ABSTRACT In severe, stable slipped capital femoral epiphysis, it is unclear whether pinning in situ (PIS) or capital realignment procedures (CRPs) are superior. Our primary aim was to compare patient-reported outcome measures (PROMs) following each strategy. Secondary aims were to compare rates of femoral head avascular necrosis (AVN) and complications. MEDLINE, Embase and Cochrane databases were searched according to an agreed strategy. Narrative review articles, case reports, letters to the editor and articles not written in English were excluded. The risk of bias was assessed using the Newcastle–Ottawa Scale. Of the 132 citations identified, 127 were excluded following de-duplication and application of the exclusion criteria. Three observational studies comparing PIS with CRP and two case series considering CRP alone were identified. One article was considered fair quality, and four articles were considered poor. In total, 198 hips from five studies were included (66 PIS, 132 CRP). PIS was associated with moderate-good functional outcomes, and CRP with good-high outcomes. Two comparative studies reported significantly better PROMs following CRP. AVN was reported in 1.5% following PIS and 10.6% following CRP. Regarding other complications, chondrolysis occurred in 3.0% following PIS and 2.4% following CRP. Femoroacetabular impingement rates were markedly higher following PIS (60.6% versus 2.3%). Reoperation rates were also greater following PIS (34.5% versus 13.3%). PIS tends to be associated with favourable AVN rates, but CRP with favourable PROMs and complication rates. However, comparisons were drawn from heterogeneous studies lacking long-term follow-up. Further high-quality research is required.
对于严重、稳定的股骨骨骺脱位，目前尚不清楚原位钉钉(PIS)和骨骺复位(CRPs)孰优孰优。我们的主要目的是比较每种策略下患者报告的结果测量(PROMs)。次要目的是比较股骨头缺血性坏死(AVN)和并发症的发生率。按照商定的策略检索MEDLINE、Embase和Cochrane数据库。记叙性评论文章、病例报告、给编辑的信件和非英文的文章被排除在外。偏倚风险采用纽卡斯尔-渥太华量表进行评估。在查明的132条引文中，127条在重复删除和适用排除标准后被排除。三个比较PIS与CRP的观察性研究和两个单独考虑CRP的病例系列被确定。一篇文章被认为质量一般，四篇文章被认为质量差。总共纳入了来自5项研究的198例髋关节(66例PIS, 132例CRP)。PIS与中优功能预后相关，CRP与优高预后相关。两项比较研究报告CRP治疗后PROMs明显改善。PIS患者中AVN占1.5%，CRP患者中AVN占10.6%。至于其他并发症，PIS组3.0%发生软骨溶解，CRP组2.4%。股骨髋臼撞击率明显高于PIS (60.6% vs 2.3%)。PIS术后再手术率也更高(34.5%比13.3%)。PIS倾向于与有利的AVN率相关，但CRP与有利的PROMs和并发症发生率相关。然而，比较来自缺乏长期随访的异质研究。需要进一步的高质量研究。
{"title":"Comparing pinning <i>in situ</i> and capital realignment procedures for severe, stable slipped capital femoral epiphysis: a systematic review","authors":"Grace E M Kennedy, Jack Pullan, Ahmed El-Bakoury","doi":"10.1093/jhps/hnad032","DOIUrl":"https://doi.org/10.1093/jhps/hnad032","url":null,"abstract":"ABSTRACT In severe, stable slipped capital femoral epiphysis, it is unclear whether pinning in situ (PIS) or capital realignment procedures (CRPs) are superior. Our primary aim was to compare patient-reported outcome measures (PROMs) following each strategy. Secondary aims were to compare rates of femoral head avascular necrosis (AVN) and complications. MEDLINE, Embase and Cochrane databases were searched according to an agreed strategy. Narrative review articles, case reports, letters to the editor and articles not written in English were excluded. The risk of bias was assessed using the Newcastle–Ottawa Scale. Of the 132 citations identified, 127 were excluded following de-duplication and application of the exclusion criteria. Three observational studies comparing PIS with CRP and two case series considering CRP alone were identified. One article was considered fair quality, and four articles were considered poor. In total, 198 hips from five studies were included (66 PIS, 132 CRP). PIS was associated with moderate-good functional outcomes, and CRP with good-high outcomes. Two comparative studies reported significantly better PROMs following CRP. AVN was reported in 1.5% following PIS and 10.6% following CRP. Regarding other complications, chondrolysis occurred in 3.0% following PIS and 2.4% following CRP. Femoroacetabular impingement rates were markedly higher following PIS (60.6% versus 2.3%). Reoperation rates were also greater following PIS (34.5% versus 13.3%). PIS tends to be associated with favourable AVN rates, but CRP with favourable PROMs and complication rates. However, comparisons were drawn from heterogeneous studies lacking long-term follow-up. Further high-quality research is required.","PeriodicalId":48583,"journal":{"name":"Journal of Hip Preservation Surgery","volume":"98 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-09-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135425444","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Jeroen C F Verhaegen, Emin Süha Dedeoğulları, Isabel S Horton, Paul E Beaulé, George Grammatopoulos
