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Background: Postoperative femoral head cartilage injury (FHCI) is a rare condition that can be observed in a certain proportion of patients undergoing hip arthroscopy. However, the prevalence and associated factors of FHCI, and the effect of this condition on clinical outcomes still remain unknown. Patients and methods: Consecutive patients who were diagnosed with femoroacetabular impingement syndrome (FAIS) and labral tear and underwent hip arthroscopic treatment in our institute between July 2020 and July 2021 were retrospectively evaluated. Supine anteroposterior hip radiographs, cross-table lateral radiographs, magnetic resonance imaging (MRI), and computed tomography (CT) were obtained preoperatively. Postoperative MRI, at least 6 months after arthroscopy, was performed. Postoperative FHCI was evaluated by two surgeons through MRI. Preoperative patient-reported outcomes (PROs) including visual analog scale (VAS) for pain, and modified Harris Hip Score (mHHS) before surgery and at final followup were obtained. Results: A total of 196 patients were included. Postoperative FHCI was identified in 21 (10.7%) patients. The intraobserver reliability of the observer A and B for detecting postoperative FHCI using 3.0-T MRI was high (k = 0.929, and k = 0.947, respectively). The interobserver reliability between the two observers for detecting FHCI using 3.0-T MRI was high (k = 0.919). There was no significant difference in preoperative and postoperative mHHS, VAS, and percentage of patients who surpassed minimal clinically important difference (MCID) and achieved patient acceptable symptom state (PASS) between patients with and without postoperative FHCI (P > 0.05). Conclusion: Although postoperative FHCI was observed in 10.7% of patients, which was associated with larger labrum, this condition did not result in inferior clinical outcomes. Level of evidence IV, retrospective case series. Trial registration The Chinese Clinical Trial Registry approved the registration (ChiCTR2200061166). The date of registration is 2022-06-15. [ABSTRACT FROM AUTHOR]

Abstract Purpose (1) to investigate the consecutive changes in hip muscle volume in patients with femoroacetabular impingement syndrome (FAIS) during the initial postoperative period, and (2) to determine the potential effect of the early changes in hip muscle volume on clinical outcomes. Methods Data between March 2021 and March 2022 was reviewed. Patients diagnosed with FAIS based on clinical symptoms and radiographic findings, and undergoing hip arthroscopic treatment were included. Exclusion criteria were incomplete MRI data, prior history of hip surgery, and concomitant hip conditions including hip osteoarthritis with a Tönnis grade > 1, avascular necrosis, Legg-Calvé-Perthes disease, osteoid osteoma, synovial chondromatosis, pigmented villonodular synovitis, and developmental dysplasia of the hip (DDH). MRI was performed preoperatively and 3, 6, 12-month postoperatively. Cross-sectional area (CSA) of hip muscles including rectus femoris (RF), iliocapsularis (IC), iliopsoas (IP), gluteus medius/minimus complex (G-med/min), and gluteus maximus (G-max) were collected on MRI. The CSA was corrected by body surface area (BSA). Preoperative and a minimum of 2-year postoperative patient-reported outcome (PRO) scores including Visual Analog pain Scale (VAS), modified Harris Hip Score (mHHS), and international Hip Outcome Tool, 12-component form (iHOT-12) were collected. A multivariate linear regression model was built to determine the influence of the potential factors on postoperative PROs. Results A total of 76 patients were included in the study. Compared to the preoperative level, decreased volume of RF and G-max, and increased IC/RF ratio were observed at postoperative 3 months (all with P

Background/Objectives: Hip–knee coupling is a well-documented phenomenon, and interventions to one joint can alter biomechanics at the other. The purpose of this study was to investigate if knee surgery is associated with later onset of femoroacetabular impingement syndrome (FAIS). Methods: A retrospective chart review was conducted regarding patients at a single academic institution who underwent hip arthroscopy for FAIS between January 2011–October 2021. Patient charts were queried for past surgical history of knee arthroscopy before hip arthroscopy. Patients who previously underwent hip arthroscopy with no history of knee arthroscopy served as controls. Details about demographics and the onset of hip symptoms were abstracted from patient charts. Statistical analysis was conducted using Mann–Whitney testing and binary logistic regression. Results: Of the 1569 patients identified, 127 had a history of knee arthroscopy and reported no hip symptoms at or prior to the time of surgery. Patients who had undergone prior knee arthroscopy were significantly older at onset of initial hip symptoms (42.15 ± 11.80 years versus 34.62 ± 12.49 years, p < 0.001) and at the time of hip arthroscopy (44.12 ± 11.85 years versus 36.90 ± 12.14 years, p < 0.001) when controlling for age, sex, and BMI. These patients first developed hip symptoms at a mean of 8.57 ± 8.53 years following knee arthroscopy (median 6.10 years) and underwent operative treatment 1.76 ± 1.96 years later. Conclusions: Patients with a history of prior knee arthroscopy are older at the time of hip symptom onset and subsequent hip arthroscopy for the treatment of FAIS. [ABSTRACT FROM AUTHOR]

Purpose: (1) to investigate the consecutive changes in hip muscle volume in patients with femoroacetabular impingement syndrome (FAIS) during the initial postoperative period, and (2) to determine the potential effect of the early changes in hip muscle volume on clinical outcomes. Methods: Data between March 2021 and March 2022 was reviewed. Patients diagnosed with FAIS based on clinical symptoms and radiographic findings, and undergoing hip arthroscopic treatment were included. Exclusion criteria were incomplete MRI data, prior history of hip surgery, and concomitant hip conditions including hip osteoarthritis with a Tönnis grade > 1, avascular necrosis, Legg-Calvé-Perthes disease, osteoid osteoma, synovial chondromatosis, pigmented villonodular synovitis, and developmental dysplasia of the hip (DDH). MRI was performed preoperatively and 3, 6, 12-month postoperatively. Cross-sectional area (CSA) of hip muscles including rectus femoris (RF), iliocapsularis (IC), iliopsoas (IP), gluteus medius/minimus complex (G-med/min), and gluteus maximus (G-max) were collected on MRI. The CSA was corrected by body surface area (BSA). Preoperative and a minimum of 2-year postoperative patient-reported outcome (PRO) scores including Visual Analog pain Scale (VAS), modified Harris Hip Score (mHHS), and international Hip Outcome Tool, 12-component form (iHOT-12) were collected. A multivariate linear regression model was built to determine the influence of the potential factors on postoperative PROs. Results: A total of 76 patients were included in the study. Compared to the preoperative level, decreased volume of RF and G-max, and increased IC/RF ratio were observed at postoperative 3 months (all with P <.05). Both G-med/min and G-max presented decreased volume at postoperative 6 months (all with P <.05). G-med/min presented decreased volume (P =.001) at postoperative 12 months. Changes in RF at postoperative 3 months and 12 months were positively related to improvement of iHOT-12 (Beta = 0.371, P =.012 and Beta = 0.330, P =.026, respectively). Changes in IC at postoperative 6-month was positively related to improvement of mHHS (Beta = 0.367, P =.027) and iHOT-12 (Beta = 0.315, P =.044). Conclusion: During the initial first year following arthroscopic treatment for FAIS, decreased volume of the RF and gluteal muscles was observed. Early changes in volume of RF and IC were positively correlated to the improvement of minimum 2-year PROs. Level of evidence: Level IV; case series. [ABSTRACT FROM AUTHOR]

PURPOSE: To serve as a guide for non-operative physicians in the management of femoroacetabular impingement syndrome and provide an algorithm as to when to refer patients for potential surgical management. RECENT FINDINGS: Supervised physical therapy programs that focus on active strengthening and core strengthening are more effective than unsupervised, passive, and non-core-focused programs. There is promising evidence for the use of intra-articular hyaluronic acid and PRP as adjunct treatment options. Recent systematic reviews and meta-analyses have found that in young active patients, hip arthroscopy demonstrates improved short-term outcomes over physical therapy. The decision for the management of FAIS is complex and should be specific to each patient. Consideration of the patients age, timing to return to sport, longevity of treatment, hip morphology, and degree of cartilage degeneration is required to make an informed decision in the treatment of these patients.

Background Primary cam morphology, an acquired bony prominence at the head-neck junction of the femur, is highly prevalent in athlete populations, and causally associated with femoroacetabular impingement syndrome and early hip osteoarthritis. Experts agreed on key elements for primary cam morphology and a prioritised research agenda for the field. This research agenda will require higher-quality research to achieve meaningful progress on the aetiology, prognosis and treatment of primary cam morphology in athletes. Aim To explore stakeholders’ perspectives of high-quality research in the research field of primary cam morphology and its natural history. Methods Grounded in interpretive description, we used semi-structured interviews to explore stakeholders’ perspectives of high-quality research in the primary cam morphology research field. The framework for INcreasing QUality In patient-orientated academic clinical REsearch (INQUIRE) informed the interview guide. Audio-recorded interviews were transcribed and analysed using thematic analysis. We recruited a heterogenous and purposive maximum variation sample, drawing from a network of research contacts. Results Fifteen individuals, several with multiple perspectives on research quality in the field, participated. Exploring stakeholders’ perspectives on research quality through an established research quality framework (INQUIRE) illuminated areas for immediate action for research communities in the field of primary cam morphology and its natural history. We crafted five action inviting themes: research communities should: partner with athletes/patients; champion equity, diversity and inclusion; collaborate with one another; pursue open science; and nurture young scholars. Conclusion The findings of this study could inform concrete actions by research communities to pursue higher quality research—more research value and less waste—in the field of primary cam morphology and its natural history. Although the five action-inviting themes reflect contemporary trends in research, and could therefore be transferable to other areas of research, their practical application remains context- and field-specific.

