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Purpose: To identify the PASS and SCB thresholds for hip arthroscopy and provide guidance on how to choose among the thresholds., Methods: A systematic review of literature was conducted in PubMed and MEDLINE databases in August 2024 using the Preferred Reporting Items for Systematic Reviews and Meta-analyses guidelines. Studies with Level I to IV evidence that defined SCB or PASS thresholds for PROs for hip arthroscopy in the setting of intra-articular pathology were included. Case reports, review, technique, and non-English articles were excluded. Title, authors, publication date, study design, patient demographics, timepoint of interest, threshold values, anchor information, and calculation method were recorded., Results: In total, 35 studies met the inclusion criteria with 102 PASS thresholds and 82 SCB thresholds being defined across 13 PROs. Hip Outcome Score - Sport Specific Subscale (HOS-SSS) was the most commonly defined PASS threshold with 22 designations at the 12-, 24-, 60-, and 120-month periods ranging from 63.9 - 75, 64.3 - 82.3, 75.2 - 86.8, and 60.2 - 61.1, respectively. International Hip Outcome Tool (iHOT-12) was the most commonly defined threshold for SCB with 18 thresholds designations at the 12-, 24-, and 60-month periods ranged from 72.6 - 86.0, 66.7 - 86.0, and 86.1 - 87.5., Conclusion: Clinically relevant thresholds exhibit significant variability depending on the characteristics of the specific cohort. This study identified several key factors contributing to the heterogeneity in PASS and SCB values, including (1) the anchor questions used, particularly for SCB, (2) the criteria defining responders versus non-responders, (3) the follow-up time at the timepoint of interest, (4) sample size, and (5) the demographics of the patient population. When determining which threshold to use, surgeons should prioritize those that align closely with the follow-up timepoint of interest for the specific procedure for more accurate comparisons., Level of Evidence: Level IV: Systematic Review of Level II-IV studies., (Copyright © 2024. Published by Elsevier Inc.)

Purpose: To report the minimum 2-year clinical outcomes of endoscopic iliopsoas fractional lengthening (IFL) in patients with recalcitrant iliopsoas tendinitis after total hip arthroplasty (THA)., Methods: Data were prospectively collected from 2014 to 2020 for patients who underwent IFL after primary THA as part of our institutional hip outcomes registry. Patients were included if they had completed the following patient-reported outcomes preoperatively and at minimum 2-year follow-up: modified Harris Hip Score and visual analog scale score. Preoperative and postoperative data were available for the International Hip Outcome Tool 12 score, and patient satisfaction was analyzed. Patients included in the study reported irritation of the iliopsoas tendon after cementless THA, refractory to conservative treatment methods. IFL was recommended after a workup that included ruling out infection and aseptic loosening, as well as a positive response to an iliopsoas guided diagnostic injection., Results: Seventeen patients were included in the study. The mean age at IFL was 56.42 years (range, 30.17-81.29 years). The mean interval between THA and IFL was 2.72 years (range, 0.25-8.34 years). There was a significant improvement in all evaluated patient-reported outcomes, and a high percentage of patients met the minimal clinically important difference for the modified Harris Hip Score (14, 82.35%), International Hip Outcome Tool 12 score (11, 91.66.00%), and visual analog scale score (16, 94.12%) (P < .05). Furthermore, 15 patients (88.2%) reported a positive response to the patient acceptable symptom state anchor question. No impact on preoperative versus postoperative active range of motion was observed, and no patient reported weakness at the latest follow-up (P > .05). Preoperative flexion was 106.33° (range, 85.0°-120.0°), and postoperative flexion was 106° (range, 90°-120°)., Conclusions: Endoscopic IFL yielded significant improvements in functional outcomes with high patient satisfaction at minimum 2-year follow-up, with no reported complications. This procedure did not have a significant negative impact on hip range of motion., Level of Evidence: Level IV, retrospective case series., Competing Interests: Disclosures The authors declare the following financial interests/personal relationships which may be considered as potential competing interests: R.Q-J. receives travel reimbursement from Arthrex, Stryker, and Zimmer Biomet. A.H.K-R. receives travel reimbursement from Arthrex, Stryker, and Zimmer Biomet. T.R.M. has received grants from Arthrex; education support from Smith & Nephew, Crossroads Orthopedics, and Prime Surgical; and hospitality payments from Medacta USA. B.G.D. reports that financial support was provided by American Orthopedic Foundation. In addition, B.G.D. reports a consulting or advisory relationship with Arthrex, Medacta, Stryker, and SI-Bone; receives funding grants from Arthrex, Stryker, Smith & Nephew, and Ossur; receives nonfinancial support from Arthrex, DJO Global, Medacta, Stryker, Medwest Associates, Saint Alexius Medical Center, Zimmer Biomet, DePuy Synthes, Medtronic, SI-Bone, Trice Medical, Xiros, Intellijoint Surgical, and Electronic Waveform Lab; receives speaking and lecture fees from Arthrex; receives royalties from Arthrex, DJO Global, Medacta, and Orthomerica; receives travel reimbursement from Arthrex and Stryker; has patent No. 8920497 with royalties paid from Arthrex; has patent No. 2612625 with royalties paid from Orthomerica and DJO Global; has patent No. RE47811 with royalties paid from Arthrex; has patent No. 0338177 with royalties paid from Orthomerica; is a board member of American Hip Institute Research Foundation, AANA Learning Center Committee, Journal of Hip Preservation Surgery, Arthroscopy, American Orthopaedic Society for Sports Medicine Research Committee, and International Society for Hip Arthroscopy Executive Board; is Director of Hip Preservation at St. Alexius Medical Center; and has had ownership interests in the American Hip Institute and affiliates, North Shore Surgical Suites, and Munster Specialty Surgery Center. All other authors (A.R.S., I.P.) declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024 Arthroscopy Association of North America. Published by Elsevier Inc. All rights reserved.)

