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3、遺傳因素對髖關節骨關節炎比膝關節骨關節炎的影響更大：基于接受關節置換的雙胞胎人群研究4、假體周圍感染高風險患者關節置換術后延長口服抗生素應用時間的效費比研究5、機器人輔助單髁關節置換術提高假體位置的準確性：前瞻性隨機對照研究6、究比基尼切口與縱向切口用于前入路全髖關節置換術：系統評價7、初次全膝關節置換術中內側副韌帶骨撕脫損傷對療效的影響9、有癥狀和無癥狀人群中臨界髖臼發育不良的患病率:系統綜述和meta分析10、無手術干預的髖關節發育不良患者骨關節炎進展的危險因素11、股骨截骨術和全髖關節置換術治療股骨頭壞死的患者報告結果:一項前瞻性的病例研12、利用解剖影像學參數拓寬LCEA在髖關節發育不良分類中的應用13、髖關節軟骨病變：相關解剖學、影像學檢查和治療方式的最新進展14、男性以及競技運動員身份與髖臼后傾患者髖關節鏡檢查后更好的預后相關目的：血友病患者會出現反復的關節積血。逐漸會導致癥狀型關節病，經常累及膝關節。現代的治療方法可以延緩關節病進展到晚期，而全膝關節置換（TKA）只用以治療部分晚期關節病患者。盡管圍手術期針對血液病治療有新的進展，但潛在的嚴重出血依然存在。本研究的目的是測定血友病患者TKA術后即時的失血量和血液學方面的并發癥。方法：回顧性的分析了12年間在單一中心做了TKA手術的A、B型血友病患者。將這些患者與所有作為對照組的接受TKA手術的非血友病患者和文獻報告的接受TKA手術的非血友病患者的結果進行比較。結果：有18名患者（A型血友病占72%，B型占28%）的21例TKA手術被納入研究，平均年齡44歲。術后24和48小時平均血紅蛋白下降2.7 g/dl 和3.8 g/dl。與非血友病對照組比較，兩組間術后48小時的血紅蛋白下降數量無顯著性差異(P = 0.2644)。沒有術后即時的并發癥發生，有2名（9.6%）患者需要輸血。結論：與非血友病對照組和文獻報道的非血友病患者數據比較，血友病患者在專業的三級轉診中心做單側初次TKA手術看上去圍手術期失血量相似。對于這類復雜的患者，有經驗的骨科醫生和血液科醫生的介入會帶來良好的效果。Perioperative haematological outcomes following total knee arthroplasty in haemophiliacsPurpose: Patients with haemophilia suffer from recurrent joint haemarthrosis. This can progress to symptomatic arthropathy commonly affecting the knee. While modern coagulation strategies have reduced those proceeding to endstage arthropathy, total knee arthroplasty (TKA) remains the optimal treatment for some patients. Despite innovation in perioperative haematological management, concerns about the potential for excessive haemorrhage still exist. The aim of this study is to quantify immediate postoperative blood loss and haematological complications in haemophiliacs following TKA. Methods: A retrospective study of patients with haemophilia types A or B who underwent a TKA over a 12-year period at a single institution was conducted. These patients were compared to both a non-haemophiliac control group and to published standards in non-haemophiliacs undergoing TKA. Results: Twenty-one TKA procedures in 18 patients (72% haemophilia A, 28% haemophilia B) were suitable for inclusion with a mean age of 44 years. The mean haemoglobin drops at 24 and 48 h postoperatively were 2.7 g/dl and 3.8 g/dl respectively. There was no significant difference in haemoglobin drop at 48 h postoperatively when compared to the non-haemophiliac control group (P ? 0.2644). There were no immediate perioperative complications and two patients (9.6%) required postoperative transfusion. Conclusion: Haemophiliacs undergoing a unilateral primary TKA in a specialised tertiary referral centre appear to have comparable rates of perioperative blood loss when compared to both a non-haemophiliac control group as and published haemostatic standards in non-haemophiliac patients following TKA. Perioperative management with expert orthopaedic and haematological input is recommended to optimise outcomes in this complex patient group.文獻出處：Mohan K, Broderick JM, Raftery N, McAuley NF, McCarthy T, Hogan N. Perioperative haematological outcomes following total knee arthroplasty in haemophiliacs. J Orthop Surg (Hong Kong). 2021 Sep-Dec;29(3):23094990211033999. doi: 10.1177/23094990211033999. PMID: 34583559.背景：股骨頭缺血壞死（AVNFH）是一種缺血改變，雖然經過不同方法治療，常導致股骨頭塌陷和髖關節置換（THA）。但有關磁共振成像（MRI）可以預測股骨頭壞死進展和髖關節置換的影像所見，尚不明了。目的：評估AVNFH的磁共振影像特征，明確可預測髖關節置換的類型。材料和方法：本研究為回顧性研究，自2015年5月至2017年12月，共15例18髖（男12人，女3人）連續病例，進行了鉆孔減壓聯合局部骨髓干細胞的治療。治療后3個月、術后1年和/或髖關節置換前，進行磁共振檢查（1.5T）。隨訪至2018年11月，共有10髖進行了髖關節置換，未置換組有1例AECO I型患者無癥狀失訪。觀察置換組與未置換組的骨循環協會分級（ARCO）與磁共振影像所見，包括AVNFH面積、部位、股骨頸骨髓水腫、軟骨下骨折和關節滲液情況。結果：病情進展到髖關節置換的患者，股骨頸骨髓水腫更多（90% vs. 0%）、壞死區附近骨髓水腫更多（100% vs. 43%）、髖臼側骨髓水腫更多（90% vs.14%），軟骨下骨折更多（70% vs. 0%）、關節滲液更多（80% vs. 29%），滑膜炎更多（80% vs. 14.3%），更大的壞死面積、及負重區股骨頭外側柱受累及，也是預測髖關節置換的因素。結論：股骨頭缺血壞死（AVNFH）患者中，發展到髖關節置換的患者、較未發展到髖關節置換的患者，在磁共振影像中常存在多種影像特征。注：未置換組術后12個月有1例ARCO I型患者無癥狀失訪，n=7。Magnetic resonance imaging of avascular necrosis of the femoral head: predictive findings of total hip arthroplastyBackground: Avascular osteonecrosis of the femoral head (AVNFH) is an ischemic condition which despite different treatments often leads to collapse of the femoral head and to total hip arthroplasty. However, the magnetic resonance imaging findings predisposing to disease progression and total hip arthroplasty are somewhat elusive.Purpose: To evaluate the magnetic resonance imaging findings of AVNFH and to assess the patterns of findings which may predict total hip arthroplasty.Materials and methods: A retrospective study was conducted with a total of 18 diagnosed AVNFH treated with core decompression combined with intraosseous stem cell treatment. After treatment, magnetic resonance imaging follow-ups were done at three-month and one-year follow-up or until total hip arthroplasty. Association Research Circulation Osseous classification and magnetic resonance imaging findings such as the size and the location of the AVNFH, bone marrow edema in femoral neck, effusion and subchondral fracture were evaluated.Results: Hips advancing to total hip arthroplasty have more often bone marrow edema in femoral neck (90% vs. 0%), adjacent to necrotic lesion (100% vs. 43%) and in acetabulum (90% vs. 14%), but also subchondral fractures (70% vs. 0%), effusion (80% vs. 29%), and synovitis (80% vs. 14,3%). The greater size and the lateral weight-bearing location of the necrotic lesion also predicted future total hip arthroplasty.Conclusion: Hips advancing to total hip arthroplasty have often a combination of pathognomonic AVNFH imaging findings compared to hips not advancing to total hip arthroplasty.