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Purpose: To determine factors associated with grade IV cartilage defects in the hip in patients undergoing hip arthroscopy with joint pain., Methods: Data from consecutive patients who underwent hip arthroscopy performed by a single surgeon over a period of 4 years were included in this study. The study group included 1,097 patients (491 women and 606 men; mean age, 37 years) who underwent hip arthroscopy for pain, had no prior hip surgery, and were aged 18 years or older. Preoperative radiographs, patient demographic characteristics, and operative details were used to identify risk factors for cartilage defects., Results: Grade IV chondral defects were present in 308 of 1,097 hips (28%). Isolated chondral lesions were more frequently observed on the acetabulum (76%) than on the femoral head (24%). Defects of the acetabulum were more commonly anterosuperior (94.7%) and less commonly posterolateral (5.3%). Patients with less than 2 mm of joint space on preoperative radiographs were 8 times more likely to have a grade IV lesion than those with more than 2 mm. Men were more likely than women to have grade IV lesions (35% v 19%, P = .0001); patients with grade IV lesions were older than those without (42 years v 34 years, P = .0001). Hips with grade IV lesions had significantly higher alpha angles than those without (74° v 70°, P = .0001). Patients with grade IV defects reported a longer duration of symptoms than those without (37 months v 27 months, P = .007). Independent risk factors for the presence of grade IV chondral defects were less than 2 mm of joint space, male gender, increasing age, larger alpha angle, and longer duration of symptoms., Conclusions: Grade IV chondral defects in patients undergoing hip arthroscopy were associated with decreased joint space, increased time from symptom onset to arthroscopy, male gender, and larger alpha angles associated with femoroacetabular impingement., Level of Evidence: Level IV, prognostic case series., (Copyright © 2016 Arthroscopy Association of North America. Published by Elsevier Inc. All rights reserved.)

Background: All patients considering joint-preserving hip arthroscopy should be educated on the risk of THA after arthroscopy. The degree of radiographic osteoarthritis predicts subsequent THA. To provide patients with the best information, the best radiographic measure that predicts THA after hip arthroscopy should be identified., Questions/purposes: We therefore determined if Tönnis grade, Kellgren-Lawrence grade, or joint space narrowing was superior in predicting THA after hip arthroscopy., Methods: We retrospectively reviewed 203 patients 50 years of age or older treated with hip arthroscopy between March 2007 and October 2010. Of these, 96 patients met the study inclusion criteria. Sixty-five did not undergo THAs during the followup time (non-THA group) and 31 patients did (THA group). We determined Tönnis grade, Kellgren-Lawrence grade, and/or joint space narrowing before arthroscopy. The median followup for the non-THA group was 54 months (95% confidence interval, 49.9-58.9 months)., Results: In 81% of the patients, joint space accurately predicted THA or non-THA, whereas Kellgren-Lawrence was accurate in 73% and Tönnis grade was accurate in 65%. On binary logistic regression, the only predictor (r(2) = 0.45) of THA was joint space of 2 mm or less., Conclusions: Measuring joint space by determining if any measurement is 2 mm or less predicts patients progressing to THA after hip arthroscopy approximately 80% of the time. At this early time point, joint space measurements were the most accurate predictor of THA and should be used in patient education to define the risk of early failure from hip arthroscopy.

Femoroacetabular impingement (FAI) is widely understood to be an underlying etiology of injuries to the acetabular labrum and cartilage in the adult hip, although somewhat less attention has previously been spent on its incidence in the pediatric and adolescent populations. Initially recognized as a consequence of periacetabular osteotomies performed for developmental dysplasia of the hip, it can also be because of a number of other disorders or to a developmental process causing irregular bony growth. The adolescent presenting with FAI is athletic, particularly in endeavors placing excessive stress on the hip and surrounding soft tissues. The pain is characterized as sharp, localized around the anatomic femoral head location, and may be associated with catching or popping. Complete physical examination includes full range of motion testing, as a hallmark of FAI is restriction and pain with internal rotation. Special tests include the anterior impingement test, the FABER test, and the dial test. Imaging includes anteroposterior pelvic and cross-table lateral radiographs and magnetic resonance imaging. Treatment in all patients is 6 weeks of conservative therapy. If patients see no improvement with conservative treatment, they may be candidates for hip arthroscopy. Arthroscopic treatment of FAI includes rim trimming for pincer lesions, osteoplasty for cam decompression and labral detachment, and repair or reconstruction for labral tears. Studies have shown improvements in the modified Harris Hip Score and the Hip Outcomes Score postoperatively. As FAI is diagnosed most frequently in athletes, and it is estimated that 30 to 45 million adolescents 6 and 18 years old are involved in sports, it is becoming imperative to identify factors that may predict its development, study treatments, and improve outcomes.