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Yang J, Sun P, Liu Z, Li Y, Zhang J, Liu Y, Zou G. Mid-term Clinical Outcomes of "Light Bulb" Core Decompression with Arthroscopic Assistance in Peri-collapse Osteonecrosis of the Femoral Head: A Retrospective Comparative Study. Orthop Surg 2024; 16:1399-1406. [PMID: 38714345 PMCID: PMC11144504 DOI: 10.1111/os.14058] [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: 10/20/2023] [Revised: 03/17/2024] [Accepted: 03/24/2024] [Indexed: 05/09/2024] Open
Abstract
OBJECTIVE Nontraumatic osteonecrosis of the femoral head (ONFH) is commonly encountered in orthopedics. Without early clinical intervention, most patients with peri-collapse of the ONFH will develop femoral head necrosis and eventually require hip replacement surgery. The aim of this study is to evaluate clinical outcomes in patients with ONFH who underwent "light bulb" core decompression (CD) with arthroscopic assistance and to compare them with the outcomes of those treated with traditional procedures. METHODS A retrospective review of patients with Stage II and IIIA (Peri-collapse) radiographic findings based on the Association Research Circulation Osseous (ARCO) stage for ONFH who underwent "light bulb" CD with or without arthroscopic assistance by a single-surgeon team between March 2014 and December 2018 was performed. All patients were followed up for a minimum of 2 years. The visual analogue scale (VAS) pain score, Harris hip score (HHS), and radiological imaging were evaluated. The categorical parameters were analyzed by chi-square test and the continuous variables conforming to a normal distribution were analyzed by Student's t-test. RESULTS The study included a total of 39 patients (18 and 21 patients in the with and without arthroscopic assistance groups, respectively), with a mean age of 40.3 years and a mean follow-up of 22.2 months. Overall, there was a better VAS score in the arthroscopic assistance group than in the control group (p < 0.05), There was a significant difference in HHS (80.1 ± 9.2 vs 75.1 ± 12.7) at the last follow-up (p < 0.05). The rate of good and excellent outcomes was 94%. Similarly, there was no significant difference in the total rate of complications or conversion to THA. CONCLUSION With arthroscopic assistance, "light bulb" CD could be achieved via hip arthroscopy with less trauma, and it offered the opportunity for more precise evaluation and monitoring for therapy and yielded better VAS scores after surgery and better hip function outcomes at the last follow-up.
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Affiliation(s)
- Jibin Yang
- Department of Orthopedic SurgeryAffiliated Hospital of Zunyi Medical UniversityZunyiChina
| | - Pengpeng Sun
- Department of Orthopedic SurgeryAffiliated Hospital of Zunyi Medical UniversityZunyiChina
| | - Ziming Liu
- Beijing Key Laboratory of Sports Injuries, Department of Sports MedicineInstitute of Sports Medicine of Peking University, Peking University Third HospitalBeijingChina
| | - Yuwan Li
- Beijing Key Laboratory of Sports Injuries, Department of Sports MedicineInstitute of Sports Medicine of Peking University, Peking University Third HospitalBeijingChina
| | - Jun Zhang
- Department of OrthopedicsThe First Affiliated Hospital of Chongqing Medical University, Orthopedic Laboratory of Chongqing Medical UniversityChongqingChina
| | - Yi Liu
- Department of Orthopedic SurgeryAffiliated Hospital of Zunyi Medical UniversityZunyiChina
| | - Gang Zou
- Department of Orthopedic SurgeryAffiliated Hospital of Zunyi Medical UniversityZunyiChina
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Arriaza CR, Navarrete CA, Palos J, Suarez-Ahedo C. Traction-related complications in hip arthroscopy for 26 years. A systematic review. J Hip Preserv Surg 2023; 10:69-74. [PMID: 37900890 PMCID: PMC10604058 DOI: 10.1093/jhps/hnad007] [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: 07/06/2022] [Revised: 01/05/2023] [Accepted: 03/01/2023] [Indexed: 10/31/2023] Open
Abstract
The primary aim of the study is to determine the rate of traction-related complications in hip arthroscopy (HA) including perineal compression and distraction injuries, and the secondary objective is to report the incidence of complications in HA found on the studies selected by a systematic review. Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines were used for data extraction from the PubMed and Cochrane databases obtained in February 2022. Reviewers extracted the title, author, date of publication, number of hips treated and number of complications describing the affected area, nerve and soft tissue injury related to traction. Studies on postless HA and HA combined with other procedures were excluded. Twenty-six years of HA literature was found in the search that included 35 studies and 8126 hips (89% Level IV) that reported the complications found during the procedure and described complications related to traction. A total of 623 hips (7.7%) had some sort of complications during HA, and complications related to traction were in 227 hips (36%). Injuries caused specifically by the perineal compression were in 144 hips (23%) that included the pudendal nerve and soft tissue injury of the groin area. Complications caused by the distraction were in 83 hips (13%) that included sciatic and peroneal nerve injury, numbness or pain of ankle and foot. HA complications occurred in 7.7% of hips treated, which is found in this systematic review. One-third of the complications are related to traction, 23% are caused by perineal compression and 13% are caused by distraction.
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Affiliation(s)
- Carlos R Arriaza
- Department of Orthopaedic Surgery and Hip Arthroscopy, Hospital Herrera Llerandi, 6A avenida 8-71, Guatemala City, Guatemala
- Department of Adult Hip and Knee Reconstruction, Instituto Nacional de Rehabilitacion LGII, Calz. México Xochimilco No. 289 Col. Arenal de Guadalupe, Mexico City C.P.14389, Mexico
| | - Carlos Andrés Navarrete
- Department of Adult Hip and Knee Reconstruction, Instituto Nacional de Rehabilitacion LGII, Calz. México Xochimilco No. 289 Col. Arenal de Guadalupe, Mexico City C.P.14389, Mexico
- Department of Hip Preservation Surgery, Centro de Especialidades Ortopedicas, Av. Mariana de Jesús OE7-02 y Nuño de Valderrama P.B, Quito, Ecuador
| | - Jaime Palos
- Department of Adult Hip and Knee Reconstruction, Instituto Nacional de Rehabilitacion LGII, Calz. México Xochimilco No. 289 Col. Arenal de Guadalupe, Mexico City C.P.14389, Mexico
- Department of Sports Medicine and Arthroscopy, Hospital Central Dr. Ignacio Morones Prieto, Avenida Venustiano Carranza No. 2395, San Luis Potosi C.P. 78290, Mexico
| | - Carlos Suarez-Ahedo
- Department of Adult Hip and Knee Reconstruction, Instituto Nacional de Rehabilitacion LGII, Calz. México Xochimilco No. 289 Col. Arenal de Guadalupe, Mexico City C.P.14389, Mexico
- Department of Orthopaedic Surgery, Hospital Medica Sur SA, Puente de Piedra 150, Toriello Guerra, Tlalpan, Mexico City C.P. 14050, Mexico
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Su T, Ao Y, Yang L, Chen GX. Tissue Integration and Chondroprotective Potential of Acetabular Labral Augmentation with Autograft Tendon: Study of a Porcine Model. J Bone Joint Surg Am 2023; 105:435-447. [PMID: 36728738 DOI: 10.2106/jbjs.22.00896] [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: 02/03/2023]
Abstract
BACKGROUND The aim of this study was to explore the tissue healing process and changes in articular cartilage following acetabular labral augmentation in a porcine model. METHODS The labrum was resected unilaterally from 10 o'clock to 1 o'clock on the capsular side in 36 pigs. Eighteen pigs underwent labral augmentation (AUG group) using autologous Achilles tendon. No additional procedures were performed in the remaining pigs (control group). The pigs were killed at 6, 12, or 24 weeks postoperatively for histological assessment and measurement of the inflammatory cytokines interleukin (IL)-6, IL-1β, and tumor necrosis factor (TNF)-α in synovial fluid. RESULTS All autografts were well placed in the labral defect in the AUG group, and good integration of the autograft with the remnant chondrolabral junction was observed at 24 weeks; only scar tissue was observed in the control group at 6, 12, and 24 weeks. Fibrochondrocytes were concentrated at the transition between the autograft and native labrum at early time points, and the cells within the autograft labrum were predominantly fibrochondrocytes at 24 weeks. Rough and irregular articular cartilage surfaces were observed in 3 of the 6 samples in the AUG group at 24 weeks; the others appeared smooth. Focal cartilage erosion (predominantly in the acetabulum) occurred in all samples in the control group at 12 and 24 weeks. The Mankin score at 24 weeks was significantly lower in the AUG group than in the control group (mean [95% confidence interval]: 2.33 [1.06 to 3.6] versus 9 [8.06 to 9.94], p < 0.001). Likewise, the concentrations of all cytokines (in pg/mL) were significantly lower in the AUG group than in the control group at 24 weeks (IL-6: 166.6 [155.22 to 177.94] versus 245.9 [242.66 to 249.14], p < 0.001; IL-1β: 122.1 [116.4 to 127.83] versus 282.9 [280.29 to 285.51], p < 0.001; and TNF-α: 56.22 [53.15 to 59.29] versus 135 [131.66 to 138.24], p < 0.001). CONCLUSIONS Autograft tendon used for labral augmentation was able to integrate well with the native labrum, which may help to preserve the articular cartilage. CLINICAL RELEVANCE Labral augmentation with autograft tendon may be a feasible option in cases of viable labral remnants.
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Affiliation(s)
- Tiao Su
- Center for Joint Surgery, Southwest Hospital, Army Medical University, Chongqing, People's Republic of China
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Shapira J, Owens JS, Bheem R, Maldonado DR, Rosinsky PJ, Meghpara MB, Lall AC, Domb BG. Outcomes Among Athletes Versus Nonathletes After Arthroscopic Management of Femoroacetabular Impingement. Orthopedics 2022; 45:e288-e94. [PMID: 35858127 DOI: 10.3928/01477447-20220706-04] [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] [Indexed: 02/03/2023]
Abstract
This study synthesizes and reports patient-reported outcomes (PROs) among athletes vs nonathletes after hip arthroscopy for femoroacetabular impingement. A systematic review was performed in November 2020 with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) process. We included studies that reported PROs for athletes vs nonathletes. We excluded articles that did not contain full text, that were not in English, and that included level IV evidence. Four studies reporting on a total of 294 athletes and 230 nonathletes were included. Of these studies, 3 found superior outcomes among athletes, and 1 found that athletes recovered faster, but nonathletes had equivalent outcomes at later follow-up. Athletes and nonathletes showed significant improvements in PROs; however, athletes showed a trend toward superior PROs. Thus, pre-operative athletic activity is associated with favorable outcomes after hip arthroscopy. [Orthopedics. 2022;45(6):e288-e294.].
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Kaveeshwar S, Rocca MP, Oster BA, Schneider MB, Tran A, Kolevar MP, Adib F, Henn RF, Meredith SJ. Depression and anxiety are associated with worse baseline function in hip arthroscopy patients. Knee Surg Sports Traumatol Arthrosc 2022; 30:3563-3569. [PMID: 35416491 DOI: 10.1007/s00167-022-06963-y] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/19/2021] [Accepted: 03/25/2022] [Indexed: 10/18/2022]
Abstract
PURPOSE The purpose of this study was to analyze the correlation between baseline depression and anxiety and preoperative functional status in hip arthroscopy patients. METHODS A prospective, institutional review board-approved orthopaedic registry was used to retrospectively study 104 patients undergoing hip arthroscopy. Enrolled patients were administered baseline questionnaires for Patient-Reported Outcomes Measurement Information System (PROMIS) domains, Musculoskeletal Outcomes Data Evaluation and Management System (MODEMS) preoperative expectations, and Numeric Pain Scale (NPS). RESULTS The average baseline PROMIS Depression and Anxiety scores were 49.9 ± 9.8 and 55.5 ± 9.3, respectively. Bivariate analysis demonstrated that greater baseline PROMIS Anxiety correlated with worse preoperative PROMIS PI (p < 0.001), Fatigue (p < 0.001), Social Satisfaction (p < 0.001), and NPS score (p = 0.013). Bivariate analysis showed that greater PROMIS Depression correlated with worse preoperative PROMIS PF (p = 0.001), PI (p < 0.001), Fatigue (p < 0.001), SS (p < 0.001), and NPS score (p = 0.004). After controlling for confounders, multivariable analysis confirmed increased PROMIS Depression as an independent predictor of worse preoperative PROMIS PF (p = 0.009), MODEMS Expectations (p = 0.025), and NPS score (p = 0.002). Increased PROMIS Anxiety was predictive of worse baseline PROMIS PI (p < 0.001), Fatigue (p < 0.001), and Social Satisfaction (p < 0.001). A previous clinical diagnosis of depression or anxiety was only an independent predictor of worse baseline PROMIS Fatigue (p = 0.002) and was insignificant in all other models. CONCLUSION Increasing severity of depression and anxiety correlated with and predicted worse functional status at baseline in hip arthroscopy patients. As compared to clinical diagnosis of anxiety and depression, PROMIS metrics have superior utility in recognizing potentially modifiable mental health concerns that predict worse preoperative status. Ultimately, the study identifies an at-risk population undergoing hip arthroscopy that requires particular attention and potential mental health intervention in the preoperative setting. LEVEL OF EVIDENCE III.
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Affiliation(s)
- Samir Kaveeshwar
- Department of Orthopaedics, University of Maryland School of Medicine, 2200 Kernan Drive, Baltimore, MD, 21207, USA
| | - Michael P Rocca
- Department of Orthopaedics, University of Maryland School of Medicine, 2200 Kernan Drive, Baltimore, MD, 21207, USA
| | - Brittany A Oster
- Department of Orthopaedics, University of Maryland School of Medicine, 2200 Kernan Drive, Baltimore, MD, 21207, USA
| | - Matheus B Schneider
- Department of Orthopaedics, University of Maryland School of Medicine, 2200 Kernan Drive, Baltimore, MD, 21207, USA
| | - Andrew Tran
- Department of Orthopaedics, University of Maryland School of Medicine, 2200 Kernan Drive, Baltimore, MD, 21207, USA
| | - Matthew P Kolevar
- Department of Orthopaedics, University of Maryland School of Medicine, 2200 Kernan Drive, Baltimore, MD, 21207, USA
| | - Farshad Adib
- Department of Orthopaedics, University of Maryland School of Medicine, 2200 Kernan Drive, Baltimore, MD, 21207, USA
| | - R Frank Henn
- Department of Orthopaedics, University of Maryland School of Medicine, 2200 Kernan Drive, Baltimore, MD, 21207, USA
| | - Sean J Meredith
- Department of Orthopaedics, University of Maryland School of Medicine, 2200 Kernan Drive, Baltimore, MD, 21207, USA.