文獻出處：V??n?nen M, Tervonen O, Nevalainen MT. Magnetic resonance imaging of avascular necrosis of the femoral head: predictive findings of total hip arthroplasty. Acta Radiol Open. 2021 Apr 27;10(4):20584601211008379. doi: 10.1177/20584601211008379. PMID: 35140984; PMCID: PMC8819766.目的:探討和量化遺傳作用與可改變的環境因素作用對于已進展到需要接受關節置換的骨關節炎的影響。研究設計: 1915-1960年出生的同性雙胞胎(53.4%女性)的前瞻性隊列研究，數據來源于2014年以前的挪威關節置換術登記系統數據與挪威雙胞胎登記處的國家身份號碼相關聯。患者自行報告的教育程度，身高/體重，并計算體重指數(BMI)。髖關節置換術的總隨訪時間為27年(1987-2014,424,914人年)，膝關節置換術為20年(1994-2014,306,207人年)。在髖關節和膝關節的單獨分析中估計了關節置換術的一致性和遺傳因素。結果:研究人群包括9058對雙胞胎(n=3803單卵(mz)，n=5226雙卵(dz))。總的來說，73%的髖關節和45%的膝關節置換變異的73%可以用遺傳因素來解釋。當調整性別，年齡，教育程度和BMI(hr=2.98,95%ci=1.90-4.67，單卵與雙卵雙胞胎相比)時，遺傳因素與髖關節置換術相關。當調整受精卵和其他協變量(hr=1.15,95%ci=1.02-1.29)時，膝關節置換術在更大程度上于BMI相關。結論:髖關節置換術受遺傳因素影響較大，而膝關節置換術在很大程度上取決于較高的體重指數。與髖關節置換術相比，這項研究表明通過外界干預可以減少意患者接受膝關節置換術的概率。Genetic factors contribute more to hip than knee surgery due to osteoarthritis - a population-based twin registry study of joint arthroplastyObjective: To explore and quantify the relative strengths of the genetic contribution vs the contribution of modifiable environmental factors to severe osteoarthritis (OA) having progressed to total joint arthroplasty.Design: Incident data from the Norwegian Arthroplasty Registry were linked with the Norwegian Twin Registry on the National ID-number in 2014 in a population-based prospective cohort study of same-sex twins born 1915-60 (53.4% females). Education level and height/weight were self-reported and Body Mass Index (BMI) calculated. The total follow-up time was 27 years for hip arthroplasty (1987-2014, 424,914 person-years) and 20 years for knee arthroplasty (1994-2014, 306,207 person-years). We estimated concordances and the genetic contribution to arthroplasty due to OA in separate analyses for the hip and knee joint.Results: The population comprised N = 9058 twin pairs (N = 3803 monozygotic (MZ), N = 5226 dizygotic (DZ)). In total, 73% (95% confidence intervals (CI) = 66-78%) and 45% (95% CI = 30-58%) of the respective variation in hip and knee arthroplasty could be explained by genetic factors. Zygosity (as a proxy for genetic factors) was associated with hip arthroplasty concordance over time when adjusted for sex, age, education and BMI (HR = 2.98, 95% CI = 1.90-4.67 for MZ compared to DZ twins). Knee arthroplasty was to a greater extent dependent on BMI when adjusted for zygosity and the other covariates (HR = 1.15, 95% CI = 1.02-1.29).Conclusion: Hip arthroplasty was strongly influenced by genetic factors whereas knee arthroplasty to a greater extent depended on a high BMI. The study may imply there is a greater potential for preventing progression of knee OA to arthroplasty in comparison with hip OA.文獻出處：Magnusson K, Scurrah K, Ystrom E, ?rstavik RE, Nilsen T, Steingrímsdóttir óA, Ferreira P, Fenstad AM, Furnes O, Hagen KB. Genetic factors contribute more to hip than knee surgery due to osteoarthritis - a population-based twin registry study of joint arthroplasty. Osteoarthritis Cartilage. 2017 Jun;25(6):878-884. doi: 10.1016/j.joca.2016.12.015. Epub 2016 Dec 13. PMID: 27986619.背景：對關節置換（TJA）術后感染高風險患者延長口服抗生素應用時間可以降低假體周圍感染（PJI）發生率。然而其效費比卻并不明確。本研究中，我們應用一個收支平衡的經濟模型研究對高感染風險的關節置換患者延長口服抗生素應用時間的效費比。方法：我們從既往文獻和醫院采購登記信息中收集的數據包括高風險患者的假體周圍感染率，治療PJI施行的關節翻修術花費以及延長口服抗生素應用的花費。我們將這些數據錄入一個收支平衡的經濟模型中來計算為有效降低感染率而延長口服抗生素應用的絕對風險降低值（ARR）。絕對風險降低值被用來明確需治療人數（NNT）。結果：高感染風險的全膝關節置換術病例術后延長口服抗生素頭孢氫氨芐使用時間可以降低感染風險0.187%（需治療人數=535），高感染風險的全髖關節置換術病例術后延長口服抗生素頭孢氫氨芐使用時間可以降低感染風險0.151%（需治療人數=662）。該方法的效費比也隨著抗生素品種不同、感染治療花費不同和感染率的不同而變化。結論：對于高感染風險的關節置換病人延長口服抗生素應用時間可以降低術后假體周圍感染的風險，效費比可觀。然而，目前支持這一觀點的循證學證據質量有限。此外，其應用還可能會導致未來產生抗生素耐藥性而變為負價值，我們在應用時要充分權衡其利弊。The Cost-Effectiveness of Extended Oral Antibiotic Prophylaxis for Infection Prevention after Total Joint Arthroplasty in High-Risk PatientsBackground: Extended oral antibiotic prophylaxis may decrease rates of prosthetic joint infection (PJI) after total joint arthroplasty (TJA) in patients at high risk for infection. However, the cost-effectiveness of this practice is not clear. In this study, we used a break-even economic model to determine the cost effectiveness of routine extended oral antibiotic prophylaxis for PJI prevention in high-risk TJA patients. Methods: Baseline PJI rates in high-risk patients, the cost of revision arthroplasty for PJI, and the costs of extended oral antibiotic prophylaxis regimens were obtained from the literature and institutional purchasing records. These variables were incorporated in a break-even economic model to calculate the absolute risk reduction (ARR) in infection rate necessary for extended oral antibiotic prophylaxis to be cost-effective. ARR was used to determine the number needed to treat (NNT).Results: Extended oral antibiotic prophylaxis with Cefadroxil in patients at high risk for PJI was cost effective at an ARR in baseline infection rate of 0.187% (NNT = 535) and 0.151% (NNT = 662) for TKA and THA, respectively. Cost-effectiveness was preserved with varying costs of antibiotic regimens, PJI treatment costs, and infection rates.Conclusion: The use of extended oral antibiotic prophylaxis may reduce PJI rates in patients at high risk for infection following TJA and appears to be cost-effective. However, the current evidence supporting this practice is limited in quality. The use of extended oral antibiotic prophylaxis should be weighed against the possible development of future antimicrobial resistance, which may change the value proposition.