Hip Joint Research

Research Highlights

Special Recognition: AOSSM Specialty Day Symposium, AAOS Annual Meeting, 2025

  • Global Acetabular Retroversion Is Associated with Increased Risk of Conversion to Total Hip Arthroplasty after Primary Hip Arthroscopy and Greater Chondrolabral Junction Breakdown: A Propensity- Matched Analysis with Minimum 8-Year Follow-up.

Special Recognition: AOSSM Specialty Day Symposium, AAOS Annual Meeting, 2025

  • Hip Arthroscopy Patients Experiencing Greater Neighborhood-Level Socioeconomic Disadvantage are More Likely to Achieve Minimal Clinically Important Diff erences in Functional Outcomes at 1-Year Follow-up.

O’Donoghue Research Award Winner, AOSSM Annual Meeting, 2024

  • Hip Arthroscopy Versus Physical Therapy for the Treatment of Symptomatic Acetabular Labral Tears in Patients Older Than 40 Years: A 2-Year Report of A Randomized Controlled Trial

Best Sports Medicine Poster Presentation, MSOS Annual Meeting, 2024

  • The role of chondrolabral junction breakdown on functional outcomes following hip arthroscopy at minimum two-year follow-up.

Best Clinical Paper, Orthopaedic Summit, 2023

Chondral Flap: Patients with Worse Chondral Damage Report Better Two-Year Functional Outcomes After Treatment with Bone Marrow Aspirate Concentrate During Acetabular Labral Repair.

Areas of Study, 2024-5

  • Caprine Study
    • Histological staining
    • Electron Microscopy
    • Polarized Light Microscopy
  • Bone Marrow Aspirate Concentrate (BMAC)
    • PROMs
    • Randomized controlled trial: BMAC vs no BMAC
      • actively enrolling
    • Cell Analysis
  • Retrospective Study of Labral Repair with Chondrolabral preservation
    • >10 years, >5 years, >2 years
  • Randomized Controlled Trial in Hip Arthroscopy vs. Physical Therapy in Patients Over 40
    • 2-year follow-up
  • Orthobiologics
  • Abductor Tendon
  • Chronic Hamstring Tears

Hip Joint: Recent Significant Publications

Relationship Between Neighborhood-Level Socioeconomic Status and Functional Outcomes After Hip Arthroscopy, Am J Sports Med

Conclusion: Although hip arthroscopy patients experiencing a greater neighborhood-level socioeconomic disadvantage exhibited significantly lower preoperative baseline PROM scores, this disparity resolved at 1-year follow-up. In fact, when adjusting for patient characteristics including ADI score, more disadvantaged patients achieved greater odds of achieving the minimal clinically important difference. The present study is merely a first step toward understanding health inequities among patients seeking orthopaedic care. Further development of clinical guidelines and health policy research is necessary to advance care for patients from disadvantaged communities.

Lee JS, Rachala RR, Gillinov SM, Siddiq BS, Dowley KS, Cherian NJ, Martin SD. Relationship Between Neighborhood-Level Socioeconomic Status and Functional Outcomes After Hip Arthroscopy. Am J Sports Med. 2024 Oct;52(12):3054-3064. https://doi.org/10.1177/03635465241272077 PMID: 39272223

A Conserved Transcription Factor Regulatory Program Promotes Tendon Fate, Developmental Cell
  • Chemical screen identifi es the cAMP-PKA-Creb1/CREB1 pathway as promoting tendon fate
  • Creb1a induces tendon fate by directly activating the newly identifi ed scxa enhancer SEN
  • Motif analysis of enhancer regions identifi es Ebf/EBF as a novel tendon regulator
  • Creb1/CREB1 and Ebf/EBF are suffi cient and necessary for tendon development

Niu X, Melendez D, Raj S, Cai J, Senedeera D, Mandelbaum J, Shestopalov IA, Martin SD, Zon LI, Schlaeger TM, Lai LP, McMahon AP, April M. Craft AM, Galloway JL. A Conserved Transcription Factor Regulatory Program Promotes Tendon Fate. Devopmental Cell. https://doi.org/10.1016/j.devcel. Online ahead of print. PMID: 49216481

Hip arthroscopy versus physical therapy for the treatment of symptomatic acetabular labral tears in patients older than 40 years: 24-month results from a randomized controlled trial, Am J Sports Med

Conclusion: In patients ≥40 years of age with limited osteoarthritis, hip arthroscopy with postoperative physical therapy led to better outcomes than PTA at a 24-month follow-up. However, additional preoperative physical therapy did not compromise surgical outcomes and allowed some patients to avoid surgery. When surgery is indicated, age ≥40 years should not be considered an independent contraindication to arthroscopic acetabular labral repair.

