Journal of Hip Preservation Surgery最新文献

Femoroacetabular impingement syndrome (FAIS) is a motion-related condition causing hip pain in young active adults. Physical impairment measures of body function include objective and reproducible measures of hip mobility, muscle power, and movement coordination. Limited data on physical impairments and the effects of arthroscopic surgery exist. The aim of this systematic review was to investigate changes in physical impairments in those with FAIS, pre- and post-arthroscopic surgery. Six databases were searched for English-language studies reporting on pre- and postoperative physical impairments using physical outcome measures. Reporting quality was assessed using the Grading of Recommendations Assessment, Development and Evaluations (GRADE) framework, the Cochrane Risk of Bias tools and Methodological Index for Non-Randomized Studies (MINORS); for pooled data [standardized mean difference (SMD), and 95% confidence intervals (CI)]. Seventeen studies were included (two randomized controlled trials; fifteen pre/postintervention studies), varying from low-critical risk of bias, low-moderate on the MINORS, and very low reporting quality using the GRADE tool. Postoperatively, participants with FAIS walked with a higher peak hip flexion moment [SMD 0.5, 95% CI (0.12-0.88); heterogeneity I ² = 0%, P = .82] and reduced external rotation range [SMD -0.68, 95% CI (-1.34 to -0.01); heterogeneity I ² = 61%, P = .05]. Surgery increased participant hip flexion moment and impulse, hip strength and faster gluteus maximus contraction time. Patients demonstrated reduced hip extension, abduction and adduction angles during walking gait, and peak hip extension moments during gait and squatting. While this review found some physical impairments changed postoperatively, further research into specific subgroups of FAIS would enhance understanding and inform rehabilitation programs and optimize patient outcomes. Level of Evidence: IV (systematic review of III and IV evidence).

Hip dysplasia causes pathologic joint mechanics and can produce hip instability, leading to progressive joint degeneration and osteoarthritis. Weight-bearing computed tomography (WBCT) is an emerging technology that may enable quantification of femoral-acetabular displacement as an objective indicator of instability. To evaluate this potential, 10 patients indicated for periacetabular osteotomy to treat hip dysplasia and 10 healthy controls underwent two WBCT protocols. Participants were scanned in a neutral stance [weight-bearing (WB)] and again with the hip stressed in maximal external rotation (WB-stress), a position hypothesized to reproduce anterior instability. Clinical, nonweight-bearing computed tomography (CT) scans were available for patients with hip dysplasia. Congruency of the femoroacetabular joint space and position of the femoral head in the acetabulum were quantified via multiple 2D manual measurements and automated 3D measurements. There were no 2D measurements found to differ between the WB and WB-stress scans in either dysplastic (P = .742-1.000) or control (P = .203-1.000) hips. 3D translation of the femoral head center from WB to WB-stress averaged 1.3 ± 0.6 mm in the control hips, compared to 0.9 ± 0.4 mm in the dysplastic hips (P = .096). 3D joint space width (JSW) was determined for both the control and dysplastic hips, with greater JSW found in control hips for both the WB (P = .049) and WB-stress (P = .003) scans. WBCT has the potential to better capture subtle femoral-acetabular displacement derived from both automated 3D and manual 2D measurements in static instability-prone joint orientations.

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 ….

In evaluations of a cam deformity on femoroacetabular impingement, the head-neck junction (HNJ) must be accurately assessed. We conducted this study to determine the ability of plain radiography to visualize the end-to-end bone surface of the HNJ. We used six human bone models. Ten examiners evaluated the degree to which attached stainless wire marker at the 1:00, 1:30, and 2:00 radial plane defined in reconstructed computed tomography can be accurately detected on the bone surface on plain radiographies. We employed 13 plain radiographies: the cross-table lateral view, frog-leg lateral view, Espié frog-leg lateral view, false-profile view, modified false-profile view, 30° Dunn view (DV), 45° DV, 60° DV, 90° DV, 30° modified Dunn view (MDV), 45° MDV, 60° MDV, and 90° MDV. Examiners scored the degree to which the radiographic images accurately detected the stainless wire marker on the bone surface of the HNJ on a scale of 1 point (0% match) to 5 points (almost 100% match). The highest score for the 1:00 plane was 4.98 points on the 45° DV. Similarly, the highest scores of the 1:30 and 2:00 planes were 4.98 points for the 45° MDV and 4.68 points for the 90° MDV, respectively. On these bone model studies, the most suitable plain radiography for describing the HNJ at the 1:00, 1:30, and 2:00 planes were both the 45° DV, the 45° MDV, and the 90° MDV, respectively.

