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). Methods. Data on adult patients who underwent hip arthroscopy or periacetabular osteotomy (PAO) between January 2012 and December 2018 was extracted from the UK Non-Arthroplasty Hip Registry dataset allowing a minimum of 12 months follow-up. Data is collected via an online clinician and patient portal. Outcomes comprised EuroQol-5 Dimensions (EQ-5D) index and the International Hip Outcome Tool 12 (iHOT-12), preoperatively and at 6 and 12 months. Results. A total of 6,666 patients were identified with BMI data available in 52%, comprising 3,220 arthroscopies and 277 PAO. Patients were divided into WHO groups: <25kg/m. 2. (n=1,745 (49.8%)), 25–30kg/m. 2. (n=1,199 (34.2%)), and ≥30kg/m. 2. (n=562 (16.0%)). Patients with higher BMI tended to be older. Pre-operative, 6 and 12-month follow-up were available for 91%, 49% and 45% of cases respectively. Higher BMI was associated with significantly poorer baseline, 6- and 12-month outcomes (12-month mean iHOT-12 score: <25kg/m. 2. = 62.3 (95%CI 60.4 to 64.3), 25–30kg/m. 2. = 57.3 (95%CI 55.0 to 59.7), ≥30kg/m. 2. = 54.7 (95%CI 51.1 to 58.2)). However, all groups saw similar and statistically significant improvement in pre- vs post-op scores (mean 12-month iHOT-12 gain: <25kg/m. 2. = +27.1 (95%CI 25.1 to 29.0), 25–30kg/m. 2. = +26.5 (95%CI 24.0 to 29.0), ≥30kg/m. 2. = +26.8 (95%CI 23.2 to 30.4), between-group p = 0.9). EQ-5D outcomes followed the same trend. Modelling for age, sex and procedure we found no significant difference in 12-month iHOT-12 gain between BMI groups. Conclusion. Whilst obese patients started from, and achieved lower post-operative raw functional scores, all BMI groups saw similar and significant degrees of improvement in functional outcome post-operatively. Obesity should not be considered a contraindication to hip preservation surgery

This study aims to describe the characteristics and outcomes of patients who reported their pre-operative quality of life (QoL) was ‘worse than death’ (‘WTD’) prior to hip arthroscopy (HA) or peri-acetabular osteotomy (PAO). Adult patients who underwent HA or PAO between 1. st. January 2012 and 31. st. October 2020 were extracted from the UK Non-Arthroplasty Hip Registry. International Hip Outcome Tool 12 (iHOT-12) and EuroQol-5 Dimensions (EQ-5D) index questionnaires were collected pre-operatively and at 6 and 12 months. WTD was defined as an EQ-5D score of less than zero. Chi-squared and t-tests were used to compare categorical and continuous variables respectively. 8493 procedures (6355 HA, 746 PAO) were identified in whom 7101 (84%) returned pre-operative EQ-5D questionnaires. 283 HA and 52 PAOs declared their pre-operative QoL to be ‘WTD’. Compared to those patients with pre-operative QoL ‘better than death’ (n=6072, control group) (EQ-5D ≥ zero) patients reporting ‘WTD’ function prior to HA were more likely to be female (66% vs 59%, p = 0.013), of higher body mass index (mean 27.6 kg/m. 2. (SD 5.9) vs 25.7 kg/m. 2. (4.5), p < 0.0001) however there were no statistically significant differences in mean age (36.8 vs 36.4 years), femoroacetabular impingement pattern, or femoral or acetabular cartilage lesion severity. There were no significant demographic differences for PAO. For HA, iHOT-12 scores in WTD patients were significantly poorer pre- [10.8 (95% CI 9.6 to 12.0) vs 33.3 (32.8 to 33.8)] and 12 months post-operatively [34.9 (29.0 to 40.8) vs 59.3 (58.2 to 60.4)] compared to controls. Whilst the majority of patients saw improvement in their scores (p <0.0001), a significantly smaller proportion achieved the minimum clinically important difference for iHOT-12 by 12 months. (51% in the WTD group vs 65% in the control group). Similar trends were observed for PAO. Patients with WTD quality of life may benefit less from hip preservation surgery and should be counselled accordingly regarding expectations. Although the scores improve, only 51% achieve scores beyond MCID

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.