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Chona DV, Minetos PD, LaPrade CM, Cinque ME, Abrams GD, Sherman SL, Safran MR. Hip Dislocation and Subluxation in Athletes: A Systematic Review. Am J Sports Med 2022; 50:2834-2841. [PMID: 34623933 DOI: 10.1177/03635465211036104] [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] [Indexed: 01/31/2023]
Abstract
BACKGROUND Hip dislocation is a rare occurrence during sports but carries serious implications for athletes. PURPOSE To systematically review treatment strategies and outcomes for hip dislocation in athletes, with the ultimate goal of providing sports medicine physicians with the information necessary to appropriately treat and counsel patients sustaining this injury. STUDY DESIGN Systematic review; Level of evidence, 4. METHODS PubMed, MEDLINE, and Embase were searched for studies relating to hip instability and athletics from January 1, 1989 to October 1, 2019. Abstracts and articles were evaluated on the basis of predefined inclusion and exclusion criteria. Inclusion criteria were the following: (1) data from ≥1 patients, (2) native hip dislocation or subluxation occurring during sports, (3) patients aged at least 10 years, and (4) written in English. Exclusion criteria were (1) patients younger than 10 years; (2) nonnative or postoperative hip dislocation or subluxation; (3) a native hip injury without dislocation or subluxation; (4) patients with dislocation or subluxation secondary to neuromuscular, developmental, or syndromic causes; (5) dislocation or subluxation not occurring during sports; (6) patients with physeal fractures; or (7) review articles or meta-analyses. Data were recorded on patient demographics, injury mechanism, treatment strategies, and clinical and radiographic outcomes. Where possible, pooled analysis was performed. Studies were grouped based on reported outcomes. Meta-analysis was then performed on these pooled subsets. RESULTS A total of 602 articles were initially identified, and after screening by 2 reviewers, 27 articles reporting on 145 patients were included in the final review. There were 2 studies that identified morphological differences between patients with posterior dislocation and controls, including decreased acetabular anteversion (P = .015 and .068, respectively), increased prevalence of a cam deformity (P < .0035), higher alpha angles (P≤ .0213), and decreased posterior acetabular coverage (P < .001). No differences were identified for the lateral center edge angle or Tonnis angle. Protected postreduction weightbearing was most commonly prescribed for 2 to 6 weeks, with 65% of reporting authors recommending touchdown, toe-touch, or crutch-assisted weightbearing. Recurrence was reported in 3% of cases. Overall, 4 studies reported on findings at hip arthroscopic surgery, including a 100% incidence of labral tears (n = 27; 4 studies), 92% incidence of chondral injuries, 20% incidence of capsular tears, and 84% incidence of ligamentum teres tears (n = 25; 2 studies). At final follow-up, 86% of patients reported no pain (n = 14; 12 studies), 87% reported a successful return to play (n = 39; 10 studies), and 11% had radiographic evidence of osteonecrosis (n = 38; 10 studies). CONCLUSION Various treatment strategies have been described in the literature, and multiple methods have yielded promising clinical and radiographic outcomes in patients with native hip dislocation sustained during sporting activity. Data support nonoperative treatment with protected weightbearing for hips with concentric reduction and without significant fractures and an operative intervention to obtain concentric reduction if unachievable by closed means alone. Imaging for osteonecrosis is recommended, with evidence suggesting 4- to 6-week magnetic resonance imaging and follow-up at 3 months for those with suspicious findings in the femoral head.
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Affiliation(s)
- Deepak V Chona
- Department of Orthopaedic Surgery, Stanford University, Redwood City, California, USA
| | - Paul D Minetos
- Rothman Orthopaedic Institute, Philadelphia, Pennsylvania, USA
| | - Christopher M LaPrade
- Department of Orthopaedic Surgery, Stanford University, Redwood City, California, USA
| | - Mark E Cinque
- Department of Orthopaedic Surgery, Stanford University, Redwood City, California, USA
| | - Geoffrey D Abrams
- Department of Orthopaedic Surgery, Stanford University, Redwood City, California, USA
| | - Seth L Sherman
- Department of Orthopaedic Surgery, Stanford University, Redwood City, California, USA
| | - Marc R Safran
- Department of Orthopaedic Surgery, Stanford University, Redwood City, California, USA
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Two-Tiered Resection of Cam Lesions in Hip Femoroacetabular Impingement: Optimizing Femoral Head Sphericity. Arthrosc Tech 2022; 11:e1311-e1316. [PMID: 35936847 PMCID: PMC9353533 DOI: 10.1016/j.eats.2022.03.015] [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: 02/05/2022] [Accepted: 03/11/2022] [Indexed: 02/03/2023] Open
Abstract
Hip arthroscopy is one of the most rapidly growing fields in orthopaedic surgery. One of the most frequent pathologies treated with hip arthroscopy remains femoroacetabular impingement, which is addressed by labral repair and femoral osteoplasty. The most commonly cited reason for failure of arthroscopic treatment of femoroacetabular impingement is under-resection of the cam lesion. Surgeons frequently use evaluations of preoperative images, intraoperative fluoroscopy, and dynamic range of motion to ensure adequate resection. In this article, we describe a reproducible and standardized technique to assist in appropriate resection. This is achieved by a 2-tiered resection technique: Tier 1 aims to set the depth of resection and restore the head-neck offset. Tier 2 then matches the depth of the resection set by tier 1 and allows for retention of appropriate transition of the proximal convexity to the distal concavity seen in more ideally shaped femoral heads. With this technique, we offer a tool to avoid under-resection in the area of maximal conflict while simultaneously minimizing the risk of proximal over-resection and thus compromising the fluid seal dynamics of the joint in deeper flexion angles.
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Outcome-Affecting Parameters of Hip Arthroscopy for Femoroacetabular Impingement with Concomitant Cartilage Damage-Data Analysis from the German Cartilage Registry. J Clin Med 2022; 11:jcm11061532. [PMID: 35329858 PMCID: PMC8949441 DOI: 10.3390/jcm11061532] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2022] [Revised: 03/08/2022] [Accepted: 03/09/2022] [Indexed: 02/01/2023] Open
Abstract
This study aims to report on a prospectively collected, multicenter database of patients undergoing hip arthroscopy for femoroacetabular impingement syndrome (FAI) and concomitant cartilage damage (according to the International Cartilage Repair Society) and to assess the outcome-affecting parameters. In the study, 353 hips with up to 24 months’ follow-up were assessed by iHOT-33 scoring and achievement of the minimal clinically important difference (MCID) and patient acceptable symptom state (PASS) levels. Multiple and binary regression analyses were performed to identify factors related to (un-) favorable outcomes and to assess their clinical relevance with regard to achieving the MCID and PASS. Multiple regression yielded the parameters of male sex (p = 0.022) and lower body mass index (BMI) (p = 0.019) at 6 months, lower BMI (p = 0.022) and younger age (p = 0.022) at 12 months, and younger age at 24 months (p = 0.039) to be significantly associated with higher iHOT scoring. Male sex (p = 0.019) and lower BMI (p = 0.018) were significantly correlated with achievement of the PASS in binary regression at 6 months, whereas at 12 (p = 0.010) and at 24 (p = 0.003) only younger age was shown to be significantly correlated. None of the parameters was statistically associated with achievement of the MCID. As the parameters of younger age, male sex, and lower BMI were identified as temporarily correlated with a preferable outcome in general and with achievement of the PASS in particular, these findings help to preoperatively identify factors associated with (un-) favorable therapy results.
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Hartwell MJ, Morgan AM, Nelson PA, Fernandez CE, Nicolay RW, Sheth U, Tjong VK, Terry MA. Isolated Acetabuloplasty for Femoroacetabular Impingement: Favorable Patient-Reported Outcomes and Sustained Survivorship at Minimum 5-Year Follow-Up. Arthroscopy 2021; 37:3288-3294. [PMID: 33878420 DOI: 10.1016/j.arthro.2021.03.080] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/30/2020] [Revised: 03/31/2021] [Accepted: 03/31/2021] [Indexed: 02/02/2023]
Abstract
PURPOSE To evaluate minimum 5-year outcomes and conversion rate to total hip arthroplasty (THA) for the treatment of femoroacetabular impingement (FAI) syndrome with an isolated acetabular osteoplasty. METHODS Patients undergoing hip arthroscopy with an isolated acetabular osteoplasty from March 2009 to June 2014 for FAI syndrome with pincer and/or cam morphology and a labral tear were identified. Those who underwent femoroplasty or prior ipsilateral hip surgery or who had previous hip conditions, ipsilateral hip dysplasia, or a Tönnis grade higher than 2 were excluded. Patient-reported outcomes (PROs) collected included Patient-Reported Outcomes Measurement Information System (PROMIS) scores specific to physical functioning and pain interference, modified Harris Hip Score, International Hip Outcome Tool 12, Hip Outcome Score-Activities of Daily Living, Hip Outcome Score-Sport-Specific Subscale, and Numeric Pain Rating Scale. Patients were also queried about secondary surgical procedures and conversion to THA. RESULTS We identified 86 patients at minimum 5-year follow-up (average, 7.4 years). The average patient age was 39.8 ± 12.3 years, 70.9% of patients were female, and 7% of patients had Tönnis grade 2. The mean PRO scores were 52.0 ± 8.9 for the PROMIS physical functioning score, 39.6 ± 7.5 for the PROMIS pain interference score, 78.7 ± 12.0 for the modified Harris Hip Score, 73.3 ± 23.1 for the International Hip Outcome Tool 12 score, 89.9 ± 12.0 for the Hip Outcome Score-Activities of Daily Living, and 81.4 ± 21.0 for the Hip Outcome Score-Sport-Specific Subscale. Of the patients, 72.1% achieved the patient acceptable symptomatic state (PASS) according to previously established PASS scores for FAI syndrome treated with hip arthroscopy at minimum 5-year follow-up. The overall rate of revision arthroscopy was 3.5%, and the rate of conversion to THA was 5.8%. CONCLUSIONS An isolated acetabular osteoplasty can provide sustained clinical benefits for the treatment of FAI syndrome with labral tears, with good to excellent PROs and PASS rates and a low rate of conversion to THA at minimum 5-year follow-up. LEVEL OF EVIDENCE Level IV, case series.
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Affiliation(s)
- Matthew J Hartwell
- Department of Orthopaedic Surgery, Feinberg School of Medicine, Northwestern University, Chicago, Illinois, U.S.A..
| | - Allison M Morgan
- Department of Orthopaedic Surgery, Feinberg School of Medicine, Northwestern University, Chicago, Illinois, U.S.A
| | - Patrick A Nelson
- Department of Orthopaedic Surgery, Feinberg School of Medicine, Northwestern University, Chicago, Illinois, U.S.A
| | - Claire E Fernandez
- Department of Orthopaedic Surgery, Feinberg School of Medicine, Northwestern University, Chicago, Illinois, U.S.A
| | - Richard W Nicolay
- Department of Orthopaedic Surgery, Feinberg School of Medicine, Northwestern University, Chicago, Illinois, U.S.A
| | - Ujash Sheth
- Department of Orthopaedic Surgery, Feinberg School of Medicine, Northwestern University, Chicago, Illinois, U.S.A
| | - Vehniah K Tjong
- Department of Orthopaedic Surgery, Feinberg School of Medicine, Northwestern University, Chicago, Illinois, U.S.A
| | - Michael A Terry
- Department of Orthopaedic Surgery, Feinberg School of Medicine, Northwestern University, Chicago, Illinois, U.S.A
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Intraoperative Computer Vision Integrated Interactive Fluoroscopy Correlates With Successful Femoroplasty on Clinic-Based Radiographs. Arthroscopy 2021; 37:3371-3382. [PMID: 33957216 DOI: 10.1016/j.arthro.2021.04.044] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/22/2020] [Revised: 04/06/2021] [Accepted: 04/15/2021] [Indexed: 02/02/2023]
Abstract
PURPOSE To quantitatively evaluate computer vision interface (CVI)-guided femoroplasty in the arthroscopic treatment of femoroacetabular impingement syndrome and compare those results with traditional unguided resections. METHODS Consecutive patients undergoing hip arthroscopy for femoroacetabular impingement syndrome between July 2019 and October 2019 were evaluated. Cases with CVI were identified along with controls, consisting of patients from the same study period who underwent surgery without the CVI and were balanced for age, sex, laterality, and preoperative alpha angles. Alpha angles were measured on pre- and postoperative clinic radiographs, as well as intraoperatively for the CVI group. Cam resections were quantified by measuring pre- and postresection alpha angles and compared between groups. The correlation between CVI views and office-based radiographs was assessed, and the 3 CVI views that best correlated with each of the 3 standard clinic radiographs were evaluated for accuracy and performance in detection of cam deformity with alpha angle ≥48° with the clinic-based films as the reference. RESULTS A total of 49 patients (51 hips) (average age, 28.7; 33 female patients) in the CVI group, and 51 patients (51 hips) (average age: 29.9; 35 female patients) in the control group. There were no significant differences between groups with respect to age, sex, laterality, or preoperative alpha angle (all P > .05). Significant alpha angle reduction occurred on all intraoperative and postoperative clinic views (all P < .01). The CVI views that best correlated with the clinic radiographs were 11:45 with the anteroposterior (ρ = 0.588, P = .0025), 12:30 with the Dunn lateral (ρ = 0.632, P = .0009), and 1:45 with the false-profile (ρ = 0.575, P = .0033). Greater reliability was observed with 12:30/Dunn (accuracy = 83.33%, P < .0001; sensitivity = 77.14%; specificity = 87.76%) and 1:45/false-profile (accuracy = 82.35%, P = .0051; sensitivity = 81.82%; specificity = 82.61%) than with 11:45/anteroposterior (accuracy = 69.15%, P = .0077; sensitivity = 56.10%; specificity = 79.25%). CONCLUSIONS CVI-guided cam resection results in successful resection of proximal femur cam lesions and represents a femoroplasty templating method that does not require preoperative computed tomography imaging or additional invasive intraoperative referencing modules. The accuracy and adequacy of this resection was validated by comparison with routine clinic radiographs. LEVEL OF EVIDENCE Therapeutic Level III: retrospective comparative analysis.
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Tsutsumi M, Nimura A, Akita K. Clinical anatomy of the musculoskeletal system in the hip region. Anat Sci Int 2021; 97:157-164. [PMID: 34686966 PMCID: PMC8817995 DOI: 10.1007/s12565-021-00638-3] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2021] [Accepted: 10/15/2021] [Indexed: 01/09/2023]
Abstract
Although the hip joint is regarded as inherently stable, hip pain and injuries caused by traumatic/non-traumatic hip instability are relatively common in active individuals. A comprehensive understanding of hip anatomy may provide better insight into the relationships between hip stability and clinical problems. In this review, we present our recent findings on the hip morphological characteristics, especially focusing on the intramuscular tendon of the gluteus medius tendon and its insertion sites, hip capsular attachment on the anterosuperior region of the acetabular margin, and composition of the iliofemoral ligament. We further discussed the hip stabilization mechanism based on these findings. The characteristics of the gluteus medius tendon suggest that even a single muscle has multiple functional subunits within the muscle. In addition, the characteristics of the hip capsular attachment suggest that the width of the capsular attachment is wider than previously reported, and its wide area shows adaptive morphology to mechanical stress, such as bony impression and distribution of the fibrocartilage. The composition of the iliofemoral ligament and its relation to periarticular structures suggest that some ligaments should be defined based on the pericapsular structures, such as the joint capsule, tendon, and aponeurosis, and also have the ability to dynamically coordinate joint stability. These anatomical perspectives provide a better understanding of the hip stabilization mechanism, and a biomechanical study or an in vivo imaging study, considering these perspectives, is expected in the future.
