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Background: The indirect head of the rectus femoris (IHRF) tendon has been used as an autograft for segmental labral reconstruction. However, the biomechanical properties and anatomic characteristics of the IHRF, as they relate to surgical applications, have yet to be investigated. Purpose: To (1) quantitatively and qualitatively describe the anatomy of IHRF and its relationship with surrounding arthroscopically relevant landmarks; (2) detail radiographic findings pertinent to IHRF; (3) biomechanically assess segmental labral reconstruction with IHRF, including restoration of the suction seal and contact pressures in comparison with iliotibial band (ITB) reconstruction; and (4) assess potential donor-site morbidity caused by graft harvesting. Study Design: Descriptive laboratory study. Methods: A cadaveric study was performed using 8 fresh-frozen human cadaveric full pelvises and 7 hemipelvises. Three-dimensional anatomic measurements were collected using a 3-dimensional coordinate digitizer. Radiographic analysis was accomplished by securing radiopaque markers of different sizes to the evaluated anatomic structures of the assigned hip.Suction seal and contact pressure testing were performed over 3 trials on 6 pelvises under 4 different testing conditions for each specimen: intact, labral tear, segmental labral reconstruction with ITB, and segmental labral reconstruction with IHRF. After IHRF tendon harvest, each full pelvis had both the intact and contralateral hip tested under tension along its anatomic direction to assess potential site morbidity, such as tendon failure or bony avulsion. Results: The centroid and posterior apex of the indirect rectus femoris attachment are respectively located 10.3 ± 2.6 mm and 21.0 ± 6.5 mm posteriorly, 2.5 ± 7.8 mm and 0.7 ± 8.0 mm superiorly, and 5.0 ± 2.8 mm and 22.2 ± 4.4 mm laterally to the 12:30 labral position. Radiographically, the mean distance of the IHRF to the following landmarks was determined as follows: anterior inferior iliac spine (8.8 ± 2.5 mm), direct head of the rectus femoris (8.0 ± 3.9 mm), 12-o'clock labral position (14.1 ± 2.8 mm), and 3-o'clock labral position (36.5 ± 4.4 mm). During suction seal testing, both the ITB and the IHRF reconstruction groups had significantly lower peak loads and lower energy to peak loads compared with both intact and tear groups (P =.01 to.02 for all comparisons). There were no significant differences between the reconstruction groups for peak loads, energy, and displacement at peak load. In 60° of flexion, there were no differences in normalized contact pressure and contact area between ITB or IHRF reconstruction groups (P >.99). There were no significant differences between intact and harvested specimen groups in donor-site morbidity testing. Conclusion: The IHRF tendon is within close anatomic proximity to arthroscopic acetabular landmarks. In the cadaveric model, harvesting of the IHRF tendon as an autograft does not lead to significant donor-site morbidity in the remaining tendon. Segmental labral reconstruction performed with the IHRF tendon exhibits similar biomechanical outcomes compared with that performed with ITB. Clinical Relevance: This study demonstrates the viability of segmental labral reconstruction with an IHRF tendon and provides a detailed anatomic description of the tendon in the context of an arthroscopic labral reconstruction. Clinicians can use this information during the selection of a graft and as a guide during an arthroscopic graft harvest. [ABSTRACT FROM AUTHOR]

Background: In patients with femoroacetabular impingement (FAI), mental health has been implicated in both symptom severity and postoperative outcomes. However, there are limited data regarding the independent influences of baseline mental health and hip pathology on patient-reported outcomes over time after hip arthroscopy. Purpose: To evaluate the association between mental health and structural hip pathology with pain, hip function, and quality of life (QOL). Study Design: Cohort study; Level of evidence, 3. Methods: Patient records from a single surgeon's hip outcomes registry were retrospectively reviewed. Mental health was evaluated using the Patient-Reported Outcomes Measurement Information System Anxiety and Depression scores. Pain was evaluated with the Single Assessment Numeric Evaluation score for Activities of Daily Living (SANE-ADL), while hip-related QOL was evaluated with the 12-item International Hip Outcome Tool (iHOT-12). Hip function was assessed with the Hip Outcome Score (HOS) Sport-Specific (SS) and ADL subscales. Separate mixed models were used to predict pain, QOL, and hip function, including hip pathology measures (size of labral tear, grade of chondral damage, preoperative alpha angle), anxiety, depression, and time as fixed effects and individuals as a random effect. Results: A total of 312 patients were included in this study. The preoperative alpha angle, degree of intraoperative cartilage damage, and size of the labral tear were not associated with pain or QOL (P >.05 for all). However, higher levels of anxiety and depression were significantly associated with lower SANE-ADL scores (estimate ± SE) (anxiety: –0.59 ± 0.07, P <.0001; depression: –0.64 ± 0.08, P <.0001), iHOT-12 scores (anxiety: –0.72 ± 0.07, P <.0001; depression: –0.72 ± 0.08, P <.0001), HOS-SS scores (anxiety: –0.68 ± 0.09, P <.0001; depression: –0.57 ± 0.10, P <.0001), and HOS-ADL scores (anxiety: –0.43 ± 0.05, P <.0001; depression: –0.43 ± 0.06, P <.0001). Conclusion: Patients had similar improvements in pain scores, QOL, and hip function after hip arthroscopy for FAI irrespective of their degree of hip pathology. Additionally, preoperative symptoms of anxiety and depression symptoms were associated with greater pain, decreased QOL, and worse hip function both pre- and postoperatively, independent of the degree of hip pathology. This suggests that efforts to directly address symptoms of anxiety and depression may improve outcomes after hip arthroscopy. [ABSTRACT FROM AUTHOR]

Background: Hip arthroscopy has proved successful in treating femoroacetabular impingement syndrome (FAIS) in patients with and without borderline hip dysplasia (BHD). Despite a high prevalence of BHD in patients who participate in sports with high flexibility requirements, a paucity of literature evaluates the efficacy of hip arthroscopy in treating FAIS in flexibility sport athletes with BHD. Purpose: To compare minimum 2-year patient-reported outcomes (PROs) and achievement of clinically significant outcomes in flexibility sport athletes with BHD undergoing primary hip arthroscopy for FAIS with capsular plication with results in flexibility sport athletes without dysplasia. Study Design: Cohort study; Level of evidence, 3. Methods: Data were prospectively collected for patients undergoing primary hip arthroscopy for FAIS with BHD, defined as a lateral center-edge angle of 18° to 25°, who reported participation in a sport with a high flexibility requirement, including dance, gymnastics, figure skating, yoga, cheerleading, and martial arts, according to previous literature. These patients were matched 1:2 to flexibility sport athletes without dysplasia, controlling for age, sex, and body mass index. Preoperative and minimum 2-year postoperative PROs were collected and compared between groups. Cohort-specific minimal clinically important difference and patient acceptable symptom state achievement was compared between groups. Results: In total, 52 flexibility sport athletes with BHD were matched to 104 flexibility sport athletes without BHD. Both groups showed similar sport participation (P =.874) and a similar level of competition (P =.877). Preoperative lateral center-edge angle (22.2°± 1.6° vs 31.5°± 3.9°; P <.001) and Tönnis angle (10.9°± 3.7° vs 5.8°± 4.4°; P <.001) differed between groups. Capsular plication was performed in all cases. Both groups achieved significant improvement in all PROs (P <.001) with no differences in postoperative PROs between groups (P ≥.147). High minimal clinically important difference (BHD group: 95.7%; control group: 94.8%) and patient acceptable symptom state (BHD group: 71.7%; control group: 72.2%) achievement for any PRO was observed with no differences between groups (P ≥.835). Conclusion: Flexibility sport athletes with BHD achieved similar outcomes as those of flexibility sport athletes without BHD after hip arthroscopy for FAIS with capsular plication. [ABSTRACT FROM AUTHOR]

Background: An everted acetabular labrum (EL) is a pathologic variant in which the labrum is flipped to the capsular side of the acetabular rim. An iatrogenic EL is a known complication of a poorly executed labral repair, and a recent study described the native acetabular EL. Purpose: To analyze surgical outcomes after advancement or reconstruction of an EL in a native hip. Study Design: Cohort study; Level of evidence, 3. Methods: This was a multicenter retrospective review of prospectively collected data on primary hip arthroscopic surgeries performed between 2013 and 2023. An EL was identified arthroscopically as a labrum–femoral head gap while off traction in the native hip. All patients with EL who were analyzed in this study underwent arthroscopic labral repair and advancement or labral augmentation or reconstruction. Patients with hip dysplasia also underwent periacetabular osteotomy with or without a derotational femoral osteotomy. Patient-reported outcomes (PROs) were assessed using the 12-item International Hip Outcome Tool (iHOT-12) and the Nonarthritic Hip Score. PROs were obtained preoperatively and up to 24 months after surgery. PROs were compared with those of a case-matched control cohort in a 1:2 ratio. Only patients with PROs available at ≥1 year postoperatively were included in the outcome analysis. Results: A total of 111 patients (129 hips) with EL during the study period were identified, with PROs available in 96 hips. The mean age of patients with EL was 30.5 years, and women made up 87% of the cohort. Of the 129 hips with an EL, an isolated diagnosis of an EL was present in 11.6% of hips. Deficient acetabular coverage (lateral center-edge angle <25°) was seen in 40.6% of EL hips. No difference was seen in iHOT-12 scores between EL and control groups at 12- or 24-month follow-up (P =.18 and.94, respectively). Patients with EL reported a significant improvement of PROs at latest follow-up (P <.001 for iHOT-12 and Nonarthritic Hip Score). Conclusion: Surgical management of a native EL with restoration of the labral seal on the femoral head and correction of concomitant pathologies resulted in significant clinical improvement, with postoperative outcome scores comparable to those of patients without an EL. These findings provide evidence supporting surgical intervention for a native EL. [ABSTRACT FROM AUTHOR]

Background: Hip arthroscopy is rapidly advancing, with positive published outcomes at short- and midterm follow-up; however, available long-term data remain limited. Purpose: To evaluate outcomes of primary hip arthroscopy at a minimum 10-year follow-up at 2 academic centers by describing patient-reported outcomes and determining reoperation and total hip arthroplasty (THA) rates. Study Design: Case series; Level of evidence, 4. Methods: Patients with primary hip arthroscopy performed between January 1988 and April 2013 at 2 academic centers were evaluated for postoperative patient-reported outcomes—including the visual analog scale, Tegner Activity Scale score, Hip Outcome Score Activities of Daily Living and Sport Specific subscales, modified Harris Hip Score, Nonarthritic Hip Score, 12-item International Hip Outcome Tool, surgery satisfaction, and reoperations. Results: A total of 294 patients undergoing primary hip arthroscopy (age, 40 ± 14 years; 66% women; body mass index, 27 ± 6) were followed for 12 ± 3 years (range, 10-24 years) postoperatively. Labral debridement and repair were performed in 41% and 59% of patients, respectively. Of all patients who underwent interportal capsulotomy, 2% were extended to a T-capsulotomy, and 11% underwent capsular repair. At final follow-up, patients reported a mean visual analog scale at rest of 2 ± 2 and with use of 3 ± 3, a 12-item International Hip Outcome Tool of 68 ± 27, a Nonarthritic Hip Score of 81 ± 18, a modified Harris Hip Score of 79 ± 17, and a Hip Outcome Score Activities of Daily Living of 82 ± 19 and Sport Specific subscale of 74 ± 25. The mean surgical satisfaction was 8.4 ± 2.4 on a 10-point scale, with 10 representing the highest level of satisfaction. In total, 96 hips (33%) underwent reoperation—including 65 hips (22%) converting to THA. THA risk factors included older age, higher body mass index, lower lateral center-edge angle, larger alpha angle, higher preoperative Tönnis grade, as well as labral debridement and capsular nonrepair (P ≤.039). Patients undergoing combined labral and capsular repair demonstrated a THA conversion rate of 3% compared with 31% for patients undergoing combined labral debridement and capsular nonrepair (P =.006). Labral repair trended toward increased 10-year THA-free survival (84% vs 77%; P =.085), while capsular repair demonstrated significantly increased 10-year THA-free survival (97% vs 79%; P =.033). Conclusion: At a minimum 10-year follow-up, patients undergoing primary hip arthroscopy demonstrated high satisfaction and acceptable outcome scores. In total, 33% of patients underwent reoperation—including 22% who underwent THA. Conversion to THA was associated with patient factors including older age, higher Tönnis grade, and potentially modifiable surgical factors such as labral debridement and capsular nonrepair. [ABSTRACT FROM AUTHOR]

Background: Previous studies have shown that dexamethasone has a positive effect on postoperative pain control, opioid consumption, nausea, and vomiting and length of hospital stay after arthroplasty surgery. Purpose/Hypothesis: The purpose of this study was to assess whether adding perioperative dexamethasone to our current pain regimen after hip arthroscopy is more effective than a placebo. It was hypothesized that dexamethasone would reduce postoperative pain, reduce opioid consumption, improve subjective pain and nausea scores, and reduce the number of vomiting events. Study Design: Randomized controlled trial; Level of evidence, 1. Methods: A total of 50 patients requiring unilateral elective hip arthroscopy were randomized to receive intravenous dexamethasone immediately before induction of anesthesia and at 8 am on the first postoperative day (2 ×12 mg) or a placebo (sodium chloride 0.9%). The patient, the surgeons, the treating anesthesiologist, and the involved nursing and physical therapy personnel were blinded to group assignment. The primary outcome was postoperative pain, and secondary outcomes were opioid consumption and nausea scores—assessed using a translated revised version of the American Pain Society Patient Outcome Questionnaire 6 hours postoperatively and on days 1 and 2—and vomiting events. A clinical follow-up was performed 12 weeks postoperatively to assess adverse events. Results: The mean age at inclusion was 29 years in both groups. Postoperative pain levels did not differ significantly in most instances. Opioid requirements during the hospitalization in the dexamethasone group were significantly lower than those in the placebo group (31.96 ± 20.56 mg vs 51.43 ± 38 mg; P =.014). Significantly fewer vomiting events were noted in the dexamethasone group (0.15 ± 0.59 vs 0.65 ± 0.91; P =.034). Descriptive data and surgical parameters did not differ significantly. Conclusion: Perioperative intravenous dexamethasone significantly reduced postoperative opioid consumption by 40% without compromising pain level and safety, as no corticosteroid-related side effects were observed. Dexamethasone may be a valuable adjuvant to a multimodal systemic pain regimen after hip arthroscopy. Registration: NCT04610398 (ClinicalTrials.gov identifier). [ABSTRACT FROM AUTHOR]

