This paper highlights the fact that full length labral tears are a cause of instability in posterior fracture-dislocations of the hip. From July 1994 to March 2001, 133 consecutive posterior fracture-dislocations of the hip were surgically treated. On admission, all patients were initially subjected to closed reduction, and in some cases skeletal or skin traction was applied. Pelvic radiographs were taken to confirm relocation, and CT done to look for intra-articular bone fragments. Intra-operative findings and surgical technique were recorded. Redislocation occurred in eight patients, whose surgical notes were reviewed to determine the cause. Despite 9 kg of skeletal traction, one patients’s hip redislocated the day after closed reduction. In the other seven, redislocation occurred postoperatively. The time to redislocation varied from one day to 16 weeks, and because redislocation was sometimes painless, not all patients reported it immediately. Two patients, whose radiographs showed very small fragments at the superior-posterior position, would normally have been treated conservatively. On one, surgery was performed because the fragment was lodged at the weight-bearing area of the joint. The hip of the other redislocated on skeletal traction the day after closed reduction. At surgery, it was noted that both patients had extensive soft tissue stripping and full length tears of the labrum. The other six patients had clear posterior wall fractures requiring surgical reconstruction. The fragments were often attached to the capsule but were too small to fix with screws, so buttress plating was used alone. Full-length labral tears in posterior dislocations of the hip cause instability, and failure to address this adequately at surgery may result in redislocation

We treated 133 traumatic posterior dislocations surgically between July 1994 and March 2001. In 16 patients, labral tears had occurred. Operating on posterior hip dislocations, initially we fixated the posterior wall with screws and/or buttress plate, depending on the size of the fragment, and did suture the torn labrum, relying rather on the buttress plate or intact posterior wall for stability. We began repairing the torn labrum when we realised that any small fragments still attached to the labrum simply pull out from under the buttress plate, allowing the hip to redislocate. Once the wall has been reconstructed, interrupted sutures are passed through the labrum, with the hip internally rotated to prevent shortening of the capsule when sutures are tied. A one-third tubular plate is placed over the sutures lying on the posterior wall and fixed with screws. The sutures are then tied individually over the plate. Postoperatively the patient is kept in bed for six weeks, with the hip abducted and knee extended. Seven patients in whom the labrum was not repaired experienced redislocation. We performed second operations on two of them, repositioning the plates and reconstructing the posterior wall, but redislocation again occurred. The redislocated femoral heads were damaged because they rubbed against the plate and screws. In the other nine patients, we sutured the labrum, and in a 3 month to 2.5 year follow-up, no redislocation has occurred. . Labral repair restores stability, and tying interrupted sutures over a buttress plate is an easy and effective method of repair

The gold standard treatment of hip dysplasia is a peri-acetabular osteotomy (PAO). Labral tears are seen in the majority of patients presenting with hip dysplasia and diagnosed using Magnetic Resonance Imaging (MRI). The goal was to (1) evaluate utility/value of MRI in patients undergoing hip arthroscopy at time of PAO, and (2) determine whether MRI findings of labral pathology can predict outcome. A prospective randomized controlled trial was conducted at tertiary institutions, comparing patients with hip dysplasia treated with isolated PAO versus PAO with adjunct hip arthroscopy. This study was a subgroup analysis on 74 patients allocated to PAO and adjunct hip arthroscopy (age 26±8 years; 89.2% females). All patients underwent radiographic and MRI assessment using a 1.5-Tesla with or 3-Tesla MRI without arthrography to detect labral or cartilage pathology. Clinical outcome was assessed using international Hip Outcome Tool-33 (iHOT). 74% of patients (55/74) were pre-operatively diagnosed with a labral tear on MRI. Among these, 41 underwent labral treatment (74%); whilst among those without a labral tear on MRI, 42% underwent labral treatment (8/19). MRI had a high sensitivity (84%), but a low specificity (56%) for labral pathology (p=0.053). There was no difference in pre-operative (31.3±16.0 vs. 37.3±14.9; p=0.123) and post-operative iHOT (77.7±22.2 vs. 75.2±23.5; p=0.676) between patients with and without labral pathology on MRI. Value of MRI in the diagnostic work-up of a patient with hip dysplasia is limited. MRI had a high sensitivity (84%), but low specificity (44%) to identify labral pathology in patients with hip dysplasia. Consequently, standard clinical MRI had little value as a predictor of outcome with no differences in PROM scores between patients with and without a labral tear on MRI. Treatment of labral pathology in patients with hip dysplasia remains controversial. The results of this subgroup analysis of a prospective, multi-centre RCT do not show improved outcome among patients with dysplasia treated with labral repair

