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Pålsson A, Nae JÄ. The association between hip adductor and extensor strength, and hip-related patient-reported outcomes in patients with longstanding hip and groin pain: An exploratory cross-sectional study. Phys Ther Sport 2024; 70:61-66. [PMID: 39312863 DOI: 10.1016/j.ptsp.2024.09.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2024] [Revised: 09/13/2024] [Accepted: 09/15/2024] [Indexed: 09/25/2024]
Abstract
OBJECTIVE The objective of this study was to assess the association between hip muscle strength and hip-related patient-reported outcome measures (PROMs) in patients with longstanding hip and groin pain (LHGP). DESIGN Cross-sectional design. SETTING Orthopedic care. PARTICIPANTS Eighty-one patients with LHGP were consecutively recruited. MAIN OUTCOME MEASURES Hip muscle strength was measured in adduction and extension. Hip-related PROMs was measured with the Copenhagen Hip and Groin Outcome Score (HAGOS) which includes six subscales (Symptoms, Pain, Activity in Daily Living (ADL), Physical Function in Sports and Recreation (Sport/Rec), Participation in Physical Activities (PA), and Quality of Life (QoL). Linear regression examined the association between hip muscle strength and each HAGOS subscale. RESULTS Greater isometric hip muscle strength in adduction was associated with better HAGOS score for Pain and ADL (p ≤ 0.037), but not for Symptoms, Sport/Rec, PA, or QoL (p ≥ 0.154). Greater isometric hip muscle strength in extension was associated with better HAGOS score for Symptoms, Pain, and ADL (p ≤ 0.034), but not for Sport/Rec, PA, or QoL (p ≥ 0.084). CONCLUSIONS In patients with LHGP, greater isometric hip muscle strength seems to be associated with less symptoms and pain, and better function in ADL. No association was found for Sport/Rec, PA, or QoL.
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Affiliation(s)
- Anders Pålsson
- Department of Health Sciences, Faculty of Medicine, Lund University, Lund, Sweden.
| | - Jenny Älmqvist Nae
- Department of Health Sciences, Faculty of Medicine, Lund University, Lund, Sweden
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Bourgeault-Gagnon Y, Patel M, Walker M, Khalik HA, Duong A, Simunovic N, Ayeni OR. Moderate burden amongst caregivers posthip arthroscopy linked to younger caregiver age and task load: A cross-sectional survey study. Knee Surg Sports Traumatol Arthrosc 2024. [PMID: 39148222 DOI: 10.1002/ksa.12414] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/22/2024] [Revised: 07/24/2024] [Accepted: 07/26/2024] [Indexed: 08/17/2024]
Abstract
PURPOSE To evaluate the burden experienced by primary informal caregivers of patients who have undergone hip arthroscopy and to identify factors that predict increased caregiver burden. METHODS A cross-sectional study was conducted at a single academic hospital centre, enroling caregivers of patients who underwent hip arthroscopy between November 2018 and November 2023. Caregiver burden was assessed using the Caregiver Burden Inventory (CBI) survey. Multivariable linear regression models were used to identify predictors of caregiver burden, with the global CBI score serving as the primary outcome measure. Secondarily, open-ended survey questions were analyzed qualitatively to elucidate specific challenges and facilitators of caregiving, as reported by the caregivers themselves. RESULTS The study involved 99 eligible caregivers (mean [standard deviation] age; 47 [11] years), 58% were female, and 85% were relatives of the patient. The median global CBI score was 13.0 (interquartile range: 8.0-22.4), indicating a moderate burden. Regression analyses demonstrated that younger caregiver age and a higher number of caregiving tasks were significant predictors of increased global burden. Additionally, nonweightbearing status of patients, female gender of caregivers and working full-time statistically significantly increased specific dimensions of caregiver burden. CONCLUSION This study highlights the meaningful burden faced by caregivers of patients undergoing hip arthroscopy, despite its minimally invasive nature and outpatient setting. Identified risk factors such as younger caregiver age, female gender of the caregiver, nonweight-bearing status and increased caregiving tasks suggest targeted areas for intervention. The qualitative analysis revealed that caregivers struggle with time management and physical and emotional strain, yet better communication and practical support from healthcare teams could help to alleviate these challenges. LEVEL OF EVIDENCE Level IV, prognostic study.
