Staged Hip Arthroscopy and Periacetabular Osteotomy in Active Patients Aged 45 Years and Older Produce Comparable Improvements in Outcome Scores to Younger Patients.

Purpose: To determine staged hip arthroscopy and periacetabular osteotomy (PAO) mid-term outcomes in active patients aged 45 years and older compared with a younger group.

Methods: All patients aged 45 years and older who underwent staged arthroscopy and PAO between 2015 and 2021 were retrospectively analyzed and compared with a case-matched control group of younger patients. All patients underwent at least 6 months of nonoperative management prior to surgery.

Risk Factors for Failure of Hip Arthroscopy in Patients With Borderline Dysplasia Include a Tönnis Angle ≥15°, Age ≥40 to 42 Years, Female Sex, Anterior Wall Index <0.35, Labral Debridement, and Preexisting Hip Osteoarthritis: A Systematic Review.

Purpose: To systematically review the literature to determine potential risk factors for failure of hip arthroscopy (HA) in patients with borderline hip dysplasia (BHD).

Methods: A systematic review was conducted according to Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines by searching PubMed, the Cochrane Library, and Embase to identify English-language clinical studies reporting on patients with BHD undergoing HA from 2003 to 2023. The search terms used were (borderline OR mild) AND hip AND (arthroscopy OR dysplasia) AND failure.

The Physics of Postless Hip Arthroscopy.

Hip arthroscopy is commonly performed to treat femoroacetabular impingement syndrome. A post-assisted arthroscopic hip preservation surgery approach provides joint distraction for central-compartment access. Owing to the location, compression of the post in the perineum may cause injuries to the pudendal nerve, perineal soft tissue, or genitourinary system.

Association Between Low-Dose Ketamine After Periacetabular and/or Femoral Osteotomy and Postoperative Opioid Requirements.

Background: Previous studies have sought to determine the effect of inpatient ketamine therapy on postoperative pain in a variety of surgical specialties.

Purpose: To determine the effects of postoperative ketamine analgesia after periacetabular osteotomy (PAO) and/or derotational femoral osteotomy (DFO) on opioid requirements, pain, and discharge time.

Study Design: Cohort study; Level of evidence, 3.

Midterm Outcomes After Simultaneous Hip Arthroscopic Surgery for Bilateral Femoroacetabular Impingement.

Background: Bilateral hip arthroscopic surgery for the treatment of femoroacetabular impingement (FAI) has demonstrated good outcomes at short-term follow-up, with significant improvements in pain, hip function, and patient-reported outcomes, coupled with a complication rate similar to that of unilateral surgery.

Purpose: To investigate whether, in patients with bilateral symptomatic FAI, simultaneous bilateral hip arthroscopic surgery is an efficacious option that produces effective midterm outcomes.

Study Design: Cohort study; Level of evidence, 3.

The Principles of Hip Joint Preservation.

The three primary factors involved in preservation of the hip joint include femoroacetabular impingement (FAI), hip dysplasia/instability, and femoral torsion abnormalities. Each of these factors affects the health of the acetabular labrum and femoroacetabular cartilage. The appropriate surgical treatments for each of these factors include arthroscopic or open femoroplasty/acetabuloplasty for FAI, periacetabular osteotomy for hip dysplasia/instability, and derotational femoral osteotomy for femoral torsion abnormalities.

The Principles of Hip Joint Preservation.

The 3 primary factors involved with preservation of the hip joint are femoroacetabular impingement (FAI), hip dysplasia, and femoral torsion abnormalities. Each of these factors affects the health of the acetabular labrum and femoroacetabular cartilage. The appropriate surgical treatments for each of these factors include arthroscopic or open femoroplasty or acetabuloplasty for FAI, periacetabular osteotomy (PAO) for acetabular dysplasia, and de-rotational femoral osteotomy for femoral torsion abnormalities.

Arthroscopic Femoral Head Allograft With Proximal Femoral/Periacetabular Osteotomies for Sequelae of Perthes: A Case Report.

