Abstract Avascular necrosis of the femoral head (AVN) is a progressive disorder that may lead to femoral head deformity and total hip arthroplasty (THA). Bone marrow aspirate concentrate (BMAC) and hyperbaric oxygen therapy (HBOT) are used as adjuncts to core decompression (CD), but comparative evidence is limited. In this retrospective cohort study, 87 patients with Ficat–Arlet IIA–IIB AVN underwent CD + BMAC (n = 42, Group A) or CD + HBOT (n = 45, Group B) between 2012 and 2023. Inclusion required MRI-confirmed AVN, Tönnis grade 0–1, and a minimum follow-up of 24 months. Clinical outcomes were assessed using the Harris Hip Score (HHS), and radiological progression using the Tönnis classification. Most baseline characteristics were similar between groups, except for affected side (right-sided involvement: 45.2% versus 66.7%, P = 0.044) and bilaterality (50.0% versus 24.4%, P = 0.014). Among patients who did not undergo THA (n = 66; Group A, n = 31; Group B, n = 35), mean HHS did not differ between groups (83.68 ± 10.34 versus 82.69 ± 11.22, P = 0.711). Tönnis grade distribution (P = 0.361) and THA conversion rates (26.2% versus 22.2%, P = 0.803) also did not differ significantly between groups. Stage IIB patients showed worse outcomes, with shorter THA-free survival (log-rank P = 0.036). Two-way analysis of variance (ANOVA) revealed no treatment × stage interaction (P = 0.193). On multivariable analysis, the combined necrotic angle was the only independent predictor of both radiological progression and THA conversion, whereas Ficat stage was not independently associated with either outcome. The combined necrotic angle showed acceptable discrimination for THA conversion (AUC = 0.773). In this cohort, no significant difference in clinical or radiological outcomes was detected between CD + BMAC and CD + HBOT in early-stage femoral head AVN; however, the study was not powered to establish equivalence. Necrotic lesion extent was the strongest prognostic factor identified in this cohort. Level of Evidence: Therapeutic Level III, retrospective comparative study.
Abstract This study aimed to quantify the patient-level carbon footprint of hip arthroscopy in athletically active patients and to identify its structural determinants and relationship with functional outcomes. A retrospective cohort study was conducted on 58 athletically active patients who underwent primary hip arthroscopy for femoroacetabular impingement between March 2023 and March 2025 at a tertiary center. Carbon emissions (kgCO₂e) were calculated per patient across six domains: operating room energy, surgical materials, sterilization, anesthesia, patient transportation, and waste management. Functional outcomes were assessed using the International Hip Outcome Tool-12 (iHOT-12), Hip Outcome Score–Activities of Daily Living, and Hip Outcome Score–Sport at 12 months. Multivariable regression identified independent predictors of total carbon footprint and carbon efficiency. The mean total carbon footprint was 75.14 ± 24.18 kgCO₂e per patient. Transportation (52.9%) and surgical materials (29.6%) were the largest contributors. Patient travel distance (β = 0.797, P < .001), operation time (β = 0.860, P = .003), and visit count (β = 7.187, P = .009) were significant predictors, with the structural model explaining 77.7% of variance (adjusted R2 = 0.751). Material-related emissions differed significantly between 2 versus ≥3 anchor groups (P = .022), although the 2-anchor subgroup (n = 4) should be interpreted as hypothesis-generating. Higher preoperative iHOT-12 scores (β = 0.005, P = .017) predicted better carbon efficiency, while revision surgery predicted poorer efficiency (β = −0.171, P = .038). In this exploratory single-center study, the carbon footprint of hip arthroscopy was predominantly driven by patient transportation and surgical materials. These findings suggest that optimizing travel logistics, operative efficiency, and material selection may reduce environmental impact without compromising clinical outcomes, although validation in larger multicenter cohorts is warranted. Highlights What is known about this subject: Healthcare operations generate 4%–5% of global greenhouse gas emissions, with orthopedic surgery being a primary source due to energy-intensive equipment and high consumable turnover.While previous life cycle assessments have quantified emissions for knee and hip arthroplasty, the environmental burden of hip arthroscopy, a procedure involving specialized anchors and distinct anesthesia protocols, remains unexplored.The relationship between a procedure’s environmental cost and the clinical value it returns (functional improvement) has not been previously modeled in sports medicine. What this study adds to existing knowledge: This study provides, to our knowledge, the first patient-level carbon footprint analysis for hip arthroscopy, revealing a mean emission of 75.14 kgCO₂e, primarily driven by patient transportation (52.9%) and surgical materials (29.6%).It demonstrates that specific surgical choices, such as using suture anchors instead of metal anchors and minimizing anchor count, significantly reduce material-related emissions without affecting 12-month functional outcomes (International Hip Outcome Tool-12 (iHOT-12), Hip Outcome Score).The introduction of the “Carbon Efficiency” metric suggests that patients with higher baseline function may derive a greater clinical return per unit of carbon emitted, while revision surgery substantially diminishes environmental efficiency; however, this association should be interpreted as descriptive rather than causal.The findings provide a data-driven roadmap for “Green Sports Medicine,” highlighting that optimized travel logistics, surgical efficiency, and judicious material selection can decouple clinical excellence from environmental impact.
