Periacetabular osteotomy is an effective treatment for developmental dysplasia of the hip (DDH). However, a periacetabular osteotomy cannot treat intra-articular pathologies such as tears or inverted labrums. This may result in difficulty in obtaining a femoral head centripetal position after osteotomy or residual postoperative hip pain. In this study, we report the long-term outcomes of cases of DDH with subluxation of the hip, which have advanced intra-articular pathology and are challenging to achieve centripetal position, treated with concomitant periacetabular osteotomy and hip arthroscopy from April 2011 to December 2013. Eleven hips of 11 patients were eligible. The mean age at surgery was 33.6 years, all were female, the mean lateral center edge angle (LCEA) was -10 degrees, and Shenton's lines were broken in all. The average Japanese Orthopaedic Association Hip Disease Evaluation Questionnaire (JHEQ), an 84-point scale widely used for patient-reported outcome measures in Japan, was 41. The mean operative time was 227 minutes, the mean blood loss was 399 ml, and the mean postoperative LCEA was 38.3 degrees showing significant improvement from the preoperative status (p<0.001). Intra-articular findings showed torn and inverted labrums in all. In the three hips, the labral tears could be repaired. In the remaining eight hips, debridement was performed on the severely damaged labrum tears. All cases are still being followed up, with an average observation period of 122 months. The latest mean JHEQ has improved significantly from preoperative scores to an average of 65 (p<0.001), and no cases have resulted in total hip replacement.

Aim
The mid- to long-term clinical and radiographic outcomes of the Birmingham Interlocking Pelvic Osteotomy (BIPO), from the original inventor series, have been previously described.
The aim of this study was to evaluate the survivorship and radiographic outcomes of the BIPO, for the treatment of acetabular dysplasia and acetabular versional abnormalities, in a non-inventor series.
Patients and Methods
155 consecutive patients (179 hips; 146 in women, 33 in men) were treated with BIPO between August 2013 and December 2019 by three different surgeons, independently trained in the technique by the original inventor.
Joint survivorship, radiographic outcomes and intra- and post-operative complications were recorded. 142 hips were treated for acetabular dysplasia, 37 hips for acetabular versional abnormalities. The mean age at time of surgery was 27 years (10 to 44).
Results
118 hips with acetabular dysplasia were available for radiographic analysis. Mean pre-operative lateral centre-edge (LCE) angle was 13.3°, mean postoperative LCE angle was 34.6°.. Mean pre-operative Tönnis angle was 17.7°, mean post-operative Tönnis angle was -1.6°.
At two years 140 hips were available at follow up, with one hip converted to THA. At five years 59 hips were available at follow up, an additional 3 hips underwent THA. Two-year survivorship to THA was 98.6%. Five-year survivorship was 93.3%.
Conclusion
At two- to five-year post-surgery the BIPO provides good to excellent survivorship.
The degree of bony correction achievable is comparable to prior published studies. The initial stability achieved by the interlocking design allows weight bearing as tolerated in the early phase.

Introduction- Open reduction for developmental dysplasia of hip has been described through 2 approaches, Medial and anterior. Both have their own advantages and disadvantages. Medial approach is minimally invasive, but apprehensions exist due to risk of AVN. Anterior approach offers greater visibility and allows for pelvic osteotomy. We compared the rates of AVN, redislocation, clinical and radiological outcomes of both approaches.
Methods: After a thorough database review 5 comparative studies were included. . We included randomised controlled trials, retrospective and prospective cohort studies published in English language. The literature search was conducted by two authors. The study characteristics and findings were tabulated in Microsoft excel independently by two authors and were compiled into a single table later.

Results. Study included 257 hips of 222 patients. Meta analysis showed that AVN was more likely to occur in open reduction by anterior approach. No statistically significant differences were found in rate of further corrective surgery, clinical and radiological outcomes.

Conclusion- Medial approach is a safe and effective approach for open reduction of hip in children with DDH aged 6-24 months.

