Aims

To clarify the mid-term results of transposition osteotomy of the acetabulum (TOA), a type of spherical periacetabular osteotomy, combined with structural allograft bone grafting for severe hip dysplasia.

The February 2023 Shoulder & Elbow Roundup³⁶⁰ looks at: Arthroscopic capsular release or manipulation under anaesthesia for frozen shoulder?; Distal biceps repair through a single incision?; Distal biceps tendon ruptures: diagnostic strategy through physical examination; Postoperative multimodal opioid-sparing protocol vs standard opioid prescribing after knee or shoulder arthroscopy: a randomized clinical trial; Graft healing is more important than graft technique in massive rotator cuff tear; Subscapularis tenotomy versus peel after anatomic shoulder arthroplasty; Previous rotator cuff repair increases the risk of revision surgery for periprosthetic joint infection after reverse shoulder arthroplasty; Conservative versus operative treatment of acromial and scapular spine fractures following reverse total shoulder arthroplasty.

Aims

This study uses prospective registry data to compare early patient outcomes following arthroscopic repair or debridement of the acetabular labrum.

Aims

Responsiveness and ceiling effects are key properties of an outcome score. No such data have been reported for the original English version of the International Hip Outcome Tool 12 (iHOT-12) at a follow-up of more than four months. The aim of this study was to identify the responsiveness and ceiling effects of the English version iHOT-12 in a series of patients undergoing hip arthroscopy for intra-articular hip pathology at a minimum of one year postoperatively.

Aims

Femoroacetabular impingement (FAI) is a potential cause of hip osteoarthritis (OA). The purpose of this study was to investigate the expression profile of matrix metalloproteinases (MMPs) in the labral tissue with FAI pathology.

Aims

The number of patients undergoing arthroscopic surgery of the hip has increased significantly during the past decade. It has now become an established technique for the treatment of many intra- and extra-articular conditions affecting the hip. However, it has a steep learning curve and is not without the risk of complications. The purpose of this systematic review was to determine the prevalence of complications during and following this procedure.

Objectives

The purpose of this study was to evaluate the existing literature from 2005 to 2016 reporting on the efficacy of surgical management of patients with femoroacetabular impingement (FAI) secondary to slipped capital femoral epiphysis (SCFE).

Aims

Several studies have reported the safety and efficacy of subcapital re-alignment for patients with slipped capital femoral epiphysis (SCFE) using surgical dislocation of the hip and an extended retinacular flap. Instability of the hip and dislocation as a consequence of this surgery has only recently gained attention. We discuss this problem with some illustrative cases.

Slipped capital femoral epiphysis (SCFE) may lead to symptomatic femoroacetabular impingement (FAI). We report our experience of arthroscopic treatment, including osteochondroplasty, for the sequelae of SCFE.

Data were prospectively collected on patients undergoing arthroscopy of the hip for the sequelae of SCFE between March 2007 and February 2013, including demographic data, radiological assessment of the deformity and other factors that may influence outcome, such as the presence of established avascular necrosis. Patients completed the modified Harris hip score (mHHS) and the non-arthritic hip score (NAHS) before and after surgery.

In total, 18 patients with a mean age of 19 years (13 to 42), were included in the study. All patients presented with pain in the hip and mechanical symptoms, and had evidence of FAI (cam or mixed impingement) on plain radiographs.

The patients underwent arthroscopic osteoplasty of the femoral neck. The mean follow-up was 29 months (23 to 56).

The mean mHHS and NAHS scores improved from 56.2 (27.5 to 100.1) and 52.1 (12.5 to 97.5) pre-operatively to 75.1 (33.8 to 96.8, p = 0.01) and 73.6 (18.8 to 100, p = 0.02) at final follow-up, respectively. Linear regression analysis demonstrated a significant association between poorer outcome scores and increased time to surgery following SCFE (p < 0.05 for all parameters except baseline MHHS).

Symptomatic FAI following (SCFE) may be addressed using arthroscopic techniques, and should be treated promptly to minimise progressive functional impairment and chondrolabral degeneration.

Take home message: Arthroscopy of the hip can be used to treat femoroacetabular impingement successfully following SCFE. However, this should be performed promptly after presentation in order to prevent irreversible progression and poorer clinical outcomes.

Cite this article: Bone Joint J 2016;98-B:21–7.

