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Ray LJ, Hassan MM, Fader RR. Maximizing the Benefits of Postless Hip Arthroscopy: On-Off Traction Technique During Labral Repair to Restore the Labral Suction Seal. Arthrosc Tech 2024; 13:102941. [PMID: 38835468 PMCID: PMC11144804 DOI: 10.1016/j.eats.2024.102941] [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: 09/09/2023] [Accepted: 01/12/2024] [Indexed: 06/06/2024] Open
Abstract
The acetabular labrum plays a key role in proper biomechanical hip function through creation or maintenance of a suction seal between the femoral head and acetabulum. The suction seal effect has been shown to provide stability within the hip, improve biomechanics, and decrease the chance for long-term development of osteoarthritis by optimizing function and force distribution within the hip. Femoral acetabular impingement syndrome damages the labrum and chondrolabral junction, thus negatively impacting the ability of the labrum to maintain native suction seal. Our technique describes the use of a postless hip arthroscopy table and the on-off traction technique throughout the labral repair, ensuring precise reduction of the labrum and restoration of the suction seal sequentially as anchors are placed.
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Affiliation(s)
- Lucas J. Ray
- Department of Orthopaedic Surgery, University of Minnesota Medical School, Minneapolis, Minnesota, U.S.A
| | - Mahad M. Hassan
- Department of Orthopaedic Surgery, University of Minnesota Medical School, Minneapolis, Minnesota, U.S.A
| | - Ryan R. Fader
- Allina Health Orthopedics, Plymouth, Minnesota, U.S.A
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Maldonado DR, George T, Padmanabhan S, Curley AJ, Domb BG. Defining Thresholds and Predictors for Achieving the Patient Acceptable Symptom State for Patient-Reported Outcome Measures After Revision Hip Arthroscopy. Am J Sports Med 2023; 51:3772-3780. [PMID: 37975493 DOI: 10.1177/03635465231209320] [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] [Indexed: 11/19/2023]
Abstract
BACKGROUND The Patient Acceptable Symptom State (PASS) after primary hip arthroscopy has been determined; nonetheless, the PASS still needs to be defined for revision hip arthroscopy. PURPOSE To define minimum 2-year follow-up PASS thresholds for the modified Harris Hip Score (mHHS), Nonarthritic Hip Score (NAHS), Hip Outcome Score-Sports Specific Subscale (HOS-SSS), visual analog scale (VAS) for pain, and International Hip Outcome Tool-12 (iHOT-12) after revision hip arthroscopy, and to identify predictors of achieving the PASS. STUDY DESIGN Case-control study; Level of evidence, 3. METHODS Data were prospectively collected and retrospectively reviewed for all patients who underwent revision hip arthroscopy between April 2017 and July 2020. Patients were included if they had baseline and minimum 2-year follow-up scores for the mHHS, NAHS, HOS-SSS, VAS for pain, and iHOT-12. PASS was calculated using the anchor-based method. Receiver operating characteristic curve analysis was used to determine the thresholds for the PASS. A multivariate logistic regression was used to identify predictors for achieving the PASS. RESULTS A total of 318 patients who underwent revision hip arthroscopy met the inclusion criteria. Of those patients, 292 (91.8%) had baseline and minimum 2-year follow-up. Of this group, 68 patients (72.1% female and 27.9% male; mean age, 32.9 years) answered the PASS anchor question. Achievement PASS rates were 58.8%, 41.2%, 52.9%, 60.3%, and 52.9% for the mHHS, NAHS, HOS-SSS, VAS, and iHOT-12, respectively. The area under the curve (AUC) values for the PASS for mHHS, NAHS, HOS-SSS, VAS, and iHOT-12 were 0.912, 0.888, 0.857, 0.903, and 0.871, respectively, indicating excellent discrimination. The PASS for the mHHS was 76 (sensitivity, 0.809; specificity, 0.905), for the NAHS was 86.3 (sensitivity, 0.660; specificity, 1), for the HOS-SSS was 64.3 (sensitivity, 0.745; specificity, 0.905), for the VAS was 3 (sensitivity, 0.830; specificity, 0.905), and for the iHOT-12 was 64.3 (sensitivity, 0.745; specificity, 0.905). Body mass index (BMI) was identified as a significant predictor of achieving PASS for the NAHS (OR, 0.967; 95% CI, 0.940-0.996; P = .027), as patients with a BMI ≤25.4 had 1.03 times higher odds ratio of achieving PASS for the NAHS. CONCLUSION After revision hip arthroscopy, the minimum 2-year follow-up PASS thresholds for the mHHS, NAHS, HOS-SSS, VAS for pain, and iHOT-12 were 76, 86.3, 64.3, 3, and 64.3, respectively. The odds ratio of achieving PASS for the NAHS was 1.03 times higher for patients with a BMI ≤25.4.