Aims. The frequency of severe femoral retroversion is unclear in patients with femoroacetabular impingement (FAI). This study aimed to investigate mean femoral version (FV), the frequency of absolute femoral retroversion, and the combination of decreased FV and acetabular retroversion (AR) in symptomatic patients with FAI subtypes. Methods. A retrospective institutional review board-approved observational study was performed with 333 symptomatic patients (384 hips) with hip pain due to FAI evaluated for hip preservation surgery. Overall, 142 patients (165 hips) had cam-type FAI, while 118 patients (137 hips) had mixed-type FAI. The allocation to each subgroup was based on reference values calculated on anteroposterior radiographs. CT/MRI-based measurement of FV (Murphy method) and AV were retrospectively compared among five FAI subgroups. Frequency of decreased FV < 10°, severely decreased FV < 5°, and absolute femoral retroversion (FV < 0°) was analyzed. Results. A significantly (p < 0.001) lower mean FV was found in patients with cam-type FAI (15° (SD 10°)), and in patients with mixed-type FAI (17° (SD 11°)) compared to severe over-coverage (20° (SD 12°). Frequency of decreased FV < 10° was significantly (p < 0.001) higher in patients with cam-type FAI (28%, 46 hips) and in patients with over-coverage (29%, 11 hips) compared to severe over-coverage (12%, 5 hips). Absolute femoral retroversion (FV < 0°) was found in 13% (5 hips) of patients with over-coverage, 6% (10 hips) of patients with cam-type FAI, and 5% (7 hips) of patients with mixed-type FAI. The frequency of decreased FV< 10° combined with acetabular retroversion (AV < 10°) was 6% (8 hips) in patients with mixed-type FAI and 5% (20 hips) in all FAI patients. Of patients with over-coverage, 11% (4 hips) had decreased FV < 10° combined with acetabular retroversion (AV < 10°). Conclusion. Patients with cam-type FAI had a considerable proportion (28%) of decreased FV < 10° and 6% had absolute femoral retroversion (FV < 0°), even more for patients with pincer-type FAI due to over-coverage (29% and 13%). This could be important for patients evaluated for open hip preservation surgery or hip arthroscopy, and each patient requires careful personalized evaluation. Cite this article: Bone Jt Open 2022;3(7):557–565

Aims

Femoroacetabular impingement (FAI) patients report exacerbation of hip pain in deep flexion. However, the exact impingement location in deep flexion is unknown. The aim was to investigate impingement-free maximal flexion, impingement location, and if cam deformity causes hip impingement in flexion in FAI patients.

Aims

Periacetabular osteotomy (PAO) is widely recognized as a demanding surgical procedure for acetabular reorientation. Reports about the learning curve have primarily focused on complication rates during the initial learning phase. Therefore, our aim was to assess the PAO learning curve from an analytical perspective by determining the number of PAOs required for the duration of surgery to plateau and the accuracy to improve.

Orthopaedic surgeons have accepted various radiological signs to be representative of acetabular retroversion, which is the main characteristic of focal over-coverage in patients with femoroacetabular impingement (FAI). Using a validated method for radiological analysis, we assessed the relevance of these signs to predict intra-articular lesions in 93 patients undergoing surgery for FAI. A logistic regression model to predict chondral damage showed that an acetabular retroversion index (ARI) > 20%, a derivative of the well-known cross-over sign, was an independent predictor (p = 0.036). However, ARI was less significant than the Tönnis classification (p = 0.019) and age (p = 0.031) in the same model. ARI was unable to discriminate between grades of chondral lesions, while the type of cam lesion (p = 0.004) and age (p = 0.047) were able to. Other widely recognised signs of acetabular retroversion, such as the ischial spine sign, the posterior wall sign or the cross-over sign were irrelevant according to our analysis. Regardless of its secondary predictive role, an ARI > 20% appears to be the most clinically relevant radiological sign of acetabular retroversion in symptomatic patients with FAI.

Cite this article: Bone Joint J 2013;95-B:893–9.

