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Hartwell MJ, Morgan AM, Nelson PA, Fernandez CE, Nicolay RW, Sheth U, Tjong VK, Terry MA. Isolated Acetabuloplasty for Femoroacetabular Impingement: Favorable Patient-Reported Outcomes and Sustained Survivorship at Minimum 5-Year Follow-Up. Arthroscopy 2021; 37:3288-3294. [PMID: 33878420 DOI: 10.1016/j.arthro.2021.03.080] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/30/2020] [Revised: 03/31/2021] [Accepted: 03/31/2021] [Indexed: 02/02/2023]
Abstract
PURPOSE To evaluate minimum 5-year outcomes and conversion rate to total hip arthroplasty (THA) for the treatment of femoroacetabular impingement (FAI) syndrome with an isolated acetabular osteoplasty. METHODS Patients undergoing hip arthroscopy with an isolated acetabular osteoplasty from March 2009 to June 2014 for FAI syndrome with pincer and/or cam morphology and a labral tear were identified. Those who underwent femoroplasty or prior ipsilateral hip surgery or who had previous hip conditions, ipsilateral hip dysplasia, or a Tönnis grade higher than 2 were excluded. Patient-reported outcomes (PROs) collected included Patient-Reported Outcomes Measurement Information System (PROMIS) scores specific to physical functioning and pain interference, modified Harris Hip Score, International Hip Outcome Tool 12, Hip Outcome Score-Activities of Daily Living, Hip Outcome Score-Sport-Specific Subscale, and Numeric Pain Rating Scale. Patients were also queried about secondary surgical procedures and conversion to THA. RESULTS We identified 86 patients at minimum 5-year follow-up (average, 7.4 years). The average patient age was 39.8 ± 12.3 years, 70.9% of patients were female, and 7% of patients had Tönnis grade 2. The mean PRO scores were 52.0 ± 8.9 for the PROMIS physical functioning score, 39.6 ± 7.5 for the PROMIS pain interference score, 78.7 ± 12.0 for the modified Harris Hip Score, 73.3 ± 23.1 for the International Hip Outcome Tool 12 score, 89.9 ± 12.0 for the Hip Outcome Score-Activities of Daily Living, and 81.4 ± 21.0 for the Hip Outcome Score-Sport-Specific Subscale. Of the patients, 72.1% achieved the patient acceptable symptomatic state (PASS) according to previously established PASS scores for FAI syndrome treated with hip arthroscopy at minimum 5-year follow-up. The overall rate of revision arthroscopy was 3.5%, and the rate of conversion to THA was 5.8%. CONCLUSIONS An isolated acetabular osteoplasty can provide sustained clinical benefits for the treatment of FAI syndrome with labral tears, with good to excellent PROs and PASS rates and a low rate of conversion to THA at minimum 5-year follow-up. LEVEL OF EVIDENCE Level IV, case series.
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Affiliation(s)
- Matthew J Hartwell
- Department of Orthopaedic Surgery, Feinberg School of Medicine, Northwestern University, Chicago, Illinois, U.S.A..
| | - Allison M Morgan
- Department of Orthopaedic Surgery, Feinberg School of Medicine, Northwestern University, Chicago, Illinois, U.S.A
| | - Patrick A Nelson
- Department of Orthopaedic Surgery, Feinberg School of Medicine, Northwestern University, Chicago, Illinois, U.S.A
| | - Claire E Fernandez
- Department of Orthopaedic Surgery, Feinberg School of Medicine, Northwestern University, Chicago, Illinois, U.S.A
| | - Richard W Nicolay
- Department of Orthopaedic Surgery, Feinberg School of Medicine, Northwestern University, Chicago, Illinois, U.S.A
| | - Ujash Sheth
- Department of Orthopaedic Surgery, Feinberg School of Medicine, Northwestern University, Chicago, Illinois, U.S.A
| | - Vehniah K Tjong
- Department of Orthopaedic Surgery, Feinberg School of Medicine, Northwestern University, Chicago, Illinois, U.S.A
