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Study Design & Statistics

Femoroacetabular impingement (FAI) morphology and management: cam, pincer, and combined types, with a focus on patient selection and predictors of arthroscopic success.

Overview

Clinical research design must prioritize the identification of clinically important differences and present effect measures with confidence intervals to minimize bias [1]. However, methodological rigor is often compromised by discrepancies between registered trial data and final presentations of eligibility criteria or outcomes [2]. In comparative studies, observed differences in outcomes such as knee scores may reflect underlying patient population variations rather than operative technique or implant design if groups are not matched for clinically relevant factors [3]. To mitigate this, adjusted survival curves should accompany adjusted analyses to visualize fair comparisons of event rates between groups [4].

Emerging technologies and biologic preparations require precise documentation to verify true benefits and ensure reproducibility [10, 16]. Current studies on mesenchymal stem cells for orthopaedic applications are frequently limited by inadequate reporting of preparation protocols and composition, lacking the detail necessary for definitive efficacy conclusions [7, 16]. Understanding current evidence and appropriate indications is critical for the safe utilization of these technologies [10]. Researchers bear the responsibility for ensuring appropriate documentation of biologic components to support rigorous evaluation [16].

Surgical management decisions must be grounded in an understanding of indications and potential risk factors to improve overall patient outcomes [28]. Trial feasibility remains a constraint; for instance, a study suggested that investigating total hip arthroplasty for hip fractures may not be deliverable within current United Kingdom care systems [30]. Methodological innovations continue to evolve, including the first use of blinding and prospective full economic evaluation in outpatient total hip arthroplasty trials [19]. In implant comparisons, fixed-bearing unicompartmental knee arthroplasties have demonstrated slightly higher survival rates than commonly used mobile-bearing designs in similar patient populations [20].

Anatomy & Pathophysiology

Osseous Morphology and Biomechanics

Hip microinstability is characterized by abnormal femoral head micromotion within the acetabulum, leading to cartilage damage and osteoarthritis, and is often associated with acetabular dysplasia or femoroacetabular impingement syndrome [42]. In patients with dysplasia, increased flexed-hip internal rotation is significantly decreased by common associated cam morphology, despite having similar preoperative pain and functional profiles to patients without dysplasia [54]. The orientation and severity of femoral torsion at the time of hip arthroscopy for femoroacetabular impingement syndrome did not affect the propensity for clinically meaningful outcome improvement at midterm follow-up [67].

In experimental models, there was no effect of femoral offset on bone implant micromotion [55]. Finite element analysis determined that PFNA exhibits significantly better biomechanical stability than DHS+CS when subjected to varying lateral femoral wall thicknesses [65]. The addition of a medial buttress plate achieved superior medial buttress stability and performance because it perfectly fits with the existing anatomic structure of the medial femoral neck in treating displaced femoral neck fracture [66].

Ligamentous and Soft Tissue Structures

The ligamentum teres forms a sling-like structure that supports the femoral head inferiorly during combined flexion and abduction resembling a squat, providing stabilization to the hip joint [46]. In biomechanical analyses, the hook effectively dispersed stress and improved the initial fixation strength of the acetabular reinforcement ring in dysplastic hip arthroplasty [43].

Kinematics and Simulation

Contemporary hip and knee simulator studies provide good information for screening new UHMWPE formulations for clinical wear performance, but comparable methodologies are lacking for screening for fracture resistance [52]. The use of dynamic simulation software to determine the presence of motion limiting deformities of the femoroacetabular is validated in a cadaveric validation study [48].

Classification

FEDS: The FEDS system classifies glenohumeral instability into 16 clinically significant categories [14].

Consensus Definitions: A consensus definition for the key parts of arthroplasty procedures may be built upon the presented data [32].

Clinical Presentation

Outcome Estimation: Rigorous study design requires identifying a clinically important difference [1], presenting effect measures with confidence intervals [1], and taking necessary steps to minimize bias [1]. However, methodological integrity is often compromised; changes to eligibility criteria and primary/secondary outcomes are frequently made in randomized controlled trials without reflection in registered trial data [2]. Furthermore, existing evidence on centralization for meniscal extrusion exhibits a notable amount of methodological heterogeneity [21].

Interpretation of Clinical Data: Observed differences in knee scores between study groups not matched for clinically relevant factors are at least as likely to represent differences in patient populations as they are to represent differences in operative technique or implant design [3]. When analyzing survival, it is often helpful to provide adjusted survival curves, in conjunction with an adjusted analysis, to visualize a fair comparison of event rates between groups [4]. The proportions of patients who achieved clinically meaningful thresholds varied depending on the measurement used, with the greatest variation seen between SCB-JR and PASS-JR [29].

Demographic and Diagnostic Patterns: Gender differences exist in degenerative lumbar scoliosis (DLS) patients regarding clinical and radiological presentation, with low back pain being more pronounced in male patients and scoliosis being more severe in female patients [33]. Patients who had a preoperative diagnosis of osteonecrosis (ON) had worse clinical outcomes than those who had other diagnoses following osteochondral allograft transplantation for femoral head cartilage lesions [26]. Clinical improvement is associated with smaller magnitudes of change on PROMIS Physical Function when patients present with better reported function [17].

