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Iida H, Kai T, Kuri M, Tanabe K, Nakagawa M, Yamashita C, Yonekura H, Iida M, Fukuda I. A practical guide for perioperative smoking cessation. J Anesth 2022; 36:583-605. [PMID: 35913572 DOI: 10.1007/s00540-022-03080-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2022] [Accepted: 05/24/2022] [Indexed: 12/15/2022]
Abstract
The perioperative management of patients who are smokers presents anesthesiologists with various challenges related to respiratory, circulatory, and other clinical problems. Regarding 30-day postoperative outcomes, smokers have higher risks of mortality and complications than non-smokers, including death, pneumonia, unplanned tracheal intubation, mechanical ventilation, cardiac arrest, myocardial infarction, and stroke. Given the benefits of smoking cessation and the adverse effects of smoking on perioperative patient management, patients should quit smoking long before surgery. However, anesthesiologists cannot address these issues alone. The Japanese Society of Anesthesiologists established guidelines in 2015 (published in a medical journal in 2017) to enlighten surgical staff members and patients regarding perioperative tobacco cessation. The primary objective of perioperative smoking cessation is to reduce the risks of adverse cardiovascular and respiratory events, wound infection, and other perioperative complications. Perioperative preparations constitute a powerful teachable moment, a "golden opportunity" for smoking cessation to achieve improved primary disease outcomes and prevent the occurrence of tobacco-related conditions. This review updates the aforementioned guidelines as a practical guide to cover the nuts and bolts of perioperative smoking cessation. Its goal is to assist surgeons, anesthesiologists, and other medical professionals and to increase patients' awareness of smoking risks before elective surgery.
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Affiliation(s)
- Hiroki Iida
- Japanese Society of Anesthesiologists Perioperative Smoking Cessation Working Group, Kobe, Japan. .,Department of Anesthesiology and Pain Medicine, Gifu University Graduate School of Medicine, Gifu, Japan. .,Anesthesiology and Pain Relief Center, Central Japan International Medical Center, 1-1 Kenkonomachi, Minokamo, Gifu, 505-8510, Japan.
| | - Tetsuya Kai
- Japanese Society of Anesthesiologists Perioperative Smoking Cessation Working Group, Kobe, Japan.,Department of Anesthesiology, National Hospital Organization Kyushu Medical Center, Fukuoka, Japan
| | - Michioki Kuri
- Japanese Society of Anesthesiologists Perioperative Smoking Cessation Working Group, Kobe, Japan.,Department of Anesthesiology and Intensive Care Medicine, Osaka University Graduate School of Medicine, Suita, Japan
| | - Kumiko Tanabe
- Japanese Society of Anesthesiologists Perioperative Smoking Cessation Working Group, Kobe, Japan.,Department of Anesthesiology and Pain Medicine, Gifu University Graduate School of Medicine, Gifu, Japan
| | - Masashi Nakagawa
- Japanese Society of Anesthesiologists Perioperative Smoking Cessation Working Group, Kobe, Japan.,Department of Intensive Care Medicine, Tokyo Women's Medical University, Shinjuku, Japan
| | - Chizuru Yamashita
- Japanese Society of Anesthesiologists Perioperative Smoking Cessation Working Group, Kobe, Japan.,Department of Anesthesiology and Critical Care Medicine, Fujita Health University School of Medicine, Toyoake, Japan
| | - Hiroshi Yonekura
- Japanese Society of Anesthesiologists Perioperative Smoking Cessation Working Group, Kobe, Japan.,Department of Anesthesiology and Pain Medicine, Fujita Health University Bantane Hospital, Nagoya, Japan
| | - Mami Iida
- Japanese Society of Anesthesiologists Perioperative Smoking Cessation Working Group, Kobe, Japan.,Department of Internal Medicine, Gifu Prefectural General Medical Center, Gifu, Japan
| | - Ikuo Fukuda
- Japanese Society of Anesthesiologists Perioperative Smoking Cessation Working Group, Kobe, Japan.,Cardiovascular Center, Suita Tokushukai Hospital, Suita, Japan
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Lee MS, Jimenez AE, Owens JS, Curley AJ, Paraschos OA, Maldonado DR, Lall AC, Domb BG. Comparison of Outcomes Between Nonsmokers and Patients Who Discontinued Smoking 1 Month Before Primary Hip Arthroscopy: A Propensity-Matched Study With Minimum 2-Year Follow-up. Orthop J Sports Med 2022; 10:23259671221097372. [PMID: 35693458 PMCID: PMC9185012 DOI: 10.1177/23259671221097372] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/14/2021] [Accepted: 12/23/2021] [Indexed: 11/23/2022] Open
Abstract
Background: Cigarette smoking has been shown to negatively affect outcomes after hip
arthroscopy for femoroacetabular impingement syndrome (FAIS). The effect of
cessation of cigarette smoking before surgery has not been well
established. Purposes: (1) To report minimum 2-year patient-reported outcomes (PROs) of former
smokers who underwent primary hip arthroscopy for FAIS and (2) to compare
these results with those of a propensity-matched control group of
nonsmokers. Study Design: Cohort study; Level of evidence, 3. Methods: Data were collected for all patients who underwent primary hip arthroscopy
for FAIS between December 2008 and November 2017. Patients were eligible if
they indicated that they had previously smoked cigarettes but had quit
smoking at least 1 month before surgery and had minimum 2-year postoperative
outcomes for the modified Harris Hip Score (mHHS), Nonarthritic Hip Score
(NAHS), and visual analog scale (VAS) for pain. The percentage of hips
achieving the minimal clinically important difference (MCID) were recorded.
The study group was then propensity matched in a 1:1 ratio by age, sex, and
body mass index (BMI) to patients who had never smoked. Results: A total of 83 former-smoking patients (84 hips; age, 45.0 ± 13.5 years) were
included at a median follow-up of 38.6 months (interquartile range,
27.5-48.2 months); all patients had stopped smoking at a mean ± standard
deviation of 14.3 ± 24.5 months preoperatively. Former smokers demonstrated
significant improvement from preoperatively to the minimum 2-year follow-up
for all recorded PROs (P < .001 for all) and achieved
the MCID for the mHHS, NAHS, and VAS at favorable rates (75.0%-81.6%).
Logistic regression analysis did not identify a significant relationship
between cessation time and rates of achieving MCID for mHHS, NAHS, or VAS.
When compared with 84 never-smokers (84 hips), the former smokers
demonstrated similar preoperative scores, postoperative scores, and
improvement on all recorded PROs (P > .05 for all). Both
groups achieved MCID for mHHS, NAHS, and VAS at similar rates and
demonstrated similar rates of revision surgery. Conclusion: Former smokers who underwent primary hip arthroscopy for FAIS demonstrated
significant improvement in PROs at minimum 2-year follow-up. When compared
with a propensity-matched control group of never-smokers, they achieved
similar postoperative PROs and rates of achieving psychometric
thresholds.
