Aims. Psychological factors play a critical role in patient presentation, satisfaction, and outcomes. Pain catastrophizing, anxiety, and depression are important to consider, as they are associated with poorer outcomes and are potentially modifiable. The aim of this study was to assess the level of pain catastrophizing, anxiety, and depression in patients with a range of hip pathology and to evaluate their relationship with patient-reported psychosocial and functional outcome measures. Patients and Methods. Patients presenting to a tertiary-centre specialist hip clinic were prospectively evaluated for outcomes of pain catastrophizing, anxiety, and depression. Validated assessments were undertaken such as: the Pain Catastrophizing Scale (PCS), the Hospital Anxiety Depression Scale (HADS), and the 12-Item Short-Form Health Survey (SF-12). Patient characteristics and demographics were also recorded. Multiple linear regression modelling, with adaptive least absolute shrinkage and selection operator (LASSO) variable selection, was used for analysis. Results. A total of 328 patients were identified for inclusion, with diagnoses of hip dysplasia (DDH; n = 50), femoroacetabular impingement (FAI; n = 55), lateral trochanteric pain syndrome (LTP; n = 23), hip osteoarthrosis (OA; n = 184), and avascular necrosis of the hip (AVN; n = 16) with a mean age of 31.0 years (14 to 65), 38.5 years (18 to 64), 63.7 years (20 to 78), 63.5 years (18 to 91), and 39.4 years (18 to 71), respectively. The percentage of patients with abnormal levels of pain catastrophizing, anxiety, or depression was: 22.0%, 16.0%, and 12.0% for DDH, respectively; 9.1%, 10.9%, and 7.3% for FAI, respectively; 13.0%, 4.3%, and 4.3% for LTP, respectively; 21.7%, 11.4%, and 14.1% for OA, respectively; and 25.0%, 43.8%, and 6.3% for AVN, respectively. HADS Anxiety (HADSA) and Hip Disability Osteoarthritis Outcome Score Activities of Daily Living subscale (HOOS ADL) predicted the PCS total (adjusted R. 2. = 0.4599). Age, HADS Depression (HADSD), and PCS total predicted HADSA (adjusted R. 2. = 0.4985). Age, HADSA, patient’s percentage of perceived function, PCS total, and HOOS Quality of Life subscale (HOOS QOL) predicted HADSD (adjusted R. 2. = 0.5802). Conclusion. Patients with hip pathology may exhibit significant pain catastrophizing, anxiety, and depression. Identifying these factors and understanding the impact of psychosocial function could help improve patient treatment outcomes. Perioperative multidisciplinary assessment may be a beneficial part of comprehensive orthopaedic hip care. Cite this article: Bone Joint J 2019;101-B:800–807

Objectives. The aim of this study was to systematically review the literature on measurement of muscle strength in patients with femoroacetabular impingement (FAI) and other pathologies and to suggest guidelines to standardise protocols for future research in the field. Methods. The Cochrane and PubMed libraries were searched for any publications using the terms ‘hip’, ‘muscle’, ‘strength’, and ‘measurement’ in the ‘Title, Abstract, Keywords’ field. A further search was performed using the terms ‘femoroacetabular’ or ‘impingement’. The search was limited to recent literature only. Results. A total of 29 articles were reviewed to obtain information on a number of variables. These comprised the type of device used for measurement, rater standardisation, the type of movements tested, body positioning and comparative studies of muscle strength in FAI versus normal controls. The studies found that hip muscle strength is lower in patients with FAI; this is also true for the asymptomatic hip in patients with FAI. Conclusions. Current literature on this subject is limited and examines multiple variables. Our recommendations for achieving reproducible results include stabilising the patient, measuring isometric movements and maximising standardisation by using a single tester and familiarising the participants with the protocol. Further work must be done to demonstrate the reliability of any new testing method. Cite this article: E. Mayne, A. Memarzadeh, P. Raut, A. Arora, V. Khanduja. Measuring hip muscle strength in patients with femoroacetabular impingement and other hip pathologies: A systematic review. Bone Joint Res 2017;6:66–72. DOI: 10.1302/2046-3758.61.BJR-2016-0081

