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Surgical treatment of labral injuries has shifted from debridement to preservation over the past decades. Primary repair and secondary augmentation or reconstruction techniques are aimed at restoring the labral seal and preserving or improving contact mechanics. Currently, the standard of care for non-repairable tears favours the use of auto- or allografts. As an alternative, we present our initial experience using a synthetic, off-the-shelf polyurethane scaffold for augmentation and reconstruction of segmental labral tissue loss or irreparable labral damage. Three patients aged 37–44 (two male, one female) with femoroacetabular impingement without associated dysplasia (Wiberg > 25°) or osteoarthritis (Tönnis

This study was designed to evaluate the clinical and radiographic results of arthroscopic treatment of femoroacetabular impingement (FAI) using the technique of initial access to the peripheral compartment. It is based on a single surgeon large case series with a minimum of 2 years follow-up. Prospective longitudinal study with consecutive patients. Inclusion criteria were the presence of FAI syndrome that had failed non-operative treatment and had a hip arthroscopy with initial access to the peripheral compartment. Exclusion criteria were previous hip surgery, patients younger than 16 or older than 60 years, Tonnis grade ≥ 2 osteoarthritis, hip dysplasia based on radiographic evidence of LCEA less than 25° and workers compensation cases. One hundred and sixty hips met the inclusion criteria, 84 were female and 70 were male patients (six bilateral cases), with a median age of 36 years (range 16–59). The median alpha angle correction was 22.6o (range 5.9–46.7) (p

Hip preservation surgery is now an established part of orthopedic surgery and sports medicine. This report describes the key findings of the 11th Annual Scientific Meeting of International Society for Hip Arthroscopy—the International Hip Preservation Society—in Madrid, Spain from 16 to 19 October 2019. Lectures, seminars and debates explored the most up-to-date and expert views on a wide variety of subjects, including: diagnostic problems in groin pain, buttock pain and low back pain; surgical techniques in acetabular dysplasia, hip instability, femoroacetabular impingement syndrome, labral repair and reconstruction, cartilage defects, adolescent hips and gluteus medius and hamstring tears; and new ideas about femoral torsion, hip–spine syndrome, hip capsule surgery, impact of particular sports on hip injuries, registries, robotics and training for hip preservation specialists. Surgeons, sports physicians, radiologists and physiotherapists looking after young people with hip problems have an increasingly sophisticated armoury of ideas and techniques with which to help their patients. The concept of hip preservation has developed incredibly fast over the last decade; now it is clear that the best results can only be achieved by a multidisciplinary team working together. The 2020s will be the decade of ‘Teamwork in Hip Preservation’.

Fluoroscopy is used in hip arthroscopy (HA) for portal placement, instrument localisation, and guidance in bony resection. The recent increase in arthroscopic hip procedures may place patients and surgeons at risk for increased radiation exposure and radiation-induced complications. The purpose of the current systematic review was to assess intraoperative radiation exposure in HA. The systematic review was conducted according to PRISMA guidelines; inclusion criteria were studies assessing radiation exposure in HA. 9 studies including 994 patients were included. Mean age was 38.6 years and 48% (436 of 906) were female. Mean time of fluoroscopy exposure was 0.58 minutes. Dose area product was 129.5 cGycm2. Mean intraoperative absorbed radiation dose studies was 12.6 mGy. Mean intraoperative effective dose was 0.48 mSv. The mean occupational exposure to the surgeon per case was 0.0031 mSv. Higher patient body mass index (BMI) correlated to greater patient effective and cumulative dose ( p Radiation dose and effective dose were well under the thresholds for deterministic effects (2 Gy) and annual radiation exposure for occupational workers (20 mSv). Intraoperative radiation exposure to patients and surgeons is within acceptable annual radiation limits. Ensuring careful selection of perioperative imaging modalities, proper protective shielding, specifically the use of leaded eyeglasses, and optimal C-arm positioning are key strategies to reduce radiation exposure to patients and surgeons alike.

