Cam osteoplasty refers to reshapement of an aspherical femoral head-neck junction to remove abnormal bone causing femoroacetabular impingement (FAI). It is commonly performed during hip arthroscopy.

Cam osteoplasty is indicated for symptomatic cam-type FAI not responsive to conservative measures. Candidates have clear cam morphology on imaging correlating with clinical findings of FAI. The goal is to restore normal head-neck contour and address associated lesions.

With the patient supine, anterolateral and mid anterior portals are established. The cam lesion is visualized and probed to mark the areas of resection. A motorized burr is used to contour the head-neck junction to a more anatomic morphology. Fluoroscopy assists with assessing resection adequacy.

The focus is smoothing the transition zone while preserving the femoral neck circumference and offset. Over-resection risks iatrogenic injury. Leaving residual deformity leads to continued impingement. The articular cartilage should be viable for repair if damaged.

Postoperative guidelines initially restrict weightbearing and range of motion to protect repaired tissue. Around 6 weeks, physical therapy focuses on restoring mobility and core strength. Impact activities are limited for 3-4 months. Full return to sports typically occurs between 9-12 months.

Multiple studies show arthroscopic cam osteoplasty significantly improves pain, function, and quality of life in appropriately selected FAI patients. Success rates over 80% have been reported at 2-3 year follow-up. Milder disease and shorter duration of symptoms portend better outcomes.

Risks include those of hip arthroscopy such as neurovascular injury (1-2%), thromboembolism (<1%), and heterotopic ossification (2-4%). Under-resection may fail to resolve impingement. Specific risks of cam osteoplasty include femoral neck fracture and avascular necrosis, but these are very rare.

In summary, arthroscopic cam osteoplasty has become the gold standard treatment for symptomatic cam-type FAI with favorable outcomes when performed well in indicated patients. Further studies continue to refine techniques and patient selection criteria.

Pincer osteoplasty involves reshaping the acetabulum to reduce overcoverage causing femoroacetabular impingement (FAI). It can be performed arthroscopically for symptomatic pincer-type FAI.

Pincer osteoplasty is indicated for focal or global pincer lesions with clinical correlation not responding to conservative measures. Candidates have clear pincer morphology on imaging and no advanced arthritic changes. The aim is to restore normal acetabular anatomy.

With the patient supine, anterolateral and mid anterior portals are established. The pincer lesion and labrum are inspected. Using a motorized burr the acetabular rim is contoured, reducing overcoverage while preserving the labrum. Fluoroscopy helps assess resection adequacy. Capsular plication may help stabilize the repair.

The goal is smooth, circumferential rim trimming without violating the weightbearing zone. Over-resection medializes the joint center. Leaving residual deformity continues impingement. Preserving the labrum is preferable, but partial resection may be required.

Postoperative guidelines initially restrict hip range of motion and weightbearing. Around 6 weeks, physical therapy focuses on core strength, flexibility and neuromuscular control. Impact activities are limited for 3-4 months. Full return to sports typically occurs between 9-12 months.

Multiple studies show pincer osteoplasty significantly improves symptoms and function in appropriately selected FAI patients. Success rates over 75% have been demonstrated at 2-3 year follow-up. Milder disease severity and younger age portend better outcomes.

Risks include those of hip arthroscopy such as neurovascular injury (1-2%), DVT (<1%), and heterotopic ossification (2-4%). Under-resection may fail to resolve impingement. Specific risks include joint instability and iatrogenic cartilage damage.

In summary, arthroscopic pincer osteoplasty has become an effective treatment for symptomatic pincer-type FAI with favorable outcomes. Further studies will continue to optimize patient selection and refine surgical techniques.

Labral reconstruction is an emerging technique to restore the native labrum using autograft or allograft tissue when repair is not possible. It can be performed arthroscopically in indicated cases.

The acetabular labrum provides essential stability and lubrication to the hip joint. However, severe damage or absence limits repair options. Labral reconstruction aims to restore these functions in patients with irreparable labral pathology and preserve the native joint.

Candidates include those with severe labral deficiency and functional impairments unresponsive to conservative measures. Associated disorders like FAI must be corrected. The hip cartilage should be in relatively good condition without arthritis. Patient factors impacting graft incorporation are considered.

Graft choice is either iliotibial band or tensor fascia lata allograft or autograft. Using arthroscopic portals, the acetabular rim is prepared and the graft is fixed with suture anchors mimicking the native labral shape and dimensions. Capsular repair helps stabilize the reconstruction.

Postoperative guidelines restrict hip range of motion and weightbearing initially. Around 6 weeks, physical therapy focuses on core strength, flexibility and neuromuscular control. Impact activities are limited for 6 months. Return to sports criteria are gradually met over 9-12 months.