Pre-existing hip pathology such as femoroacetabular impingement is believed by some, to have a direct causal relationship with osteoarthritis of the hip. The strength of this relationship remains unknown. We investigate the prevalence of abnormal bone morphology in the symptomatic hip on the pre-operative anteroposterior pelvic radiograph of consecutive patients undergoing hip resurfacing. Rotated radiographs were excluded. One hundred patients, of mean age 53.5 years were included (range 33.4–71.4 years, 32% female). We examined the films for evidence of a cam-type impingement lesion (alpha angle >50.5°, a pistol grip, Pitt's pits, a medial hook, an os acetabuli and rim ossification), signs of acetabular retroversion or a pincer-type impingement lesion (crossover sign, posterior wall sign, ischial sign, coxa profunda, protrusio, coxa vara, Tonnis angle < 5°), and hip dysplasia (a Tonnis acetabular angle >14° and a lateral centre-edge angle of Wiberg <20°). Pre-existing radiographic signs of pathology were present in a large proportion of hips with low grade (Tonnis grade 1–2) arthritis. There is a group of patients who presented with more advanced osteoarthritis in which we suspect abnormal bone morphology to be a causative factor but, for example, neck osteophytes obscure the diagnosis of a primary cam lesion. Our findings corroborate those of Harris and Ganz. Impingement is radiographically detectable in a large proportion of patients who present with early arthritis of the hip, and therefore we agree that it is a likely pre-cursor for osteoarthritis. Treatments directed at reducing hip impingement may stifle the progression of osteoarthritis

Physical functioning in patients undergoing hip surgery is commonly assessed in three ways: patient-reported outcome measure (PROM), performance test, or clinician-administered measure. It is recommended that several types of measures are used concurrently to capture an extended picture of function. Patient fatigue and burden, time, resources and logistical constraints of clinic and research appointments mean that collecting multiple measures is seldom feasible, leading to focus on a limited number of measures, if not a single one. While there is evidence that performance-tests and PROMs do not fully correlate, correlations between PROMs, performance tests and clinician-administrated measures are yet to be evaluated. It is also not known if the associations between function and patient characteristics depend on how function is measured. The aim of our study was to use different measures to assess function in the same group of patients before their hip surgery to determine 1. how well PROMs, performance tests and clinician-administrated measures correlate with one another and 2. Whether these measures are associated with the same patient characteristics.

We conducted a cross-sectional analysis of the pre-operative information of 125 participants listed for hip replacement. The WOMAC function subscale, Harris Hip Score (HHS) and walk-, step- and balance-tests were assessed by questionnaire or during a clinic visit. Participant socio-demographics and medical characteristics were also collected. Correlations between functional measures were investigated with correlation coefficients (r). Regression models were used to test the association between the patient's characteristics and each of the three types of functional measures.

None of the correlations between the PROM, clinician-administrated measure and performance tests were very high (r<0.90). The highest correlations were found between the WOMAC-function and the HHS (r=0.7) or the Walk-test (r=0.6), and between the HHS and the walk-test(r=0.7). All the other performance-tests had low correlations with the other measures(r ranging between 0.3 and 0.5).

The associations between patient characteristics and functional scores varied by type of measure. Psychological status was associated with the WOMAC function (p-value<0.0001) but not with the other measures. Age was associated with the performance test measures (p-value ranging from ≤0.01 to <0.0001) but not with the WOMAC function. The clinician-administered (HHS) measure was not associated with age or psychological status.

When evaluating function prior to hip replacement clinicians and researchers should be aware that each assessment tool captures different aspects of function and that patient characteristics should be taken into account. Psychological status influences the perception of function; patients may be able to do more than they think they can do, and may need encouragement to overcome anxiety. A performance test like a walk-test would provide a more comprehensive assessment of function limitations than a step or balance test, although performance tests are influenced by age.

For the most precise description of functional status a combination of measures should be used. Clinicians should supplement their pre-surgery assessment of function with patient-reported measure to include the patient's perspective.

