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Kim AG, Rizk AA, Ina JG, Magister SJ, Salata MJ. Declining Inflation-Adjusted Medicare Physician Fees: An Unsustainable Trend in Hip Arthroscopy. J Am Acad Orthop Surg 2024; 32:604-610. [PMID: 38626441 DOI: 10.5435/jaaos-d-23-00080] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/24/2023] [Accepted: 02/25/2024] [Indexed: 04/18/2024] Open
Abstract
INTRODUCTION Although hip arthroscopy continues to be one of the most used arthroscopic procedures, no focused, comprehensive evaluation of reimbursement trends has been conducted. The purpose of this study was to analyze the temporal Medicare reimbursement trends for hip arthroscopy procedures. METHODS From 2011 to 2021, the Medicare Physician Fee Schedule Look-Up Tool was queried for Current Procedural Terminology (CPT) codes related to hip arthroscopy (29860 to 29863, 29914 to 29916). All monetary data were adjusted to 2021 US dollars. The compound annual growth rate and total percentage change were calculated. Mann-Kendall trend tests were used to evaluate the reimbursement trends. RESULTS Based on the unadjusted values, a significant increase in physician fee was observed from 2011 to 2021 for CPT codes 29861 (removal of loose or foreign bodies; % change: 3.49, P = 0.03) and 29862 (chondroplasty, abrasion arthroplasty, labral resection; % change: 3.19, P = 0.03). The remaining CPT codes experienced no notable changes in reimbursement based on the unadjusted values. After adjusting for inflation, all seven of the hip arthroscopy CPT codes were observed to experience a notable decline in Medicare reimbursement. Hip arthroscopy with acetabuloplasty (CPT: 29915) and labral repair (CPT: 29916) exhibited the greatest reduction in reimbursement with a decrease in physician fee of 24.69% ( P < 0.001) and 24.64% ( P < 0.001), respectively, over the study period. DISCUSSION Medicare reimbursement for all seven of the commonly used hip arthroscopy services did not keep up with inflation, demonstrating marked reductions from 2011 to 2021. Specifically, the inflation-adjusted reimbursements decreased between 19.23% and 24.69% between 2011 and 2021.
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Affiliation(s)
- Andrew G Kim
- From the Department of Orthopaedic Surgery and Sports Medicine, University Hospitals Cleveland Medical Center, Cleveland, OH
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Tian J, Li Y, Tong Y, Ji L, Zhang W, Zhong X, Zhu S, Kang Y, Bi Q. Unveiling hotspots and trends in hip arthroscopy research: A bibliometric and visualized analysis (1900-2022). Medicine (Baltimore) 2024; 103:e38198. [PMID: 38788035 PMCID: PMC11124675 DOI: 10.1097/md.0000000000038198] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/07/2023] [Accepted: 04/19/2024] [Indexed: 05/26/2024] Open
Abstract
Over the past 10 years, hip arthroscopy has been increasingly employed to effectively diagnose and safely treat a range of hip pathologies. With research related to hip arthroscopy continually expanding, the number of articles connected with hip arthroscopy has also consistently grown. We aimed to investigate trends and hotspots in hip arthroscopy-related research, and analyze the top 100 most-cited articles on hip arthroscopy. We searched for ("hip arthroscopy") AND ("article" OR "review") AND "English" in the Web of Science database from 1900 to 2022, which was used to obtain all publications relating to hip arthroscopy. Distribution of country, affiliated institution, journal, authors, citation frequency and keywords were analyzed using VOSviewer. A total of 1094 articles were selected from the Web of Science Core Collection (WoSCC) from 1900 to 2022. The number of publications concerning hip arthroscopy displayed an ascending trend over time. Among the countries, the United States emerged as the largest contributor to the number of articles. The highest prolific institution was American Hip Institute. Among the journals, the highest-ranking journal was "Arthroscopy-the Journal of Arthroscopic and Related Surgery," with 8316 citation counts and 262 articles. The area of greatest research interest was diagnosis and therapy in the field. The scientific articles on the subject of hip arthroscopy have risen continuously in recent years. The United States was the most influential country and made the most significant contributions to this field globally. We identified the research direction and trend for the first time and provided the most recent bibliometric analysis on hip arthroscopy, which may assist researchers in conducting studies on hip arthroscopy.