文獻出處：Lipson S, Pagani NR, Moverman MA, Puzzitiello RN, Menendez ME, Smith EL. The Cost-Effectiveness of Extended Oral Antibiotic Prophylaxis for Infection Prevention After Total Joint Arthroplasty in High-Risk Patients. J Arthroplasty. 2022 Oct;37(10):1961-1966. doi: 10.1016/j.arth.2022.04.025. Epub 2022 Apr 25. PMID: 35472436.背景：據報道，與接受全膝關節置換術的患者相比，接受單髁關節置換手術的患者翻修率更高，而假體位置不良是導致內植物失敗的一個因素。機器人輔助手術已被認為可提高關節置換術中假體植入位置準確性。這項前瞻性、隨機、單盲、對照試驗的目的是比較機器人輔助和傳統手術在單髁關節置換術中假體位置精確性。方法：將139名患者隨機分為2組，一組使用MAKO機器人交互式機械臂（RIO）系統輔助手術，另一組使用傳統手術方式，兩組患者均使用Oxford Phase-3單髁關節假體。術后三個月進行CT掃描，以評估軸向、冠狀和矢狀位上假體位置的準確性。結果：共有120例患者的數據可用，其中62例接受了機器人輔助單髁關節置換術，58例接受了傳統單髁關節置換術。所有測量的假體位置參數的觀察者內部一致性均為良好。使用機器人輔助手術提高了假體定位的準確性，所有假體參數的均方根誤差較低，中值誤差顯著降低（p<0.01）。與傳統的單髁關節置換，機器人輔助單髁關節置換術在假體放置在目標位置誤差2°以的比例更高，其中股骨假體矢狀位（57%與26%，p=0.0008）、股骨假體冠狀位（70%與28%，p=0.0001）、股骨假體軸位（53%與31%，p=0.0163）、脛骨假體矢狀位置（80%與22%，p=1.0001）和脛骨假體軸位置（48%與19%，p=2.0009）。結論：與傳統的單髁關節置換手術技術相比，使用MAKO RIO的機器人輔助手術提高了植入物定位的準確性。Improved Accuracy of Component Positioning with Robotic-Assisted Unicompartmental Knee Arthroplasty: Data from a Prospective, Randomized Controlled StudyBackground: Higher revision rates have been reported in patients who have undergone unicompartmental knee arthroplasty compared with patients who have undergone total knee arthroplasty, with poor component positioning identified as a factor in implant failure. A robotic-assisted surgical procedure has been proposed as a method of improving the accuracy of component implantation in arthroplasty. The aim of this prospective, randomized, single-blinded, controlled trial was to evaluate the accuracy of component positioning in unicompartmental knee arthroplasty comparing robotic-assisted and conventional implantation techniques.Methods: One hundred and thirty-nine patients were randomly assigned to treatment with either a robotic-assisted surgical procedure using the MAKO Robotic Interactive Orthopaedic Arm (RIO) system or a conventional surgical procedure using the Oxford Phase-3 unicompartmental knee replacement with traditional instrumentation. A postoperative computed tomographic scan was performed at three months to assess the accuracy of the axial, coronal, and sagittal component positioning.Results: Data were available for 120 patients, sixty-two who had undergone robotic-assisted unicompartmental knee arthroplasty and fifty-eight who had undergone conventional unicompartmental knee arthroplasty. Intraobserver agreement was good for all measured component parameters. Tith the use of the he accuracy of component positioning was improved wrobotic-assisted surgical procedure, with lower root mean square errors and significantly lower median errors in all component parameters (p < 0.01). The proportion of patients with component implantation within 2° of the target position was significantly greater in the group who underwent robotic-assisted unicompartmental knee arthroplasty compared with the group who underwent conventional unicompartmental knee arthroscopy with regard to the femoral component sagittal position (57% compared with 26%, p = 0.0008), femoral component coronal position (70% compared with 28%, p = 0.0001), femoral component axial position (53% compared with 31%, p = 0.0163), tibial component sagittal position (80% compared with 22%, p = 0.0001), and tibial component axial position (48% compared with 19%, p = 0.0009).Conclusions: Robotic-assisted surgical procedures with the use of the MAKO RIO lead to improved accuracy of implant positioning compared with conventional unicompartmental knee arthroplasty surgical techniques.文獻出處：Bell SW, Anthony I, Jones B, MacLean A, Rowe P, Blyth M. Improved Accuracy of Component Positioning with Robotic-Assisted Unicompartmental Knee Arthroplasty: Data from a Prospective, Randomized Controlled Study. J Bone Joint Surg Am. 2016 Apr 20;98(8):627-35. doi: 10.2106/JBJS.15.00664. PMID: 27098321.背景：直接前入路全髖關節置換術（DAA THA）傳統上采用縱向切口，但比基尼切口可以改善術后疤痕外觀和患者滿意度，同時減少傷口并發癥。本系統綜述比較了DAATHA比基尼與縱向切口的臨床結局和手術并發癥。方法：對 PubMed、Cochrane 和 EMBASE 進行系統評價和薈萃分析檢索，以確定 2010 年至 2021 年發表的比較DAA THA 比基尼與縱向切口的原始文章。收集患者人口統計數據和術后結局（疤痕外觀、患者滿意度、功能性髖關節評分和并發癥）并進行定性評估。結果：共納入8項雙臂研究，可以比較比基尼切口（n = 952）與縱向切口（n = 1361）的臨床結局。75%（4篇中3篇）的研究比較術后疤痕外觀和患者滿意度的研究中，報告了比基尼切口后的改善，而1項研究報告了兩個切口結果相似。股外側皮神經損傷是前路THA后最常報告的并發癥，但總體發生率較低，后期大多數可恢復。結論：比基尼切口與傳統縱向切口具有相似的臨床結果，但比基尼切口可改善美容和患者滿意度，同時減少傷口并發癥。目前的證據表明，比基尼切口導致股外側皮神經損傷的風險增加，但這需要在進一步的前瞻性隨機研究中得到證實。