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Domb BG, Annin S, Monahan PF, Lee MS, Jimenez AE, Maldonado DR. Ten-Year Survivorship, Outcomes, and Sports Participation in Athletes After Primary Hip Arthroscopy for Femoroacetabular Impingement Syndrome. Am J Sports Med 2023; 51:2383-2395. [PMID: 37366226 DOI: 10.1177/03635465231180305] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/28/2023]
Abstract
BACKGROUND Hip arthroscopy is an effective treatment tool for athletes with femoroacetabular impingement (FAI) syndrome. However, long-term data are scarce. PURPOSE To assess survivorship, minimum 10-year patient-reported outcome measures (PROMs), and sports participation after primary hip arthroscopy for FAI syndrome in athletes and to perform a propensity-matched comparison between patients undergoing labral debridement and labral repair. STUDY DESIGN Cohort study; Level of evidence, 3. METHODS Athletes who underwent hip arthroscopy for FAI syndrome between February 2008 and December 2010 were eligible. Exclusion criteria were other ipsilateral hip condition, Tönnis grade ≥2, or no baseline PROMs. Survivorship was defined as no conversion to total hip arthroplasty. The Patient Acceptable Symptom State (PASS), minimal clinically important difference (MCID), maximum outcome improvement (MOI) satisfaction threshold, and sports participation were reported. A propensity-matched comparison between labral debridement and labral repair was performed. Two additional propensity-matched subanalyses were performed for capsular management and cartilage damage. RESULTS In total, 189 hips (177 patients) were included. The mean ± SD follow-up was 127.2 ± 6.0 months. Survivorship was 85.7%. Significant improvement in all PROMs was reported (P < .001). A total of 46 athletes with labral repair were propensity matched to 46 athletes with labral debridement. This subanalysis demonstrated significant and comparable improvement in all PROMs at minimum 10-year follow-up (P < .001). For the labral repair group, the PASS achievement rates were 88.9% for the modified Harris Hip Score (mHHS) and 80% for the Hip Outcome Score-Sport Specific Subscale (HOS-SSS); the MCID achievement rates were 80.6% for the mHHS and 84% for HOS-SSS; and for the MOI satisfaction threshold, rates were 77.8%, 80.6%, and 55.6% for the mHHS, Nonarthritic Hip Score, and visual analog scale, respectively. For the labral debridement group, the PASS achievement rates were 85.3% for the mHHS and 70.4% for the HOS-SSS; the MCID achievement rates were 81.8% for the mHHS and 74.1% for HOS-SSS; and for the MOI satisfaction threshold, rates were 72.7%, 81.8%, and 66.7% for the mHHS, Nonarthritic Hip Score, and visual analog scale. Total hip arthroplasty conversions occurred significantly sooner with labral debridement than labral repair (P = .048). Age was identified as a significant predictor of achieving the PASS. CONCLUSION Primary hip arthroscopy for FAI syndrome in athletes results in 85.7% survivorship and sustained PROM improvement at a minimum 10-year follow-up. A significant time delay to total hip arthroplasty conversion at 10-year follow-up was reported with labral repair over debridement, although this should be interpreted with caution, as the total number of conversions was small.
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Affiliation(s)
| | - Shawn Annin
- American Hip Institute, Chicago, Illinois, USA
| | | | | | | | - David R Maldonado
- Department of Orthopaedic Surgery, McGovern Medical School, University of Texas Health Science Center at Houston, Houston, Texas, USA
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Aichmair A, Sutter R, Dietrich TJ, Dora C, Zingg PO. Magnetic Resonance Arthrographic Findings After Hip Labrum Resection Versus Refixation. Orthopedics 2021; 44:e607-e613. [PMID: 34292826 DOI: 10.3928/01477447-20210618-25] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
The aim of this study was to evaluate whether new tissue formation occurs after labral debridement/excision, and, if so, which morphological features are typical for a neo-labrum. The authors further compared the findings after labrum resection with those seen after labrum refixation. Patients with femoroacetabular impingement who underwent hip arthroscopy or surgical hip dislocation to address a labrum pathology were retrospectively included, and postoperative magnetic resonance arthrography studies were assessed. Forty-two patients had undergone either labrum resection (n=25) or refixation (n=17), performed arthroscopically (47.6%) or via surgical hip dislocation (52.4%). In the subgroup of patients after debridement/resection, there was anterosuperior/superior scar tissue in 83.5%, with amorphous configuration in 92%, irregular surface in approximately two-thirds of the cases, and a mean±SD thickness of 7.0±2.7 mm. A labrum-like shape of the scar plate was seen in 7.7%. Regarding the subgroup of patients who had undergone labral refixation, an irregular or rounded labrum shape was noted in 26.5% and 51.3% of cases, respectively, with a triangular shape in less than one-fourth of cases. Labrum re-tears (35.7%) were mainly observed at the base (71.7%), rather than within the labral substance (28.4%). New tissue formation can be observed in the majority of cases after excision of the hip labrum, with amorphous and irregular surface configuration compared with a native labrum. This new tissue should therefore be referred to as scar tissue rather than as neo-labrum. Whether scar tissue is inferior to a refixed labrum needs to be further elucidated in follow-up studies. [Orthopedics. 2021;44(4):e607-e613.].