Purpose: Femoroacetabular impingement (FAI) is proposed as a leading pathomechanic cause enrolled in pathogenesis of degenerative changes that lead to osteoarthritis (OA) of hip joint. Main objective of this study is to report clinical outcome following the arthroscopic treatment of patients with FAI in the presence mild OA in form of radiological staging (Tönnis I) hips. Methods: Thirty-six patients underwent arthroscopic surgery for FAI and labral tear; all with preoperative radiological signs of Tönnis I were prospectively included in this study between March 2018 to March 2020. With minimum two-year follow-up, clinical assessment with Hip Outcome Score (HOS), international Hip Outcome Tool-12 Score and conversion rate to total hip replacement were addressed. Results: The study included 36 patients (36 hips); 20 males, 16 females. Age range was 18-55 years (mean 39.9 year). With mean follow-up 34.59 months, none of our patients had undergone total hip replacement at end point of two years. At last follow up, 36 patients reported that they were satisfied with the outcome of surgery, HOS mean preoperatively was 54.84 (average 15-93.4 points) and 77.69 (average 11.11-100 points) postoperatively with mean improvement 22.85 points and p-value <0. 001, international hip outcome tool-12 score was significantly improved (80.85±13.46 preoperatively versus 58.03±23.89 postoperatively with p-value <0. 001). Conclusion: Arthroscopic treatment for patients with FAI in Tönnis I hips resulted in clinically relevant improvements regarding pain; function and quality of life in patients included in our study.

Introduction: The purpose of this study was to compare the role of the various surgical modalities Hemiarthroplasty, Dynamic Hip Screw (DHS), and Cephalo-medullary nail (CMN) in the management of intertrochanteric fractures in the elderly population with a comparison of the results and assessment of the complications encountered with each method. Methods: A total of 120 adult patients having intertrochanteric fractures managed from July 2015 to December 2020 at a tertiary trauma care centre and followed for a minimum of 24 months were included in the study. Patients were divided into three groups primary hemiarthroplasty (group A), DHS (group B) and PFN (group C) of 40 patients each. Functional evaluation was done using the Modified Harris Hip score (HHS) at different intervals. Results: The mean age of patients was 76.14 ± 3.9 years. Group A's mean operative time and blood loss were significantly higher than the other two groups. The Hemiarthroplasty group could ambulate earlier than DHS/PFN group. Mean HHS at final follow-up was 85.40±7 in group A while in group B and group C, these values were 76.36±16.45 and 76.85±10.52 respectively. Harris Hip score was significantly higher (p, 0.01) in the hemiarthroplasty group in comparison to the DHS group. No case of superficial or deep infection was noted. Conclusion: The study outcome suggests using hemiarthroplasty for unstable intertrochanteric fracture in elderly patients with lesser failure rates, early mobilization and better functional outcomes.

Background; Direct Superior Approach in total hip arthroplasty (DSA-THA) is one of the posterior approach, that preserved some of the short external rotators. In our modified DSA technique, the piriformis, the external obturator, the quadratus femoris muscle, and the iliotibial band were routinely preserved. The detached conjoint tendon and the posterior capsule were repaired by reattaching them to the greater trochanter. Objectives; The purpose of this study was to assess our surgical effort whether preserved short external rotators during DSA-THA are well preserved using postoperative MRI. Muscle atrophy degeneration in short external rotators were also evaluated. Methods; Between August 2018 and November 2022, modified DSA-THA was performed in 133 cases, of which 81 hips with MRI were included in this study. These muscle qualities were classified as no atrophy, mild atrophy, or severe atrophy based on the cross-section of the muscle bellies on MRI. Results; Atrophy degeneration was observed in the piriformis muscle (no atrophy:77 mild atrophy:4 severe atrophy:0), the external obturator muscle (80,1,0, respectively), the internal obturator muscle (0,33,48 respectively), and the quadratus femoris muscle (30,17,26, respectively). Conclusions; This is the first study to show the degree of atrophy degeneration of the hip muscles analyzed with postoperative MRI in patients who underwent modified DSA-THA. Our procedure revealed good preservation of muscles except for the internal obturator muscle, which was detached and repaired at the time of surgery. Therefore, our modified DSA technique may improve not only postoperative hip stability but also overall hip function after THA.

Hip arthroscopy is a minimally invasive, effective and innovative orthopedic procedure with a relatively low rate of complications. In our patient, residual cam deformity and a bone fragment that remained in the front hip capsule after hip arthroscopy performed three years before caused thigh numbness, muscle fasciculations, and paresthesia. It was assumed that the loose bony fragment remained following burring on prior procedure. During hip flexion, neural structures were compressed and caused the mentioned symptoms. Revision hip arthroscopy was performed and the loose fragment in addition to residual cam deformity was removed. Resolution of pain and anterior thigh numbness was
reported after the revision surgery.