Background: Both knotless and knot-tying anchors are commonly employed in the arthroscopic repair of hip labral tears. Purpose: To compare the midterm clinical results of arthroscopic hip labral repair using knot-tying versus knotless suture anchors. Study Design: Cohort study; Level of evidence, 3. Methods: Patients who underwent arthroscopic hip labral repair between January 2017 and January 2021 and who had at least 2 years of follow-up were included. The patients were divided into 2 groups based on the suture anchor type: a 2.9-mm knotless suture anchor (knotless group) or a 1.8-mm knot-tying suture anchor (knot-tying group). All patients underwent femoroplasty for cam lesions and acetabular rim trimming for pincer lesions. The modified Harris Hip Score (mHHS), Hip Outcome Score–Sport-Specific Subscale (HOS-SSS), Hip Outcome Score–Activities of Daily Living (HOS-ADL), 12-item International Hip Outcome Tool (iHOT-12), and visual analog scale (VAS) for pain were administered both preoperatively and postoperatively. The consistency of the outcome scores was assessed using the minimal clinically important difference and Patient Acceptable Symptom State. The statistical significance between groups was evaluated using the Mann-Whitney test and quantile-based analysis of variance. Results: A total of 413 patients were included: 256 patients in the knotless group (median age, 35 years [interquartile range, 31-38 years]; median follow-up, 34 months) and 157 patients in the knot-tying group (median age, 34 years [interquartile range, 30-38 years]; median follow-up, 25 months). There were no significant differences in postoperative mHHS, HOS-ADL, or iHOT-12 scores between the 2 groups. However, there were significant differences, favoring the knotless group over the knot-tying group, in postoperative HOS-SSS (87 ± 2 vs 86 ± 1, respectively) and VAS pain (1 vs 2, respectively) scores (P <.0001 for both). Postoperative synovitis was found in significantly more patients in the knot-tying group than in the knotless group (17 vs 5, respectively; P =.01). Conclusion: In this study, patients who underwent arthroscopic hip labral repair with knotless suture anchors had slightly better postoperative HOS-SSS and VAS pain scores and a lower incidence of postoperative synovitis compared with patients who underwent repair with knot-tying suture anchors. [ABSTRACT FROM AUTHOR]

Background: The relationship between hip rotational abnormalities and hip labral size has not been fully investigated. Purposes: To (1) examine the correlation between rotational abnormalities of the hip and labral size, while also identifying other predictive values for hip labral size, and (2) explore whether femoral torsion will lead to increased labral size. Study Design: Cross-sectional study; Level of evidence, 3. Methods: A total of 180 patients (180 hips) with femoroacetabular impingement syndrome (FAIS) (mean age, 36.81 ± 10.17 years; 67 male, 113 female) who underwent hip arthroscopic surgery between January 2021 and May 2022 were included. The femoral version (FV), acetabular version, and combined version angles were measured on computed tomography, and the labral length and height at the 12-o'clock and 3-o'clock positions were measured on magnetic resonance imaging. The hips were categorized into 3 groups based on FV angle: small (SFV; <10°); moderate (MFV; ≥10° and ≤20°), and large (LFV; >20°), and group comparisons were performed. Linear correlation and regression analysis were employed. Results: Predictive factors for labral length were FV angle (β = 0.298; P =.02), sex (β = −0.302; P <.001), and age (β = −0.169; P =.016) at 3 o'clock and lateral center-edge angle (LCEA; β = −0.208; P =.005) and age (β = −0.186; P =.011) at 12 o'clock. FV angle was positively correlated with labral length at 3 o'clock (r = 0.267; P <.001) and negatively correlated with age (r = −0.222; P =.003) and female sex (r = −0.202; P =.006). LCEA (r = −0.227; P =.002) and age (r = −0.205; P =.006) were negatively correlated with labral length at 12 o'clock. Labral length at 3 o'clock was significantly different between the LFV (n = 49 hips), MFV (n = 65 hips), and SFV (n = 66 hips) groups (9.85 ± 2.28, 8.89 ± 2.44, and 8.30 ± 2.05 mm, respectively; P =.027 for LFV vs MFV; P <.001 for LFV vs SFV). Conclusion: Patients with FAIS who exhibited a higher FV angle were at a greater likelihood of having a larger anterior labral length. Increased femoral anteversion and decreased LCEA, male sex, and younger age were significantly associated with longer hip labral length. [ABSTRACT FROM AUTHOR]

Females of reproductive age constitute one of the largest demographics of the hip arthroscopy population, but it is unclear as to how pregnancy planning affects decision-making regarding surgery or vice versa. The purpose of this study was to assess perceived risks to pregnancy from hip pain and/or hip arthroscopy among reproductive-age females who underwent arthroscopic treatment of femoroacetabular impingement syndrome (FAIS). A cross-sectional study was conducted involving females aged 18–44 years who underwent hip arthroscopy for the treatment of FAIS, with a single surgeon included in the study. Subjects completed a survey that assessed obstetric and gynecologic history, decision-making regarding the planning and timing of hip surgery and pregnancy, and perceived risks to pregnancy from hip pain and/or hip surgery. Subjects were classified as nulligravid (Group 1), pregnant at least once before hip surgery but never again following hip surgery (Group 2), or pregnant at least once following hip surgery (Group 3). A total of 85 patients were enrolled with a mean age of 32.3 ± 6.5 years at the time of surgery. The mean follow-up time was 51.9 ± 34.5 months. There were 39 subjects in Group 1 (45.9%), 20 in Group 2 (23.5%), and 26 in Group 3 (30.6%). About half of all subjects expressed "some" to "a lot of" concern that their hip pain could get worse during pregnancy (49.4%), and about half had "no concern" that hip arthroscopy would affect the health of their fetus/baby (54.1%). Reproductive-age females undergoing hip arthroscopy for FAIS generally consider the procedure to be safe with respect to future pregnancy outcomes. [ABSTRACT FROM AUTHOR]

Background: The labral suction seal has been shown to provide the majority of resistance in the initial phase of hip distraction. However, the effect of an unrepaired interportal capsulotomy and capsular repair on the initial phase of hip distractive stability in vivo is not well understood. Purpose: To investigate the effect of capsular repair on the initial phase of distractive stability of hip joints in patients with femoroacetabular impingement (FAI) syndrome. Study Design: Controlled laboratory study. Methods: Patients undergoing primary hip arthroscopy for FAI between March and August 2020 were prospectively enrolled. Total joint space was measured on fluoroscopic images at the medial and lateral edges of the sourcil at 12.5-lb (5.7-kg) axial traction intervals (up to 100 lb [45.4 kg]) in 3 capsular states: (1) native capsule, (2) interportal capsulotomy, and (3) capsular repair. Distraction on anteroposterior radiographs was calculated as the difference between total joint space at each traction interval and baseline joint space at 0 lb, normalized to millimeters. The native, capsulotomy, and capsular repair states were compared using Wilcoxon signed-rank and McNemar tests. Results: Included were 36 hips in 35 patients. The median force required to distract ≥3 mm was 75 lb (34.0 kg; 95% CI, 70-80 lb [31.8-36.3 kg]) in both the native and capsular repair states (P =.629), which was significantly greater than the median force required to distract ≥3 mm in the capsulotomy state (50 lb [22.7 kg]; 95% CI, 45-55 lb [20.4-24.9 kg]) (P <.001). The most rapid rates of change in joint space were observed at the traction interval at which hips first achieved ≥3 mm of distraction (n = 33 hips; 92%). Conclusion: The traction force at which hips distracted ≥3 mm was 75 lb (34.0 kg) in both the native capsular and capsular repair states. Significantly less traction force (50 lb [22.7 kg]) distracted hips ≥3 mm in the capsulotomy state. Complete capsular closure after interportal capsulotomy resulted in restoration of initial distractive stability relative to the unrepaired capsulotomy state at time zero after primary hip arthroscopy. Clinical Relevance: This study provides surgeons with an improved understanding of the additional stability to the hip joint from capsular repair after hip arthroscopy for FAI syndrome. [ABSTRACT FROM AUTHOR]

Purpose of reviewDetermining the correct diagnosis can be challenging in patients presenting with hip pain. The physical examination is an essential tool that can aid in diagnosis of hip pathology. The purpose of this review is to provide an updated summary of recent literature on the physical exam of the hip, particularly as it relates to diagnosis of femoroacetabular impingement (FAI) syndrome, labral injury, and hip microinstability.Recent findingsPhysical exam findings consistent with the diagnosis of FAI include reduced supine hip internal rotation and positive flexion-adduction-internal rotation maneuvers. Labral tears can be detected on exam with the Scour test. Studies demonstrate altered hip biomechanics in patients with FAI during activities such as walking and squatting. Those with FAI have slower squat velocities, slower sit-to-stand tests, and increased hip flexion moments during ambulation. Hip microinstability is a dynamic process, which can occur after prior hip arthroscopy. For hip microinstability, the combination of the three following positive tests (anterior apprehension, abduction-extension-external rotation, and prone external rotation) is associated with a 95% likelihood of microinstability as confirmed by examination under anesthesia at the time of surgery. A comprehensive hip physical exam involves evaluation of the hip in multiple positions and assessing hip range of motion, strength, as well as performing provocative testing. A combination of physical exam maneuvers is necessary to accurately diagnose FAI syndrome and labral pathology as individual tests vary in their sensitivity and specificity. While an elevated level of suspicion is needed to diagnose hip microinstability, the provocative tests for microinstability are highly specific.

The purpose of this study was to determine if there is a difference in hip survivorship rates and patient-reported outcomes (PROs) at a 5-year follow-up after arthroscopic treatment of femoroacetabular impingement syndrome (FAIS) between patients with versus without systemic inflammatory diseases (SIDs). A retrospective single-surgeon matched cohort study of FAIS patients who underwent hip arthroscopy and had a minimum of a 5-year follow-up was conducted. Subjects with SIDs were matched at a ratio of 2:3 of age and body mass index (BMI) with respect to controls without SIDs. Subjects completed the modified Harris Hip Score (mHHS) and Non-Arthritic Hip Score (NAHS) prior to surgery and at a 2-year and 5-year follow-up. Survival distributions for time to reoperation and to total hip arthroplasty (THA) were compared between groups using the log-rank test. Fifteen subjects with SIDs (mean age 41.5 years) were matched with twenty-five controls (41.8 years). There were no significant differences in reoperation rates (SIDs 27% vs. controls 20%, p = 0.71) or THA conversion rates (SIDs 7% vs. controls 12%, p = 1.00) at the 5-year follow-up, nor were there differences in survival distributions for reoperations (p = 0.72) or THAs (p = 0.55). There were no significant differences in postoperative mHHS (SIDs 79.3 vs. controls 88.5, p = 0.09) or NAHS (SIDs 82.7 vs. controls 89.3, p = 0.77) by the 5-year follow-up. At the 5-year follow-up, FAIS patients with comorbid SIDs experienced a significant clinical improvement from hip arthroscopy that is comparable to that of FAIS patients without SIDs.

Objective Hip arthroscopy has recently appeared as a successful therapy in treating borderline developmental dysplasia of the hip (BDDH). This study aimed to describe the minimal 2‐year follow‐up after hip arthroscopy for patients with BDDH in the Asian population and use the combination of lateral center edge angle (LCEA) and alpha angles to detect the appearance of impingement in the BDDH population. Methods This retrospective investigation was conducted utilizing information from arthroscopically treated BDDH patients in 2018 and 2019. The following patient‐reported outcomes were reported: modified Harris Hip Score, Hip Outcome Score‐Activities of Daily Living, International Hip Outcome Tool 12‐component form, and Visual Analog Scale. We also considered the clinical data regarding radiological measurements, intraoperative findings, interventions, complications, and subsequent surgical revisions, in the analysis of combination angles in detecting the occurrence of impingement. Patients with asymptomatic contralateral hips from traumatic hip injury (pelvic fracture) served as the control group. A 2:1 propensity score matching was based on age, sex, and BMI. A receiver operating characteristic curve (ROC) was used to identify the thresholds of combination angles and their accuracies. Results A total of 77 hips met the inclusion and exclusion requirements. After the follow‐up period, most patients showed a considerable improvement in patient‐reported outcomes compared to their preoperative values (P 80.5° could be a reliable predictive factor of impingement in BDDH populations.