Femoroacetabular impingement (FAI) is increasingly recognized as a risk factor for early hip degeneration in young active patients. The diagnosis depends on clinical examination and proper imaging that should be able to identify abnormal and sometimes subtle morphological changes. Labral tears and cartilage lesions rarely occur without underlying bone abnormalities. Surgical approaches to treat FAI are increasing significantly worldwide, even without a clearly defined consensus of what should be accepted as the standard imaging diagnosis for FAI morphology.Hip abnormalities encompass many variations related to the shape, size, and spatial orientation of both sides of the joint and can be difficult to characterize if adequate imaging is not available.This article presents a comprehensive review about the information orthopaedic surgeons need to know from radiologists to plan the most rational approach to a painful hip resulting from a mechanical abnormality.

Subspine impingement syndrome by definition involves a prominent antero-inferior iliac spine (AIIS) which can lead to impingement on the femoral neck thereby causing symptoms. We present the case of a 22-year-old semi-professional athlete who presented with a Type III AIIS morphology leading to subspine impingement syndrome and was managed via a mini open anterior approach. Radiological examination revealed a fairly prominent left AIIS resembling the ‘horn of a rhino’ extending to the trochanteric region anteriorly. A mini-anterior surgical approach was utilized for the resection of the ‘rhino horn’ and the rectus femoris was reattached. The patient remained asymptomatic at the one-year follow-up and had resumed weightlifting. Following this case, we propose a new classification of the type III AIIS morphology in view of the clinical presentation. The AIIS type III-Standard represents an extension from the acetabular rim to less than 1 cm (type III-S) and type III-Large, with an extension from the acetabular rim beyond 1 cm (type III-L). The type III-L will further be divided into two groups based on its relation to the ilium, type III-Lr (‘rib shape’) and type III-Lrh (‘rhino horn’).

Imaging assessment for the clinical management of femoroacetabular impingement (FAI) is controversial because of a paucity of evidence-based guidance and notable variability among practitioners. Hence, expert consensus is needed because standardised imaging assessment is critical for clinical practice and research. We aimed to establish expert-based statements on FAI imaging by using formal methods of consensus building. The Delphi method was used to formally derive consensus among 30 panel members from 13 countries. Forty-four questions were agreed upon, and relevant seminal literature was circulated and classified in major topics to produce answering statements. The level of evidence was noted for all statements, and panel members were asked to score their level of agreement (0–10). This is the second part of a three-part consensus series and focuses on ‘General issues’ and ‘Parameters and reporting’. Forty-seven statements were generated and group consensus was reached for 45. Twenty-five statements pertaining to ‘General issues’ (9 addressing diagnosis, differential diagnosis, and postoperative imaging) and ‘Parameters and reporting’ (16 addressing femoral/acetabular parameters) were produced. The available evidence was reviewed critically, recommended criteria for diagnostic imaging highlighted, and the roles/values of different imaging parameters assessed. Radiographic evaluation (AP pelvis and a Dunn 45° view) is the cornerstone of hip-imaging assessment and the minimum imaging study that should be performed when evaluating adult patients for FAI. In most cases, cross-sectional imaging is warranted because MRI is the ‘gold standard’ imaging modality for the comprehensive evaluation, differential diagnosis assessment, and FAI surgical planning. • Diagnostic imaging for FAI is not standardised due to scarce evidence-based guidance on which imaging modalities and diagnostic criteria/parameters should be used. • Radiographic evaluation is the cornerstone of hip assessment and the minimum study that should be performed when assessing suspected FAI. Cross-sectional imaging is justified in most cases because MRI is the ‘gold standard’ modality for comprehensive FAI evaluation. • For acetabular morphology, coverage (Wiberg’s angle and acetabular index) and version (crossover, posterior wall, and ischial spine signs) should be assessed routinely. On the femoral side, the head–neck junction morphology (α° and offset), neck morphology (NSA), and torsion should be assessed.

The original version of this article, published on 14 May 2020, unfortunately contained a mistake.

