASS, and reoperation-free survivorship to patients with isolated FAIS at minimum 5-year follow-up. The prevalence of LBP and LSP was 28.9% and 11.5% in Asian patients with FAIS, respectively.

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

A complex interplay exists between the hip joint and the lumbosacralpelvis. As a patient moves from a standing to seated position, the lower back, pelvis, and hips must move in concert to properly function. Conceptually, any deviation from the norm risks early hip impingement. Current evidence is conflicted regarding whether concomitant lumbar pathology (LP) negatively affects outcomes following hip arthroscopy with labral repair for patients with femoroacetabular impingement syndrome (FAIS), though the preponderance of evidence suggests some degree of negative relationship. Fortunately, studies that do report a negative relationship also uniformly report significant improvement in combined FAIS/LP patients, though less improvement than those without LP. Based on current evidence, it is reasonable to offer appropriately indicated FAIS patients surgery in the presence of concomitant LP, but physicians should also set appropriate expectations.

PURPOSE: To evaluate the impact of the pericapsular nerve group (PENG) block on postoperative pain scores and opioid consumption in patients undergoing hip arthroscopy.

METHODS: A systematic literature review adhering to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines was conducted in July 2025. PubMed, Cochrane Central Register of Controlled Trials, and Scopus databases were searched using the terms "pericapsular" and "hip." Primary research studies reporting pain scores and postoperative opioid consumption in hip arthroscopy patients receiving PENG blocks were included. Study quality was assessed using the Cochrane Risk-of-Bias Tool 2 for randomized controlled trials and the methodological index for nonrandomized studies criteria for nonrandomized studies.

RESULTS: Eleven studies with a total of 386 patients met the inclusion criteria. The mean age of patients ranged from 26.5 ± 10.4 to 44.1 ± 13.7 years. Five studies revealed that PENG blocks significantly reduced postoperative opioid consumption, whereas 3 studies reported no significant difference. Reductions in opioid consumption in the postanesthesia care unit ranged from 0 to 2 mg morphine equivalents. PENG block showed significant postoperative pain benefit compared with the fascia iliaca block, but no significant postoperative pain benefit compared with other nerve blocks. Pain scores in the PENG block group were significantly lower in 5 out of 6 studies when compared with a control group with no nerve block. Additionally, the PENG block reduced postanesthesia care unit stay times in 5 studies, with average reductions ranging from 28 to 60 minutes compared with no nerve block.

CONCLUSIONS: The PENG block improves postoperative pain control and reduces opioid consumption in patients undergoing hip arthroscopy, particularly when compared with no peripheral nerve block.

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

Postoperative pain control remains a central determinant of discharge readiness, patient satisfaction, and opioid exposure after hip arthroscopy. Even modest improvements in early analgesia can meaningfully influence recovery pathways. The pericapsular nerve group block offers a focused, motor-sparing approach that aligns with modern outpatient care. Although comparative data remain inconsistent, current evidence suggests that pericapsular nerve group blocks represent a clinically relevant and underused tool for optimizing perioperative pain management. In an era of opioid stewardship and ambulatory surgery, failure to implement effective regional techniques may carry increasing clinical and systemic consequences.

PURPOSE: To evaluate the mid-term (≥5 years) to long-term (≥10 years) clinical outcomes of isolated hip arthroscopy in borderline hip dysplasia (BDH) patients compared to those with normal acetabular coverage.

METHODS: A comprehensive literature search was performed in PubMed, Ovid Medline, and Scopus. Studies were included if they directly compared BDH patients to controls with normal acetabular coverage after isolated hip arthroscopy, with a minimum follow-up of 5 years. Outcomes analyzed included patient-reported outcomes, revision surgery rates, and conversion to hip replacement.

RESULTS: Four studies (478 patients: 157 BDH, 321 control) with follow-up ranging from 5 to 10 years were included. The pooled analysis demonstrated no statistically significant differences in postoperative patient-reported outcomes, revision rates (14.0% vs 20.9%; odds ratio, 0.61; P = .07), or conversion to hip replacement (1.9% vs 4.7%; odds ratio, 0.45; P = .22) between BDH and control groups.

CONCLUSIONS: Patients with BDH undergoing isolated hip arthroscopy demonstrate comparable clinical outcomes, revision rates, and hip survivorship to those with normal acetabular coverage at mid- to long-term follow-up (ranging from 5 to 10 years).

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

PURPOSE: To evaluate the prognostic efficacy of in-office local anesthetic intra-articular injection response in predicting hip arthroscopy outcomes.

METHODS: This scoping review was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses for Scoping Reviews using the PubMed, Embase, and Web of Science databases from inception to October 1, 2024. The articles were reviewed, and the risk of bias was assessed. Pertinent data was extracted and analyzed.

RESULTS: Four studies (n = 368 patients; 48.6% women; mean age 21.6-38.8 years; level of evidence II-IV; mean follow-up 12-24 months) evaluated local anesthetic injections (lidocaine alone or with ropivacaine; 5 to 20 mL) assessed 20 to 30 minutes postinjection for femoroacetabular impingement syndrome. Definitions of positive injection response varied substantially. Three of the 4 studies showed significant associations between positive injection response and superior postoperative outcomes, with positive responders achieving higher Hip Outcome Score Activities of Daily Living, Hip Outcome Score-Sports, Nonarthritic Hip Score, and Patient-Reported Outcome Measure Information System scores (P = .003-0.045) and higher minimum clinically important difference/patient acceptable symptomatic state achievement rates. Change in Visual Analog Scale for Pain predicted substantial clinical benefit (odds ratio 1.2, P < .001), and postinjection International Hip Outcome Tool correlated with 1-year outcomes (r = 0.784, P < .001). Postoperative modified Harris Hip Score ranged from 87.5 to 87.7 in positive responders versus 81.6 to 84 in negative responders. One study found no significant correlation (P = .589), with 49% of patients with poor surgical outcomes showing good injection response.

CONCLUSIONS: Based on limited available literature, it is suggested that a positive in-office response to intra-articular injection of local anesthetic portends a favorable outcome after hip arthroscopy. A negative response to in-office injection was not suggested to foreshadow a poor surgical outcome and based on the current evidence is inconclusive as a tool by which to help select surgical candidates.

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

PURPOSE: To determine whether losartan is associated with lower prevalence of hip adhesions, instability, and repeat procedures after hip arthroscopy and to assess this association among men, women, and patients under 30 years of age.

METHODS: The TriNetX database was queried to identify all patients who underwent hip arthroscopy. Two cohorts were generated: one consisting of patients prescribed losartan after surgery and a comparison group excluding patients with any documented prescription for commonly used angiotensin-converting enzyme inhibitors or angiotensin-receptor II blockers. After 1:1 propensity score matching by age, sex, body mass index, essential hypertension, lower respiratory disease, nicotine dependence, diabetes mellitus, anemia, chronic kidney disease, heart failure, and metabolic disease, both cohorts included 947 patients. Rates of medical and orthopaedic complications were analyzed at 30, 90, and 180 days and at 2 years. A subanalysis was performed for patients under 30 years of age.

RESULTS: Rates of lysis of adhesions were low at all time points in both cohorts of 947 patients. This held true for other orthopaedic complications. Rates of serious medical complications were low and had no significant differences between cohorts. Subanalysis of cohorts with women (627 patients), men (308 patients), and patients 29-years-old or less (388 patients) also showed similar rates of lysis of adhesions.

CONCLUSIONS: Orthopaedic complications after hip arthroscopy are very rare regardless of whether or not postoperative losartan is prescribed. Serious medical complications were also rare in both cohorts. These results were consistent when stratified by sex and among patients 29-years-old or younger.

LEVEL OF EVIDENCE: Level III, retrospective cohort study.

AIMS: The aim of this study was to evaluate the cost-effectiveness of screening programmes for identifying developmental hip dysplasia (DDH) in children born in England and Wales.

METHODS: The costs and quality-adjusted life-years (QALYs) associated with DDH screening programmes were estimated using a decision-analytic model. Six programmes were modelled from an NHS perspective: 1) Current practice - 'selective' screening: clinical examination with later ultrasound screening (USS) for those with an abnormal examination or specific risk factors (breech birth, first degree family history of DDH); 2) No hip screening: no clinical examination or risk factor assessment; 3) Clinical examination: treatment decisions based solely upon a positive Barlow or Ortolani manoeuvre; 4) Universal USS at birth: USS in the neonatal period in addition to a postnatal check; 5) Universal USS at six weeks: USS in addition to the six-week postnatal check; 6) Sex-stratified screening: clinical examination with selective USS for males and universal USS in the neonatal period for females. The incremental net monetary benefit (INMB) was estimated at a cost-effectiveness threshold of £20,000 per QALY gained. Whether the result was robust to assumptions was assessed using analyses of uncertainty. Secondary outcomes included an estimate of the value of reducing the uncertainty of the decisions.

