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3、遗传因素对髋关节骨关节炎比膝关节骨关节炎的影响更大：基于接受关节置换的双胞胎人群研究4、假体周围感染高风险患者关节置换术后延长口服抗生素应用时间的效费比研究5、机器人辅助单髁关节置换术提高假体位置的准确性：前瞻性随机对照研究6、究比基尼切口与纵向切口用于前入路全髋关节置换术：系统评价7、初次全膝关节置换术中内侧副韧带骨撕脱损伤对疗效的影响9、有症状和无症状人群中临界髋臼发育不良的患病率:系统综述和meta分析10、无手术干预的髋关节发育不良患者骨关节炎进展的危险因素11、股骨截骨术和全髋关节置换术治疗股骨头坏死的患者报告结果:一项前瞻性的病例研12、利用解剖影像学参数拓宽LCEA在髋关节发育不良分类中的应用13、髋关节软骨病变：相关解剖学、影像学检查和治疗方式的最新进展14、男性以及竞技运动员身份与髋臼后倾患者髋关节镜检查后更好的预后相关目的：血友病患者会出现反复的关节积血。逐渐会导致症状型关节病，经常累及膝关节。现代的治疗方法可以延缓关节病进展到晚期，而全膝关节置换（TKA）只用以治疗部分晚期关节病患者。尽管围手术期针对血液病治疗有新的进展，但潜在的严重出血依然存在。本研究的目的是测定血友病患者TKA术后即时的失血量和血液学方面的并发症。方法：回顾性的分析了12年间在单一中心做了TKA手术的A、B型血友病患者。将这些患者与所有作为对照组的接受TKA手术的非血友病患者和文献报告的接受TKA手术的非血友病患者的结果进行比较。结果：有18名患者（A型血友病占72%，B型占28%）的21例TKA手术被纳入研究，平均年龄44岁。术后24和48小时平均血红蛋白下降2.7 g/dl 和3.8 g/dl。与非血友病对照组比较，两组间术后48小时的血红蛋白下降数量无显著性差异(P = 0.2644)。没有术后即时的并发症发生，有2名（9.6%）患者需要输血。结论：与非血友病对照组和文献报道的非血友病患者数据比较，血友病患者在专业的三级转诊中心做单侧初次TKA手术看上去围手术期失血量相似。对于这类复杂的患者，有经验的骨科医生和血液科医生的介入会带来良好的效果。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 ¼ 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.文献出处：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：股骨头缺血坏死（AVNFH）是一种缺血改变，虽然经过不同方法治疗，常导致股骨头塌陷和髋关节置换（THA）。但有关磁共振成像（MRI）可以预测股骨头坏死进展和髋关节置换的影像所见，尚不明了。目的：评估AVNFH的磁共振影像特征，明确可预测髋关节置换的类型。材料和方法：本研究为回顾性研究，自2015年5月至2017年12月，共15例18髋（男12人，女3人）连续病例，进行了钻孔减压联合局部骨髓干细胞的治疗。治疗后3个月、术后1年和/或髋关节置换前，进行磁共振检查（1.5T）。随访至2018年11月，共有10髋进行了髋关节置换，未置换组有1例AECO I型患者无症状失访。观察置换组与未置换组的骨循环协会分级（ARCO）与磁共振影像所见，包括AVNFH面积、部位、股骨颈骨髓水肿、软骨下骨折和关节渗液情况。结果：病情进展到髋关节置换的患者，股骨颈骨髓水肿更多（90% vs. 0%）、坏死区附近骨髓水肿更多（100% vs. 43%）、髋臼侧骨髓水肿更多（90% vs.14%），软骨下骨折更多（70% vs. 0%）、关节渗液更多（80% vs. 29%），滑膜炎更多（80% vs. 14.3%），更大的坏死面积、及负重区股骨头外侧柱受累及，也是预测髋关节置换的因素。结论：股骨头缺血坏死（AVNFH）患者中，发展到髋关节置换的患者、较未发展到髋关节置换的患者，在磁共振影像中常存在多种影像特征。注：未置换组术后12个月有1例ARCO I型患者无症状失访，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.文献出处：Väänänen 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:探讨和量化遗传作用与可改变的环境因素作用对于已进展到需要接受关节置换的骨关节炎的影响。研究设计: 1915-1960年出生的同性双胞胎(53.4%女性)的前瞻性队列研究，数据来源于2014年以前的挪威关节置换术登记系统数据与挪威双胞胎登记处的国家身份号码相关联。患者自行报告的教育程度，身高/体重，并计算体重指数(BMI)。髋关节置换术的总随访时间为27年(1987-2014,424,914人年)，膝关节置换术为20年(1994-2014,306,207人年)。在髋关节和膝关节的单独分析中估计了关节置换术的一致性和遗传因素。