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Purpose: Exacerbations of osteoarthritis (OA) pain significantly impair activities of daily living and walking, thereby reducing quality of life. Despite various treatments, persistent pain remains a challenge, particularly in patients with hip OA, where pain perception mechanisms extend beyond nociceptive pain. This study examined the pain characteristics in patients with hip OA, with an emphasis on neuropathic pain and central sensitization (CS). Methods: A total of 421 patients scheduled for unilateral total hip arthroplasty were analyzed using the painDETECT score and Central Sensitization Inventory to classify the pain types as nociceptive (Noc), CS, neuropathic (Neu), or neuropathic with CS (NeuCS). Results: The results indicated that 72.9% of patients experienced Noc pain, while 5.0% experienced combined NeuCS pain. The Neu and NeuCS groups exhibited significantly lower modified Harris Hip Score and EuroQol-5 Dimensions Questionnaire (EQ-5D) scores than the Noc group, indicating worse clinical outcomes and quality of life. Neu pain was more intense at rest, and when combined with CS it significantly diminished the quality of life. Conclusion: These findings highlight the need for mechanism-based pain treatment strategies, such as Neu pain and CS components, which independently and cumulatively affect clinical scores and quality of life. This study highlights the importance of early recognition and targeted treatment of these pain mechanisms in patients with hip OA. Future research should focus on evaluating therapeutic interventions for Neu pain and CS to optimize patient outcomes.

Clinical outcomes of Chiari pelvic osteotomy for acetabular dysplasia, including conversion to total hip arthroplasty (THA), have not been adequately explored. The purpose of this study was to examine the long-term results and clinical outcomes of Chiari pelvic osteotomy as the primary outcome and to analyze its prognostic factors as the second outcome. This study was a multicenter, retrospective cohort study. Ninety-seven patients underwent Chiari pelvic osteotomy at three hospitals between March 1975 and October 1997. The long-term clinical outcomes of Chiari pelvic osteotomy, including conversion to THA and hip pain, were analyzed using the Kaplan–Meier method. In addition, the prognostic factors for conversion to THA after Chiari pelvic osteotomy were evaluated with clinical variables and radiographic parameters. The study included 51 hips in 45 patients (4 men and 41 women) with long-term follow-up. The survival rates assessed by Kaplan–Meier analysis with conversion to THA as an endpoint, were 90.2% (95% confidence interval (CI) 82.0–98.4%) at 20 years and 73.5% (95% CI 61.1–86.0%) at 30 years. In contrast, the Kaplan–Meier survival rates with the Japanese Orthopaedic Association hip score for pain ≤20 as an endpoint, were 86.3% (95% CI 76.8–95.7%) at 20 years and 65.6% (95% CI 52.3–79.0%) at 30 years. Only older age at osteotomy was the significantly poor prognostic factor for conversion to THA, with a hazard ratio of 1.11/year, 95% CI 1.06 to 1.18, (p < 0.01). Chiari pelvic osteotomy may still be a good alternative to bony reconstructive surgery for acetabular dysplasia especially in young patients. Only older age at the osteotomy was related to the poor prognosis of preserving hip function. [ABSTRACT FROM AUTHOR]

Purpose: The conjoined external rotator tendon (CERT), composed of the tendons of the gemellus superior, obturator internus (OI), and gemellus inferior muscles, stabilizes the hip joint. The study investigates the clinical and radiological effects of the CERT release during anterolateral-supine approach (ALSA) total hip arthroplasty (THA). Methods: A cohort of 60 patients who underwent ALSA THA was examined. Pre- and post-operative muscle width, muscle strength, and radiological data were compared between the CERT-detached and preserved groups. In addition, Clinical assessments were performed using the Japanese Orthopaedic Association Hip-Disease Evaluation Questionnaire and the short-form 36 questionnaires. Results: 58.3% had CERT detached, resulting in radiological atrophy of the OI muscle. Despite this, hip flexion, extension, and abduction muscle strength significantly improved at 6 months post-surgery. The detached CERT did not substantially affect patient-reported outcome measures, including pain and daily activities, within the 6-month follow-up. Discussion: The study suggests that while CERT detachment can lead to muscle atrophy, it has a limited impact on muscle strength and patient-reported outcome measures, indicating the muscle’s potential redundancy. Preserving the CERT might enhance stability and prevent atrophy but could increase the risk of complications. CERT release is recommended when femur exposure is inadequate. [ABSTRACT FROM AUTHOR]

Background: Avascular osteonecrosis of the femoral head (AVN) often results in total hip arthroplasty (THA). The cause for increased THA revision rates among patients with AVN is not yet fully understood. Purpose: To perform a comparative radiological analysis of implant integration between patients with AVN and osteoarthritis (OA). Material and Methods: After a matched pair analysis of 58 patients, 30 received THA due to OA, 28 due to AVN. X-ray images were evaluated after one week ("baseline") and on average 37.58 months postoperatively ("endline"). The prosthesis was grouped into 10 regions of interest (ROI): seven femoral and three acetabular. Incidence, width, and extent of "radiolucent lines" were measured within each zone. Results: Between baseline and endline, width and extent progressed more noticeably in all femoral and acetabular zones among patients with AVN. In femoral ROI 1, the width increased in 40% of AVN cases compared to 6.7% of OA cases. For acetabular ROI 3, the width increased in 26.7% of AVN cases compared to no perceived changes in the OA group. No signs of prosthetic loosening were found in the AVN group. Conclusion: The increase of width and extent of radiolucent lines over time in patients with AVN could be a sign of lack of osteointegration. However, prosthetic loosening in absence of clinical symptoms cannot be deduced from radiological findings after medium-term postoperative follow-up. Further long-term studies are required to monitor how radiolucent lines develop in respect to long-term implant loosening. Dependent on bone quality, individually adapted reaming and broaching of the implant site are recommended. [ABSTRACT FROM AUTHOR]