Background: Patients with borderline hip dysplasia (BHD) have demonstrated similar outcomes following primary hip arthroscopy for femoroacetabular impingement syndrome (FAIS) compared to equivalent patients without dysplasia at short- and mid-term follow-up. However, outcomes in these groups have not yet been compared at long-term follow-up. Objectives: To compare long-term clinical outcomes following primary hip arthroscopy for FAIS between patients with BHD and non-dysplastic matched controls. Methods: A retrospective review was conducted of patients who underwent primary hip arthroscopy for FAIS from January 2012 through February 2013. Patients with BHD, defined as a lateral center edge angle (LCEA) between 18° and 25°, were propensity matched in a 1:3 ratio by sex, age, and body mass index (BMI) to non-dysplastic controls. Preoperative and postoperative radiographs were assessed. Patient-reported outcomes (PROs) were collected preoperatively and 10 years postoperatively, and achievement rates of Minimal Clinically Important Difference (MCID) and Patient-Acceptable Symptom State (PASS) were calculated. PRO measures included the Hip Outcome Score Activities of Daily Living (HOS-ADL) and Sports-Specific (HOS-SS) subscales, modified Harris Hip Score (mHHS), 12-item international Hip Outcome Tool (iHOT-12), and Visual Analog Scales (VAS) for Pain and Satisfaction. Gross survivorship was assessed using Kaplan-Meier curves. PROs, MCID and PASS achievement rates, and survivorship were compared between groups. Results: Twenty-eight patients with BHD (71.4% female; age: 30.8 ± 10.8 years, BMI: 24.2 ± 3.9 kg/m2) were matched to 84 controls (66.7% female, age: 34.4 ± 10.5 years, BMI: 24.9 ± 5.1 kg/m2; p ≥ 0.135). Mean follow-up was 10.3 ± 0.3 years. There were no significant differences between groups in any demographic characteristics, radiographic measurements, or intraoperative findings (p ≥ 0.096), except pre- and post-operative LCEA and Tönnis angle, which were lower and higher, respectively, among BHD patients (p < 0.001). Both groups demonstrated significant improvement in all PROs between the preoperative and 10-year postoperative time points (p < 0.001 for all). Preoperative, 10-year postoperative, and magnitude of change (delta) in PRO scores were similar between groups for all measures (p ≥ 0.072), except 10-year postoperative HOS-SS (BHD: 62.9 ± 31.9 vs. Controls: 80.1 ± 26.0, p = 0.030) and change in VAS Pain (BHD: -34.2 ± 27.2 vs. Controls: -48.5 ± 26.1, p = 0.047). Rates of MCID achievement were similar between groups for all PRO measures, but rates of PASS achievement were significantly lower among BHD patients for HOS-ADL (BHD: 39.1% vs. Controls: 77.4%, p = 0.002), HOS-SS (BHD: 45.5% vs. Controls: 84.7%, p = 0.001), and VAS Pain (BHD: 50.0% vs. Controls: 78.5%, p = 0.015). There was no difference in reoperation rate between groups (BHD: 14.3% vs. Controls: 17.9%, p = 0.778). Kaplan-Meier survival analysis demonstrated comparable gross survivorship at long-term follow-up (p = 0.645). Conclusions: Patients with BHD undergoing primary hip arthroscopy for FAIS demonstrated significantly lower sports-specific PRO scores than propensity-matched controls at 10-year follow-up, with a trend toward significantly worse scores for measures assessing activities of daily living, pain, and satisfaction. Rates of MCID achievement were similar between groups, but BHD patients demonstrated lower rates of PASS achievement for the majority of PRO measures. However, patients with BHD had similar long-term hip survivorship compared to controls, with no significant differences in rates of revision hip arthroscopy or conversion to total hip arthroplasty. [ABSTRACT FROM AUTHOR]

Background: Alterations in hip kinematics during functional tasks occur in positions that cause anterior impingement in patients with femoroacetabular impingement (FAI) syndrome. However, tasks that do not promote motions of symptomatic hip impingement remain understudied. Purpose: To compare movement patterns of the hip and pelvis during a step-down pivot-turn task between patients with FAI and controls as well as in patients with FAI before and after hip arthroscopy. Study Design: Controlled laboratory study. Methods: Three-dimensional motion capture was acquired in 32 patients with FAI and 27 controls during a step-down pivot-turn task. An FAI subsample (n = 14) completed testing 9.2 ± 2.0 months (mean ± SD; range, 5.8-13.1 months) after hip arthroscopy. Statistical parametric mapping analysis was used to analyze hip and pelvis time series waveforms (1) between the FAI and control groups, (2) in the FAI group before versus after hip arthroscopy, and (3) in the FAI group after hip arthroscopy versus the control group. Continuous parametric variables were analyzed by paired t test and nonparametric variables by chi-square test. Results: There were no significant differences in demographics between the FAI and control groups. Before hip arthroscopy, patients with FAI demonstrated reduced hip flexion (P =.041) and external rotation (P =.027), as well as decreased anterior pelvic tilt (P =.049) and forward rotation (P =.043), when compared with controls. After hip arthroscopy, patients demonstrated greater hip flexion (P <.001) and external rotation of the operative hip (P <.001), in addition to increased anterior pelvic tilt (P ≤.036) and pelvic rise (P ≤.049), as compared with preoperative values. Postoperatively, the FAI group demonstrated greater hip flexion (P ≤.047) and lower forward pelvic rotation (P =.003) as compared with the control group. Conclusion: Movement pattern differences between the FAI and control groups during the nonimpingement-related step-down pivot-turn task were characterized by differences in the sagittal and transverse planes of the hip and pelvis. After hip arthroscopy, patients exhibited greater hip flexion and external rotation and increased pelvic anterior tilt and pelvic rise as compared with presurgery. When compared with controls, patients with FAI demonstrated greater hip flexion and lower pelvic forward rotation postoperatively. Clinical Relevance: These findings indicate that hip and pelvis biomechanics are altered even during tasks that do not reproduce the anterior impingement position. [ABSTRACT FROM AUTHOR]

The purpose of this study was to determine if there is a difference in hip survivorship rates and patient-reported outcomes (PROs) at a 5-year follow-up after arthroscopic treatment of femoroacetabular impingement syndrome (FAIS) between patients with versus without systemic inflammatory diseases (SIDs). A retrospective single-surgeon matched cohort study of FAIS patients who underwent hip arthroscopy and had a minimum of a 5-year follow-up was conducted. Subjects with SIDs were matched at a ratio of 2:3 of age and body mass index (BMI) with respect to controls without SIDs. Subjects completed the modified Harris Hip Score (mHHS) and Non-Arthritic Hip Score (NAHS) prior to surgery and at a 2-year and 5-year follow-up. Survival distributions for time to reoperation and to total hip arthroplasty (THA) were compared between groups using the log-rank test. Fifteen subjects with SIDs (mean age 41.5 years) were matched with twenty-five controls (41.8 years). There were no significant differences in reoperation rates (SIDs 27% vs. controls 20%, p = 0.71) or THA conversion rates (SIDs 7% vs. controls 12%, p = 1.00) at the 5-year follow-up, nor were there differences in survival distributions for reoperations (p = 0.72) or THAs (p = 0.55). There were no significant differences in postoperative mHHS (SIDs 79.3 vs. controls 88.5, p = 0.09) or NAHS (SIDs 82.7 vs. controls 89.3, p = 0.77) by the 5-year follow-up. At the 5-year follow-up, FAIS patients with comorbid SIDs experienced a significant clinical improvement from hip arthroscopy that is comparable to that of FAIS patients without SIDs. [ABSTRACT FROM AUTHOR]

Abstract Background Patient-reported outcomes are commonly used to assess patient symptoms. The effect of specific hip pathology on relationships between perceived and objectively measured symptoms remains unclear. The purpose of this study was to evaluate differences of function and pain in patients with FAIS and DDH, to assess the correlation between perceived and objective function, and to determine the influence of pain on measures of function. Methods This prospective cross-sectional study included 35 pre-operative patients (60% female) with femoroacetabular impingement syndrome (FAIS) and 37 pre-operative patients (92% female) with developmental dysplasia of the hip (DDH). Objectively measured function (6-min walk [6MWT], single leg hop [SLHT], Biodex sway [BST], hip abduction strength [HABST], and STAR excursion balance reach [STAR] tests), patient-reported function (UCLA Activity, Hip Outcome Score [HOS], Short Form 12 [SF-12], and Hip Disability and Osteoarthritis Outcome Score [HOOS]), and patient-reported pain (HOOS Pain, visual analogue scale (VAS), and a pain location scale) were collected during a pre-surgical clinic visit. Between-group comparisons of patient scores were performed using Wilcoxon Rank-Sum tests. Within-group correlations were analyzed using Spearman’s rank correlation coefficients. Statistical correlation strength was defined as low (r = ± 0.1–0.3), moderate (r = ± 0.3–0.5) and strong (r > ± 0.5). Results Patients with DDH reported greater pain and lower function compared to patients with FAIS. 6MWT distance was moderately-to-strongly correlated with a number of patient-reported measures of function (FAIS: r = 0.37 to 0.62, DDH: r = 0.36 to 0.55). Additionally, in patients with DDH, SLHT distance was well correlated with patient reported function (r = 0.37 to 0.60). Correlations between patient-reported pain and objectively measured function were sparse in both patient groups. In patients with FAIS, only 6MWT distance and HOOS Pain (r = -0.53) were significantly correlated. In patients with DDH, 6MWT distance was significantly correlated with VAS Average (r = -0.52) and Best (r = -0.53) pain. Conclusion Pain is greater and function is lower in patients with DDH compared to patients with FAIS. Moreover, the relationship between pain and function differs between patient groups. Understanding these differences is valuable for informing treatment decisions. We recommend these insights be incorporated within the clinical continuum of care, particularly during evaluation and selection of surgical and therapeutic interventions.

Objective When considering surgical treatment options, many patients who undergo hip arthroscopy value continuing active lifestyles. To address these concerns, the purpose of this study was to determine the effect of preoperative activity level on postoperative patient‐reported outcomes (PROs) in femoroacetabular impingement syndrome (FAIS) patients following hip arthroscopy. Methods Data was retrospectively reviewed for FAIS patients who received hip arthroscopy between 2016 and 2018. Patients were divided into active group and inactive group based on preoperative HOS‐SSS scores. Preoperative active patients were 1:1 propensity‐score matched to inactive patients based on age, sex, BMI, and follow‐up period. PROs (HOS‐ADL, HOS‐ADL, iHOT‐12, mHHS), VAS scores, radiographic measures, performed procedures, complications, and revision surgery were compared and analyzed for both groups by Student's t test. Results A total of 71 patients in the active group and 71 patients in the inactive group were found using propensity‐score matching. Active patients had superior preoperative HOS‐ADL, HOS‐SSS, iHOT‐12, mHHS (p

Aims: The aims of the study were to report for a cohort aged younger than 40 years: 1) indications for HRA; 2) patient-reported outcomes in terms of the modified Harris Hip Score (HHS); 3) dislocation rate; and 4) revision rate. Methods: This retrospective analysis identified 267 hips from 224 patients who underwent an hip resurfacing arthroplasty (HRA) from a single fellowship-trained surgeon using the direct lateral approach between 2007 and 2019. Inclusion criteria was minimum two-year follow-up, and age younger than 40 years. Patients were followed using a prospectively maintained institutional database. Results: A total of 217 hips (81%) were included for follow-up analysis at a mean of 3.8 years. Of the 23 females who underwent HRA, none were revised, and the median head size was 46 mm (compared to 50 mm for males). The most common indication for HRA was femoroacetabular impingement syndrome (n = 133), and avascular necrosis ( (n = 53). Mean postoperative HHS was 100 at two and five years. No dislocations occurred. A total of four hips (1.8%) required reoperation for resection of heterotopic ossification, removal of components for infection, and subsidence with loosening. The overall revision rate was 0.9%. Conclusion: For younger patients with higher functional expectations and increased lifetime risk for revision, HRA is an excellent bone preserving intervention carrying low complication rates, revision rates, and excellent patient outcomes without lifetime restrictions allowing these patients to return to activity and sport. Thus, in younger male patients with end-stage hip disease and higher demands, referral to a high-volume HRA surgeon should be considered. Cite this article: Bone Jt Open 2023;4(6):408–415.