结果:研究人群包括9058对双胞胎(n=3803单卵(mz)，n=5226双卵(dz))。总的来说，73%的髋关节和45%的膝关节置换变异的73%可以用遗传因素来解释。当调整性别，年龄，教育程度和BMI(hr=2.98,95%ci=1.90-4.67，单卵与双卵双胞胎相比)时，遗传因素与髋关节置换术相关。当调整受精卵和其他协变量(hr=1.15,95%ci=1.02-1.29)时，膝关节置换术在更大程度上于BMI相关。结论:髋关节置换术受遗传因素影响较大，而膝关节置换术在很大程度上取决于较高的体重指数。与髋关节置换术相比，这项研究表明通过外界干预可以减少意患者接受膝关节置换术的概率。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.文献出处：Magnusson K, Scurrah K, Ystrom E, Ørstavik 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：对关节置换（TJA）术后感染高风险患者延长口服抗生素应用时间可以降低假体周围感染（PJI）发生率。然而其效费比却并不明确。本研究中，我们应用一个收支平衡的经济模型研究对高感染风险的关节置换患者延长口服抗生素应用时间的效费比。方法：我们从既往文献和医院采购登记信息中收集的数据包括高风险患者的假体周围感染率，治疗PJI施行的关节翻修术花费以及延长口服抗生素应用的花费。我们将这些数据录入一个收支平衡的经济模型中来计算为有效降低感染率而延长口服抗生素应用的绝对风险降低值（ARR）。绝对风险降低值被用来明确需治疗人数（NNT）。结果：高感染风险的全膝关节置换术病例术后延长口服抗生素头孢氢氨苄使用时间可以降低感染风险0.187%（需治疗人数=535），高感染风险的全髋关节置换术病例术后延长口服抗生素头孢氢氨苄使用时间可以降低感染风险0.151%（需治疗人数=662）。该方法的效费比也随着抗生素品种不同、感染治疗花费不同和感染率的不同而变化。结论：对于高感染风险的关节置换病人延长口服抗生素应用时间可以降低术后假体周围感染的风险，效费比可观。然而，目前支持这一观点的循证学证据质量有限。此外，其应用还可能会导致未来产生抗生素耐药性而变为负价值，我们在应用时要充分权衡其利弊。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.文献出处：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：据报道，与接受全膝关节置换术的患者相比，接受单髁关节置换手术的患者翻修率更高，而假体位置不良是导致内植物失败的一个因素。机器人辅助手术已被认为可提高关节置换术中假体植入位置准确性。这项前瞻性、随机、单盲、对照试验的目的是比较机器人辅助和传统手术在单髁关节置换术中假体位置精确性。方法：将139名患者随机分为2组，一组使用MAKO机器人交互式机械臂（RIO）系统辅助手术，另一组使用传统手术方式，两组患者均使用Oxford Phase-3单髁关节假体。术后三个月进行CT扫描，以评估轴向、冠状和矢状位上假体位置的准确性。结果：共有120例患者的数据可用，其中62例接受了机器人辅助单髁关节置换术，58例接受了传统单髁关节置换术。所有测量的假体位置参数的观察者内部一致性均为良好。使用机器人辅助手术提高了假体定位的准确性，所有假体参数的均方根误差较低，中值误差显著降低（p<0.01）。与传统的单髁关节置换，机器人辅助单髁关节置换术在假体放置在目标位置误差2°以的比例更高，其中股骨假体矢状位（57%与26%，p=0.0008）、股骨假体冠状位（70%与28%，p=0.0001）、股骨假体轴位（53%与31%，p=0.0163）、胫骨假体矢状位置（80%与22%，p=1.0001）和胫骨假体轴位置（48%与19%，p=2.0009）。结论：与传统的单髁关节置换手术技术相比，使用MAKO RIO的机器人辅助手术提高了植入物定位的准确性。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.文献出处：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：直接前入路全髋关节置换术（DAA THA）传统上采用纵向切口，但比基尼切口可以改善术后疤痕外观和患者满意度，同时减少伤口并发症。本系统综述比较了DAATHA比基尼与纵向切口的临床结局和手术并发症。方法：对 PubMed、Cochrane 和 EMBASE 进行系统评价和荟萃分析检索，以确定 2010 年至 2021 年发表的比较DAA THA 比基尼与纵向切口的原始文章。收集患者人口统计数据和术后结局（疤痕外观、患者满意度、功能性髋关节评分和并发症）并进行定性评估。结果：共纳入8项双臂研究，可以比较比基尼切口（n = 952）与纵向切口（n = 1361）的临床结局。