Hip arthroscopy with initial access to the peripheral compartment represents a specific technique to approach the hip that can be particularly useful. This technique is suitable for both the arthroscopic treatment of femoroacetabular impingement syndrome and other pathologies that can be addressed by classic arthroscopy with central compartment initial access. Minimal capsulotomies preserve the fluid pressure in the peripheral compartment, which allows the "ballooning" of the capsule and improved joint exposure with decreased risk of fluid extravasation. In the vast majority of cases, the hip joint can be accessed by any technique depending on the surgeon preference/expertise. Interestingly, access to the central compartment under direct arthroscopic visualization decreases the risk of iatrogenic labral and chondral damage. This is particularly important when access to the central compartment is technically challenging (e.g., acetabular overcoverage, labral hypertrophy, and limited joint distraction). Such a technique is also preferable if the pathology is mainly located in the peripheral compartment. Despite several advantages, hip arthroscopy with initial access to the peripheral compartment is not a commonly performed technique. Our purpose is to perform a step-by-step explanation of a previously described technique. info:eu-repo/semantics/publishedVersion

Greater trochanter pain syndrome (GTPS) or lateral hip pain terms include external snapping hip, trochanteric bursitis and gluteus medius or minimus pathology. The aim of this review is to update the most recent knowledge about non-surgical management of peritrochanteric disorders. A literature review was performed including articles most relevant in the last years that were focused in non-surgical treatment of peritrochanteric disorders. Conservative treatment still has a place and includes activity modification, NSAIDs, analgesics, physiotherapy, home training, local corticosteroid injection (CSI) and shock wave therapy (SWT). These non-surgical alternatives have demonstrated good clinical results with low rate of complications. Most patients tend to resolve GTPS or lateral hip pain with non-surgical management in the mid-term but when everything failed, surgical options should be evaluated. The next frontier that will be a game changer is to determine an individualized treatment plan based on the exact pathology. V.

Hip impingement syndromes, particularly femoroacetabular impingement syndrome, have attracted tremendous attention in the past decade. We address some of the less common hip impingement syndromes, mainly the extra-articular hip impingement syndromes. The clinical presentation, imaging, and treatment of anterior, posterior, and lateral hip impingement syndromes are discussed.

This chapter updates main topics in hip arthroscopy. Since chondrolabral injury has been proposed the beginning of hip osteoarthritis, other new entities play a role in the painful hip. Actually, if we want to improve long-term clinical results, we should establish better indications for surgical treatment rather than surgical technical modifications. Different options to manage chondrolabral lesions are described in this chapter, and labral reconstruction is a very popular option nowadays. Capsular management is also a hot topic that will be discussed, and its relationship with hip instability is an interesting debate. The importance of cam deformity resection and modern therapies to treat cartilage defects are other problems directly related to osteoarthritis progression in the hip.

Hip arthroscopy has been well established in managing iliopsoas impingement in painful total hip arthroplasty (THA) and as a diagnostic tool for unexplained pain following a seemingly normal THA. Other indications described in the literature are reactive synovitis, adhesions, loose bodies, and infection. With the ever-expanding portfolio of indications, hip arthroscopy in THA is going to rise steeply in numbers and hence, more associated complications will appear. The technical challenge with regard to hip arthroscopy in the setting of hip arthroplasty and associated learning curve must be addressed.

To evaluate intra-abdominal pressure changes during hip arthroscopy and define its relationship with other patient related variables.A prospective multicenter study evaluating intra-abdominal pressure (IAP) in patients undergoing arthroscopic treatment of femoroacetabular impingement was performed. The IAP was measured indirectly by a bladder catheter (AbViser Autovalve Intra-abdominal pressure monitor) and documented every 30 minutes during the entire procedure. The following risk factors were analyzed: traction time, duration surgery, previous abdominal surgery, capsule repair, psoas tenotomy, and surgical approach.One hundred and five patients with symptomatic femoroacetabular impingement that underwent hip arthroscopy met the inclusion criteria. There were significant differences in the IAP between the preoperative measurement of IAP and the IAP at different time points during surgery (P .01). The IAP increased continuously from the commencement of surgery (considered as time point from portal establishment) until the first 60 minutes. After first 60 minutes of surgery, the IAP did not increase significantly. There were no significant associations between increased IAP and the risk factors analyzed.IAP increases significantly during the first 60 minutes of hip arthroscopy; it then stabilizes for the duration of surgery before decreasing just after the completion of surgery. The highest recorded IAP was not associated with additional complications. No symptomatic intra-abdominal hypertension was documented. Finally, patient- and procedure-specific risk factors did not predict changes in IAP. Systemic monitoring of IAP during the hip arthroscopy procedure can easily and effectively be done, allowing the surgeon to early detect any significant change.Level IV, therapeutic case series.

