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Domb BG, Owens JS, Maldonado DR, Harris WT, Perez-Padilla PA, Sabetian PW. Favorable and Durable Outcomes at 10-Year Follow-Up After Endoscopic Gluteus Medius Repair With Concomitant Hip Arthroscopy. Arthroscopy 2024; 40:2215-2224. [PMID: 37967732 DOI: 10.1016/j.arthro.2023.10.049] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/22/2022] [Revised: 10/23/2023] [Accepted: 10/26/2023] [Indexed: 11/17/2023]
Abstract
PURPOSE To evaluate 10-year patient-reported outcome (PRO) scores following endoscopic surgery for gluteus medius partial and full-thickness tears with concomitant hip arthroscopy for labral tears and/or femoroacetabular impingement syndrome (FAIS). METHODS Prospectively collected data on patients followed for a minimum of 10 years after endoscopic gluteus medius repair with concomitant hip arthroscopy performed by a single surgeon were retrospectively analyzed. Patients with preoperative and 10-year follow-up for the following PROs were included: modified Harris Hip Score (mHHS), Nonarthritic Hip Score (NAHS), Hip Outcome Score-Sports Specific Subscale (HOS-SSS), and Visual Analog Scale (VAS) score for pain. RESULTS There were 13 patients eligible for inclusion, 11 (84.6%) of whom had 10-year follow up, with a mean of 127.6 months (range: 120.0-140.2 months). The group consisted of 10 females (90.9%) and one male (9.1%) with a mean age at surgery of 60.1 years (range: 46.2-74.8 years). PRO scores improved from preoperative to 10-year follow-up as follows: mHHS from 60.4 to 88.0 (P = .011); NAHS from 50.1 to 90.6 (P < .001); HOS-SS from 37.5 to 85.1 (P = .001); and VAS from 4.8 to 1.2 (P = .006). Mean patient satisfaction rating was 8.3. Patients achieved PASS and MCID for mHHS and HOS-SSS at a rate of 81.8%. There was no significant decline in PROs or satisfaction between 2, 5, and 10 years postoperatively. All patients underwent concomitant hip arthroscopy and labral treatment (debridement or repair). One patient, who had arthroscopic findings of acetabular and femoral outerbridge grade 4 lesions, subsequently underwent total hip arthroplasty; however, the GM was assessed during the THA, and it was verified that the repair was intact. There were no clinical failures, secondary operations, or complications. CONCLUSIONS Endoscopic repair of gluteus medius tears is a safe procedure with favorable and durable long-term outcomes at minimum 10-year follow-up. LEVEL OF EVIDENCE Level IV, therapeutic case series.
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Affiliation(s)
- Benjamin G Domb
- American Hip Institute Research Foundation, Chicago, Illinois, U.S.A.; American Hip Institute, Chicago, Illinois, U.S.A..
| | - Jade S Owens
- American Hip Institute Research Foundation, Chicago, Illinois, U.S.A
| | - David R Maldonado
- American Hip Institute Research Foundation, Chicago, Illinois, U.S.A
| | - W Taylor Harris
- American Hip Institute Research Foundation, Chicago, Illinois, U.S.A
| | | | - Payam W Sabetian
- American Hip Institute Research Foundation, Chicago, Illinois, U.S.A
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Domb BG, Lee MS, Owens JS, Harris WT. Long-term Survivorship and Outcomes of Patients Without Dysplasia Undergoing Capsular Repair During Primary Hip Arthroscopy for Femoroacetabular Impingement Syndrome. Am J Sports Med 2024; 52:2037-2045. [PMID: 38828912 DOI: 10.1177/03635465241248603] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/05/2024]
Abstract
BACKGROUND There is a paucity of literature evaluating long-term outcomes and survivorship of patients undergoing primary hip arthroscopy with capsular repair for femoroacetabular impingement syndrome (FAIS). PURPOSE To report 10-year survivorship and patient-reported outcomes (PROs) after primary hip arthroscopy with capsular repair for FAIS and evaluate the effect of capsular repair in patients at the highest risk for conversion to arthroplasty. STUDY DESIGN Cohort study; Level of evidence, 3. METHODS Data were prospectively collected and retrospectively reviewed on all patients undergoing primary hip arthroscopy with capsular repair between October 2008 and February 2011. Patients with a minimum 10-year follow-up on the modified Harris Hip Score (mHHS), Nonarthritic Hip Score (NAHS), and visual analog scale for pain (VAS) scores were selected. The preoperative and minimum 10-year follow-up Hip Outcome Score-Sports Specific Subscale (HOS-SSS) scores were also reported, if available. Patients with ipsilateral hip surgery, worker's compensation, Tönnis osteoarthritis grade >1, and hip dysplasia (lateral center-edge angle <25°) were excluded. Survivorship, PROS, and clinical benefit-minimal clinically important difference (MCID) and Patient Acceptable Symptom State (PASS)-were reported. An additional propensity-matched subanalysis was performed on patients at the highest risk for conversion to arthroplasty, comparing patients undergoing capsular repair to patients with unrepaired capsules. RESULTS A total of 145 (n = 130 patients) out of 180 eligible hips (n = 165 patients) had a minimum 10-year follow-up (80.6%). Also, 126 hips (86.9%) belonged to women, and 19 hips (13.1%) belonged to men. The mean patient age was 30.3 ± 12.9 years. The survivorship rate was 91% at the 10-year follow-up. The cohort experienced significant improvements (P < .001) in the mHHS, NAHS, HOS-SSS, and VAS for pain scores. Moreover, the cohort achieved high rates of the PASS for the mHHS (89.8%), high rates of the MCID for the mHHS (82.4%), and high rates of the MCID for VAS for pain (80.6%) scores. In the propensity-matched subanalysis performed on patients with the highest risk for arthroplasty, 29 hips with capsular repair were matched to 81 hips with unrepaired capsules. While both groups experienced significant improvements in all PROs (P < .05), the group without capsule repair trended toward a higher conversion to arthroplasty rate when compared with the repair group. In addition, an odds ratio was calculated for the likelihood of converting to arthroplasty after having an unrepaired capsule compared with capsular repair (2.54 [95% CI, 0.873-7.37]; P = .087). CONCLUSION Patients undergoing primary hip arthroscopy with capsular repair experienced a high survivorship rate of 91% at a minimum 10-year follow-up. Patients who did not convert to arthroplasty saw favorable improvements in PROs and achieved high clinical benefit rates. In addition, among those patients at the highest risk for conversion to arthroplasty, a trend toward greater survivorship was observed with capsular repair.
