Aims. Hip arthroscopy has gained prominence as a primary surgical intervention for symptomatic femoroacetabular impingement (FAI). This study aimed to identify radiological features, and their combinations, that predict the outcome of hip arthroscopy for FAI. Methods. A prognostic cross-sectional cohort study was conducted involving patients from a single centre who underwent hip arthroscopy between January 2013 and April 2021. Radiological metrics measured on conventional radiographs and magnetic resonance arthrography were systematically assessed. The study analyzed the relationship between these metrics and complication rates, revision rates, and patient-reported outcomes. Results. Out of 810 identified hip arthroscopies, 359 hips were included in the study. Radiological risk factors associated with unsatisfactory outcomes after cam resection included a dysplastic posterior wall, Tönnis grade 2 or higher, and over-correction of the α angle. The presence of acetabular retroversion and dysplasia were also significant predictors for worse surgical outcomes. Notably, over-correction of both cam and pincer deformities resulted in poorer outcomes than under-correction. Conclusion. We recommend caution in performing hip arthroscopy in patients who have three positive acetabular retroversion signs. Acetabular dysplasia with a lateral centre-edge angle of less than 20° should not be treated with isolated hip arthroscopy. Acetabular rim-trimming should be avoided in patients with borderline dysplasia, and care should be taken to avoid over-correction of a cam deformity and/or pincer deformity. Cite this article: Bone Joint J 2024;106-B(8):775–782

Aims. This paper aims to review the evidence for patient-related factors associated with less favourable outcomes following hip arthroscopy. Methods. Literature reporting on preoperative patient-related risk factors and outcomes following hip arthroscopy were systematically identified from a computer-assisted literature search of Pubmed (Medline), Embase, and Cochrane Library using Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) guidelines and a scoping review. Results. Assessment of these texts yielded 101 final articles involving 90,315 hips for qualitative analysis. The most frequently reported risk factor related to a less favourable outcome after hip arthroscopy was older age and preoperative osteoarthritis of the hip. This was followed by female sex and patients who have low preoperative clinical scores, severe hip dysplasia, altered hip morphology (excess acetabular retroversion or excess femoral anteversion or retroversion), or a large cam deformity. Patients receiving workers’ compensation or with rheumatoid arthritis were also more likely to have a less favourable outcome after hip arthroscopy. There is evidence that obesity, smoking, drinking alcohol, and a history of mental illness may be associated with marginally less favourable outcomes after hip arthroscopy. Athletes (except for ice hockey players) enjoy a more rapid recovery after hip arthroscopy than non-athletes. Finally, patients who have a favourable response to local anaesthetic are more likely to have a favourable outcome after hip arthroscopy. Conclusion. Certain patient-related risk factors are associated with less favourable outcomes following hip arthroscopy. Understanding these risk factors will allow the appropriate surgical indications for hip arthroscopy to be further refined and help patients to comprehend their individual risk profile. Cite this article: Bone Joint J 2020;102-B(7):822–831

Objective. Hip arthroscopy in the setting of hip dysplasia is controversial in the orthopaedic community, as the outcome literature has been variable and inconclusive. We hypothesise that outcomes of hip arthroscopy may be diminished in the setting of hip dysplasia, but outcomes may be acceptable in milder or borderline cases of hip dysplasia. Methods. A systematic search was performed in duplicate for studies investigating the outcome of hip arthroscopy in the setting of hip dysplasia up to July 2015. Study parameters including sample size, definition of dysplasia, outcomes measures, and re-operation rates were obtained. Furthermore, the levels of evidence of studies were collected and quality assessment was performed. Results. The systematic review identified 18 studies investigating hip arthroscopy in the setting of hip dysplasia, with 889 included patients. Criteria used by the studies to diagnose hip dysplasia and borderline hip dysplasia included centre edge angle in 72% of studies but the range of angles were quite variable. Although 89% of studies reported improved post-operative outcome scores in the setting of hip dysplasia, revision rates were considerable (14.1%), with 9.6% requiring conversion to total hip arthroplasty. Conclusion. The available orthopaedic literature suggests that although improved outcomes are seen in hip arthroscopy in the setting of hip dysplasia, there is a high rate of re-operation and conversion to total hip arthroplasty. Furthermore, the criteria used to define hip dysplasia vary considerably among published studies. Cite this article: M. Yeung, M. Kowalczuk, N. Simunovic, O. R. Ayeni. Hip arthroscopy in the setting of hip dysplasia: A systematic review. Bone Joint Res 2016;5:225–231. DOI: 10.1302/2046-3758.56.2000533

