保髋文献荟萃 — 2026年4月 第3周

BACKGROUND: Although periacetabular osteotomy (PAO) is a commonly used procedure with generally good intermediate and long-term outcomes, complications such as stress fractures of the ischium or pubis have been reported. A limited number of studies have investigated stress fracture after PAO, but the results lack consensus and do not thoroughly explore lifestyle factors or patient-reported outcome measures (PROMs). QUESTIONS/PURPOSES: Among patients treated with PAO: (1) What percentage of patients and hips developed a stress fracture after PAO? (2) What preoperative and intraoperative factors were associated with stress fractures? (3) Did PROMs or the minimum clinically important difference (MCID) and the patient acceptable symptom state (PASS) achievement differ between patients with stress fractures and patients without at most recent follow-up? METHODS: Six hundred seventy-five hips (546 patients) were treated with PAO with or without hip arthroscopy for symptomatic acetabular dysplasia between February 2016 and October 2024 by one surgeon in a mature hip preservation practice. Patients were excluded if the index procedure for those who had bilateral PAOs occurred before the study period. Patients who underwent concomitant femoral osteotomy, surgical hip dislocation, or relative neck lengthening were also excluded, yielding 90% (608 of 675) of hips from 487 patients as potentially eligible for analysis. Ninety-four percent (574 of 608) of PAOs were performed in women, and 65% (396 of 608) were performed without concomitant hip arthroscopy. The mean ± SD age was 26 ± 8 years, and the mean BMI was 23.2 ± 3.9 kg/m 2 . All hips had 6-week, 3-month, and 6-month postoperative radiographs available for review. Two patients with stress fractures and one without converted to THA, leaving 81% (393 of 484) of patients with available minimum 1-year PROMs after their most recent PAO surgery. Stress fracture diagnoses were tallied by hip and by patient to establish the percentages. Exploratory analyses included age, BMI, preoperative vitamin D levels, magnitude of lateral center-edge angle (LCEA) correction, magnitude of anterior center-edge angle correction, Tönnis grade, sex, marijuana use, nicotine use, screw type, prior ipsilateral surgery, PAO with or without concomitant hip arthroscopy, initial PAO versus subsequent contralateral PAO, and diagnoses of Ehlers-Danlos syndrome (EDS) or hypermobility. Factors with p < 0.1 were considered in the multivariate analysis. To determine the association between stress fractures and postoperative outcomes, univariate regression was performed with the presence of stress fractures as the independent variable. Multivariate regressions were performed to determine whether stress fractures were associated with modified Harris hip score (mHHS) and International Hip Outcome Tool-12 (iHOT-12) improvement after controlling for factors identified in the previous analysis. Similarly, regression models were used to determine whether stress fractures were associated with achievement of the MCID and PASS. RESULTS: Stress fractures occurred in 8% (37 of 487) of patients and in 7% (40 of 608) of hips. For patients who underwent bilateral PAOs, 11% (13 of 121) experienced a stress fracture after the second surgery. Bilateral stress fractures occurred in 2% (3 of 121) of patients. After controlling for potential confounding variables such as age, BMI, LCEA correction, substance use, and EDS or hypermobility, we found that several factors were associated with developing stress fractures. Increasing age was associated with higher odds of stress fracture (OR 1.05 [95% confidence interval (CI) 1.01 to 1.09] for each year of increasing age; p = 0.03). Higher BMI was associated with greater odds of stress fracture (OR 1.09 [95% CI 1.002 to 1.19] for each kg/m 2 increase in BMI; p = 0.046). Greater magnitude of LCEA correction was associated with higher odds of stress fracture (OR 1.05 [95% CI 1.01 to 1.10] for each degree of correction; p = 0.02). Current marijuana users had greater odds of stress fracture compared with nonusers (OR 3.06 [95% CI 1.2 to 8.0]; p = 0.02), as did current nicotine users (OR 6.41 [95% CI 1.2 to 34]; p = 0.03). Patients with EDS or hypermobility diagnoses also had higher odds of stress fracture (OR 2.88 [95% CI 1.3 to 6.0]; p = 0.01). Although the proportion was higher, no difference was found between stress fracture occurrence after the first PAO and second PAO in patients who underwent bilateral procedures (OR 2 [95% CI 1 to 4]; p = 0.07). After controlling for factors found to be associated with stress fractures, preoperative PROM scores, and time since most recent PAO, stress fractures were found to be associated with lower preoperative to postoperative improvements in mHHS and iHOT-12 scores, along with decreased odds of achieving the PASS for iHOT-12 and the MCID for mHHS. Patients with stress fractures had mean 6 points less improvement in mHHS than patients without (95% CI -11.6 to -0.84; p = 0.02). Patients with stress fractures had mean 12 points less improvement in iHOT-12 scores than patients without (95% CI -20.6 to -2.45; p = 0.01). Patients with stress fractures had lower odds of achieving the PASS for iHOT-12 (OR 0.36 [95% CI 0.15 to 0.86]; p = 0.02) and lower odds of achieving the MCID for mHHS (OR 0.33 [95% CI 0.13 to 0.83]; p = 0.02). Stress fractures were not associated with achieving the PASS for mHHS (OR 0.52 [95% CI 0.18 to 1.53]; p = 0.24) or the MCID for iHOT-12 (OR 0.86 [95% CI 0.33 to 2.24]; p = 0.76). CONCLUSION: Increasing age, higher BMI, greater LCEA correction, marijuana use, nicotine use, and EDS or hypermobility were associated with increased risk of stress fracture development after PAO for symptomatic acetabular dysplasia. At minimum 1-year follow-up, stress fractures were associated with smaller improvements in mHHS and iHOT-12, as well as lower odds of achieving the PASS for iHOT-12 and the MCID for mHHS. Rather than serving as barriers to surgery, these factors can guide surgeon-patient discussions to provide personalized counseling and rehabilitation, including guidance on potential substance cessation, the use of extended nonweightbearing periods, and realistic expectations for early functional gains. With larger samples of stress fractures, potentially through multicenter registries, future studies should aim to establish clinically meaningful thresholds for associated factors and evaluate the long-term relationship between stress fractures and PROMs, including the influence of fracture healing and fracture location. LEVEL OF EVIDENCE: Level III, therapeutic study.

