2025年1月 保髋进展 JCR Q3 区

The purpose of this study was to investigate a novel posterior intra-articular hip injection approach while discussing the clinical pearls for methodology, accuracy, and associated adverse events. The goal was to investigate if this approach could potentially be used in those where the typical anterior access would be challenging.

According to Association Research Circulation Osseous (ARCO) staging, patients with ARCO III osteonecrosis of femoral head (ONFH) have joint pain and dysfunction due to the collapse of femoral head. Current hip preservation surgeries are not satisfying in the treatment of ARCO III ONFH according to the long-term follow-up. In our practice, we focused on reconstructing femoral head by restoring the round shape of femoral head and subsequently preventing the development of hip arthritis. To lift the collapsed femoral head and postpone the potential total hip arthroplasty, we practiced Jack surgery, combining surgical hip dislocation, removal of necrotic bone, impaction bone grafting, and lifting the cartilage of femoral head.

Surgical intervention is critical in the treatment of hip developmental dysplasia in children. Perioperative analgesia, usually based on high opioid dosages, is frequently used in these patients. In some circumstances, regional anesthetic procedures such as caudal block and lumbar plexus block have also been used. Previous research has shown that pericapsular nerve group (PENG) block provides excellent anesthetic efficacy during open hip surgery in adults. PENG block is thought to provide a similar analgesia effect comparable to caudal block.

Hip pain in active patients with early osteoarthritis can be quite debilitating, affecting mobility, quality of life, and overall well-being. Management of this patient population is challenging because arthroplasty implants inevitably have limited life expectancy while chondral damage can mitigate the benefits of arthroscopic or open hip preservation. A multifaceted, patient-specific approach to clinical decision making is crucial in this patient population, given their higher activity level and expectations compared with older cohorts. Several advances have been made to better stratify patients into the spectrum of management, which includes nonsurgical measures; injections, including orthobiologics; arthroscopic hip preservation; open hip preservation; hip resurfacing; and total hip arthroplasty.

Background: Variations in femoral version are increasingly recognized as contributing factors to the development of symptomatic femoroacetabular impingement (FAI) and ischiofemoral impingement (IFI). Despite having implications for both hip arthroplasty and hip preservation surgery, functional femoral version (FFV) and overall limb torsion (OLT) are understudied. This study was conducted with the primary aim of defining and measuring FFV as a function of OLT. Methods: A cohort of 106 patients scheduled for primary hip arthroplasty underwent detailed retrospective assessment through CT and EOS imaging. Femoral torsion, transmalleolar axis, tibial torsion, trochanteric station and limb torsion were measured. The trochanteric station distance was also defined on both CT as well as on the lateral standing EOS. Statistical analyses examined the relationships between FFV, OLT, and other measurements. Results: Findings indicate a strong correlation between OLT and FFV. Agreement between CT and EOS imaging for trochanteric station was 0.88. Conclusions: The study reveals that OLT offers a more comprehensive assessment of impingement risk than anatomical femoral version alone. As OLT correlates with FFV, it highlights the role of axial limb alignment in hip joint biomechanics. Understanding the interplay between FFV and OLT can guide more individualized surgical techniques, potentially improving patient outcomes.

Hip arthroscopy has become an effective method for treating several symptomatic disorders of the hip, which includes femoroacetabular impingement (FAI). Capsulotomy is often necessary for visualization of hip pathology; however, this presents multiple challenges in both capsular management intraoperatively and final capsule closure. Current techniques include use of capsular suspension sutures to provide adequate views of the central and peripheral compartments. We present an atraumatic technique that may be used in conjunction with suspension sutures to decrease the need for excessive capsular debridement, additional personnel, and risk of injury for adequate visualization.

This scoping review aimed to identify the indications, techniques, outcomes, and knowledge gaps related to managing postoperative native hip instability. Specifically, it examined how capsular repair and reconstruction strategies address iatrogenic capsular insufficiency following hip preservation procedures, with the goal of clarifying optimal surgical decision-making and guiding future research.

Osteonecrosis of the femoral head is a debilitating condition that can lead to cysts at the head-neck junction. Without timely intervention, the disease often progresses to femoral head collapse, ultimately necessitating hip replacement surgery. This article describes a hip preservation treatment method that involves core decompression by drilling small holes in the femoral neck and hernia sac, followed by filling femoral pits with allogeneic bone. The advantage of this technique lies in its ability to reduce intracapsular pressure, enhance blood circulation, and stabilize the femoral head, thus preventing collapse. Additionally, the blood released during core decompression nourishes the transplanted bone, further supporting its integration and effectiveness.

Iliopsoas pathology is commonly diagnosed when treating patients presenting with hip pain. Clinically associated with painful internal snapping in the setting of femoroacetabular impingement or acetabular dysplasia, iliopsoas impingement traditionally has been managed surgically with iliopsoas lengthening or release. Concerns about the development of flexion weakness as well as iliopsoas atrophy have prompted the development of additional techniques to manage psoas pathology during hip-preservation surgery. We present a technique of iliopsoas tunnel deepening with anterior labral refixation for the management of iliopsoas impingement.

