Team Approach: Hip Preservation Surgery.

Background: Femoroacetabular impingement has been recently described as a common cause of hip pain and labral tears in young adults. We evaluated the early clinical results and quality of life after osteochondroplasty of the femoral head-neck junction for the treatment of femoroacetabular impingement. Methods: Thirty-seven hips in thirty-four patients with persistent hip pain and a mean age of 40.5 years underwent surgical dislocation of the hip and osteochondroplasty of the femoral head-neck junction for the treatment of camtype femoroacetabular impingement. All of the patients had had preoperative evidence of pathological changes in the labrum on imaging. The clinical course and the quality of life were assessed postoperatively. Results: The mean score on the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) increased from 61.2 points preoperatively to 81.4 points at a mean of 3.1 years postoperatively (p < 0.001), the mean University of California at Los Angeles (UCLA) activity score increased from 4.8 to 7.5 points (p < 0.001), the mean Short Form-12 (SF-12) physical component score increased from 37.3 to 45.6 points (p < 0.001), and the mean SF-12 mental component score increased from 46.4 to 51.2 points (p = 0.031). None of the hips underwent additional reconstructive surgery. There were no cases of osteonecrosis. Nine patients underwent screw removal from the greater trochanter because of persistent bursitis. Six of the thirty-four patients were dissatisfied with the outcome. Conclusions: Cam-type femoroacetabular impingement is associated with insufficient concavity at the anterolateral head-neck junction and with pathological changes in the labrum. Osteochondroplasty of the femoral head-neck junction following surgical dislocation of the hip joint is safe and effective and can provide a significant improvement in the overall quality of life of most patients. Level of Evidence: Therapeutic Level IV. See Instructions to Authors for a complete description of levels of evidence.

A common cause of hip pain and restricted range of hip motion in adolescents and young adults is femoroacetabular impingement (FAI). If left untreated, patients run the substantial risk of developing early-onset osteoarthritis of the hip. With the rise in awareness of FAI and ongoing evolution of hip-preserving surgery, imaging has gained a fundamental role in the postoperative assessment. While the majority of patients enjoy a positive outcome, a not unsubstantial number experience persistent or recurrent symptoms after surgery. Routine postoperative follow-up includes conventional radiographs. In patients with postoperative complaints additional imaging in the form of MR arthrography of the hip is indicated which allows the evaluation of the surgical osseous correction as well as structures such as the labrum and cartilage and is well suited for the detection of most postoperative complications.

Management of hip pain in young adults

Femoroacetabular impingement (FAI) is a common cause of hip pain, and open surgical approaches remain an important treatment option for FAI. This systematic review of the literature sought to determine what post-operative radiographic outcomes have been reported following open surgical correction of FAI. After screening and full-text review, 18 studies involving 1192 hips in 1084 patients were included for analysis. In total, 24 radiological outcomes were reported. CAM-type FAI was most frequently assessed using the alpha angle (61.1%) and head-neck offset/head-neck offset ratio (33.3%). Lateral center edge angle (27.8%) and the acetabular index (22.2%) were the most commonly reported outcomes for pincer-type FAI. The results of this review suggest that reporting of post-operative radiographic outcomes is variable, that no single radiographic parameter is optimal, and that the clinician must use a combination of reproducible measurements, together with their clinical examination, to confirm adequate restoration of normal hip morphology.

Background: Femoroacetabular impingement (FAI) is a common cause of hip pain and dysfunction, especially in young and active individuals, and it may require surgical management for associated labral tears and cartilage damage. The management of FAI has advanced radically over the last few years, and hip arthroscopy has gained a leading role. However, despite the increasing number of published research and technological advancements, a comprehensive systematic review summarising current evidence is still missing. Methods: All the clinical studies investigating the arthroscopic management of FAI were accessed. Only studies with a minimum of six months of follow-up were considered. The 2020 PRISMA guidelines were followed. In December 2024, PubMed, Web of Science, and Embase were accessed without time constraints. Results: The present systematic review included 258 clinical investigations (57,803 patients). The mean length of follow-up was 34.2 ± 22.7 months. The mean age was 34.7 ± 5.3, and the mean BMI was 25.1 ± 2.0 kg/m2. Conclusions: The present systematic review updates current evidence on patients who have undergone arthroscopic surgery for FAI, updating and discussing current progress in managing labral injuries and patient selection, emphasising outcomes and pitfalls. Progress in surgery and improvement in eligibility criteria, as well as current controversies and prospects, were also discussed.