Prior to 2000, hip arthroscopy had been described by Burman but was not widely employed in clinical practice. After the early 2000s, however, hip arthroscopy became of interest to many surgeons, and its utilization has continued to increase over time. From the early days of hip arthroscopy, numerous studies have provided technical, anatomic, and clinical evidence in support of the use of arthroscopic hip surgery, including contributions from our group. This manuscript highlights key developments in the management of labral pathology, including the development of labral repair techniques, improved understanding of acetabular anatomy, and the development of labral reconstruction procedures, along with biomechanical studies to support their use. For the treatment of labral injuries from debridement to reconstruction, clinical outcome investigations and biomechanical studies have helped guide current surgical strategies. Finally, this review also discusses basic science research and ongoing translational clinical trials investigating novel orthobiologic approaches to support the next generation of evidence-based treatments for hip pathology. Research on patient-centered care management has increasingly focused on improving outcomes and avoiding the need for revision surgery, incorporating translational bench-to-bedside as well as bed-to-benchside approaches. This comprehensive research included in this paper spans over a 25-year period and combines four areas of research, including large clinical outcomes studies, biomechanics, biomotion/imaging, and finally novel therapies for regenerative and personalized medicine. The goal of this work is to continue improving outcomes for patients undergoing hip arthroscopy.