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Affiliation(s)
- David R Maldonado
- American Hip Institute Research Foundation, Chicago, Illinois, USA
- Department of Orthopaedic Surgery, McGovern Medical School, University of Texas Health Science Center at Houston, Houston, Texas, USA
| | - Tracy George
- American Hip Institute Research Foundation, Chicago, Illinois, USA
| | | | - Andrew J Curley
- American Hip Institute Research Foundation, Chicago, Illinois, USA
| | - Benjamin G Domb
- American Hip Institute Research Foundation, Chicago, Illinois, USA
- American Hip Institute, Chicago, Illinois, USA
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Horner N, Chapman RS, Larson J, Hevesi M, Nho SJ. Workers' Compensation Patients Undergoing Hip Arthroscopy for Femoroacetabular Impingement Syndrome Experience Worse Mid-Term Outcomes but Similar Return-to-Work: A Propensity-Matched Analysis at 5-Year Follow-Up. Arthroscopy 2023; 39:2293-2299.e1. [PMID: 37100215 DOI: 10.1016/j.arthro.2023.03.023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/07/2022] [Revised: 01/30/2023] [Accepted: 03/21/2023] [Indexed: 04/28/2023]
Abstract
PURPOSE To investigate mid-term patient-reported outcomes (PROs) and return-to-work for workers' compensation (WC) patients undergoing primary hip arthroscopy (HA) for femoroacetabular impingement syndrome (FAIS) versus propensity-matched, non-WC controls and to determine whether achievement rates of minimal clinically important difference (MCID) and patient-acceptable symptom state (PASS) differ between these populations. METHODS A retrospective cohort study was conducted on WC patients who underwent primary HA for FAIS from 2012 to 2017. WC and non-WC patients were propensity matched on a 1:4 basis by sex, age, and body mass index (BMI). PROs were compared preoperatively and at 5 years postoperatively, employing the Hip Outcome Score Activities of Daily Living (HOS-ADL) and Sports-Specific (HOS-SS) subscales, modified Harris Hip Score (mHHS), 12-item international Hip Outcome Tool (iHOT-12), and visual analog scales (VAS) for pain and satisfaction. MCID and PASS were calculated using published thresholds for these measures. Preoperative and postoperative radiographs and the presence and timing of return to unrestricted work were evaluated. RESULTS Forty-three WC patients were successfully matched to 172 non-WC controls and followed for 64.2 ± 7.7 months. WC patients demonstrated lower preoperative scores for all measures (P ≤ .031) and worse HOS-ADL, HOS-SS, and VAS pain scores at 5-year follow-up (P ≤ .021). There were no differences in MCID achievement rates or magnitude of change between preoperative and 5-year postoperative PROs (P ≥ .093); however, WC patients achieved PASS at lower rates for HOS-ADL and HOS-SS (P ≤ .009). 76.7% of WC and 84.3% of non-WC patients returned to work without restrictions (P = .302) at 7.4 ± 4.4 versus 5.0 ± 3.8 months, respectively (P < .001). CONCLUSIONS WC patients undergoing HA for FAIS report worse preoperative pain and function than non-WC patients and experience worse pain, function, and PASS achievement at 5-year follow-up. However, they demonstrate similar MCID achievement and magnitude improvement between preoperative and 5-year postoperative PROs, and return to work without restrictions at a similar rate to non-WC patients, although they may take longer to do so. LEVEL OF EVIDENCE Level III, retrospective cohort study.
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Affiliation(s)
- Nolan Horner
- Section of Young Adult Hip Surgery, Division of Sports Medicine, Department of Orthopedic Surgery, Rush University Medical Center, Chicago, Illinois, U.S.A
| | - Reagan S Chapman
- Section of Young Adult Hip Surgery, Division of Sports Medicine, Department of Orthopedic Surgery, Rush University Medical Center, Chicago, Illinois, U.S.A..
| | - Jordan Larson
- Section of Young Adult Hip Surgery, Division of Sports Medicine, Department of Orthopedic Surgery, Rush University Medical Center, Chicago, Illinois, U.S.A
| | - Mario Hevesi
- Section of Young Adult Hip Surgery, Division of Sports Medicine, Department of Orthopedic Surgery, Rush University Medical Center, Chicago, Illinois, U.S.A
| | - Shane J Nho
- Section of Young Adult Hip Surgery, Division of Sports Medicine, Department of Orthopedic Surgery, Rush University Medical Center, Chicago, Illinois, U.S.A
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Barnes RH, Vasileff WK. Modified Loop Suture Technique in Arthroscopic Labral Repair of the Hip. Arthrosc Tech 2023; 12:e1541-e1547. [PMID: 37780652 PMCID: PMC10533857 DOI: 10.1016/j.eats.2023.04.026] [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: 03/04/2023] [Accepted: 04/22/2023] [Indexed: 10/03/2023] Open
Abstract
Hip arthroscopy is rapidly increasing in case volume annually in the United States. However, it remains a challenging surgery with a steep learning curve. Labral repair is commonly performed to preserve the labrum rather than labral debridement or reconstruction. Many techniques have been described for labral repair. In this technical note, we describe our technique for a modified loop suture technique for arthroscopic labral repair of the hip.