| | - Michael A Terry
- Department of Orthopaedic Surgery, Feinberg School of Medicine, Northwestern University, Chicago, Illinois, U.S.A
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Manchanda K, Larson BJ, Chapman CB. Delayed Avascular Necrosis of the Talus Following Arthroscopic Os Trigonum Excision. FOOT & ANKLE ORTHOPAEDICS 2021; 6:24730114211015214. [PMID: 35097453 PMCID: PMC8702953 DOI: 10.1177/24730114211015214] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Affiliation(s)
- Kshitij Manchanda
- Miami Orthopedics and Sports Medicine Institute, Coral Gables, FL, USA
| | | | - Cary B. Chapman
- Miami Orthopedics and Sports Medicine Institute, Coral Gables, FL, USA
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You JS, Flores SE, Friedman JM, Lansdown DA, Zhang AL. The Learning Curve for Hip Arthroscopic Surgery: A Prospective Evaluation With 2-Year Outcomes in Patients With Femoroacetabular Impingement. Orthop J Sports Med 2020; 8:2325967120959140. [PMID: 33178877 PMCID: PMC7592324 DOI: 10.1177/2325967120959140] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/11/2020] [Accepted: 05/07/2020] [Indexed: 11/17/2022] Open
Abstract
Background The use of hip arthroscopic surgery in the treatment of femoroacetabular impingement (FAI) is increasing, but it is universally known as a technically demanding procedure with a "steep" learning curve. There are limited data investigating the correlation between surgeon experience and patient-reported outcomes (PROs) as well as procedure and traction times. Purpose To prospectively evaluate the relationship between surgeon experience and PROs after hip arthroscopic surgery for the treatment of FAI. Study Design Cohort study; Level of evidence, 2. Methods A total of 190 patients undergoing primary hip arthroscopic surgery for FAI were prospectively enrolled during a sports medicine fellowship-trained surgeon's first 36 months of practice. A radiographic evaluation as well as PRO surveys including the 12-Item Short Form Health Survey (SF-12), the modified Harris Hip Score (mHHS), and the Hip disability and Osteoarthritis Outcome Score (HOOS) were administered preoperatively and at 2 years postoperatively. Logistic regression as well as analysis of variance was performed to evaluate for correlations between surgical experience and PROs, procedure time, and traction time. Results Of the 190 patients, 168 (88%; mean age, 35.3 ± 9.6 years; mean body mass index, 25.07 ± 3.98) completed a 2-year follow-up and were included for analysis. The mean procedure time was 91.5 ± 23.9 minutes, and the mean traction time was 54.0 ± 17.7 minutes. Patients demonstrated significant improvements at 2 years after surgery for all PRO scores (mHHS, HOOS, and SF-12 physical component summary; P < .001), except the SF-12 mental component summary, which had no change (P = .43). The procedure time significantly decreased after 70 cases, while the traction time continued to decrease until 110 cases (R 2 = 0.99; P < .0001). There was no correlation between increasing case volume and 2-year PRO scores (P > .2 for mHHS, HOOS, and SF-12). There was also no difference with increasing case volume and amount of improvement from preoperative to 2-year postoperative PRO scores for the SF-12 and HOOS. Case volume did not affect the complication rate, as this cohort experienced 4 minor cases of neurapraxia. Conclusion Surgical efficiency in hip arthroscopic surgery for the treatment of FAI was maximized after 110 cases in this cohort. However, significant PRO improvements can be achieved early in a surgeon's practice prior to maximizing surgical efficiency.