OBJECTIVE: To establish an ultrasound protocol for identifying the muscular structures of the ventromedial hip region that contribute to coxofemoral joint stability, with comparative MRI and gross anatomic dissection confirmation of accurate structure identification. METHODS: High-frequency B-mode ultrasonography and 3-Tesla MRI were utilized to bilaterally investigate the muscular anatomy of the ventromedial hip region in 5 normal adult canine pelvis cadaver specimens (n = 10) from September 1, 2024, through August 30, 2025. Ultrasonographic and MRI appearance and anatomic relationships of the evaluated structures were documented and assessed for consistency. Structure identification was confirmed through ultrasound-guided dye placement (using 2 separate specimens for each evaluated structure) followed by gross anatomical dissection. RESULTS: High-quality ultrasound and MRI images of the pectineus, iliopsoas, adductor longus, adductor magnus et brevis, gracilis, and external obturator muscles were acquired in all specimens. The ultrasonographic approach for evaluating muscles of the ventromedial hip region was documented. Specimen dissection immediately following ultrasound-guided dye injections confirmed accurate identification of all 6 muscles on both attempts, performed separately by 2 clinicians. Structure identification and anatomical descriptions were consistent amongst MRI, ultrasound, and dissection. CONCLUSIONS: This study provides foundational knowledge in ultrasound and MRI anatomy of the ventromedial hip region and demonstrates methods for effective ultrasonographic evaluation of this region. CLINICAL RELEVANCE: These findings provide a foundation for diagnosing soft tissue injuries in the ventromedial hip region and guiding rehabilitation strategies in dogs with hip disease.

BACKGROUND: Developmental dysplasia of the hip (DDH) with complete dislocation (grade ≥III) in older patients often requires open reduction. However, achieving long-term stability remains challenging. This study introduces and evaluates a novel surgical technique, intraosseous tunneling and ligamentodesis of the ligamentum teres (LT), conceived to enhance postoperative hip stability while preserving the ligament's anatomic course. METHODS: Pediatric patients with grade ≥III DDH, as classified by the International Hip Dysplasia Institute (IHDI), underwent open reduction using a novel ligamentum teres ligamentodesis technique to enhance joint stability. The ligament was detached, sutured, and tunneled intraosseously from the fovea to the greater trochanter, then anchored to the periosteum. Postoperative evaluation included gait status, pain, hip range of motion, reluxation, residual dysplasia, avascular necrosis (AVN), physeal bars, growth arrest, complications, and need for reintervention. RESULTS: Nineteen hips in 16 patients (14 females, 2 males) with a median age of 24 months underwent LT intraosseous ligamentodesis combined with femoral and pelvic osteotomies. At a median follow-up of 23 months, all patients were pain-free, had normal gait, and no functional limitations, except for one case of persistent limping and one hip with mild limitation of abduction. Radiographically, all hips achieved satisfactory outcomes with IHDI type I, and severing grades I (80%) and II (20%). No cases of redislocation, dysplasia, infection, physeal bars, or growth arrest were observed. Two hips (10.5%) developed asymptomatic AVN. CONCLUSIONS: The ligamentum teres intraosseous ligamentodesis ("Teretization") is a safe and technically feasible adjunct to open reduction in severe DDH, demonstrating favorable mid-term outcomes with no redislocations and low complication rates. These findings support its potential role in enhancing hip stability without jeopardizing femoral head physis and vascularity. LEVEL OF EVIDENCE: Level IV-therapeutic case series. This study evaluates a novel surgical technique in a series of patients with congenital hip dislocation without a control group.

Secondary osteoarthritis, a degenerative joint disease, is often precipitated by well‑characterized etiological factors, with developmental dysplasia of the hip (DDH) emerging as a leading contributor. Despite its clinical importance, the intricate molecular and cellular cascades triggered by the biomechanical perturbations associated with DDH remain poorly understood. In the present study, a swaddling‑induced rat model of DDH was successfully developed, which recapitulated key pathological features including acetabular labral tears and cartilage degeneration. Through comprehensive mRNA‑sequencing analysis of acetabular cartilage samples from rats with DDH, a notable upregulation of dual‑specificity phosphatase 26 (DUSP26) was identified, a protein with previously unreported roles in joint homeostasis. Subsequently, in an