Objectives. The aim of this study was to investigate the structural integrity of torn and non-torn human acetabular labral tissue. Methods. A total of 47 human labral specimens were obtained from a biobank. These included 22 torn specimens and 25 control specimens from patients undergoing total hip arthroplasty with macroscopically normal labra. The specimens underwent dynamic shear analysis using a rheometer to measure storage modulus, as an indicator of structural integrity. Results. There was a significant difference in the storage modulus between torn (mean modulus = 2144.08 Pa) and non-torn (3178.1 Pa) labra (p = 0.0001). Conclusion. The acetabular labrum of young patients with a tear has significantly reduced structural integrity compared with a non-torn labrum in older patients with end-stage osteoarthritis. This study contributes to the understanding of the biomechanics of labral tears, and the observation of reduced structural integrity in torn labra may explain why some repairs fail. Our data demonstrate that labral tears probably have a relatively narrow phenotype, presenting a basis for further investigations that will provide quantifiable data to support their classification and a means to develop a standardized surgical technique for their repair. This study also demonstrates the value of novel biomechanical testing methods in investigating pathological tissues of orthopaedic interest. Cite this article: A. K. Woods, J. Broomfield, P. Monk, F. Vollrath, S. Glyn-Jones. Dynamic shear analysis: a novel method to determine mechanical integrity of normal and torn human acetabular labra: Implications for prediction of outcome of repair. Bone Joint Res 2018;7:440–446. DOI: 10.1302/2046-3758.77.BJR-2017-0282.R2

Arthroscopic hip surgery is increasingly common in Australia. Hip arthroscopy is indicated for a range of diagnostic and therapeutic purposes, including labral tears, capsular laxity and femoral-acetabular impingement (FAI). Despite this, previous cohort studies aiming to characterise hip pathology seen on arthroscopic examination are mostly limited to patients with known diagnoses of FAI. Therefore, little is known of the native articular wear patterns encountered in other disease states. Therefore, we aimed to define common osteochondral wear patterns for a cohort of patients managed via hip arthroscopy. We retrospectively analysed intraoperative data for 1127 patients managed via hip arthroscopy between 2008 and 2013, for either therapeutic or diagnostic purposes. Intraoperative data was categorized by location (A-E as defined by Fontana et al. 2016) and chondral damage (0-4 scale as defined by Beck et al. 2005) with respect to both acetabulum and femoral head. Data for 1127 patients were included. Location of acetabular chondral pathology was variable with locations C. 1. and D. 1. representing the most common regions of damage. Labral tears predominated in locations C and D. Femoral chondral pathology was evenly distributed. The degree of femoral chondral injury was predominantly grade 1, whilst acetabular wear was evenly distributed. Large proportions of wear were observed at the peripheral superior and anterior regions of the lunate surface of the acetabulum in keeping with prior works. However, we observed higher rates of central wear and lower rates of grade 4 acetabular damage extending into superior/posterior zones, in our cohort. Our work characterises common articular wear patterns encountered at the time of hip arthroscopy. Further inquiry into the natural history of osteochondral lesions is needed to better understand and manage these conditions

