Nonarthritic Hip Score Research Articles

Patients Undergoing Microfracture With Allograft Cartilage and autologous Platelet Rich Plasma Augmentation For Chondromalacia In The Hip Achieving High Rates Of Meaningful Outcomes At 2-Year Follow-Up.

To evaluate rates of achieving meaningful outcomes and clinical failure at 2 years after undergoing microfracture augmented with allograft cartilage with autologous PRP, and to identify predictors of conversion to total hip arthroplasty. Data from a prospective series of consecutive patients with Outerbridge grade IV chondromalacia of the acetabulum or femoral head who underwent hip microfracture augmented with allograft cartilage between January 2017 and June 2022 was analyzed. Patient-reported outcomes were collected preoperatively and at minimum 2 years postoperatively. The Hip Outcome Score- Activity of Daily Living (HOS-ADL), -Sports Subscale (HOS-SS), modified Hip Harris Score (mHHS), and Non-Arthritic Hip Score (NAHS) thresholds for achieving the minimal clinically important difference (MCID), patient acceptable symptomatic state (PASS), and substantial clinical benefit (SCB) at 2-year after surgery were calculated. Logistic regression analysis was performed to identify any association between non-modifiable variables and clinical failure. A total of 108 hips (80.6%) among 106 patients had 2-year follow up and were included in the final analysis. The combined mean age and BMI were 37.9+10.1 years and 26.8+4.7 respectively, with a mean follow-up time of 31.9+8.4 months (range 24-53 months). There was a statistically significant improvement in all functional score averages over the 2 years (p<0.05). A total of 84.7%, 75.5%, and 70.4% reached at least one threshold for achieving MCID, PASS, and SCB, respectively. There were 11(10.2%) patients that underwent conversion to THA (Total Hip Arthroplasty), with increased age, BMI, and preoperative pain duration increasing the likelihood of requiring THA (p<0.05 for all). Lastly, chondromalacia size or chondromalacia index (e.g., Outerbridge grade x surface area) was not associated with clinical failure or achieving meaningful outcomes (p>0.05 for all). Patients undergoing microfracture with allograft cartilage and autologous PRP augmentation for acetabular or femoral head chondromalacia demonstrated statistically improved outcome scores and high rates of achieving meaningful outcomes at 2-year follow-up regardless of chondromalacia defect size. Conversion to THA was 10.2%, with increased age, BMI, and preoperative pain duration increasing the likelihood of requiring THA. Level 2, prospective cohort.

Lack of validated patient-reported outcome tools persists in paediatric and adolescent hip arthroscopy-A systematic review.

This systematic review aimed to (1) identify commonly used patient-reported outcome (PRO) tools in paediatric hip arthroscopy and (2) assess whether the PROs used in this population have been formally validated. Two systematic searches of MEDLINE, Embase and CENTRAL, from inception to 31 March 2024 and 22 August 2024, respectively, followed the Preferred Reporting Items for Systematic Reviews and Meta-analyses guidelines. The first search identified PRO instruments used in studies on hip arthroscopy in patients aged 19 and under. The second focused on the clinimetric properties of these tools in paediatric hip arthroscopy. PRO utilization was stratified by pathology, trends over time and publication type. Use of the Consensus-based Standards for the Selection of Health Measurement Instruments tool, and a descriptive analysis, were planned to assess the eligible clinimetric studies. Fifty-seven studies were included, identifying 10 hip-specific and 5 nonspecific PROs. The second search did not identify any clinimetric studies on these tools used in paediatric patients. The most commonly reported hip-specific PRO were the modified Hip Harris Score (n = 48), the Hip Outcome Score-Sport-Specific Subscale (n = 25) and the Non-Arthritic Hip Score (n = 20). Hip arthroscopy was used to treat over seven different conditions, with femoroacetabular impingement being the most common (n = 41, 77%). Between 2005 and 2024, the variety of hip-specific PROs increased, with seven new ones introduced by 2019-2024. Additionally, this study found a relatively equal distribution of outcomes across presentation abstracts and manuscripts. The key finding of this study is the ongoing lack of hip-specific PRO tools in the paediatric hip arthroscopy literature, with reliance on adult-derived instruments. The absence of clinimetric studies and heterogeneity in PRO use emphasises the need for standardized, paediatric-specific tools. Developing and validating such instruments should be prioritized to ensure accurate, age-appropriate outcome assessment and care. Level III.

A meta-analysis of the effectiveness and side effects of hip arthroscopy and open surgical dislocation in the management of femoroacetabular impingement