RESULTS: Universal USS (including stratification by sex) was more clinically effective, but at significant additional cost. Current practice was the most cost-effective screening programme in 96% of modelled simulations. Differences in INMB were statistically significant. The reconfiguration of service so that USS does not require additional hospital visits would reduce marginal losses and introduce uncertainty to the conclusion. The benefit of generating better evidence about a reconfigured USS service was valued at £1.91 per live birth, equating to £11 million over ten years.

CONCLUSION: Clinical examination with USS for those with an abnormal examination, or specific risk factors, is likely to be the most cost-effective DDH screening programme in the UK. Further research focused on the costs and efficacy of screening programmes could add value for informing future policy decisions.

Hip arthroscopy is increasingly used in the management of femoroacetabular impingement syndrome (FAIS), yet the definition of treatment failure remains unsettled. In response to the recent study by Mygind-Klavsen et al., we argue that conversion to total hip arthroplasty (THA), although clinically important, is a late and highly selective endpoint that does not capture the broader spectrum of unsuccessful hip preservation. Patients who remain symptomatic, fail to achieve clinically meaningful improvement, or undergo revision without THA are not represented by arthroplasty conversion alone. We further question whether conventional radiographic variables such as alpha angle, lateral joint-space width, and Tönnis grade are sufficient to explain failure in a condition as structurally and biologically heterogeneous as femoroacetabular impingement syndrome. Recent evidence suggests that cartilage status, composite risk stratification, and technique-related factors may be more informative for long-term survivorship than conventional morphology alone. Finally, the long registry period analysed in the target article spans different technical eras, raising the possibility that treatment-era effects were conflated with patient-related risk. In our view, the study provides a useful registry-based estimate of THA conversion after hip arthroscopy, but its findings should not be interpreted as establishing the dominant determinants of failure in contemporary hip-preservation practice.

Despite 14 systematic reviews and meta-analyses published between 2018 and 2026, the role of capsular closure after hip arthroscopy for femoroacetabular impingement syndrome remains controversial. While several studies report superior outcomes following capsular repair, others demonstrate little or no clinically meaningful benefit. This persistent inconsistency raises the possibility that current meta-analyses may be addressing the wrong question. Most published studies compare different capsular management strategies, including non-closure, partial (T-capsule) repair and complete capsular closure, across highly heterogeneous patient populations while largely ignoring baseline hip stability characteristics. Patients with BDDH, generalized ligamentous laxity, increased femoral version, and other manifestations of microinstability are frequently analysed together with mechanically stable hips. Consequently, pooled estimates may represent averages across fundamentally different biomechanical phenotypes. The common hidden thread running through all the studies might simply be that capsular closure is likely dependent on the underlying stability profile of the hip rather than being universally beneficial or universally unnecessary. Future studies and meta-analyses should move beyond simple comparisons of closure versus non-closure and instead focus on stability phenotype-based analyses. The key question may no longer be whether capsular closure works, but rather in which hips capsular closure matters.

BACKGROUND: Hip arthroscopy has shown satisfactory outcomes for the treatment of intra-articular pathology and femoroacetabular impingement syndrome (FAIS) in the setting of acetabular dysplasia at short- and mid-term follow-up. However, the long-term outcomes remain less understood.

PURPOSE: To systematically review the literature to determine patient-reported outcomes (PROs), clinically significant outcome (CSO) achievement, reoperation rates, and predictors of failure in patients with acetabular dysplasia undergoing hip arthroscopy at long-term follow-up.

STUDY DESIGN: Systematic review; Level of evidence, 4.

METHODS: Three databases were searched around the following terms: hip arthroscopy, dysplasia, and long-term follow-up. Articles available in English, presenting original data, and reporting on a mean follow-up of ≥10 years after primary hip arthroscopy using either PROs, CSOs, or conversion to total hip arthroplasty (THA) and/or revision surgery were included. Quality assessment was completed using Methodological Index for Non-Randomized Studies (MINORS) assessment.

RESULTS: Five studies (555 hips) were included in the systematic review: patients had a mean age of 30 to 41 years, 13% to 88% of patients were female, and follow-up ranged from 9.6 to 12 years. MINORS assessment ranged from 11 to 21. All studies included PROs and reported statistically significant improvement for most PROs. The most frequent PRO was the Modified Harris Hip Score (mHHS) (n = 5). All studies reported CSO achievement, with mHHS and Hip Outcome Score-Sport Specific (HOS-SS) being the most common (n = 4). Revision surgery and conversion to THA ranged from 2.6% to 15.2% and from 2.6% to 23.7%, respectively across dysplasia cohorts. The most common definition of failure was conversion to THA, and Tönnis angle was the most common predictor of failure. Four studies made comparisons to a nondysplasia group, with 1 study finding inferior HOS-SS and inferior achievement of Patient Acceptable Symptom State across multiple PROs in the dysplasia group. All 4 comparative studies found no differences in rates of revision surgery or conversion to THA between groups.

CONCLUSION: Hip arthroscopy can reliably provide durable and clinically meaningful improvements for the treatment of intra-articular pathology and FAIS in patients with acetabular dysplasia at long-term follow-up, with comparable rates of revision surgery and conversion to THA to nondysplastic cohorts, although select dysplastic populations may demonstrate inferior patient-reported outcomes.

BACKGROUND: Psychiatric comorbidity-most commonly depression and anxiety-is frequently reported among patients undergoing hip arthroscopy and may influence postoperative trajectories, but existing analyses vary in scope and methods, limiting clinical interpretation.

PURPOSE: To determine whether recorded psychiatric diagnoses are associated with worse surgical, patient-reported, and health care utilization outcomes after hip arthroscopy.

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

METHODS: The authors conducted a PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses)-compliant search (International Prospective Register of Systematic Reviews [PROSPERO] CRD420251101816) of the MEDLINE, Embase, Web of Science, and PsycINFO databases to identify studies comparing postoperative outcomes in patients undergoing hip arthroscopy with and without recorded psychiatric diagnoses. Two reviewers independently screened, extracted data, and assessed the risk of bias using the Risk of Bias in Non-randomized Studies of Interventions tool. Primary endpoints were arthroscopy failure, revision, conversion to total hip arthroplasty (THA), and readmission. Secondary endpoints included the modified Harris Hip Score (mHHS), International Hip Outcome Tool-12 (iHOT-12) score, visual analog scale (VAS) pain score, and costs. Random-effects meta-analyses with Hartung-Knapp-Sidik-Jonkman intervals, prediction intervals, leave-one-out sensitivity analyses, and Grading of Recommendations, Assessment, Development and Evaluation (GRADE) certainty assessment were performed.

RESULTS: Eighteen comparative studies were included. Recorded psychiatric diagnoses were associated with higher odds of revision (k = 5; OR, 2.53; 95% CI, 1.87-3.43) and arthroscopy failure (k = 5; OR, 1.76; 95% CI, 1.41-2.20). No association was observed with conversion to THA (k = 5; OR, 1.00; 95% CI, 0.72-1.38). Readmissions were modestly increased (k = 3; OR, 1.37; 95% CI, 1.02-1.84). Patients with psychiatric diagnoses reported worse outcomes (mHHS mean difference [MD], -8.85 [k = 3], VAS pain score MD, +10.67 [k = 4], and iHOT-12 MD, -9.50 [k = 2]). GRADE certainty ranged from very low (most patient-reported outcomes and complications) to moderate (revision). Heterogeneity and variable exposure definitions limited some inferences; cost data were narratively summarized.

CONCLUSION: Recorded psychiatric diagnoses are associated with substantially higher odds of revision and arthroscopy failure, modestly higher readmissions, and worse postoperative pain and function, but not with conversion to THA within the available follow-up. Findings support routine preoperative psychiatric screening and perioperative co-management to identify and optimize higher-risk patients.

BACKGROUND: Central acetabular osteophytes (CAOs) have been implicated in abnormal hip biomechanics. However, their relationship with microinstability in borderline developmental dysplasia of the hip (BDDH) is unclear.