Background: Little is known about the effect of modern hip arthroscopy on the natural history of femoroacetabular impingement syndrome (FAIS) with respect to joint preservation. Purpose: To (1) characterize the natural history of FAIS and (2) understand the effect of modern hip arthroscopy by radiographically comparing the hips of patients who underwent only unilateral primary hip arthroscopy with a minimum follow-up of 10 years. Study Design: Cohort study; Level of evidence, 3. Methods: Between 2010 and 2012, 619 consecutive patients were reviewed from the practice of a single fellowship-trained hip arthroscopic surgeon. Inclusion criteria were FAIS, bilateral radiographic findings of femoroacetabular impingement, primary unilateral hip arthroscopy (labral repair, femoroplasty, or capsular closure), and minimum 10-year follow-up. The preoperative and minimum 10-year postoperative radiographs of patients were evaluated at each time point. Both operative and nonoperative hips were graded using the Tönnis classification or the presence of hip arthroplasty by 2 independent reviewers. Subgroup analyses were performed. Results: A total of 200 hips from 100 patients were evaluated at a mean follow-up of 12.0 years. Preoperatively, 98% and 99% of operative and nonoperative hips were evaluated as Tönnis grades 0 and 1, respectively; 5% of nonoperative hips had worse Tönnis grades than operative hips. The nonoperative hip advanced to a worse Tönnis grade in 48% (48/100) of cases compared with 28% (28/100) among operative hips. At follow-up, Tönnis grades between hips were equal in 70% (70/100) of the cases, the operative hip had a better grade 25% (25/100) of the time, and the nonoperative hip had a better grade 5% (5/100) of the time. Modern hip arthroscopy was associated with a relative risk reduction of 42% in osteoarthritis progression. Impingement with borderline dysplasia, age, preoperative Tönnis grade, and alpha angle >65° were key risk factors in the radiographic progression of osteoarthritis. Conclusion: Although the majority of patients (70%) undergoing hip arthroscopy for FAIS did not experience differences between operative and nonoperative hips in terms of the radiographic progression of osteoarthritis, the natural history may be favorably altered for 25% of patients whose Tönnis grade was better after undergoing arthroscopic correction. Modern hip arthroscopy indications and techniques represent a valid joint-preservation procedure conferring a relative risk reduction of 42% in the progression of osteoarthritis. Arthroscopy for mixed patterns of impingement and instability were the fastest to degenerate. [ABSTRACT FROM AUTHOR]

Background: Minimal clinically important difference (MCID) and patient acceptable symptom state (PASS) thresholds have been previously defined for the Patient-Reported Outcomes Measurement Information System (PROMIS) at 1-year follow-up in patients undergoing hip arthroscopy for femoroacetabular impingement syndrome; however, the MCID and PASS thresholds are yet to be defined for the PROMIS at 2-year follow-up. Purpose: (1) To establish MCID and PASS thresholds for the PROMIS Pain Interference (PROMIS-PI) and PROMIS Physical Function (PROMIS-PF) at 2-year follow-up and (2) to correlate PROMIS scores with hip-specific patient-reported outcome measure (PROM) scores. Study Design: Cohort study (diagnosis); Level of evidence, 3. Methods: Patients undergoing primary hip arthroscopy for femoroacetabular impingement syndrome between August and November 2020 with preoperative and minimum 2-year postoperative data were identified. Collected scores included those for the PROMIS-PI, PROMIS-PF, Hip Outcome Score–Activities of Daily Living (HOS-ADL), Hip Outcome Score–Sports Subscale (HOS-SS), International Hip Outcome Tool–12 (iHOT-12), and visual analog scale (VAS) for pain. MCID thresholds were calculated using the distribution-based method and PASS thresholds using the anchor-based method. Pearson correlation coefficients were used to compare scores between PROMs. Results: A total of 65 patients met the criteria for inclusion (72.3% female; mean age, 36.9 ± 13.5 years; mean body mass index, 26.2 ± 6.0). The mean follow-up was 25.3 ± 3.3 months. Significant preoperative to postoperative improvements were observed for all PROMs (P <.001). MCID thresholds and achievement rates were as follows: HOS-ADL, 10.1 and 75%, respectively; HOS-SS, 13.8 and 79%, respectively; iHOT-12, 14.0 and 67%, respectively; VAS pain, –13.8 and 78%, respectively; PROMIS-PI, –4.7 and 65%, respectively; and PROMIS-PF, 5.8 and 60%, respectively. PASS thresholds and achievement rates were as follows: HOS-ADL, 78.7 and 67%, respectively; HOS-SS, 76.4 and 62%, respectively; iHOT-12, 67.4 and 60%, respectively; VAS pain, 25.5 and 61%, respectively; PROMIS-PI, 57.0 and 65%, respectively; and PROMIS-PF, 45.6 and 58%, respectively. PROMIS-PI scores correlated most strongly with HOS-ADL (r = −0.836), HOS-SS (r = −0.767), and iHOT-12 (r = −0.719) scores and exhibited at least moderate correlations (r ≥−0.595) with the other PROM scores. PROMIS-PF demonstrated moderate correlations with all the other PROM scores (r ≥−0.586). Strong correlations were seen between the hip-specific PROM scores (r ≥−0.745). Conclusion: This study defined 2-year MCID and PASS thresholds for the PROMIS-PI and PROMIS-PF and demonstrated moderate to strong correlations between PROMIS scores and hip-specific PROM scores. [ABSTRACT FROM AUTHOR]

Background: The amount of resection or the starting point of the resection on the femoral head for cam lesions in femoroacetabular impingement (FAI) is controversial. Aim: The purpose of this study was to study the effect of postoperative resection depth, and resection arc ratio of cam lesion on the frequency of achieving substantial clinical benefit (SCB), patient acceptable state (PASS) in modified Harris Hip Score (mHHS) and Hip Outcome Score Activity of Daily Living (HOSADL), 2 years postoperatively. Patients and methods: All patients who underwent first-time hip arthroscopy for FAI with a 2-year follow-up were included in this study. Patient-reported outcomes included the mHHS, HOSADL, and visual analogue scale for pain (Pain VAS). Radiological parameters such as alpha angletraditional (αT), alpha anglecartilage (αC), resection arc ratio (% alpha anglecartilage-alpha angletraditional/360°), resection depth (''D"mm) and resection depth ratio 'D%' (D/femoral head diameter %) were measured using the 45° Dunn view. Results: We identified 26 patients (27 hips) with 2-year follow-up. There were 10 female and 16 male patients. The mean age of the patients was 33 ± 12 years. Higher frequency of achieving SCB threshold for mHHS was related to labrum repair (73% vs. debridement '27%' p = 0.03), lower preoperative αT (64° vs. 76°, p = 0.04), lower preoperative mHHS (54 vs. 81, p < 0.001) and higher preoperative VAS scores (8 vs. 7, p = 0.02). Higher frequency of reaching PASS threshold for mHHS was associated with lower αC (82°vs. 92° p :0.02), lower RA (8% vs. 11%, p = 0.03), lower D (2.8 mm vs. 4.5 mm p :0.03), lower D% (4.7% vs. 8.4% p = 0.04) and higher postoperative mHHS (97 vs. 82 p < 0.001). Conclusions: A higher frequency of achieving SCB for HOSADL was related to lower D% (5% vs. 10.5%, p = 0.04). Cam resection depth affects the frequency of achieving clinically meaningful scores and resection depth less than 6% of the femoral head diameter seems to be appropriate for optimal results. The starting point of resection on head cartilage needs to be <90° when alpha angle is used for reference. [ABSTRACT FROM AUTHOR]

Background: In the setting of femoroacetabular impingement (FAI), decompression osteoplasties reconcile deleterious loading patterns caused by cam and pincer lesions. However, native variations of spinopelvic sagittal alignment may continue to perpetuate detrimental effects on the labrum, chondrolabral junction, and articular cartilage after hip arthroscopy. Purpose: To evaluate the effect of pelvic incidence (PI) on postoperative outcomes after hip arthroscopy for acetabular labral tears in the setting of FAI. Study Design: Cohort study; Level of evidence, 3. Methods: A retrospective query of prospectively collected data identified patients ≥18 years of age who underwent primary hip arthroscopy for FAI and acetabular labral tears between February 2014 and January 2022, with 3-, 6-, 12-, and 24-month follow-ups. Measurements for PI, pelvic tilt (PT), sacral slope (SS), and acetabular version were obtained via advanced diagnostic imaging. Patients were stratified into low-PI (<45°), moderate-PI (45°≤ PI ≤ 60°), and high-PI (>60°) cohorts. Patient-reported outcome measures (PROMs), clinically meaningful outcomes (ie, minimal clinically important difference, Patient Acceptable Symptom State, substantial clinical benefit, and maximal outcome improvement), visual analog scale (VAS) pain scores, and patient satisfaction were compared across cohorts. Results: A total of 74 patients met eligibility criteria and were stratified into low-PI (n = 28), moderate-PI (n = 31), and high-PI (n = 15) cohorts. Correspondingly, patients with high PI displayed significantly greater values for PT (P =.001), SS (P <.001), acetabular version (P <.001), and acetabular inclination (P =.049). By the 12- and 24-month follow-ups, the high-PI cohort was found to have significantly inferior PROMs, VAS pain scores, rates of clinically meaningful outcome achievement, and satisfaction relative to patients with moderate and/or low PI. No significant differences were found between cohorts regarding rates of revision arthroscopy, subsequent spine surgery, or conversion to total hip arthroplasty. Conclusion: After hip arthroscopy, patients with a high PI (>60°) exhibited inferior PROMs, rates of achieving clinically meaningful thresholds, and satisfaction at 12 and 24 months relative to patients with low or moderate PI. Conversely, the outcomes of patients with low PI (<45°) were found to match the trajectory of those with a neutral spinopelvic alignment (45°≤ PI ≤ 60°). These findings highlight the importance of analyzing spinopelvic parameters preoperatively to prognosticate outcomes before hip arthroscopy for acetabular labral tears and FAI. [ABSTRACT FROM AUTHOR]

Background: Current classification systems for intra-articular pathology intraoperatively have been described for patients with femoroacetabular impingement rather than dysplasia. Purpose: To (1) describe intra-articular findings in dysplastic hips undergoing combined hip arthroscopy and periacetabular osteotomy (PAO); (2) propose a new chondrolabral classification system for dysplastic hips based on these findings; and (3) correlate patient-reported outcome measures (PROM) with the newly proposed classification. Study Design: Case series; Level of evidence, 4. Methods: A total of 46 hips underwent combined hip arthroscopy and PAO at our institution between September 2013 and December 2014, irrespective of symptoms or radiographic findings. PROMs were evaluated preoperatively and at 2 years postoperatively. At the time of hip arthroscopy, the chondrolabral junction was classified as normal without tear (1 hip, type 1); hypertrophic labrum without chondrolabral disruption (19 hips, type 2); chondrolabral disruption on the articular side, not extending into the capsular side (16 hips, type 3A); chondrolabral disruption extending through the capsular side (3 hips, type 3B); and exposed acetabular subchondral bone (7 hips, type 4). Results: There was a significant difference in postoperative modified Harris Hip Score (mHHS) (P =.020), Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) pain scores (P =.037), and WOMAC total scores (P =.049) between chondrolabral junction types. Post hoc analyses demonstrated significant differences between type 2 (84.9 ± 12.9) and type 3A (67.8 ± 20.7; P =.198), and between type 2 and type 4 (59.3 ± 24.3; P =.011) in postoperative mHHS scores; and between type 2 (83.9 ± 12.9) and type 3A (68.9 ± 23.7; P =.045) in postoperative WOMAC total scores. In multivariate analysis, chondrolabral type 3 or type 4, age >35 years, and previous surgery were significantly correlated with worse mHHS scores at 2 years. Conclusion: This new chondrolabral classification is proposed to describe intra-articular pathology seen during combined hip arthroscopy and PAO, specifically in dysplastic hips. More advanced chondrolabral disease was associated with worse PROMs at 2 years. [ABSTRACT FROM AUTHOR]