Abstract Femoroacetabular impingement syndrome (FAIS) is a recognized risk factor for early hip osteoarthritis (OA), and hip arthroscopy (HA) is widely used as a joint-preserving intervention. While short- and mid-term outcomes are favourable, long-term effects of HA on structural degeneration and conversion to total hip arthroplasty (THA) remain unclear. This systematic review and meta-analysis evaluated long-term degenerative outcomes following HA for FAIS. PubMed, MEDLINE, and Embase were searched from inception to 12 October 2025. Studies reporting mean follow-up ≥10-years and at least one degenerative endpoint (OA progression, new radiographic OA, or THA conversion) were included. Two independent reviewers performed screening, data extraction, and methodological assessment using the methodological index for non-randomized studies (MINORS). Random-effects meta-analyses generated pooled THA conversion rates, with subgroup analyses stratifying labral management and preoperative OA severity. Sixteen studies (2432 patients; mean age 28–44 years; follow-up 10–20 years) were included. The pooled THA conversion rate was 16% (95% confidence interval [CI], 12%–21%). Labral-preserving cohorts demonstrated lower THA conversion (7%; 95% CI, 5%–9%). Preoperative OA strongly predicted failure, with THA conversion of 8% in Tönnis grade 0–1 hips compared with 27% in higher-grade OA. Two comparative studies showed no significant difference in THA conversion between HA and conservative management, although both reported less OA progression following HA. At ≥10-year follow-up, HA for FAIS demonstrates variable long-term survivorship. Labral preservation and minimal preoperative OA are associated with improved outcomes, and limited comparative evidence suggests HA may mitigate OA progression compared with nonoperative care.
Early surgical intervention for avascular necrosis (AVN) of the femoral head can preserve the hip joint and delay the need for total hip arthroplasty (THA). Therefore, the purpose of this study is to compare the efficacy of various surgical modalities to treat femoral head AVN as assessed by THA-free survivorship, radiographic failure, and patient reported outcomes measures (PROMs). PubMed, Cochrane, and Scopus were queried in March 2024. Studies reporting THA conversion rates at minimum 2-year follow-up after index surgery for femoral head AVN were included. Seventy study cohorts met inclusion criteria across all interventions: Core Decompression (CD) (n=20), Core Decompression with Orthobiologics (CDO) (n=15), Vascularized Bone Grafting (VBG) (n=19), and Rotational Osteotomy (RO) (n=16), representing 6,573 patients [CD n: 910; CDO: 779; VBG: 3998; RO: 886]. Conversion to THA rates among the various surgical techniques were: 41.8% for CD, 29.7% for CDO, 9.7% for VBG, and 24.3% for RO. Post-operative radiographic failure rates included: 47.0% for CD, 37.1% for CDO, 33.3% for VBG, and 31.2% for RO. Finally, all four surgical techniques reported improved post-operative PROMs compared to pre-operative scores. VBG patients report lower rates of conversion to THA compared to those undergoing other surgical management techniques. CD patients had the highest rates of radiographic failure and THA-free survivorship that both decreased with orthobiologic augmentation. Furthermore, patients had improvement in post-operative PROMs compared to pre-operative scores regardless of surgical technique.