Emerging evidence shows significant improvement in pain, function and quality of life after labral reconstruction at early term follow-up. Graft hypertrophy and incorporation occur by 1 year. Success rates over 80% have been reported in appropriately chosen surgical candidates. Longer term data is still needed.

Risks include those of hip arthroscopy such as neurovascular injury (1-2%), DVT (<1%), and heterotopic ossification (2-4%). Specific risks include delayed graft incorporation, poor healing, and reconstruction failure. Secondary procedures may be required in 5-10% of patients.

In summary, arthroscopic labral reconstruction shows promise for restoring labral function when repair is not feasible. However, appropriate patient selection criteria are still being defined as longer term outcomes remain unknown.

Hip arthroscopy has become a common procedure to address hip pain and dysfunction in adolescent athletes. Labral tears are a frequent finding during hip arthroscopy in this population. After labral repair, appropriate return to sport (RTS) progressions are important to ensure athletes can successfully resume their prior level of competition. This statement will review considerations for RTS after hip arthroscopy labral repair in adolescent athletes.

Current techniques allow labral repair rather than debridement in most adolescent athletes undergoing hip arthroscopy. Surgical goals include restoring labral suction seal and acetabular coverage. Post-operative rehabilitation progresses from protected weightbearing to restoration of range of motion, strength, neuromuscular control, and sport-specific activities. Rehabilitation should last around 4-6 months before cleared for full sports participation.

The decision to clear adolescent athletes for unrestricted return to sport should involve both objective and subjective criteria. Objective measures include hip strength and range of motion comparable to the nonoperative side. Subjective measures include resolution of pain with sport-specific movements, high-level dynamic neuromuscular control, and psychological readiness to resume full competition. Input from surgeons, physical therapists, athletic trainers, coaches, and parents should factor into the RTS decision.

Average time for RTS after hip arthroscopy varies from 4-6 months but depends on many individual factors. A primary consideration is the type and level of sport participation. Non-impact endurance sports such as swimming or cycling can be resumed earlier than cutting/pivoting field sports or high impact sports. Elite adolescent athletes also require longer recovery periods compared to recreational athletes before RTS. Other factors influencing timing include tissue healing, rehabilitation progress, and whether any complications occurred.

A systematic review found an overall reoperation rate of 6.3% in patients under 20 years old within 2 years after hip arthroscopy. However, studies have found low rates of recurrent labral tearing after repair in adolescent athletes with appropriate surgical technique and rehabilitation. Still, youth athletes should be counseled on activity modification to limit hip flexor strain and adverse or uneven hip loading after RTS. Continued neuromuscular retraining helps ensure dynamic hip control and stability.

Hip labral repair in adolescent athletes aims to eliminate mechanical symptoms and restore function. Appropriate surgical technique and compliance with rehabilitation helps enable a successful return to sport. However, RTS timelines and activity modification should be individualized. Continued assessment and training can help reduce injury recurrence and optimize outcomes. With coordinated management, most adolescent athletes can achieve lasting relief from hip pain and return to their pre-injury activity level.

Hip arthroscopy with labral repair has become a common technique to address labral tears in active patients. However, outcomes may differ based on patient age. This statement will review the current evidence on the impact of age on outcomes after hip arthroscopic labral repair.

In patients over 50 years old undergoing hip arthroscopy with labral repair, high satisfaction rates around 80% have been reported at 2 years follow-up. However, older patients have shown slightly lower outcome scores and higher revision rates compared to younger patients. Predictors of poorer outcomes in older patients include greater pre-operative arthritis, chondral damage, and limb length discrepancy. Thus, appropriate patient selection is important when considering hip arthroscopy with labral repair in older patients.

Patients between 40-60 years old can still have favorable outcomes from hip labral repair. In a study of patients with an average age of 45 years, modified Harris hip scores improved from 61 preoperatively to 83 at 2 years after surgery. Satisfaction rates exceeded 90% in another study of patients between 40-60 years old. Outcomes are optimized if pre-operative joint space is preserved and appropriate rehabilitation is completed.

Patients under 20 years old have shown excellent outcomes after hip labral repair, with modified Harris hip scores improving from 67 preoperatively to 94 at 1 year follow-up. High return to sport rates around 80-90% have been reported in adolescent athletes after hip arthroscopy. However, young patients that resume cutting/pivoting sports may have a higher risk of recurrence requiring revision surgery compared to low-impact athletes.

A retrospective matched-cohort analysis compared outcomes of hip labral repair in patients aged 15-25 years and 40-60 years. At 1 year follow-up, both groups showed significant improvement in modified Harris hip scores without a significant difference between age groups. However, adolescent/young adult patients were 3.6 times more likely to require revision hip arthroscopy within 3 years of surgery compared to middle-aged patients.