Residual acetabular dysplasia in children after reduction of hip dislocation is often treated using Salter innominate osteotomy to prevent future osteoarthritis. Preventive surgery for asymptomatic patients, which could result in overtreatment, should be carefully applied with consideration of patients' opinions. In this study, we aimed to describe opinions on Salter innominate osteotomy as preventive surgery for children among adult patients who had undergone periacetabular osteotomy for hip pain due to hip dysplasia. A mail-in questionnaire survey was conducted with 77 patients who underwent periacetabular osteotomy. Participants responded whether they would recommend Salter innominate osteotomy as preventive surgery for children and the reason for their opinion. We also performed a patient-based evaluation using the Japanese Orthopaedic Association Hip-Disease Evaluation Questionnaire and assessed clinical outcome measures with the Japanese Orthopedic Association score. Their recommendations and reasons were evaluated, and associations between their opinions and demographic and clinical characteristics were analyzed. Forty-three patients (56%) responded to the questionnaire. Of these, 10 (23%) patients recommended undergoing Salter innominate osteotomy, 28 (65%) patients did not, and 5 (12%) patients responded they were undecided. No significant association was observed between their opinions and demographic/clinical characteristics evaluated in the survey. The most frequent reason for why they do not recommend Salter innominate osteotomy was related to uncertainty about future hip pain. In total, 65% of the study participants did not recommend Salter innominate osteotomy for children with risk of dysplasia in the future. Participants' preferences regarding preventive surgery were not influenced by demographic and clinical characteristics. [ABSTRACT FROM AUTHOR]

Objective: To evaluate the existing evidence on the effect of exercise therapy in patients with hip osteoarthritis (OA) compared to no treatment and explore whether a further trial will change the current evidence. Design: Systematic review and cumulative meta-analysis using randomized controlled trials (RCT) to determine the effect on pain and function post-treatment, and at 6–9 months after treatment. Standardized mean difference (SMD) ​≤ ​−0.37 was considered clinically worthwhile. Extended funnel plots were used to simulate the impact of a new trial on the pooled effect size of pain and function. Results: 18 RCTs were included. Post-treatment we found a beneficial effect of exercise therapy on pain (SMD -0.38, 95% Confidence Interval (CI): 0.55 to −0.22) and function (SMD -0.31, 95% CI -0.49 to −0.11). A beneficial effect of exercise therapy on pain (SMD -0.23, 95% CI: 0.41 to −0.05) and function (SMD -0.29, 95% CI: 0.45 to −0.12) was found 6–9 months after treatment. Most effect estimates were small, and it is unclear whether these are clinically meaningful. Extended funnel plots and a simulation of a new trial showed that only a new trial with a larger effect than the current pooled effect or a trial including 74,843 participants would change the pooled effect estimate from an unclear to a clearly clinically worthwhile effect. Conclusions: We found a beneficial effect of exercise therapy on pain and function in hip OA. It is unlikely a new trial added to current evidence will change the conclusion.

Purpose: This study aimed to compare the utility score of dysplastic osteoarthritis of the hip (OA) after different surgical treatments. Methods: In this cross-sectional study, we evaluated the utility scores of 204 patients using the Short Form-6 Dimension. Results: Utility scores of all surgery types were significantly higher than those preoperatively in OA (p < 0. 0 5). The utility scores of the unilateral primary total hip arthroplasty (THA) were significantly higher than those of the revision THA. Conclusions: Although THA and osteotomy are effective surgical procedures, lifetime treatment plans should be considered to avoid revision surgery as far as possible. [ABSTRACT FROM AUTHOR]

Hip osteoarthritis (OA) is a prevalent condition causing significant pain and disability. Platelet-rich plasma (PRP) intra-articular injections have emerged as a potential therapeutic option, but their efficacy is still debatable and their safety profile remains under-explored compared to standard treatments. This systematic review aims to evaluate the efficacy and safety of PRP injections in patients with hip OA by analyzing data from randomized clinical trials (RCTs). A comprehensive literature search was conducted in PubMed, Scopus, and the Virtual Health Library (VHL) until October 31, 2022, adhering to Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) guidelines. Studies were included if they were RCTs assessing PRP injections for hip OA and reporting adverse events. Data extraction and methodological quality assessment were performed using the Cochrane Risk of Bias Tool (RoB 2 tool). Out of 188 identified studies, five met the inclusion criteria. The studies varied in sample size (43-111 patients) and PRP preparation methods (closed vs. open systems). All studies demonstrated significant pain reduction and functional improvement with PRP. No major adverse events were reported, indicating a favorable safety profile. Minor side effects were transient and resolved without further intervention. Methodological quality ranged from low to high risk of bias. In conclusion, PRP injections appear to be a safe and effective treatment option for managing hip OA, with favorable outcomes compared to hyaluronic acid. Further research is necessary to standardize PRP protocols and assess long-term safety and efficacy., Competing Interests: Conflicts of interest: In compliance with the ICMJE uniform disclosure form, all authors declare the following: Payment/services info: All authors have declared that no financial support was received from any organization for the submitted work. Financial relationships: All authors have declared that they have no financial relationships at present or within the previous three years with any organizations that might have an interest in the submitted work. Other relationships: All authors have declared that there are no other relationships or activities that could appear to have influenced the submitted work., (Copyright © 2024, Almutairi et al.)

Nowadays, osteoporosis is the most common bone disease globally, with an increased incidence of fractures osteoporosis-related. Predisposing factors such as anatomical abnormalities of the hip, certain occupations family history, obesity, and genetic factors, manage to create a chain of interactions which led finally to osteoarthritis and osteoporosis. Material and methods: In this retrospective study we aimed to summarize the current literature by analysis of data from the largest database (PubMed, ScienceDirect, Elsevier, Wiley, ProQuest, Web of Science) including retrospective, cohort, and multicentric studies based on keywords (pelvic asymmetry, the etiopathogenesis of osteoporosis, more common pelvic pathology; hip dysplasia, femoroacetabular impin gement, osteoarthritis of the hip). Finally, only 39 studies that met the mentioned criteria were included in the final analysis. Results: Worldwide, up to 5 % of newborns are diagnosed with unstable hips, while in 10% of cases they require specific non-surgical. Also, the risk of dysplasia of the hip (DDH) is greater in the female gender (5-fold higher) affecting 19/1.000 girls vs. 4.1/1.000 boys. Regarding femoroacetabular impingement (FAI), this condition affects 54.4/100.000 person-years in the general population, with an increasing incidence over the years from 40.3/100.000 person-years (2000-2004) to 72.6/100.000 person-years (2010-2016). Moreover, parallel with the increasing cases of DDH and FAI, rising osteoarthritis of the hip incidence and also of osteoarthritis-related complications are present in recent years affecting approximately 9.2% of subjects over the age of 45 years. Conclusions: The etiopathogenic chain appears to be pelvic asymmetry (caused by one of the above or post-traumatic causes) - osteoarthritis - osteoporosis. Further studies should be performed aiming at the early detection and rehabilitation of pelvic symmetry. [ABSTRACT FROM AUTHOR]

