Citations

Abstract Purpose Patients presenting for iliopsoas tendinitis consultation after total hip arthroplasty (THA) often describe a prolonged time to diagnosis and subsequent surgical management. The purpose of this study was to quantify time from symptom onset to diagnosis and subsequent arthroscopic iliopsoas fractional lengthening, including number of providers seen. Methods Patients undergoing arthroscopic iliopsoas fractional lengthening after THA were prospectively identified between 2023-2025 at a single institution. Time from symptom onset to iliopsoas tendinitis diagnosis as well as arthroscopic lengthening were determined. Number of providers seen, diagnostic relief from preoperative iliopsoas bursal injections, and postoperative satisfaction after fractional lengthening were also evaluated to better quantify indications and outcomes of arthroscopic intervention in this population. Results A total of 44 hips in 41 patients (23 females and 18 males) were included (mean age: 64.7 ± 10.2, mean BMI: 29.9 ± 5.9 kg/m2). Of note, 7 patients (16%) had undergone revision THA prior to iliopsoas symptom onset. Patients had on average 2.2 ± 2.1 years of symptoms and saw 2.5 ± 1.7 [range: 1-8] providers prior to being diagnosed with iliopsoas tendinitis and referred for consideration of arthroscopic fractional lengthening. Preoperatively, 93% of patients underwent at least 1 iliopsoas bursal corticosteroid injection, with an average of 81.1% symptom relief during the diagnostic (anesthetic) phase. The mean time between THA and iliopsoas fractional lengthening was 4.8 ± 3.4 years, whereas the mean time between initial iliopsoas tendinitis symptoms to fractional lengthening was 3.1 ± 2.5 years. At a mean of 11.3 ± 6.8 months postoperatively, mean surgery satisfaction was 8.1 ± 2.6 on a scale of 1 to 10, with the vast majority of patients (89.5%) stating that they would undergo fractional lengthening again. Conclusion Patients often experience a protracted period of symptoms and see multiple clinicians prior to being diagnosed with iliopsoas tendinitis and undergoing arthroscopic management. In patients refractory to conservative management, arthroscopic fractional lengthening can provide high surgery satisfaction, with most patients stating they would undergo the procedure again. These findings highlight the importance of increased recognition and appropriate referral of patients with iliopsoas tendinitis following THA.

Abstract Purpose Iliopsoas tendinitis following total hip arthroplasty (THA) has been described to result from acetabular component overhang as well as prominent femoral collars. Yet, a portion of patients experience iliopsoas tendinitis in the setting of well-positioned components. The purpose of this study was to assess anatomic factors predisposing to iliopsoas tendinitis after THA. Methods Patients with THAs performed at three academic institutions who subsequently underwent arthroscopic iliopsoas release were retrospectively reviewed from 2015 to 2025 and propensity matched in a 1:3 fashion to a control group of THAs without subsequent iliopsoas release. Controls were matched by age, surgery date, laterality, sex, surgical approach, and implanted femoral component. Patients with iliopsoas tendinitis and subsequent release (THA-IP) were evaluated for anterior acetabular component overhang and femoral collar overhang, when a collar was present. We also evaluated the absolute and relative profile of the lesser trochanter on anteroposterior radiographs, understanding that when less of the lesser trochanter is visualized, the trochanter is anatomically displaced posterolaterally, resulting in a more arduous route from the inner pelvic origin of the iliopsoas to its insertion on the femur. Results Forty-five patients (mean age: 57±11; 71% female; 19 direct anterior, 10 anterolateral, 16 posterior approach) undergoing THA-IP were analyzed and matched to 135 controls. Both groups demonstrated a median cup size of 54 mm and head size of 36 mm. Average time to iliopsoas release after THA was 4 years. Anterior cup overhang of >2 mm was present in 49% of THA-IP patients, with 18% having collared femoral components, and 9% demonstrating collar overhang of >2 mm. Overall, 19 THA-IP patients had <2 mm of cup and collar overhang and 26 patients had >2 mm of overhang. THA-IP patients with <2 mm of cup and collar overhang had significantly greater relative posterolateralization of the lesser trochanter compared to those with overhang of >2 mm (p=0.010) and to controls (p=0.037). Conclusion Visualizing “Less of the Lesser” on anteroposterior hip radiographs and associated posterolateralization of the lesser trochanter may be an anatomic risk factor for iliopsoas tendinitis following THA, even in the presence of satisfactorily positioned components.