Martin SD, Dean MC, Gillinov SM, Cherian NJ, Eberlin CT, Kucharik MP, Abraham PF, Nazal MR, Conaway WK, Quinlan NJ, Alpaugh K, Torabian KA. Hip arthroscopy versus physical therapy for the treatment of symptomatic acetabular labral tears in patients older than 40 years: 24-month results from a randomized controlled trial. Am J Sports Med. 2024 Aug 5:3635465241263595. https://doi.org/10.1177/03635465241263595 Online ahead of print. PMID: 39101607.

Variation in the Cost of Hip Arthroscopy for Labral Pathological Conditions: A Time-Driven Activity-Based Costing Analysis, JBJS

Conclusions: By applying TDABC to outpatient hip arthroscopy, we identified wide patient-to-patient cost variation that was most effectively explained by the method of labral management, the operating surgeon, the osteoplasty type, and the surgery center. Given current procedural coding trends, declining reimbursements, and rising health-care costs, these insights may enable stakeholders to design bundled payment structures that better align reimbursements with costs.

Dean MC, Cherian NJ, Beck da Silva Etges AP, Dowley KS, LaPorte ZL, Torabian KA, Eberlin CT, Best MJ, Martin SD. Variation in the Cost of Hip Arthroscopy for Labral Pathological Conditions: A Time-Driven Activity-Based Costing Analysis. J Bone Joint Surg Am. 2024 Aug 7, 106(15):p 1362-1372. https://doi.org/10.2106/jbjs.23.00500  Epub ahead of print. PMID: 38781316

Puncture Capsulotomy Technique During Hip Arthroscopy. (Video) Puncture capsulotomy during hip arthroscopy, JBJS Essential Surgical Techniques
puncture_capsulotomy_techniqueDownload

Gillinov SM, Siddiq BS, Cherian NJ, Martin SD. Puncture Capsulotomy Technique During Hip Arthroscopy. (Video) Puncture capsulotomy during hip arthroscopy. JBJS Essential Surgical Techniques 14(2):e23.00061, April-June 2024. 10.2106/JBJS.ST.23.00061 PMCID: PMC11186812 PMID: 38903605

Chondrolabral Junction Breakdown Predicts Conversion to Total Hip Arthroplasty After Hip Arthroscopy for Symptomatic Labral Tears: Minimum 8-Year Follow-up, Am J Sports Med

Conclusion: Although most patients achieved favorable minimum 8-year outcomes, several pre- and intraoperative factors were associated with THA conversion; of these, worse CLJ breakdown, higher Tönnis grade, and older age were the strongest predictors.

Dean MC, Cherian NC, LaPorte ZL, Eberlin CT, Wang C, Torabian KA, Dowley KS, Kucharik MP, Abraham PF, Nazal MR, Martin SD. Chondrolabral Junction Breakdown Predicts Conversion to Total Hip Arthroplasty After Hip Arthroscopy for Symptomatic Labral Tears: Minimum 8-Year Follow-up. Am J Sports Med. 2024 Apr; 52(5): 1153–1164. https://doi.org/10.1177/03635465241234258 PMID: 38476016 PMCID: PMC10986152

High Pelvic Incidence Predicts Inferior Outcomes Following Hip Arthroscopy for Femoroacetabular Impingement and Acetabular Labral Tears, Am J Sports Med

Conclusion: After hip arthroscopy, patients with a high PI (>60°) exhibited inferior PROMs, rates of achieving clinically meaningful thresholds, and satisfaction at 12 and 24 months relative to patients with low or moderate PI. Conversely, the outcomes of patients with low PI (<45°) were found to match the trajectory of those with a neutral spinopelvic alignment (45°≤ PI ≤ 60°). These findings highlight the importance of analyzing spinopelvic parameters preoperatively to prognosticate outcomes before hip arthroscopy for acetabular labral tears and FAI.

Torabian KA, Cherian NJ, Eberlin CT, Dean MC, Dowley KS, LaPorte ZL, Kucharik MP, Gillinov SM, Martin, SD. High Pelvic Incidence Predicts Inferior Outcomes Following Hip Arthroscopy for Femoroacetabular Impingement and Acetabular Labral Tears. Am J Sports Med. 2024 Mar;52(3):631-642. https://doi.org/10.1177/03635465231219261 PMID: 38369972 PMCID: PMC10905981

Figure 1. Spinopelvic measurements using (A-C) computed tomography scans or (D-F) magnetic resonance imaging scans. The center points of the femoral heads were marked on sagittal slices (A, C, D, F). These positions were translated onto the sagittal cut that incorporated the center of the sacral endplate (B, E). A line was then drawn connecting the center of the femoral heads, and the midpoint was identified to yield the center of the bicoxofemoral axis. Using this orientation, we then measured spinopelvic parameters, which included pelvic incidence, pelvic tilt, and sacral slope.
Harvest and Application of Bone Marrow Aspirate Concentrate to Address Acetabular Chondral Damage During Hip Arthroscopy, JBJS Essential Surgical Techniques
Harvest_and_Application_of_Bone_Marrow_AspirateDownload