ABSTRACT Change in pelvic tilt (PT) during and after peri-acetabular osteotomy (PAO) is important for surgical planning. The aims of this study were to (i) determine how PT varies throughout the course of treatment in patients undergoing PAO, (ii) test what factors influence the change in PT and (iii) assess whether changes in PT influenced achieved correction. This is an retrospective, single-centre, consecutive case series of 111 patients treated with PAO for global (n = 79), posterior (n = 49) or anterior dysplasia (n = 6) (mean age: 27.3 ± 7.7 years; 85% females). PT was determined on supine, anteroposterior pelvic radiographs pre-, intra-, 1 day, 6 weeks and 1 year post-operatively, using the sacro-femoral-pubic (SFP) angle, a validated, surrogate marker of PT. An optimal acetabular correction was based on the lateral centre-edge angle (25°–40°), acetabular index (−5° to 10°) and cross-over ratio (<20%). There was a significant difference across pre- (70.1° ± 4.8°), 1-day (71.7° ± 4.3°; P < 0.001) and early post-operative SFP (70.6° ± 4.7°; P = 0.004). The difference in SPF between pre-operative and 1-year post-operative was −0.5° ± 3.1° (P = 0.043), with 9% of cases having a difference of >5°. The difference in SFP did not correlate with age, sex, body mass index, type of dysplasia or achievement of optimal acetabular correction (P = 0.1–0.9). In the early post-operative period, PT is reduced, leading to a relative appearance of acetabular retroversion, which gradually corrects and is restored by annual follow-up. The degree of change in PT during PAO did not adversely affect fragment orientation. PT does not significantly change in most patients undergoing PAO and therefore does not appear to be a compensatory mechanism.
{"title":"Does pelvic tilt change with a peri-acetabular osteotomy?","authors":"Jeroen C F Verhaegen, Emin Süha Dedeoğulları, Isabel S Horton, Paul E Beaulé, George Grammatopoulos","doi":"10.1093/jhps/hnad029","DOIUrl":"https://doi.org/10.1093/jhps/hnad029","url":null,"abstract":"ABSTRACT Change in pelvic tilt (PT) during and after peri-acetabular osteotomy (PAO) is important for surgical planning. The aims of this study were to (i) determine how PT varies throughout the course of treatment in patients undergoing PAO, (ii) test what factors influence the change in PT and (iii) assess whether changes in PT influenced achieved correction. This is an retrospective, single-centre, consecutive case series of 111 patients treated with PAO for global (n = 79), posterior (n = 49) or anterior dysplasia (n = 6) (mean age: 27.3 ± 7.7 years; 85% females). PT was determined on supine, anteroposterior pelvic radiographs pre-, intra-, 1 day, 6 weeks and 1 year post-operatively, using the sacro-femoral-pubic (SFP) angle, a validated, surrogate marker of PT. An optimal acetabular correction was based on the lateral centre-edge angle (25°–40°), acetabular index (−5° to 10°) and cross-over ratio (&lt;20%). There was a significant difference across pre- (70.1° ± 4.8°), 1-day (71.7° ± 4.3°; P &lt; 0.001) and early post-operative SFP (70.6° ± 4.7°; P = 0.004). The difference in SPF between pre-operative and 1-year post-operative was −0.5° ± 3.1° (P = 0.043), with 9% of cases having a difference of &gt;5°. The difference in SFP did not correlate with age, sex, body mass index, type of dysplasia or achievement of optimal acetabular correction (P = 0.1–0.9). In the early post-operative period, PT is reduced, leading to a relative appearance of acetabular retroversion, which gradually corrects and is restored by annual follow-up. The degree of change in PT during PAO did not adversely affect fragment orientation. PT does not significantly change in most patients undergoing PAO and therefore does not appear to be a compensatory mechanism.","PeriodicalId":48583,"journal":{"name":"Journal of Hip Preservation Surgery","volume":"5 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-09-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"136107779","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Heath P Melugin, Spencer M Comfort, Trevor S Shelton, Hannah K Day, Joseph J Ruzbarsky, Grant J Dornan, Marc J Philippon
ABSTRACT To evaluate the patient-reported outcomes (PROs) and survivorship of combined arthroscopic hip labral reconstruction/augmentation, capsular reconstruction, femoral neck remplissage and lysis of adhesions. Patients ≥18 years old who underwent this combination of procedures during revision hip arthroscopy and were eligible for minimum 2-year follow-up were identified. PRO scores including Hip Outcome Score (HOS)-Activities of Daily Living scale, HOS-Sports scale, modified Harris Hip Score, Short Form 12, and Western Ontario & McMaster Universities Osteoarthritis Index, patient satisfaction and failure rates were analyzed. Seven patients (5 females and 2 males) with average age of 45.0 ± 5.2 (range: 40–54 years) met inclusion criteria. Patients had a median of 1 (range: 1–3) prior hip surgery at an outside institution. All patients had previously undergone femoral osteoplasty, and 85% (6/7) of patients had a labral repair performed. Four patients had no capsule closure performed in their prior procedures. Six patients were available for minimum 2-year follow-up. Two patients converted to total hip arthroplasty: one patient with four prior hip arthroscopies and the other had advanced osteoarthritis with outerbridge grade 3/4 defects requiring microfracture. Mean patient satisfaction was 7 (range: 2–9). At mean follow-up of 3 years, most patients who underwent the combination of labral reconstruction, capsular reconstruction, femoral neck remplissage and lysis of adhesions during revision hip arthroscopy demonstrated improved PROs. This salvage procedure has the potential to restore hip function in patients who have failed an initial hip arthroscopy procedure. In patients with these pathologies present and concomitant joint space narrowing, a total hip arthroplasty may be a more appropriate salvage option.