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Lall AC, Annin S, Chen JW, Diulus S, Ankem HK, Rosinsky PJ, Shapira J, Meghpara MB, Maldonado DR, Hartigan DE, Krych AJ, Levy BA, Domb BG. Consensus-based classification system for intra-operative management of labral tears during hip arthroscopy-aggregate recommendations from high-volume hip preservation surgeons. J Hip Preserv Surg 2021; 7:644-654. [PMID: 34377508 PMCID: PMC8349576 DOI: 10.1093/jhps/hnab043] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/14/2020] [Revised: 03/16/2021] [Indexed: 11/13/2022] Open
Abstract
The purpose of this study was to survey high-volume hip preservation surgeons regarding their perspectives on intra-operative management of labral tears to improve decision-making and produce an effective classification system. A cross-sectional survey of high-volume hip preservation surgeons was conducted in person and anonymously, using a questionnaire that is repeated for indications of labral debridement, repair and reconstruction given the torn labra are stable, unstable, viable or non-viable. Twenty-six high-volume arthroscopic hip surgeons participated in this survey. Provided the labrum was viable (torn tissue that is likely to heal) and stable, labral debridement would be performed by 76.92% of respondents for patients >40 years of age and by >84% of respondents for stable intra-substance labral tears in patients without dysplasia. If the labrum was viable but unstable, labral repair would be performed by >80% of respondents for patients ≤40 years of age and > 80% of respondents if the labral size was >3 mm and located anteriorly. Presence of calcified labra or the Os acetabuli mattered while deciding whether to repair a labrum. In non-viable (torn tissue that is unlikely to heal) and unstable labra, labral reconstruction would be performed by 84.62% of respondents if labral size was <3 mm. The majority of respondents would reconstruct calcified and non-viable, unstable labra that no longer maintained a suction seal. Surgeons performing arthroscopic hip labral treatment may utilize this comprehensive classification system, which takes into consideration patient age, labral characteristics (viability and stability) and bony morphology of the hip joint. When choosing between labral debridement, repair or reconstruction, consensus recommendations from high-volume hip preservation surgeons can enhance decision-making.
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Affiliation(s)
- Ajay C Lall
- American Hip Institute, Chicago, IL 60018, USA.,American Hip Institute Research Foundation, Chicago, IL 60018, USA.,AMITA Health St. Alexius Medical Center, Hoffman Estates, IL 60169, USA
| | - Shawn Annin
- American Hip Institute Research Foundation, Chicago, IL 60018, USA
| | - Jeff W Chen
- Vanderbilt Medical School, Nashville, TN, 37232, USA
| | - Samantha Diulus
- American Hip Institute Research Foundation, Chicago, IL 60018, USA
| | - Hari K Ankem
- American Hip Institute Research Foundation, Chicago, IL 60018, USA
| | | | - Jacob Shapira
- American Hip Institute Research Foundation, Chicago, IL 60018, USA
| | - Mitchell B Meghpara
- American Hip Institute Research Foundation, Chicago, IL 60018, USA.,AMITA Health St. Alexius Medical Center, Hoffman Estates, IL 60169, USA
| | | | - David E Hartigan
- Department of Orthopedic Surgery, Mayo Clinic, Phoenix, AZ, 85054, USA
| | - Aaron J Krych
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, MN 55905, USA
| | - Bruce A Levy
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, MN 55905, USA
| | - Benjamin G Domb
- American Hip Institute, Chicago, IL 60018, USA.,American Hip Institute Research Foundation, Chicago, IL 60018, USA.,AMITA Health St. Alexius Medical Center, Hoffman Estates, IL 60169, USA
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Lall AC, Walsh JP, Maldonado DR, Pinto LE, Ashberg LJ, Lodhia P, Radha S, Correia APR, Domb BG, Perez-Carro L, Marín-Peña O, Griffin DR. Teamwork in hip preservation: the ISHA 2019 Annual Scientific Meeting. J Hip Preserv Surg 2020; 7:2-21. [PMID: 33072394 PMCID: PMC7546541 DOI: 10.1093/jhps/hnaa037] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Hip preservation surgery is now an established part of orthopedic surgery and sports medicine. This report describes the key findings of the 11th Annual Scientific Meeting of International Society for Hip Arthroscopy-the International Hip Preservation Society-in Madrid, Spain from 16 to 19 October 2019. Lectures, seminars and debates explored the most up-to-date and expert views on a wide variety of subjects, including: diagnostic problems in groin pain, buttock pain and low back pain; surgical techniques in acetabular dysplasia, hip instability, femoroacetabular impingement syndrome, labral repair and reconstruction, cartilage defects, adolescent hips and gluteus medius and hamstring tears; and new ideas about femoral torsion, hip-spine syndrome, hip capsule surgery, impact of particular sports on hip injuries, registries, robotics and training for hip preservation specialists. Surgeons, sports physicians, radiologists and physiotherapists looking after young people with hip problems have an increasingly sophisticated armoury of ideas and techniques with which to help their patients. The concept of hip preservation has developed incredibly fast over the last decade; now it is clear that the best results can only be achieved by a multidisciplinary team working together. The 2020s will be the decade of 'Teamwork in Hip Preservation'.
