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Cancienne J, Kunze KN, Beck EC, Chahla J, Suppauksorn S, Nho SJ. Influence of Cigarette Smoking at the Time of Surgery on Postoperative Outcomes in Patients With Femoroacetabular Impingement: A Matched-Pair Cohort Analysis. Am J Sports Med 2019; 47:1138-1144. [PMID: 30943076 DOI: 10.1177/0363546519832545] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND There is literature on the association between smoking in patients undergoing orthopaedic procedures and poor short-term outcomes. However, there are few data on smoking as an independent predictor of midterm outcomes in patients undergoing hip arthroscopic surgery for femoroacetabular impingement (FAI). PURPOSE To evaluate 2-year postoperative outcomes in patients undergoing hip arthroscopic surgery for FAI in current smokers compared with an age- and body mass index (BMI)-matched group with no smoking history. STUDY DESIGN Cohort study; Level of evidence, 3. METHODS Consecutive patients undergoing primary hip arthroscopic surgery for FAI between June 2012 and January 2016 were screened for smoking habits. Exclusion criteria included revision or bilateral surgery, dysplasia, and less than 2-year follow-up. Forty current smokers at the time of surgery were matched 1:2 by age and BMI to patients with no smoking history. Outcome measures included the Hip Outcome Score (HOS)-Activities of Daily Living (ADL), HOS-Sports-Specific Subscale (SSS), modified Harris Hip Score (mHHS), and visual analog scale (VAS) for pain and satisfaction. Minimal clinically important difference (MCID) and patient acceptable symptom state rates were calculated for all patients. RESULTS All patients demonstrated significant improvements in all outcome measures ( P < .001). Current smokers experienced inferior postoperative HOS-ADL (80.4 vs 89.1, respectively; P = .013) and HOS-SSS (65.8 vs 75.6, respectively; P = .046) scores and greater VAS pain scores (3.2 vs 1.8, respectively; P = .011) than nonsmokers. Current smoking was correlated with inferior HOS-ADL ( r = -0.27, P = .003) and HOS-SSS ( r = -0.18, P = .046) scores and greater VAS pain scores ( r = 0.26, P = .005). Controlling for age, sex, and BMI, smoking was a significant independent predictor of postoperative HOS-ADL (β = -8.7 [95% CI, -14.3 to -3.0]; P = .003), HOS-SSS (β = -9.8 [95% CI, -19.5 to -0.2]; P = .046), and VAS pain (β = 14.6 [95% CI, 4.4 to 23.7]; P = .005) scores. Current smokers had lower odds of achieving the MCID for the HOS-ADL (odds ratio, 0.31 [95% CI, 0.12-0.83]; P = .019) and mHHS (odds ratio, 0.31 [95% CI, 0.10-0.88]; P = .028). CONCLUSION Current smokers had inferior postoperative HOS-ADL and HOS-SSS scores, increased pain, and lower odds of achieving the MCID for the HOS-ADL and mHHS at 2 years postoperatively than patients without any smoking history.
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Affiliation(s)
- Jourdan Cancienne
- Section of Young Adult Hip Surgery, Division of Sports Medicine, Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, Illinois, USA
| | - Kyle N Kunze
- Section of Young Adult Hip Surgery, Division of Sports Medicine, Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, Illinois, USA
| | - Edward C Beck
- Section of Young Adult Hip Surgery, Division of Sports Medicine, Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, Illinois, USA
| | - Jorge Chahla
- Section of Young Adult Hip Surgery, Division of Sports Medicine, Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, Illinois, USA
| | - Sunikom Suppauksorn
- Section of Young Adult Hip Surgery, Division of Sports Medicine, Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, Illinois, USA
| | - Shane J Nho
- Section of Young Adult Hip Surgery, Division of Sports Medicine, Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, Illinois, USA
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Frank RM, Kunze KN, Beck EC, Neal WH, Bush-Joseph CA, Nho SJ. Do Female Athletes Return to Sports After Hip Preservation Surgery for Femoroacetabular Impingement Syndrome?: A Comparative Analysis. Orthop J Sports Med 2019; 7:2325967119831758. [PMID: 30915378 PMCID: PMC6429664 DOI: 10.1177/2325967119831758] [Citation(s) in RCA: 25] [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] [Indexed: 01/18/2023] Open
Abstract
Background Female patients undergoing surgery for femoroacetabular impingement syndrome (FAIS) often experience inferior clinical outcomes and higher failure rates when compared with male patients. The influence of athletic status on hip arthroscopic outcomes in female patients, however, is unclear. Purpose To compare patient-reported outcomes (PROs) of athletic and nonathletic female patients undergoing hip arthroscopic surgery for FAIS, and to determine the return-to-sports rate in the athlete group. Study Design Cohort study; Level of evidence, 3. Methods Two-year PROs were assessed in female patients who had undergone hip arthroscopic surgery for FAIS by a single surgeon. Patients who self-identified as athletes were compared with nonathletes. Preoperative and postoperative PRO scores including the Hip Outcome Score-Activities of Daily Living (HOS-ADL), Hip Outcome Score-Sport-Specific (HOS-SS), modified Harris Hip Score (mHHS), and visual analog scale (VAS) for pain and satisfaction were analyzed and compared between athletes and nonathletes. Subanalysis was performed based on patient age and body mass index (BMI). Results A total of 330 female patients undergoing hip arthroscopic surgery for FAIS were identified. Of these, 221 patients identified as athletes (mean age, 29.1 ± 11.1 years; mean BMI, 23.0 ± 3.5 kg/m2) and 109 as nonathletes (mean age, 39.3 ± 11.4 years; mean BMI, 27.8 ± 5.8 kg/m2). Both groups demonstrated improvements in HOS-ADL, HOS-SS, mHHS, VAS for pain, and VAS for satisfaction scores (P < .001 for all). Athletes had significantly higher postoperative PRO scores compared with nonathletes (P < .001 for all). A 1:1 matched-pair subanalysis of 97 athletes and 97 nonathletes controlling for age and BMI indicated that these relationships held independently of potential demographic confounders (P < .001 for all). The number of patients meeting the minimal clinically important difference (MCID) and patient acceptable symptomatic state (PASS) for the HOS-ADL, HOS-SS, and mHHS was significantly higher in athletes aged ≤25 years versus those aged >25 years and for athletes versus nonathletes (P < .05 for all). Further, 189 of 194 athletes returned to sports at a mean of 6.0 ± 3.9 months postoperatively, with 93.7% reporting returning to the same or higher level of competition. Conclusion Among female patients undergoing hip arthroscopic surgery for FAIS, patients considered athletes achieved superior clinical outcomes compared with patients considered nonathletes. In addition, younger female athletes had higher rates of achieving the MCID and PASS for all PRO measures.
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Affiliation(s)
- Rachel M Frank
- Division of Sports Medicine and Shoulder Surgery, Department of Orthopaedic Surgery, University of Colorado School of Medicine, Aurora, Colorado, USA
| | - Kyle N Kunze
- Section of Young Adult Hip Surgery, Division of Sports Medicine, Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, Illinois, USA
| | - Edward C Beck
- Section of Young Adult Hip Surgery, Division of Sports Medicine, Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, Illinois, USA
| | - William H Neal
- Section of Young Adult Hip Surgery, Division of Sports Medicine, Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, Illinois, USA
| | - Charles A Bush-Joseph
- Section of Young Adult Hip Surgery, Division of Sports Medicine, Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, Illinois, USA
| | - Shane J Nho
- Section of Young Adult Hip Surgery, Division of Sports Medicine, Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, Illinois, USA
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Implementing a Scientifically Valid, Cost-Effective, and Scalable Data Collection System at Point of Care: The Cleveland Clinic OME Cohort. J Bone Joint Surg Am 2019; 101:458-464. [PMID: 30845040 DOI: 10.2106/jbjs.18.00767] [Citation(s) in RCA: 88] [Impact Index Per Article: 17.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND Improving outcomes after surgical procedures and determining the value of health care can be facilitated by a scientifically valid, cost-effective, and scalable data outcome collection system. We hypothesized that such a system could be constructed in orthopaedic surgery to (1) capture >95% of baseline validated patient-reported outcome measures (PROMs) for patients undergoing elective surgery, (2) capture >95% of surgeon-entered data on disease severity and treatment, and (3) be implemented as standard clinical care in daily practice. METHODS A modified Research Electronic Data Capture (REDCap) system was developed and was implemented at the time of surgery in a prospective cohort to collect demographic data, general health PROMs, joint-specific PROMs, and disease severity and treatments from patients and surgeons. All elective knee, hip, and shoulder orthopaedic surgical procedures performed in the Cleveland Clinic system at 7 hospitals were included. RESULTS Of 16,021 consecutive eligible patients (February 18, 2015, to July 31, 2017), 2% (320) were excluded because of language or physical barriers, and 0.6% (91) of the remaining 15,701 patients refused to participate. Of the remaining 15,610 patients, 97.4% (15,202) completed PROMs, and surgeons provided details on the disease severity and treatment for 99.9% (15,592) of the 15,610 patients. Overall, 97.3% (15,185) of the 15,610 patients had complete patient-reported and surgeon-reported baseline enrollment. The median completion time was 11.5 minutes for the patients and 1.6 minutes for the surgeons. The overall complete 1-year follow-up rate was 72.5% (9,354 of 12,896). CONCLUSIONS A data collection system with validated measures with >97% baseline completion of PROMs and surgeon forms regarding disease severity and treatments, across elective knee, hip, and shoulder orthopaedic surgical procedures, was successfully implemented at 7 hospitals. The system is potentially scalable to the entire orthopaedic community and could serve as a template for all procedural-based specialties during routine patient care.