Classification and Prognostic Models: There are 16 categories within the FEDS classification for glenohumeral instability that are clinically significant [14]. Preliminary results for predicting surgical outcomes in patients with recurrent patellar dislocations are promising, but an improvement of the model and a larger clinical dataset are necessary to increase accuracy and comprehensively validate model performance [11].

Specific Pathology Presentations: The overall modest long-term results of arthroscopically treated discoid lateral meniscus in children illustrate the need for improved operative treatments to prevent progressive clinical decline [5]. Analysis demonstrated significant improvements in pain and functional patient-reported outcomes (PROs) in both limited and persistent pain groups after arthroscopic treatment of femoroacetabular impingement, though those with persistent pain had significantly lower PRO scores [31].

Intervention Reporting Limitations: All existing clinical studies evaluating mesenchymal stem cells (MSCs) for orthopaedic or sports medicine applications are limited by inadequate reporting of preparation protocols and composition [7]. Despite these limitations, all patients presented significant mid-term clinical, functional, and radiological improvement after adipose-derived culture-expanded mesenchymal stem cell implantation in knee focal cartilage defects [15].

Investigations

Plain radiography: Observed differences in knee scores between unmatched study groups are at least as likely to represent differences in patient populations as operative technique or implant design [3]. Double semitendinosus anterior cruciate ligament reconstruction stabilizes the evolution of degenerative lesions as shown by standing X-ray [51]. In the evaluation of vitamin E diffused highly cross-linked polyethylene, all cups were stable based on radiographic and clinical examinations with no signs of loosening at 3 years [53]. Reliable clinical methods of radiographic wear measurement are needed for knees and total disk replacements [70].

MRI: Graft size and orientation significantly influence graft healing, as assessed on 1-year high-resolution MRI scans after anterior cruciate ligament reconstruction [57]. Magnetic resonance imaging indicates that the donor site is resurfaced with fibrous tissue after autologous osteochondral mosaicplasty for cartilaginous lesions of the elbow joint [73]. However, radiographic methods including MRI cannot be considered an accurate and reliable basis for the diagnosis and treatment of subspine impingement in femoroacetabular impingement patients [68].

CT: CT has higher interobserver reliability than MRI for measuring femoral anteversion in the hip [27]. Like MRI, 3-D CT cannot be considered an accurate and reliable basis for the diagnosis and treatment of subspine impingement in femoroacetabular impingement patients [68].

Other Considerations: Outcome estimation should aim at identifying a clinically important difference, presenting measures of effects with confidence intervals, and taking necessary steps to minimize bias [1]. The authors were commended on their efforts to evaluate the reliability of radiograph measurements when assessing hip pathology [8]. Understanding the current evidence and appropriate indications of emerging technologies is critical for their utilization [10]. The study developed the first national consensus-based best practice guidelines for the surgical and nonsurgical management of femoroacetabular impingement [12]. All patients presented significant mid-term clinical, functional, and radiological improvement after adipose-derived culture-expanded mesenchymal stem cells implantation in knee focal cartilage defects [15]. Clinical improvement is associated with smaller magnitudes of change on PROMIS Physical Function when patients present with better reported function [17]. Few papers with long-term follow-up reported no progression of hip osteoarthritis after surgical treatment of slipped capital femoral epiphysis (SCFE) by Dunn procedure modified by Ganz, but longer follow-up studies are needed to validate this statement because the patients are adolescent at surgery [25]. Double semitendinosus anterior cruciate ligament reconstruction is efficient in restoring a satisfactory stability for most patients [51]. There is considerable interstudy variability in the values of Minimal Clinically Important Difference (MCID) for shoulder instability surgery, although MCID has been the most frequently reported metric [63]. Intraoperative findings of the labrum cannot be considered an accurate and reliable basis for the diagnosis and treatment of subspine impingement in femoroacetabular impingement patients [68]. Extensive preclinical laboratory wear testing is imperative for prototype disk arthroplasties until retrieval data becomes widely available [70]. The outcomes of a randomised controlled trial comparing surgical and nonsurgical treatment for cervical radiculopathy will contribute to better decision making in the treatment of cervical radiculopathy [71]. The effect of radiation therapy versus usual care for heterotopic ossification prophylaxis after fixation of acetabular fractures through a posterior approach on functional outcomes remains unclear because surgery to perform heterotopic ossification excision remains exceedingly rare [72]. Diagnosis of femoral anteversion should not rely exclusively on either physical examination or radiologic criteria [27].

Treatment

Non-Operative

Conservative management options for hallux rigidus and osteoarthrosis of the first metatarsophalangeal joint include non-operative measures, with the selection of specific interventions depending on disease stage and patient factors [59]. For chronic, nonradicular, discogenic low back pain, intradiskal electrothermal therapy reports therapeutic success rates of 60% to 80%, though precise quantification of clinical benefits requires randomized prospective trials [38]. Moderate nonprogressive coxa vara deformity in childhood often does not require surgery [74].