BackgroundThe influence of femoroacetabular (FA) impingement has been implied in early hip osteoarthritis, particularly in young patients who enjoy athletics. The purpose of this meta-analysis is to assess the effectiveness and safety of hip arthroscopy compared to open surgical dislocation for the treatment of femoroacetabular impingement (FAI), based on clinical trials that have been published.MethodsA comprehensive literature search was conducted through PUBMED, EMBASE, and the Cochrane Central Register of Controlled Trials for studies evaluating coxoscopy and open surgical dislocation as treatment modalities for femoroacetabular impingement syndrome (FAI).ResultsUltimately 9 studies were added in this meta-analysis. 9 studies reported the Improvement of alpha angle of the Hip Arthroscopy treatment group and the surgical treatment group, which was no remarkable statistical significance(SMD: -5.54; 95% Cl: -12.45,1.38; P = 0.117) compared to the surgical treatment group, Modified Harris Hip Score (mHHS) after 12 months of follow-up(SMD: 0.94; 95% Cl: -2.87,4.75; P = 0.629), Nonarthritic Hip Score (NAHS) after 12 months of follow-up (SMD:6.31; 95% Cl: 0.53,12.09; P = 0.032), rate of recurrence (OR: 0.48; 95% Cl: 0.29,0.82; P < 0.01), and rate of Complication (OR: 0.66; 95% Cl: 0.26,1.65; P = 0.372).ConclusionAlpha angle improvement, mHHS, NAHS after 12 months of follow-up, rate of recurrence, and rate of Complication are some of the indicators of the study’s results point to the possibility that hip arthroscopy may be effective for patients with FA impingement; hence, these conclusions required to be corroborated by additional superior-quality studies.

Sex-Based Differences in the Arthroscopic Treatment of Femoroacetabular Impingement Syndrome: 10-Year Outcomes With a Nested Propensity-Matched Comparison

Background: Sex has been associated with different pathologic characteristics in painful hips undergoing hip arthroscopic surgery. Purpose: To compare minimum 10-year patient-reported outcomes (PROs) and survivorship in patients who underwent primary hip arthroscopic surgery for femoroacetabular impingement syndrome and labral tears according to sex. Study Design: Cohort study; Level of evidence, 3. Methods: Data from patients who underwent primary hip arthroscopic surgery between March 2009 and May 2011 were reviewed. Patients with minimum 10-year PROs for the modified Harris Hip Score (mHHS), Non-Arthritic Hip Score (NAHS), Hip Outcome Score–Sports-Specific Subscale (HOS-SSS), and visual analog scale (VAS) for pain were eligible. Exclusion criteria included previous ipsilateral hip conditions or surgical procedures, Tönnis grade >1, or dysplasia (lateral center-edge angle <25°). In the subanalysis, female patients were matched to male patients using a 1:1 ratio by age, sex, and body mass index. Results: A total of 375 hips had a minimum 10-year follow-up. There were 249 female (mean age, 36.8 ± 13.1 years) and 126 male (mean age, 38.9 ± 13.1 years) hips. Survivorship was defined as no conversion to total hip arthroplasty. Female and male hips exhibited similarly high rates of survivorship (80.3% vs 72.2%, respectively; P = .076). Female hips underwent secondary arthroscopic surgery at a statistically higher rate of 14.5% (P = .021) and had higher rates of capsular repair and iliopsoas fractional lengthening (P < .0001 and P < .001, respectively). Male hips had a significantly higher rate of acetabular labrum articular disruption/Outerbridge grade 3 and 4 damage at 54.0% compared with female hips (both P < .001) and underwent femoroplasty and acetabular microfracture at significantly higher rates of 88.1% versus 51.0%, respectively, and 16.7% versus 4.8%, respectively (both P < .001). In the subanalysis, both groups showed significant improvements in all PROs from baseline (all P < .001). Even though female patients demonstrated a higher rate of secondary arthroscopic surgery, they had a higher self-reported mean satisfaction score of 9.0 compared with 8.4 (P = .003) and a greater magnitude of improvement in 10-year PROs (ΔmHHS: 29.3 ± 17.5 vs 23.1 ± 19.8, respectively [P = .036]; ΔNAHS: 33.2 ± 21.3 vs 25.1 ± 19.5, respectively [P = .012]; ΔHOS-SSS: 47.0 ± 32.0 vs 32.7 ± 31.9, respectively [P = .008]; and ΔVAS: –4.6 ± 2.7 vs −3.5 ± 2.0, respectively [P = .009]). However, all PROs at a minimum 10-year follow-up were similar between the groups. Conclusion: After undergoing hip arthroscopic surgery for femoroacetabular impingement syndrome, both female and male patients reported significant improvements in all PROs at a minimum 10-year follow-up and high patient satisfaction, with similar final functional scores. Even though female patients demonstrated a higher rate of secondary arthroscopic surgery, they had a higher satisfaction score and a greater magnitude of improvement in PROs postoperatively.

Hip Arthroscopy for Femoroacetabular Impingement With Initial Access to the Peripheral Compartment: A Systematic Review of Clinical Outcomes.

The purpose of this review is to report clinical outcomes of patients undergoing hip arthroscopy for femoroacetabular impingement (FAI) with initial access to the peripheral compartment (PC) of the hip. A search following Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines was performed in the PubMed, Embase, and Scopus databases. Studies in which clinical outcomes were reported for patients who underwent hip arthroscopy for FAI with initial access to the PC were included. Data on study characteristics, patient demographics, radiographic outcomes, patient-reported outcomes (PROs), complications, and secondary surgery were extracted. Five studies with 881 patients and 976 hips (55.2% male, age range 32.1 to 48.4 years, follow-up range 3.0 to 74.4 months) were included. In two studies reporting radiographic measurements, the range of preoperative and postoperative alpha angle was 55.5° to 68.7° and 45.5° to 48.3°, respectively. The range of preoperative and postoperative lateral center-edge angles was 33.8° to 39.2° and 30.5° to 32.9°, respectively. Four studies reported one or more PRO measures with all demonstrating significant preoperative to postoperative improvement. The postoperative Non-Arthritic Hip Score (NAHS) and Visual Analog Score (VAS) pain scales ranged from 78.0 to 83.2 and 1.4 to 2.8, respectively. Complication rates ranged from 0.3% to 23.3%, with the rate of paresthesia specifically ranging from 0% to 8.1%. The rate of secondary surgery ranged from 0% to 6.3%. The rate of revision hip arthroscopy and conversion to total hip arthroplasty, specifically, ranged from 0% to 3.1% and 0% to 3.7%, respectively. This systematic review demonstrates that hip arthroscopy for FAI with initial access to the PC shows significant improvements in PROs with low rates of complications and secondary surgery.