Objective The number of indications for total hip replacement (THR) and total knee replacement (TKR) surgery is increasing. Enhanced recovery after surgery (ERAS) represents the next step in the evolution of standardised care. The primary aim of this study is to measure the in-hospital 30-day medical and surgical postoperative complications rate. The study's secondary aims are to determine the length of stay, 30-day mortality rate, 30-day reoperation and readmission rates, the ERAS overall compliance and predefined ERAS individual items compliance. Methods This multicentre, prospective, observational study will include adult patients (aged >18 years) undergoing elective THR and TKR surgery. Consecutive patients undergoing surgery within the 2-month data collection period will be included. Centres that offer the THR and/or TKR surgery will be eligible to participate. The data collection will be done through an online data collection form via a secure, password-protected platform at each centre with predefined data fields. Results Ethical approval for this study has been obtained from the Comite de Etica de la Investigacion de la Comunidad Autonoma de Aragon (C.P.-C.I. PI18/135; on 23 May 2018). It was prospectively registered on 27 June 2018, at www.clinicaltrials.gov with identification no. NCT03570944. Conclusion The study will be disseminated through the SPARN-RedGERM, SEDAR, GERM and through social media. Peer-reviewed publications will be published under corporate authorship, including POWER.2 Study Group and SPARN-RedGERM.

Although the cement in cement technique is a simple method for exchanging cemented stems, it may be technical demanding. The different geometry of different-offset Exeter long stems can be a problem with this technique. We describe a case revision hip surgery as a consequence of neglected bipolar hemiarthroplasty dislocation in which a 44 mm offset long stem was exchanged by a shorter and smaller size 37.5 mm offset stem. The implications of the procedure and the surgical pitfalls are discussed.

Hip arthroscopy has become very popular in the last decade. Numbers are increasing rapidly worldwide. More than 11,000 hip arthroscopies were performed at the English public health system from 2002 to 2013. It means an increase of more than 700%. Similar numbers were published in North America, with an increase of more than 350% in the period 2004–2009. During a similar period on the opposite side of the globe, Korean researches published a twofold increase between 2007 and 2010. In the midterm, there is a projected increase of 1388% by 2023 [1].

Chondrolabral complex is a weak point along an histological transition zone. Most cartilage and labral lesions in the femoroacetabular impingement syndrome are located in this area. Different classifications are used to evaluate the severity and predict the prognosis of chondrolabral complex injuries. Acetabular Labrum Articular Disruption (ALAD) and Multicenter Arthroscopy of the Hip Outcomes Research Network (MAHORN) classifications are commonly used with a prognosis and treatment implication. Treatment of chondrolabral lesions detected on magnetic resonance imaging (MRI), should only be considered when clinical symptoms are presented. A wide range of treatment options include debridement with or without microfracture, repair or regenerate therapies. The future of hip joint preservation should be directed towards to the development of the treatment of chondrolabral injuries.