Introduction. Magnetic resonance arthrogram (MRA) is the investigation of choice in young adults with symptoms of femero acetabular impingement. The aim of the study is to assess the accuracy of MRA when correlated with surgical findings on hip arthroscopy. Materials and Method. Between June 2007 and January 2014, 136 patients had MRA followed by subsequent arthroscopy at our institution. The radiology information system was used to gather MRA data. All scans were reported by a consultant radiologist with a specialist interest in musculoskeletal radiology. Patient records were reviewed to gather surgical data. Assessment was made of labral injury, Camshaft (CAM) or Pincer lesion and degeneration of the cartilage. Results. Mean age at MRA was 34.5 years with a 2.5:1 female to male ratio. For labral pathology sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV) were 89, 100, 100 and 22% respectively. For CAM (62, 80, 79 and 64% respectively) and Pincer lesions (15, 84, 81 and 18% respectively). MRA was specific for picking up Grade 3/4 degenerate changes in the articular cartilage (92.2%) but was not as sensitive (60%), PPV 55 and NPV 94. Conclusion. These findings demonstrate that MRA is a sensitive and specific imaging modality for assessing the labrum and articular surface, but not as good for assessing CAM and Pincer lesions. This could be due to the static nature of the MRA or a lack of firm definition as to what constitutes a CAM or Pincer lesion leading to under reporting. This maybe better assessed with plane X ray or Computed tomography with 3 dimensional reconstruction. Further to this it would be interesting to combine the plane X ray and MRA finding and see if sensitivity and specificity was improved

The cam-type deformity in femoroacetabular impingement is a 3D deformity. Single measurements using radiographs, CT or MRI may not provide a true estimate of the magnitude of the deformity. We performed an analysis of the size and location of measurements of the alpha angle (α°) using a CT technique which could be applied to the 3D reconstructions of the hip. Analysis was undertaken in 42 patients (57 hips; 24 men and 18 women; mean age 38 years (16 to 58)) who had symptoms of femoroacetabular impingement related to a cam-type abnormality. An α° of > 50° was considered a significant indicator of cam-type impingement. Measurements of the α° were made at different points around the femoral head/neck junction at intervals of 30°: starting at the nine o’clock (posterior), ten, eleven and twelve o’clock (superior), one, two and ending at three o’clock (anterior) position.

The mean maximum increased α° was 64.6° (50.8° to 86°). The two o’clock position was the most common point to find an increased α° (53 hips; 93%), followed by one o’clock (48 hips; 84%). The largest α° for each hip was found most frequently at the two o’clock position (46%), followed by the one o’clock position (39%). Generally, raised α angles extend over three segments of the clock face.

Single measurements of the α°, whether pre- or post-operative, should be viewed with caution as they may not be representative of the true size of the deformity and not define whether adequate correction has been achieved following surgery.

Cite this article: Bone Joint J 2014;96-B:1167–71.

Hip replacement is a very successful operation and the outcome is usually excellent. There are recognised complications that seem increasingly to give rise to litigation. This paper briefly examines some common scenarios where litigation may be pursued against hip surgeons. With appropriate record keeping, consenting and surgical care, the claim can be successfully defended if not avoided. We hope this short summary will help to highlight some common pitfalls. There is extensive literature available for detailed study.

In Japan, osteoarthritis (OA) of the hip secondary to acetabular dysplasia is very common, and there are few data concerning the pathogeneses and incidence of femoroacetabular impingement (FAI). We have attempted to clarify the radiological prevalence of painful FAI in a cohort of Japanese patients and to investigate the radiological findings. We identified 176 symptomatic patients (202 hips) with Tönnis grade 0 or 1 osteoarthritis, whom we prospectively studied between August 2011 and July 2012. There were 61 men (65 hips) and 115 women (137 hips) with a mean age of 51.8 years (11 to 83). Radiological analyses included the α-angle, centre–edge angle, cross-over sign, pistol grip deformity and femoral head neck ratio. Of the 202 hips, 79 (39.1%) had acetabular dysplasia, while 80 hips (39.6%) had no known aetiology. We found evidence of FAI in 60 hips (29.7%). Radiological FAI findings associated with cam deformity were the most common. There was a significant relationship between the pistol grip deformity and both the α-angle (p < 0.001) and femoral head–neck ratio (p = 0.024). Radiological evidence of symptomatic FAI was not uncommon in these Japanese patients.

Cite this article: Bone Joint J 2013;96-B:172–6.

Background. The acetabular labrum is an essential stabilizer of the hip joint, imparting its greatest effect in extreme joint positions where the femoral head is disposed to subluxation and dislocation. However, its stabilizing value has proved difficult to quantify. The objective of the present study was to assess the contribution of the entire acetabular labrum to mechanical joint stability. We introduce a novel “dislocation potential test” that utilizes a dynamic, cadaveric, robotic model that functions in real-time under load-control parameters to map the joint space for low-displacement determination of stability, and quantify using the “stability index”. Methods. Five fresh-frozen human cadaveric hips without labral tears were mounted to a six-degree-of-freedom robotic manipulator and studied in 2 distinct joint positions provocative for either anterior or posterior dislocation. Dislocation potential tests were run in 15° intervals, or sweep planes, about the face of the acetabulum. For each interval, a 100 N force vector was applied medially and swept laterally until dislocation occurred. Three-dimensional kinematic data from conditions with and without labrum were quantified using the stability index, which is the percentage of all directions a constant force can be applied within a given sweep plane while maintaining a stable joint. Results. Global stability indices, considering all sweep planes, were significantly greater with labrum intact than after total labrectomy for both anterior (Figure 1A) (p = 0.02) and posterior (Figure 1B) (p<0.001) provocative positions. Regional stability indices, based upon the expected range of dislocation for each provocative position, were also significantly greater and of slightly larger magnitude for the intact condition than after total labrectomy (p<0.001). Conclusions. This is the first known application of a six-degree-of-freedom robot to recreate mechanical hip impingement and dislocation to elucidate the role of the labrum in hip stability. Our results suggest that at least in extreme positions, the labrum imparts significant overall mechanical resistance to hip dislocation compared to the condition without the labrum. Regional contributions of the labrum are greatest in the direction of dislocation as foretold by joint position as indicated by region-based stability indices. Future studies involving more clinically relevant injury patterns with greater soft tissue preservation in a younger cadaveric population would better reflect the in vivo effects of labral injury so that treatment strategies can be developed accordingly