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Affiliation(s)
- Ajay C Lall
- American Hip Institute Research Foundation, 999 E Touhy Ave Ste 450, Des Plaines, IL 60018, USA.,American Hip Institute, 999 E Touhy Ave Ste 450, Des Plaines, IL 60018, USA
| | - John P Walsh
- American Hip Institute Research Foundation, 999 E Touhy Ave Ste 450, Des Plaines, IL 60018, USA.,Des Moines University, Desert Orthopaedic Center, 2800 E, Desert Inn Rd, Las Vegas, NV 89121, USA
| | - David R Maldonado
- American Hip Institute Research Foundation, 999 E Touhy Ave Ste 450, Des Plaines, IL 60018, USA
| | - Leonardo E Pinto
- Centro Medico Decente La Trinidad (Trinity Medical Center), Av. Principal de El Hatillo, Caracas 1080, Metropolitan District of Caracas, Venezuela
| | - Lyall J Ashberg
- Atlantis Orthopaedics, 4560 Lantana Rd Suite 100, Lake Worth, Atlantis, FL 33463, USA
| | - Parth Lodhia
- Footbridge Centre for Integrated Orthopaedic Care, 181 Keefer Pl #221, Vancouver, BC V6B 6C1, Canada
| | - Sarkhell Radha
- Croydon University Hospital, 530 London Rd, Thornton Heath CR7 7YE, London, UK
| | | | - Benjamin G Domb
- American Hip Institute Research Foundation, 999 E Touhy Ave Ste 450, Des Plaines, IL 60018, USA.,American Hip Institute, 999 E Touhy Ave Ste 450, Des Plaines, IL 60018, USA
| | - Luis Perez-Carro
- Hospital Clinica Mompia, Av. de los Condes, s/n, 39108 Mompía, Cantabria, Spain
| | - Oliver Marín-Peña
- University Hospital Infanta Leonor, Av. Gran Vía del Este, 80, 28031 Madrid, Spain and
| | - Damian R Griffin
- Warwick Medical School, University of Warwick and University Hospitals of Coventry and Warwickshire, Coventry CV4 7AL, UK
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Rajappa R, Nazal MR, Stelzer JW, Hsu HP, Conaway WK, Rokkappanavar S, Niu W, Upadhyaya S, Alpaugh K, Spector M, Martin SD. Translational relevance of the goat as a preclinical model of the human labrum and chondrolabral junction-histological study. J Orthop Res 2020; 38:1070-1080. [PMID: 31788831 DOI: 10.1002/jor.24546] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/28/2019] [Accepted: 11/24/2019] [Indexed: 02/04/2023]
Abstract
The purpose of this study was to evaluate the histologic features of the caprine labrum, with emphasis on the chondrolabral junction, with the goal of informing the feasibility of the goat as an animal model. The left hip joint of six adolescent Spanish goats (Capra pyrenaica) was harvested and subjected to anatomical and histological assessments. Human acetabular and femoral head samples, collected during total hip arthroplasty, served as comparison samples. The caprine labrum was found to consist of mostly type I collagen with uniform crimp, with an average crimp length of 20.8 µm. Upon histological assessment, acetabular articular chondrocytes were found to express substance-P, especially near or in the chondrolabral junction. And the majority of nonvascular cells expressed α-smooth muscle actin (SMA), with no notable elastin and laminin expression. Human labrum demonstrated similar staining patterns. Overall, the goat hip was found to be homologous to the human hip, demonstrating potential as a useful animal model for future studies. This is the first report of a crimped collagen structure in the labrum. Crimped type I collagen at the chondrolabral junction imparts an extension-recovery property which allows for toleration of stress without permanent deformation, underlying the importance of its preservation during surgery. The high expression of substance-P reflects the degree to which the labrum is innervated. Finally, the expression of α-SMA with contractile characteristics could indicate the potential for chondrocyte (i.e., myochondrocytes) modeling of the extracellular matrix. Statement of Clinical Significance: Establishment of a large animal model and deeper knowledge of the histological composition of the hip joint will enhance our study of the acetabular labrum, including repair techniques. © 2019 Orthopaedic Research Society. Published by Wiley Periodicals, Inc. J Orthop Res 38:1070-1080, 2020.
