Background Pericapsular Nerve Group (PENG) block reduces pain and opioid consumption in hip arthroscopy. We compared the effects of PENG block versus placebo on pain, morphine consumption, and length of stay (LOS) in patients undergoing surgical hip dislocation (SHD).Methods Single-centre, parallel-group, prospective, randomized, double-blind, controlled trial of patients undergoing SHD for femoroacetabular impingement between June 2022 and November 2023. Both groups (PENG n = 38; placebo n = 33) underwent ultrasound-guided injection of 20 ml solution (PENG 0.5% ropivacaine, placebo 0.9% NaCl). We assessed pain at 1, 6, 12, and 24 h postoperatively using Visual Analogue Scale (VAS), total morphine consumption in Morphine Equivalent Dose (MED) during the first 24 h after surgery, and LOS in days.Results Median (range) VAS in the PENG group versus placebo group was 4 (0-8) versus 5 (1-10) at 1 h (P = .044); 3 (0-7) versus 3 (0-7) at 6 h (P = .614); 3 (0-8) versus 3 (0-8) at 12 h (P = .977); and 3 (0-6) versus 3 (0-7) at 24 h (P = .398). Mean +/- SD 24-h morphine consumption was 48 +/- 24 MED (PENG) versus 49 +/- 29 MED (placebo; P = .842). Median (range) LOS was 3 (1-5) days (PENG) versus 3 (1-14) days (placebo; P = .250).Conclusion In this trial, PENG block only showed slight decrease in reported VAS at 1 h postoperatively compared to placebo, with no difference in morphine consumption and LOS after SHD.

Purpose:Patients with femoroacetabular impingement (FAI) can present with abnormal femoral version(FV). Discrepancies were reported for FV Measurement comparing MRI and CT. We assessed difference of FV measurement on MRI and on matched CT. Methods:A retrospective IRB-approved comparative study involving 100 hips of symptomatic FAI patients was performed. All patients(100 hips) had hip pain(mean age 28 ± 10 years) and underwent pelvic CT scan and MRI of the same hip. Routine unilateral, multiplanar MRI of the hip was acquired for chondrolabral lesions. Of them, 52 hips(46 patients) underwent hip MRI with standard T1 images, while 48 hips underwent hip MRI with an additional fast MRI with Dixon based images(bilateral T1 Vibe Dixon based images of pelvis and knee) to measure FV. Two readers independently measured FV(Murphy method) on CT and MRI. Results:Difference of FV decreased significantly(p < 0.001) between CT and MRI with standard images from 4.9 ± 4.5° for Reader 1(7.3 ± 6.7° for Reader 2) to -0.05 ± 1.5°(r = 0.993, p < 0.001)for Reader 1 (0.73 ± 2.95°, r = 0.975, p < 0.001, for Reader 2) with fast Dixon based images.Difference of FV of CT between two readers was 1.9 ± 3.2°(r = 0.969, p < 0.001) and was not significantly different compared to fast MRI with Dixon based images (1.1 ± 4.4°,r = 0.943, p < 0.001).Number of hips with Difference of FV> 5° between CT and MRI were significantly(p < 0.001) reduced from 35 hips (67%,with standard images) to 2 hips (4%, Dixon based images) for reader 1. Conclusion:We changed our clinical practice and use fast MRI with T1 Dixon-based images for FV measurement. This decreased measurement errors in FV and misdiagnosis of FV and could potentially reduce CT scans.

Proximal femoral osteotomy remains an important joint-preserving option for adolescents and young adults with symptomatic proximal femoral deformity, preserved cartilage, and deformity amenable to correction.Surgical hip dislocation provides circumferential access to the femoral head, neck, and acetabulum while preserving the retinacular blood supply, and it allows direct dynamic assessment of impingement together with concomitant treatment of intra-articular pathology.The extended retinacular flap has expanded the indications for intra-articular correction at the femoral neck and head level, enabling larger corrections closer to the deformity with less secondary displacement when compared to extra-articular osteotomies.Preoperative planning must combine standardized radiographs, CT- or MRI-based torsion analysis, and MRI-based cartilage assessment; outcomes depend mainly on cartilage status, patient age, timing of correction, and technical precision.