In Japan, 88% of secondary osteoarthritis cases are associated with acetabular dysplasia (AD) or developmental dislocation of the hip (DDH). However, it is unknown whether severe AD causes hip pain at a lower age. We therefore investigated whether the age at onset of hip pain correlates with radiographic parameters used for the evaluation of AD. This study included 254 patients (235 women and 19 men; mean age 40.7 years, range 17–59 years) who visited our hospital for consultation regarding hip joint pain. Patients were examined radiographically and questioned regarding any history of DDH treatment in infancy. Of the 254 patients, 89 (35%) had a history of treatment for DDH (DDH group) and 165 (65%) had no history of DDH (non-DDH group). In the DDH group, there were no significant correlations between age and any of the tested radiographic parameters. In the non-DDH group, a moderate correlation was observed between age and acetabular angle (r = − 0. 3 8 , p < 0. 0 0 1). Our data suggest that severe AD causes onset of hip pain at a young age in patients without a history of treatment for DDH. [ABSTRACT FROM AUTHOR]

Abstract Background There is consistent evidence from observational studies of an association between occupational lifting and carrying of heavy loads and the diagnosis of hip osteoarthritis. However, due to the heterogeneity of exposure estimates considered in single studies, a dose-response relationship between cumulative physical workload and hip osteoarthritis could not be determined so far. Methods This study aimed to analyze the dose-response relationship between cumulative physical workload and hip osteoarthritis by replacing the exposure categories of the included studies with cumulative exposure values of an external reference population. Our meta-regression analysis was based on a recently conducted systematic review (Bergmann A, Bolm-Audorff U, Krone D, Seidler A, Liebers F, Haerting J, Freiberg A, Unverzagt S, Dtsch Arztebl Int 114:581–8, 2017). The main analysis of our meta-regression comprised six case-control studies for men and five for women. The population control subjects of a German multicentre case-control study (Seidler A, Bergmann A, Jäger M, Ellegast R, Ditchen D, Elsner G, Grifka J, Haerting J, Hofmann F, Linhardt O, Luttmann A, Michaelis M, Petereit-Haack G, Schumann B, Bolm-Audorff U, BMC Musculoskelet Disord 10:48, 2009) served as the reference population. Based on the sex-specific cumulative exposure percentiles of the reference population, we assigned exposure values to each category of the included studies using three different cumulative exposure parameters. To estimate the doubling dose (the amount of physical workload to double the risk of hip osteoarthritis) on the basis of all available case-control-studies, meta-regression analyses were conducted based on the linear association between exposure values of the reference population and the logarithm of reported odds ratios (ORs) from the included studies. Results In men, the risk to develop hip osteoarthritis was increased by an OR of 1.98 (95% CI 1.20–3.29) per 10,000 tons of weights ≥20 kg handled, 2.08 (95% CI 1.22–3.53) per 10,000 tons handled > 10 times per day and 8.64 (95% CI 1.87–39.91) per 106 operations. These estimations result in doubling dosages of 10,100 tons of weights ≥20 kg handled, 9500 tons ≥20 kg handled > 10 times per day and 321,400 operations of weights ≥20 kg. There was no linear association between manual handling of weights at work and risk to develop hip osteoarthritis in women. Conclusions Under specific conditions, the application of an external reference population allows for the derivation of a dose-response relationship despite high exposure heterogeneities in the pooled studies.

Objective: To provide an effective treatment for the Osteoarthritis of the hip by observing the effect of local blocking of HongHua injection on relieving hip pain. Methods: Methods from June 2015 to May 2017, 60 patients with Osteoarthritis of the hip in Wangjing Hospital of Chinese Academy of Sciences were randomly divided into treatment group and control group, 30 cases in each group. The treatment group was given local blockingof HongHua injection treatment, control group using Compound Betamethasone Injection local closed treatment. Visual analogue scale (VAS) score, pericoxal local tenderness and hip mobility were used to evaluate the therapeutic effect. The therapeutic indicators at six different time points after 1 days, 3 days, 7 days, 2 weeks and 1 months after treatment were compared. Results: All the 60 cases completed treatment and follow-up, and there were no cases of abscission. There was no significant difference in gender, age, etiology, classification and Harris score before treatment between the two groups (P > 0.05), which was comparable. VAS score: There was no significant difference between the two groups on the 1st, 3rd, 7th and 2nd week after treatment (P > 0.05), but the treatment group was lower than the control group on the 1st month after treatment (P < 0.01). Hip joint activity: There was no significant difference in hip joint activity between the two groups 1 day, 3 days, 7 days, 2 weeks and 1 month after treatment (P > 0.05). Local tenderness around hip: The efficacy of the midpoint inguinal tenderness score was similar between the two groups at 1 day, 7 days, 2 weeks and 1 month after treatment (P > 0.05); the treatment group was lower than the control group at 3 days after treatment (P < 0.01); the adductor starting tenderness score had no significant difference at 1 day, 3 days, 7 days, 2 weeks and 1 month after treatment (P > 0.05). Conclusion: Local blockingof HongHua injection is effective and effective in treating hip pain in Osteoarthritis of the hip. The HongHua injection has many advantages, such as good safety and wide indications. It is worthy of further clinical application. [ABSTRACT FROM AUTHOR]

Background: Hip resurfacing (HR) is an alternative to conventional total hip arthroplasty (THA) for the treatment of osteoarthritis (OA) in very active, young male patients. However, there is no study in the literature that has proven its benefits for high-impact sport over standard primary THA. The aim of the current study was to investigate the return to sport and function level of male patients after THA vs. HR.Materials and Methods: This prospective study is based on a telephone questionnaire for general health and sports activities. 40 HRs were matched with 40 THAs based on preoperative University of California Arthroplasty Score (UCLA), BMI, age at time of surgery and age at follow-up. The mean follow-up period was 56 months (range 24-87 months).Results: HR patients showed a significantly higher High-activity arthroplasty score (HAAS) (14.9 vs. 12.9, p < 0.001) and Lower extremity activity scale (LEAS) (15.9 vs. 14.1, p < 0.001) and reached significantly higher values in the Hip cycle score (HCS) (44.7 vs. 35.7 p = 0.037) and Impact score (IS) (40.9 vs. 29.6, p < 0.002) than THA patients. No significant differences were found in the HOOS function section (91.4 vs. 90.3, p = 0.803) and the Pain numeric rating scale (NRS)-11 (0.6 vs. 0.9 p = 0.169). Patients with HR had a slightly higher Harris hip score (HHS) (97.8 vs. 95.6, p = 0.015) CONCLUSION: The current study suggests that young male patients are able to engage in higher activity levels after HR compared to standard THA. [ABSTRACT FROM AUTHOR]

