Reply to the Letter to the Editor: Bilateral Femoroacetabular Impingement: What is the Fate of the Asymptomatic Hip?
Bibliographic record
Abstract
To the Editor, We thank Dr. Kohno for his interest in our article and for pointing out some important questions that would be beneficial to the surgeons who treat hip pain in young adults. We defined developmental dysplasia of the hip (DDH) as a lateral center-edge angle that is less than 20°, and borderline dysplasia as a lateral center-edge angle between 20° and 25°. In our study, we had four patients with DDH and 21 patients with borderline DDH. We agree with Dr. Kohno that hip symptoms for patients with DDH may be different from those in patients with femoroacetabular impingement (FAI). It is also important to note that patients with DDH can have impingement at the same time. We usually advocate pelvic osteotomy for patients with DDH and hip symptoms. The four patients with DDH in our series were offered pelvic osteotomy as a first-line treatment, but some patients are unwilling to undergo major pelvic osteotomy surgery. In a very select group of patients with symptomatic DDH, who also have impingement symptoms and are unwilling to undergo pelvic osteotomy, we may consider femoroacetabular osteoplasty surgery. As you can see from this cohort, those patients are rare. The nature of femoroacetabular osteoplasty surgery in patients with DDH is somewhat different. We do not trim the acetabulum in these patients. Instead, we repair the labrum and perform a tight capsular closure. Although we believe femoroacetabular osteoplasty surgery can have a role in a very select group of patients with mild DDH, we agree with Dr. Azboy that patients with DDH who have signs and symptoms of instability should not be treated by femoroacetabular osteoplasty but rather offered pelvic osteotomy. Thank you again for raising important questions related to our study.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.003 | 0.029 |
| Meta-epidemiology (narrow) | 0.001 | 0.001 |
| Meta-epidemiology (broad) | 0.002 | 0.001 |
| Bibliometrics | 0.001 | 0.001 |
| Science and technology studies | 0.002 | 0.002 |
| Scholarly communication | 0.002 | 0.005 |
| Open science | 0.003 | 0.001 |
| Research integrity | 0.023 | 0.026 |
| Insufficient payload (model declined to judge) | 0.005 | 0.003 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".