Journal of Hip Preservation Surgery最新文献

The aim of this study was to compare outcomes between anteverting proximal femoral osteotomy (APFO) and anteverting periacetabular osteotomy (APAO) for femoroacetabular impingement syndrome (FAIS) due to combined acetabular retroversion (ARV) and femoral retrotorsion (FRT). We also compared these outcomes with hip arthroscopy (HA) for FAIS without ARV or FRT. Twelve patients with ARV and FRT underwent either APAO (six) or APFO (six) at two centres. A control group of 24 patients underwent HA for FAIS without version abnormality. Outcome measures included various hip scores, time to radiological bony union, complications, and conversion to hip arthroplasty. At the 2-year follow-up, no AFPO or APAO hips required arthroplasty. Patient-reported outcome scores showed no significant difference between the APAO and APFO groups: Non-Arthritic Hips Scores (NAHS) (APAO: median 72, range 52-78; APFO: 76, 52-80, P = .76), International Hip Outcome Tool 12 (iHOT-12) (APAO: 64, 48-70 vs. APFO: 55, 46-72, P = .57), EuroQol 5 Dimension Visual Analogue Scale (APAO: 72, 57-78 vs. APFO: 75, 49-80 P = .78), and University of California Los Angeles Score (APAO: 7, 4-8 vs. APFO: 6, 4-9 P = .43). APAO patients achieved radiological union faster (10.2 weeks: 6.6-19.3 vs. 19.2 weeks: 12-23, P = .05). Aside from metalwork removal, one AFPO patient required revision intramedullary nail to induce union. Compared to AFPO or APAO, HA patients (NAHS: 86.7, 72.1-94.1; iHOT-12: 73.1, 63.2-88.1) had better outcome scores (P < .05). Both APFO and APAO can achieve good outcomes and short-term survivorship for combined ARV and FRT, although function may be inferior to HA in patients without rotational abnormalities.

Determining which patients with acetabular dysplasia will benefit most from periacetabular osteotomy (PAO) can be challenging. Intra-articular corticosteroid injection (CSI) is often used for therapeutic and diagnostic purposes in various hip pathologies. This study aims to assess the relationship between self-reported preoperative CSI pain relief and postoperative pain relief after PAO. The case log of a single hip-preservation surgeon was queried from 2013 onward for patients who underwent PAO with preoperative intra-articular CSI. Patients were asked, 'overall, what percent improved are your symptoms from 0-100%?' following preoperative CSI and again at each postoperative visit. A successful postoperative pain outcome was defined as pain relief ≥75% compared to preoperative symptoms at the approximate 6 month postoperative visit. A total of 76 hips met inclusion criteria. Average self-reported relief from preoperative intra-articular CSI was 70 ± 35%. Mean postoperative pain relief was 88 ± 18%. Analysis showed a positive but weak correlation between preoperative CSI response and postoperative relief (0.278, P = .016). Receiver operator characteristic curve analysis found CSI pain relief ≥60% to be the optimal threshold for predicting a successful postoperative pain outcome. Positive predictive value remained high and negative predictive value (NPV) remained low over a range of CSI relief thresholds. Most patients had significant pain relief following PAO, with only 10 patients failing to achieve at least 75% improvement. As a result, the NPV associated with any CSI pain relief threshold remained low. As our patients generally experienced significant postoperative pain relief regardless of preoperative CSI response, further work is warranted to identify those less likely to benefit from surgery.

This study evaluates the efficacy of administering platelet-rich plasma (PRP) compared to hyaluronic acid (HA) for pain management hip osteoarthritis (OA) secondary to developmental dysplasia of the hip (DDH). It highlights PRP treatment as a slightly more effective or equivalent treatment for reducing hip pain in such cases. From 2019 to 2021, a double-blind, randomized controlled trial was conducted with 42 patients who consented to participate. They were divided into two groups: one receiving intra-articular PRP injections and the other HA injections. The primary focus of the study was pain relief, measured using the pain-Visual Analogue Scale (VAS) and Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC)-pain scores over a 24-week period. Functionality was assessed as a secondary outcome. The results showed significant pain reduction in both PRP and HA groups compared to their baseline pain levels. Notably, the PRP treatment group exhibited a marginally higher improvement in pain-VAS scores (38.5) than the HA group (18.7; P = .041). However, the difference in WOMAC-pain scores between the groups was not statistically significant (4.3 for PRP vs. 2.9 for HA; P = .245). The Kellgren-Lawrence grade was the only factor significantly associated with the improvement in pain-VAS scores within the PRP group. The study finds that PRP treatment is at least as effective as HA treatment in reducing hip pain for OA secondary to DDH. Treatment with PRP showed notably better pain-VAS scores compared to HA, highlighting its potential. Therefore, intra-articular PRP injections are a viable alternative to HA for effectively reducing pain in OA secondary to DDH.