Labral tears are increasingly recognized as a source of hip pain. These rarely occur in normal hips, but in individuals with subtle femoral deformities. Anterior impingement of the femoral neck on the acetabulum due to loss of anterior offset results in a labral tear in active individuals. Future surgeries should be directed at this anterior offset deficiency in order to completely alleviate pain and prevent further recurrences. To determine the incidence of anterior hip impingement and femoral pathology in patients undergoing hip arthroscopy for labral tear. Anterior labral tears occur in the presence of abnormal femoral anatomy, which results in anterior hip impingement. Future treatment of labral tears should include addressing the hip impingement. Labral tears of the hip are increasingly being recognized as a source of hip pain in young, active individuals. Athroscopic labral debridement is commonly associated with poor results. As a result, it is likely that other hip pathology is present at the time of labral tear. The purpose of this study was to determine the incidence of anterior hip impingement secondary to a pistol grip deformity in patients undergoing hip arthroscopy for labral tears. The charts and radiographs of forty consecutive patients who underwent hip arthroscopy were evaluated. X-rays were evaluated for presence of acetabular or femoral pathology. Femoral pathology was then graded based on degree of slip and posterior slip angle. All patients who underwent hip arthroscopy for labral tears had abnormal femoral or acetabular anatomy. In those patients without acetabular dysplasia, a pistol grip deformity of the femoral head was present in all cases. Evidence of anterior hip impingement with osteophyte formation was present in ninety-two percent. In these patients, hip arthroscopy results in complete resolution of mechanical symptoms, but hip pain was still present. Labral tears of the hip appear to be secondary to anterior femoral impingement. This is analogous to a rotator cuff tear in the presence of shoulder impingement. Anterior impingement of the femoral neck on the acatabulum due to an anterior femoral offset deformity results in both pain and labral tears. Future surgeries should be directed at this anterior offset deficiency in order to prevent recurrent injuries or residual pain

Background: Acetabular labral tears are increasingly recognised as a cause of hip pain in young adults and middle aged patients. Degenerative acetabular conditions and sporting activities can cause labral injury. Recent interest has focussed on anterior femoroacetabular impingement as a cause of labral injury, progressive articular cartilage damage and secondary osteoarthritis. Labral tears are difficult to diagnose clinically or with conventional radiographic techniques. Aim: The purpose of this study was to assess the accuracy of MR arthrography in locating labral tears and articular cartilage defects compared with hip arthroscopy. Materials and Methods: 200 consecutive patients with a diagnosis of acetabular labral tear underwent hip arthroscopy. All of them had a preoperative Magnetic Resonance Arthrogram done by a single musculoskeletal radiologist using a standard protocol. The labrum was assessed for abnormalities of morphology and signal intensity. Acetabular articular cartilage defects were expressed as a reduction in joint space. All hip arthroscopies were done by a single surgeon after a trial period of conservative therapy consisting of activity modification, physiotherapy and non-steroidal anti-inflammatory medications. All procedures were recorded digitally and documented in an operative report. Labral tears and acetabular cartilage abnormalities were described by location and appearance. Results: Comparison of MRA and hip arthroscopy findings demonstrate MRA to have a sensitivity of 100%, positive predictive value of 99%, negative predictive value of 100% and accuracy of 99% in predicting labral tears. MRA correctly identified the location of labral tears in 90% of cases. Acetabular cartilage abnormalities were under recognised by MRA (43 hips on MRA vs 54 hips on arthroscopy). MRA was not sensitive enough to pick up early delamination of cartilage adjacent to labral tear in 6 hips. Conclusion: Hip MRA with radial reformatting has high accuracy rates in diagnosing and localising hip labral lesions

This study aimed to analyse the incidence, the operative findings and outcomes of hip arthroscopy after periacetabular osteotomy (PAO). We conducted a retrospective study of prospective collected data to report the operative findings and outcomes of hip arthroscopy for recurrent pain following PAO for acetabular dysplasia. Demographic data, radiographic and arthroscopic findings were analysed. Pre- and post-operative patient reported outcome measures (PROMs) were collected. Of 184 PAO patients, 15 hips in 15 patients (8.2%) underwent post-PAO hip arthroscopy with 2 males and 13 females at a mean time of 3.9 ±2.9(0.3–10) years. Hip arthroscopy findings included labral tears (15 hips, 100%), chondral damage (11 hips, 73%) with one Beck 1, two Beck 2, four Beck 4, and four Beck 5 damage. There were 8 (53%) isolated labral debridement, 7 (47%) labral repair, and 2 (13%) adhesiolysis. A femoral osteochondroplasty was performed in 4 (27%) hips. Four hips (27%) were finally converted to total hip replacement at a mean delay of 2.3 ±1.4 (0.7–3.2) years post hip arthroscopy and these 4 patients were significantly older than those who were not (p=0.02). There were no significant differences in PROMs pre and post hip scope. 8.2% of patients undergoing a PAO required a hip scope for persistent hip pain. Common post-PAO hip arthroscopy findings included labral tears, chondral changes and femoroacetabular impingement. 27% of patients finally underwent conversion to total hip replacement at a mean follow-up of 4.5 years post hip scope

