It has been reported that 60-85% of patients who undergo PAO have concomitant intraarticular pathology that cannot be addressed with PAO alone. Currently, there are limited diagnostic tools to determine which patients would benefit from hip arthroscopy at the time of PAO to address intra-articular pathology. This study aims to see if preoperative PROMs scores measured by IHOT-33 scores have predictive value in whether intra-articular pathology is addressed during PAO + scope. The secondary aim is to see how often surgeons at high-volume hip preservation centers address intra-articular pathology if a scope is performed during the same anesthesia event.

A randomized, prospective Multicenter trial was performed on patients who underwent PAO and hip arthroscopy to treat hip dysplasia from 2019 to 2020. Preoperative PROMs and intraoperative findings and procedures were recorded and analyzed. A total of 75 patients, 84% Female, and 16% male, with an average age of 27 years old, were included in the study. Patients were randomized to have PAO alone 34 patients vs. PAO + arthroscopy 41 patients during the same anesthesia event. The procedures performed, including types of labral procedures and chondroplasty procedures, were recorded. Additionally, a two-sided student T-test was used to evaluate the difference in means of preoperative IHOT score among patients for whom a labral procedure was performed versus no labral procedure.

A total of 82% of patients had an intra-articular procedure performed at the time of hip arthroscopy. 68% of patients who had PAO + arthroscopy had a labral procedure performed. The most common labral procedure was a labral refixation which was performed in 78% of patients who had a labral procedure performed. Femoral head-neck junction chondroplasty was performed in 51% of patients who had an intra-articular procedure performed. The mean IHOT score was 29.3 in patients who had a labral procedure performed and 33.63 in those who did not have a labral procedure performed P- value=0.24.

Our findings demonstrate preoperative IHOT-33 scores were not predictive in determining whether intra-articular labral pathology was addressed at the time of surgery. Additionally, we found that if labral pathology was addressed, labral refixation was the most common repair performed. This study also provides valuable information on what procedures high-volume hip preservation centers are performing when performing PAO + arthroscopy.

Management of acetabular fractures in the elderly population remains somewhat controversial in regards to when to consider is open reduction internal fixation (ORIF) versus acute primary total hip. study aims to (1) describe outcome of this complex problem and investigate predictors of successful outcome.

This retrospective study analyzes all acetabular fractures in patients over the age of 60, managed by ORIF at a tertiary trauma care centre between 2007 and 2018 with a minimum follow up of one year. Of the 117 patients reviewed, 85 patients undergoing ORIF for treatment of their acetabular fracture were included in the analysis. The remainder were excluded based management option including acute ORIF with THA (n=10), two-stage ORIF (n=2), external fixator only (n=1), acute THA (n=1), and conservative management (n=1). The remainder were excluded based on inaccessible medical records (n=6), mislabelled diagnosis (n=6), associated femoral injuries (n=4), acetabular fracture following hemiarthroplasty (n=1). The mean age of the cohort is 70±7 years old with 74% (n=62) of patients being male. Data collected included: demographics, mechanism of injury, Charlson Comorbidity Index (CCI), ASA Grade, smoking status and reoperations. Pre-Operative Radiographs were analyzed to determine the Judet and Letournel fracture pattern, presence of comminution and posterior wall marginal impaction. Postoperative radiographs were used to determine Matta Grade of Reduction. Outcome measures included morbidity-, mortality- rates, joint survival, radiographic evidence of osteoarthritis and patient reported outcome measures (PROMs) using the Oxford Hip Score (OHS) at follow-up. A poor outcome in ORIF was defined as one of the following: 1) conversion to THA or 2) the presence of radiographic OA, combined with an OHS less than 34 (findings consistent with a hip that would benefit from a hip replacement). The data was analyzed step-wise to create a regression model predictive of outcome following ORIF.

Following ORIF, 31% (n=26) of the cohort had anatomic reduction, while 64% (n=54) had imperfect or poor reduction. 4 patients did not have adequate postoperative radiographs to assess the reduction. 31 of 84 patients undergoing ORIF had a complication of which 22.6% (n=19) required reoperation. The most common reason being conversion to THA (n=14), which occurred an average of 1.6±1.9 years post-ORIF. The remainder required reoperation for infection (n=5). Including those converted to THA, 43% (n=36) developed radiographic OA following acetabular fracture management. The mean OHS in patients undergoing ORIF was 36 ± 10; 13(16%) had an OHS less than 34. The results of the logistic regression demonstrate that Matta grade of reduction (p=0.017), to be predictive of a poor outcome in acetabular fracture management. With non-anatomic alignment following fixation, patients had a 3 times greater risk of a poor outcome. No other variables were found to be predictive of ORIF outcome.

The ability to achieve anatomic reduction of fracture fragments as determined by the Matta grade, is predictive of the ability to retain the native hip with acceptable outcome following acetabular fracture in the elderly. Further research must be conducted to determine predictors of adequate reduction in order to identify candidates for ORIF.

