Aims. Young adults undergoing total hip arthroplasty (THA) largely have different indications for surgery, preoperative function, and postoperative goals compared to a standard patient group. The aim of our study was to describe young adult THA preoperative function and quality of life, and to assess postoperative satisfaction and compare this with functional outcome measures. Methods. A retrospective cohort analysis of young adults (aged < 50 years) undergoing THA between May 2018 and May 2023 in a single tertiary centre was undertaken. Median follow-up was 31 months (12 to 61). Oxford Hip Score (OHS) and focus group-designed questionnaires were distributed. Searches identified 244 cases in 225 patients. Those aged aged under 30 years represented 22.7% of the cohort. Developmental dysplasia of the hip (50; 45.5%) and Perthes’ disease (15; 13.6%) were the commonest indications for THA. Results. Preoperatively, of 110 patients, 19 (17.2%) were unable to work before THA, 57 (52%) required opioid analgesia, 51 (46.4%) were reliant upon walking aids, and 70 (63.6%) had sexual activity limited by their pathology. One patient required revision due to instability. Mean OHS was 39 (9 to 48). There was a significant difference between the OHS of cases where THA met expectation, compared with the OHS when it did not (satisfied: 86 (78.2%), OHS: 41.2 (36.1%) vs non-satisfied: 24 (21%), OHS: 31.6; p ≤ 0.001). Only one of the 83 patients (75.5%) who returned to premorbid levels of activity did so after 12 months. Conclusion. Satisfaction rates of THA in young adults is high, albeit lower than commonly quoted figures. Young adults awaiting THA have poor function with high requirements for mobility aids, analgesia, and difficulties in working and undertaking leisure activities. The OHS provided a useful insight into patient function and was predictive of satisfaction rates, although it did not address the specific demands of young adults undertaking THA. Function at one year postoperatively is a good indication of overall outcomes. Cite this article: Bone Jt Open 2024;5(4):304–311

Shoulder arthritis in the young adult is a deceptive title. The literature is filled with articles that separate outcomes based on an arbitrary age threshold and attempt to provide recommendations for management and even potential criteria for implanting one strategy over another using age as the primary determinant. However, under the age of 50, as few as one out of five patients will have arthritis that can be accurately classified as osteoarthritis. Other conditions such as post-traumatic arthritis, post-surgical arthritis including capsulorrhaphy arthropathy, and rheumatoid arthritis create a mosaic of pathologic bone and soft tissue changes in our younger patients that distort the conclusions regarding “shoulder arthritis” in the young adult. In addition, we are now seeing more patients with unique conditions that are still poorly understood, including arthritis of the pharmacologically performance-enhanced shoulder. Early arthritis in the young adult is often recognised at the time of arthroscopic surgery performed for other preoperative indications. Palliative treatment is the first option, which equals “debridement.” If the procedure fails to resolve the symptoms, and the symptoms can be localised to an intra-articular source, then additional treatment options may include a variety of cartilage restoration procedures that have been developed primarily for the knee and then subsequently used in the shoulder, including microfracture, and osteochondral grafting. The results of these treatments have been rarely reported with only case series and expert opinion to support their use. When arthritis is moderate or severe in young adults, non-arthroplasty interventions have included arthroscopic capsular release, debridement, acromioplasty, distal clavicle resection, microfracture, osteophyte debridement, axillary nerve neurolysis, and bicep tenotomy or tenodesis, or some combination of these techniques. Again, the literature is very limited, with most case series less than 5 years of follow-up. The results are typically acceptable for pain relief, some functional improvement, but not restoration to completely normal function from the patient's perspective. Attempts to resurface the arthritic joint have resulted in limited benefits over a short period of time in most studies. While a few remarkable procedures have provided reasonable outcomes, they are typically in the hands of the developer of the procedure and subsequently, other surgeons fail to achieve the same results. This has been the case with fascia lata grafting of the glenoid, dermal allografts, meniscal allografts, and even biologic resurfacing with large osteochondral grafts for osteoarthritis. Most surgical interventions that show high value in terms of improvement in quality of life require 10-year follow-up. It is unlikely that any of these arthroscopic procedures or resurfacing procedures will provide outcomes that would be valuable in terms of population healthcare; they are currently used on an individual basis to try to delay progression to arthroplasty, with surgeon bias based on personal experience, training, or expert opinion. Arthroplasty in the young adult remains controversial. Without question, study after study supports total shoulder arthroplasty over hemiarthroplasty once the decision has been made that joint replacement is the only remaining option