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Affiliation(s)
- Michael S Lee
- American Hip Institute Research Foundation, Chicago, Illinois, USA
| | - Andrew E Jimenez
- American Hip Institute Research Foundation, Chicago, Illinois, USA
| | - Jade S Owens
- American Hip Institute Research Foundation, Chicago, Illinois, USA
| | - Andrew J Curley
- American Hip Institute Research Foundation, Chicago, Illinois, USA
| | | | | | - Ajay C Lall
- American Hip Institute Research Foundation, Chicago, Illinois, USA.,American Hip Institute, Chicago, Illinois, USA
| | - Benjamin G Domb
- American Hip Institute Research Foundation, Chicago, Illinois, USA.,American Hip Institute, Chicago, Illinois, USA
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Jimenez AE, Lee MS, Owens JS, Maldonado DR, Saks BR, Lall AC, Domb BG. Effect of Cigarette Smoking on Midterm Outcomes After Arthroscopic Surgery for Femoroacetabular Impingement Syndrome: A Propensity-Matched Controlled Study With Minimum 5-Year Follow-up. Orthop J Sports Med 2022; 10:23259671221090905. [PMID: 35571968 PMCID: PMC9098985 DOI: 10.1177/23259671221090905] [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: 11/01/2021] [Accepted: 11/08/2021] [Indexed: 12/02/2022] Open
Abstract
Background: There is limited literature evaluating patient-reported outcomes (PROs) in
cigarette smokers undergoing hip arthroscopy for femoroacetabular
impingement syndrome (FAIS) at midterm follow-up. Purpose: (1) To report minimum 5-year PROs for cigarette-smoking patients who
underwent primary hip arthroscopy for FAIS and (2) to compare these results
with a propensity-matched control group of never-smoking patients. Study Design: Cohort study; Level of evidence, 3. Methods: Data were collected for all patients who underwent primary hip arthroscopy
for FAIS between June 2009 and March 2016. Patients were eligible if they
indicated that they smoked cigarettes within 1 month of surgery and had
minimum 5-year postoperative outcomes for the modified Harris Hip Score,
Nonarthritic Hip Score, Hip Outcome Score–Sport Specific Subscale (HOS-SSS),
and International Hip Outcome Tool–12 (iHOT-12). The percentages of patients
achieving the Patient Acceptable Symptom State (PASS) and maximum outcome
improvement satisfaction threshold were recorded. The study group was then
propensity matched in a 1:2 ratio to patients who had never smoked for
comparison. Results: Included were 35 patients (35 hips) with a mean age of 39.4 ± 13.0 years and
mean follow-up of 64.6 ± 4.1 months. These patients demonstrated significant
improvement from preoperatively to a minimum 5-year follow-up for all
recorded PROs (P < .05). When compared with 70 control
patients (70 hips), smoking patients demonstrated significantly worse
preoperative scores for all PROs (P < .05). Study
patients also demonstrated worse minimum 5-year scores for all recorded PROs
compared with control patients, which did not reach statistical significance
but trended toward significance for HOS-SSS (70.4 vs 81.9;
P = .076) and iHOT-12 (74.7 vs 82.2; P
= .122). Smoking patients also trended toward lower rates of achieving PASS
for the iHOT-12 compared with never-smoking patients (50.0% vs 68.2%;
P = .120). Conclusion: Patients who smoked cigarettes and underwent primary hip arthroscopy for FAIS
demonstrated significant improvement in PROs at a minimum 5-year follow-up.
When compared with a propensity-matched control group of never-smokers, they
trended toward lower postoperative HOS-SSS and iHOT-12 scores and lower
rates of achieving PASS on the iHOT-12.
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Affiliation(s)
| | - Michael S. Lee
- American Hip Institute Research Foundation, Chicago, Illinois, USA
| | - Jade S. Owens
- American Hip Institute Research Foundation, Chicago, Illinois, USA
| | | | - Benjamin R. Saks
- American Hip Institute Research Foundation, Chicago, Illinois, USA
| | - Ajay C. Lall
- American Hip Institute Research Foundation, Chicago, Illinois, USA
- American Hip Institute, Chicago, Illinois, USA
| | - Benjamin G. Domb
- American Hip Institute Research Foundation, Chicago, Illinois, USA
- American Hip Institute, Chicago, Illinois, USA
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4
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Jimenez AE, Lee MS, George T, Owens JS, Maldonado DR, Saks BR, Lall AC, Domb BG. Effect of Cigarette Smoking on Outcomes in Patients Undergoing Primary Hip Arthroscopy and Labral Reconstruction: A Propensity-Matched Controlled Study With Minimum 2-Year Follow-up. Orthop J Sports Med 2022; 10:23259671221075642. [PMID: 35237697 PMCID: PMC8882953 DOI: 10.1177/23259671221075642] [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: 10/05/2021] [Accepted: 11/12/2021] [Indexed: 11/16/2022] Open
Abstract
Background: There is a paucity of literature evaluating the effect of cigarette smoking
on outcomes in patients undergoing hip arthroscopy and labral
reconstruction. Purpose: (1) To report minimum 2-year patient-reported outcome (PRO) scores for
patients who smoke cigarettes and underwent primary hip arthroscopic labral
reconstruction and (2) to compare these results with those of a
propensity-matched control group of patients who have never smoked. Study Design: Cohort study; Level of evidence, 3. Methods: Data were collected for all patients who underwent primary hip arthroscopy
for labral reconstruction between January 2011 and January 2019. Patients
were eligible for the study if they indicated that they smoked cigarettes
within 1 month of surgery and had minimum 2-year postoperative outcome
scores for the modified Harris Hip Score (mHHS), Nonarthritic Hip Score
(NAHS), and the visual analog scale (VAS) for pain. The percentage of
patients achieving the minimal clinically important difference (MCID) and
patient-acceptable symptom state (PASS) was recorded. Rates of revision
surgery were also documented. These patients were then propensity matched in
a 1:3 ratio to patients who had never smoked (controls) for comparison. Results: A total of 20 patients (20 hips) were included with a mean follow-up of 39.9
± 13.0 months and mean age of 41.4 ± 10.4 years. These patients demonstrated
significant improvement from preoperatively to the minimum 2-year follow-up
for mHHS, NAHS, and VAS (P < .05). They also achieved
MCID for mHHS and VAS at acceptable rates, 70% for both. When outcomes were
compared with those of 60 control patients (60 hips), patients who smoke
demonstrated lower preoperative PRO scores but similar minimum 2-year
postoperative PRO scores for mHHS and NAHS. Patients who smoke demonstrated
lower rates of achieving PASS for mHHS (55% vs 75%) and NAHS (40% vs 61.7%)
compared with controls; however, these findings were not statistically
significant. Rates of secondary surgery were statistically significantly
higher in the smoking group compared with controls (25% vs 5%;
P = .031). Survivorship for the smoking patients was
80% and 98.3% for the control group. At the two-year mark survivorship was
90% for the smoking group and 100% for the control group (P
= .06) Conclusion: While smokers can still derive significant improvement from hip arthroscopy,
their ultimate functional outcome and rate of secondary surgeries are
inferior to those of nonsmokers. As smoking is a significant and modifiable
risk factor, we should continue to counsel smokers on smoking cessation
prior to and after surgery
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Affiliation(s)
| | - Michael S. Lee
- American Hip Institute Research Foundation, Chicago, Illinois, USA
| | - Tom George
- American Hip Institute Research Foundation, Chicago, Illinois, USA
