2025年4月 保髋进展 JCR Q1 区

To systematically review the literature on delays in diagnosis or treatment of hip preservation patients.

To evaluate the accuracy of the current times and work relative value units (wRVUs) recommended by the Relative Value Scale (RVS) Update Committee (RUC) for the perioperative work associated with hip arthroscopy in a single surgeon's practice.

To determine the reliability of sagittal radiographic variables across multiple positions and radiographic views and to correlate measures obtained on anteroposterior (AP) radiographs to lateral pelvis imaging.

With the recognition of the positive effect of the iliofemoral ligament in maintaining hip stability, particularly in patients with borderline developmental dysplasia of the hip, some surgeons recommend restoring its native anatomy through conservative capsulotomy and final closure. In the many different kinds of capsulotomy, longitudinal capsulotomy is a technique that can reduce damage to the iliofemoral ligament. This protective effect is sufficient to restore hip stability in patients with femoroacetabular impingement but may be inadequate for patients with borderline developmental dysplasia of the hip because of the laxity and capsular instability. Therefore, we propose a surgical technique that utilizes artificial tape to augment the anterior capsule under longitudinal capsulotomy.

A 21-year-old woman with a history of bilateral developmental dysplasia of the hips (DDH), congenital hip dislocation, and hypermobility syndrome presented with severe bilateral external snapping hips. Following the failure of nonoperative management, bilateral open iliotibial band fasciectomy performed 5 months apart provided significant relief from both the active and passive snapping, as well as complete pain relief at the 12-month follow-up.

External coxa saltans, or "snapping hip," is present in about 5% of the population and typically stems from a tight iliotibial band (ITB) passing over the greater trochanter. For patients who have been unresponsive to nonoperative treatments, endoscopic ITB release can be effective in relieving symptoms. Various techniques have been described, including those involving lateral decubitus positioning, alternative portal placement, and outside-in release of the ITB. In this technique, we describe an endoscopic partial ITB release for external coxa saltans using supine positioning, standard hip arthroscopy portals, and inside-out release from the peritrochanteric space, which allows treatment of concomitant intra-articular pathology and direct visualization of the posterior undersurface of the ITB for a more precise release of the involved pathologic tissue.

The capsule management during hip arthroscopy continues to be an important concern independent of the approach (inside-out or outside-in). Preserving most of the anatomy of the capsule ligaments is challenging when we encounter hips with large cam deformities. T-capsulotomy is a good option to improve visualization, but it requires the disruption of the zona orbicularis, increasing the risk for developing instability if not repaired properly or hip adhesions and motion restriction when we do close it or secondary to the capsular disruption itself. In this Technical Note, we introduce a technique to assist us during the hip arthroscopy, specifically in the osteochondroplasty. By doing this, we improve our visualization of the femoral head-neck junction when correcting a cam deformity in a less invasive way, preserving more of the normal anatomy of the hip capsule.

The number of pathologies treated successfully by hip arthroscopy continues to increase, and multiple efficacious techniques exist to perform this procedure. Hip arthroscopy performed with patients in the lateral decubitus position without a perineal post is less appreciated yet encourages increased visualization of the hip joint, improved ergonomics and maneuverability, and decreased postoperative complications. This article includes a detailed description of post-less hip arthroscopy with patient positioning in lateral decubitus.

Patients diagnosed with slipped capital femoral epiphysis (SCFE) are admitted and treated with timely screw stabilization to prevent instability. This study compares the safety of SCFE stabilization in an inpatient versus outpatient setting, specifically evaluating the rates of revision procedures and complications between each setting.

Patients undergoing hip arthroscopic surgery for femoroacetabular impingement syndrome (FAIS) have been shown to achieve clinically significant outcomes (CSOs) at high rates. However, limited studies, to date, have identified independent predictors of achieving CSOs at a minimum 10-year follow-up, and even fewer studies have reported on patients treated with contemporary hip arthroscopic techniques, including chondrolabral preservation, surgical correction of FAIS morphology, and capsular repair.

To investigate postoperative opioid use and patient-reported outcome measurement (PROM) data after primary or revision hip arthroscopy in the setting of femoroacetabular impingement syndrome.

