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Introduction: Hip abductor tendon (HAT) tearing is commonly implicated in greater trochanteric pain syndrome. Surgical studies are often reported in small cohorts and with limited information on functional improvement. This study reports the clinical and functional outcomes after HAT repair., Methods: 112 patients with symptomatic HAT tears, diagnosed via magnetic resonance imaging, underwent open bursectomy, V-Y lengthening of the iliotibial band, debridement of the diseased tendon, decortication of the trochanteric foot-plate and reattachment of the tendon with suture anchors, augmented with a LARS ligament through a trans-osseous tunnel. Patients were evaluated pre-surgery and at 3, 6 and 12 months post-surgery using the Harris (HHS) and Oxford (OHS) Hip Scores, SF-12, hip range of motion, 6-minute walk and 30-second single leg stance tests. Maximal isometric hip abduction strength (HAS) was assessed and limb symmetry indices (LSIs) were calculated between the operated and non-operated limbs. Patient satisfaction and perceived global rating of change (GRC) was evaluated. Analysis of variance evaluated improvement over time., Results: There was a significant improvement (p<0.05) in all clinical and functional measures. HAS significantly improved over time (p<0.002) and all LSIs were >85% at 12 months. At 12 months, a mean GRC score of 3.5 (range -1 to 5) was reported, while 96% of patients were satisfied with their surgical outcome. There was a 2.7% (n = 3) failure rate at 12 months., Conclusions: HAT reconstruction, augmented with a synthetic ligament, demonstrated significantly improved clinical and functional outcomes, high levels of patient satisfaction and a low failure rate to 12 months post-surgery.

Background: Hip arthroscopy has evolved into a well-established and rapidly growing field of orthopedic surgery for the management of labral tears. The purpose of this study was to review clinical outcomes of patients less than 25 years of age undergoing hip arthroscopy for treatment of a labral tear., Methods: From 2005 to 2013, 82 hips in 76 patients with mean age of 20.4 (16-25 range) underwent hip arthroscopy for treatment of labral-chondral damage. The Western Ontario McMaster Universities Osteoarthritis Index (WOMAC) and hip disability and osteoarthritis outcome score (HOOS) were recorded at latest follow-up., Results: 36 of 86 hips (42%) had isolated labral pathology with no associated bony pathology (normal alpha and centre-edge angle; no retroversion). Beck score (intraoperative cartilage damage) of 3 or more was significantly associated with an alpha angle of more than 55 degrees (odds ratio [OR], 3.6; confidence interval [CI], 1.2-11.0) and presence of femeroacetabular impingement (OR, 4.5; CI, 1.3-15.2). HOOS pain, sports/recreation, and quality of life significantly improved from preoperative to one year after surgery (p<0.05). 8 patients had re-operations for persistent pain; 5 underwent arthroscopic labral repair; 2 underwent arthroscopy with subsequent periacetabular osteotomy (PAO); 1 had only a periacetabular osteotomy (PAO). Complications included 2 lateral femoral cutaneous nerve deficits and 1 deep vein thrombosis., Conclusions: Labral tears in patients less than 25 years of age occurs commonly without bony deformities, with those with normal head/neck contour demonstrating significantly less early cartilage damage than those with bony pathology. Hip arthroscopy in young patients can improve function and quality of life with minimal morbidity.

Advanced hip imaging and surgical findings have demonstrated that a common cause of greater trochanteric pain syndrome (GTPS) is gluteal tendon tears. Conservative measures are initially employed to treat GTPS and manage gluteal tears, though patients frequently undergo multiple courses of non-operative treatment with only temporary pain relief. Therefore, a number of surgical treatment options for recalcitrant GTPS associated with gluteal tears have been reported. These have included open trans-osseous or bone anchored suture techniques, endoscopic methods and the use of tendon augmentation for repair reinforcement. This review describes the anatomy, pathophysiology and clinical presentation of gluteal tendon tears. Surgical techniques and patient reported outcomes are presented. This review demonstrates that surgical repair can result in improved patient outcomes, irrespective of tear aetiology, and suggests that the patient with "trochanteric bursitis" should be carefully assessed as newer surgical techniques show promise for a condition that historically has been managed conservatively.