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Stone AV, Malloy P, Beck EC, Neal WH, Waterman BR, Bush-Joseph CA, Nho SJ. Predictors of Persistent Postoperative Pain at Minimum 2 Years After Arthroscopic Treatment of Femoroacetabular Impingement. Am J Sports Med 2019; 47:552-559. [PMID: 30822125 DOI: 10.1177/0363546518817538] [Citation(s) in RCA: 34] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND Hip arthroscopy for femoroacetabular impingement syndrome (FAIS) is a rapidly expanding field, and preoperative factors predictive of persistent postoperative pain are currently unknown. PURPOSE To identify predictors for persistent postoperative pain at the site of surgery after hip arthroscopy for FAIS. STUDY DESIGN Case-control study; Level of evidence, 3. METHODS Patients who underwent hip arthroscopy for FAIS and had a minimum 2-year follow-up with patient-reported outcomes (PROs) were included in this study. Patients with previous open hip surgery and diagnoses other than FAIS were excluded. Patients were grouped by visual analog scale scores for pain as limited (<30) and persistent (≥30). Patient factors and outcomes were analyzed with univariate and correlation analyses to build a logistic regression model to identify predictors of persistent postoperative pain. RESULTS The limited pain (n = 514) and persistent pain (n = 174) groups totaled 688 patients (449 females). There was a statistically significant difference in age between groups, with the persistent pain group being older than the low pain group (35.9 ± 12.2 vs 32.4 ± 12.6, respectively; P = .002). Patients with persistent postoperative pain demonstrated significantly lower preoperative PRO scores in the Hip Outcome Score-Activities of Daily Living (57.6 ± 21.2 vs 67.7 ± 16.8), Hip Outcome Score-Sport Specific (35.9 ± 23.9 vs 44.1 ± 22.7), modified Harris Hip Score (51.6 ± 16.2 vs 59.6 ± 12.9), and International Hip Outcome Tool (32.0 ± 16.8 vs 40.0 ± 17.82) but no significant differences in preoperative visual analog scale scores for pain (7.3 ± 1.8 vs 7.2 ± 1.7). Mean postoperative PRO differences between pain groups were all statistically significant. Bivariate logistic regression analysis demonstrated that history of anxiety or depression (odds ratio, 1.8; 95% CI, 1.02-3.32; P = .042), revision hip arthroscopy (odds ratio, 8.6; 95% CI, 1.79-40.88; P = .007), and a low preoperative modified Harris Hip Score (odds ratio, 0.97; 95% CI, 0.95-0.99; P = .30) were predictors of persistent postoperative pain. CONCLUSION Independent predictors for persistent postoperative pain include revision hip arthroscopy and mental health history positive for anxiety and depression. Our analysis demonstrated significant improvements in pain and functional PROs in the limited pain and persistent pain groups; however, those with persistent pain demonstrated significantly lower PRO scores.
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Affiliation(s)
- Austin V Stone
- Department of Orthopaedic Surgery, University of Kentucky, Lexington, Kentucky, USA
| | - Philip Malloy
- Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, Illinois, USA
| | - Edward C Beck
- Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, Illinois, USA
| | - William H Neal
- Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, Illinois, USA
| | | | - Charles A Bush-Joseph
- Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, Illinois, USA
| | - Shane J Nho
- Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, Illinois, USA
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Lall AC, Hammarstedt JE, Gupta AG, Laseter JR, Mohr MR, Perets I, Domb BG. Effect of Cigarette Smoking on Patient-Reported Outcomes in Hip Arthroscopic Surgery: A Matched-Pair Controlled Study With a Minimum 2-Year Follow-up. Orthop J Sports Med 2019; 7:2325967118822837. [PMID: 30729147 PMCID: PMC6354311 DOI: 10.1177/2325967118822837] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Background The rate of hip arthroscopic surgery has recently increased; however, there is limited literature examining patient-reported outcomes (PROs) in cigarette smokers. Purpose/Hypothesis The purpose of this study was to evaluate whether smoking status for patients undergoing hip arthroscopic surgery affects clinical findings and PRO scores. We hypothesized that patients who smoke and undergo primary hip arthroscopic surgery will have similar clinical examination findings and preoperative and postoperative PRO scores compared with nonsmoking patients. Study Design Cohort study; Level of evidence, 3. Methods Data were collected on all patients who underwent primary hip arthroscopic surgery from