With Proper Surgical Indications, Sex-Based Differences in Pathology Do Not Impact Hip Arthroscopy Outcomes or Complications: A Systematic Review.

To identify sex-based differences in pathology, outcomes, and complications after hip arthroscopy for femoroacetabular impingement (FAI), and to compare patient-reported outcomes (PRO) scores between male and female patients. The PubMed and MEDLINE databases were searched in September 2024, according to Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Included studies had data stratified by sex, minimum 2-year PRO scores for hip arthroscopy in the setting of FAI and labral pathology, and a 2014 or later publication date. Patient demographic information, preoperative radiographic measurements, and surgical procedure information was also recorded. PROs were recorded when discussed. Information on the minimum clinically important difference, patient acceptable symptomatic state, and substantial clinical benefit was recorded when available. In total, 21 studies were included in the systematic review. The systematic review found that there are sex-based differences in preoperative characteristics, such as male patients having a significantly greater incidence of acetabular injury, larger alpha angle, complex labral tearing, and greater grade LT villar classification, leading to differences in surgical indication, and female patients being indicated for capsular repair or plication at a greater frequency. There was a significant heterogeneity between male and female patients for preoperative modified Harris Hip Score (mHHS) (male: 55.7-83; female: 49-64.45; I2= 0.78), Non-Arthritic Hip Score (NAHS) (male: 62.54-78.1; female: 47.2-66; I2= 0.77), Hip Outcome Score-Sport-Specific Subscale (HOS-SSS) (male: 46.72-52.3; female: 22.8-45.7; I2= 0.96), as well as postoperative HOS-SSS (male: 72.2-91; female: 62.6-82.4; I2= 0.66). Despite these differences, both male and female patients experienced similar magnitudes of improvement for mHHS (male: 13-20.14; female: 20.6-30.2; I2= 0.00), NAHS (male: 18-19.93; female: 18.75-33.5; I2= 0.00), and HOS-SSS (male: 27.7-31.4; female: 26.75-39.8; I2= 0.42), as well as postoperative scores for mHHS (male: 82.445-96; female: 79.2-89.6; I2= 0.00) and NAHS (male: 82.445-94.5; female: 81.2-89.2; I2= 0.00). No differences were consistently identified in regard to survival rates and complications. Male and female patients present with different preoperative characteristics that affect surgical treatment. With proper surgical indication, both male and female patients achieve significant postoperative improvement after hip arthroscopy and demonstrate comparable survival rates. Level IV, systematic review of Level II-IV studies.

Arthroscopic Bone Grafting of Deep Acetabular Cysts in Hip Preservation Surgery: A Matched Case-Control Study.

Acetabular subchondral cysts are commonly identified signs of joint degeneration and arthritis. This pathology is generally considered a relative contraindication for hip preservation surgery. To investigate the effect of arthroscopic bone grafting for the treatment of acetabular subchondral cysts. Cohort study (diagnosis); Level of evidence, 3. We completed a retrospective analysis of hip arthroscopies performed by the senior author between 2013 and 2021. Patients with radiologic evidence of acetabular cysts who underwent arthroscopic bone grafting, with or without subsequent periacetabular osteotomy (PAO) and/or derotational femoral osteotomy with a minimum of 2-year follow-up, were included in the analysis. Patients undergoing surgical treatment for diagnoses of slipped capital femoral epiphysis, Legg-Calves-Perthe disease, osteochondromatosis, or postdislocation syndrome, as well as patients who refused to participate in the study, were excluded. We compared the patient-reported outcomes (PROs) for patients who underwent arthroscopic bone grafting with a case-matched control group without acetabular cysts with the same surgical route (hip arthroscopy or hip arthroscopy followed by PAO). An "inside-out" arthroscopic bone grafting technique was utilized, which allowed for precise access to the cystic cavity through the articular side. We analyzed postoperative PROs at a minimum of 2 years postoperatively using the international Hip Outcome Tool (iHOT-12) and Nonarthritic Hip Score (NAHS). In total, there were 44 hips in the experimental group and 78 hips in the control group. The mean PRO interval in the experimental group was 3.4 years (range, 2-5 years postoperatively), with 20 patients reaching PROs 5 years postoperatively. The experimental group reported significant improvement of iHOT-12 and NAHS scores postoperatively (both P < .001). Postoperative iHOT-12 and NAHS scores did not significantly differ between groups over a 5-year follow-up interval (P = .26 and .17, respectively). Radiographic evidence of cyst healing was achieved in all 7 patients who underwent postoperative magnetic resonance imaging, with 3 cases of complete resolution. Acetabular subchondral cysts treated with an inside-out method of arthroscopic bone grafting in the setting of hip preservation surgery with or without PAO was associated with a significant improvement in midterm PROs, comparable with a control group of patients without acetabular cysts who did not undergo bone grafting. Our results support the use of arthroscopic grafting in appropriately selected patients and suggest that hip preservation is not contraindicated in patients with acetabular subchondral cysts.

