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Suarez-Ahedo C, Camacho-Galindo J, López-Reyes A, Martinez-Gómez LE, Pineda C, Domb BG. A comprehensive review of hip arthroscopy techniques and outcomes. SAGE Open Med 2024; 12:20503121231222212. [PMID: 38249944 PMCID: PMC10798066 DOI: 10.1177/20503121231222212] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2023] [Accepted: 12/04/2023] [Indexed: 01/23/2024] Open
Abstract
Transforming the orthopedic landscape, hip arthroscopy pioneers a minimally invasive surgical approach for diagnosing and addressing hip pathologies. With its origins dating back to Burman's 1931 cadaveric study, this groundbreaking technique gained clinical relevance in 1939 through Takagi's report. However, the 1980s marked the actual emergence of hip arthroscopy for treating a wide range of hip disorders. Now, a staple in modern orthopedics, hip arthroscopy empowers patients with previously undiagnosed and untreated hip conditions, enabling them to obtain relief and reclaim their lives. By employing a compact camera and specialized tools, surgeons expertly navigate the hip joint, performing procedures from excising loose bodies and mending labral tears to addressing femoroacetabular impingement and tackling other intricate issues. This innovative approach has dramatically elevated patients' quality of life, allowing them to embrace targeted treatments and resume daily activities without resorting to lifestyle alterations.
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Affiliation(s)
- Carlos Suarez-Ahedo
- Adult Hip and Knee Reconstruction Department, National Rehabilitation Institute of Mexico, Mexico City, Mexico
- Geriatric Science Laboratory, National Rehabilitation Institute of Mexico, Mexico City, Mexico
- American Hip Institute, Chicago, IL, USA
| | | | - Alberto López-Reyes
- Geriatric Science Laboratory, National Rehabilitation Institute of Mexico, Mexico City, Mexico
| | - Laura E Martinez-Gómez
- Geriatric Science Laboratory, National Rehabilitation Institute of Mexico, Mexico City, Mexico
| | - Carlos Pineda
- National Rehabilitation Institute of Mexico, Mexico City, Mexico
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Zanchi N, Safran MR, Herickhoff P. Return to Play After Femoroacetabular Impingement. Curr Rev Musculoskelet Med 2023; 16:587-597. [PMID: 37816998 PMCID: PMC10733256 DOI: 10.1007/s12178-023-09871-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 09/27/2023] [Indexed: 10/12/2023]
Abstract
PURPOSE OF REVIEW Femoroacetabular impingement (FAI) is a pathomechanical process whereby abnormal contact between proximal femur and acetabulum at end range of hip motion induces chondrolabral lesions within the hip joint. Surgery followed by a rehabilitation program or physical therapy with possible addition of an intra-articular corticosteroid injection are the two predominant treatments. The majority of authors recognize that a well-designed rehabilitation protocol is essential to achieve good outcomes with both nonoperative and surgical treatment. However, there is little evidence about what is the best rehabilitation protocol and most of the literature available is based on expert level opinion. This current review investigates the recent literature on nonoperative and postoperative rehabilitation protocol and return to play in FAI patients and describes our approach. RECENT FINDINGS Historically, rehabilitation protocols for treatment of FAI as well as return to play protocols were based on experts' opinion and low-level evidence studies. In order to improve standardization of protocols and to allow a better comparison in between different protocols, different authors have created standardized rehabilitation protocols with consensus building methods comparing them with other treatment options in high-level evidence trials (FASHIoN trial, etc.). Despite the excellent results reported after nonoperative and post-surgical rehabilitation, and the high RTP rate after FAI treatment, there is a significant variability in between protocols. Further high-level evidence studies are necessary in order to establish a gold standard in rehabilitation and RTP protocols.
