Abstract This cadaveric radiographic study aimed to define the proximal hamstring footprint using reproducible ischial landmarks and to compare pelvis and hip posterior–anterior (PA) radiographs in depicting its borders. The goal was to provide practical reference values to guide anatomical anchor placement during endoscopic repair. A total of 10 hips (from five formaldehyde-fixed cadavers) were examined. Marking pins were placed at the proximal hamstring tendon footprint to identify anatomical boundaries. Pelvis PA and hip PA radiographs were obtained to determine the radiological borders and their relationship with the ischial tuberosity. The distances from the superior, medial, lateral, and inferior borders of the tendon to the line connecting the ischial tuberosities and the ischial apex were measured. The pelvis and hip radiographs were compared using the Mann–Whitney U test. Four cadavers were male, with a mean age of 67 years. Distances from the tendon’s borders to the ischium and ischial apex were consistent across the pelvis and hip radiographs, with no statistically significant differences (P > 0.05). Median distances of tendon footprint borders ranged from 15.5 (IQR: 8.6) to 35.5 (IQR:5.4) mm for the ischial tuberosity line and 30.05 (IQR: 9.07) to 47.1 (IQR: 9.6) mm for the ischial apex. Similar results were observed in hip radiographs. Radiographic localisation of the proximal hamstring footprint is feasible and yields consistent measurements on both pelvic and hip PA views. These values offer practical anatomical guidance that may support more accurate anchor placement during endoscopic proximal hamstring repair.

Abstract In patients with borderline hip dysplasia (BHD), radiographic and clinical variables influence in the decision to treat the painful hip with periacetabular osteotomy (PAO) versus isolated hip arthroscopy (iHA). The purpose of this study focusing on adolescent and young adult patients with BHD was to evaluate the surgical decision-making process at a specialist hip centre and to identify a combination of variables that predict treatment with PAO or iHA. Accordingly, patient demographics, baseline radiographic variables, and several clinical variables were recorded for 68 patients treated surgically for BHD. While a number of variables were associated with treatment decision, regression analysis showed that sex, femoral version, femoro-epiphyseal acetabular roof (FEAR) index, and anterior centre edge angle were principal predictors of treatment. The PAO versus Arthroscopic Treatment of the Hip (PATH) score was defined (one point for anterior centre edge angle < 25°, one point for FEAR index > − 3°, and one point for femoral version ≥15°). Among patients without prior contralateral hip surgery, males were treated with iHA unless they had a maximum PATH score of 3 (PAO), while females with PATH score ≥ 2 were universally treated with PAO. Females with PATH score ≤ 1 were variably treated with PAO or iHA, underscoring the need for clearer guidelines regarding indications and improved microinstability testing in this subgroup.

Abstract As artificial intelligence (AI) Large Language Models (LLM) like ChatGPT become more common in healthcare, patients increasingly use them to find medical information. While ChatGPT may support health literacy, its readability and accuracy compared to established resources remain unclear. The purpose of this study is to evaluate ChatGPT-4 responses on femoroacetabular impingement (FAI) and its surgical management compared to AAOS OrthoInfo content. We hypothesize that ChatGPT may deliver medically accurate information, but its readability may fall short when compared to OrthoInfo. Nine questions based on the OrthoInfo FAI page were submitted to ChatGPT-4, with and without a readability prompt. Topics included anatomy, pathology, cause, symptoms, workup, imaging, treatment, role of hip arthroscopy, and outcomes. Readability was assessed using validated indices. Accuracy was independently rated using a 4-point scale. Statistical comparisons were made using t-tests and ANOVA (P < 0.01 threshold). OrthoInfo content had a mean reading grade level of 8.0 and a Flesch Reading Ease score of 60.7. Unprompted ChatGPT responses were significantly less readable (grade level 16.2; Flesch score 21.7; P < 0.001). Prompting for readability improved ChatGPT outputs (grade level 10.6; Flesch score 58.2), making them comparable to OrthoInfo (P < 0.09). Accuracy was high across all sources, though OrthoInfo's response on FAI causes scored slightly lower (3.5 versus 4.0; P < 0.46). ChatGPT provides accurate information on FAI. However, without prompting, its complexity may hinder patient understanding. Prompting for readability enables ChatGPT to match established resources like OrthoInfo. Tailored prompting is key to using LLM effectively in patient education and promoting health literacy.