PURPOSE/HYPOTHESIS: The purpose of this study is to compare radiographic parameters between BDDH hips with and without CAOs and to determine whether CAOs are associated with microinstability. It was hypothesized that CAOs would correlate with increased version abnormalities and microinstability.

STUDY DESIGN: Case-control study; Level of evidence, 3.

METHODS: We retrospectively reviewed patients with BDDH, defined as a lateral center-edge angle of 18° to 25°, who underwent hip arthroscopy from 2020 to 2024. Patients were grouped as BDDH with CAO (cBDDH) or without CAO (nBDDH). Radiographic parameters, including anterior/posterior acetabular coverage, femoral neck version, acetabular version, and combined anteversion, were compared. Intraoperative findings of microinstability and ligamentum teres (LT) pathology were analyzed. Binary logistic regression identified predictors of CAO.

RESULTS: A total of 157 patients were included (cBDDH, 76; nBDDH, 81). The cBDDH group demonstrated higher rates of microinstability and LT tears, as well as increased femoral neck, acetabular, and combined anteversion. Logistic regression showed that microinstability (β = .027; P < .001), LT tear (β = .010; P = .001), and combined anteversion (β = 1.343; P = .029; R2 = 0.542) were associated with CAO.

CONCLUSION: In BDDH, CAOs were strongly associated with microinstability, LT tears, and increased combined anteversion. CAO may serve as a radiographic marker of instability and early osteoarthritis in BDDHs.

BACKGROUND: There is a paucity of literature comparing the midterm outcomes of arthroscopic labral reconstruction and arthroscopic labral repair in the revision setting.

PURPOSE: To evaluate the minimum 5-year patient-reported outcomes (PROs) of patients who underwent revision hip arthroscopy, comparing labral reconstruction with labral repair.

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

METHODS: A retrospective analysis was performed for patients who underwent revision hip arthroscopy, either labral repair or labral reconstruction, to treat femoroacetabular impingement and labral tears between 2008 and 2019. Patients who underwent reconstruction were matched 1:1 to patients who underwent repair. Included patients had complete preoperative and minimum 5-year follow-up scores for at least one of the following PRO measures: modified Harris Hip Score, Non-Arthritic Hip Score, Hip Outcome Score-Sports-Specific Subscale, patient satisfaction, and visual analog scale for pain. Rates of achieving the minimal clinically important difference and patient acceptable symptom state as well as secondary surgery rates were compared between groups.

RESULTS: A total of 68 patients were included, with 34 patients who underwent labral reconstruction successfully matched to 34 patients who underwent labral repair, controlling for age, body mass index, sex, acetabular Outerbridge grade, and capsular treatment. The reconstruction group had a significantly higher incidence of Seldes type 1 and 2 labral tears (n = 21 [61.8%]) compared to the repair group, which had a higher proportion of Seldes type 1 tears (n = 11 [32.4%]) (both P < .05). Both groups demonstrated a significant improvement in scores from preoperatively to postoperatively (all P < .01) and achieved the minimal clinically important difference and patient acceptable symptom state at similar rates across all PRO measures. There were no significant differences between groups in the rates of revision arthroscopy or conversion to arthroplasty.

CONCLUSION: Patients undergoing revision hip arthroscopy with adequate labral treatment, either labral reconstruction or labral repair, can expect favorable and comparable outcomes, reaching clinically relevant thresholds at similar rates, with a low complication rate, at midterm follow-up.

BACKGROUND: Subspine impingement (SSI) is a frequently coexisting pathology in patients undergoing hip arthroscopy for femoroacetabular impingement (FAI). While short-term outcomes after arthroscopic subspine decompression (SSD) are promising, midterm outcomes remain unclear.

PURPOSE: To evaluate minimum 5-year patient-reported outcomes (PROs), survivorship, and rates of clinically meaningful improvement after arthroscopic SSD in patients undergoing hip arthroscopy for FAI; and to compare these results to a matched cohort without SSD.

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

METHODS: The data of patients undergoing primary hip arthroscopy for FAI between 2009 and 2019 were retrospectively reviewed. Inclusion criteria included a confirmed diagnosis of FAI and SSI and complete PROs (modified Harris Hip Score, Nonarthritic Hip Score, Hip Outcome Score-Sports-Specific Subscale, International Hip Outcome Tool-12 score, and visual analog scale score) at a minimum of 5 years. Exclusion criteria included prior ipsilateral hip surgery, workers' compensation claims, and Tönnis grade >1. Patients with SSD were matched 1:2 to a control group without SSI. Matching variables included age, sex, body mass index, follow-up duration, lateral center-edge angle, alpha angle, Tönnis grade, acetabular labrum articular disruption grade, and labral treatment. Outcomes were compared between groups, including survivorship and achievement of the minimal clinically important difference (MCID) and Patient Acceptable Symptom State (PASS).

RESULTS: A total of 94 patients with SSD were matched to 188 control patients. Patients who underwent SSD demonstrated significant improvements in all PROs at a minimum 5-year follow-up (P < .0001). MCID and PASS achievement rates were comparable between groups (P > .05). The SSD cohort also demonstrated favorable survivorship, with 5.3% converting to total hip arthroplasty or hip resurfacing. Compared to patients with type 1 morphology who did not undergo SSD, outcomes in the SSD group were comparable in terms of postoperative PROs, satisfaction (P > .05), and conversion rates to further surgery (P = .61). Notably, time to revision arthroscopy was significantly longer in the SSD group (52.0 vs 32.8 months; P = .04). The mean time to conversion (arthroplasty) was similar between both cohorts (P = 0.71).

CONCLUSION: Arthroscopic SSD performed concurrently with FAI correction yields durable improvements in hip function and pain relief at a minimum 5-year follow-up. Outcomes and survivorship are comparable to those of patients without SSI undergoing FAI correction alone, supporting the use of SSD in appropriately selected patients with SSI.

BACKGROUND: Arthroscopic management of acetabular labral pathology in femoroacetabular impingement (FAI) has progressively shifted toward labrum preservation; however, the effectiveness of labral repair over debridement remains unsettled.

PURPOSE: To compare arthroscopic labral repair versus debridement for FAI regarding patient-reported outcomes, pain, and risk of conversion to total hip arthroplasty (THA).

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

METHODS: The study protocol was registered on PROSPERO (CRD420251062063). A systematic search of PubMed, Embase, and the Cochrane Central Register of Controlled Trials was performed through October 21, 2025. Randomized controlled trials (RCTs) and comparative cohort studies evaluating arthroscopic labral repair versus arthroscopic labral debridement for FAI were included. Open procedures and labral reconstruction were excluded to minimize clinical heterogeneity. Outcomes included the Modified Harris Hip Score (mHHS), Hip Outcome Score-Activities of Daily Living (HOS-ADL), Hip Outcome Score-Sport-Specific Subscale (HOS-SSS), visual analog scale (VAS) pain score, and conversion to THA. Random-effects models were applied, with prespecified subgroup analyses by study design and follow-up duration (<5 vs ≥5 years).

RESULTS: Ten studies consisting of 2730 hips (1580 repairs, 1150 debridements) were included. No significant difference was observed in pooled mHHS (mean difference [MD], 1.92; 95% CI, -2.33 to 6.16). HOS outcomes varied by study design: observational cohorts demonstrated no significant between-group differences for HOS-ADL (MD, 0.69) or HOS-SSS (MD, 0.11), whereas the RCT demonstrated significantly higher scores favoring labral repair for both HOS-ADL (MD, 10.30) and HOS-SSS (MD, 12.40). VAS pain scores were comparable at short-term follow-up but favored repair at ≥5 years (MD, -1.37). Conversion to THA occurred in 3.5% of repaired hips versus 7.4% of debrided hips, with labral repair associated with a significantly lower risk of THA (risk ratio, 0.56; 95% CI, 0.37 to 0.84; P = .006), driven by long-term follow-up.

CONCLUSION: Labral repair confers a significant protective benefit against conversion to THA and superior pain relief at mid- to long-term follow-up. While functional outcomes appear equivalent in observational cohorts, randomized evidence demonstrates superior activity-related scores favoring repair.