Operative

Indications: Surgical management is indicated for progressive, painful, unilateral coxa vara deformity or leg-length discrepancy in childhood [74]. Improved operative treatments are needed to prevent progressive clinical decline in arthroscopically treated discoid lateral meniscus in children [5].

Surgical Approach / Technique: Best practice guidelines for the surgical and nonsurgical management of femoroacetabular impingement were developed via a Delphi process [12]. Three methods of managing intraoperative nondisplaced calcar fractures demonstrated little radiographic stem subsidence, but the risk of reoperation was much higher than expected [47]. Non-union of distal humeral fractures in the elderly is associated with poor clinical outcomes [40].

Implant Selection: Fixed-bearing unicompartmental knee arthroplasties demonstrated slightly higher survival than a commonly used mobile-bearing design in similar patient populations [20]. Treatment options for hallux rigidus and osteoarthrosis of the first metatarsophalangeal joint range from non-operative measures to surgical procedures including cheilectomy, arthroplasty, and arthrodesis, with selection depending on disease stage and patient factors [59].

Other Considerations: Outcome estimation should aim at identifying a clinically important difference [1], presenting measures of effects with confidence intervals [1], and taking the necessary steps to minimize bias [1]. Changes to the final presentation of eligibility criteria and primary and secondary outcomes are frequently not reflected in registered trial data [2]. Observed differences in knee scores between unmatched study groups are at least as likely to represent differences in patient populations as they are to represent differences in operative technique or implant design [3]. Adjusted survival curves should be provided in conjunction with adjusted analysis to visualize a fair comparison of event rates between groups [4]. Existing clinical studies evaluating mesenchymal stem cells for orthopaedic or sports medicine applications are limited by inadequate reporting of preparation protocols and composition [7]. Understanding the current evidence and appropriate indications of emerging technologies is critical for their utilization [10]. Improvement of predictive models and larger clinical datasets are necessary to increase accuracy and comprehensively validate model performance for predicting surgical outcomes in patients with recurrent patellar dislocations [11].

Long-term anticoagulation use was associated with poorer medical and surgical outcomes at both 90 days and 2 years postoperatively in patients undergoing unicompartmental knee arthroplasty, even after rigorous adjustment for confounders [13]. Females undergoing total hip arthroplasty presented with worse baseline conditions and showed relatively less improvement at 1-year postsurgery compared to males [35]. Non-responders to patient-reported outcomes in hip and knee arthroplasty had significantly increased mortality and significantly worse baseline scores despite similar demographics and revision risk [37]. Workers’ compensation patients undergoing hip arthroscopy for femoroacetabular impingement syndrome experience worse mid-term outcomes but similar return-to-work rates at 5-year follow-up compared to non-workers’ compensation patients [75]. Workers’ compensation patients demonstrate similar minimal clinically important difference achievement and magnitude of improvement between preoperative and 5-year postoperative patient-reported outcomes compared to non-workers’ compensation patients [75]. Workers’ compensation patients may take longer to return to work without restrictions compared to non-workers’ compensation patients [75].

Complications

Other Considerations: Long-term anticoagulation: Use is associated with poorer medical and surgical outcomes at both 90 days and 2 years postoperatively in patients undergoing unicompartmental knee arthroplasty (UKA), even after rigorous adjustment for confounders [13]. BMI: Utilizing SSLR analysis, four empiric BMI cutoffs (≤ 31, 32-37, 38-49, ≥ 50) have been identified which show sequential increased risk for 30-day major complications in patients undergoing total hip arthroplasty [61]. Bipolar radial head arthroplasty: Despite major primary complications and a high incidence of radiographic signs of degenerative changes after 8.8 years, mainly good clinical results were achieved with Judet's bipolar prosthesis [56]. Quality of life: While acute fracture and complications may have resolved clinically, the detrimental effect on a patient's quality of life persists up to 12 months after the injury [45]. Study validity: Observed differences in knee scores between different study groups that have not been matched for various clinically relevant factors are at least as likely to represent differences in the patient populations as they are to represent differences in the operative technique or the design of the implant [3]. Changes are frequently made to the final presentation of eligibility criteria and primary and secondary outcomes that are not reflected in the registered trial data [2]. MSC reporting: All existing clinical studies evaluating mesenchymal stem cells (MSCs) for orthopaedic or sports medicine applications are limited by inadequate reporting of both preparation protocols and composition [7]. Outcome estimation: Should aim at identifying a clinically important difference, presenting measures of effects with confidence intervals, and taking the necessary steps to minimize bias [1]. Survival curves: It is often helpful to provide adjusted survival curves, in conjunction with an adjusted analysis, to visualize a fair comparison of event rates between groups [4].

Recovery

Light activity (weeks): Evidence does not specify a week range for light activity or desk work.

Full activity (months): Evidence does not specify a month range for full activity or sport.