Background: The essential component of managing femoroacetabular impingement involves restoration of the original labral function. Circumferential labral reconstruction (CLR) has shown positive results. However, biomechanical studies of CLR are limited and have not established the efficacy of the modern knotless all-suture anchor (ASA) pull-through technique., Hypotheses: (1) CLR with knotless ASA fixation will restore native labral suction seal biomechanics; (2) tensioning the ASA to a high-tension state will increase the peak distractive force., Study Design: Controlled laboratory study., Methods: Eight fresh-frozen human cadaveric hips were dissected free of all soft tissue except the native labrum and transverse acetabular ligament. On an electromechanical testing system, the hips were compressively loaded to 250 N to initiate a suction seal and distracted at a rate of 10 mm/s until rupture of the suction seal. Hips were tested in 4 states: intact labrum, full labral removal, knotless CLR with moderate anchor tension, and CLR with high anchor tension. Peak distractive force (in newtons) was compared using repeated measures analysis of variance ( P < .05). Acetabular bevel angles (θ) were measured at labral clockface positions outside the transverse acetabular ligament using a 3-dimensional digitizer stylus after rim preparation. Linear regression plots compared θ and peak distractive force in the CLR state., Results: Peak force values were 138.5 ± 13.6 N (mean ± SE) for the intact labrum, 18.4 ± 2.79 N for labral excision, 95.4 ± 23.3 N for moderate-tension CLR, and 126.2 ± 27.3 N for high-tension CLR. Significant differences were observed only when full labral removal was compared with the other conditions: intact ( P < .001), moderate-tension CLR ( P = .016), and high-tension CLR ( P = .002). Steeper acetabular bevel angles (smaller θ) were correlated with greater suction seal restoration ( P < .05)., Conclusion: CLR restored distractive stability on average to 82.0% of the intact value after labral deficiency. Retensioning did not significantly increase peak distractive forces., Clinical Relevance: These findings provide biomechanical validation supporting CLR using knotless ASAs in an effort to minimize volumetric bone loss and provide other surgical advantages. The prepared rim's bevel angle may be an important variable to optimize for improved suction seal restoration., Competing Interests: One or more of the authors has declared the following potential conflict of interest or source of funding: This work was funded by Arthrex, Inc (grant AIRR-20106). A.C.L. has received consulting fees from Arthrex and Graymont Medical; research support from Arthrex and Stryker; and other financial or material support from Iroko, Medwest Associates, Smith & Nephew, Stryker, Vericel, and Zimmer Biomet. B.L.S. A.N.K., and C.A.W. are employees of Arthrex. B.G.D. is a board or committee member for the AANA Learning Center and American Hip Institution Research Foundation and has received consulting fees from Arthrex; royalties from Arthrex, DJO Global, Medacta, and Orthomerica; and research support from Arthrex, Medacta, Ossur, and Stryker. 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.