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Affiliation(s)
- Ravikumar Rajappa
- Tissue Engineering Laboratories, VA Boston Healthcare System, 150S Huntington Avenue, Boston, Massachusetts, 02130.,Department of Orthopedic Surgery, Brigham and Women's Hospital, Harvard Medical School, 75 Francis Street, Boston, Massachusetts, 02115
| | - Mark R Nazal
- Sports Medicine, Department of Orthopaedic Surgery, Massachusetts General Hospital, Partners Heath System, Boston, Massachusetts, 02114
| | - John W Stelzer
- Sports Medicine, Department of Orthopaedic Surgery, Massachusetts General Hospital, Partners Heath System, Boston, Massachusetts, 02114
| | - Hu Ping Hsu
- Tissue Engineering Laboratories, VA Boston Healthcare System, 150S Huntington Avenue, Boston, Massachusetts, 02130.,Department of Orthopedic Surgery, Brigham and Women's Hospital, Harvard Medical School, 75 Francis Street, Boston, Massachusetts, 02115
| | - William K Conaway
- Sports Medicine, Department of Orthopaedic Surgery, Massachusetts General Hospital, Partners Heath System, Boston, Massachusetts, 02114
| | - Swetha Rokkappanavar
- Tissue Engineering Laboratories, VA Boston Healthcare System, 150S Huntington Avenue, Boston, Massachusetts, 02130.,Department of Orthopedic Surgery, Brigham and Women's Hospital, Harvard Medical School, 75 Francis Street, Boston, Massachusetts, 02115
| | - Wanting Niu
- Tissue Engineering Laboratories, VA Boston Healthcare System, 150S Huntington Avenue, Boston, Massachusetts, 02130.,Department of Orthopedic Surgery, Brigham and Women's Hospital, Harvard Medical School, 75 Francis Street, Boston, Massachusetts, 02115
| | - Shivam Upadhyaya
- Department of Orthopedic Surgery, Brigham and Women's Hospital, Harvard Medical School, 75 Francis Street, Boston, Massachusetts, 02115
| | - Kyle Alpaugh
- Department of Orthopedic Surgery, Brigham and Women's Hospital, Harvard Medical School, 75 Francis Street, Boston, Massachusetts, 02115
| | - Myron Spector
- Tissue Engineering Laboratories, VA Boston Healthcare System, 150S Huntington Avenue, Boston, Massachusetts, 02130.,Department of Orthopedic Surgery, Brigham and Women's Hospital, Harvard Medical School, 75 Francis Street, Boston, Massachusetts, 02115.,Harvard-MIT Division of Health Sciences and Technology, Massachusetts Institute of Technology, 77 Massachusetts Avenue, Cambridge, Massachusetts, 02139
| | - Scott D Martin
- Sports Medicine, Department of Orthopaedic Surgery, Massachusetts General Hospital, Partners Heath System, Boston, Massachusetts, 02114
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Naal FD. [From Pathomorphology to Hip Osteoarthritis - Femoroacetabular Impingement as an Example]. PRAXIS 2020; 109:459-464. [PMID: 32345178 DOI: 10.1024/1661-8157/a003432] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
From Pathomorphology to Hip Osteoarthritis - Femoroacetabular Impingement as an Example Abstract. Femoroacetabular impingement (FAI) occurs due to abnormal morphology and subsequent contact between the proximal femur and the acetabulum and can be a source of labral and chondral damage in the hip joint. While there is evidence that Cam-type FAI is correlated with hip osteoarthritis, there is yet no clear link between osteoarthritis and Pincer-FAI in which primarily the labrum gets injured. Hips with evident deformity and beginning chondral and/or labral damage should undergo surgery. Most cases (80-90 %) can be successfully treated by hip arthroscopy. At the time of surgery, the typical FAI-patient is 30 years old. With correct indication and proper surgical technique, favorable outcomes are achieved in more than 80 % of the cases at a short- to mid-term follow-up.
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Freke M, Kemp J, Crossley K, Sims K, Russell T, Semciw A. Strength and range of movement deficits are associated with symptom severity in people scheduled for hip arthroscopy. Eur J Pain 2019; 23:1083-1090. [PMID: 30746810 DOI: 10.1002/ejp.1371] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2018] [Revised: 11/09/2018] [Accepted: 01/20/2019] [Indexed: 12/19/2022]
Abstract
BACKGROUND Identifying the physical impairments associated with worse symptoms and greater functional limitations in people with hip pain could enable targeted rehabilitation programmes designed to improve quality of life. The objective of this study was to compare physical characteristics between subgroups of symptoms and functional limitation severity in individuals with hip pain scheduled for arthroscopic surgery. METHODS Hip range of motion (ROM) and muscle strength were measured in 114 individuals (48 women; aged 32 ± 8 years) with hip pain scheduled for hip arthroscopy. Pain and disability were measured with the International Hip Outcome Tool (iHOT33) subscale of Symptoms and Functional Limitation, and a cluster analysis was used to identify mild, moderate and severe subgroups. Between-group differences were then evaluated using multivariate analysis of covariance, including sex as a covariate, followed by post hoc testing. Significance was set at 0.05. RESULTS Lesser hip muscle strength in all directions was reported in the severe symptoms and functional limitation group compared to the mild group. Hip flexion ROM differed when comparing the moderate to both the mild and severe subgroups. Hip internal rotation did not differ between subgroups of severity. CONCLUSIONS Individuals with hip pain and severe scores in the iHOT33 subscale of symptoms and functional limitations present with significantly lesser hip muscle strength and hip flexion ROM than individuals with moderate or mild scores. Targeted programmes to improve hip strength and flexion ROM in more severe patients may help reduce symptoms and improve function. SIGNIFICANCE Individuals with severe hip pain and functional limitation possess significantly lesser muscle strength and flexion ROM than individuals with moderate or mild scores.