Complete recovery / outcome plateau (months): At one year after primary total hip arthroplasty (THA) for osteoarthritis, at least 13% of Danish patients experienced moderate to severe postsurgical pain [77]. Long-term anticoagulation use was associated with poorer medical and surgical outcomes at both 90 days and 2 years postoperatively in patients undergoing unicompartmental knee arthroplasty (UKA), even after rigorous adjustment for confounders [13]. At a minimum 5-year follow-up, arthroscopic labral base repair (LBR) in the hip continued to be a successful procedure and valid technique based on 3 patient-reported outcomes (PROs): the VAS, patient satisfaction, and survivorship [44]. The dysplastic cohort had outcomes and failure rates similar to those of rigorously matched controls at midterm follow-up after arthroscopic labral repair [22].

Rehabilitation protocol: Evidence does not specify PT phasing, immobilisation duration, or weight-bearing progression.

Functional milestones: The Musculoskeletal Function Assessment Questionnaire was more responsive than the SF-36 and more efficient in measuring changes in function between baseline and follow-up values [36]. Outcome estimation should aim at identifying a clinically important difference [1]. Outcome estimation should aim at presenting measures of effects with confidence intervals [1]. Outcome estimation should aim at taking the necessary steps to minimize bias [1]. It is often helpful to provide adjusted survival curves in conjunction with an adjusted analysis to visualize a fair comparison of event rates between groups [4].

Other Considerations: Changes to the final presentation of eligibility criteria and primary and secondary outcomes are frequently not reflected in registered trial data [2]. There were no clinically relevant differences in early postoperative mortality between simultaneous and staged bilateral primary total hip arthroplasty in healthy patients [76]. Arthroscopically treated discoid lateral meniscus in children shows modest long-term results, illustrating the need for improved operative treatments to prevent progressive clinical decline [5]. Further studies with long-term follow-up are needed to determine whether the grafted area maintains structural and functional integrity over time after autologous matrix-induced chondrogenesis for treatment of focal cartilage defects in the knee [18]. Long-term analysis is necessary to assess possible economic tradeoffs of cervical disk arthroplasty [23]. Papers with long-term follow-up for slipped capital femoral epiphysis (SCFE) treated by the Dunn procedure modified by Ganz reported no progression of hip osteoarthritis, but longer follow-up studies are needed to validate this statement since patients are adolescent at surgery [25]. Mobile and fixed-bearing (all-polyethylene tibial component) total knee arthroplasty designs functioned equivalently at the time of early follow-up in a low-to-moderate-demand patient group [9].