Osteoarthritis (OA) of the hip is a common cause of hip pain. The arthroscopic management of patients with femoro-acetabular impingement (FAI) has been reported to yield good outcomes. The purpose of this study was to report on outcome following the arthroscopic treatment of patients with FAI in the presence of mild to moderate OA. Seventy-five patients undergoing arthroscopic surgery for FAI, all with preoperative radiological signs of mild to moderate OA were prospectively included in this study. A 2-year follow-up, using web-based patient-reported outcome measures, including the International Hip Outcome Tool (iHOT-12), Copenhagen Hip and Groin Outcome (HAGOS), EQ-5D, Hip Sports Activity Scale (HSAS) for physical activity level and a visual analogue scale (VAS) for overall hip function, was performed, complemented by a radiographic evaluation. At follow-up (mean 26 months, SD 5), five patients (7%) had undergone total hip arthroplasty, leaving 70 patients for the analysis. Preoperative scores compared with those obtained at the 2-year follow-up revealed significant improvements (P < 0.0001) for all measured outcomes; the iHOT-12 (42 versus 65), VAS for global hip function (48 versus 68), HSAS (2.5 versus 3), EQ5D index (0.62 versus 0.76), EQ VAS (69 versus 75) and different HAGOS subscales (54 versus 72, 47 versus 67, 56 versus 75, 40 versus 61, 33 versus 56, 31 versus 55). At follow-up, 56 (82%) patients reported that they was satisfied with the outcome of surgery. Arthroscopic treatment for patients with FAI in the presence of mild to moderate OA resulted in statistically significant and clinically relevant improvements in outcome measures related to pain, symptoms, function, physical activity level and quality of life in the majority of patients.

In young, active patients, the common causes of hip pain are multiple and can include muscle strain, contusion, acetabular labral tear, osteochondral injury, sports hernia, snapping hip, proximal femoral stress fracture, and spinal abnormalities1-3. In most patients, an initial trial of nonoperative management is instituted. If pain persists or is of an unusual presentation, a more extensive diagnostic workup may be used. A thorough clinical evaluation can expedite the diagnosis of uncommon conditions of the musculoskeletal system, and the diagnostic evaluation may include magnetic resonance imaging of the pelvis and hip to evaluate the integrity of the periarticular structures. The case of the patient in the present report illustrates an unusual presentation of disseminated Blastomyces dermatitidis infection causing hip pain that was diagnosed with magnetic resonance imaging and was successfully treated through a multidisciplinary approach. The parents of the patient were informed that data concerning the case would be submitted for publication, and they consented. A seventeen-year-old boy presented to our clinic with a chief complaint of an insidious onset of hip pain of approximately two weeks’ duration that was minimally responsive to nonsteroidal anti-inflammatory drugs. He had previously worked at a job in construction requiring heavy labor and lived in the Missouri River valley region. The hip pain was limiting his ability to work at his normal level. The pain was primarily localized to the lateral aspect of the hip at the greater trochanteric region and the lateral iliac wing without radiation. He denied any fevers, chills, or other constitutional symptoms …

Background:Femoroacetabular impingement (FAI) is a common cause of hip pain in female athletes. There are limited data on midterm outcomes for female athletes undergoing hip arthroscopic surgery.Purpose:To evaluate return-to-sport rates and clinical outcomes in female athletes with FAI after primary hip arthroscopic surgery with labral repair and femoral osteochondroplasty.Study Design:Case series; Level of evidence, 4.Methods:A retrospective analysis of a single institution’s database was performed to identify female athletes who underwent primary hip arthroscopic surgery with labral repair and femoral osteochondroplasty from July 2011 to October 2019 with a minimum 5-year follow-up. Preoperative radiographs were evaluated for the lateral center-edge angle, Tonnis angle, Tonnis grade, and alpha angle. Patient-reported outcome measure (PROM) scores, including those for the modified Harris Hip Score, Hip Outcome Score, Tegner Activity Scale, and visual analog scale for pain, as well as patient satisfaction with surgery were analyzed postoperatively.Results:A total of 63 hips (27 left, 36 right) in 56 female patients (mean age, 21.6 ± 8.0 years; mean body mass index, 24.7 ± 4.8 kg/m2) were included and followed for a mean of 8.4 ± 2.1 years (range, 5.0-13.2 years). Preoperatively, patients participated in basketball (n = 18), dance (n = 21), hockey (n = 8), and soccer (n = 12). Of the 56 patients, 41 attempted to return to sport. There were 28 (68%) female athletes who successfully returned to their preoperative sport. Of the total cohort, 21 (38%) patients cited non–hip-related factors for discontinuing their sport. All postoperative PROM scores improved significantly compared with preoperatively (P ≤ .002) for patients with available preoperative data. Those who returned to sport had significantly improved Hip Outcome Score values compared with those who did not return to sport (P ≤ .010).Conclusion:Female athletes who underwent primary hip arthroscopic surgery for FAI had significant improvements in PROM scores and moderate return-to-sport rates at a minimum 5-year follow-up. Most athletes discontinued sports because of non–hip-related factors, although hip-related issues were also cited. Our analysis highlights the need for thorough perioperative counseling and establishing appropriate patient expectations for female athletes before hip arthroscopic surgery.