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Affiliation(s)
- Jinlong Tian
- Center for Rehabilitation Medicine, Department of Orthopedics, Zhejiang Provincial People’s Hospital (Affiliated People’s Hospital, Hangzhou Medical College), Hangzhou, China
- Bengbu Medical College, Bengbu, Anhui, China
| | - Yanlei Li
- Center for Rehabilitation Medicine, Department of Orthopedics, Zhejiang Provincial People’s Hospital (Affiliated People’s Hospital, Hangzhou Medical College), Hangzhou, China
- Bengbu Medical College, Bengbu, Anhui, China
| | - Yu Tong
- Center for Rehabilitation Medicine, Department of Orthopedics, Zhejiang Provincial People’s Hospital (Affiliated People’s Hospital, Hangzhou Medical College), Hangzhou, China
| | - Lichen Ji
- Department of Joint Surgery, Shanghai East Hospital, Tongji University School of Medicine, Shanghai, China
| | - Wei Zhang
- Department of Orthopedics, Taizhou Hospital of Zhejiang Province affiliated to Wenzhou Medical University, Linhai, Zhejiang, China
| | - Xugang Zhong
- Center for Rehabilitation Medicine, Department of Orthopedics, Zhejiang Provincial People’s Hospital (Affiliated People’s Hospital, Hangzhou Medical College), Hangzhou, China
| | - Senbo Zhu
- Center for Rehabilitation Medicine, Department of Orthopedics, Zhejiang Provincial People’s Hospital (Affiliated People’s Hospital, Hangzhou Medical College), Hangzhou, China
| | - Yao Kang
- Center for Rehabilitation Medicine, Department of Orthopedics, Zhejiang Provincial People’s Hospital (Affiliated People’s Hospital, Hangzhou Medical College), Hangzhou, China
| | - Qing Bi
- Center for Rehabilitation Medicine, Department of Orthopedics, Zhejiang Provincial People’s Hospital (Affiliated People’s Hospital, Hangzhou Medical College), Hangzhou, China
- Bengbu Medical College, Bengbu, Anhui, China
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McMillan S, Ford E, Lau V. Arthroscopic Hip Labral Repair Using Needle Arthroscopic Visualization. Arthrosc Tech 2024; 13:102819. [PMID: 38312889 PMCID: PMC10837843 DOI: 10.1016/j.eats.2023.08.024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/25/2023] [Accepted: 08/27/2023] [Indexed: 02/06/2024] Open
Abstract
Hip arthroscopy has become increasingly popular in recent years and continues to grow as techniques and understanding of hip arthroscopy evolve. Needle hip arthroscopy is emerging as a technique that can offer potential advantages compared with a traditional arthroscope. These benefits include a higher degree field of view, lower profile design for easier maneuverability, decreased arthroscopic fluid, and potentially decreased postoperative pain and swelling. We herein present and describe a technique of needle hip arthroscopy as a viable option in the treatment of hip pathology.
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Affiliation(s)
| | | | - Vincent Lau
- Jefferson Health, New Jersey, Stratford, New Jersey, U.S.A
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Tzaveas A, Kyriakidis T, Chouliaras V, Iosifidis M. Arthroscopic Removal of a Free-Floating Bullet From the Hip Joint. Cureus 2023; 15:e51127. [PMID: 38274932 PMCID: PMC10810554 DOI: 10.7759/cureus.51127] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/26/2023] [Indexed: 01/27/2024] Open
Abstract
Gunshot injuries and bullet removal are extremely rare indications for hip arthroscopy. We present the case of a 22-year-old male with a free-floating bullet in the hip joint after a gunshot injury. A thorough imaging investigation was used to demonstrate the exact location of the foreign body. The bullet was removed by arthroscopic means under fluoroscopic guidance. The patient has been symptom-free for two years postoperatively. The tips and tricks of the technique are discussed. Hip arthroscopy is a minimally invasive technique to remove a free-floating bullet and avoid potential long-term complications like chondral injury and lead intoxication.