Overnight admission is a rare but major complication after hip arthroscopy (HA), and the paucity of data surrounding its causes limits patient education and quality of care. The purpose of this study was to identify risk factors for an unanticipated overnight admission after HA and assess for associated complications. This analysis queried the American College of Surgeons National Surgical Quality Improvement Program database using Current Procedural Terminology codes to identify hip arthroscopies from 2005 to 2017. Patient demographics, perioperative variables, and comorbidities were compared between ambulatory and nonambulatory patients [length of stay (LOS) ≥ 1] using bivariate analysis. Multivariate stepwise logistic regression then identified independent risk factors of adverse outcomes. Linear regression analyzed correlation of LOS with age, operative time, modified fragility index (mFI-5), and year of operation. A total of 2420 cases were included in this study with 400 (16.5%) overnight admissions. The mean subject age was 40 ± 13.9 years old (58.1% female). Admitted patients generally had higher American Society of Anesthesiologists (ASA) scores and a higher mFI-5 index. Multivariate logistic regression showed that mFI-5 > 0, bleeding disorders, operative time >1.5 h, and nongeneral anesthesia were independent risk factors for prolonged hospital stay. Patients aged 31-40 years had decreased risk of LOS ≥1. Nonambulatory surgery was associated with significantly increased risk for any complication, readmission, wound complication, and venous thromboembolism. This analysis demonstrates that operations >1.5 h and increased medical comorbidities predispose patients to greater risk of being admitted to the hospital after HA. Surgeons should consider these data to optimize controllable factors and patient selection to reduce the risk of postoperative admission.

The aim of this study was to evaluate the bilateral changes in hip muscle strength after a 6-month rehabilitation period for patients undergoing surgical hip dislocation (SHD) to treat femoroacetabular impingement syndrome (FAIS). We conducted a retrospective analysis on a cohort of 22 patients (mean ± SD age: 26 ± 7, 68% male) who underwent SHD for FAIS between March 2020 and January 2023 at La Tour Hospital. Bilateral isometric strength of eight hip muscle groups (abductors, adductors, hamstrings, quadriceps, extensors, flexors, internal, and external rotators) was assessed using a handheld dynamometer before surgery, and at 3 and 6 months postoperatively. After 6 months of rehabilitation, only the external rotators were weaker compared to preoperative levels (-13% ± 23%, P = .021). Strength levels were similar to preoperative levelsfor adductors (-2% ± 21%, P = .309), internal rotators (0% ± 25%, P = .444), quadriceps (0%± 23%, P = .501), hamstrings (7%± 20%, P = .232), extensors (7%± 19%, P = .336), flexors (8%± 34%, P = .781), and abductors (8% ± 25%, P = .266). At 6 months, 59% (abductors) to 82% (adductors) of patients did not achieve a clinically relevant strength improvement (>15%) compared to their preoperative status for aforementioned muscles. Additionally, 50% of the cohort experienced a clinically relevant loss of strength in the external rotators at 6 months post-surgery. To conclude, after SHD, most FAIS patients regained their preoperative strength for all muscle groups except the external rotators with a 6-month rehabilitation program. However, the effectiveness of the rehabilitation protocol varies on an individual level.