The hip is a common source of pain not only in the adult and elderly population but also in our competitive athletes. Hip pathology can be found in newborns (developmental hip dysplasia), childhood (Legg-Calve-Perthes disease), adolescence (slipped femoral epiphysis), and adulthood (osteoarthritis, labral tears, tendinopathies, etc.). With adavancement in imaging studies and surgical techniques, we have gained insight into the incidence of labral tear pathologies, for example, and anatomical variants that can contribute to hip and groin pain. However, much work is still needed to search for new techniques that will improve our patient’s clinical outcomes and quality of life. The goal of this chapter is to review the role of regenerative medicine techniques, including viscosupplementation, platelet-rich plasma, and stem cells in the management of hip pathologies. We will discuss the most common causes of hip pain, the current standard of care for management, and the evidence for the use of regenerative medicine in those pathologies.

Femoroacetabular impingement is a common cause of hip pain in adolescents. Compared with the pincer-type, the incidence of cam-type is more common in asymptomatic adolescent patients. At present, there is much research on the treatment of FAI by arthroscopic surgery, and it has been shown that it has a positive intervention effect. However, there is little research on therapeutic exercise and a lack of normative understanding. The purpose of this review is to provide clues and ideas for the treatment of adolescents with cam FAI by summarizing the research results of therapeutic exercise management of FAI. We searched the articles in PubMed, Web of Science, CNKI, WanFang, WeiPu with the key words of “Femoracetabular Impingements”, Rehabilitation Exercise", "CAM" in Chinese and English, respectively. Repetitive literature and those that were not closely related to the purpose of this study were eliminated, and finally, 25 articles were included for review. Therapeutic exercises that adolescents with cam FAI can perform include patient education and movement adjustment, postural exercise, hip Strength exercise, core stabilization exercise, flexibility and mobility exercise, etc. In addition, the effectiveness of WMW and pelvic tilt correction has yet to be demonstrated. Through this review, it was found that there are the following deficiencies: (1) There are few high-quality studies on therapeutic exercise, and the follow-up period of the studies is short, and the number of samples is small, so the reliability of the treatment results needs to be verified. (2) There is no study on the difference in damage under different types of FAI. (3) There are no therapeutic exercise management programs for different types of FAI. (4) As a special population, adolescents have no standardized and targeted therapeutic exercise management. (5) In terms of physical impairments, there are contrary findings; more high-quality studies are needed. (6) Impairments in adolescents with FAI require further confirmation. (7) The duration of therapeutic exercise is uncertain.

Femoroacetabular impingement represents a common cause of hip pain in adolescents. The purpose of the present study was to evaluate the safety and efficacy of simultaneous bilateral hip arthroscopy for bilateral symptomatic femoroacetabular impingement in adolescent athletes. Clinical data were collected in a prospective database on patients who underwent unilateral or simultaneous bilateral hip arthroscopy and included complications, reoperation rate, and return to play time. Differences in International Hip Outcome Tool (iHOT)-12 scores according to hip side and postoperative follow-up time (preoperative, 1.5, 3, 6, 12, and 24 mo) were evaluated using a 2×6 repeated-measures analysis of variance with post hoc repeated-measures 1-way analysis of variance and Bonferroni-corrected paired t tests. In total, 24 patients (36 hips) were studied, of whom 12 underwent simultaneous bilateral hip arthroscopy (24 hips) and a case-matched control group of 12 patients underwent unilateral hip arthroscopy. There were 5 males in each group (41.7%). Average age was 15.7 and 16.5 years in the bilateral and unilateral groups, respectively. No patients were lost to follow-up. In the bilateral group, a significant increase in mean iHOT-12 score was observed between 1.5- and 3-month follow-up (61.8 vs. 82.8, respectively; P=0.003), and 6-, 12-, and 24-month follow-up (91.4, 95.1, and 96.6, respectively, P=0.004). At all follow-up times, there were no significant differences in mean iHOT-12 scores or other outcome measures between bilateral and unilateral cohorts. Time to return to preinjury level of activity was similar between the bilateral and unilateral groups (4.7 vs. 4.9 mo, respectively; P=0.40). One transient lateral femoral cutaneous nerve palsy occurred in each group, though no other complications were documented. No patients required revision surgery by latest follow-up. Bilateral simultaneous hip arthroscopy is safe and reproducible in adolescent athletes, achieving equivalent outcomes, and similar rehabilitation time when compared with unilateral surgery. Level II-therapeutic study.