Different pathologies of the hip are characterized by the abnormal shape of the bony structures of the joint, namely the femur and the acetabulum. Three-dimensional (3D) models of the hip can be used for diagnosis, biomechanical simulation, and planning of surgical treatments. These models can be generated by building 3D surfaces of the joint's structures segmented on magnetic resonance (MR) images. Deep learning can avoid time-consuming manual segmentations, but its performance depends on the amount and quality of the available training data. Data augmentation and transfer learning are two approaches used when there is only a limited number of datasets. In particular, data augmentation can be used to artificially increase the size and diversity of the training datasets, whereas transfer learning can be used to build the desired model on top of a model previously trained with similar data. This study investigates the effect of data augmentation and transfer learning on the performance of deep learning for the automatic segmentation of the femur and acetabulum on 3D MR images of patients diagnosed with femoroacetabular impingement. Transfer learning was applied starting from a model trained for the segmentation of the bony structures of the shoulder joint, which bears some resemblance to the hip joint. Our results suggest that data augmentation is more effective than transfer learning, yielding a Dice similarity coefficient compared to ground-truth manual segmentations of 0.84 and 0.89 for the acetabulum and femur, respectively, whereas the Dice coefficient was 0.78 and 0.88 for the model based on transfer learning. The Accuracy for the two anatomical regions was 0.95 and 0.97 when using data augmentation, and 0.87 and 0.96 when using transfer learning. Data augmentation can improve the performance of deep learning models by increasing the diversity of the training dataset and making the models more robust to noise and variations in image quality. The proposed segmentation model could be combined with radiomic analysis for the automatic evaluation of hip pathologies.

Far more publications are available for osteoarthritis of the knee than of the hip. Recognizing this research gap, the Arthritis Foundation (AF), in partnership with the Hospital for Special Surgery (HSS), convened an in-person meeting of thought leaders to review the state of the science of and clinical approaches to hip osteoarthritis. This article summarizes the recommendations gleaned from 5 presentations given on hip-related rehabilitation at the 2023 Hip Osteoarthritis Clinical Studies Conference, which took place on February 17 and 18, 2023, in New York City. [ABSTRACT FROM AUTHOR]

It is unclear whether hip and pelvic mobility in the sagittal plane are associated with hip function in FAIS. This study aimed to determine whether hip-pelvis-lumbar mobility is associated with preoperative hip function and postoperative outcomes in FAIS. This was a level 3 case–control study. This study included 111 patients who underwent arthroscopic FAI correction and labral preservation between 2015 and 2019. The Hip-Pelvic-Lumbar Mobility Test (HPLMT) was performed preoperatively; hip flexion with the hip adducted and internally rotated was examined in the lateral decubitus position, and a total hip flexion angle of less than 120° was diagnosed as positive. HPLMT-positive patients were classified as cases, and HPLMT-negative patients were classified as controls. Hip muscle strength was measured preoperatively using a hand-held dynamometer. The modified Harris hip score (mHHS), Nonarthritic Hip Score (NAHS), and International Hip Outcome Tool-12 score were obtained preoperatively and postoperatively. The rates of patient acceptable symptomatic state (PASS) achievement for patient-reported outcome scores (PROSs) were compared between groups. The preoperative PROSs for the HPLMT-positive patients were significantly lower than those for the HPLMT-negative patients. HPLMT-positive patients had significantly weaker hip strength on the affected side than HPLMT-negative patients (flexion; p < 0.001, abduction; p = 0.001). HPLMT-positive patients had significantly lower postoperative mHHS than HPLMT-negative patients. HPLMT-positive patients were significantly less likely to achieve a PASS for the mHHS (62% versus 85%) and NAHS (48% versus 71%) than HPLMT-negative patients. Hip-pelvis-lumbar mobility is associated with hip function and clinical outcomes in FAIS patients. The HPLMT is an efficient tool for assessing FAIS patients. [ABSTRACT FROM AUTHOR]

Objective: Hip arthroscopy has recently appeared as a successful therapy in treating borderline developmental dysplasia of the hip (BDDH). This study aimed to describe the minimal 2‐year follow‐up after hip arthroscopy for patients with BDDH in the Asian population and use the combination of lateral center edge angle (LCEA) and alpha angles to detect the appearance of impingement in the BDDH population. Methods: This retrospective investigation was conducted utilizing information from arthroscopically treated BDDH patients in 2018 and 2019. The following patient‐reported outcomes were reported: modified Harris Hip Score, Hip Outcome Score‐Activities of Daily Living, International Hip Outcome Tool 12‐component form, and Visual Analog Scale. We also considered the clinical data regarding radiological measurements, intraoperative findings, interventions, complications, and subsequent surgical revisions, in the analysis of combination angles in detecting the occurrence of impingement. Patients with asymptomatic contralateral hips from traumatic hip injury (pelvic fracture) served as the control group. A 2:1 propensity score matching was based on age, sex, and BMI. A receiver operating characteristic curve (ROC) was used to identify the thresholds of combination angles and their accuracies. Results: A total of 77 hips met the inclusion and exclusion requirements. After the follow‐up period, most patients showed a considerable improvement in patient‐reported outcomes compared to their preoperative values (P < 0.001 for all). The overall rate of complications was 5.2%, whereas the rate of revisions was 3.9%. Increasing preoperative alpha angle age was significantly positively correlated with improving patient‐reported outcomes. The combined angle cut‐off was determined to be 80.5° (AUC, 0.858; 95% CI: 0.757–0.938; sensitivity (SE), 98.1%; specificity (SP), 74.1%; P < 0.001) for the occurrence of impingement in BDDH population. Conclusion: Good patient‐reported outcomes and low revision rates can be expected in the BDDH population with careful selection of patients in Asian populations. A combination angle >80.5° could be a reliable predictive factor of impingement in BDDH populations. [ABSTRACT FROM AUTHOR]

Purpose of Review: Femoroacetabular impingement syndrome (FAIS) is a common cause of hip pain that may potentially lead to osteoarthritis. Operative management of FAIS seeks to arthroscopically reshape the abnormal hip morphology and repair the labrum. For rehabilitation following operative management, a structured physical therapy program is unanimously recommended for the patient to return to their previous level of physical activity. Yet, despite this unanimous recommendation, significant heterogeneity exists among the current recommendations for postoperative physical therapy programs. Recent Findings: A four-phase postoperative physical therapy protocol is favored among current literature, with each phase being comprised of its own goals, restrictions, precautions, and rehabilitation techniques. Phase 1 aims to protect the integrity of the surgically repaired tissues, reduce pain and inflammation, and regain ~ 80% of full ROM. Phase 2 guides a smooth transition to full weightbearing, so the patient may regain functional independence. Phase 3 helps the patient become recreationally asymptomatic and restores muscular strength and endurance. Finally, phase 4 culminates in the pain-free return to competitive sports or recreational activity. Summary: At this time, there exists no single, unanimously agreed upon postoperative physical therapy protocol. Among the current recommendations, variation exists regarding specific timelines, restrictions, precautions, exercises, and techniques throughout the four phases. It is imperative to reduce ambiguity in current recommendations and more specifically define postoperative physical therapy following operative management of FAIS to more expeditiously return patients to functional independence and physical activity. [ABSTRACT FROM AUTHOR]

Objective Hip preservation surgery has expanded to include treatment of hip pathology in elderly patients. Most data on efficacy of arthroscopy treatment in patients with femoroacetabular impingement syndrome (FAIS) has been generated from Western populations, while studies in the older Asian FAIS population are lacking. Here, we report efficacy of hip arthroscopy for treatment of Asian patients aged 50 years and above. Methods We retrospectively reviewed data from 775 hips that were treated arthroscopically for FAIS between 2016 and 2019. Patients with a history of hip surgery, contralateral surgery during the follow‐up period, lateral center‐edge angle (LCEA)

Background: Patient-reported outcomes are commonly used to assess patient symptoms. The effect of specific hip pathology on relationships between perceived and objectively measured symptoms remains unclear. The purpose of this study was to evaluate differences of function and pain in patients with FAIS and DDH, to assess the correlation between perceived and objective function, and to determine the influence of pain on measures of function. Methods: This prospective cross-sectional study included 35 pre-operative patients (60% female) with femoroacetabular impingement syndrome (FAIS) and 37 pre-operative patients (92% female) with developmental dysplasia of the hip (DDH). Objectively measured function (6-min walk [6MWT], single leg hop [SLHT], Biodex sway [BST], hip abduction strength [HABST], and STAR excursion balance reach [STAR] tests), patient-reported function (UCLA Activity, Hip Outcome Score [HOS], Short Form 12 [SF-12], and Hip Disability and Osteoarthritis Outcome Score [HOOS]), and patient-reported pain (HOOS Pain, visual analogue scale (VAS), and a pain location scale) were collected during a pre-surgical clinic visit. Between-group comparisons of patient scores were performed using Wilcoxon Rank-Sum tests. Within-group correlations were analyzed using Spearman's rank correlation coefficients. Statistical correlation strength was defined as low (r = ± 0.1–0.3), moderate (r = ± 0.3–0.5) and strong (r > ± 0.5). Results: Patients with DDH reported greater pain and lower function compared to patients with FAIS. 6MWT distance was moderately-to-strongly correlated with a number of patient-reported measures of function (FAIS: r = 0.37 to 0.62, DDH: r = 0.36 to 0.55). Additionally, in patients with DDH, SLHT distance was well correlated with patient reported function (r = 0.37 to 0.60). Correlations between patient-reported pain and objectively measured function were sparse in both patient groups. In patients with FAIS, only 6MWT distance and HOOS Pain (r = -0.53) were significantly correlated. In patients with DDH, 6MWT distance was significantly correlated with VAS Average (r = -0.52) and Best (r = -0.53) pain. Conclusion: Pain is greater and function is lower in patients with DDH compared to patients with FAIS. Moreover, the relationship between pain and function differs between patient groups. Understanding these differences is valuable for informing treatment decisions. We recommend these insights be incorporated within the clinical continuum of care, particularly during evaluation and selection of surgical and therapeutic interventions. [ABSTRACT FROM AUTHOR]