75%（4篇中3篇）的研究比较术后疤痕外观和患者满意度的研究中，报告了比基尼切口后的改善，而1项研究报告了两个切口结果相似。股外侧皮神经损伤是前路THA后最常报告的并发症，但总体发生率较低，后期大多数可恢复。结论：比基尼切口与传统纵向切口具有相似的临床结果，但比基尼切口可改善美容和患者满意度，同时减少伤口并发症。目前的证据表明，比基尼切口导致股外侧皮神经损伤的风险增加，但这需要在进一步的前瞻性随机研究中得到证实。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.文献出处：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)寻找术中应用螺钉和垫圈治疗内侧副韧带撕脱症(MCL)的临床和影像学结果，(2)预测可能导致初次全膝关节置换术(TKA)中发生撕脱型MCL损伤的术前因素。方法：2011年1月至2015年12月，在连续4916例初次TKA中，有46例(0.8%)发生术中MCL撕脱伤。排除后，41个膝关节与未受MCL损伤的对照组进行1:2匹配，并比较各种临床、放射学和功能参数。分析的临床参数包括年龄、性别、体重指数、术前诊断如骨关节炎或类风湿性关节炎、活动范围、矢状面畸形和维生素D水平。计算的放射学参数包括冠状位畸形、胫骨近端内翻角、股骨远端外翻角、关节线一致角、胫骨后倾角、“杯/碟”形态、有无膝关节半脱位、胫骨外翻和股骨前弓。分析术前、术后膝关节社会评分及膝关节社会功能评分。如果有并发症或翻修，会在随访期间记录。采用多因素logistic回归分析预测MCL撕脱伤的术前危险因素。结果：平均随访58.4±19.3个月，影像学和体格检查均未发现不稳定。与术前残疾相比，两组患者和对照组在最终随访时的临床评分(膝关节学会评分和膝关节学会功能评分)均有统计学意义上的改善(P < .001)。研究组术前平均冠状畸形为170.6°±6.96°，对照组为167.7°±4.3°(P = .021)。研究组术前胫骨斜度平均为10.5°±4.9°，对照组为7.91°±4.15° (P = .003)。研究组中有48.8%的膝关节出现术前半脱位(P < .001)， 68.3例膝关节呈“杯/碟”形态(P < .001)。严重内翻畸形(优势比[OR] 1.462, 95%可信区间[CI] 1.15-1.86)、膝关节半脱位(OR 39.78, 95% CI 3.78-418.86)和“杯/碟”形态(OR 33.11, 95% CI 5.69-192.66)的MCL撕脱损伤几率较大。结论：初次TKA术中MCL骨撕脱伤可以通过螺钉和垫圈结构成功处理，无需增加假体约束性。严重内翻畸形、膝关节半脱位和“杯/碟”形态的存在往往增加MCL撕脱损伤的机会。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.文献出处：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.全膝关节置换术（TKA）是终末期单间室膝骨关节炎的治疗方法，而膝关节单髁置换术（UKA）是一种保留骨和韧带的替代治疗方法。尽管UKA是一种成功的手术方法，UKA的多种优势与它的自身使用无关，很可能与基于对假体生存能力、患者选择、理想的垫片设计以及先进手术技术的谨慎使用等方面的考虑有关。因此，本研究的目的是回顾和总结有争议的文献，并将这些争议讨论作为“UKA的十大困惑”。对于一个符合UKA手术适应症的病人，你在选择 UKA或TKA的时候犹豫不决，你还会倾向选择UKA吗？Kozinn和Scott提出的UKA的经典理想适应症和非理想适应症在较新的先进假体中仍然有效吗？3.术前MRI：在考虑患者行UKA前，它是否在决策中发挥作用？8.前交叉韧带（ACL）重建与UKA同时进行：是否过度治疗？10.机器人、计算机导航、个性化器械（PSI）和假体：传统与技术辅助的UKA哪个更佳？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?文献出处：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:临界髋臼发育不良患者是保髋治疗中有争议的患者群体，因为一些患者主要有撞击性症状，而另一些患者有不稳定性症状。临界发育不良最常被定义为外侧中心边缘角(LCEA)为20°至25°。然而，还没有文献清楚描述它的患病率。 目的:(1)通过对文献的系统回顾和荟萃分析，明确临界髋关节发育不良在一般人群和髋关节疼痛的人群中的患病率;(2)描述男女患者之间的差异以及与典型髋关节发育不良患病率的差异。 方法:使用搜索词对文献进行系统回顾，以获取临界发育不良或不同LCEA患病率的研究。搜索产生了1932个结果，其中11篇文章符合纳入标准，被纳入最后的系统综述。研究按患者队列分组为(1)无症状的一般人群，(2)无症状的目标人群(例如，特定运动项目的运动员)，和(3)有症状的髋关节疼痛人群。患病率按受试者或按髋关节进行统计。