A 42-year-old athletic woman attended our clinic complaining of right groin pain. The pain had begun 2 years previously when jogging. The pain had gradually become worse, limiting her daily activities and any sporting activities. Clinical examination showed a positive impingement test and limitation of internal rotation of up to 20o at 90o of hip flexion. Plain radiogrpahs showed a normal alpha angle, and a 12 × 14 mm “os acetabuli” was present at the superolateral acetabular rim (Figure 1). The joint was mildly dysplastic with a center-edge angle (CEA) (excluding the “os acetabuli”) of 15o (25o in the contralateral hip). The Tonnis angle was 24o. Differential diagnoses were an “os acetabuli” in a dysplastic hip, chronic avulsion fracture of de anteroinferior iliac spine (Larson et al. 2011), stress fracture (Martinez et al. 2006), or enchondroma-like lesion. The CT described the presence of an “os acetabuli” beside the joint surface with an intact anteroinferior iliac spine (Figure 2). Figure 1. Plain AP (A) and lateral view (B) showing a normal alpha angle. A 12 × 14 mm calcified irregular-shaped image was seen at the superolateral acetabular rim. Excluding the “os acetabuli”, the center-edge angle was 15o (25o ... Figure 2. Sagittal plane CT scan image optimized for bone density, showing the “os acetabuli” (arrow). The patient’s pain persisted, and we made a hip arthroscopy. She was placed supine on the traction table. Due to the shape, size, and location of the lesion, access to the central compartment was difficult and an “outside-in” technique with a T-shaped capsulotomy was performed (Horisberger et al. 2010, Cuellar et al. 2013). Dynamic intraoperative assessment showed impingement between the “os acetabuli” and the superior labrum, which was slightly frayed and detached from the acetabulum (Figure 3). The bony lesion was dissected and resected, keeping the underlying labrum intact. The labrum was reinserted with three 2.3-mm Bioraptor bone anchors (Smith and Nephew). The capsule was then repaired with interrupted Ultrabride sutures, with 2 side-to-side sutures. No femoral osteochondroplasty was performed. Figure 3. View of the peripheral compartment from the anteromedial portal with a 30o scope. The close relation between the detached labrum (L) and the “os acetabuli” (O) can be seen. F: femoral head. After surgery, the patient was instructed not to bear weight for 4 weeks and then to resume partial weight bearing for another 4 weeks. Hyperextension was restricted for the first 3 months, to protect capsular healing. At 4-month follow-up, the patient was walking unaided and was free from pain; she had a full range of motion and radiographs confirmed the complete resection of the “os acetabuli”—but a slight joint narrowing was detected. At 6-month follow-up, she had again developed groin pain. At 10 months, radiographs showed a Tonnis-III degenerative stage (Figure 4). A total hip replacement was required at 12 months. During the joint replacement, we found osteoarthritis and a reduction of femoral head coverage. Figure 4. A. At 4-month follow-up, complete resection of the “os acetabuli” and a slight narrowing of the joint space. B. At 10-month follow-up anterosuperior subluxation and clear degenerative joint disease with sclerotic joint line and subchondral ...

Hip arthroscopy is an evolving surgical technique that has recently increased in popularity.Although femoroacetabular impingement was an important launch pad for this technique, extra-articular pathology has been described through hip endoscopy.Good clinical results in the medium term will allow improvements in this technique and increase its indications. Cite this article: EFORT Open Rev 2017;2:58-65. DOI: 10.1302/2058-5241.2.150041. info:eu-repo/semantics/publishedVersion

FAI (femoroacetabular impingement) is a morphologic hip radiographic finding with a high prevalence in asymptomatic patients. Following an injury, it may result in pain and functional limitation in young patients and, if left untreated, could result in degenerative disease of the hip joint. In symptomatic patients, surgery should be considered. Surgical treatment will likely require repair of labral and cartilage damage as well as correction of the head–neck deformity. Safe surgical dislocation and mini-anterior arthroscopically assisted and pure arthroscopic approaches have been described to safely access the joint and effectively treat FAI.

Extrarticular causes of impingement have a current, interesting role in the complaint of groin pain in athletes. Subspine impingement is related to a prominent anterior inferior iliac spine (AIIS) and is actually described as a frequent cause of groin pain. Ischiofemoral impingement is described when the space between the lesser trochanter is decreased. Psoas impingement appears between the psoas tendon and the anterior labrum and anterior acetabular rim.