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Affiliation(s)
- Jae S You
- Department of Orthopaedic Surgery, University of California, San Francisco, San Francisco, California, USA
| | - Sergio E Flores
- Department of Orthopaedic Surgery, University of California, San Francisco, San Francisco, California, USA
| | - James M Friedman
- Department of Orthopaedic Surgery, University of California, San Francisco, San Francisco, California, USA
| | - Drew A Lansdown
- Department of Orthopaedic Surgery, University of California, San Francisco, San Francisco, California, USA
| | - Alan L Zhang
- Department of Orthopaedic Surgery, University of California, San Francisco, San Francisco, California, USA
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Zhang C, Zhu X, Pei G, Xu P, Zeng X, Zhang L, Zhang N, Zeng D, Cao L, Yu W, Zhang X. Dyslipidaemia for patients with low-energy femoral neck fractures after the treatment of cancellous screws: a retrospective study with a 3-year minimum follow-up. BMC Musculoskelet Disord 2017; 18:440. [PMID: 29126401 PMCID: PMC5681794 DOI: 10.1186/s12891-017-1804-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/09/2017] [Accepted: 11/03/2017] [Indexed: 01/13/2023] Open
Abstract
Background Avascular necrosis of the femoral head (AVNFH) occurs infrequently following femoral neck fracture. The association between AVNFH and dyslipidaemia remains controversial. Although major risk factors for AVNFH have been proposed, most of them remain under discussion. Our purpose herein was to evaluate the association between dyslipidaemia and AVNFH following low-energy femoral neck fractures treated with cancellous screws in elderly patients in our tertiary care centre. Methods Four hundred and seventy-two consecutive patients (472 hips) with low-energy femoral neck fractures were identified and treated with cancellous screws from July 2007 to April 2013. Patients underwent evaluations preoperatively and each subsequent postoperative visit (months 1, 6, 12, 18, 24, 30, and 36). Clinical and radiographic evaluations were documented at each visit. The risk factors of AVNFH were assessed by multivariate binary logistic analysis. Results Follow-up was available for 277 patients, which included 135 patients diagnosed with AVNFH (AVNFH group) and 142 patients without AVNFH (control group). The median follow-up for patients alive at the time of analysis was 40 months (range, 37 to 46 months). The mean total cholesterol (TC), triglyceride (TG), low density lipoprotein cholesterol (LDL-C), and apolipoprotein B (Apo-B) values were considerably higher in the AVNFH group compared with those in the control group. The mean high density lipoprotein cholesterol (HDL-C) and apolipoprotein A1(Apo-A1) values were significantly lower in the AVNFH group compared with those in the control group. A multivariate logistic backward regression model showed that HDL-C and LDL-C were the only variables associated with the development of postoperative AVNFH in patients with a femoral neck fracture (Odds ratio[OR] 33.09, 95% Confidence Interval[CI]: 2.65–19.42, p < 0.001 and OR 45.94, 95% CI: 0.47–27.75, p < 0.001, respectively). Conclusion Our results suggest that both low HDL-C and high LDL-C have a tendency to result in the occurrence of AVNFH in elderly patients with low-energy femoral neck fractures treated with cancellous screws.
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Affiliation(s)
- Chi Zhang
- The first clinical college of Jinan University, Huangpu Avenue West No.613, Tianhe District, Guangzhou, 510630, China.,Department of joint surgery, The Third Affiliated Hospital of Guangzhou Medical University, Duobao Road No.63, Liwan District, Guangzhou, Guangdong, 510150, China
| | - Xiaoxiao Zhu
- Endocrine Department, The First Affiliated Hospital of Sun Yat-sen University, Huangpu East Road No. 183, Huangpu District, Guangzhou, 510700, China
| | - Genwang Pei
- Department of ENT, The First Affiliated Hospital of Sun Yat-sen University, Huangpu East Road No. 183, Huangpu District, Guangzhou, 510700, China
| | - Ping Xu
- Radiology Department, The First Affiliated Hospital of Sun Yat-sen University, Huangpu East Road No. 183, Huangpu District, Guangzhou, 510700, China
| | - Xianshang Zeng
- Department of Orthopedics, The First Affiliated Hospital of Sun Yat-sen University, Huangpu East Road No. 183, Huangpu District, Guangzhou, 510700, China
| | - Lili Zhang
- Department of Anesthesiology, The First Affiliated Hospital of Sun Yat-sen University, Huangpu East Road No. 183, Huangpu District, Guangzhou, 510700, China
| | - Nan Zhang
- Department of Anesthesiology, The First Affiliated Hospital of Sun Yat-sen University, Huangpu East Road No. 183, Huangpu District, Guangzhou, 510700, China
| | - Dan Zeng
- Ultrasonography Department, The First Affiliated Hospital of Sun Yat-sen University, Huangpu East Road No. 183, Huangpu District, Guangzhou, 510700, China
| | - Lei Cao
- Department of Anesthesiology, The Central Hospital of Wuhan, Tongji Medical College, Huazhong University of Science and Technology, Gusao Road No. 16, Jianghan District, Wuhan, Hubei, 430014, China
| | - Weiguang Yu
- Department of Orthopedics, The First Affiliated Hospital of Sun Yat-sen University, Huangpu East Road No. 183, Huangpu District, Guangzhou, 510700, China
| | - Xinchao Zhang
- Department of Orthopaedics, Jinshan Hospital, Fudan University, Longhang Road No. 1508, Jinshan District, Shanghai City, 201508, China.
