2025年12月 保髋进展 JCR Q1

Iliopsoas impingement refers to the painful contact between the iliopsoas tendon and the anterior acetabular rim of the hip joint. This mechanism can occur in the native hip as part of an internal snapping hip syndrome and, in particular, following total hip arthroplasty, leading to chronic groin pain and a substantial reduction in the quality of life. This review article outlines the diagnostic approaches for identifying iliopsoas impingement and presents both established open procedures and innovative minimally invasive arthroscopic techniques for iliopsoas tendon release, in order to facilitate precise treatment planning and avoid potential complications. Das Iliopsoas-Impingement bezeichnet den schmerzhaften Kontakt der Iliopsoassehne mit dem vorderen Pfannenrand des Hüftgelenks. Dieser Mechanismus kann sowohl am nativen Hüftgelenk im Rahmen einer Coxa saltans interna als auch insbesondere nach Implantation einer Hüfttotalendoprothese zu chronischen Leistenschmerzen und einer erheblichen Einschränkung der Lebensqualität führen. Der vorliegende Übersichtsartikel beschreibt die diagnostischen Verfahren zur Identifikation eines Iliopsoas-Impingements und stellt etablierte offene als auch innovative minimal-invasive arthroskopische Techniken zur Sehnenentlastung (Iliopsoas-Release) vor, um eine gezielte Therapieplanung zu ermöglichen und potenzielle Komplikationen zu vermeiden.

The clinical impact of periacetabular osteotomy (PAO) in patients with borderline hip dysplasia (BHD) remains unclear. This systematic review aims to evaluate outcomes in patients with BHD undergoing PAO. A systematic review was conducted according to PRISMA guidelines by searching PubMed, Embase, and the Cochrane Library for English-language studies reporting clinical outcomes of PAO in BHD patients. Outcomes assessed included conversion to total hip arthroplasty (THA), return-to-sport (RTS) rates and patient-reported outcome measures (PROMs) such as the modified Harris Hip Score (mHHS), Hip Outcome Score (HOS), Subjective Hip Value (SHV), Hip Disability and Osteoarthritis Outcome Score (HOOS), Short-Form Health Survey (SF-12/SF-36), International Hip Outcome Tool (iHOT-12/iHOT-33) and Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) scores. Eleven studies (2 Level III, 9 Level IV) with 657 hips met inclusion criteria. The mean patient age was 26.9 years, and follow-up was 48.1 months. The average BMI was 23.3 kg/m², and 13.0% of patients were male. mHHS improved significantly in four studies (mean: 62.6-82.9). SF-12/SF-36 physical scores improved in three studies (37.8-47.6). Two studies each showed gains in iHOT and SHV scores. The reoperation rate was 9.5%, mostly for implant irritation. THA conversion occurred in 0.2%. One study reported a 92.5% return-to-sport rate, typically within 6 months. In patients with BHD undergoing PAO, there is consistent improvement in most PROMs along with a low rate of reoperation and conversion to THA. Level IV, systematic review of Level III-IV studies.

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. Emerging evidence indicates distinct morphological and clinical patterns of FAI between sexes. Cam-type morphology is more prevalent in males, whereas females more frequently present with pincer morphology and generalized joint hypermobility. Sex-specific differences in acetabular and femoral version, pelvic anatomy, and ligamentous laxity may contribute to variable symptomatology and diagnostic challenges. Postoperative outcomes following hip arthroscopy also appear to vary, with some studies reporting inferior outcome scores in females while others report no differences based on patient sex. Sex-based anatomical and biomechanical differences in FAI are clinically significant and may impact diagnosis, treatment strategy, and surgical outcomes. Recognizing and addressing these distinctions can optimize outcomes for both male and female patients. Continued research is needed to refine our understanding sex-specific etiology, pathology, and management approaches to ultimately improve long-term hip preservation.