Objective: When considering surgical treatment options, many patients who undergo hip arthroscopy value continuing active lifestyles. To address these concerns, the purpose of this study was to determine the effect of preoperative activity level on postoperative patient‐reported outcomes (PROs) in femoroacetabular impingement syndrome (FAIS) patients following hip arthroscopy. Methods: Data was retrospectively reviewed for FAIS patients who received hip arthroscopy between 2016 and 2018. Patients were divided into active group and inactive group based on preoperative HOS‐SSS scores. Preoperative active patients were 1:1 propensity‐score matched to inactive patients based on age, sex, BMI, and follow‐up period. PROs (HOS‐ADL, HOS‐ADL, iHOT‐12, mHHS), VAS scores, radiographic measures, performed procedures, complications, and revision surgery were compared and analyzed for both groups by Student's t test. Results: A total of 71 patients in the active group and 71 patients in the inactive group were found using propensity‐score matching. Active patients had superior preoperative HOS‐ADL, HOS‐SSS, iHOT‐12, mHHS (p < 0.001 for all), and VAS (p = 0.002) scores compared with inactive patients. At the final follow‐up, active patients still had better PROs in HOS‐ADL (p = 0.003), HOS‐SSS (p < 0.001), iHOT‐12 (p = 0.043), and mHHS scores (p = 0.003). There was no difference detected in postoperative VAS score (p = 0.117) between the two groups. However, inactive patients showed significantly higher net improvement in HOS‐ADL (p = 0.009), HOS‐SSS (p = 0.005), and iHOT‐12 (p = 0.023). Conclusions: Active patients have absolute higher preoperative PROs and achieve better postoperative PROs than inactive patients. However, inactive patients can obtain greater net improvements in PROs following hip arthroscopic surgery, with comparable pain alleviation as active patients. [ABSTRACT FROM AUTHOR]

Background: The COVID-19 pandemic has accelerated the demand for utilising telehealth as a major mode of healthcare delivery, with increasing interest in the use of tele-platforms for remote patient assessment. In this context, the use of smartphone technology to measure squat performance in people with and without femoroacetabular impingement (FAI) syndrome has not been reported yet. We developed a novel smartphone application, the TelePhysio app, which allows the clinician to remotely connect to the patient's device and measure their squat performance in real time using the smartphone inertial sensors. The aim of this study was to investigate the association and test–retest reliability of the TelePhysio app in measuring postural sway performance during a double-leg (DLS) and single-leg (SLS) squat task. In addition, the study investigated the ability of TelePhysio to detect differences in DLS and SLS performance between people with FAI and without hip pain. Methods: A total of 30 healthy (nfemales = 12) young adults and 10 adults (nfemales = 2) with diagnosed FAI syndrome participated in the study. Healthy participants performed DLS and SLS on force plates in our laboratory, and remotely in their homes using the TelePhysio smartphone application. Sway measurements were compared using the centre of pressure (CoP) and smartphone inertial sensor data. A total of 10 participants with FAI (nfemales = 2) performed the squat assessments remotely. Four sway measurements in each axis (x, y, and z) were computed from the TelePhysio inertial sensors: (1) average acceleration magnitude from the mean (aam), (2) root-mean-square acceleration (rms), (3) range acceleration (r), and (4) approximate entropy (apen), with lower values indicating that the movement is more regular, repetitive, and predictable. Differences in TelePhysio squat sway data were compared between DLS and SLS, and between healthy and FAI adults, using analysis of variance with significance set at 0.05. Results: The TelePhysio aam measurements on the x- and y-axes had significant large correlations with the CoP measurements (r = 0.56 and r = 0.71, respectively). The TelePhysio aam measurements demonstrated moderate to substantial between-session reliability values of 0.73 (95% CI 0.62–0.81), 0.85 (95% CI 0.79–0.91), and 0.73 (95% CI 0.62–0.82) for aamx, aamy, and aamz, respectively. The DLS of the FAI participants showed significantly lower aam and apen values in the medio-lateral direction compared to the healthy DLS, healthy SLS, and FAI SLS groups (aam = 0.13, 0.19, 0.29, and 0.29, respectively; and apen = 0.33, 0.45, 0.52, and 0.48, respectively). In the anterior–posterior direction, healthy DLS showed significantly greater aam values compared to the healthy SLS, FAI DLS, and FAI SLS groups (1.26, 0.61, 0.68, and 0.35, respectively). Conclusions: The TelePhysio app is a valid and reliable method of measuring postural control during DLS and SLS tasks. The application is capable of distinguishing performance levels between DLS and SLS tasks, and between healthy and FAI young adults. The DLS task is sufficient to distinguish the level of performance between healthy and FAI adults. This study validates the use of smartphone technology as a tele-assessment clinical tool for remote squat assessment. [ABSTRACT FROM AUTHOR]

Purpose: The purpose of this protocol was to discover the connection between patients with non-surgical pain or other discomfort and their psychosocial status. Cognitive behavior therapy will be used, which we verified will determine the effect and feasibility of postoperative rehabilitation processes. Materials and Methods: This study will include 200 patients ranging from 18 to 60 years old who have underwent or will undergo FAI arthroscopy in the West China Hospital Sports Medicine Center from 2023 to 2026. A standardized prospective single-center parallel-group randomized controlled trial will be used for these participants. The participants will be divided into intervention (telephone versus face-to-face versus music versus floatation) and control groups. The follow-up periods will be measured pre-operatively, as well as postoperatively at 1, 3, and 6 months. The primary outcomes will include the modified Harris Hip Score (mHHS) and the Visual Analogic Score (VAS), and the secondary outcomes will include the range of motion (ROM), the Huaxi Emotional-distress Index (HEI), and the depression, anxiety, and stress scale (DASS-21 scale). Furthermore, the Patient Health Questionnaire-9 (PHQ-9) and a Short-Form 12 (SF-12) questionnaire will also be evaluated. Discussion: This study will evaluate the clinical and cost-effectiveness of different types of psychosocial-therapy-based rehabilitation methods designed to improve the quality of life of FAI patients with persistent symptoms. [ABSTRACT FROM AUTHOR]

BackgroundFemoroacetabular acetabular impingement syndrome consists of abnormal hip joint morphology resulting in painful hip joint impingement. Hip arthroscopy corrects the abnormal morphology and reduces clinical symptoms associated with femoroacetabular impingement syndrome yet the effects of hip arthroscopy on gait mechanics and cartilage health are not well understood.MethodsTen femoroacetabular impingement syndrome patients and 10 matched asymptomatic controls underwent gait analysis consisting of three-dimensional hip joint kinematics and kinetics. Femoroacetabular impingement syndrome patients underwent gait analysis and quantitative magnetic resonance imaging of the surgical hip joint before and seven months post-surgery. Patient reported outcomes were obtained from all study participants and were used to quantify hip joint pain, function and quality of life.FindingsPrior to surgery, femoroacetabular impingement syndrome patients demonstrated hip joint kinematics or kinetics as the control group. After surgery, femoroacetabular impingement syndrome patients exhibited improved patient reported outcomes, similar hip joint kinematic patterns, increased hip flexion and decreased hip extension moment impulses within the surgical limb. The femoroacetabular impingement syndrome patients that ambulated with increased HFMI post-surgery demonstrated a decrease in femoral cartilage T1ρ and T2 values.InterpretationFemoroacetabular impingement syndrome patients exhibited improved clinical symptoms yet ambulated with altered sagittal plane hip joint loading after hip arthroscopy. Increased hip flexion moment impulse post-surgery was associated with improved cartilage health within the surgical limb. These study findings suggest that sagittal plane hip joint loading at short-term follow-up after hip arthroscopy is associated with cartilage health and may be an important biomechanical parameter in post-operative rehabilitation programs.

Objective: Hip preservation surgery has expanded to include treatment of hip pathology in elderly patients. Most data on efficacy of arthroscopy treatment in patients with femoroacetabular impingement syndrome (FAIS) has been generated from Western populations, while studies in the older Asian FAIS population are lacking. Here, we report efficacy of hip arthroscopy for treatment of Asian patients aged 50 years and above. Methods: We retrospectively reviewed data from 775 hips that were treated arthroscopically for FAIS between 2016 and 2019. Patients with a history of hip surgery, contralateral surgery during the follow‐up period, lateral center‐edge angle (LCEA) <25°, Tӧnnis grade ≥2, and incomplete records were excluded. Patient‐reported outcomes (PROs), such as modified Harris Hip Score (mHHS), Hip Outcome Score‐Activities of Daily Living (HOS‐ADL), International Hip Outcome Tool 12‐component form (iHOT‐12), and Visual Analog Scale (VAS) were compared pre‐ and post‐operation. We also recorded radiographic measures, intraoperative findings, procedures, complications, and subsequent surgical revisions. Finally, we correlated demographics with PRO improvement among the study group. Results: A total of 57 hips met the inclusion and exclusion requirements and were therefore included in the final analysis. After the follow‐up period (3.3 years), most patients exhibited significantly higher PROs than preoperative values, HOS‐ADL (65.0–81.7), iHOT‐12 (44.3–69.1), mHHS (58.9–81.7), and VAS (5.8–2.2; all p < 0.001). Shorter symptom duration was significantly correlated with improved HOS‐ADL (p = 0.015), and mHHS score (p = 0.022). The overall rate of complications and rate of revisions were 5.3% and 7.0%, respectively, and none of the patients required total hip arthroplasty (THA). Conclusions: Arthroscopic surgery confers significant clinical outcomes in most FAIS patients in the Asian population who are aged 50 years and above. These benefits are accompanied by either a low revision rate or conversion to THA, while shorter symptom duration is positively correlated with improved HOS‐ADL and mHHS scores. [ABSTRACT FROM AUTHOR]

Abstract Background Cholesterol can trigger degenerative processes in the chondrocytes. The internal layer of the hip labral consists of cartilage-specific type II collagen-positive fibrocartilage. The purpose of this study was to compare outcomes after arthroscopy labral repair in FAIS patients with preoperative hyperlipidemia to a control group with no hyperlipidemia. Methods Data were prospectively collected and retrospectively reviewed for FAIS patients who had arthroscopy 2019. Patients with hyperlipidemia were 1:1 propensity-score matched to patients without hyperlipidemia. Patient-reported outcomes (HOS-ADL, iHOT-12, mHHS), VAS scores, radiographic measures, performed procedures, complications, and revision surgery were compared and analyzed for both groups. Results A total of 41 patients with hyperlipidemia and 41 patients without hyperlipidemia were found using propensity-score matching. When compared to preoperative levels, both groups demonstrated significant improvements in PROs and VAS scores at the final follow-up. Besides, there were no significant differences in preoperative scores and final outcome scores between the groups. Besides, there were no other differences in revision rate and the rate of meeting the PASS and MCID between the study and the control groups. Conclusion It was demonstrated in this study that FAIS patients with hyperlipidemia can expect to experience similar good short-term patient-reported outcomes as compared with patients without hyperlipidemia. Level of evidence Case-series study; Level of Evidence: Level III.