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Affiliation(s)
- Nicolò Zanchi
- Orthopaedic Surgery, Penn State Health Milton S. Hershey Medical Center, 1850 E Park Ave, State College, PA, USA.
| | - Marc R Safran
- Department of Orthopaedic Surgery, Stanford University, Redwood City, CA, USA
| | - Paul Herickhoff
- Orthopaedic Surgery, Penn State Health Milton S. Hershey Medical Center, 1850 E Park Ave, State College, PA, USA
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Sienko A, Ekhtiari S, Khanduja V. The growth of hip preservation as a speciality. Knee Surg Sports Traumatol Arthrosc 2023; 31:2540-2543. [PMID: 37045973 DOI: 10.1007/s00167-023-07409-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/28/2023] [Accepted: 03/28/2023] [Indexed: 04/14/2023]
Affiliation(s)
- Anna Sienko
- University of Cambridge, Clinical School of Medicine, Cambridge, UK
| | - Seper Ekhtiari
- Young Adult Hip Service, Addenbrooke's-Cambridge University Hospital, Hills Road, Box 37, Cambridge, CB2 0QQ, UK
| | - Vikas Khanduja
- Young Adult Hip Service, Addenbrooke's-Cambridge University Hospital, Hills Road, Box 37, Cambridge, CB2 0QQ, UK.
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Wörner T, Eek F, Kraus-Schmitz J, Sansone M, Stålman A. Rapid decline of yearly number of hip arthroscopies in Sweden: a retrospective time series of 6,105 hip arthroscopies based on a national patient data register. Acta Orthop 2021; 92:562-567. [PMID: 34018896 PMCID: PMC8519534 DOI: 10.1080/17453674.2021.1928396] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023] Open
Abstract
Background and purpose - Hip arthroscopies (HAs) have increased exponentially worldwide and are expected to continue rising. We describe time trends in HA procedures in Sweden (10 million inhabitants) between 2006 and 2018 with a focus on procedure rates, surgical procedures, and patient demographics such as age and sex distribution.Patients and methods - We retrospectively collected data from the Swedish National Patient Register (NPR) for all surgeries including surgical treatment codes considered relevant for HA from 2006 to 2018. Surgical codes were validated through a multiple-step procedure and classified into femoroacetabular impingement syndrome (FAIS) related or non-FAIS related procedure. Frequencies, sex differences, and time trends of surgical procedures and patient demographics are presented.Results - After validation of HA codes, 6,105 individual procedures, performed in 4,924 patients (mean age 34 years [SD 12]) were confirmed HAs and included in the analysis. Yearly HA procedure rates increased from 15 in 2006 to 884 in 2014, after which a steady decline was observed with 469 procedures in 2018. The majority (65%) of HAs was performed in males. Male patients were younger, and surgeries on males more frequently included an FAIS-related procedure.Interpretation - Similar to previous studies in other parts of the world, we found dramatic increases in HA procedures in Sweden between 2006 and 2014. Contrary to existing predictions, HA rates declined steadily after 2014, which may be explained by more restrictive patient selection based on refined surgical indications, increasing evidence, and clinical experience with the procedure.