Background: Femoral version deformities are key in the diagnostic evaluation of young patients with hip pain. While computed tomography (CT) and magnetic resonance imaging (MRI) are commonly used for femoral version assessment, their limitations include a lack of standardized reference values, high costs, and accessibility constraints. An accessible and reproducible alternative is needed, particularly in the context of joint-preserving hip surgery. Purpose: To evaluate the reliability and reproducibility of femoral version measurements on the modified Budin view, to compare these measurements with 4 established cross-sectional imaging methods (CT or MRI), and to determine the diagnostic accuracy of the modified Budin view in identifying abnormal femoral version. Study Design: Case series; Level of evidence, 4. Methods: The authors retrospectively analyzed the records of 93 patients (107 hips; mean age, 31 ± 9 years [range, 16-55 years]; 43 female hips [40%]) evaluated for joint-preserving hip surgery at a specialized tertiary center. Femoral version was measured using the modified Budin view and compared to 4 cross-sectional imaging methods (CT and MRI) using Bland-Altman analysis and diagnostic accuracy metrics. Results: The mean femoral version measured on the modified Budin view was 13°± 7° (95% CI, 12°-14°). The technique demonstrated excellent intra- and interobserver reliability (ICC, 0.99 and 0.98, respectively). Compared to the Reikerås method, the mean difference was 1°± 4° (95% CI, 0°-2°; P = .042; Bonferroni-corrected significance level, P < .01). The mean differences were 3°± 5° (95% CI, 2°-3°) for the Lee method, 11°± 5° (95% CI, 10°-12°) for the Tomczak method, and 12°± 6° (95% CI, 11°-14°) for the Murphy method (all P < .001). Diagnostic accuracy for detecting abnormal femoral version was high, with an area under the curve ranging from 0.88 to 0.98 and a consistently high negative predictive value (91%-100%). Conclusion: The modified Budin view is a highly reliable and accessible radiographic method for femoral version measurement in young patients undergoing joint-preserving hip surgery. It closely reflects the femoral neck version as measured by the Reikerås method, and demonstrates high diagnostic accuracy for detecting abnormal femoral version, making it a valuable screening tool for femoral version deformities in clinical practice.

Background:Proximal humerus fractures are the fourth most common type of fracture in elderly humans, seventh most common overall, and their incidence is rising. In 2019, the St. Gallen Algorithm (SGA) for treatment of proximal humerus fractures was proposed to improve treatment outcomes and reduce secondary surgeries. To date, no external validation of this algorithm has been reported. Methods:We performed a retrospective validation study with patients who sustained an isolated proximal humerus fracture between January 2010 and December 2020 at our institution. We calculated the prevalence of patients following the SGA and compared failure rates and Subjective Shoulder Value scores between those following the SGA and not. We also evaluated the entire cohort for predictors of treatment failure. Results:The prevalence of patients receiving treatment based on the SGA at our institution was 43% (n = 316). The overall failure rate was 13% (94/730 patients) at a mean follow-up of 22 months. The failure rate was 11% (36/316 patients) for the SGA group and 14% (58/414 patients) for the non-SGA group (P value = .3). Subjective Shoulder Value scores were 89 ± 12 in the SGA group (n = 33) and 90 ± 13 in the non-SGA group (n = 52; P = .7). Kaplan-Meier analysis showed no difference in survivorship between following and not following the SGA. Univariate analysis identified algorithm pathway 10 and Neer fracture type 3 as risk factors for failure. Multivariable analysis suggested a potential association between adherence to the SGA and reduced failure risk; however, this finding should be interpreted cautiously given the borderline statistical significance and limitations of the regression model. Conclusion:Following the SGA produced similar results to not following the SGA in terms of failure rate, survivorship, and clinical outcome scores. However, multivariate analysis identifies following the SGA as protective against failure. The findings of this study provide supportive but not definitive evidence for the clinical utility of the SGA as a decision-making aid in the treatment of proximal humerus fractures.