在一项研究中，将临界发育不良的发生率与典型髋关节发育不良(LCEA＜20°)的发生率进行比较。 结果:总共11项研究纳入分析，包括19,648髋(11,754例患者)。在无症状的普通人群中，临界发育不良患病率的汇总估计为总受试者数的19.8%，占总髋关节数的23.3%(范围为16.7%-46.0%)。目标亚组包括236名运动员，包括芭蕾、足球、曲棍球、排球、足球和田径，其患病率在17.8%到51.1%之间。伴有髋关节疼痛的组中临界发育不良的患病率为12.8%(范围为12.6%-16.0%)。在无症状的普通人群中，临界髋关节发育不良的发生率是典型髋关节发育不良的3.5倍。 结论:该研究显示，在无症状的普通人群中，临界发育不良的患病率为19.8%至23.3%。此外，在有症状的患者中，临界发育不良的患病率约12.8%，这些患者的治疗决策尚存争议。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.文献出处： 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.髋关节发育不良（DDH）是髋关节疼痛的常见原因，也是髋关节骨关节炎(OA)和早期全髋关节置换术(THA)的危险因素。然而目前对与OA风险增加相关的具体因素知之甚少。本研究目的是(i)明确DDH髋关节骨关节炎发生和全髋关节置换术的总发生率，(ii)确定与症状性髋关节骨关节炎发展相关的影像学特征和患者特征。使用数据库确定2000年至2016年期间被诊断为症状性髋关节发育不良的所有14-50岁患者。Kaplan-Meier分析用于确定骨关节炎的发生率，定义为髋关节x线片Tönnis骨关节炎分级≥1级。采用单因素和多因素比例风险回归模型确定OA的危险因素。在1893例髋关节疼痛患者中，159例(144例)髋关节发育不良(52 F:107 M)患者纳入研究。其中45例(28%)有严重的髋关节发育不良，外侧中心边缘角≤18°。发病时平均年龄为26.1岁。随访时间8.2±5年。结果显示，OA率为20%。11%的患者接受了THA治疗。体重指数>29 (P = 0.03)和年龄增加(P < 0.01)是OA的危险因素。有症状的髋关节是骨关节炎发生的显著危险因素。因此，体重指数>29以及出现髋关节疼痛时年龄≥35岁是髋关节骨关节炎发生的危险因素。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 Tönnis 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.文献出处：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:患者报告评分系统近年来被应用于外科手术后。本前瞻性研究的目的是评估患者报告的股骨截骨术和全髋关节置换术(THA)治疗股骨头坏死(ONFH)的结果。方法:42例对侧髋关节无症状的有症状的ONFH患者接受经转子前旋转截骨术(ARO)或THA作为初次手术。在这些患者中，有20名患者在最终随访时(术后1年多)对侧髋关节仍无症状，被招募参加本研究。ARO治疗9例(ARO组)，THA治疗11例(THA组)。牛津髋关节评分(OHS)和短髋关节评分(SF-36)均在术前和最终随访时进行评估。结果:ARO组和THA组术前OHS分别为29.1 + 10.9和21.9 + 9.6分，末次随访时OHS分别为38.4 + 9.4和40.3 + 5.1分。ARO组和THA组术前身体成分总结评分分别为30.8 + 12.8分和17.8 + 14.5分，最终随访时分别为44.5 + 10.6分和43.3 + 10.4分。ARO组和THA组的术前心理成分总结评分分别为48.0 + 8.5分和48.6 + 11.3分，在末次随访时均未发生变化。结论:本研究的短期患者报告结果表明，ARO和THA治疗ONFH均可显著改善术后髋关节功能。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.文献出处：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外侧中心边缘角（LCEA）和Tönnis角（TA）利用一条“水平线”在负重前后骨盆X线片上测量髋关节。根据手术医生的偏好，目前使用3种不同的定义方法：（1）平行于X线片底部的线（F），（2）连接髋臼泪滴（AT）下缘的线，或（3）连接坐骨结节（IT）的线。必须在初步检查时准确评估髋关节发育不良的程度，以选择合适的手术干预。目的：评估X线“水平线”的选择如何影响LCEA和TA的测量。第二个目的是评估水平线的选择如何影响正常、临界发育不良或发育不良髋关节的分类。方法：于2016年2月至2020年11月接受保髋手术（140例髋关节镜手术，46例髋关节镜联合髋臼周围截骨术）的186名患者的所有术前负重前后骨盆X线片上测量LCEA和TA，每髋分别使用F、AT和IT水平线测量3次。