Objectives: Femoral head reduction osteotomy (FHRO) was described more than 10 years ago to treat misshapen femoral head that is causing intraarticular hip pain. The published literature showed discrepancies in patient selection, surgical techniques, and decision to perform concurrent acetabular osteotomy. Very few studies used Standardized Outcome Measures (SOMs). This study aims to describe the technique of FHRO and report the results of our series of 22 patients using SOMs and compare them to former peer reviewed articles.
Methods: Twenty two hips in 22 patients with hip pain caused by mishshapen femoral were treated with FHRO with or without triple pelvic osteotomy (TPO). Patients with poor hip range of motion and significant hip joint arthritis were excluded. The mean patient age was 15.8 (range, 9.2 to 23.9). Clinical results were reported using the HHS. Radiographical results were reported by comparing Lateral Center Edge Angle (LCEA), extrusion index, Tonnis angle, head size percent, sphericity index, and distance from tip of trochanter to center of femoral head.
Results: The mean follow up was 3.2 years. Only 5 patients received TPO. The HHS showed statistical improvement from 62.0 to 81.6 (The median interquartile range 63.5–88.5). Six patients had HHS less than 70 at the latest follow up. All radiographic parameters except the Tonnis angle, showed statistically significant improvement.
Conclusion: FHRO with or without pelvic osteotomy is a good salvage procedure for patients presenting with misshapen femoral head with intraarticular hip pain, who still have good preoperative ROM with no signs of hip arthritis.

INTRODUCTION: Post-COVID the incidence of AVN Hip has increased drastically. Core decompression has been one of the best option for delaying the need for THR and also the best treatment option in earliest stages. In our study we used multiple drilling with long drill bit for decompression. METHODOLOGY : Our series include 40 patients who were diagnosed with AVN hip post-COVID. The patient was positioned in supine without need of any fracture table and small incision of less than 1cm was made in lateral aspect of thigh. Using a single 3.5mm drill bit, multiple holes were drilled into the femoral head under C-arm guidance. We didn’t use any adjunctive. Patients were allowed for partial weight bearing mobilisation with walker assistance for four weeks. RESULTS : Our case series includes totally 40 patients of Ficat stage I,II and III of AVN hip POST-COVID. We had follow up of 9 months. Patients who were symptomatic and showing oedema in femoral head had better results. Harris hip score was used for assessment. Post operatively patients showed improvement clinically. Only one patient required Total Hip Replacement later. None of the cases reported any peri-operative fracture. CONCLUSION : Core decompression has been evolved the most reliable treatment for early stages of AVN hip. We improvised and made it simpler, less invasive, time saving , with better outcome and promising results, eliminating the fracture risk and other risks of single coring technique. Thus, multiple hole drilling is the best method of core decompression of femoral head.

Introduction: Regenerative therapy has shown promising results in the treatment of avascular necrosis of the femoral head. We compared the safety, efficacy, functional, and clinical outcomes of intra-osseus implantation of autologous adipose tissue-derived stromal vascular fraction (SVF) isolated using ultrasonic cavitation (Sahaj therapy – Australian Patent technology) implantation in avascular necrosis of femoral head. Materials and methods: The present prospective observational study was conducted over 3 years. We enrolled 53 patients in our study where 7 patients got excluded as they didn’t meet the inclusion criteria. All 46 patients received autologous adipose tissue-derived SVF intraosseous and were followed up at the end of 1, 3, 6, 12, 24, and 36 months. A p-value of <0.05 was considered significant. Results: The results show that patients had significantly improved Harris Hip Score (86.49 ± 6.54). Similarly, it was found that they had significantly lesser VAS scores (3.17 ± 0.94). Although three patients have progressed to stage IV at the maximum follow-up, others have had complete resolution of their symptoms, as well as improvement in the MRI findings. No serious adverse events were reported from the SVF harvest or graft procedure. Conclusion: For individuals with avascular necrosis of the femoral head, autologous SVF grafting in the same surgical procedure is an innovative and promising treatment modality. Even after 3 years of follow-up, the study participants with AVN femoral head have shown a good clinical and functional outcome.