Background Although the hip is generally considered a stable joint, certain morphological configurations—such as acetabular dysplasia or abnormal femoral torsion—can predispose it to instability. Gluteus minimus indentation, a lateral femoral head morphologic finding, has been described in patients with cerebral palsy and severe dysplasia; however, whether it occurs in other instability-related hip morphologies and whether it has clinical relevance remains unclear. Questions/purposes (1) Did a higher percentage of patients with hip dysplasia (defined as a lateral center-edge angle [LCEA] < 22°) have gluteus minimus indentation than patients without dysplasia? (2) Was there an association between gluteus minimus indentation and acetabular or femoral radiological parameters? (3) Were there differences in three-dimensional (3D) cartilage and labral parameters between hips with and without gluteus minimus indentation? Methods Between November 2019 and December 2024, 761 hips (703 patients) underwent MR arthrography for nontraumatic hip pain at our institution and were included in this retrospective, single-center study. MR arthrography was ordered for patients whose hip pain had not improved after at least 3 months of conservative treatment and who were being considered for hip preservation surgery. We excluded 47% (357 of 761) of hips for previous hip surgery, trauma, avascular necrosis, advanced osteoarthritis, tumors, childhood conditions, or inadequate imaging, and a further 2% (12 of 761) to retain one hip per patient, leaving 392 hips for analysis. The included patients had a mean ± SD age of 32 ± 10 years, and 58% (229 of 392) of patients were females. In all, 18% (69 of 392) had dysplasia (LCEA < 22°) and 59% (231 of 392) had increased femoral torsion (> 25°). No patients had cerebral palsy. Gluteus minimus indentation and its topographic distribution, reported using a clockface system, were assessed on radial MR sequences. Radiographic parameters were measured on AP pelvis radiographs. Three-dimensional models of the acetabular cartilage and labrum were generated from an MRI sequence (magnetization-prepared 2 rapid gradient-echo) that produces high-contrast images in which cartilage and the labrum can be clearly distinguished. The models were created using a previously validated deep-learning algorithm trained to outline these structures. In the validation study, agreement with manual segmentation was excellent. Results Gluteus minimus indentation was present in 7% (29 of 392) of hips. A higher percentage of patients with hip dysplasia had gluteus minimus indentation than patients without dysplasia (22% [15 of 69] versus 4% [14 of 323]; p < 0.01). After controlling for acetabular version, retroversion index, caput-collum-diaphyseal angle, age, and sex, each 5° decrease in LCEA was associated with a 1.5 times higher odds of gluteus minimus indentation (95% confidence interval (CI) 1.2 to 1.9; p < 0.01), and each 5° increase in femoral torsion was associated with a 1.3 times higher odds (95% CI 1.1 to 1.6; p < 0.01) of gluteus minimus indentation. In dysplastic hips, defined as a LCEA < 22°, and hips with increased femoral torsion (> 25°), those with gluteus minimus indentation had a smaller relative cartilage surface area, a greater labral volume, and a greater labral contribution to the joint surface. These differences persisted after accounting for LCEA and for femoral torsion, respectively. Conclusion Gluteus minimus indentation was most common in dysplastic hips, although it also occurred in hips with increased femoral torsion and normal coverage. Its association with a smaller cartilage surface area and greater labral contribution suggests that it may be a marker of instability that warrants closer evaluation. The frequency and clinical significance of gluteus minimus indentation in asymptomatic hips are unknown, and the presence of gluteus minimus indentation should not influence treatment until its relevance to prognosis, natural history, or treatment response is established. Level of Evidence Level IV, prognostic study.

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.