Abstract Purpose FAI (femoroacetabular impingement syndrome) is a common cause of hip pain, resulting in a decreased life quality. This study aims to compare the postoperative clinical outcome between arthroscopic surgery (AT) and conservative treatment (CT). Method The six studies were selected from PubMed, Embase and OVID database. The data were extracted and analyzed by RevMan5.3. Mean differences and 95% confidence intervals were calculated. RevMan5.3 was used to assess the risk of bias. Result Six observational studies were assessed. The methodological quality of the trials indicated five of six studies had a low risk of bias and one article had a high risk of bias. The differences were statistically significant between AT and CT for HOS (follow-up for 6 months), iHOT-33 (follow-up for 6 months) improvement, iHOT-33 (follow-up for 12 months) improvement, iHOT-33 (follow-up for 12 months), EQ-5D-5L index score (follow-up for 12 months) and AT showed higher benefits than CT. Meanwhile no statistically significant were found in iHOT-33 (follow-up for 6 months), EQ-5D-5L index score (follow-up for 6 months), EQ5D-VAS (follow-up for 6 months) and EQ5D-VAS (follow-up for 12 months). Conclusion AT and CT both can have clinical effects when facing FAI. In our meta-analysis, hip arthroscopy is statistically superior to conservative treatment in both long-term and short-term effects.

IntroductionFemoroacetabular Impingement (FAI) is a hip pathology characterized by impingement of the femoral head-neck junction against the acetabular rim, due to abnormalities in bone morphology. FAI is normally diagnosed by manual evaluation of morphologic features on magnetic resonance imaging (MRI). In this study, we assess, for the first time, the feasibility of using radiomics to detect FAI by automatically extracting quantitative features from images.Material and methods17 patients diagnosed with monolateral FAI underwent pre-surgical MR imaging, including a 3D Dixon sequence of the pelvis. An expert radiologist drew regions of interest on the water-only Dixon images outlining femur and acetabulum in both impingement (IJ) and healthy joints (HJ). 182 radiomic features were extracted for each hip. The dataset numerosity was increased by 60 times with an ad-hoc data augmentation tool. Features were subdivided by type and region in 24 subsets. For each, a univariate ANOVA F-value analysis was applied to find the 5 features most correlated with IJ based on p-value, for a total of 48 subsets. For each subset, a K-nearest neighbor model was trained to differentiate between IJ and HJ using the values of the radiomic features in the subset as input. The training was repeated 100 times, randomly subdividing the data with 75%/25% training/testing.ResultsThe texture-based gray level features yielded the highest prediction max accuracy (0.972) with the smallest subset of features. This suggests that the gray image values are more homogeneously distributed in the HJ in comparison to IJ, which could be due to stress-related inflammation resulting from impingement.ConclusionsWe showed that radiomics can automatically distinguish IJ from HJ using water-only Dixon MRI. To our knowledge, this is the first application of radiomics for FAI diagnosis. We reported an accuracy greater than 97%, which is higher than the 90% accuracy for detecting FAI reported for standard diagnostic tests (90%). Our proposed radiomic analysis could be combined with methods for automated joint segmentation to rapidly identify patients with FAI, avoiding time-consuming radiological measurements of bone morphology.

Simple Summary: Femoroacetabular impingement represents an important burden for affected patients in their daily life. Possible and successful treatments to alleviate patient symptoms are corrections of bone deformities using either arthroscopy or surgical hip dislocation. Nevertheless, the aforementioned surgeries might also weaken the operated hip in addition to the impact of the pathology itself. There is, however, little or no published data on the impact of arthroscopy and surgical hip dislocation on hip muscles strength, which motivated us to perform this study. For arthroscopy, we found that patients exhibited on the operated hip a moderate decrease in abductors strength, as well as a small but noticeable decrease in hamstrings, external rotators and flexors strengths three months after surgery. Interestingly, patients also had a small but relevant strength decrease on the non-operated side, located on external rotators. For surgical hip dislocation, patients exhibited on the operated hip a large decrease in internal rotators strength and a moderate decrease in abductors, quadriceps and external rotators strengths. These findings suggest that several hip muscles can be moderately or largely affected after arthroscopy (abductors) or surgical hip dislocation (internal and external rotators, abductors and quadriceps). This study also suggests that a rehabilitation method based on isolated muscle reinforcement and functional exercises is needed and emphasizes the need for a rehabilitation protocol that goes beyond three postoperative months. Hip arthroscopy and surgical hip dislocation (SHD) can be adequate surgical options for patients suffering from femoroacetabular impingement (FAI) syndrome, but there is to date no published data on their impact on hip muscles strength. The purpose of this retrospective study was, therefore, to evaluate it on a consecutive series of 50 FAI patients treated either by arthroscopy (n = 29, aged 27.4 ± 7.5 years, 76% of women) or SHD (n = 21, aged 25.9 ± 6.5 years, 38% of women) at La Tour Hospital between 2020 and 2021. The bilateral isometric strengths of eight hip-related muscles were evaluated before and three months after surgery (halfway through the rehabilitation program). For arthroscopy, a statistically significant (p < 0.05) reduction in hip muscles strength could be noted on the operated hamstrings (1.49 ± 0.43 vs. 1.39 ± 0.38 Nm/kg), flexors (1.88 ± 0.46 vs. 1.73 ± 0.41 Nm/kg), abductors (1.97 ± 0.42 vs. 1.72 ± 0.40 Nm/kg) and external rotators (1.17 ± 0.40 vs. 1.04 ± 0.37 Nm/kg). The abductors were the most affected muscles, with 45% of the patients suffering from a strength reduction ≥15%. The non-operated external rotators were also affected but to a lesser extent (1.21 ± 0.38 vs. 1.10 ± 0.36 Nm/kg). For SHD, a statistically significant strength reduction could be noted on the operated extensors (2.28 ± 0.84 vs. 2.05 ± 0.70 Nm/kg), abductors (1.87 ± 0.49 vs. 1.65 ± 0.41 Nm/kg), quadriceps (2.96 ± 0.92 vs. 2.44 ± 0.89 Nm/kg), external rotators (1.16 ± 0.42 vs. 0.93 ± 0.36 Nm/kg) and internal rotators (1.26 ± 0.38 vs. 0.96 ± 0.30 Nm/kg). The internal rotators were the most affected muscles, with 75% of the patients suffering from a strength reduction ≥15%. To conclude, particular attention should be paid to operated abductors for patients treated by arthroscopy as well as operated internal/external rotators, abductors and quadriceps for those treated by surgical hip dislocation. It reinforces that a rehabilitation method based on isolated muscle reinforcement and functional exercises that goes beyond three postoperative months is needed. [ABSTRACT FROM AUTHOR]

Background: Radiographic studies have reported a high prevalence of cam morphology in athletes, especially in male athletes, suggesting these individuals are at an elevated risk of developing femoroacetabular impingement syndrome (FAIS). However, recent research has shown that 2-dimensional measurements do not accurately characterize cam deformities, motivating the need for 3-dimensional (3D) analyses., Purpose: To develop a 3D statistical shape model of the proximal femur to evaluate cam morphology in collegiate athletes through (1) quantifying shape variation, (2) establishing sex-based shape differences, and (3) comparing shapes between male athletes and male cam FAIS patients., Study Design: Cross-sectional study; Level of evidence, 3., Methods: Double-echo steady-state magnetic resonance images were prospectively acquired of the hips of Division I collegiate athletes (28 male, 23 female). An existing data set of computed tomography scans of cam FAIS patients (26 male) and morphologically screened controls (30 male, 17 female) was also evaluated. The proximal femur was segmented, reconstructed into a 3D surface, and analyzed to generate a correspondence model using ShapeWorks. Principal component analysis, parallel analysis, and linear discriminant analysis quantified variation in proximal femoral shape., Results: Variation in the full cohort primarily occurred in the head-neck junction, femoral offset, and location of the greater trochanter relative to the head/neck (mode VIII, adjusted P = .01; modes I and IV, adjusted P = .002 and adjusted P = .003, respectively; modes IV and VIII, adjusted P = .0003 and adjusted P = .0007, resepctively. P < .001). Modes represented anatomic variation significantly different between pairs within a group. Variation between male and female athletes occurred in the concavity of the head at the head-neck junction, length of the femur, and length of the femoral offset (modes I and II, adjusted P = .006 and adjusted P = .009, respectively). Variation between male athletes and male patients and between male patients and male controls occurred in the concavity of the head at the head-neck junction and femoral torsion (mode IV, adjusted P = .02 and adjusted P = .003, respectively). Shape scores, which represented a generalized value of the entire shape, were significantly different between athletes and patients (adjusted P = .003) and patients and controls (adjusted P < .0001)., Conclusion: Athletes in our study had a proximal femur shape more similar to morphologically screened controls than FAIS patients. Sex-based differences occurred in athletes in regions where cam morphology typically occurs., Competing Interests: One or more of the authors has declared the following potential conflict of interest or source of funding: This study received funding from the PAC-12 Student Athlete Health and Well-Being Initiative and the National Institutes of Health under grant No. NIBIB-U24EB029011, NIBIB-R01EB016701, NIAMS-R01AR076120, NHLBI-R01HL135568, NIGMS-P41GM103545, and R24 GM136986. K.B.F. has received education payments from Intuitive Surgical. S.K.A. has received consulting fees from Stryker. T.G.M. has received nonconsulting fees from Arthrex, consulting fees from Arthrex, and education payments from Active Medical. AOSSM checks author disclosures against the Open Payments Database (OPD). AOSSM has not conducted an independent investigation on the OPD and disclaims any liability or responsibility relating thereto. Ethical approval for this study was obtained from the University of Utah (IRB No. 00109768)., (© The Author(s) 2025.)

Femoroacetabular impingement syndrome (FAI) is essentially a mechanical conflict that occurs when the acetabulum edge of the pelvic bone interacts with femur head and neck with clinical symptoms. In a basis of this conflict, as a rule, is a single or bilateral anatomical bone defect that causes an irregular shape of the hip joint with congenital or acquired etiology. Radiography, performed in a direct projection and in 45 Dunn position with external rotation of 40, is traditionally considered as basic tool for the radiological diagnosis of hip joint pathology. It allows to assess the anatomical and morphological structure of joint surfaces and their relationship. Detection of severe hip deformations may require computed tomography (CT). Magnetic resonance imaging (MRI) or magnetic resonance arthrography (MRA) is used to assess the condition of soft tissue structures of hip joint, its damage is often found in patients with FAI. The modern method of treating patients with FAI is hip arthroscopy, the undeniable advantage of which is low traumatic nature of the operation, low level of intraoperative complications and short postoperative rehabilitation period. For its successful implementation, it is necessary to take into account the complexity of performing hip arthroscopy, its duration, the necessity for good technical equipment and a high skill level of the operating surgeon. However, this operation has a number of limitations, which must be taken into account when selecting patients.