A high proportion of patients demonstrate recall bias in the retrospective collection of patient-reported outcomes following hip arthroscopy.

The aim of this study is to assess agreement between retrospectively and prospectively collected patient-reported outcome measures (PROMs) following hip arthroscopy for femoroacetabular impingement syndrome (FAIS). Patients undergoing hip arthroscopy from 2021 to 2023 for FAIS completed preoperative PROMs, including the modified Harris Hip Score (mHHS) and the Non-Arthritic Hip Score (NAHS). Post-operatively, patients were surveyed and asked to recall their preoperative hip function. Paired two-sample t tests were used to compare baseline and recalled baseline PROMs and the difference between scores was compared to previously published minimally clinically important difference (MCID) values. Intraclass correlation coefficients (ICCs) were calculated to test the reliability between scores based on a single-rater, two-way mixed-effects model. Multivariable regression, accounting for age, sex and preoperative baseline scores, was used to evaluate the relationship of time elapsed since surgery with recall accuracy. A total of 116 patients (age: 37.6 ± 11.8 years; 61.2% female) were included. The mean time elapsed for recalled data was 13.1 months (range: 1-27 months). Overall, patients' recalled scores were significantly lower than those prospectively collected (mHHS: 52.9 ± 20.1 vs. 61.5 ± 18.5, p < 0.0001; NAHS: 54.7 ± 20.0 vs. 58.8 ± 19.1, p < 0.0001). Frequency distribution found 68.1% of recalled mHHS and 61.2% of NAHS scores to have a greater difference (between baseline and recalled scores) than the MCID. The ICC was moderate for both mHHS (ICC = 0.559, 95% confidence interval [CI] = [0.420-0.672], p < 0.001) and NAHS (ICC = 0.612, 95% CI = [0.484-0.714], p < 0.001). Multivariate regression analysis did not find time elapsed since surgery to be associated with the difference between baseline and recalled mHHS (n.s.) or NAHS (n.s.). There are significant differences between retrospective and prospectively collected PROMs in patients undergoing hip arthroscopy that are not predicted by time to recall. These findings should impact the interpretation of the existing literature, support the routine collection of prospective data and inform patient counsel regarding their perceived post-operative outcomes. Level IV.

Revision hip arthroscopy for hip synovial chondromatosis is effective despite inferior postoperative clinical outcomes compared to patients undergoing primary hip arthroscopy: a matched control study with minimum 2-year follow-up

Purpose(1) To determine the clinical outcomes following revision arthroscopy for patients with hip synovial chondromatosis (SC), and (2) to compare the clinical outcomes between patients undergoing revision hip arthroscopy and primary hip arthroscopy.MethodsPatients undergoing hip arthroscopy between December 2014 and January 2021 was reviewed. Patients treated for SC and confirmed by postoperative pathology were included. Exclusion criteria were age less than 18 years old, hip osteoarthritis (Tönnis grade > 1), history of autoimmune disease, avascular necrosis, and Legg–Calve–Perthes disease. Patients undergoing revision surgery were included in the revision group, while those undergoing primary surgery were matched in a 1:4 ratio and included in the primary group. Preoperative and postoperative patient-reported outcome (PRO) scores including Visual Analog pain Scale (VAS), modified Harris Hip Score (mHHS), Nonarthritic Hip Score (NAHS), and international Hip Outcome Tool, 12-component form (iHOT-12) were collected and compared. The PROs and percentage of achieving minimal clinically important difference (MCID) and patient acceptable symptom state (PASS) of mHHS, iHOT-12, and NAHS were compared between the two groups.ResultsA total of 12 patients were included in the revision group, while 48 patients were included in the primary group. No significant difference was found in baseline characteristics (all with P > .05). No significant difference was found in the arthroscopic findings and procedures (all with P > .05). Both groups presented significant improvement of postoperative PROs compared to the preoperative PROs (all with P < .001). No significant difference was found in preoperative PROs between the two groups (all with P > .05). Postoperatively, the revision group presented inferior VAS (P = .007), mHHS (P = .007), iHOT-12 (P = .004), and NAHS (P = .028), as well as lower rate of achieving MCID of NAHS (P = .038), and PASS of mHHS (P = .003) compared to the primary group.ConclusionPatients undergoing revision arthroscopy for hip SC presented favorable clinical outcomes at minimum of 2-year follow-up, although the postoperative PROs, rate of achieving MCID, and PASS were lower compared to patients undergoing primary arthroscopy.Level of Evidence: III.

No Effect of Cigarette Smoking in the Outcome of Arthroscopic Management for Femoroacetabular Impingement: A Systematic Review.