Key Evidence

  • [L5] Outcome estimation should aim at identifying a clinically important difference, at presenting measures of effects with confidence intervals and at taking the necessary steps to minimize bias. (10.1302/2058-5241.3.170064)
  • [L2] Changes are also frequently made to the final presentation of eligibility criteria and primary and secondary outcomes that are not reflected in the registered trial data. (10.1177/0363546512448363)
  • [L4] Observed differences in knee scores between different study groups that have not been matched for various clinically relevant factors are at least as likely to represent differences in the patient populations as they are to represent differences in the operative technique or the design of the implant. (10.2106/00004623-199706000-00009)
  • [L5] It is often helpful to provide adjusted survival curves, in conjunction with an adjusted analysis, to visualize a fair comparison of event rates between groups. (10.1016/j.arth.2021.06.002)
  • [L3] The overall modest long-term results illustrate the need for improved operative treatments to prevent progressive clinical decline. (10.1007/s00167-017-4825-y)
  • [L1] All existing clinical studies evaluating MSCs for orthopaedic or sports medicine applications are limited by inadequate reporting of both preparation protocols and composition. (10.1177/0363546518758667)
  • [Commentary] The authors are to be commended on their efforts to evaluate the reliability of our radiograph measurements when assessing hip pathology. (10.1016/j.arthro.2019.01.041)
  • [L1] The two designs functioned equivalently at the time of early follow-up in this low-to-moderate-demand patient group. (10.2106/jbjs.j.00157)
  • [L4] Preliminary results are promising, but an improvement of the model and a larger clinical dataset are necessary to increase accuracy and comprehensively validate model performance. (10.1177/23259671251324527)
  • [L5] The study developed the first national consensus-based best practice guidelines for the surgical and nonsurgical management of femoroacetabular impingement. (10.5435/jaaos-d-18-00041)
  • [L3] This study demonstrated that long-term anticoagulation use was associated with poorer medical and surgical outcomes at both 90 days and 2 years postoperatively in patients undergoing UKA, even after rigorous adjustment for confounders. (10.1016/j.arth.2024.02.021)
  • [L4] There are 16 categories within the FEDS classification that are clinically significant. (10.1016/j.jse.2018.08.014)
  • [L4] The findings demonstrate that all patients presented significant mid-term clinical, functional and radiological improvement. (10.1007/s00167-019-05688-9)
  • [Commentary] It is the responsibility of researchers to ensure appropriate documentation of biologic preparation and components to verify true benefits, as current studies often lack the detail necessary for reproducibility and definitive conclusions on efficacy. (10.1016/j.arthro.2019.08.016)
  • [L4] Clinical improvement is associated with smaller magnitudes of change on PROMIS Physical Function when patients present with better reported function. (10.1016/j.jhsa.2019.02.015)
  • [L4] However, further studies with long-term follow-up are needed to determine whether the grafted area will maintain structural and functional integrity over time. (10.1007/s00167-010-1042-3)
  • [L2] This protocol describes the first randomized trial to use blinding to evaluate outpatient THA compared to standard overnight stay and the first to prospectively perform a full economic evaluation. (10.1186/s12891-020-03699-z)
  • [L3] In similar patient populations, FB UKAs demonstrated slightly higher survival than a commonly used MB design. (10.1302/0301-620x.106b9.bjj-2024-0075.r1)
  • [L1] Existing evidence is still scarce and exhibits a notable amount of methodological heterogeneity. (10.1002/ksa.12410)
  • [L3] The dysplastic cohort had outcomes and failure rates similar to those of rigorously matched controls at midterm follow-up. (10.1177/0363546518767399)
  • [L5] Long-term analysis is necessary to assess possible economic tradeoffs. (10.5435/jaaos-d-24-00127)
  • [L3] The few papers with long term follow-up reported no progression of hip osteoarthritis, however, since the patients are adolescent at surgery, longer follow-up studies are needed to validate this statement. (10.1186/s12891-022-05071-9)
  • [L4] Patients who had a preoperative diagnosis of ON had worse clinical outcomes than those who had other diagnoses. (10.1016/j.arth.2024.06.030)
  • [L3] CT was found to have higher interobserver reliability than MRI, and diagnosis should not rely exclusively on either examination or radiologic criteria. (10.1016/j.arthro.2011.10.021)
  • [Commentary] Understanding indications and identifying potential risk factors before surgical management are essential steps to improving overall patient outcomes. (10.1016/j.arthro.2019.07.011)
  • [L3] The proportions of patients who achieved clinically meaningful thresholds varied depending on the measurement used, with the greatest variation seen between SCB-JR and PASS-JR. (10.1016/j.arth.2025.09.027)
  • [L2] This feasibility study suggests that any trial investigating the effectiveness of total hip arthroplasty for fracture of the hip might not be deliverable within the constraints of current systems of care in the United Kingdom. (10.1302/0301-620x.98b11.bjj-2016-0478.r1)
  • [L3] Analysis demonstrated significant improvements in pain and functional PROs in both limited and persistent pain groups, though those with persistent pain had significantly lower PRO scores. (10.1177/0363546518817538)
  • [L4] The data presented here suggest a foundation upon which a consensus definition for the key parts of arthroplasty procedures may be built. (10.5435/jaaos-d-17-00381)
  • [L4] Gender differences exist in DLS patients regarding clinical and radiological presentation, with low back pain being more pronounced in male patients and scoliosis being more severe in female patients. (10.1186/s13018-023-04357-5)
  • [L3] THA remains an effective treatment for severe hip osteoarthritis, but females presented with worse baseline conditions and showed relatively less improvement at 1-year postsurgery compared to males. (10.1002/ksa.12124)
  • [L3] It was more responsive than the SF-36 and more efficient in measuring changes in function between baseline and follow-up values. (10.2106/00004623-199709000-00006)
  • [L3] Non-responders had significantly increased mortality and significantly worse baseline scores despite similar demographics and revision risk. (10.1302/0301-620x.108b1.bjj-2025-0683.r1)