| | - Jade S. Owens
- American Hip Institute Research Foundation, Chicago, Illinois, USA
| | | | - Benjamin R. Saks
- American Hip Institute Research Foundation, Chicago, Illinois, USA
| | - Ajay C. Lall
- American Hip Institute Research Foundation, Chicago, Illinois, USA
- American Hip Institute, Chicago, Illinois, USA
| | - Benjamin G. Domb
- American Hip Institute Research Foundation, Chicago, Illinois, USA
- American Hip Institute, Chicago, Illinois, USA
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Beck EC, Gowd AK, White JC, Knio ZO, O'Gara TJ. The effect of smoking on achieving meaningful clinical outcomes one year after lumbar tubular microdecompression: a matched-pair cohort analysis. Spine J 2021; 21:1303-1308. [PMID: 33774211 DOI: 10.1016/j.spinee.2021.03.020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/14/2020] [Revised: 02/05/2021] [Accepted: 03/22/2021] [Indexed: 02/03/2023]
Abstract
BACKGROUND CONTEXT There has been a shift in the spine literature in reporting meaningful outcomes, including meaningful clinically important difference (MCID), after surgery. The evidence on the effect of tobacco smoking at the time of lumbar tubular microdecompression (LTMD) on meaningful outcomes is limited. PURPOSE To compare differences in 1-year functional outcomes and rates of achieving MCID between current smokers and non-smokers who underwent LTMD for lumbar spinal stenosis (LSS). STUDY DESIGN A nested case control study to compare the difference in patient reported outcomes (PROs) between smokers and non-smokers 1-year after undergoing LTMD. PATIENT SAMPLE This study included patients that underwent single level LTMD by a single surgeon between January 2014 through August 2019. OUTCOME MEASURES Preoperative and postoperative PROs were recorded using the questionnaires EQ-5D, Oswestry Disability Index (ODI), and the visual analog scale (VAS) for back pain and leg pain. The MCID was also used. METHODS Current tobacco smokers at the time of surgery were matched 1:2 to non-smokers by age (+/- 1year). Preoperative and postoperative functional scores were compared between the two groups using independent t-tests. Additionally, thresholds for achieving MCID were calculated for each individual functional score, and were compared using Fisher's exact test. RESULTS Of the 183 patients with 1-year follow-up who met inclusion criteria, 35 patients were identified as smokers and were matched to 70 non-smokers. No statistical differences were identified between age, BMI, or gender. Comparison of preoperative PROs showed no statistically significant differences between smokers and non-smokers (p>0.05 for all), while smokers had statistically lower EQ-5D (p<0.001) and higher ODI (p=0.05), VAS back (p=0.033), and VAS leg (p=0.03) score averages at a minimum of one year follow-up. Evaluation of meaningful outcomes demonstrated non-smokers had higher rates of achieving MCID on at least 1 threshold score as compared to smokers (98.5% vs. 91.1%; p=0.043). CONCLUSIONS Current smokers at the time of surgery have inferior postoperative EQ-5D scores, increased pain and disability, and lower odds of achieving the MCID at 1-year after undergoing LTMD when compared to patients without any smoking history.
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Affiliation(s)
- Edward C Beck
- Department of Orthopedic Surgery, Wake Forest Baptist Health, Medical Center Boulevard, 4th Floor Comprehensive Cancer Center, Winston-Salem, NC 27157, USA.
| | - Anirudh K Gowd
- Department of Orthopedic Surgery, Wake Forest Baptist Health, Medical Center Boulevard, 4th Floor Comprehensive Cancer Center, Winston-Salem, NC 27157, USA
| | - Jonathan C White
- Department of Orthopedic Surgery, Wake Forest Baptist Health, Medical Center Boulevard, 4th Floor Comprehensive Cancer Center, Winston-Salem, NC 27157, USA
| | - Ziyad O Knio
- Department of Anesthesiology, University of Virginia Health System, 200 Jeanette Lancaster Way Charlottesville, VA 22903, USA
| | - Tadhg J O'Gara
- Department of Orthopedic Surgery, Wake Forest Baptist Health, Medical Center Boulevard, 4th Floor Comprehensive Cancer Center, Winston-Salem, NC 27157, USA; Department of Neurosurgery , Wake Forest Baptist Health, Medical Center Boulevard, 4th Floor Comprehensive Cancer Center, Winston-Salem, NC 27157, USA
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6
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Knapik DM, Clapp IM, Wichman D, Nho SJ. Use of Younger Patient Age and Greater Anterior Center-Edge Angle to Predict the Need for Bilateral Hip Arthroscopy in Patients With Bilateral Femoroacetabular Impingement-Related Hip Pain. Am J Sports Med 2021; 49:2110-2116. [PMID: 34081563 DOI: 10.1177/03635465211015431] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND In patients with symptomatic femoroacetabular impingement syndrome, bilateral hip pain has been reported to occur in high frequency. However, not all patients require bilateral hip arthroscopy. PURPOSE To determine the incidence, patient-specific variables, and postoperative outcomes in patients who presented with bilateral hip pain at the time of index hip arthroscopy and underwent subsequent contralateral arthroscopic hip surgery. STUDY DESIGN Case series; Level of evidence, 4. METHODS Patients who presented with bilateral hip pain, underwent primary hip arthroscopy between January 2012 and June 2018 for indication of femoroacetabular impingement syndrome, and had minimum 2-year follow-up were retrospectively analyzed. Baseline descriptive data, preoperative hip range of motion, and radiographic measurements were recorded with pre- and postoperative patient-reported outcomes (PROs). Independent samples t test was used to compare continuous variables, and chi-square test was used to compare categorical variables between patients undergoing unilateral and bilateral surgery. Bivariate correlations and a multivariable binary logistic regression were performed to determine factors predictive of the need for future contralateral hip arthroscopy. RESULTS In total, 108 patients were identified who reported bilateral hip pain during the index evaluation, underwent primary hip arthroscopy, and had 2-year follow-up. Among these, 42% (n = 45) elected to undergo hip arthroscopy on the contralateral hip at a mean of 6.0 months (range, 1-17 months) after the index surgery. Patients requiring bilateral surgery were significantly younger (P = .004) and had a larger preoperative anterior center-edge angle (ACEA; P = .038) when compared with patients who had unilateral surgery. There were no significant differences in alpha angle measurements between patients who had unilateral and bilateral surgery. On bivariate analysis, younger age at the time of the index surgery (r = -0.272; P = .005) and preoperative ACEA (r = 0.249; P = .016) were significantly correlated with the need for bilateral surgery. On multivariate analysis, younger age remained a significant predictor for bilateral surgery (odds ratio, 0.95; 95% CI, 0.91-0.99). Patients who underwent bilateral hip arthroscopy reported significant improvement in all PROs (P < .001), with a significantly greater mean Hip Outcome Score- Sports Specific Subscale score when compared with patients undergoing unilateral surgery (P = .037). CONCLUSION Subsequent contralateral hip arthroscopy was performed in 42% of patients who presented with bilateral hip pain. Younger age at the time of the index surgery and greater ACEA were predictive of the need for contralateral surgery. Patients undergoing bilateral surgery reported significantly improvement in PROs at minimum 2-year follow-up.