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Affiliation(s)
- Masahiro Tsutsumi
- Department of Clinical Anatomy, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, 1-5-45 Yushima, Bunkyo-ku, Tokyo, 113-8519, Japan. .,Inclusive Medical Science Research Institute, Morinomiya University of Medical Sciences, Osaka, Japan.
| | - Akimoto Nimura
- Department of Functional Joint Anatomy, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, Tokyo, Japan
| | - Keiichi Akita
- Department of Clinical Anatomy, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, 1-5-45 Yushima, Bunkyo-ku, Tokyo, 113-8519, Japan
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Addai D, Zarkos J, Pettit M, Sunil Kumar KH, Khanduja V. Outcomes following surgical management of femoroacetabular impingement: a systematic review and meta-analysis of different surgical techniques. Bone Joint Res 2021; 10:574-590. [PMID: 34488425 PMCID: PMC8479569 DOI: 10.1302/2046-3758.109.bjr-2020-0443.r1] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
Abstract
Outcomes following different types of surgical intervention for femoroacetabular impingement (FAI) are well reported individually but comparative data are deficient. The purpose of this study was to conduct a systematic review (SR) and meta-analysis to analyze the outcomes following surgical management of FAI by hip arthroscopy (HA), anterior mini open approach (AMO), and surgical hip dislocation (SHD). This SR was registered with PROSPERO. An electronic database search of PubMed, Medline, and EMBASE for English and German language articles over the last 20 years was carried out according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. We specifically analyzed and compared changes in patient-reported outcome measures (PROMs), α-angle, rate of complications, rate of revision, and conversion to total hip arthroplasty (THA). A total of 48 articles were included for final analysis with a total of 4,384 hips in 4,094 patients. All subgroups showed a significant correction in mean α angle postoperatively with a mean change of 28.8° (95% confidence interval (CI) 21 to 36.5; p < 0.01) after AMO, 21.1° (95% CI 15.1 to 27; p < 0.01) after SHD, and 20.5° (95% CI 16.1 to 24.8; p < 0.01) after HA. The AMO group showed a significantly higher increase in PROMs (3.7; 95% CI 3.2 to 4.2; p < 0.01) versus arthroscopy (2.5; 95% CI 2.3 to 2.8; p < 0.01) and SHD (2.4; 95% CI 1.5 to 3.3; p < 0.01). However, the rate of complications following AMO was significantly higher than HA and SHD. All three surgical approaches offered significant improvements in PROMs and radiological correction of cam deformities. All three groups showed similar rates of revision procedures but SHD had the highest rate of conversion to a THA. Revision rates were similar for all three revision procedures.
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Affiliation(s)
- Daniel Addai
- Technische Universitat Dresden, Dresden, Germany.,West Suffolk Hospital, Bury St Edmunds, UK
| | | | | | | | - Vikas Khanduja
- Young Adult Hip Service, Department of Trauma & Orthopaedics, Addenbrooke's - Cambridge University Hospital, Cambridge, UK
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A Current Update on Pelvifemoral Conditions That Should be in the Differential Diagnosis for Patients With Lower Extremity Radiculopathy. Clin Spine Surg 2021; 34:206-215. [PMID: 34121075 DOI: 10.1097/bsd.0000000000001180] [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: 03/14/2020] [Accepted: 02/24/2021] [Indexed: 11/27/2022]
Abstract
Patients presenting to an outpatient spine clinic frequently report symptoms of low back pain with associated buttock, groin, and lower extremity pain. While many of these individuals suffer from lumbar spine radiculopathy, a number of different orthopedic pathologies can mimic these symptoms. Management depends substantially on a detailed history and physical examination, in addition to working from a broad list of differential diagnoses when evaluating these patients. It is imperative that spine practitioners have a comprehensive understanding of the differential diagnoses that may mimic those originating from the lumbar spine, especially when a patient's symptoms are atypical from classic radicular pain. Misdiagnosis can lead to unnecessary testing and treatment, while delaying an accurate clinical assessment and treatment plan. This review highlights common orthopedic diagnoses that may present similar to lumbar spine pathologies and the evidence-based evaluation of these conditions.
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14
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Femoroacetabular Impingement and Core Muscle Injury in Athletes: Diagnosis and Algorithms for Success. Sports Med Arthrosc Rev 2021; 29:9-14. [PMID: 33395224 DOI: 10.1097/jsa.0000000000000294] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Athletic hip injuries account for a substantial portion of missed time from sports in high-level athletes. For both femoroacetabular impingement (FAI) and core muscles injuries, a thorough history and physical examination are paramount to guide the treatment. While advanced imaging including computed tomography and magnetic resonance imaging are frequently obtained, a wealth of information can be ascertained from standard radiographs alone. For patients with isolated or combined FAI and core muscle injuries (CMIs), the initial treatment is often nonoperative and consists of rest, activity modification, and physical therapy of the hips, core, and trunk. Injections may then aid in both confirming diagnosis and temporary symptom abatement. Arthroscopic procedures for refractory FAI in experienced hands have been shown to be both safe and efficacious. While surgical repair options for CMIs are significantly more variable, long-term studies have demonstrated the rapid resolution of symptoms and high return to play rates. More recently, anatomic and clinical correlations between FAI and CMIs have been identified. Special attention must be paid to elite athletes as the incidence of concurrent FAI with CMI is extremely high yet with significant symptom variability. Predictable return to play in athletes with coexisting symptomatic intra-articular and extra-articular symptomatology is incumbent upon the treatment of both pathologies.
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Heaps BM, Feingold JD, Swartwout E, Turcan S, Greditzer HG, Kelly BT, Ranawat AS. Lumbosacral Transitional Vertebrae Predict Inferior Patient-Reported Outcomes After Hip Arthroscopy. Am J Sports Med 2020; 48:3272-3279. [PMID: 33030966 DOI: 10.1177/0363546520961160] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND While the association between spinal disease and hip arthroplasty outcomes has been well studied, there is less known about the effect of spinal pathology in hip arthroscopy (HA) outcomes. Lumbosacral transitional vertebrae (LSTV) are anatomic variations where caudal vertebrae articulate or fuse with the sacrum or ilium. HYPOTHESIS LSTV can lead to inferior outcomes after HA for treatment of femoroacetabular impingement. STUDY DESIGN Cohort study; Level of evidence, 3. METHODS We retrospectively reviewed the prospectively collected Hip Arthroscopy Database at our institution for patients with LSTV who underwent HA between 2010 and 2017. A total of 62 patients with LSTV were identified and then matched to controls. Patient-reported outcome measures (PROMs) were collected, including the modified Harris Hip Score, Hip Outcome Score-Activities of Daily Living, Hip Outcome Score-Sports, and the 33-item International Hip Outcome Tool. They were collected at 4 time points: preoperatively and 5 to 11 months, 12 to 23 months, and 24 to 35 months postoperatively. Longitudinal analysis of the PROMs was done using generalized estimating equation modeling. Additionally, alpha angles were measured from preoperative radiographic data. RESULTS Preoperatively, there was no significant difference between patients with and without LSTV on 3 of the 4 PROMs; however, patients with LSTV did have significantly lower preoperative scores than controls for the Hip Outcome Score-Activities of Daily Living (P = .029). Patients with LSTV reported significantly lower scores on all 4 PROMs at each postoperative time point. Radiographic data showed no significant difference in alpha angles across cohorts. When LSTV were compared by Castellvi type, types 3 and 4 tended to have lower scores than types 1 and 2; however, these comparisons were not significant. CONCLUSION The data support our hypothesis that HA has less benefit in patients with LSTV as compared with patients without LSTV. In patients with LSTV, careful evaluation of the anomaly is recommended to help guide surgical counseling and manage expectations.
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Affiliation(s)
| | | | | | - Sava Turcan
- Hospital for Special Surgery, New York, New York, USA
| | | | - Bryan T Kelly
- Hospital for Special Surgery, New York, New York, USA
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Validation of Pediatric Self-Report Patient-Reported Outcomes Measurement Information System (PROMIS) Measures in Different Stages of Legg-Calvé-Perthes Disease. J Pediatr Orthop 2020; 40:235-240. [PMID: 31318732 DOI: 10.1097/bpo.0000000000001423] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
OBJECTIVES Patient-reported outcomes (PRO) assessing health-related quality of life (HRQoL) are important outcome measures, especially in Legg-Calvé-Perthes disease (LCPD) where symptoms (pain and limping), activity restrictions, and treatments vary depending on the stage of the disease. The purpose of this study was to investigate the validity of the Patient-reported Outcomes Measurement Information System (PROMIS) for measuring HRQoL of patients with LCPD in various stages of the disease. METHODS This is a multicenter validity study. Patients with LCPD between 4 and 18 years old were included and classified into modified Waldenström stages of disease: Early (1 or 2A), Late (2B or 3), or Healed (4). Seven PROMIS domains were collected, including Pain Interference, Fatigue, Mobility, Depression, Anger, Anxiety, and Peer Relationships. Convergent, discriminant, and known group validity was determined. RESULTS A total of 190 patients were included (mean age: 10.4±3.1 y). All 7 domains showed the worst scores in patients in the Early stage (known group validity). Within each domain, all domains positively correlated to each other (convergent validity). Patients who reported more anxiety, depression, and anger were associated with decreased mobility and increased fatigue and pain. Peer relationships had no to weak associations with other domains (discriminant validity). CONCLUSIONS PROMIS has construct validity in measuring the HRQoL of patients in different stages of LCPD, suggesting that PROMIS has potential to serve as a patient-reported outcome tool for this population. LEVEL OF EVIDENCE Diagnostic level III study.
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Moley PJ, Tatka J, Singh JR. Running with Femoral Acetabular Impingement: Operative Vs Nonoperative Treatment. PM R 2020; 12:817-822. [PMID: 32535998 DOI: 10.1002/pmrj.12438] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2020] [Accepted: 06/11/2020] [Indexed: 11/08/2022]
Abstract
A 31-year-old female lawyer presents with right hip pain starting approximately 3 years ago and worsening over the past 2 to 3 months. She is an avid runner, running 20 to 30 miles weekly, and noticed that her pain started after a running program training for the marathon. Her pain is primarily over the lateral aspect of her hip with some radiation into the groin. The pain is made worse with impact exercises such as running and made better with walking and cycling. She has done physical therapy for the past 3 months without any significant improvement. She has not had any injections or taken anti-inflammatories because of a history of gastric ulcer disease. On physical examination she has mild tenderness over her right greater trochanter and her range of motion tests are full in terms of flexion, internal rotation, and external rotation. She has a positive FADIR (flexion-adduction-internal rotation) impingement that causes both groin and lateral hip pain. Radiograph of the right hip revealed preservation of the joint space and an anterior cam lesion with reduced offset at the femoral head neck junction. Magnetic resonance imaging (MRI) of the right hip revealed a tear at the anterior superior labrum at the 1 to 2 o'clock position along with subjacent bone marrow edema in the femoral head that is likely reactive. Computed tomography (CT) scan of the right hip confirmed a combined cam and pincer type femoral acetabular impingement of the right hip with overcoverage of the femoral head. There was 15° of femoral anteversion and the coronal lateral center of edge angle (LCEA) is 34°. Dr. Peter Moley argues that a focused rehabilitation program to restore strength and motor control of the deep hip stabilizers will provide optimal functional recovery. Dr. Jakub Tatka argues that right hip arthroscopy with labral repair and possible osteochondralplasty are indicated in order to prevent early hip arthritis and prevent long-term sequela of femoral acetabular impingement.
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Affiliation(s)
| | - Jakub Tatka
- Department of Orthopedic Surgery, Columbia University, New York, NY, USA
| | - Jaspal Ricky Singh
- Weill Cornell Medicine, Department of Rehabilitation Medicine, Weill Cornell Center for Comprehensive Spine Care, New York, NY, USA
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Lin Y, Li T, Deng X, Huang X, Zhang K, Li Q, Li J, Fu W. Repaired or unrepaired capsulotomy after hip arthroscopy: a systematic review and meta-analysis of comparative studies. Hip Int 2020; 30:256-266. [PMID: 31570008 DOI: 10.1177/1120700019880818] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
PURPOSE To conduct a systematic review and meta-analysis comparing the surgical techniques, clinical outcomes, rates of revision and conversion to arthroplasty and complications between a repaired and unrepaired capsulotomy after hip arthroscopy. METHODS A search of the PubMed, Embase and Google Scholar databases was performed to identify comparative articles published prior to 10 July 2019 that reported the capsule management strategy and clinical outcomes after hip arthroscopy. A narrative analysis and meta-analysis were performed to integrate and compare the results of the 2 groups. RESULTS 12 comparative studies (n = 1185 hips) with an average (methodological index for non-randomized studies) MINORS score of 17.45 ± 2.02 were identified for analysis, of which 5 were included in the meta-analysis. The pre- to postoperative improvements in the modified Harris Hip Score (mHHS), Hip Outcome Score-Sport-Specific Subscale (HOS-SS), and Hip Outcome Score-Activities of Daily Living (HOS-ADL) revealed no significant differences between the repaired and unrepaired groups (p = 0.40, 0.26 and 0.61, respectively). The risk ratio of the revision rate for the 2 groups was 0.66 (p = 0.21). Evaluation of the MRI scans and the rate of heterotopic ossification also showed no significant differences. The most preferred capsulotomy techniques were interportal and T-shape. No postoperative hip instability was reported in any of the 12 studies. CONCLUSION The currently published evidence is still not strong enough to confirm the superiority of repairing the capsule after hip arthroscopy; hence, routine repair of the capsule during surgery cannot be suggested.