{"title":"The revision hip arthroscopy complex: capsular deficiency, labral deficiency, femoral over-resection and adhesions can result in good survivorship with revision hip arthroscopy","authors":"Heath P Melugin, Spencer M Comfort, Trevor S Shelton, Hannah K Day, Joseph J Ruzbarsky, Grant J Dornan, Marc J Philippon","doi":"10.1093/jhps/hnad026","DOIUrl":"https://doi.org/10.1093/jhps/hnad026","url":null,"abstract":"ABSTRACT To evaluate the patient-reported outcomes (PROs) and survivorship of combined arthroscopic hip labral reconstruction/augmentation, capsular reconstruction, femoral neck remplissage and lysis of adhesions. Patients ≥18 years old who underwent this combination of procedures during revision hip arthroscopy and were eligible for minimum 2-year follow-up were identified. PRO scores including Hip Outcome Score (HOS)-Activities of Daily Living scale, HOS-Sports scale, modified Harris Hip Score, Short Form 12, and Western Ontario & McMaster Universities Osteoarthritis Index, patient satisfaction and failure rates were analyzed. Seven patients (5 females and 2 males) with average age of 45.0 ± 5.2 (range: 40–54 years) met inclusion criteria. Patients had a median of 1 (range: 1–3) prior hip surgery at an outside institution. All patients had previously undergone femoral osteoplasty, and 85% (6/7) of patients had a labral repair performed. Four patients had no capsule closure performed in their prior procedures. Six patients were available for minimum 2-year follow-up. Two patients converted to total hip arthroplasty: one patient with four prior hip arthroscopies and the other had advanced osteoarthritis with outerbridge grade 3/4 defects requiring microfracture. Mean patient satisfaction was 7 (range: 2–9). At mean follow-up of 3 years, most patients who underwent the combination of labral reconstruction, capsular reconstruction, femoral neck remplissage and lysis of adhesions during revision hip arthroscopy demonstrated improved PROs. This salvage procedure has the potential to restore hip function in patients who have failed an initial hip arthroscopy procedure. In patients with these pathologies present and concomitant joint space narrowing, a total hip arthroplasty may be a more appropriate salvage option.","PeriodicalId":48583,"journal":{"name":"Journal of Hip Preservation Surgery","volume":"75 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-09-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"136191953","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Alexander F Heimann, Iris F Brouze, Guoyan Zheng, Angela M Moosmann, Joseph M Schwab, Moritz Tannast, Corinne A Zurmühle
ABSTRACT Patients with developmental dysplasia of the hip (DDH) are believed to present with increased anterior pelvic tilt to compensate for reduced anterior femoral head coverage. If true, pelvic tilt in dysplastic patients should be high preoperatively and decrease after correction with periacetabular osteotomy (PAO). To date, the evolution of pelvic tilt in long-term follow-up after PAO has not been reported. We therefore asked the following questions: (i) is there a difference in pelvic tilt between patients with DDH and an asymptomatic control group? (ii) How does pelvic tilt evolve during long-term follow-up after Bernese PAO compared with before surgery? This study is a therapeutic study with the level of evidence III. We retrospectively compared preoperative pelvic tilt in 64 dysplastic patients (71 hips) with an asymptomatic control group of 20 patients (20 hips). In addition, immediate postoperative and long-term follow-up (at 18 ± 8 [range 7–34 years) pelvic tilt was assessed and compared. Dysplastic patients had a significantly higher mean preoperative pelvic tilt than controls [2.3 ± 5.3° (−11.2° to 16.4°) versus 1.1 ± 3.0° (−4.9 to 5.9), P = 0.006]. Mean pelvic tilt postoperatively was 1.5 ± 5.3° (−11.2 to 17.0º, P = 0.221) and at long-term follow-up was 0.4 ± 5.7° (range −9.9° to 20.9°, P = 0.002). Dysplastic hips undergoing PAO show a statistically significant decrease in pelvic tilt during long-term follow-up. However, given the large interindividual variability in pelvic tilt, the observed differences may not achieve clinical significance.