Bikini Incision vs Longitudinal Incision for Anterior Total Hip Arthroplasty A Systematic ReviewBackground: Direct anterior approach total hip arthroplasty (DAA THA) traditionally involves a longitudinal incision, but a bikini incision may improve postoperative scar cosmesis and patient satisfaction while reducing wound complications. This systematic review compares the clinical outcomes and surgical complications in patients undergoing DAA THA via a bikini vs longitudinal incision.Methods: A Preferred Reporting Items for Systematic Review and Meta-Analyses-compliant search of PubMed, Cochrane, and EMBASE was performed to identify original articles comparing patients undergoing DAA THA via a bikini vs longitudinal incision published from 2010 to 2021. Patient demographic data and postoperative outcomes (scar appearance, patient satisfaction, functional hip scores, and complications) were collected and qualitatively evaluated.Results: A total of 8 double-armed studies were included, allowing comparison of clinical outcomes of a bikini incision (n = 952) vs a longitudinal incision (n = 1361). Three out of 4 (75.0%) studies comparing postoperative scar appearance and patient satisfaction reported improvements following bikini incision, while 1 study reported comparable results between incision types. Postoperative hip function was similar between incision types in 3 of 4 (75.0%) studies comparing this outcome. Lateral femoral cutaneous nerve injury was the most frequently reported complication following anterior THA, but rates were low overall, and most injuries resolved.Conclusions: Bikini incision appears to be a safe alternative to the traditional longitudinal incision, with similar functional hip outcomes and potentially improved cosmesis and patient satisfaction while reducing wound complications. Current evidence suggests an elevated risk of lateral femoral cutaneous nerve injury with bikini incision, but this needs to be confirmed in further prospective randomized studies.文獻出處：Justin Butler , Amy Singleton , Richard Miller, Bradley Morse, Brandon Naylor, Charles DeCook. Bikini Incision vs Longitudinal Incision for Anterior Total Hip Arthroplasty: A Systematic Review. Arthroplast Today . 2022 Jul 31;17:1-8.背景：本研究的目的是(1)尋找術中應用螺釘和墊圈治療內側副韌帶撕脫癥(MCL)的臨床和影像學結果，(2)預測可能導致初次全膝關節置換術(TKA)中發生撕脫型MCL損傷的術前因素。方法：2011年1月至2015年12月，在連續4916例初次TKA中，有46例(0.8%)發生術中MCL撕脫傷。排除后，41個膝關節與未受MCL損傷的對照組進行1:2匹配，并比較各種臨床、放射學和功能參數。分析的臨床參數包括年齡、性別、體重指數、術前診斷如骨關節炎或類風濕性關節炎、活動范圍、矢狀面畸形和維生素D水平。計算的放射學參數包括冠狀位畸形、脛骨近端內翻角、股骨遠端外翻角、關節線一致角、脛骨后傾角、“杯/碟”形態、有無膝關節半脫位、脛骨外翻和股骨前弓。分析術前、術后膝關節社會評分及膝關節社會功能評分。如果有并發癥或翻修，會在隨訪期間記錄。采用多因素logistic回歸分析預測MCL撕脫傷的術前危險因素。結果：平均隨訪58.4±19.3個月，影像學和體格檢查均未發現不穩定。與術前殘疾相比，兩組患者和對照組在最終隨訪時的臨床評分(膝關節學會評分和膝關節學會功能評分)均有統計學意義上的改善(P < .001)。研究組術前平均冠狀畸形為170.6°±6.96°，對照組為167.7°±4.3°(P = .021)。研究組術前脛骨斜度平均為10.5°±4.9°，對照組為7.91°±4.15° (P = .003)。研究組中有48.8%的膝關節出現術前半脫位(P < .001)， 68.3例膝關節呈“杯/碟”形態(P < .001)。嚴重內翻畸形(優勢比[OR] 1.462, 95%可信區間[CI] 1.15-1.86)、膝關節半脫位(OR 39.78, 95% CI 3.78-418.86)和“杯/碟”形態(OR 33.11, 95% CI 5.69-192.66)的MCL撕脫損傷幾率較大。結論：初次TKA術中MCL骨撕脫傷可以通過螺釘和墊圈結構成功處理，無需增加假體約束性。嚴重內翻畸形、膝關節半脫位和“杯/碟”形態的存在往往增加MCL撕脫損傷的機會。Influence of intraoperative medial collateral ligament bony avulsion injury on the outcome of primary total knee arthroplastyBackground: The purpose of this study is (1) to find the clinical and radiological outcome of intraoperative bony avulsion of medial collateral ligament (MCL) treated with screw and washer construct and (2) to predict the preoperative factors which may contribute to the avulsion-type MCL injury during primary total knee arthroplasty (TKA).Methods: Intraoperative MCL avulsion injury occurred in 46 (0.8%) of the 4916 consecutive primary TKA from January 2011 to December 2015. After exclusion, the 41 knees were matched 1:2 with controls without MCL injury and compared for the various clinical, radiological, and functional parameters. The clinical parameters analyzed were age, gender, body mass index, preoperative diagnosis like osteoarthritis or rheumatoid arthritis, range of motion, sagittal deformity, and vitamin D levels. The radiological parameters calculated were coronal deformity, proximal tibial varus angle, distal femur valgus angle, joint line congruence angle, posterior tibial slope, 'cup and saucer' morphology, presence or absence of knee subluxation, tibia vara, and femoral bowing. The preoperative and postoperative Knee Society Score and Knee Society Functional Score were analyzed. Complications or revisions, if any, were noted during the follow-up. Multivariate logistic regression analysis was used to predict the preoperative risk factors for MCL avulsion injury.Results: At a mean follow-up of 58.4 ± 19.3 months, there were no radiological or physical examination findings of instability. Compared to the preoperative disability, there was a statistically significant improvement in clinical scores (Knee Society Score and Knee Society Functional Score) in the final follow-up (P < .001) in both cases and the control group. The mean preoperative coronal deformity was 170.6 ± 6.96 in the study group and 167.7 ± 4.3 in the control group (P = .021). The mean preoperative tibial slope was 10.5 ± 4.9 in the study group and 7.91 ± 4.15 in the control group (P = .003). The preoperative knee subluxation was present in 48.8% knees (P < .001) and 'cup and saucer' morphology in 68.3 knees (P < .001) in the study group. The adjusted odds of MCL avulsion injury were greater for severe varus deformity (odds ratio [OR] 1.462, 95% confidence interval [CI] 1.15-1.86), knee subluxation (OR 39.78, 95% CI 3.78-418.86), and 'cup and saucer' morphology (OR 33.11, 95% CI 5.69-192.66).Conclusion: Intraoperative MCL bony avulsion injury can be managed successfully with screw and washer construct without the need for increased prosthetic constraint in primary TKA. The presence of severe varus deformity, knee subluxation, and 'cup and saucer' morphology tend to have an increased chance of MCL avulsion injury.