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Affiliation(s)
- Derrick M Knapik
- Division of Sports Medicine, Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, Illinois, USA
| | - Ian M Clapp
- Division of Sports Medicine, Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, Illinois, USA
| | - Daniel Wichman
- Division of Sports Medicine, Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, Illinois, USA
| | - Shane J Nho
- Division of Sports Medicine, Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, Illinois, USA
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Kunze KN, Polce EM, Nwachukwu BU, Chahla J, Nho SJ. Development and Internal Validation of Supervised Machine Learning Algorithms for Predicting Clinically Significant Functional Improvement in a Mixed Population of Primary Hip Arthroscopy. Arthroscopy 2021; 37:1488-1497. [PMID: 33460708 DOI: 10.1016/j.arthro.2021.01.005] [Citation(s) in RCA: 24] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/03/2020] [Revised: 12/30/2020] [Accepted: 01/03/2021] [Indexed: 02/06/2023]
Abstract
PURPOSE To (1) develop and validate a machine learning algorithm to predict clinically significant functional improvements after hip arthroscopy for femoroacetabular impingement syndrome and to (2) develop a digital application capable of providing patients with individual risk profiles to determine their propensity to gain clinically significant improvements in function. METHODS A retrospective review of consecutive hip arthroscopy patients who underwent cam/pincer correction, labral preservation, and capsular closure between January 2012 and 2017 from 1 large academic and 3 community hospitals operated on by a single high-volume hip arthroscopist was performed. The primary outcome was the minimal clinically important difference (MCID) for the Hip Outcome Score (HOS)-Activities of Daily Living (ADL) at 2 years postoperatively, which was calculated using a distribution-based method. A total of 21 demographic, radiographic, and patient-reported outcome measures were considered as potential covariates. An 80:20 random split was used to create training and testing sets from the patient cohort. Five supervised machine learning algorithms were developed using 3 iterations of 10-fold cross-validation on the training set and assessed by discrimination, calibration, Brier score, and decision curve analysis on an independent testing set of patients. RESULTS A total of 818 patients with a median (interquartile range) age of 32.0 (22.0-42.0) and 69.2% female were included, of whom 74.3% achieved the MCID for the HOS-ADL. The best-performing algorithm was the stochastic gradient boosting model (c-statistic = 0.84, calibration intercept = 0.20, calibration slope = 0.83, and Brier score = 0.13). Of the initial 21 candidate variables, the 8 most important features for predicting the MCID for the HOS-ADL included in model training were body mass index, age, preoperative HOS-ADL score, preoperative pain level, sex, Tönnis grade, symptom duration, and drug allergies. The algorithm was subsequently transformed into a digital application using local explanations to provide customized risk assessment: https://orthoapps.shinyapps.io/HPRG_ADL/. CONCLUSIONS The stochastic boosting gradient model conferred excellent predictive ability for propensity to gain clinically significant improvements in function after hip arthroscopy. An open-access digital application was created, which may augment shared decision-making and allow for preoperative risk stratification. External validation of this model is warranted to confirm the performance of these algorithms, as the generalizability is currently unknown. LEVEL OF EVIDENCE IV, Case series.
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Affiliation(s)
- Kyle N Kunze
- Department of Orthopedic Surgery, Division of Sports Medicine, Hospital for Special Surgery, New York, New York, U.S.A..
| | - Evan M Polce
- Section of Young Adult Hip Surgery, Division of Sports Medicine, Department of Orthopedic Surgery, Rush Medical College of Rush University, Rush University Medical Center, Chicago, Illinois
| | - Benedict U Nwachukwu
- Department of Orthopedic Surgery, Division of Sports Medicine, Hospital for Special Surgery, New York, New York, U.S.A
| | - Jorge Chahla
- Section of Young Adult Hip Surgery, Division of Sports Medicine, Department of Orthopedic Surgery, Rush Medical College of Rush University, Rush University Medical Center, Chicago, Illinois
| | - Shane J Nho
- Section of Young Adult Hip Surgery, Division of Sports Medicine, Department of Orthopedic Surgery, Rush Medical College of Rush University, Rush University Medical Center, Chicago, Illinois
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8
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Lindman I, Nikou S, Öhlin A, Senorski EH, Ayeni O, Karlsson J, Sansone M. Evaluation of outcome reporting trends for femoroacetabular impingement syndrome- a systematic review. J Exp Orthop 2021; 8:33. [PMID: 33893563 PMCID: PMC8065071 DOI: 10.1186/s40634-021-00351-0] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/05/2021] [Accepted: 04/08/2021] [Indexed: 11/10/2022] Open
Abstract
PURPOSE The aim of this systematic review was to evaluate the trends in the literature regarding surgical treatment for femoroacetabular impingement syndrome (FAIS) and to present which patient-reported outcome-measures (PROMs) and surgical approaches are included. METHODS This systematic review was conducted with the PRISMA guidelines. The literature search was performed on PubMed and Embase, covering studies from 1999 to 2020. Inclusion criteria were clinical studies with surgical treatment for FAIS, the use of PROMs as evaluation tool and studies in English. Exclusion criteria were studies with patients < 18 years, cohorts with < 8 patients, studies with primarily purpose to evaluate other diagnoses than FAIS and studies with radiographs as only outcomes without using PROMs. Data extracted were author, year, surgical intervention, type of study, level of evidence, demographics of included patients, and PROMs. RESULTS The initial search yielded 2,559 studies, of which 196 were included. There was an increase of 2,043% in the number of studies from the first to the last five years (2004-2008)-(2016-2020). There were 135 (69%) retrospective, 55 (28%) prospective and 6 (3%) Randomized Controlled Trials. Level of evidence ranged from I-IV where Level III was most common (44%). More than half of the studies (58%) originated from USA. Arthroscopic surgery was the most common surgical treatment (85%). Mean follow-up was 27.0 months (± 17 SD), (range 1.5-120 months). Between 1-10 PROMs were included, and the modified Harris Hip Score (mHHS) was most commonly used (61%). CONCLUSION There has been a continuous increase in the number of published studies regarding FAIS with the majority evaluating arthroscopic surgery. The mHHS remains being the most commonly used PROM.