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Affiliation(s)
- Benjamin G Domb
- American Hip Institute Research Foundation, Chicago, Illinois, USA
- American Hip Institute, Chicago, Illinois, USA
| | - Michael S Lee
- American Hip Institute Research Foundation, Chicago, Illinois, USA
| | - Jade S Owens
- American Hip Institute Research Foundation, Chicago, Illinois, USA
| | - W Taylor Harris
- American Hip Institute Research Foundation, Chicago, Illinois, USA
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Heifner JJ, Keller LM, Grewal G, Davis TA, Brutti J, Hommen JP. Characterizations of Capsule Closure in Hip Arthroscopy Are Infrequently and Incompletely Reported: A Systematic Review. Arthrosc Sports Med Rehabil 2024; 6:100820. [PMID: 39006782 PMCID: PMC11240021 DOI: 10.1016/j.asmr.2023.100820] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2023] [Accepted: 10/10/2023] [Indexed: 07/16/2024] Open
Abstract
Purpose To review the recent literature to provide an updated characterization of capsule closure techniques in hip arthroscopy and to determine if the characteristics of closure impacted clinical outcomes. Methods In keeping with the Preferred Reporting in Systematic Reviews and Meta Analyses (PRISMA) guidelines, a systematic review was performed with the following eligibility criteria: patients over 18 years of age who underwent primary hip arthroscopy with reporting of patient reported outcome measures or revision/failure, and a sufficiently detailed description of capsule closure. The GRADE framework evaluated study quality, and ROBINS-I evaluated the risk of bias. Results Across 18 studies (N = 3277) an interportal capsulotomy was reported in 12 studies (1972/3277) cases, and a T-type capsulotomy was reported in six studies (1305/3277) cases). Six studies reported using #2 suture. Nonabsorbable suture was reported in six studies, and absorbable suture in six studies. The rate of failure was 10.5% across five studies (N = 1133) and the rate of revision was 4.4% across 13 studies (N = 2957). Conclusions Capsule closure is commonly performed with #2 high strength suture-the T-type using two to three sutures in the vertical limb and two to three in the transverse limb, and the interportal type using two to three sutures. Compared to earlier reports, there is a trend for increased utilization of T-type capsulotomy. Although there is a growing body of investigations into the efficacy of routine capsule closure following hip arthroscopy, our results demonstrate infrequent and inconsistent reporting of capsule closure characteristics. Level of Evidence Level IV, systematic review of Level I-IV studies.
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Affiliation(s)
- John J. Heifner
- Miami Orthopaedic Research Foundation, Miami, Florida, U.S.A
| | - Leah M. Keller
- Lake Erie College of Osteopathic Medicine, Erie, Pennsylvania, U.S.A
| | - Gagan Grewal
- Larkin Hospital Department of Orthopaedic Surgery, Coral Gables, Florida, U.S.A
| | - Ty A. Davis
- Larkin Hospital Department of Orthopaedic Surgery, Coral Gables, Florida, U.S.A
| | | | - Jan Pieter Hommen
- Larkin Hospital Department of Orthopaedic Surgery, Coral Gables, Florida, U.S.A
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Shen LY, Li QR, Xue XA, Li H, Li HY. Capsular Repair Versus No Repair After Hip Arthroscopy in Patients Without Dysplasia or Generalized Ligamentous Laxity: A Systematic Review and Meta-analysis. Orthop J Sports Med 2024; 12:23259671241251413. [PMID: 38831873 PMCID: PMC11144363 DOI: 10.1177/23259671241251413] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/05/2023] [Accepted: 11/14/2023] [Indexed: 06/05/2024] Open
Abstract
Background Many recent studies have shown that patients who undergo capsular repair after hip arthroscopy achieve superior clinical outcomes compared with those who do not. However, patients with dysplasia or generalized ligamentous laxity (GLL) were not excluded from most of these studies, which may have affected the outcomes. Purpose To determine whether capsular repair influences the outcomes of hip arthroscopy for patients without dysplasia or GLL. Study Design Systematic review; Level of evidence, 1. Methods Under the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines, randomized controlled trials comparing the outcomes of capsulotomy with versus without repair were included, but studies that included patients with dysplasia or GLL were excluded. The study outcomes were patient-reported outcome measures (PROMs) at 6 months and 2 years postoperatively-including the modified Harris Hip Score (mHHS), Hip Outcome Score-Activities of Daily Living (HOS-ADL), and Hip Outcome Score-Sport-Specific Subscale (HOS-SSS)- and were compared between the repair and no-repair groups. A narrative analysis and meta-analysis were performed to integrate and compare the results of the 2 groups. In the meta-analysis of the outcome measures, studies with significant differences in the preoperative scores between the repair and no-repair groups were excluded because previous studies have shown that these can affect the outcomes. Results A total of 761 studies were initially identified, of which 3 were included. Of the 322 included patients, 136 underwent capsular repair, and 186 underwent capsulotomy with no repair. The meta-analysis showed that capsular repair was associated with significantly higher postoperative PROMs: the mHHS at 2 years (P = .03), the HOS-ADL at 6 months (P = .02) and 2 years (P < .0001), and the HOS-SSS at 6 months (P = .02) and 2 years (P = .001). Conclusion Capsular repair after hip arthroscopy was associated with superior clinical outcomes when compared with no capsular repair in patients without dysplasia or GLL.
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Affiliation(s)
- Lin-Yi Shen
- Sports Medicine Institute of Fudan University, Shanghai, China
- Department of Sports Medicine and Arthroscopy Surgery, Huashan Hospital of Fudan University, Shanghai, China
| | - Qian-Ru Li
- Sports Medicine Institute of Fudan University, Shanghai, China
- Department of Sports Medicine and Arthroscopy Surgery, Huashan Hospital of Fudan University, Shanghai, China
| | - Xiao-Ao Xue
- Sports Medicine Institute of Fudan University, Shanghai, China
- Department of Sports Medicine and Arthroscopy Surgery, Huashan Hospital of Fudan University, Shanghai, China
| | - Hong Li
- Sports Medicine Institute of Fudan University, Shanghai, China
- Department of Sports Medicine and Arthroscopy Surgery, Huashan Hospital of Fudan University, Shanghai, China
| | - Hong-Yun Li
- Sports Medicine Institute of Fudan University, Shanghai, China
- Department of Sports Medicine and Arthroscopy Surgery, Huashan Hospital of Fudan University, Shanghai, China
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Hapa O, Aydemir S, Akdogan AI, Celtik M, Aydin O, Gocer B, Gursan O. Eighty-One Percent of Unrepaired Interportal Capsulotomies Showed Healed Capsules on Magnetic Resonance Imaging 5 Years After Primary Hip Arthroscopy. Arthrosc Sports Med Rehabil 2024; 6:100943. [PMID: 39006785 PMCID: PMC11240033 DOI: 10.1016/j.asmr.2024.100943] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2023] [Accepted: 04/02/2024] [Indexed: 07/16/2024] Open
Abstract
Purpose To evaluate whether unrepaired interportal capsulotomy presents with capsular defect on magnetic resonance imaging (MRI) 5 years after primary hip arthroscopy and to determine its effect on functional results and findings of osteoarthritis on radiographs or MRI scans. Methods Patients with femoroacetabular impingement (without arthritis or dysplasia) were retrospectively reviewed after arthroscopic labral repair or debridement and femoroplasty through interportal capsulotomy without closure. Patients were assessed preoperatively and at a minimum of 5 years postoperatively using patient-reported outcomes (Hip Outcome Score-Activities of Daily Living scale, modified Harris Hip Score, and visual analog scale pain score), radiographic measures, and MRI scans. Results Forty patients (42 hips) were deemed eligible for the study and were evaluated. Of the hips, 81% had healed capsules, whereas 8 (19%) had capsular defects on the latest MRI scan. There were 3 hips with subchondral edema in the defect group compared with 1 in the healed-capsule group (P = .01) on the latest MRI scan, which was not present on preoperative MRI (still positive on multivariate analysis when the preoperative alpha angle was also taken into consideration). Functional results did not differ between the groups (P > .05). Conclusions In this study, 81% of interportal capsulotomies healed without repair at 5 years after primary hip arthroscopy. Clinical Relevance Understanding the prevalence and implications of unhealed capsulotomies could encourage surgeons to be meticulous in capsular closure.