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Affiliation(s)
- Matthew Freke
- Enoggera Health Centre, Gallipoli Barracks, Enoggera, Queensland, Australia.,School of Health and Rehabilitation Sciences, University of Queensland, Brisbane, Queensland, Australia
| | - Joanne Kemp
- School of Allied Health, College of Science, Health and Engineering, La Trobe University, Melbourne, Victoria, Australia
| | - Kay Crossley
- School of Allied Health, College of Science, Health and Engineering, La Trobe University, Melbourne, Victoria, Australia
| | - Kevin Sims
- School of Health and Rehabilitation Sciences, University of Queensland, Brisbane, Queensland, Australia
| | - Trevor Russell
- School of Health and Rehabilitation Sciences, University of Queensland, Brisbane, Queensland, Australia
| | - Adam Semciw
- School of Health and Rehabilitation Sciences, University of Queensland, Brisbane, Queensland, Australia.,School of Allied Health, College of Science, Health and Engineering, La Trobe University, Melbourne, Victoria, Australia
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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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Abstract
The use of hip arthroscopy continues to expand. Understanding potential pitfalls and complications associated with hip arthroscopy is paramount to optimizing clinical outcomes and minimizing unfavorable results. Potential pitfalls and complications are associated with preoperative factors such as patient selection, intraoperative factors such as iatrogenic damage, traction-related complications, inadequate correction of deformity, and nerve injury, or postoperative factors such as poor rehabilitation. This article outlines common factors that contribute to less-than-favorable outcomes.
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Affiliation(s)
- Aaron Casp
- Department of Orthopaedic Surgery, University of Virginia, University of Virginia Health System, 400 Ray C. Hunt, Suite 330, Charlottesville, VA 22903, USA
| | - Frank Winston Gwathmey
- Department of Orthopaedic Surgery, University of Virginia, University of Virginia Health System, 400 Ray C. Hunt, Suite 330, Charlottesville, VA 22903, USA.
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10
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Domb BG, Yuen LC, Ortiz-Declet V, Litrenta J, Perets I, Chen AW. Arthroscopic Labral Base Repair in the Hip: 5-Year Minimum Clinical Outcomes. Am J Sports Med 2017; 45:2882-2890. [PMID: 28731779 DOI: 10.1177/0363546517713731] [Citation(s) in RCA: 51] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND Arthroscopic labral base repair (LBR) in the hip is a previously described technique designed to restore the native functional anatomy of the labrum by reproducing its seal against the femoral head. LBR has been shown to have good short-term outcomes. Hypothesis/Purpose: The purpose was to evaluate clinical outcomes of an LBR cohort with a minimum 5-year follow-up. It was hypothesized that patients who underwent LBR would continue to have significant improvement from their preoperative scores and maintain scores similar to their 2-year outcomes. STUDY DESIGN Case series; Level of evidence, 4. METHODS Data for patients undergoing primary hip arthroscopic surgery with LBR from February 2008 to May 2011 with a minimum 5-year follow-up were prospectively collected and retrospectively reviewed. Patients with preoperative Tonnis osteoarthritis grade ≥2, previous hip conditions (slipped capital femoral epiphysis, avascular necrosis, Legg-Calv-Perthes disease), severe dysplasia (lateral center-edge angle <18°), or previous ipsilateral hip surgery were excluded. Statistical equivalence tests evaluated patient-reported outcomes (PROs) including the modified Harris Hip Score (mHHS), Non-Arthritic Hip Score (NAHS), Hip Outcome Score-Sport-Specific Subscale (HOS-SSS), visual analog scale (VAS) for pain, and patient satisfaction (0-10 scale; 10 = very satisfied). RESULTS Of the 70 patients (74 hips) who met inclusion and exclusion criteria, 60 (85.7%) patients (64 hips) were available at a minimum 5-year follow-up. All PRO scores significantly improved from preoperative values with a mean follow-up of 67.8 ± 7.4 months (range, 60.0-89.7 months). The mean mHHS increased from 64.4 ±13.8 to 85.3 ± 17.7 ( P < .001), the mean NAHS from 63.7 ± 17.0 to 87.0 ± 14.7 ( P < .001), and the mean HOS-SSS from 47.1 ± 23.2 to 76.5 ± 25.9 ( P < .001). The mean VAS score decreased from 5.9 ± 2.4 to 2.0 ± 2.1 ( P < .001). The mean patient satisfaction score was 8.1 ± 2.0. The improvement in PRO scores was sustained from 2- to 5-year follow-up. At 2 and 5 years, survivorship rates were 96.9% and 90.6%, respectively, and the respective secondary arthroscopic surgery rates were 10.9% (7/64) and 17.2% (11/64). CONCLUSION At a minimum 5-year follow-up, arthroscopic LBR continued to be a successful procedure and valid technique based on 3 PROs, the VAS, patient satisfaction, and survivorship. Significantly improved outcome scores were maintained compared with preoperative values and showed no signs of deterioration from the 2-year scores. The long-term survivorship of hip arthroscopic surgery has yet to be determined; however, these midterm results demonstrate the rates of additional procedures (both secondary arthroscopic surgery and conversion to total hip arthroplasty), that may be necessary after 2 years.