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Affiliation(s)
- Tobias Wörner
- Department of Health Sciences, Lund University, Lund,Capio Artro Clinic, Stockholm,Correspondence:
| | - Frida Eek
- Department of Health Sciences, Lund University, Lund
| | - Jesper Kraus-Schmitz
- Stockholm Sports Trauma Research Center, Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm,Department of Orthopaedics, Skåne University Hospital, Malmö
| | - Mikael Sansone
- Gothenburg Sports and Trauma Research Center, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Anders Stålman
- Capio Artro Clinic, Stockholm,Stockholm Sports Trauma Research Center, Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm
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5
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Lindman I, Nikou S, Öhlin A, Senorski EH, Ayeni O, Karlsson J, Sansone M. Evaluation of outcome reporting trends for femoroacetabular impingement syndrome- a systematic review. J Exp Orthop 2021; 8:33. [PMID: 33893563 PMCID: PMC8065071 DOI: 10.1186/s40634-021-00351-0] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/05/2021] [Accepted: 04/08/2021] [Indexed: 11/10/2022] Open
Abstract
PURPOSE The aim of this systematic review was to evaluate the trends in the literature regarding surgical treatment for femoroacetabular impingement syndrome (FAIS) and to present which patient-reported outcome-measures (PROMs) and surgical approaches are included. METHODS This systematic review was conducted with the PRISMA guidelines. The literature search was performed on PubMed and Embase, covering studies from 1999 to 2020. Inclusion criteria were clinical studies with surgical treatment for FAIS, the use of PROMs as evaluation tool and studies in English. Exclusion criteria were studies with patients < 18 years, cohorts with < 8 patients, studies with primarily purpose to evaluate other diagnoses than FAIS and studies with radiographs as only outcomes without using PROMs. Data extracted were author, year, surgical intervention, type of study, level of evidence, demographics of included patients, and PROMs. RESULTS The initial search yielded 2,559 studies, of which 196 were included. There was an increase of 2,043% in the number of studies from the first to the last five years (2004-2008)-(2016-2020). There were 135 (69%) retrospective, 55 (28%) prospective and 6 (3%) Randomized Controlled Trials. Level of evidence ranged from I-IV where Level III was most common (44%). More than half of the studies (58%) originated from USA. Arthroscopic surgery was the most common surgical treatment (85%). Mean follow-up was 27.0 months (± 17 SD), (range 1.5-120 months). Between 1-10 PROMs were included, and the modified Harris Hip Score (mHHS) was most commonly used (61%). CONCLUSION There has been a continuous increase in the number of published studies regarding FAIS with the majority evaluating arthroscopic surgery. The mHHS remains being the most commonly used PROM.
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Affiliation(s)
- Ida Lindman
- Department of Orthopaedics, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, 413 45, Gothenburg, Sweden.
| | - Sarantos Nikou
- Department of Orthopaedic Surgery, South Älvsborg Hospital, 501 82, Borås, Sweden
| | - Axel Öhlin
- Department of Orthopaedics, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, 413 45, Gothenburg, Sweden
| | - Eric Hamrin Senorski
- Department of Health and Rehabilitation, Institute of Neuroscience and Physiology, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Olufemi Ayeni
- Division of Orthopaedic Surgery, McMaster University, Hamilton, ON, L8N 3Z5, Canada
| | - Jon Karlsson
- Department of Orthopaedics, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, 413 45, Gothenburg, Sweden
| | - Mikael Sansone
- Department of Orthopaedics, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, 413 45, Gothenburg, Sweden
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Tejpal T, Shanmugaraj A, Kay J, Simunovic N, Ayeni OR. Historical analysis of the diagnosis and management of femoroacetabular impingement prior to the year 2000: a systematic review. J Hip Preserv Surg 2020; 7:378-389. [PMID: 33948194 PMCID: PMC8081417 DOI: 10.1093/jhps/hnaa055] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/05/2020] [Revised: 08/31/2020] [Accepted: 10/27/2020] [Indexed: 12/27/2022] Open
Abstract
This systematic review aims to assess the diagnosis, indications and treatment of femoroacetabular impingement (FAI) prior to the year 2000 and to determine if historical concepts remain applicable today. PUBMED, MEDLINE and EMBASE were searched for literature evaluating the diagnosis/treatment of FAI prior to 2000. Cadaver/non-human, non-English and review studies were excluded. Quality assessment was performed using the Methodological Index for Non-Randomized Studies. Nine studies comprising 307 patients [315 hips; mean age of 32.6 ± 2.4 years (range, 12-58)] were included. Patients reported groin pain. Magnetic resonance arthrography (MRA; n = 76) and the anterior impingement test (AIT) (n = 88) were used to diagnose impingement. Surgical dislocation with a trochanteric flip osteotomy (n = 237) and Bernese periacetabular osteotomy (n = 40) were common treatments. Pain and range of motion improved for patients. Overall complication rate was 35% (n = 99), with heterotopic ossification (n = 79) most commonly reported. Prior to 2000, there was low quantity and quality of research on the diagnosis/management of FAI. Diagnostic evaluation was primarily through clinical examination (i.e. groin pain and AIT). MRA was occasionally used to detect labral degeneration; however, utilization of computed tomography (CT) and diagnostic injections were not reported. Surgical dislocation and osteotomies of the acetabulum yielded desirable short-term clinical outcomes with a moderate complication rate. No study reported using arthroscopy for FAI management prior to 2000. Clinicians today can learn from historical principles (i.e. clinical diagnosis of FAI, management with surgical correction of femoral head-neck offset) while applying novel techniques (i.e. CT, injections, arthroscopic surgical techniques and rehabilitation) to improve patient outcomes. Level of Evidence IV (systematic review of III and IV evidence).