Between 1997 and 2000, internal arthrodiastasis procedures (endo-apparatus), using an internal skeletal distraction device, were performed on 33 young patients who had reached the point of total hip arthroplasty or arthrodesis.

The mean age of the 20 males and 13 females was 19 years (range 11 to 51 years). We removed 19 implants, eight after completion of treatment or because they had outlived their usefulness, and 11 because no improvement in the hip disorder had been achieved.

Good results were achieved in two thirds of the patients, including patients suffering from avascular necrosis of the femoral head, old Perthes’ disease and contained hip dysplasia with joint space narrowing and pain. Chondrolysis and stiffness of the hip appear to be contraindications for this type of treatment. The three post-traumatic hip disorders were probably also not ideal cases.

In young patients, the results of total hip arthroplasty after trauma are poor, and the indications for internal arthrodiastasis should be redefined.

Introduction: rapidly destructive hip arthropathy is a recognised condition. Some authors considered it as a subset of osteoarthritis but none has identiþed the aetiology, pathogenesis or risk factors. Patients and methods: Authors present 14 cases of an extreme subset of rapidly destructive hip arthropathy. The radiological deterioration occurred dramatically over a short period ranging from 2 weeks up to few months. Loss of femoral head ranged from 25% up to 100% of the head volume. Acetabulum was damaged in all cases and femoral neck was partially lost in 9 cases (up to 75%). 4 cases were associated with dislocation. Age ranges from 53 to 85, female to male ratio (8 to 6), 2 patients had bilateral disease. Results: Clinical and radiological features were similar to those of neuropathic joint, infection, neoplasia, or avascular necrosis. However these conditions were excluded by further investigations; laboratory, imaging, surgical exploration and histopathology. All patients underwent hip arthroplasty. Some common (at risk) features included elderly patients, long history of receiving strong NSAIDs, radiologically atrophic and predominantly lateral disease. Conclusion: It appears that this condition represents a new entity but authors were not able to identify the aetiology. Awareness of this condition is important and at risk patients should be closely monitored.

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

Background

Since 2011, the knee service at the Nuffield Orthopaedic Centre has been offering a neutralising medial opening wedge high tibial osteotomy (HTO) to a group of patients presenting with early medial osteoarthritis of the knee, varus alignment and symptoms for more than 2 years. During development of this practice an association was observed between this phenotype of osteoarthritis and the presence of CAM deformity at the hip.

Introduction: Hip fractures are usually evident on plain radiographs. Some are not obvious and require further investigation. A review of the pertinent literature reveals different treatment algorithms for such patients but MRI is recommended as the investigation of choice. Little is stated about the clinical findings in patients with an occult fracture of the hip.

Aims: To investigate any correlation between clinical findings and the presence of fracture on MRI in occult fracture of the hip and use this as a means of speeding the diagnosis of such patients.

Methods: We report a prospective, multi-centre trial. 22 patients admitted with a suspected occult fracture of the hip were assessed clinically for evidence of resting deformity, ecchymosis, point tenderness, hip pain on heel percussion or pistoning and ability to straight leg raise (SLR). The same features were assessed in the contralateral limb. All patients were alert and orientated as to comply with examination. Plain radiograph and MRI findings of both hips were recorded in each case.

Results: Of 22 patients, 17 were unable to perform SLR on the affected side, 5 were able to do so. Of the 18 patients, all had a fracture of either the acetabulum or proximal femur on MRI. Of the group of 5, 2 had normal MRI scans, 1 had a pubic ramus fracture, 1 had bone marrow oedema secondary to osteoarthritis and 1 patient had a six week old valgus impaction fracture. All patients could SLR and had normal MRI of the contralateral hip.

Conclusions: Under the conditions of this study straight leg raise test is 95% sensitive and 95% specific for predicting the presence of fracture in either the acetabulum or proximal femur. We recommend that this simple test can be used to help speed up the diagnosis of and further management of occult fractures of the hip

A randomised prospective study of four bearing surfaces in hip replacements is being conducted. The primary objective is to identify the best long term bearing surf ace clinically and radiographically, and metal ion levels have been measured in all cases.