Objective: Initial report on establishment of a hip service in Phnom Penh, Cambodia at Children's Surgical Centre. We describe indications for total hip replacement (THR) and initial results., Methods: A database was established to collect data and track patients for follow up. Initial data collected included; diagnosis, implant used, post-operative complications. As the service developed, pre- and postoperative Harris hip scores were included., Results: High rate of avascular necrosis (AVN) as the initial diagnosis. Five years post initiation of the hip service, 95 patients have received 116 THRs; including 10 revisions, 12 bilateral procedures. Complications/failures requiring revision involved four prosthetic femoral neck fractures, two aseptic acetabular component, two late infections, one instability. One failure, a periprosthetic acetabular fracture, required removal of all prosthetics. Complications not requiring revision, included three post-op foot drops, three superficial wound infections, one Vancouver B1 periprosthetic femur fracture. Average age was 41. Overall implant survival is 85% at three years., Discussion: AVN was the most common indication for THR: many patients had a history of hip trauma, and/or prolonged steroids from traditional healers for pain. Problems with specific implants were addressed by the company. A different stem is now routinely used, no further fractures have been reported. Acetabular loosening, thought to be due to poor technique, has been addressed by focused training. Infection rate is monitored, and microbiology resources are improving., Conclusion: Developing an affordable hip arthroplasty service in a country like Cambodia is challenging. Developing a local registry has helped to identify complications and modify techniques.

Background: To determine if the addition of anterior capsular tightening to the treatment of partial ligamentum teres (LT) tears by debridement will diminish the recurrence rate of symptoms due to LT retears., Method: A prospective case series, including all patients treated for an isolated LT tear from June 2009 to August 2011. Arthroscopically the tear was debrided using radiofrequency (RF) and the joint capsule was tightened using either RF or suture plication. All the patients were prospectively assessed with the Modified Harris Hip Score (MHHS) and the Non Arthritic Hip Score (NAHS). A total of 1574 hip arthroscopies were performed from June 2009 to November 2011. Isolated partial LT tears, were found in 27 hips (26 patients). The average age was 24.4 years (range 12-45). There were 24 females and two males., Results: Over an average follow-up period of 32 months (range 23-49), MHHS and NAHS preoperative outcome scores improved significantly. No revision surgery was required for a recurrent tear., Conclusion: Debridement of partial thickness LT tears, with additional anterior capsule tightening, has been shown to lead to improvents in MHHS and NAHS, with no recurrence of symptoms due to LT retear in the short to medium term.

We report a case of a 28-year-old male who sustained an indirect injury of his left hip while playing soccer, which resulted in a posterior fracture-dislocation. Radiological examination showed signs of combined femoroacetabular impingement (FAI). We discuss the role of FAI as a risk factor for hip dislocation in low energy sport injuries.

The safety and efficacy of metal-on-metal surface arthroplasty in post-traumatic arthritis and post-traumatic osteonecrosis (PT OA and PT ON) cases has not previously been thoroughly investigated. This study compared the outcomes of metal-on-metal hip resurfacing (HR) in patients performed for an indication of OA secondary to trauma to compared to PT ON. Metal-on-metal resurfacing arthroplasties were performed on 62 hips, 43 with PT OA and 19 with PT ON with secondary osteoarthritis. There were 51 males and 11 females. All patients were followed up clinically and radiographically with a mean follow-up of 87.2 months. Clinical outcome scores, survivorship, and radiographs were compared between the PT OA and PT ON group. The clinical outcomes for the PT ON and PT OA groups were similar with a survival rate of 95% (95% CI 82.1% to 98.8%) for the PT OA group alone at 8 years and 91% for those with PT OA with ON at 8 years (95% CI 50.8%-98.7%). The Kaplan-Meier survivorship curves for the cohorts of PT OA and PT ON patients were not statistically significantly different (Log rank, p=0.6036). Metal-on-metal hip resurfacing appears to be a safe and effective procedure for the treatment of both post-traumatic osteoarthritis and osteonecrosis.

Hip arthroscopy was first described in 1931 by Burman, and in recent years the applications have extended to labral surgery, osteochondroplasty, and a variety of other procedures. Hip arthroscopy may also be employed to extract loose or foreign bodies from the hip, and may be associated with more rapid recovery than an open procedure. We present a case of arthroscopic bullet removal from the hip in a 24-year-old man.