Background: The impact of smoking in arthroscopic surgery for femoroacetabolar impingement (FAI) is controversial. This systematic review updates and discusses current evidence on the influence of cigarette smoking on the outcome of arthroscopic management of FAI. The outcomes of interest were to compare patient-reported outcome measures (PROMs) and complications. Methods: The present systematic review followed the PRISMA guidelines. Embase, Web of Science, and PubMed were accessed in June 2024 without additional filters or temporal constraints. All the clinical investigations comparing smokers versus nonsmokers in patients who underwent arthroscopic management for FAI were considered. The risk of bias in nonrandomised controlled trials was assessed using the Risk of Bias in Nonrandomised Studies of Interventions (ROBINS-I). Results: Data from 368 patients were retrieved. The mean length of follow-up was 34.1 ± 7.1 months. The mean age was 40.4 ± 4.0 years and the mean BMI was 27.1 ± 1.6 kg/m2. No significant difference was evidenced in the visual analogue scale, Harris hip score, Hip Outcome Score-Sport subscale, and Non-Arthritic Hip Score. No difference was observed in the complication rate: reoperation (p = 0.6) and progression to THA (p = 0.4). Conclusions: Tobacco smoking does not appear to influence the outcomes of arthroscopic management for FAI. At approximately 34 months of follow-up, no difference was found in pain, PROMs, reoperation rate, and progression to THA.

Staged Hip Arthroscopy and Periacetabular Osteotomy in Active Patients 45 Years and Older Produces Comparable Improvements in Outcome Scores to Younger Patients

PurposeTo determine staged hip arthroscopy and periacetabular osteotomy (PAO) mid-term outcomes in active patients aged 45 years and older compared with a younger group. Materials and MethodsAll patients aged ≥45 years old who underwent staged arthroscopy and PAO between 2015 and 2021 were retrospectively analyzed and compared to a case-matched control of younger patients. All patients underwent at least 6 months of non-operative management prior to surgery. Prior to PAO, all patients underwent hip arthroscopy to address any intra-articular pathology. The experimental group consisted of dysplastic patients >45 years of age without significant osteoarthritis who underwent PAO and reported a minimum of 1-year postoperative PROs. Patient-reported outcomes (PROs) were quantified using the International Hip Outcomes Tool (iHOT-12) and Non-Arthritic Hip Score (NAHS). ResultsThe cohort consisted of 35 patients (44 hips) with a mean age of 49.4 ± 3.8 years. The lateral center edge angle significantly improved from preoperatively (20.1 ± 4.5 degrees) to postoperatively (33.2 ± 3.2 degrees) (p<0.001). Mean follow up in the PAO ≥45 cohort was 2.80 (±1.3) years postoperatively. Patients reported significant improvement of iHOT-12 (preoperative: 36.6 ± 14.1, latest follow-up: 81.2 ± 21.0; p<0.001) and NAHS scores (preoperative: 59.2 ± 15.5, latest follow-up: 87.4 ± 13.1; p<0.001). Compared to the control, the older cohort did not report significantly different iHOT-12 scores between groups at any point, and age did not significantly affect either outcome score (p>0.05). ConclusionsPatients ≥45 years of age reported a statistically significant improvement in hip function and pain following staged hip arthroscopy and PAO, with outcome scores comparable to a younger cohort. Our findings demonstrate that appropriately selected older dysplastic patients without significant preexisting hip osteoarthritis experience clinically meaningful improvements in hip pain and function following hip preservation surgery. Level of EvidenceIII, retrospective comparative case series

Hip shelf acetabuloplasty in borderline dysplasia, an alternative between Periacetabular Osteotomy and arthroscopic procedures.

Surgical treatments for symptomatic borderline dysplastic hips (Lateral Center-Edge Angle: LCEA 18-25°) remain challenging, instability being the primary issue. Currently, treatment options include arthroscopic procedures or peri-acetabular osteotomy (PAO). Although the popularity of the acetabular shelf bone block has declined in favor of PAO, it may still be relevant as a hip joint stabilizer and coverage area, rather than for increasing coverage area by cartilage. We analyzed clinical and radiographic outcomes of 23 borderline hips after undergoing shelf procedure with a minimum follow-up of two years. This is a retrospective descriptive study. Clinical evaluations (modified Harris Hip Score: mHHS, Non-Arthritic Hip Score: NAHS, International Hip Outcome Tool: iHOT12) and radiographic assessments were performed before and after surgery. We collected data on revision surgery rates, associated surgical procedures (labrum, impingement), complications, arthrosis progression, and conversion to total hip replacement (THR). The mean LCEA was 21°, and the mean follow-up period was five years (2 to 14 years). Clinical scores showed significant improvement at the last follow-up, mHHS increasing from 47 to 72 (p < 0.001), NAHS from 42 to 68 (p < 0.001), iHOT12 from 28 to 52 (p < 0.001), and pain levels decreasing from 7 to 3. Revision surgery rate was 13%, and complication rate was 8%. No osteoarthritis beyond Tönnis grade 2, and no cases required conversion to THR. Arthroscopic procedures and PAO have shown promising results in the treatment of borderline hips. The hip shelf procedure appears to be a simple and effective treatment for stabilizing borderline hips, with favorable outcomes for 80% of patients and a low rate of arthritic progression. Shelf procedure could be a valuable addition to the therapeutic options for painful borderline dysplasia of the hip.