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Affiliation(s)
- Yipeng Lin
- Department of Orthopedics, West China Hospital, Sichuan University, Chengdu, China
| | - Tao Li
- Department of Orthopedics, West China Hospital, Sichuan University, Chengdu, China
| | - Xinghao Deng
- Department of Orthopedics, West China Hospital, Sichuan University, Chengdu, China
| | - Xihao Huang
- Department of Orthopedics, West China Hospital, Sichuan University, Chengdu, China
| | - KaiBo Zhang
- Department of Orthopedics, West China Hospital, Sichuan University, Chengdu, China
| | - Qi Li
- Department of Orthopedics, West China Hospital, Sichuan University, Chengdu, China
| | - Jian Li
- Department of Orthopedics, West China Hospital, Sichuan University, Chengdu, China
| | - Weili Fu
- Department of Orthopedics, West China Hospital, Sichuan University, Chengdu, China
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Intra-abdominal Pressure Changes During Hip Arthroscopy: A Prospective Multicenter Study. Arthroscopy 2020; 36:1053-1060. [PMID: 31805384 DOI: 10.1016/j.arthro.2019.11.117] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/04/2019] [Revised: 11/10/2019] [Accepted: 11/17/2019] [Indexed: 02/02/2023]
Abstract
PURPOSE To evaluate intra-abdominal pressure changes during hip arthroscopy and define its relationship with other patient related variables. METHODS A prospective multicenter study evaluating intra-abdominal pressure (IAP) in patients undergoing arthroscopic treatment of femoroacetabular impingement was performed. The IAP was measured indirectly by a bladder catheter (AbViser Autovalve Intra-abdominal pressure monitor) and documented every 30 minutes during the entire procedure. The following risk factors were analyzed: traction time, duration surgery, previous abdominal surgery, capsule repair, psoas tenotomy, and surgical approach. RESULTS One hundred and five patients with symptomatic femoroacetabular impingement that underwent hip arthroscopy met the inclusion criteria. There were significant differences in the IAP between the preoperative measurement of IAP and the IAP at different time points during surgery (P < .01). The IAP increased continuously from the commencement of surgery (considered as time point from portal establishment) until the first 60 minutes. After first 60 minutes of surgery, the IAP did not increase significantly. There were no significant associations between increased IAP and the risk factors analyzed. CONCLUSIONS IAP increases significantly during the first 60 minutes of hip arthroscopy; it then stabilizes for the duration of surgery before decreasing just after the completion of surgery. The highest recorded IAP was not associated with additional complications. No symptomatic intra-abdominal hypertension was documented. Finally, patient- and procedure-specific risk factors did not predict changes in IAP. Systemic monitoring of IAP during the hip arthroscopy procedure can easily and effectively be done, allowing the surgeon to early detect any significant change. LEVEL OF EVIDENCE Level IV, therapeutic case series.
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20
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Best Practice Guidelines for Hip Arthroscopy in Femoroacetabular Impingement: Results of a Delphi Process. J Am Acad Orthop Surg 2020; 28:81-89. [PMID: 31181030 DOI: 10.5435/jaaos-d-18-00041] [Citation(s) in RCA: 46] [Impact Index Per Article: 11.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023] Open
Abstract
BACKGROUND Treatment algorithms for the arthroscopic management of femoroacetabular impingement (FAI) syndrome remain controversial because of a paucity of evidence-based guidance. Consequently, notable variability in clinical practice exists between different practitioners, necessitating expert consensus. The purpose of this study is to establish best practice guidelines (BPG) using formal techniques of consensus building among a group of experienced hip arthroscopists driven by the results of a systematic review and meta-analysis. The scope of these guidelines includes preoperative recommendations, intraoperative practices, and postoperative protocols. METHODS The validated Delphi process and the nominal group technique (NGT), used by the Centers for Disease Control and Prevention and the peer-reviewed orthopaedic literature, were used to formally derive consensus among 15 surgeons in North America. Participants were surveyed for current practices, presented with the results of a meta-analysis and systematic literature review, and asked to vote for or against the inclusion of nonleading, impartially phrased items during three iterative rounds while preserving the anonymity of participants' opinions. Agreement greater than 80% was considered consensus, and items near consensus (70% to 80% agreement) were further queried using the NGT in a moderated group session at the American Orthopaedic Society for Sports Medicine annual meeting. RESULTS Participants had a mean of 12.3 years of practice (range: 1 to 29 years) and performed an annual mean of 249 (range 100 to 500+) hip arthroscopies, with a combined total of approximately 52,580 procedures. Consensus was reached for the creation of BPG consisting of 27 preoperative recommendations, 15 intraoperative practices, and 10 postoperative protocols. The final checklist was supported by 100% of participants. CONCLUSION We developed the first national consensus-based BPG for the surgical and nonsurgical management of FAI. The resulting consensus items can serve as a tool to reduce the variability in preoperative, intraoperative, and postoperative practices and guide further research for the arthroscopic management of FAI.
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Wilson KW, Kannan AS, Kopacko M, Vyas D. Rehabilitation and Return to Sport After Hip Arthroscopy. ACTA ACUST UNITED AC 2019. [DOI: 10.1016/j.oto.2019.100739] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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23
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Feingold JD, Heaps B, Turcan S, Swartwout E, Ranawat A. A history of spine surgery predicts a poor outcome after hip arthroscopy. J Hip Preserv Surg 2019; 6:227-233. [PMID: 34012553 PMCID: PMC8117947 DOI: 10.1093/jhps/hnz029] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/04/2019] [Revised: 06/19/2019] [Accepted: 06/23/2019] [Indexed: 01/04/2023] Open
Abstract
This study compared patient reported outcomes scores (PROMs) between patients undergoing hip arthroscopy who have and have not had previous lumbar spine surgery. We aimed to determine if prior spine surgery impacts the outcome of hip arthroscopy. Data were prospectively collected and retrospectively reviewed in patients who underwent hip arthroscopy between 2010 and 2017. Twenty cases were identified for analysis and matched to a control group. Four PROMs were collected pre-operatively and between 6 months and 2 years post-operatively (mean 16.2 months): Modified Harris Hip Score (mHHS), Hip Outcome Score-Activities of Daily Living (HOS-ADL), Hip Outcome Score-Sports (HOS-Sports) and the 33-item International Hip Outcome Tool (iHOT-33). Patients with previous spine surgery reported significantly worse (P-value <0.001) post-operative scores on all PROMs and smaller net changes on all PROMs with the difference on the mHHS (P-value 0.007), HOS-Sport (P-value 0.009) and iHOT-33 (P-value 0.007) being significant. Subsequent analyses revealed that the type of spine surgery matters. Patients with a spine fusion reported worse post-operative scores on all PROMs compared with patients with a spine decompression surgery with the difference on the mHHS (P-value 0.001), HOS-ADL (P-value 0.011) and HOS-Sport (P-value 0.035) being significant. Overall, patients with prior decompression surgery experienced considerable improvements from hip arthroscopy whereas patients with a prior spine fusion reported poor post-operative outcomes. Given these results, it is vital that hip preservation surgeons understand the impact of the lumbar spine on the outcome of hip arthroscopy.
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Affiliation(s)
- Jacob D Feingold
- Department of Orthopedic Surgery, Hospital for Special Surgery, 535 East 70th Street, New York, NY, USA
| | - Braiden Heaps
- Department of Orthopedic Surgery, Hospital for Special Surgery, 535 East 70th Street, New York, NY, USA
| | - Sava Turcan
- Department of Orthopedic Surgery, Hospital for Special Surgery, 535 East 70th Street, New York, NY, USA
| | - Erica Swartwout
- Department of Orthopedic Surgery, Hospital for Special Surgery, 535 East 70th Street, New York, NY, USA
| | - Anil Ranawat
- Department of Orthopedic Surgery, Hospital for Special Surgery, 535 East 70th Street, New York, NY, USA
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Wong TT, Weeks JK, Ahmed FS, Francescone MA, Rasiej MJ, Liu MZ, Kazam JK. How Many Radiographs Does It Take to Screen for Femoral Cam Morphology?: A Noninferiority Study. Curr Probl Diagn Radiol 2019; 50:48-53. [PMID: 31351696 DOI: 10.1067/j.cpradiol.2019.07.010] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2019] [Revised: 06/28/2019] [Accepted: 07/11/2019] [Indexed: 11/22/2022]
Abstract
PURPOSE To compare a 2-view radiograph series (AP of the pelvis and 45° Dunn of the hip) with a 5-view radiograph series for sensitivity in identifying femoral cam morphology. MATERIALS AND METHODS This is a retrospective review of consecutive patients with a 5-view radiograph series (AP pelvis and AP, 45° Dunn, frog lateral, and false profile of the affected hip) from 2016 to 2017. Three fellowship trained radiologists blindly and independently evaluated 2 views (AP pelvis and Dunn) for a femoral cam lesion, acetabular rim calcification, Tonnis grade, and important incidental findings. Two weeks later, the same assessment was made on all 5 views. A noninferiority test of the 2-view series vs the 5-view series for sensitivity in identifying femoral cam morphology was conducted. Individual reader sensitivity calculations were performed and agreement was determined with the kappa statistic. RESULTS The 2-view series was noninferior to the 5-view series for cam identification (P value = 0.010). In comparing the 2-view vs 5-view series for individual readers, there was no difference in the sensitivities (84%-100% vs 85%-98%, P = 0.85-1.0) or specificities (11%-56% vs 7%-56%, P = 0.58-1.0) for cam identification. There was fair to excellent 2-view intrareader agreement (k = 0.38-0.93) and similar inter-reader agreement between the 2-view and 5-view (k = 0.33 vs 0.37). CONCLUSIONS A 2-view radiograph series (AP pelvis and Dunn hip) is noninferior to a 5-view radiograph series for sensitivity in identifying femoral cam morphology.
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Affiliation(s)
- Tony T Wong
- New York Presbyterian Hospital, Columbia University Medical Center, Department of Radiology, New York NY.
| | - Joanna K Weeks
- New York Presbyterian Hospital, Columbia University Medical Center, Department of Radiology, New York NY
| | - Firas S Ahmed
- New York Presbyterian Hospital, Columbia University Medical Center, Department of Radiology, New York NY
| | - Mark A Francescone
- New York Presbyterian Hospital, Columbia University Medical Center, Department of Radiology, New York NY
| | - Michael J Rasiej
- New York Presbyterian Hospital, Columbia University Medical Center, Department of Radiology, New York NY
| | - Michael Z Liu
- New York Presbyterian Hospital, Columbia University Medical Center, Department of Radiology, New York NY
| | - Jonathan K Kazam
- New York Presbyterian Hospital Brooklyn Methodist, Department of Radiology, Brooklyn, NY
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25
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Lynch TS, O'Connor M, Minkara AA, Westermann RW, Rosneck JT. Biomarkers for Femoroacetabular Impingement and Hip Osteoarthritis: A Systematic Review and Meta-analysis. Am J Sports Med 2019; 47:2242-2250. [PMID: 30388026 DOI: 10.1177/0363546518803360] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND The early recognition and management of patients with hip lesions, such as femoroacetabular impingement (FAI) and early hip osteoarthritis (OA), may preempt significant hip morbidity. The identification of reliable biomarkers may help guide decision making in an efficient and cost-effective manner. PURPOSE To determine the biomarkers that have been associated with FAI as well as identify serum, synovial, and urinary analytes that have shown clinical utility in the prediction or identification of hip OA. STUDY DESIGN Systematic review and meta-analysis. METHODS The terms "hip arthroscopy," "femoroacetabular impingement," "labral tear," "osteoarthritis," and "biomarker" were searched in PubMed, Web of Science, Scopus, Cochrane Library, and Google Scholar, yielding 276 articles. After screening, 7 articles were included. Pooled estimates were calculated utilizing a fixed-effects inverse-variance model weighted for individual study size. RESULTS A total of 1747 patients with a mean age of 37.5 ± 4.5 years (76.4% female) were identified. Forty-three unique biomarkers were assessed. Although general proinflammatory cytokines IL-1 and TNF-α exhibited inconsistent trends in arthritic hips, IL-6 demonstrated a consistent increase (+84.8% [95% CI, 81.9%-87.6%]; P < .05). A significant difference was found in levels of the fibronectin-aggrecan complex (FAC) in patients with OA compared with controls (0.08 ± 0.40 vs 1.15 ± 0.35 μg/mL, respectively; P < .001). It was the only specific analyte to show a significant difference between those with and without OA. In the setting of FAI, cartilage oligomeric matrix protein (COMP) was significantly increased in athletes after adjusting for concurrent knee and hip OA. A statistically significant difference was present in FAI-positive hips (9.0 ± 0.1 [95% CI, 8.8-9.3]) compared with controls (8.4 ± 0.1 [95% CI, 8.2-8.4]) (P < .05). Other biomarkers, such as CXCL3, which exhibited statistically significant differences compared with controls, did not control for underlying factors such as age and concomitant lesions. CONCLUSION COMP and FAC are specific biomarkers with potential utility in the diagnosis and management of FAI and hip OA, given their ability to differentiate between controls and patients with hip lesions. Further research is necessary to identify their ability in determining disease severity, predicting the response to treatment, and establishing an association with the risk of long-term OA.
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Affiliation(s)
- T Sean Lynch
- Department of Orthopedic Surgery, Vagelos College of Physicians and Surgeons, Columbia University, New York, New York, USA
| | - Michaela O'Connor
- Department of Orthopedic Surgery, Vagelos College of Physicians and Surgeons, Columbia University, New York, New York, USA
| | - Anas A Minkara
- Department of Orthopaedic Surgery, Cleveland Clinic, Cleveland, Ohio, USA
| | - Robert W Westermann
- Department of Orthopedics and Rehabilitation, University of Iowa, Iowa City, Iowa, USA
| | - James T Rosneck
- Department of Orthopaedic Surgery, Cleveland Clinic, Cleveland, Ohio, USA
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Sogbein OA, Shah A, Kay J, Memon M, Simunovic N, Belzile EL, Ayeni OR. Predictors of Outcomes After Hip Arthroscopic Surgery for Femoroacetabular Impingement: A Systematic Review. Orthop J Sports Med 2019; 7:2325967119848982. [PMID: 31259183 PMCID: PMC6585257 DOI: 10.1177/2325967119848982] [Citation(s) in RCA: 102] [Impact Index Per Article: 20.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
Background The benefits of hip arthroscopic surgery in the setting of femoroacetabular impingement (FAI) have been well established; however, some patients may experience a greater degree of improvement than others. Identifying positive and negative predictors of outcomes would assist the orthopaedic surgeon's management algorithm for patients with FAI. Purpose/Hypothesis The objective of this systematic review was to identify demographic, radiographic, and other operative predictors of positive and negative outcomes after hip arthroscopic surgery for patients with FAI. It was hypothesized that factors including FAI morphology, age, body mass index (BMI), sex, dysplasia, articular cartilage damage, radiographic joint space, and labral treatment would predict outcomes after hip arthroscopic surgery. Study Design Systematic review; Level of evidence, 4. Methods This systematic review was performed in accordance with the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines. Three databases (Embase, PubMed, and Ovid [MEDLINE]) were searched on May 19, 2018, using terms including "hip," "arthroscopy," and "FAI." Studies were screened and data extracted in duplicate. Results A total of 39 studies were included in this systematic review, comprising 9272 hips with a mean age of 36.5 years (47.2% female). Younger age, male sex, lower BMI (<24.5 kg/m2), Tönnis grade 0, and preoperative pain relief from diagnostic intra-articular hip injections predicted positive outcomes. Female sex, older age (>45 years), longer duration of preoperative symptoms (>8 months), elevated BMI, increased Tönnis grade (≥1), chondral defects, decreased joint space (≤2 mm), increased Kellgren-Lawrence grade (>3), increased lateral center-edge angle (LCEA), and undergoing labral debridement alone were predictors of negative outcomes. Conclusion In patients with FAI, younger age, male sex, lower BMI (<24.5 kg/m2), Tönnis grade 0, and pain relief from preoperative intra-articular hip injections are significantly more likely to achieve positive outcomes after hip arthroscopic surgery. On the other hand, older age (>45 years), female sex, elevated BMI, osteoarthritic changes, decreased joint space (≤2 mm), chondral defects, increased LCEA, and undergoing labral debridement compared with labral repair are associated with negative outcomes.