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Affiliation(s)
- Ida Lindman
- Department of Orthopaedics, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, 413 45, Gothenburg, Sweden.
| | - Sarantos Nikou
- Department of Orthopaedic Surgery, South Älvsborg Hospital, 501 82, Borås, Sweden
| | - Axel Öhlin
- Department of Orthopaedics, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, 413 45, Gothenburg, Sweden
| | - Eric Hamrin Senorski
- Department of Health and Rehabilitation, Institute of Neuroscience and Physiology, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Olufemi Ayeni
- Division of Orthopaedic Surgery, McMaster University, Hamilton, ON, L8N 3Z5, Canada
| | - Jon Karlsson
- Department of Orthopaedics, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, 413 45, Gothenburg, Sweden
| | - Mikael Sansone
- Department of Orthopaedics, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, 413 45, Gothenburg, Sweden
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Emara AK, Grits D, Samuel LT, Acuña AJ, Rosneck JT, Kamath AF. Hip Arthroscopy in Smokers: A Systematic Review of Patient-Reported Outcomes and Complications in 18,585 Cases. Am J Sports Med 2021; 49:1101-1108. [PMID: 32628512 DOI: 10.1177/0363546520922854] [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 Although the negative effects of smoking have been documented for other types of arthroscopic procedures, there is limited information regarding its influence on hip arthroscopy outcomes. PURPOSE To examine the effect of smoking on the following outcomes after hip arthroscopy: patient-reported outcomes (PROs), the degree of improvement in PROs relative to baseline, complication rates, and rates of revision arthroscopy and/or conversion to total hip arthroplasty (THA). STUDY DESIGN Systematic review. METHODS The PubMed, Embase, and Cochrane Library databases were queried for studies published between January 1, 1985, and January 14, 2020, comparing the outcomes of hip arthroscopy between smokers and nonsmokers. Case reports, basic science studies, and studies investigating pediatric patients or lacking a description of outcomes were excluded. Included outcome tools were the modified Harris Hip Score, the visual analog scale (VAS) for pain and satisfaction, and the Hip Outcome Score (HOS)-Sports Specific and HOS-Activities of Daily Living. Preoperative characteristics and operative indications were also recorded. RESULTS Postoperative combined means (± SD) were better in nonsmokers versus smokers for the modified Harris Hip Score (75.67 ± 20.88 vs 82.32 ± 15.5; P = .001), the VAS pain (3.13 ± 2.79 vs 2.13 ± 2.21; P < .001), and the HOS-Sports Specific (62.54 ± 25.38 vs 71.7 ± 23.3; P < .001). There was no difference between groups in VAS satisfaction (P = .23) or HOS-Activities of Daily Living (P = .13). The extent of PRO score improvement relative to baseline values was similar in smokers and nonsmokers in all PRO measures (P > .05 for all). Smokers demonstrated higher rates of postoperative thromboembolic (P = .0177) and infectious (P = .006) complications. There was no difference between rates of revision arthroscopy (P = .47) and THA conversion (P = .31). CONCLUSION Smoking adversely affects certain postoperative PROs and is associated with higher postoperative complication rates. Further studies are required investigating the degree of PRO improvement and long-term arthroscopy revision and THA conversion rates.
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Affiliation(s)
- Ahmed K Emara
- Department of Orthopaedic Surgery, Cleveland Clinic Foundation, Cleveland, Ohio, USA
| | - Daniel Grits
- Department of Orthopaedic Surgery, Cleveland Clinic Foundation, Cleveland, Ohio, USA
| | - Linsen T Samuel
- Department of Orthopaedic Surgery, Cleveland Clinic Foundation, Cleveland, Ohio, USA
| | - Alexander J Acuña
- Department of Orthopaedic Surgery, Cleveland Clinic Foundation, Cleveland, Ohio, USA
| | - James T Rosneck
- Department of Orthopaedic Surgery, Cleveland Clinic Foundation, Cleveland, Ohio, USA
| | - Atul F Kamath
- Department of Orthopaedic Surgery, Cleveland Clinic Foundation, Cleveland, Ohio, USA
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Large Heterogeneity Among Minimal Clinically Important Differences for Hip Arthroscopy Outcomes: A Systematic Review of Reporting Trends and Quantification Methods. Arthroscopy 2021; 37:1028-1037.e6. [PMID: 33186696 DOI: 10.1016/j.arthro.2020.10.050] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/14/2020] [Revised: 08/18/2020] [Accepted: 10/25/2020] [Indexed: 02/02/2023]
Abstract
PURPOSE To perform a systematic review of reporting trends and quantification methods for the minimal clinically important difference (MCID) within the hip arthroscopy literature. METHODS Cochrane, PubMed, and OVID/MEDLINE databases were queried for hip arthroscopy articles that reported the MCID. Studies were classified as (1) calculating new MCID values for their specific study-population or (2) referencing previously established MCID values. Data pertaining to patient demographics, study characteristics, outcome measures, method of MCID quantification, MCID value, anchor questions, measurement error, and study from which referenced MCID values were obtained were extracted. RESULTS A total of 59 articles with 18,830 patients (19,867 hips) was included. A total of 19 unique outcome measures was reported. A total of 33 (n = 55.9%) studies (follow-up range 6-60 months) used previously established MCID values to assess their study population (MCID values established at a follow-up range 6-31 months). The remaining 26 studies (44.1%) performed new MCID calculations. The MCID values were inconsistent and varied widely (Hip Outcome Score-Activities of Daily Living: 5.0-15.4; Hip Outcome Score-Sports Subscale: 6-25; modified Harris hip score: 2.4-20.9). Among the 33 studies that used previously established MCID values, 10 different studies were cited as the reference. Among the remaining 26 studies that calculated a new MCID value, the most common method was 0.5 standard deviation method (n = 21, 80.8%). Only 3 of 26 (11.5%) studies reported a measurement of error in conjunction with their MCID values. CONCLUSIONS Inconsistencies in MCID reporting and quantification methods led to a wide range of MCID values for commonly administered outcome measures within the hip arthroscopy literature-even for the same outcome measures. The majority of studies referenced previously established MCID values with variable ranges of follow-up and applied those values to assess their specific study population at varying follow-ups. LEVEL OF EVIDENCE IV, systematic review.