Purpose: To compare lateral center-edge angle (LCEA) and Tönnis angle (TA) values measured in radiographs and computed tomography (CT) scans with commercially available software and to determine the degree of concurrence in the classification of acetabular dysplasia as depicted in radiographs and CT scans., Methods: Retrospectively collected data from patients undergoing preoperative CT protocol and x-rays for hip arthroscopy from June 2019 to December 2021. The preoperative anteroposterior supine view of the pelvis was utilized to measure LCEA and TA, and measurements were compared to CT scan views through commercially available software., Results: In total, 323 patients (371 hips) were included, with 216 women (67%) and a mean patient age of 35.3 ± 14.5 years. There was a statistically significant difference (P < .001) in LCEA and TA measurements between x-ray and CT scan, with CT yielding higher mean ± SD values (LCEA: 32.9 ± 7.3, TA: 8.2 ± 5.9) compared to x-ray (LCEA: 30.3 ± 6.3, TA: 4.8 ± 4.6). The absolute mean difference between CT and x-ray was 4.1 for LCEA and 4.4 for TA. When defining dysplasia as LCEA <25°, 77 (21.8%) hips were dysplastic by x-rays (odds ratio, 2.0) and 43 (11.6%) by CT (P < .001). Using a threshold of >10° for TA, 71 (19.1%) hips were dysplastic by x-rays (odds ratio, 0.5) and 118 (32%) by CT (P < .001). A strong correlation was obtained between radiographs and CT on measured LCEA (r = 0.78) and TA (r =0.67)., Conclusions: Measuring with x-ray underestimates both LCEA and TA values compared to CT. Hip dysplasia diagnosis was twice as likely with LCEA and half as likely with TA when measured through x-rays. CT scans with commercially available software offer an alternative viewpoint for assessing acetabular dysplasia and can serve as a valuable complement when used in addition to x-ray measurements., Level of Evidence: Level IV, retrospective case series., Competing Interests: Disclosures The authors declare the following financial interests/personal relationships which may be considered as potential competing interests: A.K-R. reports receiving travel reimbursement from Arthrex, Stryker, and Zimmer Biomet. A.P. reports a relationship with Smith & Nephew that includes nonfinancial support. F.L. reports a relationship with Stryker that includes employment and equity or stocks and has a patent (#US20190231434A1) issued to Stryker. B.G.D. has received nonfinancial support from Arthrex, DJO Global, Medacta, Stryker, Medwest Associates, Saint Alexius Medical Center, Zimmer Biomet, DePuy Synthes, Medtronic, SI-Bone, Trice Medical, Xiros, Intellijoint Surgical, and Electronic Waveform Lab; has received financial support from the American Orthopedic Foundation; is a consultant or advisor for Arthrex, Medacta, Stryker, and SI-Bone; has received funding grants from Arthrex, Stryker, Ossur, and Smith & Nephew; has received royalties from Arthrex, DJO Global, Medacta, and Orthomerica; has received speaking and lecture fees from Arthrex; has received travel reimbursement from Arthrex and Stryker; has patents with royalties paid from Arthrex (#8920497), Orthomerica and DJO Global (#2612625), Arthrex (#RE47811), and Orthomerica (#0338177); is a board member of American Hip Institute Research Foundation, AANA Learning Center Committee, the Journal of Hip Preservation Surgery, the Journal of Arthroscopy, AOSSM Research Committee, and ISHA Executive Board; is the Director of Hip Preservation at St. Alexius Medical Center; and has had ownership interests in the American Hip Institute and affiliates, North Shore Surgical Suites, and Munster Specialty Surgery Center. All other authors (J.N-F., E.G.W.) declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024 Arthroscopy Association of North America. Published by Elsevier Inc. All rights reserved.)

Background: The purpose of this study was to report the short-term clinical outcomes of hip resurfacing with navigation and the impact on accuracy of acetabular implant placement in both the frontal and sagittal planes., Materials and Methods: Data were retrospectively analyzed for patients who received hip resurfacing between 2010 and 2021. Eligible patients had postoperative radiographs and completed a minimum 2-year follow-up questionnaire for the following patient-reported outcomes: modified Harris Hip Score (mHHS), Harris Hip Score (HHS), Forgotten Joint Score (FJS), visual analog scale (VAS) score, satisfaction, and Hip Disability and Osteoarthritis Outcome Score, Joint Replacement (HOOS-JR). Hips were propensity matched in a 1:1 ratio based on the use of navigation, age, and body mass index. The percentage of hips that met the minimal clinically important difference (MCID) for mHHS and VAS score was noted. Component placement analysis was conducted based on the safe zones defined by Lewinnek and Callanan and the Relative Acetabular Inclination Limit., Results: Seventy-six hips were matched, 38 per group. No differences were observed in patient-reported outcomes or the percentage of hips reaching MCID between the groups. The navigation group was 28.8 and 6.8 times more likely to be within the Callanan and Lewinnek safe zones, respectively. Based on the Relative Acetabular Inclination Limit, the navigation group was 3.1 and 6.4 times more likely to be within the 95% and 99% CI safe zones, respectively., Conclusion: Comparable improvements in patient-reported outcomes were observed in the two groups during a minimum 2-year follow-up. Navigation-assisted surgery enhances the accuracy of acetabular component positioning, with a higher likelihood of cup placement within the safe zones. [ Orthopedics . 202x;4x(x):xx-xx.].