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Affiliation(s)
- Onur Hapa
- Department of Orthopedics, Dokuz Eylül University Faculty of Medicine, Izmir, Turkey
| | - Selahaddin Aydemir
- Department of Orthopedics, Dokuz Eylül University Faculty of Medicine, Izmir, Turkey
| | - Asli Irmak Akdogan
- Department of Radiology, Katip Celebi University Faculty of Medicine, Izmir, Turkey
| | - Mustafa Celtik
- Department of Orthopedics and Traumatology, Ankara Oncology Research and Training Hospital, Ankara, Turkey
| | - Ozgur Aydin
- Department of Orthopedics, Dokuz Eylül University Faculty of Medicine, Izmir, Turkey
| | - Batuhan Gocer
- Department of Orthopedics, Dokuz Eylül University Faculty of Medicine, Izmir, Turkey
| | - Onur Gursan
- Department of Orthopedics, Dokuz Eylül University Faculty of Medicine, Izmir, Turkey
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Arshad Z, Marway P, Shoman H, Ubong S, Hussain A, Khanduja V. Hip Arthroscopy in Patients With Generalized Joint Hypermobility Yields Successful Outcomes: A Systematic Review. Arthroscopy 2024; 40:1658-1669. [PMID: 37952744 DOI: 10.1016/j.arthro.2023.10.047] [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] [Received: 02/07/2023] [Revised: 10/19/2023] [Accepted: 10/25/2023] [Indexed: 11/14/2023]
Abstract
PURPOSE To evaluate the outcomes of hip arthroscopy in patients with generalized joint hypermobility (GJH). METHODS A systematic review was performed according to Preferred Reporting Items for Systematic Reviews and Meta-Analyses. An electronic record search was performed in PubMed, Web of Science, Cochrane Library, and Embase. A 2-stage title/abstract and full-text screening was performed using the following inclusion criteria: (1) observational studies, cohort studies, and randomized controlled trials; (2) describing more than 5 patients with a mean age over 18 years and GJH; (3) undergoing arthroscopy of the hip; (4) reporting patient-reported outcome measures (PROMs), return to sport, or complications/reoperations; and (5) published in English. RESULTS Of the 517 articles identified, 10 studies meeting all selection criteria were included. Included studies report significant improvements in a range of different functional and pain-based PROMs. Most patients (25.0%-97.0%) in each study achieved a clinically important improvement postoperatively in at least 1 PROM. No complications were described in any of the 4 studies reporting this metric. One study each found an association between GJH and an increased risk of postoperative deep gluteal syndrome and iliopsoas tendinitis. The rate of revision arthroscopy ranged from 0% to 11.4%, and only 2 patients in a single study of 11 hips required conversion to total hip arthroplasty. No statistically significant differences were reported between patients with and without GJH with respect to any of the described outcomes. CONCLUSIONS Patients with GJH may achieve good outcomes following hip arthroscopy with respect to PROMs, perioperative complications, reoperation, and return to sport. With effective labral repair and capsular closure, outcomes achieved in patients with GJH are comparable to those reported in patients without hypermobility. LEVEL OF EVIDENCE Level IV, systematic review of level III to IV studies.
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Affiliation(s)
- Zaki Arshad
- University Hospitals Leicester NHS Trust, Leicester, England
| | | | - Haitham Shoman
- Department of Experimental Surgery, Faculty of Medicine, McGill University, Montreal, Quebec, Canada
| | - Sonia Ubong
- Department of Surgery, University of Cambridge, Cambridge, England
| | - Ali Hussain
- East Kent Hospitals University NHS Foundation Trust, Kent, England
| | - Vikas Khanduja
- Young Adult Hip Service, Addenbrooke's Hospital, Cambridge University Hospitals NHS Foundation Trust, Cambridge, England.
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Maldonado DR, Owens JS, George T, Curley AJ, Domb BG. Acetabular Labral Reconstruction Does Not Demonstrate Superior Biomechanical Properties Compared to Labral Repair or Intact Native Labrum but Is Superior to Labral Excision: A Systematic Review of Cadaveric Studies. Arthroscopy 2024; 40:614-629. [PMID: 37270115 DOI: 10.1016/j.arthro.2023.05.025] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/09/2022] [Revised: 05/16/2023] [Accepted: 05/20/2023] [Indexed: 06/05/2023]
Abstract
PURPOSE To systematically review and compare biomechanical properties of labral reconstruction to labral repair, intact native labrum, and labral excision in cadaveric studies. METHODS A search of the PubMed and Embase databases was performed using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines and checklist. Cadaveric studies focused on hip biomechanics related to intact labrum, labral repair, labral reconstruction, labral augmentation, and labral excision were included. Investigated parameters included biomechanical data measures, such as distraction force, distance to suction seal rupture, peak negative pressure, contact area, and fluid efflux. Review articles, duplicates, technique reports, case reports, opinion articles, articles written in a language other than English, clinical studies focusing on patient-reported outcomes, studies performed in animals, and articles with no abstract available were also excluded. RESULTS Fourteen cadaveric biomechanical studies were included that compared labral reconstruction to labral repair (4 studies), labral reconstruction to labral excision (4 studies); and evaluation of distractive force of the labrum (3 studies), the distance to suction seal rupture (3 studies), fluid dynamics (2 studies), displacement at peak force (1 study), and stability ratio (1 study). Data pooling was not performed because of methodological heterogenicity of the studies. Labral reconstruction did not outperform labral repair in restoring the hip suction seal or any other biomechanical property. Labral repair significantly prevented greater fluid efflux when compared to labral reconstruction. Labral repair and reconstruction improved the distractive stability of the hip fluid seal from the labral tear and labral excision stage, respectively. Furthermore, labral reconstruction demonstrated to have better biomechanical properties than labral excision. CONCLUSIONS In cadaveric studies, labral repair or intact native labrum was biomechanically more superior than labral reconstruction; however, labral reconstruction can restore acetabular labral biomechanical properties and was biomechanically superior to labral excision. CLINICAL RELEVANCE In cadaveric models, labral repair outperforms segmental labral reconstruction in preserving the hip suction seal; nonetheless, segmental labral reconstruction biomechanically outperforms labral excision at time 0.