To summarize and evaluate the surgical technique, patient-reported outcomes (PROs), and complications of combined periacetabular osteotomy (PAO) and hip arthroscopy for the treatment of hip dysplasia and intra- and extra-articular hip pathology, respectively. Clinical studies evaluating outcomes of simultaneous combined hip arthroscopy and PAO procedures performed under the same anesthesia event were identified in PubMed, Embase, and The Cochrane Library per the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines up to October 10, 2024. PROs, complications, intraoperative procedures, radiographic parameters, and demographic factors were assessed. Study quality and bias were assessed using the modified Coleman score and Methodological Index for Non-Randomized Studies (MINORS). Studies assessing hip arthroscopy and PAO not performed under the same anesthesia event were excluded. Twelve studies with 730 hips (612 female and 118 male) were included, with average follow-up time ranging from 1.7 to 12.8 years. Eleven studies reported PROs, and all studies that compared postoperative and baseline outcomes reported a statistically significant improvement in modified Harris Hip Score, Hip Outcome Score-Activities of Daily Living, Hip Outcome Score-Sport, and visual analog scale for pain postoperatively compared to baseline. The modified Harris Hip Score, visual analog scale for pain, and Non-Arthritic Hip Score ranged from 55 to 72 preoperatively to 82 to 90 postoperatively, 5.1 to 6 preoperatively to 1.9 to 3 postoperatively, and 57 to 61 preoperatively to 80 to 90 postoperatively, respectively. Minimal clinically important difference was reported in 4 studies and patient acceptable symptom state in 2 studies. Thirty-three hips (4.5%) experienced complications, and 8 hips (1%) converted to total hip arthroplasty. The median modified Coleman methodology score was 59 (Range: 43-65), and the median MINORS score was 12 (Range: 11-14) for noncomparative studies and 20.5 (Range: 19-22) for comparative studies. Combined hip arthroscopy and PAO results in statistically significant improvement in PROs, low complication rates, and low conversion to arthroplasty at short- to medium-term follow-up. Level IV, systematic review of Level III and IV studies.

Scientific literature commonly aims to establish an association between exposures of interest- hormonal contraception in the case of the present study-and their dependent effects. As readers, studies confirming risk factors we suspected all along-or even those bringing new risk factors to light-are often stored away in our clinical minds as causation rather than association, regardless of how clearly their findings were presented. This is a bias we must be cognizant of given that some exposures of interest are nonmodifiable whereas others, while modifiable, should not necessarily be modified.

This article provides a comprehensive overview of the orthopedic management strategies in Duchenne muscular dystrophy (DMD). DMD manifests with severe muscle wasting, respiratory insufficiency, and cardiomyopathy, with initial symptoms emerging in early childhood. By the age of 10-12 years, most patients require wheelchairs due to muscle degeneration, which often leads to spinal deformities and joint contractures. The absence of dystrophin causes the breakdown of the dystrophin glycoprotein complex, causingmuscle degeneration, necrosis, and fibrosis. Current treatments focus on symptom management, including physical therapy, corticosteroids, orthopedic surgery, ventilatory and nutritional support, and cardiac care. Long-term glucocorticoid therapy can extend mobility and life expectancy, delay the need for ventilation, and reduce the rates of scoliosis surgery. Orthopedic care focuses on prevention to preserve motor function and bone health and involves an interdisciplinary team, early use of orthotic devices, and promotion of proper posture. Common deformities include varus equinus, hip flexor retractions, scoliosis, and pelvic obliquity. Scoliosis management involves posterior fusion surgery extended to the pelvis or limited to the L5 vertebra. Preoperative evaluation should include assessing the risk of hip flexion contracture decompensation following arthrodesis. There now seems to be increasing consensus favoring lower extremity surgery only in exceptional cases. This shift is due to the limited success of surgery, with frequent recurrence of muscle retractions and minimal expected benefits. Fracture management involves bisphosphonate therapy post-fracture, with vertebral compression and lower limb fracture being the most prevalent.

Glucocorticoid-induced osteoporosis (GIOP) is a major cause of secondary bone loss characterized by rapid trabecular deterioration and increased fracture risk, and while bisphosphonates are widely used as first-line therapy, the comparative effectiveness of denosumab remains clinically relevant. This systematic review synthesized evidence from randomized trials, imaging studies, and observational cohorts evaluating denosumab versus bisphosphonates in adults receiving glucocorticoids, focusing on bone mineral density, bone turnover, microarchitecture, fractures, and safety. Denosumab consistently produced greater increases in lumbar spine bone mineral density, with modest but generally favorable effects at the hip and variable advantages at the femoral neck. High-resolution imaging suggested superior preservation of cortical thickness, trabecular density, and estimated bone strength with denosumab, accompanied by deeper suppression of bone turnover markers across studies. Fracture outcomes did not demonstrate meaningful differences between treatments, likely due to limited power and relatively short follow-up. Safety profiles were broadly comparable, without significant variation in adverse events or serious complications. Overall, denosumab appears to offer stronger densitometric and mechanistic benefits than bisphosphonates in GIOP, supporting its use in patients who are inadequately responsive to alternative therapies or require long-term glucocorticoid treatment, although larger and longer trials with fracture endpoints are still needed.