Accurate diagnosis of early-stage osteonecrosis of the femoral head (ONFH) remains challenging due to reliance on subjective radiological interpretation. This multicenter retrospective study developed an automated, multi-sequence MRI-based diagnostic model for early ONFH using data from 342 ONFH-affected femoral heads (FHs) from 282 patients and 265 healthy FHs from 233 healthy individuals obtained from two geographically distinct institutions. The dataset comprised three MRI sequences (T1WI, FS-T2WI, and Cor STIR) and 7844 annotated FH instances labeled as normal or abnormal. A You Only Look Once (YOLO) segmentation model was trained on both single-sequence and multi-sequence datasets, and a global attention mechanism (GAM) was integrated to enhance diagnostic performance, yielding the GAM-YOLO model. Model performance was compared with that of radiology residents using Fisher's exact test. The multi-sequence YOLO model achieved superior diagnostic accuracy (sensitivity 93.19%, specificity 94.65%, accuracy 94.04%) compared to single-sequence models. Incorporation of GAM further improved performance (sensitivity 97.00%, specificity 97.52%, accuracy 97.30%; p < 0.05). When applied to entire FH images, the GAM-YOLO model achieved sensitivity, specificity, and accuracy of 99.03%, 98.51%, and 98.82%, respectively, showing higher diagnostic performance than residents (p < 0.01). These findings suggest that the GAM-YOLO model offers a promising and objective tool for early ONFH diagnosis, demonstrating potential for clinical application.

BACKGROUND: Biologic augmentation with bone marrow aspirate concentrate (BMAC) and platelet-rich plasma (PRP) has been used in conjunction with hip decompression (HD) for the treatment of pre-collapse osteonecrosis (ON) of the femoral head. This study reports a concise minimum 10-year follow-up of a previously published prospective cohort of patients who had corticosteroid-induced ON treated with HD augmented with BMAC and PRP.

METHODS: There were 21 patients (34 hips) who had precollapse corticosteroid-associated ON who underwent HD combined with BMAC and PRP. Their mean age and body mass index at surgery were 43 years (range, 22 to 66) and 31 (range, 22 to 41), respectively. Survivorship free from femoral head collapse and conversion to total hip arthroplasty (THA) was assessed using Kaplan-Meier analysis. Risk factors for failure were evaluated using Cox regression analyses. Functional outcomes were assessed using the Harris Hip Score.

RESULTS: At a mean follow-up of 11 years (range, 10 to 13), survivorship free from conversion to THA was 62%. Indications for conversion included femoral head collapse (n = 5), persistent pain without collapse (n = 5), and progression of osteoarthritis (n = 2). Patients who had low preoperative Kerboul angles (KAs) (grades 1 to 2) demonstrated 11-year survivorship of 91% free from collapse and 66% free from THA, whereas those who had high KA (grades 3 to 4) demonstrated survivorship of 40% for both outcomes (P = 0.0004 and P = 0.083, respectively). High preoperative KA independently increased the risk of femoral head collapse (hazard ratio 13.2; P = 0.005). In hips not converted to THA, mean Harris Hip Score improved from 58 preoperatively to 86 at final follow-up (P < 0.0001). There were no additional conversions to THA beyond the previously reported mean 7-year follow-up.

CONCLUSIONS: At a minimum of 10 years, HD augmented with BMAC and PRP resulted in sustained hip preservation in patients who had corticosteroid-induced osteonecrosis. Lesion size, as defined by the KA, remains the most important predictor of longer-term success.

BACKGROUND: Femoral head decentration, seen on MRI as a fluid gap between the femoral head and acetabulum, has recently been introduced as a sign of hip instability. Although periacetabular osteotomy (PAO) effectively corrects bony morphology in developmental dysplasia of the hip (DDH), it is unknown whether femoral head decentration is reversible after acetabular reorientation or whether it persists because of factors such as femoral version or intraarticular degeneration.

QUESTIONS/PURPOSES: (1) Does femoral head decentration, femoral head decentration distance, and its radial extension decrease after PAO for treatment of DDH? (2) Do osseous hip morphologies differ between hips with and without persistent femoral head decentration? (3) Does the severity of joint damage on morphologic indirect magnetic resonance (MR) arthrography of the hip and biochemical cartilage degeneration assessed with the delayed gadolinium-enhanced MRI of cartilage (dGEMRIC) index differ between hips with and without persistent femoral head decentration?

METHODS: We performed a secondary retrospective analysis of a prospectively collected cohort of 34 patients (34 hips) undergoing isolated PAO for symptomatic DDH (lateral center-edge angle < 20°). The original prospective study was designed to evaluate changes in cartilage biochemistry after PAO using serial indirect MR arthrography for dGEMRIC. Thirty-seven patients completed the 1-year MRI follow-up, and 34 had complete imaging data sets available for the present analysis. This cohort was suitable for the present secondary analysis because the standardized MRI protocol included high-resolution radial sequences that enabled assessment of femoral head decentration, osseous morphology, and intraarticular degeneration before surgery and at 1-year follow-up, which was considered sufficient to assess persistent postoperative femoral head decentration after healing and adaptation to acetabular reorientation. Exclusion criteria comprised advanced osteoarthritis (Tönnis Grade ≥ II), neuromuscular disorders, joint incongruity, or incomplete MRI sequences. All patients underwent 1.5-Tesla MRI preoperatively and at 1-year follow-up as part of the source prospective study, utilizing intravenous gadolinium contrast for dGEMRIC and isotropic T2-weighted MRI sequence to assess femoral head decentration and joint morphology. Femoral head decentration was defined as a visible fluid layer on radial MRI slices, quantifying its prevalence, distance (in mm), and radial extension (in degrees around the circumference). The median (IQR) age at surgery was 27 years (20 to 30), and 94% (32 of 34) of patients were female. All patients underwent PAO. Hips with preoperative femoral head decentration were stratified into "resolved" (no femoral head decentration at follow-up) and "persistent" (femoral head decentration at follow-up) groups. We compared groups with resolved and persistent femoral head decentration regarding radiographic parameters (lateral center-edge angle, acetabular index, neck-shaft angle, femoral version), morphologic degeneration (cartilage damage, subchondral cysts, labral tears), and biochemical cartilage damage (mean anterior dGEMRIC index).

RESULTS: Preoperatively, femoral head decentration was present in 29 of 34 of hips. One year after PAO, femoral head decentration completely resolved in 9 of 29 hips and persisted in 20 of 29 hips, with a reduction in median femoral head decentration distance from 4 to 3 mm (p < 0.001) and median radial extension from 90° to 53° (p = 0.003). Preoperatively, hips with persistent femoral head decentration exhibited higher median femoral anteversion (22° versus 10°; p = 0.01) and a higher preoperative acetabular index (24° versus 15°; p = 0.01) compared with hips in which femoral head decentration resolved. Hips with persistent femoral head decentration demonstrated a substantially greater burden of intraarticular degeneration, including severe cartilage damage (13 of 20 versus 1 of 9; p = 0.01), subchondral cysts (14 of 20 versus 0 of 9; p < 0.001), and complex and extensive labral tears (18 of 20 and 17 of 20, respectively, in the persistent group versus 2 of 9 and 3 of 9, respectively, in the resolved group; p < 0.001). Biochemical cartilage health was worse in the persistent group, with a lower median dGEMRIC index (436 msec versus 606 msec; p = 0.004).

CONCLUSION: Although PAO reduced the magnitude and extent of femoral head decentration, complete anatomic resolution occurred in only about one-third of patients with complete follow-up, and it may be less frequent among patients lost to follow-up. Persistent femoral head decentration after PAO was present in hips with excessive femoral anteversion and advanced intraarticular degeneration, including severe cartilage loss, subchondral cysts, and labral lesion. These findings suggest that acetabular reorientation alone may be insufficient to fully restore joint containment in patients with these specific morphologic and degenerative factors. Future studies should further investigate the relationship between femoral head decentration and femoral version abnormalities, which may help define a potential role of concomitant femoral derotational osteotomies.

LEVEL OF EVIDENCE: Level III, therapeutic study.

OBJECTIVE: To assess the effectiveness and safety of corticosteroid injections (CSI) for pediatric patients with non-rheumatologic peripheral musculoskeletal pain conditions.

DESIGN: Systematic review.

METHODS: A comprehensive search of PubMed, Embase, Web of Science, and Cochrane Central was performed through August 2024 in alignment with PRISMA 2020 guidelines. Eligible studies included pediatric patients receiving CSI for peripheral musculoskeletal pain unrelated to rheumatologic disease. Primary outcomes were pain relief and functional improvement; secondary outcomes consisted of safety and adverse events. MASTER and GRADE scales evaluated risk of bias and certainty of evidence.