Background: Hip dysplasia is a common condition in active adults with hip pain that can lead to joint degeneration. Periacetabular osteotomy (PAO) is a common surgical treatment for hip dysplasia. The effect of this surgery on pain, function and quality of life (QOL) has not been systematically analysed. Purpose: In adults with hip dysplasia: (1) evaluate differences in pain, function and QOL in those undergoing PAO and healthy controls; (2) evaluate pre- to post-PAO changes in pain, function and QOL; (3) evaluate differences in pain, function and QOL in those with mild versus severe dysplasia, undergoing PAO; and (4) evaluate differences in pain, function and QOL in those having primary PAO versus those with previous hip arthroscopy. Methods: A comprehensive, reproducible search strategy was performed on 5 different databases. We included studies that assessed pain, function and QOL in adults undergoing PAO for hip dysplasia, using hip-specific patient reported outcomes measures. Results: From 5017 titles and abstracts screened, 62 studies were included. Meta-analysis showed PAO patients had worse outcomes pre- and post-PAO compared to healthy participants. Specifically, pain (standardised mean difference [SMD] 95% confidence interval [CI]): −4.05; −4.78 to −3.32), function (−2.81; −3.89 to −1.74), and QOL (−4.10; −4.43 to −3.77) were significantly poorer preoperatively. Meta-analysis found patients experienced improvements following PAO. Pain improved from pre-surgery to 1-year (standardised paired difference [SPD] 1.35; 95% CI, 1.02–1.67) and 2 years postoperatively (1.35; 1.16–1.54). For function, the activities of daily living scores at 1 year (1.22; 1.09–1.35) and 2 years (1.06; 0.9–1.22) and QOL at 1 year (1.36; 1.22–1.5) and 2 years (1.3; 1.1–1.5) all improved. No difference was found between patients undergoing PAO with mild versus severe dysplasia. Conclusions: Before undergoing PAO surgery, adults with hip dysplasia have worse levels of pain, function and QOL compared to healthy participants. These levels improve following PAO, but do not reach the same level as their healthy participants. Registration: PROSPERO (CRD42020144748) [ABSTRACT FROM AUTHOR]

Background: Short stems are designed with a bone preservation philosophy in mind. This study aims to compare the outcomes/complications and survival of a collarless fully hydroxyapatite (HA)-coated conventional tapered stem and a HA-coated partial neck-retaining uncemented short stem in patients ⩽55 years old at medium-term follow-up. Methods: We retrospectively studied 247 uncemented THAs operated between 2010 and 2014, comparing 146 patients treated with the fully HA-coated collarless stem (Group A) with 101 patients treated with a partial neck preserving, HA-coated short stem (Group B). 87 and 62 males were in groups A and B, respectively (p = 0.11). The mean age of the series was 46 years (17–55) (p = 0.16). The mean follow-up of groups A and B were 9.9 (7–12) years and 9.7 (7–12) years, respectively (p = 0.21). Results: Mean Harris Hip Score improved from 55 to 92 in group A (p < 0.001) and from 54 to 95 in group B (p < 0.001), without differences between groups. Mean femoral neck length preservation in groups A and B was 13.6 (0–28) mm and 26 (11–38) mm, respectively (p = 0.001). 13 (8.9%) and 1 (1%) patients in groups A and B presented postoperative complications, respectively (p = 0.008). The conventional stem group had more aseptic loosening (Group A 3.4% vs. Group B 0%, p = 0.06) along with more Symptomatic radiolucent lines (Group A 3.4% vs. Group B 0%, p = 0.06). Conclusions: Both conventional and short stems showed excellent implant survival rates and functional outcomes at a mean follow-up of 9.8 years. However, complications and radiolucent lines were more frequent with a collarless conventional-length stem. Bone preservation of the femoral neck and diaphysis may be preferred in active young patients. [ABSTRACT FROM AUTHOR]

Purpose: Several controversies in the optimal treatment of femoral neck fractures persist, together with large variations in clinical practice. Methods: A narrative literature review covering 4 current controversies in the surgical management of femoral neck fractures (total hip arthroplasty (THA) versus hemiarthroplasty (HA), cemented versus uncemented HA, internal fixation versus arthroplasty, operative versus non-operative) was performed. Available literature was balanced against annual trends in the management of femoral neck fractures from the public domain of several national registries (Sweden, Norway, The Netherlands, Australia and New Zealand). Results: For most controversies, the literature provides stronger evidence than is reflected by variations encountered in daily practice. Implementation of clinical evidence tends to lag behind and important differences exist between countries. Conclusions: Trends of clinical practice from national registries indicate that implementation of available clinical evidence needs to be improved. [ABSTRACT FROM AUTHOR]

Background: The postoperative management of femoroacetabular impingement (FAI) is variable with favourable surgical outcomes. Yet there is no evidence on the efficacy of hydrotherapy in athletes undergoing hip arthroscopy for FAI. The purpose of this study was to evaluate the role and the impact of hydrotherapy on return to sports following hip arthroscopy for symptomatic FAI. Methods: 2 cohorts of mixed level of athletes from various sports: a hydrotherapy group that followed land-based exercises in combination with hydrotherapy exercises and a control group that followed solely the same land-based exercises. Pre- and postoperative pain and hip-specific outcome scores were completed, and patient satisfaction was rated. Results: A total of 88 hip arthroscopies were included with a minimum of 2 years follow-up; the hydrotherapy group comprised of 36 hips and the control group, 52 hips. There was a significant improvement in time to return to previous performance (HR 1.91, 95% CI, 1.21–3.01; p = 0.005) in the hydrotherapy group compared with the control. The hip-specific scores and patient satisfaction were considerably improved in the hydrotherapy group. Conclusions: The analysis of our data indicates that the incorporation of hydrotherapy into postoperative rehabilitation for hip arthroscopy for FAI accelerates the return of athletes to their pre-injury performance, since recovery time decreased significantly. [ABSTRACT FROM AUTHOR]

Background: Previous studies evaluating the outcomes of hip arthroscopy for patients with global acetabular overcoverage and focal superolateral acetabular overcoverage suffer from short-term follow-up and inconsistent radiographic criteria when defining these subpopulations of patients with femoroacetabular impingement syndrome (FAIS). Purpose: To evaluate the intermediate-term postoperative outcomes for patients with FAIS in the setting of global acetabular overcoverage, lateral acetabular overcoverage, and normal acetabular coverage. Study Design: Cohort study; Level of evidence, 3. Methods: Patients undergoing hip arthroscopy for FAIS were enrolled in a prospective cohort study, and those with a minimum follow-up of 5 years were included in this analysis. Patients were grouped based on type of acetabular coverage: global overcoverage (lateral center-edge angle [LCEA] ≥40°, with coxa profunda), lateral overcoverage (LCEA ≥40°, without coxa profunda), and no overcoverage (LCEA <40°). Functional outcomes (modified Harris Hip Score and Nonarthritic Hip Score) and failure of primary hip arthroscopy were compared between groups. Results: In total, 94 patients (mean age, 41.9 ± 14.2 years) were included with a mean follow-up duration of 6.1 ± 0.9 years. Of these patients, 40.4% had no acetabular overcoverage, 36.2% had lateral overcoverage, and 23.4% had global overcoverage. There was no difference between groups with respect to percentage of patients who underwent reoperation for either revision arthroscopy or conversion to total hip arthroplasty (28.9% for the normal acetabular coverage group, 29.4% for the lateral overcoverage group, and 31.8% for the global overcoverage group; P =.971). Among patients for whom primary hip arthroscopy did not fail, there was no difference in 5-year functional outcomes between groups. Postoperative LCEA >40° (β = −13.3; 95% CI, –24.1 to −2.6; P =.016), female sex (β = −14.5; 95% CI, –22.7 to −6.2; P =.001), and higher body mass index (β = −1.9; 95% CI, –2.8 to −1.0; P <.001) were associated with worse intermediate-term hip function in terms of modified Harris Hip Score. Conclusion: There was no difference in functional outcomes or rate of reoperation at a minimum of 5 years postoperatively between those with global acetabular overcoverage, those with regional lateral overcoverage, and those with normal acetabular coverage. Provided that an appropriate acetabuloplasty is performed, there is no evidence to suggest that global acetabular overcoverage portends a worse prognosis than other FAIS subtypes. [ABSTRACT FROM AUTHOR]

Background: Hip arthroscopic surgery for femoroacetabular impingement syndrome (FAIS) has proven to be an effective surgical intervention, with high rates of return to sport and work as well as favorable outcomes at short- and midterm follow-up. However, limited data exist on outcomes at long-term follow-up. Purpose: To evaluate patient-reported outcomes (PROs) at a minimum 10-year follow-up after primary hip arthroscopic surgery including labral repair, femoral osteochondroplasty, acetabular osteochondroplasty, and capsular closure for FAIS. Study Design: Case series; Level of evidence, 4. Methods: Patients who underwent primary hip arthroscopic surgery for FAIS between June 2012 and January 2013 were identified. PROs were collected preoperatively and at a minimum of 10 years postoperatively, including the Hip Outcome Score–Activities of Daily Living (HOS-ADL), Hip Outcome Score–Sports Subscale (HOS-SS), modified Harris Hip Score (mHHS), International Hip Outcome Tool–12 (iHOT-12), and visual analog scale (VAS) for pain and satisfaction. Unique minimal clinically important difference (MCID) and patient acceptable symptom state (PASS) thresholds were calculated, and their rates of achievement were analyzed. An alpha level of <.05 was used to determine statistical significance. Results: A total of 94 patients (55 female; mean age, 34.3 ± 12.4 years) were analyzed with a mean follow-up of 10.1 ± 0.3 years (range, 10.0-10.7 years). Patients demonstrated significant 10-year improvement across all PRO measures (P <.001). MCID and PASS thresholds were calculated as follows: HOS-ADL (10.4 and 85.3, respectively), HOS-SS (14.6 and 60.2, respectively), mHHS (8.8 and 76.0, respectively), VAS pain (14.6 and 27.5, respectively), and iHOT-12 (PASS: 71.4). The majority of patients achieved the MCID and PASS for each PRO measure: HOS-ADL (73.4% and 70.9%, respectively), HOS-SS (78.5% and 77.2%, respectively), mHHS (81.0% and 70.9%, respectively), VAS pain (88.6% and 70.9%, respectively), and iHOT-12 (PASS: 73.4%). Overall, 9 patients (9.6%) underwent subsequent revision hip arthroscopic surgery at a mean 4.9 ± 3.7 years (range, 1.1-10.1 years) postoperatively, and 6 patients (6.4%) underwent conversion to total hip arthroplasty at a mean 4.1 ± 3.1 years (range, 0.9-9.3 years) postoperatively. Conclusion: Patients who underwent primary hip arthroscopic surgery for FAIS utilizing contemporary methods of labral repair, acetabular and/or femoral osteochondroplasty, and capsular closure commonly experienced sustained clinical improvement and reported high levels of satisfaction at a minimum 10-year follow-up with low rates of reoperation. [ABSTRACT FROM AUTHOR]

Background: Hip arthroscopy has become the mainstay surgical intervention for the treatment of femoroacetabular impingement syndrome (FAIS). However, postoperative outcomes and rates of secondary surgery are mixed in patients with differing levels of preoperative osteoarthritis (OA). Furthermore, there is a paucity of literature comparing patients with and without OA at long-term follow-up. Purpose: To compare outcomes and rates of secondary surgery at minimum 10-year follow-up, including revision hip arthroscopy and conversion to total hip arthroplasty (THA), in patients with Tönnis grade 1 undergoing hip arthroscopy for FAIS compared with a propensity-matched control group of patients with Tönnis grade 0. Study Design: Cohort study; Level of evidence, 3. Methods: Patients who underwent primary hip arthroscopy for FAIS between January 2012 and February 2013 were identified. Patients with Tönnis grade 1 were propensity matched in a 1:2 ratio by age, sex, and body mass index (BMI) to patients with Tönnis grade 0. Patient-reported outcomes (PROs) were collected at varying timepoints including preoperatively and 1, 2, 5, and 10 years postoperatively and compared between the 2 cohorts. Rates of minimal clinically important difference (MCID) and Patient Acceptable Symptom State (PASS) achievement at 10 years were evaluated and compared between groups. Rates of secondary surgery including revision hip arthroscopy and conversion to total hip arthroplasty (THA) were evaluated. Gross survivorship between cohorts was evaluated using a Kaplan-Meier gross survivorship curve. A subanalysis was performed comparing patients with Tönnis grade 1 who converted to THA and those who did not. Results: A total of 31 patients with Tönnis grade 1 (age, 42.6 ± 9.0 years; BMI, 28.0 ± 6.3) were successfully matched to 62 patients with Tönnis grade 0 (age, 42.1 ± 8.5, P =.805; BMI, 26.1 ± 3.9, P =.117). Both the Tönnis grade 1 and Tönnis grade 0 groups demonstrated significant improvements regarding all PROs at minimum 10 years (P <.05 for all), except for the Hip Outcome Score Activities of Daily Living subscale (HOS-ADL) (P =.066) in the Tönnis grade 1 cohort. No significant difference (P >.05 for all) was noted between cohorts regarding any 10-year PRO. When the authors evaluated comparisons between preoperative and 1-, 2-, 5-, and 10-year PRO measures, significant differences were noted between cohorts regarding 2-year HOS-ADL (P =.021), Hip Outcome Score Sports-Specific subscale (P =.016), and modified Harris Hip Score (P =.026); otherwise, differences did not reach significance. High rates of 10-year MCID and PASS achievement were seen, with no significant differences between groups. Patients with Tönnis grade 1 had significantly higher rates of conversion to THA compared with patients who had Tönnis grade 0 (25.8% vs 4.8%; P =.006). Patients with Tönnis grade 1 had significantly lower gross survivorship compared with those who had Tönnis grade 0 (71.0% vs 85.5%, respectively; P =.04). Conclusion: Hip arthroscopy confers comparable postoperative clinical improvements to patients who have FAIS with and without mild OA; however, the benefits among patients with mild OA may be less durable. Patients with Tönnis grade 1 had significantly higher conversion to THA and reduced gross survivorship compared with patients with no evidence of preoperative OA, suggesting that patients with evidence of OA may need to be cautioned on the higher rate of conversion surgery. [ABSTRACT FROM AUTHOR]