The complex and dynamic biomechanics of soccer significantly increase the susceptibility of the hip joint to injury. While hip arthroscopy is a valuable diagnostic and therapeutic modality that facilitates an expedited return to play for athletes, the specific extent of its clinical benefit for soccer players requires further evaluation. A systematic review and meta-analysis were conducted. Embase, Pubmed, ScienceDirect, and Wiley Online were selected as search databases. Case series related to "soccer" and "hip arthroscopy" were retrieved. After screening, Joanna Briggs Institute (JBI) tools was used to assess the risk of bias. The differences before and after treatment in modified Hip Harris Score (mHHS) scores, Visual Analog Scale (VAS) scores, Activities of Daily Living (ADL) scores, and Return to Play (RTP) rates were evaluated. This study included 12 case series studies into quantitative analysis, with a total of 361 soccer players. Among them, eight with high-quality and four with moderate quality. The meta-analysis results showed that after receiving hip arthroscopy, patients' mHHS scores increased (MD = 28.49, 95%CI [19.23; 37.75], Z = 6.03, P < 0.0001), VAS scores decreased (MD=-4.91, 95%CI [-7.02; -2.80], Z=-4.57, P < 0.0001), and ADL scores increased (MD = 23.59, 95%CI [18.04; 29.14], Z = 8.33, P < 0.0001). Soccer players who underwent hip arthroscopy surgery had an RTP of Proportion = 0.910, 95%CI [0.822; 0.974], a high-level performance RTP ratio of Proportion = 0.71, 95%CI [0.40; 0.90], and a mean return to play time of 6.34, 95%CI [4.50; 8.18] months. Among soccer players with hip injuries, hip arthroscopy surgery is associated with improved hip function, reduced pain levels, enhanced ability to perform daily activities, and a high return-to-sport rate.

There is disagreement regarding use of hip orthoses after arthroscopic surgery for femoroacetabular impingement syndrome (FAIS). Few data exist on the postoperative effect of bracing in this context. It was hypothesized that at 6 weeks after arthroscopic surgery for FAIS, patients wearing a brace would have significantly lower mean Numerical Pain Ranking Scale (NPRS) score compared with those who did not wear a brace. Secondary goals included comparison of additional patient-reported outcome measures, physical examination findings, complications, and use of medications or injections at 6 weeks and 6 months postoperatively. Randomized controlled trial; Level of evidence 1,Methods:An intention-to-treat randomized controlled trial for treatment superiority was performed. Inclusion criteria were patients aged 14 to 60 years undergoing arthroscopic osteoplasty and labral repair for FAIS. Patients who would not be able to undergo follow-up in clinic or who did not speak English were excluded. Patients were randomized to brace and no-brace groups at their preoperative appointment. Braces were worn full-time for 3 weeks postoperatively and then weaned. Surgeries were performed by a single surgeon who was not aware of brace assignment. Patients completed NPRS, Hip disability Osteoarthritis Outcome Score (HOOS), and Veterans Rand 12 (VR-12) assessment at regular intervals with a primary endpoint of 6 weeks after surgery. The study was designed to have 80% power to detect a clinically meaningful difference in NPRS of 1.2 points (32 patients per group). In this randomized controlled trial, patients who wore a hip brace after FAIS surgery did not experience less pain (mean NPRS) at 6 weeks postoperatively compared with patients who did not wear a brace. Clinicaltrials.gov NCT04599296.

The spectrum of hip pathology treated by hip preservation surgery ranges from femoroacetabular impingement to hip dysplasia. Borderline hip dysplasia (BHD) represents a challenging diagnosis where the surgical indication is not always clear. BHD is a complex pathology which presents challenges in surgical decision-making between hip arthroscopy and open surgery, specifically periacetabular osteotomy. Research has shown efficacy for both isolated hip arthroscopy and/or periacetabular osteotomy as a treatment option in the appropriately selected patients.