To analyze postoperative opioid prescriptions after hip arthroscopy for femoroacetabular impingement syndrome (FAIS) in a large, opioid-naive population and to evaluate factors associated with receiving more opioids.

To explore the association between obesity classification and patient-reported outcomes (PROs) in hip arthroscopy.

To systematically review and examine the current literature regarding the representation of female athletes in studies examining arthroscopic hip labral repair procedures.

To characterize variation in the value of hip arthroscopy for femoroacetabular impingement and explore associations between value and patient-specific demographic characteristics, comorbidities, preoperative patient-reported outcome measures (PROMs), and intraoperative variables.

To (1) compare 5-year survivorship (avoiding repeat hip arthroscopy (HA)/total hip replacement conversion) between those undergoing routine capsular repair compared with where no repair was performed; (2) compare patient-reported outcome measures (PROMs) and achievability of metrics of clinically important improvement between these groups; and (3) evaluate the moderating influence of age and sex on outcomes.

Hip arthroscopy for femoroacetabular impingement syndrome has been shown to achieve favorable long-term outcomes, but patients with elevated body mass index (BMI) show improved but inferior outcomes and a significantly higher rate of conversion to total hip arthroplasty in comparison to nonobese controls. BMI is a well-known risk factor for the development of osteoarthritis in various joints, including the hip, owing to various factors, including increased mechanical loading and systemic inflammation. It is important to recognize that BMI is a modifiable variable that can change over time, and on its own, BMI does not differentiate between lean muscle mass and adipose tissue.

To evaluate patient-reported outcomes (PROs), achievement of clinically significant outcomes, and reoperation-free survivorship at short-term follow-up after hip arthroscopy (HA) for femoroacetabular impingement syndrome (FAIS) in patients with and without fibromyalgia (FM).

A 21-year-old man presented with a ∼1.5-year history of atraumatic left hip pain and imaging suspicious for a diffuse tenosynovial giant cell tumor (TSGCT) with signs of osteoarthritis. Hip arthroscopy for tumor debulking and treatment of associated pathology were recommended given his age and activity level. TSGCT diagnosis was confirmed, and the patient has remained pain and tumor free per annual magnetic resonance imaging with excellent functional outcomes 13 years postoperatively.

Periacetabular osteotomy (PAO) can treat pain, dysfunction, and decreased activity secondary to hip dysplasia. Patients' pre- and postoperative activity can be measured using the University of California Los Angeles (UCLA) activity score, a validated questionnaire. Understanding return to and maintenance of activity at long-term follow-up after PAO is a priority for active patients.

Hip arthroscopy is a successful treatment option for patients with femoroacetabular impingement syndrome, with favorable reported outcomes at >10-year follow-up. Still, a minority of patients experience persistent symptoms postoperatively and potentially require reoperation, such as revision hip arthroscopy or conversion to total hip arthroplasty. There is strong evidence suggesting that patients with pre-existing osteoarthritis (Tönnis grade 2 or greater) at the time of primary surgery are at risk for inferior long-term clinical outcomes after hip arthroscopy. Higher body mass index (BMI), advanced age, and female sex have also been shown to be negatively associated with postoperative outcomes and increase the risk of reoperation in patients undergoing hip arthroscopy surgery. Of concern, nearly 42% of patients with femoroacetabular impingement syndrome undergoing hip arthroscopy in the United States are considered overweight or obese. With that being said, older age, high BMI, and female sex are not contraindications for undergoing primary hip arthroscopy. Older patients without the presence of degenerative changes can still achieve reliable outcomes after hip arthroscopy surgery. High BMI is a modifiable risk factor that can be optimized before proceeding with surgery. Female patients may be more likely to have microinstability, which can be addressed by hip capsulotomy repair. Favorable outcomes may be achieved with appropriate preoperative counseling, optimization of modifiable risk factors, and a patient-specific approach.