Background: Historically, symptomatic hip labral lesions were treated with arthroscopic debridement. Hip labral repair has become the standard treatment for labral pathology; however, to date, there are limited long-term studies regarding the outcomes of isolated labral debridement. Purpose: To (1) evaluate the long-term patient-reported outcomes of isolated labral debridement, (2) report reoperation and arthroplasty rates, and (3) identify risk factors contributing to reoperation or poor clinical outcomes. Study Design: Case series; Level of evidence, 4 Methods: A retrospective review of a prospectively generated cohort of 59 hips in 57 patients from 1996 to 2010 who underwent hip arthroscopy with labral debridement was performed. Only patients with Tönnis grade <3 were included. Additionally, given the time period analyzed, resection of cam morphology was not performed, and the interportal capsulotomy was not repaired. The pre- and postoperative modified Harris Hip Score; Hip Outcome Score (HOS)-Activities of Daily Living and -Sports scores; and reoperation, conversion to total hip arthroplasty, and risk factors were analyzed. Results: In total, 48 hips in 47 patients (14 men, 33 women; mean age, 48.0 ± 12.9 years) met inclusion criteria and were followed for a mean of 17 ± 3 years (range, 13-27 years). The mean preoperative Tönnis grade was 1.3 ± 0.6 (range, 0-2), the mean chondral acetabular International Cartilage Regeneration & Joint Preservation Society (ICRS) grade was 1.7 ± 1.6 (range, 0-4), the mean chondral femoral ICRS grade was 0.9 ± 1.4, and the mean acetabular labral articular cartilage grade was 2.5 ± 1.2 (range, 0-4). At the final follow-up, mean the modified Harris Hip Score, HOS-Activities of Daily Living score, and HOS-Sports score were 82.2 ± 16.6, 81.9 ± 20.5, and 82.2 ± 20.5, respectively. Nineteen hips underwent subsequent reoperation at a mean of 5.5 ± 6.2 years (range, 0.5-21.2 years) postoperatively, including 16 hips (33% overall) being converted to total hip arthroplasty. Higher acetabular ICRS chondral grades at the time of surgery were observed in patients who went on to subsequent surgery compared with those who did not (2.3 ± 1.6 vs 1.1 ± 1.5; P =.02). In reoperation-free hips, Tönnis grade demonstrated a trend of increasing over time (1.4 preoperatively vs 1.7 at radiographic follow-up; P =.08). At the final follow-up, 19 hips (40%) had undergone reoperation, and 5 additional hips (10%) were rated as "abnormal" or "severely abnormal" in function, resulting in an overall clinical failure rate of 50%. Conclusion: Isolated labral debridement was found to result in high rates of failure and reoperation, with a third of patients being converted to arthroplasty and half of patients meeting criteria for reoperation or clinical failure. Of note, for patients remaining reoperation-free, satisfactory outcome scores were observed. [ABSTRACT FROM AUTHOR]

Background: The Patient Acceptable Symptom State (PASS) after primary hip arthroscopy has been determined; nonetheless, the PASS still needs to be defined for revision hip arthroscopy. Purpose: To define minimum 2-year follow-up PASS thresholds for the modified Harris Hip Score (mHHS), Nonarthritic Hip Score (NAHS), Hip Outcome Score–Sports Specific Subscale (HOS-SSS), visual analog scale (VAS) for pain, and International Hip Outcome Tool-12 (iHOT-12) after revision hip arthroscopy, and to identify predictors of achieving the PASS. Study Design: Case-control study; Level of evidence, 3. Methods: Data were prospectively collected and retrospectively reviewed for all patients who underwent revision hip arthroscopy between April 2017 and July 2020. Patients were included if they had baseline and minimum 2-year follow-up scores for the mHHS, NAHS, HOS-SSS, VAS for pain, and iHOT-12. PASS was calculated using the anchor-based method. Receiver operating characteristic curve analysis was used to determine the thresholds for the PASS. A multivariate logistic regression was used to identify predictors for achieving the PASS. Results: A total of 318 patients who underwent revision hip arthroscopy met the inclusion criteria. Of those patients, 292 (91.8%) had baseline and minimum 2-year follow-up. Of this group, 68 patients (72.1% female and 27.9% male; mean age, 32.9 years) answered the PASS anchor question. Achievement PASS rates were 58.8%, 41.2%, 52.9%, 60.3%, and 52.9% for the mHHS, NAHS, HOS-SSS, VAS, and iHOT-12, respectively. The area under the curve (AUC) values for the PASS for mHHS, NAHS, HOS-SSS, VAS, and iHOT-12 were 0.912, 0.888, 0.857, 0.903, and 0.871, respectively, indicating excellent discrimination. The PASS for the mHHS was 76 (sensitivity, 0.809; specificity, 0.905), for the NAHS was 86.3 (sensitivity, 0.660; specificity, 1), for the HOS-SSS was 64.3 (sensitivity, 0.745; specificity, 0.905), for the VAS was 3 (sensitivity, 0.830; specificity, 0.905), and for the iHOT-12 was 64.3 (sensitivity, 0.745; specificity, 0.905). Body mass index (BMI) was identified as a significant predictor of achieving PASS for the NAHS (OR, 0.967; 95% CI, 0.940-0.996; P =.027), as patients with a BMI ≤25.4 had 1.03 times higher odds ratio of achieving PASS for the NAHS. Conclusion: After revision hip arthroscopy, the minimum 2-year follow-up PASS thresholds for the mHHS, NAHS, HOS-SSS, VAS for pain, and iHOT-12 were 76, 86.3, 64.3, 3, and 64.3, respectively. The odds ratio of achieving PASS for the NAHS was 1.03 times higher for patients with a BMI ≤25.4. [ABSTRACT FROM AUTHOR]

Background: Femoroacetabular impingement (FAI) has been described as repetitive and abnormal contact between a structurally abnormal proximal femur (cam) and/or acetabulum (pincer), occurring during the terminal range of motion of the hip. While cam and pincer lesions have traditionally been defined as osseous abnormalities, there may be a subset of adolescent patients whose impingement is primarily soft tissue (nonosseous). The existence of a nonosseous cam lesion in adolescents with FAI has not been well described. Purpose: To identify and characterize a series of adolescent patients with nonosseous (soft cam) FAI identified on magnetic resonance imaging (MRI) and compare these patients' clinical presentation and outcome with those of a cohort with primary osseous cam FAI in the same age group. Study Design: Case series; Level of evidence, 4. Methods: A prospective institutional registry of patients with symptomatic FAI was reviewed. Patients were included if they had an MRI scan and a lateral radiograph of the hip (45° Dunn or frog) at a baseline visit. On MRI, the anterolateral femoral head was evaluated using radial, coronal, sagittal, or axial oblique sequences. A soft cam lesion was identified by the presence of soft tissue thickening of ≥2 mm at the anterolateral femoral head-neck junction. An alpha angle was measured on MRI scans and radiographs when a lesion was identified. The cohort with soft cam lesions was reviewed and findings and outcomes were compared with those of a cohort with osseous cam lesions. Continuous variables were first examined for normality, and then nonparametric tests—such as the Kruskal-Wallis test—were considered. The change between pre- and postoperative patient-reported outcomes (PROs) was described by mean and standard deviation and evaluated with an independent-samples t test. Results: A total of 31 (9.3%) of 332 hips (mean age, 16.4 years [range 13.1-19.6 years]; women, 83.9%) were identified with a soft tissue impingment lesion on MRI at the femoral head-neck junction between the 12 and 3 o'clock positions. These lesions demonstrated a thickened perichondral ring (71%), periosteal thickening (26%), or a cartilaginous epiphyseal extension (3%). The mean alpha angle on MRI was greater than on radiographs (63.5°± 7.9° vs 51.3°± 7.9°; P <.0001). A total of 22 patients (71%) with soft impingement underwent hip preservation surgery. When compared with patients in the osseous cohort who also underwent surgical management, both groups showed similar significant improvements from pre- to postoperatively (soft: modified Harris Hip Score [mHHS], 26.9 ± 18.2; Hip disability and Osteoarthritis Outcome Score [HOOS], 31.4 ± 22.9; osseous: mHHS, 22.8 ± 20.8; HOOS, 27.4 ± 20.1; P <.0001), with a mean follow-up of 3.4 years (range, 1-7 years) in the soft cam cohort and 3 years (1-10.1 years) in the osseous cam cohort. Conclusion: Clinicians should be aware of nonosseous or soft cam lesions that cause impingement in adolescent patients without an obvious osseous cam on radiographs. MRI is required to detect these soft cam lesions. When nonoperative treatment fails, the PROs in these patients after operative management are comparable with those in patients with osseous cam lesions. Further research is needed to determine whether the soft cam precedes an osseous cam or whether it is a separate entity. [ABSTRACT FROM AUTHOR]

Background: The transtendinous technique has been used to treat partial-thickness gluteus medius tears in the setting of concomitant arthroscopy for labral tears. The tendon compression bridge technique for gluteus medius repair has been developed as an alternative method, providing several advantages; however, comparative studies between the 2 techniques are lacking in the literature. Purpose: (1) To evaluate the short-term patient-reported outcomes (PROs) of the tendon compression bridge technique and (2) to compare these findings with short-term PROs of the transtendinous technique. Study Design: Cohort study; Level of evidence, 3. Methods: Data were prospectively collected on patients who were followed for a minimum of 2 years after an endoscopic tendon compression bridge procedure for gluteus medius repair in the setting of concomitant hip arthroscopy for labral tears. The following PROs were collected preoperatively and postoperatively: modified Harris Hip Score, Nonarthritic Hip Score, Hip Outcome Score–Sports Specific Subscale, visual analog scale score for pain, and the International Hip Outcome Tool. Clinical outcomes were assessed using the Patient Acceptable Symptom State, minimal clinically important difference, and maximum outcome improvement satisfaction threshold. Patients were propensity matched 1:1 to a cohort that underwent gluteus medius repair using the endoscopic transtendinous technique with concomitant hip arthroscopy. Results: A total of 48 hips (48 patients) that met inclusion criteria (age, 53.3 ± 9.8 years; 92% female; body mass index, 26.7 ± 4.6), with a mean follow-up of 38.5 ± 15.7 months, were matched to 48 hips (46 patients) that underwent gluteus medius repair using the transtendinous technique. Both groups demonstrated significant improvement from preoperative scores to latest follow-up (P <.05). Mean magnitude of improvement and latest follow-up scores were not significantly different between the tendon compression bridge group and the transtendinous group, and the groups demonstrated similar favorable rates of achieving Minimal Clinically Important Difference (79% vs 79%, respectively), Patient Acceptable Symptom State (73% vs 73%, respectively), and Maximum Outcome Improvement Satisfaction threshold (65% vs 58%, respectively) for modified Harris Hip Score (P >.05). Patient satisfaction between groups was similar (8.1 ± 2.2 vs 7.7 ± 2.7, respectively) (P =.475). Conclusion: At minimum 2-year follow-up, the endoscopic tendon compression bridge technique for partial-thickness gluteus medius tears, when performed with concomitant hip arthroscopy, was associated with significant improvement in functional outcomes. These postoperative results were comparable with those of a matched cohort that underwent the endoscopic transtendinous technique for partial-thickness gluteus medius tears, suggesting that the tendon compression bridge technique for gluteus medius repair is an effective treatment option for partial-thickness gluteus medius tears. [ABSTRACT FROM AUTHOR]

Background: Previous studies have demonstrated alterations in squat kinematics in patients with femoroacetabular impingement syndrome (FAIS). Little is known about the effects of arthroscopic hip surgery on biomechanics during a single-leg squat (SLS) in these patients. Purpose/Hypothesis: The purpose of this study was to determine if (1) lower extremity dynamic range of motion (ROM) during an SLS task improves after hip arthroscopy for FAIS and (2) correlations exist between changes in patient-reported outcomes (PROs) and changes in lower extremity dynamic ROM during an SLS after hip arthroscopy for FAIS. It was hypothesized that dynamic hip ROM would improve after hip arthroscopy and that hip dynamic ROM would be associated with changes in PRO scores at both 6 months and 1 year. Study Design: Descriptive laboratory study. Methods: Patients with FAIS performed 3 SLSs that were analyzed using a 20-camera motion capture system. Dynamic ROMs were calculated in 3 planes for the hip, knee, ankle, and pelvic segments. Squat depth was calculated as the change in vertical center of mass during the squat cycle. PROs including the Hip Outcome Score–Activities of Daily Living (HOS-ADL), Hip Outcome Score–Sports (HOS–Sports), International Hip Outcome Tool–12, and visual analog scale for pain scores were collected preoperatively and at the time of postoperative testing. Paired-samples t tests were used to compare kinematic variables pre- and postoperatively. Correlations were used to compare changes in PROs with changes in kinematics. All statistical analysis was performed using SPSS Version 26. Results: Fifteen patients were tested preoperatively and at a mean of 9 months postoperatively. All PRO measures improved postoperatively at 6 months and 1 year. Squat depth and sagittal plane hip and knee dynamic ROMs were significantly improved postoperatively. Positive correlations existed between changes in (1) hip ROM with the 6-month HOS-ADL score (r = 0.665) and (2) knee ROM with the 6 month (r = 0.590) and 1-year (r = 0.565) HOS–Sports scores. Conclusion: Dynamic sagittal plane hip and knee ROMs improve after hip arthroscopy for FAIS. These improvements demonstrate strong correlations with improvements in some but not all postoperative PROs. Clinical Relevance: The current study sought to better understand the role of dynamic movement in the diagnosis and treatment of FAIS. These findings indicate that dynamic ROM and squat depth can, similarly to PROs, serve as biomarkers for patient function both before and after hip arthroscopic surgery. [ABSTRACT FROM AUTHOR]