Relationship Between Neighborhood-Level Socioeconomic Status and Functional Outcomes After Hip Arthroscopy

Background: Despite the growing volume of neighborhood-level health disparity research, there remains a paucity of prospective studies investigating the relationship between Area Deprivation Index (ADI) and functional outcomes for patients undergoing hip arthroscopy. Purpose: To investigate the relationship between neighborhood-level socioeconomic status and functional outcomes after hip arthroscopy. Study Design: Cohort study; Level of evidence, 3. Methods: A retrospective analysis of prospectively collected data was performed on patients aged ≥18 years with minimum 1-year follow-up who underwent hip arthroscopy for the treatment of symptomatic labral tears. The study population was divided into ADILow and ADIHigh cohorts according to ADI score: a validated measurement of neighborhood-level socioeconomic status standardized to yield a score between 1 and 100. Patient-reported outcome measures (PROMs) included the modified Harris Hip Score, Nonarthritic Hip Score, Hip Outcome Score–Activities of Daily Living, Hip Outcome Score–Sports-Specific Subscale, 33-item International Hip Outcome Tool, visual analog scale for pain, and patient satisfaction. Results: A total of 228 patients met inclusion criteria and were included in the final analysis. After patients were stratified by ADI score (mean ± SD), the ADILow cohort (n = 113; 5.8 ± 3.0; range, 1-12) and ADIHigh cohort (n = 115; 28.0 ± 14.5; range, 13-97) had no differences in baseline patient demographics. The ADIHigh cohort had significantly worse preoperative baseline scores for all 5 PROMs; however, these differences were not present by 1-year follow-up. Furthermore, the 2 cohorts achieved similar rates of the minimal clinically important difference for all 5 PROMs and the Patient Acceptable Symptom State for 4 PROMs. When controlling for patient demographics, patients with higher ADI scores had greater odds of achieving the minimal clinically important difference for all PROMs except the 33-item International Hip Outcome Tool. Conclusion: Although hip arthroscopy patients experiencing a greater neighborhood-level socioeconomic disadvantage exhibited significantly lower preoperative baseline PROM scores, this disparity resolved at 1-year follow-up. In fact, when adjusting for patient characteristics including ADI score, more disadvantaged patients achieved greater odds of achieving the minimal clinically important difference. The present study is merely a first step toward understanding health inequities among patients seeking orthopaedic care. Further development of clinical guidelines and health policy research is necessary to advance care for patients from disadvantaged communities.

Hip Labral Repair versus Reconstruction: Meta-analysis.

The purpose of this meta-analysis is to compare the postoperative outcomes and complications of labral repair with those of labral reconstruction. An electronic search strategy was conducted from 1986 until August 2023 using the following databases: PubMed, Cochrane, and Google Scholar (pages 1-20). The primary objectives included the postoperative clinical outcomes determined by the number of patients who reached minimal clinical important difference (MCID) on the visual analog scale (VAS), modified Harris hip score (mHHS), Hip Outcome Score-Sports Subscale (HOS-SS), Hip Outcome Score-Activities of Daily Life (HOS-ADL), and International Hip Outcome Tool-12 (iHOT-12). In addition, analysis of the rate of revision arthroscopy, the rate of conversion to total hip arthroplasty (THA), the postoperative VAS, mHHS, HOS-SS, HOS-ADL, iHOT-12, nonarthritic hip score (NAHS), patient satisfaction, lower extremity function scale (LEFS), and the SF-12 (12-item shortform) was also performed. Any differences arising between the investigators were resolved by discussion. Seventeen studies were relevant to the inclusion criteria and were included in this meta-analysis. A higher rate of patients who reached MCID in the mHHS (P=0.02) as well as a higher rate of revision arthroscopy was observed for labral repair (P=0.03). The remaining studied outcomes were comparable. Despite the greater predictability of success in the reconstruction group, conduct of additional studies will be required for evaluation of the benefits of such findings. In addition, labral reconstruction is more technically demanding than a labral repair.

Victorian Institute of Sport Assessment questionnaire specifically tailored for greater trochanteric pain syndrome for the Dutch population.

Greater trochanteric pain syndrome (GTPS) is a highly prevalent condition characterized by lateral hip and thigh pain. The Victorian Institute of Sport Assessment (VISA) questionnaire specifically tailored for GTPS (VISA-G) questionnaire was developed for the purpose of assessing and quantifying the severity of symptoms related to gluteal tendinopathy or GTPS. It is commonly used in research and clinical settings to evaluate the impact of GTPS on patient function and quality of life. The VISA-G questionnaire was developed for English-speaking populations. Before this questionnaire can be used in non-English-speaking populations, it has to be translated and validated for a particular population. The current study aimed to translate and validate the VISA-G questionnaire for a Dutch-speaking context (VISA-G-Dutch). In this study, we conducted a comprehensive process involving forward and back translation, along with a thorough comparison with other established hip-related questionnaires. The COSMIN checklist was used to ensure uniformity in the validation study. A sample of 100 participants, 50 symptomatic and 50 asymptomatic, completed the VISA-G-Dutch, Harris Hip Score, Hip Disability and Osteoarthritis Outcome Score, Oxford Hip Score, and Nonarthritic Hip Score questionnaires. Internal consistency and test-retest reliability were measured. Construct validity was assessed through positive correlations between the VISA-G-Dutch and gold standard questionnaires. Strong internal consistency and test-retest reliability correlations were found in both the asymptomatic and symptomatic groups. The test-retest reliability also demonstrated strong positive correlations for the symptomatic group. The standard error of measurement was ∼2.3 for the symptomatic group. These results prove that the VISA-G-Dutch is a reliable and valid tool for assessing GTPS and gluteal tendinopathy in Dutch-speaking individuals, providing clinicians with a valuable assessment tool.