There is little known about how patient socioeconomic status impacts clinical outcomes in hip preservation surgery. The aim of this study was to evaluate the relationship between indices of multiple deprivation, funding provider (NHS Funded or Private Funded) and clinical outcomes following surgery for femoroacetabular impingement (FAI). The study analysed the data of 5590 patients recorded in the NAHR who underwent primary hip arthroscopic treatment for FAI between November 2013 and July 2023. Records were matched to the UK National index of multiple deprivation using the lower layer super output area. Using iHOT12 score, patient reported outcome measures were analysed at base line and 1 year following surgery. 2358 records were matched to LLSOA deciles. Between the lowest (most deprived) 3 deciles and the highest (least deprived) the average baseline iHOT12 score was 28.98 (n=366) and 35.33 (n=821). The proportion of patients receiving treatment through NHS funding compared to independent funding for the most deprived, 292 (90%) 37 (10%) respectively compared to the least deprived 515 (70%) and 244 (30%) respectively. At 1year, iHOT12 scores for each group were 51.64 (29.1 SD) compared to 61.5 (28.06 SD) respectively. The study demonstrates that patients from lower socioeconomic backgrounds had poorer baseline and one-year post-surgery iHOT12 scores compared to those from higher socioeconomic strata. Furthermore, a higher reliance on NHS funding was observed among the most deprived, while more affluent patients predominantly opted for private funding. These findings underscore the significant influence of socioeconomic status on both the quality of healthcare received and recovery outcomes in hip preservation surgery, calling attention to the need for more equitable healthcare solutions

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

To investigate whether anterior pelvic plane-pelvic tilt (APP-PT) is associated with distinct hip pathomorphologies, we asked: (1) Is there a difference in APP-PT between symptomatic young patients eligible for joint preservation surgery and an asymptomatic control group? (2) Does APP-PT vary between distinct acetabular and femoral pathomorphologies? (3) Does APP-PT differ in symptomatic hips based on demographic factors?. IRB-approved, single-center, retrospective, case-control, comparative study in 388 symptomatic hips (357) patients (mean age 26 ± 2 years [range 23 to 29], 50% females) that presented to our tertiary center for joint preservation over a five year-period. Patients were allocated to 12 different morphologic subgroups. The overall study group was compared to a control group of 20 asymptomatic hips (20 patients). APP-PT was assessed in all patients based on AP pelvis X-rays using the validated HipRecon software. Values between overall and control group were compared using an independent samples t-test. Multiple regression analysis was performed to examine the influences of diagnoses and demographic factors on APP-PT. Minimal clinically important difference (MCID) of APP-PT was defined as >1 standard deviation. No significant differences in APP-PT between the control group and overall group (1.1 ± 3.0° [−4.9 to 5.9] vs 1.8 ± 3.4° [−6.9 to 13.2], p = 0.323) were observed. Acetabular retroversion and overcoverage groups showed higher APP-PT compared to the control group (both p < 0.05) and were the only diagnoses with significant influence on APP-PT in the stepwise multiple regression analysis. However, all observed differences were below the MCID. Demographic factors age, gender, height, weight and BMI showed no influence on APP-PT. APP-PT across different hip pathomorphologies showed no clinically significant variation. It does not appear to be a relevant contributing factor in the evaluation of young patients eligible for hip preservation surgery

Young patients undergoing THA or hip used. HOS and iHOT33 have demonstrated to be useful in hip preservation surgery but never used in THA. The aim of the study was to evaluate long-term clinical outcomes with HOS and iHOT33 in hip arthroscopy and THA. We conducted a retrospective study with prospective data collection of 118 consecutive young patients (<65 y.o.) between 2008 to 2012 who underwent hip arthroscopy or THA. The mean follow-up was 12.05 years. All surgeries were done by the same senior surgeon. PROMs used were iHOT-33 and HOS preoperatively, at one year and 10 years. SPSS Statistics Grad Pack 28.0 software was used for statistical analysis. Arthroscopy Group (57 patients): Mean age 35.36 years. 55.93% were male. iHOT33 mean differential improvement was 24.43 at 1 year, 70,17% exceed MCID and 49,1% SCB. HOS mean differential improvement was 16.26 at one year. 54,38 % patients exceed MCID and 49,36% SCB. At 10 years, iHOT33 mean differential improvement was 14,36 and 12.56 for HOS. Regarding complications, 3 patients underwent THA (5.26%) and 10 (17.54%) continued with groin pain. THA Group (61 patients): Mean age 52,54 years. 55.73% were male. Cementless THA was used in all patients with ceramic on ceramic used in 77%. iHOT33 mean differential improvement was 41,57 at 1 year. 95,08% patients exceed MCID and 85,25% SCB. HOS mean differential improvement was 16.57 points at one year. 85,25% patients exceed MCID and 81,97% SCB. At 10 years, iHOT33 mean differential improvement was 20,15 and 14.12 for HOS. Regarding complications, 1 patient underwent DAIR for infection (1.64%) and 1 dislocation with close reduction (1.64%). iHOT33 or HOS scores should be considered to be used in young active patients after hip preserving surgery or THA, with more predictable results at long-term in THA group

