Outcomes of Arthroscopic Decompression of the Anterior Inferior Iliac Spine: A Systematic Review and Meta-analysis

Background: Anterior inferior iliac spine (AIIS) impingement has been increasingly recognized as a source of extra-articular impingement and hip pain. However, no aggregate data analysis of patient outcomes after AIIS decompression has been performed. Purpose: To evaluate outcomes after arthroscopic AIIS decompression. Study Design: Meta-analysis; Level of evidence, 4. Methods: A systematic review was performed according to the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines. PubMed, EMBASE, and Cochrane Central Register of Controlled Trials were queried for all English-language studies reporting outcomes of arthroscopic AIIS decompression performed in isolation or in conjunction with hip impingement correction surgery. After screening, 10 articles were included. The indications for AIIS decompression were recorded, and weighted mean improvements in patient-reported outcome (PRO) scores, complication rates, and revision rates were calculated. Results: A total of 547 patients (311 women; 57%) were identified, with a total of 620 operative hips. The mean age was 28.42 ± 5.6 years, and the mean follow-up was 25.22 ± 11.1 months. A total of 529 hips (85%) underwent AIIS decompression, 530 hips (85%) underwent femoral osteochondroplasty, and 458 hips (74%) underwent labral repair. Of the patients, 13% underwent bilateral AIIS decompression. The mean modified Harris Hip Score improved from 61.3 ± 6.9 to 88.7 ± 4.7 postoperatively (change, 27.4 ± 5.7 points; P < .001), the Hip Outcome Score–Activities of Daily Living improved from 67.2 ± 10.6 to 91.1 ± 3.2 postoperatively (change, 24.0 ± 8.0 points; P = .001), and the Hip Outcome Score–Sports Specific Subscale improved from 36.8 ± 19.2 to 82.8 ± 3.8 postoperatively (change, 46.0 ± 18.2 points; P = .002). The pooled risk of postoperative complications was 1.1% (95% CI, 0.1%-2.1%), and the pooled risk of needing revision surgery was 1.0% (95% CI, 0.1%-2.0%). No complication was directly attributed to the AIIS decompression portion of the procedure. Conclusion: PROs improved significantly after hip arthroscopy with AIIS decompression, with a low risk of postoperative complications and subsequent revision surgeries. Failure to identify extra-articular sources of hip pain in outcomes of femoroacetabular impingement syndrome, including from the AIIS, could lead to poorer outcomes and future revision surgery.

Are dogs with hip dysplasia in less pain after total hip replacement than femoral head ostectomy?

PICO question In large breed juvenile dogs with hip dysplasia and radiographic bilateral osteoarthritis, is a total hip replacement superior/inferior/or equivalent to bilateral femoral head ostectomy at reducing the severity of long-term hip pain? Clinical bottom line Category of research question Treatment The number and type of study designs reviewed Twelve papers were critically appraised. One paper was a systematic review. Six papers were prospective case series. Five papers were retrospective case series Strength of evidence Weak Outcomes reported Besides one systematic review, there are no other studies available that directly compare pain reduction with total hip replacement and femoral head ostectomy for the treatment of hip dysplasia in large breed juvenile dogs with radiographic evidence of secondary osteoarthritis. In one study, 12/12 (100%)of owners that responded to an owner outcome questionnaire reported no hip pain with femoral head and neck ostectomy. In this study, owners assessed pain based on activity level of the dog (running, playing, jumping, using stairs normally), gait abnormalities (only when running or after strenuous exercise), and duration of postoperative medications. In eight studies, 91–100% of cases had no hip pain with total hip replacement reported via clinical examination and/or owner outcome questionnaire Conclusion There is evidence suggesting that both total hip replacement and femoral head ostectomy may be capable of reducing long-term pain as a result of osteoarthritis, secondary to hip dysplasia, however, based on the current literature, it is challenging to say whether total hip replacement is superior to femoral head and neck ostectomy at reducing long-term hip pain. It is important to recognise that other factors considered as outcomes (i.e. range of motion, ground reaction forces, force-plate analysis, etc.) may contribute to differing outcomes overall for total hip replacement vs femoral head ostectomy, but this paper focused specifically on pain. While there is a systematic review that provides evidence supporting that total hip replacement is superior at returning dogs to normal function, evaluating return to normal function was not the focus of this Knowledge Summary How to apply this evidence in practice The application of evidence into practice should take into account multiple factors, not limited to: individual clinical expertise, patient’s circumstances and owners’ values, country, location or clinic where you work, the individual case in front of you, the availability of therapies and resources. Knowledge Summaries are a resource to help reinforce or inform decision making. They do not override the responsibility or judgement of the practitioner to do what is best for the animal in their care.