RESULTS: In brief, 1061 studies were identified, six of which met inclusion criteria, encompassing 267 pediatric patients. Interventions targeted hip pain related to dislocation or femoroacetabular impingement (n = 4 studies), sacroiliac pain (n = 1), and acute anterior cruciate ligament tears (n = 1). Across most studies, CSI provided short-term pain relief and functional improvement, with post-injection follow-up ranging from 5 days to 5 years. However, the randomized controlled trial in ACL tear patients found no significant difference between CSI and saline placebo. Rare adverse events were reported, including localized swelling, pain flare, and one transient sciatic nerve block post-SI joint injection. There were no long-term complications reported. Evidence certainty was rated "very low" due to small sample sizes, heterogeneity, and risk of bias.

CONCLUSIONS: CSI may provide temporary pain relief for select pediatric peripheral musculoskeletal conditions, albeit with limited and low quality supporting evidence. Despite current data suggesting a favorable short-term safety profile, longer-term effects and standardized dosing guidelines are insufficient. Larger, higher-quality trials with more varied pediatric pathologies are required in order to elucidate the role of CSI in non-rheumatologic pediatric pain management.

PURPOSE: Favorable outcomes of pelvic osteotomy (PO) with concomitant hip arthroscopy (AS) have been reported. As severe acetabular dysplasia (AD) entails a risk of postoperative instability due to the difficulty of improving acetabular coverage, the choice to add AS, which has a potential to induce joint instability, should be carefully considered. This study evaluated the long-term outcomes of a PO procedure known as rotational acetabular osteotomy (RAO) with AS in patients with severe AD.

METHODS: A retrospective review was performed of the medical records of consecutive patients with severe AD (lateral center-edge angle <0° and a break in the Shenton line) who underwent RAO with AS at the authors' hospital between April 2011 and December 2013. Arthroscopic procedures were performed without interportal capsulotomy to minimize the risk of aggravating joint instability. This study used the visual analog scale (VAS) score for hip pain, the modified Harris Hip Score (mHHS), and the Japanese Orthopaedic Association Hip Disease Evaluation Questionnaire (JHEQ) score.

RESULTS: RAO with AS was performed on 11 consecutive hips of 10 Japanese patients with severe AD, all of whom were followed up (average duration of 151.8 months at the time of analysis). Labrum repair was performed in 27% of the patients, and labrum tear debridement was performed in 73%. None required conversion to total hip replacement. All patients showed statistically significant improvements in the VAS, mHHS, and JHEQ scores (7 [1-9.5] to 2 [0.3-6.0], P = 0.009; 64.5 ± 18.3 to 87.1 ± 9.3, P = 0.002; 40.1 ± 18.0 to 66.9 ± 9.9, P < 0.001, respectively).

CONCLUSION: This study demonstrates favorable long-term outcomes of RAO with concomitant AS in patients with severe AD, though the results should be interpreted with caution because of the small sample size.

LEVEL OF EVIDENCE: IV, case series.

INTRODUCTION/OBJECTIVES: Developmental dysplasia of the hip is associated with inferior clinical outcomes when treating concomitant intra-articular pathologies. Shelf acetabuloplasty has been proposed as a less invasive alternative to periacetabular osteotomy for developmental dysplasia of the hip; however, there is a lack of biomechanical studies regarding its efficacy. We hypothesized that a cadaveric dysplasia model would cause increased range of motion and lateral femoral head translation compared to native, and that shelf acetabuloplasty would restore native biomechanics.

METHODS: Ten cadaveric hips were dissected down to the capsule and mounted to a six-degree-of-freedom robotic arm. Each specimen was tested sequentially in 4 states: 1) Native, 2) Capsular repair, 3) Acetabular dysplasia model created by acetabular rim resection to achieve a lateral center-edge angle (LCEA) of 15-20° under fluoroscopic guidance, and 4) Shelf acetabuloplasty restoring LCEA of 35-40° utilizing a bone graft harvested from the iliac crest. Robotic testing included: 1) 5- Newton Meter (Nm) abduction, 2) 5-Nm internal rotation (IR) at 75° flexion, 3) 5-Nm flexion, and 4) 88-N lateral drawer. Range of motion under standardized torque was used as a surrogate measure of rotational stability. The effect of specimen state was determined using analysis of variance, and post hoc pairwise comparisons were made using Tukey's method.

RESULTS: Capsular repair did not statistically significantly differ from the native state. Compared to native, the acetabular dysplasia model showed increased abduction (+2.3°, p = 0.004) and IR at 75° flexion (+0.9°, p = 0.017) without statistically significant changes in flexion or lateral translation. Shelf acetabuloplasty restored native abduction and IR at 75° flexion but reduced hip flexion (-1.7°, p = 0.003).

CONCLUSION: This study demonstrated that acetabular rim resection increased rotational motion under applied torque, while shelf acetabuloplasty restored rotational motion to native levels. However, shelf acetabuloplasty resulted in a statistically significant reduction in hip flexion (-1.7°, p = 0.003), suggesting potential over-constraint depending on graft positioning.

LEVEL OF EVIDENCE: Not Applicable, Controlled Laboratory Study.

PURPOSE: Periacetabular osteotomy (PAO) is increasingly considered a treatment option for symptomatic borderline hip dysplasia (BHD) with a lateral center-edge angle (LCEA) of 20°-25°. However, whether BHD hips are likely to benefit from PAO compared to truly dysplastic hips (LCEA <20°) remains unclear. The aim of this study was to compare the short-term outcome of PAO in borderline hip dysplasia with frank dysplasia.

METHODS: A prospective PAO database was utilized. A total of 230 hips with a minimum follow-up of 1 year that had undergone PAO by a single surgeon between January 2022 and December 2024 were included in this study. Patients were divided into BHD and frank dysplasia based on LCEA. The University of California and Los Angeles activity scale (UCLA), Hip Disability and Osteoarthritis Outcome Score - Physical Function Short Form, Western Ontario and McMaster Universities Osteoarthritis Index, international hip outcome tool-12, Harris Hip Score (HHS), modified HHS , German Forgotten Joint Score and Postel Merle d'Aubigné score were assessed at a mean follow-up of 17-21 months. Postoperative PROMs were compared between groups using unadjusted analyses and multivariable linear regression models adjusting for baseline PROMs, demographic factors, radiographic parameters, and concomitant procedures.

RESULTS: Most patient-reported outcome measures (PROMs) differed significantly preoperatively and were inferior in the BHD group. All PROMs improved significantly in both groups at follow-up. No statistically significant between-group differences were observed at final follow-up. In multivariable regression analyses, dysplasia severity was not associated with postoperative outcomes for any PROM. The improvement in UCLA was statistically significantly greater in the BHD group (p = 0.043).

CONCLUSION: Patients with BHD benefit from PAO with a magnitude of improvement comparable to frank dysplasia. Severity of hip dysplasia was not an independent predictor of outcome, indicating comparable short-term clinical benefit between groups.

LEVEL OF EVIDENCE: Level III.

INTRODUCTION: Cam morphology is prevalent in physically active adolescent males and is associated with the development of femoroacetabular impingement, yet the biomechanical factors associated with its development remain unclear. This study aimed to (1) investigate longitudinal changes in squat kinematics and their association with cam morphology development; and (2) compare kinematics between asymptomatic athletes with and without cam morphology.

METHODS: This prospective 2-year study evaluated spinopelvic and hip kinematics in elite adolescent soccer players aged 12 to 16 years (baseline: n = 29; and follow-up: n = 20), classified as having or not having cam morphology based on skeletal maturity and an alpha angle >60° on hip radiographs. Three-dimensional motion capture was performed at both time points during standardized and unstandardized deep squats. Inverse kinematics of the trunk, lumbopelvic region, pelvis, and hip were analyzed.

RESULTS: At baseline and follow-up, 58.5% of participants were classified as having cam morphology (right hips = 16; and left hips = 15). Statistical parametric mapping paired t-tests showed no statistically significant longitudinal changes in kinematic waveforms within either group. In the skeletally age-matched cross-sectional comparison, the Cam group demonstrated greater trunk flexion (17%-34%, p = 0.032), lumbopelvic flexion (11%-30%, p = 0.027), anterior pelvic tilt (35%-55%, p = 0.012), and hip internal rotation (45%-55%, p = 0.024) during the unstandardized squat compared with the No Cam group. Pelvic range of motion was also greater in the Cam group (28.0 ± 5.3° vs 20.5 ± 4.6°). No between-group differences were observed during the standardized squat.