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Affiliation(s)
- Yoan Bourgeault-Gagnon
- Division of Orthopaedic Surgery, Department of Surgery, McMaster University, Hamilton, Ontario, Canada
| | - Mansi Patel
- Division of Orthopaedic Surgery, Department of Surgery, McMaster University, Hamilton, Ontario, Canada
| | - Madison Walker
- Division of Orthopaedic Surgery, Department of Surgery, McMaster University, Hamilton, Ontario, Canada
| | - Hassaan Abdel Khalik
- Division of Orthopaedic Surgery, Department of Surgery, McMaster University, Hamilton, Ontario, Canada
| | - Andrew Duong
- Division of Orthopaedic Surgery, Department of Surgery, McMaster University, Hamilton, Ontario, Canada
| | - Nicole Simunovic
- Division of Orthopaedic Surgery, Department of Surgery, McMaster University, Hamilton, Ontario, Canada
| | - Olufemi R Ayeni
- Division of Orthopaedic Surgery, Department of Surgery, McMaster University, Hamilton, Ontario, Canada
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Bourgeault-Gagnon Y, Khalik HA, Patel M, Simunovic N, Ayeni OR. Risk factors for prolonged opioid consumption following hip arthroscopy: A secondary analysis of the Femoroacetabular Impingement RandomiSed controlled Trial and embedded cohort study. Knee Surg Sports Traumatol Arthrosc 2024; 32:1854-1861. [PMID: 38713876 DOI: 10.1002/ksa.12204] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/15/2023] [Revised: 01/16/2024] [Accepted: 04/09/2024] [Indexed: 05/09/2024]
Abstract
PURPOSE The purpose of the study was to identify prognostic risk factors for prolonged opioid use at 2 and 6 weeks after hip arthroscopy using data from the Femoroacetabular Impingement RandomiSed controlled Trial and its external validation cohort study. METHODS Opioids were prescribed for postoperative pain management at the surgeon's discretion, with a majority being prescribed a combination of oxycodone and paracetamol (5/325 mg). Prolonged opioid use was defined as the ongoing use of any dosage of opioids reported at either 2 or 6 weeks after surgery to treat femoroacetabular impingement, as recorded in the patient's study medication log. Multivariable logistic regressions were performed to evaluate patient and surgical characteristics, such as preoperative opioid use, type of surgical procedure and intraoperative cartilage state that may be associated with prolonged opioid use at either 2 and 6 weeks postoperatively. RESULTS A total of 265 and 231 patients were included for analysis at 2 and 6 weeks postoperatively, respectively. The median age of participants was 35 years (interquartile range [IQR]: 27-42) and 33% were female. At 2 weeks postoperatively, female sex (odds ratio [OR]: 2.56; 95% confidence interval: [CI] 1.34-4.98, p = 0.005), higher body mass index (BMI) (OR: 1.10; 95% CI: 1.02-1.18, p = 0.009), active tobacco use (OR: 4.06; 95% CI: 1.90-8.97, p < 0.001), preoperative opioid use (OR: 10.1; 95% CI: 3.25-39.1, p < 0.001) and an Outerbridge classification of ≥3 (OR: 2.33; 95% CI: 1.25-4.43, p = 0.009) were significantly associated with prolonged opioid use. At 6 weeks postoperatively, only preoperative opioid use was significantly associated with prolonged opioid consumption (OR: 10.6; 95% CI: 3.60-32.6, p < 0.001). CONCLUSION Preoperative opioid use was significantly associated with continued opioid use at 2 and 6 weeks postoperatively. Specific patient factors including female sex, higher BMI, active tobacco use and more severe cartilage damage should be considered in developing targeted strategies to limit opioid use after surgery. LEVEL OF EVIDENCE Level III.
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Affiliation(s)
- Yoan Bourgeault-Gagnon
- Department of Surgery, Division of Orthopaedic Surgery, McMaster University, Hamilton, Ontario, Canada
| | - Hassaan Abdel Khalik
- Department of Surgery, Division of Orthopaedic Surgery, McMaster University, Hamilton, Ontario, Canada
| | - Mansi Patel
- Department of Surgery, Division of Orthopaedic Surgery, McMaster University, Hamilton, Ontario, Canada
| | - Nicole Simunovic
- Department of Surgery, Division of Orthopaedic Surgery, McMaster University, Hamilton, Ontario, Canada
| | - Olufemi R Ayeni
- Department of Surgery, Division of Orthopaedic Surgery, McMaster University, Hamilton, Ontario, Canada
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Zacharias AJ, Dooley M, Mosiman S, Spiker AM. Depression Scores Decrease After Hip Arthroscopy for Femoroacetabular Impingement Syndrome. Arthrosc Sports Med Rehabil 2024; 6:100871. [PMID: 38495634 PMCID: PMC10944102 DOI: 10.1016/j.asmr.2023.100871] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2023] [Accepted: 12/18/2023] [Indexed: 03/19/2024] Open
Abstract
Purpose To evaluate clinical depression scores and functional outcomes following arthroscopic treatment of femoroacetabular impingement syndrome in patients with elevated preoperative depressive symptoms as defined by Patient-Reported Outcomes Measurement Information System for Depression (PROMIS-D). Methods Patients with femoroacetabular impingement syndrome completed the PROMIS-D Computer Adaptive Test and additional patient-reported outcome (PRO) measures preoperatively and at the time of postoperative visits. Patients were categorized into preoperative clinically depressed (CD) and nonclinically depressed (NCD) groups based on preoperative PROMIS-D scores. Scores ≥55 correlate to mild clinical depression, and this cutoff was used to determine preoperative depression status. PROMIS-D scores and functional outcome scores were assessed at 6 months and a minimum of 1-year postoperatively. Results In total, 100 patients were included with complete PROs at a minimum of 1-year follow-up. Of those included, 21 (21%) were categorized with preoperative CD. There were no differences in demographic or radiographic variables between the preoperative CD and NCD groups. At 6 months and 12 months postoperatively, the percentage of patients in the preoperative CD group with continued depression was 33.3% and 23.8%, respectively. Overall, 1-year change in PROMIS-D score for the CD group was -9.1 versus -0.8 in the NCD group (P = .001). There was no significant difference in rates of patients achieving patient acceptable symptom state between the preoperative CD and NCD groups. Conclusions Patients with symptoms of preoperative CD, as defined by the PROMIS-D score, demonstrated significant improvement in depressive symptoms following hip arthroscopy. In addition, patients with CD preoperatively did not show decreased rates of achieving minimum clinically important difference or patient acceptable symptom state on postoperative PROs compared with patients with NCD. Level of Evidence Level IV, therapeutic case series.