Periacetabular osteotomy (PAO) is an established surgical intervention for symptomatic acetabular dysplasia. While outcomes are traditionally assessed through patient-reported outcome measures (PROMs), the broader impact on return to activities of daily living (ADLs) remains underexplored. This systematic review aims to synthesize existing literature on post-PAO recovery beyond conventional PROMs, focusing on occupational reintegration, return to sports, driving, sexual function, and social participation. A systematic search of MEDLINE, Embase, and MEDLINE databases was conducted, identifying studies reporting on ADL outcomes following PAO. Thematic analysis was used to categorize and synthesize data across diverse domains due to heterogeneity in study designs and outcomes measures. Eleven eligible studies were identified. PAO generally supports favourable recovery across multiple ADLs. Patients typically return to work and sports, though modifications in role or activity type are common. Return to sports outcomes vary by baseline athletic level, with competitive athletes facing greater challenges. Sexual health improvements are frequently linked to pain reduction, though outcomes are often variable. Limited evidence suggests temporary impairments in driving function, while broader improvements in social engagement and quality of life are evident over time. However, research across these domains remains limited and inconsistent in outcome definition. Beyond biomechanical correction, PAO impacts diverse aspects of daily life. A more holistic understanding of recovery, integrating ADL and psychosocial outcomes, is essential for optimizing patient counselling and care. Future research should prioritize standardized definitions, long-term follow-up, and the use of novel tools to assess real-world function.
The impact of arthroscopic hip surgery on urinary incontinence (UI) and other pelvic floor disorders (PFDs), such as faecal incontinence (FI) and pelvic organ prolapse (POP), has been understudied, despite the high prevalence of PFDs in women. The purpose of this prospective, single-centre cohort study was to evaluate changes prevalence of UI at baseline and 3 months post-procedure among women undergoing hip arthroscopy for the treatment of hip labral tears and femoroacetabular impingement syndrome (FAIS). We secondarily sought to assess UI at 1 year, in addition to FI and POP at 3 months and 1 year. Of 55 baseline participants, 46 (83.6%) and 40 (72.7%) completed 3 month and 1-year follow-ups, respectively. Mean participant age was 36 +/- 12 years. Between 18.18 and 23.64% of women reported prevalence of stress urinary incontinence (SUI), whereas 9.09%-16.36% of women reported urgency urinary incontinence (UUI). SUI and UUI rates did not significantly change between baseline and 3 months or 1 year. There was no significant difference in prevalence of UI, FI, or POP symptoms between baseline and 3 months, though a trend was observed towards improved symptom and quality-of-life scores between baseline and 1 year. In conclusion, we found no significant differences in UI prevalence or other PFDs at 3 months or 1 year postoperatively. Our findings suggest that women with symptomatic PFDs may still require treatment for pelvic floor symptoms following hip arthroscopy. Larger studies are needed to understand the full impact of arthroscopic hip surgery on long-term pelvic floor symptoms.
Core decompression is a standard treatment for early-stage osteonecrosis of the femoral head (ONFH). Synthetic bone substitutes such as biphasic calcium composite (CaSO4/CaPO4) and bioactive glass have been used to augment the procedure, but their clinical benefit remains uncertain. We retrospectively reviewed 83 hips (78 patients) treated with core decompression, with or without augmentation, from 2013 to 2024 at two hospitals. Patients received biphasic calcium, bioactive glass, or no graft. The primary endpoint was conversion to total hip arthroplasty (THA). Kaplan-Meier survival and multivariate logistic regression were performed. THA occurred in 38.9% of biphasic calcium cases, 42.9% with bioactive glass, and 42.1% in controls (P = .959). Kaplan-Meier analysis showed no significant survival difference (log-rank P = .707). BMI >= 25 predicted higher THA risk (OR 7.98; 95% CI 2.03-31.32; P = .003). Compared with alcohol-related or other aetiologies, steroid-associated ONFH was associated with a lower risk of THA conversion (adjusted OR 0.11; P = .020). Synthetic augmentation did not reduce THA conversion after core decompression for ONFH. Elevated BMI was a strong predictor of failure, underscoring the importance of patient selection and modifiable risk factors in hip-preserving surgery.