The diagnosis and treatment of hip disease in young adults has rapidly evolved over the past ten years. Despite the advancements of improved diagnostic skills and refinement of surgical techniques, the psychosocial impact hip disease has on the young adult has not yet been elucidated. This observational study aimed to characterise the functional and psychosocial characteristics of a group of patients from our young hip clinic. 49 patients responded to a postal questionnaire which included the Oswestry Disability Index (ODI) and Hospital Anxiety and Depression Scale (HADS). Median age was 20 years (range 16-38) with a gender ratio of 2:1 (female: male). The most common diagnoses were Perthes' disease and developmental hip dysplasia. More than half of our patients had moderate to severe pain based on the Visual Analogue Scale (VAS) and at least a moderate disability based on the ODI. Thirty-two percent of patients were classified as having borderline to abnormal levels of depression and 49% of patients were classified as having borderline to abnormal levels of anxiety based on the HADS. Comparison of the ODI with the VAS and HADS anxiety and depression subscales showed a significant positive correlation (p<0.05). Multiple regression showed the ODI to be a significant predictor of the HADS anxiety and depression scores (regression coefficient 0.13, 95% confidence interval 0.06 to 0.21, p<0.05). This study highlights the previously unrecognised psychosocial effects of hip disease in the young adult. A questionnaire which includes HADS may be of particular value in screening for depression and anxiety in young people with physical illness. This study also highlights that collaboration with psychologists and other health care providers may be required to achieve a multidisciplinary approach in managing these patients

Acetabular dysplasia may present as previously undiagnosed or as a sequel to treated DDH in a young adult, with a natural history of subsequent development of early osteoarthritis. Patients with acetabular dysplasia and a normal neck shaft angle, no significant leg length inequality and who demonstrate congruency at arthrogram are considered suitable for realignment pelvic osteotomy. We report the results of 15 young adults who underwent a modified Tonnis triple osteotomy with a mean 21-month follow up. The modification was the ischial osteotomy being performed through a groin incision. The only common complication was the requirement of catheterisation post-operatively (60%). There were no infections. There was 1 delayed union but no non-unions. One patient developed a deep vein thrombosis. All patients reported an improvement in their symptoms and level of activity, with a mean post-operative Harris hip score of 92. All showed an improved centre-edge angle of 28° (mean increase of 18°) and acetabular angle 37° (mean decrease of 13°). The early results of this procedure show this to be a safe and useful option to delay the natural history of early osteoarthritis in the young adult

The modified Hedgehog technique was previously used to reattach pure chondral shear-off fragments in the pediatric knee. In the modified Hedgehog technique, the calcified side of chondral fragments is multiple times incised and trimmed obliquely for an interlocking fit in the defect site. Fibrin glue with or without sutures is subsequently applied to fix the fragment to the defect. This preliminary report further elucidates the potential of the technique by evaluation of its application in young adults using patient reported outcome measures (PROMs) and high-field Magnetic Resonance Imaging (MRI) as outcome measures. Three patients with a femoral cartilage defect (2 medial, 1 lateral), and a concomitant pure chondral corpus liberum were operatively treated by the modified Hedgehog technique. Age at surgery ranged from 20.6–21.2 years, defect size ranged from 3.8–6.0 cm2. Patients were evaluated at three months and one year after surgery by PROMs and 7.0T MRI. PROMs included the Internation Knee Documentation (IKDC), Knee Injury and Osteoarthritis Outcome Score (KOOS) and Visual Analog Scale (VAS) questionnaires. 7.0T MRI (Magnetom, Siemens Healthcare, Erlangen, Germany) using a 28-channel proton knee coil (QED, Electrodynamics LLC, Cleveland, OH) included a proton density weighted turbo spin-echo sequence with fat suppression to assess morphological tissue structure andgagCEST imaging to measure the biochemical tissue composition in terms of glycosaminoglycans (GAG). Twelve months after surgery all patients reported no pain and showed full range of motion. While PROMs at three months showed large variability between patients, one year after surgery the scores were consistently improved. Over time, morphological MRI visualized improvements in integration of the cartilage fragment with the surrounding cartilage, which was supported by biochemical MRI showing increased GAG values at the defect edges. Statistics were not applied to the results because of the small sample size. The modified Hedgehog technique in young adults with an acute onset caused by a pure chondral corpus liberum can be considered promising. The improved PROM results over time were supported by 7.0T MRI that visualized improvements in tissue structure and biochemical composition. Inclusion of more patients in future studies would allow statistical analysis and more conclusive results. The etiology of loosening and time between onset of symptoms and surgery for successful graft integration may differ between pediatric and young adult patients and is subject for future studies