Purpose: A prospective investigation to define the syndrome associated with symptomatic labral tears definitively diagnosed at hip arthroscopy. Methods: 66 consecutive patients that had an arthroscopically documented labral tear were evaluated. Demographics, symptomatology, examination, previous treatments, functional limitations, were assessed prospectively. Onset/duration of symptoms to diagnosis of tears, other diagnoses offered by healthcare providers, and non-labral procedures that patients had undergone for the symptoms were analyzed. Radiographic abnormalities and MR arthrography findings were recorded. Results: There were 47 female and 19 male patients with a mean age of 38 years. Initial presentation: insidious in 61%, acute injury in 30%, and trauma in 9% hips. Moderate to severe pain occurred in 86% of patients, with groin pain predominating (92%). Fifty three percent had true mechanical symptoms - catching/locking. Walking, pivoting, impact activity aggravated patient symptoms (p< 0.05). Pain was characterized as a combination of dull aching pain with intermittent episodes of sharp pain in 70%(p=0.001). Pain was frequently activity related (p< 0.05) and night pain occurred in 71% of patients (p=0.0006). The majority of patients (98%) with a labral tear reported being active/athletic. On examination 39% patients had a limp, 38% a positive Trendelenburg sign, and 95% a positive impingement sign. The mean time to diagnosis of labral tear from the onset of symptoms was 21 months. A mean of 3.3 healthcare providers were seen prior to a definitive diagnosis. Surgery on another anatomic site was recommended in 11 patients and 4 of these underwent an unsuccessful surgery prior to diagnosis of the labral tear. Radiographic data indicated that 38% of hips had an underlying structural abnormality consistent with mild development dysplasia or anterior femoroacetabular impingement. Preoperative MRA detected 73% of the labral tears. Conclusions: The clinical presentation of a labral tear may vary, with duration of symptoms often greater than 12 months prior to diagnosis. In young, active patients with a predominant complaint of groin pain with or without a history of trauma, the diagnosis of a labral tear should be suspected, and investigated, as radiographs and history may be nonspecific for this diagnosis

Introduction: Hip pain in young adults can be associated with radiographic finding of acetabular labral tears in magnetic resonance arthrography. Acetabular labral tears can occur in dysplastic hips and in arthrotic hips as well, but often no comobidity is found. Up to now there is no prospective study published following patients with magnetic resonance arthrography verified acetabular labral tears over time and re-evaluating them with MR years later. There is also no stage related therapy published according to labral damage. The aim of this study was to follow 100 MRI verified acetabular labral tears for four years. Material and methods: Study design was prospective, observers were blinded. At primary investigation 36 clinical and 30 radiological parameters were recorded. At follow up these factors were recorded again and additionally SF36 and Harris Hip score were recorded. Results: 100 patients with average age 42 were included. 91% of all patients could be followed for over 48 months. 55 operations were performed in 50 patients . 20 patients showed concomitant developmental dysplasia of the hip, 16 patients arthrosis, 40 patients both and 15 patients had a labral lesion alone. The last group of patients never required any operation. 28 patients had a labral lesion grade I, 29 grade II, 34 grade III. Patients with grade III lesions had a significantly lower HHS at the first examination. At follow up between all groups of patients no difference regarding any clinical parameter was found. Operations were only necessary if comorbidity (dysplasia or arthrosis) was found. No single radiologic or clinical parameter could predict operation. Nine of thirteen labral surgeries were revised (triple osteotomies or THR). No correlation between severity of labral lesion at first MRI and any parameter at follow up could be found. Conclusion: If no comorbidity was found an acetabular labral tear alone never needed operative treatment. Although there exist a series of different operative treatment opportunities in meniscal/glenoid labrum surgery , we could not find the need for surgical intervention if the acetabular labral tear occurs alone. We therefore recommend physiotherapy and non – operative treatment for these patients

