Editorial Commentary: Comprehensive Treatment of Hip Acetabular Dysplasia Plus Labral and/or Cam Pathology With Combined Periacetabular Osteotomy and Hip Arthroscopy.

Periacetabular osteotomy (PAO) is the agreed-upon treatment for symptomatic hip dysplasia in the skeletally mature patient. Many surgeons perform hip arthroscopy to address intra-articular damage around the time of the PAO. Other surgeons believe that correcting the dysplasia with the PAO unloads the soft tissues, which negates the need for arthroscopy.

The incidence of subsequent hip arthroscopy after rectus-sparing periacetabular osteotomy.

Aims: Periacetabular osteotomy (PAO) is the preferred treatment for symptomatic acetabular dysplasia in adolescents and young adults. There remains a lack of consensus regarding whether intra-articular procedures such as labral repair or improvement of femoral offset should be performed at the time of PAO or addressed subsequent to PAO if symptoms warrant. The purpose was to determine the rate of subsequent hip arthroscopy (HA) in a contemporary cohort of patients, who underwent PAO in isolation without any intra-articular procedures.

Editorial Commentary: High Tibial Osteotomy and Distal Femoral Osteotomy Address Biologics and Biomechanics.

Osteotomies were historically a common treatment for knee osteoarthritis. This has given way to arthroplasty in many patients. However, osteotomies are still an excellent treatment for younger patients with malignment and joint pain.

Combined Borderline Acetabular Dysplasia and Increased Femoral Anteversion Is Associated With Worse Outcomes in Female Patients Undergoing Hip Arthroscopy for Femoroacetabular Impingement.

Purpose: To determine the relationship of increased femoral anteversion and borderline acetabular dysplasia on the outcomes of hip arthroscopy for femoroacetabular impingement in a female cohort of patients.

Methods: This is a retrospective study of female patients undergoing hip arthroscopy for femoroacetabular impingement. All patients had preoperative radiographs and computed tomography scans from which lateral center edge angle (LCEA) and femoral anteversion were measured.

Association of Radiographic Markers of Hip Instability and Worse Outcomes 2 to 4 Years After Hip Arthroscopy for Femoroacetabular Impingement in Female Patients.

Background: Reported outcomes of patients undergoing hip arthroscopy for femoroacetabular impingement (FAI) with underlying borderline acetabular dysplasia are mixed. This may in part be the result of mixed-sex reporting.

Purpose: To determine the effect of radiographic measures of acetabular dysplasia and hip instability on outcomes of female patients undergoing hip arthroscopy for FAI.

Asymmetrically increased femoral version with high prevalence of moderate and severe femoral anteversion in unilateral Legg-Calvé-Perthes disease.

Purpose: To determine and stratify femoral version in Legg-Calvé-Perthes disease (LCPD), and to compare the femoral version between the LCPD hip and the contralateral unaffected hip.

Methods: We performed a retrospective review of 45 patients with unilateral LCPD who had available CT scan through the hips and knees between January 2000 and June 2017. There were 34 (76%) male cases with a mean age of 14 years (sd 4.

Editorial Commentary: Complete Capsular Closure During Hip Arthroscopy Provides the Most Reliable and Durable Outcome . . . Capsule Closed . . . Case Closed!

The management of the hip capsule has been a recent area of controversy in hip arthroscopy. Over the past 5 years, there has been mounting biomechanical and clinical evidence that complete capsular closure is an important step to achieve the best and most durable outcome from hip arthroscopy. Numerous studies in the laboratory have shown that repairing the capsulotomy during simulated hip arthroscopy establishes normal hip biomechanics.

Transition to Telehealth Physical Therapy After Hip Arthroscopy for Femoroacetabular Impingement: A Pilot Study With Retrospective Matched-Cohort Analysis.

Background: Telehealth use has increased significantly of late. However, outside of total hip and knee arthroplasty, there is minimal evidence regarding its efficacy in orthopaedics and postoperative rehabilitation.

Purpose: To determine the efficacy and cost-effectiveness of a transition to postoperative telehealth physical therapy in patients undergoing hip arthroscopy for femoroacetabular impingement (FAI).

Standardizing the Diagnostic Evaluation of Nonarthritic Hip Pain Through the Delphi Method.

Background: Femoroacetabular impingement and acetabular dysplasia have gained increased attention as nonarthritic sources of pain and dysfunction in young, active patients. To date, no standardized approach to the diagnostic evaluation of nonarthritic hip pain has been identified, as previous work has focused on the diagnostic evaluation and management of patients with femoroacetabular impingement undergoing hip arthroscopy.

Purpose: To explore the standard diagnostic evaluation practice of experts in the field of hip preservation surgery and combine their expertise through the Delphi method to form a standardized approach to the diagnostic evaluation of patients with nonarthritic hip pain.