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Affiliation(s)
- David R Maldonado
- Department of Orthopaedic Surgery, McGovern Medical School, University of Texas Health Science Center at Houston, Houston, Texas, U.S.A
| | - Jade S Owens
- American Hip Institute Research Foundation, Chicago, Illinois, U.S.A
| | - Tracy George
- American Hip Institute Research Foundation, Chicago, Illinois, U.S.A
| | - Andrew J Curley
- American Hip Institute Research Foundation, 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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Zhang AL. Editorial Commentary: Capsular Management During Hip Arthroscopy Is Recommended, But a Limited Capsulotomy in Male Patients May Heal Without Closure. Arthroscopy 2024:S0749-8063(24)00056-2. [PMID: 38278460 DOI: 10.1016/j.arthro.2024.01.012] [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: 01/15/2024] [Accepted: 01/16/2024] [Indexed: 01/28/2024]
Abstract
The hip capsule consists of the iliofemoral, ischiofemoral, and pubfemoral ligaments. The iliofemoral ligament is an important part of the anterior hip capsule that functions to stabilize the joint but is commonly incised in order to obtain access during hip arthroscopy, as described in techniques such as interportal, T, puncture, and periportal capsulotomy. For the most commonly used interportal capsulotomy, recent literature has advocated for closure of the capsule at the end of the surgery to avoid iatrogenic instability or microinstability. Systematic reviews and cohort studies have reported significantly better patient-reported outcomes after hip arthroscopy for femoroacetabular impingement syndrome with capsule closure compared to without capsule closure. However, recent high-level evidence from a randomized controlled trial demonstrated that in a predominantly male cohort there was no difference in patient-reported outcomes improvements or complications between patients undergoing hip arthroscopy for femoroacetabular impingement syndrome through an interportal capsulotomy who were randomized to receive capsule closure versus no capsule closure. Of note, male patients have inherently tighter and more stable joints than female patients and therefore are at lower risk for postoperative instability or microinstability from an interportal capsulotomy that does not properly heal. Also, if the capsule is not violated below the 3-o'clock position (for a right hip, or 9 o'clock for a left hip), there may be less risk to destabilizing the hip joint. A limited interportal capsulotomy in male patients could lead to healing in an unrepaired state.
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Más Martínez J, Cuenca Copete A, Verdú Román C, Jiménez Arias D, Beneito Pastor D, Sanz-Reig J. [Translated article] Hip arthroscopy for femoroacetabular impingement with 10-year minimum follow-up. Rev Esp Cir Ortop Traumatol (Engl Ed) 2024; 68:T35-T43. [PMID: 37995818 DOI: 10.1016/j.recot.2023.11.012] [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: 11/28/2022] [Accepted: 06/25/2023] [Indexed: 11/25/2023] Open
Abstract
PURPOSE To determine outcomes after hip arthroscopy (HA) for femoroacetabular impingement (FAI) at a minimun 10-year follow up and identified risk factors for revision surgery. METHODS Retrospective study of a prospective database of patients undergoing HA between January 2010 and December 2011. Rim chondral injuries were evaluated using the acetabular labral articular disruptions system (ALAD). Clinical and radiological data was obtained. Cumulative survival was estimated by Kaplan-Meier and a multivariate Cox proportional hazards model. RESULTS Seventy-four patients were included in the study. Mean follow-up was 132 months. There was statistically significant improvement from preoperative PROs at latest follow-up. Seventeen patients (23.9%) underwent revision surgery. Odds ratio for revision surgery was 8.08 in a patient above 40 years old, 7.57 in a patient Tönnis greater than 1, and 4.25 in a patient ALAD 2-3. Cumulative survivorship rate at 10 years was 77.8%, with a 45.4% for patients with Tönnis grade greater than 1 in front of 85.2% for patients with Tönnis grade of 1 or less (p<.001). Risk factor for revision surgery was preoperative degree of osteoarthrosis (p=.02). CONCLUSION Cumulative survivorship rate at 10 years was 45.4% for patients with Tönnis grade greater than 1 in front of 85.2% for patients with Tönnis grade of 1 or less (p<.001). Age, chondral injuries, and degree of osteoarthrosis would increase the risk for revision surgery.
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Affiliation(s)
- J Más Martínez
- Traumatología Vistahermosa, HLA Clínica Vistahermosa, Alicante, Spain
| | - A Cuenca Copete
- Traumatología Vistahermosa, HLA Clínica Vistahermosa, Alicante, Spain
| | - C Verdú Román
- Traumatología Vistahermosa, HLA Clínica Vistahermosa, Alicante, Spain
| | - D Jiménez Arias
- Traumatología Vistahermosa, HLA Clínica Vistahermosa, Alicante, Spain
| | - D Beneito Pastor
- Traumatología Vistahermosa, HLA Clínica Vistahermosa, Alicante, Spain
| | - J Sanz-Reig
- Traumatología Vistahermosa, HLA Clínica Vistahermosa, Alicante, Spain.
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Más Martínez J, Cuenca Copete A, Verdú Román C, Jiménez Arias D, Beneito Pastor D, Sanz-Reig J. Hip arthroscopy for femoroacetabular impingement with 10-year minimum follow-up. Rev Esp Cir Ortop Traumatol (Engl Ed) 2024; 68:35-43. [PMID: 37406732 DOI: 10.1016/j.recot.2023.06.015] [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: 11/28/2022] [Revised: 06/20/2023] [Accepted: 06/25/2023] [Indexed: 07/07/2023] Open
Abstract
PURPOSE To determine outcomes after hip arthroscopy (HA) for femoroacetabular impingement (FAI) at a minimun 10-year follow up and identified risk factors for revision surgery. METHODS Retrospective study of a prospective database of patients undergoing HA between January 2010 and December 2011. Rim chondral injuries were evaluated using the acetabular labral articular disruptions system (ALAD). Clinical and radiological data was obtained. Cumulative survival was estimated by Kaplan-Meier and a multivariate Cox proportional hazards model. RESULTS Seventy-four patients were included in the study. Mean follow-up was 132 months. There was statistically significant improvement from preoperative PROs at latest follow-up. Seventeen patients (23.9%) underwent revision surgery. Odds ratio for revision surgery was 8.08 in a patient above 40 years old, 7.57 in a patient Tönnis greater than 1, and 4.25 in a patient ALAD 2-3. Cumulative survivorship rate at 10 years was 77.8%, with a 45.4% for patients with Tönnis grade greater than 1 in front of 85.2% for patients with Tönnis grade of 1 or less (P<.001). Risk factor for revision surgery was preoperative degree of osteoarthrosis (P=.02). CONCLUSION Cumulative survivorship rate at 10 years was 45.4% for patients with Tönnis grade greater than 1 in front of 85.2% for patients with Tönnis grade of 1 or less (P<.001). Age, chondral injuries, and degree of osteoarthrosis would increase the risk for revision surgery.