Martin SD, Eberlin CT, Kucharik MP, Cherian NJ. Harvest and Application of Bone Marrow Aspirate Concentrate to Address Acetabular Chondral Damage During Hip Arthroscopy. JBJS Essential Surgical Techniques 13(2):e22.00010, April-June 2023. https://doi.org/10.2106/JBJS.ST.22.00010

Comparing the Risk of Osteonecrosis of the Femoral Head Following Intra-articular Corticosteroid and Hyaluronic Acid Injections, JBJS

Conclusions: The incidence of ONFH after intra-articular hip injection was similar between patients who received CSIs and those who received HAIs. Although this study could not determine whether intra-articular injections themselves (regardless of the drug that was used) lead to ONFH, the results suggest that ONFH after CSI often may be due, in part, to the natural course of the underlying disease. Future randomized controlled trials are needed to definitively answer this question; in the interim, clinicians may be reassured that they may continue judicious use of CSIs as clinically indicated.

Varady NH, Abraham PF, Kucharik MP, Freccero DM, Smith EL, Martin SD. Comparing the Risk of Osteonecrosis of the Femoral Head Following Intra-articular Corticosteroid and Hyaluronic Acid Injections. J Bone Joint Surg Am. 2022 Jun 15;104(12):1055-1060. [Published Online Ahead of Print 2022 Mar 11] http://doi.org/10.2106/JBJS.21.01043 PMID: 35275891

Functional Outcomes of Arthroscopic Acetabular Labral Repair with and without Bone Marrow Aspirate Concentrate, JBJS

Conclusions: Patients with moderate cartilage injury undergoing arthroscopic acetabular labral repair with BMAC application reported significantly greater functional improvements when compared with similar patients without BMAC application.

Martin SD, Kucharik MP, Abraham PF, Varady NH, Meek WM, Nazal MR. Functional Outcomes of Arthroscopic Acetabular Labral Repair with and without Bone Marrow Aspirate Concentrate. JBJS. 2022 Jan 5;104(1):4-14. doi.org/10.2106/JBJS.20.01740 PMID: 34648479

Bone Marrow Aspirate Concentrate
Harvesting Bone Marrow with a Jamshidi Needle
Minimum 2-Year Functional Outcomes of Patients Undergoing Capsular Autograft Labral Reconstruction, Am J Sports Med

Conclusions: In this study of 97 hips undergoing arthroscopic labral repair with capsular autograft labral reconstruction, we found favorable outcomes that exceeded the MCID thresholds in the majority of patients at a mean 28.2 months’ follow-up. Future studies should compare outcomes between this technique and other methods of autograft and allograft reconstruction to determine differences in patient-reported outcomes, donor-site morbidity, and complications.

Kucharik MP, Abraham PF, Nazal MR, Varady NH, Meek WM, Martin SD. Minimum 2-Year Functional Outcomes of Patients Undergoing Capsular Autograft Labral Reconstruction. Am J Sports Med. 2021 Aug;49(10):2659-2667. doi.org/10.1177/03635465211026666. Epub 2021 Jul 2. PubMed PMID: 34213975

Hip Arthroscopy versus Physical Therapy for the Treatment of Symptomatic Acetabular Labral Tears in Patients Older than 40: A Randomized Control Trial, Am J Sports Med

Conclusion: In patients older than 40 years with limited osteoarthritis, arthroscopic acetabular labral repair with postoperative physical therapy led to better outcomes than physical therapy alone. Thus, age over 40 years should not be considered a contraindication to arthroscopic acetabular labral repair.

Martin SD, Abraham PF, Varady NH, Nazal MR, Conaway WC, Quinlan NJ, Alpaugh K. Hip Arthroscopy versus Physical Therapy for the Treatment of Symptomatic Acetabular Labral Tears in Patients Older than 40: A Randomized Control Trial. Am J Sports Med. 2021 Apr;49(5):1199-1208. doi.org/10.1177/0363546521990789 Epub 2021 Mar 3. PMID: 33656950

Translational Relevance of the Goat as a Preclinical Model of the Human Labrum and Chondrolabral Junction—Histological Study, J Ortho Res.

Statement of Clinical Significance: Establishment of a large animal model and deeper knowledge of the histological composition of the hip joint will enhance our study of the acetabular labrum, including repair techniques.