Injuries to the Lisfranc joint have a high potential for chronic disability. Posttraumatic arthritis remains the most common complication but not all patients who develop degenerative radiographic changes are symptomatic. A cohort of 32 patients with a Lisfranc fracture dislocation was reviewed. Initial reduction and secondary displacement were measured by the Myerson scale. Radiographic evidence of osteoarthritis (OA) was also investigated. Long-term radiographical data were classified as good, fair or poor results. Functional outcome was measured using several different scales. Mean follow up was 14 years. Seventeen patients with anatomic close reduction but instability were treated with closed reduction and K-wire fixation followed by cast immobilisation. Eight patients with stable anatomic close reduction were treated with closed reduction and cast. Seven patients with unacceptable closed reduction were treated with open reduction and K-wire stabilisation. The analysis of radiological long-term data showed 15 patients with good results, 8 with fair results and 9 with poor results. Final mean AOFAS score was 91.7/100. There was no statistically significant difference between overall PFS scores and different type of treatment, Hardcastle long-term radiological scores or Hardcastle type of fracture (p >0.05). Overall, there was a poor association between the extent of radiological arthritis and clinical scores. We advocate that for the evaluation of long-term outcome of these injuries functional parameters should be the focus of assessment, instead of radiological changes.

Purpose The anatomical anterior cruciate ligament (ACL) reconstruction attempts to, by reproducing the natural orientation of its fibres, achieve a better rotational stability of the knee. The aim of this paper is to quantify the anteroposterior and rotational laxity of the knee before and after an anatomic ligamentoplasty using the Orthopilot ® navigation system as a supporting tool. Material and method We describe the distinctive steps of Orthopilot ® navigation as well as conducting a retrospective cross-sectional study on a cohort of 20 patients operated in our hospital for chronic primary ACL rupture from January 2010 to May 2011. The precise location of the tunnels was defined with the help of the navigator and the intra-articular landmarks and stability tests were performed in both the sagittal and axial planes. Results In our technique for anatomical ACL reconstruction placed the tibial tunnel at a mean distance of 16.8 ± 4.92 mm from the posterior cruciate ligament in a position that represented 44.1 ± 4.35% of the total width of the tibial plateau. The average distance from the centre of the femoral tunnel to the posterior cortex of the lateral condyle was 7.89 ± 2.78 mm. Intra-operatively and before ACL reconstruction, the mean (±SD) anteroposterior movement, internal rotation and external rotation of the tibia at 30° position were 15.5 mm (±5.11), 19° (±3.62) and 19.65° (±3.26), respectively. After reconstruction these values decreased to 5.6 mm (±1.72°), 12.17° (±3.76) and 16.9° (±4.42), respectively. Conclusions The use of navigation systems supporting the surgery allows the systematic positioning of bone tunnels and standardises the procedures for the desired reconstruction. ACL reconstruction using the technique described, improves the anteroposterior and rotational stability compared to preoperative status, to a stability state that could be considered physiological according to current scientific knowledge.

We describe our modified anterior mini-invasive technique and results obtained in our first consecutive 117 cases in 105 patients. To assess the influence of preoperative Tönnis degenerative stage, cases were divided into group A (Tönnis 0, 32 hips), B (Tönnis 1, 61 hips), and C (Tönnis 2, 24 hips). The clinical score Dexeus combined score (DCS) was used preoperatively, 3 months, 6 months, and every year after operation. At 3-month follow-up, impingement test results improved significantly in 30 hips of group A (94%; p0.05). No statistical difference was observed at 3-year visit in all groups. Merle d'Aubigné-Postel and WOMAC scores improved significantly in group A (p0.05). We concluded that anterior mini-invasive technique is an effective method to treat femoroacetabular impingement, and results are highly influenced by preoperative degenerative state, especially in stage Tönnis 2. Therefore, it seems to be a reasonable early surgical treatment in symptomatic patients.