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Affiliation(s)
- J Más Martínez
- Traumatología Vistahermosa, HLA Clínica Vistahermosa, Alicante, España
| | - A Cuenca Copete
- Traumatología Vistahermosa, HLA Clínica Vistahermosa, Alicante, España
| | - C Verdú Román
- Traumatología Vistahermosa, HLA Clínica Vistahermosa, Alicante, España
| | - D Jiménez Arias
- Traumatología Vistahermosa, HLA Clínica Vistahermosa, Alicante, España
| | - D Beneito Pastor
- Traumatología Vistahermosa, HLA Clínica Vistahermosa, Alicante, España
| | - J Sanz-Reig
- Traumatología Vistahermosa, HLA Clínica Vistahermosa, Alicante, España.
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Anantha-Krishnan A, Myers CA, Fitzpatrick CK, Clary CW. Instantaneous Generation of Subject-Specific Finite Element Models of the Hip Capsule. Bioengineering (Basel) 2023; 11:37. [PMID: 38247914 PMCID: PMC10813259 DOI: 10.3390/bioengineering11010037] [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: 12/07/2023] [Accepted: 12/22/2023] [Indexed: 01/23/2024] Open
Abstract
Subject-specific hip capsule models could offer insights into impingement and dislocation risk when coupled with computer-aided surgery, but model calibration is time-consuming using traditional techniques. This study developed a framework for instantaneously generating subject-specific finite element (FE) capsule representations from regression models trained with a probabilistic approach. A validated FE model of the implanted hip capsule was evaluated probabilistically to generate a training dataset relating capsule geometry and material properties to hip laxity. Multivariate regression models were trained using 90% of trials to predict capsule properties based on hip laxity and attachment site information. The regression models were validated using the remaining 10% of the training set by comparing differences in hip laxity between the original trials and the regression-derived capsules. Root mean square errors (RMSEs) in laxity predictions ranged from 1.8° to 2.3°, depending on the type of laxity used in the training set. The RMSE, when predicting the laxity measured from five cadaveric specimens with total hip arthroplasty, was 4.5°. Model generation time was reduced from days to milliseconds. The results demonstrated the potential of regression-based training to instantaneously generate subject-specific FE models and have implications for integrating subject-specific capsule models into surgical planning software.
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Affiliation(s)
- Ahilan Anantha-Krishnan
- Center of Orthopaedic Biomechanics, University of Denver, Denver, CO 80208, USA; (A.A.-K.); (C.A.M.)
| | - Casey A. Myers
- Center of Orthopaedic Biomechanics, University of Denver, Denver, CO 80208, USA; (A.A.-K.); (C.A.M.)
| | - Clare K. Fitzpatrick
- Mechanical and Biomedical Engineering, Boise State University, Boise, ID 83725, USA;
| | - Chadd W. Clary
- Center of Orthopaedic Biomechanics, University of Denver, Denver, CO 80208, USA; (A.A.-K.); (C.A.M.)
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12
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Morris SC, Haselman WT, Banffy MB. Patient Outcomes Are Not Improved by Platelet-Rich Plasma Injection Onto the Capsule at the Time of Closure During Hip Arthroscopy for Femoroacetabular Impingement Syndrome. Arthrosc Sports Med Rehabil 2023; 5:100816. [PMID: 38034028 PMCID: PMC10685153 DOI: 10.1016/j.asmr.2023.100816] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2022] [Accepted: 09/28/2023] [Indexed: 12/02/2023] Open
Abstract
Purpose To determine the effect of platelet-rich plasma (PRP) injection onto the capsule at time of closure on outcomes of patients undergoing hip arthroscopy for femoroacetabular impingement syndrome. Methods Patients who underwent hip arthroscopy between January 2014 and December 2021 were retrospectively identified. The first cohort included patients who received PRP injection onto the capsule following capsular closure at the conclusion of the case. The second cohort did not receive PRP. Pain scores on a visual analog scale, Modified Harris Hip Scores, Single Assessment Numeric Evaluation (SANE), as well as Patient-Reported Outcomes Measurement Information System Physical Function scores were obtained preoperatively as well as at multiple time points postoperatively up to 2 years. Results In total, 345 patients were included in the study, with 293 in the PRP cohort and 52 in the non-PRP cohort. There was no significance difference in age (P = .69), sex, or preoperative pain (P = .92) and patient-reported outcome scores between the 2 groups (modified Harris Hip Score, P = .38; Patient-Reported Outcomes Measurement Information System Physical Function, P = .48), except for preoperative SANE scores, which had a greater baseline in the PRP group (P < .001). Using both observed data as well as repeated measure analysis of variance model to estimate for missing data after baseline, we found there were no differences in visual analog scale pain scores nor patient-reported outcome scores at any time point. There was similarly no difference in change from baseline for SANE scores. There was no difference in rate of revision surgery between the 2 cohorts (P = .66). Conclusions Based on the results of this study, intraoperative PRP injection onto the capsule at the time of capsular closure does not improve outcomes of patients undergoing hip arthroscopy for femoroacetabular impingement syndrome. Level of Evidence Level III, retrospective comparative study.
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Affiliation(s)
- S. Craig Morris
- Cedars-Sinai Kerlan-Jobe Institute, Los Angeles, California, U.S.A
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13
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Hartwell MJ, Moulton SG, Zhang AL. Capsular Management During Hip Arthroscopy. Curr Rev Musculoskelet Med 2023; 16:607-615. [PMID: 37436651 PMCID: PMC10733234 DOI: 10.1007/s12178-023-09855-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 06/22/2023] [Indexed: 07/13/2023]
Abstract
PURPOSE OF REVIEW Hip arthroscopy is widely used for the management of intra-articular pathology and there has been growing interest in strategies for management of the hip capsule during surgery. The hip capsule is an essential structure that provides stability to the joint and it is necessarily violated during procedures that address intra-articular pathology. This article reviews different approaches to capsular management during hip arthroscopy including anatomical considerations for capsulotomy, techniques, clinical outcomes, and the role of routine capsular repair. This article also reviews the concept of hip microinstability and its potential impact on capsular management options as well as iatrogenic complications that can occur as a result of poor capsular management. RECENT FINDINGS Current research highlights the key functional role of the hip capsule and the importance of preserving its anatomy during surgery. Capsulotomies that involve less tissue violation (periportal and puncture-type approaches) do not appear to require routine capsular repair to achieve good outcomes. Many studies have investigated the role of capsular repair following more extensive capsulotomy types (interportal and T-type), with most authors reporting superior outcomes with routine capsular repair. Strategies for capsular management during hip arthroscopy range from conservative capsulotomy techniques aimed to minimize capsular violation to more extensive capsulotomies with routine capsule closure, all of which have good short- to mid-term outcomes. There is a growing trend towards decreasing iatrogenic capsular tissue injury when possible and fully repairing the capsule when larger capsulotomies are utilized. Future research may reveal that patients with microinstability may require a more specific approach to capsular management.