Do acetabular parameters measured on 2D imaging correlate with CT, and can lateral centre-edge angle predict femoral head coverage?

Aims The lateral centre-edge angle (LCEA) is a plain radiological measure of superolateral cover of the femoral head. This study aims to establish the correlation between 2D radiological and 3D CT measurements of acetabular morphology, and to describe the relationship between LCEA and femoral head cover (FHC). Methods This retrospective study included 353 periacetabular osteotomies (PAOs) performed between January 2014 and December 2017. Overall, 97 hips in 75 patients had 3D analysis by Clinical Graphics, giving measurements for LCEA, acetabular index (AI), and FHC. Roentgenographical LCEA, AI, posterior wall index (PWI), and anterior wall index (AWI) were measured from supine AP pelvis radiographs. The correlation between CT and roentgenographical measurements was calculated. Sequential multiple linear regression was performed to determine the relationship between roentgenographical measurements and CT FHC. Results CT-measured LCEA and AI correlated strongly with roentgenographical LCEA ( r = 0.92; p < 0.001) and AI ( r = 0.83; p < 0.001). Radiological LCEA correlated very strongly with CT FHC ( r = 0.92; p < 0.001). The sum of AWI and PWI also correlated strongly with CTFHC ( r = 0.73; p < 0.001). CT measurements of LCEA and AI were 3.4° less and 2.3° greater than radiological LCEA and AI measures. There was a linear relation between radiological LCEA and CT FHC. The linear regression model statistically significantly predicted FHC from LCEA, F(1,96) = 545.1 (p < 0.001), adjusted R2 = 85.0%, with the prediction equation: CT FHC(%) = 42.1 + 0.77(XRLCEA) Conclusion CT and roentgenographical measurement of acetabular parameters are comparable. Currently, a radiological LCEA greater than 25° is considered normal. This study demonstrates that those with hip pain and normal radiological acetabular parameters may still have deficiencies in FHC. More sophisticated imaging techniques such as 3D CT should be considered for those with hip pain to identify deficiencies in FHC. Cite this article: Bone Jt Open 2022;3(1):12–19.

The Influence of Abdominal Obesity on Hip Pain, Function, and Walking Ability after Three Years of THA: A Prospective Cohort Study

Background: There are many clinical studies about the impact of obesity on postoperative function following THA, but their conclusions are different and even contradictory. Abdominal obesity is closely related to obesity, while its impact on postoperative function following THA remains to be elucidated.Methods: Four hundred and thirteen patients were included in this study. They were divided into an AO group (waist circumference ≥ 90 cm for men and ≥ 85 cm for women) and a non-AO group (waist circumference ≤ 90 cm for men and ≤ 85 cm for women). Preoperative assessments including numerical pain rating, the Oxford Hip Score, and 6-minute walk test were repeated at 1,2, and 3 years postoperatively. Postoperative assessments included the anteversion and inclination of the acetabular prosthesis and satisfaction survey.Results：At a mean follow-up of 48±1.3 months, there was a significant difference in the improvement of the 6-minute walk test (251.22 to 387.46, 410.34, 410.07 vs 207.79 to 362.17, 395.82, 403.36; p < 0.001) at 1, 2 and 3 years and the numerical pain rating scale (6.00 to 0.39 vs 5.76 to 0.80; p < 0.001) at 1 year between the non-AO group and AO group. There was no difference between both groups in inclination, anteversion, OHS, and satisfaction. Conclusion: AO does not increase the complications after THA, nor does it have a significant impact on the function after THA, but it seems to have a negative effect on the improvement of walking ability and the relief of hip pain.