James S. MacLeod

Purpose: To compare radiographic parameters obtained from supine versus standing pelvic radiographs in patients with femoroacetabular impingement (FAI) and acetabular dysplasia (AD). Methods: This study was registered on the International Prospective Register of Systematic Reviews and performed in accordance with Preferred Reporting Items for Systematic Reviews and Meta‐Analyses guidelines. PubMed, Cochrane Central Register of Controlled Trials, and Scopus were queried in June 2025. Included studies compared supine versus standing radiographic parameters in patients with FAI or AD. Articles were excluded if they failed to provide extractable radiographic data for both positions. Demographics, study design, and radiographic parameters, including lateral center‐edge angle (LCEA), pelvic tilt, Tönnis angle, femoral head translation, Sharp angle, joint space width, and femoroepiphyseal acetabular roof index, were analyzed. Meta‐analyses with a random‐effects model were performed to evaluate mean differences in supine versus standing measurements for LCEA, Tönnis angle, and pelvic tilt, stratified by FAI and AD cohorts. Results: Twelve studies were analyzed, comprising 824 hips in 675 patients. Statistically significant differences in individual‐study supine versus standing comparisons were identified for pelvic tilt (10/10 studies), Tönnis angle (7/8), and LCEA (6/10). Four studies reported sex‐disaggregated data. Meta‐analyses showed greater pelvic tilt in supine in FAI (+1.38 cm, 95% confidence interval [CI]: 0.92, 1.84; P < .001) and AD (+1.98 cm, 95% CI: 0.37, 3.59; P = .020) populations. Tönnis angle was smaller in supine in FAI (−1.14°, 95% CI: −2.19, −0.09; P = .030) and AD (−1.93°, 95% CI: −3.20, −0.65; P = .003). LCEA measurements were not significantly different in FAI (+0.97°, 95% CI: −0.80, 2.74; P = .28) and AD (+1.03°, 95% CI: −0.70, 2.76; P = .24). Conclusions: Supine pelvic radiographs resulted in greater pelvic tilt measurements, decreased Tönnis angles, and similar LCEA compared with standing radiographs. Supine and standing radiographic parameters should not be considered interchangeable. Level of Evidence: Level IV, systematic review of Level II to IV studies.

Periacetabular osteotomy (PAO) has demonstrated favourable outcomes for the treatment of acetabular dysplasia. Minimally invasive (MI) PAO uses a smaller incision to preserve soft tissue, minimize complications, and accelerate recovery; however, the outcomes of MI PAO are still being established. The purpose of this study was to conduct a systematic review to assess the reoperation rates and patient-reported outcomes following MI PAO. A systematic review of the literature was conducted in PubMed, CENTRAL, and Scopus in April 2024 with the following keywords: (mini*) AND (periacetabular osteotomy”). The PRISMA criteria were used. Only studies that reported on patient-reported outcome measures (PROMs) of MI PAO techniques were included. Eight studies with study periods ranging between 2004 and 2021 including a total of 2247 hips were included in this review. Mean follow-up ranged from 12 to 60 months. The mean age at the time of surgery ranged from 20.0 to 38.7 years, and 85.6% of included hips were from female patients. Seven out of 8 included studies reported significant improvement in preoperative vs postoperative PROMs. The mean Non-Arthritic Hip Score ranged from 49.8 to 58.7 preoperatively compared to 77.2–89.4 postoperatively. Mean UCLA scores ranged from 3.9 to 4.67 preoperatively to 6.3–6.97 postoperatively. Mean Harris Hip Scores ranged from 50.8 to 66 preoperatively compared to 87.4–93 postoperatively. Conversion to THA rates ranged from 0% to 5.3% at a mean of 4.9 years (0.6–14). Patients undergoing MI PAO surgery for the treatment of acetabular dysplasia demonstrated low rates of conversion to THA and significant improvement in PROMs at short- to mid-term follow-up.

Case: A 76-year-old woman presented with bilateral hip pain and hip abductor weakness following years of trochanteric bursa steroid injections. MRI showed injury of the hip abductor tendons bilaterally with muscle atrophy, and she underwent staged bilateral hip abductor tendon repair with gluteus maximus transfer, resulting in improvement in pain and function. Conclusion: This is among the first reported cases of bilateral hip abductor tendon repairs with gluteus maximus transfers in a patient with native hips. Patients presenting with hip abductor insufficiency and muscle atrophy may benefit from this application of a well-documented surgery.