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Affiliation(s)
- Olawale A Sogbein
- Northern Ontario School of Medicine, Laurentian University, Sudbury, Ontario, Canada
| | - Ajay Shah
- Michael G. DeGroote School of Medicine, McMaster University, Hamilton, Ontario, Canada
| | - Jeffrey Kay
- Division of Orthopaedic Surgery, Department of Surgery, McMaster University, Hamilton, Ontario, Canada
| | - Muzammil Memon
- Division of Orthopaedic Surgery, Department of Surgery, McMaster University, Hamilton, Ontario, Canada
| | - Nicole Simunovic
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Ontario, Canada
| | | | - Olufemi R Ayeni
- Division of Orthopaedic Surgery, Department of Surgery, McMaster University, Hamilton, Ontario, Canada
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Renouf J, Pergaminelis N, Tran P, Fary C, Tirosh O. The outcome of arthroscopic repair of acetabular labral tears using the iHOT-33. BMC Musculoskelet Disord 2019; 20:210. [PMID: 31084619 PMCID: PMC6515603 DOI: 10.1186/s12891-019-2611-3] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/07/2018] [Accepted: 05/03/2019] [Indexed: 11/10/2022] Open
Abstract
Background The purpose of this study was to determine patient reported outcome measures (PROMS) after arthroscopic repair of an isolated labral tear using the validated International Hip Outcome Tool (iHOT-33). The iHOT-33 specifically measures (1) symptoms and functional limitations, (2) sport and recreation limitations, (3) job related concerns and social and (4) emotional and lifestyle concerns. Methods A retrospective review was performed on 45 procedures in 43 patients between September 2012 and September 2015. Two patients had bilateral isolated labral tears. Patients were excluded if they were younger than 18 years, had prior ipsilateral hip surgery and had radiological or arthroscopic evidence of femoroacetabular impingement (FAI), hip dysplasia or other bony dysmorphism. Results Of the 43 patients undergoing arthroscopy there were 29 right and 16 left hips repaired. There were 34 females and 9 males. The mean age at surgery was 37.4 years (range 19–63 years) with a mean follow up of 1.7 years (range 1.0–2.6 years). At follow up the mean total iHOT-33 score improved from 34.1 to 67.3 (p < 0.02). The mean improvement was 33.2 (p = < 0.02). Significant improvements were described in all 4 iHOT-33 sub sections. Conclusion The study showed statistically significant favourable outcomes in selected patients with short follow-up for patients that underwent hip arthroscopy for an isolated labral tear using the validated iHOT-33. Level of Evidence IV, retrospective non-randomised study.
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Affiliation(s)
- Jesse Renouf
- Department of Orthopaedic Surgery, Western Health, Melbourne, Victoria, 3011, Australia. .,Australian Institute for Musculoskeletal Science (AIMSS), St Albans, Melbourne, VIC, Australia. .,The University of Melbourne and Western Health, Parkville, Melbourne, VIC, Australia.
| | - Nicholas Pergaminelis
- Department of Orthopaedic Surgery, Western Health, Melbourne, Victoria, 3011, Australia.,Australian Institute for Musculoskeletal Science (AIMSS), St Albans, Melbourne, VIC, Australia.,The University of Melbourne and Western Health, Parkville, Melbourne, VIC, Australia
| | - Phong Tran
- Department of Orthopaedic Surgery, Western Health, Melbourne, Victoria, 3011, Australia.,Australian Institute for Musculoskeletal Science (AIMSS), St Albans, Melbourne, VIC, Australia
| | - Camdon Fary
- Department of Orthopaedic Surgery, Western Health, Melbourne, Victoria, 3011, Australia.,Australian Institute for Musculoskeletal Science (AIMSS), St Albans, Melbourne, VIC, Australia
| | - Oren Tirosh
- Department of Orthopaedic Surgery, Western Health, Melbourne, Victoria, 3011, Australia.,Australian Institute for Musculoskeletal Science (AIMSS), St Albans, Melbourne, VIC, Australia
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Low-Dose Computed Tomography Reduces Radiation Exposure by 90% Compared With Traditional Computed Tomography Among Patients Undergoing Hip-Preservation Surgery. Arthroscopy 2019; 35:1385-1392. [PMID: 30987906 PMCID: PMC6500754 DOI: 10.1016/j.arthro.2018.11.013] [Citation(s) in RCA: 29] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/20/2018] [Revised: 11/03/2018] [Accepted: 11/04/2018] [Indexed: 02/02/2023]
Abstract
PURPOSE To compare the delivered radiation dose between a low-dose hip computed tomography (CT) scan protocol and traditional hip CT scan protocols (i.e., "traditional CT"). METHODS This was a retrospective comparative cohort study. Patients who underwent hip-preservation surgery (including arthroscopy, surgical hip dislocation, or periacetabular osteotomy procedures) at our institution between 2016 and 2017 were identified. Patients were excluded if they had a body mass index (BMI) greater than 35, they underwent previous surgery, or a radiation dose report was absent. The low-dose group included patients who underwent hip CT at our institution using a standardized protocol of 100 kV (peak), 100 milliampere-seconds (mAs), and a limited scanning field. The traditional CT group included patients who had hip CT scans performed at outside institutions. The total effective dose (Ehip), effective dose per millimeter of body length scanned, patients' age, and patients' BMI were compared by univariate analysis. The correlation of Ehip to BMI was assessed. RESULTS The study included 41 consecutive patients in the low-dose group and 18 consecutive patients in the traditional CT group. Low-dose CT resulted in a 90% reduction in radiation exposure compared with traditional CT (Ehip, 0.97 ± 0.28 mSv vs 9.68 ± 6.67 mSv; P < .0001). Age (28 ± 11 years vs 26 ± 10 years, P = .42), sex (83% female patients vs 76% female patients, P = .74), and BMI (24 ± 3 vs 24 ± 3, P = .75) were not different between the 2 groups. Ehip had a poor but significant correlation to BMI in the low-dose CT group (R2 = 0.14, slope = 0.03, P = .02) and did not correlate to BMI in the traditional CT group (R2 = 0.13, P = .14). CONCLUSIONS A low-dose hip CT protocol for the purpose of hip-preservation surgical planning resulted in a 90% reduction in radiation exposure compared with traditional CT. LEVEL OF EVIDENCE Level II, diagnostic study.
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Haynes JA, Xiong A, Nepple JJ, An T, Nunley RM, Clohisy JC. Does Previous Hip Arthroscopy Affect the Clinical Outcomes of Total Hip Arthroplasty? Orthop J Sports Med 2019; 7:2325967119829736. [PMID: 30886875 PMCID: PMC6413427 DOI: 10.1177/2325967119829736] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/26/2022] Open
Abstract
Background Failure of hip arthroscopy procedures and the need for subsequent total hip arthroplasty (THA) have been estimated to be as high as 16%. Prior literature has shown that failed ipsilateral knee arthroscopy may have a negative impact on the functional outcome of subsequent total knee arthroplasty. To date, there is limited information regarding the impact of failed hip arthroscopy on the clinical outcomes of subsequent primary THA. Purpose To compare clinical outcomes in primary THA between patients with and without prior arthroscopic hip surgery. Study Design Cohort study; Level of evidence, 3. Methods Patients undergoing primary THA with a history of ipsilateral hip arthroscopy were matched and compared in a 1:2 manner with patients undergoing primary THA without a history of hip arthroscopy. Patient-reported clinical outcomes were measured with the modified Harris Hip Score, the University of California-Los Angeles Activity Score, and 3 subscales from the Western Ontario and McMaster Universities Osteoarthritis Index (Pain, Stiffness, and Physical Function). Results At a mean follow-up of 42 months, there was no significant difference in any of the outcome measures between the 58 study hips and 116 matched controls. Additionally, both groups exhibited an absolute change in outcome scores that exceeded the minimum clinically important difference. Conclusion Prior ipsilateral arthroscopic hip surgery does not adversely affect the clinical outcome of subsequent THA.
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Affiliation(s)
- Jacob A Haynes
- Department of Orthopaedic Surgery, Washington University School of Medicine, St Louis, Missouri, USA
| | - Ao Xiong
- Orthopedic Department, Peking University Shenzhen Hospital, Shenzhen, Guangdong, China
| | - Jeffrey J Nepple
- Department of Orthopaedic Surgery, Washington University School of Medicine, St Louis, Missouri, USA
| | - Tonya An
- Department of Orthopaedic Surgery, Washington University School of Medicine, St Louis, Missouri, USA
| | - Ryan M Nunley
- Department of Orthopaedic Surgery, Washington University School of Medicine, St Louis, Missouri, USA
| | - John C Clohisy
- Department of Orthopaedic Surgery, Washington University School of Medicine, St Louis, Missouri, USA
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Minkara AA, Westermann RW, Rosneck J, Lynch TS. Systematic Review and Meta-analysis of Outcomes After Hip Arthroscopy in Femoroacetabular Impingement. Am J Sports Med 2019; 47:488-500. [PMID: 29373805 DOI: 10.1177/0363546517749475] [Citation(s) in RCA: 171] [Impact Index Per Article: 34.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND Femoroacetabular impingement (FAI) has become a more commonly recognized cause of limited hip range of motion and hip pain among young adults and athletes. Hip arthroscopy is recommended for the surgical treatment of this disorder, unless specific contraindications exist. Despite the increasing rate of published studies in this area, there remains no aggregate data for outcomes after this approach. PURPOSE To evaluate risk factors and outcomes after arthroscopic management of FAI, including return to play, revision rate, surgical and nonsurgical complications, change in α-angle, intraoperative bone resection, and patient-reported outcomes. STUDY DESIGN Meta-analysis and systematic review. METHODS A review of the current literature was performed with the terms "femoroacetabular impingement," "hip arthroscopy," and numerous variations thereof in PubMed, EMBASE, BioMed Central, Cochrane, Science Direct, and Scopus, yielding 1723 abstracts. After screening by eligibility criteria, 31 articles were included. The incidence of bilateral FAI was determined by enrollment data, and pooled estimates were calculated for postoperative patient-reported outcome measures, α-angles, return to sport, postoperative complications, and reoperation risk. RESULTS A total of 1981 hips among 1911 patients were identified, with a mean ± SD age of 29.9 ± 1.9 years and 29.5 ± 14.0 months of follow-up. The incidence of bilateral FAI in these studies that required operative intervention was 3.6%. The pooled risk of reoperation after hip arthroscopy, including revision surgery or subsequent total hip arthroplasty, was 5.5% (95% CI, 3.6%-7.5%). The risk of clinical complications was 1.7% (95% CI, 0.9%-2.5%). In total, 87.7% of patients demonstrated return to sport after surgery (95% CI, 82.4%-92.9%, P < .001), and all patient-reported outcomes improved postoperatively, with the highest increase observed in the Hip Outcome Score sports scale (41.7 points; 95% CI, 34.1-49.4; P < .001). The α-angle decreased by an average of 23.6° (95% CI, 18.2°-29.0°; P < .001). We identified 11 factors associated with the success of hip arthroscopy in FAI and 16 factors associated with failure or negative outcomes. CONCLUSION A high percentage of patients return to sport activities after hip arthroscopy for FAI, with a low rate of complications and reoperation. All patient-reported outcome measures, except for mental health, significantly improved after surgery.
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Affiliation(s)
- Anas A Minkara
- Columbia University Medical Center, New York, New York, USA
| | | | | | - T Sean Lynch
- Columbia University Medical Center, New York, New York, USA
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Clinical and radiological outcome at mean follow-up of 11 years after hip arthroscopy. Arch Orthop Trauma Surg 2019; 139:1-6. [PMID: 30101362 DOI: 10.1007/s00402-018-3024-8] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/01/2017] [Indexed: 02/09/2023]
Abstract
INTRODUCTION The use of hip arthroscopy (HA) has substantially increased over the last decade. However, while the benefits of HA after 1 year in patients with femoroacetabular impingement (FAI) are well documented, long-term data on the progression of osteoarthritis (OA) or patient-reported outcomes (PROMs) are lacking. OBJECTIVES To evaluate long-term clinical and radiological outcomes after HA. MATERIALS AND METHODS Preoperative clinical records, operative notes, and radiographs from all patients who underwent HA at our hospital between 1998 and 2006 were reviewed. Exclusion criteria were previous hip surgery or diagnostic HA. Primary endpoints were subsequent total hip arthroplasty (THA) or other hip surgery. Secondary endpoints were OA progression and PROMs. RESULTS HA was performed in 92 consecutive patients from 1998 to 2006. Indications for HA were FAI, labral lesions, early OA, and focal osteochondral defects. Mean follow-up was 11.2 years (SD 2.5, range 7.9-16). Data from 43 patients were available for analysis; 38 patients were excluded, and 11 were lost to follow-up. 20 patients had subsequent hip surgery, of which 11 patients required THA. 33 patients (77%) stated that they would undergo HA again under the same circumstances. Longitudinal radiological analysis showed no significant OA progression in patients without THA. The Forgotten Joint Score-12 was the only PROM to significantly differ between patients who had no further surgery and patients who had undergone revision (p = 0.037). CONCLUSION There was no significant OA progression on plain radiography at an average of 11 years post-HA. Sound indication criteria is essential, as 45% of patients required subsequent surgery.
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Atzmon R, Radparvar JR, Sharfman ZT, Dallich AA, Amar E, Rath E. Graft choices for acetabular labral reconstruction. J Hip Preserv Surg 2018; 5:329-338. [PMID: 30647922 PMCID: PMC6328747 DOI: 10.1093/jhps/hny033] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/11/2018] [Accepted: 07/08/2018] [Indexed: 12/21/2022] Open
Abstract
The acetabular labrum plays a key role in maintaining hip function and minimizing hip degeneration. Once thought to be a rare pathology, advances in imaging have led to an increase in the number of diagnosed labral tears. While still a relatively new field, labral reconstruction surgery is an option for tears that are irreparable or require revision after primary repair. Various autograft and allograft options exist when considering labral reconstruction. The first labral reconstruction surgery was described using the ligamentum teres capitis, and has since evolved, incorporating more graft sources and reconstructive techniques. The purpose of this review is to assess and describe the different graft sources and technique currently implemented by hip surgeons. Moreover, this review attempts to determine whether a single labral reconstructive graft type is superior to the others. Techniques using the Ligamentum teres capitis autograft, ITB autograft, gracilis autograft, quadriceps tendon autograft, capsular autograft, semitendinosus allograft, indirect head of the rectus femoris autograft, peroneus brevis tendon allograft and Tensor fascia lata allograft were found. Scoring was available on 5 out of the 9 graft types. The advantages and disadvantages of each graft source is described as a comparative tool. No single graft type has shown increased benefit in acetabular labral reconstruction. The lack of uniform outcome measurements hinders comparison of reported outcomes. Surgeons should make an informed decision based on their experience as well as the patient's history and needs when choosing which graft type would be best suited for their patients.