Recent research shows a small but statistically significant reduction in hip labral size in hips requiring revision after primary arthroscopy for femoroacetabular impingement syndrome. What drives this divergence in healing? Rather than fixating on differences measured in millimeters, let's focus on labral healing resulting in the need for revision independent of residual impingement. A hypothesis is that capsulolabral adhesions, a dynamic and 3-dimensional problem, may play a role. As bony correction techniques have improved, attention must shift to the complex and undercharacterized processes of soft-tissue healing. Routine assessment and reporting of adhesions in revision femoroacetabular impingement studies are essential to our understanding of labral mechanics, failure patterns, and postoperative care.

We previously established a small animal model of femoral head-neck cam-type hip deformity by inducing physeal injury in immature rabbits. We investigated whether this induced deformity led to hip osteoarthritis (OA) within 4 months.

To investigate the effects of neighborhood-level socioeconomic disadvantage on health care accessibility and midterm functional outcomes for patients undergoing primary hip arthroscopy for the treatment of acetabular labral tears.

» Femoroacetabular impingement (FAI) is the premature contact of the femoral head-neck junction with the superior acetabular rim during hip range of motion, which may further damage intra-articular soft tissue structures and lead to the accelerated development of osteoarthritis.» FAI syndrome is diagnosed by a triad of symptoms, clinical signs, and imaging findings, and is a common cause of hip pain in young patients that have a significant impact on patient hip-related function and quality of life.» The treatment of FAI syndrome begins with noninvasive nonoperative modalities such as patient education and supervised exercise-based physical therapy. For recalcitrant symptoms, various injections have been explored for both diagnostic and therapeutic purposes; however, the efficacy of these interventions have generally not been demonstrated outside of the short term» In this article, we examine the available literature regarding the nonoperative treatment of FAI and provide insight into the effectiveness of current treatment modalities.

Traditionally, acetabular global overcoverage had been treated by open surgical dislocation of the hip and was a relative contraindication for hip arthroscopy. With advancing arthroscopic techniques, hip arthroscopy can successfully treat acetabular global overcoverage with less morbidity for the patient than an open hip procedure. Successful arthroscopic treatment of this condition is not for the beginner hip arthroscopist. Pitfalls of an arthroscopic technique include difficult entry into the joint and labral insufficiency with the inability to perform a repair, and these difficulties should be understood ahead of the procedure. However, with careful, thoughtful technique, arthroscopic treatment of acetabular global overcoverage has successful outcomes and now should be considered the preferred option instead of open surgical dislocation of the hip.

One-fifth of patients with femoroacetabular impingement (FAI) have bilateral symptoms. Performing bilateral hip arthroscopy on the same day minimizes the overall rehabilitation period compared with staged bilateral surgery, but most studies of outcomes from simultaneous surgery are in small cohorts.

The sequelae of open reduction of developmental and/or syndromic hip dislocations include osteonecrosis/proximal femoral growth disturbance and residual dysplasia. There is limited information comparing the rates of these sequelae in patients with developmental dysplasia of the hip (DDH) and arthrogryposis multiplex congenita (AMC). We performed a dual-center retrospective cohort study to compare rates of proximal femoral growth disturbance and residual dysplasia between patients with DDH and AMC who had undergone open hip reduction for the treatment of non-traumatic hip dislocations.

PURPOSE: To systematically review the literature on delays in diagnosis or treatment of hip preservation patients. METHODS: A systematic review was performed by searching PubMed, the Cochrane Library, and Embase, from inception to November 2024, to identify any study reporting on delays in diagnosis or treatment of hip preservation patients, that is, patients with femoroacetabular impingement syndrome, hip dysplasia, or femoral torsion abnormalities. The search terms used were as follows: delay AND (diagnosis OR treatment) AND ("femoroacetabular impingement" OR "hip dysplasia" OR "hip arthroscopy" OR "periacetabular osteotomy"). Outcomes reported included demographic characteristics, preoperative duration of symptoms, and patient-reported outcomes. RESULTS: Twelve articles (1 Level II, 1 Level III, and 10 Level IV) met the inclusion criteria, with a total of 2,883 hips. The mean patient age ranged from 16.4 to 45.0 years, and the overall percentage of male patients ranged from 0% to 56.9%. The mean time from symptom onset to accurate diagnosis for hip preservation patients ranged from 17.2 to 61.5 months across studies. Prior health care providers consulted were largely other orthopaedic surgeons and primary care physicians; each patient consulted with an average of 1.9 to 4.2 providers and received a multitude of alternate diagnoses, imaging assessments, and treatment attempts before presentation to a hip preservation specialist. In studies comparing outcomes between patients with short and long durations of symptoms (i.e., <2 years and >2 years, respectively), significantly worse postoperative patient-reported outcomes were observed in the groups with a longer symptom duration. CONCLUSIONS: Patients presenting with hip preservation pathologies commonly experience delays in diagnosis and/or treatment and consult with multiple health care providers across specialties before receiving an accurate diagnosis and appropriate treatment. In turn, this leads to poorer post-treatment outcomes compared with patients who receive appropriate treatment in a timely manner. LEVEL OF EVIDENCE: Level IV, systematic review of Level II to IV studies.