Abstract Introduction Abductor tendon pathology is a common cause of greater trochanteric pain syndrome. The gluteus minimus tendon inserts on the anterior facet of the greater trochanter; the gluteus medius tendon inserts at both the lateral and posterosuperior facets. The Dunn view brings the anterior facet into profile and allows for differentiation of the anterior facet and the insertion of the gluteus minumus from the insertion site of gluteus medius. We hypothesize isolated enthesophytes at the anterior facet best seen on the Dunn view are associated with gluteus minimus tendon pathology. Methods Fifty patients with a history of lateral hip pain with hip radiographs and ipsilateral hip MRI were reviewed. Patients were excluded if the time between radiographs and MRIs >6months or if the patient had prior surgery on the affected side. The radiographs were reviewed by a single-reader to identify enthesophytes (≥ 2mm) at the anterior facet on the Dunn views and lateral facet on the AP view. MRIs were reviewed to categorize the gluteus minimus and medius tendons into the following: normal, tendinopathy, partial thickness tear and full thickness tear. Results The mean age of the fifty patients was 62 (range 19-79; 80% were females). 28 patients had left hip pathology and 22 had right hip. The mean difference between the time between radiograph and MRI was 53 days. Out of the 50 patients, 38 had anterior facet enthesophytes on Dunn views. 97% of these patients had gluteus minimus tendon pathology on MRI, including 76% with tendon tears (positive predictive value [PPV] of 89%). 30 patients had lateral enthesophytes on AP views. 87% of these patients had gluteus medius pathology, including 70% tears (PPV of 83%). Only 3 out of 50 patients had posterosuperior facet enthesophytes. All 3 of these patients had abductor pathology (PPV of 67%). Conclusion There is a correlation between enthesophytes at the greater trochanter anterior facet and lateral facet with respective gluteus minimus and medius tendon pathology. Dunn views add value in detecting anterior facet enthesophytes not visible on AP views and are highly predictive of gluteus minimus tendon pathology.

Abstract Introduction Labral reconstruction has seen an increase in utilization over the last decade. As a result of the increasing number of labral reconstructions being performed, there has been a subsequent increase in the number of failed labral reconstructions requiring revision. The purpose of the present study was to report the short-term survivorship and outcomes of patients who underwent segmental acetabular labral reconstruction in the setting of a failed prior labral reconstruction. Methods A retrospective review of all labral reconstructions performed by the senior author between 01/01/2010-04/01/2022 was conducted. Patients who underwent a labral reconstruction and were over 18 at the time of surgery were included. Patients with a history of avascular necrosis, Legg-Calvé-Perthes, or with a lateral center edge angle < 18° were excluded. Demographics, radiographic parameters, and patient reported outcomes (PROs) were collected. Patients who underwent a labral reconstruction in the setting of a prior failed labral reconstruction (Group B) were matched in a 1:1 fashion to patients in a control group who underwent only one labral reconstruction (Group A) by age, sex, LCEA, minimum joint space, and the presence of an Outerbridge Grade 3 or 4 defect. Results A total of 24 hips (23 patients) were included in Group B. Mean age at the time of surgery was 36 ± 13 years, and most hips were female (n=14, 58%). Twenty-two (92%) of the hips met a study endpoint, with 3 (14%) converting to total hip arthroplasty (THA) and 3 (14%) undergoing a subsequent hip-preserving surgery. The remaining 16 hips reported 2-year minimum PROs and had a median patient satisfaction of 9.5 (Range: 6-10). Additionally, they demonstrated significant improvement from baseline in SF-12 PCS (p=0.004), WOMAC Total (p<0.001), mHHS (p=0.004), HOS-ADL (p=0.002), and HOS-Sport (p=0.002). Notably, patients in Group B demonstrated similar improvement in PROs from baseline compared to the matched-control group (Group A). Conclusion Patients who undergo revision labral reconstruction in the setting of a failed prior labral reconstruction demonstrate significant improvement in PROs post-operatively compared to baseline at a rate similar to patients who underwent only one labral reconstruction.