Case: We describe the unique case of a 20-year-old man with a history of Legg-Calve-Perthes disease, hip dysplasia, and osteochondral fragmentation of the medial femoral head. We performed arthroscopic femoroplasty and femoral head allografting, followed by a valgus-producing derotational femoral osteotomy (DFO) and periacetabular osteotomy (PAO). At 1-year follow-up, the patient achieved osseous union and complete femoral head healing with return to his active hobbies.

Patients Undergoing Postless Hip Arthroscopy Demonstrate Significantly Better Patient-Reported Outcomes and Clinically Significant Outcomes Compared to Conventional Post-Assisted Hip Arthroscopy at Short-Term Follow-Up.

Purpose: To prospectively compare the short-term clinical outcomes of patients undergoing hip arthroscopy with versus without the use of a perineal post.

Methods: A prospective, single-surgeon cohort study was performed on a subset of patients undergoing hip arthroscopy between 2020 and 2022. A post-free hip distraction system was used at 1 center at which the senior author operates, and a perineal post was used at another surgical location.

The Everted Acetabular Labrum: Outcomes of Surgical Management.

Background: An everted acetabular labrum (EL) is a pathologic variant in which the labrum is flipped to the capsular side of the acetabular rim. An iatrogenic EL is a known complication of a poorly executed labral repair, and a recent study described the native acetabular EL.

Purpose: To analyze surgical outcomes after advancement or reconstruction of an EL in a native hip.

During Postless Hip Arthroscopy, Male Patients, High Body Mass Index, Low Beighton Scores, and Limited Range of Motion Require High Traction Force.

Purpose: To determine the effects of demographic and anatomic factors on traction force required during postless hip arthroscopy.

Methods: A prospectively collected database was retrospectively analyzed on patients undergoing hip arthroscopy by the senior author, including patient sex, age, body mass index (BMI), Beighton Hypermobility Score, hip range of motion in clinic and under anesthesia, hip dysplasia, acetabular version, and femoral version. All patients underwent postless hip arthroscopy under general anesthesia.

Radiographic Parameters of Adult Hip Dysplasia.

As knowledge about the origin and morphologic characteristics of hip pain in the young adult has evolved, so too has the clinician's ability to assess for various pathologies of the hip on radiographs, magnetic resonance imaging (MRI)/magnetic resonance arthrography (MRA), and computed tomography (CT). Because there is no algorithm at this time directly indicating what to do in more subtle hip morphologies, such as microinstability and borderline hip dysplasia (BHD), a skilled hip preservation specialist must use multiple imaging sources and know how to interpret them correctly. Imaging parameters used in the workup for hip dysplasia and BHD include the lateral center-edge angle, Tönnis angle, iliofemoral line, and presence of an upsloping lateral sourcil or everted labrum, among many others.

Postless Arthroscopic Hip Preservation Can be Adequately Performed Using Published Techniques.

Purpose: To identify and evaluate techniques used for postless hip arthroscopy.

Methods: A narrative review was performed using Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines to identify surgical technique articles or clinical studies describing techniques for the use of postless hip arthroscopy. Specific items sought for analysis included hip arthroscopy for femoroacetabular impingement including cam or pincer-type lesions, surgical time, traction time, traction force, bed Trendelenburg angle, intraoperative techniques, and postoperative outcomes, including complications.

Current Trends in the Use of Postless Hip Arthroscopy: A Survey of the International Society for Hip Arthroscopy Membership.

Background: Previous studies have demonstrated the risks of pudendal nerve and/or soft tissue complications due to the use of a perineal post during hip arthroscopy. Recently, various postless hip arthroscopy techniques have been described in the literature.

Purpose: To assess the current international trends in the use of postless hip arthroscopy among hip preservation specialists.

A Technique for Optimizing Hip Labrum Suction Seal With a Double-Limb, Oblique Inverting Mattress Stitch: The "X" and the "M" Configurations.

Classic techniques in arthroscopic hip labral repair use circumferential or intrasubstance suture secured with anchors typically placed behind the labrum (capsular side). The primary goal of labral repair is to re-establish the hip suction seal and is often achieved via fixation techniques that invert viable labral tissue to restore or improve contact with the femoral head. Many repair techniques use only 1 suture limb either passed circumferentially around the labrum or passed in an intrasubstance manner, resulting in smaller purchase of labral tissue and lack of a strong inverting vector.