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Affiliation(s)
- Benjamin G Domb
- American Hip Institute, Westmont, Illinois, USA.,Hinsdale Orthopaedics, Hinsdale, Illinois, USA
| | | | | | | | - Itay Perets
- American Hip Institute, Westmont, Illinois, USA
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11
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Dierckman BD, Ni J, Hohn EA, Domb BG. Does duration of symptoms affect clinical outcome after hip arthroscopy for labral tears? Analysis of prospectively collected outcomes with minimum 2-year follow-up. J Hip Preserv Surg 2017; 4:308-317. [PMID: 29250339 PMCID: PMC5721369 DOI: 10.1093/jhps/hnx023] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/10/2017] [Revised: 03/28/2017] [Accepted: 04/26/2017] [Indexed: 11/13/2022] Open
Abstract
Limited research exists on the possible association between duration of symptoms and clinical outcomes following hip arthroscopy for labral tears. The purpose of this study was to evaluate whether duration of symptoms affected clinical and patient-reported outcome (PRO) scores following hip arthroscopy for labral tears. From 2008 to 2011, data were collected prospectively on all patients undergoing primary hip arthroscopy for labral tears. Workers' compensation cases, dysplasia cases and patients with previous ipsilateral hip surgeries were excluded. A total of 738 patients were identified with a minimum of 2-year follow-up, and clinical and PRO data were available for 680 patients. Uni- and multivariate analyses were performed to determine the relationship between duration of symptoms along with other variables and PROs. Overall, patients experienced significant improvements in all clinical and PRO scores. Results of univariate analysis revealed that all PROs were negatively associated with increasing Log10 months of symptoms as were pain and satisfaction scores. During multivariate analyses, increasing Log10 months of symptoms, age, body mass index and trauma were all negatively associated with PROs (P < 0.05). Our study demonstrates that clinical and PRO scores were negatively associated with increasing duration of symptoms prior to hip arthroscopy for treatment of labral tears. Although this implies that delay in treatment may adversely affect outcome, conservative treatment remains the gold standard first line of treatment. Surgeons should incorporate this information into their treatment algorithm to maximize patient outcomes following treatment for labral tears. Level of evidence: Level IV, prospective case series.
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Affiliation(s)
- Brian D Dierckman
- Southern California Orthopedic Institute, 6815 Noble Avenue, Van Nuys, CA 91405, USA
| | - Jake Ni
- Southern California Orthopedic Institute, 6815 Noble Avenue, Van Nuys, CA 91405, USA
| | - Eric A Hohn
- Southern California Orthopedic Institute, 6815 Noble Avenue, Van Nuys, CA 91405, USA
| | - Benjamin G Domb
- American Hip Institute, Adventist Hinsdale Hospital, 550 W Ogden Avenue, Chicago, IL 60521, USA
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Kuhn AW, Noonan BC, Kelly BT, Larson CM, Bedi A. The Hip in Ice Hockey: A Current Concepts Review. Arthroscopy 2016; 32:1928-38. [PMID: 27318779 DOI: 10.1016/j.arthro.2016.04.029] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/10/2016] [Revised: 04/18/2016] [Accepted: 04/25/2016] [Indexed: 02/02/2023]
Abstract
Ice hockey is a fast, physical sport with unique associated biomechanical demands often placing the hip in forced and repetitive supraphysiological ranges of motion. Ice hockey players commonly endure and are sidelined by nebulous groin injury or hip pain. Underlying causes can be chronic or acute and extra-articular, intra-articular, or "hip-mimicking." This article serves to review common hip-related injuries in ice hockey. For each, we define the particular condition; comment on risk factors and preventive strategies; discuss key historical, physical examination, and imaging findings; and finally, suggest nonoperative and/or operative treatment plans.
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Affiliation(s)
- Andrew W Kuhn
- MedSport and Department of Orthopaedic Surgery, University of Michigan, Ann Arbor, Michigan, U.S.A
| | | | - Bryan T Kelly
- Sports Medicine and Shoulder Service, Hospital for Special Surgery, New York, New York, U.S.A
| | | | - Asheesh Bedi
- MedSport and Department of Orthopaedic Surgery, University of Michigan, Ann Arbor, Michigan, U.S.A..
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Abstract
The indications for hip arthroscopy over the last decade have increased rapidly, driven by technical and technological advances aimed at hip joint preservation. This article reviews the current indications and supporting evidence for hip arthroscopy, explores some newer techniques/technologies and discusses the future directions in this rapidly evolving and expanding field.