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Affiliation(s)
- Ryan H. Barnes
- Department of Orthopaedics, The Ohio State University Wexner Medical Center, Columbus, Ohio, U.S.A
| | - W. Kelton Vasileff
- Department of Orthopaedics, The Ohio State University Wexner Medical Center, Columbus, Ohio, U.S.A
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Domb BG, Owens JS, Glein RM, Jimenez AE, Maldonado DR. Borderline Dysplasia After Primary Hip Arthroscopy with Capsular Plication and Labral Preservation: Ten-Year Survivorship and Patient-Reported Outcomes. J Bone Joint Surg Am 2023; 105:687-699. [PMID: 37083686 DOI: 10.2106/jbjs.22.00340] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/22/2023]
Abstract
BACKGROUND The arthroscopic management of borderline hip dysplasia (BHD) is controversial, and long-term follow-up data are scarce. The purpose of this study was to report prospectively collected survivorship and patient-reported outcome measures (PROMs) at a minimum 10-year follow-up following primary hip arthroscopy with capsular plication and labral preservation in patients with BHD. METHODS Data were prospectively collected on all patients who underwent primary hip arthroscopy between September 2008 and September 2011. Patients with BHD (defined by a lateral center-edge angle [LCEA] between 18° and 25°) were included. Preoperative and minimum 10-year follow-up scores for the modified Harris hip score (mHHS), Nonarthritic Hip Score (NAHS), Hip Outcome Score-Sports Specific Subscale (HOS-SSS), and visual analog scale (VAS) for pain were collected. Exclusion criteria were prior ipsilateral hip surgery, Workers' Compensation status, Tönnis grade of >1, previous hip conditions, or LCEA of <18°. Survivorship was defined as no conversion to total hip arthroplasty (THA). The risk factors for THA conversion were analyzed. The achievement rate for the minimal clinically important difference (MCID) was reported. A propensity-matched comparison with a control group without BHD was performed. RESULTS Forty-five (80%) of 56 eligible hips were included in this study: 38 hips (84%) of female patients and 7 hips (16%) of male patients. The mean patient age was 31.0 ± 12.9 years, and the mean patient body mass index (BMI) was 24.5 ± 5.4 kg/m2. The 10-year survivorship was 82.2%, and there was significant improvement in all PROMs and VAS pain from baseline to the minimum 10-year follow-up (p < 0.001). The odds of undergoing conversion to THA were 4.4 times higher for patients with a BMI of ≥23 kg/m2 and 7.1 times higher for patients who were ≥42 years of age. The MCID was achieved at high rates for the mHHS (79%), NAHS (79%), HOS-SSS (70%), and VAS pain (76%). The minimum 10-year survivorship, PROMs, and MCID achievement rates for the BHD group were comparable with those for the control group. CONCLUSIONS Patients with BHD who underwent primary hip arthroscopy with capsular plication and labral preservation demonstrated an overall survivorship of 82.2% and significant improvement in all PROMs and achieved the MCID at high rates at a minimum 10-year follow-up. LEVEL OF EVIDENCE Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence.
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Affiliation(s)
- Benjamin G Domb
- American Hip Institute Research Foundation, Chicago, Illinois
- American Hip Institute, Chicago, Illinois
| | - Jade S Owens
- American Hip Institute Research Foundation, Chicago, Illinois
| | - Rachel M Glein
- American Hip Institute Research Foundation, Chicago, Illinois
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Su T, Ao Y, Yang L, Chen GX. The Vascularization Course of Labral Autograft and Its Effect on Tissue Healing: Acetabular Labral Augmentation Versus Labral Reconstruction in a Porcine Model. Am J Sports Med 2022; 50:2647-2658. [PMID: 35853160 DOI: 10.1177/03635465221108195] [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 The preservation of the native labral vascularization is assumed to be the potential advantage of acetabular labral augmentation, the effect of which remains unknown. PURPOSE To identify the vascular distribution within the labral autograft and its effect on the healing process between labral augmentation (AUG) and reconstruction (RECON) in a porcine model. STUDY DESIGN Controlled laboratory study. METHODS A total of 36 pigs randomly underwent unilateral labral augmentation or reconstruction (AUG group, n = 18; RECON group, n = 18). The pigs were randomly sacrificed at 6, 12, and 24 weeks postoperatively. The labral autografts were harvested for macroscopic evaluation and histologic assessment. The labral autograft was zoned into 2 halves to observe the vascular distribution: the capsular half (zone I) and the articular half (zone II). Each zone was divided into 2 parts: the peripheral part (IA and IIA) and the part attached to the acetabulum (IB and IIB). RESULTS At 6 weeks, there existed more vascular ingrowth in zone I, whereas zone IIB appeared nearly avascular in both groups. At 12 weeks, the area with the greatest vascularity was zone II in the RECON group and zone IA in the AUG group. The vascularity was concentrated at zones IA and IIA in both groups at 24 weeks. The labral autografts were hypertrophic with sufficient filling of the labral defect in both groups at 6 weeks. At 12 weeks, an insufficient volume of the articular half was observed in 3 of 6 labral autografts in the RECON group, while all autografts remained well integrated with the chondrolabral junction in the AUG group. At 24 weeks, unsatisfactory merging of the labral autograft with the cartilage at the articular side was found in 2 of 6 labral autografts in the RECON group, which was not observed in the AUG group despite the sufficient volume of autografts labrum in both groups. CONCLUSION Slow vascular ingrowth within the articular half might account for the poor healing of the reconstructed labral autograft. Labral augmentation provides the possibility of better tissue healing because of the preservation of the original chondrolabral junction compared with labral reconstruction. CLINICAL RELEVANCE Labral augmentation might be a feasible alternative to labral reconstruction under the condition of viable labral remnants.