Outcomes after hip labral repair appear to be influenced more by intra-articular findings and procedures performed rather than age alone. Patients with greater pre-operative arthritis or cartilage damage have shown less optimal outcomes regardless of age group. Recent studies have not found a significant independent association between age and outcomes if other confounding variables are controlled. Appropriate surgical indications and rehabilitation remain essential for a successful outcome across age groups undergoing hip labral repair.

Patients from adolescence through the mid-60s can have significant improvement in pain and function after hip labral repair. However, outcomes may decline with advanced age and arthritis. Surgical indications should be carefully considered in older patients to optimize results. Young active patients can return to high level sports after surgery but have a higher risk of recurrence. Continued research is needed to better define age-related factors affecting outcomes after hip labral repair.

Labral tears are a common cause of hip pain and mechanical symptoms in active patients over 50 years old. Treatment options include hip arthroscopy with labral repair or total hip arthroplasty (THA). This statement compares outcomes of these procedures for older patients with hip labral tears.

In patients over 50 with minimal arthritis, hip arthroscopy with labral repair may relieve pain and improve function. In a systematic review, patients over 50 reported high satisfaction rates of 78-89% at 2 years after hip arthroscopy. Advantages of labral repair include less surgical morbidity, faster recovery, and retention of the native hip joint. However, outcomes decline with advancing age, severity of cartilage damage, and progression of arthritis. The re-operation rate is estimated around 10% at 5-10 years after hip arthroscopy in this population.

For patients over 50 with end-stage hip arthritis or joint space <2mm, THA is the standard treatment to relieve pain and restore function. Numerous studies show excellent pain relief, functionality, and survivorship at over 90% with modern THA implants and techniques. THA has more surgical morbidity but provides more reliable long-term outcomes compared to hip arthroscopy. However, activity is still restricted after THA and risks include dislocation, infection, and eventual prosthetic loosening.

There are limited direct comparisons of hip arthroscopy versus THA for labral tears in older patients. One study matched 45 patients over 50 treated with hip arthroscopy to patients who underwent THA. At 1 year follow-up, THA patients had better outcomes scores and greater improvement in pain and function compared to the hip arthroscopy group. However, arthroscopic patients still reported good satisfaction rates of 80% despite inferior outcomes versus THA.

The choice between arthroscopic labral repair versus THA depends on several factors in individual patients over 50 years old. Joint space width, arthritis severity, activity demands, and patient age are considered. In general, hip arthroscopy may be appropriate for patients 50-65 with Tönnis grade 0-1 arthritis and joint space ≥2mm. However, patients with more advanced arthritis often have better outcomes with THA. Patient expectations and desires must also be incorporated into shared decision making about surgery.

For older patients, hip arthroscopy provides symptomatic relief and delay of arthroplasty in appropriately selected individuals. However, THA remains the gold standard for end-stage arthritis. Further study is needed to refine criteria for hip preservation versus joint replacement in patients over 50 with labral pathology. Open discussion and shared decision making with patients over 50 is necessary to determine the optimal surgical treatment strategy.

Periacetabular osteotomy (PAO) is an established joint-preserving procedure for young patients with developmental dysplasia of the hip (DDH). PAO aims to provide mechanical stability and delay the onset of osteoarthritis. This statement will review indications, surgical technique, outcomes, and complications of PAO for DDH.

PAO is typically indicated for patients between ages 15-50 years with symptomatic DDH. Ideal indications include Tönnis grade 0-1 osteoarthritis, lateral center edge angle <25 degrees, and adequate hip joint congruency. PAO can provide symptomatic relief and functional improvement in this population by correcting acetabular undercoverage and abnormal mechanics associated with DDH.

During PAO, precise osteotomies are made around the acetabulum through a modified Smith-Peterson approach.3 The acetabular fragment is then reoriented laterally and anteriorly to improve coverage. Correction of femoral version or osteochondroplasty may also be performed. Stabilization is achieved with internal fixation plates and screws. Precise execution adhering to detailed surgical principles is imperative for success.

Multiple studies show PAO provides significant improvement in pain, function, and activity levels for most patients with DDH. One systematic review reported modified Harris hip scores improved from 52 preoperatively to 84 at 5 years after PAO. Up to 90% patient satisfaction has been reported as well. However, minor residual symptoms may persist, and activity modification is still required after PAO.

Reported complication rates range from 10-30% after PAO. Major complications are rare but include deep infection, vascular injury, and nerve palsies. More common complications include fracture, heterotopic ossification, and lateral femoral cutaneous nerve injuries. Appropriate surgical techniques and structured physical therapy can help reduce complications.

PAO is an effective hip preservation strategy for symptomatic DDH in appropriately selected patients. Successful PAO can provide durable improvement in pain, function, mechanics, and joint congruency. However, PAO remains a technically demanding procedure with a notable complication rate. Patient reported outcomes and survivorship after PAO are generally favorable at mid-term but long-term follow-up is still needed.