This study compared outcomes of periacetabular osteotomy (PAO) with and without femoral osteochondroplasty (OCP) in treating symptomatic acetabular dysplasia through propensity score matching. Data from a prospective multicenter cohort of patients undergoing PAO from 2007 to 2014 were analyzed. Inclusion criteria were a lateral center edge angle <25°. The exclusion criteria were history of previous procedure and age >45 years. A 2- to 5-year follow-up interval was utilized; patients outside this follow-up window were excluded. Propensity matching variables included sex, baseline hip internal rotation at 90° flexion, preoperative alpha angle, lateral center edge angle, modified Harris Hip score (mHHS), and arthroscopy at the time of surgery. Propensity scores were calculated using logistic regression with treatment as the dependent variable. Clinical failure was defined as failure to meet the minimal clinically important difference and patient acceptable symptom state for mHHS or a need for reoperation. There were 219 patients that met the inclusion criteria. Of these, 116 patients were matched, representing 58 pairs (PAO/OCP = 58; PAO without OCP = 58). Preoperative functional scores were similar between groups. At mean 4.1 years follow-up, there were no significant differences in the rates of clinical failure or reoperation between the two groups [PAO/OCP = 13 (22%), PAO without OCP = 8 (14%); P = .23] Similarly, the final mHHS was 83.2 ± 16.2 for the PAO/OCP group and 84.1 ± 15.9 for the isolated PAO group, with no significant difference (P = .74). In the treatment of symptomatic acetabular dysplasia, isolated PAO is noninferior to combined PAO/OCP at short-term follow-up in patients who are likely to be treated by either method.

Present recommendations in the literature advocate for a return to sport (RTS) between 5- and 10 months following hip arthroscopy for femoroacetabular impingement (FAI). We have adopted the International Society of Hip Preservation protocol with modifications for the rehabilitation of our patients. The aim of the present study was to examine the time to RTS with this rehabilitation approach after hip arthroscopy for FAI. It was hypothesized that most athletes will RTS by 5 months post-surgery without any adverse effects. Patients undergoing hip arthroscopy for FAI were prospectively followed with preoperative and postoperative Patient Reported Outcome Measures including: Modified Harris Hip Score (mHHS) and Copenhagen Hip and Groin Outcome Score (HAGOS). Preinjury sports and competition level, postoperative RTS rate, time, and level, complications, and revision surgeries were recorded. A total of 56 patients were identified for inclusion (36.6 ± 14.1 years old at date of surgery, 34 females and 22 males). There were 35 recreational athletes and 21 competitive-level athletes (10 in high-demand sports and 11 in moderate-demand sports). In all, 44 patients (79%) returned to sport at 5.3 ± 3.5 months postoperatively. Of the 12 patients who did not RTS, 5 (42%) did not return for reasons other than their hip. Neither HAGOS (P = .458) nor mHHS (P = .424) differed between athletes with RTS in ≤ 5 months (HAGOS: 80.4 ± 22.3; mHSS: 88.0 ± 17.7) versus >5 months (HAGOS: 84.6 ± 11.8; mHSS: 91.5 ± 8.7). The current study demonstrates that accelerated rehabilitation after hip arthroscopy for FAI can safely return athletes to sport within 6 months.

Deep learning is revolutionizing medical imaging analysis by enabling the classification of various pathoanatomical conditions at scale. Unfortunately, there have been a limited number of accurate and efficient machine learning (ML) algorithms that have been developed for the diagnostic workup of morphological hip pathologies, including developmental dysplasia of the hip and femoroacetabular impingement. The current study reports on the performance of a novel ML model with YOLOv5 and ConvNeXt-Tiny architecture in predicting the morphological features of these conditions, including cam deformity, ischial spine sign, dysplastic appearance, and other abnormalities. The model achieved 78.0% accuracy for detecting cam deformity, 87.2% for ischial spine sign, 76.6% for dysplasia, and 71.6% for all abnormalities combined. The model achieved an Area under the Receiver Operating Curve of 0.89 for ischial spine sign, 0.80 for cam deformity, 0.80 for dysplasia, and 0.81 for all abnormalities combined. Inter-rater agreement among surgeons, assessed using Gwet's AC1, was substantial for dysplasia (0.83) and all abnormalities (0.88), and moderate for ischial spine sign (0.75) and cam deformity (0.61).