Introduction: Results of total hip replacement (THR) for aseptic osteonecrosis are controversial and conflicting according to implant type and generation. The present study consisted in a retrospective assessment of implant survival in primary THR for aseptic osteonecrosis, using a cemented stem, standard polyethylene press-fit acetabular component, and metal–metal bearing. The study hypothesis was that THR results are equivalent between aseptic osteonecrosis and osteoarthritis of the hip. Material and method: A single-center retrospective study included 54 patients with metal-on-metal THR for femoral head osteonecrosis. The main endpoint was revision surgery for all causes, whether implant related or procedure related; secondary endpoints were complications and progression in clinical scores. Results: Mean follow-up was 13.9 ± 1.6 years (range 12.0–17.1 years). Eighteen of the 54 patients (33.3%) died. Implant survival at last follow-up was 93.8% (95% CI, 87.1–100). There were 12 complications (22.2%): 1 intraoperative, 5 (9.3%) immediate postoperative, and 6 (11.1%) long term. Clinical assessment found a significant 43.1 point improvement in mean Harris score (p = 8.4E−33) and a 5.6 point improvement in mean PMA score (p = 2.9E−22). Conclusion: Survival in primary THR for aseptic osteonecrosis was good. Follow-up needs to be rigorous to screen for onset of complications. Primary THR is thus justified in Ficat–Arlet stage 3 and 4 aseptic osteonecrosis of the hip. Level of evidence: IV. [ABSTRACT FROM AUTHOR]

Introduction: Patients with hip osteoarthritis (OA) show abnormal movement patterns, including the leaning of the trunk toward the affected limb (Duchenne limp). Patients with severe OA, especially those with OA due to hip dysplasia, show a lateral pelvic drop (Trendelenburg sign). Aim: The aim of this preoperative study is to investigate the relationship between superior migration of the arthritic femoral head, pain, and hip abductor muscle strength, and to clarify the relationship between the coronal plane gait patterns with pain and hip abductor muscle strength. Methods: The subjects of this study were 18 patients with unilateral hip OA secondary to dysplasia. A radiographic analysis was performed on standardised anteroposterior pelvis films. The abductor muscle strength of the OA hip joint was measured with a handheld dynamometer. The tilt angle of the pelvis and trunk lean angle during gait were obtained using a 3-dimensional motion analysis system. Visual analogue scale (VAS) of pain was obtained after trial. Results: The 2 lateral pelvic angle patterns at the mid-stance of the affected limb during gait were detected. 1 is a pattern that was pelvic rise, and the other was a contralateral pelvic drop. Subjects with pelvic drop showed more superior femoral migration than that with pelvic rise (r = 0.69 p < 0.01). VAS of pain correlate significantly with coronal trunk angle on mid-stance of affected limb during gait (r = 0.761, p < 0.01). Conclusion: The pelvic drop Trendelenburg sign was influenced by superior migration of the femoral head, whereas the trunk lean Duchenne limp was found to be affected by pain. [ABSTRACT FROM AUTHOR]

Study DesignRetrospective study.PurposeTo determine the presence and frequency of factors for degenerative spondylolisthesis (DS) in patients with hip osteoarthritis (OA).Overview of LiteratureOA of the hip joint (hip OA) in Japanese patients is associated with a high incidence of degenerative lumbar spondylolisthesis (DS). However the associated factors for DS in patients with hip OA are unclear.MethodsThe study included 518 patients (59 men and 459 women) with a mean age of 63.8 years who underwent total hip arthroplasty for hip OA at our hospital between January 2004 and May 2014. The presence of DS was assessed using preoperative standing lateral radiographs of the hip joint including the lower lumbar spine. To identify the associated factors for DS in patients with hip OA, multiple logistic regression analysis was conducted in which the presence or absence of DS was used as a dependent variable, and age, female sex, body mass index (BMI), sacral slope (SS), Crowe classification, and primary OA (P-OA) not associated with acetabular dysplasia were independent variables.ResultsPatients with DS accounted for 114 (22.0%) of 518 cases. In multiple logistic regression analysis to identify associated factors for DS in patients with hip OA, the odds ratio for age was 1.05 (95% confidence interval [CI], 1.02–1.08), female sex was 2.48 (95% CI, 1.11–5.54), BMI was 1.08 (95% CI, 1.02–1.14), SS was 1.07 (95% CI, 1.04–1.09), Crowe classification was 0.60 (95% CI, 0.40–0.91), and P-OA was 1.90 (95% CI, 1.20–3.75).ConclusionsAge, female sex, BMI, SS, low Crowe classification, and P-OA are independently associated factors for DS in patients with hip OA.

Background and Aims: Hip osteoarthritis (OA) has a prevalence of 2.9% in Portugal and is a related cause of pain and disability. A sufficient number of patients report these symptoms even after total hip arthroplasty (THA), while others are contraindicated to such surgery and suffer from uncontrolled pain. Percutaneous denervation of hip nerve branches using radiofrequency ablation (RFA) has emerged as a powerful therapeutic avenue to consider for patients with chronic hip pain., Methods: Between January 2020 and March 2021, 26 patients with chronic hip pain received ultrasound-guided RFA with a pericapsular nerve group (PENG) block technique adaptation. Patients suffering from chronic hip pain for more than three months with radiographic evidence of osteoarthritis were included. A numeric rating scale (NRS) and pain medication reduction were defined as outcome variables assessed before treatment and at three-, six-, nine-, and 12-month follow-ups., Results: All selected patients underwent the procedure. All the patients had hip osteoarthritis. Twelve-month follow-up data revealed a statistically significant decrease in the numeric rating scale. The mean NRS for pain was 2 after the procedure. Over 75% of patients reported >50% pain relief during the follow-up and 85% reduced pain medication consumption. No side effects were reported., Conclusion: Hip sensory articular branch RFA is a treatment option with interesting outcomes for chronic hip pain, as demonstrated by our study., Competing Interests: The authors have declared that no competing interests exist., (Copyright © 2024, Correia et al.)