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Affiliation(s)
- Tushar Tejpal
- Faculty of Health Sciences, McMaster University, 1200 Main Street West, 4E15, Hamilton, ON L8N 3Z5, Canada
| | - Ajaykumar Shanmugaraj
- Division of Orthopaedic Surgery, Department of Surgery, Evidence, and Impact, McMaster University Medical Centre, 1200 Main Street West, 4E15, Hamilton, ON L8N 3Z5, Canada
| | - Jeffery Kay
- Division of Orthopaedic Surgery, Department of Surgery, Evidence, and Impact, McMaster University Medical Centre, 1200 Main Street West, 4E15, Hamilton, ON L8N 3Z5, Canada
| | - Nicole Simunovic
- Division of Orthopaedic Surgery, Department of Surgery, Evidence, and Impact, McMaster University Medical Centre, 1200 Main Street West, 4E15, Hamilton, ON L8N 3Z5, Canada
- Correspondence to: O. R. Ayeni. E-mail:
| | - Olufemi R Ayeni
- Division of Orthopaedic Surgery, Department of Surgery, Evidence, and Impact, McMaster University Medical Centre, 1200 Main Street West, 4E15, Hamilton, ON L8N 3Z5, Canada
- Department of Health Research Methods, Evidence, and Impact, McMaster University Medical Centre, 1200 Main Street West, 4E15, Hamilton, ON L8N 3Z5, Canada
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Lindman I, Olsson H, Öhlin A, Hamrin Senorski E, Stålman A, Ayeni OR, Sansone M. Loss to follow-up: initial non-responders do not differ from responders in terms of 2-year outcome in a hip arthroscopy registry. J Hip Preserv Surg 2020; 7:281-287. [PMID: 33163213 PMCID: PMC7605762 DOI: 10.1093/jhps/hnaa028] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/21/2020] [Revised: 05/14/2020] [Accepted: 06/12/2020] [Indexed: 12/30/2022] Open
Abstract
Loss to follow-up in registry studies is a problem due to potential selection bias. There is no consensus on the effect of response rate. The aim of this study was to compare patient-reported outcome measures (PROMs) between responders and initial non-responders (INR) in a hip arthroscopy registry and to examine whether demographics affect the response rate. Data from hip arthroscopies performed at two centres in Gothenburg were collected and the patients were followed up with PROMs. The follow-up was a minimum of 2 years after surgery. All 536 patients who underwent primary hip arthroscopies during 2015 and 2016 and had recorded pre-operative PROMs were included. A total of 396 patients completed the follow-up and were labelled 'Responders' (R) and 107 patients responded after reminders were sent and labelled 'Initial non-responders' (INR). The mean time of follow-up was 24.7 ± 2.9 and 42.5 ± 7.0 months for the R- and INR-group, respectively. There were no differences between the two groups at the follow-up for the Copenhagen Hip and Groin Outcome Score, European Quality of life 5 dimensions questionnaire, EQ-VAS, International Hip Outcome Tool or a visual analogue scale for hip function. A larger proportion of R was satisfied after hip arthroscopy compared with INR (86% versus 70%, P = 0.0003). INR were younger than responders (31.5 ± 12.5 versus 35.6 ± 12.7 years of age). The conclusion of the study was that there were no differences between R and INR at the follow-up across the PROMs except patient satisfaction, where responders were more satisfied.