Abstract Ischiofemoral impingement is an extra-articular form of hip pain caused by narrowing of the space between the ischial tuberosity and lesser trochanter. The ischiofemoral space (IFS) can vary with hip morphology, as well as dynamically change throughout hip range of motion. The objectives of this study were to evaluate the impact of movement (gait, standing pivot, and neutral standing) and sex on IFS, as well as determine what morphological characteristics correlate with IFS. Synchronized biplane radiographs were collected from 24 participants during treadmill walking, standing pivot, and neutral standing. Subject-specific bone models, created from CT images, were used to create digitally reconstructed radiographs that were registered to the biplane radiographs using a validated matching technique. The ischial tuberosity and lesser trochanter were digitally marked to dynamically measure the IFS. Morphologic measurements were correlated with the IFS, and the effects of sex and movement on IFS were calculated. During the gait cycle, IFS was narrowest at contralateral heel strike (47%–53% of the gait cycle) and greatest during mid-swing (~85% of the gait cycle). Across all movements, IFS was greatest during standing (P < .001). There was a moderate negative correlation between acetabular version (AV) and IFS during gait (P = .002) and standing pivot (P = .007). McKibbin index was moderately negatively correlated with IFS during standing pivot (P = .001). The IFS varies with hip position, with motion involving hip extension, such as walking and pivot activities, resulting in a smaller IFS. Greater central AV and McKibbin index are associated with a smaller IFS.

Abstract The aim of this study was to compare the efficacy and safety profiles of acemetacin and indomethacin for prophylaxis of heterotopic ossification (HO) following hip arthroscopy. While indomethacin is a well-established agent, evidence on acemetacin remains limited. This retrospective study included 114 hips of 110 patients who underwent hip arthroscopy for femoroacetabular impingement between September 2022 and September 2024. Patients received indomethacin or acemetacin for 3 weeks postoperatively. HO development was assessed radiologically using the Brooker classification. Functional outcomes and non-steroidal anti-inflammatory drug-related adverse events were recorded and compared. HO developed in 6 hips (5.3%): 4 in the indomethacin group (8%) and 2 in the acemetacin group (3.1%) (P = .402). All HO cases were Brooker grade 1 or 2. Gastrointestinal adverse events occurred more frequently in the indomethacin group (16%) compared to the acemetacin group (4.7%) (P = .042). No significant differences were found between groups regarding demographic data, functional scores, or laboratory parameters. Among the variables analysed, a higher number of suture anchors used during labral repair was the only factor significantly associated with HO development (P = .023). No significant differences in functional scores were observed between HO and non-HO patients, though scores tended to be higher in the non-HO group. Both acemetacin and indomethacin are effective for HO prophylaxis after hip arthroscopy. However, acemetacin was associated with fewer gastrointestinal adverse events, suggesting it may be a more tolerable alternative. Given the retrospective design and low event rate, larger prospective trials are required to validate these findings.