Endoscopic Shelf Acetabuloplasty Combined With Hip Arthroscopic Labral Repair, Cam Osteoplasty, and Capsular Plication Enables Elite Athletes With Acetabular Dysplasia to Return to Sport: A Case Series.

To investigate clinical outcomes and return to sport timeline for athletes with acetabular dysplasia after endoscopic shelf acetabuloplasty (ESA). A retrospective review. Wakamatsu Hospital of the University of Occupational and Environmental Health, Japan between 2012 and 2019. Fifteen elite athletes (median age: 20 years) of 253 patients undergoing ESA, arthroscopic labral repair/reconstruction, cam osteochondroplasty, and capsular plication. The mean follow-up period was 27.8 months after surgery. Patient-reported outcome scales (PROSs), including the modified Harris Hip Score, Nonarthritic Hip Score, International Hip Outcome Tool 12, Hip Outcome Score-Sports, and Vail Hip Score. After ESA, all 15 elite athletes were able to return to sport effectively and compete at a preoperative level. The mean time between the operation and the first practice was 6.5 months, while the mean time between the ESA procedure and the first game was 9.6 months. Approximately 27.8 months after surgery, PROS outcomes improved significantly with no hips requiring emergency revision surgery at the final follow-up. At a mean of 47.1 months after surgery, 7 athletes decided to retire from their sport. Up to 71.1 months after surgery, the additional 8 patients continued to compete in their sport at an elite level. ESA enables elite athletes with acetabular dysplasia to return to competition at a mean of 9.6 months postsurgery. The ESA procedure is an effective and promising method of treating elite athletes with acetabular dysplasia. IV.

Application of 3D-printed individualized porous tantalum buttress in shelf acetabuloplasty for developmental dysplasia of the hip

Shelf acetabuloplasty is a viable treatment for developmental dysplasia of the hip (DDH), yet autologous bone grafts have faced challenges such as morphological mismatch, imprecise placement, and long-term graft resorption. The rapid advancement of three-dimensional (3D) printing technology in orthopedics has enabled the acquisition of digital image correlation method (DICM) data from patient pelvic to bilateral femoral proximal regions through computed tomography (CT) scans. This data is then utilized by software to create 3D models and design individualized metal implants. Using tantalum-based TA1 type I spherical powder as the raw material, a porous tantalum buttress with a pore size of 600 microns and a porosity of 75% was fabricated employing the selective electron beam melting (SEBM) technology. Our Center has applied this 3D-printed individualized porous tantalum buttress in shelf acetabuloplasty for 21 DDH patients (25 hips), including 6 males and 15 females, with a mean age of (21.38&amp;plusmn;7.39) years. The follow-up period ranged from 12 to 47 months, averaging (22.64&amp;plusmn;10.86) months. At the final follow-up, patient-reported outcomes (PROs) were used to assess patient&amp;rsquo;s subjective feelings. Significant improvements were observed in the Non-Arthritic Hip Score (NAHS), modified Harris Hip Score (mHHS), Hip Outcome Score-Sports Subscale (HOS-SSS), International Hip Outcome Tool-12 (iHOT-12), and Visual Analog Scale (VAS) compared with preoperative levels (P&lt;0.01). Radiographic assessments showed that postoperative lateral center edge (LCE) angle, Tonnis angle, acetabular angle (Sharp&amp;rsquo;s angle), and femoral head coverage all trended towards normal, with statistically significant differences (P&lt;0.01). There was no implant displacement or bone resorption in any case, and no progression in Tonnis grading for hip osteoarthritis (OA) was noted postoperatively, with an 84% patient satisfaction rate. The early follow-up results of 3D-printed individualized porous tantalum buttress in shelf acetabuloplasty are satisfactory, indicating a reliable application prospect for the treatment of DDH patients.

FEMORAL HEAD REDUCTION OSTEOTOMY APPROACH FOR SEVERE PROXIMAL FEMUR DEFORMITIES: SURGICAL TECHNIQUE AND MINIMUM TWO-YEAR RESULTS

Executing an extended retinacular flap containing the blood supply for the femoral head, reduction osteotomy (FHO) can be performed, increasing the potential of correction of complex hip morphologies. The aim of this study was to analyse the safety of the procedure and report the clinical and radiographic results in skeletally mature patients with a minimum follow up of two years.Twelve symptomatic patients (12 hips) with a mean age of 17 years underwent FHO using surgical hip dislocation and an extended soft tissue flap. Radiographs and magnetic resonance imaging producing radial cuts (MRI) were obtained before surgery and radiographs after surgery to evaluate articular congruency, cartilage damage and morphologic parameters. Clinical functional evaluation was done using the Non-Arthritic Hip Score (NAHS), the Hip Outcome Score (HOS), and the modified Harris Hip Score (mHHS).After surgery, at the latest follow-up no symptomatic avascular necrosis was observed and all osteotomies healed without complications. Femoral head size index improved from 120 ± 10% to 100 ± 10% (p&lt;0,05). Femoral head sphericity index improved from 71 ± 10% before surgery to 91 ± 7% after surgery (p&lt;0,05). Femoral head extrusion index improved from 37 ± 17% to 5 ± 6% (p&lt; 0,05). Twenty five percent of patients had an intact Shenton line before surgery. After surgery this percentage was 75% (p&lt;0,05). The NAHS score improved from a mean of 41 ± 18 to 69 ± 9 points after surgery (p&lt; 0,05). The HOS score improve from 56 ± 24 to 83 ± 17 points after surgery (p&lt; 0,05) and the mHHS score improved from 46 ± 15 before surgery to 76 ± 13 points after surgery (p&lt; 0,05).In this series, femoral head osteotomy could be considered as safe procedure with considerable potential to correct hip deformities and improve patients reported outcome measures (PROMS).Level of evidence - Level IV, therapeutic studyKeywords - Femoral head osteotomy, Perthes disease, acetabular dysplasia, coxa plana