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Affiliation(s)
- Ran Atzmon
- Department of Orthopaedic Surgery, Assuta Medical Center, Faculty of Health and Science and Ben Gurion University, Ha-Refu'a St 7, Ashdod, Israel
| | - Joshua R Radparvar
- Department of Orthopaedic Surgery, Tel Aviv Medical Center, Sackler Faculty of Medicine and Tel Aviv University, Weizmann St 6, Tel Aviv-Yafo, Israel
| | - Zachary T Sharfman
- Department of Orthopaedic Surgery, Montefiore Medical Center, Albert Einstein College of Medicine, 1300 Morris Park Avenue, Forcheimer Building, Bronx, NY, USA
| | - Alison A Dallich
- Department of Orthopaedic Surgery, Tel Aviv Medical Center, Sackler Faculty of Medicine and Tel Aviv University, Weizmann St 6, Tel Aviv-Yafo, Israel
| | - Eyal Amar
- Department of Orthopaedic Surgery, Tel Aviv Medical Center, Sackler Faculty of Medicine and Tel Aviv University, Weizmann St 6, Tel Aviv-Yafo, Israel
| | - Ehud Rath
- Department of Orthopaedic Surgery, Tel Aviv Medical Center, Sackler Faculty of Medicine and Tel Aviv University, Weizmann St 6, Tel Aviv-Yafo, Israel
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Weber AE, Neal WH, Mayer EN, Kuhns BD, Shewman E, Salata MJ, Mather RC, Nho SJ. Vertical Extension of the T-Capsulotomy Incision in Hip Arthroscopic Surgery Does Not Affect the Force Required for Hip Distraction: Effect of Capsulotomy Size, Type, and Subsequent Repair. Am J Sports Med 2018; 46:3127-3133. [PMID: 30307738 DOI: 10.1177/0363546518800710] [Citation(s) in RCA: 31] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND Interportal and T-capsulotomies are popular techniques for exposing femoroacetabular impingement deformities. The difference between techniques with regard to the force required to distract the hip is currently unknown. PURPOSE To quantify how increasing interportal capsulotomy size, conversion to T-capsulotomy, and subsequent repair affect the force required to distract the hip. STUDY DESIGN Controlled laboratory study. METHODS Eight fresh-frozen cadaveric hip specimens were dissected and fixed in a materials testing system, such that pure axial distraction of the iliofemoral ligament could be achieved. The primary outcome measure was the load required to distract the hip to a distance of 6 mm at a rate of 0.5 mm/s. Each hip was tested in the intact state and then sequentially under varying capsulotomy conditions: 2-cm interportal, 4-cm interportal, half-T (4-cm interportal and 2-cm T-capsulotomy), and full-T (4-cm interportal and 4-cm T-capsulotomy). After serial testing, isolated T-limb repair and then subsequent complete repair were performed. Repaired specimens underwent distraction testing as previously stated to assess the ability to restore hip stability to the native profile. Distraction force as well as the relative distraction force (percentage normalized to the intact capsule) were compared between all capsulotomy and repair conditions. RESULTS Increasing interportal capsulotomy size from 2 to 4 cm resulted in significantly less force required to distract the hip ( P < .001). The largest relative decrease in force was seen between the intact state (274.6 ± 71.2 N; 100%) and 2-cm interportal (209.7 ± 73.2 N; 76.4% ± 15.6%; P = .0008). There was no significant mean difference in distraction force when 4-cm interportal (160.4 ± 79.8 N) was converted to half-T (140.7 ± 73.5 N; P = .270) and then full-T (112.0 ± 70.2 N; P = .204). When compared with the intact state, isolated T-limb repair partially restored stability (177.3 ± 86.3 N; 63.5% ± 19.8%; P < .0001), while complete repair exceeded native values (331.7 ± 103.7 N; 122.7% ± 15.1%; P = .0008). CONCLUSION The conversion of interportal capsulotomy to T-capsulotomy did not significantly affect the force required to distract the hip in a cadaveric model. However, larger interportal capsulotomies resulted in significant stepwise decreases in distraction force. When performing interportal or T-capsulotomy, the iliofemoral ligament strength is significantly decreased, but complete capsular repair demonstrated the ability to restore joint stability to the native, intact hip. CLINICAL RELEVANCE Increasing interportal capsulotomy size decreases the force required to distract the hip. In an effort to maximize visualization and minimize the magnitude of iliofemoral ligament fibers cut, many surgeons have moved from extended interportal capsulotomy to T-capsulotomy. Interportal and T-capsulotomies result in equivalent hip distraction, partial capsular repair marginally improves hip stability, and only complete repair has the ability to restore the hip to its native biomechanical profile.
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Affiliation(s)
- Alexander E Weber
- Department of Orthopaedic Surgery, Keck School of Medicine, University of Southern California, Los Angeles, California, USA
| | - William H Neal
- Section of Young Adult Hip Surgery, Division of Sports Medicine, Department of Orthopedic Surgery, Rush University Medical Center, Chicago, Illinois, USA
| | - Erik N Mayer
- Department of Orthopaedic Surgery, Keck School of Medicine, University of Southern California, Los Angeles, California, USA
| | - Benjamin D Kuhns
- Department of Orthopaedics, University of Rochester Medical Center, Rochester, New York, USA
| | - Elizabeth Shewman
- Section of Young Adult Hip Surgery, Division of Sports Medicine, Department of Orthopedic Surgery, Rush University Medical Center, Chicago, Illinois, USA
| | - Michael J Salata
- Department of Orthopaedics, University Hospitals Cleveland Medical Center, Cleveland, Ohio, USA
| | - R Chad Mather
- Department of Orthopaedic Surgery, Duke University School of Medicine, Durham, North Carolina, USA
| | - Shane J Nho
- Section of Young Adult Hip Surgery, Division of Sports Medicine, Department of Orthopedic Surgery, Rush University Medical Center, Chicago, Illinois, USA
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Kantrowitz DE, Trofa DP, Woode DR, Ahmad CS, Lynch TS. Athletic Hip Injuries in Major League Baseball Pitchers Associated With Ulnar Collateral Ligament Tears. Orthop J Sports Med 2018; 6:2325967118800704. [PMID: 30288391 PMCID: PMC6168728 DOI: 10.1177/2325967118800704] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/03/2022] Open
Abstract
Background: Ulnar collateral ligament (UCL) reconstruction is a reliable treatment for
elite overhand throwers with UCL tears. In recent years, this procedure has
become increasingly common among Major League Baseball (MLB) pitchers.
Predisposing factors and associated comorbidities, however, have not been
fully elucidated. Purpose/Hypothesis: The purpose of this study was to determine whether professional baseball
pitchers who underwent UCL reconstruction had an increased incidence of hip
or groin injuries 4 years before or after surgery. We hypothesized that MLB
pitchers who sustain hip or groin injuries may be more likely to develop UCL
tears because of alterations and overcompensation in the kinetic chain
during overhand throwing. Study Design: Cohort study; Level of evidence, 3. Methods: A comprehensive list of all 247 MLB players who underwent UCL reconstruction
between 2005 and 2017 was created using publicly accessible online data. The
application of inclusion criteria yielded a final sample size of 145
athletes. These athletes’ injury histories were identified and
cross-referenced with the official MLB disabled list. Matched controls were
generated for a comparison of results. Results: Of the 145 MLB pitchers who underwent UCL reconstruction between 2005 and
2017, 40 (27.6%) endured a proximal lower extremity injury within 4 years of
their surgery. Specifically, 16 pitchers sustained hip injuries, 13 suffered
hamstring injuries, and 14 experienced groin injuries. A significantly lower
rate of hip- and groin-related injuries (17.9%) was identified in matched
controls during a similar time frame (P = .049). Conclusion: The results of this study demonstrate that MLB pitchers who required UCL
reconstruction sustained a higher frequency of proximal lower extremity
injuries both before and after surgery compared with matched controls. This
finding is significant as the treatment of antecedent hip lesions, as well
as an emphasis on hip and core muscle mobility and strengthening, may help
reduce injuries to the UCL.
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Affiliation(s)
- David E Kantrowitz
- Department of Orthopedic Surgery, New York-Presbyterian/Columbia University Medical Center, New York, New York, USA
| | - David P Trofa
- Department of Orthopedic Surgery, New York-Presbyterian/Columbia University Medical Center, New York, New York, USA
| | - Denzel R Woode
- Department of Orthopedic Surgery, New York-Presbyterian/Columbia University Medical Center, New York, New York, USA
| | - Christopher S Ahmad
- Department of Orthopedic Surgery, New York-Presbyterian/Columbia University Medical Center, New York, New York, USA
| | - T Sean Lynch
- Department of Orthopedic Surgery, New York-Presbyterian/Columbia University Medical Center, New York, New York, USA
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O'Connor M, Minkara AA, Westermann RW, Rosneck J, Lynch TS. Return to Play After Hip Arthroscopy: A Systematic Review and Meta-analysis. Am J Sports Med 2018; 46:2780-2788. [PMID: 29595996 DOI: 10.1177/0363546518759731] [Citation(s) in RCA: 65] [Impact Index Per Article: 10.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND The use of arthroscopic treatment for intra-articular hip pathology has demonstrated improved patient-reported outcomes (PROs) with a lower rate of complications, reoperation, and patient morbidity as compared with traditional methods. Although the use of this minimally invasive approach has increased in prevalence, no evidence-based return-to-play (RTP) criteria have been developed to ensure an athlete's preparedness for sporting activities. PURPOSE To determine if there exists sufficient evidence in the literature to support an RTP protocol and functional assessment after hip arthroscopy, as well as to assess the mean rate and duration of RTP. STUDY DESIGN Systematic review and meta-analysis. METHODS The search terms "hip arthroscopy," "return to play," and 10 related terms were searched in PubMed, Cochrane Library, Scopus, and Web of Science, yielding 263 articles. After screening, 22 articles were included. RTP timeline, rehabilitation protocols, and conditional criteria measures were assessed with previously established criteria. Pooled estimates were calculated for RTP rate and duration, and weighted mean scores were determined for PROs. RESULTS A total of 1296 patients with 1442 total hips were identified. Although 54.5% (12 of 22) of studies did not provide a guideline for RTP duration after hip arthroscopy, 36.4% (8 of 22) recommended a duration of 4 months, while 9.1% (2 of 22) recommended 3 months. The most frequently described postoperative rehabilitation protocols were weightbearing guidelines (15 studies) and passive motion exercises (9 studies). Only 2 studies satisfied the criteria for a sufficient RTP protocol, and 3 provided a specific replicable test for RTP. The mean RTP duration was 7.4 months (95% CI, 6.1-8.8 months), and the return rate was 84.6% (95% CI, 80.4%-88.8%; P = .008) at a mean ± SD follow-up of 25.8 ± 2.4 months. Mean modified Harris Hip Score (mHHS) improved from 63.1 to 84.1 postoperatively (+33.3%), while Non-arthritic Hip Score improved from 61.7 to 86.8 (+40.7%). A lower preoperative mHHS was significantly associated with a higher postoperative improvement ( r = -0.95, P = .0003). CONCLUSION Significant variability exists in RTP protocols among institutions owing to a lack of standardization. Despite a high overall rate of RTP and improvement in PROs after hip arthroscopy, the majority of rehabilitation protocols are not evidence based and rely on expert opinion. No validated functional test currently exists to assess RTP.
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Affiliation(s)
| | - Anas A Minkara
- Columbia University Medical Center, New York, New York, USA
| | | | | | - T Sean Lynch
- Columbia University Medical Center, New York, New York, USA
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Sonnenfeld JJ, Trofa DP, Mehta MP, Steinl G, Lynch TS. Hip Arthroscopy for Femoroacetabular Impingement. JBJS Essent Surg Tech 2018; 8:e23. [PMID: 30588368 DOI: 10.2106/jbjs.st.18.00043] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Background The first recorded attempt at arthroscopic visualization of the hip can be attributed to Dr. Michael Burman in 1931. Since then, hip arthroscopy has become widely used for the management of femoroacetabular impingement (FAI) because of its clear benefits, including a low complication rate and limited patient morbidity as compared with traditional open approaches. Description Arthroscopic management of FAI begins with arthroscopy of the central compartment, where the intra-articular damage is identified. Standard portal placement provides optimal access for surveying and accessing intra-articular injury. The pathological findings identified preoperatively and confirmed during diagnostic arthroscopy dictate the necessary arthroscopic procedures. Correction of acetabular overcoverage and repair of the labrum to the acetabular rim can correct pincer lesions. Femoral-sided cam lesions require removal of traction and application of hip flexion in order to perform a femoral osteoplasty to recreate a normal anatomic femoral head-neck offset. Finally, capsular management is performed as clinically indicated. Alternatives Appropriate management of FAI typically begins with nonoperative care consisting of rest, nonsteroidal anti-inflammatory drugs (NSAIDs), activity modification, and physical therapy1. Intra-articular corticosteroid injections can also provide relief2. Open procedures involving surgical hip dislocation can be utilized to address pathological conditions not accessible arthroscopically. Additionally, a "mini-open" procedure in which intra-articular disorders are treated arthroscopically and cam lesions are resected via a small anterior exposure can be employed3,4. Rationale Hip arthroscopy offers a minimally invasive technique that can be effective for treating intra-articular hip disorders and is usually favored over open surgical dislocation. Hip arthroscopy has been shown to result in higher functional outcome scores than open procedures, with lower rates of complications5. Hip arthroscopy is playing an increasingly important role as an adjunct diagnostic and therapeutic tool in conjunction with open femoral and/or periacetabular osteotomy for complex hip deformities.
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Affiliation(s)
- Julian J Sonnenfeld
- Columbia University Vagelos College of Physicians and Surgeons, New York, NY
| | - David P Trofa
- Columbia University Vagelos College of Physicians and Surgeons, New York, NY
| | - Manish P Mehta
- Columbia University Vagelos College of Physicians and Surgeons, New York, NY
| | - Gabrielle Steinl
- Columbia University Vagelos College of Physicians and Surgeons, New York, NY
| | - T Sean Lynch
- Columbia University Vagelos College of Physicians and Surgeons, New York, NY
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Davies O, Grammatopoulos G, Pollard TCB, Andrade AJ. Factors increasing risk of failure following hip arthroscopy: a case control study. J Hip Preserv Surg 2018; 5:240-246. [PMID: 30393551 PMCID: PMC6206686 DOI: 10.1093/jhps/hny020] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/11/2017] [Revised: 05/09/2018] [Accepted: 05/22/2018] [Indexed: 11/14/2022] Open
Abstract
We aimed to identify factors such as pre-arthroscopy and intra-operative variables that were associated with failure of hip arthroscopy as a joint preserving operation. We performed a retrospective analysis of a database containing 344 consecutive hip arthroscopies performed at our institution. Forty-four hips were identified that underwent a subsequent arthroplasty procedure following their hip arthroscopy (cases). Sixty-six control hips (hip arthroscopy with no subsequent arthroplasty) were randomly selected from the same database. Cases and controls were matched for age, sex and follow-up (P = 0.59, 0.48, 0.10, respectively). Pre-operative radiographs/MRI scans plus intra-operative findings were analysed to identify factors associated with failure. Both a lower centre edge angle and higher acetabular index on pre-operative radiographs were associated with higher rates of failure (P < 0.001). The presence of any acetabular wear at operation was also associated with failure (P < 0.001). Highest rates of failure were seen in hips with both features of dysplasia on pre-operative radiographs and any intra-operative acetabular wear (relative risk: 5, odds ratio: 9.13, P < 0.001). Dysplastic features on pre-operative radiographs and the finding of acetabular wear at hip arthroscopy increase the risk of subsequent arthroplasty. Identification of these features pre-operatively with evolving imaging techniques would improve the results of hip arthroscopy as joint preserving surgery.