Structural abnormalities of the hip including developmental dysplasia (DDH) and femoroacetabular impingement (FAI) are a predominant cause of primary osteoarthritis. While affected patients may have significant pain and functional limitations, many may remain asymptomatic and will likely incur intra-articular damage over time. The objective of this review is to explore the natural history of DDH, FAI, and the current outcomes of hip preservation surgery including peri-acetabular osteotomy, hip arthroscopy, and surgical hip dislocation. [ABSTRACT FROM AUTHOR]

ABSTRACT The principal aim of this study was to clarify the time course of pain-related behavior and pain-related sensory innervation in a rat model of hip osteoarthritis (OA) induced by intra-articular injection of mono-iodoacetate (MIA). Using 6-week-old male Sprague Dawley rats, 25 μl of sterile saline of 1% Fluoro-Gold solution (FG) (control group; n = 30) and 25 μl of sterile saline of 1% FG with 2 mg of MIA (MIA group; n = 30) was injected into the right hip joints. Gait function was evaluated using a CatWalk system after 7, 14, 28, 42, and 56 days ( n = 5, respectively). Neurons in the dorsal root ganglion (DRG) between L1 and L5 were immunostained for calcitonin gene-related peptide (CGRP) and activating transcription factor-3 (ATF3). Gait analysis revealed the mean six parameters of hind paws at all time points were significantly lower in the MIA group ( p = 0.05). The number of CGRP-immunoreactive (-IR) DRG neurons was significantly increased on days 7, 14, 28, and 42 peaking at 14 days in the MIA group. By contrast, expression of ATF3-IR in FG-labeled DRG neurons was significantly increased on days 42 and 57. The FG-labeled DRG neurons were distributed between L1 and L5, mainly at the L4 level. Pain-related behavior indicated by gait disturbance was observed in a MIA model of hip OA in rat. Early elevation of CGRP expression and late expression of ATF-3 were demonstrated in DRG neurons, possibly reflecting inflammatory pain and neuropathic pain in hip OA. © 2017 Orthopaedic Research Society. Published by Wiley Periodicals, Inc. J Orthop Res 35:1424-1430, 2017. [ABSTRACT FROM AUTHOR]

BACKGROUND: The symptoms of hip osteoarthritis (OA) influence instrumental activities of daily living (IADL). Evidence form previous studies suggest that body functions and walking speed are important etiological factors for IADL. However, no studies have investigated which factors that have the greatest influence on IADL. OBJECTIVE: The aims of this study were (1) to analyze factors related to IADL in patients with hip OA, including 10 m walking speed (10 mWS), and (2) to establish cut-off values for factors that predict maintenance of IADL. METHODS: Forty-eight patients participated in this study. IADL was treated as dependent variable. Range of motion (ROM), muscle strength of the hips and knees, and 10 mWS were measured as independent variables. Other potential confounding factors were also measured. Data were analyzed using hierarchical multiple regression and Receiver Operating Characteristic curve analysis. RESULTS: The hip flexion ROM on the affected side and 10 mWS were selected as significant variables in this study. The cut-off values obtained were 92.5 degrees for the hip flexion ROM on the affected side and 42.3 m/min for 10 mWS. CONCLUSIONS: The suggested target associated with maintaining IADL in patients with hip OA is the cut-off value of 42.3 m/min for 10 mWS found in this study. [ABSTRACT FROM AUTHOR]

Osteoarthritis (OA) of the hip is a rare condition that occurs in adults can be a result of avascular necrosis or a history of steroids that can wear away the articulating cartilage of the hip joint causing friction, pain in the groin region, stiffness, and decreased functional mobility. We present a 30-year-old adult who came with chief complaints of pain in the groin region, stiffness, difficulty in walking, and experiencing pain while walking, which had reduced his activity of daily living. The investigation was done, and the patient was diagnosed with bilateral hip OA secondary to avascular necrosis. To reduce morbidity, preoperative physiotherapy management for eight weeks was planned and started before the operation. The purpose was to educate the patient about the condition, reduce pain, increase the ranges of the hip, improve strength, and provide gait re-education. We added basic proprioception training and plyometric exercises for the hip to improve strength and balance. At the end of the session patient, positive results were achieved. The progress of proprioception or balance training can be improved by using single-leg balance as an outcome measure. Hence, our study aims to use exercise therapy to reduce or postpone the need for hip arthroscopy. However, future research should focus on plyometric exercises for the lower limbs or any abnormalities associated with the lower limbs. However, they should be carried out when some recovery is observed in patients., Competing Interests: The authors have declared that no competing interests exist., (Copyright © 2023, Tiwari et al.)

Objective. The objective of the study was to determine the life quality of patients before and after total knee or hip replacement using selected codes from the International Classification of Functioning, Disability and Health. Patients and methodology. One hundred patients with knee osteoarthritis and 100 respondents with hip osteoarthritis were interviewed in two phases: before operation and after it (in 3 and 6 months) using the tool the International Classification of Functioning, Disability and Health. Results. There was chosen set of 19 codes based on respondents' answers that described the most frequently mentioned problems of the respondents with osteoarthritis of the weight-bearing joints. Physical health and pain codes indicated lowest quality of life before the surgery. These codes also showed the greatest improvement after surgery. Family and friends were the largest facilitators from the environmental factors, accessibility deficiencies were the largest barriers. Conclusions. Selected classification codes indicate the objective improvement of health status and life quality of patients after total endoprosthesis. They can be understood as a set of codes recommended for patients with osteoarthritis in the Czech Republic based on the conducted correlations with other questionnaires evaluating the quality of life of these patients and compared with foreign studies. [ABSTRACT FROM AUTHOR]

Background: In placebo-controlled RCT of symptomatic treatment in osteoarthritis (OA) the extent of pain reduction is heterogeneous, the pooled effect size rather small. Pain reduction is typically higher in knee than in hip trials. The recommended trial duration is 3 months, but in knee OA the best treatment effect vs placebo is observed at 2 weeks. We hypothesized that the placebo response differs in knee vs hip OA.Objective: We performed a meta-analysis to describe the time course of pain in placebo groups of trials in knee and hip OA over 3 months.Methods: A systematic search of PubMed, MEDLINE and Google Scholar of placebo-controlled cox-2 inhibitor (coxib) RCT (from 1999 to 2007) of hip and knee OA was performed. Pain levels (visual analogue scale [VAS], Western Ontario and McMaster Universities Osteoarthritis Index [WOMAC]) in the placebo groups at different measurement time points were extracted, expressed as weighted mean at weeks 2, 4, 6-8 and 12-13.Results: Twenty-one studies included 3064 knee OA patients and 608 hip OA patients. For knee OA, pain (VAS) decreased from 15 mm at week 2, to 20 mm at week 6-8, and 21 mm at week 12-13. For hip OA patients, pain decreased by 12 mm, 14 mm and 14 mm, respectively.Conclusion: Pain decreased in both knee and hip OA patients treated with placebo at 2 weeks, but further decreases up to week 12 occurred only in knee OA, especially for pain VAS, resulting in a time dependent impact on the magnitude of treatment outcome. Primary endpoint pain should be assessed at 2-4 weeks. [ABSTRACT FROM AUTHOR]