A Prospective Comparison of Groin-Related Complications After Hip Arthroscopy With and Without a Perineal Post.

Background: Previous studies have demonstrated various groin-related nerve and soft tissue complications in patients undergoing hip arthroscopy with a perineal post.

Purpose: To prospectively compare groin-related nerve and soft tissue complications between patients undergoing hip arthroscopy with and without the use of a perineal post.

Study Design: Cohort study; Level of evidence, 2.

Correlation of Delayed Gadolinium-Enhanced MRI of Cartilage (dGEMRIC) Value With Hip Arthroscopy Intraoperative Findings and Midterm Periacetabular Osteotomy Outcomes.

Background: Delayed gadolinium-enhanced magnetic resonance imaging of cartilage (dGEMRIC) is an advanced imaging technique that is purported to quantify cartilage damage in acute and chronic joint disease and predict periacetabular osteotomy (PAO) outcomes. There is a paucity of literature relating dGEMRIC values to arthroscopic findings before PAO and postoperative outcomes after PAO.

Purpose: To assess the utility and validity of dGEMRIC as a preoperative and prognostic assessment tool of cartilage status and integrity as it relates to intraoperative findings and midterm postoperative outcomes after PAO.

A proposed algorithm for the treatment of core muscle injuries.

In recent years, there has been increased awareness and treatment of groin injuries in athletes. These injuries have been associated with various terminologies including sports hernia, core muscle injury (CMI), athletic pubalgia and inguinal disruption, among others. Treatment of these injuries has been performed by both orthopaedic and general surgeons and may include a variety of procedures such as rectus abdominis repair, adductor lengthening, abdominal wall repair with or without mesh, and hip arthroscopy for the treatment of concomitant femoroacetabular impingement.

Criteria for the Operating Room Confirmation of the Diagnosis of Hip Instability: The Results of an International Expert Consensus Conference.

Purpose: The purpose of this study was to establish an international expert consensus on operating room findings that aid in the diagnosis of hip instability.

Methods: An expert panel was convened to build an international consensus on the operating room diagnosis/confirmation of hip instability. Seventeen surgeons who have published or lectured nationally or internationally on the topic of hip instability were invited to participate.

Post-Related Complications in Hip Arthroscopy Are Reported Significantly Greater in Prospective Versus Retrospective Literature: A Systematic Review.

Purpose: To determine whether there are differences in (1) the incidence of post-related complications following hip arthroscopy between prospective and retrospective publications; and (2) between post-assisted and postless techniques.

Methods: A systematic review was performed using PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines to characterize post-related complications following hip arthroscopy for central or peripheral compartment hip pathology, including femoroacetabular impingement syndrome and chondrolabral injury. Inclusion criteria were prospective and retrospective Level I-IV evidence investigations that reported results of hip arthroscopy performed in the supine position.

Platelet-Rich Plasma Versus Hyaluronic Acid for Hip Osteoarthritis Yields Similarly Beneficial Short-Term Clinical Outcomes: A Systematic Review and Meta-analysis of Level I and II Randomized Controlled Trials.

Purpose: To systematically review the literature to compare the efficacy of platelet-rich plasma (PRP) and hyaluronic acid (HA) injections for the treatment of hip osteoarthritis (OA).

Methods: A systematic review was performed by searching PubMed, the Cochrane Library, and Embase to identify randomized controlled trials that compared the clinical efficacy of PRP and HA injections for hip OA. The search phrase used was hip, osteoarthritis, platelet-rich plasma, hyaluronic acid, randomized.

Risk of Infection in Knee Arthroscopy Patients Undergoing Corticosteroid Injections in the Perioperative Period.

Background: Recent evidence suggests that there may be an increased risk of infection for patients undergoing a corticosteroid injection before, during, or after knee arthroscopy.

Purpose: To systematically review the literature to evaluate the risk of postoperative infection in patients undergoing intra-articular corticosteroid injections (CSI) before, during, or after knee arthroscopy.

Study Design: Systematic review; Level of evidence, 3.