Patients have been randomised to the four bearing surfaces viz. Ceramic-on-XLinked Polyethelene, Ceramic-on-Ceramic, Metal-on-Metal and Ceramic-on-Metal. Pre-operative blood samples and follow-up blood samples for metal ion analysis using ICP-MS method have been taken in all patients. As at February 2008 187 patients have been recruited, and metal ion levels at one year are available in 52 patients.

Metal ion levels are not increased with Ceramic-on-XLPE or Ceramic-on-Ceramic bearings. At one year follow-up the metal ion levels in Ceramic-on–Metal bearings is half that of Metal-on-Metal bearings using mean levels, and one third using median levels. Of note is that chromium levels in Ceramic-on-Metal bearings is the least elevated.

Due to the laboratory evidence that ceramic-on-metal bearings have the best surf ace wear characteristics with no head stripe wear on a ceramic head, and the laboratory and clinic al evidence of lower metal ion levels, Ceramic-on-Metal hip replacements could be one of the bearing surfaces of the future.

Introduction: Hip arthroplasty is growing in importance and relevance in the detection and treatment of various pathologies affecting the hip joint. A growing number of indications exist including the diagnosis and treatment of synovial-based disease, extraction of loose bodies within the joint, and treating chondral flaps and labral tears. Hip arthroplasty represents a minimally invasive, joint preserving, effective and reproducible tool to achieve these. The literature cites few complications arising from the procedure.

Study: Retrospective study of the outcomes of 20 patients who underwent hip arthroplasty between March 1999 and October 2002.

Methods: All the patients were first clinically assessed and then underwent Magnetic Resonance Imaging of their hips prior to undergoing arthroplasty. The indications for the MR arthrography included hip or groin pain, joint stiffness with associated impaired exercise tolerance. Arthroscopy was performed as a day case under general anaesthetic. The patients were placed supine on a fracture table and traction applied, under image control 30 and 70 degree arthoscopes were placed through an anterior and peritrochanteric portals. The patients followed up for an average of 20 months (6–44 months) and assessed for pain, mechanical symptoms, activity level, work status, sports ability and performance of activities of daily living. Data collected was retrospectively reviewed.

Results: The correlation between MR imaging and arthroscopy was approximately 80%. MR imaging detected all the labral tears present in 10 patients. This sensitivity was however reduced for the detection of small osteophytes (105), synovitis (5%), and minor labral radial fibrillation (5%). Four patients had loose bodies, which were successfully extracted. The patients whose symptoms were the result of mechanical pathology achieved complete resolution of their symptoms post operatively. No complications were seen.

Conclusion: Hip arthroplasty can be performed for a variety of conditions with reasonable expectations of success and minimal complication rate.

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

Aims. Pelvic tilt is believed to affect the symptomology of osteoarthritis (OA) of the hip by alterations in joint movement, dysplasia of the hip by modification of acetabular cover, and femoroacetabular impingement by influencing the impingement-free range of motion. While the apparent role of pelvic tilt in hip pathology has been reported, the exact effects of many forms of treatment on pelvic tilt are unknown. The primary aim of this study was to investigate the effects of surgery on pelvic tilt in these three groups of patients. Methods. The demographic, radiological, and outcome data for all patients operated on by the senior author between October 2016 and January 2020 were identified from a prospective registry, and all those who underwent surgery with a primary diagnosis of OA, dysplasia, or femoroacetabular impingement were considered for inclusion. Pelvic tilt was assessed on anteroposterior (AP) standing radiographs using the pre- and postoperative pubic symphysis to sacroiliac joint (PS-SI) distance, and the outcomes were assessed with the Hip Outcome Score (HOS), International Hip Outcome Tool (iHOT-12), and Harris Hip Score (HHS). Results. The linear regression model revealed a significant negative predictive association between the standing pre- and postoperative PS-SI distances for all three groups of patients (all p < 0.001). There was a significant improvement in all three outcome measures between the pre- and postoperative values (p < 0.05). Conclusion. There is a statistically significant decrease in pelvic tilt after surgery in patients with OA of the hip, dysplasia, and femoroacetabular impingement. These results confirm that surgery significantly alters the pelvic orientation. Pelvic tilt significantly decreased after total hip arthroplasty, periacetabular osteotomy, and arthroscopy/surgical hip dislocation. The impact of surgery on pelvic tilt should be considered within the therapeutic plan in order to optimize pelvic orientation in these patients. Cite this article: Bone Joint J 2022;104-B(9):1025–1031