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Affiliation(s)
- Anthony J. Zacharias
- Department of Orthopedic Surgery Froedtert South, Pleasant Prairie, Wisconsin, U.S.A
| | - Matthew Dooley
- Department of Orthopedics and Rehabilitation, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin, U.S.A
| | - Samuel Mosiman
- Department of Biostatistics and Medical Informatics, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin, U.S.A
| | - Andrea M. Spiker
- Department of Orthopedics and Rehabilitation, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin, U.S.A
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DeMargel RD, Steger-May K, Haroutounian S, Zorn P, Cheng A, Clohisy JC, Harris-Hayes M. Personal factors and baseline function in patients undergoing non-operative management for chronic hip-related groin pain: a cross-sectional study. BMJ Open Sport Exerc Med 2023; 9:e001685. [PMID: 37937305 PMCID: PMC10626773 DOI: 10.1136/bmjsem-2023-001685] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/10/2023] [Indexed: 11/09/2023] Open
Abstract
Aim Little is known about the relationship between personal factors and perception of hip-related function among patients with chronic hip-related groin pain (HRGP) seeking non-operative management. This analysis was performed to determine if depressive symptoms, central sensitisation, movement evoked pain (MEP), pressure hypersensitivity and activity level were associated with patients' perception of hip-related function, represented by the International Hip Outcome Tool (iHOT-33). Methods This cross-sectional study used baseline data from a pilot randomised clinical trial. Participants had anterior hip symptoms for at least 3 of the past 12 months reproduced on examination. Depressive symptoms, central sensitisation and activity level were quantified with self-report questionnaires. MEP was assessed during step down and squat. Pain pressure threshold (PPT) was used to assess pressure hypersensitivity. Statistical analysis was performed to assess bivariate association between variables and independent association of variables with iHOT-33. Results Data from 33 participants (aged 18-40 years) with HRGP were analysed. Greater depressive symptoms (rs=-0.48, p=0.005), higher MEP during step down (rs=-0.36, p=0.040) and squat (rs=-0.39, p=0.024), and greater central sensitisation (rs=-0.33, p=0.058) were associated with lower (worse) iHOT-33 scores. Greater depressive symptoms (β=-0.47, 95% CI -0.76 to -0.17; p=0.003) and higher MEP during squat (β=-0.38, 95% CI -0.68 to -0.08; p=0.014) accounted for 37% of variability in iHOT-33. After adjusting for depressive symptoms and MEP, PPT, central sensitisation symptoms and activity level were not associated iHOT-33. Conclusions In patients with HRGP seeking non-operative management, greater depressive symptoms and MEP are independently associated with worse self-perceived hip function. Trial registration number NCT03959319.
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Affiliation(s)
- Rebecca D DeMargel
- Program in Physical Therapy, Washington University School of Medicine, St Louis, Missouri, USA
| | - Karen Steger-May
- Division of Biostatistics, Washington University School of Medicine, St Louis, Missouri, USA
| | - Simon Haroutounian
- Department of Anesthesiology and Washington University Pain Center, Washington University School of Medicine, St Louis, Missouri, USA
| | - Patricia Zorn
- Patricia Zorn Center for Physical Therapy and Spine Rehabilitation, St Louis, Missouri, USA
| | - Abby Cheng
- Department of Orthopedic Surgery, Washington University School of Medicine, St Louis, Missouri, USA
| | - John C Clohisy
- Department of Orthopedic Surgery, Washington University School of Medicine, St Louis, Missouri, USA
| | - Marcie Harris-Hayes
- Program in Physical Therapy, Washington University School of Medicine, St Louis, Missouri, USA
- Department of Orthopedic Surgery, Washington University School of Medicine, St Louis, Missouri, USA
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Enseki KR, Bloom NJ, Harris-Hayes M, Cibulka MT, Disantis A, Di Stasi S, Malloy P, Clohisy JC, Martin RL. Hip Pain and Movement Dysfunction Associated With Nonarthritic Hip Joint Pain: A Revision. J Orthop Sports Phys Ther 2023; 53:CPG1-CPG70. [PMID: 37383013 DOI: 10.2519/jospt.2023.0302] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/30/2023]
Abstract
The Academy of Orthopaedic Physical Therapy (AOPT), formerly the Orthopaedic Section of the American Physical Therapy Association (APTA), has an ongoing effort to create evidence-based practice guidelines for orthopaedic physical therapy management of patients with musculoskeletal impairments described in the World Health Organization's International Classification of Functioning, Disability, and Health (ICF). This is an update to the 2014 Clinical Practice Guideline (CPG) for Hip Pain and Movement Dysfunction Associated with Nonarthritic Hip Joint Pain. The goals of the revision were to provide a concise summary of the contemporary evidence since publication of the original guideline and to develop new recommendations or revise previously published recommendations to support evidence-based practice. This current CPG covers pathoanatomical features, clinical course, prognosis, diagnosis, examination, and physical therapy interventions in the management of nonarthritic hip joint pain. J Orthop Sports Phys Ther 2023;53(7):CPG1-CPG70. doi:10.2519/jospt.2023.0302.