This study aimed to analyse the incidence, the operative findings and outcomes of hip arthroscopy after periacetabular osteotomy (PAO). We conducted a retrospective study of prospective collected data to report the operative findings and outcomes of hip arthroscopy for recurrent pain following PAO for acetabular dysplasia. Demographic data, radiographic and arthroscopic findings were analysed. Pre- and post-operative patient reported outcome measures (PROMs) were collected. Of 184 PAO patients, 15 hips in 15 patients (8.2%) underwent post-PAO hip arthroscopy with 2 males and 13 females at a mean time of 3.9 ±2.9(0.3–10) years. Hip arthroscopy findings included labral tears (15 hips, 100%), chondral damage (11 hips, 73%) with one Beck 1, two Beck 2, four Beck 4, and four Beck 5 damage. There were 8 (53%) isolated labral debridement, 7 (47%) labral repair, and 2 (13%) adhesiolysis. A femoral osteochondroplasty was performed in 4 (27%) hips. Four hips (27%) were finally converted to total hip replacement at a mean delay of 2.3 ±1.4 (0.7–3.2) years post hip arthroscopy and these 4 patients were significantly older than those who were not (p=0.02). There were no significant differences in PROMs pre and post hip scope. 8.2% of patients undergoing a PAO required a hip scope for persistent hip pain. Common post-PAO hip arthroscopy findings included labral tears, chondral changes and femoroacetabular impingement. 27% of patients finally underwent conversion to total hip replacement at a mean follow-up of 4.5 years post hip scope

Introduction. With resumption of non-urgent surgery in May 2020, standard anesthesia for hip arthroscopy switched from general with endotracheal intubation (GA) to spinal (SA) in response to COVID-19 implications; reducing potential aerosolized exposure for patient and staff and reducing consumption of personal protective equipment (PPE). There are no studies that compare the attributes for these two anesthesia methods for hip arthroscopy; and thus, this was viewed as an opportunity to perform a comparative observational study on SA to a recent matched group of GA. Methods. Beginning in May 2020, SA became the standard for hip arthroscopy. GA was used if the patient refused SA or had a history of previous lumbar spinal surgery, or body mass index (BMI) greater than 35. SA patients were carefully matched for age, gender and procedure to a recent previous GA population and compared for recovery room (RR) length of stay, entry and discharge visual analog scores (VAS), morphine mg equivalent (MME) usage, and untoward events. Additionally, SA and GA cases performed since May 2020 were compared for the length of time from entry to the operating room (OR) until the surgeon was able to perform an examination under anesthesia (EUA). Results. Statistical analysis determined that these groups are too small (46 in each group) to establish significant differences, but the authors felt that an opportunity to explore this, based on a recent change out of necessity (COVID-!9), was worth presenting as a novel study to compare two accepted methods of anesthesia for hip arthroscopy. SA patients required fewer regional blocks (7 vs 1) and needed less narcotics (99 vs 153). As a potential advantage of SA, continued investigation to see if this reaches statistical significance is meaningful. SA patients did spend more time in the PACU (136 vs 133); and had more problems with urinary retention, requiring catheterization (5 vs 0); but most of these occurred early in the experience and was corrected by having the patient void immediately prior to transfer to the OR and avoiding anticholinergic medications. SA seemed to add only slightly to the length of time until the surgeon could perform an EUA and begin positioning for the procedure (9 vs 8). Conclusion. Hip arthroscopy can be effectively performed with either GA or SA. Of particular interest with further studies will be whether choice of anesthesia affects early postoperative rehabilitation