Background: Comprehensive assessment of hip cartilage morphology and composition is essential for surgical decision-making in femoroacetabular impingement and hip dysplasia. Magnetization-prepared 2 rapid gradient-echo (MP2RAGE) enables T1 mapping and segmentation but requires long acquisition times, limiting clinical adoption. To validate a compressed sensing (CS) MP2RAGE protocol against the standard sequence for hip cartilage T1 mapping and automated 3D segmentation of hip cartilage and labrum. Methods: This retrospective study included 18 patients who underwent direct MR arthrography with both standard MP2RAGE (7 min 32 s) and CS-MP2RAGE (5 min). Automated segmentation of cartilage and labrum was performed using a 3D U-Net deep learning model to extract global and regional (anterior, superior, posterior) hip cartilage T1 values and 3D parameters of hip cartilage and labrum. Morphological damage was scored semi-quantitatively on clinical proton-density weighted MRI. Agreement was assessed using paired t-tests, Bland-Altman analysis, Dice similarity coefficients, and Spearman correlations. Results: The mean difference in overall T1 values was 24.5 ms (4.2%, p < 0.001) with excellent correlation (r(s) = 0.983). Both sequences showed strong inverse correlations with morphological damage scores (CS: r(s) = -0.78; standard: r(s) = -0.76). Relative differences for cartilage volume, thickness, area, and surface area ranged from -6.9% to -0.6%. Labral volume, area, and joint surface contribution ranged from -2.6% to 0.4%. All morphological parameters showed excellent correlation (r(s) > 0.96). Conclusions: Compressed sensing MP2RAGE enables 5-min acquisition with strong agreement for cartilage T1 and automated morphological assessment compared with conventional MP2RAGE. Further prospective validation is needed before broader clinical implementation.

PURPOSE:The aim of this study was (1) to investigate the accuracy of identifying the femoral and tibial anterior cruciate ligament (ACL) footprints (FPs) using the Compressed Lateral and Anteroposterior Anatomical Systematic Sequences (CLASS) method compared to the to the gold standard (anatomical dissection with direct FP marking, referred to as aCLASS); (2) to determine whether the planned CLASS corresponds to the fluoroscopic imaging used during surgery and (3) to determine whether the position of the C-arm matters. HYPOTHESIS:Planned CLASS (pCLASS) accurately corresponds to anatomical CLASS (aCLASS) and to intraoperative fluoroscopy, with superior accuracy using contralateral C-arm positioning. METHOD:Ten cadaveric knees were used in this study. A magnetic resonance imaging (MRI) scan was obtained of the native and dissected knee. MRI images of the dissected knee with marked femoral and tibial ACL FPs were used to create the aCLASS. Additionally, the native MRI was used to identify the ACL FP to simulate preoperative planning and generate the pCLASS. True-lateral fluoroscopic images with the image receptor contralaterally and ipsilaterally positioned were obtained. Statistical tests included the Friedman test for positional comparison across all groups. One-way analysis of variance (ANOVA) with Bonferroni adjustment and paired two-way t test was conducted for clinically relevant groups, with p < 0.05 set as the level of statistical significance. RESULTS:No significant differences were found among aCLASS, pCLASS, contralateral and ipsilateral measurements for femoral high-low (p = 0.753), femoral deep-shallow (p = 0.197) and tibial anterior-posterior (p = 0.106). ANOVA and paired t tests confirmed no significant difference between pCLASS and both fluoroscopic positions (all p > 0.05). CONCLUSION:The CLASS method demonstrated no significant difference in FP localization compared with anatomic reference. This study validates CLASS as a reliable, patient-specific method for ACL FP identification that translates from preoperative MRI to intraoperative fluoroscopy regardless of whether the C-arm is positioned ipsilaterally or contralaterally. CLASS standardizes anatomical ACL reconstruction across diverse operative settings and surgeon experience levels. LEVEL OF EVIDENCE:N/A.

