Journal of Hip Preservation Surgery最新文献

This study evaluates the quality and readability of responses given by ChatGPT 4 relating to common patient queries on Developmental Dysplasia of the Hip (DDH) and Periacetabular Osteotomy (PAO). Frequently asked questions on DDH and PAO were selected from online Patient Education Materials and posed to ChatGPT 4. The responses were evaluated by four high-volume PAO surgeons using a well-established evidence-based rating system, categorizing responses from 'excellent response not requiring clarification' to 'unsatisfactory requiring substantial clarification'. Readability assessments were subsequently conducted to determine the required literacy level to understand the content provided. Responses from ChatGPT 4 varied significantly between preoperative and postoperative queries. In the postoperative category, 50% of responses were rated as 'excellent', showing no need for further clarification, while the preoperative responses frequently required minimal to moderate clarification. The overall median response rating was 'satisfactory requiring minimal clarification'. Readability tests showed that the average Reading Grade Level was 13.44, considerably higher than the recommended sixth-grade level for patient education materials, indicating a substantial barrier to comprehension for the general public. While ChatGPT delivers generally reliable information, the complexity of its language is a major barrier to widespread utilization as a tool for patient education. Future iterations of ChatGPT should aim to utilize more simplistic language, as such enhancing accessibility without compromising content quality.

The femoral neck axis (FNA) is an important reference in femoral neck rotational osteotomy, which is a hip preservation procedure. The purpose of this study was to propose a method for determining the FNA with high accuracy and reliability and to evaluate the effect of FNA determination accuracy on the stress and strain distribution in the proximal femur. Femoral computed tomography data from 50 patients were reconstructed, and the FNA was fitted by the centroid iterative method. The fitting accuracy was evaluated in terms of the distance between the femoral head centre and the FNA. The reliability was assessed by intraclass correlation coefficient (ICC). Stress-strain distributions of the native femur model and rotational osteotomy models with accurate FNA and deviated FNA were simulated by finite element analysis and digital image correlation methods. The distance between the femoral head centre and the FNA was 1.24 ± 0.35 mm. The intra- and interobserver reliability was high, with ICC values of 0.960 and 0.924, respectively. The maximum von Mises stress was 25.76 MPa, 50.82 MPa, and 93.24 MPa for the native femur model, accurate FNA model, and deviated FNA model, respectively. The finite element strain distributions were linearly correlated with digital image correlation results. The centroid iterative method for FNA fitting has high accuracy and reliability. Accurate determination of the FNA reduces stress concentration in the proximal femur and decreases the risk of subsequent fracture and non-union of the osteotomy surface.

The Journal of Hip Preservation Surgery (JHPS) is not the only place where work in the field of hip preservation can be published. Although our aim is to offer the best of the best, we are continually fascinated by work, which finds its way into journals other than our own. There is much to learn from it, and so JHPS has selected six recent and topical subjects for those who seek a summary of what is taking place in our ever-fascinating world of hip preservation. What you see here are the mildly edited abstracts of the original articles, to give them what JHPS hopes is a more readable feel. If you are pushed for time, what follows should take you no more than 10 min to read. So here goes.

Spherical Periacetabular Osteotomy (SPO) is a novel procedure using an osteotomy line similar to that for Rotational Acetabular Osteotomy (RAO). The major difference between these procedures is that an anterior approach is used for SPO and an anterior and posterior approach for RAO. This study compared early bone union between these procedures. We enrolled 12 patients (12 hips) post-RAO and 15 patients (15 hips) post-SPO who consented to undergo computed tomography (CT) imaging about 5 weeks after surgery. Results showed no significant differences in lateral centre-edge angle or acetabular roof obliquity between these groups, both before and after surgery. Partial bone union was observed in 7 of 12 cases (58.3%) in the RAO group and 14 of 15 cases (93.3%) in the SPO group, with the SPO group showing a significantly higher incidence of bone union (P = .03). X-ray images taken simultaneously with CT scans did not reveal any bone union in either group. Functional outcomes measured by the Japanese Orthopaedic Association score revealed no significant differences between groups at 6 months and 1 year postoperatively. Both procedures preserved the quadrilateral surface, avoided cutting the pubic bone, and achieved good stability of the pelvic ring as well as wide contact area on the cut bone. Through CT imaging, this study highlighted the potential of SPO to achieve superior early bone union, likely due to its preservation of blood flow and minimally invasive approach. This study suggests the potential utility of CT imaging in evaluating early bone union after osteotomy.

The function of the ligamentum teres (LT) remains debated, particularly its role in limiting motion. The aim of this study was to use finite element analysis to assess LT stress during hip movements, which included external rotation with flexion. A 3D model of the hip joint, including the femoral head and LT, was constructed from magnetic resonance imaging data using 3D Slicer. The models were imported into Ansys SpaceClaim 2022R1 for refinement and assembly. The von Mises stress in the LT was extracted during six hip movements: external rotation, internal rotation, abduction, adduction, flexion, and extension. LT stress response was also extracted during external rotation at hip flexion angles of 0°, 30°, 60°, and 90°. The results found there was a sharper increase in LT stress during movements involving hip external rotation, internal rotation, abduction, and adduction when compared to movements in flexion and extension. External rotation in larger hip flexion angles resulted in greater LT stress, with the highest stress observed at 90° flexion. These findings help to support the LT's role as a rotational stabilizer in the frontal and transverse planes wrapping around the femoral head to act as a sling. Additionally, the increased stress during external rotation at greater degrees of hip flexion suggests an enhanced role for the LT in hip stability as flexion increases. These results add as a proof of concept in that the LT is under stress during hip movements and has a potential role in stabilizing the hip joint.

