2025年07月 保髋进展 JCR Q2

PURPOSE: A comprehensive meta-analysis is required to address the lack of quantitative evidence on treatment outcomes in borderline developmental dysplasia of the hip (BDDH). This study compares periacetabular osteotomy (PAO) and hip arthroscopy (HAS) through a multi-level meta-analysis, providing quantitative insights into their efficacy and safety. METHODS: A systematic literature search was conducted in PubMed, Epistemonikos, and Embase up to February 28, 2025. A frequentist meta-analysis was performed using the Hartung-Knapp-Sidik-Jonkman heterogeneity estimator. Continuous variables were analyzed using mean values with 95% confidence intervals (CIs), and binary outcomes as proportions with 95% CIs. Sensitivity analysis compared studies defining BDDH as 20-25° versus all included studies. Statistical heterogeneity was assessed using Higgins' RESULTS: The literature search identified 39 primary studies with a total of 2075 patients (2121 hips). The test for subgroup differences showed no statistically significant difference between the PAO group and the HAS group in post-operative mHHS ( CONCLUSION: PAO and HAS yield comparable short- to mid-term outcomes in BDDH. Long-term studies are needed to determine whether HAS is a definitive treatment or delays structural correction. Future research should standardize BDDH definitions (LCEA 20-25°) to enhance comparability and treatment consistency. LEVEL OF EVIDENCE: A meta-analysis of retrospective and prospective primary studies.

Treatment for neuromuscular hip dysplasia (NMHD) typically involves osteotomies of the proximal femur and/or pelvis, and the potential for significant volume blood loss is high. Tranexamic acid (TXA) functions as an antifibinolytic and has been shown to reduce bleeding in many operative settings. Retrospective evidence for the use of TXA in children undergoing NMHD reconstruction is inconclusive, and to our knowledge, prospective evaluation has never been performed. The purpose of this study was to examine the effectiveness of TXA use on intra- and postoperative outcomes during bony reconstruction for NMHD. In this matched comparative study, a prospective cohort of patients undergoing bony reconstruction for NMHD who were given TXA was enrolled and then matched to a retrospective cohort who previously underwent the same surgery without administration of TXA. The primary outcome variable was a change in perioperative hemoglobin values from preoperative to 1 day postoperatively. Secondary objectives were percent loss of estimated blood volume, postoperative transfusion requirements, and length of hospital stay. Forty-eight patients, 24 in each cohort, were included in the analyses. Mean age at surgery was 7.09 years (±2.5). Fifty percent of each cohort underwent bilateral varus derotational osteotomy with pelvic acetabuloplasty. No statistical differences were found in postoperative hemoglobin differences ( P  = 0.18), length of hospital stay ( P  = 0.45), or blood transfusion requirements ( P  = 0.56) between cohorts. Intraoperative administration of TXA to patients undergoing bony reconstruction for NMHD was not found to reduce postoperative blood loss or requirement for blood transfusion. Future studies should employ a larger, prospective randomized controlled trial to verify these findings.

BACKGROUND: Iliopsoas impingement after total hip replacement is an uncommon, but well recognised cause of residual groin pain. The primary aim of this study was to review patient outcomes following arthroscopic iliopsoas release. Secondary outcome was to determine the incidence of postoperative instability and review the literature on this complication. METHODS: A retrospective cohort study of all arthroscopic THR iliopsoas release procedures performed from 2012 until 2022 was undertaken. All patients had completed a minimum of 12 months of conservative treatment and had undergone a preoperative ultrasound-guided diagnostic steroid injection.Postoperatively, patients were classified into 3 categories at their 12-month clinical review: complete relief of symptoms; incomplete relief of symptoms but significant improvement; and no/minimal benefit. Any complications were documented and reviewed. RESULTS: 30 patients were included (31 hips); there were 14 males and 16 females. Mean age was 53.4 (range 34-77) years. 21 patients had a THR, 7 patients had a hip resurfacing, 1 patient had bilateral hip resurfacings and underwent bilateral release, and 1 patient had a revision THR. 2 patients were lost to follow-up, leaving 29 hips for inclusion in the study. Patients underwent arthroscopic release a median of 48 months following primary THR (range 12-180 months). At 12-month follow-up, 13 patients (44.8%) had complete relief of symptoms, 9 patients (31.0%) had incomplete relief of symptoms but significant improvement, and 7 patients (24.1) had no improvement.3 patients (10.3%) had frank anterior dislocation of their THR in the early postoperative period. CONCLUSIONS: The majority of patients with persistent iliopsoas tendinitis following hip arthroplasty had significant improvement in symptoms with arthroscopic iliopsoas release. However, the series highlights the potential for postoperative instability and we would advise caution with regards to excessive capsular resectio