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Affiliation(s)
- Alexandros Tzaveas
- 3rd Orthopedic Department, Interbalkan Medical Center, Thessaloniki, GRC
| | | | | | - Michael Iosifidis
- 3rd Orthopedic Department, Interbalkan Medical Center, Thessaloniki, GRC
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Holler JT, Halvorson RT, Salesky M, Ma CB, Feeley BT, Leavitt AD, Lansdown DA, Zhang AL. Incidence of Venous Thromboembolism After Hip Arthroscopy Is Low With or Without Prophylaxis but Risk Factors Include Oral Contraceptive Use, Obesity, and Malignancy. Arthroscopy 2023; 39:981-987.e1. [PMID: 36334853 DOI: 10.1016/j.arthro.2022.10.029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/08/2022] [Revised: 09/28/2022] [Accepted: 10/20/2022] [Indexed: 11/18/2022]
Abstract
PURPOSE To determine the incidence of and risk factors for symptomatic venous thromboembolism (VTE) after hip arthroscopy (HA) and thromboprophylaxis prescription utilization for this procedure. METHODS The PearlDiver Mariner database was queried using Current Procedural Terminology codes to identify adult patients (aged ≥ 18 years) who underwent HA between 2010 and 2020. Patient demographic information, including age, oral contraceptive use, and medical comorbidities, as well as perioperative thromboprophylaxis utilization, was recorded using International Classification of Diseases codes and National Drug Codes. The incidence of postoperative VTE within 90 days was determined. Multivariate logistic regression was used to identify predictors of perioperative thromboprophylaxis utilization and risk factors for VTE. RESULTS The queried records identified 60,181 patients who met the inclusion criteria. Of these patients, 367 (0.6%) experienced VTE, including deep venous thrombosis (0.5%) and/or pulmonary embolism (0.2%). Approximately 2.1% of patients used thromboprophylaxis, including aspirin (1.1%), low-molecular-weight heparin (0.9%), and oral factor Xa inhibitors (0.1%). Oral contraceptive pill use (adjusted odds ratio [aOR], 2.16; 95% confidence interval [CI], 1.34-3.46), obesity (aOR, 1.37; 95% CI, 1.05-1.79), and a history of malignancy (aOR, 1.69; 95% CI, 1.12-2.54) were associated with increased odds of experiencing VTE. Perioperative thromboprophylaxis (aOR, 0.52; 95% CI, 0.19-1.39) was not significantly associated with decreased odds of experiencing VTE. However, obesity (aOR, 1.17; 95% CI, 1.00-1.38) and hypertension (aOR, 1.17; 95% CI, 1.02-1.36) were associated with increased odds of thromboprophylaxis prescription utilization. CONCLUSIONS Although the overall risk of symptomatic VTE after HA remains low, oral contraceptive use, obesity, and a history of malignancy are associated with increased odds of thromboembolic events within 90 days. Routine thromboprophylaxis after HA may not be indicated in all patients but can be considered based on patient-specific risk factors. LEVEL OF EVIDENCE Level III, retrospective prognostic comparative trial.
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Affiliation(s)
- Jordan T Holler
- Department of Orthopaedic Surgery, University of California San Francisco, San Francisco, California, U.S.A
| | - Ryan T Halvorson
- Department of Orthopaedic Surgery, University of California San Francisco, San Francisco, California, U.S.A
| | - Madeleine Salesky
- Department of Orthopaedic Surgery, University of California San Francisco, San Francisco, California, U.S.A
| | - C Benjamin Ma
- Department of Orthopaedic Surgery, University of California San Francisco, San Francisco, California, U.S.A
| | - Brian T Feeley
- Department of Orthopaedic Surgery, University of California San Francisco, San Francisco, California, U.S.A
| | - Andrew D Leavitt
- Division of Hematology and Oncology, Department of Medicine, University of California San Francisco, San Francisco, California, U.S.A
| | - Drew A Lansdown
- Department of Orthopaedic Surgery, University of California San Francisco, San Francisco, California, U.S.A
| | - Alan L Zhang
- Department of Orthopaedic Surgery, University of California San Francisco, San Francisco, California, U.S.A..
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Teissier V, Pujol N. Unplanned return to the operating room after arthroscopic procedures: a need to consider 12 months after the initial surgery. Arch Orthop Trauma Surg 2023; 143:2055-2062. [PMID: 35778529 DOI: 10.1007/s00402-022-04522-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/07/2022] [Accepted: 06/12/2022] [Indexed: 11/25/2022]
Abstract
INTRODUCTION The purpose of this study was to report the proportion and cause of unplanned revision surgery rates within 1 year following arthroscopic procedures. Our hypothesis was that there is a significant rate of unplanned returns (URs) occurring between 3 and 12 months after the initial procedure and that causes of revision are different when considering the delay after the index surgery. MATERIALS AND METHODS Among 4142 consecutive patients who underwent an arthroscopic procedure in a single department of orthopedics and traumatology, patients undergoing revision surgery for any reasons directly related to the primary procedure were included. Cause for revision, surgical site, delay from index procedure, and number of revisions were screened. RESULTS Seventy-eight patients underwent 97 revision surgeries (2.3%) for reasons directly related to the primary procedure. Most revision surgeries were performed after month 3 following index surgery (59 patients, 60.8%). Mean time to revision surgery was 5.3 ± 4.3 months (range 0-365 days). Usual early-onset (< 3 months) reasons for unplanned revision were surgical site infection (17 patients, 0.41%), wound-healing defect (12 patients, 0.29%), and hemorrhagic complication (7 patients, 0.17%). Reasons for delayed unplanned revision (> 3 months) were index procedure failure (21 patients, 0.51%), stiffness (18 patients, 0.43%), and removal of hardware (16 patients, 0.41%). CONCLUSIONS Reasons for return to the operating room (OR) are different depending on the timepoint from index procedure. Patients should receive relevant information accordingly when scheduling any arthroscopic procedure, including up to 1-year potential complications. LEVEL OF EVIDENCE Prognostic study, Case series, Level IV.