Purpose: Acetabular labral tears are most commonly associated with minor or atraumatic events. As a result, it is likely that these tears occur in the presence of an abnormal hip joint. The purpose of this investigation was to establish whether anterior hip impingement, secondary to an anterior femoral offset deficiency from a pistol grip deformity, was a common and poorly recognized cause of acetabular labral tears. Methods: Sixty-five consecutive patients who underwent a hip arthroscopy and were found to have a labral tear were evaluated. Preoperative hip radiographs were evaluated for abnormalities of the femur and /or acetabulum. The patient’s outcome with respect to resolution to pain and mechanical symptoms was assessed. Results: All labral tears identified at the time of hip arthroscopy were found to be located anteriorly. A pistol grip deformity of the proximal femur was identified on the preoperative radiographs in 92% of the patients. Labral excision resulted in complete resolution of hip pain in only 8 (28%). With the remaining 72% experiencing mild or moderate pain. Conclusions: Acetabular labral tears are the result of repetitive femoral-acetabular impingement, from a pistol grip deformity, with eventual tearing of the labrum from a relatively minor trauma. This is analogous to a rotator cuff repair in the shoulder that is secondary to repetitive impingement by the acromium. Decompression or correction of the anterior hip impingement should routinely be considered at the time of labral surgery to provide complete relief of symptoms and diminish the risk of future joint degeneration

Background. Magnetic resonance arthrography is the current method of choice for investigating patients with a clinical diagnosis of femoroacetabular impingement prior to performing hip arthroscopy. The aim of our study was to assess the efficacy of this investigation by comparing the findings of MR arthrogram with those found at arthroscopy, with reference to labral tears and chondral damage. Methods. A prospective trial to investigate the sensitivity, specificity, accuracy and predictive value of MRA for diagnosis of labral tears and chondral defects. Over a 25-month period 69 hips undergoing hip arthroscopy were investigated with MRA prior to the definitive operative procedure. MRA findings were compared to the intraoperative findings. Results. In the assessment of labral tears, MRA demonstrated a sensitivity of 81% with a specificity of 51% and an accuracy of 58%. Positive predictive value of MRA was 33% and negative predictive value 90%. For chondral defects MRA demonstrated a sensitivity of 17%, a specificity of 100% and accuracy of 55%. Positive predictive value of MRA was 100% and negative predictive value was 51%. Conclusions. In what the authors believe to be the first UK study to explore both chondral injury and labral tears in a prospective manner and looking specifically at accuracy, it can be seen that the MRA has poor accuracy for both pathologies. Therefore we suggest a moved away from MRA, which is an invasive procedure with associated risks

Background: Cam-type femoroacetabular impingement (FAI) is becoming more recognized. Cartilage lesions of the acetabulum and labral tears are frequently encountered. The goal of this study was to accurately describe and communicate these injuries and thus providing a standard for reporting injury, management, and outcome. Methods: We evaluated acetabular cartilage lesions and labral tears found during hip arthroscopy in 52 patients with radiological signs of cam-type FAI. They were graded according to the morphology and extent of the lesion. The labral tears were described according to the classification by Lage. Results: Eleven patients (21.2%) had normal cartilage, 14 (26.9%) had a grade 1, 17 (32.7%) a grade 2, 6 (11.5%) a grade 3, and 4 (7.7%) a grade 4 lesion. Labral tears were found in 31 patients (59.6%). There was a high correlation between age and the presence and extent of acetabular cartilage and labral lesions (r=0.70; p< 0.0001 and r=0.45; p< 0.001 respectively). There was also a high correlation between the extent of the acetabular cartilage lesion and the presence of labral lesions (r=0.62; p< 0.0001). Conclusion: In our study there was a high prevalence of associated injuries (86.5%) in cam-type FAI. Despite the recognized consequences of associated lesions on treatment and outcome, no classification system includes this aspect of FAI. Based on our findings, we developed a system to grade acetabular cartilage lesions according to their morphology and extent. This should provide the surgeon with a standardized tool to better describe the full extent of the injury and treat it accordingly