{"title":"Pelvic tilt after Bernese periacetabular osteotomy—a long-term follow-up study","authors":"Alexander F Heimann, Iris F Brouze, Guoyan Zheng, Angela M Moosmann, Joseph M Schwab, Moritz Tannast, Corinne A Zurmühle","doi":"10.1093/jhps/hnad030","DOIUrl":"https://doi.org/10.1093/jhps/hnad030","url":null,"abstract":"ABSTRACT Patients with developmental dysplasia of the hip (DDH) are believed to present with increased anterior pelvic tilt to compensate for reduced anterior femoral head coverage. If true, pelvic tilt in dysplastic patients should be high preoperatively and decrease after correction with periacetabular osteotomy (PAO). To date, the evolution of pelvic tilt in long-term follow-up after PAO has not been reported. We therefore asked the following questions: (i) is there a difference in pelvic tilt between patients with DDH and an asymptomatic control group? (ii) How does pelvic tilt evolve during long-term follow-up after Bernese PAO compared with before surgery? This study is a therapeutic study with the level of evidence III. We retrospectively compared preoperative pelvic tilt in 64 dysplastic patients (71 hips) with an asymptomatic control group of 20 patients (20 hips). In addition, immediate postoperative and long-term follow-up (at 18 ± 8 [range 7–34 years) pelvic tilt was assessed and compared. Dysplastic patients had a significantly higher mean preoperative pelvic tilt than controls [2.3 ± 5.3° (−11.2° to 16.4°) versus 1.1 ± 3.0° (−4.9 to 5.9), P = 0.006]. Mean pelvic tilt postoperatively was 1.5 ± 5.3° (−11.2 to 17.0º, P = 0.221) and at long-term follow-up was 0.4 ± 5.7° (range −9.9° to 20.9°, P = 0.002). Dysplastic hips undergoing PAO show a statistically significant decrease in pelvic tilt during long-term follow-up. However, given the large interindividual variability in pelvic tilt, the observed differences may not achieve clinical significance.","PeriodicalId":48583,"journal":{"name":"Journal of Hip Preservation Surgery","volume":"16 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-09-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"136107780","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Jacek Mazek, Nader Helmy, Antonio Porthos Salas, Pawel Skowronek, Arkadiusz Madej, John M O´Donnell, Dimitris Dimitriou
ABSTRACT The aim of the present study was to report the in vivo thickness of the cotyloid fossa at the acetabular ligamentum teres (LT) attachment and investigate the clearance of the obturator neurovascular bundle. Fifty-five consecutive patients undergoing a total hip arthroplasty for hip osteoarthritis were included. The thickness of the cotyloid fossa was measured at the acetabular LT attachment using a standard depth gauge. The minimal distance (clearance) of the obturator neurovascular bundle to the center of the acetabular LT attachment was measured in 7 patients (14 hips) who also underwent a computed tomography angiography. The average thickness of the cotyloid fossa at the acetabular LT attachment was 4.1 ± 2.3 (range: 1–10) mm. The obturator vein was closest to the acetabular LT attachment, but the clearance was more than the defined safe zone of 15 mm in all cases. Based on the current findings, it can be assumed that bone anchors might not be suitable for fixation of the graft in LT reconstruction (LTR) and an alternative implant such as a cortical button should be considered. Acetabular fixation of the graft with a 12-mm cortical button is relatively safe concerning injury to obturator neurovascular structures. The results of the present study provide a better understanding of the cotyloid fossa anatomy and might be relevant for surgeons who perform arthroscopic LTR.