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Affiliation(s)
- Victoria Teissier
- Department of Orthopedic Surgery, Centre Hospitalier de Versailles, Le Chesnay, France
| | - Nicolas Pujol
- Department of Orthopedic Surgery, Centre Hospitalier de Versailles, Le Chesnay, France.
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Inclan PM, Wright RW, Smith MV, Brophy RH. Early-Career Sports Medicine Surgeons Perform a Large Volume of Non-Sports Medicine Procedures: American Board of Orthopaedic Surgery (ABOS) Part-II Data Regarding Orthopaedic Surgeons Specializing in Sports Medicine. J Bone Joint Surg Am 2022; 104:e97. [PMID: 35777936 DOI: 10.2106/jbjs.21.01129] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND The purpose of this study was to utilize the American Board of Orthopaedic Surgery (ABOS) Part-II Case List database to (1) define the practice patterns of sports medicine-trained ABOS Part- II Oral Examination Candidates and (2) describe the frequency and practice patterns of individuals who are dual fellowship-trained sports medicine candidates. METHODS The ABOS Part-II Case List database was utilized to define all cases submitted by 3,298 applicants indicating completion of a sports medicine fellowship between January 1, 2003, and January 1, 2020. Cases were classified by subspecialty category and case type. The frequency and practice patterns of candidates pursuing additional fellowship training (i.e., "dual fellowship-trained") were recorded. Descriptive statistical methods were used to describe the annual and overall procedure volume and candidate case mix. Trends in the relative frequency of cases performed and fellowship training patterns were determined using linear regression analysis. RESULTS On average, sports medicine-trained candidates submitted 100.6 cases for review during the 6-month case collection period: 59.0 (58.6%) sports medicine/arthroscopy cases, 29.3 (29.1%) trauma/general cases, 4.5 (4.5%) adult reconstruction cases, and 7.8 (7.8%) "other" cases per candidate. Although candidates performed fewer total (r 2 = 0.84, p < 0.001) and sports medicine/arthroscopy (r 2 = 0.85, p < 0.001) cases over the study period, the proportion of sports medicine/arthroscopy cases did not change over the study period (p = 0.18). Dual fellowship training was indicated by 333 individuals (10.1%). The number of dual fellowship-trained candidates pursuing additional fellowship training in pediatrics and adult reconstruction increased over the study period, and the number of dual fellowship-trained candidates pursuing additional fellowship training in trauma decreased over the study period. CONCLUSIONS Early-career sports medicine candidates are likely to perform >40% of cases outside of the sports medicine subspecialty. Sports medicine trainees are increasingly likely to pursue a second fellowship in pediatrics or adult reconstruction. LEVEL OF EVIDENCE Therapeutic Level III . See Instructions for Authors for a complete description of levels of evidence.
