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.

PurposeTo investigate the return to sport (RTS) rate in patients with hip dysplasia after combined periacetabular osteotomy (PAO) and hip arthroscopy.SignificancePrior studies of patients with hip dysplasia have documented approximately 75% RTS with arthroscopy alone, 75 to 92.5% RTS with PAO alone, and approximately 82% with combined PAO and hip arthroscopy. Combined procedures may be the most successful in this population.MethodologyThis was a retrospective single-institution review of all patients who underwent a combined PAO and hip arthroscopy between 2016 and 2023. One pair of surgeons performed all procedures. Inclusion criteria were hip dysplasia and documented participation in a sport or athletic activity undergoing a combined PAO and hip arthroscopy. Patients were excluded for not participating in a sport or activity or follow up less than 6 months. Demographic data was compiled from electronic medical record review to include age, body mass index (BMI), sex, sports or activities, and history of prior hip surgery. Modified Harris hip score (mHHS), RTS, and time to RTS were documented. Preoperative and postoperative radiographs were reviewed with documentation of lateral center edge angle (LCEA), extrusion index (EI), acetabular index (AI), and alpha angle.ResultsA total of 103 athletic hips were included with a mean age and BMI of 20.3 +/- 6.9 years and 23.9 +/- 4.5, respectively. Mean LCEA and AI were 20.8 +/- 5.4 and 11.9 +/- 4.8, respectively. Average postoperative follow up was 514.9 +/- 326.5 days. From this cohort, 89.3% of hips returned to sport at an average of 297.5 days. There was no significant association between RTS rates and any demographics, diagnoses, or preoperative and postoperative measurements. There was no significant association between RTS and mHHS. There was no significant association between degree of dysplasia and RTS. Contact athletes had an 82.5% RTS and non-contact athletes had an 93.7% RTS.ConclusionsCombined PAO and hip arthroscopy may be the most successful procedure for patients with hip dysplasia hoping to return to sport. Our data suggests higher RTS rates than previously documented, even in patients with severe dysplasia and those participating in contact sports.

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.

PurposeTo perform a systematic review of studies reporting on minimum 10-year outcomes of patients undergoing hip arthroscopy (HA) to determine whether capsular management influences PROs, rates of clinically significant outcome, rates of revision surgery or conversion to total hip arthroplasty (THA), and rates of osteoarthritis progression.MethodsPubMed and Google Scholar were searched around the terms hip arthroscopy, FAIS, 10-year follow-up, and capsule management. Articles available in English, presenting original data, and reporting minimum 10-year follow-up after HA using either PROs, conversion to THA and/or revision surgery, or rates of osteoarthritis progression were included.ResultsFourteen articles were included. Nine studies were identified without capsular repair including a total of 1,189 hips, at an age of 24.4 – 43.0 years and follow-up range of 10.0-20.0 years. Five studies were identified with capsular repair including a total of 594 hip, at an age range of 16.0 – 34.3 years and follow-up range of 10.0-12.0 years. Nine studies included PROs and all reported significant improvement (p<0.05) at the 10-year timepoint, with modified Harris Hip Score (mHHS) being the most frequent (n=8). No differences were noted between groups regarding any of the measured PROs. Average rates of achieving MCID and PASS for mHHS were similar between patients without capsular repair (MCID 74.5%-88%, PASS 62.0%-83.3%, n=3) and with capsular repair (MCID 75.5%-89.0%, PASS 65.4%-84, n=4). Revision rates in unrepaired capsules ranged from 2.5%-24%, while repaired capsular studies ranged from 4.7%-10%. Conversion to THA occurred in 0%-54% and 0%-9% % for patients with an unrepaired and repaired capsule, respectively. One study reported that hip arthroscopy demonstrated 25% chance of improved Tonnis grade compared to the nonoperative hip, with a relative risk reduction of 42% regarding osteoarthritis progression.ConclusionsPatients undergoing hip arthroscopy for FAI had significant improvement in PRO scores at minimum 10-year follow-up, and scores did not differ between patients that underwent capsular repair and those that did not. Similar rates of markers of clinical benefit and revision were achieved by both groups; however, lower rates of conversion to total hip arthroscopy were demonstrated in the capsular repair cohort.

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.

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

ObjectiveTo introduce a set of hip arthroscopic capsular management for patients with symptomatic Borderline Developmental Dysplasia of the Hip and evaluate its clinical outcomes at a mean 2-year follow-up.MethodsA retrospective study was conducted on symptomatic BDDH patients who underwent hip arthroscopy for labrum tear from January 2020 to January 2024. Inclusion criteria were that hip arthroscopy with outside-in longitudinal capsulotomy and comprehensive capsular closure, which includes proximal capsular augmentation and anatomical repair of the zona orbicularis addition to the side-to-side plication, and had a minimum follow-up of 6 months. The exclusion criteria included inflammatory synovitis of the hip, infections and frank dysplasia. Demographic data, surgical details and patient-reported outcomes were collected and analyzed, including International Hip Outcome Tool 12 (iHOT-12) Score, Visual Analogue Score (VAS) and Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC).ResultFifty-three patients were finally enrolled with an average age of 35.4±10.9 years and a mean follow-up of 2.6±1.5 years. Beside common findings such as labral tear, cartilage injure, and ligamentum teres injuries, a relative thinner anterior capsule was confirmed 4.6±1.0 mm. Comprehensive capsular closure was performed in all cases. Significant improvements were observed in iHOT-12 (44.6±8.2 VS 79.9±7.1), VAS (3.7±1.0 VS 1.1±0.8) and WOMAC (19.4±9.7 VS 9.7±4.0) from preoperative to the final follow-up (P < 0.0001). No significant complications were found in all patients.ConclusionHip arthroscopy with outside-in longitudinal capsulotomy and comprehensive capsular closure provide a feasible and safe solution for BDDH, and it achieve good clinical outcomes in short term follow-up.