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clinical trials are important aspects of Mayo Clinic’s efforts to manage hip conditions. A study redefining the natural history of osteoarthritis in people with hip dysplasia and impingement received the John Charnley Award in 2017. In the January 2021 issue of American Journal of Sports Medicine, Mayo orthopedic surgeons defined the incidence of FAI in the general population and the increase in diagnoses of FAI between 2000 and 2016. Patients treated at the Young Hip Clinic might also be eligible to participate in clinical trials. Mayo Clinic is leading a randomized trial evaluating treatment outcomes for individuals with hip dysplasia who have concomitant hip arthroscopy during PAO compared with patients treated with PAO alone. “Right now, we don’t completely grasp whether arthroscopy is always beneficial with PAO. This trial will advance the science of treating these conditions,” Dr. Sierra says. Mayo Clinic is also participating in a multicenter clinical trial, funded by the Department of Defense, that is investigating predictors of outcomes for FAI. In addition, Mayo’s orthopedic surgeons are working to improve surgical techniques. One Figure 1. A preoperative X-ray illustrates the complex condition of 26-year-old man with combined hip dysplasia and impingement due to femoral head-neck junction abnormality and femoral retroversion. B. An intraoperative image shows hip arthroscopy performed after labral repair and femoral head-neck junction osteochondroplasty. C. An X-ray taken four months after treatment shows correction after periacetabular osteotomy, cam resection and derotational femoral osteotomy. Figure 2. Images illustrate the advantages of 3D imaging for the management of complex hip conditions. A. An X-ray shows what appears to be a good cam resection (red arrow) in a 24-year-old man who presented at Mayo Clinic with continued hip pain after two hip arthroscopy procedures performed elsewhere. B. A 3D CT scan of the same hip shows large areas of residual cam impingement (yellow and red arrows). A A B B C MAYO CLINIC | OrthopedicSurgeryUpdate 7 Brandon J. Yuan, M.D. Ankle Injuries: Seeking Stability and a Return to Activity Ankle injuries are fairly common and often debilitating, preventing individuals from resuming their normal levels of activity. And treatment modalities are evolving. At Mayo Clinic, orthopedic surgeons specializing in trauma take a personalized approach for patients of all ages and activity levels. “We have a very high volume of ankle fractures — up to 250 patients a year — with many seen during the winter when people slip and fall on ice,” says Brandon J. Yuan, M.D., an orthopedic surgeon at Mayo Clinic in Rochester, Minnesota, with fellowship training in trauma. One unresolved issue in ankle fracture care is the need for fixation of the posterior malleolus during surgical fixation of ankle fractures, particularly when the fragment is small. Mayo Clinic is launching a clinical trial to evaluate operative versus nonoperative interventions for individuals with posterior malleolar fractures that involve less than 25% of the articular surface. Increasing attention is also being paid to the long-term stability of an individual’s ankle after treatment for fracture. “We are focusing more on the role of the deltoid ligament. For some patients, deltoid repair is important to providing ankle stability,” Dr. Yuan says. Treatment modalities are also evolving for the syndesmosis. “Our thinking has shifted. We’re focusing more on the rotational and translational instability associated with the syndesmosis, and the role that suture fixation or ligament repair can have in restoring normal motion, as opposed to screw fixation,” Dr. Yuan says. “Our goal is for patients to get back to what feels like a normal ankle, especially because syndesmotic injuries are common and occur in people who are younger and and of working age (Figure).” As a major orthopedic surgery center, Mayo Clinic has physical therapists with extensive experience with ankle rehabilitation. “A multidisciplinary approach is key to helping patients regain function,” Dr. Yuan says. “Our care starts with orthopedic traumatologists but continues through all aspects of the patient’s medical care and recovery.” For more information Clinical trials: A Study to Evaluate Operative versus Non-operative Intervention of Posterior Malleolar Fractures Involving Less than 25% of the Articular Surface. Mayo Clinic. project involves the use of 3D-printed surgical guides for patients having PAO. In another effort, Mayo’s engineering specialists are working to develop finite element analysis to improve the positioning of the hip during surgery to better prevent arthritis. “What’s truly unique about the Young Hip Clinic is the number and range of specialties that we utilize,” Dr. Sierra says. “It’s a new, holistic approach to care for these patients.” For more information Wyles CC, et al. The John Charnley Award: Redefining the natural history of osteoarthritis in patients with hip dysplasia and impingement. Clinical Orthopaedics and Related Research. 2017;475:336. Hale RF, et al. Incidence of femoroacetabular impingement and surgical management trends over time. American Journal of Sports Medicine. 2021;49:35. Mayo Clinic. Clinical Trial of Concomitant Hip Arthroscopy During PAO. ClinicalTrials.gov. Washington University School of Medicine. Identification of
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