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Tjong VK, Gombera MM, Kahlenberg CA, Patel RM, Han B, Deshmane P, Terry MA. Isolated Acetabuloplasty and Labral Repair for Combined-Type Femoroacetabular Impingement: Are We Doing Too Much? Arthroscopy 2017; 33:773-779. [PMID: 28063762 DOI: 10.1016/j.arthro.2016.10.022] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/17/2016] [Revised: 10/07/2016] [Accepted: 10/24/2016] [Indexed: 02/02/2023]
Abstract
PURPOSE To evaluate patient outcomes after isolated arthroscopic volumetric acetabular osteoplasty and labral repair for the treatment of patients with combined femoroacetabular impingement (FAI) lesions. METHODS A review of a prospectively collected registry identified 86 patients (106 hips) with an average age of 38.1 years (range, 17-59 years) with combined-type FAI that underwent isolated acetabular osteoplasty and labral repair. Preoperative α-angle, degree of radiographic degenerative changes, and presence of a crossover sign were recorded. Clinical outcomes were assessed with the modified Harris Hip Score (mHHS), International Hip Outcome Tool-12 (iHOT-12), Hip Outcome Score Sport-Specific Subscale (HOS-SSS), and patient satisfaction score (out of 10) at a minimum 2-year follow-up. RESULTS Clinical follow-up was obtained at a mean follow-up of 37.2 months (range, 27.9-79.2 months). Patients with Tönnis grade 0 and I findings had significantly higher mHHS (83.5 vs 71.5, P = .01), HOS-SSS (81.3 vs 59.9, P = .02), and iHOT-12 scores (71.1 vs 58.8, P = .04) compared to patients with Tonnis grade II changes. However, patient satisfaction scores (8.0 vs 7.2, P = .45) were no different. No significant difference was noted between unilateral and bilateral hip patient outcome scores. Patient age and preoperative α-angles did not correlate with any outcome scores (all R2 <0.05). There were no cases of revision surgery or progression to arthroplasty. CONCLUSIONS Isolated acetabular decompression may adequately address the underlying impingement in combined-type FAI while avoiding the risks associated with femoral-sided decompression. Good to excellent patient-reported outcomes and satisfaction scores were noted with significantly higher scores in patients with minimal arthritic change. Patient age and preoperative α-angle had less effect on postoperative outcomes. LEVEL OF EVIDENCE Level IV, therapeutic case series.
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Affiliation(s)
- Vehniah K Tjong
- Northwestern University, Feinberg School of Medicine, Chicago, Illinois, U.S.A..
| | - Mustafa M Gombera
- Northwestern University, Feinberg School of Medicine, Chicago, Illinois, U.S.A
| | | | - Ronak M Patel
- Northwestern University, Feinberg School of Medicine, Chicago, Illinois, U.S.A
| | - Brian Han
- Northwestern University, Feinberg School of Medicine, Chicago, Illinois, U.S.A
| | - Prashant Deshmane
- Northwestern University, Feinberg School of Medicine, Chicago, Illinois, U.S.A
| | - Michael A Terry
- Northwestern University, Feinberg School of Medicine, Chicago, Illinois, U.S.A
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7
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Seijas R, Ares O, Sallent A, Cuscó X, Álvarez-Díaz P, Tejedor R, Cugat R. Hip arthroscopy complications regarding surgery and early postoperative care: retrospective study and review of literature. Musculoskelet Surg 2016; 101:119-131. [PMID: 27928731 DOI: 10.1007/s12306-016-0444-x] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2016] [Accepted: 11/27/2016] [Indexed: 11/24/2022]
Abstract
PURPOSE The purpose is to describe the rate of complications in a series of hip arthroscopies performed at our center, as well as perform a systematic review of the current literature in order to compare our outcomes. METHODS Two hundred and fifty-eight patients affected of femoroacetabular impingement and treated with hip arthroscopy have been studied. All minor and major complications were studied during the first postsurgery year. Furthermore, a systematic review was performed comparing major and minor complications with our series. Two attending orthopedic surgeons selected the different studies with the same inclusion and exclusion criteria, remaining with 48 studies that have been reviewed and included in the present study. RESULTS Mean age was 36.6 years old (SD 17.45), and the ratio men:women was 137:121. The mean complication rate observed was 14.34% (37/258) of global complications. Only three patients showed major complications: femoral neck fracture, septic arthritis and avascular necrosis of the femoral head. Any of these patients had permanent side effects. CONCLUSIONS Hip arthroscopy has a low rate of major complications, but a higher number of minor complications that could be avoided with certain preventive measures.