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Hall A, Dandu N, Sonnier JH, Rao S, Holston K, Liu J, Freedman K, Tjoumakaris F. The Influence of Psychosocial Factors on Hip Surgical Disorders and Outcomes After Hip Arthroscopy: A Systematic Review. Arthroscopy 2022; 38:3194-3206. [PMID: 35660519 DOI: 10.1016/j.arthro.2022.05.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/19/2021] [Revised: 05/02/2022] [Accepted: 05/12/2022] [Indexed: 02/02/2023]
Abstract
PURPOSE To systematically review the associations between mental health and preoperative or postoperative outcomes of hip arthroscopy for femoroacetabular impingement. METHODS The literature search was conducted using the PubMed, EMBASE and PsychINFO databases following the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-analyses) guidelines. RESULTS Nine studies were identified that met the inclusion and exclusion criteria. All studies assessing patient-reported outcomes found significantly lower patient-reported outcomes (modified Harris Hip Score, Hip Outcome Score-Activities of Daily Living, Hip Outcome Score-Sports-Specific Subscale, and International Hip Outcome Tool scores) related to worse mental health functioning before surgery. Specifically, preoperative Hip Outcome Score-Activities of Daily Living and Hip Outcome Score-Sports-Specific Subscale were significantly greater in control patients than patients in the mental health group by 11.6 points (mean difference; 95% confidence interval 7.58-15.79, P < .001) and 10 points (95% confidence interval 5.14-14.87, P < .001), without significant heterogeneity between studies (I2 = 28.59, P = .25; I2 = 0, P = .93), respectively. Patients with lower mental health status also had lower rates of achieving a minimal clinically important difference in 5 studies included in this review. CONCLUSIONS This systematic review finds consistent evidence supporting the association between negative psychological function and worse preoperative and postoperative outcomes for patients with hip disorders. Understanding both the effect of mental health on surgical outcomes and the potential benefits of psychological intervention may represent an opportunity to improve patient outcomes following hip arthroscopy. LEVEL OF EVIDENCE IV, systematic review of Level II-IV studies.
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Affiliation(s)
- Anya Hall
- Rothman Orthopaedic Institute, Philadelphia, Pennsylvania, U.S.A
| | - Navya Dandu
- Rothman Orthopaedic Institute, Philadelphia, Pennsylvania, U.S.A
| | | | - Somnath Rao
- Rothman Orthopaedic Institute, Philadelphia, Pennsylvania, U.S.A
| | - Kayla Holston
- Rothman Orthopaedic Institute, Philadelphia, Pennsylvania, U.S.A
| | - James Liu
- Rothman Orthopaedic Institute, Philadelphia, Pennsylvania, U.S.A
| | - Kevin Freedman
- Rothman Orthopaedic Institute, Philadelphia, Pennsylvania, U.S.A
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Kaveeshwar S, Rocca MP, Oster BA, Schneider MB, Tran A, Kolevar MP, Adib F, Henn RF, Meredith SJ. Depression and anxiety are associated with worse baseline function in hip arthroscopy patients. Knee Surg Sports Traumatol Arthrosc 2022; 30:3563-3569. [PMID: 35416491 DOI: 10.1007/s00167-022-06963-y] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/19/2021] [Accepted: 03/25/2022] [Indexed: 10/18/2022]
Abstract
PURPOSE The purpose of this study was to analyze the correlation between baseline depression and anxiety and preoperative functional status in hip arthroscopy patients. METHODS A prospective, institutional review board-approved orthopaedic registry was used to retrospectively study 104 patients undergoing hip arthroscopy. Enrolled patients were administered baseline questionnaires for Patient-Reported Outcomes Measurement Information System (PROMIS) domains, Musculoskeletal Outcomes Data Evaluation and Management System (MODEMS) preoperative expectations, and Numeric Pain Scale (NPS). RESULTS The average baseline PROMIS Depression and Anxiety scores were 49.9 ± 9.8 and 55.5 ± 9.3, respectively. Bivariate analysis demonstrated that greater baseline PROMIS Anxiety correlated with worse preoperative PROMIS PI (p < 0.001), Fatigue (p < 0.001), Social Satisfaction (p < 0.001), and NPS score (p = 0.013). Bivariate analysis showed that greater PROMIS Depression correlated with worse preoperative PROMIS PF (p = 0.001), PI (p < 0.001), Fatigue (p < 0.001), SS (p < 0.001), and NPS score (p = 0.004). After controlling for confounders, multivariable analysis confirmed increased PROMIS Depression as an independent predictor of worse preoperative PROMIS PF (p = 0.009), MODEMS Expectations (p = 0.025), and NPS score (p = 0.002). Increased PROMIS Anxiety was predictive of worse baseline PROMIS PI (p < 0.001), Fatigue (p < 0.001), and Social Satisfaction (p < 0.001). A previous clinical diagnosis of depression or anxiety was only an independent predictor of worse baseline PROMIS Fatigue (p = 0.002) and was insignificant in all other models. CONCLUSION Increasing severity of depression and anxiety correlated with and predicted worse functional status at baseline in hip arthroscopy patients. As compared to clinical diagnosis of anxiety and depression, PROMIS metrics have superior utility in recognizing potentially modifiable mental health concerns that predict worse preoperative status. Ultimately, the study identifies an at-risk population undergoing hip arthroscopy that requires particular attention and potential mental health intervention in the preoperative setting. LEVEL OF EVIDENCE III.