INTRODUCTION: We aimed to establish age-related characteristics of posture-dependent pelvic tilt and standing spinopelvic alignment in patients with symptomatic hip dysplasia (HD) from adolescence to middle age. MATERIALS AND METHODS: A total of 101 patients with HD indicated for eccentric rotational acetabular osteotomy (ERAO) between 2016 and 2024 were included. Pelvic tilt in supine and standing positions was quantified using the anterior pelvic plane (APP) angle estimated from computed tomography-based 3D pelvic models matched to supine and standing anteroposterior hip radiographs. The change from supine to standing was calculated as standing minus supine; negative values indicated a posterior change. Three-dimensional acetabular coverage during postural transition was compared across age groups. Standing radiographic hip and spinopelvic parameters were also examined using multivariable regression analysis to identify factors associated with age. RESULTS: Age was correlated with the supine-to-standing change in the APP angle (r = 0.47, p < 0.001). The change shifted closer to zero with increasing age, with younger patients showing a larger posterior change compared with older patients. Patients in their teens showed a more pronounced decrease in anterosuperior acetabular coverage at the 2 o'clock position compared with those in their 40 s (p = 0.017) and 50 s (p = 0.040). Furthermore, anterior wall index in standing (β = 0.26, p = 0.007), sagittal vertical axis (β = 0.24, p = 0.015), and sacral slope (β = 0.24, p = 0.014) were identified as independent factors associated with age. CONCLUSIONS: Younger patients with HD showed a larger posterior change in pelvic tilt during postural transition compared with middle-aged patients. These findings support preoperative assessment of functional acetabular coverage in the standing position, particularly in the anterosuperior region in younger patients, when planning ERAO. Longitudinal studies are needed to determine whether maintaining anterior pelvic tilt during standing contributes to preservation of joint integrity into middle adulthood.

PURPOSE: Focal labral ossification is a recognized radiographic finding in developmental dysplasia (DDH) and is typically regarded as a chronic lesion resulting from excessive stress on the chondro-labral junction. The necessity for direct surgical intervention at the time of periacetabular osteotomy (PAO) for these ossifications remains a subject of debate. This study aimed to explore the natural course of pre-existing focal labral ossifications following isolated PAO in adolescents and adults, hypothesizing that biomechanical correction alone would facilitate the spontaneous resolution of this focal labral metaplasia. METHODS: A retrospective observational subgroup analysis of an institutional database identified a single treatment group who underwent isolated PAO for symptomatic DDH in adolescents and adults between January 2022 and November 2024. Pre- and 1-year postoperative radiographs were independently assessed for the status of the labral ossification. Radiographic parameters of acetabular coverage and validated patient-reported outcome measures (PROMs) were compared between hips with and without ossification. Multivariable regression analysis was performed to identify factors associated with labral ossification. RESULTS: Of 389 hips undergoing PAO, 41 (10%) demonstrated preoperative labral ossification. Baseline PROMs and most radiographic parameters were comparable between hips with and without ossification, although posterior coverage was significantly reduced in the ossification group. At 1-year follow-up, 37 of 41 hips (90%) showed complete radiographic resolution of labral ossification, two hips (5%) demonstrated partial regression and two hips (5%) remained unchanged. Multivariable analysis identified a mild association between posterior coverage and the presence of ossification, while no associations were found with activity level or PROMs. CONCLUSION: Isolated PAO was found to be strongly associated with spontaneous remission of focal rim ossification in the vast majority of dysplastic hips within 1 year after surgery. These findings challenge the concept that focal rim ossifications represent irreversible degenerative pathology and instead suggest that they are a more appropriately interpreted as a metaplastic adaptation, indicating a remodeling potential of the chondro-labral junction following biomechanical correction alone. Routine surgical treatment of chronic labral ossifications at the time of PAO may therefore be unnecessary. LEVEL OF EVIDENCE: Level III.