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Affiliation(s)
- Matthew J Hartwell
- Department of Orthopaedic Surgery, University of California-San Francisco, 1500 Owens Street, Box 3004, San Francisco, CA, 94158, USA
| | - Samuel G Moulton
- Department of Orthopaedic Surgery, University of California-San Francisco, 1500 Owens Street, Box 3004, San Francisco, CA, 94158, USA
| | - Alan L Zhang
- Department of Orthopaedic Surgery, University of California-San Francisco, 1500 Owens Street, Box 3004, San Francisco, CA, 94158, USA.
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14
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Uchida S, Kizaki K, Arjuna MS, Murata Y, Shimozono Y, Miura K, Nakagawa K, Nakamae A, Nakamura T, Sakai T, Kikugawa K, Mae T, Tsuda E, Tohyama H. Arthroscopic Hip Capsular Repair Improves Patient-Reported Outcome Measures and Is Associated With a Decreased Risk of Revision Surgery and Conversion to Total Hip Arthroplasty. Arthrosc Sports Med Rehabil 2023; 5:100800. [PMID: 37854131 PMCID: PMC10579288 DOI: 10.1016/j.asmr.2023.100800] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2023] [Accepted: 08/08/2023] [Indexed: 10/20/2023] Open
Abstract
Purpose To perform a systematic review to assess the effect of capsular repair compared with nonrepair on patient-reported outcome measures (PROMs) and conversion to total hip arthroplasty (THA) after hip arthroscopy in patients with femoroacetabular impingement syndrome. Methods We initially searched the Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE, EMBASE, and PubMed databases, as well as ongoing clinical trials (https://clinicaltrials.gov), on December 15, 2022. The eligibility criteria were randomized controlled trials (Level Ⅰ) and prospective comparative studies (Level II) of patients who underwent capsular repair and nonrepair via hip arthroscopy with a minimum follow-up period of 2 years. We registered this protocol a priori on PROSPERO (identification No. CRD42021239306). We assessed the risk of bias using the Methodological Index for Non-randomized Studies (MINORS) appraisal tool. Results This review included 5 studies with a total of 639 patients (270 with capsular repair [average age, 35.4 years; 41% female patients] and 369 with nonrepair [average age, 37.3 years; 38% female patients]). In the included studies, surgical procedures consisting of labral repair and pincer or cam osteoplasty were performed via hip arthroscopy. The modified Harris Hip Score was measured in all the included studies, and the standardized mean difference in PROMs for capsular repair versus nonrepair in the included studies was 0.42 (95% confidence interval [CI], 0.20 to 0.63). A sensitivity analysis of randomized controlled trials achieved consistent results (standardized mean difference in PROMs, 0.31; 95% CI, 0.02 to 0.60). Capsular repair was not associated with a reduction in revision surgery (risk difference, -0.02; 95% CI, -0.06 to 0.03; 26 of 270 patients with capsular repair vs 42 of 369 with nonrepair) but was associated with a reduction in conversion to THA (risk difference, -0.05; 95% CI -0.09 to -0.01; 12 of 270 patients with capsular repair vs 38 of 369 with nonrepair). The average Methodological Index for Non-randomized Studies (MINORS) score in the included studies was 20. Conclusions Patients who undergo capsular repair in conjunction with other arthroscopic hip preservation techniques have better PROMs and a lower incidence of THA conversion. Level of Evidence Level II, systematic review of Level I and II investigations.
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Affiliation(s)
- Soshi Uchida
- Department of Orthopaedic Surgery, Wakamatsu Hospital of the University of Occupational and Environmental Health, Kitakyushu, Japan
| | - Kazuha Kizaki
- Department of Surgery, Division of Arthroscopy & Sports Medicine, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Maharaj S. Arjuna
- Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Yoichi Murata
- Department of Orthopaedic Surgery, Wakamatsu Hospital of the University of Occupational and Environmental Health, Kitakyushu, Japan
| | | | - Kazutomo Miura
- Department of Orthopaedic Surgery, Kensei Hospital, Hirosaki, Japan
| | - Koichi Nakagawa
- Department of Orthopaedic Surgery, Toho University Sakura Medical Center, Sakura, Chiba, Japan
| | - Atsuo Nakamae
- Department of Orthopaedic Surgery, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan
| | - Toshiyasu Nakamura
- Department of Orthopaedic Surgery, School of Medicine, International University of Health and Welfare, Tokyo, Japan
| | - Tadahiro Sakai
- Department of Orthopaedic Surgery, Toyota Memorial Hospital, Nagoya, Japan
| | | | - Tatsuo Mae
- Department of Orthopaedic Surgery, Osaka University Graduate School of Medicine, Osaka, Japan
| | - Eiichi Tsuda
- Department of Rehabilitation Medicine, Hirosaki University Graduate School of Medicine, Hirosaki, Japan
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15
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Dasari SP, Kasson LB, Condon JJ, Mameri ES, Kerzner B, Khan ZA, Jackson GR, Gursoy S, Sivasundaram L, Hevesi M, Chahla J. Systematic Review and Meta-analysis of Studies Comparing Complete Capsular Closure Against Unrepaired Hip Capsules During Hip Arthroscopy. Orthop J Sports Med 2023; 11:23259671231197435. [PMID: 37868216 PMCID: PMC10585995 DOI: 10.1177/23259671231197435] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/08/2023] [Accepted: 04/26/2023] [Indexed: 10/24/2023] Open
Abstract
Background While the biomechanical importance of the hip capsule is well described, there remains controversy over the necessity of routine capsular closure after hip arthroscopy. Purpose To perform a meta-analysis of clinical studies to compare pooled outcomes of complete hip capsular closure cohorts against unrepaired hip capsule cohorts. Study Design Systematic review; Level of evidence, 3. Methods The Cochrane Database of Systematic Reviews, Cochrane Register of Controlled Trials, PubMed, MEDLINE, Web of Science, CINAHL/EBSCO, and Scopus were queried in February 2022 for studies that directly compared clinical outcomes for hip arthroscopy patients treated with either complete capsular closure or an unrepaired capsule. Outcomes assessed were incidence of revision hip arthroscopy, incidence of subsequent conversion to total hip arthroplasty (THA), and improvement from baseline in modified Harris Hip Score (mHHS), Hip Outcome Score (HOS) activities of daily living (ADL), HOS sports specific (SS) subscale, Copenhagen Hip and Groin Outcome Score (HAGOS) ADL, and HAGOS SS subscale. A pooled weighted mean difference (WMD) was used to compare changes in mHHS. A pooled standardized mean difference (SMD) was used to compare changes in the ADL and SS outcomes. A pooled risk ratio (RR) was used to compare the probability of revision hip arthroscopy and conversion to THA based on capsular management. For pooled outcomes where heterogeneity was regarded as potentially unimportant, a fixed-effects model was implemented. For pooled outcomes with considerable heterogeneity, a random-effects model was implemented. Results Of the 1896 records identified in our search, 11 studies (1897 patients) were included. A significantly higher improvement in mHHS (WMD, -3.72; 95% CI, -4.95 to -2.50; P < .00001) and ADL outcomes (SMD, -0.30; 95% CI, -0.54 to -0.07; P = .01) were seen after complete capsular closure. There was a significantly lower probability of subsequent revision hip arthroscopy (RR, 1.67; 95% CI, 1.14 to 2.45; P = .008) and conversion to THA (RR, 2.01; 95% CI, 1.06 to 3.79; P = .03) after complete capsular repair. There was no difference in SS outcomes (SMD, -0.02; 95% CI, -0.16 to 0.13; P = .81) between the 2 groups. Conclusion This meta-analysis demonstrated that routine complete capsular closure after hip arthroscopy led to superior clinical outcomes relative to unrepaired hip capsules.