PURPOSE: To systematically review the literature on delays in diagnosis or treatment of hip preservation patients. METHODS: A systematic review was performed by searching PubMed, the Cochrane Library, and Embase, from inception to November 2024, to identify any study reporting on delays in diagnosis or treatment of hip preservation patients, that is, patients with femoroacetabular impingement syndrome, hip dysplasia, or femoral torsion abnormalities. The search terms used were as follows: delay AND (diagnosis OR treatment) AND ("femoroacetabular impingement" OR "hip dysplasia" OR "hip arthroscopy" OR "periacetabular osteotomy"). Outcomes reported included demographic characteristics, preoperative duration of symptoms, and patient-reported outcomes. RESULTS: Twelve articles (1 Level II, 1 Level III, and 10 Level IV) met the inclusion criteria, with a total of 2,883 hips. The mean patient age ranged from 16.4 to 45.0 years, and the overall percentage of male patients ranged from 0% to 56.9%. The mean time from symptom onset to accurate diagnosis for hip preservation patients ranged from 17.2 to 61.5 months across studies. Prior health care providers consulted were largely other orthopaedic surgeons and primary care physicians; each patient consulted with an average of 1.9 to 4.2 providers and received a multitude of alternate diagnoses, imaging assessments, and treatment attempts before presentation to a hip preservation specialist. In studies comparing outcomes between patients with short and long durations of symptoms (i.e., <2 years and >2 years, respectively), significantly worse postoperative patient-reported outcomes were observed in the groups with a longer symptom duration. CONCLUSIONS: Patients presenting with hip preservation pathologies commonly experience delays in diagnosis and/or treatment and consult with multiple health care providers across specialties before receiving an accurate diagnosis and appropriate treatment. In turn, this leads to poorer post-treatment outcomes compared with patients who receive appropriate treatment in a timely manner. LEVEL OF EVIDENCE: Level IV, systematic review of Level II to IV studies.

Hip arthroscopy is a valuable tool through which intra- and extra-articular hip pathologies may be addressed, with the goal of improving pain and function while preventing osteoarthritis progression. Little data are available regarding the effect of social determinants of health on hip arthroscopy outcomes.

The late diagnosis rate of developmental dysplasia of the hip (DDH) with universal ultrasound screening is 0.2 per 1,000 children according to a recent meta-analysis, which is the same as in Japan where selective ultrasound screening is used. We hypothesized that Finland's current program of universal clinical screening complemented with targeted ultrasound is noninferior to universal and selective ultrasound screening programs.

Sport participation has been associated with favorable outcomes following hip arthroscopy (HA) for femoroacetabular impingement (FAI) at short- and mid-term follow-up; however, few studies have evaluated the 10-year outcomes in this population. The purpose of this study was to compare patient-reported outcome measures (PROMs), the achievement of clinically significant outcomes, and reoperation-free survivorship between patients with and without regular preoperative sport participation who underwent HA for FAI and had a minimum of 10 years of follow-up.

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.