The ligamentum teres (LT) is frequently found injured during hip arthroscopy in young, active patients, yet its functional relevance remains uncertain. Although not a primary stabilizer, the LT may contribute to intra-articular pain through nociceptive and proprioceptive mechanisms. Most existing histological studies focus on older arthroplasty patients or cadaveric specimen leaving limited information on young adults undergoing joint-preserving surgery, which is the population at risk.This study aimed to determine (i) the presence of mechanoreceptors-specifically Vater-Pacinian corpuscles and Ruffini endings-and (ii) the presence of T-cell infiltration as a marker of inflammation. LT samples were harvested intraoperatively from 21 consecutive patients undergoing surgical hip dislocation (April-September 2019). After excluding individuals with prior hip surgery or Legg-Calv & eacute;-Perthes disease, 16 specimens were analysed. Preoperative anteroposterior pelvis radiographs and CT determined hip morphology. Samples were paraffin-embedded, stained with Masson-Goldner, and examined histologically. Immunohistochemistry with SMI-31 and S100 identified nerve fibres, while CD3 staining detected T-lymphocytes. Lymphocyte infiltration was graded as absent, moderate, or severe.No type I-III mechanoreceptors were found in any specimen, although all LTs contained unmyelinated free nerve endings (type IV). T-cell infiltration was present in 88% of samples, most commonly in the mid-substance, followed by the acetabular and femoral regions.These findings support the LT as a potential source of hip pain in young patients, reflecting both sensory innervation and immune activation. Recognition of LT pathology may aid in diagnosing unexplained intra-articular hip pain and guide targeted management.Level of Evidence: IV.
The field of hip arthroscopy has rapidly advanced, becoming a primary treatment for hip disorders like femoroacetabular impingement (FAI) and labral tears. While effective for addressing mechanical impingement, managing subchondral injuries remains challenging. The condition of subchondral bone, critical for joint stability and load distribution, is often overlooked, with no established classification system for assessing its health. This study aims to assess the interobserver and intraobserver reliability of a novel subchondral porosity and resilience score (SPRS) classification for evaluating subchondral femoral head and neck bone health. A prospective study was conducted on adult patients undergoing hip arthroscopy for FAI at a tertiary orthopedic center. A novel scale was developed to quantify SPRS observations of trabecular volume, porosity, and deformity and was employed to assess subchondral bone health after the removal of articular cartilage. Grading was performed by three fellowship-trained orthopedic surgeons based on arthroscopic images and intraoperative videos. Interobserver and intraobserver reliability were assessed using the intraclass correlation coefficient (ICC) and Fleiss' kappa statistics. A total of 58 patients were evaluated. The overall interobserver agreement was high, with a percent agreement of 90.8% and an ICC of 0.92. Fleiss' kappa value was 0.85, indicating substantial agreement among raters. Each individual SPRS grade showed substantial to perfect agreement, particularly Grade 4, which achieved a kappa value of 1.00. Kendall's coefficient of concordance was 0.94, demonstrating high concordance among raters. The SPRS classification demonstrates strong interobserver and intraobserver reliability, suggesting its potential utility for assessing subchondral bone health during hip arthroscopy. A standardized grading system could enhance clinical decision-making and inform future research on the relationship between bone quality and patient outcomes.
Central compartment (CC) first hip arthroscopy is the traditional method for accessing the hip arthroscopically. However, hip instability and iatrogenic damage have been associated with this hip arthroscopy approach. Recently, peripheral compartment (PC) first with limited periportal capsulotomies has been shown to be a safe and effective method while maintaining capsular integrity. The purpose of this study was to assess whether there is a difference in early patient outcomes and surgical components between the CC first approach with capsulotomy and capsule repair versus the PC first approach with periportal access for the arthroscopic treatment of femoroacetabular impingement and labral pathology. We retrospectively reviewed 45 patients who underwent CC first approach (control group) and 57 patients who underwent PC first approach (study group). Significant improvement in average subjective hip value and modified Harris Hip Score values were seen in the study group 3 months postoperatively (94.28 +/- 5.28, 69.56 +/- 6.29) compared to the control group (88.24 +/- 9.58, P = .001; 65.96 +/- 4.81, P = .002) respectively, but pain scores were not significantly different at 3 months postoperatively. Average traction and surgical times were significantly lower in the study group (38.26 +/- 6.15 min, 106.02 min +/- 24.42) versus the control group (48.16 +/- 10.52 min, P < .001; 134.89 min +/- 29.13, P < .001), respectively. The PC first approach is associated with significant improvements in surgical time, traction time, and early patient reported outcome scores when compared to the CC first approach, although follow up time was limited to 3 months.