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Affiliation(s)
- Tiao Su
- Center for Joint Surgery, Southwest Hospital, Army Medical University, Chongqing, China
| | - Yunong Ao
- Center for Joint Surgery, Southwest Hospital, Army Medical University, Chongqing, China
| | - Liu Yang
- Center for Joint Surgery, Southwest Hospital, Army Medical University, Chongqing, China
| | - Guang-Xing Chen
- Center for Joint Surgery, Southwest Hospital, Army Medical University, Chongqing, China
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Maldonado DR, Fox JD, Kyin C, Jimenez AE, Saks BR, Curley AJ, Lall AC, Domb BG. Maximal Outcome Improvement Willingness Thresholds Are Predictive of a Patient’s Willingness to Undergo the Same Surgery, in Retrospect, Given the Known Outcome of Their Primary Hip Arthroscopy. Arthrosc Sports Med Rehabil 2022; 4:e1007-e1013. [PMID: 35747669 PMCID: PMC9210379 DOI: 10.1016/j.asmr.2022.02.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2021] [Accepted: 02/11/2022] [Indexed: 11/26/2022] Open
Abstract
Purpose To determine the percent maximal outcome improvement willingness thresholds (MOWTs) for the Nonarthritic Hip Score (NAHS) and the visual analog scale (VAS) for pain that were associated with a patient’s willingness to undergo surgery, in retrospect, given the known outcome of their primary hip arthroscopy with concomitant endoscopy for gluteus medius (GM) tear repair. Methods An anchor question was provided to patients who underwent primary hip arthroscopy for femoroacetabular impingement syndrome with concomitant endoscopic GM tear repair between April 2008 to April 2020. Patients were included if they answered the anchor question and had baseline and postoperative minimum 1-year follow-up scores for the NAHS and VAS. Patients were excluded if they had a previous ipsilateral hip surgery, Tönnis grade >1, hip dysplasia, previous hip conditions, or a preoperative score that was already at the maximum value for the NAHS and VAS scores. Receiver operating characteristic (ROC) analysis was used to determine the MOWT. Significance was indicated by a P value <.05. Results A total of 107 patients (107 hips) were included, with 101 (94.4%) females and 6 (5.6%) males. The average age and body mass index was 56.20 ± 9.88 years and 28.80 ± 4.92 kg/m2, respectively. The average follow-up time was 54.89 ± 29.52 months. The ROC analysis determined that the MOWT for the mHHS and VAS were 54.7%, and 62.6%, respectively. The probability of a patient being willing to undergo surgery again if they met the MOWT was 85.8% and 85.6% for the NAHS and VAS, respectively. Conclusion The MOWTs that were predictive of willingness to undergo surgery again following primary hip arthroscopy with concomitant endoscopy for GM tear repair were 54.7% and 62.6% for the NAHS, and VAS, respectively. Clinical Relevance Outcome assessment has been a point of increasing emphasis in hip preservation surgery. Having a tool to measure whether patients would go through the process of surgery again knowing their current outcome status is important to understanding outcomes after surgery.