{"title":"Quantitative cotyloid fossa thickness and proximity to obturator neurovascular bundle: implications for arthroscopic ligamentum teres reconstruction","authors":"Jacek Mazek, Nader Helmy, Antonio Porthos Salas, Pawel Skowronek, Arkadiusz Madej, John M O´Donnell, Dimitris Dimitriou","doi":"10.1093/jhps/hnad020","DOIUrl":"https://doi.org/10.1093/jhps/hnad020","url":null,"abstract":"ABSTRACT The aim of the present study was to report the in vivo thickness of the cotyloid fossa at the acetabular ligamentum teres (LT) attachment and investigate the clearance of the obturator neurovascular bundle. Fifty-five consecutive patients undergoing a total hip arthroplasty for hip osteoarthritis were included. The thickness of the cotyloid fossa was measured at the acetabular LT attachment using a standard depth gauge. The minimal distance (clearance) of the obturator neurovascular bundle to the center of the acetabular LT attachment was measured in 7 patients (14 hips) who also underwent a computed tomography angiography. The average thickness of the cotyloid fossa at the acetabular LT attachment was 4.1 ± 2.3 (range: 1–10) mm. The obturator vein was closest to the acetabular LT attachment, but the clearance was more than the defined safe zone of 15 mm in all cases. Based on the current findings, it can be assumed that bone anchors might not be suitable for fixation of the graft in LT reconstruction (LTR) and an alternative implant such as a cortical button should be considered. Acetabular fixation of the graft with a 12-mm cortical button is relatively safe concerning injury to obturator neurovascular structures. The results of the present study provide a better understanding of the cotyloid fossa anatomy and might be relevant for surgeons who perform arthroscopic LTR.","PeriodicalId":48583,"journal":{"name":"Journal of Hip Preservation Surgery","volume":"2 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-08-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135088582","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Riley Hemstock, Drew Mulhall, Janine Didyk, Dan Ogborn, Devin Lemmex
ABSTRACT Despite recent increased interest in hip arthroscopy for the management of femoroacetabular impingement (FAI), there is little evidence to guide weight-bearing recommendations and rehabilitation postoperatively. The primary objective of this study was to determine if sufficient evidence exists to recommend specific weight-bearing restrictions postoperatively. This study was registered with PROSPERO (CRD42021247741). PubMed, MEDLINE and Embase were searched on 3 March 2023 for Level I–IV studies including patients over the age of 18 years, with a minimum 1-year follow-up and reporting of a weight-bearing status, a patient-reported outcome measure (PROM) and a clinical outcome. Meta-analysis was precluded due to heterogeneity in the included studies, and a descriptive analysis was undertaken. Methodological quality and risk of bias were assessed with the methodological index for non-randomized studies (MINORS). Twenty-four studies including 2231 patients who underwent hip arthroscopy for treatment of FAI were included (follow-up interval 33.2 ± 24.7 months). Most articles (62.5%) were case series. There were seven terms describing weight-bearing recommendations, with 83% being some variation of ‘partial weight-bearing’. Eight PROMs were reported, with 83% using the modified Harris Hip Score and 87.5% of studies reporting reoperation rates. Only 75% of studies reported rehabilitation protocols. The average MINORS score was 11.07 ± 1.10 out of 16 for non-comparative studies and 18.22 ± 1.48 out of 24 for comparative studies. The reporting of weight-bearing status, clinical outcomes, PROMs and rehabilitation parameters remains poor. At present, sufficient comparative evidence does not exist to make specific weight-bearing recommendation postoperatively.
{"title":"Postoperative weight-bearing restrictions and rehabilitation protocols after hip arthroscopy for femoroacetabular impingement: a systematic review","authors":"Riley Hemstock, Drew Mulhall, Janine Didyk, Dan Ogborn, Devin Lemmex","doi":"10.1093/jhps/hnad023","DOIUrl":"https://doi.org/10.1093/jhps/hnad023","url":null,"abstract":"ABSTRACT Despite recent increased interest in hip arthroscopy for the management of femoroacetabular impingement (FAI), there is little evidence to guide weight-bearing recommendations and rehabilitation postoperatively. The primary objective of this study was to determine if sufficient evidence exists to recommend specific weight-bearing restrictions postoperatively. This study was registered with PROSPERO (CRD42021247741). PubMed, MEDLINE and Embase were searched on 3 March 2023 for Level I–IV studies including patients over the age of 18 years, with a minimum 1-year follow-up and reporting of a weight-bearing status, a patient-reported outcome measure (PROM) and a clinical outcome. Meta-analysis was precluded due to heterogeneity in the included studies, and a descriptive analysis was undertaken. Methodological quality and risk of bias were assessed with the methodological index for non-randomized studies (MINORS). Twenty-four studies including 2231 patients who underwent hip arthroscopy for treatment of FAI were included (follow-up interval 33.2 ± 24.7 months). Most articles (62.5%) were case series. There were seven terms describing weight-bearing recommendations, with 83% being some variation of ‘partial weight-bearing’. Eight PROMs were reported, with 83% using the modified Harris Hip Score and 87.5% of studies reporting reoperation rates. Only 75% of studies reported rehabilitation protocols. The average MINORS score was 11.07 ± 1.10 out of 16 for non-comparative studies and 18.22 ± 1.48 out of 24 for comparative studies. The reporting of weight-bearing status, clinical outcomes, PROMs and rehabilitation parameters remains poor. At present, sufficient comparative evidence does not exist to make specific weight-bearing recommendation postoperatively.","PeriodicalId":48583,"journal":{"name":"Journal of Hip Preservation Surgery","volume":"15 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-08-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135746209","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Michael B Geary, Caitlin A Orner, Helen Shammas, John M Reuter, Alayna E Loiselle, Brian D Giordano, Chia-Lung Wu
ABSTRACT Osteoarthritis (OA) of the hip is a common and debilitating painful joint disease. However, there is paucity of surgically induced hip OA models in small animals that allow scientists to study the onset and progression of the disease. A growing body of evidence indicates a positive association between periarticular myotendinous pathology and the development of hip OA. Thus, in the current study, we aimed to establish a novel mouse instability–associated hip OA model via selective injury of the abductor complex around the hip joint. C57BL6/J mice were randomized to sham surgery or abductor injury, in which the myotendinous insertion at the third trochanter and greater trochanter were surgically detached. Mice were allowed free active movement until they were sacrificed at either 3 weeks or 20 weeks post-injury. Histologic analyses and immunohistochemical staining of the femoral head articular cartilage were performed, along with microCT (µCT) analysis to assess subchondral bone remodeling. We observed that mice receiving abductor injury exhibited significantly increased instability-associated OA severity with loss of proteoglycan and type II collagen staining compared to sham control mice at 20 weeks post-surgery, while comparable matrix metalloproteinase 13 expression was observed between injury and sham groups. No significant differences in subchondral bone remodeling were found after 3 or 20 weeks following injury. Our study further supports the link between abductor dysfunction and the development of instability-associated hip OA. Importantly, this novel surgically induced hip OA mouse model may provide a valuable tool for future investigations into the pathogenesis and treatment of hip OA.