  • [L5] The treatment of chronic, nonradicular, discogenic low back pain remains controversial, and while intradiskal electrothermal therapy shows reported therapeutic success rates of 60% to 80%, a more precise quantification of clinical benefits remains to be proved in randomized prospective trials. (10.5435/00124635-200301000-00003)
  • [L3] Non-union is associated with poor clinical outcomes. (10.1177/17585732221131923)
  • [Paper] In biomechanical analyses, the hook effectively dispersed stress and improved the initial fixation strength of the acetabular reinforcement ring. (10.1186/s13018-018-1023-7)
  • [L4] At a minimum 5-year follow-up, arthroscopic LBR continued to be a successful procedure and valid technique based on 3 PROs, the VAS, patient satisfaction, and survivorship. (10.1177/0363546517713731)
  • [L2] While the acute fracture and complications may have resolved clinically, the detrimental effect on a patient's quality of life persists up to 12 months after the injury. (10.1302/0301-620x.100b9.bjj-2017-1488.r1)
  • [L5] The ligamentum teres forms a sling-like structure to support the femoral head inferiorly during combined flexion and abduction resembling a squat, providing stabilization to the hip joint. (10.1007/s00167-012-2168-2)
  • [L3] The three described methods of managing intraoperative nondisplaced calcar fractures demonstrated little radiographic stem subsidence; however, the risk of reoperation was much higher than expected. (10.1016/j.arth.2024.03.049)
  • [L4] The use of this dynamic simulation software to determine the presence of motion limiting deformities of the femoroacetabular is validated. (10.1186/s12891-015-0504-7)
  • [L4] The study shows that the procedure is efficient in restoring a satisfactory stability for most patients and stabilises the evolution of the degenerative lesions as shown by standing X-ray. (10.1007/s001670050076)
  • [L5] Contemporary hip and knee simulator studies provide good information for screening new UHMWPE formulations for clinical wear performance, but comparable methodologies are lacking for screening for fracture resistance. (10.5435/00124635-200800001-00019)
  • [L3] Despite having similar preoperative pain and functional profiles to patients without dysplasia, dysplasia patients may have increased flexed-hip internal rotation, which is significantly decreased by common associated cam morphology. (10.1016/j.arthro.2017.08.285)
  • [Paper] There was no effect of femoral offset on bone implant micromotion; thus, a surgeon does not need to evaluate the implications of femoral offset on micromotion and can determine a femoral offset that best decreases the work load of abductor muscles, increases range of motion, and reduces hip pain. (10.1016/j.otsr.2016.01.010)
  • [L4] Despite major primary complications and high incidence of radiographic signs of degenerative changes after 8.8 years, mainly good clinical results were achieved with Judet's bipolar prosthesis. (10.1016/j.jse.2010.05.022)
  • [L4] Both graft size and graft orientation appeared to have a significant influence on graft healing as assessed on 1-year high-resolution MRI scan. (10.1177/0363546519885104)
  • [L5] Treatment options range from non-operative measures to various surgical procedures including cheilectomy, arthroplasty, and arthrodesis, with selection depending on disease stage and patient factors. (10.2106/00004623-199806000-00015)
  • [L3] Utilizing SSLR analysis, this study identified four empiric BMI cutoffs of ≤ 31, 32-37, 38-49, ≥ 50 which have shown sequential increased risk for 30-day major complications using current data in a nationally representative patient sample. (10.1016/j.arth.2022.04.030)
  • [L1] Although MCID has been the most frequently reported metric, there is considerable interstudy variability observed in their values. (10.1016/j.arthro.2024.07.039)
  • [L5] Finite element analysis determined that PFNA exhibits significantly better biomechanical stability than DHS+CS when subjected to varying lateral femoral wall thicknesses. (10.1186/s12891-024-07582-z)
  • [Paper] The finite element analysis encouraged the authors that the addition of a medial buttress plate achieved superior medial buttress stability and performance because it perfectly fits with the existing anatomic structure of the medial femoral neck. (10.1016/j.injury.2019.08.024)
  • [L3] The orientation and severity of femoral torsion at the time of hip arthroscopy for FAIS in this study's cohort did not affect the propensity for clinically meaningful outcome improvement at midterm follow-up. (10.1177/03635465231182151)
  • [L4] Radiographic methods including 3-D CT and MRI as well as the intraoperative findings of the labrum cannot be considered an accurate and reliable basis for the diagnosis and treatment of SSI in FAI patients. (10.1186/s12891-022-06045-7)
  • [L5] Reliable clinical methods of radiographic wear measurement are needed for knees and total disk replacements, and extensive preclinical laboratory wear testing is imperative for prototype disk arthroplasties until retrieval data becomes widely available. (10.5435/00124635-200800001-00021)
  • [L1] The outcomes of this study will contribute to better decision making in the treatment of cervical radiculopathy. (10.1186/s12891-020-3188-6)
  • [L3] However, its effect on functional outcomes remains unclear because surgery to perform heterotopic ossification excision remains exceedingly rare. (10.5435/jaaos-d-24-00491)
  • [L4] However, magnetic resonance imaging indicates that the donor site is resurfaced with fibrous tissue. (10.1177/0363546507306465)
  • [L5] Surgical management is indicated for progressive, painful, unilateral deformity or leg-length discrepancy, while moderate nonprogressive deformity often does not require surgery. (10.5435/00124635-199803000-00003)
  • [L3] However, they demonstrate similar MCID achievement and magnitude improvement between preoperative and 5-year postoperative PROs, and return to work without restrictions at a similar rate to non-WC patients, although they may take longer to do so. (10.1016/j.arthro.2023.03.023)
  • [L3] There were no clinically relevant differences in early postoperative mortality between simultaneous and staged bilateral surgery in healthy patients. (10.1186/s12891-015-0535-0)
  • [L4] At one year after primary THA, at least 13% of Danish patients experienced moderate to severe postsurgical pain. (10.1016/j.arth.2025.09.057)