Aims. Research on hip biomechanics has analyzed femoroacetabular contact pressures and forces in distinct hip conditions, with different procedures, and used diverse loading and testing conditions. The aim of this scoping review was to identify and summarize the available evidence in the literature for hip contact pressures and force in cadaver and in vivo studies, and how joint loading, labral status, and femoral and acetabular morphology can affect these biomechanical parameters. Methods. We used the PRISMA extension for scoping reviews for this literature search in three databases. After screening, 16 studies were included for the final analysis. Results. The studies assessed different hip conditions like labrum status, the biomechanical effect of the cam, femoral version, acetabular coverage, and the effect of rim trimming. The testing and loading conditions were also quite diverse, and this disparity limits direct comparisons between the different researches. With normal anatomy the mean contact pressures ranged from 1.54 to 4.4 MPa, and the average peak contact pressures ranged from 2 to 9.3 MPa. Labral tear or resection showed an increase in contact pressures that diminished after repair or reconstruction of the labrum. Complete cam resection also decreased the contact pressure, and acetabular rim resection of 6 mm increased the contact pressure at the acetabular base. Conclusion. To date there is no standardized methodology to access hip contact biomechanics in hip arthroscopy, or with the preservation of the periarticular soft-tissues. A tendency towards improved biomechanics (lower contact pressures) was seen with labral repair and reconstruction techniques as well as with cam correction. Cite this article: Bone Joint Res 2023;12(12):712–721

Our understanding of pre-arthritic hip disease has evolved tremendously but challenges remain in categorizing diagnosis, which ultimately impacts choice of treatments and clinical outcomes. This study aims to report patient reported outcome measures (PROMs) comparing four different condition groups within hip preservation surgery by a group of fellowship-trained surgeons. From 2018 to 2021, 380 patients underwent hip preservation surgery at our center and were classified into five condition groups: dysplasia: 82 (21.6%), femoro-acetabular impingement (FAI): 173 (45.4%), isolated labral tear: 103 (27.1%), failed hip preservation: 20 (5.3%) and history of childhood disease/other: 2 (0.5%). International hip outcomes Tool 12 (IHOT-12), numeric pain score and patient-reported outcomes measurement information system (PROMIS) were collected pre-operatively and at 3 months and 1 year post-operatively, with 94% and 82% follow-up rate respectively. Arthroscopy (75.5%) was the most common procedure followed by peri-acetabular osteotomy (PAO) (22.4%) and surgical dislocation (2.1%). Re-operation rate were respectively 18.3% (15), 5.8% (10), 4.9% (5), 30% (6) and 0%. There were 36 re-operations in the cohort, 14 (39%) for unintended consequences of initial surgery, 10 (28%) for mal-correction leading to a repeat operation, 8 (22%) progression of arthritis, and 4 (11%) for incorrect initial diagnosis/intervention. Most common re-operations were hardware removal 31% (7 PAO, 3 surgical hip dislocation and 1 femoral de-rotational osteotomy), arthroscopy 31% (11) and arthroplasty 28% (10). All groups had significant improvements in their IHOT-12 as well as PROMIS physical and numerical pain scales, except those with failed hip preservation. Dysplasia group showed a slower recovery. Overall, this study demonstrated a clear relation between the condition groups, their respective intervention and the significant improvements in PROMs with isolated labral pathology being a valid diagnosis. Establishing tertiary referral centers for hip preservation and longer follow-up is needed to monitor the overall survivorship of these various procedures