The main aim of this study was to analyze correlations between individual international hip outcome tool 12 (iHOT-12) items and overall iHOT-12 score within and across timepoints. A retrospective multicenter hip arthroscopy registry was queried for patients from January 2014 to October 2023 with completed iHOT-12 reports. Pearson coefficient analysis was used to identify correlations between individual iHOT-12 items and overall iHOT-12 score at each timepoint and between preoperative individual iHOT-12 items and postoperative overall iHOT-12 scores. Validity, reliability, and responsiveness of the iHOT-12 were analyzed at each timepoint. Within timepoints, correlations ranged in strength from fair (preoperative maintain fitness level, r = 0.52, P < .00001) to excellent (5-year hip pain after activity, r = 0.93, P < .00001). Correlations increased in strength over time. Across timepoints, correlations ranged in strength from no correlation (2-year maintain fitness level, r = -0.001, P = 0.94) to poor (6-month pushing or lifting heavy objects, r = 0.31, P < .00001). Correlations decreased in strength over time. No ceiling or floor effects were exhibited. The Cronbach alpha for the baseline, 6-month, 1-year, 2-year, and 5-year timepoints were 0.87, 0.96, 0.95, 0.96, and 0.97, respectively. Cohen's d values at 6 months, 1 year, 2 years, and 5 years were 1.19, 1.43, 1.71, and 1.58, respectively. Within timepoints, hip pain after activity had the strongest correlations to overall iHOT-12 score. Across timepoints, correlations between preoperative individual iHOT-12 items and postoperative overall iHOT-12 score were poor and weakened over time, suggesting similar long-term postoperative iHOT-12 scores among both high- and low-scoring preoperative patients. The iHOT-12 demonstrated good validity, reliability, and responsiveness at all timepoints.

Sufficient hip distraction is crucial for the assessment of the central compartment in hip arthroscopic surgery. The aim of this study was to identify the risk factors linked to insufficient hip distraction during hip arthroscopic surgery. We hypothesized that the presence of pincer- or mixed-type femoroacetabular impingement (FAI) could hinder effective hip distraction during the procedure. Inclusion criteria included indication for hip arthroscopy, and persistent symptoms that have not responded to extensive conservative treatment, such as activity adjustments and physical therapy over a period of 6-12 weeks. The enrollment period spanned from January 2003 to May 2021. Data on age, sex, diagnosis of FAI, body mass index, body height, body weight, lateral center-edge angle (LCEA), hip joint space, Tönnis grading, and Beighton score were collected. Among the cases, 34 had insufficient hip distraction while 643 did not. Crude odds ratio analysis revealed that male gender, body height, increased LCEA, the presence of pincer- or mixed-type FAI, and a lower Beighton score were associated with a higher risk of insufficient distraction. Further analyses confirmed that only FAI, sex, and Beighton score remained significant predictors of risk. Adjusted odds ratios indicated a strong association with pincer- or mixed-type FAI. The presence of pincer- or mixed-type FAI is identified as a risk factor for insufficient hip distraction during hip arthroscopic surgery. In high-risk patients, adopting a peripheral compartment approach initially and avoiding hip traction can help prevent traction-related complications.

Variations in the femoral version are increasingly recognized as a cause of coxalgia due to impingement or instability. The true prevalence of these variations remains unknown. The authors report a case of bilateral ischiofemoral impingement (IFI) caused by excessive femoral anteversion treated with a subtrochanteric femoral derotational osteotomy and long intramedullary nailing. We report the case of a 22-year-old female patient with deep left hip pain, consistent with IFI, refractory to conservative treatment. Imaging revealed an ischiofemoral space (IFS) of 16 mm and a femoral anteversion of 34°. A subtrochanteric femoral derotational osteotomy stabilized with a long intramedullary nail was performed. At 18 months, the same surgical procedure was performed due to similar symptoms on the right side, with an IFS of 14 mm and femoral anteversion of 35°. Joint mobility was restored bilaterally, and the symptoms were resolved. Lesser trochanter resection has been reported as a surgical option for IFI in small case series. While conventional subtrochanteric femoral derotational osteotomy with plate fixation shows good functional outcomes, pseudarthrosis remains a concern. The authors' minimally invasive technique using the backstroke technique for osteotomy site compression helps prevent this complication while preserving the iliopsoas insertion. In this case study, a subtrochanteric femoral derotational osteotomy effectively treated bilateral IFI associated with increased femoral anteversion. The patient achieved excellent clinical outcomes with complete symptom resolution following successful consolidation of both osteotomies, though subsequent implant removal was performed to facilitate potential future surgeries.

Osteonecrosis of the femoral head (ONFH) often leads to femoral head collapse, which makes joint preservation challenging. Although curved varus osteotomy (CVO) is an effective surgical method for joint preservation in young ONFH patients, there are some cases where it cannot prevent femoral head collapse. This research aims to evaluate the usefulness of teriparatide (TPD) in bone healing and preventing femoral head collapse in CVO-treated ONFH patients. This retrospective study included 48 patients (56 hips) diagnosed with ONFH, categorized into three groups: glucocorticoid-associated ONFH with TPD treatment (GCs + TPD), glucocorticoid-associated ONFH (GCs), and alcohol- associated ONFH (Alc). No significant differences were found in terms of surgical details, stage, conversion to total hip arthroplasty (THA), and clinical scores. The GCs + TPD group showed a shorter bone union duration, reduced femoral head collapse, and a lower incidence of advanced collapse than the other groups. Lower BMI and TPD use were associated with a shorter duration of bone union. TPD and union duration were identified as factors contributing to the advanced collapse. In conclusion, TPD administration accelerates bone union at the osteotomy site and mitigates femoral head collapse after joint-preserving osteotomy. In addition, combining TPD with CVO may be a promising strategy for younger patients.