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Affiliation(s)
- Ida Lindman
- Gothenburg Sports and Trauma Research Center, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Harald Olsson
- Gothenburg Sports and Trauma Research Center, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Axel Öhlin
- Gothenburg Sports and Trauma Research Center, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Eric Hamrin Senorski
- Gothenburg Sports and Trauma Research Center, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Anders Stålman
- Department of Molecular Medicine and Surgery, Stockholm Sports Trauma Research Center, Karolinska Institutet, Stockholm SE-114 86, Sweden
| | - Olufemi R Ayeni
- Division of Orthopaedic Surgery, McMaster University, Hamilton, ON L8N 3Z5, Canada
| | - Mikael Sansone
- Gothenburg Sports and Trauma Research Center, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
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Öhlin A, Karlsson L, Senorski EH, Jónasson P, Ahldén M, Baranto A, Ayeni OR, Sansone M. Quality Assessment of Prospective Cohort Studies Evaluating Arthroscopic Treatment for Femoroacetabular Impingement Syndrome: A Systematic Review. Orthop J Sports Med 2019; 7:2325967119838533. [PMID: 31106220 PMCID: PMC6509989 DOI: 10.1177/2325967119838533] [Citation(s) in RCA: 14] [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: 11/15/2022] Open
Abstract
Background Femoroacetabular impingement (FAI) syndrome is a cause of pain and reduced range of motion in the hip joint. Given the limited number of randomized controlled trials, prospective cohort studies constitute the dominant part of the available prospective evidence evaluating relevant clinical outcomes after arthroscopic hip surgery for FAI. Purpose To assess the methodological quality of prospective cohort studies evaluating arthroscopic surgery for FAI and to determine whether there has been an improvement in methodological quality over time. Study Design Systematic review; Level of evidence, 4. Methods A systematic literature search was performed in PubMed, Embase (OvidSP), and the Cochrane Library. Included studies were clinical prospective cohort studies of primary arthroscopic surgery for cam and/or pincer morphology FAI. Methodological quality was assessed with the Methodological Index for Non-randomized Studies (MINORS). The mean MINORS score for studies published during the first 5 years of the period was compared with those published during the last 5 years to evaluate methodological improvement over time. The methodological quality of randomized controlled trials was also assessed with the Coleman Methodology Score. Results The search yielded 53 studies. There were 34 noncomparative studies, 15 nonrandomized comparative studies, and 4 randomized controlled trials. The included studies were published between 2008 and 2017. The mean ± SD MINORS score for noncomparative and comparative studies was 10.4 ± 1.4 of 16 possible and 18.7 ± 2.0 of 24 possible, respectively. The mean Coleman Methodology Score for randomized controlled trials was 79.0 ± 7.0 of 100 possible. Conclusion The methodological quality of prospective cohort studies evaluating arthroscopic surgery for FAI is moderate for comparative and noncomparative studies. Common areas for improvement include unbiased assessment of study endpoints and prospective sample-size calculations. Despite an increase in the number of published studies, an improvement in methodological quality over time was not observed.