The supraacetabular fossa (SAF) is a bony fossa in the acetabular roof's load-bearing region. Its role in acetabular development and hip morphology remains unclear, with potential implications for hip preservation procedures. We aimed to (i) determine the prevalence of SAF by age, (ii) measure its dimensions in patients with hip pain undergoing magnetic resonance (MR) arthrogram, and (iii) assess associations between SAF and acetabular or femoral morphologies. We performed a retrospective analysis of patients with hip pain who underwent MR arthrograms. SAF were classified as type 1 (unfilled) or type 2 (cartilage-filled), and its dimensions measured. Acetabular and femoral morphology were assessed on radiographs, and hips were categorized into 13 morphology groups. 697 hips from 615 patients were included. SAF was present in 10.9% (76/697) of hips, with affected patients being younger (24.3 ± 7.6 years) than those without SAF (31.8 ± 11.2 years, P < 0.001). Type 1 SAF had a mean depth of 3.1 mm versus 4.8 mm for type 2 (P < 0.001). SAF prevalence was 30.8% in acetabular protrusion and 5.2% in dysplasia (P = 0.0135). Acetabular protrusion (OR 3.78, P = 0.03) were risk factors for SAF, but no associations were found with femoral morphology. SAF occurs predominantly in patients under 25 years and is nearly six times more common in acetabular protrusion than dysplasia. Future studies should investigate the implications of SAF on acetabular rim trimming and reorientation procedures, particularly focusing on their effect on residual joint contact forces.

Periprothetische Acetabulumfrakturen (PPAF) sind eine seltenere, aber zunehmend relevante Komplikation nach Hüfttotalendoprothesen. Ihre Versorgung ist komplex und erfordert Expertise in der Frakturversorgung und der Revisionsendoprothetik. Die Behandlungsplanung basiert auf den morphologischen Frakturmerkmalen nach dem Pfeilerkonzept nach Letournel, dem Ausmaß von Knochendefekten (frakturbedingt oder vorbestehend), der Stabilität der Pfannenkomponente sowie patientenbezogenen Faktoren. Diese Übersichtarbeit beschreibt einen praxisbezogenen Algorithmus zur Behandlung von PPAF. Neben der präoperativen Diagnostik werden etablierte Klassifikationssysteme, operative Zugangswege und therapeutische Strategien bei unterschiedlichen Fraktursituationen dargestellt.

Background/Objective: Tibial eminence avulsion fracture (TEAF) is a traumatic injury of the anterior cruciate ligament that occurs in children with an immature skeletal system. It has an incidence of 3 per 100,000 children, with an increasing prevalence over time. The objective of this study was to evaluate the long-term clinical and subjective outcomes of displaced TEAF requiring surgical intervention and to assess the return to sport. Methods: A retrospective cohort study was conducted, identifying all patients who underwent arthroscopic-assisted TEAF refixation at HFR-Fribourg between 2012 and 2020, performed by a single surgeon. A total of fifteen patients were included for descriptive analysis, while twelve patients underwent clinical assessment of knee joint stability and functional outcomes using patient-reported outcome measures (PROMs): Pedi-IKDC, Lysholm, Tegner, and Marx. Results: Of the fifteen patients, fourteen had type III and one had type II TEAF according to the McKeever classification. The mean age at the time of injury was 11.5 years, and the average time between surgery and long-term follow-up was 5.1 years (range: 0.9-8.9 years). For the primary outcomes of the operated knee, no significant differences were observed in muscle mass or range of motion between the operated and non-operated limbs (p > 0.05). Anterior knee stability, as assessed by the Lachman test and Rolimeter, showed no significant difference between the operated and non-operated knee (p > 0.05). Regarding secondary outcomes, the Pedi-IKDC and Lysholm scores were 98 out of 100, the Tegner score was 5.5 out of 10, and the Marx score was 14.5 out of 20 at the final follow-up. There were no significant differences in the number of hours per week or frequency of sport activity (mean three times per week) before and after surgery. Conclusions: The surgical treatment for displaced TEAF, specifically the pull-out suture technique with arthroscopic assistance, demonstrates excellent clinical and functional outcomes, with high recovery rates and restored knee stability. This technique allows patients to return to sports without significant impairment. Although no comparative analysis was performed, these findings provide a foundation for future studies to further validate and compare the effectiveness of this surgical approach.