Over half of postpartum women experience pelvic ring or hip pain, with multiple anatomic locations involved. The sacroiliac joints, pubic symphysis, lumbar spine and pelvic girdle are all well documented pain generators. However, despite the prevalence of postpartum hip pain, there is a paucity of literature regarding underlying soft tissue intra-articular etiologies. The purpose of this systematic review is to document and assess the available evidence regarding underlying intra-articular soft tissue etiologies of peri- and postpartum hip pain. Three online databases (Embase, PubMed and Ovid [MEDLINE]) were searched from database inception until April 11, 2021. The inclusion criteria were English language studies, human studies, and those regarding symptomatic labral pathology in the peri- or postpartum period. Exclusion criteria were animal studies, commentaries, book chapters, review articles and technical studies. All titles, relevant abstracts and full-text articles were screened by two reviewers independently. Descriptive characteristics including the study design, sample size, sex ratio, mean age, clinical and radiographic findings, pathology, subsequent management and outcomes were documented. The methodological quality of the included studies was assessed using the Methodological Index for Non-Randomized Studies (MINORS) instrument. The initial search identified 2472 studies. A systemic screening and assessment of eligibility identified 5 articles that satisfied the inclusion criteria. Twenty-two females were included. Twenty patients presented with labral pathology that necessitated hip arthroscopy with labral debridement or repair with or without acetabuloplasty and/or femoroplasty. One patient presented with an incidental labral tear in the context of osteitis condensans illi. One patient presented with post-traumatic osteoarthritis necessitating a hip replacement. The mean MINORS score of these 5 non-comparative studies was 2.8 (range 0-7) demonstrating a very low quality of evidence. The contribution of intra-articular soft tissue injury is a documented, albeit sparse, etiology contributing to peri- and postpartum hip pain. Further research to better delineate the prevalence, mechanism of injury, natural history and management options for women suffering from these pathologies at an already challenging time is necessary to advance the care of these patients

Introduction: The popularity of hip arthroscopy has lagged behind that of other joints. However surgeons are increasingly using hip arthroscopy to investigate and treat disorders such as early osteoarthritis, inflammatory arthritis, labral tears, loose bodies and paediatric hip disease. We present the indications, intra operative findings and outcomes of patients undergoing hip arthroscopy. Methods: Prospective study of 43 patients from 2000 to 2005 undergone hip arthroscopy performed by the senior author. Pre & post operative visual analogue scores and oxford hip scores were recorded. CT or MRI was performed were clinically indicated. Mean follow up 4 months, range(2– 10). Results: 45 hips. 20 right. 21 left. 2 bilateral. 22 females. 21 males. Mean age 39.6yrs, Range 20–65yrs. Symptoms: Pain, Clicking, Giving way. History: Idiopathic pain 30, DDH 5, Perthes 3, Trauma acetabulum fracture 2, RT A Dislocation 1, SUFE 1, Non union 1. 6 patients had pre-op CT scans and 22 had MRI. MRI Findings: 3 loose bodies, 14 labral tears, 2 large filling defects, 3 normal MRI. 42 Arthroscopic debridement and wash outs, 3 failed scopes. Intra operative findings: 5 loose bodies, 4 degenerate labrum’s, 10 labral tears, 14 Grade 3–4 Osteoarthritic changes, 7 Torn ligament Teres,1 normal joint. 3 normal MRI findings had labral tears and articular cartilage defects. Mean Pre-op VAS- 7.9 Range(5– 10). Mean Post-op VAS- 4.7 Range(1– 10). Mean Pre-op Oxford Hip score – 39.4 Range(27–53). Mean Post-op Oxford Hip Score – 25.2 Range(12–51). Patient Satisfaction score – 7.3 Range(1–10). 1 Superficial wound infection, settled with antibiotics. Discussion: Hip arthroscopy is of value in assessing and treating patients with hip pain of uncertain cause. Our results indicated good patient satisfaction and outcomes with improved pain and Oxford hip scores. However patient selection and diagnostic expertise are critical to successful outcomes