Acetabular Coverage Decreases at the End of Skeletal Growth: A 3DCT Study of Healthy Hips.

Background: Abnormalities in size and position of the acetabulum have been linked to both developmental dysplasia of the hip and femoroacetabular impingement. Owing to its 3-dimensional (3D) complexity, plain radiography and cross-sectional studies [computed tomography (CT) and magnetic resonance imaging] have limitations in their ability to capture the complexity of the acetabular 3D anatomy. The goal of the study was to use 3D computed tomography reconstructions to identify the acetabular lunate cartilage and measure its size at varying ages of development and between sexes.

How Common Is Femoral Retroversion and How Is it Affected by Different Measurement Methods in Unilateral Slipped Capital Femoral Epiphysis?

Background: Although femoral retroversion has been linked to the onset of slipped capital femoral epiphysis (SCFE), and may result from a rotation of the femoral epiphysis around the epiphyseal tubercle leading to femoral retroversion, femoral version has rarely been described in patients with SCFE. Furthermore, the prevalence of actual femoral retroversion and the effect of different measurement methods on femoral version angles has yet to be studied in SCFE.

Questions/purposes: (1) Do femoral version and the prevalence of femoral retroversion differ between hips with SCFE and the asymptomatic contralateral side? (2) How do the mean femoral version angles and the prevalence of femoral retroversion change depending on the measurement method used? (3) What is the interobserver reliability and intraobserver reproducibility of these measurement methods?

Methods: For this retrospective, controlled, single-center study, we reviewed our institutional database for patients who were treated for unilateral SCFE and who had undergone a pelvic CT scan.

Surgical treatment of symptomatic post-slipped capital femoral epiphysis deformity: a comparative study between hip arthroscopy and surgical hip dislocation with or without intertrochanteric osteotomy.

Purpose: Our primary research question was to investigate the severity of deformity and articular damage as well as outcomes in patients undergoing hip arthroscopy compared with open surgery for the treatment of symptomatic slipped capital femoral epiphysis (SCFE) deformity.

Methods: Retrospective review of surgical treatment of symptomatic SCFE deformity with a minimum one-year follow-up. Patients were divided into three groups: the arthroscopic group, surgical hip dislocation(SHD) group and SHD with femoral osteotomy (SHD+ITO) group.

Editorial Commentary: The First Hip Arthroscopy Is the Best Hip Arthroscopy, Capsular Defect or Not.

Hip arthroscopy has evolved significantly over the last 5 to 10 years. With this comes the burden of patients with continued pain after their index procedure. Reasons for the need for revision surgery can be many, including incomplete resection of impingement morphology, unrecognized/unaddressed acetabular dysplasia or hip instability, failure to manage the soft tissue appropriately (i.

What factors affect fluoroscopy use during Bernese periacetabular osteotomy for acetabular dysplasia?

Periacetabular osteotomy (PAO) is the treatment of choice for acetabular dysplasia in the skeletally mature. Little is known about factors affecting fluoroscopy use in PAO. Therefore, we strived to determine patient and surgery factors are associated with the amount of fluoroscopy time and radiation dose during PAO.

The Natural History of Femoroacetabular Impingement.

Background: Structural hip abnormalities have long been suspected of causing hip osteoarthritis. The concept of deformity of the proximal femur as a cause of osteoarthritis (OA) started with description of the tilt deformity and progressed to the pistol grip, then eventually cam-type femoroacetabular impingement (FAI). Acetabular over-coverage or retroversion as a cause of impingement is commonly referred to as pincer-type FAI.

Automatic MRI-based Three-dimensional Models of Hip Cartilage Provide Improved Morphologic and Biochemical Analysis.

Background: The time-consuming and user-dependent postprocessing of biochemical cartilage MRI has limited the use of delayed gadolinium-enhanced MRI of cartilage (dGEMRIC). An automated analysis of biochemical three-dimensional (3-D) images could deliver a more time-efficient and objective evaluation of cartilage composition, and provide comprehensive information about cartilage thickness, surface area, and volume compared with manual two-dimensional (2-D) analysis.

Questions/purposes: (1) How does the 3-D analysis of cartilage thickness and dGEMRIC index using both a manual and a new automated method compare with the manual 2-D analysis (gold standard)? (2) How does the manual 3-D analysis of regional patterns of dGEMRIC index, cartilage thickness, surface area and volume compare with a new automatic method? (3) What is the interobserver reliability and intraobserver reproducibility of software-assisted manual 3-D and automated 3-D analysis of dGEMRIC indices, thickness, surface, and volume for two readers on two time points?

Methods: In this IRB-approved, retrospective, diagnostic study, we identified the first 25 symptomatic hips (23 patients) who underwent a contrast-enhanced MRI at 3T including a 3-D dGEMRIC sequence for intraarticular pathology assessment due to structural hip deformities.