Osteomyelitis is usually related to trauma, surgery, immunocompromised patients, IV drug abuse, poor vascular supply, diabetes, sickle cell disease or peripheral neuropathy. We report an unusual case of femur osteomyelitis without any of these risk factors. A 31 years old male, light smoker, presented at the Emergency Room for pain in the left thigh for about a month, without any previous event. He had 2 previous visits to the hospital with similar diffuse complaints interpreted as irradiated low back pain. He was pale, feverish but no signs of local inflamation. His left knee ROM was 30°-15°-0°. He had no neurologic deficits. Blood tests showed high WBC count and PCR (400mg/L). After contrasted CT showing an 1,2×6×2,5cm abcess the patient was taken to the OR for irrigation and debridment. The day after the patient did a MRI that showed extended femur osteomyelitis and adjacent myositis (images). He underwent new surgery for a more extensive irrigation and debridment, femur medular canal included, from where a large pus quantity erupted. The hemocultures and bone biopsys, revealed a Multissensible Strep. Alfa-hemolitic (S. anginosus) and appropriate antibiotherapy was implemented (Amoxicillin/Clavulanate). He slowed improve till 11th day when he showed rise of PCR and a new MRI showed the same inflammatory process. He underwent new surgery but no pus was visible. He gradually improved, started hyperbaric oxygen therapy and was discharged on the 28th day after the first surgery, continuing antibiotherapy at home for a total of 8 weeks. Transthoracic Ecography was normal, as well Brucella, HIV, and other serologies. Three weeks later, the patient again presented to the ER with fever and rise of inflammatory markers in blood, consistent with recurrence of the infection. The patient was taken to the OR for surgical debdridment and irrigation, but this time the cultures showed a multissensible Gemella haemolysans, possible contamination during the hyperbaric oxygen therapy sessions. This is the case of a healthy young adult with an idiopathic femur osteomyelitis, initially misinterpreted for irradiated low back pain, that recurred after the first medical and surgical successful treatment, with an unusual agent

Young Adult Hip [YAH] pathology is now better recognised and treated than decades ago. However, our patients have suggested to us that they encountered delays in recognition and referral. For the past four years incoming referrals of YAH have been questioned away from the ROH clinic environment in groups of 100 incoming referrals by TS Gambling, Senior Lecturer in Psychology. Time from onset of symptoms to clinic attendance; number of GP visits; Consultants seen before accurate diagnosis; validity of earlier investigations; severity and effects of symptoms on their daily lives and careers; social effects; body image; self-confidence; oxford hip scores. The median age was 28 years; the mean delay in being seen at a YAH clinic was 8.3–8.6 years. The mean number of consultants seen before the YAH clinic was 2.3 – 2.6. Fewer than 5% were properly investigated by these consultants. The mean oxford hip score was 30; in only 8% was it less than 20, the common level for hospital referral. 22% were unable to work. In 8% their career was unaffected. Although 70% were working or pursuing a career, almost all required adaptations /redeployment to sedentary work/Long-term sickness testing employers' tolerance/Intermittent sickness/putting off promotion/ further education/part time working/change of career. Only 8% were unaffected at work. In addition, there were profound social effects upon self-esteem, body image, relationships, as well as comfort during sex. These results do not make comforting news. In addition to the above difficulties, all our patients expressed; Powerlessness; Frustration; Anger; Not being listened to; being unsupported; Undermined; Humiliation. The family doctor/ GP services are poor at appreciating the disability in YAH patients. YAH onset is characteristically at 19.5 years, just when youngsters are becoming independent and self-reliant. The OHS is an invalid/misleading discriminator in these patients when considering referral. The hospital orthopaedic service is poor at recognising and investigating YAH disease