Hip dysplasia has traditionally been classified based on the lateral centre edge angle (LCEA). A recent meta-analysis demonstrated no definite consensus and a significant heterogeneity in LCEA values used in various studies to define hip dysplasia and borderline dysplasia. To overcome the shortcomings of classifying hip dysplasia based on just LCEA, a comprehensive classification for adult acetabular dysplasia (CCAD) was proposed to classify symptomatic hips into three discrete prototypical patterns of hip instability, lateral/global, anterior, or posterior. The purpose of this study was to assess the reliability of this recently published CCAD.

One thirty four consecutive hips that underwent a PAO were categorized using a validated software (Hip2Norm) into four categories of normal, lateral/global, anterior or psosterior. Based on the prevalence of individual dysplasia and using KappaSize R package version 1.1, seventy four cases were necessary for reliability analysis: 44 dysplastic and 30 normal hips were randomly selected. Six blinded fellowship trained raters were then provided with the classification system and they looked at the x-rays (74 images) at two separate time points (minimum two weeks apart) to classify the hips using standard PACS measurements. Thereafter, a consensus meeting was held where a simplified flow diagram was devised before a third reading by four raters using a separate set of 74 radiographs took place.

Intra-rater results per surgeon between Time 1 and Time 2 showed substantial to almost perfect agreement amongst the raters. With respect to inter-rater reliability, at time 1 and time 2, there was substantial agreement overall between all surgeons (kappa of 0.619 for time 1 and 0,623 for time 2). Posterior and anterior rating categories had moderate and fair agreement at time 1 and time 2, respectively. At time 3, overall reliability (kappa of 0.687) and posterior and anterior rating improved from Time 1 and Time 2.

The comprehensive classification system provides a reliable way to identify three categories of acetabular dysplasia that are well-aligned with surgical management. The term borderline dysplasia should no longer be used.

Developmental dysplasia of the hip (DDH) is a common risk factor of early osteoarthritis (OA), with insufficient coverage of the femoral head by the acetabulum which leads to excessive cartilage stresses in the hip joint. Knowledge of the molecular health of cartilage using MRI may diagnose and stage chondral disease, but more importantly allows for treatment stratification and prognostication. Delayed gadolinium-enhanced magnetic resonance imaging of cartilage (dGEMRIC) is a validated MRI technique for detecting early loss of proteoglycan (PG). However, it requires an injection of contrast agent and exercise prior to the scan. MRI techniques such as T1ρ and T2 mapping have also been shown to be sensitive to early biochemical changes in cartilage but can be performed without any contrast injection. In this study we evaluate three quantitative MR techniques (dGEMRIC, T1ρ and T2 mapping) in patients with DDH. Our hypothesis is that both T1ρ and T2 correlate with dGEMRIC, and thus may be effective non-contrast based techniques for biochemical cartilage mapping in DDH hips.

Seven informed and consented patients (mean age: 31.1 years) with DDH were enrolled in this IRB approved MRI study before surgery. DDH was defined as a lateral center-edge angle under 25º and acetabular index >13º on the plain x-ray. All subjects underwent two successive MRI sessions at 3T: In the first cartilage T1ρ and T2 mapping were performed. After leaving the scanner the subjects were injected with 0.4ml/kg Dotarem (i.v.), walked for 15min and rested for 25min before returning into the MRI. dGEMRIC (T1post) mapping was initiated approximately 45min after the injection. Image post-processing, registration and cartilage segmentation was performed with Matlab. The joint was subdivided into anterior and posterior regions in the sagittal plane and into lateral, intermediate and medial zones in the transverse plane, resulting in six region of interest (ROIs): antero-lateral, antero-intermediate, antero-medial, postero-lateral, postero-intermediate and postero-medial. The correlation between the dGEMRIC and T1ρ and dGEMRIC and T2 were evaluated using Spearman's Rho and tested for significance.

The analysis of all six cartilage ROIs for all subjects resulted in a significant (p < 0 .001) negative correlation (Rho = −0.50) between the dGEMRIC index (T1post) and the T1ρ relaxation time. The dGEMRIC index and T2 correlated positive (Rho = 0.55) and significant (p < 0 .001).

Although this pilot study has a small sample size a negative correlation between dGEMRIC and T1ρ was found in patients with DDH. Both methods are known to probe the PG content of cartilage, where a decreased PG content leads to lower dGEMRIC index and an increased T1ρ value. The correlation coefficient was moderate, but significant, which shows that T1ρ mapping as an effective tool to probe the cartilage PG content similar to dGEMRIC. A comparable, but positive correlation was found between dGEMRIC and T2. T2 is sensitive to the cartilage collagen content with a decreased T2 value in degenerated cartilage. In symptomatic DDH, where an onset of OA is assumed, both PG depletion and collagen decay are in progress and can be evaluated using these mapping techniques.