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Reconstruction of nonrepairable acetabular labral tears with allografts: mid-term results. Hip Int 2016; 26 Suppl 1:43-7. [PMID: 27174068 DOI: 10.5301/hipint.5000410] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 04/22/2016] [Indexed: 02/04/2023]
Abstract
BACKGROUND Many labral tears are nonrepairable. For these cases, labral reconstruction procedures may be considered in order to restore the joint fluid seal and prolong hip longevity. AIMS The aim of this study was to describe the clinical and functional outcomes of a series of cases with nonrepairable labral tears that underwent labral reconstruction with tendon allografts. The hypothesis was that labral reconstruction would provide good clinical outcomes. METHOD A cohort of 20 patients with nonrepairable labral tears, which underwent to labral grafting mainly by means of arthroscopic assisted anterior mini-open approach, were included in this study. The study period was comprised between July 2008 and September 2013. RESULTS DCS-score resulted in 17 satisfactory results, whereas Nonarthritic Hip Score (NAHS) resulted in mean improvement of 39 points. 1 retrieved allograft demonstrated 8 weeks after implantation new whole revascularisation. CONCLUSIONS We concluded that labral reconstruction with tendon allograft provides relief of painful symptoms, and represents a reliable alternative for patients with nonrepairable labral tears that are not yet candidates for a joint replacement procedure.
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Validation of a German version of the International Hip Outcome Tool 12 (iHOT12) according to the COSMIN checklist. Health Qual Life Outcomes 2016; 14:3. [PMID: 26746236 PMCID: PMC4706721 DOI: 10.1186/s12955-016-0407-9] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2015] [Accepted: 01/04/2016] [Indexed: 11/17/2022] Open
Abstract
Background Patient Reported Outcome (PRO) measurements have become an important tool to evaluate disease-related quality of life. The “International Hip Outcome Tool” (iHOT12) is a self-administered patient-reported outcome tool, which includes questions on the patient’s symptoms, functional and sports limitations as well as social, emotional, and occupational limitations. The purpose of this study was to adapt and validate a German version of the iHOT12 according to the COSMIN checklist. Methods In order to validate the German translation of the iHOT12, we conducted a prospective multicenter cohort study on patients with hip disorders and a score ≥4 on the modified Tegner Activity Scale (mTAS). The patients completed the German iHOT12 questionnaire and other functional scores (Hip Outcome Score, modified Tegner Activity Scale, EuroQol-5D) twice at intervals of at least two weeks. Evaluation of psychometric properties was conducted following the COSMIN checklist for validation of health status measurement instruments. The methodical testing for reliability included internal consistency, test-retest reliability, and measurement error. For testing of validity, we analyzed construct validity, hypotheses testing, interpretability and responsiveness. Results Between December 2013 and December 2014, eighty-three consecutive patients completed both questionnaires and were available for data analysis. Cronbach’s alpha was 0.94 (95 %-CI: 0.91, 0.95) confirming internal consistency and test-retest reliability of the iHOT-12 was high with an ICC = 0.94 (95 %-CI: 0.89, 0.97). All a priori hypotheses were confirmed. Further, no relevant floor- or ceiling effects occurred. The iHOT12 showed good responsiveness with a minimal important change (MIC) under 14 points. Conclusions The German translation of the iHOT-12 is a reliable, valid, and responsive tool for the evaluation of disease-related quality of life in active patients with a hip disorder. We could show that the minimal important change, a change of health condition the patient discerns, is less than 14 points in the iHOT12 scale.
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Validation of a German version of the International Hip Outcome Tool (G-iHOT33) according to the COSMIN checklist: how much improvement is clinically relevant? Arch Orthop Trauma Surg 2016; 136:83-91. [PMID: 26419895 DOI: 10.1007/s00402-015-2336-1] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/28/2015] [Indexed: 10/23/2022]
Abstract
PURPOSE The evaluation of the subjective health-related quality of life is especially for young, active patients with hip joint disorders important. The MAHORN study group has recently developed the "International Hip Outcome Tool" (iHOT33), a self-administered patient-reported outcome tool, which includes questions on the patient's symptoms, functional and sports limitations as well as social, emotional, and occupational limitations. The purpose of this study was to adapt and validate a German version of the iHOT33 according to the COSMIN checklist. METHODS To validate the G-iHOT33, we conducted a prospective multicenter cohort study on patients with hip disorders and a score ≥4 on the modified Tegner Activity Scale. The patients completed the G-iHOT33 questionnaire twice at intervals of at least 2 weeks. In addition, we recorded the Hip Outcome Score (HOS), a modified Tegner Activity Scale (TAS), the EuroQol-5D (EQ5-D), and a subjective assessment of the limitations. Evaluation of psychometric properties was conducted following the COSMIN checklist for validation of health status measurement instruments. The methodical testing for reliability included internal consistency, test-retest reliability, and measurement error. For testing of validity, we analyzed construct validity, hypotheses testing, interpretability, and responsiveness. RESULTS Between December 2013 and December 2014, eighty-three consecutive patients completed both questionnaires and were available for data analysis. Cronbach's α was 0.97 (95% CI 0.96, 0.99) confirming internal consistency and test-retest reliability of the G-iHOT-33 was high with an ICC = 0.88 (95% CI 0.80, 0.99). All a priori hypotheses were confirmed, further, no floor- or ceiling-effects occurred. The G-iHOT33 showed good responsiveness with a minimal important change (MIC) of 10 points. CONCLUSIONS The German translation of the iHOT-33 (G-iHOT-33) is a viable tool for the evaluation of active patients with a hip disorder. Following the complete COSMIN checklist, we could prove that G-iHOT33 is a reliable, valid, and responsive PRO measurement tool. We could show that the minimal important change, a change of health condition the patient discerns is 10 points in the G-iHOT33 scale. This is the first study providing results on psychometric properties of the iHOT33 subscales. Level of evidence 1b validating cohort study.