This study aims to compare the biomechanical stability of different screw and plate configurations used in the fixation of acetabular fragments after periacetabular osteotomy (PAO). A total of 42 synthetic hemipelvis models were categorized into six fixation groups: three iliac screws (3 V), four iliac screws (4 V), three screws + lateral compression (LC) screw (3 V + LC), locking three-screw plate (3P), plate + LC screw (3P + LC), and eight-screw plate (4P). All samples were evaluated for stiffness under a constant load of 700 N and for stiffness under maximum load. The greatest failure load was observed in the 3 V group (1249.4 N), whereas the 3P group demonstrated the lowest (658.5 N). In terms of maximum force, both the 3 V and 4 V groups were significantly superior to the 3P (P = .003 and P = .018, respectively) and 3P + LC (P = .006 and P = .021, respectively) groups. Although the 4P configuration showed the highest fracture stiffness (155.1 N/mm), this did not differ significantly among groups. Stiffness at a constant load of 700 N, the 3 V and 3 V + LC groups demonstrated higher stiffness than the 3P and 3P + LC groups, with comparisons to the 3P group approaching statistical significance (P = .064 and P = .063, respectively). Traditional iliac screw structures (especially 3 V and 4 V) provide effective fixation in terms of load-bearing and stiffness, while plate-based systems require a high number of screws and optimal placement to provide adequate stability. Although the LC screw increases stiffness, it provides only a limited contribution to breaking strength.
The purpose of this study was to determine if marijuana use was correlated with patient reported outcomes or complications after arthroscopic treatment of femoroacetabular impingement syndrome (FAIS). This was a cohort Study (Level of Evidence: 3). Data were prospectively collected from patients with a minimum of 2-year follow-up after arthroscopic treatment for FAIS. Inclusion criteria included primary hip arthroscopy for FAIS and completion of both preoperative and 2-year postoperative Hip Disability and Osteoarthritis Outcome Scores (HOOS) surveys. Primary outcomes were the HOOS subscales. Secondary outcomes included complications and subsequent hip surgery. Patients were divided into two cohorts according to preoperative self-reported marijuana use: current/prior use ('User') versus no use ('Nonuser'). Additional predictors included demographics, tobacco use, radiographic and intraoperative data, and preoperative HOOS scores. Included were 101 patients: 31 in the User cohort and 70 in the Nonuser cohort. Baseline demographics between cohorts were similar in most categories, except for a statistically greater history of tobacco use (54.8% versus 14.3%, P < .001). Mean HOOS change scores and rates of minimal clinically important difference (MCID) achievement were similar between groups, except for the Pain subscale, where more Nonusers achieved MCID than Users (P = .026). Rates of complications and revisions were similar between groups. In this prospective cohort study, patients with a current or prior use of marijuana ('Users') had similar outcomes to Nonusers after arthroscopic treatment for FAIS at 2-year follow up, although fewer Users reached the MCID for HOOS pain and most outcomes trended worse in the User group.
Background: One of the reasons for revision surgery post-hip arthroscopy (HA) is adhesions. Losartan displays inhibitory effects on transforming growth factor beta (TGF-beta) and has been used to mitigate the impact of scar tissue formation and adhesions. This study aimed to assess the compliance of patients undergoing HA with Losartan off-label use, the reasons for non-compliance, and the subsequent short-term patient-related outcomes. Methods: A prospective clinical study evaluated compliance amongst 177 consecutive patients prescribed off-label Losartan for 2 weeks post-HA. A novel questionnaire was developed for patients to complete at their 6-week follow-up to assess compliance and identify reasons for non-compliance. Clinical and functional outcomes were assessed at 1-year follow-up and compared between Losartan-compliant and Losartan-non-compliant patients. Results: The compliance rate was 54%. There were 14.6% (n = 14) who experienced adverse effects in the 'compliant' group and 13.6% (n = 11) in the 'non-compliant' group. The main reasons for non-compliance were avoiding side effects (55%), forgetting to take the medication (30%), and insufficient education (25%). The patient activation measure (PAM) score correlated compliance directly to a patient activation measure (P-value < 0.0001). Conclusion: No demographic or surgical factors were predictive of adherence. The only significant association with adherance was with lower PAM scores, (95% confidence interval, P-value < 0.0001), highlighting the importance of patient education in optimizing adherence. No early differences in clinical or functional outcomes were found between the groups, raising questions about the short-term benefit of Losartan. Its favourable safety profile and potential to reduce revision risk, as reported in large-scale studies, warrant further investigation.