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Affiliation(s)
- R Seijas
- Department of Orthopaedic Surgery, Artroscopia GC - Fundación García Cugat, Hospital Quirón Barcelona, Barcelona, Spain.,Universitat Internacional de Catalunya, Barcelona, Spain
| | - O Ares
- Department of Orthopaedic Surgery, Artroscopia GC - Fundación García Cugat, Hospital Quirón Barcelona, Barcelona, Spain.,Universitat Internacional de Catalunya, Barcelona, Spain
| | - A Sallent
- Department of Orthopaedic Surgery, Hospital Vall d'Hebron, Paseo Vall d'Hebron, 119-129, Barcelona, Spain.
| | - X Cuscó
- Department of Orthopaedic Surgery, Artroscopia GC - Fundación García Cugat, Hospital Quirón Barcelona, Barcelona, Spain.,Universitat Internacional de Catalunya, Barcelona, Spain
| | - P Álvarez-Díaz
- Department of Orthopaedic Surgery, Artroscopia GC - Fundación García Cugat, Hospital Quirón Barcelona, Barcelona, Spain.,Universitat Internacional de Catalunya, Barcelona, Spain.,Mutualitat Catalana de Futbolistes of Spanish Soccer Federation, Barcelona, Spain
| | - R Tejedor
- Department of Orthopaedic Surgery, Artroscopia GC - Fundación García Cugat, Hospital Quirón Barcelona, Barcelona, Spain.,School of Medicine, Hospital Clínic Barcelona, University of Barcelone, Barcelone, Spain
| | - R Cugat
- Department of Orthopaedic Surgery, Artroscopia GC - Fundación García Cugat, Hospital Quirón Barcelona, Barcelona, Spain.,Mutualitat Catalana de Futbolistes of Spanish Soccer Federation, Barcelona, Spain
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Complications in Hip Arthroscopy: A Systematic Review and Strategies for Prevention. Sports Med Arthrosc Rev 2016; 23:187-93. [PMID: 26524553 DOI: 10.1097/jsa.0000000000000084] [Citation(s) in RCA: 80] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
The primary objective of this study was to determine the minor and major complication rate of hip arthroscopy. The secondary objective was to provide strategies for avoiding complications. A systematic review was performed in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines and checklist. Therapeutic hip arthroscopy investigations that reported on adverse events or complications were included. Narrative and other systematic reviews, meta-analyses, conference abstracts or proceedings, and level V evidence studies were excluded. No follow-up minimum was imposed. The results yielded 53 studies (8189 hip arthroscopies in 8071 subjects). Most studies were level IV evidence (74%) with a mean of 2.2±2.1 years follow-up. Femoroacetabular impingement (FAI) and labral pathology were the 2 most common indications for surgery, and osteochondroplasty for FAI and labral treatment were the 2 most common procedures performed. The minor and major complication rates were 7.9% and 0.45%, respectively. Iatrogenic chondrolabral damage and temporary nerve injury were the 2 most common minor complications. Extra-articular fluid extravasation was the most common major complication encountered. Minor complications associated with hip arthroscopy are generally technical in nature and may be related to the learning curve associated with hip arthroscopy. As surgeon experience increases and patient selection improves, a corresponding decline should be observed in minor complications. Strategies to prevent complications include careful preoperative planning, appropriate surgical indications, attention to detail in the operating room, and proper postoperative rehabilitation.