The gold standard treatment of hip dysplasia is a peri-acetabular osteotomy (PAO). Labral tears are seen in the majority of patients presenting with hip dysplasia and diagnosed using Magnetic Resonance Imaging (MRI). The goal was to (1) evaluate utility/value of MRI in patients undergoing hip arthroscopy at time of PAO, and (2) determine whether MRI findings of labral pathology can predict outcome. A prospective randomized controlled trial was conducted at tertiary institutions, comparing patients with hip dysplasia treated with isolated PAO versus PAO with adjunct hip arthroscopy. This study was a subgroup analysis on 74 patients allocated to PAO and adjunct hip arthroscopy (age 26±8 years; 89.2% females). All patients underwent radiographic and MRI assessment using a 1.5-Tesla with or 3-Tesla MRI without arthrography to detect labral or cartilage pathology. Clinical outcome was assessed using international Hip Outcome Tool-33 (iHOT). 74% of patients (55/74) were pre-operatively diagnosed with a labral tear on MRI. Among these, 41 underwent labral treatment (74%); whilst among those without a labral tear on MRI, 42% underwent labral treatment (8/19). MRI had a high sensitivity (84%), but a low specificity (56%) for labral pathology (p=0.053). There was no difference in pre-operative (31.3±16.0 vs. 37.3±14.9; p=0.123) and post-operative iHOT (77.7±22.2 vs. 75.2±23.5; p=0.676) between patients with and without labral pathology on MRI. Value of MRI in the diagnostic work-up of a patient with hip dysplasia is limited. MRI had a high sensitivity (84%), but low specificity (44%) to identify labral pathology in patients with hip dysplasia. Consequently, standard clinical MRI had little value as a predictor of outcome with no differences in PROM scores between patients with and without a labral tear on MRI. Treatment of labral pathology in patients with hip dysplasia remains controversial. The results of this subgroup analysis of a prospective, multi-centre RCT do not show improved outcome among patients with dysplasia treated with labral repair

Young adult hip pathology commonly affects patients of reproductive age. The extent to which hip arthroscopy (HA) treatments influence sexual function is not well described and limited to small cohorts. This study aims to describe trends in self-reported reported sexual function before and after HA. Adult (≥18 years) patients who underwent HA between 1. st. January 2012 and 31. st. October 2020 were extracted from the UK Non-Arthroplasty Hip Registry. International Hip Outcome Tool 12 (iHOT-12) questionnaires were collected pre-operatively and at 6 and 12 months. Patients are first asked if ‘questions about sexual activity are relevant to them’. The iHOT-12 then asks asking patients to quantify ‘how much trouble they experience with sexual activity because of their hip?’ with responses converted to a continuous scale (0–100) to measure function. Chi-squared and t-tests were used to compare categorical and continuous variables respectively. Of 7639 procedures (59% female, mean age 36.5 years (SD 11)), 91% (5616 of 6151 respondants) indicated pre-operatively that questions about sexual activity were relevant to them (male 93%, female 90%, p < 0.001). Overall, mean pre-operative sexual function increased from 42.0 (95%CI 41.2 to 42.8, n=5267) to 61.8 (60.6 to 63.1, n=2393) at 6 months, and 62.1 (60.8 to 63.5, n=2246) at 12 months post-operatively. At 12 months, both sexes saw significant improvement in their pre-operative sexual function scores (p<0.0001). Males started from significantly higher baseline sexual function (53.3 vs 34.2) and achieved higher scores by 12 months (68.8 vs 58.0) compared to female patients. There was no significant difference in pre- or post-operative scores when comparing younger (<40 years) and older (>40 years). Most patients can expect to experience improvement in their sexual function following hip arthroscopy, regardless of sex or age group

Aims. Responsiveness and ceiling effects are key properties of an outcome score. No such data have been reported for the original English version of the International Hip Outcome Tool 12 (iHOT-12) at a follow-up of more than four months. The aim of this study was to identify the responsiveness and ceiling effects of the English version iHOT-12 in a series of patients undergoing hip arthroscopy for intra-articular hip pathology at a minimum of one year postoperatively. Methods. A total of 171 consecutive patients undergoing hip arthroscopy with a diagnosis of femoroacetabular impingement (FAI) under the care of a single surgeon between January 2013 and March 2017 were included. iHOT-12 and EuroQol 5D-5L (EQ-5D-5L) scores were available pre- and postoperatively. Effect size and ceiling effects for the iHOT-12 were calculated with subgroup analysis. Results. A total of 122 patients (71.3%) completed postoperative PROMs scores with median follow-up of 24.3 months (interquartile range (IQR) 17.2 to 33.5). The median total cohort iHOT-12 score improved significantly from 31.0 (IQR 20 to 58) preoperatively to 72.5 (IQR 47 to 90) postoperatively (p < 0.001). The effect size (Cohen’s d) was 1.59. In all, 33 patients (27%) scored within ten points (10%) of the maximum score and 38 patients (31.1%) scored within the previously reported minimal clinically important difference (MCID) of the maximum score. Furthermore, nine (47%) male patients aged < 30 years scored within 10% of the maximum score and ten (53%) scored within the previously reported MCID of the maximum score. Conclusion. There is a previously unreported ceiling effect of the iHOT-12 at a minimum one-year follow-up which is particularly marked in young, male patients following hip arthroscopy for FAI. This tool may not have the maximum measurement required to capture the true outcome following this procedure. Cite this article: Bone Joint J 2020;102-B(8):1010–1015