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11
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Zimmerer A, Janz V, Sobau C, Wassilew GI, Miehlke W. Defining the Clinically Meaningful Outcomes for Arthroscopic Treatment of Femoroacetabular Impingement Syndrome at Minimum 10-Year Follow-up: The Timing of Surgery Is Crucial. Orthop J Sports Med 2021; 9:2325967120985140. [PMID: 33718501 PMCID: PMC7922622 DOI: 10.1177/2325967120985140] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/27/2020] [Accepted: 09/21/2020] [Indexed: 11/16/2022] Open
Abstract
Background Arthroscopic treatment of femoroacetabular impingement syndrome (FAIS) has become a common procedure. However, meaningful long-term clinical outcomes have not been defined. Purpose To define the minimal clinically important difference (MCID), substantial clinical benefit (SCB), and patient acceptable symptomatic state (PASS) for the modified Harris Hip Score (mHHS) at a minimum 10-year follow-up in patients undergoing arthroscopic treatment for FAIS and identify preoperative predictors for achievement of the MCID, SCB, and PASS. Study Design Case-control study; Level of evidence, 3. Methods A consecutive series of patients undergoing arthroscopic treatment for FAIS between 2007 and 2009 with a minimum 10-year follow-up was analyzed. Patient data included patient characteristics, radiographic parameters, and the pre- and postoperative mHHS and visual analog scale (VAS) for pain score. Paired t tests were used to compare the patient-reported outcome measures (PROMs). The MCID was determined by calculating half of the standard deviation, and SCB and PASS were calculated by the anchor method. Correlation and logistic regression analyses were conducted to identify predictors for the achievement of the MCID, SCB, and PASS. Results A total of 44 patients (27 men, 17 women) were included. The mean age and body mass index were 42.2 years (range, 16-67 years) and 22.3 kg/m2 (range, 16.76-29.78 kg/m2), respectively. The MCID, absolute SCB, net change SCB, and PASS of the mHHS were calculated to be 19.6, 90.1, 31.5, and 84.4 points, respectively. Preoperative symptom duration was identified as an independent predictor for the achievement of meaningful clinical outcomes. The median symptom durations for patients who achieved the MCID, absolute SCB, net change SCB, and PASS were 11.7, 9.1, 9.0, and 10.8 months, respectively. The median symptom duration for patients who did not achieve the MCID, absolute SCB, net change SCB, and PASS were 15.8, 17.4, 17.3, and 18.4 months, respectively. No other statistically significant correlations were found. Conclusion The preoperative duration of symptoms was identified as an independent predictor for achievement of the MCID, SCB, and PASS. These findings can be helpful in accelerating the transition to surgical treatment of FAIS.
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Affiliation(s)
- Alexander Zimmerer
- ARCUS Sportklinik Pforzheim, Germany.,Department of Orthopaedics, University Medicine Greifswald, Greifswald, Germany
| | - Viktor Janz
- Department of Orthopaedics, University Medicine Greifswald, Greifswald, Germany
| | | | - Georgi I Wassilew
- Department of Orthopaedics, University Medicine Greifswald, Greifswald, Germany
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12
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Development of Machine Learning Algorithms to Predict Being Lost to Follow-up After Hip Arthroscopy for Femoroacetabular Impingement Syndrome. Arthrosc Sports Med Rehabil 2020; 2:e591-e598. [PMID: 33134999 PMCID: PMC7588627 DOI: 10.1016/j.asmr.2020.07.007] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2020] [Accepted: 07/03/2020] [Indexed: 11/21/2022] Open
Abstract
Purpose To determine factors predictive of patients who are at risk for being lost to follow-up after hip arthroscopy for femoroacetabular impingement syndrome (FAIS). Methods A prospective clinical repository was queried between January 2012 and October 2017 and all patients who underwent hip arthroscopy for primary or revision FAIS with minimum 2-year follow-up were included. A total of 27 potential risk factors for loss to follow-up were available and tested for predictive value. An 80:20 random sample split of all patients was performed to create training and testing sets. Cross-validation, minimum Bayes information criteria, and adaptive machine-learning algorithms were used to develop the predictive model. The model with the best predictive performance was selected based off of the lowest postestimation deviance between the training and testing samples. The c-statistic is a measure of discrimination. It ranges from 0.5 to 1.0, with 1.0 being perfect discrimination and 0.5 indicating the model is no better than chance. A log-likelihood χ2 test was used to evaluate the goodness-of-fit of the logistic regression model. Results A total of 2113 patients were included. Inference of minimum Bayes information criteria model indicated that male sex (odds ratio [OR] 1.82, P = .028), non-white race (African American OR 2.41, P = .013; other non-white OR 1.42, P = .042), smoking (OR 1.07, P = .021), and failure to provide a phone number (OR 1.78, P = .032) increased the risk for being lost to follow-up. Furthermore, greater preoperative International Hip Outcome Tool 12-item component questionnaire (OR 1.03, P = .004), and modified Harris Hip Score (OR 1.05, P = .014) scores increased the risk of being lost to follow-up. The c-statistic was 0.76 (95% confidence interval 0.701-0.848). The log-likelihood indicated that the regression model as a whole was statistically significant (P = .002). Conclusions Patients who are male, non-white, smokers, fail to provide a telephone number, and have greater preoperative modified Harris Hip Score and International Hip Outcome Tool 12-item component questionnaire scores are at an increased risk for being lost to follow-up 2 years after hip arthroscopy for FAIS. Level of Evidence Level III, case control study.
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13
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Beletsky A, Nwachukwu BU, Gorodischer T, Chahla J, Forsythe B, Cole BJ, Verma NN. Psychometric properties of visual analog scale assessments for function, pain, and strength compared with disease-specific upper extremity outcome measures in rotator cuff repair. JSES Int 2020; 4:619-624. [PMID: 32939496 PMCID: PMC7479024 DOI: 10.1016/j.jseint.2020.04.012] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Patient-reported outcome measures (PROMs) are being increasingly used in orthopedic surgery; however, there is significant variability and burden associated with their administration. The visual analog scale (VAS) for function, strength, and pain may represent a simple and efficient way to measure outcomes, specifically after rotator cuff repair (RCR) surgery. PURPOSE To define the efficiency and longitudinal psychometric properties of VAS instruments assessing function, strength, and pain after RCR. METHODS Single-question VAS measures assessing function, strength, and pain as a percentage of normal were administered alongside legacy PROMs in patients undergoing RCR. VAS and PROMs were administered at preoperative, 6- and 12-month time points between June 2017 and April 2018. An electronic registry was used to examine time-to-completion data. PROM performance was assessed using Spearman correlation coefficients. Both absolute and relative floor and ceiling effects were examined. Effect size was measured at 6 and 12 months through the calculation of Cohen's d coefficient. Receiver-operating curves with area under the curve calculations were used to determine the ability of preoperative VAS scores in predicting minimally clinically important difference achievement on American Shoulder and Elbow Surgeons score (ASES). RESULTS A total of 190 patients (55.6 ± 10.9 years, 66.9% male) met criteria. The 3 VAS PROMs required less time to complete than ASES (1.36 ± 1.12 vs. 5.17 ± 2.39) and Patient-Reported Outcome Measurement Information System (PROMIS) Upper Extremity v2.0 (UE) Computer Adaptive Test (1.72 ± 1.48). Compared with ASES, VAS function, strength, and pain demonstrated fair correlations preoperatively (r = 0.44-0.46) that improved to good at 6 months (r = 0.61-0.67) and further improved at 1 year (r = 0.62-0.78). The performance of VAS measures with other function PROMs was comparable with performance relative to ASES, with poor to very good correlations preoperatively (r = 0.21-0.62) that improved to good to excellent by 1 year (r = 0.62-0.94). A significant relative ceiling effect was demonstrated by PROMIS UE at 12 months (16.9%). Large effect sizes were demonstrated by the ASES, Single Assessment Numeric Evaluation, Constant, PROMIS UE, and VAS function and strength instruments (Cohen d ≥ 0.8). CONCLUSION Single-question VAS assessments for function, strength, and pain are an efficient means for assessing outcome in RCR surgery and may be particularly useful in the postoperative setting. VAS instruments collectively trended toward floor effects preoperatively, suggesting that legacy instruments may more appropriately establish preoperative baselines. However, in the postoperative setting, VAS instruments demonstrate good-to-excellent correlation, minimized time-to-completion, and no appreciable floor or ceiling effects.