{"title":"The surgical destabilization of the abductor muscle leads to development of instability-associated hip osteoarthritis in mice","authors":"Michael B Geary, Caitlin A Orner, Helen Shammas, John M Reuter, Alayna E Loiselle, Brian D Giordano, Chia-Lung Wu","doi":"10.1093/jhps/hnad015","DOIUrl":"https://doi.org/10.1093/jhps/hnad015","url":null,"abstract":"ABSTRACT Osteoarthritis (OA) of the hip is a common and debilitating painful joint disease. However, there is paucity of surgically induced hip OA models in small animals that allow scientists to study the onset and progression of the disease. A growing body of evidence indicates a positive association between periarticular myotendinous pathology and the development of hip OA. Thus, in the current study, we aimed to establish a novel mouse instability–associated hip OA model via selective injury of the abductor complex around the hip joint. C57BL6/J mice were randomized to sham surgery or abductor injury, in which the myotendinous insertion at the third trochanter and greater trochanter were surgically detached. Mice were allowed free active movement until they were sacrificed at either 3 weeks or 20 weeks post-injury. Histologic analyses and immunohistochemical staining of the femoral head articular cartilage were performed, along with microCT (µCT) analysis to assess subchondral bone remodeling. We observed that mice receiving abductor injury exhibited significantly increased instability-associated OA severity with loss of proteoglycan and type II collagen staining compared to sham control mice at 20 weeks post-surgery, while comparable matrix metalloproteinase 13 expression was observed between injury and sham groups. No significant differences in subchondral bone remodeling were found after 3 or 20 weeks following injury. Our study further supports the link between abductor dysfunction and the development of instability-associated hip OA. Importantly, this novel surgically induced hip OA mouse model may provide a valuable tool for future investigations into the pathogenesis and treatment of hip OA.","PeriodicalId":48583,"journal":{"name":"Journal of Hip Preservation Surgery","volume":"15 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-07-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135444755","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Zhendong Zhang, Dianzhong Luo, Hui Cheng, Hong Zhang, Jianli Zhang, Ningtao Ren, Yong Li, Reinhold Ganz
ABSTRACT The present study aimed to investigate the clinical results of the modified Codivilla–Hey Groves–Colonna capsular arthroplasty in the treatment of young patients with developmental dislocation of the hip. We retrospectively evaluated 90 patients (92 hips) who underwent the modified capsular arthroplasty from June 2012 to June 2021. Hips were evaluated using the modified hip Harris score (mHHS), the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) score and the 12-item International Hip Outcome Tool (iHOT-12). The Tönnis osteoarthritis grade and the Severin classification system were used to assess the radiographic outcomes. The average age was 15.7 years (range: 8–26 years). The mean pre-operative mHHS, the WOMAC score and the iHOT-12 score were 83.03, 14.05 and 52.79, respectively. The patients were followed for a mean of 41.1 months (range: 12.1–120.9 months). The patients had a mean mHHS of 83.61 (range: 31.2–97), a WOMAC score of 16.41 (range: 0–51) and an iHOT-12 score of 64.81 (range: 12.9–98.2) at the final follow-up. Capsular thickness had a positive predication on the final functional outcomes. The excellent/good rate of radiological reduction was 79.3%. More than 60% of patients had no/slight osteoarthritis. A total of 54 hips (58.7%) had superior radiographic outcomes. The risk factors for inferior radiographic outcomes were capsular quality (odds ratio [OR]: 0.358, 95% confidence interval [CI]: 0.113–0.931) and capsular thickness (OR: 0.265, 95% CI: 0.134–0.525). Joint stiffness was the most common complication (14.1%). We confirmed the efficacy of this procedure in the treatment of developmental hip dislocation. Patients with poor capsular quality are not suitable for this procedure. With suitable selection according to indications, this procedure can restore the hip rotation center with a low incidence of femoral head necrosis or severe osteoarthritis.