Introduction. Femoroacetabular impingement(FAI) is a relatively common cause causes of hip pain and dysfunction in active young adults. The concept of FAI was popularized by Ganz et al in early 2000s. Surgical treatment for FAI has been widely employed over the last two decades. The long term outcome of femoroacetabular osteoplasty (FAO) and risk factors for long-term failure of FAO is less studied. The goal of this single surgeon series is to identify the long term outcome of FAO (minimum 10-year follow-up) and risk factors for surgical treatment failure in these patients. Methods. The prospective database on hip joint preservation identified 1,120 patients who have undergone FAO between January 2005-June 2019. Of these 164 patients (178 hips) have a minimum 10-year follow-up (range, 10–14). The database collects detailed information on patient demographics, clinical history, radiographic and cross sectional imaging findings, intraoperative findings (site and size of chondral lesion, labral tear, subchondral cyst, size of cam lesion, etc), and patient outcome using the modified HHS, SF-36, and UCLA activity score. Patients are contacted on an annual basis and the functional outcome instruments administered. Of 1,120 patients, 122 patients have been lost to follow-up. Results. The mean age of patients in the cohort is 34.3±10.4 years and 39.6% of patients are female. FAO resulted in an improvement in mean mHHS (58.2±3.9 to 86.4±3.2) and SF-36(60.4±4 to 85±4.1) in 89% of patients. At the latest follow up 8.1% of patients have undergone THA. The study found that older age, longer preoperative symptomatic period, higher preoperative alpha angle, presence of hip dysplasia and acetabular retroversion, inability to repair acetabular labrum, and full thickness acetabular chondral lesion were associated with higher risk of failure of treatment. Conclusion. Patients with symptomatic FAI who undergo surgery experience pain relief and functional improvement that appears to endure over a decade in the majority. This study on a large cohort with long term follow-up has also identified patients who are at higher risk of failure. The study has also shed light on some interesting findings such as labral tear being very common in patients without hip symptoms and others that will be presented. For any tables or figures, please contact the authors directly

Since its creation, labral repair has become the preferred method among surgeons for the arthroscopic treatment of acetabular labral tears resulting in pain and dysfunction for patients. Labral reconstruction is performed mainly in revision hip arthroscopy but can be used in the primary setting when the labrum cannot be repaired or is calcified. The purpose of this study was to compare the survival between primary labral repair and labral reconstruction with survival defined as no further surgery (revision or total hip replacement). Patients who underwent labral repair or reconstruction between January 2005 and December 2018 in the primary setting were included in the study. Patients were included if they had primary hip arthroscopy with the senior author for femoroacetabular impingement (FAI), involving either labral reconstruction or labral repair, and were within the ages of 18 and 65 at the time of surgery. Exclusion criteria included confounding injuries (Leggs Calves Perthes, avascular necrosis, femoral head fracture, etc.), history of unilateral or bilateral hip surgeries, or Tönnis grades of 2 or 3 at the time of surgery. Labral repairs were performed when adequate tissue was available for repair and labral reconstruction was performed when tissue was absent, ossified or torn beyond repair. A total of 501 labral repairs and 114 labral reconstructions performed in the primary setting were included in the study. Labral reconstruction patients were older (37±10) compared to labral repair (34±11).(p=0.021). Second surgeries were required in 19/114 (17%) of labral reconstruction and 40/501(8%) [odds ratio: 2.3; 95% CI 1.3 to 4.2] (p=0.008). Revision hip arthroscopy were required in 6/114(5%) labral reconstructions and 33/501(6.5%) labral repair (p=0.496). Total hip replacement was required in 13/114 labral reconstructions and 7/501 labral repairs [odds ratio:9.1 95%CI 3.5 to 23] (p=< 0.01). The mean survival for the labral repair group was 10.2 years (95%CI:10 to 10.5) and 11.9 years (98%CI:10.9 to 12.8) in the labral reconstruction group. Conversion to total hip was required more often following primary labral reconstruction. Revision hip arthroscopy rates were similar between groups as was the mean survival, with both over 10 years. Similar survival was seen in labral repair and reconstruction when strict patient selection criteria are followed

The December 2013 Hip & Pelvis Roundup. 360 . looks at: Enhanced recovery works; Acetabular placement; Exercise better than rest in osteoarthritis patients; if Birmingham hip resurfacing is immune from pseudotumour; HIV and arthroplasty; Labral tears revisited; Prophylactic surgery for FAI; and Ceramics and impaction grafting