Abstract The objective was to use convolutional neural networks (CNNs) for automatic segmentation of hip cartilage and labrum based on 3D MRI. In this retrospective single-center study, CNNs with a U-Net architecture were used to develop a fully automated segmentation model for hip cartilage and labrum from MRI. Direct hip MR arthrographies (01/2020-10/2021) were selected from 100 symptomatic patients. Institutional routine protocol included a 3D T1 mapping sequence, which was used for manual segmentation of hip cartilage and labrum. 80 hips were used for training and the remaining 20 for testing. Model performance was assessed with six evaluation metrics including Dice similarity coefficient (DSC). In addition, model performance was tested on an external dataset (40 patients) with a 3D T2-weighted sequence from a different institution. Inter-rater agreement of manual segmentation served as benchmark for automatic segmentation performance. 100 patients were included (mean age 30 ± 10 years, 64% female patients). Mean DSC for cartilage was 0.92 ± 0.02 (95% confidence interval [CI] 0.92–0.93) and 0.83 ± 0.04 (0.81–0.85) for labrum and comparable (p = 0.232 and 0.297, respectively) to inter-rater agreement of manual segmentation: DSC cartilage 0.93 ± 0.04 (0.92–0.95); DSC labrum 0.82 ± 0.05 (0.80–0.85). When tested on the external dataset, the DSC was 0.89 ± 0.02 (0.88–0.90) and 0.71 ± 0.04 (0.69–0.73) for cartilage and labrum, respectively.The presented deep learning approach accurately segments hip cartilage and labrum from 3D MRI sequences and can potentially be used in clinical practice to provide rapid and accurate 3D MRI models.

BACKGROUND:Multiple 2-dimensional magnetic resonance imaging (MRI) studies have indicated that the size of the labrum adjusts in response to altered joint loading. In patients with hip dysplasia, it tends to increase as a compensatory mechanism for inadequate acetabular coverage. PURPOSE:To determine the differences in labral contribution to the joint surface among different hip deformities as well as which radiographic parameters influence labral contribution to the joint surface using a deep learning-based approach for automatic 3-dimensional (3D) segmentation of MRI. STUDY DESIGN:Cross-sectional study; Level of evidence, 4. METHODS:This retrospective study was approved by the local ethics committee with waiver for informed consent. A total of 98 patients (100 hips) with symptomatic hip deformities undergoing direct hip magnetic resonance arthrography (3 T) between January 2020 and October 2021 were consecutively selected (mean age, 30 ± 9 years; 64% female). The standard imaging protocol included proton density-weighted turbo spin echo images and an axial-oblique 3D T1-weighted MP2RAGE sequence. According to acetabular morphology, hips were divided into subgroups: dysplasia (lateral center-edge [LCE] angle, <23°), normal coverage (LCE, 23°-33°), overcoverage (LCE, 33°-39°), severe overcoverage (LCE, >39°), and retroversion (retroversion index >10% and all 3 retroversion signs positive). A previously validated deep learning approach for automatic segmentation and software for calculation of the joint surface were used. The labral contribution to the joint surface was defined as follows: labrum surface area/(labrum surface area + cartilage surface area). One-way analysis of variance with Tukey correction for multiple comparison and linear regression analysis was performed. RESULTS:The mean labral contribution of the joint surface of dysplastic hips was 26% ± 5% (95% CI, 24%-28%) and higher compared with all other hip deformities (P value range, .001-.036). Linear regression analysis identified LCE angle (β = -.002; P < .001) and femoral torsion (β = .001; P = .008) as independent predictors for labral contribution to the joint surface with a goodness-of-fit R2 value of 0.35. CONCLUSION:The labral contribution to the joint surface differs among hip deformities and is influenced by lateral acetabular coverage and femoral torsion. This study paves the way for a more in-depth understanding of the underlying pathomechanism and a reliable 3D analysis of the hip joint that can be indicative for surgical decision-making in patients with hip deformities.