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Maldonado DR, Glein RM, Lee MS, Annin S, Owens JS, Jimenez AE, Saks BR, Sabetian PW, Lall AC, Domb BG. Patients With Concomitant Painful External Snapping Hip and Femoroacetabular Impingement Syndromes Reported Complete Snapping Resolution With Release of the Gluteus Maximus and Iliotibial Band, and Comparable Minimum 2-Year Outcomes to a Propensity-Matched Control Group. Arthroscopy 2022; 38:1890-1899. [PMID: 34920010 DOI: 10.1016/j.arthro.2021.11.048] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/26/2021] [Revised: 11/17/2021] [Accepted: 11/30/2021] [Indexed: 02/02/2023]
Abstract
PURPOSE To report minimum 2-year patient-reported outcome measures (PROMs) following primary hip arthroscopy for femoroacetabular impingement syndrome (FAIS) and painful external snapping hip (ESH) treatment and ESH resolution, and to compare these PROMs to a benchmark FAIS propensity-matched control group without ESH. METHODS Data were prospectively collected and retrospectively reviewed between November 2009 and April 2018. Patients were eligible if they were preoperatively diagnosed with FAIS and painful ESH and received primary hip arthroscopy to address these pathologies. ESH was treated with gluteus maximus and iliotibial band releases. Inclusion criteria were baseline and minimum two-year follow-up scores for the modified Harris Hip Score, Nonarthritic Hip Score, Hip Outcome Score-Sport Specific Subscale, and visual analog scale for pain. Exclusion criteria were Tönnis grade >1 and previous hip conditions. A secondary subanalysis was performed to benchmark these outcomes to a FAIS propensity-matched control group without ESH, according to age, sex, body mass index (BMI), Tönnis grade, and preoperative lateral center-edge and α-angles using a 1:3 ratio. The minimal clinically important difference (MCID) and the maximum outcome improvement (MOI) rates were reported. RESULTS Twenty-two hips (21 patients) were included. The mean age, BMI, and follow-up were 31.3 years ± 14.0, 26 kg/m2 ± 5.0, and 31.4 months ± 4.4, respectively, with 68.2% being female. ESH was resolved in 100% of patients. Significant improvement for all PROMs at a minimum two-year (P < .001) was reported. The minimum two-year PROMs and the rate of achieving the MCID and MOI threshold were comparable to the control group. CONCLUSION Following primary hip arthroscopy for FAIS and painful ESH, patients demonstrated significant improvement in all PROMs, and the rate of resolution of ESH was 100% at minimum two-year follow-up: with gluteus maximus and iliotibial band releases. Functional outcomes and rates of MCID and MOI achievement were comparable to a FAIS propensity-matched benchmark control group without ESH. LEVEL OF EVIDENCE Level III, retrospective comparative study.
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Affiliation(s)
- David R Maldonado
- American Hip Institute Research Foundation, Chicago, Illinois, U.S.A
| | - Rachel M Glein
- American Hip Institute Research Foundation, Chicago, Illinois, U.S.A
| | - Michael S Lee
- American Hip Institute Research Foundation, Chicago, Illinois, U.S.A
| | - Shawn Annin
- American Hip Institute Research Foundation, Chicago, Illinois, U.S.A
| | - Jade S Owens
- American Hip Institute Research Foundation, Chicago, Illinois, U.S.A
| | - Andrew E Jimenez
- American Hip Institute Research Foundation, Chicago, Illinois, U.S.A
| | - Benjamin R Saks
- American Hip Institute Research Foundation, Chicago, Illinois, U.S.A.; AMITA Health St. Alexius Medical Center, Hoffman Estates, Illinois, U.S.A
| | - Payam W Sabetian
- American Hip Institute Research Foundation, Chicago, Illinois, U.S.A
| | - Ajay C Lall
- American Hip Institute Research Foundation, Chicago, Illinois, U.S.A.; American Hip Institute, Chicago, Illinois, U.S.A.; AMITA Health St. Alexius Medical Center, Hoffman Estates, Illinois, U.S.A
| | - Benjamin G Domb
- American Hip Institute Research Foundation, Chicago, Illinois, U.S.A.; American Hip Institute, Chicago, Illinois, U.S.A.; AMITA Health St. Alexius Medical Center, Hoffman Estates, Illinois, U.S.A..
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Sabetian PW, Monahan PF, Fox JD, Jimenez AE, Maldonado DR, Saks BR, Ankem HK, Lall AC, Domb BG. Workers' Compensation Patients Improved After Hip Arthroscopy for Labral Tears: A 5-Year Outcome Propensity Score-Matched Study. Am J Sports Med 2022; 50:1281-1290. [PMID: 35286179 DOI: 10.1177/03635465221078620] [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] [Indexed: 01/31/2023]
Abstract
BACKGROUND The workers' compensation (WC) status has been associated with inferior outcomes in orthopaedic procedures and is usually excluded from clinical outcome studies. Therefore, comparative studies based on WC status are scarce. PURPOSE (1) To determine outcomes of patients with WC claims treated with hip arthroscopy for labral tears at a minimum 5-year follow-up and (2) to compare these findings with a propensity score-matched control group without WC claims. STUDY DESIGN Cohort study; Level of evidence, 3. METHODS Patients were propensity score matched to a control group without WC claims. Data were prospectively collected for all patients undergoing hip arthroscopy. Patients were included if they received primary hip arthroscopy for labral tears in the setting of femoroacetabular impingement, had a WC claim, and had preoperative and minimum 5-year follow-up patient-reported