Abstract Introduction Understanding factors that impact outcomes of total hip arthroplasty (THA) can aid clinical decision-making and patient counselling. The purpose of this study was to investigate functional outcomes, complications, and reoperation rates among patients undergoing primary THA after hip arthroscopy (HA-THA) compared to a matched cohort of primary THA patients without prior arthroscopy (THA-only). Methods A retrospective review was performed to identify all patients who underwent primary THA after prior hip arthroscopy from 2009-2022 at a single institution. Patients with a history of revision arthroscopy were excluded. Cases were propensity-matched with primary THA controls in a 1:4 ratio by age at time of THA, sex, body mass index, surgical approach, and year of surgery. At minimum 2-year follow-up, patient-reported outcomes (PROs) including Forgotten Joint Score (FJS), Modified Harris Hip Score (mHHS), Hip Disability and Osteoarthritis Outcome Score Pain (HOOS pain), and Visual Analog Pain Scale (VAS) were analyzed. Results Sixty-three hips in 60 patients (age: 47.3±9.4 years, BMI: 29.8±6.2 kg/m2) were matched to 252 THA-only hips, with patients converting to THA at a mean 3.1 years (range 0.3-10.3) following hip arthroscopy. While both HA-THA and THA patients demonstrated significant (p<0.001) postoperative improvements in PROs, HA-THA patients reported significantly lower postoperative FJS, mHHS, HOOS pain, and VAS pain scores (p<0.001) as compared to THA-only controls. At mean 6.6±3.2 years follow-up, HA-THA patients with preoperative Tönnis grades 2-3 reported significantly increased FJS, mHHS, and HOOS pain compared to those with preoperative Tönnis grades of 0-1 (p≤0.03). Additionally, HA-THA patients with preoperative Tönnis grades 0-1 exhibited worse PROs (p<0.001) as compared to THA-only controls. While there were no differences in complication rates between HA-THA patients and THA-only controls (8% vs. 5%, p=0.49), all-cause reoperation was greater amongst HA-THA patients compared to THA-only (10% vs. 2%, p=0.01). Conclusion While improved compared to preoperatively, patients undergoing THA after prior hip arthroscopy demonstrated inferior outcomes at mid-term follow up as compared to a demographically age-matched cohort without prior arthroscopy. When considering conversion to THA following arthroscopy, clinicians should consider counseling patients regarding improved outcomes in the setting of advanced radiographic osteoarthritis, and potentially increased all-cause reoperation.

Abstract Purpose To investigate clinical outcomes, including patient reported outcome measures (PROMs), subjective anterior groin pain and hip flexion strength, and reoperation rates following arthroscopic iliopsoas fractional lengthening after total hip arthroplasty (THA). Methods Patients who were indicated for arthroscopic iliopsoas fractional lengthening after ipsilateral THA were prospectively identified between 2023-2025 at a single institution. Pre- and post-operative PROMs, including Visual Analog Scale (VAS), Tegner activity scale, Single Assessment Numeric Evaluation (SANE), and subjective anterior groin pain and hip flexion strength were analyzed. Reoperations at final follow-up were also evaluated. Results A total of 44 hips in 41 patients (23 females and 18 males) were included (mean age: 64.7 ± 10.2, mean BMI: 29.9 ± 5.9 kg/m2). Fifty-five percent of patients underwent surgery on their right hip. The mean postoperative follow-up timeframe was 10.0 ± 7.1 months. There was a significant improvement in postoperative PROMs compared to pre-operative levels for VAS at rest (1.3 ± 1.9 vs. 2.9 ± 2.2), VAS with use (3.1 ± 3.8 vs. 8.0 ± 1.6), Tegner activity scale (2.9 ± 1.3 vs. 2.1 ± 1.1), and SANE (74.0 ± 20.3 vs. 47.9 ± 23.4) (p<0.001 for all). Over 90% of patients reported feeling much better or slightly better regarding their anterior groin pain at 2-weeks post-operatively (93%), 6 weeks post-operatively (90%), 3 months post-operatively (93%), and at final follow-up (91%). Regarding hip flexion strength, 73% reported feeling much better or slightly better at 2-weeks post-operatively, 95% at 6-weeks post-operatively, 85% at 3 months post-operatively, and 61% at final follow-up. Only 2 patients (5%) reported feeling much weaker at final follow-up. Two of 44 hips (5%) underwent reoperation at final follow-up. One patient underwent a 2-stage revision THA at 5 months postoperatively due to infection, while 1 patient underwent an open iliopsoas release with acetabular screw removal and liner exchange. Overall, the mean surgery satisfaction was 8.1 ± 2.6 on a scale of 1-10. Conclusion Patients who underwent arthroscopic iliopsoas fractional lengthening following THA demonstrated satisfactory postoperative outcomes, with over 90% reporting durably improved anterior groin pain and nearly two-thirds reporting increased hip flexor strength throughout follow-up.