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Affiliation(s)
- Samir Kaveeshwar
- Department of Orthopaedics, University of Maryland School of Medicine, 2200 Kernan Drive, Baltimore, MD, 21207, USA
| | - Michael P Rocca
- Department of Orthopaedics, University of Maryland School of Medicine, 2200 Kernan Drive, Baltimore, MD, 21207, USA
| | - Brittany A Oster
- Department of Orthopaedics, University of Maryland School of Medicine, 2200 Kernan Drive, Baltimore, MD, 21207, USA
| | - Matheus B Schneider
- Department of Orthopaedics, University of Maryland School of Medicine, 2200 Kernan Drive, Baltimore, MD, 21207, USA
| | - Andrew Tran
- Department of Orthopaedics, University of Maryland School of Medicine, 2200 Kernan Drive, Baltimore, MD, 21207, USA
| | - Matthew P Kolevar
- Department of Orthopaedics, University of Maryland School of Medicine, 2200 Kernan Drive, Baltimore, MD, 21207, USA
| | - Farshad Adib
- Department of Orthopaedics, University of Maryland School of Medicine, 2200 Kernan Drive, Baltimore, MD, 21207, USA
| | - R Frank Henn
- Department of Orthopaedics, University of Maryland School of Medicine, 2200 Kernan Drive, Baltimore, MD, 21207, USA
| | - Sean J Meredith
- Department of Orthopaedics, University of Maryland School of Medicine, 2200 Kernan Drive, Baltimore, MD, 21207, USA.
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Saks BR, Glein RM, Jimenez AE, Ankem HK, Sabetian PW, Maldonado DR, Lall AC, Domb BG. Patients Obtain Meaningful Clinical Benefit After Hip Arthroscopy Despite Preoperative Psychological Distress: A Propensity-Matched Analysis of Mid-Term Outcomes. Arthroscopy 2022; 38:773-782. [PMID: 34019982 DOI: 10.1016/j.arthro.2021.05.010] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/08/2021] [Revised: 04/20/2021] [Accepted: 05/05/2021] [Indexed: 02/02/2023]
Abstract
PURPOSE To evaluate the influence of baseline psychological distress on patient-reported outcomes (PROs) after arthroscopic hip surgery for femoroacetabular impingement at a minimum of 5 years. METHODS Demographic and intraoperative data were prospectively collected from patients who underwent primary arthroscopic hip surgery for femoroacetabular impingement and labral tears after failure of conservative management between June 2012 and December 2014. Included patients had preoperative and minimum 5-year postoperative PROs and visual analog scale scores for pain and satisfaction. The 12-item Short Form Health Survey (SF-12) Mental Component Summary (MCS) score was used to stratify patients into 2 cohorts: Patients with an average or above-average score (SF-12 MCS score ≥ 50) were considered psychologically non-distressed, whereas those who scored below average (SF-12 MCS score < 50) were considered to have psychological distress. Distressed patients were propensity matched by age, sex, and body mass index to an equal number of non-distressed patients. RESULTS Of the 153 hips that met the inclusion criteria, 117 (76.5%) had minimum 5-year follow-up. Eighty-two hips were included in the final analysis after propensity matching, with 41 in both the distressed and non-distressed cohorts. Preoperatively, patients in the distressed cohort reported inferior scores for all PROs. There was a significant difference in the SF-12 MCS score between groups at 2 years, but similar scores were observed for all other PROs. At minimum 5-year follow-up, there were no differences between groups for any PRO. There were no differences in the rates of achieving the minimal clinically important difference for all PROs or in achieving the patient acceptable symptomatic state for the modified Harris Hip Score. CONCLUSIONS Patients with baseline psychological distress may have a lower functional status at the time of presentation but still gain meaningful clinical benefit and pain improvement from arthroscopic hip surgery, with mid-term outcomes comparable to those obtained by patients without preoperative psychological distress. LEVEL OF EVIDENCE Level III, retrospective comparative study.