outcomes ([PROs]; modified Harris Hip Score [mHHS], Non-Arthritic Hip Score [NAHS], Hip Outcome Score-Sports Specific Subscale [HOS-SSS], and visual analog scale [VAS] for pain). Clinical outcomes were measured using the Patient Acceptable Symptom State (PASS), minimal clinically important difference (MCID), and maximum outcome improvement satisfaction threshold (MOI). RESULTS A total of 111 from 132 (84.1%) eligible WC patients met the inclusion criteria with an average follow-up time of 80.3 ± 37.3 months. WC cases demonstrated significant improvement from preoperatively to a minimum 5-year follow-up for mHHS, NAHS, HOS-SSS, and VAS for pain (P < .05). WC patients returned to work at a 66% rate, with an average clearance time of 4.7 months to light duty and 9.5 months to heavy duty. When compared with the control group, the WC group demonstrated lower pre- and postoperative PROs (P < .05); however, WC cases had a greater magnitude of improvement (ΔmHHS [P = .0012], ΔNAHS [P < .001], and ΔHOS-SSS [P = .012]). Rates of achieving MCID and MOI were similar in both groups (P > .05). The WC group went on to receive a future arthroscopy in 19 cases (17.1%), while 10 cases (4.5%) in the control group required revision arthroscopy (P < .001). Patients in both the WC and the control groups converted to total hip arthroplasty at similar rates (13.3% and 15.4%, respectively; P > .05). CONCLUSION Patients with WC claims treated with hip arthroscopic surgery showed significant improvement and high rates of returning to work at a minimum 5-year follow-up. Although having lower scores in PROs and achieving PASS rates, no differences were found in MCID and MOI rates. Furthermore, WC patients had a greater magnitude of improvement from preoperatively to a minimum 5-year follow-up after hip arthroscopy. Therefore, even though more studies are needed to determine the causes of inconsistent outcomes in the WC population, hip arthroscopy can effectively treat labral tears in the setting of femoroacetabular impingement, regardless of the WC status.
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Affiliation(s)
- Payam W Sabetian
- American Hip Institute Research Foundation, Chicago, Illinois, USA
| | - Peter F Monahan
- American Hip Institute Research Foundation, Chicago, Illinois, USA
| | - James D Fox
- American Hip Institute Research Foundation, Chicago, Illinois, USA
| | - Andrew E Jimenez
- American Hip Institute Research Foundation, Chicago, Illinois, USA
| | | | - Benjamin R Saks
- American Hip Institute Research Foundation, Chicago, Illinois, USA
| | - Hari K Ankem
- 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, Owens JS, Monahan PF, Maldonado DR, Saks BR, Sabetian PW, Ankem HK, Lall AC, Domb BG. Return to Sports and Minimum 2-Year Outcomes of Hip Arthroscopy in Elite Athletes With and Without Coexisting Low Back Pain: A Propensity-Matched Comparison. Am J Sports Med 2022; 50:68-78. [PMID: 34807750 DOI: 10.1177/03635465211056964] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND Patient-reported outcomes (PROs) and return to sports (RTS) after hip arthroscopy for femoroacetabular impingement syndrome (FAIS) have not been established in elite athletes with coexisting low back pain (LBP). PURPOSE (1) To report minimum 2-year PROs and RTS rates after primary hip arthroscopy for FAIS in elite athletes with coexisting LBP and (2) to compare clinical results with a propensity-matched control group of elite athletes without back pain. STUDY DESIGN Cohort study; Level of evidence, 3. METHODS Data were reviewed for elite athletes (college and professional) who underwent hip arthroscopy for FAIS and had coexisting LBP between October 2009 and October 2018. Inclusion criteria were preoperative and minimum 2-year follow-up for the modified Harris Hip Score, Nonarthritic Hip Score, Hip Outcome Score-Sports Specific Subscale (HOS-SSS), and visual analog scale for pain. Exclusion criteria were Tönnis grade >1, hip dysplasia (lateral center-edge angle <18°), and previous ipsilateral hip or spine surgery or conditions. Rates of achieving the minimal clinically importance difference (MCID), patient acceptable symptomatic state (PASS), and maximum outcome improvement satisfaction threshold were recorded in addition to RTS. For the subanalysis, the elite athlete study group was propensity matched to an elite athlete control group without back pain. RESULTS A total of 48 elite athletes with LBP who underwent primary hip arthroscopy met inclusion criteria, and follow-up was available for 42 (87.5%) at 53.2 ± 31.6 months (mean ± SD). Elite athletes with coexisting LBP demonstrated significant improvements in all recorded PROs and achieved the MCID and PASS for the HOS-SSS at rates of 82.5% and 67.5%, respectively. They also returned to sports at a high rate (75.8%), and 79% of them did not report LBP postoperatively. PROs, rates of achieving the MCID and PASS for the HOS-SSS, and RTS rates were similar between the study group and propensity-matched control group. CONCLUSION Elite athletes with coexisting LBP who undergo primary hip arthroscopy for FAIS may expect favorable PROs, rates of achieving the MCID and PASS for the HOS-SSS, and RTS rates at minimum 2-year follow-up. These results were comparable to those of a propensity-matched control group of elite athletes without back pain. In athletes with hip-spine syndrome, successful treatment of their hip pathology may help resolve their back pain.