文獻出處：Rajkumar N, Soundarrajan D, Dhanasekararaja P, Rajasekaran S. Influence of Intraoperative Medial Collateral Ligament Bony Avulsion Injury on the Outcome of Primary Total Knee Arthroplasty. J Arthroplasty. 2021 Apr;36(4):1284-1294. doi: 10.1016/j.arth.2020.10.051. Epub 2020 Oct 31. PMID: 33229070.全膝關節置換術（TKA）是終末期單間室膝骨關節炎的治療方法，而膝關節單髁置換術（UKA）是一種保留骨和韌帶的替代治療方法。盡管UKA是一種成功的手術方法，UKA的多種優勢與它的自身使用無關，很可能與基于對假體生存能力、患者選擇、理想的墊片設計以及先進手術技術的謹慎使用等方面的考慮有關。因此，本研究的目的是回顧和總結有爭議的文獻，并將這些爭議討論作為“UKA的十大困惑”。對于一個符合UKA手術適應癥的病人，你在選擇 UKA或TKA的時候猶豫不決，你還會傾向選擇UKA嗎？Kozinn和Scott提出的UKA的經典理想適應癥和非理想適應癥在較新的先進假體中仍然有效嗎？3.術前MRI：在考慮患者行UKA前，它是否在決策中發揮作用？8.前交叉韌帶（ACL）重建與UKA同時進行：是否過度治療？10.機器人、計算機導航、個性化器械（PSI）和假體：傳統與技術輔助的UKA哪個更佳？Unicompartmental knee arthroplasty, an enigma, and the ten enigmas of medial UKAUnicompartmental knee arthroplasty (UKA) is a bone- and ligament-sparing alternative to total knee arthroplasty in the patients with end-stage single-compartment degeneration of the knee. Despite being a successful procedure, the multiple advantages of UKA do not correlate with its usage, most likely due to the concerns regarding prosthesis survivability, patient selection, ideal bearing design, and judicious use of advanced technology among many others. Therefore, the purpose of this study is to review and summarize the debated literature and discuss the controversies as 'Ten Enigmas of UKA.'If you had a dilemma in using UKA or TKA in an UKA-indicated patient, would you choose UKA?2.Are classical ideal and nonideal indications of UKA proposed by Kozinn and Scott still valid with newer advanced prostheses?Preoperative MRI: Do they have a role in the decision-making while considering UKA in a patient?4.Errors in component placement: Should incision be minimal or optimal?5.Choice of bearing design: Mobile or fixed bearing?6.Should we use cementless implants instead of cemented ones?7.Ideal limb alignment and optimal position of UKA prosthesis: What is the consensus?8.Anterior cruciate ligament (ACL) reconstruction simultaneously with UKA: Is it too much?9.Is UKA a cost-effective surgery?10.Robotics, computer navigation, and patient-specific instrumentation and implants: Conventional versus technology-assisted UKA?文獻出處：Mittal A, Meshram P, Kim WH, Kim TK. Unicompartmental knee arthroplasty, an enigma, and the ten enigmas of medial UKA. J Orthop Traumatol. 2020 Sep 2;21(1):15. doi: 10.1186/s10195-020-00551-x. PMID: 32876817; PMCID: PMC7468046.背景:臨界髖臼發育不良患者是保髖治療中有爭議的患者群體，因為一些患者主要有撞擊性癥狀，而另一些患者有不穩定性癥狀。臨界發育不良最常被定義為外側中心邊緣角(LCEA)為20°至25°。然而，還沒有文獻清楚描述它的患病率。 目的:(1)通過對文獻的系統回顧和薈萃分析，明確臨界髖關節發育不良在一般人群和髖關節疼痛的人群中的患病率;(2)描述男女患者之間的差異以及與典型髖關節發育不良患病率的差異。 方法:使用搜索詞對文獻進行系統回顧，以獲取臨界發育不良或不同LCEA患病率的研究。搜索產生了1932個結果，其中11篇文章符合納入標準，被納入最后的系統綜述。研究按患者隊列分組為(1)無癥狀的一般人群，(2)無癥狀的目標人群(例如，特定運動項目的運動員)，和(3)有癥狀的髖關節疼痛人群。患病率按受試者或按髖關節進行統計。在一項研究中，將臨界發育不良的發生率與典型髖關節發育不良(LCEA＜20°)的發生率進行比較。 結果:總共11項研究納入分析，包括19,648髖(11,754例患者)。在無癥狀的普通人群中，臨界發育不良患病率的匯總估計為總受試者數的19.8%，占總髖關節數的23.3%(范圍為16.7%-46.0%)。目標亞組包括236名運動員，包括芭蕾、足球、曲棍球、排球、足球和田徑，其患病率在17.8%到51.1%之間。伴有髖關節疼痛的組中臨界發育不良的患病率為12.8%(范圍為12.6%-16.0%)。在無癥狀的普通人群中，臨界髖關節發育不良的發生率是典型髖關節發育不良的3.5倍。 結論:該研究顯示，在無癥狀的普通人群中，臨界發育不良的患病率為19.8%至23.3%。此外，在有癥狀的患者中，臨界發育不良的患病率約12.8%，這些患者的治療決策尚存爭議。Prevalence of Borderline Acetabular Dysplasia in Symptomatic and Asymptomatic Populations: A Systematic Review and Meta-analysisBACKGROUND: Patients with borderline acetabular dysplasia are a controversial patient population in hip preservation, as some have primarily impingement-based symptoms and others have instability-based symptoms. Borderline dysplasia is most commonly defined as a lateral center-edge angle (LCEA) of 20° to 25°. However, its prevalence has not been well established in the literature. PURPOSE: To (1) define the prevalence of borderline hip dysplasia in the general population as well as in populations presenting with hip pain using a systematic review and meta-analysis of the literature and (2) describe differences between male and female patients as well as differences in prevalence from that of classic acetabular dysplasia. STUDY DESIGN: Systematic review; Level of evidence, 3. METHODS: A systematic review of the literature was performed using search terms to capture borderline dysplasia, or studies reporting prevalence by LCEA. The search yielded 1932 results, of which 11 articles met inclusion criteria and were included in the final systematic review. Studies were grouped by patient cohort as (1) asymptomatic general population, (2) asymptomatic targeted population (eg, athletes in a specific sport), and (3) symptomatic hip pain population. The reporting of prevalence rates by subject or by hip was recorded. In a study, the rates of borderline dysplasia were compared with those of classic acetabular dysplasia (LCEA,<20°). RESULTS: The 11 studies included 19,648 hips (11,754 patients). In the asymptomatic general population, the pooled estimate of the prevalence of borderline dysplasia was 19.8% by subject and 23.3% by hip (range, 16.7%-46.0%). The targeted subpopulation group included 236 athletes with subgroups in ballet, football, hockey, volleyball, soccer, and track and field with prevalence ranging from 17.8% to 51.1%. The prevalence of borderline dysplasia in groups presenting with hip pain was 12.8% (range, 12.6%-16.0%). Borderline acetabular dysplasia was 3.5 times more common than classic acetabular dysplasia in the asymptomatic general population. CONCLUSION: This study demonstrated a prevalence of borderline dysplasia of 19.8% to 23.3% in the asymptomatic general population. Additionally, an estimated prevalence of 12.8% of hips in symptomatic patients highlights the common decision-making challenges in this population.