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Affiliation(s)
- Owain Davies
- Department of Trauma and Orthopaedics, NHS Foundation Trust, Royal Berkshire Hospital, London Road, Reading, Berkshire, UK
| | - George Grammatopoulos
- Department of Trauma and Orthopaedics, NHS Foundation Trust, Royal Berkshire Hospital, London Road, Reading, Berkshire, UK
| | - Tom C B Pollard
- Department of Trauma and Orthopaedics, NHS Foundation Trust, Royal Berkshire Hospital, London Road, Reading, Berkshire, UK
| | - Antonio J Andrade
- Department of Trauma and Orthopaedics, NHS Foundation Trust, Royal Berkshire Hospital, London Road, Reading, Berkshire, UK
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O'Connor M, Minkara AA, Westermann RW, Rosneck J, Lynch TS. Outcomes of Joint Preservation Procedures for Cartilage Injuries in the Hip: A Systematic Review and Meta-analysis. Orthop J Sports Med 2018; 6:2325967118776944. [PMID: 29942815 PMCID: PMC6009090 DOI: 10.1177/2325967118776944] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
Background: The detection and management of chondral injuries of the hip, especially in a younger patient population, may preempt joint degeneration. Although the outcomes of preservation techniques have been well described for other weightbearing joints, such as the knee, evidence for hip joint preservation after procedures such as microfracture and autologous chondrocyte implantation remains in its infancy. Purpose: To evaluate outcomes of joint preservation procedures in the hip, including the success rate and patient-reported outcomes (PROs). Study Design: Systematic review; Level of evidence, 4. Methods: This review was performed using the terms “hip arthroscopy,” “microfracture,” “autologous chondrocyte implantation,” “fibrin glue,” “osteochondral transfer,” and variations thereof in 5 electronic databases, yielding 325 abstracts. After the application of eligibility criteria, 19 articles were included. Weighted means were calculated for PROs, and pooled estimates were calculated for age, follow-up, chondral lesion size, and success of hip preservation procedures with a random-effects proportion meta-analysis. Results: A total of 1484 patients (1502 hips) were identified across 19 studies (mean age, 38.0 ± 1.3 years; mean follow-up, 31.8 ± 9.6 months). Hip joint preservation techniques demonstrated a high success rate, ranging from 85.6% to 99.7%. The mean pooled chondral lesion size was 2.5 ± 0.3 cm2 (95% CI, 1.9-3.0 cm2). Microfracture was the most frequent technique, utilized by 11 studies, and demonstrated an 89.6% success rate (95% CI, 82.4%-96.7%). The highest pooled success rate was exhibited by autologous membrane-induced chondrogenesis in 3 studies (99.7% [95% CI, 99.0%-100.0%]). All PROs demonstrated a statistically significant increase postoperatively, including the modified Harris Hip Score, Nonarthritic Hip Score, and Hip Outcome Score–Activities of Daily Living and Hip Outcome Score–Sports-Specific Subscale (all P < .05). The visual analog scale for pain also demonstrated a statistically significant decrease of 37.2% (P < .05). Conclusion: Hip preservation procedures demonstrate a high success rate, with microfracture representing the most frequently utilized cartilage preservation technique in the peer-reviewed literature. PROs significantly improved after surgery. Further investigation of hip preservation modalities with long-term follow-up is required to create evidence-based clinical recommendations and treatment algorithms.
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Affiliation(s)
| | - Anas A Minkara
- Columbia University Medical Center, New York, New York, USA
| | | | | | - T Sean Lynch
- Columbia University Medical Center, New York, New York, USA
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Preoperative Use of a 3D Printed Model for Femoroacetabular Impingement Surgery and Its Effect on Planned Osteoplasty. AJR Am J Roentgenol 2018; 211:W116-W121. [PMID: 29873507 DOI: 10.2214/ajr.17.19400] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
OBJECTIVE The purpose of this study was to determine the effect that preoperative use of 3D printed models has on planned osteoplasty for femoroacetabular impingement (FAI) surgery. MATERIALS AND METHODS This experimental study utilizing retrospective data included 10 consecutive patients from July 1, 2013, to January 1, 2015, with a clinical diagnosis of FAI and imaging consisting of radiographs, CT scans, and MR images. Three-dimensional models of each patient's affected hip were printed to scale from CT data. Two orthopedic surgeons evaluated each patient in a routine preoperative manner. The effect of the 3D models in altering the planned osteoplasty was then determined. Proportions of osteoplasty change were calculated at various positions, and categoric variables were assessed with the chi-square test for independence. RESULTS Proportions of osteoplasty changes ranged from 20% to 55% at femoral positions (greatest at lateral and depth positions) and 35-75% at acetabular positions (greatest at anterior and depth positions). More osteoplasty changes occurred in patients with alpha angles of 60° or more (p = 0.00030) and without a radiographic crossover sign (p = 0.0075). We found no difference in the proportion of osteoplasty changes when stratifying by lateral center edge angle and coxa profunda (p = 0.190 and 0.109, respectively). The planned osteoplasty was changed for at least one reader in 9/10 (90%) femurs and 10/10 (100%) acetabula. CONCLUSION Use of 3D models in preoperative planning can change both the extent and location of planned osteoplasty for FAI surgery and is particularly influential in patients with alpha angles of 60° or more and without a radiographic crossover.
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Nwachukwu BU, Chang B, Rotter BZ, Kelly BT, Ranawat AS, Nawabi DH. Minimal Clinically Important Difference and Substantial Clinical Benefit After Revision Hip Arthroscopy. Arthroscopy 2018; 34:1862-1868. [PMID: 29653791 DOI: 10.1016/j.arthro.2018.01.050] [Citation(s) in RCA: 64] [Impact Index Per Article: 10.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/05/2017] [Revised: 01/31/2018] [Accepted: 01/31/2018] [Indexed: 02/02/2023]
Abstract
PURPOSE To define minimal clinically important difference (MCID) and substantial clinical benefit (SCB) in revision hip arthroscopy. METHODS The modified Harris Hip Score (mHHS), the Hip Outcome Score (HOS), and the international Hip Outcome Tool (iHOT-33) were administered to revision hip arthroscopy patients. At 1 year postoperatively, patients graded their hip function based on anchor responses. SCB was defined as both a net change and an absolute value. Receiver operating characteristic analysis with area under the curve was used to confirm psychometric values. A distribution-based method was used for MCID. RESULTS Forty-nine patients were included with a mean age of 29.7 (±8.6) years. The most common indication for revision hip arthroscopy was residual femoroacetabular impingement (FAI; N = 34; 69.4%) followed by capsular management (N = 8; 16.3%). At 1-year follow-up, 34 patients reported feeling improved. Outcome score change corresponding to MCID and SCB net change for the mHHS, HOS Activities of Daily Living (ADL), HOS Sports, and iHOT-33 was 7.9/23.1, 7.9/16.2, 13.1/25.0, and 12.8/25.5, respectively. A higher proportion of patients with residual FAI achieved MCID compared with patients with other diagnoses. On the preoperative HOS ADL, HOS Sports, and iHOT-33, patients scoring below 67.7 (0.78), 55.6 (0.81), and 35.7 (0.73) were significantly more likely to achieve SCB postoperatively. Thirty-four patients (73.9%) were classified as receiving physical function improvement, and on the HOS Sports, MCID was achieved by 65% whereas 43% met the SCB criteria. CONCLUSIONS MCID values ranged from 7.9 on the mHHS and the HOS ADL to 13.1 on the HOS Sports. SCB net change ranged from 16.2 on the HOS ADL to 25.2 on the iHOT-33, whereas absolute SCB ranged from 82.4 on the iHOT-33 to 84.7 on the mHHS. Residual FAI and capsular management were the most common indications for revision surgery with patients who underwent surgery for the former found to be most likely to achieve clinically significant improvement. LEVEL OF EVIDENCE Level IV, case series.
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Affiliation(s)
- Benedict U Nwachukwu
- Department of Orthopaedic Surgery, Hospital for Special Surgery, New York, New York, U.S.A..
| | - Brenda Chang
- Department of Orthopaedic Surgery, Hospital for Special Surgery, New York, New York, U.S.A
| | - Ben-Zion Rotter
- Department of Orthopaedic Surgery, Hospital for Special Surgery, New York, New York, U.S.A
| | - Bryan T Kelly
- Department of Orthopaedic Surgery, Hospital for Special Surgery, New York, New York, U.S.A
| | - Anil S Ranawat
- Department of Orthopaedic Surgery, Hospital for Special Surgery, New York, New York, U.S.A
| | - Danyal H Nawabi
- Department of Orthopaedic Surgery, Hospital for Special Surgery, New York, New York, U.S.A
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Möckel G, Miehlke W. [Arthroscopic treatment of psoas impingement]. OPERATIVE ORTHOPADIE UND TRAUMATOLOGIE 2018. [PMID: 29541796 DOI: 10.1007/s00064-018-0535-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVE Tenotomy of the psoas tendon in symptomatic internal coxa saltans or psoas impingement should relieve pain. INDICATIONS Indicated in conservative treatment-resistant internal coxa saltans and in psoas impingement. CONTRAINDICATIONS Contraindications are symptomatic psoas pathologies in hip dysplasia patients. SURGICAL TECHNIQUE Three different procedures exist with the arthroscopic technique, in which the psoas tenotomy can be performed at one of three different levels. These are the arthroscopic transcapsular, the endoscopic extra-articular, and the arthroscopic central techniques. POSTOPERATIVE MANAGEMENT Forearm crutches are recommended for approximately 2-4 weeks as well as physiotherapy to strengthen the hip flexors. RESULTS A literature-based comparison could reveal no difference between the extra-articular and transcapsular techniques. Particularly in the long term was no loss of strength evident. Various different authors describe the techniques as good, finding neither complications nor recurrence of internal snapping hip.
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Affiliation(s)
- G Möckel
- Arthroskopische Hüftchirurgie, Helios Klinik Berlin-Buch und Asklepios Klinik Birkenwerder, Berlin, Deutschland.
| | - W Miehlke
- Arcus Klinik Pforzheim, Rastatter Str. 17-19, Pforzheim, Deutschland
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Kaya M. Impact of extra-articular pathologies on groin pain: An arthroscopic evaluation. PLoS One 2018; 13:e0191091. [PMID: 29324877 PMCID: PMC5764340 DOI: 10.1371/journal.pone.0191091] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2017] [Accepted: 11/28/2017] [Indexed: 11/18/2022] Open
Abstract
Purpose For patients who have anterior hip pain evaluated by Patrick’s test and tenderness at Scarpa’s triangle, we perform periarticular debridement based on the hypothesis that extra-articular pathologies are responsible for the hip pain. The purpose of this study was to categorize the endoscopic extra-articular findings and to evaluate the clinical significance of periarticular pathologies in anterior hip pain. Methods Arthroscopic findings of 77 patients who underwent periarthritic debridement were evaluated. As extra-articular pathologies, injuries of the direct head and reflective head of the rectus femoris muscle were evaluated. A thin layer of fat tissue normally exists on the anterior inferior iliac spine (AIIS), the attachment site of the direct head of the rectus femoris muscle. The macroscopic appearance of the fat pad on the AIIS was categorized as normal, blood vessel-rich adipose tissue or adipose tissue with fibrosis or scar formation and histologically confirmed. Adhesion of gluteal muscles to the joint capsule was also evaluated. Results Of the 77 patients, 75 had rupture of the direct head of the rectus femoris. In contrast, rupture of the reflective head was extremely rare. Seven patients had a normal fat pad on the AIIS, 11 had blood vessel-rich adipose tissue and 55 had adipose tissue with fibrosis. Fat tissue was completely replaced by fibrous scar tissue in another 4 patients. In 64 patients, adhesion between the anterior joint capsule and gluteus muscles was marked. Groin pain disappeared soon after the operation even when labral tears were not repaired and all patients returned to daily life and sports activities within 2 weeks after operation. Conclusion Rectus femoris tendinosis, fibrosis of the AIIS fat pad, and adhesion of gluteal and rectus femoris muscles are common extra-articular pathologies in patients with anterior hip pain. Management of only these lesions induces rapid relief of anterior hip pain even in the absence of labral tear repair. My observations suggest that it is desirable to be aware of the presence of periarticular pathologies as a cause of groin pain.
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Affiliation(s)
- Mitsunori Kaya
- Hitsujigaoka Hospital, Sapporo, Hokkaido, Japan
- * E-mail:
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Should the Capsule Be Repaired or Plicated After Hip Arthroscopy for Labral Tears Associated With Femoroacetabular Impingement or Instability? A Systematic Review. Arthroscopy 2018; 34:303-318. [PMID: 28866345 DOI: 10.1016/j.arthro.2017.06.030] [Citation(s) in RCA: 85] [Impact Index Per Article: 14.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/30/2016] [Revised: 05/17/2017] [Accepted: 06/20/2017] [Indexed: 02/02/2023]
Abstract
PURPOSE To critically evaluate the existing literature on hip capsule biomechanics, clinical evidence of instability, and outcomes of capsular management to answer the following question: Should the capsule be repaired or plicated after hip arthroscopy for labral tears associated with femoroacetabular impingement or instability? METHODS We used PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-analyses) guidelines to find articles using PubMed and Embase. Included studies were Level I through V studies and focused on hip capsule biomechanics, postarthroscopic instability, and clinical outcomes. Articles were excluded if they discussed treatment of the hip capsule during arthroplasty, dislocations without a history of arthroscopy, and pre-existing conditions. The Methodological Index for Non-randomized Studies (MINORS) was used for quality assessment of clinical outcome studies. RESULTS A total of 34 articles were included: 15 biomechanical studies, 9 instability case reports, and 10 outcome studies. There is consensus from biomechanical studies that the capsule is an important stabilizer of the hip and repairing it provides better stability than when unrepaired. Case reports of instability have raised concerns about capsular management during the index procedure to decrease the complications associated with this problem. Furthermore, outcome studies suggest that there may be an advantage of capsular closure versus capsulotomy during hip arthroscopy for nonarthritic patients. CONCLUSIONS Short-term outcome studies suggest that capsular closure is safe and effective in nonarthritic patients undergoing hip arthroscopic procedures and may yield superior outcomes compared with unrepaired capsulotomy. Moreover, biomechanical evidence strongly supports the role of capsular repair in maintaining stability of the hip. In patients with stiffness or inflammatory hip disorders, a release may be appropriate. In patients who have signs and symptoms of instability, there is existing evidence that capsular plication may be associated with significant improvement in patient-reported outcomes. Although the multiple procedures performed in combination with capsular treatment present confounding variables, current evidence appears to support routine capsular closure in most cases and to support capsular plication in cases of instability or borderline dysplasia. LEVEL OF EVIDENCE Level IV, systematic review of Level II through IV studies.