References

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[2] Publication of Sports Medicine–Related Randomized Controlled Trials Registered in ClinicalTrials.gov. The American Journal of Sports Medicine. 2012. DOI: 10.1177/0363546512448363

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[4] Adjusted Survival Curves Improve Understanding of Multivariable Cox Model Results. The Journal of Arthroplasty. 2021. DOI: 10.1016/j.arth.2021.06.002

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[7] Reporting of Mesenchymal Stem Cell Preparation Protocols and Composition: A Systematic Review of the Clinical Orthopaedic Literature. The American Journal of Sports Medicine. 2018. DOI: 10.1177/0363546518758667

[8] Editorial Commentary: Quantifying Anterior and Lateral Acetabular Coverage in Hip Dysplasia: What About Posterior Coverage?. Arthroscopy: The Journal of Arthroscopic & Related Surgery. 2019. DOI: 10.1016/j.arthro.2019.01.041

[9] Mobile and Fixed-Bearing (All-Polyethylene Tibial Component) Total Knee Arthroplasty Designs. Journal of Bone and Joint Surgery. 2010. DOI: 10.2106/jbjs.j.00157

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[11] Predicting Surgical Outcomes in Patients With Recurrent Patellar Dislocations. Orthopaedic Journal of Sports Medicine. 2025. DOI: 10.1177/23259671251324527

[12] Best Practice Guidelines for Hip Arthroscopy in Femoroacetabular Impingement: Results of a Delphi Process. Journal of the American Academy of Orthopaedic Surgeons. 2020. DOI: 10.5435/jaaos-d-18-00041

[13] Outcomes of Unicompartmental Knee Arthroplasty in Patients Receiving Long-Term Anticoagulation Therapy: A Propensity-Matched Cohort Study. The Journal of Arthroplasty. 2024. DOI: 10.1016/j.arth.2024.02.021

[14] Epidemiology of the Frequency, Etiology, Direction, and Severity (FEDS) system for classifying glenohumeral instability. Journal of Shoulder and Elbow Surgery. 2019. DOI: 10.1016/j.jse.2018.08.014

[15] Good mid-term outcomes after adipose-derived culture-expanded mesenchymal stem cells implantation in knee focal cartilage defects. Knee Surgery, Sports Traumatology, Arthroscopy. 2019. DOI: 10.1007/s00167-019-05688-9

[16] Editorial Commentary: Platelet-Rich Plasma: The Devil Is in the Details, and the Details Need to Be Better Reported. Arthroscopy: The Journal of Arthroscopic & Related Surgery. 2019. DOI: 10.1016/j.arthro.2019.08.016

[17] Minimal Clinically Important Difference for PROMIS Physical Function in Patients With Distal Radius Fractures. The Journal of Hand Surgery. 2019. DOI: 10.1016/j.jhsa.2019.02.015

[18] Mid‐term results of Autologous Matrix‐Induced Chondrogenesis for treatment of focal cartilage defects in the knee. Knee Surgery, Sports Traumatology, Arthroscopy. 2010. DOI: 10.1007/s00167-010-1042-3

[19] A protocol for a randomized controlled trial investigating the safety and cost-effectiveness of outpatient total hip arthroplasty. BMC Musculoskeletal Disorders. 2020. DOI: 10.1186/s12891-020-03699-z

[20] Outcomes of fixed versus mobile-bearing medial unicompartmental knee arthroplasty. The Bone & Joint Journal. 2024. DOI: 10.1302/0301-620x.106b9.bjj-2024-0075.r1

[21] Centralization reduces meniscal extrusion, improves joint mechanics and functional outcomes in patients undergoing meniscus surgery: A systematic review and meta‐analysis. Knee Surgery, Sports Traumatology, Arthroscopy. 2024. DOI: 10.1002/ksa.12410

[22] Are Results of Arthroscopic Labral Repair Durable in Dysplasia at Midterm Follow-up? A 2-Center Matched Cohort Analysis. The American Journal of Sports Medicine. 2018. DOI: 10.1177/0363546518767399

[23] Cervical Disk Arthroplasty: Updated Considerations of an Evolving Technology. Journal of the American Academy of Orthopaedic Surgeons. 2024. DOI: 10.5435/jaaos-d-24-00127

[25] Surgical treatment of slipped capital femoral epiphysis (SCFE) by Dunn procedure modified by Ganz: a systematic review. BMC Musculoskeletal Disorders. 2022. DOI: 10.1186/s12891-022-05071-9

[26] Outcomes of Osteochondral Allograft Transplantation for Femoral Head Cartilage Lesions: Minimum 2-Year Follow-Up. The Journal of Arthroplasty. 2024. DOI: 10.1016/j.arth.2024.06.030

[27] Femoral Anteversion in the Hip: Comparison of Measurement by Computed Tomography, Magnetic Resonance Imaging, and Physical Examination. Arthroscopy. 2012. DOI: 10.1016/j.arthro.2011.10.021

[28] Editorial Commentary: Patient Profiling: Identifying Risk Factors That Help Predict Outcomes of Hip Arthroscopy Candidates. Arthroscopy: The Journal of Arthroscopic & Related Surgery. 2019. DOI: 10.1016/j.arthro.2019.07.011

[29] Expanding the Scope of Centers for Medicare and Medicaid Services Patient-Reported Outcome Measures Mandatory Reporting: Evaluating Total Hip Arthroplasty Outcomes Beyond Substantial Clinical Benefit for Hip Disability and Osteoarthritis Outcome Score-Joint Replacement. The Journal of Arthroplasty. 2026. DOI: 10.1016/j.arth.2025.09.027

[30] A randomised feasibility study comparing total hip arthroplasty with and without dual mobility acetabular component in the treatment of displaced intracapsular fractures of the proximal femur. The Bone & Joint Journal. 2016. DOI: 10.1302/0301-620x.98b11.bjj-2016-0478.r1