Introduction. Intracapsular fractures of the femoral neck in young adults are a surgical emergency. Recent literature reviews have questioned whether the timing of surgery reduces the incidence of avascular necrosis, non-union and revision. A study was performed to determine how many patients met a 12-hour target for operative fixation with this injury. Possible sources of delay to theatre were reviewed. Methods. A Fractures Outcomes Research Database was used to identify patients aged 18–64 who were admitted to the Royal Victoria Hospital in Belfast between 1. st. Jan 2008 and 31. st. Dec 2009. Intracapsular fractures of the femoral neck which were treated with a 2-hole dynamic hip screw were included. Time of injury, time of presentation in A&E, time of admission to fracture ward, operation time, demographic data, and the mechanism of injury were extracted from the database. Results. 81 patients were identified who met the inclusion criteria. Median age was 56 years (range 26–64y). 64 injuries were low energy. 16 patients were alcoholics, 34 smoked cigarettes. 31 of 81 operations were performed within 12 hours of the injury. Of the delayed 50 patients, 25 sustained their injury between 1700–2359. 51 of 81 operations were performed on daytime lists (0900–1659), 23 in the evening (1700–2359) and 7 overnight (0000–0859). Median time from injury to presentation at A&E was 1 hour 39 minutes. Time from A&E presentation to ward admission was 4 hours. Time from ward admission to surgery was 8 hours 13 minutes. Conclusions. The time from ward admission to arrival in theatre accounted for the greatest delay, and is modifiable. Injuries which occur in the evening are often operated on the next day. The majority of the patients had low energy injuries, and a minority smoke cigarettes and abuse alcohol. The long-term implications of this delay will require further work

Aims

Developmental dysplasia of the hip (DDH) describes a pathological relationship between the femoral head and acetabulum. Periacetabular osteotomy (PAO) may be used to treat this condition. The aim of this study was to evaluate the results of PAO in adolescents and adults with persistent DDH.

Autologous Chondrocyte Implantation (ACI) is a technique for repair of isolated symptomatic articular cartilage defects in the young adult knee. The knee is arthroscopically assessed and a sample of cartilage is harvested from the margin of the joint, this is digested and the liberated chondrocytes expanded in culture. At subsequent arthrotomy, the articular cartilage lesion is debrided and the cells injected behind a sutured flap. A concern regarding ACI is the iatrogenic insult to non-injured healthy cartilage adjacent to that harvested for culture. Damaged cartilage around the lesion is routinely debrided and discarded at the second stage operation. The purpose of this study was to determine whether this damaged debrided cartilage could yield an adequate number of equivalent chondrocytes for ACL. Cells from 11 patients were analysed. The debrided “waste” from around the lesion was collected, enzymatically digested and the liberated chondrocytes cultured in monolayer. The cells were recovered and placed in a 3D-pellet culture in a defined medium. Chondrocytes obtained from the routine harvest of healthy cartilage were placed in a similar culture system. The two groups were compared using DNA and GAG assays, histological and immunohistochemical techniques. Chondrocytes obtained from the debrided cartilage lesion were equivalent to those obtained from the harvested healthy cartilage. Sufficient cell numbers for implantation were achieved for all patients, however cells cultured from the debrided defect in patients who had a large degenerate lesion required significantly longer in culture to attain the required number of cells. For many patients undergoing ACI, the potential iatrogenic insult to the joint cartilage of the harvesting procedure could be avoided by harvesting the damaged tissue from around the defect itself