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Rupp RE, Rupp SN. Femoral Head Avascular Necrosis Is Not Caused by Arthroscopic Posterolateral Femoroplasty. Orthopedics 2016; 39:177-80. [PMID: 27064782 DOI: 10.3928/01477447-20160404-01] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/08/2015] [Accepted: 09/09/2015] [Indexed: 02/03/2023]
Abstract
This study was conducted to identify the risk of avascular necrosis of the femoral head after arthroscopic femoroplasty extending to the posterolateral femoral neck, the source of the primary blood supply to the femoral head. Cam lesions of femoroacetabular impingement are typically anterior along the junction of the femoral head and neck. However, anatomic variations can involve the posterolateral vascular region of the femoral head and neck. Femoroplasty involving this vascular region can lead to injury to the blood supply to the femoral head, with subsequent avascular necrosis. If the posterolateral portion of the cam lesion is preserved, persistent femoroacetabular impingement may occur. A retrospective review identified 112 patients who underwent arthroscopic femoroplasty for femoroacetabular impingement over a 2-year period. Of these patients, 14 had femoroplasty that extended to the posterolateral femoral head. Of this group, 5 had undergone magnetic resonance imaging (MRI) after femoroplasty and the other 9 were contacted to undergo MRI of the hip to evaluate for avascular necrosis. A radiologist and the senior author evaluated all MRI scans specifically for avascular necrosis of the femoral head. All procedures were performed by the senior author. Mean age of the 14 patients (8 women and 6 men) with femoroplasty that extended into the posterolateral vascular region of the femoral head was 44 years (range, 23-69 years). All 14 patients underwent MRI evaluation of the affected hip a mean of 25 months (range, 7-44 months) after femoroplasty. No MRI scans showed evidence of avascular necrosis of the femoral head. Femoroplasty of the posterolateral vascular region of the femoral head is not associated with avascular necrosis. Patients with femoroacetabular impingement and a cam lesion extending to the posterolateral femoral head can undergo femoroplasty of this region without the development of avascular necrosis. [Orthopedics. 2016; 39(3):177-180.].
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de Sa D, Stephens K, Parmar D, Simunovic N, Philippon MJ, Karlsson J, Ayeni OR. A Comparison of Supine and Lateral Decubitus Positions for Hip Arthroscopy: A Systematic Review of Outcomes and Complications. Arthroscopy 2016; 32:716-25.e8. [PMID: 26947742 DOI: 10.1016/j.arthro.2015.12.028] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/20/2015] [Revised: 12/08/2015] [Accepted: 12/11/2015] [Indexed: 02/02/2023]
Abstract
PURPOSE This systematic review examines outcomes and risk profiles of the hip arthroscopy in the supine versus lateral decubitus positions to elucidate any superiority of one approach over the other. METHODS Three databases (Embase, PubMed, and Medline) were searched for studies that addressed hip arthroscopy performed in either position, and were subsequently screened by two reviewers with data abstracted in duplicate. RESULTS Similar outcomes were observed. Supine studies showed a greater mean postoperative improvement for modified Harris hip score (33.74), visual analog scale (-3.99), nonarthritic hip score (29.61), Harris hip score (35.73), and hip outcome score (31.4). Lateral decubitus studies showed greater improvement using the Western Ontario and McMaster University Osteoarthritis (14.76) score. Supine studies reported more neuropraxic injuries (2.06% v 0.47%), labral penetration (0.65% v 0%), and heterotopic ossification (0.21% v 0%). Lateral decubitus studies reported more fluid extravasation (0.21% v 0.05%) and missed loose bodies (0.08% v 0.01%). Similar rates of revision (1.8% lateral, 1.4% supine) and conversion to open procedures (2.6% in lateral, 2.0% in supine) were also identified. CONCLUSIONS Because of quality of evidence, direct comparisons are currently limited; however, the supine position is associated with more neuropraxic injuries, labral penetration, and heterotopic ossification, whereas lateral decubitus has increased risk of fluid extravasation and missed loose bodies. At this time, no evidence exists to establish superiority of one position. LEVEL OF EVIDENCE Level IV, systematic review of Level II, III, and IV studies.
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Affiliation(s)
- Darren de Sa
- Division of Orthopaedic Surgery, Department of Surgery, McMaster University Medical Centre, Hamilton, Ontario, Canada
| | - Kellee Stephens
- Michael G. DeGroote School of Medicine, McMaster University, Hamilton, Ontario, Canada
| | - Daniel Parmar
- Division of Orthopaedic Surgery, Department of Surgery, McMaster University Medical Centre, Hamilton, Ontario, Canada
| | - Nicole Simunovic
- Department of Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, Ontario, Canada
| | | | - Jon Karlsson
- Department of Orthopaedics, Sahlgrenska University Hospital, Sahlgrenska Academy, Gothenburg University, Gothenburg, Sweden
| | - Olufemi R Ayeni
- Division of Orthopaedic Surgery, Department of Surgery, McMaster University Medical Centre, Hamilton, Ontario, Canada.