Background: Patients undergoing hip arthroscopy performed with perineal post distraction may experience postoperative nerve and soft tissue complications related to the perineal post. Purpose: To compare rates of postoperative numbness in patients undergoing hip arthroscopy for femoroacetabular impingement syndrome (FAIS) with postless distraction and perineal post distraction methods. Study Design: Cohort study; Level of evidence, 3. Methods: A retrospective review of prospectively collected data was performed on patients who underwent hip arthroscopy for FAIS, with postless distraction and perineal post distraction methods. Medical records were reviewed for patient characteristics, radiographic data, and operative data. Traction force data were collected on all patients prospectively using a previously validated method. Data on postoperative numbness (presence/absence and regionality) were collected prospectively at routine postoperative follow-ups (6-week and 3-month postoperative clinic visits). Results: Overall, 195 patients were included, with 94 patients (mean age, 30.4 years) in the postless distraction cohort and 101 patients (mean age, 31.9 years) in the post distraction cohort. The overall numbness rates were 29 of 94 (30.9%) in the postless distraction group and 45 of 101 (44.6%) in the post distraction group (P =.068). Rates of postoperative groin numbness were 1 of 94 (1.1%) in the postless distraction group and 19 of 101 (18.8%) in the post distraction group (P <.001). Multivariate analysis for postoperative groin numbness demonstrated post distraction (odds ratio [OR], 16.5; P =.022) and traction time (OR, 1.7; P =.020) to be statistically significant variables. In subgroup analysis of the post distraction group, traction time (P =.015), but not holding (P =.508) or maximum traction force (P =.665), reached statistical significance in patients who developed postoperative groin numbness. Conclusion: Postless distraction hip arthroscopy demonstrated a statistically significantly lower rate of groin numbness rates in comparison with a traditional perineal post distraction method. In the post distraction group, traction time was significantly higher in patients who developed postoperative groin numbness than in those who did not. [ABSTRACT FROM AUTHOR]

Background: During the early evolution of femoroacetabular impingement (FAI) treatment, undercorrection of femoral deformity was a leading cause of hip arthroscopy failures. As the pendulum has swung, overresection of femoral deformity has increased in prevalence as a cause of persistent hip pain after arthroscopy. Computed tomography (CT) scans are increasingly being used in hip arthroscopy for preoperative planning purposes and may allow for improved 3-dimensional (3D) assessment of complex femoral deformities after previous femoroplasty. Purpose: To assess whether CT scans provide additional utility over standard radiographs in understanding proximal femoral morphology in patients being evaluated for revision hip arthroscopy after previous femoroplasty in the setting of FAI. Study Design: Cohort study (Diagnosis); Level of evidence, 3. Methods: Preoperative CT scans and standard radiographs were obtained in 80 patients who underwent revision hip arthroscopy for FAI. The anteroposterior and Dunn radiographic views were used to assess patients for residual proximal femoral deformity and were compared with the CT scan views using a commercially available software program. Determinations of underresection were made using alpha angle, while overresection was determined according to a previously described technique. Chi-square tests were performed to determine statistical significance between radiographic and CT classifications of overresection, underresection, and concomitant over- and underresection. A kappa value was calculated to determine the agreement between measurements on the radiographs and CT scans. Results: There were 30 patients (37.5%) for whom the CT scans revealed information about femoral morphology that was not detected on the radiographs. The kappa value of agreement was 0.28 between CT and radiographic measurements. Underresected cams were detected in 30 patients (37.5%) on CT scans versus 17 patients (21.3%) on radiographs (P =.024). Overresected cams were detected in 31 patients (38.8%) on CT scans versus 14 patients (17.5%) on radiographs (P =.0049). Concomitant areas of under- and overresection were detected in 12 patients (15.0%) on CT scans versus 3 patients (3.8%) on radiographs (P =.027). Conclusion: CT scans with 3D planning software may be more sensitive than traditional radiographic views at detecting aberrant proximal femoral anatomy in the setting of failed FAI surgery. The use of 3D planning software may be considered as an adjunctive tool to better understand complex deformity in the proximal femur for the planning of revision hip arthroscopy. [ABSTRACT FROM AUTHOR]

Background: The overlapping biomechanical relationship between the lumbosacral spine and pelvis poses unique challenges to patients with concomitant pathologies limiting spinopelvic range of motion. Purpose: To assess the influence of concomitant, symptomatic lumbosacral spine pathology on patient-reported outcome measures (PROMs) after hip arthroscopy for the treatment of femoroacetabular impingement (FAI) and symptomatic labral tears. Study Design: Cohort study; Level of evidence, 3. Methods: A retrospective query of prospectively collected data identified patients aged ≥18 years with a minimum 24-month follow-up who underwent hip arthroscopy by a single surgeon for the treatment of symptomatic labral tears secondary to FAI. Patients were stratified into cohorts based on the presence (hip-spine [HS]) or absence (matched control [MC]) of symptomatic lumbosacral spine pathology. Inclusion within the HS cohort required confirmation of lower back pain/symptoms on preoperative surveys plus a diagnosis of lumbosacral spine pathology verified by radiology reports and correlating clinical documentation. Patients with previous spine surgery were excluded. PROMs were compared between groups, along with rates of achieving minimal clinically important difference (MCID) thresholds, Patient Acceptable Symptom State (PASS) thresholds, revision arthroscopy, and conversion to total hip arthroplasty (THA). Results: A total of 70 patients with lumbosacral pathology were coarsened exact matched to 87 control patients without spinal pathology. The HS cohort had preoperative baseline scores that were significantly worse for nearly all PROMs. Follow-ups at 3, 6, 12, and 24 months displayed similar trends, with the HS cohort demonstrating significantly worse scores for most collected outcomes. However, at every time point, HS and MC patients exhibited similar magnitudes of improvement across all PROM and pain metrics. Furthermore, while significantly fewer HS patients achieved PASS for nearly all PROMs at 12- and 24-month follow-ups, MCID thresholds were reached at similar or greater rates across all PROMs relative to the MC cohort. Finally, there were no significant differences in rates of revision or THA between cohorts at maximum available follow-up. Conclusion: After hip arthroscopy to address labral tears in the setting of FAI, patients with symptomatic lumbosacral pathologies and no history of spine surgery were found to exhibit inferior pre- and postoperative PROMs but achieved statistically similar clinical benefit and rates of PROM improvement through 24-month follow-up compared with the MC cohort with isolated hip disease. These findings aid in providing a realistic recovery timeline and evidence that coexisting hip and spine disorders are not a contraindication for arthroscopic hip preservation surgery. [ABSTRACT FROM AUTHOR]

Introduction: Shoulder arthroplasty is mostly performed as an inpatient procedure. Same-day discharge arthroplasty has shown positive results in hip and knee surgery. Primary objective of this study was to investigate whether a safe and satisfactory same-day discharge (SDD) can be predicted with a set of easy to use predefined criteria, without increasing complications and re-admissions. Methods: This study was a prospective cohort study. Patient selection criteria were: <85 years old, ASA 1, 2, and mild ASA 3. Primary outcome variables were successful SDD, complications, re-admissions and patient satisfaction. Secondary outcomes were patient-reported outcome scores. The results are compared with the inpatient cohort. Results: In total, 163 patients were treated for elective shoulder arthroplasty. Of which 51 patients were selected for same-day discharge arthroplasty. 94% of pre-planned same-day discharge arthroplasty patients were discharged on the day of surgery. In the same-day discharge group, there were no complications related to the early discharge and a 2% readmission rate as opposed to a 3% readmission rate in the inpatient group. Surgery related as well as medical complications did not differ between the same-day discharge and inpatient cohort. Discussion: Same-day discharge shoulder arthroplasty is a safe and satisfying treatment option in selected patient groups. [ABSTRACT FROM AUTHOR]

Introduction: Release of some of the short external rotator tendons may be needed in the direct anterior approach (DAA) for Total Hip Arthroplasty (THA). It is unknown if these tendons heal. The purpose of this prospective study is to examine short external rotator tendon healing after release and the associated effect on muscle volume. In addition, we examined the relation with external rotation force and patient reported outcome measures (PROMs). Methods: In 21 DAA THA patients, preoperative MRI was compared with postoperative MRI at 6 weeks and 12 months. PROMs and rotation force of both hips were assessed. Tendon integrity and muscle volume of the obturator internus and piriformis were assessed on MRI using dedicated software. Results: In 5 patients all tendons remained intact, in 4 patients only the conjoined tendon was released and in 12 patients both the conjoined and piriformis were released. Obturator externus remained intact in all patients. In patients with tendon release, mean volume of obturator internus and piriformis muscle decreased 27% (SD 11) and 23% (SD 16) 6 weeks after surgery, respectively. Released tendons and muscle volume loss did not recover 12 months after surgery. We found no relation between tendon release and hip rotation force or PROMs. Conclusions: We found absent tendon healing and muscle volume loss when the conjoined or piriformis tendons were released. Although we found no relation between tendon detachment and hip force or PROMs, we have adapted our operative technique to make it more preserving for the piriformis. [ABSTRACT FROM AUTHOR]

Background: Femoroacetabular impingement (FAI) is a common cause of hip pain, especially in young patients. When left untreated, it has been demonstrated to be a risk factor for the onset or progression of osteoarthritis (OA) and has been identified as one of the main contributors leading to the need for total hip arthroplasty (THA) at a young age. While the short-term therapeutic potential of hip arthroscopy is widely recognized, little is known regarding its potential mid- to long-term preventive effect on the progression of hip OA. Purpose: To (1) report clinical outcomes of arthroscopically treated FAI syndrome with a minimum 5-year follow-up and compare the results to a cohort with FAI treated nonsurgically and (2) determine the influence of hip arthroscopy on the onset and progression of hip OA in patients diagnosed with FAI. Study Design: Cohort study; Level of evidence, 3. Methods: Patients who had hip pain and were diagnosed with FAI were included. Exclusion criteria were (1) previous or concomitant hip surgery, (2) <5 years of follow-up, and (3) insufficient radiographs. Patients treated with hip arthroscopy were compared with a cohort of patients with FAI who were treated nonsurgically. Kaplan-Meier estimates of failure (defined as conversion to THA) were performed. Bivariate analysis and Cox regression were used to identify factors associated with inferior clinical and radiographic outcomes. Results: A total of 957 patients (650 female, 307 male; 1114 hips) (mean age, 28.03 ± 8.9 years [range, 6.5-41.0 years]) with FAI were included. A total of 132 hips underwent hip arthroscopy and 982 hips were nonoperatively treated. The mean follow-up was 12.5 ± 4.7 years (range, 5.0-23.4 years). At the final follow-up, the rate of OA progression was 26.5% in the operative group and 35.2% in the nonoperative cohort (P <.01). Conversion to THA was performed in 6.8% of the surgical patients and 10.5% of the initially nonsurgical patients (P =.19). Additionally, there was no significant difference in the risk of failure between the operatively and nonoperatively treated patients. Male sex, increased age at initial diagnosis, presence of cam morphology, and increased initial Tönnis grade were risk factors for failure (male sex: hazard ratio [HR], 2.3; P <.01; per year of increased age: HR, 1.1; P <.01; presence of cam: HR, 3.5; P <.01; per Tönnis grade: HR, 4.0; P <.01). Conclusion: At a mean follow-up of nearly 13 years, 7% of patients of the surgical group experienced progression to THA, compared with 11% of the nonoperative control group. While most of the operative group showed little to no OA at final follow-up, moderate OA (Tönnis grade 2) was present in 12% of the cohort compared with 22% of nonsurgical patients. Increased age at diagnosis, male sex, presence of a cam morphology, and presence of initial arthritic joint changes were found to be risk factors for failure. The results of this study demonstrated evidence for a preventive effect of hip arthroscopy on the development and progression of OA in young patients with FAI at mid- to long-term follow-up. [ABSTRACT FROM AUTHOR]

Background: Borderline acetabular dysplasia is commonly radiographically defined as a lateral center-edge angle (LCEA) of 20° to 25°. While the variability of plain radiographic assessment of this population has been reported, an understanding of the variability of 3-dimensional (3D) hip morphology remains to be better defined. Purpose: To investigate the variability of 3D hip morphology present on low-dose computed tomography (CT) in the setting of symptomatic borderline acetabular dysplasia and to determine if plain radiographic parameters correlate with 3D coverage. Study Design: Cohort study (diagnosis); Level of evidence, 2. Methods: A total of 70 consecutive hips with borderline acetabular dysplasia undergoing hip preservation surgery were included in the current study. Plain radiographic evaluation included LCEA, acetabular inclination, anterior center-edge angle (ACEA), anterior wall index (AWI), posterior wall index (PWI), and alpha angles on anteroposterior, 45° Dunn, and frog-leg views. All patients underwent low-dose pelvic CT for preoperative planning, which allowed detailed characterization of 3D morphology relative to normative data. Acetabular morphology was assessed with radial acetabular coverage (RAC) calculated according to standardized clockface positions from 8:00 (posterior) to 4:00 (anterior). Coverages at 10:00, 12:00, and 2:00 were classified as normal, undercoverage, or overcoverage relative to 1 SD from the mean of normative RAC values. Femoral morphology was assessed with femoral version, alpha angle (measured at 1:00 increments), and maximum alpha angle. Correlation was assessed with the Pearson correlation coefficient (r). Results: Lateral coverage (12:00 RAC) was deficient in 74.1% of hips with borderline dysplasia. Anterior coverage (2:00 RAC) was highly variable, with 17.1% undercoverage, 72.9% normal, and 10.0% overcoverage. Posterior coverage (10:00 RAC) was also highly variable, with 30.0% undercoverage, 62.9% normal, and 7.1% overcoverage. The 3 most common patterns of coverage were isolated lateral undercoverage (31.4%), normal coverage (18.6%), and combined lateral and posterior undercoverage (17.1%). The mean femoral version was 19.7°± 10.6° (range, −4° to 59°), with 47.1% of hips having increased femoral version (>20°). The mean maximum alpha angle was 57.2° (range, 43°-81°), with 48.6% of hips having an alpha angle ≥ 55°. The ACEA and AWI were poorly correlated with radial anterior coverage (r = 0.059 and 0.311, respectively), while the PWI was strongly correlated with radial posterior coverage (r = 0.774). Conclusion: Patients with borderline acetabular dysplasia demonstrate highly variable 3D deformities, including anterior, lateral, and posterior acetabular coverage; femoral version; and alpha angle. Plain radiographic assessments of anterior coverage are poorly correlated with anterior 3D coverage on low-dose CT. [ABSTRACT FROM AUTHOR]