Introduction: Lacrosse continues to be one of the fastest growing sports in the United States. Despite this, few studies look at evaluation and management of hip-related injuries, and one of the leading causes of hip injury, femoroacetabular impingement syndrome, in lacrosse athletes. Objectives: The purpose of this article is to review stepwise diagnosis and management of femoroacetabular impingement syndrome in the lacrosse athlete. This review takes into account the uniqueness of the sport as both a cutting and overhead sport. Methods: A review of recent literature and expert opinion was utilized in providing current diagnosis and management strategies for treating hip pain in the lacrosse athlete. Results: Limited research exists specific to outcomes in lacrosse athletes, however, previous studies have shown high return to sport rates. Conclusions: A stepwise approach to diagnosis and treatment of lacrosse athletes should be utilized with consideration given to the demands of the sport, both cutting and overhead. Prior to proceeding with hip arthroscopy, conservative treatments should be trialed, and even if surgery is required, can often be used to delay surgery until the off season.

Background: While sex-based differences in outcomes after hip arthroscopic surgery for femoroacetabular impingement syndrome (FAIS) are often recorded, no studies have been dedicated to analyzing the literature as a whole. Purpose: To investigate whether sex is a predictor of outcomes in studies evaluating hip arthroscopic surgery for FAIS. Study Design: Systematic review; Level of evidence, 4. Methods: A systematic review was conducted following PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines. We searched the PubMed, Embase, Cochrane, Ovid, and PubMed Central databases for English-language studies that evaluated sex-specific outcomes in human populations. The search terms used were as follows: ("Hip Arthroscopy") AND ("Femoroacetabular Impingement" OR "FAI") AND ("Sex" OR "Gender" OR "Male" OR "Female"). Studies with evidence levels 2 through 4 were included. The studies were then screened, followed by data extraction. Modified Harris Hip Score (mHHS) outcomes and return-to-sport (RTS) rates were recorded. These were analyzed using random-effects meta-analysis. Heterogeneity was calculated using the I 2 statistic. Results: Of 256 full-text articles screened, 48 articles were included in this analysis; of these, 14 studies (29%) concluded that female sex was a negative predictor of postoperative outcomes, while 6 studies (13%) found female sex to be positive predictor. The remaining 28 studies (58%) found no sex-based differences in postoperative outcomes. Of 7 studies (416 male and 519 female) included in the mHHS analysis, 2 studies concluded that male patients had significantly higher postoperative mHHS scores. Of 6 studies (502 male and 396 female) included in the RTS analysis, 1 study concluded that male patients had a significantly higher RTS rate. Conclusion: Almost one-third of the included studies determined that female sex was a negative predictor of postoperative outcomes, 13% found female sex to be a positive predictor, and 58% found no sex-based differences. Our study illustrates an insufficiency of high-level evidence supporting sex-specific differences in outcomes after hip arthroscopic surgery, but findings indicated that the postoperative mHHS score and RTS rate may be influenced by sex. [ABSTRACT FROM AUTHOR]

Background: Most of the research data of arthroscopic treatment for femoroacetabular impingement syndrome (FAIS) have been generated from Western populations. Purpose: To report the minimum 2-year follow-up results after hip arthroscopy for FAIS in Chinese patients. Study Design: Case series; Level of evidence, 4. Methods: A total of 434 hips that underwent primary hip arthroscopy for FAIS between 2016 and 2018 were included. Excluded were patients with previous ipsilateral hip surgery, ipsilateral surgery during the follow-up time, preoperative lateral center-edge angle <25°, Tönnis grade ≥2, sacroiliac joint disease, or incomplete preoperative radiographs or medical records. Preoperative and postoperative patient-reported outcomes (PROs; modified Harris Hip Score [mHHS], Hip Outcome Score–Activities of Daily Living [HOS-ADL], international Hip Outcome Tool, 12-component form [iHOT-12], and visual analog scale [VAS] for pain) were compared with the 2-tailed paired Student t test. Radiographic measures, intraoperative findings, performed procedures, complications, and revision surgery were also reported. The Spearman rank correlation was used to determine the association between patient characteristics and improvement in PRO scores. Results: Included were 272 hips with a mean follow-up of 39.4 ± 8.1 months. Overall, 243 hips (89.3%) underwent labral repair. The PROs from baseline to final follow-up were 64.7 to 90.0 for HOS-ADL, 41.1 to 73.4 for iHOT-12, 62.8 to 89.6 for mHHS, and 6.1 to 1.7 for VAS (P <.001 for all). Younger age was correlated significantly with improved iHOT-12 scores (r = -0.230; P <.001), and shorter symptom duration was significantly correlated with improved HOS-ADL (r = -0.190; P =.003), iHOT-12 (r = -0.146; P =.024), and VAS pain (r = -0.143; P =.027) scores. The overall complication and revision hip arthroscopy rates were 4.0% and 3.3% respectively. At the final follow-up, no patient required conversion to total hip arthroplasty (THA). Conclusion: At 2 years after hip arthroscopy for FAIS, Chinese patients demonstrated statistically significant improvement in PROs, with a low rate of revision surgery or conversion to THA. Shorter symptom duration and younger age were significantly positively correlated with improvement in PROs. [ABSTRACT FROM AUTHOR]

Background: Inadequate resection of cam lesions can cause inferior outcomes after hip arthroscopy and result in revision surgery for femoroacetabular impingement syndrome (FAIS). Purpose: To evaluate the association between postoperative cam lesions measured using the proximal boundaries of resection area (PBRE) relative to the epiphyseal line and 2-year outcomes after hip arthroscopy. Study Design: Cohort study; Level of evidence, 3. Methods: Included were patients with FAIS who had undergone primary hip arthroscopy between 2016 and 2018. The PBRE was calculated by measuring the linear distance from the PBRE to the epiphyseal line, dividing it by the diameter of the femoral head, and multiplying by 100; PBRE measurements were made at the 12-, 1-, and 2-o'clock positions on postoperative hip computed tomography. Within each clockface position, patients were divided into subgroups depending on whether their postoperative PBRE was greater than a half standard deviation above the mean (adequate resection) or less than or equal to a half standard deviation above the mean (inadequate resection). Patient-reported outcomes (PROs; Hip Outcome Score–Activities of Daily Living [HOS-ADL], International Hip Outcome Tool–Short Form [iHOT-12], modified Harris Hip Score [mHHS], and pain visual analog scale [VAS]) and rates of achieving the minimal clinically important difference (MCID) and patient-acceptable symptomatic state (PASS) were compared among the subgroups. Results: Included were 80 pairs of hips at 12 o'clock, 81 pairs of hips at 1 o'clock, and 80 pairs of hips at 2 o'clock. All subgroups demonstrated significant improvements in PRO scores at a minimum 2-year follow-up compared with preoperatively. At the 12-o'clock position, the subgroup with adequate resection had significantly superior HOS-ADL (P =.004), iHOT-12 (P <.001), and mHHS (P <.001) scores and were more likely to achieve the MCID for the iHOT-12 score (P =.035) and the PASS for the HOS-ADL (P =.003), iHOT-12 (P =.007), and mHHS (P <.001) scores compared with the matched subgroup. There were no significant differences in PRO scores or rates of MCID and PASS for the 1- or 2-o'clock groups. Conclusion: The epiphyseal line may be a useful and reproducible landmark measurement for cam-type deformity. Patients considered to have inadequate resection at 12 o'clock had lower outcome scores at a minimum 2-year follow-up. [ABSTRACT FROM AUTHOR]

Aims: Cam and pincer morphologies are potential precursors to hip osteoarthritis and important contributors to non-arthritic hip pain. However, only some hips with these pathomorphologies develop symptoms and joint degeneration, and it is not clear why. Anterior impingement between the femoral head-neck contour and acetabular rim in positions of hip flexion combined with rotation is a proposed pathomechanism in these hips, but this has not been studied in active postures. Our aim was to assess the anterior impingement pathomechanism in both active and passive postures with high hip flexion that are thought to provoke impingement. Methods: We recruited nine participants with cam and/or pincer morphologies and with pain, 13 participants with cam and/or pincer morphologies and without pain, and 11 controls from a population-based cohort. We scanned hips in active squatting and passive sitting flexion, adduction, and internal rotation using open MRI and quantified anterior femoroacetabular clearance using the β angle. Results: In squatting, we found significantly decreased anterior femoroacetabular clearance in painful hips with cam and/or pincer morphologies (mean -11.3° (SD 19.2°)) compared to pain-free hips with cam and/or pincer morphologies (mean 8.5° (SD 14.6°); p = 0.022) and controls (mean 18.6° (SD 8.5°); p < 0.001). In sitting flexion, adduction, and internal rotation, we found significantly decreased anterior clearance in both painful (mean -15.2° (SD 15.3°); p = 0.002) and painfree hips (mean -4.7° (SD 13°); p = 0.010) with cam and/pincer morphologies compared to the controls (mean 7.1° (SD 5.9°)). Conclusion: Our results support the anterior femoroacetabular impingement pathomechanism in hips with cam and/or pincer morphologies and highlight the effect of posture on this pathomechanism. Cite this article: Bone Jt Open 2021;2(11):988–996.

Abstract Background Using the database of the German Cartilage Registry (KnorpelRegister DGOU), this study aims to present patient- and joint-related baseline data in a large cohort of patients with cam-derived femoroacetabular impingement syndrome (FAI) and to detect symptom-determining factors. Materials and methods Requiring cam morphology as the primary pathology, 362 patients were found to be eligible for inclusion in the study. The assessment of preoperative baseline data was performed using the patient-reported outcome measure—International Hip Outcome Tool (iHOT-33). Descriptive statistics were performed to present baseline data. Univariate and multiple regression with post hoc testing were used to identify patient- and joint-related factors that might affect the preoperative iHOT-33 and its subscores, respectively. Results The study collective’s mean age was 36.71 ± 10.89 years, with 246 (68%) of them being male. The preoperative mean iHOT-33 total was 46.31 ± 20.33 with the subsection “sports and recreational activities” presenting the strongest decline (26.49 ± 20.68). The parameters “age,” “sex,” “body mass index” (BMI), and the confirmation of “previous surgery on the affected hip” were identified to statistically affect the preoperative iHOT-33. In fact, a significantly lower mean baseline score was found in patients aged > 40 years (p 40 years,” “female sex,” “BMI ≥ 25,” and confirmation of “previous surgery on the affected hip” were detected as significantly associated with decreased preoperative iHOT-33 scores. These results help to identify symptom-defining baseline characteristics of cam-derived FAI syndrome. Trial registration: The German Cartilage Registry is conducted in accordance with the Declaration of Helsinki and registered at germanctr.de (DRKS00005617). Registered 3 January 2014—retrospectively registered. The registration of data was approved by the local ethics committees of every participating institution. Primary approval was given by the ethics committee at the University of Freiburg (No. 105/13). https://www.drks.de/drks_web/navigate.do?navigationId=trial.HTML&TRIAL_ID=DRKS00005617