Improvement in survival for teenagers and young adults (TYAs) has lagged behind those of children and adults, (Stiller et al 2006). In seeking explanations investigators have focused on two main factors. Firstly, the low accrual of TYAs into clinical trials (Newburger et al, 2002), and secondly the lack of appropriate multidisciplinary care (Stevens, 2005). Data from the UK Office of National Statistics confirms this with 70% of paediatric patients being entered into a clinical trial compared to only 20% of 15–24 year olds. In 2007 the Teenage Cancer Trust (TCT) asked over 200 14–25 year olds with cancer if they had been offered a clinical trial (TCT survey results, 2008). Of the total cohort only 30% reported that they had been given the opportunity to enter a clinical trial. The National Cancer Research Institute (NCRI) established a Teenage and Young Adult Clinical Studies Development Group in 2005 to address the issues surrounding the accrual of TYAs into clinical trials. At a specialist Teenage Cancer Trust Unit in the UK a TYA Clinical Research Nurse was appointed in May 2008; in order to improve TYA accrual into clinical trials. An audit is currently been undertaken to examine present data of clinical trial entry and retrospective data from 2006 and 2007. The focus of the audit is on patients aged 16–24 years with a bone or soft tissue sarcoma being treated in one TCT unit in the UK. The audit will examine whether the appointment of a TYA research nurse has influenced the accrual of TYA patients into clinical trials. The paper will focus on the particular difficulties and challenges with recruiting TYA patients and the developing role of the TYA Research Nurse in influencing practice. It is essential that improvements are made with regard to trial entry for this unique age group and the TYA Research Nurse may play a vital role in this in the future

Introduction. Femoroacetabular impingement (FAI) is a morphological hip joint deformity associated with pain and early degenerative changes. Cam-type FAI is prevalent in young male athletes. While biomechanical deficiencies (decreased hip muscle strength and range of motion (ROM)) have been associated with symptomatic cam-type FAI (sFAI), results have been conflicting and little is known about biomechanical characteristics during dynamic tasks. Objectives. (1) Compare coronal-plane hip muscle strength, activation and joint rotation during movement tasks in sFAI hips against healthy controls. (2) Investigate the effect of hip internal rotation ROM (IR-ROM) on these outcomes. Methods. 11 sFAI and 24 well-matched healthy control hips from 18 young adult male athletes were recruited (Table.1). Passive hip IR-ROM was measured with goniometry. Weight-normalised hip abductor and adductor isometric maximal voluntary contraction torques were quantified with handheld dynamometry. Gluteus medius and adductor longus activation and hip coronal-plane kinematics were collected with surface electromyography (EMG) and motion-capture during time-defined phases of sit-to-stand (Fig.1) and single-leg-squat (Fig.2) tasks. Effect of sFAI with hip IR-ROM as a separate independent variable was calculated with 1-way MANCOVA. Results. sFAI had significantly less IR-ROM (19.25°±5.94) than controls (28.83°±7.24) (p<0.001). During the sit-to-stand ascent phase, significantly more hip abduction (F=4.93, p=0.03) was observed in sFAI (13.06°±3.16) compared to controls (10.16°±3.72). With IR-ROM differences controlled for, significantly higher gluteus medius:adductor longus EMG activation ratio (F=4.32, p=0.046) was observed in the same phase in sFAI (0.16±0.34) compared to controls (−0.11±0.31). No other significant results were found. Conclusion. sFAI hips demonstrate altered muscle activation and movement patterns when ascending from seated positions compared to controls, with reduced hip IR-ROM in sFAI hips influencing findings. Abductor and adductor function imbalance may explain why sFAI increases risk of early degenerative changes. Despite study limitations (no imaging for sFAI diagnosis), these findings should be considered when optimising rehabilitation in this population. For any figures and tables, please contact the authors directly

Purpose: Compared to paediatric cancer patients adolescents and young adults may have disadvantaged access to care. Therefore we investigated the correlation of patient, tumour and institutional characteristics with the outcome of osteosarcoma in this age group. Method: Analysis of consecutive patients aged 15–24 years with newly diagnosed high-grade osteosarcoma entered into the Cooperative Osteosarcoma Study Group(COSS) registry 1980–2004 and treated in pediatric (PO) or medical oncology institutions (MO). Standardised multimodal therapy according to a COSS-protocol. Event-free survival rates (EFS) evaluated in relation to patient demographics and registering institution (MO vs PO and treatment volume as: < 1, 1–3 or > 3 osteosarcoma/year). Results: 944 patients identified (median age: 17.35 years; range: 15.01–24.99; 79% aged < 20 years). Patients > 20 years were more likely than younger patients to be treated in centers with low treatment volume (p< .0001) and MO (p< .0001) but otherwise comparable. After a median follow-up of 5.59 years (range: 0.12 – 27.92) for all patients and 8.08 years (range: 0.19 – 27.92) for 617 survivors, actuarial 5/10 year event-free survival probability (EFS) was 58%/54%. Upon univariate analysis of the total cohort neither of the institutional variables correlated significantly with EFS. There was a correlation between treatment in PO and improved EFS for patients > 20 years (p=.001) and for those with primary metastases (p=.009). Upon multivariate testing type of center (odds ratio: 1.26; p=.022) but not treatment volume were significant. Conclusion: Within a framework of standardised regimens and consultation supportby our group’s infrastructure, similar EFS-probabilites were obtained regardless of institutional treatment volumes. Observed variations in outcome between PO and MO may be partly due to different distributions of presenting factors but deserve further investigation

