Background: The role of hip arthroscopy in the treatment of patients with borderline hip dysplasia is controversial and evolving. Purpose: To evaluate outcomes at a minimum 10-year follow-up in patients who underwent hip arthroscopy for femoroacetabular impingement in a hip with borderline dysplasia. Study Design: Case series; Level of evidence, 4. Methods: All hips that underwent labral repair between June 2006 and March 2009 for femoroacetabular impingement with borderline dysplasia were included if they had a lateral center-edge angle of 20° to 25°, had primary hip arthroscopy for the diagnosis of femoroacetabular impingement, and were aged 18 to 70 years. Patients were excluded if they had previous hip surgery, avascular necrosis, or fracture. Kaplan-Meier survivorship was performed, with survivorship defined as avoidance of conversion to total hip arthroplasty (THA). Results: A total of 45 patients met the inclusion criteria, and 38 were contacted at a minimum 10 years postoperatively (84%; mean ± SD, 12 ± 1.3 years). There were 23 women and 15 men with an average age of 41 ± 9.6 years (range, 25-69). Twenty patients were ≥40 years of age. In this patient cohort, survivorship was 87% at 5 years and 79% at 10 years for conversion to THA. Of the 38 patients included, 9 were converted to THA (24%), and 3 required revision hip arthroscopy (7%). Patient age, Tönnis grade, microfracture of cartilage lesions, and Tönnis angle >15° were associated with conversion to THA. No statistically significant differences were found between those who underwent conversion to THA and those who did not regarding lateral center-edge angle, Sharp angle, or alpha angle. Significant improvements were seen at follow-up of 12 years (range, 10-13) for the modified Harris Hip Score (58 to 83; P = .002), Hip Outcome Score–Activities of Daily Living (70 to 87; P = .003), Hip Outcome Score–Sport (47 to 76; P = .004), and Western Ontario and McMaster Universities Osteoarthritis Index (31 to 10; P = .001). At follow-up, >80% maintained the minimal clinically important difference for the Hip Outcome Score (Activities of Daily Living and Sport) with no differences between patients aged <40 and ≥40 years. Conclusion: Risk factors for conversion to THA after hip arthroscopy in the borderline dysplastic hip included older age, higher Tönnis grades, grade 4 chondral lesions that were microfractures, and Tönnis angle >15°. In those patients who did not convert to THA, improvement in outcome measures was seen at 10 years. Careful patient selection is critical to the success of this procedure.

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Introduction: The prevalence of food insecurity (FI) and insulin rationing among patients with diabetes who present to the emergency department (ED) is unclear. We examined the prevalence of food insecurity and subtherapeutic insulin use among patients who presented to the ED with a blood glucose level of greater than 250 milligrams per deciliter. Methods: This was a single-center, cross-sectional survey of clinically stable, hyperglycemic adults in the ED for food insecurity using the Hunger Vital Sign screening tool. Patients who were insulin dependent were asked about insulin usage and rationing.

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Background: Femoroacetabular impingement (FAI) is often a chronic problem, which can lead to a decrease in mental well-being. Purpose/Hypothesis: The purpose of this study was to determine patient mental health improvement after hip arthroscopy and if this improvement correlated with improved outcomes. It was hypothesized that patients with low mental health (LMH) status would improve after hip arthroscopy for FAI and that their patient-reported outcomes (PROs) would significantly improve after surgery. Study Design: Cohort study; Level of evidence, 3. Methods: Patients who underwent hip arthroscopy with labral repair between 2008 and 2015 were included. The minimum follow-up was 2 years. PROs included the modified Harris Hip Score (mHHS), Hip Outcome Score–Activities of Daily Living (HOS-ADL), HOS–Sports (HOS-Sports), and 12-Item Short Form Health Survey (SF-12). The minimal clinically important difference and Patient Acceptable Symptom State (PASS) were determined for HOS-ADL, HOS-Sports, and the mHHS based on previously published studies. Patients who scored <46.5 on the SF-12 Mental Component Summary (MCS) were in the LMH group, and those who scored ≥46.5 were in the high mental health (HMH) group. Results: In total, 120 (21%) of the 566 patients were in the LMH group and 446 (79%) patients were in the HMH group preoperatively. There was no difference in age or sex between groups. Patients in the LMH group had lower mHHS, HOS-ADL, and HOS-Sports at the mean 4-year follow-up and were less likely to reach PASS for the scores. Postoperatively, 84% (478/566) of the entire group was in the HMH group. A total of 88 (73%) of the LMH group improved to HMH. A multiple linear regression model for change in MCS identified independent predictors of changes in preoperative MCS to be LMH group preoperatively, change in HOS-Sports, and change in mHHS ( r2 = 0.4; P < .001). Conclusion: HMH was achieved in 84% of the patients after hip arthroscopy for FAI. Improvement in MCS was correlated with function and activity, as indicated by a significant correlation with HOS-ADL and HOS-Sports. A small percentage of patients did see a decline in their MCS score. This study showed that patients with LMH scores before hip arthroscopy for FAI can improve to normal/high mental health, and this correlated with higher PROs.

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Background: There is no established superior treatment for femoral neck impingement cysts, which may be symptomatic and can create a challenge in the arthroscopic treatment of femoroacetabular impingement. Isolated decompression of these cysts may lead to biomechanical compromise and an increased risk of femoral neck fracture similar to that associated with cortical perforation in osteoplasty of cam lesions, given the remaining focal osseous disruption and cortical discontinuity analogous to a burr perforation. Indications: In patients undergoing arthroscopic treatment of femoroacetabular impingement and found to have femoral neck impingement cyst warranting decompression, occlusion of the remaining defect with a biocomposite anchor may improve symptoms related to the impingement cyst as well as reduce the risk of femoral neck fracture. Technique Description: This surgical technique video demonstrates the filling of a femoral neck impingement cyst using a case example of a very active middle-aged woman undergoing arthroscopic treatment of femoroacetabular impingement. During cam osteoplasty in the peripheral compartment phase, the cyst is decompressed using a curette. An appropriately sized bioabsorbable suture anchor is secured into the defect and the sutures removed. The osteoplasty is resumed over the screw to achieve contouring of the femoral neck commensurate with an adequate head-neck offset confirmed by dynamic intraoperative hip examination. Results: Postoperative imaging from this procedure reveals bony in-fill with gradual dissolution of the biocomposite anchor. In our cohort of patients treated with biocomposite anchors concomitant to arthroscopic treatment of femoracetabular impingement with follow-up ranging from 2 to 12 years, there were no self-reported femoral neck fractures. Discussion/Conclusion: We expect that treatment of femoral neck impingement cysts with biocomposite anchors will stimulate bony in-fill of the defect stimulated by the anchor, with a decrease in the risk of femoral neck fracture as compared with an untreated cyst. Further research is needed to strengthen the evidence surrounding comparative treatment of impingement cysts as well as the optimal choice of material in the case of occlusion with a biocomposite anchor.