Femoroacetabular regularization in hip impingement is currently performed by means of trochanter osteotomy and hip dislocation or more recently by means of hip arthroscopy. We present a novel alternative through a unique mini-invasive anterior approach. Our first series consisted of 35 hips (32 patients) with a mean follow-up of 29.2 months. Range of motion (ROM) and clinical scores were evaluated preoperatively at six weeks, three months, six months and one-year follow-up (FU). Impingement test was negative in 33 out of 35 cases six weeks after surgery. Mean hospitalisation time was 2.6 days (2-5 days). Mean improvement in internal rotation was 23 degrees (p=0.006) and 21 degrees in flexion (p=0.011). There was a significant improvement in hip score according to the Merle d'Aubign evaluation (13.8 points preoperative vs. 16.9 at one-year visit) (p=0.017). No Trendelenburg, heterotopic calcifications or osteonecrosis were observed. Complications related to the femorocutaneous nerve appeared in six cases (17.1%) although all but one were neuroapraxia and disappeared before one year. Mean rehabilitation time was 4.4 weeks. We conclude that the anterior surgical approach for the treatment of femoroacetabular impingement enables early resumption of sport while accuracy in bone resection is maintained.

In recent years, abnormal hip joint morphology has emerged as a significant factor responsible for the onset of hip osteoarthritis (OA). This is believed to lead to pathological loading patterns that produce shear stresses on the hip joint over time.1 Ganz et al 2 described two different morphological patterns of femoroacetabular impingement (FAI): cam and pincer FAI. What is the prevalence of FAI morphology in the general population? Estimates vary wildly owing to disparity in the definition of FAI morphology used and in the populations sampled. The proportion of the population with symptoms related to FAI is only a fraction of those with FAI morphology. Furthermore, the presence of severe morphological abnormalities does not always bring about hip OA, suggesting that there are other factors at play in hip OA pathogenesis than just joint morphology. This recently defined clinical problem of FAI with widely disparate definitions available and controversy about management motivated the need for some consensus. This international consensus ( see page 1169 ) provides a broad overview of important questions in this challenging field …

Orthopaedic surgeons have accepted various radiological signs to be representative of acetabular retroversion, which is the main characteristic of focal over-coverage in patients with femoroacetabular impingement (FAI). Using a validated method for radiological analysis, we assessed the relevance of these signs to predict intra-articular lesions in 93 patients undergoing surgery for FAI. A logistic regression model to predict chondral damage showed that an acetabular retroversion index (ARI) > 20%, a derivative of the well-known cross-over sign, was an independent predictor (p = 0.036). However, ARI was less significant than the Tönnis classification (p = 0.019) and age (p = 0.031) in the same model. ARI was unable to discriminate between grades of chondral lesions, while the type of cam lesion (p = 0.004) and age (p = 0.047) were able to. Other widely recognised signs of acetabular retroversion, such as the ischial spine sign, the posterior wall sign or the cross-over sign were irrelevant according to our analysis. Regardless of its secondary predictive role, an ARI > 20% appears to be the most clinically relevant radiological sign of acetabular retroversion in symptomatic patients with FAI. Cite this article: Bone Joint J 2013;95-B:893–9.

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 patient with FAI is typically a 20–50-year-old male with insidious hip pain but with no traumatic injury [1, 2]. In the first appointment, the focus must be placed on the etiology of the symptoms. These symptoms could be divided into pain that is referred to the hip (lumbar pain, pelvic pain), extra-articular pain (piriformis syndrome, trochanteric bursitis, psoas bursitis), intra-articular pain without bone deformity (labral lesion, chondral defects, loose bodies, synovitis), intra-articular pain with bone deformity (dysplasia, femoroacetabular impingement, Perthes-type deformity, avascular necrosis), and advanced joint degeneration.

Femoroacetabular osteoplasty or osteochondroplasty comprises in the removal of the anatomical abnormalities causing femoroacetabular impingement (FAI) and the repair of labral and retrolabral chondral lesions. Since the beginning of the twenty-first century, different techniques have been proposed to address this condition, which can be classified as follows

Clinical scores are used by orthopedic surgeons as a way of monitoring their patients’ evolution. Surgeons can use these scores to follow the evolution of a given condition in time and to determine the effect exerted by different therapeutic procedures on such pathologies and on their patients.