Hip arthroscopy (HA) and pelvic osteotomy (PO) are surgical procedures used to treat a variety of hip pathology affecting young adults, including femoroacetabular impingement and hip dysplasia respectively. This study aimed to investigate the trends and regional variation in the provision of HA and PO across England from 2010 to 2023 to inform healthcare resource allocation. We analysed the National Hospital Episode Statistics database for all HA and PO procedures in NHS England using specific OPCS-4 codes: HA: ‘W83+Z843’ or ‘W84+Z843’; PO: ‘X222+Z75’. We collected patient demographics, age, sex, and region of treatment. We performed descriptive and regression analyses to evaluate temporal trends in PO volume, age, sex and regional variation. 22,401 HAs and 1,348 POs were recorded between 2010 and 2023. The annual number of HAs declined by 28.4%, whilst the number of POs increased by 64% (p<0.001). Significantly more females underwent PO vs HA (90% vs 61.3%) and were older than males undergoing the same procedure (PO: 29.0±8.7 vs 25.8±9.2 years; HA: 36.8±12.0 years vs 35.8±11.2 years, p<0.001). For HA, the mean age of both sexes decreased by 3.3 and 2.9 years respectively (p<0.001), whereas the age of PO patients did not change significantly over the study period. There were significant regional variations with a mean incidence of 1.60/100,00 for HA (ranging from 0.70–2.66 per 100,000) and 0.43/100,000 for PO (ranging from 0.08–2.07 per 100,000). We have observed a decline in HA volume in England, likely due to improved patient selection and the impact of COVID-19, whilst PO volume has significantly increased, with regional variation persisting for both procedures. These trends highlight the need for equitable HA and PO access to improve patient outcomes and call for strategic healthcare planning and resource allocation to reduce disparities and improve training opportunities

To evaluate the impact of routine capsular repair on patient-reported outcomes, survivorship and achievability of clinically important improvement, minimum 5-years post-surgery. Our prospective institutional registry was reviewed for cases undergoing primary HA for FAI, and stratified into two groups depending on whether the capsule was repaired or not. Routine repair was introduced in late 2013. The No Repair group consisted of patients undergoing HA between Jan 2010-June 2013 while the Repair group consisted of patients undergoing HA between Jan 2015-Sept 2018. Exclusion criteria consisted of >50 years, Tonnis>1, dysplasia(LCEA<25), concomitant hip pathologies. PROMs consisted of mHHS, SF36 and UCLA. Metrics of clinically important improvement was evaluated using MCID and SCB. Rates of repeat HA or THA conversion were recorded. 985 cases were included (359 No Repair; 626 Repair), 86% male, average age 27.4±6.7years. Significant improvement in all PROMs at minimum 5-years was observed for both groups (p<0.001 for all; large effect sizes for mHHS and SF36, medium effect sizes for UCLA). At 5-years post-op there was no significant difference between groups for mHHS(p=0.078) or UCLA(0.794). SF36 was significantly poorer for those cases undergoing routine repair(p<0.001) however effect size was small (0.20). Thresholds of MCID and SCB were calculated as 69% and 86% for mHHS, 64% and 77% for UCLA, 43% and 60% for SF36. Both groups achieved MCID and SCB at similar rates for mHHS and UCLA. A significantly lower proportion of cases in the repair groups achieved MCID for SF36 (53.6% vs 63.5%, p=0.034) and SCB for SF36 (37.3% vs 52.8%, p<0.001). No significant difference between groups for THA conversion (0.6% No Repair vs 0.5% Repair) or repeat HA (9.7% No Repair vs 8.1% Repair). Routinely repairing the capsule following HA for FAI demonstrates no clinical benefit over not repairing the capsule 5 years post-surgery