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Affiliation(s)
- Benjamin R Saks
- American Hip Institute Research Foundation, Chicago, Illinois, U.S.A.; AMITA Health St. Alexius Medical Center, Hoffman Estates, Illinois, U.S.A
| | - Rachel M Glein
- American Hip Institute Research Foundation, Chicago, Illinois, U.S.A
| | - Andrew E Jimenez
- American Hip Institute Research Foundation, Chicago, Illinois, U.S.A
| | - Hari K Ankem
- American Hip Institute Research Foundation, Chicago, Illinois, U.S.A
| | - Payam W Sabetian
- American Hip Institute Research Foundation, Chicago, Illinois, U.S.A
| | - David R Maldonado
- American Hip Institute Research Foundation, Chicago, Illinois, U.S.A
| | - Ajay C Lall
- American Hip Institute Research Foundation, Chicago, Illinois, U.S.A.; American Hip Institute, Chicago, Illinois, U.S.A
| | - Benjamin G Domb
- American Hip Institute Research Foundation, Chicago, Illinois, U.S.A.; American Hip Institute, Chicago, Illinois, U.S.A..
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Zacharias AJ, Lemaster NG, Hawk GS, Duncan ST, Thompson KL, Jochimsen KN, Stone AV, Jacobs CA. Psychological Healthcare Burden Lessens After Hip Arthroscopy for Those With Comorbid Depression or Anxiety. Arthrosc Sports Med Rehabil 2021; 3:e1171-e1175. [PMID: 34430898 PMCID: PMC8365206 DOI: 10.1016/j.asmr.2021.05.005] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2020] [Accepted: 05/14/2021] [Indexed: 11/30/2022] Open
Abstract
Purpose In this study, we investigated whether patients undergoing arthroscopic treatment of femoral acetabular impingement syndrome (FAIS) seek health care for treatment of comorbid depression and anxiety in the year following hip arthroscopy. Methods Using the Truven Health Marketscan database, FAIS patients who underwent hip arthroscopy between January 2009 and December 2016 were identified. Claims related to depression or anxiety filed during the year before surgery were required for inclusion. Using claims for pharmaceutical and psychological therapy treatments for mental health disorders, four groups of patients were analyzed on the basis of preoperative anxiety/depression treatment: medication only, therapy only, medication + therapy, and no treatment. Number of opioid pain prescriptions within 180 days prior to surgery and >90 days after hip arthroscopy were also compared. Results Depression and anxiety claims were identified in 5,208/14,830 (35.1%) patients. Preoperative treatment for depression and anxiety included medication only (n = 648, 12.4%), therapy only (n = 899, 17.3%), medication + therapy (n = 252, 4.8%), and no treatment (n = 3,409, 65.5%). Of the 900 patients who filled an anxiety/depression-related prescription prior to surgery, 422 (46.9%) patients did not fill a similar prescription in the postoperative year. Of the 1,151 patients receiving anxiety/depression-related therapy prior to surgery, 549 (47.7%) did not receive therapy in the postoperative year. Preoperative opioid prescriptions were filled for 393 patients (60.6%) in medication-only group, 275 (30.6%) in therapy-only group, 156 (61.9%) in medication + therapy group, and 1,059 (31.1%) in the group receiving no treatment. Opioid prescriptions >90 days postoperatively were filled for 330 (50.9%), 225 (25.0%), 120 (47.6%), and 861 (25.3%) patients, respectively. Conclusion Hip arthroscopy for FAIS is associated with a decreased postoperative use of health care resources for the treatment of depression and anxiety. Clinicians should also be aware of the potential interplay between preoperative psychotropic medication use and prolonged opioid use when counseling patients. Level of Evidence IV, therapeutic case series.