文獻出處： Freiman S M , Schwabe M T , Fowler L , et al. Prevalence of Borderline Acetabular Dysplasia in Symptomatic and Asymptomatic Populations: A Systematic Review and Meta-analysis:[J]. Orthopaedic Journal of Sports Medicine, 2022, 10(2):918-923.髖關節發育不良（DDH）是髖關節疼痛的常見原因，也是髖關節骨關節炎(OA)和早期全髖關節置換術(THA)的危險因素。然而目前對與OA風險增加相關的具體因素知之甚少。本研究目的是(i)明確DDH髖關節骨關節炎發生和全髖關節置換術的總發生率，(ii)確定與癥狀性髖關節骨關節炎發展相關的影像學特征和患者特征。使用數據庫確定2000年至2016年期間被診斷為癥狀性髖關節發育不良的所有14-50歲患者。Kaplan-Meier分析用于確定骨關節炎的發生率，定義為髖關節x線片T?nnis骨關節炎分級≥1級。采用單因素和多因素比例風險回歸模型確定OA的危險因素。在1893例髖關節疼痛患者中，159例(144例)髖關節發育不良(52 F:107 M)患者納入研究。其中45例(28%)有嚴重的髖關節發育不良，外側中心邊緣角≤18°。發病時平均年齡為26.1歲。隨訪時間8.2±5年。結果顯示，OA率為20%。11%的患者接受了THA治療。體重指數>29 (P = 0.03)和年齡增加(P < 0.01)是OA的危險因素。有癥狀的髖關節是骨關節炎發生的顯著危險因素。因此，體重指數>29以及出現髖關節疼痛時年齡≥35歲是髖關節骨關節炎發生的危險因素。Risk factors for long-term hip osteoarthritis in patients with hip dysplasia without surgical interventionHip dysplasia is a common cause of hip pain and a known risk factor for hip osteoarthritis (OA) and early total hip arthroplasty (THA). Unfortunately, little is known about the specific factors associated with an increased risk of OA. The purpose was (i) to report the overall rate of symptomatic hip OA and THA and (ii) to identify radiographic features and patient characteristics associated with the development of symptomatic hip OA. A geographic database was used to identify all patients aged 14-50 years old diagnosed with symptomatic hip dysplasia between 2000 and 2016. Kaplan-Meier analysis was used to determine the rate of symptomatic hip OA, defined as a T?nnis grade of ≥1 on hip radiograph. Univariate and multivariate proportional hazard regression models were performed to determine risk factors for OA. One hundred and fifty-nine hips (144 patients) with hip dysplasia (52 F:107 M) out of 1893 patients with hip pain were included. Of these, 45 (28%) had severe hip dysplasia with a lateral center-edge angle ≤18°. Mean age at time of presentation was 26.1 (±10.1) years. Mean follow-up time was 8.2 (±5) years. The rate of OA was 20%. THA was performed in 11% of patients. Body mass index >29 (P = 0.03) and increased age (P < 0.01) were risk factors for OA. Patients with symptomatic hip dysplasia are at significant risk of developing hip OA. Body mass index >29 and age ≥35 years at the time of presentation with hip pain were risk factors for hip OA.文獻出處：Melugin HP, Hale RF, Lee DR, LaPrade MD, Okoroha KR, Sierra RJ, Trousdale RT, Levy BA, Krych AJ. Risk factors for long-term hip osteoarthritis in patients with hip dysplasia without surgical intervention. J Hip Preserv Surg. 2022 Jan 19;9(1):18-21. doi: 10.1093/jhps/hnac007. PMID: 35651707; PMCID: PMC9142191.摘要 背景:患者報告評分系統近年來被應用于外科手術后。本前瞻性研究的目的是評估患者報告的股骨截骨術和全髖關節置換術(THA)治療股骨頭壞死(ONFH)的結果。方法:42例對側髖關節無癥狀的有癥狀的ONFH患者接受經轉子前旋轉截骨術(ARO)或THA作為初次手術。在這些患者中，有20名患者在最終隨訪時(術后1年多)對側髖關節仍無癥狀，被招募參加本研究。ARO治療9例(ARO組)，THA治療11例(THA組)。牛津髖關節評分(OHS)和短髖關節評分(SF-36)均在術前和最終隨訪時進行評估。結果:ARO組和THA組術前OHS分別為29.1 + 10.9和21.9 + 9.6分，末次隨訪時OHS分別為38.4 + 9.4和40.3 + 5.1分。ARO組和THA組術前身體成分總結評分分別為30.8 + 12.8分和17.8 + 14.5分，最終隨訪時分別為44.5 + 10.6分和43.3 + 10.4分。ARO組和THA組的術前心理成分總結評分分別為48.0 + 8.5分和48.6 + 11.3分，在末次隨訪時均未發生變化。結論:本研究的短期患者報告結果表明，ARO和THA治療ONFH均可顯著改善術后髖關節功能。Patient-reported outcomes of femoral osteotomy and totalhip arthroplastyfor osteonecrosis of the femoral head: a prospective caseseries studyBackground: Patient-reported scoring systems have recently been used after surgical procedures. The purpose of this prospective study was to evaluate the patient-reported outcomes of femoral osteotomy and total hip arthroplasty (THA) for osteonecrosis of the femoral head (ONFH). Methods: Forty-two symptomatic ONFH patients with asymptomatic contralateral hip underwent either transtrochanteric anterior rotational osteotomy (ARO) or THA as a primary operation. Of these, 20 patients whose contralateral hips remained asymptomatic at the final follow-up (more than 1 year postoperatively) were recruited to participate in this study. Nine patients were treated with ARO (ARO group) and 11 patients were treated with THA (THA group). Both the Oxford hip score (OHS) and the short form 36 (SF-36) were evaluated preoperatively and at the final follow-up. Results: The preoperative OHS was 29.1 + 10.9 and 21.9 + 9.6 points in the ARO and THA groups, which significantly improved to 38.4 + 9.4 and 40.3 + 5.1 points at the final follow-up, respectively. The preoperative physical component summary score was 30.8 + 12.8 and 17.8 + 14.5 points in the ARO group and THA groups, which significantly improved to 44.5 + 10.6 and 43.3 + 10.4 points at the final follow-up, respectively. The preoperative mental component summary score was 48.0 + 8.5 and 48.6 + 11.3 points in the ARO and THA groups, both of which remained unchanged at the final follow-up. Conclusions: The short-term patient-reported outcomes of this study suggested that both ARO and THA for ONFH resulted in significantly improved postoperative hip joint function.