Morphological hip abnormalities (MHAs) significantly influence lifelong prognosis of the hip, contributing to early-onset osteoarthritis and impaired functionality. Developmental dysplasia of the hip (DDH) and femoroacetabular impingement (FAI) represent key pathologies, resulting from insufficient or excessive femoral head coverage, respectively. These abnormalities alter hip biomechanics, leading to structural damage, pain, and accelerated joint degeneration. Advances in genetic research have illuminated the interplay between genetics and mechanical loading in shaping hip morphology. Genes associated with osteoarthritis, DDH, and FAI include COL1A1, MMP13, and IL-6. Genes associated with FAI and osteoarthritis include ADAMTS4. Genes associated with DDH and osteoarthritis include FRZB, CX3CR1, ASPN, DKK1, PDRG1, GDF5, UQCC1, and TGF-β1. The mechanisms linking morphological derangements to symptomatic osteoarthritis remain incompletely understood. Multimodal approaches integrating imaging, biomechanics, and genetics may uncover distinct disease subtypes, enabling personalized interventions. Early detection of MHAs is critical in preventing early-onset osteoarthritis. Incorporating advanced imaging techniques, such as statistical shape modelling, can enhance the understanding of complex 3D hip morphologies and their progression to osteoarthritis. Future research should explore the genetic underpinnings of other morphologic hip conditions, including Slipped Capital Femoral Epiphysis and Legg-Calvé-Perthes disease, to refine preventive and therapeutic strategies. A comprehensive approach combining genetics, imaging, and clinical insights holds promise for mitigating the lifelong impact of MHAs.

Curved varus osteotomy (CVO) is a surgical option to preserve a hip joint affected by osteonecrosis of the femoral head (ONFH). Femoral anteversion varies among patients; however, the osteotomy design on the axial plane in CVO has not been well investigated. This study evaluated the variation in the osteotomy angle on the axial plane in a CVO and its effect on the postoperative intact ratio, which determines the postoperative outcome. This study included 10 patients with Type C1 ONFH who underwent CVO according to the Japanese Investigation Committee classification. The osteotomy angles relative to the posterior condylar and femoral neck axes on the axial plane were measured on postoperative computed tomography images. The progression of collapse and osteoarthritic change were reviewed on serial radiographs. The mean osteotomy angles to the posterior condylar axis and the femoral neck axis were 0.2° and 15.3°, respectively. The mean postoperative intact ratio was 45.6% (range: 28.0-62.8%). The osteotomy angle to the femoral neck axis was significantly and negatively correlated with the postoperative intact ratio (ρ = -0.782, P = .008). In three cases, the osteotomy line was directed >25° anteromedial to the femoral neck axis, and the postoperative intact ratio was less than the target (34%); one showed progression of the collapse of the femoral head, and another an osteoarthritic change. We observed wide variations in the osteotomy angle on the axial plane during manually performed CVO. The osteotomy angle to the femoral neck axis on the axial plane affected the postoperative intact ratio.

Patients with symptomatic hip dysplasia may undergo periacetabular osteotomy (PAO) and 10% of these patients have pain >6 months after the operation. An intra-articular lidocaine injection is used to determine if the pain comes from labral pathology in the hip joint or structures around the hip. To allow the patient a longer period of time to test the hip, we wanted to test if an intra-articular injection of Botox combined with local anaesthetic could reduce pain and allow the patient to test the hip. Eleven patients who received a PAO and suffered from persistent pain at least 6 months postoperative had an intra-articular joint injection with 100IE Botox, 3 ml NaCl water and 3 ml lidocaine. Hip pain on the day of injection and after 6 weeks was evaluated using the Visual Analog Scale score, International Hip Outcome Tool (iHOT-12), and Hip and Groin Outcome Score (HAGOS). Botox in the hip joint reduced the pain level and the iHOT-12 score, with a statistically significant improvement 6 weeks after injection. Hip joint injection of a controlled dosage of 100 IU diluted in 3 ml NaCl solution mixed with lidocaine had no side effects in this study with a limited group of patients. Botox has a promising pain-reducing effect on the hip joint in the majority of patients comparable with findings in knee and shoulder joints. Hip joint injection of a controlled dosage of 100 IU, 3 ml NaCl solution mixed with lidocaine had no side effects in this study with a limited group of patients.

This systematic review aims to evaluate clinical outcomes for arthroscopic-assisted core decompression (AACD) for avascular necrosis (AVN) of the femoral head. A literature search following Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines was performed in PubMed, Embase, and Scopus. Nine studies were included, five comparing AACD with isolated core decompression (CD) and four evaluating outcomes of only AACD. A total of 358 patients (462 hips, 71.8% male) underwent AACD. In the five comparative studies, the AACD and isolated CD groups had 97.6% (72.2-100.0%) and 98.5% (81.0-100.0%) of hips with precollapse AVN, respectively. The modified Harris hip score, reported in five comparative studies, was significantly higher in the AACD group in four studies and not significantly different in one study. The visual analog scale pain score, reported in two comparative studies, was significantly lower in the AACD group in one study and not significantly different in the other study. The collapse rate ranged from 2.9% to 14.0% at a mean follow-up of 37.9 months in the AACD group and from 14.6% to 28.6% at a mean follow-up of 34.7 months in the isolated CD group, with all five comparative studies reporting significantly higher collapse rates in the isolated CD group. In the four AACD only studies, 42.9-100.0% of hips had precollapse AVN with the collapse rate ranging from 23.2% to 45.5% at a mean follow-up of 39.2 months. Patients undergoing AACD for treatment of AVN of the femoral head demonstrate excellent patient-reported outcomes and low rate of collapse and complications, with a possibility of superior outcomes compared to isolated CD.