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Affiliation(s)
- Paul M Inclan
- Department of Orthopaedic Surgery, Washington University in St. Louis, St. Louis, Missouri
| | - Rick W Wright
- Department of Orthopaedic Surgery, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Matthew V Smith
- Department of Orthopaedic Surgery, Washington University in St. Louis, St. Louis, Missouri
| | - Robert H Brophy
- Department of Orthopaedic Surgery, Washington University in St. Louis, St. Louis, Missouri
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Ramkumar PN, Helm JM, Berrier AS, Vega JF, Yalcin S, Kunze KN, Harris JD, Nwachukwu BU. Preoperative Magnetic Resonance Imaging Offers Questionable Clinical Utility, Delays Time to Hip Arthroscopy, and Lacks Cost-Effectiveness in Patients Aged ≤40 Years With Femoroacetabular Impingement Syndrome: A Retrospective 5-Year Analysis. Arthroscopy 2022; 38:3013-3019. [PMID: 35364263 DOI: 10.1016/j.arthro.2022.03.025] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/06/2022] [Revised: 03/11/2022] [Accepted: 03/11/2022] [Indexed: 02/02/2023]
Abstract
PURPOSE To assess the clinical utility of preoperative magnetic resonance imaging (MRI) and quantify the delay in surgical care for patients aged ≤40 years undergoing primary hip arthroscopy with history, physical examination, and radiographs concordant with femoroacetabular impingement syndrome (FAIS). METHODS From August 2015 to December 2020, 1,786 consecutive patients were reviewed from the practice of 1 fellowship-trained hip arthroscopist. Inclusion criteria were FAIS, primary surgery, and age ≤40 years. Exclusion criteria were MRI contraindication, reattempt of conservative management, or concomitant periacetabular osteotomy. After nonoperative treatment options were exhausted and a surgical plan was established, patients were stratified by those who presented with versus without MRI. Those without existing MRI received one, and any deviations from the surgical plan were noted. All preoperative MRIs were compared with office evaluation and intraoperative findings to assess agreement. Demographic data, Hip Disability and Osteoarthritis Outcome Score (HOOS)-Pain, and time from office to MRI or arthroscopy were recorded. RESULTS Of the patients indicated by history, physical examination, and radiographs alone (70% female, body mass index 24.8 kg/m2, age 25.9 years), 198 patients presented without MRI and 934 with MRI. None of the 198 had surgical plans altered after MRI. Patients in both groups had MRI findings demonstrating anterosuperior labral tears that were visualized and repaired intraoperatively. Mean time from office to arthroscopy for patients without MRI versus those with was 107.0 ± 67 and 85.0 ± 53 days, respectively (P < .001). Time to MRI was 22.8 days. No difference between groups was observed among the 85% of patients who surpassed the HOOS-Pain minimal clinically important difference (MCID). CONCLUSION Once indicated for surgery based on history, physical examination, and radiographs, preoperative MRI did not alter the surgical plan for patients aged ≤40 years with FAIS undergoing primary hip arthroscopy. Moreover, preoperative MRI delayed time to arthroscopy. The necessity of routine preoperative MRI in the young primary FAIS population should be challenged.
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Affiliation(s)
- Prem N Ramkumar
- Department of Orthopaedic Surgery, Brigham & Women's Hospital, Boston, Massachusetts, U.S.A.; Center for Hip Preservation, Hospital for Special Surgery, New York, New York, U.S.A..
| | - J Matthew Helm
- Department of Orthopaedic Surgery, McGovern Medical School University of Texas Health Science Center, Houston, Texas, U.S.A
| | - Ava S Berrier
- Department of Orthopaedic Surgery, Baylor College of Medicine, Houston, Texas, U.S.A
| | - Jose F Vega
- Sports Health Center, Cleveland Clinic, Cleveland, Ohio, U.S.A
| | - Sercan Yalcin
- Department of Sports Medicine, Yale School of Medicine, New Haven, Connecticut, U.S.A
| | - Kyle N Kunze
- Center for Hip Preservation, Hospital for Special Surgery, New York, New York, U.S.A
| | - Joshua D Harris
- Houston Methodist Orthopedics & Sports Medicine, Houston, Texas, U.S.A
| | - Benedict U Nwachukwu
- Center for Hip Preservation, Hospital for Special Surgery, New York, New York, U.S.A
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Sudah SY, Michel C, Faccone RD, Kirchner G, Kim R, Menendez ME, Gabisan G. Ankle Arthroscopy Procedural Volume Is Low Among Graduating Orthopaedic Surgery Residents. Arthrosc Sports Med Rehabil 2022; 4:e1609-e1615. [PMID: 36312716 PMCID: PMC9596817 DOI: 10.1016/j.asmr.2022.06.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2022] [Accepted: 06/04/2022] [Indexed: 11/24/2022] Open
Abstract
Purpose To evaluate graduating orthopaedic resident case volume and variability for ankle arthroscopy from 2016 to 2020. Methods The Accreditation Council for Graduate Medical Education surgical case log data from 2016 to 2020 for graduating United States orthopaedic surgery residents was assessed. Arthroscopy procedures of the leg/ankle were categorized. The average number of cases performed per resident was compared from 2016 to 2020 to determine the percent change in case volume. The 10th, 30th, 50th, 70th, and 90th percentiles of case volumes from 2016 to 2020 were presented to demonstrate case volume variability. Results There was no significant change in the average number of leg/ankle arthroscopy cases from 2016 to 2020 (6.2 ± 5 [range 0-35] vs 6.1 ± 6 [range 0-76] P = .732), despite a 19% increase in the average number of total leg/ankle procedures performed over time (168.4 ± 47 [range 55-414] in 2016; 200.8 ± 57 in 2020 [range 67-601], P < .001). There was wide variability in ankle arthroscopy case volume among residents. The 90th percentile of residents performed 13 cases in 2020, compared with 5 in 50th percentile, and 1 in the 10th percentile. Conclusions Orthopaedic surgery resident exposure to ankle arthroscopy has remained low and highly variable overtime, despite an overall increase in the total number of leg/ankle procedures performed. Clinical Relevance Understanding ankle arthroscopy in case volume and variability is important for programs to ensure that orthopaedic residents are gaining adequate exposure to increasingly popular procedures. Orthopaedic surgery residency programs should explore methods to increase resident exposure to ankle arthroscopy.