Abstract

90% of young patients that develop DJD of the hip have an underlying structural problem, most frequently hip dysplasia. The structural problem results in decreased contact area, increased contact stresses about the anterior and lateral acetabulum and femoral head and results in labral pathology, early cartilage damage and if left untreated leads to end stage hip arthritis.

Despite the optimism of alternative bearing surfaces and highly cross linked polyethylene, THA should still be discouraged in young patients. Many patients with symptomatic hip dysplasia in the absence of arthritis will benefit from joint preservation. The goal of treatment should be restoration of anatomy as close to normal as possible. The Bernese PAO is the preferred technique in many centres in North America and Europe because of its balance between minimal exposure, complications, and ability to provide optimal correction. The ideal patient for a PAO is young, has no arthritis, is not obese (BMI <30) and has poorly covered femoral head where congruency is possible. A PAO has advantages over other osteotomies and include: 1)

Performed through one incision without violation of the abductors

The results of the osteotomy have been encouraging with up to 60% survivorship free from total hip arthroplasty at 20 years. Most studies show improvement in pain and function, improvement in radiographic coverage of the femoral head with no improvement in range of motion. Treatment should be individualised to each patient based on radiographic findings, age and cartilage status and restoration of anatomy as close to normal as possible should be the ideal treatment, most commonly in the form of a periacetabular osteotomy.

Patient selection has always been considered an important criterion in determining the success or failure of a TKA. In the early days of TKA, orthopaedic surgeons and patients were both uncertain as to the long-term outcomes and most TKAs were performed in patients >65 years of age. Since that time, a number of peer-reviewed studies have provided Level III evidence indicating that TKA was a reliable procedure with 91% to 99% survivorship during the first decade and 85% to 97% during the second decade of follow-up. These encouraging TKA results have prompted a growth in TKA utilisation, particularly in younger patients and a move away from procedures such as osteotomy and UKA which have been associated with higher re-operation rates. As a result, over the past decade, the fastest growing TKA patient cohorts have been in the 45–54 (337% increase for females, 271% for males) and 55–64 (260% increase for females and 213% for males) year old patient groups!

The Swedish Knee Arthroplasty Register has followed Swedish TKA patients since 1975 and has provided useful insights with regards the use of knee arthroplasties in younger patients (i.e. an encouraging TKA revision risk reduction from 1976 to 2009, a higher revision rate for UKAs and higher revision rates for both TKAs and UKAs in younger patients). The Australian National Joint Replacement Registry has also found that age adversely affects knee arthroplasty revision rates, noting higher cumulative, ten-year revision rates for both UKA and TKA patients <55 years of age (UKA 25%, TKA 13%) and 55–64 years of age (UKA 17%, TKA 8%) and a 6X greater revision rate for TKA patients <55 compared to those >75 years of age! In addition, although mobile-bearing TKAs have often been promoted for use in younger patients, higher cumulative revision rates were noted for mobile-bearing TKAs (7%) as compared to fixed-bearing TKAs (5%) at 10 years.

In summary, although TKA outcomes have improved with time, the lack of long-term supporting data should prompt surgeons to be cautious in offering TKA to patients with 20 to 40 more years of life expectancy. New TKA bearing couple technologies (ie. cross-linked polyethylenes and improved femoral counterfaces) should be encouraged, but their introduction should not be based on laboratory tests alone, but also supported by safety and efficacy studies in patients and long-term post-market surveillance data.