CONCLUSION: Asymptomatic adolescents with cam morphology demonstrate distinct, task-dependent spinopelvic and hip kinematics during deep squatting, including greater pelvic motion. These patterns remain stable over time and are evident only under self-selected conditions, suggesting preferred movement strategies rather than fixed limitations in movement capacity.

LEVEL OF EVIDENCE: III.

BACKGROUND AND PURPOSE: Optimal treatment for slipped capital femoral epiphysis (SCFE) has been controversial for decades. Capital realignment surgery (predominant technique: modified Dunn) is a technique to restore anatomy, but it is associated with varying risks of avascular necrosis (AVN) of the femoral head. The aim of our study was to describe outcomes following capital realignment for severe SCFE in a nationwide cohort.

METHODS: A longitudinal, nationwide, retrospective cohort study of SCFE patients treated with capital realignment between 2009 and 2021 was conducted, with radiographic and clinical follow-up 2-15 years after surgery. Primary radiographic outcome was AVN. Clinical outcomes were assessed using patient-reported outcome measures (the Copenhagen Hip and Groin Outcome Score [HAGOS] and the 12-item International Hip Outcome Tool [iHOT12]).

RESULTS: 28 patients were included but 1 patient declined radiographic follow-up. 6/27 (22%, 95% confidence interval [CI] 11-41), developed AVN: 2/19 patients with stable SCFE and 4/8 patients with unstable SCFE. None of the 8 cases in which epiphyseal perfusion was monitored intraoperatively developed AVN. The median total HAGOS and iHOT12 scores were 77 (CI 56-94) and 76 (CI 72-88), respectively. When capital realignment was performed as primary treatment (< 1 month from diagnosis), the corresponding scores were 91 (CI 70-98) and 88 (CI 73-98).

CONCLUSION: The overall AVN rate was 22%. Our findings suggest that capital realignment should be reserved for stable SCFE and performed as primary treatment, with intraoperative epiphyseal perfusion monitoring.

Background/Objectives: Hip ultrasound is the standard screening method for developmental dysplasia of the hip (DDH) in infants, yet sonographic acetabular rim irregularities (SARIs) remain understudied regarding their prevalence and clinical associations. Methods: A total of 1010 infants within the first four months of life, referred to a specialized pediatric orthopedic hip clinic between 2014 and 2019 for suspected or confirmed DDH, were included in this retrospective cohort study. Hip ultrasound was performed using the standardized Graf technique. Clinical, demographic, and sonographic data were extracted from patient records. Two pediatric orthopedic specialists assessed all ultrasound hip images for the presence of an SARI and measured its relative size (d/D). Associations among SARI, patient characteristics, and sonographic parameters were analyzed using appropriate univariate and multivariable statistical methods (p < 0.05). Results: We identified SARI in 9.11% of all hips and in 13.07% of all infants, with many developing during Pavlik harness treatment. Univariate and multivariate analyses revealed cesarean delivery as an independent factor associated with SARI occurrence. SARIs that developed over time had a significantly larger d/D ratio compared with those that were visible from the very beginning (p = 0.04). Conclusions: These findings establish a baseline prevalence and highlight potential risk markers for SARI in a dysplasia-enriched cohort. Further prospective studies are warranted to elucidate the clinical significance of SARI and its impact on treatment outcomes and hip development.

Background: Epidemiological patterns vary across populations and treatment centres worldwide, with obesity consistently reported as the main risk factor. The primary aim of this study was to characterise age- and sex-adjusted body mass index (BMI) z-scores in children with slipped capital femoral epiphysis (SCFE) treated in Bern, as well as to investigate their association with clinical characteristics. A secondary aim was to compare the observed characteristics with those reported internationally. Methods: This is a single-centre, retrospective cohort study conducted at the Department of Pediatric Surgery, University Children's Hospital, Inselspital, University of Bern, and included patients under the age of 18 who were treated for SCFE between 2005 and 2025. Demographic, clinical, and anthropometric data were collected for all patients, including sex, age at the time of surgery, slip severity using the Southwick angle, intraoperative slip stability, symptom duration, as classified by Fahey/O'Brien, affected side of the hip, as well as height and weight at the time of surgery. The primary outcome was the age- and sex-adjusted BMI z-score at the time of surgery. Analyses stratified by sex, age, and slip severity were prespecified as secondary analyses. All other subgroup analyses were exploratory and hypothesis-generating. Results: The final cohort included 90 males (69.23%) and 40 females (30.77%). BMI data were available for 114 of the 130 patients. Two-thirds of the patients (62.3%) were overweight or obese. The median BMI z-score was 1.43 (interquartile range 0.72-2.19; mean 1.31 ± 1.11) and was significantly higher than the expected reference value of 0 (p < 0.001). There was no statistically significant difference in BMI z-scores between females and males (p = 0.288). A statistically significant association was observed between age at surgery and BMI z-score. Higher age at surgery was associated with lower BMI z-scores (p = 0.007). There was a trend towards lower BMI z-scores with increasing slip severity. However, this difference did not reach statistical significance (p = 0.158). In an exploratory, hypothesis-generating analysis, patients with stable slips had significantly higher BMI z-scores than those with unstable slips (p = 0.008). This association persisted after adjustment for age and after correction for multiple testing (p_adj = 0.032). A further exploratory, hypothesis-generating analysis showed that BMI z-scores also differed significantly across symptom duration, as classified by Fahey/O'Brien (p = 0.026). The lowest values were observed in the acute-on-chronic group. However, these differences just missed the threshold for statistical significance after adjustment for age and after correction for multiple testing (p_adj = 0.052). Conclusions: In Switzerland, children diagnosed with SCFE had a significantly higher BMI compared to the reference population. Our study revealed that two-thirds of the children were classified as overweight or obese, with obesity being approximately ten times more prevalent among this group compared to the overall Swiss paediatric population. A higher relative body weight was found to be independently associated with a younger age at surgery, consistent with obesity accelerating skeletal maturation and advancing the manifestation of SCFE. We identified a trend towards lower BMI z-scores with increasing slip severity; however, this finding did not reach statistical significance. Consequently, elevated body weight should be regarded as a marker of predisposition and earlier disease onset rather than of slip severity. Childhood obesity prevention may be relevant to SCFE prevention in Switzerland.

Advances in hip arthroscopy have expanded its use beyond intra-articular pathology to include a range of extra-articular conditions (endoscopy) that affect the active adult population. These minimally invasive procedures now provide practical, evidence-based alternatives to open surgery. Endoscopic techniques allow targeted management of greater trochanteric pain syndrome, iliopsoas tendinopathy, extra-articular hip impingement, and gluteal and hamstring tears with reduced morbidity and faster recovery. The purpose of this review is to summarize the current indications, key surgical principles, and clinical outcomes for extra-articular hip endoscopy, emphasizing pearls and pitfalls relevant to the practicing orthopaedic surgeon.

Background and Objectives: Angular and rotational lower limb alignment concerns are a frequent reason for paediatric consultations. In most children, these findings reflect physiological developmental patterns that resolve spontaneously, but unilateral, progressive, or symptomatic cases may indicate pathology and require specialist assessment. Materials and Methods: This narrative review summarizes clinically relevant developmental norms, key elements of history and physical examination, common differential diagnoses, and practical indications for imaging and referral, with the objective of offering a structured clinical guidance framework for primary care and paediatric practitioners. Results: Physiological coronal plane lower limb alignment typically progresses from infant genu varum to neutral alignment by around 2 years, followed by transient genu valgum between 3 and 6 years, and stabilizes by approximately 7-8 years. Rotational alignment changes predictably with growth and most commonly presents as in-toeing due to femoral anteversion, internal tibial torsion, or metatarsus adductus. Out-toeing is less often physiological and should prompt careful evaluation for underlying disorders, including slipped capital femoral epiphysis. Clinical assessment should prioritize gait observation, foot progression angle, hip rotation, and thigh-foot angle, while imaging should be reserved for atypical presentations, asymmetry, progression, pain, or suspected systemic or neuromuscular disease. Conclusions: Most paediatric lower limb alignment "abnormalities" represent normal variants and require reassurance and observation. Recognizing age-appropriate patterns and red flags enables paediatricians to limit unnecessary interventions while ensuring timely referral and treatment for pathological conditions.

BACKGROUND: Dancers are at risk of femoroacetabular impingement (FAI) owing to supraphysiologic range of motion and associated demands placed on their hips. There remains a paucity of literature on midterm outcomes in dancers who undergo primary arthroscopy and labral repair for FAI.

