Citations

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.

Abstract In phase 3 oncology clinical trials, identifying and understanding potential sources of differential censoring (DC), which describes censoring imbalance between treatment arms, in overall survival (OS) endpoints is vital to reduce bias and misinterpretation of OS benefit. Among 322 trials, 34 (11%) trials exhibited DC overrepresented in the control arm (DCC). Compared to trials without DC or those with DC overrepresented in the experimental arm (DCE), trials with DCC showed higher rates of OS benefit (56% vs. 32%; odds ratio [OR] = 2.26, 95% CI = 1.04 to 4.90; P = .04) and were associated with patient withdrawal (median 8.0% vs. 3.8%; P = .0002), lack of double blinding (15% vs. 48%, OR = 0.19, 95% CI = 0.06 to 0.56; P = .003), and better global quality of life in the experimental arm (32% vs. 13%, OR = 3.01, 95% CI = 1.26 to 7.19; P = .01). OS DCC is a prominent challenge that requires rigorous trial design and comprehensive patient and mortality follow-up to reduce bias in interpreting OS benefit.

Background and Objectives: Autosomal dominant polycystic kidney disease (ADPKD) is characterized by multisystem involvement, including renal cysts, hepatic cysts, intracranial aneurysms, and aortic root dilatation and dissection. Though exceedingly rare, cervical artery dissections (CeAD) have been reported in association with ADPKD. The aim of this retrospective observational study is to investigate clinical features in patients with ADPKD that increase the probability of an associated CeAD diagnosis. Materials and Methods: The National Inpatient Sample from 2016 to 2020 was utilized to compare clinical features for patients with an ICD-10 code diagnosis of ADPKD, CeAD, and both ADPKD and CeAD. The Cochran–Armitage test and Chi-square test were utilized to assess clinical features or trends in ADPKD patients associated with a concurrent CeAD diagnosis. Results: Between 2016 and 2020, there were 224,065 people with ADPKD, 86,135 with CeAD and 155 with both (0.05%). The total cohort had a mean age of 56.74 years, with 47.26% female participants (p = 0.70), and was predominantly white (66.15%, p < 0.001). In patients with ADPKD, comorbid acute ischemic stroke (p < 0.001), transient ischemic attack (p < 0.001), aortic dissection (p < 0.001), coronary artery dissection (p < 0.001), subarachnoid hemorrhage (p < 0.001), coagulation defects (p = 0.002), and hypertension (p < 0.001) are risk factors associated with an increased probability of concomitant CeAD. Conclusions: CeAD in ADPKD patients is rare. In ADPKD patients, acute ischemic stroke, transient ischemic attack, aortic dissection, coronary artery dissection, subarachnoid hemorrhage, coagulation defects, and hypertension are risk factors of concomitant CeAD. Recognizing these factors can aid in the decision to screen for concomitant CeAD in patients with ADPKD.

Traumatic brain injury (TBI) is one of the leading causes of death and neurological disability worldwide. The search for biomarkers that indicate TBI severity and prognosis with greater accuracy is ongoing. This study aimed to evaluate the significance of several neuroinflammatory cytokines and chemokines, assessing their potential as biomarkers in pediatric TBI (pTBI). This was an exploratory analysis of inflammatory cytokines and chemokines measured in a subset of 26 children aged 0–18 years with TBI and 21 controls. TBI severity was determined by GCS. The functional outcome was measured via the GOS-E score at 6 weeks and 3, 6, 9, and 12 months post-injury. Serum samples were analyzed for ICAM-1, VCAM-1, SAA, CRP, IFN-g, IL-10, IL-12p70, IL-13, IL-1b, IL-2, IL-4, IL-6, IL-8, TNF-a, TNF-b, eotaxin, eotaxin-3, IP-10, MCP-1, MCP-4, MDC, MIP-1a, MIP-1b and TARC. Levels of IL-6, IL-10, IL-13, IL-16, MDC, and GM-CSF were increased, and IFN-γ, IL-5, IL-8, and eotaxin-3 were decreased at enrollment when compared with controls. Elevated IL-6 and IL-10 at enrollment were associated with severe TBI (AUC of 1, p = 0.0002 and p = <0.0001, respectively). IL-6, IL-10, IL-16, and TNF-β at enrollment and IL-5 at 24 h were elevated in children with unfavorable outcomes, with an AUC > 0.8, suggesting biomarker potential. Our data indicate that several cytokines and chemokines measured after TBI may aid in the assessment of pTBI severity and prognosis. IL-6, IL-10, and IL-16 may show potential as biomarkers for pTBI severity and outcomes.

Background: Adeno-associated viruses (AAVs) are widely used vectors for in vivo gene therapy, but their standard storage at −80 °C limits deployment in regions lacking ultracold infrastructure. Strategies enabling stable AAV storage at higher temperatures are needed to support global distribution. Methods: Nine AAV serotypes were lyophilized in simple sucrose-based buffers. Post-lyophilization vector integrity was assessed by measuring in vitro transduction efficiency using a luciferase reporter in cell-based assays. Stability of selected serotypes (AAV2.5 and AAV6) was further evaluated over 8 weeks under varying storage temperatures. Results: Lyophilization in sucrose preserved transduction activity for all tested serotypes (AAV1, AAV2, AAV2.5, AAV3, AAV4, AAV5, AAV6, AAV8, AAV9, and AAVrh10). Notably, AAV2, AAV2.5, and AAV6 exhibited 3- to 6-fold increases in transduction, an effect attributable to the sucrose excipient rather than the lyophilization process itself. Long-term stability of lyophilized vectors varied by serotype, temperature, and vial-seal integrity. AAV6 retained full activity for at least 8 weeks when stored at 4 °C or −20 °C. Conclusions: AAV vectors can be effectively lyophilized in simple sucrose solutions, enabling storage at standard −20 °C freezer temperatures while maintaining functional activity. Optimization of lyophilization buffers and excipients may further extend AAV stability at higher temperatures, improving feasibility for global gene therapy deployment.