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Affiliation(s)
- Anthony J Zacharias
- Department of Orthopaedic Surgery & Sports Medicine, University of Kentucky, Lexington, Kentucky, U.S.A
| | - Nicole G Lemaster
- Department of Rehabilitation Science, University of Kentucky, Lexington, Kentucky, U.S.A
| | - Gregory S Hawk
- Department of Statistics, University of Kentucky, Lexington, Kentucky, U.S.A
| | - Stephen T Duncan
- Department of Orthopaedic Surgery & Sports Medicine, University of Kentucky, Lexington, Kentucky, U.S.A
| | | | - Kate N Jochimsen
- Division of Athletic Training, West Virginia University, Morgantown, West Virginia, U.S.A
| | - Austin V Stone
- Division of Sports Medicine, Department of Orthopaedic Surgery & Sports Medicine, University of Kentucky, Lexington, Kentucky, U.S.A
| | - Cale A Jacobs
- Department of Orthopaedic Surgery & Sports Medicine, University of Kentucky, Lexington, Kentucky, U.S.A
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Weber AE, Bolia IK, Mayfield CK, Ihn H, Kang HP, Bedi A, Nho SJ, Philippon MJ. Can We Identify Why Athletes Fail to Return to Sport After Hip Arthroscopy for Femoroacetabular Impingement Syndrome? A Systematic Review and Meta-analysis. Am J Sports Med 2021; 49:1651-1658. [PMID: 33017544 DOI: 10.1177/0363546520956292] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND No previous systematic review has focused on the athletes who fail to return to sport after hip arthroscopy for femoroacetabular impingement syndrome (FAIS). PURPOSE To review the literature on the athletes who fail to return to sport after hip arthroscopy for FAIS to determine the rate of nonreturning athletes and explore the reasons for their inability to return to sport after arthroscopic FAI surgery. STUDY DESIGN Systematic review and meta-analysis. METHODS Three electronic databases were searched for eligible articles. Two reviewers independently screened the titles, abstracts, and full-text articles using prespecified criteria. Eligible articles were those that clearly stated the rate of athletes who did not return to sport after hip arthroscopy for FAIS. Data collected were the rate of patients who did not return to sport, the level of competition (high level, recreational, or mixed), the type of sport, comments on patients who did not return to sport, the rate of subsequent hip surgeries (total hip replacement or revision hip arthroscopy) in nonreturning athletes, and the reported reason for not returning to sport. A random-effects model was used for meta-analysis. RESULTS Twenty studies were eligible for inclusion, and 1093 athletes were analyzed. The weighted rate of athletes who did not return to sport after hip arthroscopy for FAIS was 12.1% (95% CI, 7.7-17.4). Only 2 studies (2/20;10%) reported the age of the athletes who did not return, while sex was reported in 3 studies (3/20;15%). The estimated proportion of athletes who did not return to sport because of hip-related issues was significantly greater than the percentage of athletes who did not return for reasons unrelated to their hip (74.3% vs 22.3%; P < .0001). Persistent hip pain was the most commonly reported factor (52/110 patients; 47.2%) associated with failure to return to sport. Whether the nonreturning athletes underwent any subsequent hip procedure after hip arthroscopy for FAIS was reported in only 4 out of 20 studies (20%). There was evidence of publication bias and study heterogeneity. CONCLUSION The estimated rate of athletes who did not return to sport after hip arthroscopy for FAIS was 12%, with the majority of athletes being unable to return because of persistent hip pain. There is a severe lack of evidence on the athlete characteristics and clinical course of the nonreturning athletes, and the rate of subsequent hip procedures is unknown. The outcomes and reasons for athletes not returning to sport should be reported in detail to improve patient care.
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Affiliation(s)
- Alexander E Weber
- USC Epstein Family Center for Sports Medicine at Keck Medicine of USC, Los Angeles, California, USA
| | - Ioanna K Bolia
- USC Epstein Family Center for Sports Medicine at Keck Medicine of USC, Los Angeles, California, USA
| | - Cory K Mayfield
- USC Epstein Family Center for Sports Medicine at Keck Medicine of USC, Los Angeles, California, USA
| | - Hansel Ihn
- USC Epstein Family Center for Sports Medicine at Keck Medicine of USC, Los Angeles, California, USA
| | - Hyunwoo P Kang
- USC Epstein Family Center for Sports Medicine at Keck Medicine of USC, Los Angeles, California, USA
| | - Asheesh Bedi
- Department of Orthopaedic Surgery, University of Michigan Medical School, Ann Arbor, Michigan, USA
| | - Shane Jay Nho
- Midwest Orthopaedics at Rush, Chicago, Illinois, USA
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Cheng AL, Schwabe M, Doering MM, Colditz GA, Prather H. The Effect of Psychological Impairment on Outcomes in Patients With Prearthritic Hip Disorders: A Systematic Review and Meta-analysis. Am J Sports Med 2020; 48:2563-2571. [PMID: 31829034 DOI: 10.1177/0363546519883246] [Citation(s) in RCA: 33] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND Recent studies have suggested that mental health disorders negatively affect postoperative outcomes in patients with femoroacetabular impingement (FAI). However, the outcome measures reported and the effect sizes have varied. Furthermore, it is unknown whether similar effects are present in young adults with other hip disorders such as acetabular dysplasia. PURPOSE To synthesize current evidence regarding the effect of baseline psychological impairment on postintervention outcomes in patients with prearthritic hip disorders. STUDY DESIGN Systematic review and meta-analysis. METHODS In February 2019, the Ovid Medline, Embase, Scopus, Cochrane Central Register of Controlled Trials, Cochrane Database of Systematic Reviews, and ClinicalTrials.gov databases were searched for longitudinal studies that evaluated the effect of baseline psychological impairment (such as depression or anxiety) on a postintervention clinical outcome in patients with prearthritic hip disorders including FAI, acetabular dysplasia, and/or acetabular labral tears. Descriptive measures of study quality and bias were recorded, and studies that reported statistically comparable outcomes were analyzed in meta-analyses through use of random effects models. RESULTS We identified 12 eligible studies, all of which specifically evaluated patients with FAI after hip arthroscopy. No eligible studies described patients with acetabular dysplasia. Of the included studies, 8 studies reported odds ratios (ORs). The other 4 studies reported mean postoperative scores on patient-reported outcome measures (PROMs), all of which were scored from 0 to 100, with higher numbers being favorable. Patients with psychological impairment were less likely to achieve a favorable outcome after arthroscopy (OR, 0.74; 95% CI, 0.62 to 0.88; P < .001), and they reported worse postoperative PROM scores compared with nonimpaired patients (weighted mean difference, -20.2 points; 95% CI, -32.9 to -7.5; P < .001). CONCLUSION Baseline psychological impairment is associated with clinically significantly worse outcomes in patients with femoroacetabular impingement who undergo hip arthroscopy. More standardized reporting would facilitate improved understanding of this important, potentially modifiable risk factor. REGISTRATION CRD42019124836 (PROSPERO).