Expected time off work is a common question from patients undergoing periacetabular osteotomy (PAO) as most are of working age. Planning for financial and social impacts plays an important role when considering PAO. No previous studies have reported on the time taken to return to work following PAO. The aim of this study was to quantify the amount of time taken off work following PAO.

The aim of our study is to evaluate the efficacy of dynamic hip screw (DHS) combined with autologous half-fibular grafting in treating displaced femoral neck fractures in elderly patients aged 60-75 years, focusing on the potential for achieving stable fracture union and preserving joint functionality.

This technical note presents a hip capsular reattachment and plication technique using an arthroscopically assisted mini-open direct anterior approach (DAA). By placing a dual-channeled suture anchor at or slightly proximal to the original capsular insertion in the posteroinferior groove of the anterior inferior iliac spine (AIIS), a controlled reattachment is achieved, with the option for a superior shift if required. This method minimizes iatrogenic damage and ensures stable capsular reattachment while allowing for a tailored shift and plication based on the desired degree of imbrication. Furthermore, it preserves anatomical integrity without increasing the risk of postoperative stiffness. LEVEL OF EVIDENCE: V.

Hip arthroscopy is an effective surgical procedure to treat intra-articular hip pathology including femoroacetabular impingement (FAI) and labral tears. This review aims to synthesize current evidence on sex-based differences in the pathology, presentation, surgical management, and outcomes of femoroacetabular impingement (FAI) and hip arthroscopy.

This study evaluates the relationship between preoperative cartilage quality, measured by T2 mapping, and patient-reported outcomes following labral tear treatment. We retrospectively reviewed patients aged 14-50 who underwent primary hip arthroscopy with either labral repair or reconstruction. Preoperative T2 values of femoral, acetabular, and labral tissue were assessed from MRI by blinded reviewers. International Hip Outcome Tool (iHOT-12) scores were collected preoperatively and up to two years postoperatively. Associations between T2 values and iHOT-12 scores were analyzed using univariate mixed linear models. Twenty-nine patients were included (mean age of 32.5 years, BMI 24 kg/m

In the past 10 years, the field of hip preservation has advanced significantly with the improvement of new surgical techniques, highlighting the importance of torsional abnormalities of the femur as one of the main contributors to hip pain and femoroacetabular impingement. Femoral version is crucial for predicting postarthroscopy outcomes. The increased femoral version negatively affects hip mechanics and is linked to multiple hip disorders, including femoroacetabular impingement and osteoarthritis, especially in those with borderline dysplasia. Proximal femoral derotational osteotomy is an effective intervention for these abnormalities. This study introduces a refined technique using a 4.5-mm locking compression plate alongside hip arthroscopy, offering a cost-effective alternative to intramedullary nails, particularly in resource-limited countries, while ensuring optimal patient outcomes.

Nonunion of an osteotomy site is one of the most reported complications following periacetabular osteotomy (PAO). Identification of risk factors for nonunion is an important area of research as hip preservation has an increasing presence in orthopaedic surgery.

The Layer Concept is a widely used model that provides an excellent anatomic framework with which to systematically diagnose and treat non-arthritic hip pain. More recently, there is a growing body of evidence highlighting the significant impact that psychosocial factors can have on both the presentation of various hip disorders and clinical outcomes following hip preservation surgery (HPS). Herein we propose the Layer + Model as a simple modification to help clinicians better diagnose and treat patients presenting with non-arthritic hip pain.

Patient portal (PP) usage enhances patient engagement, quality of care, and clinical outcomes. However, effective utilization requires digital literacy and internet access, resulting in disparities, particularly among older, non-White, uninsured, or publicly insured patients. While prior studies have examined PP use in specific orthopaedic subspecialties, comprehensive analyses are limited. The aim of this study was to identify social determinants of health of interest (SDOH) associated with PP utilization across orthopaedic subspecialties and to assess its association with outcomes.

Synovial chondromatosis is a benign proliferation of the synovial membranes surrounding joints and tendon sheaths that may cause serious joint instability and dysfunction. If left untreated, loose bodies generated within the joint can lead to accelerated joint destruction. Arthroscopic synovectomy with loose body removal has been recommended in certain cases to limit the rate of recurrence. Past techniques have utilized suction as well as manual removal of larger loose bodies.

Chronic posterior hip dislocations are rare and diffcult to treat. Open reduction is exceptionally challenging given the significant amount of scar tissue and muscle contractures, and need to preserve the blood supply to the femoral head while obtaining a stable, concentric reduction. The goal of this article was to describe the outcomes of two different novel surgical techniques for open reduction of chronic posterior hip dislocations.

Osteonecrosis of the femoral head (ONFH) is a prevalent clinical condition, and as the affected population becomes younger and more widespread, an increasing number of patients prefer to retain their own hip joints. In comparison to joint replacement and hip-preserving surgeries, conservative hip preservation treatment is gaining more recognition from both clinicians and patients.