Hip arthroscopy is a rapidly expanding technique that has a steep learning curve. Simulation may have a role in helping trainees overcome this. However there is as yet no validated hip arthroscopy simulator. This study aimed to test the construct validity of a virtual reality hip arthroscopy simulator. Nineteen orthopaedic surgeons performed a simulated arthroscopic examination of a healthy hip joint in the supine position. Surgeons were categorized as either expert (those who had performed 250 hip arthroscopies or more) or novice (those who had performed fewer than this). Twenty-one targets were visualized within joint; nine via the anterior portal, nine via the anterolateral and three via the posterolateral. This was followed by a task testing basic probe examination of the joint in which a series of eight targets were probed via the anterolateral portal. Each surgeon's performance was evaluated by the simulator using a set of pre-defined metrics including task duration, number of soft tissue & bone collisions, and distance travelled by instruments. No repeat attempts at the tasks were permitted. Construct validity was then evaluated by comparing novice and expert group performance metrics over the two tasks using the Mann–Whitney test, with a p value of less than 0.05 considered significant. On the visualization task, the expert group outperformed the novice group on time taken (P=0.0003), number of collisions with soft tissue (P=0.001), number of collisions with bone (P=0.002) and distance travelled by the arthroscope (P=0.02). On the probe examination, the two groups differed only in the time taken to complete the task (P=0.025). Increased experience in hip arthroscopy was reflected by significantly better performance on the VR simulator across two tasks, supporting its construct validity. This study validates a virtual reality hip arthroscopy simulator and supports its potential for developing basic arthroscopic skills

There is a known association between femoroacetabular impingement and osteoarthritis of the hip. What is not known is whether arthroscopic excision of an impingement lesion can significantly improve a patient’s symptoms. This study compares the results of hip arthroscopy for cam-type femoracetabular impingement in two groups of patients at one year. The study group comprised 24 patients (24 hips) with cam-type femoroacetabular impingement who underwent arthroscopic debridement with excision of their impingement lesion (osteoplasty). The control group comprised 47 patients (47 hips) who had arthroscopic debridement without excision of the impingement lesion. In both groups, the presence of femoroacetabular impingement was confirmed on pre-operative plain radiographs. The modified Harris hip score was used for evaluation pre-operatively and at one-year. Non-parametric tests were used for statistical analysis. A tendency towards a higher median post-operative modified Harris hip score was observed in the study group compared with the control group (83 vs 77, p = 0.11). There was a significantly higher proportion of patients in the osteoplasty group with excellent/good results compared with the controls (83% vs 60%, p = 0.043). Additional symptomatic improvement may be obtained after hip arthroscopy for femoroacetabular impingement by the inclusion of femoral osteoplasty

Periacetabular osteotomy (PAO) is the preferred treatment for symptomatic acetabular dysplasia in adolescents and young adults. There remains a lack of consensus regarding whether intra-articular work such as labral repair or improvement of femoral offset should be performed at the time of PAO or addressed subsequent to PAO if symptoms warrant. The purpose was to determine the rate of subsequent hip arthroscopy (HA) in a contemporary PAO cohort with no intra-articular work performed at the time of PAO. From June 2012 to March 2022, 368 rectus sparing PAOs were performed and followed for a minimum of one year (mean 5.9 years). The average age was 24 (range 14–46) and 89% were female. Patients were evaluated at last follow-up for patient-reported outcomes (PROMs). Clinical records were reviewed for complications or subsequent surgery. Radiographs were reviewed for the following acetabular parameters: LCEA, ACEA, AI, and the alpha-angle (AA). Patients were cross-referenced from the two largest hospital systems in our area to determine if subsequent HA was performed. Descriptive statistics were used to analyze risk factors for HA. 16 hips (15 patients) (4.4%) underwent subsequent HA with labral repair and femoral osteochondroplasty most common. For those with a minimum of two years of follow-up, 5.3% underwent subsequent HA. No hips underwent THA; one revision PAO was performed. 14 hips experienced a complication and 99 underwent hardware removal. All PROMs improved significantly post-operatively. Radiographically 80% of hips were in goal for acetabular correction parameters with no significant differences between those who underwent subsequent HA and those who did not. Rectus sparing PAO is associated with a low rate of subsequent HA for intra-articular pathology at 5-year follow-up. Acetabular correction alone may be sufficient as the primary intervention for the majority of patients with symptomatic acetabular dysplasia