文獻出處：Kubo Y, Yamamoto T, Motomura G, Karasuyama K, Sonoda K, Iwamoto Y. Patient-reported outcomes of femoral osteotomy and total hip arthroplasty for osteonecrosis of the femoral head: a prospective case series study. Springerplus. 2016 Oct 26;5(1):1880. doi: 10.1186/s40064-016-3576-4. PMID: 27833839; PMCID: PMC5081314.背景：Wiberg外側中心邊緣角（LCEA）和T?nnis角（TA）利用一條“水平線”在負重前后骨盆X線片上測量髖關節。根據手術醫生的偏好，目前使用3種不同的定義方法：（1）平行于X線片底部的線（F），（2）連接髖臼淚滴（AT）下緣的線，或（3）連接坐骨結節（IT）的線。必須在初步檢查時準確評估髖關節發育不良的程度，以選擇合適的手術干預。目的：評估X線“水平線”的選擇如何影響LCEA和TA的測量。第二個目的是評估水平線的選擇如何影響正常、臨界發育不良或發育不良髖關節的分類。方法：于2016年2月至2020年11月接受保髖手術（140例髖關節鏡手術，46例髖關節鏡聯合髖臼周圍截骨術）的186名患者的所有術前負重前后骨盆X線片上測量LCEA和TA，每髖分別使用F、AT和IT水平線測量3次。使用Student t檢驗分析LCEA和TA測量值的差異，并量化不同發育不良分類組內的不一致率。結果：對于整個研究人群，平均LCEAF（23.4°±7.4°）顯著高于LCEAIT（23.1°±7.2°）（95%CI，-0.634至-0.003；P=0.047）和LCEAAT（23.0°±7.1°）值（95%CI，-0.723至-0.139；P=.004）。LCEAIT和LCEAAT之間無差異（95%CI，-0.305至0.080；P=0.251）。當通過髖關節鏡手術分層時，平均LCEAF（26.3°±5.6°）顯著大于LCEAAT（25.8° ± 5.3°）（95%CI，-0.845至-0.162；P=0.004）。總體而言，在發育不良分類中與LCEAF相比，LCEAIT和LCEAAT不一致率分別為17.7%和18.3%。整個研究人群、關節鏡手術組、關節鏡聯合髖臼周圍截骨術組的平均TAIT、TAAT和TAF之間無顯著統計學差異。結論：對于LCEA測量，AT和IT組之間測量沒有統計學差異。與F組相比，發育不良測量在另2個分組間更為一致。TA測量不受參考水平線選擇的影響。Use of Anatomic Radiographic Horizons for the Lateral Center-Edge Angle in the Classification of Hip DysplasiaBackground: The lateral center-edge angle of Wiberg (LCEA) and T?nnis angle (TA) rely on a ''horizon’’ that functions as a reference point for measurements of hip dysplasia on weightbearing anteroposterior pelvis radiographs. There are 3 different horizons that are currently utilized depending on surgeon preference: (1) a line parallel to the radiographic floor (F), (2) a line that connects the inferior portions of the acetabular teardrops (ATs), or (3) a line that connects the ischial tuberosities (ITs). It is imperative to accurately assess the degree of hip dysplasia on initial workup to select the appropriate surgical intervention.Purpose: To assess how the choice of a radiographic horizon affects the measurements of the LCEA and TA. The secondary purpose was to assess how the horizon affected the classification of hips as either normal, borderline dysplastic, or dysplastic.Study Design: Cohort study (diagnosis); Methods: The LCEA and TA were measured on all preoperative weightbearing anteroposterior pelvis radiographs for 186 consecutive patients who underwent hip preservation surgery between February 2016 and November 2020 (140 hip arthroscopic procedures, 46 combined hip arthroscopic procedures with periacetabular osteotomy), 3 times per hip, each time using an F, AT, and IT horizon. The Student t test was used to analyze the differences in the measurements of the LCEA and TA, and discordance rates in the dysplasia classification between horizons were quantified.Results: For the entire study population, the mean LCEAF (23.4° ± 7.4°) was significantly greater than the mean LCEAIT (23.1° ± 7.2°) (95% CI, -0.634 to -0.003; P = .047) and mean LCEAAT (23.0° ± 7.1°) (95% CI, -0.723 to -0.139; P = .004). There was no difference between the LCEAIT and LCEAAT (95% CI, -0.305 to 0.080; P = .251). When stratified by hip arthroscopic surgery, the mean LCEAF (26.3° ± 5.6°) was significantly greater than the mean LCEAT (25.8° ± 5.3°) (95% CI, -0.845 to -0.162; P = .004). Overall, there was a 17.7% and 18.3% discordance rate in the dysplasia classification using the LCEAIT and LCEAAT compared with the LCEAF, respectively. There were no statistically significant differences between the mean TAIT, TAAT, and TAF for the entire study population, the arthroscopic surgery group, and the combined arthroscopic surgery and periacetabular osteotomy group.Conclusion: There was no statistical difference between the AT and IT horizons for LCEA measurements. The dysplasia classification was in better agreement between the 2 anatomic horizons compared with the F horizon. The TA was not affected by changes in the horizon.文獻出處：Megerian MF, Strony JT, Mengers SR, Joseph NM, Salata MJ, Wetzel RJ. Use of Anatomic Radiographic Horizons for the Lateral Center-Edge Angle in the Classification of Hip Dysplasia. Am J Sports Med. 2022 Nov;50(13):3610-3616. doi: 10.1177/03635465221125784. Epub 2022 Oct 11. PMID: 36220151.髖關節軟骨病變的診斷和治療一直是骨科領域的挑戰。軟骨病變很常見，并且存在幾種分類系統，以根據嚴重程度、病變位置、放射學相關參數和可能的治療選擇來對其進行分類。當處理可能患有髖關節軟骨病變的患者時，必須進行完整的病史采集、全面的體格檢查和輔助影像學檢查。應對患者站立、仰臥、俯臥和側方等全方位進行體格檢查。普通X線片是一線（最基本的）拍片檢查方法。然而，除關節鏡檢查外，磁共振成像目前是診斷軟骨病變的金標準。多種治療方式可以解決髖關節存在的軟骨病變，并繼續研究報道新的治療方法。目前，軟骨成形術、微骨折術、軟骨移植（自體骨軟骨移植、鑲嵌成形術、同種異體骨軟骨骨移植術）和骨生物學聯合方式（自體軟骨細胞植入ACI，自體基質誘導的軟骨再生AMIC，PRP）均被用來成功治療髖關節軟骨病變。進一步完善研究這些方法和新技術，以繼續提高外科醫生解決髖關節中軟骨病變的能力。圖1. (A, B) Ilizaliturri 的髖臼六分區法右側(A)和左側(B)髖關節（1區：前-下髖臼；2區：前-上；3區：中-上；4區：后-上；5區：后-下；6區：髖臼切跡）。