To the editor, We read the study, “Femoroacetabular Impingement Predisposes to Traumatic Posterior Hip Dislocation” by Steppacher et al. [3] with great interest. As the authors mentioned, the proposal that femoroacetabular impingement could play a role in low-energy hip dislocations was suggested by Philippon et al. [2], based on the arthroscopic findings in professional athletes during active competition. There are scarce references reporting anatomic factors that predispose to posterior hip dislocation [4]. Steppacher and colleagues’ article proposed a mechanism of fulcrum by the interaction between the nonspherical femoral head and the acetabular rim in patients with femoroacetabular impingement-type CAM [3]. We were satisfied to read that the authors agreed with the mechanism that we recently described and represented graphically [1] in a case report of a young soccer player with femoroacetabular impingement that suffered from a low-energy posterior fracture-dislocation. In our publication, we also suggested other factors that could enhance posterior hip dislocation in patients with femoroacetabular impingement: retroversion of the femoral neck, retroversion of the acetabulum, and decreased acetabular depth. The study by Steppacher et al. [3] shows a higher prevalence of femoroacetabular features in patients with posterior hip dislocation compared with the normative data of the proposed mechanism. We believe posterior low-energy hip dislocation should not only be attributed to femoroacetabular impingement as an isolated mechanism. Further investigations should be performed to rule out the contributing factors in this entity.

Background The international Hip Outcome Tool-33 (iHOT-33) is a 33-item self administered outcome measure based on a Visual Analogue Scale response format designed for young and active population with hip pathology. The aim of the present study is to translate and validate the iHOT-33 into Spanish. Methods 97 patients undergoing hip arthroscopy were included in this prospective and multicenter study performed between January 2012 and May 2014. Crosscultural adaptation was used to translate iHOT-33 into Spanish. Patients completed the questionnaire before and after surgery. Feasibility, reliability, internal consistency, construct validity (correlation with Western Ontario and McMaster Universities Osteoarthritis Index), ceiling and floor effects and sensitivity to change were assessed for the present study. Results Mean age was 48 years old. Feasibility: 41.2 % patients had no blank questions, and 71.3 % of patients had fulfilled all but one or two questions. Reliability: ICC for the global questionnaire was 0.97, showing that the questionnaire is highly reproducible. Internal consistency: Cronbach’s alpha was 0.98 for the global questionnaire. Construct validity: there was a high correlation with WOMAC (correlation coefficient >0.5). The Ceiling effect (taking into account the minimum detectable change) was 12.1 % and the floor effect was 21.6 %, for the global questionnaire. Large sensitivity to change was shown. Conclusion the Spanish version of iHOT-33 has shown to be feasible, reliable and sensible to changes for patients undergoing hip arthroscopy. This validated translation of iHOT-33 allows for comparisons between studies involving either Spanish- or English-speaking patients. Level of evidence Prognostic study, Level I.

Background The Hip Outcome Score (HOS) is a self-reported questionnaire evaluating the outcomes of treatment interventions for hip pathologies, divided in 19 items of activities of daily life (ADL) and 9 sports’ items. The aim of the present study is to translate and validate HOS into Spanish. Methods A prospective and multicenter study with 100 patients undergoing hip arthroscopy was performed between June 2012 and January 2013. Crosscultural adaptation was used to translate HOS into Spanish. Patients completed the questionnaire before and after surgery. Feasibility, reliability, internal consistency, construct validity (correlation with Western Ontario and McMaster Universities Osteoarthritis Index), ceiling and floor effects and sensitivity to change were assessed for the present study. Results Mean age was 45.05 years old. 36 women and 64 men were included. Feasibility: 13% had at least one missing item within the ADL subscale and 17% within the sport subscale. Reliability: the translated version of HOS was highly reproducible with intraclass correlation coefficient of 0.95 for ADL and 0.94 for the sports subscale. Internal consistency was confirmed with Cronbach’s alpha >0.90 in both subscales. Construct validity showed statistically significant correlation with WOMAC. Ceiling effect was observed in 6% and 12% for ADL and sports subscale, respectively. Floor effect was found in 3% and 37% ADL and sports subscale, respectively. Large sensitivity to change was shown in both subscales. Conclusion The translated version of HOS into Spanish has shown to be feasible, reliable and sensible to changes for patients undergoing hip arthroscopy. This validated translation of HOS allows for comparisons between studies involving either Spanish- or English-speaking patients. Level of evidence Prognostic study, Level I