The article deals with the fate of patients after implantation of total hip endoprosthesis in the system of insurance and non-insurance benefits of social security of the Czech Republic. The author presents basic information about total hip endoprosthesis including new trends and alloplasty of hip joint. The statistics of TEP including the description of the National Registry of joint replacement of the Czech Republic is described. The article also includes statistical evaluation of the number of acknowledged (granted) invalidity cases, the certificate of persons with health handicap and a car allowance for getting a motor vehicle since 2011 till 2015 in subjects affected by hip osteoarthrosis including the condition after hip joint replacement. [ABSTRACT FROM AUTHOR]

Objective: To determine the cost-effectiveness (CE) of exercise therapy (intervention group) compared to 'general practitioner (GP) care' (control group) in patients with hip osteoarthritis (OA) in primary care.Method: This cost-utility analysis was conducted with 120 GPs in the Netherlands from the societal and healthcare perspective. Data on direct medical costs, productivity costs and quality of life (QoL) was collected using standardised questionnaires which were sent to the patients at baseline and at 6, 13, 26, 39 and 52 weeks follow-up. All costs were based on Euro 2011 cost data.Results: A total of 203 patients were included. The annual direct medical costs per patient were significantly lower for the intervention group (€ 1233) compared to the control group (€ 1331). The average annual societal costs per patient were lower in the intervention group (€ 2634 vs € 3241). Productivity costs were higher than direct medical costs. There was a very small adjusted difference in QoL of 0.006 in favour of the control group (95% CI: -0.04 to +0.02).Conclusion: Our study revealed that exercise therapy is probably cost saving, without the risk of noteworthy negative health effects.Trial Registration Number: NTR1462. [ABSTRACT FROM AUTHOR]

Although an adverse relationship between osteoporosis and osteoarthritis (OA) has been reported, it remains controversial. In most previous reports of OA, bone mineral density (BMD) changes in the subtrochanteric region have not been clarified, whilst BMD of the femoral neck and trochanteric region has been well investigated. In our current study, we investigated the BMD ratio compared to the contralateral side in the whole proximal femurs of hip OA patients. We aimed to clarify the morphologic factor that may influence these BMD ratios. We performed dual energy X-ray absorptiometry (DEXA) analysis of 69 hip joints from unilateral progressed OA cases. The minimum joint space, center edge angle, Sharp angle, acetabular head index, neck-shaft angle, and leg length discrepancy were also measured as radiographic factors. The correlation between BMD ratio and radiographic morphologic factors was then evaluated by logistic regression. The BMD ratio was higher in the femoral neck than in the distal region. In terms of radiographic factors, the neck-shaft angle was revealed to influence the decreased BMD ratio in the distal subtrochanteric part, whilst the leg length discrepancy and Sharp angle showed a relationship with the increased BMD ratio in the proximal neck region. The discrepancy in the BMD ratio between the femoral neck and the distal subtrochanteric region in the proximal femur is influenced by several morphologic factors. [ABSTRACT FROM AUTHOR]

BACKGROUND: The incidence of low back pain (LBP) is high in patients with hip osteoarthritis (OA). Evidence from previous studies suggests that lumbar alignments and hip range of motion (ROM) are important etiological factors for LBP. However, no studies have investigated which factors that have the greatest influence on LBP. OBJECTIVE: This investigation aimed to collectively examine factors related to LBP in patients with hip OA, including lumbar lordosis angle (LLA), leg length discrepancy (LLD), and hip ROM.METHODS: Thirty-five patients participated in this study. LBP was treated as a dependent variable, whereas hip ROMs were treated as independent variables. Patients' age and body mass index (BMI) were recorded as confounding factors, as were LLA and LLD. A logistic regression model was performed to determine the most accurate set of variables to predict LBP. RESULTS: BMI and ROM of hip flexion on the affected side were identified as significant variables. CONCLUSIONS: Our results suggest that BMI and ROM of hip flexion on the affected side are related to LBP in patients with hip OA and need to be assessed. [ABSTRACT FROM AUTHOR]

Several therapeutic options have been used in the past for treatment of patients with hip osteoarthritis (HO). In recent years we have witnessed to the introduction of the intra-articular injection (IA) of hyaluronic acid (HA) in clinical practice. This technique was initially used to treat knee arthritis, for which was actually introduced, but hip anatomy itself (deeper joint structure) and technical features (different methods) pose more challenges. However, results look promising in terms of symptoms improvement and delaying prosthetic surgery. Indeed, it does appear mandatory to increase pool of available data with further studies in order to refine techniques, make them more effective, and target patients who could potentially benefit more than others from treatment. [ABSTRACT FROM AUTHOR]

Between 1986 and 1997, 136 porous-coated anatomic (PCA) total hip arthroplasties were performed for patients with osteoarthritis of the hip, and data were available for 60 hips at final follow-up (mean follow-up, 15.2 years). Of these, 18 hips had undergone revision: 12 for the acetabular component, 10 for the femoral component, and 4 for both components. Survival rate at 23 years postoperatively was 60% for the acetabular component and 82% for the femoral component. Multivariate Cox proportional hazards regression showed that annual polyethylene wear rate, size, and abduction angle of the acetabular component were significantly associated with acetabular component revision surgery, and that annual polyethylene wear rate and filling ratio of the femur were associated with femoral component revision surgery. [ABSTRACT FROM AUTHOR]

Objectives. To document the reliability of Abe's classification and to clarify the predictive factors for acetabular labral lesions in osteoarthritis of the hip with radial magnetic resonance (MR) imaging. Methods. Reliability trial for the classification of acetabular labral lesion was performed by six orthopedic surgeons, grading 20 radial MR images in a blinded fashion at an interval of 4-5 weeks. Radial MR images of 275 hips in 263 patients were prospectively analyzed to determine the relationship between acetabular labral lesions, their distribution, age, and the acetabular coverage. Results. Cohen's quadratic weighted kappa of inter-observer reliability was 0.784 for the grade and 0.812 for the shape category. The weighted kappa of intra-observer reliability was 0.852 for the grade and 0.90 for the shape category. Multiple regression analysis revealed that both the grade and the shape were associated with age, acetabular coverage, and location of the labrum. Conclusions. Abe's classification of labral lesions was reliable for both the grade and shape categories. Aging, acetabular dysplasia, and the anterosuperior portion would be predictive factors for degeneration of the acetabular labrum using radial MR imaging. [ABSTRACT FROM AUTHOR]