Background: There are several anatomical problems with the hip joint that are associated with developmental dysplasia (DDH), such as the femoral head being out of place in relation to the acetabulum. The purpose of this study was to determine whether there is a difference in femur length between patients with neglected developmental dysplasia of the hip (DDH) and the normal femur

Materials and methods: This is a case series study of 14 patients with Unilateral DDH who did not have surgery. Between January 2017 and December 2020,. A Pelvis x-ray and a Full Length Femur x-ray were taken for those patients. The inclusion criteria: 1.The patient must be an adult who is at least 18 years old. 2. The deformity should only occur on one side 3. They had never had surgery before. 4. Crowe types III and IV

Results : The mean length of the affected femur was 41.6 (SD 3.88) and the mean length of the normal femur was 42.2. (SD 4.08). When we compared the baseline characteristics of patients by age group (35 years vs 35 years), we discovered that the BMI of the older age group (35 years) was statistically significantly higher than the younger age group (35 years) (P-value =0.028)

Conclusion: Preoperative considerations for unilateral DDH include taking a long film of both femurs to determine their relative length differences. This will assist in determining the amount of subtrochanteric femoral osteotomy to perform.

Aim: Total hip replacement (THR) was thought to give better outcomes in active patients with neck of femur (NOF) fractures. However, the impact of premorbid function versus type of surgery on post-operative outcomes remains controversial. This study evaluates the determinants of post-operative functional and quality of life (QOL) outcomes between THR and hemiarthroplasty (HA). Methods: A prospective cohort study was conducted on patients with low energy, non-pathological unilateral NOF fracture from 2014 to 2021 and underwent either HA or THR. Other covariates assessed include age, ASA, premorbid functional and QOL scores (Parker Mobility Scale (PMS), EuroQol-5 Dimension (EQ-5D) and SF-36 scores). Post-operative scores were collected prospectively for up to 12 months (intervals of 6 weeks, 3, 6 and 12 months). Interval changes in scores were compared using the Kruskal Wallis test and multi-variable regression analysis was done to determine the factors influencing post-operative scores. Statistical significance was taken to be p < 0.05. Results: A total of 74 THR and 381 HA were included. Patients who underwent THR had better pre-operative scores (p<0.001). The interval change in outcome scores (PMS, EQ-5D and SF-36) were not significantly different between THR and HA. Regression analysis showed that pre-operative score is the main factor influencing the respective absolute scores at 1 year follow-up (p<0.001). THR influenced only the post-operative PMS score (p = 0.037). Conclusion: The trajectory of post-operative recovery for NOF fractures does not differ significantly between THR and HA. Overall, patients’ pre-operative function is the significant factor influencing eventual post-operative outcomes.

Introduction: This study aims to describe the outcomes following operative repair of ballistic femoral neck (BFN) fractures. A cohort of BFN fractures was compared to a cohort of closed blunt-injury femoral neck fractures treated with open reduction and internal fixation (ORIF). Methods: Retrospective chart review identified all patients with BFN fractures treated at 3 academic trauma centers between 2016 and 2021, and patients with closed blunt-injury femoral neck fractures who received ORIF. Primary outcome was femoral head survival. Secondary outcomes included complications such as nonunion, postoperative infection, osteoarthritis, avascular necrosis, conversion procedure, and ambulatory status. Results: 14 BFN fractures and 39 closed blunt-injury fractures with ORIF were identified. Of the ballistic fractures, 7 patients (50%) had a minimum of 1-year follow-up or met failure criteria, compared with 20 (50%) for the closed blunt injury fractures. Median follow-up was 21 months. Ballistic fractures were significantly younger (Median age 26 vs. 38) and had greater proportion of active tobacco use (58% vs. 21%). Displaced ballistic fractures were associated with a significantly greater risk for nonunion relative to displaced closed blunt-injury fractures that received ORIF (83% vs. 30%). Only 17% (1/6) of displaced BFN fractures survived with a minimum of 1-year follow-up, as compared to 55% (11/20) of closed blunt fractures. Discussion: ORIF is often considered the optimal treatment in young patients. Our results demonstrate that BFN fractures are associated with low rates of survival and high rates of nonunion. Large-scale multicenter studies are necessary to better optimize treatment techniques for these fractures.