Iatrogenic femoroacetabular impingement following periacetabular osteotomy (PAO) is a well-documented cause of postoperative complications. The anterior inferior iliac spine (AIIS) is an increasingly recognized source of impingement, and previous studies have documented high rates of abnormal AIIS subtypes in dysplastic hips undergoing PAO. This study evaluates the effects of PAO with concomitant AIIS osteoplasty on a range of motion and function. We performed a retrospective study of 63 hips that underwent PAO with concomitant open AIIS osteoplasty. AIIS was classified using 3D-reconstruction Computed tomography (CT) and femoral version was measured on axial-CT. Pre- and post.-operative lateral center-edge angle, Tönnis-angle, and anterior center-edge angle were calculated using X-ray imaging. Hip internal rotation (IR) at 90° flexion was recorded preoperatively, intraoperatively following PAO (pre- and postosteoplasty), and 6 months postoperatively. Pre- and postoperative Merle-d'Aubigné (MDA) scores were compared using pairwise t-test. IR motion changes were compared using repeated measures analysis of variance. Regression analyses evaluated the impact of femoral version on IR before and after osteoplasty. MDA significantly improved postoperatively. Intraoperative IR prior to AIIS osteoplasty was significantly reduced compared to other timepoints, but addition of the osteoplasty improved IR intraoperatively and 6 months postoperatively. No differences were noted in IR between pre- and postoperative examination. The impact of IR restoration with AIIS osteoplasty correlated significantly with femoral version, with greater motion improvement noted in patients with lower version. When planning PAO, careful appreciation of motion parameters is critical. Regardless of AIIS morphology, consideration of an intraoperative AIIS osteoplasty should occur when IR is decreased following acetabular reorientation.

The alpha angle is a radiological measurement that has been proposed for the detection of cam morphology in patients suspected of femoroacetabular impingement syndrome (FAIS). After analysing published articles on FAIS, it is apparent that different types of circles are used in the measurement of alpha angles. To determine the interobserver and intraobserver reliability of alpha angle values measured using different types of circles on a 45° Dunn lateral radiograph in patients with symptomatic FAIS. The 45° Dunn lateral radiographs of the operated hips of patients who underwent hip preservation surgery in Dokuz Eylül University Hospital between 2014 and 2017 were evaluated retrospectively. Alpha angles were measured manually with transparent goniometers using three different circle types: thin full circle, thin-dashed circle, and thick full circle, and eye estimation without circle insertion. Measurements were made separately by an orthopaedist and a radiologist. A second measurement was made by the radiologist 1 month later for intraobserver reliability. Interobserver reliability for the thin full circle, thin-dashed circle, thick circle, and eye estimation (ICC = 0.645, 0.525, 0.494, and 0.588, respectively). Intraobserver reliability for the thin, thin-dashed, thick line, and eye estimation (ICC= 0.626, 0.681, 0.681, and 0.462 respectively). Interobserver difference of mean values of alpha angles for thin full, thin-dashed, thick full, and eye estimation were 2.7°, 0.9°, 1.1°, and 2.3°, respectively. Intraobserver differences between measurements were 1.5°, 0.9°, 0°, and 1.6°, respectively. Our study demonstrated that interobserver reliability is highest when measurements are made using a thin full circle.

Understanding the minimal clinically important difference (MCID) for a given procedure and its associated patient-reported outcome measures (PROMs) are critical for evaluating success in orthopedic surgery. The MCIDs for the International Hip Outcome Tool (iHOT-33) and Modified Harris Hip Score (mHHS) have been defined for open proximal hamstring repair (OPHR); however, the speed and reliability at which patients achieve these are unknown. A retrospective review of prospectively collected data from our institution's hip preservation registry was performed, examining pre-operative and 6-, 12-, and 24 months post-operative mHHS and iHOT-33 scores. The percentage of patients achieving MCID at each time point was determined, and factors associated with achieving MCID were assessed. A total of 37 patients were included in this analysis (n = 36 for iHOT-33 and n = 32 for mHHS). At 6 months, 83% and 78% of patients achieved MCID for iHOT-33 and mHHS, respectively. Patients with chronic symptoms (pain >6 months) were significantly less likely to achieve at least one of the MCIDs at 6 months (60% vs. 12.5%, P = .04), while patients with more severe preoperative pain were significantly more likely to achieve at least one of the MCIDs at 6 months (P = .004). Most patients who achieve the MCID for iHOT-33 and mHHS following OPHR do so by 6 months postoperatively. Chronic symptoms were associated with failure to achieve either one of the MCIDs at 6 months post-operatively. Patients with more severe preoperative pain were more likely to successfully achieve one of the MCIDs at 6 months.