BACKGROUND: Conventional robotic-assisted total knee arthroplasty (RA-TKA) relies on rigid limb fixation to suppress intra-operative motion, adding complexity and potential inefficiency. A novel motion-following control system dynamically compensates for limb movement, allowing real-time adjustment of the tool-bone relationship without immobilization. This study evaluated whether motion-following improves efficiency and osteotomy accuracy while preserving alignment and early function. METHODS: Sixty consecutive primary RA-TKA cases performed with the SkyWalker robotic platform (MicroPort, Shanghai, China) between September 2022 and August 2024 were retrospectively reviewed. Thirty procedures used conventional rigid fixation (control group) and thirty employed motion-following tracking (motion-Following group). Primary endpoints were operative time and resection thickness error, measured intraoperatively with a caliper. Secondary outcomes included coronal alignment assessed by HKA (hip-knee-ankle angle), CFCA (coronal femoral component angle), and CTCA (coronal tibial component angle), as well as functional recovery assessed by WOMAC (Western Ontario and McMaster Universities Osteoarthritis Index) at 6 months. Values are expressed as mean ± standard deviation unless otherwise specified. RESULTS: Mean operative time was shorter with motion-following (118.8 ± 9.3 min) than with conventional fixation (133.9 ± 11.9 min; p < 0.001). Mean resection-thickness error was lower with motion-following (0.53 mm vs 0.82 mm), with 93.9% versus 68.3% of cuts within ≤ 1 mm. At the plane level, motion-following achieved smaller errors on all six surfaces, with four planes: DF-M (distal femur medial), distal femur lateral (DF-L), posterior femur medial (PF-M), and tibial plateau lateral (TP-L) reaching statistical significance (p < 0.05). Post-operative coronal alignment closely reproduced the pre-operative plan in both groups, with mean deviations of approximately 1° across all parameters and no statistically significant between-group differences. WOMAC scores improved substantially in both groups, with no significant between-group difference (ΔWOMAC 32.8 ± 8.5 vs 30.1 ± 7.9; p = 0.21). CONCLUSIONS: Motion-following robotic control streamlines TKA by eliminating rigid fixation, improving workflow efficiency, and slightly enhancing osteotomy precision without compromising alignment or recovery. This dynamic, real-time tracking approach refines execution of the surgical plan and may represent a meaningful evolution toward more efficient, surgeon-friendly robotic arthroplasty.

INTRODUCTION: A periacetabular osteotomy (PAO) is a joint-preserving surgical option for treatment of acetabular dysplasia. The procedure aims to prevent, or at least delay, the development of osteoarthritis, and subsequent need for total hip arthroplasty (THA). The conversion rate to THA differs widely in the literature, but most of the studies have few patients, and the follow-up time is often short for THA as an endpoint. The aim of this study was to evaluate the long-term outcome after PAO surgery with the rate of conversion to THA as the primary outcome. MATERIALS AND METHODS: Patients ≥18 years that underwent a PAO operation at the Karolinska University Hospital in Stockholm, Sweden from 2006 to 2022 were included. Radiological signs of hip osteoarthritis, and the lateral center-edge angle (LCEA) was calculated on pre- and postoperative radiographs or CT-scans. The national Swedish Arthroplasty Register was used to find cases who had a secondary operation with THA. RESULTS: The number of cases included was 96. Median age was 30 (18–46) years, and 84% ( CONCLUSIONS: The PAO procedure is a suitable option in young patients with symptomatic dysplasia of the hip in order to avoid, or at least delay, hip arthroplasty.

BACKGROUND: Periacetabular osteotomy (PAO) is a well-established surgical intervention for symptomatic acetabular dysplasia in young, active patients. While radiographic and clinical outcomes are well documented, less is known about functional return to daily and athletic activities postoperatively. This study aimed to assess post-PAO return to activity, including sport, school, work, driving, and sexual activity. METHODS: A survey was distributed to 276 patients (348 hips) who underwent PAO in the last 10 years at a single institution, with 85 respondents (118 hips), and a response rate of 31%. Patients were asked about their activity levels and daily life preoperatively and postoperatively. RESULTS: The average age at surgery was 25 years (SD = 6.5), with a mean follow-up of 5.1 years (range, 0.4 to 11.2). Return to school (n = 35) and work (n = 62) occurred within 12 weeks for the majority of patients. Driving (n = 54) resumed within 6 weeks for 55% of patients. Sexual activity (n = 49) resumed within 9 weeks for 61.3% of patients, with hip pain (94.6%) and muscle weakness (54.1%) being the most common challenges. Among preoperative athletes, 70.1% returned to sport, primarily at a recreational level, while 27.3% of those who did not play sports preoperatively initiated a sport postoperatively. CONCLUSIONS: Most patients successfully returned to daily activities following PAO within 3 months, though many experienced moderate difficulties, particularly due to hip pain and muscle weakness. While return to sport was less frequent and often at a lower level of competitiveness, improvements in physical function were evident through patient-reported outcomes. These findings offer valuable guidance on expected recovery following PAO for both patients and providers, while underscoring the importance of targeted rehabilitation to address persistent functional limitations and promote return to daily life.