Cancer is a major health problem for teenagers and young adults (TYA’s). However, many young people are often late to receive a cancer diagnosis. Young people may not recognize symptoms as serious and delay seeking help. Furthermore, there is evidence to suggest that once a young person does seek help from a general practitioner (GP), significant delay can still occur. During the annual Find Your Sense of Tumour (FYSOT) conference 2007; a group of 200 TYA’s with cancer participated in a survey regarding their diagnostic experience; the cohort included 22 patients with bone tumours. Following the onset of symptoms; nearly half of the TYA’s with a bone tumour (46%) reported 4 or more visits to their G.P before being referred to a specialist. However, 91% of bone tumour patients had multiple, ‘classic’ cancer symptoms and the majority (77%) sought help from the G.P within 4 weeks of noticing symptoms. The ‘Christie Crew’ (CC) are a group of TYA’s who have been treated for cancer and work on various projects to improve cancer services. The Christie Crew wanted to empower young people with the knowledge that TYA’s do get cancer and to raise awareness of the signs and symptoms of cancer and have produced a DVD and education pack that has been launched across 80 schools and throughout the North West. The DVD is highlights individual’s stories of diagnosis. There is also a poster campaign highlighting signs and symptoms of cancer being displayed in large public venues across the Manchester area. The aim is to roll out the project nationally as part of the health awareness (Healthy Schools) initiative. By highlighting that young people get cancer it is hoped that more young people will recognise the signs and symptoms and be empowered to go to their GP if they have persistent problems

Abstract

Femoroacetabular impingement (FAI) is a condition of the hip where there is a mismatch of the femoral head and hip acetabulum. This mismatch creates abnormal contact between the bones and causes hip pain which can lead to damage, and eventually osteoarthritis of the hip. The diagnosis and treatment of FAI has become one of the most popular clinical scenarios in orthopaedic surgery, with hip arthroscopy procedures increasing exponentially over the past five years. Surgical intervention usually involves correcting the existing deformities by reshaping the ball and socket (“osteoplasty” or “rim trimming”) so that they fit together more easily while repairing any other existing soft tissue damage in the hip joint (e.g. labral repair). Although correction of the misshaped bony anatomy and associated intra-articular soft tissue damage of the hip is thought to appease impingement and improve pain and function, the current evidence is based on small, observational, and low quality studies. A lack of definitive evidence regarding the efficacy of osteochondroplasty in treating FAI fueled the design and execution of the FIRST randomized controlled trial (RCT). FIRST evaluated the impact of surgical correction of the hip impingement morphology with arthroscopic osteochondroplasty versus arthroscopic lavage on pain, function, and quality of life in adults aged 18–50 years diagnosed with non-arthritic FAI at one year.

FIRST was a large definitive RCT (NCT01623843) enrolling patients with FAI requiring surgical intervention across 11 international clinical sites. Participants were randomized to either arthroscopic osteochondroplasty (shaving of bone) or lavage (washing the joint of painful inflammation debris). The primary outcome was patient-reported pain within one year of the initial surgery measured using the Visual Analogue Scale (VAS). Secondary outcomes included function, health utility, and health-related quality of life using several general and hip-centric health questionnaires. An independent, blinded adjudication committee evaluated the quality of surgery, re-operations, and other patient complications. Patients and data analysts were blinded to the treatment groups.

Two-hundred and twenty participants were enrolled into the FIRST trial over a six-year period (pilot phase: N=50, from 2012–2013 and definitive phase: N=170, from 2015–2018) at 11 clinical sites in Canada, Finland, and Denmark. The FIRST results will be released at the ISAKOS annual meeting as follows. The absolute difference in rate of pain reduction between groups was XX (95% CI: YY-YY, p=X). The mean differences of the Short-Form 12 (SF-12, MCS and PCS), Hip Outcome Score (HOS), International Hip Outcome Tool (iHOT-12), and EuroQol 5-Dimensions (EQ-5D) between groups are XX (95% CI: YY-YY, p=X)…, respectively. Reoperations occurred in XX of 220 (X%) patients over the one-year follow up period (OR:XX, 95% CI: YY-YY, p=X) and the patients treated with arthroscopic osteochondroplasty conferred the following risk of reoperation within one-year compared to arthroscopic lavage (RR:XX, 95% CI: YY-YY, p=X).

This RCT represents major international efforts to definitively identify the optimal treatment strategy for FAI. The results of this trial will change practice, being used to prevent chronic hip pain and loss of function caused by hip osteoarthritis.