Hip arthroscopy (HA) and pelvic osteotomy (PO) are surgical procedures used to treat a variety of hip pathology affecting young adults, including femoroacetabular impingement and hip dysplasia respectively. This study aimed to investigate the trends and regional variation in the provision of HA and PO across England from 2010 to 2023 to inform healthcare resource allocation. We analysed the National Hospital Episode Statistics database for all HA and PO procedures in NHS England using specific OPCS-4 codes: HA: ‘W83+Z843’ or ‘W84+Z843’; PO: ‘X222+Z75’. We collected patient demographics, age, sex, and region of treatment. We performed descriptive and regression analyses to evaluate temporal trends in PO volume, age, sex and regional variation. 22,401 HAs and 1,348 POs were recorded between 2010 and 2023. The annual number of HAs declined by 28.4%, whilst the number of POs increased by 64% (p<0.001). Significantly more females underwent PO vs HA (90% vs 61.3%) and were older than males undergoing the same procedure (PO: 29.0±8.7 vs 25.8±9.2 years; HA: 36.8±12.0 years vs 35.8±11.2 years, p<0.001). For HA, the mean age of both sexes decreased by 3.3 and 2.9 years respectively (p<0.001), whereas the age of PO patients did not change significantly over the study period. There were significant regional variations with a mean incidence of 1.60/100,00 for HA (ranging from 0.70–2.66 per 100,000) and 0.43/100,000 for PO (ranging from 0.08–2.07 per 100,000). We have observed a decline in HA volume in England, likely due to improved patient selection and the impact of COVID-19, whilst PO volume has significantly increased, with regional variation persisting for both procedures. These trends highlight the need for equitable HA and PO access to improve patient outcomes and call for strategic healthcare planning and resource allocation to reduce disparities and improve training opportunities

We have investigated whether the pattern of subchondral acetabular cyst formation reflects hip pathology and may provide a prognostic indicator for treatment. A single surgeon series of sequential hip arthroscopies was reviewed to identify the most recent 200 cases undertaken on a previously un-operated joint with pre-operative plain radiographs and computed tomography or magnetic resonance scan available for review. Also, serial “non-arthritic hip scores” (NAHS) recorded pre-operatively, at 6 weeks and 3 months post-surgery. The acetabular Lateral Centre Edge Angle, the Acetabular Index, the FEAR index and the Kallgren and Lawrence grade were determined. All images were reviewed by two independent assessors and divided into four groups according to acetabular subchondral cyst distribution. NC - No cysts - 74 cases (mean: 40.1 years), SPC - a Single Peripheral Cyst – 58 cases (mean: 43.1 years), SDC - a Solitary Dome Cyst – 32 cases (mean: 33 years) and MC - Multiple Cysts – 36 cases (mean: 42.7 years). No association was identified between gender and patient reported outcomes. SDC patients were significantly younger than the other three groups (p <0.001). At three months after surgery, the average increase of the NAHS in the four groups was 25.3, 23.5, 4.2 and 4.9 respectively. Acetabular dysplasia was identified in 72% of the SDC group compared to 18%, 16% and 33% in NC, SPC and MC groups. Degenerative change was identified in 86% of the MC group compared to 18%, 40% and 41% of the NC, SPC and SDC groups. The early patient reported outcome following hip arthroscopy was significantly affected by the location and number of acetabular subchondral cysts. A Solitary Dome Cyst is indicative of underling hip dysplasia. Multiple Cysts are indicative of degenerative disease. The majority of patients in these groups have poor three-month outcomes after hip arthroscopy