Osteoarthritis of the ankle joint affects a younger and often occupational and sport-active patient group than hip and knee arthritis and in the majority of cases has a secondary or posttraumatic origin. Corrective osteotomy is a biological and functionally attractive option for these young and active patients with asymmetric arthritis and correctable malalignment as the native joint is preserved and subsequent arthrosis can be potentially prevented or delayed by arthrodesis. Decisive for the success are consistent 3‑dimensional diagnostics, precise planning, correct interpretation of the indications as well as completely addressing the fibular, hindfoot and instability components. Die Arthrose des oberen Sprunggelenks (OSG) betrifft im Vergleich zu Hüft- und Kniearthrose eine jüngere, häufig noch beruflich und sportlich aktive Patientengruppe und ist in der Mehrzahl der Fälle sekundär/posttraumatisch bedingt. Die Umstellungsosteotomie ist bei diesen jüngeren, aktiven Patienten mit asymmetrischer Arthrose und korrigierbarer Fehlstellung eine biologisch und funktionell attraktive Option, da das native Gelenk erhalten bleibt und Anschlussarthrosen durch Arthrodese potenziell vermieden bzw. hinausgezögert werden. Erfolgsentscheidend sind eine konsequent dreidimensionale Diagnostik, präzise Planung, korrekte Indikationsstellung sowie die vollständige Adressierung von Fibula‑, Rückfuß- und Instabilitätskomponenten.

Developmental dysplasia of the hip represents a spectrum of disorders ranging from mild acetabular dysplasia to complete hip dislocation. Early diagnosis and treatment are essential to prevent long-term complications. The Pavlik harness remains the first-line treatment for infants with reducible hip dysplasia or dislocation diagnosed within the first months of life and has demonstrated high success rates. However, complications related to its use may occasionally occur. One of the rare but significant complications is obturator (inferior) dislocation of the hip during treatment. We present the case of a two-month-old female infant diagnosed with Graf type IV developmental dysplasia of the right hip. Following reduction and treatment with a Pavlik harness, follow-up imaging revealed an obturator dislocation of the hip. The harness was discontinued, and closed reduction with subsequent casting was performed. Despite an initially successful reduction, the patient later developed persistent dysplasia, subluxation, and femoral head fragmentation. Long-term follow-up demonstrated improvement in hip stability, but residual acetabular dysplasia and deformity of the ossific nucleus were present, consistent with coxa plana. The patient is currently scheduled for a corrective pelvic osteotomy. This case highlights the importance of careful monitoring during Pavlik harness treatment and early recognition of atypical displacement patterns. Prompt diagnosis and appropriate management are essential to prevent further complications and optimize long-term hip development.

CASE: An 18-year-old woman with Ehlers-Danlos syndrome developed subacute thigh pain on postoperative day 21 following elective hip arthroscopy and a periacetabular osteotomy. Doppler ultrasound revealed a pulsatile "yin-yang" lesion in the rectus femoris, and CT angiography confirmed a pseudoaneurysm of the lateral circumflex femoral artery with an arteriovenous fistula. Endovascular coil embolization with thrombin injection achieved complete thrombosis and symptom resolution. CONCLUSION: Vascular injury, though rare, should be considered after hip arthroscopy in patients with connective tissue disorders. Early multimodal imaging enables timely diagnosis, and minimally invasive endovascular treatment can provide definitive management with low morbidity.