Chondral lesions in the hip: a review of relevant anatomy, imaging and treatment modalitiesThe diagnosis and treatment of chondral lesions in the hip is an ongoing challenge in orthopedics. Chondral lesions are common and several classification systems exist to classify them based on severity, location, radiographic parameters, and potential treatment options. When working up a patient with a potential hip chondral lesion, a complete history, thorough physical exam, and ancillary imaging are necessary. The physical exam is performed with the patient in standing, supine, prone, and lateral positions. Plain film radiographs are indicated as the first line of imaging; however, magnetic resonance arthrogram is currently the gold standard modality for the diagnosis of chondral lesions outside of diagnostic arthroscopy. Multiple treatment modalities to address chondral lesions in the hip exist and new treatment modalities continue to be developed. Currently, chondroplasty, microfracture, cartilage transplants (osteochondral autograft transfer, mosaicplasty, Osteochondral allograft transplantation) and incorporation of orthobiologics (Autologous chondrocyte implantation, Autologous matrix-induced chondrogenesis, Mononuclear concentrate in platelet-rich plasma) are some techniques that have been successfully applied to address chondral pathology in the hip. Further refinement of these modalities and research in novel techniques continues to advance a surgeon's ability to address chondral lesions in the hip joint.文獻出處：Alison A Dallich, Ehud Rath, Ran Atzmon, Joshua R Radparvar, Andrea Fontana, Zachary Sharfman, Eyal Amar. Chondral lesions in the hip: a review of relevant anatomy, imaging and treatment modalities. Review J Hip Preserv Surg. 2019 Apr 16;6(1):3-15. doi: 10.1093/jhps/hnz002. eCollection 2019 Jan.目的：評估髖臼整體后傾患者的髖關節鏡檢查結果，并確定性別、影像學測量結果、運動員身份和是否重返賽場與患者報告結果（PRO）之間的相關性。方法：對接受關節鏡下股骨髖臼撞擊（FAI）手術的髖臼后傾患者進行回顧性研究。整體髖臼后傾由3個標準定義：骨盆前后位片中的交叉征、坐骨棘征和后壁征。用X線測量外側中心邊緣角、α角以及前后壁指數。用三維CT測量股骨頸前傾角。人口學統計包括年齡、性別、運動員狀態、重返賽場情況和再次手術情況。PRO包括改良Harris髖關節評分、髖關節結局評分（HOS）、髖關節殘疾和骨關節炎結局評分、視覺模擬量表（VAS）和退伍軍人RAND-12。我們應用Spearman相關性分析確定了圍手術期PRO的相關性，用廣義估計方程確定獨立的預測因子。顯著性設置為P=0.05。結果：2013年至2019年，149名患者（65.0%女性）接受了髖關節鏡檢查，共160髖出現FAI和髖臼后傾。隨訪平均29.6個月。除退伍軍人RAND-12中的精神健康量表外，所有的PRO結果均表現出顯著改善。女性患者大多數術后PRO評分明顯較低，VAS評分較高（P=0.0002-0.0402）。男性受試者有更高比例達到改良Harris髖關節評分的最小臨床重要差異（88.00%vs 78.79%）。更小的股骨頸前傾角與更高的HOS ADL評分、HOS運動評分、髖關節殘疾和骨關節炎結局評分和運動評分相關（P=.0077-0.0177）。運動員報告的術前VAS評分較低，多個PRO中的圍手術期評分較高（P=0.0004-0.0486）。9髖（5.63%）再次手術。結論：接受髖關節鏡檢查的髖臼整體后傾合并FAI患者的短期隨訪結果良好。與女性受試者和非運動員受試者相比，男性受試者與運動員的結果更好。除較小的股骨前傾角外，放射學測量與結果無關。與非運動員相比，運動員的術前疼痛評分更低，術后PRO更高。Male Gender and Competitive Athlete Status Are Associated With Better Outcomes Following Hip Arthroscopy In Patients With Global Acetabular RetroversionPurpose: To evaluate outcomes of hip arthroscopy in patients with global acetabular retroversion and to identify correlations between sex, radiographic measurements, athlete status, and return to play with patient-reported outcomes (PROs).Methods: Retrospective study of patients with global acetabular retroversion who underwent arthroscopic femoroacetabular impingement (FAI) surgery was performed. Global acetabular retroversion was defined by 3 criteria: the crossover sign, ischial spine sign, and posterior wall sign on an anteroposterior (AP) pelvic radiograph. Radiographs were used to measure lateral center edge angle, alpha angle, and anterior and posterior wall indices. Femoral version was measured with 3-dimensional computed tomography. Demographics included age, gender, athlete status, return to play, and reoperation. PROs included modified Harris Hip Score, Hip Outcome Score (HOS), Hip Disability and Osteoarthritis Outcome Score, visual analog scale (VAS), and Veterans RAND-12. Spearman correlation determined correlation with perioperative PROs. Generalized estimating equation determined independent predictors. Significance was set at P = .05.Results: From 2013 to 2019, 149 patients (65.0% female) with 160 hips with FAI and global acetabular retroversion underwent hip arthroscopy. Follow-up averaged 29.6 months. All PROs demonstrated significant improvement with the exception of the Veterans RAND-12 Mental. Female patients scored significantly lower on most postoperative PROs and had greater VAS scores (P = .0002-0.0402). A greater proportion of male subjects met the minimum clinically important difference for the modified Harris Hip Score (88.00% vs 78.79%) Low femoral version correlated with greater HOS ADL, HOS Sport, and Hip Disability and Osteoarthritis Outcome Score Sport scores (P = .0077-0.0177). Athletes reported lower preoperative VAS scores, and higher perioperative scores in multiple PROs (P = .0004-0.0486). Nine hips (5.63%) underwent reoperation.Conclusions: Patients with global acetabular retroversion and FAI undergoing hip arthroscopy report good outcomes at short-term follow-up. Male subjects and athletes had superior outcomes compared to female subjects and nonathletes. Radiographic measurements did not correlate with outcomes with exception of low femoral version. Athletes reported lower preoperative pain scores and greater postoperative PROs than nonathletes.文獻出處：Olivia C O'Reilly, Molly A Day, Kayla Seiffert, Hollis M Fritts, Qiang An, Robert W Westermann, Christopher M Larson. Male Gender and Competitive Athlete Status Are Associated With Better Outcomes Following Hip Arthroscopy In Patients With Global Acetabular Retroversion. Arthrosc Sports Med Rehabil. 2022 Aug 31;4(5):e1721-e1729. PMID: 36312706. DOI: 10.1016/j.asmr.2022.06.019
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