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Arthroscopic treatment of femoroacetabular impingement: minimum five-year follow-up. Hip Int 2015; 24:381-6. [PMID: 24970321 DOI: 10.5301/hipint.5000135] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 01/27/2014] [Indexed: 02/04/2023]
Abstract
PURPOSE To evaluate the clinical outcomes of an arthroscopic treatment of femoroacetabular impingement at a minimum of a five-year follow-up. METHODS A case series with 24 subjects (26 hips) was conducted. Subjects that were submitted to an arthroscopic procedure for the treatment of femoroacetabular impingement, at a minimum of five years, were evaluated. Subjects completed the modified Harris Hip Score (mHHS), the pain numeric rating scale and a general questionnaire accessing sports practice and satisfaction. RESULTS Twenty-one of the 24 subjects (87.5%) were male and the average age at the time of surgery was 34.6 ± 9.5 years old (range 13-51). Of the 27 subjects submitted to hip arthroscopy, three (11.1%) could not be contacted. Follow-up was 6.1 ± 0.8 years, and at this time the average mHHS was 90.6 ± 11.6. Pain numeric rating scale was 2.6 ± 1.9 and 11 hips (42.3%) reported no pain. Of the 14 subjects that complained of hip pain during sports activities prior to surgery, 10 (71.4%) returned to normal sports activities while four (28.6%) subjects could not return to preoperative activities. Three patients had to be submitted to a new surgical procedure. All 24 subjects were satisfied with their procedure and would repeat it if necessary. CONCLUSIONS Arthroscopic treatment of femoroacetabular impingement, at five years follow-up, revealed good results in terms of improved function, pain relief and satisfaction.
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Prather H, Moley P, Hunt DM, Rho M. Diagnosis and Treatment of Hip Pain Associated with Femeroacetabular Impingement. CURRENT PHYSICAL MEDICINE AND REHABILITATION REPORTS 2015. [DOI: 10.1007/s40141-014-0073-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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Circumferential reconstruction of severe acetabular labral damage using hamstring allograft: surgical technique and case series. Hip Int 2014; 23 Suppl 9:S42-53. [PMID: 24318364 DOI: 10.5301/hip.2013.11662] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 06/15/2012] [Indexed: 02/04/2023]
Abstract
INTRODUCTION With excessive acetabular coverage, such as coxa profunda or protrusio, contact between the femoral neck and acetabular rim cause direct damage to the labrochondral junction, and indirect edge loading from a levering effect which may result in hip arthrosis. Arthrosis may be delayed or avoided by addressing the overcoverage and restoring mechanical function of the labrum. We describe four cases of adjunctive complete acetabular labral replacement for circumferential, irreparable labral injury using fresh frozen semitendinous allografts through surgical hip dislocation. MATERIALS AND METHODS Over a two-year period four patients (age range: 20 to 47 years) underwent surgical hip dislocation to address femoroacetabular impingement with rim trimming, femoral osteochondroplasty, and labral reconstruction. Pre- and postoperative patient reported outcomes were assessed by Oxford Hip Score (OHS), Hip Outcome Score (HOS), and Global Treatment Outcome (GTO) score. Disease progression was graded using AP pelvic radiographs and arthroMR. RESULTS The average LCE correction was 18º (range 7-25º), achieving an average LCE of 33º (range 32-35) postoperatively. Using protected weight bearing all trochanteric osteotomies healed within six weeks after surgery. OA did not progress in any hips. Mean OHS and HOS scores improved 6.3 and 19.8 at one-year follow up. All four patients reported good results according to the GTO. There were two adverse events that resolved and did not affect outcome. SUMMARY AND CONCLUSIONS Despite complex deformities and preexisting cartilage and labrum wear in this young cohort, three of four patients reported significant functional improvement after treatment of this rare condition. Preliminary experience with circumferential labral reconstruction using hamstring allografts is promising, although long-term data needs to be established.
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Gwathmey FW, Kadrmas WR. Intra-articular Hip Disorders in the Military Population. Clin Sports Med 2014; 33:655-74. [DOI: 10.1016/j.csm.2014.06.013] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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