Background: Femoral torsion measurements and outcomes are variable throughout the literature and have focused on short-term follow-up. However, there is a paucity of literature investigating clinically meaningful outcomes at midterm follow-up after hip arthroscopy for femoroacetabular impingement syndrome (FAIS). Purpose: To quantify femoral version using computed tomography imaging in patients with FAIS and to explore the relationship between version abnormalities and 5-year outcomes after hip arthroscopy. Study Design: Cohort study; Level of evidence, 3. Methods: Patients who underwent primary hip arthroscopy for FAIS between January 2012 and November 2017 were identified. Patients were included if they had 5-year follow-up with completion of ≥1 patient-reported outcome (PRO) scores and excluded if they had Tönnis grade >1, revision hip surgery, a concomitant hip procedure, a developmental disorder, or a lateral center-edge angle <20°. Torsion groups were defined as severe retrotorsion (<0°), moderate retrotorsion (0.1°-5°), normal torsion (5.1°-20°), moderate antetorsion (20.1°-25°), and severe antetorsion (>25.1°) based on computed tomography measurements. Patient characteristics were analyzed among the torsion cohorts, as were preoperative and 5-year PROs: Hip Outcome Score–Activities of Daily Living, Hip Outcome Score–Sports Subscale, modified Harris Hip Score, international Hip Outcome Tool, visual analog scale for pain, and visual analog scale for satisfaction. Achievement rates of cohort-specific thresholds for the minimal clinically important difference and Patient Acceptable Symptom State were calculated and compared among cohorts. Results: A total of 362 patients (244 female, 118 male; mean ± SD age, 33.1 ± 11.5 years; body mass index, 26.9 ± 17.8) met inclusion/exclusion criteria and were analyzed at a final mean follow-up of 64.3 ± 9.4 months (range, 53.5-115.5 months). Mean femoral torsion was 12.8°± 9.2°. The number of patients within each group was 20 for severe retrotorsion (torsion, −6.3°± 4.9°), 45 for moderate retrotorsion (2.7°± 1.3°), 219 for normal torsion (12.2°± 4.1°), 39 for moderate antetorsion (21.9°± 1.3°), and 39 for severe antetorsion (29.0°± 4.2°). No significant differences in age, body mass index, sex, smoking status, workers' compensation, psychiatric history, back pain, or physical activity were found among the torsional groups. All groups demonstrated significant improvements at 5 years postoperatively (P <.01 for all). All torsion subgroups demonstrated similar pre- to postoperative changes in PROs (P ≥.515) and PRO values at 5-year follow-up (P ≥.098). There were no significant differences in the achievement of the minimal clinically important difference (P ≥.422) or Patient Acceptable Symptom State (P ≥.161) for any of the PROs among the torsion groups. Conclusion: The orientation and severity of femoral torsion at the time of hip arthroscopy for FAIS in this study's cohort did not affect the propensity for clinically meaningful outcome improvement at midterm follow-up. [ABSTRACT FROM AUTHOR]

An introduction is presented in which the author discusses articles within the issue on topics including hip arthroscopic debridement of acetabular labral tears, total hip arthroplasties, and patients with femoroacetabular impingement syndrome treated with contemporary surgical techniques.

Background: Hip arthroscopy is an effective treatment tool for athletes with femoroacetabular impingement (FAI) syndrome. However, long-term data are scarce. Purpose: To assess survivorship, minimum 10-year patient-reported outcome measures (PROMs), and sports participation after primary hip arthroscopy for FAI syndrome in athletes and to perform a propensity-matched comparison between patients undergoing labral debridement and labral repair. Study Design: Cohort study; Level of evidence, 3. Methods: Athletes who underwent hip arthroscopy for FAI syndrome between February 2008 and December 2010 were eligible. Exclusion criteria were other ipsilateral hip condition, Tönnis grade ≥2, or no baseline PROMs. Survivorship was defined as no conversion to total hip arthroplasty. The Patient Acceptable Symptom State (PASS), minimal clinically important difference (MCID), maximum outcome improvement (MOI) satisfaction threshold, and sports participation were reported. A propensity-matched comparison between labral debridement and labral repair was performed. Two additional propensity-matched subanalyses were performed for capsular management and cartilage damage. Results: In total, 189 hips (177 patients) were included. The mean ± SD follow-up was 127.2 ± 6.0 months. Survivorship was 85.7%. Significant improvement in all PROMs was reported (P <.001). A total of 46 athletes with labral repair were propensity matched to 46 athletes with labral debridement. This subanalysis demonstrated significant and comparable improvement in all PROMs at minimum 10-year follow-up (P <.001). For the labral repair group, the PASS achievement rates were 88.9% for the modified Harris Hip Score (mHHS) and 80% for the Hip Outcome Score–Sport Specific Subscale (HOS-SSS); the MCID achievement rates were 80.6% for the mHHS and 84% for HOS-SSS; and for the MOI satisfaction threshold, rates were 77.8%, 80.6%, and 55.6% for the mHHS, Nonarthritic Hip Score, and visual analog scale, respectively. For the labral debridement group, the PASS achievement rates were 85.3% for the mHHS and 70.4% for the HOS-SSS; the MCID achievement rates were 81.8% for the mHHS and 74.1% for HOS-SSS; and for the MOI satisfaction threshold, rates were 72.7%, 81.8%, and 66.7% for the mHHS, Nonarthritic Hip Score, and visual analog scale. Total hip arthroplasty conversions occurred significantly sooner with labral debridement than labral repair (P =.048). Age was identified as a significant predictor of achieving the PASS. Conclusion: Primary hip arthroscopy for FAI syndrome in athletes results in 85.7% survivorship and sustained PROM improvement at a minimum 10-year follow-up. A significant time delay to total hip arthroplasty conversion at 10-year follow-up was reported with labral repair over debridement, although this should be interpreted with caution, as the total number of conversions was small. [ABSTRACT FROM AUTHOR]

Purpose: This study aims to reveal the exact course of the superior gluteal nerve (SGN) branch innervating the tensor fascia lata (TFL) and show how it can be protected in the direct anterior approach (DAA) and anterolateral approach (ALA). Methods: The anterolateral regions of 22 thighs from formalin-fixed cadavers were dissected. 3 anatomical points were determined. Point A, B, C indicates where the SGN enters the gluteus minimus (GMin) fibres, the SGN leaves the gluteal muscles, the SGN enters the TFL, respectively. Measurements were made on 3 separate lines. Results: On the anterior superior iliac spine (ASIS) and the head of the fibula line (Line 1), the horizontal–vertical distances from point B and C to the ASIS were 7.99 ± 3.65 mm–40.40 ± 11.50 mm and 11.74 ± 6.61 mm–70.35 ± 14.11 mm respectively. The horizontal-vertical distances from point A, B, C to the greater trochanter (GT) were 32.41 ± 9.97 mm–55.28 ± 12.25 mm; 67.70 ± 8.54 mm–17.76 ± 13.57 mm; 63.92 ± 9.96 mm–13.00 ± 7.92 mm on the GT and the head of the fibula line (Line 2), respectively. The horizontal-vertical distances from point A, B, C to the GT were 24.58 ± 9.83 mm–42.54 ± 12.86 mm; 9.45 ± 7.92 mm–36.25 ± 9.06 mm; 26.18 ± 11.12 mm–64.05 ± 11.67 mm on the ASIS and the GT line (Line 3). Conclusions: In the DAA, the increased risk of damaging the branch of the SGN that innervates the TFL must be kept in mind. The protection of this branch can be ensured with easy and applicable rules. [ABSTRACT FROM AUTHOR]

Purpose: The purpose of this study was to investigate if early postoperative ambulation metrics affect hospital quality measures and 1-year outcomes in operative hip fracture patients. Methods: A consecutive series of hip fracture patients [OTA/AO 31A, 31B, 32A-C] who underwent operative treatment were reviewed for demographic and clinical data. Chart review was performed to determine participation with physical therapy [PT] and ambulation distance on postoperative day (POD) 1, 3, and 5. POD1 ambulators and non-ambulators were statistically compared. Outcome correlates of postoperative ambulation distance were investigated by univariate and multivariate linear and logistic regression. Results: 1044 patients were identified with 546 (52.3%) able to ambulate on POD1. Those able to ambulate on POD1 were significantly younger (78.4 ± 10.9 vs. 82.1 ± 10.4, p < 0.001), had fewer co-morbidities (CCI 1.22 ± 1.60 vs. 1.73 ± 1.82, p < 0.001), and were more likely to be preoperative community ambulators (82.2% vs. 68.3%, p < 0.001). Patients unable to ambulate on POD1 had significantly higher rate of inpatient mortality (2.8% vs. 0.5%, p = 0.004), 1-year mortality (14.6% vs. 6.9%, p < 0.001), and a longer length of stay (7.94 ± 4.73 vs. 6.43 ± 4.02 days, p < 0.001). Non-ambulators more often required the intensive care unit postoperatively (18.7% vs. 7.1%, p < 0.001), and had increased rates of major complications (15.5% vs. 5.7%, p < 0.001). Patients with OTA 31B or 32A fractures were 1.63 times more likely to ambulate on POD1 while patients with an assistive device at baseline were 0.51 times less likely to ambulate on POD1. Increasing postoperative ambulation distance correlated with shorter length of stay (p < 0.001 for POD1, 3, and 5) and every foot walked was associated with 0.57% decreased odds of a hospital complication (p = 0.0353). Conclusions: Failure to ambulate on POD1 following hip fracture surgery in >55 years is associated with an increased risk of in-hospital complications and mortality. Every effort should be made address this modifiable risk factor and mobilise patients on POD1 to improve patient outcomes. [ABSTRACT FROM AUTHOR]

Objective: The primary aim was to evaluate the long-term follow-up of Collum Femoris Preserving (CFP) stem, specifically focusing on stem survivorship, complications, as well as on clinical and radiological results. The secondary study objective is an age-based sub-analysis (<65 years vs. ⩾65 years) of long-term results. Materials and methods: We performed a retrospective analysis of patients who underwent CFP implantation between 1997 and 2009. A total of 311 patients (342 hips) were included with a mean follow-up of 15.8 ± 2.2 (range 11–24) years. 2 age groups were analysed: Group-Y (age <65) and Group-E (age ⩾65). Group-Y included 182 hips (mean follow-up 16.3 ± 4.2 years), whereas Group-E included 160 hips (mean follow-up 15.5 ± 3.7 years). Clinical (HHS, OHS and VAS) and radiological data were obtained at final follow-up. Any complications, reoperations, prosthetic components revisions and stem revisions were analysed. Results: According to HSS score, 95% of patients reported excellent/good results (95.6% Group-Y vs. 94.4% Group-E) with an overall stem survival rate of 93.3% (94% Group-Y vs. 92.5% Group-E; p = 0.37). Overall, 87% of stem revisions were performed with primary stems. The rate of prosthetic components revision was 9.9 % (9.9% in Group-Y vs. 10% in Group-E; p = 1). The reoperation rate was 10.8% (11.5% in Group-Y vs. 10.0% in Group-E; p = 0.73). Conclusions: The CFP stem provides good clinical and radiological long-term results with low rate of complications in both young and elderly patients. No significant difference in stem revision and reoperation rates was observed between the 2 groups. Both in elderly and young patients, CFP stem allows revisions to be performed with primary stems. [ABSTRACT FROM AUTHOR]

Purpose: Use of prefabricated mobile spacers in end-stage cases of hip periprosthetic joint infection (HPJI) is hindered when large bone defects exist. In such cases, prefabricated custom-made antibiotic spacers (P-CMAS) offer an alternative. Such spacers are individually designed according to the size and anatomical characteristics of the bone defect. The purpose of this study is to describe and evaluate the use of such patient-specific spacers in a two-stage strategy to treat end-stage HPJI cases, and to report on clinical outcomes. Methods: A retrospective study identified all patients with end-stage HPJIs from January 2015 through December 2019, treated using a P-CMAS. Primary outcome: infection eradication rate. Secondary outcomes: spacer-related complications and patient satisfaction. Minimum follow-up: 12 months after the second-stage surgery. Results: A total of 7 end-stage cases (mean of 6.7 previous surgical procedures) were included. Mean bone defect size was 191.57 (range 47–304) mm. Polymicrobial infection was detected in 42.86% of these cases. During the spacer stage there were no periprosthetic fractures, spacer dislocations or breakages, nor spacer-drug-related complications. All patients proceeded with the second stage uneventfully, with an average time between stages of 178 (range 119–326) days. In 5 cases a total femur arthroplasty was the reconstructive procedure performed. After a mean follow-up of 27.29 (range 14–49) months the infection was clinically eradicated in all patients, despite their difficult-to-treat scenarios. Conclusions: Industrially custom-made spacers offer an effective and safe option in performing 2-stage exchange arthroplasty in cases of end-stage HPJI with extensive bone defects. [ABSTRACT FROM AUTHOR]