There are a number of patients in whom hip preservation surgery is not indicated as they have developed signs of early osteoarthritis, and nor can they have a hip replacement as they are too early in the disease process. The use of PRP in OA of the hip has not been studied systematically and this study concisely collates all the available data in the use of PRP in Hip OA. This systematic review and meta-analysis aimed to assess intra-articular platelet-rich plasma as a therapeutic intervention for hip osteoarthritis, including the duration of efficacy, influence of dose and composition of PRP, and the incidence of adverse effects. We performed literature searches on the MEDLINE, EMBASE, CINHAL, WEB OF SCIENCE, COCHRANE and SCOPUS databases, and PRSIMA guidelines were followed. Data was pooled using random effects meta-analysis. We assessed quality of the included studies using the Methodological Index for Non-Randomised Studies (MINORS) instrument, with an additional assessment for Randomised Controlled Trials with the Revised Cochrane risk-of-bias tool for randomized trials (RoB 2). Eight studies were included in the analysis, with data from a total of 331 patients. PRP significantly reduced pain compared to baseline at multiple timepoints, with the greatest effect at 1–2mo follow-up. PRP only significantly improved function at the 1–2mo follow-up. A significantly larger reduction in pain was achieved with a single injection or PRP compared to multiple injections, a total injected dose of PRP <15mL compared to ≥15mL or using a leukocyte-poor PRP preparation compared to leukocyte-rich PRP. There were no lasting adverse effects. Low and moderate quality evidence suggests that PRP reduces pain and improves function at endpoint compared to baseline. Moderate quality evidence suggests a larger reduction in pain is achieved with a single injection of PRP compared to multiple injections, and low quality evidence attributes a larger reduction of pain with a total injected dose of PRP <15mL compared to ≥15mL or using leukocyte-poor PRP compared to leukocyte-rich PRP

Aims

The aim of this study was to determine the clinical outcomes and factors contributing to failure of transposition osteotomy of the acetabulum (TOA), a type of spherical periacetabular osteotomy, for advanced osteoarthritis secondary to hip dysplasia.

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Psychological status may be an important predictor of outcome after periacetabular osteotomy (PAO). The aim of this study was to investigate the influence of psychological distress on postoperative health-related quality of life, joint function, self-assessed pain, and sports ability in patients undergoing PAO.

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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.

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The aims of this study were to validate the Forgotten Joint Score-12 (FJS-12) in the postoperative evaluation of periacetabular osteotomy (PAO), identify factors associated with joint awareness after PAO, and determine the FJS-12 threshold for patient-acceptable symptom state (PASS).

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Hip arthroscopy has gained prominence as a primary surgical intervention for symptomatic femoroacetabular impingement (FAI). This study aimed to identify radiological features, and their combinations, that predict the outcome of hip arthroscopy for FAI.

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The primary aim of this study was to determine the ten-year outcome following surgical treatment for femoroacetabular impingement (FAI). We assessed whether the evolution of practice from open to arthroscopic techniques influenced outcomes and tested whether any patient, radiological, or surgical factors were associated with outcome.

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

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Bone marrow-derived mesenchymal stem cells obtained from bone marrow aspirate concentrate (BMAC) with platelet-rich plasma (PRP), has been used as an adjuvant to hip decompression. Early results have shown promise for hip preservation in patients with osteonecrosis (ON) of the femoral head. The purpose of the current study is to examine the mid-term outcome of this treatment in patients with precollapse corticosteroid-induced ON of the femoral head.