Traditional radiographic criteria might underestimate or fail to detect subtle types of acetabular dysplasia. Acetabular sector angles (ASA) can measure the degree of anterior and posterior coverage of the femoral head on computed tomography (CT). This study aims to determine ASA values at different axial levels in a cohort of (1) asymptomatic, high-functioning hips without underlying hip pathology (controls); and (2) symptomatic, dysplastic hips that underwent periacetabular osteotomy (PAO). Thereby, we aimed to define CT-based thresholds for hip dysplasia and its subtypes. This is an IRB approved cross-sectional study of 51 high functioning, asymptomatic patients (102 hips) (Oxford Hip Score >43), without signs of osteoarthritis (Tönnis grade≤1), who underwent a CT scan of the pelvis (mean age: 52.1±5.5 years; 52.9% females); and 66 patients (72 hips) with symptomatic hip dysplasia treated with peri-acetabular osteotomy (PAO) (mean age: 29.3±7.3 years; 85.9% females). Anterior and posterior acetabular sector angles (AASA & PASA) were measured by two observers at three CT axial levels to determine equatorial, intermediate, and proximal ASA. Inter- and intra-observer reliability coefficient was high (between 0.882–0.992). Cut-off values for acetabular deficiency were determined based on Receiver Operating Characteristic (ROC) curve analysis, area under the curve (AUC) was calculated. The dysplastic group had significantly smaller ASAs compared to the Control Group, AUC was the highest at the proximal and intermediate PASA. Controls had a mean proximal PASA of 162°±17°, with a cut-off value for dysplasia of 137° (AUC: 0.908). At the intermediate level, the mean PASA of controls was 117°±11°, with a cut-off value of 107° (AUC 0.904). Cut-off for anterior dysplasia was 133° for proximal AASA (AUC 0.859) and 57° for equatorial AASA (AUC 0.868). Cut-off for posterior dysplasia was 102° for intermediate PASA (AUC 0.933). Measurement of ASA on CT is a reliable tool to identify dysplastic hips with high diagnostic accuracy. Posterior ASA less than 137° at the proximal level, and 107° at the intermediate level should alert clinicians of the presence of dysplasia

Young adult hip pathology commonly affects patients of reproductive age. The extent to which hip arthroscopy (HA) treatments influence sexual function is not well described and limited to small cohorts. This study aims to describe trends in self-reported reported sexual function before and after HA. Adult (≥18 years) patients who underwent HA 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) questionnaires were collected pre-operatively and at 6 and 12 months. Patients are first asked if ‘questions about sexual activity are relevant to them’. The iHOT-12 then asks asking patients to quantify ‘how much trouble they experience with sexual activity because of their hip?’ with responses converted to a continuous scale (0–100) to measure function. Chi-squared and t-tests were used to compare categorical and continuous variables respectively. Of 7639 procedures (59% female, mean age 36.5 years (SD 11)), 91% (5616 of 6151 respondants) indicated pre-operatively that questions about sexual activity were relevant to them (male 93%, female 90%, p < 0.001). Overall, mean pre-operative sexual function increased from 42.0 (95%CI 41.2 to 42.8, n=5267) to 61.8 (60.6 to 63.1, n=2393) at 6 months, and 62.1 (60.8 to 63.5, n=2246) at 12 months post-operatively. At 12 months, both sexes saw significant improvement in their pre-operative sexual function scores (p<0.0001). Males started from significantly higher baseline sexual function (53.3 vs 34.2) and achieved higher scores by 12 months (68.8 vs 58.0) compared to female patients. There was no significant difference in pre- or post-operative scores when comparing younger (<40 years) and older (>40 years). Most patients can expect to experience improvement in their sexual function following hip arthroscopy, regardless of sex or age group