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Affiliation(s)
- Alexander Beletsky
- Division of Sports Medicine, Midwest Orthopaedics at Rush, Rush University Medical Center, Chicago, IL, USA
| | - Benedict U. Nwachukwu
- Division of Sports Medicine, Midwest Orthopaedics at Rush, Rush University Medical Center, Chicago, IL, USA
| | - Tomás Gorodischer
- Department of Orthopedics and Traumatology, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina
| | - Jorge Chahla
- Department of Orthopedics and Traumatology, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina
| | - Brian Forsythe
- Division of Sports Medicine, Midwest Orthopaedics at Rush, Rush University Medical Center, Chicago, IL, USA
| | - Brian J. Cole
- Division of Sports Medicine, Midwest Orthopaedics at Rush, Rush University Medical Center, Chicago, IL, USA
| | - Nikhil N. Verma
- Division of Sports Medicine, Midwest Orthopaedics at Rush, Rush University Medical Center, Chicago, IL, USA
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14
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Beletsky A, Lu Y, Nwachukwu BU, Polce E, Maheshwer B, Chahla J, Forsythe B, Cole BJ, Verma NN. Preoperative psychometric properties of visual analog scale asessments for function, pain, and strength compared with legacy upper extremity outcome measures in glenohumeral osteoarthritis. JSES Int 2020; 4:443-448. [PMID: 32939466 PMCID: PMC7478988 DOI: 10.1016/j.jseint.2020.03.006] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Abstract
Background Patient-reported outcome measures (PROMs) are increasingly being used in orthopedic surgery; however, there is significant variability and burden associated with their administration. The visual analog scale (VAS) may represent an efficient, single-question method to establish functional baselines in a domain-specific manner for glenohumeral arthritis. Methods Single-question VAS measures assessing function, strength, and pain as a percentage of normal were administered alongside legacy PROMs in patients with primary glenohumeral arthritis in a preoperative setting between October 2015 and March 2017. PROM performance was assessed using Spearman correlation coefficients. Both absolute and relative floor and ceiling effects were examined. Results A total of 70 patients (age 66.09 ± 9.84 years, body mass index 28.8 ± 9.77, 57.1% male, 54.2% right-sided) were included. The VAS Pain instrument (r = 0.45-0.64) outperformed the VAS Function (r = 0.23-0.62) and VAS Strength (r = 0.21-0.65) in correlation to preoperative PROMs. The performance of VAS Pain was comparable to American Shoulder and Elbow Surgeons Standardized Shoulder Assessment Form (ASES; r = 0.47-0.84). None of the VAS instruments in our study demonstrated preoperative floor effects (7.1%-8.6%) or ceiling effects (0.0%-4.3%). The most efficient instruments were Single-Assessment Numerical Evaluation (SANE; 0.87 ± 0.41 minutes), Patient-Reported Outcome Measurement Information System Upper Extremity Computer Adaptive Test (PROMIS UE CAT; 1.27 ± 1.30 minutes), and the triad of VAS measures (1.51 ± 1.61 minutes). Conclusion VAS Pain outperformed VAS Strength and Function relative to legacy PROMs, while performing comparable to ASES. None of the VAS measures were susceptible to significant floor or ceiling effects preoperatively. The VAS instruments along with SANE and PROMIS UE were the most time-efficient measures. VAS instruments may have a role in establishing preoperative baselines in those with glenohumeral arthritis in a simple, efficient, and adoptable manner.
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Affiliation(s)
- Alexander Beletsky
- Division of Sports Medicine, Department of Orthopedics, Midwest Orthopedics at Rush, Rush University, Chicago, IL, USA
| | - Yining Lu
- Division of Sports Medicine, Department of Orthopedics, Midwest Orthopedics at Rush, Rush University, Chicago, IL, USA
| | - Benedict U Nwachukwu
- Department of Orthopaedic Surgery, Hospital for Special Surgery, New York, NY, USA
| | - Evan Polce
- Division of Sports Medicine, Department of Orthopedics, Midwest Orthopedics at Rush, Rush University, Chicago, IL, USA
| | - Bhargavi Maheshwer
- Division of Sports Medicine, Department of Orthopedics, Midwest Orthopedics at Rush, Rush University, Chicago, IL, USA
| | - Jorge Chahla
- Division of Sports Medicine, Department of Orthopedics, Midwest Orthopedics at Rush, Rush University, Chicago, IL, USA
| | - Brian Forsythe
- Division of Sports Medicine, Department of Orthopedics, Midwest Orthopedics at Rush, Rush University, Chicago, IL, USA
| | - Brian J Cole
- Division of Sports Medicine, Department of Orthopedics, Midwest Orthopedics at Rush, Rush University, Chicago, IL, USA
| | - Nikhil N Verma
- Division of Sports Medicine, Department of Orthopedics, Midwest Orthopedics at Rush, Rush University, Chicago, IL, USA
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15
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Beck EC, Nwachukwu BU, Chapman R, Gowd AK, Waterman BR, Nho SJ. The Influence of Lumbosacral Spine Pathology on Minimum 2-Year Outcome After Hip Arthroscopy: A Nested Case-Control Analysis. Am J Sports Med 2020; 48:403-408. [PMID: 31877059 DOI: 10.1177/0363546519892916] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND Previous literature has examined the association between lumbosacral pathology and hip pathomechanics. However, the effect of lumbosacral pathologies and previous lumbosacral surgery on achieving meaningful outcomes after hip arthroscopy for femoroacetabular impingement syndrome (FAIS) has yet to be studied conclusively. PURPOSE To determine whether a history of lumbosacral spine pathology has an influence on achieving minimal clinically important differences (MCIDs) after hip arthroscopy for FAIS. STUDY DESIGN Cohort study; Level of evidence, 3. METHODS Patients undergoing hip arthroscopy for FAIS by a single, fellowship-trained orthopaedic surgeon between January 2012 and April 2017 with minimum 2-year follow-up were retrospectively reviewed. Patients with a history of lumbosacral spine pathology (eg, lumbosacral fusion, disc or vertebral pathology, or history of lumbosacral fractures) were matched 1:2 by age, body mass index, and sex to patients without spine pathology. Clinical outcomes including the Hip Outcome Score-activities of daily living subscale (HOS-ADL), HOS-sports subscale (HOS-SS), modified Harris Hip Score (mHHS), international Hip Outcome Tool-12 (iHOT-12), visual analog scale (VAS) pain, and VAS satisfaction were compared between the groups using an independent t test. The threshold of every outcome score for achieving MCID was calculated separately for each group and frequencies were compared. RESULTS A total of 83 of 108 eligible patients with lumbosacral pathology were identified and matched to 166 patients without any spine pathology. When compared with the non-spine pathology group, the lumbosacral pathology group had significantly lower 2-year postoperative outcome score averages across all reported outcome tools (all P < .001). There were significant differences in the proportion achieving the threshold for HOS-ADL (60.6% vs 80.0%; P = .004), HOS-SS (57.6% vs 82.1%; P < .001), mHHS (66.7% vs 81.7%; P = .025), and iHOT-12 (54.8% vs 87.6%; P < .001) scores for MCID when comparing the lumbosacral and nonlumbosacral pathology groups. CONCLUSION Patients with a history of lumbosacral pathology achieved significantly lower short-term meaningful clinical outcomes after undergoing hip arthroscopy for FAIS when compared with patients without spine pathology. The present study findings have implications for preoperative patient screening, shared decision-making processes/expectation management, and rehabilitation strategies.