Arthroscopic procedures are increasingly performed for femoroacetabular impingement (FAI). The Non-Arthroplasty Hip Register (NAHR) collects data including the iHOT12 and EQ5D. However there is currently little evidence of its usefulness in assessing hip arthroscopy outcomes. This study aims to assess minimum 1-year outcomes of hip arthroscopy for FAI using the minimum data set (MDS) of the NAHR by comparing these to a patient satisfaction questionnaire. Pre-operative scores for 78 consecutive hips in 76 patients (43F/33M, mean age at surgery 31.76±10.02 years) undergoing hip arthroscopy for FAI at our institution between February 2013-June 2015 were entered into the NAHR. Insufficient post-operative data was available from the registry. Therefore we collected iHOT12, EQ5D and satisfaction data by postal survey. Preoperative mean iHOT-12 score was 32.67±14.23, median EQ5D Index score 0.653 (IQR 0.277) and median EQ5D Visual Analogue Scale 70 (IQR 25). Postoperative scores were available for 56 cases (55 patients, 71.8%) at median 18.9 months (IQR 13.77). There was a significant postoperative improvement in self-reported outcome as measured by iHOT-12 (mean improvement 35.7 points, p<0.001) and EQ5DIndex scores (median improvement 0.127, p=0.001). 24 patients were very satisfied, 19 satisfied, 6 neutral, 4 dissatisfied and 1 very dissatisfied. Satisfied patients exhibited greater improvement in iHOT-12 (mean 41.64±19.29 vs 2.8±24.08, p<0.001) and EQ5D index scores (p=0.013) but no difference in EQ5D VAS (p=0.15). Improvement in iHOT12 correlated with improvement in EQ5DIndex (r=0.676, p<0.001) and EQ5DVAS(r=0.552, p<0.001). Hip arthroscopy for FAI yielded significant improvements in iHOT-12 and EQ5D index scores and 80% of responders were satisfied/very satisfied at a minimum one year postop. iHOT12 and EQ5DIndex correlated with patient satisfaction and improvements in iHOT12 correlated with improvements in general quality of life. Our findings suggest that the MDS of the NAHR is useful for assessing the outcome in these patients

This study used a national registry to assess the outcomes of hip arthroscopy (HA) for the treatment femoroacetabular impingement (FAI). All HAs for FAI recorded in the UK Non-Arthroplasty Hip Registry (NAHR) between January 2012 and September 2023 were identified. Cases were grouped according to the index procedure performed for FAI (cam, pincer, or mixed). Patient outcomes captured included the International Hip Outcome Tool (iHOT)-12. 7,511 HAs were identified; 4,583 cam (61%), 675 pincer (9%), 2,253 mixed (30%). Mean age (34.8) was similar between groups. There was a greater proportion of females in the pincer group (75%) compared to cam (52%) and mixed (50%). A higher proportion of patients had a recorded cartilage injury in association with a cam lesion compared to pincer. The pincer group had poorer mean pre-op iHOT-12 scores (31.6 \[95%CI 29.9 to 33.3\]; n=364) compared to cam (33.7 \[95%CI 32.1 to 34.4\]; n=3,941) and achieved significantly lower scores at 12 months (pincer = 52.6 (50.2 to 55); n=249, cam = 58.3 (57.1 to 59.5); n=1,679). Overall, significant (p < 0.0001) iHOT-12 and EQ-5D improvement vs baseline pre-operative scores were achieved for all FAI subtypes at 6 months (overall mean iHOT-12 improvement +26.0 \[95%CI 25.0 to 26.9\]; n=2,983) and maintained out to 12 months (+26.2 \[25.1 to 27.2\]; n=2,760) at which point 67% and 48% of patients continued to demonstrate a score improvement greater than or equal to the minimum clinically important difference (>/=13 points) and substantial clinical benefit (>/=28 points) for iHOT-12 respectively. This study demonstrates excellent early functional outcomes following HA undertaken for FAI in a large national registry