Background: Femoroacetabular impingement is one of the most common causes of hip pain in young, active individuals. It is characterized by abnormal contact between the femoral head and acetabulum. Open osteochondroplasty, which involves dislocating the hip to reshape the femoral head-neck junction and acetabular rim, remains vital in cases of complex deformities despite the advent of arthroscopic techniques. The study aimed at evaluating the short-term results of open osteochondroplasty in patients with symptomatic FAI, focusing on pain relief, functional improvement, ROM, and complications. Methods: A retrospective analysis was performed on 31 patients who underwent open osteochondroplasty for FAI. Outcomes measures included VAS, HOS, WOMAC, iHOT-12, ROM, general health status by means of the EQ-5D Index and SF-12, and finally, postoperative complications. Results: The results of the study were significantly improved. Pain was reduced by 58% from a VAS of 7.4 to 3.1 (p

Femoro-acetabular impingement is a common cause of hip pain in young athletes. Evaluation typically includes radiographs and magnetic resonance imaging. It is important to appreciate uncommon diagnoses and the role of complimentary imaging. This clinical vignette emphasizes the need complete imaging with CT in select case of atypical hip pain.We present a 19-year old soccer player who underwent seemingly successful arthroscopic FAI surgery but returned with pain. Computed tomography (CT) revealed osteoid osteoma of the lesser trochanter. The lesion was successfully treated with percutaneous CT guided radiofrequency ablation.

Background and purpose — Femoroacetabular impingement syndrome (FAIS) is a common cause of hip pain and may contribute to the development of osteoarthritis. We investigated whether a prior hip arthroscopy affects the patient-reported outcomes (PROMs) of a later total hip arthroplasty (THA). Patients and methods — Patients undergoing hip arthroscopy between 2011 and 2018 were identified from a hip arthroscopy register and linked to the Swedish Hip Arthroplasty Register (SHAR). A propensity-score matched control group without a prior hip arthroscopy, based on demographic data and preoperative score from the EuroQoL visual analogue scale (EQ VAS) and hip pain score, was identified from SHAR. The group with a hip arthroscopy (treated group) consisted of 135 patients and the matched control group comprised 540 patients. The included PROMs were EQ-5D and EQ VAS of the EuroQoL group, and a questionnaire regarding hip pain and another addressing satisfaction. Rate of reoperation was collected from the SHAR. The follow-up period was 1 year. Results — The mean interval from arthroscopy to THA was 27 months (SD 19). The EQ-5D was 0.81 and 0.82, and EQ VAS was 78 and 79 in the treated group and the matched control group respectively. There were no differences in hip pain, and reported satisfaction was similar with 87% in the treated group and 86% in the matched control group. Interpretation — These results offer reassurance that a prior hip arthroscopy for FAIS does not appear to affect the short-term patient-reported outcomes of a future THA and indicate that patients undergoing an intervention are not at risk of inferior results due to their prior hip arthroscopy.

This study aimed to investigate the frequency of labral tears (LT) using 3.0-Tesla magnetic resonance imaging among different age groups of Japanese patients with or without acetabular dysplasia. This was a retrospective study including 481 Japanese patients with hip pain. These patients were divided into two groups according to the degree of acetabular coverage: dysplasia (n = 256) and nondysplasia (n = 225) groups, respectively. LT was observed in 341 (71%) patients with pre- or early-stage osteoarthritis and hip pain on magnetic resonance imaging. A multivariable logistic regression analysis revealed that the risk of labrum tears increased with age (odds ratio [OR] = 1.04; 95% confidence interval [CI] = 1.03-1.06; P < .001) and acetabular dysplasia (OR = 1.80; 95% CI = 1.15-2.82; P = .0096). Patients in their twenties in the dysplasia group showed a significantly higher rate of LT than those in the nondysplasia group (74% vs. 38%, P = .029). A high rate of LT was observed in Japanese patients with pre- or early-stage osteoarthritis and hip pain regardless of the degree of acetabular coverage. Patients in their twenties with dysplasia showed a significantly higher rate of LT than those without dysplasia.