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11
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Wu K, Huang J, Wang Q. The Use of Superselective Arteriography in the Evaluation of the Influence of Intracapsular Hip Joint Pressure on the Blood Flow of the Femoral Head. Med Princ Pract 2016; 25:123-9. [PMID: 26517358 PMCID: PMC5588334 DOI: 10.1159/000442019] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/12/2014] [Accepted: 10/29/2015] [Indexed: 01/22/2023] Open
Abstract
OBJECTIVE We aimed to analyze the intracapsular pressure of the hip joint following femoral neck fracture and its relationship to the position of the hip or to traction and (using superselective arteriography) to evaluate the blood supply to the femoral head and the influence of traction and hip position on the blood supply. SUBJECTS AND METHODS Twenty-six cases of fresh Garden type I-III femoral neck fractures were enrolled. After being placed in the neutral position, in internal rotation or with traction of 3 and 5 kg, respectively, intracapsular manometric changes were measured. Eight cases underwent superselective arteriography of the medial circumflex femoral artery and its branches under the manometric changes of the hip joint capsule. RESULTS Twenty-four to 48 h after the injury, the intracapsular pressure was significantly higher on the fractured side than on the normal side. The mean pressure was 28.41 ± 9.339 mm Hg in fully extended hips in the neutral position, 79.92 ± 12.80 mm Hg in internally rotated hips, 51.39 ± 15.41 mm Hg in hips with 3 kg of traction and 64.81 ± 13.56 mm Hg in hips with 5 kg of traction. The arteriographic findings revealed that traction and internal rotation reduced the perfusion of the femoral head at the medial circumflex femoral artery and its branches, and also negatively influenced venous reflux. CONCLUSION Traction and internal rotation both caused the intracapsular pressure of the hip joint to rise considerably, which reduced the femoral head perfusion and impeded venous reflux. This could lead to avascular necrosis of the femoral head.
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Affiliation(s)
- Kai Wu
- *Kai Wu, Department of Orthopedics Trauma, Shanghai Emergency Trauma Centre, The First People's Hospital Affiliated to Shanghai Jiao Tong University, No. 650 New Song Jiang Road, Shanghai 201620 (China), E-Mail
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12
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Levy DM, Grzybowski J, Salata MJ, Mather RC, Aoki SK, Nho SJ. Capsular Plication for Treatment of Iatrogenic Hip Instability. Arthrosc Tech 2015; 4:e625-30. [PMID: 26870636 PMCID: PMC4738291 DOI: 10.1016/j.eats.2015.07.007] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/20/2015] [Accepted: 07/13/2015] [Indexed: 02/03/2023] Open
Abstract
The most commonly reported reasons for persistent hip pain after hip arthroscopy are residual femoroacetabular impingement, dysplasia and dysplasia variants, or extra-articular impingement. There are some cases in which the underlying osseous pathomorphology has been appropriately treated, and the cause of persistent hip pain can be soft-tissue injuries such as chondrolabral tears or capsular abnormalities. Capsular defects after hip arthroscopy may suggest an alteration of the biomechanical properties of the iliofemoral ligament and lead to iatrogenically induced hip instability. There are a growing number of biomechanical and clinical studies showing the importance of capsular management during hip arthroscopy. We describe the workup, examination under anesthesia, diagnostic arthroscopy, and technique of capsular plication for iatrogenic instability of the hip.
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Affiliation(s)
- David M. Levy
- Hip Preservation Center, Department of Orthopedic Surgery, Rush University Medical Center, Chicago, Illinois, U.S.A.,Address correspondence to David M. Levy, M.D., Rush University Medical Center, 1611 W Harrison St, Ste 300, Chicago IL 60612, U.S.A.