Purpose: Femoroacetabular impingement is a new disease concept for hip disorders in young adults suggested as a major cause of primary hip osteoarthritis in Western countries. However, significant controversy exists regarding the prevalence and contribution of impingement deformities to osteoarthritis in Japan, owing to the higher prevalence of developmental dysplasia of the hip. Therefore, the aims of this study were to: (1) determine the prevalence of structural abnormalities associated with hip disorders in patients undergoing total hip replacement and (2) analyse the contribution of impingement deformities to osteoarthritis. Methods: We analysed 250 patients from two different medical centres who underwent primary total hip replacement except those which were due to femoral head necrosis, posttraumatic osteoarthritis and systemic inflammatory disease. The average patient age at surgery was 64 years (range, 40-89 years), with 35 men and 215 women. Results: Radiographic abnormality related to developmental dysplasia of the hip was associated with the majority of osteoarthritic hips (62 %). Hips with femoroacetabular impingement deformities were present within the cases categorized as unknown etiology. Cam impingement deformity was present in 22 % of unknown aetiology cases when cases with reactive osteophytes were excluded from all cam deformity cases (pistol grip deformity and aspherical femoral heads). Conclusions: The prevalence of femoroacetabular impingement within primary osteoarthritis cases and gender predominance of impingement deformities are relatively similar to those reported previously in Western populations. This finding indicates that femoroacetabular impingement deformities are associated with osteoarthritis in the Japanese population, although it has a lower frequency among all hip failure patients. [ABSTRACT FROM AUTHOR]

Recent reports have shown the existence of subchondral insufficiency fracture in rapidly destructive arthrosis of the hip joint (RDA), and the findings suggest that osteopenia is related to the pathogenesis of the rapid progression of this disease. Therefore, we measured bone mineral density (BMD) in RDA patients. We measured BMD of the lumbar spine, radius, and calcaneus using dual-energy X-ray absorptiometry in 19 patients with RDA and 75 with osteoarthritis of the hip (OA) and compared BMD at different skeletal sites between RDA and OA patients. No significant differences were observed in BMD of the lumbar spine, ultradistal radius, mid-radius, and calcaneous between the RDA and OA groups. Our data suggest that RDA is not accompanied by generalized osteoporosis. Factors other than generalized bone status, for example, BMD around the affected hip joint before destruction, need to be analyzed to elucidate the pathophysiological mechanism of RDA. [ABSTRACT FROM AUTHOR]

Background: Femoroacetabular impingement (FAI) is one factor known to cause pain and osteoarthritis (OA) of the hips. Although secondary OA due to hip dysplasia is common among Japanese populations, primary OA is seldom observed. Concomitantly, FAI is also thought to be uncommon in Japan, but relatively few epidemiological studies have addressed this issue. This study aimed to clarify the prevalence of radiographic findings of FAI in a Japanese population and to evaluate whether FAI is a risk factor for the development of arthritic changes. Methods: We retrospectively examined 87 patients who underwent unilateral hip osteotomy with a Charnley category A hip joint on the contralateral side. Anteroposterior-view radiographs of the non-operated hip joint were assessed for the presence of hip dysplasia, as well as pistol grip deformity and crossover sign indicative of cam-type and pincer-type impingement, respectively. The presence of arthritic changes in the non-operated hip joint was assessed in follow-up radiographs, and factors contributing to the development of arthritis were determined by survival analysis. Results: Of the 87 hips examined, dysplasia was noted in 38 (43.6%). While no pistol grip deformity was observed, crossover sign, which is indicative of pincer-type impingement, was identified in 9 of 38 dysplastic hips (23.7%) and 15 of 49 non-dysplastic hips (30.6%). Arthritic changes were present in 13 of 38 dysplastic hips (34.2%) and 11 of 49 non-dysplastic hips (22.4%). Survival analysis revealed that the presence of the crossover sign in non-dysplastic hips was significantly associated with the development of arthritis. Conclusions: The prevalence of the crossover sign in hips in a Japanese population is similar to that reported in Western populations, despite the fact that FAI is believed to be less prevalent in the Japanese population. Furthermore, the presence of the crossover sign in non-dysplastic hip joints is associated with the development of arthritis. Based on our results, pincer-type impingement could be commonly associated with the development of arthritis in Japanese populations. [ABSTRACT FROM AUTHOR]

Background Advising patients about when they can drive after surgery is common practice after arthroplasty of the knee or hip. In the literature, the preoperative braking performance values of the patients are frequently taken as the "safe" landmark. We hypothesised that osteoarthritis (OA), the most frequent reason for arthroplasty, already compromises the ability to perform an emergency stop. We expected that both Reaction Time (RT) and Movement Time (MT) as components of the Total Brake Response Time (TBRT), would be prolonged in patients with OA of the knee or hip in comparison with healthy subjects. We also expected maximum pressure levels on the brake pedal to be reduced in such cases. Methods A real car cabin was equipped with pressure sensors on the accelerator and brake pedals to measure RT, MT, TBRT and maximum Brake Force (BF) under realistic spatial constraints. Patients with OA of the knee (right n = 18, left n = 15) or hip (right n = 20, left n = 19) were compared with a healthy control group (n = 21). Results All measured values for TBRT in the control group remained below 600 ms. OA of the right hip or knee significantly prolonged the braking performance (right hip: TBRT p = 0.025, right knee: TBRT p < 0.001), whereas OA of the left hip did not impair driving ability (TBRT p = 0.228). Intriguingly, OA of the left knee prolonged RT and MT to the same degree as OA on the contralateral side (RT p = 0.001, MT p < 0.001). Conclusions This study demonstrates that depending on the localisation of OA, driving capability can be impaired; OA can significantly increase the total braking distance. To ensure safe traffic participation the safety margin for TBRT should be strictly set, under our experimental conditions, at around 600 ms. Moreover, therapeutic approaches to OA, such as physiotherapy, and patients receiving surgery of the left knee should take into account that left knee OA can also impair driving ability. [ABSTRACT FROM AUTHOR]