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Nwachukwu BU, Chang B, Kahlenberg CA, Fields K, Nawabi DH, Kelly BT, Ranawat AS. Arthroscopic Treatment of Femoroacetabular Impingement in Adolescents Provides Clinically Significant Outcome Improvement. Arthroscopy 2017. [PMID: 28623078 DOI: 10.1016/j.arthro.2017.04.008] [Citation(s) in RCA: 47] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
PURPOSE To define minimal clinically important difference (MCID) and substantial clinical benefit (SCB) for adolescents undergoing arthroscopic femoroacetabular impingement (FAI) surgery. METHODS A prospective institutional hip preservation registry was reviewed to identify hip arthroscopies performed for FAI. Patients with pre-existing hip conditions such as slipped capital femoral epiphysis and Legg-Calve-Perthese were excluded. Included patients were 18 years and younger. The modified Harris Hip Score (mHHS), the Hip Outcome Score (HOS), and the international Hip Outcome Tool (iHOT-33) were administered as part of the registry. MCID was calculated using a distribution-based method, and SCB was calculated using a physical function anchor question. Receiver operating characteristic analysis with area under the curve (AUC) was used for psychometric analyses. RESULTS Forty-seven adolescents were identified. The majority of patients were female (n = 32, 68.1%) with a mean age of 16.5 (±1.1) years. The MCID (% achieving) for the mHHS, HOS activities of daily living (ADL), HOS Sport, and iHOT-33 was 9.5 (85%), 9.8 (79%), 12.1 (85%), and 10.7 (94%), respectively. Ninety-two percent of adolescents reported some form of improved hip physical ability on the anchor question. The following 1-year absolute outcome scores were significantly representative of an SCB state on the mHHS, HOS ADL, HOS Sport, and mHHS, respectively (AUC): 93.5 (0.79), 98.5 (0.84), 96.9 (0.81), and 85.9 (0.76). CONCLUSIONS Adolescents undergoing arthroscopic FAI surgery achieve clinically significant outcome improvement. We found that the vast majority of adolescents achieve MCID on hip-specific patient-reported outcome tools. However, although adolescents readily achieve MCID, a considerable improvement in postoperative outcome score is often needed to perceive a substantial benefit (SCB). The available hip outcome tools may be subject to ceiling effects for measuring clinically significant outcome improvement in adolescents. LEVEL OF EVIDENCE Level IV, case series.
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Affiliation(s)
- Benedict U Nwachukwu
- Department of Orthopaedic Surgery, Hospital for Special Surgery, New York, New York, U.S.A..
| | - Brenda Chang
- Department of Orthopaedic Surgery, Hospital for Special Surgery, New York, New York, U.S.A
| | - Cynthia A Kahlenberg
- Department of Orthopaedic Surgery, Hospital for Special Surgery, New York, New York, U.S.A
| | - Kara Fields
- Department of Orthopaedic Surgery, Hospital for Special Surgery, New York, New York, U.S.A
| | - Danyal H Nawabi
- Department of Orthopaedic Surgery, Hospital for Special Surgery, New York, New York, U.S.A
| | - Bryan T Kelly
- Department of Orthopaedic Surgery, Hospital for Special Surgery, New York, New York, U.S.A
| | - Anil S Ranawat
- Department of Orthopaedic Surgery, Hospital for Special Surgery, New York, New York, U.S.A
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Nwachukwu BU, Chang B, Fields K, Rinzler J, Nawabi DH, Ranawat AS, Kelly BT. Outcomes for Arthroscopic Treatment of Anterior Inferior Iliac Spine (Subspine) Hip Impingement. Orthop J Sports Med 2017; 5:2325967117723109. [PMID: 28840150 PMCID: PMC5555511 DOI: 10.1177/2325967117723109] [Citation(s) in RCA: 37] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND Femoroacetabular hip impingement (FAI) is now well recognized; however, anterior inferior iliac spine (AIIS; or subspine) impingement is a form of hip impingement that is underrecognized and can be an important source of hip disability and functional limitation. PURPOSE To investigate the outcomes after arthroscopic treatment of AIIS/subspine-related hip impingement in the absence of FAI surgery. STUDY DESIGN Case series; Level of evidence, 4. METHODS A prospective institutional hip preservation registry was reviewed to identify patients who underwent arthroscopic AIIS decompression without concurrent treatment of FAI. Primary outcome tools captured in the registry included the modified Harris Hip Score (mHHS), the Hip Outcome Score (HOS), and the International Hip Outcome Tool-33 (iHOT-33). Patients with minimum 1-year follow-up were included. Meaningful outcome improvement was determined per minimal clinically important difference (MCID). Statistical analyses were primarily descriptive. RESULTS Thirty-three patients with a mean follow-up of 19.1 months (range, 12-44 months) were identified. All patients were female, with a mean ± SD age of 26.1 ± 10.3 years. All patients were found to have an associated labral tear, and the mean acetabular version was increased at 2 and 3 o'clock (14.5° and 19.8°, respectively). Mean preoperative outcome scores on the mHHS, HOS ADL (activities of daily living), HOS sport, and iHOT-33 were 57.2 ± 15.3, 66.9 ± 18.8, 43.9 ± 23.6, and 33.5 ± 18.3, respectively. At final available follow-up, mean scores on these outcome measures were 79.5 ± 19.0, 86.8 ± 15.8, 70.4 ± 32.8, and 65.0 ± 31.0, respectively. By the 1-year follow-up, MCID had been achieved in the majority of patients across all 4 tools. CONCLUSION There is a paucity of outcomes evidence on AIIS/subspine-related hip impingement. This study demonstrates that isolated subspine impingement can be a cause of hip disability, even in the absence of FAI. Patients with isolated subspine impingement are more likely to be women and to present with low patient-reported outcome scores. However, meaningful outcome improvement can be achieved with arthroscopic AIIS decompression.
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Affiliation(s)
- Benedict U Nwachukwu
- Department of Orthopaedic Surgery, Hospital for Special Surgery, New York, New York, USA
| | - Brenda Chang
- Department of Orthopaedic Surgery, Hospital for Special Surgery, New York, New York, USA
| | - Kara Fields
- Department of Orthopaedic Surgery, Hospital for Special Surgery, New York, New York, USA
| | - Jeremy Rinzler
- Department of Orthopaedic Surgery, Hospital for Special Surgery, New York, New York, USA
| | - Danyal H Nawabi
- Department of Orthopaedic Surgery, Hospital for Special Surgery, New York, New York, USA
| | - Anil S Ranawat
- Department of Orthopaedic Surgery, Hospital for Special Surgery, New York, New York, USA
| | - Bryan T Kelly
- Department of Orthopaedic Surgery, Hospital for Special Surgery, New York, New York, USA
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PANLAR Consensus Recommendations for the Management in Osteoarthritis of Hand, Hip, and Knee. J Clin Rheumatol 2017; 22:345-54. [PMID: 27660931 DOI: 10.1097/rhu.0000000000000449] [Citation(s) in RCA: 42] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
OBJECTIVE The objective of this consensus is to update the recommendations for the treatment of hand, hip, and knee osteoarthritis (OA) by agreeing on key propositions relating to the management of hand, hip, and knee OA, by identifying and critically appraising research evidence for the effectiveness of the treatments and by generating recommendations based on a combination of the available evidence and expert opinion of 18 countries of America. METHODS Recommendations were developed by a group of 48 specialists of rheumatologists, members of other medical disciplines (orthopedics and physiatrists), and three patients, one for each location of OA. A systematic review of existing articles, meta-analyses, and guidelines for the management of hand, hip, and knee OA published between 2008 and January 2014 was undertaken. The scores for Level of Evidence and Grade of Recommendation were proposed and fully consented within the committee based on The American Heart Association Evidence-Based Scoring System. The level of agreement was established through a variation of Delphi technique. RESULTS Both "strong" and "conditional" recommendations are given for management of hand, hip, and knee OA and nonpharmacological, pharmacological, and surgical modalities of treatment are presented according to the different levels of agreement. CONCLUSIONS These recommendations are based on the consensus of clinical experts from a wide range of disciplines taking available evidence into account while balancing the benefits and risks of nonpharmacological, pharmacological, and surgical treatment modalities, and incorporating their preferences and values. Different backgrounds in terms of patient education or drug availability in different countries were not evaluated but will be important.
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Lund B, Mygind-Klavsen B, Grønbech Nielsen T, Maagaard N, Kraemer O, Hölmich P, Winge S, Lind M. Danish Hip Arthroscopy Registry (DHAR): the outcome of patients with femoroacetabular impingement (FAI). J Hip Preserv Surg 2017. [PMID: 28630739 PMCID: PMC5467416 DOI: 10.1093/jhps/hnx009] [Citation(s) in RCA: 54] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
The Danish Hip Arthroscopy Registry (DHAR) was initiated in January 2012 as a web-based prospective registry. The purpose of this study was to evaluate and report the first registry based outcome data of a national population with radiological and clinical femoroacetabular impingement (FAI) undergoing hip arthroscopic treatment. Our primary hypothesis was that patients undergoing hip arthroscopy would improve significantly in pain, quality of life and sports related outcome measurements in Patient Related Outcome Measures (PROM). Peri-operative data and Patient Reported Outcome Measures (PROM) data from DHAR between January 2012 and November 2015 were extracted. Radiological pincer-type FAI was defined as LCE > 35° and cam FAI as alpha-angle > 55°. These data were combined with FAI surgical data such as osteochondroplasty and labral repair or resection. PROMs consisting of HAGOS, EQ-5 D, HSAS and NRS pain scores were submitted online by the patients pre-operatively and at 1 and 2-years follow-up. 2054 FAI procedures in 1835 patients were included in this study (219 patients had bilateral procedures performed). HAGOS demonstrated significant improvement in all subscales at follow up. EQ-5 D demonstrated improvement after 1 and 2 years from 0.66 pre-op to 0.78 at 2 years. HSAS improved significantly from 2.5 to 3.3. Pain score data demonstrated improvement in NRS-rest 39 to 17 and NRS Walk 49 to 22 at follow-up. We conclude that patients with FAI undergoing hip arthroscopy experience improvement in pain, quality of life and also in function and sports related outcome measures during the first 2 years after surgery.
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Affiliation(s)
- Bent Lund
- Department of Orthopedics, Horsens Regional Hospital, 8700 Horsens, Denmark
| | | | | | - Niels Maagaard
- Department of Orthopedics, Odense University Hospital, 5000 Odense, Denmark
| | - Otto Kraemer
- Sports Orthopedic Research Center - Copenhagen, Department of Orthopedic Surgery, Copenhagen University Hospital, 2650 Amager-Hvidovre, Denmark
| | - Per Hölmich
- Sports Orthopedic Research Center - Copenhagen, Department of Orthopedic Surgery, Copenhagen University Hospital, 2650 Amager-Hvidovre, Denmark
| | - Søren Winge
- Orthopedic clinic, CFR Private Hospital, 2800, Kgs. Lyngby, Copenhagen, Denmark
| | - Martin Lind
- Department of Orthopedics, Aarhus University Hospital THG, 8000 Aarhus C, Denmark
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Tjong VK, Gombera MM, Kahlenberg CA, Patel RM, Han B, Deshmane P, Terry MA. Isolated Acetabuloplasty and Labral Repair for Combined-Type Femoroacetabular Impingement: Are We Doing Too Much? Arthroscopy 2017; 33:773-779. [PMID: 28063762 DOI: 10.1016/j.arthro.2016.10.022] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/17/2016] [Revised: 10/07/2016] [Accepted: 10/24/2016] [Indexed: 02/02/2023]
Abstract
PURPOSE To evaluate patient outcomes after isolated arthroscopic volumetric acetabular osteoplasty and labral repair for the treatment of patients with combined femoroacetabular impingement (FAI) lesions. METHODS A review of a prospectively collected registry identified 86 patients (106 hips) with an average age of 38.1 years (range, 17-59 years) with combined-type FAI that underwent isolated acetabular osteoplasty and labral repair. Preoperative α-angle, degree of radiographic degenerative changes, and presence of a crossover sign were recorded. Clinical outcomes were assessed with the modified Harris Hip Score (mHHS), International Hip Outcome Tool-12 (iHOT-12), Hip Outcome Score Sport-Specific Subscale (HOS-SSS), and patient satisfaction score (out of 10) at a minimum 2-year follow-up. RESULTS Clinical follow-up was obtained at a mean follow-up of 37.2 months (range, 27.9-79.2 months). Patients with Tönnis grade 0 and I findings had significantly higher mHHS (83.5 vs 71.5, P = .01), HOS-SSS (81.3 vs 59.9, P = .02), and iHOT-12 scores (71.1 vs 58.8, P = .04) compared to patients with Tonnis grade II changes. However, patient satisfaction scores (8.0 vs 7.2, P = .45) were no different. No significant difference was noted between unilateral and bilateral hip patient outcome scores. Patient age and preoperative α-angles did not correlate with any outcome scores (all R2 <0.05). There were no cases of revision surgery or progression to arthroplasty. CONCLUSIONS Isolated acetabular decompression may adequately address the underlying impingement in combined-type FAI while avoiding the risks associated with femoral-sided decompression. Good to excellent patient-reported outcomes and satisfaction scores were noted with significantly higher scores in patients with minimal arthritic change. Patient age and preoperative α-angle had less effect on postoperative outcomes. LEVEL OF EVIDENCE Level IV, therapeutic case series.
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Affiliation(s)
- Vehniah K Tjong
- Northwestern University, Feinberg School of Medicine, Chicago, Illinois, U.S.A..
| | - Mustafa M Gombera
- Northwestern University, Feinberg School of Medicine, Chicago, Illinois, U.S.A
| | | | - Ronak M Patel
- Northwestern University, Feinberg School of Medicine, Chicago, Illinois, U.S.A
| | - Brian Han
- Northwestern University, Feinberg School of Medicine, Chicago, Illinois, U.S.A
| | - Prashant Deshmane
- Northwestern University, Feinberg School of Medicine, Chicago, Illinois, U.S.A
| | - Michael A Terry
- Northwestern University, Feinberg School of Medicine, Chicago, Illinois, U.S.A
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Abstract
Historically, athletic hip injuries have garnered little attention; however, these injuries account for approximately 6% of all sports injuries and their prevalence is increasing. At times, the diagnosis and management of hip injuries can be challenging and elusive for the team physician. Hip injuries are seen in high-level athletes who participate in cutting and pivoting sports that require rapid acceleration and deceleration. Described previously as the "sports hip triad," these injuries consist of adductor strains, osteitis pubis, athletic pubalgia, or core muscle injury, often with underlying range-of-motion limitations secondary to femoroacetabular impingement. These disorders can happen in isolation but frequently occur in combination. To add to the diagnostic challenge, numerous intra-articular disorders and extra-articular soft-tissue restraints about the hip can serve as pain generators, in addition to referred pain from the lumbar spine, bowel, bladder, and reproductive organs. Athletic hip conditions can be debilitating and often require a timely diagnosis to provide appropriate intervention.
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