Purpose: Decisions for postoperative immobilization after bony hip reconstructive surgery in cerebral palsy are controversial in current practice. The aim of this study was to check if choosing not to use any kind of postoperative immobilization is a safe practice. Methods: A retrospective cohort study was conducted in a pediatric orthopedic tertiary referral center. The study included 148 patients (228 hips) with cerebral palsy, who had bony hip surgery. Medical records were reviewed for incidence of complications, methods of pain control, and length of hospital stay. Three radiographic measures (neck-shaft angle, Reimers migration index, and acetabular index) were performed on preoperative and postoperative X-rays. X-rays were also checked for mechanical failure of implant, recurrent dislocation/subluxation, and fractures in the first 6 months postoperatively. Results: In total, 94 (64%) were male and 54 (36%) were female. Seventy-seven (52%) were Gross Motor Function Classification System V, mean age at surgery was 8.6 years (2.5–18.4 years). Length of hospital stay was 6.25 days (SD 4.64 days). Medical complications that may have prolonged hospital stay occurred in 41 patients (27.7%). Radiological measurements showed significant improvement postoperatively (p = 0.001). Seven patients (4.7%) had another surgery in first 6 months (three for recurrent dislocation/subluxation, three for implant failure, and one for ipsilateral femur fracture). Conclusion: Avoiding postoperative immobilization following bony hip surgery in cerebral palsy is a safe practice and associated with reduced rate of medical and mechanical problems compared to the current literature. This approach should be utilized with optimal pain and tone management. [ABSTRACT FROM AUTHOR]

Background: Magnetic resonance imaging (MRI) scans and radiographs are often utilized in assessing for preoperative osteoarthritis in patients undergoing hip preservation surgery. Purpose: To determine if MRI scans improve inter- or intrarater reliabilities over radiographs for findings of hip arthritis. Study Design: Cohort study (Diagnosis); Level of evidence, 3. Methods: Anteroposterior and cross-table lateral radiographs as well as a representative coronal and sagittal T2-weighted MRI scan were reviewed for 50 patients by 7 experienced subspecialty hip preservation surgeons, with a minimum experience of 10 years. Radiographs and MRI scans were assessed for joint space narrowing, subchondral cysts, osteophytes, subchondral sclerosis, Likert osteoarthritis grade (none, mild, moderate, or severe), and Tönnis grade. MRI scans were also evaluated for bony edema, heterogeneous articular cartilage, and chondral defects. Inter- and intrarater reliabilities were calculated utilizing the Fleiss method with a 95% CI. Results: The scans of 50 patients (28 female and 22 male) with a mean age of 42.8 years (SD, 14.2 years; range, 19-70 years) were reviewed. Radiographs revealed fair agreement for joint space narrowing (κ = 0.25 [95% CI, 0.21-0.30]), osteophytes (κ = 0.26 [95% CI, 0.14-0.40]), Likert osteoarthritis grading (κ = 0.33 [95% CI, 0.28-0.37]) and Tönnis grade (κ = 0.30 [95% CI, 0.26-0.34). Radiographs revealed moderate agreement for subchondral cysts (κ = 0.53 [95% CI, 0.35-0.69]). MRI scans demonstrated poor to fair agreement for joint space narrowing (κ = 0.15 [95% CI, 0.09-0.21]), subchondral sclerosis (κ = 0.27 [0.19-0.34]), heterogeneous articular cartilage (κ = 0.07 [95% CI, 0.00-0.14]), Likert osteoarthritis grade (κ = 0.19 [95% CI, 0.15-0.24]), and Tönnis grade (κ = 0.20 [95% CI, 0.15-0.24]). MRI scans demonstrated substantial agreement for subchondral cysts (κ = 0.73 [95% CI, 0.63-0.83]). Intrarater reliabilities were statistically improved compared with interrater reliabilities, but no differences were found between radiographs and MRI scans for joint space narrowing, subchondral cysts, osteophytes, osteoarthritis grade, or Tönnis grade. Conclusion: Radiographs and MRI scans had substantial limitations and inconsistency between raters in evaluating common markers of hip osteoarthritis. MRI scans demonstrated strong reliability in evaluating for subchondral cysts but did not improve the interobserver variability of grading hip arthritis. [ABSTRACT FROM AUTHOR]

Background: Patients with multiple comorbidities often have delayed hip fracture surgery due to medical optimization. The goal of this study is to identify the allowable time for medical optimization in severely ill hip fracture patients. Methods: The 2016-2019 NSQIP database was used to identify patients over age 60 with ASA classification scores 3 and 4 for severe and life-threatening systemic diseases. Patients were divided into immediate (<24 hours), early (24-48 hours), or late (>48 hours) groups based on time to surgery (TTS). Risk-adjusted multivariable logistic regressions were conducted to compare relationships between 30-day postoperative outcomes and TTS. Results: 43,071 hip fracture cases were analyzed for the purposes of this study. Compared to patients who underwent surgery immediately, patients who had surgeries between 24 and 48 hours were associated with higher rates of pneumonia (OR 1.357, CI 1.194-1.542), UTIs (OR 1.155, CI 1.000-1.224), readmission (OR 1.136, CI 1.041-1.240), postoperative LOS beyond 6 days (OR 1.249, CI 1.165-1.340), and mortality (OR 1.205, CI 1.084-1.338). Patients with surgeries delayed beyond 48 hours were associated with higher rates of CVA (OR 1.542, CI 1.048-2.269), pneumonia (OR 1.886, CI 1.611-2.209), UTIs (OR 1.546, CI 1.283-1.861), readmission (OR 1.212, CI 1.074-1.366), postoperative LOS beyond 6 days (OR 1.829, CI 1.670-2.003), and mortality (OR 1.475, CI 1.286-1.693) compared to patients with immediate surgery. Discussion: Severely ill patients with the hip fracture may have a 24-hour window for medical optimization. Hip fracture surgery performed beyond 48 hours is associated with higher complication rates and mortality among those who are severely ill. Further prospective studies are warranted to examine the effects of early surgical intervention among severely ill patients. [ABSTRACT FROM AUTHOR]

Background: Outcomes after isolated hip arthroscopic surgery for patients with dysplasia have been unfavorable. Results have included iatrogenic instability and conversion to total hip arthroplasty at a young age. However, patients with borderline dysplasia (BD) have shown more favorable results at short- and medium-term follow-up. Purpose: To assess long-term outcomes after hip arthroscopic surgery for femoroacetabular impingement in patients with BD (lateral center-edge angle [LCEA] = 18°-25°) compared with a control group of patients without dysplasia (LCEA = 26°-40°). Study Design: Cohort study; Level of evidence, 3. Methods: We identified a group of 33 patients (38 hips) with BD who were treated for FAI between March 2009 and July 2012. An age- and sex-matched control group of 83 patients (96 hips) was also identified. Patient-reported outcome scores were collected preoperatively and subsequently at a mean of 9.6 years postoperatively. Results: The mean LCEA and Tönnis angle were 22.42°± 2.02° and 6.27°± 3.23° in the BD group, respectively, and 31.71°± 3.52° and 2.42°± 3.02° in the control group, respectively (P <.001). At a mean follow-up of 9.6 years (range, 8.2-11.6 years), there was a significant improvement in all patient-reported outcome scores in both groups (P <.001). There were no significant differences between preoperative and postoperative scores or rates of achieving the minimal clinically important difference between the BD and control groups. Bilateral surgery was noted to be a risk factor for any revision during the follow-up period (P <.001). There were 2 hips (5.3%) that underwent revision surgery in the BD group and 10 hips (10.4%) in the control group; of these, 1 patient in the BD group underwent total hip arthroplasty, and 1 patient who had undergone bilateral surgery in the control group underwent bilateral hip resurfacing. Conclusion: Durable outcomes (>9 years) with low revision rates can be expected after hip arthroscopic surgery with an approach that involves labral preservation where possible and careful attention to capsular closure in patients with BD. The observed outcomes were similar to those of a femoroacetabular impingement group with normal coverage. These results highlight the importance of classifying patients into impingement or instability categories and tailoring treatment appropriately with arthroscopic surgery or periacetabular osteotomy, respectively. [ABSTRACT FROM AUTHOR]

Background: A limited joint space (<2 mm) is associated with poorer outcomes and conversion to total hip arthroplasty (THA) after hip arthroscopic surgery. As indications for hip arthroscopic surgery expand, it is important to reevaluate established risk factors among large patient populations. Purpose: To reevaluate the relationship between the radiographic joint space and outcomes after hip arthroscopic surgery and to assess the validity of a joint space of 2 mm as the accepted cutoff for successful hip arthroscopic surgery. Study Design: Cohort study; Level of evidence, 3. Methods: Patients aged 18 to 50 years who underwent hip arthroscopic surgery for femoroacetabular impingement between January 2008 and December 2016 and had a minimum 2-year follow-up were included. Patients with previous ipsilateral hip surgery, a history of hip fractures, dysplasia (lateral center-edge angle <20°), or osteoarthritis (Tonnis grade >2) were excluded. The joint space was categorized as diminished (≤2 mm), borderline (>2 to ≤3 mm), or preserved (>3 mm). Minimum 2-year patient-reported outcomes (modified Harris Hip Score [mHHS], Hip Outcome Score–Activities of Daily Living [HOS-ADL], Hip Outcome Score–Sports-Specific Subscale [HOS-SSS]), revision rates, and rates of conversion to THA were compared between groups. Results: A total of 699 patients (782 hips) with a mean age of 33.8 ± 10.1 years met 2-year inclusion criteria. The mean follow-up time was 4.2 ± 2.1 years. Overall, 51 hips (6.5%) had a diminished joint space, 297 (38.0%) had a borderline joint space, and 434 (55.5%) had a preserved joint space. Patients with a diminished joint space had larger femoral and acetabular defects compared with those with larger joint spaces. All groups had improved patient-reported outcome scores compared with baseline (P <.001 for all), and there were no differences between the groups in the percentage of patients who reached the minimal clinically important difference or patient acceptable symptom state. There were also no differences between the groups in revision rates (P =.95). A greater number of hips with a diminished joint space converted to THA (n = 8 [15.7%]) compared with those with a borderline (n = 9 [3.0%]) or preserved (n = 9 [2.1%]) joint space (P <.001). Considering joint space as a continuous variable, adjusted logistic regression showed that for every millimeter decrease in the joint space, the odds of conversion to THA increased by a factor of 2.5 (odds ratio, 2.5 [95% CI, 1.6-3.8]). Conclusion: This study demonstrated that patients with a diminished joint space were at a higher risk of conversion to THA. Although 2 mm should not serve as a strict cutoff, patients should be counseled based on their preoperative radiographic findings accordingly. [ABSTRACT FROM AUTHOR]

Background: Femoroacetabular impingement (FAI) is often a chronic problem, which can lead to a decrease in mental well-being. Purpose/Hypothesis: The purpose of this study was to determine patient mental health improvement after hip arthroscopy and if this improvement correlated with improved outcomes. It was hypothesized that patients with low mental health (LMH) status would improve after hip arthroscopy for FAI and that their patient-reported outcomes (PROs) would significantly improve after surgery. Study Design: Cohort study; Level of evidence, 3. Methods: Patients who underwent hip arthroscopy with labral repair between 2008 and 2015 were included. The minimum follow-up was 2 years. PROs included the modified Harris Hip Score (mHHS), Hip Outcome Score–Activities of Daily Living (HOS-ADL), HOS–Sports (HOS-Sports), and 12-Item Short Form Health Survey (SF-12). The minimal clinically important difference and Patient Acceptable Symptom State (PASS) were determined for HOS-ADL, HOS-Sports, and the mHHS based on previously published studies. Patients who scored <46.5 on the SF-12 Mental Component Summary (MCS) were in the LMH group, and those who scored ≥46.5 were in the high mental health (HMH) group. Results: In total, 120 (21%) of the 566 patients were in the LMH group and 446 (79%) patients were in the HMH group preoperatively. There was no difference in age or sex between groups. Patients in the LMH group had lower mHHS, HOS-ADL, and HOS-Sports at the mean 4-year follow-up and were less likely to reach PASS for the scores. Postoperatively, 84% (478/566) of the entire group was in the HMH group. A total of 88 (73%) of the LMH group improved to HMH. A multiple linear regression model for change in MCS identified independent predictors of changes in preoperative MCS to be LMH group preoperatively, change in HOS-Sports, and change in mHHS (r 2 = 0.4; P <.001). Conclusion: HMH was achieved in 84% of the patients after hip arthroscopy for FAI. Improvement in MCS was correlated with function and activity, as indicated by a significant correlation with HOS-ADL and HOS-Sports. A small percentage of patients did see a decline in their MCS score. This study showed that patients with LMH scores before hip arthroscopy for FAI can improve to normal/high mental health, and this correlated with higher PROs. [ABSTRACT FROM AUTHOR]

