Aims: Femoroacetabular impingement (FAI) is a serious cause of hip pain with loss of function, and development of osteoarthritis of the hip. The aim of this multilevel meta-analysis of randomized controlled trials (RCTs) was to evaluate the outcomes of FAI patients treated conservatively compared with those treated with hip arthroscopy (HAS).Methods: A systematic literature search of PubMed, CENTRAL of the Cochrane Library, Epistemonikos, and Embase databases was conducted up to 30 June 2024. In a frequentist multilevel meta-analysis with random effects model, means with 95% CIs were calculated separately in the conservative treatment subgroup and the HAS subgroup. A test for subgroup differences in meta-analysis was then performed to determine whether there was a statistically significant difference between the means of the two subgroups. Clinical assessment was based on Harris Hip Score (HHS), the International Hip Outcome Tool (iHOT), the Hip disability and Osteoarthritis Outcome Score (HOOS), the Hip Outcome Score Activities of Daily Living (HOS-ADL), and visual analogue scale (VAS) for pain.Results: A total of 21 RCTs, including 674 patients in the conservative treatment subgroup and 1,125 patients in the HAS subgroup, met the inclusion criteria. The test for subgroup differences showed that the HAS subgroup had a statistically significant 6.5-point higher HHS ≤ 12 months post-intervention (F = 12.8; df = 1.5; p = 0.016) and a statistically significant 9.8-point higher iHOT ≤ 24 months post-intervention (F = 5.3; df = 1.1; p = 0.035) than the conservative treatment subgroup. Other functional (HOOS, HOS) and pain (VAS, NRS) outcome parameters analyzed did not show statistically significant differences.Conclusion: This multilevel meta-analysis of 21 RCTs with a total of 1,799 FAI patients showed a statistically significant higher HHS ≤ 12 months post-intervention and iHOT ≤ 24 months post-intervention, favouring the HAS subgroup compared to the conservative treatment subgroup, without reaching minimal clinically important differences (MCIDs).Cite this article: Bone Jt Open 2025;6(4):480–498.

Background: The aim of the study was to compare the short-term outcome of SuperPATH, direct anterior (DAA) and conventional approach (CA) hemiarthroplasty (HA) in patients with femoral neck fractures using a network meta-analysis. Methods: PubMed, China National Knowledge Infrastructure, Epistemonikos, and Embase were searched until May 31, 2024. In a network meta-analysis, mean differences with 95% confidence intervals were calculated using the Hartung–Knapp–Sidik–Jonkman method and a fixed/random effects model for continuous outcomes, and odds ratios with 95% confidence intervals were calculated using the Mantel–Haenszel method and a fixed/random effects model for dichotomous outcomes. Results: The literature search identified a total of 9 randomized controlled trials on SuperPATH with 762 patients and 8 randomized controlled trials on DAA with 641 patients. In the overall ranking, SuperPATH was placed first, DAA second and CA third. SuperPATH HA was best in 7, second best in 2 and third best in 1 of the 10 outcome parameters. DAA HA was best in 2 and second best in 8 of the 10 outcome parameters. CA HA was best in 1 and third best in 9 of the 10 outcome parameters. In the indirect comparison between SuperPATH HA and DAA HA, SuperPATH HA had a 1.36 point lower visual analog scale at 2 to 7 days postoperatively and a 0.17 lower overall complication rate compared to DAA. Conclusion: For the treatment of patients with femoral neck fractures, SuperPATH HA ranked first, DAA HA ranked second and CA HA ranked third. Based on the results, we recommend that trauma surgeons increase their use of minimally invasive hip HA techniques. It should be noted that SuperPATH HA had a significantly lower overall complication rate compared to DAA HA when the minimally invasive technique was chosen.

Extensive research exists on artificial intelligence (AI)-assisted fracture detection in various anatomical regions, but clavicle fractures remain comparatively understudied. This study aimed to compare the diagnostic performance of AI-guided clavicle fracture detection on plain radiographs with that of an experienced orthopedic surgeon. We retrospectively analyzed all clavicle radiographs obtained at our institution between September 11,2023 and October 31,2024 following the clinical implementation of AI-guided fracture detection. Radiological findings confirmed by a senior radiologist served as the reference standard. AI performance was additionally compared with the assessments of an experienced, blinded orthopedic surgeon. Diagnostic performance metrics included accuracy, sensitivity, specificity, Cohen kappa, F1 score, and Youden index. A total of 367 clavicle radiographs were included, comprising 186 anteroposterior (AP) and 181 second-plane views. The mean patient age was 44.6 ± 26.2 years, and 59.4% were male. According to the reference standard, clavicle fractures were present in 96 AP radiographs (51.6%) and 95 second-plane radiographs (52.5%). On AP radiographs, the AI system achieved an accuracy of 97.31%, sensitivity of 95.83%, specificity of 98.89%, Cohen kappa of 0.95, and F1 score of 0.97. Diagnostic performance on second-plane radiographs was similarly high and overall comparable to that of the experienced orthopedic surgeon. This retrospective diagnostic accuracy study shows that AI-guided clavicle fracture detection is highly accurate and reliable, with performance approaching that of an experienced orthopedic surgeon. These findings support the potential role of AI as a diagnostic support tool in clavicle fracture detection, while prospective and multicenter validation remains warranted.

Background/Objectives: Orthopedic hip surgery has undergone advances driven by innovations in surgical techniques and improved patient care protocols. The aim was to synthesize and appraise all studies relevant to hip surgery published in Knee Surgery, Sports Traumatology, Arthroscopy (KSSTA) in 2022–2023. Methods: The search included all studies published in KSSTA from 1 January 2022 to 31 December 2023. Quality assessment was performed using appropriate tools for randomized controlled trials (RCTs), non-RCTs, and systematic reviews. Due to the diverse nature of the included studies, a narrative synthesis approach was used. Results: A total of 33 primary studies were included in this narrative review, of which 10 were reviews (5 systematic reviews), 1 was an RCT, and 22 were non-RCTs. A total of 11 were from the UK, 10 studies were from the USA, and 5 were from Canada. Femoroacetabular impingement (FAI) was investigated in a total of 23 studies, followed by hip micro-instability in 7 studies, dysplasia in 5 studies, and gluteal and hamstring tears in 4 studies. The RCT had a low risk of bias. Of the 22 non-RCTs, 16 had a low risk of bias, 5 had a moderate risk of bias, and 1 had a high risk of bias. All systematic reviews were of moderate quality. Conclusions: Hip arthroscopy is an effective treatment for FAI with promising early outcomes, especially when combined with closed capsular repair and appropriate rehabilitation. Surgeons should tailor their approach to capsular management to optimize recovery, as closed capsular repair may enhance functional outcomes. Additionally, preoperative tools like the HAR Index can help identify patients at higher risk of requiring hip arthroplasty after surgery. The conclusions of the included primary studies align with current general recommendations and contribute valuable insights to the field of hip orthopedics.