Background: Prior lumbar spine surgery (LSS) can limit spine mobility, potentially increasing hip motion requirements. This study aimed to assess the influence of LSS on primary total hip arthroplasty (THA)., Methods: Retrospective analysis was conducted on patients who underwent THA with prior LSS. Included patients had completed patient-reported outcomes (PROs) and visual analog scale for pain questionnaires or had a documented revision surgery with a minimum 2-year follow-up. Patients were propensity matched to a benchmark control group of patients who did not have previous spine pathology in a 1:3 ratio, controlling for age at surgery, surgical approach, use of advanced technology, sex, and body mass index. The analysis included comparisons of hip arthroplasty thresholds and complications. Subanalyses based on the type of lumbar surgery and type of approach were also conducted., Results: There were 244 hips included in the study. The LSS group reported comparatively lower postoperative PRO scores. However, the LSS group experienced a similar magnitude of improvement. The LSS group met patient acceptable symptom state threshold for Forgotten Joint Score at a significantly lower rate. The LSS had a higher frequency of complications leading to revision THA with a relative risk of 24 and a relative risk of 20.8 for revision THA due to instability. Comparing patients by type of LSS, PROs, the percentage of patients reaching hip arthroplasty thresholds, and the revision THA rates were similar. There was no difference in complications considering the type of approach., Conclusions: Patients who had prior LSS who underwent primary THA demonstrated equivalent improvements in PROs, but achieved lower overall postoperative scores and met hip arthroplasty thresholds at lower rates. Furthermore, patients undergoing primary THA with prior LSS had a higher risk of complications leading to revision surgery, including a 24-fold relative risk for complications leading to revision and a 20.8-fold relative risk of revision due to instability., (Copyright © 2024 Elsevier Inc. All rights reserved.)

Retracted full-thickness tears of the gluteus medius tendon are a well-recognized cause of disabling weakness and pain that significantly impact patients' quality of life. We present an efficient knotless parachute technique for dermal allograft augmentation in open gluteal abductor tendon repairs. Our technique reinforces the suture-tendon interface by incorporating a robust biological scaffold into a knotless double-row fixation. This approach capitalizes on the increased pressure and contact area achieved between the greater trochanter and the dermal allograft/gluteus medius tendon construct without the prominence of knotted sutures., Competing Interests: The authors report the following potential conflicts of interest or sources of funding: A.H.K-R. reports a relationship with Arthrex Inc that includes travel reimbursement. B.D.K. serves on the editorial board for the Journal of Arthroscopy. A.P. reports a relationship with Smith & Nephew that includes educational support. B.G.D. reports that financial support was provided by American Orthopedic Foundation; a relationship with Arthrex that includes consulting or advisory, funding grants, nonfinancial support, and speaking and lecture fees; a relationship with Stryker Corporation that includes funding grants and speaking and lecture fees; a relationship with Medacta USA INC that includes nonfinancial support and speaking and lecture fees; a relationship with Orthomerica that includes nonfinancial support; a relationship with Medwest Associates Inc that includes speaking and lecture fees; a relationship with Ossur that includes nonfinancial support; a relationship with Stryker Endoscopy that includes funding grants and nonfinancial support; a relationship with American Hip Institute Research Foundation that includes board membership; a relationship with AANA Learning Center Committee that includes board membership; a relationship with the Journal of Arthroscopy that includes board membership; a relationship with American Hip Institute that includes equity or stocks. B.G.D. has patents for method and instrumentation for acetabular labrum reconstruction with royalties paid to Arthrex, knotless suture anchors and methods of tissue repair with royalties paid to Orthomerica, knotless suture anchors and methods of tissue repair with royalties paid to DJO Global, adjustable multicomponent hip orthosis with royalties paid to Arthrex, and a patent with royalties paid to Medacta Inc. B.G.D. is a board member of the AANA Learning Center Committee and the Journal of Arthroscopy. All other authors (T.R.M., R.Q-J.) report no conflicts of interest in the authorship and publication of this article. Full ICMJE author disclosure forms are available for this article online, as supplementary material., (© 2024 The Authors.)