Abstract: Objectives: Although etiology in osteonecrosis of the femoral head mainly depends on alterations of bone blood flow, vasoregulatory nerve fibers of the sympathetic and sensory nervous system have never been investigated in bone of osteonecrosis patients. This study aimed to demonstrate density of sympathetic and sensory nerve fibers in femoral head and, for comparison, adjacent periosteum, and synovium of the hip joint in patients with osteonecrosis. Methods: Immunofluorescence staining techniques were applied using specific nerve fiber markers. A total of 10 patients with early femoral head osteonecrosis (ARCO I-II), 10 with late femoral head osteonecrosis (ARCO III-IV), and 10 patients with osteoarthritis of the hip were investigated. Results: In the bone of the femoral head, density of sympathetic nerve fibers was lower in early and late osteonecrosis compared to osteoarthritis. There was a marked preponderance of sympathetic over sensory nerve fibers in bone of osteoarthritis patients, which was opposite in early and late femoral head osteonecrosis. In periosteum, density of sympathetic nerve fibers was similar in all three groups but density of sensory nerve fibers and cellularity were higher in early osteonecrosis compared to the other two groups. Discussion/Conclusions: Due to the different affinity of norepinephrine for α-adrenoceptors (high affinity) and β-adrenoceptors (low affinity), the loss of sympathetic nerve fibers relative to sensory nerve fibers in femoral head osteonecrosis might change the femoral head blood flow (towards α-adrenergic vasoconstriction). Higher density of sensory nerve fibers and cellularity in periosteum might indicate an inflammatory response in early osteonecrosis. [Copyright &y& Elsevier]

Aims: The extended wait that most patients are now experiencing for hip and knee arthroplasty has raised questions about whether reliance on waiting time as the primary driver for prioritization is ethical, and if other additional factors should be included in determining surgical priority. Our Prioritization of THose aWaiting hip and knee ArthroplastY (PATHWAY) project will explore which perioperative factors are important to consider when prioritizing those on the waiting list for hip and knee arthroplasty, and how these factors should be weighted. The final product will include a weighted benefit score that can be used to aid in surgical prioritization for those awaiting elective primary hip and knee arthroplasty., Methods: There will be two linked work packages focusing on opinion from key stakeholders (patients and surgeons). First, an online modified Delphi process to determine a consensus set of factors that should be involved in patient prioritization. This will be performed using standard Delphi methodology consisting of multiple rounds where following initial individual rating there is feedback, discussion, and further recommendations undertaken towards eventual consensus. The second stage will then consist of a Discrete Choice Experiment (DCE) to allow for priority setting of the factors derived from the Delphi through elicitation of weighted benefit scores. The DCE consists of several choice tasks designed to elicit stakeholder preference regarding included attributes (factors)., Results: The study is co-funded by the University of Aberdeen Knowledge Exchange Commission (Ref CF10693-29) and a Chief Scientist Office (CSO) Scotland Clinical Research Fellowship which runs from 08/2021 to 08/2024 (Grant ref: CAF/21/06). Approval from the University of Aberdeen Institute of Applied Health Sciences School Ethics Review Board was granted 22/03/2022 - Reference number SERB/2021/12/2210., Conclusion: The PATHWAY project provides the first attempt to use patient and surgeon opinions to develop a unified approach to prioritization for those awaiting hip and knee arthroplasty. Development of such a tool will provide more equitable access to arthroplasty services, as well as providing a framework for developing similar approaches in other areas of healthcare delivery.Cite this article: Bone Jt Open  2022;3(10):753-758.

Objective. To clarify the sensory innervation and inflammatory cytokines in hypertrophic synovia associated with pain transmission in OA of the hip.Methods. A piece of the synovium was extracted during reconstruction surgery in 50 patients with OA of the hip as an inflammatory synovium and in 12 patients with femoral neck fracture as a normal synovium. Each sample was immersed in fixative solution, sectioned on a cryostat, and then processed for immunohistochemistry using antibodies as follows: neuron-specific class III β-tubulin (TuJ-1) as a general marker for nerve fibres, calcitonin gene-related peptide (CGRP) for sensory nerve fibres, nuclear factor κB (NF-κB) for the protein complex controlling the transcription of DNA in cellular responses to painful stimuli, and TNF-α for cytokines involved in acute inflammation. The number of immunopositive cells and fibres were counted using a fluorescence microscope.Results. In the inflammatory synovium of OA of the hip, TuJ-1 was positive in 46% (23 hips). Of those positive for TuJ-1, 78% (18 hips) were also positive for CGRP, but 22% (5 hips) were negative for CGRP. NF-κB was positive in 68% (34 hips). Of those positive for NF-κB, 76% (26 hips) were also positive for TNF-α, but 24% (8 hips) were negative for TNF-α. In normal synovia, all four substances were negative.Conclusion. We suggest sensory innervation and inflammatory cytokines in hypertrophic synovia are associated with nociception in OA of the hip.Trial registration: University Hospital Medical Information Network, www.umin.ac.jp, UMIN000001335. [ABSTRACT FROM AUTHOR]

Purpose: The aim of the study was to assess the role of residual hip dysplasia as a risk factor for osteoarthritis (OA) in developmental dysplasia of the hip (DDH). Methods: Fifty-one patients (60 hips) with late-detected DDH were studied. Reduction had been performed at a mean age of 19 months (range 4-65 months). On radiographs at age 8-10 years, at skeletal maturity, and at long-term follow-up, femoral head coverage was assessed using the migration percentage (MP) and centre-edge (CE) angle. OA was diagnosed if the minimum joint space width of the upper part of the joint was <2.0 mm. Results: The mean age at the last follow-up was 45 years (range 43-49 years) in patients who had not undergone total hip replacement (THR). Ten patients had developed OA and eight of them had undergone THR at a mean age of 40 years (range 32-47 years). There was a clear association between OA and residual hip dysplasia. At the last follow-up, 37 hips had normal CE angles (20° or higher) and OA had developed in only two of them (5%; 95% confidence interval [CI] 1-18%). Hip dysplasia without subluxation (CE angle 10-19°) was seen in 18 hips, of which 14 hips had good outcome and four had OA (22%; 95% CI 6-48%). Subluxation occurred in five hips, of which one had a good long-term outcome and four had OA (80%; 95% CI 28-99%). In patients without late reconstructive surgery, MP increased from the age of 10 years to skeletal maturity; thereafter, no significant change occurred. The CE angle did not change significantly between the age of 10 years and the last follow-up. Conclusion: Hip dysplasia without subluxation has a relatively good long-term prognosis. Subluxation is a risk factor for osteoarthritis. Thus, children with MP above 33% and CE angle under 10° should be evaluated for reconstructive surgery in order to improve the long-term outcome. [ABSTRACT FROM AUTHOR]