Previous studies suggest a relationship between femoroacetabular impingement (FAI) and femoral neck stress fractures (FNSF), due to pathologic biomechanics in the setting of femoral head abutment (cam morphology) and/or acetabular overcoverage (pincer morphology). The purpose of this study is to evaluate the association between cam or pincer morphology and FNSF, compared to a control group of patients without hip pain. A retrospective review of the electronic medical record at a single institution was queried for patients with FNSF over a 10-year time period from January 2011-2021. These patients were compared to a control group with diagnostic radiographs and a chief complaint that was not hip pain presenting to the institution's emergency department. Hip morphology was evaluated radiographically. A multivariate logistic regression was used to investigate an association between FNSF and cam or pincer morphology. Eighty-three patients with FNSF and a mean age of 38.6 years were compared to 55 healthy controls with a mean age of 35.8 years. Patients in the FNSF group were more often female, white, and had lower BMI. These patients were also more likely to have associated cam morphology (p = 0.010). Binary logistic regression demonstrated a statistically significant independent association between both cam (OR 5.2, p = 0.01) and pincer (OR 4.6, p = 0.022) morphology with FNSF when controlling for demographic variables. Black race and higher BMI were protective factors for FNSF (OR 0.09, OR 0.84, p < 0.01). In summary, radiographic cam morphology, superolateral acetabular overcoverage, female sex, and lower BMI are risk factors for sustaining FNSF, while the black race was found to be protective.

The dynamic alignment of the lumbar spine, pelvis and femur is increasingly studied in hip preservation surgery. However, the interaction between lumbopelvic alignment, acetabular and femoral morphology and its influence on patients' preoperative symptom burden remains poorly understood. The aim of this study was to evaluate whether lumbopelvic malalignment affects osseous hip morphology and exacerbates preoperative patient-reported joint functionality in patients undergoing periacetabular osteotomy (PAO).

Studies evaluating the long-term survival rate, patient satisfaction, and conversion to total hip arthroplasty (THA) are limited. The aim of this study was to evaluate satisfaction and hip survival at a minimum 10-year follow-up in patients following hip arthroscopy for femoroacetabular impingement syndrome (FAIS).

Adhesions are known to occur following arthroscopic as well as open surgery of multiple joints, including after hip arthroscopy, resulting in pain, stiffness, and dysfunction. Adhesions of the labrum to the overlying hip capsule can lead to eversion of the labrum and potentially compromise the suction seal, leading to microinstability and pain. Generally, patient-reported outcomes improve after surgical lysis of adhesions, with or without concurrent correction of labral, chondral, or bony pathology. Arthroscopic placement of autograft or allograft spacers may be effective when adhesions between the labrum and capsule prevent an adequate suction seal. Prevention using biologics, such as angiotensin II receptor blockers (e.g., losartan), may inhibit transforming growth factor β1, which has been associated with fibrogenesis, tissue fibrosis, and scarring. Side effects of losartan are rare but include hypotension, dizziness, angioedema, and acute kidney injury when coprescribed with nonsteroidal anti-inflammatory drugs, which are often used in heterotopic ossification prophylaxis in hip arthroscopy and are a significant concern. More data on losartan use are required prior to broader adoption.

Periacetabular osteotomy (PAO) is the agreed-upon treatment for symptomatic hip dysplasia in the skeletally mature patient. Many surgeons perform hip arthroscopy to address intra-articular damage around the time of the PAO. Other surgeons believe that correcting the dysplasia with the PAO unloads the soft tissues, which negates the need for arthroscopy. Current evidence is unclear as to whether hip arthroscopy, whether concomitant or staged, is needed when performing PAO for hip dysplasia. In the United States, the chosen approach often is determined by surgeon training, comfort level, and logistical issues. Over time, the chosen approach may change, as more surgeons are trained in both open and arthroscopic hip preservation. Certainly, some patients benefit from hip arthroscopy along with PAO for labral pathology and/or femoral cam deformity.