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Affiliation(s)
- Andrew E Jimenez
- American Hip Institute Research Foundation, Chicago, Illinois, USA
| | - Jade S Owens
- American Hip Institute Research Foundation, Chicago, Illinois, USA
| | - Peter F Monahan
- American Hip Institute Research Foundation, Chicago, Illinois, USA
| | | | - Benjamin R Saks
- American Hip Institute Research Foundation, Chicago, Illinois, USA.,AMITA Health St Alexius Medical Center, Hoffman Estates, Illinois, USA
| | - Payam W Sabetian
- American Hip Institute Research Foundation, Chicago, Illinois, USA
| | - Hari K Ankem
- American Hip Institute Research Foundation, Chicago, Illinois, USA
| | - Ajay C Lall
- American Hip Institute Research Foundation, Chicago, Illinois, USA.,AMITA Health St Alexius Medical Center, Hoffman Estates, Illinois, USA.,American Hip Institute, Chicago, Illinois, USA
| | - Benjamin G Domb
- American Hip Institute Research Foundation, Chicago, Illinois, USA.,AMITA Health St Alexius Medical Center, Hoffman Estates, Illinois, USA.,American Hip Institute, Chicago, Illinois, USA
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Maldonado DR, Ouyang VW, Owens JS, Jimenez AE, Saks BR, Sabetian PW, Lall AC, Domb BG. Labral Tear Management in Patients Aged 40 Years and Older Undergoing Primary Hip Arthroscopy: A Propensity-Matched Case-Control Study With Minimum 2-Year Follow-up. Am J Sports Med 2021; 49:3925-3936. [PMID: 34652244 DOI: 10.1177/03635465211046915] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [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 suggested that primary acetabular labral reconstruction leads to lower secondary surgery rates than does labral repair for patients aged ≥40 years. PURPOSE To report minimum 2-year patient-reported outcome (PRO) scores, survivorship, and secondary surgeries in patients aged ≥40 years who underwent primary hip arthroscopy with labral reconstruction compared with a propensity-matched primary labral repair group. STUDY DESIGN Case-control study; Level of evidence, 3. METHODS Data were prospectively collected and retrospectively reviewed for patients who underwent a primary hip arthroscopy for femoroacetabular impingement syndrome between January 2014 and June 2018. Patients aged ≥40 years who underwent a labral reconstruction or a labral repair and had preoperative and minimum 2-year PROs for the modified Harris Hip Score, Nonarthritic Hip Score, and visual analog scale (VAS) for pain were included. Patients with previous ipsilateral hip conditions and surgery, Tönnis grade >1, hip dysplasia, or workers' compensation status were excluded. Patients in the reconstruction group were propensity matched 1:2 to patients in the repair group based on age, sex, and body mass index. Secondary surgeries and achievement of the minimal clinically important difference (MCID), patient acceptable symptom state (PASS), and maximum outcome improvement (MOI) were recorded. RESULTS A total of 53 and 106 hips were included in the labral reconstruction and repair groups, respectively. The average follow-up time was 37.6 months. The average ages for the reconstruction and repair groups were 48.01 ± 5.4 years and 48.61 ± 6.0 years, respectively. Both groups achieved significant improvements in all PROs at a minimum of 2 years, with similar achievements of MCID, PASS, and MOI, and comparable secondary surgery rates. CONCLUSION Patients aged ≥40 years who received primary labral repair and primary labral reconstruction achieved similar significant improvements in all PROs, VAS pain, and patient satisfaction at the minimum 2-year follow-up, with comparable rates of secondary surgeries and achieving MCID, PASS, and MOI. Based on these findings, labral repair remains the gold standard treatment for viable labrum in this population group, while reconstruction is a useful alternative for irreparable labrum.