Introduction. The role for hip arthroscopy (HS) in combination with periacetabular osteotomy (PAO) for the treatment of symptomatic acetabular dysplasia has not been clearly defined. In this study, we assessed midterm outcomes of concurrent hip arthroscopy and PAO (HS/PAO) for the treatment of symptomatic acetabular dysplasia with associated intra-articular pathology. Methods. We performed a retrospective review of concurrent HS/PAO cases in a prospectively collected institutional hip preservation database. From November 2005 to December 2012, 85 hips in 80 patients underwent combined HS/PAO. Two hips had a diagnosis other than acetabular dysplasia and 12 hips were lost to follow up, leaving 71 hips for analysis at mean 6.6-year follow-up (range 4–11 years). Hips were evaluated using the University of California, Los Angeles (UCLA) Activity Score, modified Harris Hip Score (mHHS), and the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) pain subscore. Hips were stratified into preserved or failed groups, with failure defined as conversion to THA or a symptomatic hip (mHHS <70 or WOMAC pain subscore > 10). Complications were recorded and graded by the Clavien-Dindo classification. Regression analyses were performed to identify the interaction between patient factors, radiographic measures, and surgical details with outcome. Results. At final follow-up, two hips had undergone THA and an additional 15 hips were deemed symptomatic. 54 hips (76.1%) did not undergo conversion to THA or meet symptom thresholds, and this group had mean mHHS 92.1 ± 8.8, UCLA activity score 7.8 ± 2.1, and WOMAC pain subscore 1.8 ± 2.4. In univariate analysis, no patient factors, pre- or post-operative radiographic metrics, or intra-operative findings or procedures were associated with failure. There were 3 (4.2%) major complications (Clavien-Dindo Grade III or IV), and 5 patients underwent repeat surgery for recurrent symptoms (4 hip arthroscopy, 1 open psoas release with ramus osteoplasty) during the follow up period with resolution of symptoms following repeat surgery. Conclusion. This study demonstrates that concurrent hip arthroscopy and periacetabular osteotomy is associated with good clinical outcomes and an acceptable complication profile at midterm follow up

Surgical trainees are finding it increasingly more challenging to meet operative requirements and coupled with the effects of COVID-19, we face a future of insufficiently trained surgeons. As a result, virtual reality (VR) simulator training has become more prevalent and whilst more readily accepted in certain arthroscopic fields, its use in hip arthroscopy (HA) remains novel. This project aimed to validate VR high-fidelity HA simulation and assess its functional use in arthroscopic training. Seventy-two participants were recruited to perform two basic arthroscopic tasks on a VR HA simulator, testing hip anatomy, scope manipulation and triangulation skills. They were stratified into novice (39) and experienced (33) groups based on previous arthroscopy experience. Metric parameters recorded from the simulator were used to assess construct validity. Face validity was evaluated using a Likert-style questionnaire. All recordings were reviewed by 2 HA experts for blinded ASSET score assessment. Experienced participants were significantly faster in completing both tasks compared with novice participants (p<0.001). Experienced participants damaged the acetabular and femoral cartilage significantly less than novice participants (p=0.011) and were found to have significantly reduced path length of both camera and instrument across both tasks (p=0.001, p=0.007), demonstrating significantly greater movement economy. Total ASSET scores were significantly greater in experienced participants compared to novice participants (p=0.041) with excellent correlation between task time, cartilage damage, camera and instrument path length and corresponding ASSET score constituents. 62.5% of experienced participants reported a high degree of realism in all facets of external, technical and haptic experience with 94.4% advising further practice would improve their arthroscopic skills. There was a relative improvement of 43% in skill amongst all participants between task 1 and 2 (p<0.001). This is the largest study to date validating the use of simulation in HA training. These results confirm significant construct and face validity, excellent agreement between objective measures and ASSET scores, significant improvement in skill with continued use and recommend VR simulation to be a valuable asset in HA training for all grades