Patient Factors Influencing Outcomes at 12-Year Follow-up of Hip Arthroscopy for Femoroacetabular Impingement

Background: Arthroscopic treatment of femoroacetabular impingement has increased in popularity since the early 2000s when it was first described, although only a few midterm follow-up studies have been published. Purpose: To describe the outcomes of patients undergoing hip arthroscopy for femoroacetabular impingement at a mean 12-year follow-up and to determine the risk factors for failure. Study Design: Case-control study; Level of evidence, 3. Methods: The Non-Arthritic Hip Score (NAHS) and a radiographic evaluation were completed preoperatively and at midterm follow-up. Participants were divided into 2 groups according to their clinical evolution. The success group consisted of patients whose NAHS at the final follow-up was above the established Patient Acceptable Symptom State (PASS) threshold of 81.9, whereas patients who underwent a second surgical intervention or did not reach the PASS threshold at final follow-up were assigned to the failure group. These groups were compared to identify preoperative differences in demographic, pathological, and surgical factors. Results: A total of 95 hips were included, after 23 were lost to follow-up (80.5% follow-up). At a mean follow-up of 12.1 years (range, 9.2-16.0 years), 9 hips required total hip arthroplasty (9.5%), 5 required revision hip arthroscopy (5.3%), 29 did not achieve the NAHS PASS threshold (30.5%), and 52 achieved the NAHS PASS threshold (54.7%). The mean NAHS was 82.4 at final follow-up compared with 66.9 preoperatively (mean difference = 15.5; P < .001). Higher mean body mass index (24.9 vs 23.0; P = .030), older age (30.0 vs 27.2; P = .035), and inferior preoperative lateral joint space width (3.9 vs 4.4; P = .019) were associated with inferior prognosis in the failure group versus success group. Osteoarthritis progression was observed in 69.2% of the failure group and in 34.8% of the success group (P = .082). Labral ossification was observed in 78.3% of all patients, and its lateral projection length was statistically associated with failure (P = .015). Conclusion: At a mean 12-year follow-up, hip arthroscopy for femoroacetabular impingement led to significant clinical improvement, with 55% PASS achievement. In total, 31% of patients were below the PASS threshold, 5% had revision arthroscopy, and only 9% had conversion to total hip arthroplasty for a 45% global failure rate. Increased body mass index, older age, and smaller preoperative lateral joint space width were significant negative prognostic factors. Postoperative degenerative changes were highly prevalent and demonstrated association with failure.

High Survival Rate and Satisfaction at More Than 11-Year Follow-Up After Hip Arthroscopy for Femoroacetabular Impingement Syndrome: Impact of Preoperative Functional Scores, Osteoarthritis, and Chondrolabral Junction Damage on Failure

The purpose of the study was to investigate the survival and durability of clinical improvements following hip arthoscopy (HA) for femoroacetabular impingement syndrome (FAIS) at a minimum of 10-year follow-up. The primary objective was to determine the long-term survival, defined as: lack of conversion to total hip replacement (THR) or subsequent hip joint preservation surgery (HJPS). The secondary objective was to determine which preoperative factors were predictive of failure. Data from patients who underwent HA for FAIS between March 2003 and May 2012 were collected and retrospectively reviewed. Patients who underwent evaluation at a minimum 10-year follow-up, assessed according to hip outcome score - activities of daily living (HOS-ADL) and sport-specific subscale (HOS-SSS), and non-arthritic hip score (NAHS) were included. Satisfaction ratings were collected. Statistical analysis assessed within-group differences and survival. 95 patients with an average follow-up of 11.8 years were included. Mean age was 39.5 ± 11.0 years. Overall THR conversion rate was 24.2%, with a mean time of 3.4 ± 3.2 years. 3.2% required HJPS revision at a mean 3.2 ± 3 years. Survivorship was 72.6% at ten years. 28 patients (73.6% and 75.6%) achieved the minimal clinically important difference (MCID) for HOS-ADL and HOS-SSS, while 33 (84.6%) for NAHS. Patient Acceptable Symptom State (PASS) was achieved by 42 (61.7%), 43 (65.1%) and 44 (64.7%) patients respectively. Comparative analysis between patients who preserved their hip and those who underwent HJPS revision or THR highlighted that Tönnis ≥ 2, chondrolabral junction damage, and lower preoperative scores are associated with failure. HA for FAIS demonstrated durable results, with an accepatable THR conversion rate and sustained clinical benefits. 91.3% of the patients who preserved their hip were satisfied. Tönnis 2, MRA signs of chondrolabral junction damage and lower preoperative functional status are strongly associated with failure.