To determine the prevalence of ischiofemoral impingement (IFI) in young patients evaluated for joint-preserving hip surgery and investigate its associations with osseous deformities and intra-articular pathologies. Retrospective study of 256 hips (224 patients, mean age 34 years) that were examined with radiographs and MR arthrography for hip pain. Quadratus femoris muscle edema was used to indicate IFI and measurements of ischiofemoral space were performed. Imaging analysis assessed cam deformity, femoral torsion, neck-shaft angle, ischial angle, acetabular coverage-/ version, and chondro-labral pathology. Prevalence of MRI findings consistent with IFI was calculated and univariate- and multivariate logistic regression identified associations between IFI and hip deformities. Quadratus femoris muscle edema consistent with IFI was present in 9

We compared long term clinical and radiological outcomes of patients with trimalleolar ankle fractures including a posterior malleolar fragment (PMF) between those who underwent PMF fixation and those who did not. We also compared complication rates and identified independent risk factors associated with worse outcome. We included 69 consecutive patients undergoing operation for a trimalleolar fracture between 2008 and 2013. Mean follow-up was 11.3 years. Patients completed the SF-12 and EFAS scores. Radiological osteoarthritis (OA) was assessed using the Kellgren-Lawrence classification. Postoperative complications were classified according to Sink. PMF size was measured on preoperative x-ray and CT and classified according to the Haraguchi classification. The non-fixated group (n = 48) had a mean PCS score of 47.9, a mean MCS score of 54.1, a mean EFAS score of 17.1, and a mean EFAS-Sport score of 4.35. The fixated group (n = 21) had a mean PCS score of 49.2, a mean MCS score of 56.5, a mean EFAS score of 17.5, and a mean EFAS-Sport score of 6.05. There was no statistical difference between the two groups in the long term clinical PROMS. Patients in the fixated group developed more advanced OA (p = 0.013). Patients who underwent PMF fixation had a larger PMF size, more complications and more advanced OA, but with similar long term clinical outcomes than the non-fixated group. III, Retrospective comparative study.

Introduction: Postoperative measurement of cup orientation on pelvic radiographs is prone to error, while CT scans are less practical in routine settings. The 2D/3D-matching technique allows measurement of cup orientation normalized to anterior pelvic plane using standard radiographs. This study aimed to determine the (1) precision and (2) percentage of outliers in cup orientation among three groups with different surgical approaches, patient positioning, and cup positioning techniques. Methods We retrospectively analyzed 322 patients (349 hips) who underwent total hip arthroplasty (THA) with three different approaches: the 'direct lateral' group (66 hips) using a lateral position and direct lateral approach; the 'supine anterior' group (128 hips) using a supine position and anterior approach; and the 'lateral anterior' group (155 hips) using a lateral position and anterior approach. Cup positioning was determined intraoperatively using a mechanical device in the ‘direct lateral’ and ‘lateral anterior’ groups and using fluoroscopy in the ‘supine anterior’ group. The 2D/3D-matching technique, HipMatch, was used to measure cup inclination and anteversion on postoperative radiographs normalized to the anterior pelvic plane. Precision was assessed using standard deviations (SDs), with outliers defined as orientations outside 2 SDs (31–56° inclination, 7–36° anteversion). Results (1) The ‘supine anterior’ group showed the highest precision for inclination (SD = 4.6°) compared to the ‘direct lateral’ (SD = 6.8°) and ‘lateral anterior’ (SD = 6.2°) groups (p < 0.001). Precision for anteversion did not differ significantly (p = 0.097). (2) The percentage of outliers did not significantly differ among the groups (p = 0.183 to 0.384). Conclusion Inclination and anteversion vary with surgical approach, patient positioning in this largest series of APP normalized cup position measurements. The highest precision for inclination was seen in the anterior approach in supine position with fluoroscopy but approach, positioning, and technique did not affect the percentage of outliers.