{"title":"The modified capsular arthroplasty for young patients with developmental dislocation of the hip","authors":"Zhendong Zhang, Dianzhong Luo, Hui Cheng, Hong Zhang, Jianli Zhang, Ningtao Ren, Yong Li, Reinhold Ganz","doi":"10.1093/jhps/hnad017","DOIUrl":"https://doi.org/10.1093/jhps/hnad017","url":null,"abstract":"ABSTRACT The present study aimed to investigate the clinical results of the modified Codivilla–Hey Groves–Colonna capsular arthroplasty in the treatment of young patients with developmental dislocation of the hip. We retrospectively evaluated 90 patients (92 hips) who underwent the modified capsular arthroplasty from June 2012 to June 2021. Hips were evaluated using the modified hip Harris score (mHHS), the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) score and the 12-item International Hip Outcome Tool (iHOT-12). The Tönnis osteoarthritis grade and the Severin classification system were used to assess the radiographic outcomes. The average age was 15.7 years (range: 8–26 years). The mean pre-operative mHHS, the WOMAC score and the iHOT-12 score were 83.03, 14.05 and 52.79, respectively. The patients were followed for a mean of 41.1 months (range: 12.1–120.9 months). The patients had a mean mHHS of 83.61 (range: 31.2–97), a WOMAC score of 16.41 (range: 0–51) and an iHOT-12 score of 64.81 (range: 12.9–98.2) at the final follow-up. Capsular thickness had a positive predication on the final functional outcomes. The excellent/good rate of radiological reduction was 79.3%. More than 60% of patients had no/slight osteoarthritis. A total of 54 hips (58.7%) had superior radiographic outcomes. The risk factors for inferior radiographic outcomes were capsular quality (odds ratio [OR]: 0.358, 95% confidence interval [CI]: 0.113–0.931) and capsular thickness (OR: 0.265, 95% CI: 0.134–0.525). Joint stiffness was the most common complication (14.1%). We confirmed the efficacy of this procedure in the treatment of developmental hip dislocation. Patients with poor capsular quality are not suitable for this procedure. With suitable selection according to indications, this procedure can restore the hip rotation center with a low incidence of femoral head necrosis or severe osteoarthritis.","PeriodicalId":48583,"journal":{"name":"Journal of Hip Preservation Surgery","volume":"81 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-06-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"136106155","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Cecilia V Mitchell, Abhinav Lamba, Kelechi R Okoroha, Kostas J Economopoulos, Robert J Spinner, Aaron J Krych
ABSTRACT Snapping proximal hamstring is an uncommon phenomenon, with few case reports documenting surgical treatment. The purpose of this study is to report snapping resolution, minimum 2-year post-operative patient-reported outcome (PRO), satisfaction scores and complications from patients who underwent surgical release of the conjoint tendon from the sacrotuberous ligament with reattachment to the ischial tuberosity. Prospectively collected data from two institutional databases were retrospectively reviewed for patients who underwent hamstring repair for partial- or full-thickness tears. Patients were included if they demonstrated ‘snapping proximal hamstrings’ on preoperative physical examination, including ultrasound confirmation, and repair subsequently performed. Patients were excluded if they had reconstruction of the proximal hamstring tendon or claimed worker’s compensation. With a total of 20 patients (15 females and 5 males), successful resolution of snapping was reported in 100% of the cohort. For patients with pre- and post-surgical lower-extremity functional scores (LEFS), post-surgical LEFS were significantly higher than pre-surgical LEFS (pre-surgical: 17.0 ± 4.0, post-surgical: 73.6 ± 3.3, P < 0.001). Average post-operative PROs were as follows: International Hip Outcome Tool-12, 92.3 ± 8.3; modified Harris Hip Score, 93.2 ± 7.8; Non-arthritic Hip Score, 92.5 ± 6.8; Hip Outcome Score-Sports Specific Subscale, 94.4 ± 6.7; LEFS, 73.9 ± 3.4; and median visual analog scale of 0 with an interquartile range of 0-1. Patient satisfaction was ‘very satisfied’ in 19 (95%) patients and ‘satisfied’ in 1 (5%) patient. At a minimum 2-year follow-up, patients who underwent surgical treatment for chronic snapping of the proximal hamstrings demonstrated complete resolution of painful posterior snapping, reported high PROs and satisfaction, and had no reported post-operative complications.