Abstract Osteonecrosis (ON) of the femoral head is a significant complication following chronic corticosteroid treatment, especially in adolescents and young adults. While studies in the adult population suggest that early core decompression augmented with bone marrow aspirate concentrate injection (BMAC) may reduce progression, evidence in younger patients remains scarce. This study evaluates survivorship free from femoral head collapse and conversion to total hip arthroplasty following core decompression with BMAC in patients under 25 years old with corticosteroid-induced femoral head ON. A retrospective review was conducted of 13 patients (24 hips) who underwent hip core decompression with BMAC for corticosteroid-induced femoral head ON. Variables analyzed included sex, body-mass index, age at index surgery, continued corticosteroid use, concomitant labral tear, Kerboul angle/grade, and Steinberg classification of osteonecrosis. These variables were assessed for their association with survivorship free of THA, conversion to THA, and patient reported outcomes (PROs) (modified Harris Hip Score [mHHS] and Hip Disability and Osteoarthritis Outcome Score [HOOS-12]). The mean follow-up duration was 10 ± 5.4 years. At the final follow-up, 11 hips (45.8%) required reoperation, including 10 total hip arthroplasties and one femoral head resurfacing. Progression to radiographic femoral head collapse occurred in 9 hips (37.5%), resulting in a collapse-free survival rate of 62.5%. The mean survival time until reoperation was 8.34 years. Continued corticosteroid use (p=0.033), Steinberg stage >2 (p=0.044), male sex (p=0.045), and high BMI (p=0.002) were associated with increased risk for reoperation. On multivariate analysis, ongoing corticosteroid use (OR=6.4, p=0.01) and Steinberg stage >2 (OR=4.3, p=0.04) were predictors of reoperation. Patient-reported outcomes at final follow-up included a mean mHHS of 77.5 and a HOOS-12 score of 80%. Core decompression with BMAC for corticosteroid induced femoral head ON in adolescents and young adults resulted in collapse-free survival rate of 62.5% at average 10 years follow up with an average reoperation-free survival of 8.34 years. Patients with Steinberg stage ≥2 and ongoing corticosteroid use had high rates of reoperation and conversion to total hip arthroplasty. Our data highlights that careful patient selection and shared decision-making remain critical in optimizing patient outcomes in this challenging patient population.

Abstract Background Femoral version plays a critical role in pre-arthritic hip pain, particularly in femoroacetabular impingement (FAI). Variations in femoral version may contribute to hip instability or impingement. This study examines the outcomes of hip arthroscopy for FAI across different femoral version groups. Methods A prospective multicenter cohort of 677 FAI patients undergoing primary hip arthroscopy was collected, with 603 patients in this study based on recorded femoral version. Inclusion criteria were patients aged 14-45 years with idiopathic FAI, while previous ipsilateral hip procedures, associated disorders, or Tönnis 2 or greater osteoarthritis were excluded. Femoral version was measured on low-dose computed tomography (CT) utilizing the Yoshioka oblique method and categorized into five subgroups: <5°, 6°-15°, 16°-25°, 26°-35°, 35°+. Patient-reported outcomes (PROs) were obtained at minimum one-year follow-up. The modified Harris hip score (mHHS) was assessed relative to minimal clinically important difference (MCID) of 8 and patient acceptable symptom state (PASS) of 74. Additional PROs included HOOS Pain and Sports/Recreation subscores and iHOT-12 score. Composite failure was defined as reoperation for persistent symptoms or failure to achieve either the mHHS MCID or PASS. Results Males had statistically lower femoral version than females (14.0 vs 18.0; p<0.001). In females, 38.0% had a femoral version of 16°-25°, 17.9% between 26°-35°, and 3.6% greater than 35°, compared to 27.6%, 9.2%, and 1.8% in males, respectively (all p<0.001). Increased or decreased femoral versions appear to have similar outcomes to normal version. The mildly increased femoral anteversion groups of 16°-25° and 26°-35° demonstrated the best outcomes with changes in HOOS pain and sports subscores being significantly higher. Severely increased femoral anteversion, >35°, only present in 2.8% of patients, demonstrated a higher composite failure rate (15.4%) compared to moderately increased, 26°-35°, femoral version (3.1%). The decreased femoral version group, ≤5°, had a composite failure of 10.4% compared to normal femoral version, 16°-25° (10.2%). Conclusions The general anatomy differences between males and females lends males to be more in retroversion while females tend to be more anteverted. Overall, outcomes did not seem to differ between increased or decreased femoral versions but were superior at mildly increased femoral versions.