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Affiliation(s)
- Suleiman Y. Sudah
- Department of Orthopedics, Monmouth Medical Center, Long Branch, New Jersey, U.S.A
- Address correspondence to Suleiman Y. Sudah, M.D., Monmouth Medical Center, 50 Chelsea Ave., Long Branch, NJ 07740.
| | - Christopher Michel
- Department of Orthopedics, Monmouth Medical Center, Long Branch, New Jersey, U.S.A
| | - Robert D. Faccone
- Department of Research, Alabama College of Osteopathic Medicine, Dothan, Alabama, U.S.A
| | - Gregory Kirchner
- Department of Orthopedics, Penn State University, State College, Pennsylvania, U.S.A
| | - Raymond Kim
- Department of Orthopedics, Penn State University, State College, Pennsylvania, U.S.A
| | | | - Glenn Gabisan
- Professional Orthopedic Associates, Tinton Falls, New Jersey, U.S.A
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Hip Arthroscopy Procedural Volume Is Low Among Graduating Orthopaedic Surgery Residents. Arthrosc Sports Med Rehabil 2022; 4:e1179-e1184. [PMID: 35747642 PMCID: PMC9210477 DOI: 10.1016/j.asmr.2022.04.016] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2021] [Revised: 03/20/2022] [Accepted: 04/16/2022] [Indexed: 12/25/2022] Open
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Alter TD, Knapik DM, Guidetti M, Espinoza A, Chahla J, Nho SJ, Malloy P. Three-Dimensional Quantification of Cam Resection Using MRI Bone Models: A Comparison of 2 Techniques. Orthop J Sports Med 2022; 10:23259671221095417. [PMID: 35547617 PMCID: PMC9083056 DOI: 10.1177/23259671221095417] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/17/2022] [Accepted: 02/25/2022] [Indexed: 11/15/2022] Open
Abstract
Background: The current clinical standard for the evaluation of cam deformity in femoroacetabular impingement syndrome is based on radiographic measurements, which limit the ability to quantify the complex 3-dimensional (3D) morphology of the proximal femur. Purpose: To compare magnetic resonance imaging (MRI)–based metrics for the quantification of cam resection as derived using a best-fit sphere alpha angle (BFS-AA) method and using 3D preoperative-postoperative surface model subtraction (PP-SMS). Study Design: Descriptive laboratory study. Methods: Seven cadaveric hemipelvises underwent 1.5-T MRI before and after arthroscopic femoral osteochondroplasty, and 3D bone models of the proximal femur were reconstructed from the MRI scans. The alpha angles were measured radially along clockfaces using a BFS-AA method from the literature and plotted as continuous curves for the pre- and postoperative models. The difference between the areas under the curve for the pre- and postoperative models was then introduced in the current study as the BFS-AA–based metric to quantify the cam resection. The cam resection was also quantified using a 3D PP-SMS method, previously described in the literature using the metrics of surface area (FSA), volume (FV), and height (maximum [FHmax] and mean [FHmean]). Bivariate correlation analyses were performed to compare the metrics quantifying the cam resection as derived from the BFS-AA and PP-SMS methods. Results: The mean ± standard deviation maximum pre- and postoperative alpha angle measurements were 59.73° ± 15.38° and 48.02° ± 13.14°, respectively. The mean for each metric quantifying the cam resection with the PP-SMS method was as follows: FSA, 540.9 ± 150.7 mm2; FV, 1019.2 ± 486.2 mm3; FHmax, 3.6 ± 1.0 mm; and FHmean, 1.8 ± 0.5 mm. Bivariate correlations between the BFS-AA–based and PP-SMS–based metrics were strong: FSA (r = 0.817, P = .012), FV (r = 0.888, P = .004), FHmax (r = 0.786, P = .018), and FHmean (r = 0.679, P = .047). Conclusion: Strong positive correlations were appreciated between the BFS-AA and PP-SMS methods quantifying the cam resection. Clinical Relevance: The utility of the BFS-AA technique is primarily during preoperative planning. The utility of the PP-SMS technique is in the postoperative setting when evaluating the adequacy of resection or in patients with persistent hip pain with suspected residual impingement. In combination, the techniques allow surgeons to develop a planned resection while providing a means to evaluate the depth of resection postoperatively.