腿近端肌腱折断是一种罕见的现象，很少有病例报告记录手术治疗。本研究的目的是报告骶结节韧带联合肌腱手术释放与坐骨结节再附着的患者的断裂缓解、术后至少2年患者报告的结果(PRO)、满意度评分和并发症。前瞻性地收集了来自两个机构数据库的数据，回顾性地回顾了因部分或全层撕裂接受腘绳肌腱修复的患者。如果患者在术前体检(包括超声确认)中表现出“腘绳肌近端折断”，并随后进行修复，则纳入患者。如果患者有近端腘绳肌腱重建或要求工人赔偿，则排除在外。共有20名患者(15名女性和5名男性)，100%的患者成功解决了咬合问题。术前、术后下肢功能评分(LEFS)患者，术后LEFS明显高于术前(术前:17.0±4.0，术后:73.6±3.3,P <0.001)。术后平均PROs如下:International Hip Outcome Tool-12, 92.3±8.3;改良Harris髋关节评分:93.2±7.8;非关节炎髋部评分:92.5±6.8;髋关节结局评分-运动特定子量表，94.4±6.7;左侧，73.9±3.4;视觉模拟量表中位数为0，四分位数范围为0-1。19例(95%)患者满意度为“非常满意”，1例(5%)患者满意度为“满意”。在至少2年的随访中，接受手术治疗的腘绳肌近端慢性拉断的患者表现出完全解决了疼痛的后拉断，报告了高的PROs和满意度，并且没有报告术后并发症。
{"title":"Surgical treatment of snapping proximal hamstring tendon syndrome: the resolution of snapping and excellent patient satisfaction","authors":"Cecilia V Mitchell, Abhinav Lamba, Kelechi R Okoroha, Kostas J Economopoulos, Robert J Spinner, Aaron J Krych","doi":"10.1093/jhps/hnad016","DOIUrl":"https://doi.org/10.1093/jhps/hnad016","url":null,"abstract":"ABSTRACT Snapping proximal hamstring is an uncommon phenomenon, with few case reports documenting surgical treatment. The purpose of this study is to report snapping resolution, minimum 2-year post-operative patient-reported outcome (PRO), satisfaction scores and complications from patients who underwent surgical release of the conjoint tendon from the sacrotuberous ligament with reattachment to the ischial tuberosity. Prospectively collected data from two institutional databases were retrospectively reviewed for patients who underwent hamstring repair for partial- or full-thickness tears. Patients were included if they demonstrated ‘snapping proximal hamstrings’ on preoperative physical examination, including ultrasound confirmation, and repair subsequently performed. Patients were excluded if they had reconstruction of the proximal hamstring tendon or claimed worker’s compensation. With a total of 20 patients (15 females and 5 males), successful resolution of snapping was reported in 100% of the cohort. For patients with pre- and post-surgical lower-extremity functional scores (LEFS), post-surgical LEFS were significantly higher than pre-surgical LEFS (pre-surgical: 17.0 ± 4.0, post-surgical: 73.6 ± 3.3, P &lt; 0.001). Average post-operative PROs were as follows: International Hip Outcome Tool-12, 92.3 ± 8.3; modified Harris Hip Score, 93.2 ± 7.8; Non-arthritic Hip Score, 92.5 ± 6.8; Hip Outcome Score-Sports Specific Subscale, 94.4 ± 6.7; LEFS, 73.9 ± 3.4; and median visual analog scale of 0 with an interquartile range of 0-1. Patient satisfaction was ‘very satisfied’ in 19 (95%) patients and ‘satisfied’ in 1 (5%) patient. At a minimum 2-year follow-up, patients who underwent surgical treatment for chronic snapping of the proximal hamstrings demonstrated complete resolution of painful posterior snapping, reported high PROs and satisfaction, and had no reported post-operative complications.","PeriodicalId":48583,"journal":{"name":"Journal of Hip Preservation Surgery","volume":"34 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-06-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135602334","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Introduction: Perthes disease results in residual deformity of the hip joint that can be challenging to manage. Asphericity of the femoral head can lead to congruence issues, further com-pounded by acetabular dysplasia. Additionally, head-and-neck
{"title":"ISHA-The Hip Preservation Society 2022 Annual Scientific Meeting in Glasgow, Scotland, United Kingdom: reuniting the international hip preservation community in person.","authors":"Andrea M Spiker, Vikas Khanduja","doi":"10.1093/jhps/hnad009","DOIUrl":"https://doi.org/10.1093/jhps/hnad009","url":null,"abstract":"Introduction: Perthes disease results in residual deformity of the hip joint that can be challenging to manage. Asphericity of the femoral head can lead to congruence issues, further com-pounded by acetabular dysplasia. Additionally, head-and-neck","PeriodicalId":48583,"journal":{"name":"Journal of Hip Preservation Surgery","volume":"10 Suppl 1","pages":"i1-i15"},"PeriodicalIF":1.5,"publicationDate":"2023-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/87/4b/hnad009.PMC10259586.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9999687","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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