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Affiliation(s)
- Axel Öhlin
- Department of Orthopaedics, Institute of Clinical Sciences, University of Gothenburg, Gothenburg, Sweden
| | - Louise Karlsson
- Department of Orthopaedics, Institute of Clinical Sciences, University of Gothenburg, Gothenburg, Sweden
| | - Eric Hamrin Senorski
- Department of Health and Rehabilitation, Institute of Neuroscience and Physiology, University of Gothenburg, Gothenburg, Sweden
| | | | - Mattias Ahldén
- Department of Orthopaedics, Institute of Clinical Sciences, University of Gothenburg, Gothenburg, Sweden
| | - Adad Baranto
- Department of Orthopaedics, Institute of Clinical Sciences, University of Gothenburg, Gothenburg, Sweden
| | - Olufemi R Ayeni
- Division of Orthopaedic Surgery, Department of Surgery, McMaster University, Hamilton, Ontario, Canada
| | - Mikael Sansone
- Department of Orthopaedics, Institute of Clinical Sciences, University of Gothenburg, Gothenburg, Sweden
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Bakshi NK, Khan M, Kirsch JM, Perera E, Rinaldi G, Razdan P, Tigani L, Bedi A. Significant demographic and geographic differences exist in the reporting of superior labrum from anterior to posterior tear literature: a systematic review. J ISAKOS 2018. [DOI: 10.1136/jisakos-2017-000178] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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de Sa D, Lian J, Sheean AJ, Inman K, Drain N, Ayeni O, Mauro C. A Systematic Summary of Systematic Reviews on the Topic of Hip Arthroscopic Surgery. Orthop J Sports Med 2018; 6:2325967118796222. [PMID: 30320142 PMCID: PMC6154262 DOI: 10.1177/2325967118796222] [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: 12/30/2022] Open
Abstract
BACKGROUND There is a rapidly growing body of literature on the topic of hip arthroscopic surgery. PURPOSE To provide an overall summary of systematic reviews published on the indications, complications, techniques, outcomes, and information related to hip arthroscopic surgery. STUDY DESIGN Systematic review; Level of evidence, 4. METHODS A systematic review of all hip arthroscopic surgery-related systematic reviews published between January 2000 and May 2018 was performed using PubMed, MEDLINE, and the Cochrane Library. Narrative reviews and non-English articles were excluded. RESULTS A total of 837 articles were found, of which 85 met the inclusion criteria. Included articles were summarized and divided into 6 major categories based on the subject of the review: femoroacetabular impingement (FAI), non-FAI indications, surgical technique, outcomes, complications, and miscellaneous. CONCLUSION A summary of systematic reviews on hip arthroscopic surgery can provide surgeons with a single source for the most current synopsis of the available literature. As the prevalence of orthopaedic surgeons performing hip arthroscopic surgery increases, updated evidence-based guidelines must likewise be advanced and understood to ensure optimal patient management.
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Affiliation(s)
- Darren de Sa
- Division of Sports Medicine, Department of Orthopaedic Surgery, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Jayson Lian
- Division of Sports Medicine, Department of Orthopaedic Surgery, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
- Albert Einstein College of Medicine, New York, New York, USA
| | - Andrew J Sheean
- Division of Sports Medicine, Department of Orthopaedic Surgery, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Kathleen Inman
- School of Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Nicholas Drain
- School of Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Olufemi Ayeni
- School of Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Craig Mauro
- Division of Sports Medicine, Department of Orthopaedic Surgery, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
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Ayeni OR. Editorial Commentary: Femoroacetabular Impingement and Evidence: Are We There Yet? Arthroscopy 2018; 34:2140-2141. [PMID: 29976431 DOI: 10.1016/j.arthro.2018.03.040] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/28/2018] [Accepted: 03/30/2018] [Indexed: 02/02/2023]
Abstract
Femoroacetabular impingement has been established as an impactful cause of hip pain and dysfunction in the young active individual. Improving evidence from well-conducted studies will continue to refine indications and outcomes and perhaps lead to more questions, such as: "How was the capsule managed?" "What was the patient compliance rate with rehabilitation?" "What was the impact of surgical morphology correction on clinical outcome?" "Did cartilage status impact clinical outcome?" and "Was there a noticeable learning curve reflected in outcomes?" These are all important questions that should be addressed in future studies.