February 2008 to July 2015. A retrospective analysis of the data was then conducted to identify patients who reported cigarette use at the time of the index procedure. Patients were matched 1:2 (smoking:nonsmoking) based on sex, age within 5 years, labral treatment (repair vs reconstruction vs debridement), workers' compensation status, and body mass index within 5 kg/m2. All patients were assessed preoperatively and postoperatively using 4 PRO measures: the modified Harris Hip Score (mHHS), Non-Arthritic Hip Score (NAHS), Hip Outcome Score-Sport-Specific Subscale (HOS-SSS), and International Hip Outcome Tool-12 (iHOT-12). Pain was estimated using a visual analog scale. Satisfaction was measured on a scale from 0 to 10. Significance was set at P < .05. Results A total of 75 hips were included in the smoking group, and 150 hips were included in the control group. Preoperatively, the smoking group had significantly lower PRO scores compared with the control group for the mHHS, NAHS, and HOS-SSS. Both groups demonstrated significant improvement from preoperative levels. A minimum 2-year follow-up was achieved, with a mean of 42.5 months for the smoking group and 47.6 months for the control group (P = .07). At the latest follow-up, the smoking group reported inferior results for all outcome measures compared with controls. The improvement in PRO scores and rates of treatment failure, revision arthroscopic surgery, and complications was not statistically different between the groups. Conclusion Patients who smoke had lower PRO scores preoperatively and at the latest follow-up compared with nonsmokers. Both groups demonstrated significant improvement in all PRO scores. These results show that while hip arthroscopic surgery may still yield clinical benefit in smokers, these patients may ultimately achieve an inferior functional status. To optimize results, physicians should advise patients to cease smoking before undergoing hip arthroscopic surgery.
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Affiliation(s)
- Ajay C Lall
- American Hip Institute, Westmont, Illinois, USA
| | - Jon E Hammarstedt
- Department of Orthopaedic Surgery, Allegheny General Hospital, Pittsburgh, Pennsylvania, USA
| | | | - Joseph R Laseter
- School of Medicine, Case Western Reserve University, Cleveland, Ohio, USA
| | | | - Itay Perets
- Hadassah Medical Center, Hebrew University of Jerusalem, Jerusalem, Israel
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Derwin KA, Sahoo S, Zajichek A, Strnad G, Spindler KP, Iannotti JP, Ricchetti ET. Tear characteristics and surgeon influence repair technique and suture anchor use in repair of superior-posterior rotator cuff tendon tears. J Shoulder Elbow Surg 2019; 28:227-236. [PMID: 30318274 PMCID: PMC6339588 DOI: 10.1016/j.jse.2018.07.028] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/16/2018] [Revised: 07/13/2018] [Accepted: 07/25/2018] [Indexed: 02/01/2023]
Abstract
BACKGROUND The factors that associate with surgical decisions about repair technique and the number of suture anchors used in rotator cuff repair have not been previously investigated. This study investigated the extent to which patient, surgeon, and surgical factors associate with performing single-row vs. double-row repair technique and ultimately with the number of suture anchors used. METHODS Our institution's prospective surgical cohort was queried for patients undergoing suture anchor repair of superior-posterior rotator cuff tendon tears between February 2015 and August 2017. Exclusion criteria were patients with isolated subscapularis tears, tears that were not repaired, repairs without suture anchors, repairs involving graft augmentation, and repairs by surgeons with fewer than 10 cases. Multivariable statistical modeling was used to investigate associations between patient and surgical factors and the choice of repair technique and number of suture anchors used. RESULTS A total of 925 cases performed by 13 surgeons met inclusion criteria. Tear type (full thickness), tear size (medium, large, and massive), a greater number of torn tendons, repair type (arthroscopic), and surgeon were significantly associated with performing a double-row over a single-row repair. Tear size, a greater number of torn tendons, double-row repair technique, and surgeon were significantly associated with a greater number of anchors used for repair. CONCLUSIONS Our findings suggest that in the absence of data to conclusively support a clinical benefit of one repair technique over another, surgeons' training, experience, and inherent practice patterns become the primary factors that define their surgical methods.
