Pelvic re-orientation osteotomy is a well-recognised treatment of young adults with developmental dysplasia of the hip (DDH).

The most commonly used technique is the periacetabular osteotomy (PAO), however, some surgeons favour a triple osteotomy. These techniques can also be utilised for acetabular retroversion leading to FAI.

Despite the published literature on these techniques, the authors note a scarcity of evidence looking at patient reported outcome measures (PROMs) for these procedures.

This was a retrospective analysis of prospectively collected data utilising the UK NAHR. All patients who underwent pelvic osteotomy from January 2012 to November 2019 were identified from the NAHR database. Patients who consented to data collection received EQ-5D index and iHOT-12 questionnaires, with scores being collected pre-operatively and at 6, 12 and 24 months post-operatively.

Nine hundred and eleven (911) patients were identified with twenty-seven (27) undergoing a triple osteotomy, the remaining patients underwent PAO. Mean age was 30.6 (15–56) years and 90% of patients were female. Seventy-nine (79) (8.7%) of patients had the procedure for acetabular retroversion leading to FAI

Statistical analysis, of all patients, showed significant improvement (p<0.001) for; iHOT-12 scores (+28 at 6-months, +33.8 at 12-months and +29.9 at 24-months)

Similarly there was significant improvement (p<0.001) in EQ-5D index (+0.172 at 6-months, +0.187 at 12-months and +0.166 at 24-months)

Pre-operatively, and at each follow-up time-period, raw scores were significantly better in the DDH group compared to the FAI group (p<0.05); however, the improvement in scores was similar for both groups.

For both scoring measures, univariable and multivariable linear regression showed poorer pre-operative scores to be strongly significant predictors of greater post-operative improvement at 6 and 12 months (p<0.0001).

Background

The purpose of this study was to report functional outcome scores following arthroscopic acetabular chondral procedures using the U.K. Non-Arthroplasty Hip Registry (NAHR).

Objectives

The aim of this study was to use registry data to report and compare early patient outcomes following arthroscopic repair or debridement of the acetabular labrum.

Background

This study aimed to investigate the effect of body mass index (BMI) on functional outcome following hip preservation surgery using the U.K. Non-Arthroplasty Hip Registry (NAHR).

Background

Slipped capital femoral epiphysis (SCFE) creates a complex deformity of the hip that can result in cam type of femoroacetabular impingement (FAI), which may in turn lead to the early development of osteoarthritis of the hip. The purpose of this study was to evaluate the existing literature reporting on the efficacy of hip arthroscopic treatment of patients with FAI secondary to SCFE.

Background

Elite performance has tremendous physical demands and places elite athletes at an increased risk of sustaining a variety of orthopaedic injuries (1–4). Pain around the hip is common in high-level athletes representing up to 6% of all athletic injuries (5–7). Expedient diagnosis and effective treatment are paramount for their future sporting careers and to prevent subsequent joint degeneration. The purpose of this systematic review was to evaluate the outcome and the rate of return to play (RTP) following hip arthroscopy in elite athletes.

Introduction

Decreases in trainees' working hours, coupled with evidence of worse outcomes when hip arthroscopies are performed by inexperienced surgeons, mandate the development of additional means of arthroscopic training. Though virtual reality simulation training has been adopted by other surgical specialities, its slow uptake in arthroscopic training is due to a lack of evidence as to its benefits. These benefits can be demonstrated through learning curves associated with simulator training – with practice reflecting measurable increases in validated performance metrics.

Hip arthroscopy is a rapidly expanding technique that has a steep learning curve. Simulation may have a role in helping trainees overcome this. However there is as yet no validated hip arthroscopy simulator. This study aimed to test the construct validity of a virtual reality hip arthroscopy simulator.

Nineteen orthopaedic surgeons performed a simulated arthroscopic examination of a healthy hip joint in the supine position. Surgeons were categorized as either expert (those who had performed 250 hip arthroscopies or more) or novice (those who had performed fewer than this). Twenty-one targets were visualized within joint; nine via the anterior portal, nine via the anterolateral and three via the posterolateral. This was followed by a task testing basic probe examination of the joint in which a series of eight targets were probed via the anterolateral portal. Each surgeon's performance was evaluated by the simulator using a set of pre-defined metrics including task duration, number of soft tissue & bone collisions, and distance travelled by instruments. No repeat attempts at the tasks were permitted. Construct validity was then evaluated by comparing novice and expert group performance metrics over the two tasks using the Mann–Whitney test, with a p value of less than 0.05 considered significant.

On the visualization task, the expert group outperformed the novice group on time taken (P=0.0003), number of collisions with soft tissue (P=0.001), number of collisions with bone (P=0.002) and distance travelled by the arthroscope (P=0.02). On the probe examination, the two groups differed only in the time taken to complete the task (P=0.025).

Increased experience in hip arthroscopy was reflected by significantly better performance on the VR simulator across two tasks, supporting its construct validity.

This study validates a virtual reality hip arthroscopy simulator and supports its potential for developing basic arthroscopic skills.

To quantify the risk posed to the Lateral Femoral Cutaneous Nerve (LFCN) during Total Hip Arthroplasty using the Minimally Invasive Anterior Approach (MIAA), and during placement of the Anterior Portal (AP) in Supine Hip Arthroscopy (SHA).

Forty-five hemipelves from thirty-nine cadavers were dissected. The LFCN was identified proximal to the inguinal ligament (IL), and its path in the thigh identified. The positions of the nerve and its branches in relation to the MIAA incision and the site for AP placement were measured using Vernier Callipers.

44% of nerves crossed the incision line used in the MIAA, at an average distance of 47 ± 28mm from the proximal end of the incision. Of those that did not cross the incision line, the average minimum distance between the nerve and incision was 14.4 ± 7.4mm, occurring on average 74.0 ± 37.3mm from the proximal end of the incision. In addition, the AP was placed in the path of the nerve on 38% of occasions. The nerve took an oblique path, and when found not to intersect with the AP portal, was located 5.7 ± 4.5mm from the portal's edge. We found a reduction in risk if the portal is moved medially or laterally by 15mm from its current location.

The LFCN is at high risk of injury during both THA using the MIAA and SHA using the AP. Our study emphasises the need for meticulous dissection during these procedures, and thorough explanation of these risk whilst consenting patients. We suggest that relocation of the AP 15mm more laterally or medially will reduce the risk posed to the LFCN.