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Editorial Commentary: Safe Innovation? Arthroscopy After Traumatic Hip Dislocation. Arthroscopy 2018; 34:928-929. [PMID: 29502707 DOI: 10.1016/j.arthro.2017.11.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/01/2017] [Accepted: 11/03/2017] [Indexed: 02/02/2023]
Abstract
Hip arthroscopy can be helpful relative to conventional imaging when diagnosing (and treating) intra-articular injuries after a hip dislocation, but more evidence is required before adopting this approach diagnostic and therapeutic strategy.
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Schmaranzer F, Arendt L, Lerch TD, Steppacher SD, Nuss K, Wolfer N, Dawson HE, von Rechenberg B, Kircher PR, Tannast M. Femoral osteochondroplasty can be performed effectively without the risk of avascular necrosis or femoral neck fractures in an experimental ovine FAI model. Osteoarthritis Cartilage 2018; 26:128-137. [PMID: 29061495 DOI: 10.1016/j.joca.2017.10.009] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/22/2017] [Revised: 10/05/2017] [Accepted: 10/10/2017] [Indexed: 02/02/2023]
Abstract
OBJECTIVE The experimental induction of cam-type femoroacetabular impingement (FAI) in sheep is established. To tap the full potential of this ovine model, one should be able to perform a femoral osteochondroplasty safely. This study was based on previous cadaver experiments on the blood supply to the ovine femoral head and on the biomechanical strength of the proximal femur following offset creation. We hypothesized that offset creation in this ovine FAI model does not lead to (1) avascular necrosis (AVN) of the ovine femoral head or (2) iatrogenic femoral neck fractures and (3) can be performed effectively. DESIGN In this experimental, controlled, prospective study nine sheep underwent unilateral FAI induction through an intertrochanteric, varus osteotomy. Seventy days following FAI induction, femoral osteochondroplasty was performed. Sheep were sacrificed after another 140 days. Radiographs, computed tomography (CT) scans and MRI were acquired. Histologic samples were stained with hematoxylin-eosin. (1) The multimodal Association Research Circulation Osseous (ARCO) classification was used for assessment of AVN. (2) Femoral neck fractures were assessed with the multimodal imaging approach. (3) Pre- and postoperative (=after sacrifice) alpha angles and femoral neck diameters were compared. RESULTS (1) No signs for AVN according to the ARCO classification or (2) for femoral neck fractures were detected. (3) Mean alpha angles and femoral neck diameters decreased significantly (p < 0.001) superiorly by at least 30° respectively 4 mm after the offset creation. CONCLUSIONS Femoral osteochondroplasty can be performed effectively and without the risk of AVN or femoral neck fractures in this ovine FAI model.
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Affiliation(s)
- F Schmaranzer
- Department of Orthopaedic Surgery, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland.