The technical advances in arthroscopic surgery of the hip, including the improved ability to manage the capsule and gain extensile exposure, have been paralleled by a growth in the number of conditions that can be addressed. This expanding list includes symptomatic labral tears, chondral lesions, injuries of the ligamentum teres, femoroacetabular impingement (FAI), capsular laxity and instability, and various extra-articular disorders, including snapping hip syndromes. With a careful diagnostic evaluation and technical execution of well-indicated procedures, arthroscopic surgery of the hip can achieve successful clinical outcomes, with predictable improvements in function and pre-injury levels of physical activity for many patients.

This paper reviews the current position in relation to the use of arthroscopy in the treatment of disorders of the hip.

Cite this article: Bone Joint J 2013;95-B:10–19.

Purpose. Our understanding of the spectrum of pathological lesions of the shoulder anterior capsular-labral complex in anterior instability continues to evolve. In a previous study using magnetic resonance arthrography we have showed three variants of the essential lesion of the anterior capsular-labral complex. This is the first large arthroscopic study to finely evaluate the nature and relative proportions of these three lesions in anterior instability. Methods. We studied 122 patients, 101 male and 21 female patients with an average age of 28 (17 to 47 years old), undergoing primary arthroscopic stabilization for anterior instability between 2004 and 2008. The pathoanatomy of the anterior capsule-labral complex was documented. Based on our previous MRI arthrography experience we were able to categorize the lesions seen arthroscopically in three subgroups: the Bankart lesion, the Perthes lesion and the ALPSA (anterior periosteal sleeve avulsion). Results. Arthroscopic findings confirmed the presence of the triad of essential lesion. The relative proportions of the subcategories of the essential lesion were as follows: 71 (58%) Bankart lesions, 18 (15%) Perthes lesions and 33 (27%) ALPSA lesions. Each lesion has unique characteristics, which affect treatment and prognosis. We describe the three types of labral injury and the surgical implications. Conclusion. The literature on the essential anterior capsular-labral lesion has historically focused on the Bankart lesion. There are in fact three variants of the essential lesion: the triad of Bankart, ALPSA and Perthes. This study evaluates these lesions and quantifies their relative proportions in a large series. We believe that awareness of this sub classification of the essential lesion is important as it affects the management of this condition

Introduction. Acetabular labral pathology is now recognized as a more common injury than previously thought. With cost constraints of MRI and invasiveness of MRI arthrogram, physical examination remains essential for diagnosis. Most tests for labral pathology are currently done in the supine position. We have developed the “twist test,” which is done with the patient standing and can evaluate the patient in functional, weight bearing position. The purpose of this study is to describe the twist test and compare its reliability to MRI arthrogram. Material and methods. Between June 2009 and August 2010, the twist test was performed on all patients presenting to our clinic with complaint of hip pain. 371 patients had the twist test performed. Of these, 247 had an MRI arthrogram (MRA) of the affected hip. The twist test results were compared with MRA findings. A labral tear, degeneration, fraying and paralabral cyst were considered as a positive MRA. The twist test is done with the patient facing the examiner, toes pointing forward. The patient bends their knees to 30 degrees and performs a windshield wiper like action with maximal excursion to the left and right. If the patient tolerates this, then the patient first gets on the unaffected leg, again with the knee bent at 30 degrees, and “does the twist” one-legged, with the examiner holding their hands gently for balance. The test is then repeated on the affected hip. A positive test is groin pain on the affected hip, apprehension with performing the test on the affected hip, or gross range of motion deficits on the affected hip compared with the unaffected side. Results. Among 160 patients with positive twist test, 154 patients had positive MRA and 6 had negative MRA. Among 87 patients with negative twist test, 72 had positive MRA and 15 had negative MRA. In comparison with MRA, the sensitivity and specificity of twist test for labral injury were 68.14% and 71.5% respectively. Positive predictive value (precision) of twist test for diagnosis of labral lesion was 96.25% and the accuracy was 68.4%. Conclusions. Physical examination tests for hip pathology are an important screening tool. Current tests include the McCarthy test and the impingement test. We introduce a new test for hip labral pathology, which is done standing. In our study, the twist test had a high positive predictive value (96.25%), so this test can be beneficial for ruling out labral pathology. An added benefit is that this test is quick to perform, so it could be incorporated into a general sports physical screening examination