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Affiliation(s)
- Suhas P. Dasari
- Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, Illinois, USA
| | - Luke B. Kasson
- Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, Illinois, USA
| | - Joshua J. Condon
- Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, Illinois, USA
| | - Enzo S. Mameri
- Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, Illinois, USA
| | - Benjamin Kerzner
- Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, Illinois, USA
| | - Zeeshan A. Khan
- Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, Illinois, USA
| | - Garrett R. Jackson
- Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, Illinois, USA
| | - Safa Gursoy
- Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, Illinois, USA
| | | | - Mario Hevesi
- Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, Illinois, USA
| | - Jorge Chahla
- Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, Illinois, USA
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16
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Tahoun MF, Lizano-Díez X, Soler BC, Pons MT. Superior outcomes after arthroscopic treatment of femoroacetabular impingement and labral tears with closed versus open capsule. Knee Surg Sports Traumatol Arthrosc 2023; 31:4501-4509. [PMID: 36471028 DOI: 10.1007/s00167-022-07266-y] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/11/2022] [Accepted: 11/28/2022] [Indexed: 12/12/2022]
Abstract
PURPOSE The purpose of the study was the clinical evaluation of the capsular management with arthroscopic treatment of femoroacetabular impingement and labral tears by comparing the functional outcomes of closed versus open capsule. METHODS Patients with a median age of 38 years (18-55), clinical and radiological features of FAI and/or labral tear, and non-arthritic non-dysplastic hips were selected for arthroscopic treatment. Capsulotomy was performed primarily as an interportal section, then a distal extension preserving the zona orbicularis was added. The study compared two matched groups: patients with open capsule versus patients with closed capsule. Clinical outcomes were assessed by Non-Arthritic Hip Score, hip outcome scores of daily living activities and sports-specific scales. Scores were collected preoperatively and 6 months, 2 years and 5 years postoperatively. Rate of revision arthroscopy and conversion to total hip arthroplasty were used for comparing groups. Minimal clinically important differences were calculated for both groups. RESULTS The study included 42 patients in the OC group and 44 patients in the CC group. Significant improvement of postoperative PROMs was recorded in both groups compared to preoperative scores. CC group significantly improved more than the OC group based on NAHS, HOS-ADL and HOS-SSS over all check points except for NAHS and HOS-ADL at 6 months, which were statistically non-significant. A non-significant difference was observed in the percentage of patients who met the MCID for all reported outcome scores at 5 years in both groups. The rate of reoperation was similar in both groups, but with different indications. CONCLUSION Arthroscopic treatment of FAI and labral repair with complete closure of the hip capsule led to significantly improved functional outcomes after 5 years follow-up compared with open capsule. Closed capsule can provide greater improvement in the sports-specific outcomes at early follow-up. Controlled capsulotomy limited by zona orbicularis did not produce instability at any postoperative stage. Similar proportions of patients achieved minimal clinically important difference, and similar rates of reoperation were reported in both groups. LEVEL OF EVIDENCE III.
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Affiliation(s)
- Mahmoud Fathy Tahoun
- Dep. Of Orthopedics, Menoufia University, Shibin el Kom, Egypt.
- Hospital de L'Esperanca, Sant Josep de La Muntanya, 12, 08024, Barcelona, Spain.
| | - Xavier Lizano-Díez
- Dep. of Orthopedics. Hospital d'Igualada. Consorci Sanitari de L'Anoia, Universitat de Lleida, Lleida, Spain
- Hip Unit, iMove Traumatologia, Clínica Mitrestorres, Barcelona, Spain
- Iberic Group Hip Preservation Surgery, GIPCA, Spain-Portugal, Barcelona, Spain
| | - Bruno Capurro Soler
- Hip Unit, iMove Traumatologia, Clínica Mitrestorres, Barcelona, Spain
- ReSport Clinic, Barcelona, Spain
| | - Marc Tey Pons
- Dep. Of Orthopedics, Parc de Salut Mar, UAB, Barcelona, Spain
- Hip Unit, iMove Traumatologia, Clínica Mitrestorres, Barcelona, Spain
- Iberic Group Hip Preservation Surgery, GIPCA, Spain-Portugal, Barcelona, Spain
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17
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Kolaczko JG, Wait T, Stevanovic O, Orahovats A, Griffith E, Genuario JW. A Modified "Shuttle" Method Technique for Arthroscopic Hip Capsular Reconstruction in Capsular Deficiency. Arthrosc Tech 2023; 12:e1479-e1485. [PMID: 37780666 PMCID: PMC10533681 DOI: 10.1016/j.eats.2023.04.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/24/2023] [Accepted: 04/18/2023] [Indexed: 10/03/2023] Open
Abstract
The hip capsule has been recognized as a vital structure in the stability and proper function of the hip. Preserving its integrity during arthroscopic surgery is one of the utmost important principles in hip preservation surgery. When capsular deficiency is present, capsular reconstruction may be indicated to restore stability and proper hip mechanics. In this technical note, we introduce a simple and reproducible shuttle method technique for hip capsular reconstruction using a dermal allograft.