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Affiliation(s)
- Kathleen A. Derwin
- Department of Biomedical Engineering, Lerner Research Institute, Cleveland Clinic, Cleveland, OH, USA,Address for Correspondence: Kathleen A. Derwin, PhD, Department of Biomedical Engineering, Lerner Research Institute, ND20, Cleveland Clinic, 9500 Euclid Avenue, Cleveland, OH 44195, USA, Phone: 216-445-5982; Fax: 216-444-9198;
| | - Sambit Sahoo
- Department of Biomedical Engineering, Lerner Research Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Alexander Zajichek
- Department of Quantitative Health Sciences, Lerner Research Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Gregory Strnad
- Department of Orthopaedic Surgery, Orthopedic and Rheumatologic Institute, Clevel and Clinic, Cleveland, OH, USA
| | - Kurt P. Spindler
- Department of Orthopaedic Surgery, Orthopedic and Rheumatologic Institute, Clevel and Clinic, Cleveland, OH, USA
| | - Joseph P. Iannotti
- Department of Orthopaedic Surgery, Orthopedic and Rheumatologic Institute, Clevel and Clinic, Cleveland, OH, USA
| | - Eric T. Ricchetti
- Department of Orthopaedic Surgery, Orthopedic and Rheumatologic Institute, Clevel and Clinic, Cleveland, OH, USA
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Grace T, Neumann J, Samaan MA, Souza RB, Majumdar S, Link TM, Zhang AL. Using the Scoring Hip Osteoarthritis with Magnetic Resonance Imaging (SHOMRI) system to assess intra-articular pathology in femoroacetabular impingement. J Orthop Res 2018; 36:3064-3070. [PMID: 29947434 PMCID: PMC6429902 DOI: 10.1002/jor.24102] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/26/2018] [Accepted: 06/18/2018] [Indexed: 02/04/2023]
Abstract
There is currently no widely accepted classification system of intra-articular damage in the setting of femoroacetabular impingement (FAI). The goal of this study is to correlate the Scoring Hip Osteoarthritis with Magnetic Resonance Imaging (SHOMRI) system with arthroscopic findings in symptomatic FAI patients to justify its use in this setting. Symptomatic FAI patients scheduled for hip arthroscopy were prospectively enrolled. Prior to surgery, radiographs, and an MRI were obtained of the affected hip and all patients completed the Hip disability and Osteoarthritis Outcome Score (HOOS) questionnaire. Each MRI was graded using the SHOMRI system. Intraoperatively, cartilage and labral injury grades were recorded. SHOMRI scores were then correlated with the intraoperative cartilage and labral grades as well as preoperative radiographic findings and HOOS scores. Forty-three patients were analyzed (mean age 35.7 years, 58.1% male). SHOMRI total scores correlated with intraoperative femoral cartilage grade (ρ = 0.42; p = 0.002), acetabular cartilage grade (ρ = 0.30; p = 0.046), and labral tear grade (ρ = 0.42; p = 0.003) as well as with preoperative Tönnis grade (ρ = 0.37, p = 0.013), HOOS pain score (ρ = -0.33; p = 0.039), HOOS ADL score (ρ = -0.39; p = 0.007), and HOOS sports score (ρ = -0.30; p = 0.037). In conclusion, total scores from the SHOMRI system showed significant correlation with arthroscopic findings as well as radiographic gradings and clinical symptoms in patients with FAI. Use of this quantitative system to assess the burden of chondrolabral damage in FAI appears valid. © 2018 Orthopaedic Research Society. Published by Wiley Periodicals, Inc. J Orthop Res 36:3064-3070, 2018.
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Affiliation(s)
- Trevor Grace
- Department of Orthopedic Surgery, University of California, San Francisco, California
| | - Jan Neumann
- Musculoskeletal Quantitative Imaging Research Group, Department of Radiology and Biomedical Imaging, University of California San Francisco, San Francisco, California
| | - Michael A. Samaan
- Musculoskeletal Quantitative Imaging Research Group, Department of Radiology and Biomedical Imaging, University of California San Francisco, San Francisco, California
| | - Richard B. Souza
- Musculoskeletal Quantitative Imaging Research Group, Department of Radiology and Biomedical Imaging, University of California San Francisco, San Francisco, California,Department of Physical Therapy and Rehabilitation Science, University of California, San Francisco, California
| | - Sharmila Majumdar
- Musculoskeletal Quantitative Imaging Research Group, Department of Radiology and Biomedical Imaging, University of California San Francisco, San Francisco, California
| | - Thomas M. Link
- Musculoskeletal Quantitative Imaging Research Group, Department of Radiology and Biomedical Imaging, University of California San Francisco, San Francisco, California
| | - Alan L. Zhang
- Department of Orthopedic Surgery, University of California, San Francisco, California
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Freke MD, Crossley KM, Russell T, Sims KJ, Semciw A. Associations between type and severity of hip pathology with pre-operative patient reported outcome measures. Braz J Phys Ther 2018; 23:402-411. [PMID: 30293956 DOI: 10.1016/j.bjpt.2018.09.008] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/20/2018] [Revised: 09/08/2018] [Accepted: 09/21/2018] [Indexed: 01/22/2023] Open
Abstract