PURPOSE: To determine the rate of return to dance and patient-reported outcome measures in competitive dancers after hip arthroscopy with labral repair for FAI with minimum 2-year follow-up.

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

METHODS: This study included dancers with FAI undergoing primary hip arthroscopy with labral repair from 2010 to 2022. Patient-reported outcome measures were collected at 2-year minimum follow-up: modified Harris Hip Score (overall, activities of daily living, gait, pain), Hip Outcome Score (activities of daily living, sports-specific subscale), Tegner Activity Scale, visual analog scale for pain, and surgery satisfaction. Patients were evaluated for preoperative radiographic measurements, postoperative return to sport, and revision surgery. Return to dance was evaluated.

RESULTS: Thirty-seven dancers were followed for a mean 7.4 years (range, 3.2-12.2) postoperatively (36 female and 1 male; mean ± SD age, 21 ± 7 years; mean body mass index, 23.3 ± 4.5). All outcome scores significantly improved postoperatively as compared with preoperatively (P≤ .037). Twenty dancers (71%) returned to dance. Of those who returned to dance, 17 (85%) returned to sport at the same or higher level as compared with the preoperative level. At final follow-up, 45% of dancers who initially returned to dance continued to dance. Of the dancers who no longer participated in dance at final follow-up, 7 (65%) quit dancing for nonhip-related reasons. Mean surgery satisfaction (0-10) at final follow-up was 7.1. Four patients (10%) underwent revision hip arthroscopy with revision labral repair.

CONCLUSION: Hip arthroscopy with labral repair in dancers results in sustained improvements in function and pain at minimum 2-year follow-up. Most dancers return to their prior levels of dance, and nearly half remain active several years later. Notably, discontinuation of dance was often unrelated to hip symptoms, underscoring the importance of counseling patients on clinical and lifestyle factors influencing return to sport.

BACKGROUND: There is a paucity of research on how factors within the social determinants of health (SDOHs), specifically built environment (recreational parks, housing built pre-1980s, and walkability), affect outcomes after hip arthroscopy.

PURPOSE: To evaluate the effect of the built environment on patient-reported outcome measures (PROMs) and rates of achieving minimal clinically important difference (MCID) and patient acceptable symptom state (PASS).

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

METHODS: Patients who underwent hip arthroscopy for symptomatic labral tears were enrolled in this study. Study participants prospectively completed PROM surveys preoperatively and at 3, 6, 12, and 24 months after surgery. Patients were excluded if they were <18 years of age, had radiographic evidence of hip dysplasia (lateral center-edge angle <20°), had Tönnis grade >1, or had prior ipsilateral hip surgery. Patients were retrospectively stratified into built environment (BE; BEGood, BEAverage, and BEPoor) cohorts according to the Centers for Disease Control and Prevention's BE percentile.

RESULTS: In total, 203 patients (108 male and 95 female) met the inclusion criteria and were stratified into 3 cohorts: BEGood (mean BE: 20.4% ± 9.5%), BEAverage (mean BE: 47.8% ± 10.0%), and BEPoor (mean BE: 74.4% ± 6.0%). At baseline, the BEGood reported significantly higher scores in all PROMs compared with the BEPoor cohort (all P < .05). At 2 years, both BEGood and BEAverage reported significantly higher PROM scores compared with BEPoor (all P < .05). There were no significant differences between cohorts in achieving MCID values (P > .05). BEGood reported significantly higher PASS achievement for Hip Outcome Score-Activities of Daily Living (P = .042), Hip Outcome Score-Sports Specific Subscale (P = .013), and Non-Arthritic Hip Score (P = .021) compared with BEPoor. At 24 months, both BEGood and BEAverage reported significantly higher rates of achieving PASS for all PROMs (all P < .05), except for the modified Harris Hip Score (P = .156 and P = .410, respectively), compared with BEPoor.

CONCLUSION: Patients undergoing hip arthroscopy who reside in a poor built environment reported significantly lower preoperative baseline scores, and this disparity continued at the 24-month follow-up, with lower rates of PASS achievement. However, patients across built environment cohorts improved and achieved MCID at similar rates. These findings suggest that a poor built environment may negatively influence preoperative PROMs but that hip arthroscopy is still beneficial for patients regardless of the built environment.

BACKGROUND: Body mass index (BMI) and metabolic health are increasingly recognized as important predictors of recovery after hip arthroscopy for femoroacetabular impingement, yet limited data exist on how outcomes vary across the full BMI spectrum.

PURPOSE: To evaluate the impact of BMI-from underweight to morbidly obese-on Patient-Reported Outcomes Measurement Information System (PROMIS) physical function (PF), pain interference (PI), and depression (Dep) scores following hip arthroscopy.

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

METHODS: A single-institution review was performed for patients undergoing hip arthroscopy for femoroacetabular impingement from 2015 to 2024. Patients were stratified by BMI: underweight (<18.5), normal (18.5 ≤ to <30), obese (30 ≤ to ≤40), and morbidly obese (>40). PROMIS PF, PI, and Dep scores were collected preoperatively and ≥1 year postoperatively. Wilcoxon tests evaluated within-group changes; analysis of variance and regression analyses compared outcomes between BMI groups, adjusting for demographic covariates.

RESULTS: A total of 415 patients (mean follow-up, 28.1 ± 15.8 months) met inclusion criteria. Both normal and obese BMI groups demonstrated significant improvements across all PROMIS domains from pre- to postoperative assessments (P < .05). However, compared with the normal group, the obese group had significantly worse scores pre- and postoperatively in PF (P = .0004 and P = .005, respectively), PI (P = .01 and P = .03, respectively), and Dep (P = .002 and P = .007, respectively). Underweight patients had significantly lower preoperative PF scores (P = .02) but showed greater improvement in postoperative Dep scores (P = .04) compared with the other groups. Within-group analysis revealed that underweight patients improved only in PF (P = .005), while morbidly obese patients showed no significant improvement in any PROMIS domain.

CONCLUSION: Extremes of BMI are associated with diminished recovery following hip arthroscopy for femoroacetabular impingement, particularly in pain and mental health domain improvement. These findings highlight the need for targeted preoperative optimization and patient counseling for individuals with metabolic or nutritional risk factors.

PURPOSE: To evaluate the performance of a novel freehand 3D ultrasound system for assessing morphological deformities of the femoral head and neck associated with femoroacetabular impingement syndrome (FAIS).

METHODS: The system integrates an off-the-shelf optical tracker with a low-cost point-of-care ultrasound probe. Bone surfaces were segmented from B-mode images using a deep learning feature pyramid network trained on a publicly available dataset and refined via transfer learning with curated, manually segmented images. Deterministic algorithms were used to generate bone surface point clouds and meshes. System accuracy was assessed by comparing reconstructed bone surfaces to computed tomography (CT) in four cadaveric hips and two patient hips. The system's feasibility for clinical imaging was evaluated in five healthy volunteers.

RESULTS: The ultrasound reconstructions achieved geometric agreement with CT, within-subject repeatability and within-subject reproducibility of 0.4-0.6 mm. Alpha angles derived from CT and ultrasound scan agreed to within 0.6°. Given that clinically significant bone deformities associated with FAIS are ≥ 2 mm and clinically significant differences in alpha angle are > 5°, the system's performance appears adequate for clinical morphometry. In vivo imaging demonstrated feasibility for clinical use.

CONCLUSION: The combination of 3D optical tracking, ultrasound imaging, and deep learning-based segmentation using models trained on public datasets and enhanced by transfer learning can produce bone surface maps of the femoral head with sufficient accuracy to resolve clinically significant femoral head deformities. The system is suitable for clinical deployment.

INTRODUCTION: Developmental dysplasia of the hip (DDH) often affects young, active patients and can lead to early osteoarthritis. Periacetabular osteotomy (PAO) is a joint-preserving surgery to reorient the acetabulum and delay arthritis. The impact of PAO on return to sports and the factors influencing return to sport or patient satisfaction remain insufficiently documented. Therefore we performed a retrospective investigation aiming to: 1) evaluate the rate of return to sport after PAO, 2) identify factors associated with return to sport, patient satisfaction, and the achievement of a patient-acceptable symptom state (PASS).

HYPOTHESIS: PAO allows return to sport at a rate exceeding 80%.