Hip dysplasia is a pathomorphologic deformity that leads to decreased acetabular coverage and hip instability. Many different radiographic measurements have been explored to characterize hip dysplasia, including the lateral center-edge angle, femoral-epiphyseal acetabular roof index, and Tönnis angle. Magnetic resonance imaging offers 3-dimensional characterization of the hip pathomorphology that may be more detailed than 2-dimensional radiographs, as well as a modality that is free of radiation. Recent research has shown that dysplastic hips are associated with significantly thinner ligament thickness compared with non-dysplastic hips. The iliofemoral ligament is the most important hip capsular structure and helps to stabilize the hip joint, particularly in hip extension and external rotation. Differences in iliofemoral ligament thickness may help to explain why patients with dysplasia are more prone to hip instability, above and beyond their acetabular under-coverage. This reiterates the need for routine capsular closure and/or plication in patients with femoroacetabular impingement syndrome to prevent further instability.

To characterize hip capsule thickness on advanced imaging in patients with and without hip dysplasia and to also evaluate differences in capsular thickness between patients with borderline and patients with true dysplasia.

Hip arthroscopy (HA) is preferred for surgical management of femoroacetabular impingement syndrome, whereas periacetabular osteotomy (PAO) is the gold standard for frank developmental hip dysplasia in young adults. Borderline hip dysplasia (BHD) is a conundrum, with data supporting the use of either or both, not to mention that BHD is defined by varying lateral center-edge angle thresholds between 18° and 25° or 20° and 25° and features generalized ligamentous laxity and variations in acetabular and femoral version. That said, HA for BDH has been shown to have 10-year survivorship of 82%. In a revision situation after HA in patients with BHD, PAO seems a logical next step, but HA may be indicated under narrow indications. From a technical standpoint, capsular preservation, labral function restoration, and avoiding acetabular rim over-resection are key points when performing HA in BHD. Most important, particularly in the revision setting, is to determine the root cause of failure. Primarily, instability-driven symptoms are an indication for PAO.

The new radiographic "windshield wiper sign" detects hip instability and an instability-related osteochondral defect of the anterolateral femoral head. It is visible on plain radiographs as well as on magnetic resonance imaging and during arthroscopy, in hips otherwise considered normal or borderline based on the lateral center-edge angle. In the past 2 decades, femoral acetabular impingement syndrome with labral lesions and cartilage lesions have been treated with excellent results. Recently the focus has shifted to complex cases, revision surgery, and capsular management preventing postoperative hip instability. Microinstability of the hip causes poor outcomes, but preoperatively, there has been no gold standard for radiographic assessment of hip instability. On plain radiographs, we use the lateral center-edge angle and the anterior center-edge angle, and we can also use the Femoro-Epiphyseal Acetabular Roof Index and the gothic arch angle. These signs help detect cases in which arthroscopic surgery alone would provide poor results and a concurrent osteotomy (e.g., a periacetabular osteotomy) is needed. We now understand that hip instability in hips otherwise considered normal or borderline dysplastic can be detected by the windshield wiper sign. This is important knowledge for concomitant arthroscopic combined with osteotomy because the need for cartilage therapy can be determined preoperatively.

To assess patient-reported outcomes (PROs), clinically significant outcomes (CSOs), and survivorship after staged hip arthroscopy with labral repair, femoroplasty, and capsular plication followed by periacetabular osteotomy (PAO) for the management of femoroacetabular impingement syndrome and hip dysplasia (lateral center-edge angle ≤25°).

To compare patient-reported outcomes (PROs), achievement of clinically significant outcomes, and reoperation-free survivorship between primary and revision hip arthroscopy (HA) for femoroacetabular impingement syndrome (FAIS) in propensity-matched borderline hip dysplasia (BHD) patients at a minimum 5-year follow-up.

To evaluate a large cross-sectional sample of patients utilizing administrative database records and analyze the effects of income, insurance type, and education level on outcomes after hip arthroscopy, including 2-year revision surgery, conversion to total hip arthroplasty (THA), and 90-day hospitalizations.

To systematically investigate the outcomes of patients who underwent autologous matrix-induced chondrogenesis (AMIC) during hip arthroscopy for the treatment of acetabular chondral lesions due to femoroacetabular impingement syndrome.

To investigate a radiographic sign believed to be indicative of hip instability and acetabular suction seal disruption in the native hip, coined the "windshield wiper" (WSW) sign.

To evaluate the current body of evidence surrounding the diagnosis, management, and clinical outcomes of adhesions that developed after hip arthroscopy (HA).