BACKGROUND The relationship between hip pathology and patient reported outcome responses following hip surgery has been previously investigated. No studies have investigated the relationship between pathology and patient reported outcome responses prior to surgery. OBJECTIVES (1) Determine the prevalence of chondral and labral pathology identified during hip arthroscopy. (2) Determine the association between intra-articular findings and patient reported outcome scores in a pre-arthroscopy hip pain population. METHODS Sixty-seven (22 female) participants scheduled for hip arthroscopy after clinical examination and radiographic assessment completed a series of patient reported outcomes (Hip Disability and Osteoarthritis Outcome Score; International Hip Outcome Tool; Pain on Activity; Visual Analogue Scale). Pathology discovered/addressed during arthroscopy was classified. Univariable and multivariable linear regression models were used to assess the relationship between demographics, pathology and patient reported outcome responses. RESULTS Ninety-one percent of participants had labral pathology; 76% had acetabular chondropathy and 31% had femoral head chondropathy. Across the ten patient reported outcome subscales, severe femoral head chondropathy and large labral tears had the greatest number of significant associations with patient reported outcome scores. The strongest association was with 'Hip Disability and Osteoarthritis Outcome Score symptoms and stiffness' subscale, where severe femoral head chondropathy explained 22% of variability in symptoms and stiffness, when adjusted for Body Mass Index and presence of pincer morphology (p=0.002). CONCLUSION Severe femoral head chondropathy and large labral tears along with a high prevalence of labral pathology and acetabular chondropathy were relatively common findings during hip arthroscopy. Severe femoral head chondropathy and large labral tears are most associated with patient reported outcome's, however, at best only explain 22% of the variability.
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Affiliation(s)
- Matthew D Freke
- Enoggera Health Centre, Gallipoli Barracks, Enoggera, Queensland, Australia; School of Health and Rehabilitation Sciences, University of Queensland, Brisbane, Australia.
| | - Kay M Crossley
- School of Allied Health, College of Science, Health and Engineering, La Trobe University, Bundoora, Australia
| | - Trevor Russell
- School of Health and Rehabilitation Sciences, University of Queensland, Brisbane, Australia
| | - Kevin J Sims
- School of Health and Rehabilitation Sciences, University of Queensland, Brisbane, Australia; Cricket Australia, Albion, Queensland, Australia
| | - Adam Semciw
- School of Allied Health, College of Science, Health and Engineering, La Trobe University, Bundoora, Australia; School of Health and Rehabilitation Sciences, University of Queensland, Brisbane, Australia
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Grace T, Samaan MA, Souza RB, Link TM, Majumdar S, Zhang AL. Correlation of Patient Symptoms With Labral and Articular Cartilage Damage in Femoroacetabular Impingement. Orthop J Sports Med 2018; 6:2325967118778785. [PMID: 29977942 PMCID: PMC6024532 DOI: 10.1177/2325967118778785] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
Background: Femoroacetabular impingement (FAI) can lead to labral and articular cartilage injuries as well as early osteoarthritis of the hip. Currently, the association of patient symptoms with the progression of labral and articular cartilage injuries due to FAI is poorly understood. Purpose: To evaluate the correlation between patient-reported outcome (PRO) scores and cartilage compositional changes seen on quantitative magnetic resonance imaging (MRI) as well as cartilage and labral damage seen during arthroscopic surgery in patients with FAI. Study Design: Cohort study; Level of evidence, 3. Methods: Patients were prospectively enrolled before hip arthroscopic surgery for symptomatic FAI. Patients were included if they had cam-type FAI without radiographic arthritis. All patients completed PRO scores, including the Hip disability and Osteoarthritis Outcome Score (HOOS) and a visual analog scale for pain. MRI with mapping sequences (T1ρ and T2) on both the acetabular and femoral regions was performed before surgery to quantitatively assess the cartilage composition. During arthroscopic surgery, cartilage and labral injury grades were recorded using the Beck classification. Pearson and Spearman correlation coefficients were then obtained to evaluate the association between chondrolabral changes and PRO scores. Results: A total of 46 patients (46 hips) were included for analysis (mean age, 35.5 years; mean body mass index [BMI], 23.9 kg/m2; 59% male). Increasing BMI was correlated with a more severe acetabular cartilage grade (ρ = 0.37; 95% CI, 0.08-0.65). A greater alpha angle was correlated with an increased labral tear grade (ρ = 0.59; 95% CI, 0.37-0.82) and acetabular cartilage injuries (ρ = 0.61; 95% CI, 0.42-0.80). With respect to PRO scores, increasing femoral cartilage damage in the anterosuperior femoral head region, as measured on quantitative MRI using T1ρ and T2 mapping, correlated with lower (worse) scores on the HOOS Activities of Daily Living (r = 0.35; 95% CI, 0.06-0.64), Symptoms (r = 0.32; 95% CI, 0.06-0.57), and Pain (r = 0.31; 95% CI, 0.06-0.55) subscales. There was no correlation between PRO scores and acetabular cartilage damage or labral tearing found on quantitative MRI or during arthroscopic surgery. Conclusion: Femoral cartilage damage, as measured on T1ρ and T2 mapping, appears to have a greater correlation with clinical symptoms than acetabular cartilage damage or labral tears in patients with symptomatic FAI.