Background/Objectives: Acetabular fractures in older adults pose significant challenges due to bone fragility, complex fracture patterns, and increased comorbidities. Surgical management, including isolated open reduction and internal fixation (ORIF) and ORIF combined with acute total hip arthroplasty (THA) (combined hip procedure—CHP), have advanced considerably. Nevertheless, optimal postoperative rehabilitation and particularly weight-bearing (WB) recommendations remain controversial and inconsistent. This review aims to assess rehabilitation protocols, focusing on WB strategies following the surgical treatment of acetabular fractures in older adults. It also examines differences in WB restrictions by surgical technique (ORIF vs. CHP) and their impact on recovery, complications, reoperations, and mortality. Methods: A systematic review of PubMed, Embase, and the Cochrane Library (2006–2024) included studies involving patients aged ≥65 years treated surgically for displaced acetabular fractures. Data included WB protocols (full, partial, toe-touch), length of stay (LOS), healing, functional outcomes (mobility, Harris and Oxford Hip Scores), complications, reoperations, delayed THA, compliance, readmission, and mortality. Due to heterogeneity, findings were narratively synthesized. Risk of bias was assessed using ROBINS-I and RoB2. Results: Twenty studies involving 929 patients (530 isolated ORIF, 399 CHP) were analyzed. The overall mean follow-up was 3.5 years (range: 1–5.25 years). Postoperative WB protocols were reported in 19 studies (95%). Immediate full WB was permitted in 0% of isolated ORIF studies (0/13), with partial WB recommended by 62% (8/13) for durations typically between 6 and 12 weeks. On the other hand, immediate full WB was allowed in 53% (9/17) of CHP studies. Functional outcomes were moderate following isolated ORIF (mean HHS: 63–82 points), with delayed THA conversion rates ranging from 16.5% to 45%. CHP demonstrated superior functional outcomes (mean HHS: 70–92 points), earlier independent ambulation, and higher patient satisfaction (74–90%), yet increased orthopedic complications, including dislocations (8–11%) and implant loosening (up to 18%). LOS varied from 12 to 21 days (mean 16 days) for isolated ORIF and from 8 to 25 days (mean 17 days) for CHP. Readmission within 30 days was not explicitly reported in any study. Mortality at 1 year varied significantly (ORIF: 0–25%; CHP: 0–14%), increasing markedly at long-term follow-up (up to 42% ORIF, up to 70% CHP at five years). Compliance with WB restrictions was monitored in only two studies (11%). Conclusions: Postoperative rehabilitation after acetabular fracture surgery in older adults remains inconsistent and lacks standardization. Combining ORIF with acute THA may enable earlier weight-bearing and improved short-term function but carries risks such as dislocation and implant loosening. In contrast, isolated ORIF avoids these implant-related complications but often requires prolonged weight-bearing restrictions. Robust evidence is still missing. Future trials are essential to establish standardized protocols that balance mechanical protection and functional recovery.

Periprosthetic acetabular fractures (PPAF) are a rare but increasingly relevant complication following total hip arthroplasty. The management is complex and requires expertise in fracture treatment and revision arthroplasty. The treatment planning is based on the morphological fracture characteristics according to the column concept (Letournel), the extent of bone defects (fracture-related or pre-existing), the stability of the acetabular component and patient-related factors. This review article presents a practice-related algorithm on how to approach PPAFs. In addition to the preoperative diagnostics, established classification systems, surgical approaches and treatment strategies for various fracture scenarios are also presented.