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Affiliation(s)
- Edward C Beck
- Department of Orthopedic Surgery, Wake Forest School of Medicine, Winston-Salem, North Carolina, USA
| | - Benedict U Nwachukwu
- Department of Orthopedic Surgery, Rush University Medical Center, Chicago, Illinois, USA
| | - Reagan Chapman
- Department of Orthopedic Surgery, Rush University Medical Center, Chicago, Illinois, USA
| | - Anirudh K Gowd
- Department of Orthopedic Surgery, Wake Forest School of Medicine, Winston-Salem, North Carolina, USA
| | - Brian R Waterman
- Department of Orthopedic Surgery, Wake Forest School of Medicine, Winston-Salem, North Carolina, USA
| | - Shane J Nho
- Department of Orthopedic Surgery, Rush University Medical Center, Chicago, Illinois, USA
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16
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Jones DM, Crossley KM, Ackerman IN, Hart HF, Dundules KL, O'Brien MJ, Mentiplay BF, Heerey JJ, Kemp JL. Physical Activity Following Hip Arthroscopy in Young and Middle-Aged Adults: A Systematic Review. SPORTS MEDICINE-OPEN 2020; 6:7. [PMID: 31993831 PMCID: PMC6987281 DOI: 10.1186/s40798-020-0234-8] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/01/2019] [Accepted: 01/02/2020] [Indexed: 01/31/2023]
Abstract
Background Hip arthroscopy is a common surgical intervention for young and middle-aged adults with hip-related pain and dysfunction, who have high expectations for returning to physical activity following surgery. The purpose of this review was to evaluate the impact of hip arthroscopy on physical activity post-arthroscopy. Methods A systematic search of electronic databases was undertaken in identifying studies from January 1st 1990 to December 5th 2019. The search included English language articles reporting physical activity as an outcome following hip arthroscopy in adults aged 18-50 years. Quality assessment, data extraction and synthesis of included studies were undertaken. Results Full text articles (n = 234) were assessed for eligibility following screening of titles and abstracts (n = 2086), yielding 120 studies for inclusion. The majority (86%) of the studies were level 4 evidence. One study reported objective activity data. The most frequently occurring patient-reported outcome measure was the Hip Outcome Score-sport-specific subscale (HOS-SS, 84% of studies). Post--arthroscopy improvement was indicated by large effect sizes for patient-reported outcome measures (standard paired difference [95% confidence interval] −1.35[−1.61 to −1.09] at more than 2 years post-arthroscopy); however, the majority of outcome scores for the HOS-SS did not meet the defined level for a patient-acceptable symptom state. Conclusion The current level of available information regarding physical activity for post arthroscopy patients is limited in scope. Outcomes have focused on patients’ perceived difficulties with sport-related activities with a paucity of information on the type, quality and quantity of activity undertaken. Level of Evidence Level IV, systematic review of Level 2 through to Level 4 studies
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Affiliation(s)
- Denise M Jones
- La Trobe Sport and Exercise Medicine Research Centre, School of Allied Health, College of Science, Health and Engineering, La Trobe University, Melbourne, Victoria, Australia.
| | - Kay M Crossley
- La Trobe Sport and Exercise Medicine Research Centre, School of Allied Health, College of Science, Health and Engineering, La Trobe University, Melbourne, Victoria, Australia
| | | | - Harvi F Hart
- La Trobe Sport and Exercise Medicine Research Centre, School of Allied Health, College of Science, Health and Engineering, La Trobe University, Melbourne, Victoria, Australia.,Department of Physical Therapy, The University of Western Ontario, London, Ontario, Canada
| | - Karen L Dundules
- La Trobe Sport and Exercise Medicine Research Centre, School of Allied Health, College of Science, Health and Engineering, La Trobe University, Melbourne, Victoria, Australia
| | - Michael J O'Brien
- La Trobe Sport and Exercise Medicine Research Centre, School of Allied Health, College of Science, Health and Engineering, La Trobe University, Melbourne, Victoria, Australia
| | - Benjamin F Mentiplay
- La Trobe Sport and Exercise Medicine Research Centre, School of Allied Health, College of Science, Health and Engineering, La Trobe University, Melbourne, Victoria, Australia
| | - Joshua J Heerey
- La Trobe Sport and Exercise Medicine Research Centre, School of Allied Health, College of Science, Health and Engineering, La Trobe University, Melbourne, Victoria, Australia
| | - Joanne L Kemp
- La Trobe Sport and Exercise Medicine Research Centre, School of Allied Health, College of Science, Health and Engineering, La Trobe University, Melbourne, Victoria, Australia
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Kunze KN, Beck EC, Nwachukwu BU, Ahn J, Nho SJ. Timing of Surgery: Can It Predict Outcome? Response. Am J Sports Med 2020; 48:NP11-NP12. [PMID: 31877101 DOI: 10.1177/0363546519887119] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
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