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Affiliation(s)
- Trevor Grace
- Department of Orthopaedic Surgery, University of California-San Francisco, San Francisco, California, USA
| | - Michael A Samaan
- Musculoskeletal and Quantitative Imaging Research Group, Department of Radiology and Biomedical Imaging, University of California-San Francisco, San Francisco, California, USA
| | - Richard B Souza
- Musculoskeletal and Quantitative Imaging Research Group, Department of Radiology and Biomedical Imaging, University of California-San Francisco, San Francisco, California, USA.,Department of Physical Therapy and Rehabilitation Science, University of California-San Francisco, San Francisco, California, USA
| | - Thomas M Link
- Musculoskeletal and Quantitative Imaging Research Group, Department of Radiology and Biomedical Imaging, University of California-San Francisco, San Francisco, California, USA
| | - Sharmila Majumdar
- Musculoskeletal and Quantitative Imaging Research Group, Department of Radiology and Biomedical Imaging, 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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O'Connor M, Minkara AA, Westermann RW, Rosneck J, Lynch TS. Outcomes of Joint Preservation Procedures for Cartilage Injuries in the Hip: A Systematic Review and Meta-analysis. Orthop J Sports Med 2018; 6:2325967118776944. [PMID: 29942815 PMCID: PMC6009090 DOI: 10.1177/2325967118776944] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
Background: The detection and management of chondral injuries of the hip, especially in a younger patient population, may preempt joint degeneration. Although the outcomes of preservation techniques have been well described for other weightbearing joints, such as the knee, evidence for hip joint preservation after procedures such as microfracture and autologous chondrocyte implantation remains in its infancy. Purpose: To evaluate outcomes of joint preservation procedures in the hip, including the success rate and patient-reported outcomes (PROs). Study Design: Systematic review; Level of evidence, 4. Methods: This review was performed using the terms “hip arthroscopy,” “microfracture,” “autologous chondrocyte implantation,” “fibrin glue,” “osteochondral transfer,” and variations thereof in 5 electronic databases, yielding 325 abstracts. After the application of eligibility criteria, 19 articles were included. Weighted means were calculated for PROs, and pooled estimates were calculated for age, follow-up, chondral lesion size, and success of hip preservation procedures with a random-effects proportion meta-analysis. Results: A total of 1484 patients (1502 hips) were identified across 19 studies (mean age, 38.0 ± 1.3 years; mean follow-up, 31.8 ± 9.6 months). Hip joint preservation techniques demonstrated a high success rate, ranging from 85.6% to 99.7%. The mean pooled chondral lesion size was 2.5 ± 0.3 cm2 (95% CI, 1.9-3.0 cm2). Microfracture was the most frequent technique, utilized by 11 studies, and demonstrated an 89.6% success rate (95% CI, 82.4%-96.7%). The highest pooled success rate was exhibited by autologous membrane-induced chondrogenesis in 3 studies (99.7% [95% CI, 99.0%-100.0%]). All PROs demonstrated a statistically significant increase postoperatively, including the modified Harris Hip Score, Nonarthritic Hip Score, and Hip Outcome Score–Activities of Daily Living and Hip Outcome Score–Sports-Specific Subscale (all P < .05). The visual analog scale for pain also demonstrated a statistically significant decrease of 37.2% (P < .05). Conclusion: Hip preservation procedures demonstrate a high success rate, with microfracture representing the most frequently utilized cartilage preservation technique in the peer-reviewed literature. PROs significantly improved after surgery. Further investigation of hip preservation modalities with long-term follow-up is required to create evidence-based clinical recommendations and treatment algorithms.