[31] Predictors of Persistent Postoperative Pain at Minimum 2 Years After Arthroscopic Treatment of Femoroacetabular Impingement. The American Journal of Sports Medicine. 2019. DOI: 10.1177/0363546518817538

[32] Defining the Key Parts of a Procedure: Implications for Overlapping Surgery. Journal of the American Academy of Orthopaedic Surgeons. 2018. DOI: 10.5435/jaaos-d-17-00381

[33] Sex-based differences in clinical and radiological presentation of patients with degenerative lumbar scoliosis: a cross-sectional study. Journal of Orthopaedic Surgery and Research. 2023. DOI: 10.1186/s13018-023-04357-5

[35] Men and women undergoing total hip arthroplasty have different clinical presentations before surgery and different outcomes at 1‐year follow‐up. Knee Surgery, Sports Traumatology, Arthroscopy. 2024. DOI: 10.1002/ksa.12124

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[37] Patient-reported outcomes may be ‘missing not at random’ in hip and knee arthroplasty. The Bone & Joint Journal. 2026. DOI: 10.1302/0301-620x.108b1.bjj-2025-0683.r1

[38] Treatment of Chronic Discogenic Low Back Pain With Intradiskal Electrothermal Therapy. Journal of the American Academy of Orthopaedic Surgeons. 2003. DOI: 10.5435/00124635-200301000-00003

[40] Low and high body mass index and lower numbers of screws in the articular segment are risk factors for non-union of distal humeral fractures in the elderly: A multi-center retrospective study (TRON study). Shoulder & Elbow. 2022. DOI: 10.1177/17585732221131923

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[43] Acetabular reinforcement ring with additional hook improves stability in three-dimensional finite element analyses of dysplastic hip arthroplasty. Journal of Orthopaedic Surgery and Research. 2018. DOI: 10.1186/s13018-018-1023-7

[44] Arthroscopic Labral Base Repair in the Hip: 5-Year Minimum Clinical Outcomes. The American Journal of Sports Medicine. 2017. DOI: 10.1177/0363546517713731

[45] Deficits in preference-based health-related quality of life after complications associated with tibial fracture. The Bone & Joint Journal. 2018. DOI: 10.1302/0301-620x.100b9.bjj-2017-1488.r1

[46] Function of the ligamentum teres during multi‐planar movement of the hip joint. Knee Surgery, Sports Traumatology, Arthroscopy. 2012. DOI: 10.1007/s00167-012-2168-2

[47] Three Differing Methods of Treating Intraoperative Nondisplaced Calcar Fractures Demonstrate Similar Radiographic Stem Subsidence. The Journal of Arthroplasty. 2024. DOI: 10.1016/j.arth.2024.03.049

[48] A quantitative non-invasive assessment of femoroacetabular impingement with CT-based dynamic simulation - cadaveric validation study. BMC Musculoskeletal Disorders. 2015. DOI: 10.1186/s12891-015-0504-7

[51] Double semitendinosus anterior cruciate ligament reconstruction: 10‐year results. Knee Surgery, Sports Traumatology, Arthroscopy. 1998. DOI: 10.1007/s001670050076

[52] How do material properties influence wear and fracture mechanisms?. Journal of the American Academy of Orthopaedic Surgeons. 2008. DOI: 10.5435/00124635-200800001-00019

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[55] No effect of femoral offset on bone implant micromotion in an experimental model. Orthopaedics & Traumatology: Surgery & Research. 2016. DOI: 10.1016/j.otsr.2016.01.010

[56] Mid- to long-term results after bipolar radial head arthroplasty. Journal of Shoulder and Elbow Surgery. 2010. DOI: 10.1016/j.jse.2010.05.022

[57] Graft Size and Orientation Within the Femoral Notch Affect Graft Healing at 1 Year After Anterior Cruciate Ligament Reconstruction. The American Journal of Sports Medicine. 2019. DOI: 10.1177/0363546519885104

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[61] A Novel Method for Stratification of Major Complication Risk Using Body Mass Index Thresholds for Patients Undergoing Total Hip Arthroplasty: A National Cohort of 224,413 Patients. The Journal of Arthroplasty. 2022. DOI: 10.1016/j.arth.2022.04.030

[63] High Variability in Standardized Outcome Thresholds of Clinically Important Changes in Shoulder Instability Surgery: A Systematic Review. Arthroscopy. 2024. DOI: 10.1016/j.arthro.2024.07.039

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[66] Medial anatomical buttress plate in treating displaced femoral neck fracture a finite element analysis. Injury. 2019. DOI: 10.1016/j.injury.2019.08.024

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[72] A Multicenter, Modern Cohort, Study of Radiation Therapy Versus Usual Care for Heterotopic Ossification Prophylaxis After Fixation of Acetabular Fractures Through a Posterior Approach. Journal of the American Academy of Orthopaedic Surgeons. 2025. DOI: 10.5435/jaaos-d-24-00491

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