| | - L Arendt
- Musculoskeletal Research Unit (MSRU), Equine Hospital, Vetsuisse Faculty, University of Zürich, Zürich, Switzerland
| | - T D Lerch
- Department of Orthopaedic Surgery, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - S D Steppacher
- Department of Orthopaedic Surgery, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - K Nuss
- Musculoskeletal Research Unit (MSRU), Equine Hospital, Vetsuisse Faculty, University of Zürich, Zürich, Switzerland
| | - N Wolfer
- Musculoskeletal Research Unit (MSRU), Equine Hospital, Vetsuisse Faculty, University of Zürich, Zürich, Switzerland
| | - H E Dawson
- Institute of Pathology, University of Bern, Bern, Switzerland
| | - B von Rechenberg
- Musculoskeletal Research Unit (MSRU), Equine Hospital, Vetsuisse Faculty, University of Zürich, Zürich, Switzerland
| | - P R Kircher
- Department of Small Animals, Division of Diagnostic Imaging, Vetsuisse Faculty, University of Zürich, Zürich, Switzerland
| | - M Tannast
- Department of Orthopaedic Surgery, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland; Musculoskeletal Research Unit (MSRU), Equine Hospital, Vetsuisse Faculty, University of Zürich, Zürich, Switzerland
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Duchman KR, Westermann RW, Glass NA, Bedard NA, Mather RC, Amendola A. Who Is Performing Hip Arthroscopy?: An Analysis of the American Board of Orthopaedic Surgery Part-II Database. J Bone Joint Surg Am 2017; 99:2103-2109. [PMID: 29257016 DOI: 10.2106/jbjs.17.00342] [Citation(s) in RCA: 30] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND Hip arthroscopy utilization has increased dramatically over the last decade. However, the lack of a formal training curriculum raises concern that inconsistent technical performance may be an issue for early-career hip arthroscopists. The purpose of the present study was to investigate hip arthroscopy utilization by early-career orthopaedic surgeons while focusing on fellowship training status to better guide future development of a hip arthroscopy training curriculum. METHODS The American Board of Orthopaedic Surgery (ABOS) Part-II database was used to identify candidates who had performed ≥1 hip arthroscopy procedures between 2006 and 2015. Procedures were categorized using Common Procedural Terminology (CPT) codes, and candidates were categorized by fellowship training experience. Trends in hip arthroscopy utilization were evaluated using univariate and regression analyses while stratifying by fellowship training experience. RESULTS Overall, 9.2% (643) of 6,987 ABOS candidates had performed ≥1 hip arthroscopy procedures. Over the study period, both the proportion of candidates performing hip arthroscopy and the proportion of hip arthroscopy procedures performed (relative to all procedures performed, of any type) increased (p < 0.001). Candidates performing hip arthroscopy most frequently reported sports medicine fellowship training (74.5%; 479 of 643). Also, among the candidates who performed hip arthroscopy, the proportion who had sports medicine fellowship training increased over the study period (p = 0.001). The majority of candidates performing hip arthroscopy (67.2%; 432 of 643) performed ≤5 hip arthroscopy procedures, while a small number of high-volume hip arthroscopists (6.5%; 42 of 643) performed 34.6% (1,403 of 4,054) of all hip arthroscopy procedures. CONCLUSIONS The increase in hip arthroscopy utilization in this cohort appears to have been driven primarily by the increased number of candidates performing hip arthroscopy and less by an increasing number of hip arthroscopy procedures being performed by individual candidates. The majority of candidates performing hip arthroscopy were sports-medicine-fellowship trained. This information is valuable for both trainees and educators interested in improving education and defining a curriculum for future hip arthroscopy training.
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Affiliation(s)
- Kyle R Duchman
- Department of Orthopedics and Rehabilitation, University of Iowa Hospitals and Clinics, Iowa City, Iowa
| | - Robert W Westermann
- Department of Orthopedics and Rehabilitation, University of Iowa Hospitals and Clinics, Iowa City, Iowa
| | - Natalie A Glass
- Department of Orthopedics and Rehabilitation, University of Iowa Hospitals and Clinics, Iowa City, Iowa
| | - Nicholas A Bedard
- Department of Orthopedics and Rehabilitation, University of Iowa Hospitals and Clinics, Iowa City, Iowa
| | - Richard C Mather
- Department of Orthopedic Surgery, Duke University School of Medicine, Durham, North Carolina
| | - Annunziato Amendola
- Department of Orthopedic Surgery, Duke University School of Medicine, Durham, North Carolina
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Lodhia P, Gui C, Chandrasekaran S, Suarez-Ahedo C, Dirschl DR, Domb BG. Cost-effectiveness Analysis of Hip Arthroscopic Surgery and Structured Rehabilitation Alone in Individuals With Hip Labral Tears: Response. Am J Sports Med 2017; 45:NP2-NP4. [PMID: 28272932 DOI: 10.1177/0363546517691279] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
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