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Affiliation(s)
| | - Anas A Minkara
- Columbia University Medical Center, New York, New York, USA
| | | | | | - T Sean Lynch
- Columbia University Medical Center, New York, New York, USA
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Sochacki KR, Jack RA, Safran MR, Nho SJ, Harris JD. There Is a Significant Discrepancy Between "Big Data" Database and Original Research Publications on Hip Arthroscopy Outcomes: A Systematic Review. Arthroscopy 2018; 34:1998-2004. [PMID: 29477605 DOI: 10.1016/j.arthro.2018.01.018] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/24/2017] [Revised: 01/09/2018] [Accepted: 01/12/2018] [Indexed: 02/02/2023]
Abstract
PURPOSE The purpose of this study was to compare (1) major complication, (2) revision, and (3) conversion to arthroplasty rates following hip arthroscopy between database studies and original research peer-reviewed publications. METHODS A systematic review was performed using PRISMA guidelines. PubMed, SCOPUS, SportDiscus, and Cochrane Central Register of Controlled Trials were searched for studies that investigated major complication (dislocation, femoral neck fracture, avascular necrosis, fluid extravasation, septic arthritis, death), revision, and hip arthroplasty conversion rates following hip arthroscopy. Major complication, revision, and conversion to hip arthroplasty rates were compared between original research (single- or multicenter therapeutic studies) and database (insurance database using ICD-9/10 and/or current procedural terminology coding terminology) publishing studies. RESULTS Two hundred seven studies (201 original research publications [15,780 subjects; 54% female] and 6 database studies [20,825 subjects; 60% female]) were analyzed (mean age, 38.2 ± 11.6 years old; mean follow-up, 2.7 ± 2.9 years). The database studies had a significantly higher age (40.6 + 2.8 vs 35.4 ± 11.6), body mass index (27.4 ± 5.6 vs 24.9 ± 3.1), percentage of females (60.1% vs 53.8%), and longer follow-up (3.1 ± 1.6 vs 2.7 ± 3.0) compared with original research (P < .0001 for all). Ninety-seven (0.6%) major complications occurred in the individual studies, and 95 (0.8%) major complications occurred in the database studies (P = .029; relative risk [RR], 1.3). There was a significantly higher rate of femoral neck fracture (0.24% vs 0.03%; P < .0001; RR, 8.0), and hip dislocation (0.17% vs 0.06%; P = .023; RR, 2.2) in the database studies. Reoperations occurred at a significantly higher rate in the database studies (11.1% vs 7.3%; P < .001; RR, 1.5). There was a significantly higher rate of conversion to arthroplasty in the database studies (8.0% vs 3.7%; P < .001; RR, 2.2). CONCLUSIONS Database studies report significantly increased major complication, revision, and conversion to hip arthroplasty rates compared with original research investigations of hip arthroscopy outcomes. LEVEL OF EVIDENCE Level IV, systematic review of Level I-IV studies.
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Affiliation(s)
- Kyle R Sochacki
- Houston Methodist Orthopedic and Sports Medicine, Houston, Texas, U.S.A
| | - Robert A Jack
- Houston Methodist Orthopedic and Sports Medicine, Houston, Texas, U.S.A
| | - Marc R Safran
- Department of Orthopedic Surgery, Stanford University School of Medicine, Redwood City, California, U.S.A
| | - Shane J Nho
- Midwest Orthopedics at Rush, Chicago, Illinois, U.S.A
| | - Joshua D Harris
- Houston Methodist Orthopedic and Sports Medicine, Houston, Texas, U.S.A..
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Arthroscopic Surgical Procedures Versus Sham Surgery for Patients With Femoroacetabular Impingement and/or Labral Tears: Study Protocol for a Randomized Controlled Trial (HIPARTI) and a Prospective Cohort Study (HARP). J Orthop Sports Phys Ther 2018; 48:325-335. [PMID: 29607761 DOI: 10.2519/jospt.2018.7931] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Study Design Study protocol for a randomized controlled trial and a prospective cohort. Background The number of arthroscopic surgical procedures for patients with femoroacetabular impingement syndrome (FAIS) has significantly increased worldwide, but high-quality evidence of the effect of such interventions is lacking. Objectives The primary objective will be to determine the efficacy of hip arthroscopic procedures compared to sham surgery on patient-reported outcomes for patients with FAIS (HIP ARThroscopy International [HIPARTI] Study). The secondary objective will be to evaluate prognostic factors for long-term outcome after arthroscopic surgical interventions in patients with FAIS (Hip ARthroscopy Prospective [HARP] Study). Methods The HIPARTI Study will include 140 patients and the HARP Study will include 100 patients. The international Hip Outcome Tool-33 will be the primary outcome measure at 1 year. Secondary outcome measures will be the Hip disability and Osteoarthritis Outcome Score, Arthritis Self-Efficacy Scale, fear of movement (Tampa Scale of Kinesiophobia), Patient-Specific Functional Scale, global rating of change score, and expectations. Other outcomes will include active hip range of motion, hip muscle strength tests, functional performance tests, as well as radiological assessments using radiographs and magnetic resonance imaging. Conclusion To determine the true effect of surgery, beyond that of placebo, double-blinded placebo-controlled trials including sham surgery are needed. The HIPARTI Study will direct future evidence-based treatment of FAIS. Predictors for long-term development and progression of degenerative changes in the hip are also needed for this young patient group with FAIS; hence, responders and nonresponders to treatment could be determined. J Orthop Sports Phys Ther 2018;48(4):325-335. doi:10.2519/jospt.2018.7931.
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