Abstract Introduction Periacetabular osteotomy (PAO) is a well-established procedure for hip preservation, traditionally performed on conventional radiolucent tables that provide rigid support to the lower extremity. The Pivot Guardian™ Distraction System extension was recently introduced to facilitate concomitant hip arthroscopy and PAO, enhancing surgical efficiency. However, flexible leg support may alter the biomechanical stability of the pelvis during osteotomy cuts, particularly the ischial osteotomy. This study compared intraoperative and perioperative outcomes of PAOs performed with the Guardian Table extension to those performed on conventional radiolucent tables. Methods All PAOs performed by one surgeon since the introduction of the guardian extension were reviewed. Seventy-two PAO cases were identified; 26 were performed on a Guardian table concomitantly with arthroscopic procedures, while 46 were performed on a conventional radiolucent Demographic variables, surgical characteristics, intraoperative complications and perioperative outcomes were compared between the groups. Groups were comparable in age, BMI, smoking status, history of previous hip arthroscopy, and primary diagnoses. Results The use of the Guardian extension had a higher proportion of women (96.2% vs. 73.9%, p=0.018) and longer operative times due to the addition of the hip arthroscopy (170 ± 54 vs. 90 ± 18 min, p < 0.0001). Notably, intraoperative posterior column fractures only occurred with the use of the Guardian table (15.4% vs. 0%, p=0.0062). No other identifiable risk factors contributed to this finding. Fractures were diagnosed based on intraoperative fluoroscopic images, or immediate postop X-rays, or X-rays at the first follow up. Rates of other complications were similar between the two groups. Conclusion While the Guardian Table extension facilitates simultaneous arthroscopic procedures in the context of PAO procedures, its use was associated with an increased risk of intraoperative posterior column fractures. This may be due to the flexible structure of the leg extension component. Surgeons should be aware of the flexible nature of the table and plan for intraoperative stabilization of the distal portion to increase rigidity.

Abstract Objective Memory impairments are common in neurological disorders, especially drug‐resistant epilepsy, where cognitive deficits such as accelerated long‐term forgetting may occur before surgery due to interictal/ictal discharges, antiseizure medications, and disease progression. Postsurgical memory decline affects 40%–60% of patients. Understanding the neural mechanisms of memory encoding is essential for identifying critical network hubs and guiding surgical interventions that preserve cognitive function. Methods We analyzed intracranial electroencephalographic recordings from epilepsy patients ( n = 15) performing a verbal memory encoding task to identify key structures involved in successful memory formation. Functional connectivity was computed using multiple features across several frequency bands. Temporal dynamics of connectivity were examined to characterize pre‐encoding and encoding phases. Results The middle temporal gyrus (MTG) consistently emerged as a verbal memory hub across features and frequency bands. The inferior frontal gyrus (IFG) was identified as a beta‐band‐specific hub via phase synchrony. Temporal analyses revealed that MTG exhibited stable and widespread connectivity differences across all encoding phases, suggesting a role in pre‐encoding network priming. In contrast, IFG displayed a transient decrease in connectivity and spatial extent during early encoding, indicating a more focal and dynamic contribution. Significance These findings suggest that successful memory encoding relies on widespread, frequency‐specific connectivity patterns centered on MTG, complemented by transient, localized IFG activity. Identifying such hubs may inform surgical planning by highlighting regions critical for cognitive outcomes, ultimately supporting strategies to preserve memory in epilepsy surgery.