MATERIAL AND METHODS: We reviewed a consecutive series of 43 hips in 42 patients who underwent PAO between 2012 and 2020 at a single center. Data were collected prospectively and analyzed retrospectively. The mean age at surgery was 29.7 ± 9.7 years (range, 13-52), with 35 (83%) women. All patients met inclusion criteria of symptomatic hip dysplasia painful groin symptomatology with a LCEA < 25° and Tönnis grade ≤1 osteoarthritis. Clinical outcomes were assessed preoperatively and at last follow-up using patient-reported outcome measures (UCLA, mHHS, HOOS). Patients were surveyed about their return to sports (three‑level, referenced to the pre‑symptom level) and rated their satisfaction (5‑level Likert‑type item). Acceptable symptomatic status (PASS) was defined as reaching threshold scores. Complications were graded with a hip‑adapted Clavien-Dindo scheme. Radiological analysis included LCEA and Tönnis angles pre- and postoperatively, as well as the evolution of osteoarthritis according to the Tönnis classification. Native hip survivorship was estimated using the Kaplan-Meier method, with conversion to, or formal listing for, total hip arthroplasty (THA) defined as the endpoint.

RESULTS: At last follow-up (mean follow-up 3.8 years, range 2-12), PROMs improved substantially. UCLA, mHHS and HOOS scores increased from 6.7 ± 1.1 to 8.5 ± 1.3, from 55.9 ± 18.4 to 80.9 ± 14.6 and 49.5 ± 18.5 to 80.9 ± 14.6 respectively (p < 0.001). In total 39/43 patients (91%) returned to sports (22/43 (52%) at a level higher than pre‑op but below pre‑symptom, 17/43 (40%) at the pre‑symptom level); 4/43 (9%) did not return. Return to sport was strongly associated with achieving acceptable symptom status (PASS), with 35/39 (89.7%) of patients returning to sports reaching the PASS threshold compared to 1/4 (25%) among those who did not (p = 0.01). Radiographic parameters did not emerge as significant independent predictors of clinical success in this cohort. No signal of accelerated radiographic deterioration was observed: preoperatively, 42 of 43 hips (98%) were Tönnis grade 0 or 1. Among the 24 hips with available radiographs at final follow-up, 20 out 24 (83%) maintained their preoperative Tönnis grade, with only 4 (17%) showing osteoarthritic progression. The Kaplan-Meier survival probability of the native hip at the mean follow-up of 3.8 years was 97.7% (95% CI: 93.2%-100%).

DISCUSSION: PAO yielded a high short‑term return‑to‑sports rate with large, clinically meaningful PROM gains that align with satisfaction and PASS, with an overall return-to-sport rate above 90%. Limitations include retrospective design, non‑standardized records of sport discipline/exposure, use of non‑PAO‑validated PASS thresholds (used here as a comparability endpoint), and limited long‑term radiographic follow‑up.

LEVEL OF EVIDENCE: IV; case series.

BACKGROUND AND PURPOSE: Although studies suggested an association between patient factors and various outcome measures in the surgical management of femoroacetabular impingement (FAI), there is a lack of consistent evidence of the influence of osteoarthritis (OA) in patients with FAI syndrome treated arthroscopically. This systematic review investigated the influence of OA on the outcome of arthroscopy for FAI.

METHODS: The present systematic review followed the PRISMA statement. Web of Science, PubMed, and Embase were accessed in June 2024. All the clinical investigations comparing the outcomes of arthroscopic FAI in patients with different OA stages according to the Tönnis classification were included.

MAIN FINDINGS: Data from 1421 patients were retrieved, 52% of whom (552 of 1061) were women. The mean follow-up was 53.5 ± 34.5 months. The mean age was 37.5 ± 9.3 years, and the mean BMI was 25.7 ± 2.2 kg/m2. No significant difference was evidenced in visual analogue scale (VAS), modified Harris Hip Score (mHHS), Non-Arthritic Hip Score (NAHS), Hip Outcome Score - Activities of Daily Living (HOS-ADL), and modified Hip Outcome Score - Sport-Specific Subscale (HOS-SSS), rate of reoperation (P = 0.2), but a higher rate of progression to THA was evidenced in the groups with more advanced OA stages (P < 0.001).

CONCLUSIONS: The clinical outcomes of patients who underwent arthroscopic surgery for FAI with Tönnis stages 0, I, or II were similar at approximately 54 months of follow-up. However, a higher rate of progression to THA was evidenced in the groups with more advanced OA.

BACKGROUND/OBJECTIVES: Congenital lower-limb deficiencies, including proximal femoral focal deficiency (PFFD), fibular hemimelia (FH), and tibial hemimelia (TH), are rare, phenotypically heterogeneous disorders with important implications for reconstructive planning. However, phenotypic data remain limited. This study aimed to characterize the clinical and radiological spectrum of these deficiencies and evaluate associated anomalies and limb-length discrepancy (LLD) across diagnostic groups.

MATERIALS AND METHODS: A retrospective cohort study included all patients diagnosed with PFFD, FH, or TH at a tertiary referral center between January 2021 and December 2025. Demographic, clinical, and radiographic data were extracted from electronic medical records. Patients were classified using established systems, and associated anomalies, distal morphology, laterality, and LLD were evaluated. Descriptive statistics and exploratory non-parametric comparisons across diagnostic groups were performed.

RESULTS: A total of 143 patients were included: 91 (63.6%) with PFFD, 23 (16.1%) with FH, 10 (7.0%) with TH, 18 (12.6%) with combined PFFD + FH, and 1 (0.7%) with combined PFFD + TH. Isolated PFFD was predominantly unilateral and clustered within the milder spectrum, most commonly Paley type 1a and Aitken type A. In contrast, FH was dominated by the severe Paley type 3b phenotype, whereas TH showed marked classification heterogeneity. Upper-limb anomalies were more common in FH and TH than in isolated PFFD. LLD differed significantly among diagnostic groups (p = 0.003), with the greatest median discrepancies observed in combined PFFD + FH and isolated PFFD.

CONCLUSIONS: Congenital lower-limb deficiencies are highly heterogeneous, with combined deficiencies exhibiting greater LLD and anomaly burden. These findings provide structured regional data to support classification and reconstructive planning.

Background/Objectives: Pandemics and natural disasters may delay the diagnosis and treatment of developmental dysplasia of the hip (DDH). In this study, we evaluated the effect of 2023 Kahramanmaraş earthquake-induced healthcare disruption on the DDH screening program. Methods: Medical records of infants referred for DDH screening between February 2022 and February 2025 were retrospectively reviewed. Three consecutive twelve-month intervals: the pre-earthquake year (February 2022 to February 2023), the earthquake year (February 2023 to February 2024), and the post-earthquake year (February 2024 to February 2025) were evaluated to detect early and late effects of the earthquake on the DDH screening. Results: A thousand infants in the pre-earthquake year, 404 in the earthquake year, and 824 in the post-earthquake year were evaluated. A 60% reduction in referrals was detected during the earthquake year. DDH incidence in late presentations during pre-earthquake, earthquake, and post-earthquake years was 18.6%, 45.8%, and 22.2%, respectively. Pairwise analysis revealed a statistically significant increase in the post-earthquake year compared with the pre-earthquake period (Yates-corrected chi-square = 4.119, p = 0.042). No significant difference was found between the pre-earthquake year and the earthquake year (Yates chi-square = 1.362, p = 0.243), nor between the post-earthquake years (Yates chi-square = 0.084, p = 0.772). Conclusions: The earthquake caused significant disruption in healthcare and DDH screening. Health authorities planning post-disaster service recovery should proactively augment DDH screening capacity for infants who missed screening during the acute phase.

The use of artificial intelligence (AI) in pediatric musculoskeletal imaging has undergone significant expansion over the past few years. Until recently, the use of AI was limited to evaluating bone age and opportunistically assessing the bone health index. Currently, validated AI software for commercial use includes the detection of appendicular fractures, automated measurement of scoliosis, assessment of lower limb length discrepancy, and assessment of developing hip dysplasia. For other applications, further work is needed. Diagnostic accuracy for detecting rib and vertebral fractures in children using AI is currently not satisfactory; however, future research using enhanced deep learning is projected to address these limitations. The implementation of other applications of diagnostic AI in pediatric musculoskeletal imaging for non-accidental trauma, bone dysplasia, and tumor assessment is hindered by the lack of large pediatric datasets, which would require multicenter collaborations. This paper aims to succinctly outline the present clinical applications of AI in the pediatric musculoskeletal field, while elucidating existing possibilities, limitations, and future needs and prospects.