Maximal outcome improvement (MOI), the percentage of total possible patient-reported outcome measure (PROM) score improvement from baseline, is increasingly being used to describe clinical significance of PROMs. This study defines MOI thresholds for the modified Harris Hip Score (mHHS) and International Hip Outcome Tool-12 (iHOT-12) after periacetabular osteotomy (PAO), determines the proportions of threshold achievement, and identifies the predictors of threshold achievement. We analysed 317 patients who underwent PAO for symptomatic acetabular dysplasia with pre- and postoperative PROMs; postoperative surveys were collected at 1-2 years follow-up. MOI thresholds were calculated with receiver operating characteristic curves. Multivariable logistic regression determined predictors of achieving thresholds using pre- and intraoperative characteristics. MOI thresholds were 47.1% (mHHS) and 50.1% (iHOT-12). Proportions of threshold achievement were 63.1% (mHHS), 61.8% (iHOT-12), and 71.0% (either PROM). Variables with increased risk of failing to achieve thresholds were: mHHS-PAO as revision (OR = 2.51, 95% CI = 1.33-4.76, P < .01), higher preoperative lateral centre-edge angle (OR = 1.06, 95% CI = 1.01-1.12, P = .03), and higher T & ouml;nnis grade (OR = 1.90, 95% CI = 1.09-3.30, P = .03); iHOT-12-PAO as revision (OR = 2.30, 95% CI = 1.25-4.26, P < .01), increased body mass index (OR = 1.08, 95% CI = 1.01-1.16, P = .04), and concomitant anterior inferior iliac spine/subspine resection/decompression (OR = 1.81, 95% CI = 1.01-3.26, P = .046). Although newer, MOI provides essential information for contextualizing a patient's recovery course when used alongside other clinical thresholds.
Periacetabular osteotomy (PAO) surgically corrects hip dysplasia, restoring hip function by optimizing acetabular coverage. Changes in acetabular positioning may alter tension forces on capsular ligaments, causing range of motion (ROM) constraints, independent of acetabular orientation. Capsulotomy's role in restoring capsular mechanics following PAO has not yet been investigated. We aimed to assess how distal iliofemoral ligament (IFL) capsulotomy post-PAO affects hip ROM. Radiographic markers were implanted into the IFL in six cadaveric hip joints. External rotation (ER) and internal rotation (IR) were assessed at 90 degrees of hip flexion. Each hip underwent PAO and was re-tested, with intact capsule. Post-PAO, stepwise capsulotomy was performed. ROM was reassessed and marker displacement analyzed radiographically. Paired t-tests compared ROM in experimental settings (CI = 95%). Capsular tightening from PAO significantly restricted IR, independent of bony corrections. IR decreased by 12 degrees after PAO (P = .0039). Inverted T-capsulotomy restored IR losses (P = .0341). ER and flexion demonstrated non-significant changes pre- to post-capsulotomy interventions (P > .05). Full capsulectomy increased IR (20 +/- 3.2 degrees, P = .0028), ER (50 +/- 3.2 degrees, P = .0031), and flexion (111.25 +/- 8.3 degrees, P = .006), but compromised stability. Radiographically, PAO shifted the hip center inferomedially, tensioning the posterior capsule and impairing IR. After PAO, intracapsular markers displaced superolaterally with minimal anteroinferior movement. Capsular ligament reorientation constrained functional motion in cadaveric specimens. Inverted T-capsulotomy restored hip ROM, specifically IR, and may present a valuable tool in addressing functional limitations after PAO.