Rajappa R, Nazal MR, Stelzer JW, Hsu H, Conaway WK, Rokkappanavar S, Niu W, Upadhyaya S, Alpaugh K, Spector M, Martin SD. Translational Relevance of the Goat as a Preclinical Model of the Human Labrum and Chondrolabral Junction—Histological Study. J Ortho Res. 2020 May 38(5): 1070-80. Published online 2019 2 December. https://doi.org/10.1002/jor.24546

  • Unique histology of the chondrolabral junction
  • Caprine Model
  • Unique type-1, crimped, loose collagen
    • Answers the question of how the junction can hold up over time
  • Junction under huge sheer forces
  • Serves as a bridge between fibrocartilage of the hip labrum and articular cartilage of acetbulum
    • Leads us on a quest to find Orthobiologics
  • Current techniques cannot recapitulate the unique histology of the chondrolabral junction
Caprine Chondrolabral Junction Histology

Hip Joint Surgical Technique Videos

Puncture Capsulotomy Technique During Hip Arthroscopy. (Video) Puncture capsulotomy during hip arthroscopy, JBJS Essential Surgical Techniques
puncture_capsulotomy_techniqueDownload

Gillinov SM, Siddiq BS, Cherian NJ, Martin SD. Puncture Capsulotomy Technique During Hip Arthroscopy. (Video) Puncture capsulotomy during hip arthroscopy. JBJS Essential Surgical Techniques 14(2):e23.00061, April-June 2024. 10.2106/JBJS.ST.23.00061 PMCID: PMC11186812 PMID: 38903605

Harvest and Application of Bone Marrow Aspirate Concentrate to Address Acetabular Chondral Damage During Hip Arthroscopy, JBJS Essential Surgical Techniques
Harvest_and_Application_of_Bone_Marrow_AspirateDownload

Martin SD, Eberlin CT, Kucharik MP, Cherian NJ. Harvest and Application of Bone Marrow Aspirate Concentrate to Address Acetabular Chondral Damage During Hip Arthroscopy. JBJS Essential Surgical Techniques 13(2):e22.00010, April-June 2023. https://doi.org/10.2106/JBJS.ST.22.00010

Use of Stem Cells with Arthroscopic Hip Labral Repair

By using BMAC to augment labral repairs and coat chondrolabral junction breakdown, we are able to introduce mesenchymal stem cells to peripheral acetabular tissue with little to no drawbacks, while avoiding donor-site morbidity, open procedures, and multiple surgeries.

Stelzer JW, Martin SD. Use of Bone Marrow Aspirate Concentrate with Acetabular Labral Repair for the Management of Chondrolabral Junction Breakdown. Arthrosc Tech. 2018 Oct; 7(10): e981–e987. Published online 2018 Sep 1. doi:10.1016/j.eats.2018.06.003. PMID:30377577

Puncture Capsulotomy During Hip Arthroscopy for Femoroacetabular Impingement: Preserving Anatomy and Biomechanics

We describe an arthroscopic technique for the treatment of labral pathology and femoroacetabular impingement that provides excellent access to the central and peripheral compartments while preserving the biomechanically crucial components of hip joint stability.

Conaway WK, Martin SD. Puncture Capsulotomy during Hip Arthroscopy for FAI: Preserving Anatomy and Biomechanics. Arthrosc Tech. 2017 Dec; 6(6): e2265–e2269. Published online 2017 Nov 27. doi:10.1016/j.eats.2017.08.036.

“In-Round” Labral Repair After Acetabular Recession Using Intermittent Traction

The prevalence of hip arthroscopy has increased exponentially with the advent of arthroscopic labral repair techniques for femoroacetabular impingement. The goal of arthroscopic labral repair is to re-create the anatomic suction seal of the labrum against the femoral head. This technique re-creates the native anatomy and biomechanics of the hip after acetabular recession and labral repair while decreasing traction time.

Skelley NW, Conaway WK, Martin SD. “In-Round” Labral Repair After Acetabular Recession Utilizing Intermittent Traction. Arthrosc Tech. 2017 Oct; 6(5): e1807–e1813. Published online 2017 Oct 9. doi:10.1016/j.eats.2017.08.036.

Arthroscopic Treatment of Pigmented Villonodular Synovitis of the Hip Using Puncture Capsulotomy

Pigmented villonodular synovitis (PVNS) is a monoarticular, benign tumor arising from the synovium. Although classically treated with open synovectomy, arthroscopic treatment has demonstrated good clinical outcomes. 

Nazal MR, Parsa A, Martin SD. Arthroscopic Treatment of Pigmented Villonodular Synovitis (PVNS) of the Hip utilizing Puncture Capsulotomy Arthroscopy Techniques. Arthrosc Tech. 2019 Jun;8(6): e641–e646. Epub 2019 Jun 2. doi: 10.1016/j.eats.2019.02.007