| | - Jeffrey Grzybowski
- Hip Preservation Center, Department of Orthopedic Surgery, Rush University Medical Center, Chicago, Illinois, U.S.A
| | - Michael J. Salata
- Department of Orthopedic Surgery, University Hospitals Case Medical Center, Cleveland, Ohio, U.S.A
| | - Richard C. Mather
- Department of Orthopedic Surgery, Duke University Medical Center, Durham, North Carolina, U.S.A
| | - Stephen K. Aoki
- Department of Orthopedic Surgery, University of Utah, Salt Lake City, Utah, U.S.A
| | - Shane J. Nho
- Hip Preservation Center, Department of Orthopedic Surgery, Rush University Medical Center, Chicago, Illinois, U.S.A
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Gupta A, Redmond JM, Hammarstedt JE, Schwindel L, Domb BG. Safety measures in hip arthroscopy and their efficacy in minimizing complications: a systematic review of the evidence. Arthroscopy 2014; 30:1342-8. [PMID: 25017649 DOI: 10.1016/j.arthro.2014.04.103] [Citation(s) in RCA: 73] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/21/2014] [Revised: 04/09/2014] [Accepted: 04/23/2014] [Indexed: 02/02/2023]
Abstract
PURPOSE The purpose of this systematic review was to evaluate the literature to determine complications of hip arthroscopy, with a secondary focus on how to minimize complications and risks. METHODS Two independent reviewers performed a search of PubMed for articles that contained at least 1 of the following terms: complications and hip arthroscopy, hip impingement, femoral acetabular impingement and complications, or femoroacetabular impingement (FAI) and complications. The search was limited to articles published between 1999 and June 2013. An additional search was performed for articles evaluating techniques on how to minimize complications. RESULTS We identified 81 studies (5,535 patients; 6,277 hips). The mean age was 35.48 years, and the mean body mass index was 25.20 kg/m(2). Of the participants, 52% were male and 48% were female. The majority of studies were Level IV Evidence (63%). A total of 285 complications were reported, for an overall rate of 4.5%. There were 26 major complications (0.41%) and a 4.1% minor complication rate. The overall reoperation rate was 4.03%. A total of 94 hips underwent revision arthroscopy. Regarding open procedures, 150 patients (93%) underwent either total hip arthroplasty or a hip resurfacing procedure. The conversion rate to total hip arthroplasty or a resurfacing procedure was 2.4%. CONCLUSIONS Overall, primary hip arthroscopy is a successful procedure with low rates of major (0.41%) and minor (4.1%) complications. The reoperation rate was 4.03% in our review. There is admittedly a learning curve to performing hip arthroscopy, and we present a systematic review of the complications and how to minimize these complications with careful technique and planning. LEVEL OF EVIDENCE Level IV, systematic review of Level II to V studies.
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Affiliation(s)
| | | | | | - Leslie Schwindel
- University of Illinois-Chicago, Department of Orthopaedics, Chicago, Illinois, U.S.A
| | - Benjamin G Domb
- American Hip Institute, Westmont, Illinois, U.S.A.; Loyola University Stritch School of Medicine, Maywood, Illinois, U.S.A.; Hinsdale Orthopaedics, Westmont, Illinois, U.S.A..
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Matsuda DK, Hanami D. Hip arthroscopy for challenging deformities: posterior cam decompression. Arthrosc Tech 2013; 2:e45-9. [PMID: 23802094 PMCID: PMC3691776 DOI: 10.1016/j.eats.2012.10.007] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/03/2012] [Accepted: 10/23/2012] [Indexed: 02/03/2023] Open
Abstract
Since the classic description of cam femoroacetabular impingement occurring in the anterolateral quadrant of the proximal femur, there has been growing evidence of cam impingement extending outside of this region. Although anteromedial cam decompression may be performed, posterior cam decompression is at higher theoretic risk of vascular embarrassment with osteonecrosis and/or tensile failure with fracture, leading some investigators to believe that these major deformities require open surgical correction. We present a less invasive method of arthroscopic posterior cam decompression using the modified midanterior portal while avoiding the posterolateral vasculature of the proximal femur.
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Affiliation(s)
- Dean K. Matsuda
- Kaiser West Los Angeles Medical Center (D.K.M.), Los Angeles, California, U.S.A
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Papavasiliou AV, Bardakos NV. Complications of arthroscopic surgery of the hip. Bone Joint Res 2012; 1:131-44. [PMID: 23610683 PMCID: PMC3629445 DOI: 10.1302/2046-3758.17.2000108] [Citation(s) in RCA: 99] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/25/2012] [Accepted: 05/31/2012] [Indexed: 12/27/2022] Open
Abstract
Over recent years hip arthroscopic surgery has evolved into one of the most rapidly expanding fields in orthopaedic surgery. Complications are largely transient and incidences between 0.5% and 6.4% have been reported. However, major complications can and do occur. This article analyses the reported complications and makes recommendations based on the literature review and personal experience on how to minimise them.
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Affiliation(s)
- A V Papavasiliou
- Aristotle University of Thessaloniki, Sports Injuries Laboratory, Department of Physical Education and Sports Science, Thessaloniki 55236, Greece
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Gaskill TR, Philippon MJ. Surgical hip dislocation for femoroacetabular impingement. Am J Sports Med 2012; 40:NP1-2; author reply NP2-3. [PMID: 22215727 DOI: 10.1177/0363546511430061] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
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