The aim of this study to identify the factors associated with patients' met expectations and satisfaction two years after hip arthroscopy. It was hypothesized that postoperative patient-reported outcomes (PROs) would have the strongest correlation with met expectations and satisfaction. Patients undergoing hip arthroscopy for femoroacetabular impingement and/or labral tears were identified from a registry at a single academic institution. Preoperative and two-year postoperative PROs were collected, including the Patient-Reported Outcomes Measurement Information System (PROMIS). Met expectations and satisfaction were assessed using the Musculoskeletal Outcomes Data Evaluation and Management System (MODEMS) and Surgical Satisfaction Questionnaire (SSQ-8). Statistical analysis was performed to assess met expectations and satisfaction based on patient characteristics, baseline PROs, and 2-year PROs. Of 99 patients identified, 70 (71%) completed 2-year postoperative questionnaires. MODEMS met expectations and SSQ-8 satisfaction were strongly correlated (r = 0.81, P < .001). A history of back pain was associated with lower satisfaction (65.0 versus 79.1, P = .04). There were no other significant differences in met expectations or satisfaction across patient characteristics or preoperative PROs. Postoperative PROs were correlated with both met expectations and satisfaction, including better PROMIS physical function (r = 0.75, P < .001; r = 0.66, P < .001, respectively), pain interference (r = -0.75, P < .001; r = -0.61, P < .001, respectively), anxiety (r = -0.36, P = .002; r = -0.28, P = .020, respectively), and depression (r = -0.24, P = .048; r = -0.25, P = .041, respectively). Postoperative PROs including physical function, pain, and psychosocial health, rather than baseline characteristics or preoperative PROs, were correlated with met expectations and satisfaction 2 years after hip arthroscopy. These findings suggest that maximizing postoperative PROs is important for meeting patient expectations and enhancing satisfaction. Level III, prospectively collected retrospective study.
Deep gluteal syndrome (DGS) is an uncommon cause of buttock and posterior hip pain resulting from non-discogenic entrapment or irritation of neural structures within the deep gluteal space. Differential diagnoses of posterior hip pain include piriformis syndrome, ischiofemoral impingement, and proximal hamstring tendon pathology. Most reported cases of DGS are related to piriformis hypertrophy or fibrovascular bands, whereas congenital malformations of the short external rotators are rarely described. We report the case of a young female patient with debilitating buttock and posterior thigh pain caused by an unusual combination of obturator internus hypertrophy, piriformis hypoplasia, and complete agenesis of the quadratus femoris. Magnetic resonance imaging demonstrated an abnormal course of the sciatic nerve within the deep gluteal space. A fully endoscopic posterior hip release was performed, consisting of selective longitudinal tenotomy of the hypertrophic conjoint tendon formed by the obturator internus and gemelli muscles and combined external and internal neurolysis of the sciatic nerve, addressing dynamic neural irritation rather than fixed compressive pathology, with careful preservation of the medial femoral circumflex artery (MFCA). Postoperatively, the patient experienced complete pain relief and returned to normal daily activities within 12 weeks, maintaining full recovery at 2-year follow-up. This case highlights that congenital muscular anomalies may underlie DGS and demonstrates that posterior hip endoscopy allows safe and effective treatment of dynamic neural irritation while preserving critical vascular structures.
To report on outcomes at >= 7 years follow-up of patients with osteochondral lesions of the femoral head that underwent hip mosaicplasty through minimally invasive direct anterior approach. The cohort comprised 17 men and 7 women (24 hips) aged 28.7 +/- 7.4 years with body mass index of 23.3 +/- 2.8 kg/m2. Complications and reoperations were noted, and the modified Harris hip score (mHHS) and the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) were assessed. Descriptive statistics were used to summarize the data. Two subgroup analyses were performed: lesion size <2 cm(2) versus lesion size >= 2 cm(2), and conversion to total hip arthroplasty (THA) versus no THA conversion. Three patients were lost-to-follow-up and 6 patients were converted to THA at 5.1 +/- 3.5 years (range, 2-12). At 9.5 +/- 1.9 years follow-up (range, 7-14), the remaining 15 patients reported mHHS of 87.2 +/- 10.1 and WOMAC of 84.1 +/- 12.3. Compared to patients with lesion size <2 cm(2), patients with lesion size >= 2 cm2 tended to have greater proportion of THA conversion (57% versus 12%), lower postoperative mHHS (78.5 +/- 14.9 versus 89.4 +/- 8.0), and lower postoperative WOMAC (57.9 +/- 11.5 versus 41.2 +/- 16.9). Compared to patients without THA conversion, patients with THA tended to have more women (50% versus 22%), more femoroacetabular impingement (67% versus 39%), and greater lesion size (2.3 +/- 0.9 cm(2 )versus 1.4 +/- 0.5 cm(2)). Femoral head mosaicplasty provides good-to-excellent clinical scores at 10 years follow-up, although 25% of patients were converted to THA. Larger lesion size seemed to be associated with worse postoperative outcomes and greater rates of conversion to THA, suggesting that mosaicplasty may not be effective for lesions >= 2 cm2.