Purpose: Slipped capital femoral epiphysis is a common pediatric hip disease and was associated with femoral retroversion, but femoral version was rarely measured. Therefore, mean femoral version, mean femoral neck version, and prevalence of femoral retroversion were analyzed for slipped capital femoral epiphysis patients. Methods: A retrospective observational study evaluating preoperative hip magnetic resonance imaging of 27 patients (49 hips) was performed. Twenty-seven untreated slipped capital femoral epiphysis patients (28 slipped capital femoral epiphysis hips and 21 contralateral hips, age 10–16 years) were evaluated (79% stable slipped capital femoral epiphysis, 22 patients; 43% severe slipped capital femoral epiphysis, 12 patients). Femoral version was measured using Murphy method on magnetic resonance imaging (January 2014–December 2021, rapid bilateral 3-dimensional T1 water-only Dixon-based images of pelvis and knee). All slipped capital femoral epiphysis patients underwent surgery after magnetic resonance imaging. Results: Mean femoral version of slipped capital femoral epiphysis patients (−1° ± 15°) was significantly (p < 0.001) lower compared to contralateral side (15° ± 14°). Femoral version of slipped capital femoral epiphysis patients had significantly (p < 0.001) wider range from –42° to 35° (range 77°) compared to contralateral side (−5° to 44°, range 49°). Mean femoral neck version of slipped capital femoral epiphysis patients (6° ± 15°) was lower compared to contralateral side (11° ± 12°). Fifteen slipped capital femoral epiphysis patients (54%) had absolute femoral retroversion (femoral version < 0°). Six of the 12 hips (50%) with severe slips and 4 of the 8 hips (50%) with mild slips had absolute femoral retroversion (femoral version < 0°). Ten slipped capital femoral epiphysis patients (40%) had absolute femoral neck retroversion (femoral neck version < 0°). Conclusion: Although slipped capital femoral epiphysis patients showed asymmetrically lower femoral version compared to contralateral side, there was a wide range of femoral version, underlining the importance of patient-specific femoral version analysis on preoperative magnetic resonance imaging. Absolute femoral retroversion was prevalent in half of slipped capital femoral epiphysis patients, in half of severe slipped capital femoral epiphysis patients, and in half of mild slipped capital femoral epiphysis patients. This has implications for anterior hip impingement and for surgical treatment with in situ pinning or femoral osteotomy (e.g. proximal femoral derotation osteotomy) or other hip preservation surgery. [ABSTRACT FROM AUTHOR]

Background: Sufficient distraction of the hip is the key to a safe central compartment (CC) approach in hip arthroscopy. However, an adequate distraction gap has not been scientifically identified. Purpose: To determine the sufficient amount of distraction that could predict a successful CC access as well as to identify the risk factors for a failed or difficult CC access. Study Design: Case-control study; Level of evidence, 3. Methods: All patients who underwent hip arthroscopy by a single surgeon between January 2018 and April 2019 were prospectively enrolled. We analyzed gaps of the hip on 4 C-arm fluoroscopic images: nondistraction, preoperative manual traction, preoperative maximal traction (without distension), and intraoperative maximal traction (at the end of CC procedures in a successful CC approach or after peripheral compartment procedures in a failed or difficult CC approach). A failed CC approach was defined as failure in introducing the anterolateral portal to the CC under arthroscopic control; a difficult CC approach was defined as the presence of an incomplete diagnostic round in the CC because of a small distraction. The amount of distraction was evaluated by the ratio of the distracted gap to the undistracted gap. Patients were classified into the successful CC access group (group 1) and the failed/difficult CC access group (group 2). The amount of distraction, demographic characteristics, and preoperative radiographic parameters were compared between the groups. Results: A total of 240 patients were included in this study. Group 1 consisted of 205 patients (113 males and 92 females; mean ± SD age, 34.5 ± 11.4 years), and group 2 consisted of 35 patients (27 males and 8 females; age, 32.5 ± 11.2 years). The preoperative joint space width was not significantly different between group 1 (mean ± SD, 3.89 ± 0.83 mm) and group 2 (3.68 ± 0.68 mm). The ratio of the amount of distraction at lateral gaps under all traction conditions was significantly greater in group 1 compared with group 2 (1.50 ± 0.54 vs 1.26 ± 0.35, respectively, under preoperative manual traction; 2.84 ± 0.76 vs 2.03 ± 0.63 under preoperative maximal traction; 3.36 ± 0.96 vs 2.50 ± 0.79 under intraoperative maximal traction). An increase of the lateral gap by >2.2 times (P <.001) under preoperative maximal traction and by >2.7 times (P <.001) under intraoperative maximal traction could predict successful CC access. Male sex (odds ratio [OR], 2.94; P =.017) and increased lateral center-edge angle (OR, 1.08 for every 1° increase; P =.004) were significant risk factors for failed/difficult CC access. Conclusion: An increase of the lateral gap by >2.2 times during an unsterile traction test without joint distension could predict successful CC access. Male sex and increased lateral center-edge angle were risk factors for a failed or difficult CC access. [ABSTRACT FROM AUTHOR]

Background: Hip arthroscopy is a procedure commonly performed to correct various hip pathologies such as femoroacetabular impingement and labral tears. These hip pathologies commonly affect young, otherwise healthy patients. The recovery after hip arthroscopy can prevent patients from returning to work and impair performance levels, having significant economic repercussions. To date, there has been no cumulative analysis of the existing literature on return to work after hip arthroscopy. Purpose: The purpose of this study was to perform a systematic review of the existing literature regarding return to work after hip arthroscopy and analysis of factors associated with the ability to return to work and time to return to work. Study Design: Systematic review and meta-analysis; Level of evidence, 4. Methods: A literature search of the MEDLINE, EMBASE, and Cochrane Library databases was performed based on the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines. Studies assessing functional outcomes and return to work, including return to military duty, after hip arthroscopy were included. Patients' ability to return to work, as well as time to return, was compared between selected studies. Where available, workers' compensation status as well as type of work was compared. All statistical analysis was performed using SPSS, Version 22. P <.05 was considered statistically significant. Results: Twelve studies with 1124 patients were included. Patients were followed for an average of 17.6 months. Using weighted means, the average rate of return to work was 71.35%, while full return to previous work duties was achieved at a rate of 50.89%. Modification to work duties was required at a rate of 15.48%. On average, the time to return to work was 115 days (range, 17-219 days). Rate of return by patients with workers' compensation status was found to be 85.15% at an average of 132 days (range, 37-211 days). Rate of return to work in workers performing professions reported as strenuous vs light (ie, mostly sedentary) jobs showed a statistically higher return to work in light professions (risk ratio, 0.53; 95% CI, 0.41-0.69). Conclusion: After hip arthroscopy, there is a high rate of return to work at an average of 115 days after surgery. However, full return to work was achieved by only half of patients upon final follow–up. [ABSTRACT FROM AUTHOR]

Background: Posterior femoroacetabular impingement (FAI) is poorly understood. Patients with increased femoral anteversion (FV) exhibit posterior hip pain. Purpose: To correlate hip impingement area with FV and with combined version and to investigate frequency of limited external rotation (ER) and hip extension (<40°, <20°, and <0°) due to posterior extra-articular ischiofemoral impingement. Study Design: Cross-sectional study; Level of evidence, 3. Methods: Osseous patient-specific three-dimensional (3D) models based on 3D computed tomography scans were generated of 37 female patients (50 hips) with positive posterior impingement test (100%) and increased FV >35° (Murphy method). Surgery was performed in 50% of patients (mean age, 30 years; 100% female). FV and acetabular version (AV) were added to calculate combined version. Subgroups of patients (24 hips) with increased combined version >70° and patients (9 valgus hips) with increased combined version >50° were analyzed. The control group (20 hips) had normal FV, normal AV, and no valgus. Bone segmentation was performed to generate 3D models of every patient. Validated 3D collision detection software was used for simulation of impingement-free hip motion (equidistant method). Impingement area was evaluated in combined 20° of ER and 20° of extension. Results: Posterior extra-articular ischiofemoral impingement occurred between the ischium and the lesser trochanter in 92% of patients with FV >35° in combined 20° of ER and 20° of extension. Impingement area in combined 20° of ER and 20° of extension was larger with increasing FV and with higher combined version; correlation was significant (P <.001, r = 0.57, and r = 0.65). Impingement area was significantly (P =.001) larger (681 vs 296 mm2) for patients with combined version >70° (vs <70°, respectively) in combined 20° of ER and 20° of extension. All symptomatic patients with increased FV >35° (100%) had limited ER <40°, and most (88%) had limited extension <40°. The frequency of posterior intra- and extra-articular hip impingement of symptomatic patients (100% and 88%, respectively) was significantly (P <.001) higher compared with the control group (10% and 10%, respectively). The frequency of patients with increased FV >35° with limited extension <20° (70%) and patients with limited ER <20° (54%) was significantly (P <.001) higher compared with the control group (0% and 0%, respectively). The frequency of completely limited extension <0° (no extension) and ER <0° (no ER in extension) was significantly (P <.001) higher for valgus hips (44%) with combined version >50° compared with patients with FV >35° (0%). Conclusion: All patients with increased FV >35° had limited ER <40°, and most of them had limited extension <20° due to posterior intra- or extra-articular hip impingement. This is important for patient counselling, for physical therapy, and for planning of hip-preservation surgery (eg, hip arthroscopy). This finding has implications and could limit daily activities (long-stride walking), sexual activity, ballet dancing, and sports (eg, yoga or skiing), although not studied directly. Good correlation between impingement area and combined version supports evaluation of combined version in female patients with positive posterior impingement test or posterior hip pain. [ABSTRACT FROM AUTHOR]

Background: High tibial osteotomy (HTO) reduces the load distribution of the medial compartment by modifying leg alignment. Knee adduction moment (KAM), a surrogate measure of dynamic loading in the knee joint, decreases after HTO. However, leg alignment does not fully account for KAM. Purpose: To assess the association between the pelvis-knee-ankle angle (PKA), a novel radiographic parameter reflecting leg alignment and pelvic width, and KAM and patient-reported outcomes after HTO. Study Design: Cross sectional study; Level of evidence, 3. Methods: PKA is the angle between the line from the midpoint of the anterior superior iliac spine to the center of the knee joint and the mechanical axis of the tibia. In this study, 54 patients with medial compartment knee osteoarthritis and varus alignment who underwent 3-dimensional gait analysis preoperatively and 2 years after medial open-wedge HTO were evaluated. The primary outcomes were hip-knee-ankle angle (HKA), PKA, KAM peaks, and Knee Society Score (KSS). Single and multivariate regression analysis including PKA and KAM peaks as well as other demographic and radiologic factors was performed. Results: HKA was weakly correlated with the first peak KAM (r = −0.33; P <.01) and second peak KAM (r = −0.27; P =.01) before HTO, but not significantly correlated after HTO. PKA was moderately correlated with the first peak KAM (r = 0.45; P <.01) and second peak KAM (r = 0.45; P <.01) before HTO and with the first peak KAM (r = 0.51; P <.01) and second peak KAM (r = 0.56; P <.01) after HTO. Multivariate linear regression revealed that postoperative PKA was still associated with the KAM peaks after HTO. Only postoperative PKA was correlated with the KSS satisfaction subscale (r = −0.30; P =.03). Conclusion: Although HKA was not correlated with KAM peaks after HTO, PKA was significantly correlated with KAM peaks in patients with varus knee osteoarthritis after HTO. [ABSTRACT FROM AUTHOR]

Background: Anterior inferior iliac spine (AIIS) impingement has been increasingly recognized as a source of extra-articular impingement and hip pain. However, no aggregate data analysis of patient outcomes after AIIS decompression has been performed. Purpose: To evaluate outcomes after arthroscopic AIIS decompression. Study Design: Meta-analysis; Level of evidence, 4. Methods: A systematic review was performed according to the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines. PubMed, EMBASE, and Cochrane Central Register of Controlled Trials were queried for all English-language studies reporting outcomes of arthroscopic AIIS decompression performed in isolation or in conjunction with hip impingement correction surgery. After screening, 10 articles were included. The indications for AIIS decompression were recorded, and weighted mean improvements in patient-reported outcome (PRO) scores, complication rates, and revision rates were calculated. Results: A total of 547 patients (311 women; 57%) were identified, with a total of 620 operative hips. The mean age was 28.42 ± 5.6 years, and the mean follow-up was 25.22 ± 11.1 months. A total of 529 hips (85%) underwent AIIS decompression, 530 hips (85%) underwent femoral osteochondroplasty, and 458 hips (74%) underwent labral repair. Of the patients, 13% underwent bilateral AIIS decompression. The mean modified Harris Hip Score improved from 61.3 ± 6.9 to 88.7 ± 4.7 postoperatively (change, 27.4 ± 5.7 points; P <.001), the Hip Outcome Score–Activities of Daily Living improved from 67.2 ± 10.6 to 91.1 ± 3.2 postoperatively (change, 24.0 ± 8.0 points; P =.001), and the Hip Outcome Score–Sports Specific Subscale improved from 36.8 ± 19.2 to 82.8 ± 3.8 postoperatively (change, 46.0 ± 18.2 points; P =.002). The pooled risk of postoperative complications was 1.1% (95% CI, 0.1%-2.1%), and the pooled risk of needing revision surgery was 1.0% (95% CI, 0.1%-2.0%). No complication was directly attributed to the AIIS decompression portion of the procedure. Conclusion: PROs improved significantly after hip arthroscopy with AIIS decompression, with a low risk of postoperative complications and subsequent revision surgeries. Failure to identify extra-articular sources of hip pain in outcomes of femoroacetabular impingement syndrome, including from the AIIS, could lead to poorer outcomes and future revision surgery. [ABSTRACT FROM AUTHOR]