Objective To investigate the effectiveness of ultrasound (US) guided intra‐hip joint injection to estimate the outcome of hip arthroscopy in patients with femoroacetabular impingement (FAI) syndrome. Methods Patients with FAI syndrome (n = 60) were prospectively enrolled in our study. Before hip arthroscopy, a mix of 4 mL 2% lidocaine and 4 mL 1% ropivacaine were injected into the hip joint under the guidance of US. The clinical efficacy of the intra‐articular injection was evaluated by comparing the visual analog scale (VAS) and international hip outcome tool 12 (iHOT‐12) results before and after the injection. The outcome of hip arthroscopy was evaluated by iHOT‐12, the modified Harris hip score (MHHS), and the patient's satisfaction 12 months after the operation. The outcome of intra‐articular injection and hip arthroscopy were compared. Factors related to the outcomes of hip arthroscopy were evaluated. The correlation between the efficacy of intra‐hip joint injection and arthroscopy was evaluated. Results The VAS of patients decreased from 11.3 ± 7.7 to 3.3 ± 4.5, and the iHOT‐12 increased from 52.1 ± 23.2 to 84.1 ± 18.1 after intra‐articular injection (all P

Objective To determine the effectiveness of hip arthroscopy combined with endoscopic iliotibial band (ITB) release in patients with both femoroacetabular impingement (FAI) syndrome and external snapping hip (ESH). Methods Retrospectively review the preoperative and minimum of 2‐year follow‐up data of patients with both FAI syndrome and ESH who underwent endoscopic ITB release during hip arthroscopy (FAI + ESH group) from January 2014 to December 2018. The same number of age‐ and gender‐matched FAI syndrome patients without ESH undergoing hip arthroscopy were enrolled in the control group (FAI group). Patient‐reported outcomes (PROs) including international Hip Outcome Tool (iHOT‐33), modified Harris Hip Score (mHHS), visual analog scale for pain (VAS‐pain), and abductive force of affected hip at 3 month and 2 years postoperatively were comparatively analyzed. The VAS‐satisfaction score of two groups at 2 years postoperatively were also analyzed. Results The prevalence of ESH in FAI syndrome patients undergoing hip arthroscopy in our institution was 5.5% (39 of 715 hips), including nine males (10 hips) and 29 females (29 hips). The mean age at the time of surgery was 32.1 ± 6.9 years (range, 22–48 years). According to inclusion and exclusion criteria, 23 patients were enrolled in FAI + ITB group. Twenty‐three age‐ and sex‐matched FAI syndrome patients were enrolled in FAI group. At 24 months postoperatively, no patient still suffered ESH symptoms and painful palpation at lateral region in FAI + ITB group. The iHOT‐33, mHHS, and VAS‐pain score of patients in FAI + ESH group were significantly severer than patients in FAI group preoperatively (41.6 ± 7.5 vs 48.8 ± 7.2, 54.8 ± 7.2 vs 59.2 ± 6.9, 5.5 ± 0.9 vs 4.7 ± 1.0; P 0.05). At 3 months after surgery, the abductive force of operated hip was significantly smaller than that in FAI group (82.4 ± 12.4 N vs 91.9 ± 16.1 N, P 0.05). The VAS‐satisfaction scores of patients in the two groups were at a similarly high level (90.5 ± 6.8 vs 88.8 ± 7.3, P > 0.05). There was no complication and no arthroscopic revision in either group until 2‐year follow‐up. Conclusion Although abductive force recovery of the hip was delayed, hip arthroscopy combined with endoscopic ITB release addressed hip snapping in patients with both FAI syndrome and ESH, and could get similar functional improvement, pain relief, recovery speed, as well as patient satisfaction compared with the pure hip arthroscopy in FAI syndrome patients without ESH.

Abstract Background Arthroscopic surgery for femoroacetabular impingement syndrome (FAI) is known to lead to self-reported symptom improvement. In the context of surgical interventions with known contextual effects and no true sham comparator trials, it is important to ascertain outcomes that are less susceptible to placebo effects. The primary aim of this trial was to determine if study participants with FAI who have hip arthroscopy demonstrate greater improvements in delayed gadolinium-enhanced magnetic resonance imaging (MRI) of cartilage (dGEMRIC) index between baseline and 12 months, compared to participants who undergo physiotherapist-led management. Methods Multi-centre, pragmatic, two-arm superiority randomised controlled trial comparing physiotherapist-led management to hip arthroscopy for FAI. FAI participants were recruited from participating orthopaedic surgeons clinics, and randomly allocated to receive either physiotherapist-led conservative care or surgery. The surgical intervention was arthroscopic FAI surgery. The physiotherapist-led conservative management was an individualised physiotherapy program, named Personalised Hip Therapy (PHT). The primary outcome measure was change in dGEMRIC score between baseline and 12 months. Secondary outcomes included a range of patient-reported outcomes and structural measures relevant to FAI pathoanatomy and hip osteoarthritis development. Interventions were compared by intention-to-treat analysis. Results Ninety-nine participants were recruited, of mean age 33 years and 58% male. Primary outcome data were available for 53 participants (27 in surgical group, 26 in PHT). The adjusted group difference in change at 12 months in dGEMRIC was -59 ms (95%CI − 137.9 to - 19.6) (p = 0.14) favouring PHT. Hip-related quality of life (iHOT-33) showed improvements in both groups with the adjusted between-group difference at 12 months showing a statistically and clinically important improvement in arthroscopy of 14 units (95% CI 5.6 to 23.9) (p = 0.003). Conclusion The primary outcome of dGEMRIC showed no statistically significant difference between PHT and arthroscopic hip surgery at 12 months of follow-up. Patients treated with surgery reported greater benefits in symptoms at 12 months compared to PHT, but these benefits are not explained by better hip cartilage metabolism. Trial registration details Australia New Zealand Clinical Trials Registry reference: ACTRN12615001177549 . Trial registered 2/11/2015.

To determine the outcome and differences between arthroscopic hip surgery and conservative therapy in patients suffering from femoroacetabular impingement syndrome, we searched articles from PubMed, Embase, Cochrane, Web of Science and Clinicaltrials.gov using a Boolean search algorithm. Only randomized controlled trials comparing arthroscopic hip surgery and conservative therapy were included in this meta‐analysis of femoroacetabular impingement syndrome management. Two authors determined eligibility, extracted the needed data and assessed the risk of bias of eligible studies independently. Then we meta‐analyzed three articles to assess pooled estimate size (ES) and 95% confidence interval for Hip Outcome Score of activities of daily living (HOS ADL subscale), Hip Outcome Score sport (HOS sports subscale) and International Hip Outcome Tool (iHOT‐33) analyses were performed by using STATA version 14.0 MP (STATA, College Station, TX, USA) with the principal summary measures are mean between group difference, sample size, and standard deviation. We collected 52 articles in total after removing duplicates and screened by titles and abstracts. A total of three RCTs were included finally. There was definite evidence of additional benefit of arthroscopic hip surgery against conservative therapy in the field of improving quality of life (three trials, 575 participants, ES = 2.109, 95% CI: 1.373 to 2.845, I2 = 42.8%, P = 0.000) and activity of daily living (two trials, 262 participants, ES = 9.220, 95% CI: 5.931 to 12.508, I2 = 16.5%, P = 0.000). However, no significant difference could be seen in sports function improvement (two trials, ES = 7.562, 95% CI: −2.957 to 18.082, I2 = 60.1%, P = 0.159). In conclusion, this meta‐analysis suggests that arthroscopic hip surgery provided essential benefit compared with conservative therapy in improving activity of daily living and quality of life.

Introduction: There have been no full-scale randomised controlled trials (RCTs) comparing physiotherapist-led interventions for FAI syndrome.1 Objectives: Evaluate the effect of physiotherapist-led targeted-strengthening (STRENGTH) compared to physiotherapist-led standardised-stretching (STRETCH) on hip-related quality of life (QOL) and perceived improvement at six months in people with femoroacetabular impingement (FAI) syndrome. Study design: Double-blind, parallel, superiority RCT(2). Methods: Participants aged 18-50 years, pain ≥3/10 for ≥6 weeks, cam morphology (alpha angle ≥60°), positive flexion-- adduction--internal rotation test were included. People were excluded for physiotherapy treatment or hip joint injection in the past three months, previous or planned hip, back lower limb surgery, radiographic hip osteoarthritis. Both groups received 6-months of one-on-one treatment with a physiotherapist. STRENGTH undertook a supervised, targeted, individualised exercise therapy and education programme. STRETCH undertook a supervised standardised stretching and education program. Primary outcomes were change in hip-related QOL (International Hip Outcome Tool-33 (iHOT-33, 0-100 points)); and patient-perceived global improvement (7-point Likert scale) at six months. Secondary outcomes were hip muscle strength, functional task performance, and kinesiophobia. Statistical analyses compared betweengroup differences by intention-to-treat. Results: We recruited 154 participants (STRENGTH n=79 (53% women, 35(9) years); STRETCH n=75 (45% women, 36(9) years)). There was no difference between groups for change in hip-related QOL (mean difference (95% confidence interval) 1.6 (-4.9 to 8.1) p=0.63) or patient-perceived global improvement (0.3 (-0.1 to 0.7) p=0.11) at six-months. Both groups improved in iHOT-33 over six-months of 21.9 points. STRENGTH had greater improvements in hip abduction (21.6(7.6 to 35.5) Newtons; p=0.002) and adduction (16.9(3.9 to 29.9) Newtons; p=0.011) strength than STRETCH. Conclusions: We found no difference between a targeted, individualised strengthening program and a standardised stretching program on hip-related QOL or perceived improvement at six-months in people with FAI syndrome. Both groups showed improvements much larger than the minimal clinically important change in hip-related QOL at six- months. [ABSTRACT FROM AUTHOR]

Background: Cholesterol can trigger degenerative processes in the chondrocytes. The internal layer of the hip labral consists of cartilage-specific type II collagen-positive fibrocartilage. The purpose of this study was to compare outcomes after arthroscopy labral repair in FAIS patients with preoperative hyperlipidemia to a control group with no hyperlipidemia. Methods: Data were prospectively collected and retrospectively reviewed for FAIS patients who had arthroscopy 2019. Patients with hyperlipidemia were 1:1 propensity-score matched to patients without hyperlipidemia. Patient-reported outcomes (HOS-ADL, iHOT-12, mHHS), VAS scores, radiographic measures, performed procedures, complications, and revision surgery were compared and analyzed for both groups. Results: A total of 41 patients with hyperlipidemia and 41 patients without hyperlipidemia were found using propensity-score matching. When compared to preoperative levels, both groups demonstrated significant improvements in PROs and VAS scores at the final follow-up. Besides, there were no significant differences in preoperative scores and final outcome scores between the groups. Besides, there were no other differences in revision rate and the rate of meeting the PASS and MCID between the study and the control groups. Conclusion: It was demonstrated in this study that FAIS patients with hyperlipidemia can expect to experience similar good short-term patient-reported outcomes as compared with patients without hyperlipidemia. Level of evidence: Case-series study; Level of Evidence: Level III. [ABSTRACT FROM AUTHOR]