使用Student t检验分析LCEA和TA测量值的差异，并量化不同发育不良分类组内的不一致率。结果：对于整个研究人群，平均LCEAF（23.4°±7.4°）显著高于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之间无差异（95%CI，-0.305至0.080；P=0.251）。当通过髋关节镜手术分层时，平均LCEAF（26.3°±5.6°）显著大于LCEAAT（25.8° ± 5.3°）（95%CI，-0.845至-0.162；P=0.004）。总体而言，在发育不良分类中与LCEAF相比，LCEAIT和LCEAAT不一致率分别为17.7%和18.3%。整个研究人群、关节镜手术组、关节镜联合髋臼周围截骨术组的平均TAIT、TAAT和TAF之间无显著统计学差异。结论：对于LCEA测量，AT和IT组之间测量没有统计学差异。与F组相比，发育不良测量在另2个分组间更为一致。TA测量不受参考水平线选择的影响。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 Tönnis 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.文献出处：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.髋关节软骨病变的诊断和治疗一直是骨科领域的挑战。软骨病变很常见，并且存在几种分类系统，以根据严重程度、病变位置、放射学相关参数和可能的治疗选择来对其进行分类。当处理可能患有髋关节软骨病变的患者时，必须进行完整的病史采集、全面的体格检查和辅助影像学检查。应对患者站立、仰卧、俯卧和侧方等全方位进行体格检查。普通X线片是一线（最基本的）拍片检查方法。然而，除关节镜检查外，磁共振成像目前是诊断软骨病变的金标准。多种治疗方式可以解决髋关节存在的软骨病变，并继续研究报道新的治疗方法。目前，软骨成形术、微骨折术、软骨移植（自体骨软骨移植、镶嵌成形术、同种异体骨软骨骨移植术）和骨生物学联合方式（自体软骨细胞植入ACI，自体基质诱导的软骨再生AMIC，PRP）均被用来成功治疗髋关节软骨病变。进一步完善研究这些方法和新技术，以继续提高外科医生解决髋关节中软骨病变的能力。图1. (A, B) Ilizaliturri 的髋臼六分区法右侧(A)和左侧(B)髋关节（1区：前-下髋臼；2区：前-上；3区：中-上；4区：后-上；5区：后-下；6区：髋臼切迹）。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.文献出处：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：评估髋臼整体后倾患者的髋关节镜检查结果，并确定性别、影像学测量结果、运动员身份和是否重返赛场与患者报告结果（PRO）之间的相关性。方法：对接受关节镜下股骨髋臼撞击（FAI）手术的髋臼后倾患者进行回顾性研究。整体髋臼后倾由3个标准定义：骨盆前后位片中的交叉征、坐骨棘征和后壁征。用X线测量外侧中心边缘角、α角以及前后壁指数。用三维CT测量股骨颈前倾角。人口学统计包括年龄、性别、运动员状态、重返赛场情况和再次手术情况。PRO包括改良Harris髋关节评分、髋关节结局评分（HOS）、髋关节残疾和骨关节炎结局评分、视觉模拟量表（VAS）和退伍军人RAND-12。我们应用Spearman相关性分析确定了围手术期PRO的相关性，用广义估计方程确定独立的预测因子。显著性设置为P=0.05。结果：2013年至2019年，149名患者（65.0%女性）接受了髋关节镜检查，共160髋出现FAI和髋臼后倾。随访平均29.6个月。除退伍军人RAND-12中的精神健康量表外，所有的PRO结果均表现出显著改善。女性患者大多数术后PRO评分明显较低，VAS评分较高（P=0.0002-0.0402）。男性受试者有更高比例达到改良Harris髋关节评分的最小临床重要差异（88.00%vs 78.79%）。更小的股骨颈前倾角与更高的HOS ADL评分、HOS运动评分、髋关节残疾和骨关节炎结局评分和运动评分相关（P=.0077-0.0177）。运动员报告的术前VAS评分较低，多个PRO中的围手术期评分较高（P=0.0004-0.0486）。9髋（5.63%）再次手术。结论：接受髋关节镜检查的髋臼整体后倾合并FAI患者的短期随访结果良好。与女性受试者和非运动员受试者相比，男性受试者与运动员的结果更好。除较小的股骨前倾角外，放射学测量与结果无关。与非运动员相比，运动员的术前疼痛评分更低，术后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.文献出处：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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