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Affiliation(s)
| | | | | | | | - Benjamin R Saks
- American Hip Institute Research Foundation, Chicago, Illinois, USA
| | - Payam W Sabetian
- 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.,AMITA Health St. Alexius Medical Center, Hoffman Estates, Illinois, USA
| | - Benjamin G Domb
- American Hip Institute Research Foundation, Chicago, Illinois, USA.,American Hip Institute, Chicago, Illinois, USA.,AMITA Health St. Alexius Medical Center, Hoffman Estates, Illinois, USA
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12
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Maldonado DR, Owens JS, Ouyang VW, Saks BR, Jimenez AE, Glein RM, Lall AC, Domb BG. Short-term patient-reported outcomes following concomitant hip arthroscopy and the endoscopic modified shelf procedure for the treatment of acetabular dysplasia and intra-articular pathology. J Hip Preserv Surg 2021; 8:105-118. [PMID: 34567605 PMCID: PMC8460173 DOI: 10.1093/jhps/hnab044] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/10/2021] [Revised: 03/09/2021] [Accepted: 04/14/2021] [Indexed: 11/23/2022] Open
Abstract
The shelf procedure is a treatment of acetabular dysplasia, with the aim of increasing weight-bearing acetabular coverage. Although several shelf techniques have been described, the endoscopic procedure with concomitant hip arthroscopy is a new, less invasive alternative. Outcomes following this procedure are scarce. The purpose of this study was to report short-term patient-reported outcomes (PROs) following concomitant hip arthroscopy and endoscopic modified shelf procedure in the setting of acetabular dysplasia and labral tears. Patients that met extraordinarily selective surgical indications and underwent the abovementioned surgery between February 2016 and October 2019 and had minimum 1-year follow-up were included. There were five females with a mean age of 40.18 ± 5.05 years and follow-up of 21.55 ± 8.68 months. The lateral center-edge angle increased from 15.80° to 23.20° (P = 0.003), and vertical center-edge angle increased from 16.60° to 23.60° (P < 0.001). The Tönnis angle decreased from 15.40° to 3.74° (P < 0.001). The alpha angle decreased from 58.46° to 40.70° (P < 0.001). PROs demonstrated significant improvement at latest follow-up (modified Harris Hip Score, P = 0.042; Non-Arthritic Hip Score, P < 0.001; Hip Outcome Score–Sports Specific Subscale, P = 0.035; Visual Analog Scale, P < 0.001; International Hip Outcome Tool-12, P = 0.043), and satisfaction was 8.60 ± 0.89. No secondary surgeries were reported. Concomitant hip arthroscopy and endoscopic modified shelf procedure appears to be a safe and effective procedure for patients with acetabular dysplasia and labral tears yielding favorable outcomes and satisfaction at short-term follow-up.
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Affiliation(s)
- David R Maldonado
- American Hip Institute Research Foundation, 999 E Touhy Ave Des Plaines, Chicago, IL 60018, USA
| | - Jade S Owens
- American Hip Institute Research Foundation, 999 E Touhy Ave Des Plaines, Chicago, IL 60018, USA
| | - Vivian W Ouyang
- American Hip Institute Research Foundation, 999 E Touhy Ave Des Plaines, Chicago, IL 60018, USA
| | - Benjamin R Saks
- American Hip Institute Research Foundation, 999 E Touhy Ave Des Plaines, Chicago, IL 60018, USA.,Department of Orthopedic Surgery, AMITA Health St. Alexius Medical Center, 1555 Barrington Rd Hoffman Estates, IL 60169, USA
| | - Andrew E Jimenez
- American Hip Institute Research Foundation, 999 E Touhy Ave Des Plaines, Chicago, IL 60018, USA
| | - Rachel M Glein
- American Hip Institute Research Foundation, 999 E Touhy Ave Des Plaines, Chicago, IL 60018, USA
| | - Ajay C Lall
- American Hip Institute Research Foundation, 999 E Touhy Ave Des Plaines, Chicago, IL 60018, USA.,Department of Orthopedic Surgery, AMITA Health St. Alexius Medical Center, 1555 Barrington Rd Hoffman Estates, IL 60169, USA.,American Hip Institute, 999 E Touhy Ave Des Plaines, Chicago, IL 60018, USA
| | - Benjamin G Domb
- American Hip Institute Research Foundation, 999 E Touhy Ave Des Plaines, Chicago, IL 60018, USA.,Department of Orthopedic Surgery, AMITA Health St. Alexius Medical Center, 1555 Barrington Rd Hoffman Estates, IL 60169, USA.,American Hip Institute, 999 E Touhy Ave Des Plaines, Chicago, IL 60018, USA
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Arthroscopic Triple Reconstruction in the Hip Joint: Restoration of Soft-Tissue Stabilizers in Revision Surgery for Gross Instability. Arthrosc Tech 2021; 10:e1239-e1248. [PMID: 34141538 PMCID: PMC8185569 DOI: 10.1016/j.eats.2021.01.018] [Citation(s) in RCA: 2] [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: 11/23/2020] [Accepted: 01/11/2021] [Indexed: 02/03/2023] Open
Abstract
Gross hip instability in an active adult with previous normal hip anatomy is usually due to disruption of the static stabilizers of the hip joint. Although such a disruption can result from a high-grade injury, it can be iatrogenic after previous hip arthroscopy. The patient may present with a painful limp and recurrent subluxation sensation in the affected hip joint. Revision hip arthroscopy in this scenario is generally complicated, and it is not uncommon for all the soft-tissue stabilizers to be compromised. The labrum, ligamentum teres (LT), and capsule of the hip joint are often so damaged that reparation is not an option. Reconstruction of the torn LT is an established method to add secondary stability while addressing the labral pathology in the hip joint with microinstability. Concomitant reconstruction of all the static restraints has yet to be described addressing triple instability. This Technical Note presents a stepwise approach, including tips and pearls, for arthroscopic triple reconstruction of the labrum, LT, and capsule. We believe this method is a safe and reproducible way to effectively treat gross hip instability in young patients.
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