BackgroundAtraumatic microinstability of the hip remains a poorly defined clinical entity. The 2023 Delphi consensus study done by Khanduja et al. represents the only structured attempt to categorize diagnostic criteria, classifying various clinical, radiographic, and intraoperative factors as Major, Minor, or Not Included. However, further validation by experienced hip preservation surgeons is needed to assess the real-world relevance and applicability of these classifications.MethodsThe study group, Multicenter Arthroscopic Study of the Hip (MASH), of 10 fellowship-trained hip arthroscopists independently rated 44 potential indicators of atraumatic hip microinstability on a 1–10 scale of diagnostic importance. The 36 factors from the Delphi study were supplemented with additional criteria identified through a systematic review of the literature on hip microinstability performed by our study group. Mean scores were calculated, and factors were divided into tertiles: the top third mapped to Major, the middle third to Minor, and the bottom third to Not Included. Concordance was defined as agreement between the two groupings, and discordant factors were further analyzed.ResultsOf the 44 evaluated factors, only 17 (38.6%) were categorized similarly by both the Delphi and MASH groups, while 27 (61.4%) were placed in different categories of diagnostic importance. Several Major criteria of the Delphi study—including Vacuum sign under manual traction, Positive Hyperextension-External Rotation Test, and Hip pain—were placed in the bottom third by the MASH group. Conversely, factors identified through systematic review, such as Ligamentum Teres Tears and Distended Capsule on MRI, were rated with moderate to high importance by MASH surgeons. Additionally, some Delphi Minor criteria—such as Unrepaired Hip Capsulotomy and History of Dislocation/Subluxation—were among the highest-rated by MASH.DiscussionWhile the Delphi study provides a valuable starting point for defining atraumatic hip microinstability, the majority of factors were not categorized consistently between groups. The MASH group tended to prioritize imaging and intraoperative findings, including systematically identified factors not considered by Delphi, while placing less emphasis on physical exam maneuvers and generic symptoms. These discrepancies highlight the need for a revised, evidence-informed classification system that integrates both emerging diagnostic tools and clinical expertise.

Background and ObjectiveMeralgia paresthetica (MP) results from lateral femoral cutaneous nerve compression, leading to thigh pain and numbness. This review aims to compare surgical outcomes and complications of neurectomy versus decompression.Materials and MethodsWe systematically reviewed 23 studies, assessing 818 surgical cases (neurectomy: 213, decompression: 605). Outcomes and complications were compared using patient-reported outcomes and Methodological Index for Non-Randomized Studies.ResultsNeurectomy yielded a higher positive outcome rate (92.0%) compared to decompression (82.8%) and fewer wound complications (0.5% versus 4.0%).ConclusionNeurectomy offers more reliable symptom relief with fewer wound complications than decompression for MP.Level of EvidenceLevel III systematic review

IntroductionLimited literature exists investigating the relationship between the environmental burden patients face and their outcomes after orthopaedic surgery, especially hip arthroscopy.MethodsThis retrospective cohort study included patients who, after failing conservative treatment, underwent primary hip arthroscopy for symptomatic labral tears secondary to femoroacetabular impingement by a single surgeon. Patients were shortlisted for this specific study if they underwent surgery between 2002 and 2013 and completed surveys for modified Harris Hip Score (mHHS), international Hip Outcome Tool (iHOT), Lower Extremity Functional Scale (LEFS), and pain relief. Excluded patients did not provide consent, were < 18 years of age, had Tönnis grade ≥ 2, hip dysplasia (LCEa < 20°), incomplete follow-up data, and/or history of ipsilateral hip surgery or revision surgery. Using the CDC’s Environmental Justice Index (EJI) Explorer, included patients were stratified into two main cohorts, low environmental burden (0-49th percentile) and high environmental burden (50-100th percentile). Student’s t-tests and multivariate linear regression were used to compare continuous variables, and categorical variables were compared using chi-squared tests. This study was approved by the IRB.ResultsThe present study included 161 patients (50.9% female; mean age±SD: 37.7±11.22). Patients had a mean±SD follow-up of 10.9±2.33 years and body mass index (BMI) of 26.1±4.29 kg/m^2. In the low environmental burden cohort (n=60), there was a greater proportion of females, and in the high environmental burden cohort, there was a greater proportion of males (57.4% vs 42.6% and 40.0% vs 60.0%, p<0.001). Multivariate linear regression analyses adjusting for demographic, radiographic, and intraoperative findings further demonstrated that the high environmental burden cohort had significantly better outcomes for LEFS and iHOT than the low environmental burden cohort (p<0.05). Patients reached PASS (Patient Acceptable Symptom State) for iHOT at a higher frequency in the high environmental burden cohort than those in the low environmental burden cohort (53.4% vs 34.3%, p<0.05).ConclusionAn association between environmental burden and outcomes after hip arthroscopy exists. Cumulative environmental effects have been shown to have significant effects on patient health. Orthopaedic surgeons and the broader research community should remain cognizant of the multifactorial nature of a patient’s health.