Evolving Understanding of and Treatment Approaches to Slipped Capital Femoral Epiphysis.

Purpose Of Review: To review slipped capital femoral epiphysis (SCFE), with a focus on new insights into its etiology and evolving methods of operative fixation.

Recent Findings: The epiphyseal tubercle and its size during adolescence are paramount to understanding the mechanism of SCFE. In chronic stable SCFE, the epiphysis rotates about the tubercle protecting the lateral epiphyseal vessels from disruption.

Editorial Commentary: Acetabular Paralabral Cysts…It's All About Location, Location, Location….

With our increased understanding about the causes of young adult hip pain and femoroacetabular impingement, magnetic resonance imaging has become an important diagnostic tool for identifying labral pathology. However, arthroscopic evaluation is paramount to understanding whether a labral tear truly exists in these patients. Orthopaedic dogma suggests that acetabular paralabral cysts form due to an associated acetabular labral tear.

Mild or Borderline Hip Dysplasia: Are We Characterizing Hips With a Lateral Center-Edge Angle Between 18° and 25° Appropriately?

Background: Controversy surrounds the classification and treatment of hips with a lateral center-edge angle (LCEA) between 18° and 25°. It remains undetermined as to whether periacetabular osteotomy (PAO) or arthroscopic surgery is best used to treat this patient population.

Hypothesis: Patients with hip pain and mild or borderline acetabular dysplasia defined by an LCEA between 18° and 25° have different features of acetabular and femoral morphology, as determined by other relevant radiographic measures assessing the anterior and posterior acetabular walls, anterior coverage of the femoral head by the acetabulum, and femoral head and neck junction sphericity.

Slope-reducing tibial osteotomy decreases ACL-graft forces and anterior tibial translation under axial load.

Purpose: Posterior tibial slope (PTS) represents an important risk factor for anterior cruciate ligament (ACL) graft failure, as seen in clinical studies. An anterior closing wedge osteotomy for slope reduction was performed to investigate the effect on ACL-graft forces and femoro-tibial kinematics in an ACL-deficient and ACL-reconstructed knee in a biomechanical setup.

Methods: Ten cadaveric knees with a relatively high native slope (mean ± SD): (slope 10° ± 1.

What Is the Reliability and Accuracy of Intraoperative Fluoroscopy in Evaluating Anterior, Lateral, and Posterior Coverage During Periacetabular Osteotomy?

Background: Periacetabular osteotomy (PAO) is an established treatment for acetabular dysplasia in the skeletally mature individual. Fluoroscopy is used intraoperatively for osteotomy completion and to judge fragment correction. However, a comprehensive study validating fluoroscopy to judge anterior, lateral, and posterior coverage in PAO has not been reported.

How do the expectations of patients compare with their surgeons regarding outcomes of periacetabular osteotomy?

Our objective was to determine the frequency and strength of agreement between patients and their surgeons on preoperative expectations of the outcomes of periacetabular osteotomy (PAO) surgery. We also sought to determine whether patient preoperative function and pain levels were associated with patients' and surgeons' expectations and to identify the motivating factors for patients to undergo PAO. Two surgeons and their combined 68 patients preoperatively completed 4-point Likert-scales rating their expectations of improvement in six domains representing different hip symptoms after surgery.

Periacetabular Osteotomy Improves Pain and Function in Patients With Lateral Center-edge Angle Between 18° and 25°, but Are These Hips Really Borderline Dysplastic?

Background: The treatment of mild or borderline acetabular dysplasia is controversial with surgical options including both arthroscopic labral repair with capsular closure or plication and periacetabular osteotomy (PAO). The degree to which improvements in pain and function might be achieved using these approaches may be a function of acetabular morphology and the severity of the dysplasia, but detailed radiographic assessments of acetabular morphology in patients with a lateral center-edge angle (LCEA) of 18° to 25° who have undergone PAO have not, to our knowledge, been performed.

Questions/purposes: (1) Do patients with an LCEA of 18° to 25° undergoing PAO have other radiographic features of dysplasia suggestive of abnormal femoral head coverage by the acetabulum? (2) What is the survivorship free from revision surgery, THA, or severe pain (modified Harris hip score [mHHS] < 70) and proportion of complications as defined by the modified Dindo-Clavien severity scale at minimum 2-year followup? (3) What are the functional patient-reported outcome measures in this cohort at minimum 2 years after surgery as assessed by the UCLA Activity Score, the mHHS, the Hip disability and Osteoarthritis Outcome Score (HOOS), and the SF-12 mental and physical domain scores?

Methods: Between January 2010 and December 2014, a total of 91 patients with hip pain and LCEA of 18° to 25° underwent a hip preservation surgical procedure at our institution.