Background. Hip arthroscopy is a rapidly growing, evolving area within arthroscopic Orthopaedic Surgery, with annual rates increasing as much as 25-fold each year. Despite improvements in equipment and training, it remains a challenging procedure. Rates of revision surgery have been reported as 6.3% to 16.9%. Objectives. The primary objective was to determine the success of joint preservation after hip arthroscopy. The secondary objective was to determine whether patient characteristics or PROM functional score trends could predict revision hip arthroscopy or Total Hip Arthroplasty (THA). Study Design & Methods. We reviewed 1363 hip arthroscopies performed from January 2010 to December 2016 by a single high-volume surgeon at a single institution. Data was prospectively collected and retrospectively reviewed with a minimum 2-year follow-up. Functional outcomes were assessed with the International Hip Outcome Tool (IHOT-33). Hip arthroscopy failures were defined as Total Hip Arthroplasty or revision hip arthroscopy after index hip arthroscopy. Results. There were751 females and 612 males with an average age of 34.63 years (19 – 58 years). There were 199 cases (14.6%) of labrum repairs only, 286 (20.9%) cam and labrum repairs, 319 (23.4%) cam and pincer surgeries and 193 (14.1%) cam only surgeries. All pre-operative IHOT-33 patient-reported outcomes scores (27.42 ± 6.2) improved significantly at the 6 week-, 3 month- and 6-month follow-up visits (p<0.05). The best improvements were seen in symptoms and functional improvements (IHOT-SFL) (p<0.05) while the poorest amelioration of job-related concerns (IHOT-JRC) existed at all time points (p<0.05). There were 223 failures, 131 patients (9.61%) underwent revision hip arthroscopy and 92 required THA (6.75%) at 18.45 months ± 7.34 months. The 2-year survival rate was 89.2%. The THA conversion rate was 8.4% for patients > 50 years old and 3.72% for patients < 50 years old. Age (>50 years) and female sex were associated with increased risk of conversion to THA (p<0.05) while young (<25 years old) and female patients were most likely to undergo hip revision arthroscopy. Surgery involving repair of the labrum only are more likely to result in revision arthroscopy surgery and THA (70.7% at 10.6 years). CAM & pincer surgery have best longevity (90.9% at 10.6 years). Conclusions. Joint preservation and no subsequent surgery at 10.6 years is 83.64%. This study showed that predictors of revision hip arthroscopy or THA included poor pre-morbid functional score, female gender, age > 45, sudden functional score decrease at 3 months follow-up and cases in which only the labrum is surgically repaired

Over an eight-month period we prospectively enrolled 122 patients who underwent arthroscopic surgery of the hip for femoroacetabular impingement and met the inclusion criteria for this study. Patients with bilateral hip arthroscopy, avascular necrosis and previous hip surgery were excluded. Ten patients refused to participate leaving 112 in the study. There were 62 women and 50 men. The mean age of the patients was 40.6 yrs (95% confidence interval (CI) 37.7 to 43.5). At arthroscopy, 23 patients underwent osteoplasty only for cam impingement, three underwent rim trimming only for pincer impingement, and 86 underwent both procedures for mixed-type impingement. The mean follow-up was 2.3 years (2.0 to 2.9). The mean modified Harris hip score (HHS) improved from 58 to 84 (mean difference = 24 (95% CI 19 to 28)) and the median patient satisfaction was 9 (1 to 10). Ten patients underwent total hip replacement at a mean of 16 months (8 to 26) after arthroscopy. The predictors of a better outcome were the pre-operative modified HHS (p = 0.018), joint space narrowing ≥ 2 mm (p = 0.005), and repair of labral pathology instead of debridement (p = 0.032). Hip arthroscopy for femoroacetabular impingement, accompanied by suitable rehabilitation, gives a good short-term outcome and high patient satisfaction

Hip arthroscopy (HA) is an effective treatment for various hip conditions but has a steep learning curve and its effect on long-term joint preservation is unclear. This study uses population-level data to assess (1) the 90-day complication rate, and (2) the frequency and timing of revision HA, total hip replacement (THR), and pelvic osteotomy (PO) following primary HA. We performed a retrospective analysis of the National Hospital Episode Statistics database, examining all patients who underwent primary HA in NHS hospitals in England from 2010 to 2023 using relevant OPCS-4 codes. We evaluated patient demographics, 90-day complications, and reoperation rates for revision HA, THR, and PO. Descriptive statistical analyses were performed to calculate frequencies and average time to reoperations. We included 22,401 HA procedures in the study. The mean LOS was 0.82±2.04 days. The 90-day readmission rate was 0.17% at a mean of 54.4±8.1 days. The most common reasons for readmission were reoperation (0.071%), followed by infection (0.031%), pulmonary embolism (0.027%), pain (0.022%), bleeding (0.018%), and deep vein thrombosis (0.004%). One patient died within 90 days. Overall, 4942 patients (22.1%) required further surgery at a mean of 2.71±2.27 years. The rates of revision HA, conversion to THR, and PO were 6.94%, 14.6%, and 0.50% at a mean of 2.39±1.79, 2.87±2.46, and 2.26±1.80 years respectively. Female patients had higher rates of reoperation than males for conversion to THR (9.99% vs 4.63%), revision HA (4.92% vs 2.02%), and subsequent PO (0.43% vs. 0.06%) (p<0.001). This study demonstrates a low short-term complication rate after primary HA, supporting existing literature. However, a large proportion of patients required further surgery, especially females. These findings highlight the need for careful patient selection and counselling before HA to optimise outcomes, as well as further research on factors influencing longer-term outcomes and cost-effectiveness