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Affiliation(s)
- Thomas D. Alter
- Section of Young Adult Hip Surgery, Division of Sports Medicine, Department of Orthopedic Surgery, Hip Preservation Center, Rush University Medical Center, Chicago, Illinois, USA
- Thomas D. Alter, MS, Department of Orthopedic Surgery, Rush University Medical Center, 1611 W Harrison St, Chicago, IL 60612, USA ()
| | - Derrick M. Knapik
- Division of Sports Medicine, Department of Orthopedic Surgery, Washington University, St Louis, Missouri, USA
| | - Martina Guidetti
- Section of Young Adult Hip Surgery, Division of Sports Medicine, Department of Orthopedic Surgery, Hip Preservation Center, Rush University Medical Center, Chicago, Illinois, USA
| | - Alejandro Espinoza
- Section of Young Adult Hip Surgery, Division of Sports Medicine, Department of Orthopedic Surgery, Hip Preservation Center, Rush University Medical Center, Chicago, Illinois, USA
| | - Jorge Chahla
- Section of Young Adult Hip Surgery, Division of Sports Medicine, Department of Orthopedic Surgery, Hip Preservation Center, Rush University Medical Center, Chicago, Illinois, USA
| | - Shane J. Nho
- Section of Young Adult Hip Surgery, Division of Sports Medicine, Department of Orthopedic Surgery, Hip Preservation Center, Rush University Medical Center, Chicago, Illinois, USA
| | - Philip Malloy
- Section of Young Adult Hip Surgery, Division of Sports Medicine, Department of Orthopedic Surgery, Hip Preservation Center, Rush University Medical Center, Chicago, Illinois, USA
- Arcadia University, Glenside, Pennsylvania, USA
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Machine Learning Model Identifies Increased Operative Time and Greater BMI as Predictors for Overnight Admission After Outpatient Hip Arthroscopy. Arthrosc Sports Med Rehabil 2022; 3:e1981-e1990. [PMID: 34977657 PMCID: PMC8689272 DOI: 10.1016/j.asmr.2021.10.001] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2021] [Accepted: 10/06/2021] [Indexed: 01/05/2023] Open
Abstract
Purpose The purposes of this study were to identify patient characteristics and risk factors for overnight admission following outpatient hip arthroscopy and to develop a machine learning algorithm that can effectively identify patients requiring admission following elective hip arthroscopy. Methods A retrospective review of a prospectively collected national surgical outcomes database was performed to identify patients who underwent elective outpatient hip arthroscopy from 2006 to 2018. Patients admitted overnight postoperatively were identified as those with length of stay of 1 or more days. Models were generated using random forest (RF), extreme gradient boosting (XGBoost), adaptive boosting (AdaBoost), elastic net penalized logistic regression, and an additional model was produced as a weighted ensemble of the four final algorithms. Results Overall, 1,276 patients were included. The median age was 43 years, and 64.2% (819) were female. Of the included patients, 109 (8.5%) required an overnight stay following elective outpatient hip arthroscopy. The most important factors for inpatient admission were increasing operative time, general anesthesia, age extremes, male gender, greater body mass index (BMI), American Society of Anesthesiologists classification >1, and the following preoperative lab values outside of normal ranges: sodium, platelet count, hematocrit, and leukocyte count. The ensemble model achieved the best performance based on discrimination assessed via internal validation (area under the curve = .71), calibration, and decision curve analysis. The model was integrated into a Web-based open-access application able to provide both personalized predictions and explanations. Conclusion A machine learning algorithm developed based on preoperative features identified increasing operative time, age extremes, greater BMI, sodium, hematocrit, platelets, and leukocyte count as the most important variables associated with inpatient admission with fair validity.