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Affiliation(s)
- Abby L Cheng
- Division of Physical Medicine and Rehabilitation, Department of Orthopaedic Surgery, Washington University School of Medicine, St Louis, Missouri, USA
| | - Maria Schwabe
- Washington University School of Medicine, St Louis, Missouri, USA
| | - Michelle M Doering
- Bernard Becker Medical Library, Washington University School of Medicine, St Louis, Missouri, USA
| | - Graham A Colditz
- Division of Public Health Sciences, Department of Surgery, Washington University School of Medicine, St Louis, Missouri, USA
| | - Heidi Prather
- Division of Physical Medicine and Rehabilitation, Department of Orthopaedic Surgery, Washington University School of Medicine, St Louis, Missouri, USA
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Nwachukwu BU, Beck EC, Lee EK, Cancienne JM, Waterman BR, Paul K, Nho SJ. Application of Machine Learning for Predicting Clinically Meaningful Outcome After Arthroscopic Femoroacetabular Impingement Surgery. Am J Sports Med 2020; 48:415-423. [PMID: 31869249 DOI: 10.1177/0363546519892905] [Citation(s) in RCA: 49] [Impact Index Per Article: 12.3] [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 has become an important tool for surgical treatment of intra-articular hip pathology. Predictive models for clinically meaningful outcomes in patients undergoing hip arthroscopy for femoroacetabular impingement syndrome (FAIS) are unknown. PURPOSE To apply a machine learning model to determine preoperative variables predictive for achieving the minimal clinically important difference (MCID) at 2 years after hip arthroscopy for FAIS. STUDY DESIGN Case-control study; Level of evidence, 3. METHODS Data were analyzed for patients who underwent hip arthroscopy for FAIS by a high-volume fellowship-trained surgeon between January 2012 and July 2016. The MCID cutoffs for the Hip Outcome Score-Activities of Daily Living (HOS-ADL), HOS-Sport Specific (HOS-SS), and modified Harris Hip Score (mHHS) were 9.8, 14.4, and 9.14, respectively. Predictive models for achieving the MCID with respect to each were built with the LASSO algorithm (least absolute shrinkage and selection operator) for feature selection, followed by logistic regression on the selected features. Study data were analyzed with PatientIQ, a cloud-based research and analytics platform for health care. RESULTS Of 1103 patients who met inclusion criteria, 898 (81.4%) had a minimum of 2-year reported outcomes and were entered into the modeling algorithm. A total of 74.0%, 73.5%, and 79.9% met the HOS-ADL, HOS-SS, and mHHS threshold scores for achieving the MCID. Predictors of not achieving the HOS-ADL MCID included anxiety/depression, symptom duration for >2 years before surgery, higher body mass index, high preoperative HOS-ADL score, and preoperative hip injection (all P < .05). Predictors of not achieving the HOS-SS MCID included anxiety/depression, preoperative symptom duration for >2 years, high preoperative HOS-SS score, and preoperative hip injection, while running at least at the recreational level was a predictor of achieving HOS-SS MCID (all P < .05). Predictors of not achieving the mHHS MCID included history of anxiety or depression, high preoperative mHHS score, and hip injections, while being female was predictive of achieving the MCID (all P < .05). CONCLUSION This study identified predictive variables for achieving clinically meaningful outcome after hip arthroscopy for FAIS. Patient factors including anxiety/depression, symptom duration >2 years, preoperative intra-articular injection, and high preoperative outcome scores are most consistently predictive of inability to achieve clinically meaningful outcome. These findings have important implications for shared decision-making algorithms and management of preoperative expectations after hip arthroscopy for FAI.
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Affiliation(s)
- Benedict U Nwachukwu
- Division of Sports Medicine, Department of Orthopedic Surgery, Hospital for Special Surgery, New York, New York, USA
| | - Edward C Beck
- Division of Sports Medicine, Department of Orthopedic Surgery, Wake Forest Baptist Health, Winston-Salem, North Carolina, USA
| | | | - Jourdan M Cancienne
- Division of Sports Medicine, Department of Orthopedic Surgery, Rush University Medical Center, Chicago, Illinois, USA
| | - Brian R Waterman
- Division of Sports Medicine, Department of Orthopedic Surgery, Wake Forest Baptist Health, Winston-Salem, North Carolina, USA
| | - Katlynn Paul
- Division of Sports Medicine, Department of Orthopedic Surgery, Rush University Medical Center, Chicago, Illinois, USA
| | - Shane J Nho
- Division of Sports Medicine, Department of Orthopedic Surgery, Rush University Medical Center, Chicago, Illinois, USA
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