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Telemedicine as a Therapeutic Option in Sports Medicine: Results of a Nationwide Cross-Sectional Study among Physicians and Patients in Germany. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18137110. [PMID: 34281045 PMCID: PMC8297228 DOI: 10.3390/ijerph18137110] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/17/2021] [Revised: 06/30/2021] [Accepted: 07/01/2021] [Indexed: 12/05/2022]
Abstract
Background: Worldwide, the number of treatments in the field of sports medicine is increasing. However, the COVID-19 pandemic has changed everyday life. Many consultations had to be cancelled, postponed, or converted to a virtual format. Telemedicine in sports medicine could support physicians. This study analyzes the use and perception of telemedicine applications among physicians and patients in the field of sports medicine in Germany. Methods: This prospective cross-sectional study was based on a survey of sports medicine physicians and patients in Germany during the COVID-19 pandemic. Descriptive statistics were calculated. Results: We analyzed the responses of 729 patients and 702 sports medicine physicians. Most believed that telemedicine is useful. Both physicians and patients rated their knowledge of telemedicine as unsatisfactory. The majority of respondents said they do not currently use telemedicine but would like to do so. Patients and physicians reported that their attitude had changed positively towards telemedicine and that their usage had increased due to COVID-19. The majority in both groups agreed on implementing virtual visits in stable disease conditions. Telemedicine was considered helpful for follow-up monitoring and prevention by both groups. Conclusion: Telemedicine in sports medicine has seen limited use but is highly accepted among physicians and patients alike. The absence of a structured framework is an obstacle to effective implementation. Training courses should be introduced to improve the limited knowledge regarding the use of telemedicine. More research in telemedicine in sports medicine is needed. This includes large-scale randomized controlled trials, economic analyses and explorations of user preferences.
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Spiker AM. Editorial Commentary: Hip Arthroscopy Evolution and Causes of Failure. Arthroscopy 2021; 37:1829-1832. [PMID: 33745935 DOI: 10.1016/j.arthro.2021.03.027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/09/2021] [Accepted: 03/11/2021] [Indexed: 02/02/2023]
Abstract
Hip arthroscopy use has grown as a result of expanding indications; improved imaging including higher resolution magnetic resonance imaging with stronger magnetic fields and the advent of 3-dimensional computed tomography revealing the nuances of hip joint morphology; increased specialized training; improvements in instruments and implants; a record of successful outcomes; and increased understanding of microinstability, focal acetabular undercoverage or occult dysplasia, indications for labral reconstruction and capsular plication, and, most of all, femoroacetabular impingement syndrome, the leading diagnosis for which hip arthroscopy is performed, in the orthopaedic community as well as the general medical and athletic communities. We now know that labral repair results in better outcomes than labral debridement, and evidence suggests that capsule closure leads to better long-term success. Osteoarthritis and its correlate, advanced age, result in inferior survivorship after hip arthroscopy, which is unsurprising; hip preservation surgery is not designed to treat irreparable cartilage damage. Association of female sex with hip arthroscopy failure requires additional investigation. More females undergo hip arthroscopy than males, and females initially present with greater disability. Females tend to have smaller alpha angles, greater femoral and acetabular anteversion, and lower center edge angles than males, consistent with increased prevalence of hip dysplasia. Thus surgeons indicating females for hip arthroscopy should be aware of atypical locations of cam lesions, borderline dysplasia, or ligamentous laxity, all of which must be appropriately respected at the time of surgery. With all of the improvements we have made in techniques, patient diagnosis and surgical indications, and our overall understanding of complex anatomy and a technically challenging surgery, we can speculate that our long-term survivorship will only improve. I await with interest the long-term outcomes we will see 10 years from today, with the addition of insight from patient-reported outcome measures to answer these questions with greater certainty.
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Matsuda DK. Editorial Commentary: Expansion of Hip Arthroscopy in Sports Medicine Fellowship Training: The Good, Bad, and Ugly. Arthroscopy 2021; 37:528-529. [PMID: 33546791 DOI: 10.1016/j.arthro.2020.10.047] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/27/2020] [Accepted: 10/28/2020] [Indexed: 02/02/2023]
Abstract
Orthopaedic sports medicine fellowship experience in hip arthroscopy is increasing rapidly (2.6-fold from 2011 to 2016), although the case numbers vary quite widely (64-fold) depending on the program. Orthopaedic providers are now able to refine diagnoses and refer or render indicated less-invasive hip treatment options, many of which yield outcomes equaling or surpassing those of open equivalents. Patients benefit. Our profession benefits. However, advanced hip arthroscopy procedures are technically challenging, and complications can be significant in inexperienced hands. For those who choose to perform hip arthroscopy after fellowship training, continuing hip arthroscopy education and skill development is essential.
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