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Affiliation(s)
- Jensen G. Kolaczko
- University of Colorado School of Medicine, Aurora, Colorado, U.S.A
- Eric Griffith's Assisting Services, LLC, Fraser, Colorado, U.S.A
- Steadman Hawkins Clinic Denver, Cleveland, Ohio, U.S.A
| | - Trevor Wait
- University of Colorado School of Medicine, Aurora, Colorado, U.S.A
- Eric Griffith's Assisting Services, LLC, Fraser, Colorado, U.S.A
| | - Ognjen Stevanovic
- University of Colorado School of Medicine, Aurora, Colorado, U.S.A
- Eric Griffith's Assisting Services, LLC, Fraser, Colorado, U.S.A
| | - Alexandra Orahovats
- University of Colorado School of Medicine, Aurora, Colorado, U.S.A
- Eric Griffith's Assisting Services, LLC, Fraser, Colorado, U.S.A
| | - Eric Griffith
- Steadman Hawkins Clinic Denver, Cleveland, Ohio, U.S.A
| | - James W. Genuario
- University of Colorado School of Medicine, Aurora, Colorado, U.S.A
- Eric Griffith's Assisting Services, LLC, Fraser, Colorado, U.S.A
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18
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Kaplan DJ, Fenn TW, Jan K, Nho SJ. Capsular Repair is Associated with Lower Revision Rates Yet Similar Clinical Outcomes and Arthroplasty Conversion 5-Years after Hip Arthroscopy: A Systematic Review. Arthroscopy 2023:S0749-8063(23)00380-8. [PMID: 37146665 DOI: 10.1016/j.arthro.2023.04.016] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/10/2023] [Revised: 04/19/2023] [Accepted: 04/20/2023] [Indexed: 05/07/2023]
Abstract
PURPOSE The purpose of this study was to perform a systematic review of studies reporting on minimum 5-year outcomes of patients undergoing primary hip arthroscopy (HA) for femoroacetabular impingement syndrome (FAIS) to determine whether capsular management influences patient-reported outcomes (PROs), rates of clinically significant outcome, and rates of revision surgery or conversion to total hip arthroplasty (THA). METHODS PubMed, Scopus, and Google Scholar were searched around the terms hip arthroscopy, FAIS, five-year follow-up, and capsule management. Articles available in English, presenting original data, and reporting minimum 5-year follow-up after HA using either PROs or conversion to THA and/or revision surgery were included. Quality assessment was completed using MINORS assessment. Articles were stratified into unrepaired and repaired capsule cohorts (excluding periportal capsulotomy techniques). RESULTS Eight articles were included. MINORS assessment ranged from 11-22, with excellent (k=0.842) inter-rater reliability. Populations without capsular repair were identified in four studies including a total of 387 patients, at an age of 33.1-38.0 years and follow-up range of 60.0-77 months. Populations with capsular repair were identified in five studies including a total of 835 patients, at an age range of 33.6-43.1 years and follow-up range of 60.0-78.0 months. All studies included PROs and all reported significant improvement (p<0.05) at the 5-year timepoint, with modified Harris Hip Score (mHHS) being the most frequent (n=6). No differences were noted between groups regarding any of the measured PROs. Average rates of achieving MCID and PASS for mHHS were similar between patients without capsular repair (MCID 71.1%, PASS 73.7%, n=1) and with capsular repair (MCID 66.0%-90.6%, PASS 55.3%-87.4%, n=4). Conversion to THA occurred in 12.8-18.5% and 0.0-29.0% for patients with an unrepaired and repaired capsule, respectively. Revision HA occurred in 15.4-25.5% and 3.1-15.4% in unrepaired and repaired capsular patients, respectively. CONCLUSIONS Patients undergoing hip arthroscopy for FAI had significant improvement in PRO scores at minimum 5-year follow-up, and scores did not differ between patients that underwent capsular repair and those that did not. Similar rates of markers of clinical benefit and THA conversion were achieved by both groups; however, lower rates of revision hip arthroscopy were demonstrated in the capsular repair cohort.
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Affiliation(s)
- Daniel J Kaplan
- Section of Young Adult Hip Surgery, Division of Sports Medicine, Department of Orthopedic Surgery, Rush Medical College of Rush University, Rush University Medical Center, Chicago, IL
| | - Thomas W Fenn
- Section of Young Adult Hip Surgery, Division of Sports Medicine, Department of Orthopedic Surgery, Rush Medical College of Rush University, Rush University Medical Center, Chicago, IL.
| | - Kyleen Jan
- Section of Young Adult Hip Surgery, Division of Sports Medicine, Department of Orthopedic Surgery, Rush Medical College of Rush University, Rush University Medical Center, Chicago, IL
| | - Shane J Nho
- Section of Young Adult Hip Surgery, Division of Sports Medicine, Department of Orthopedic Surgery, Rush Medical College of Rush University, Rush University Medical Center, Chicago, IL
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19
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Kim DN, Mahatme R, Lee MS, Islam W, Jimenez AE. Knotless Implant for Arthroscopic Hip Capsule Closure. Arthrosc Tech 2023; 12:e667-e670. [PMID: 37323803 PMCID: PMC10265480 DOI: 10.1016/j.eats.2023.01.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/21/2022] [Accepted: 01/18/2023] [Indexed: 06/17/2023] Open
Abstract
The hip joint capsule plays a significant role in maintaining hip stability, including translation and rotation. Hip capsular closure or plication has been shown to increase stability of the joint following capsulotomy in hip arthroscopy for the treatment of femoroacetabular impingement syndrome (FAIS) and/or associated labral tears. This technique article describes a knotless method of closing the hip capsule.
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Affiliation(s)
- David N. Kim
- Yale School of Medicine, New Haven, Connecticut, U.S.A
| | - Ronak Mahatme
- University of Connecticut School of Medicine, Farmington, Connecticut, U.S.A
| | - Michael S. Lee
- Medical College of Wisconsin, Milwaukee, Wisconsin, U.S.A
| | - Wasif Islam
- Department of Orthopaedics and Rehabilitation, Yale School of Medicine, New Haven, Connecticut, U.S.A
| | - Andrew E. Jimenez
- Department of Orthopaedics and Rehabilitation, Yale School of Medicine, New Haven, Connecticut, U.S.A
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20
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Lee MS, Owens JS, Fong S, Kim DN, Gillinov SM, Mahatme RJ, Simington J, Monahan PF, Islam W, Moran J, Grimm NL, Jimenez AE. Mid- and Long-Term Outcomes Are Favorable for Patients With Borderline Dysplasia Undergoing Primary Hip Arthroscopy: A Systematic Review. Arthroscopy 2023; 39:1060-1073. [PMID: 36596369 DOI: 10.1016/j.arthro.2022.12.030] [Citation(s) in RCA: 10] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/23/2022] [Revised: 10/19/2022] [Accepted: 12/22/2022] [Indexed: 01/02/2023]
Abstract
PURPOSE To evaluate midterm outcomes, long-term outcomes, and survivorship in the borderline dysplastic population after primary hip arthroscopy. METHODS A systematic review of current literature was performed with the following key words: "hip, "arthroscopy," "borderline dysplasia," "borderline hip dysplasia," "developmental dysplasia," "ten-year," "survivorship," "10-year," "5-year," "five year," "mid-term," "long-term," "outcomes," "arthroscopic," and "femoroacetabular impingement" in PubMed, Cochrane, and Scopus in March 2022 using the Preferred Reporting Items for Systematic Reviews and Meta-analyses guidelines. The following information was recorded: title, author, publication date, study design, demographic, number of hips, follow-up time, study period, indications for hip arthroscopy, patient-reported outcomes (PROs), characteristics of patients converting to total hip arthroplasty (THA), and rates of secondary surgeries and conversion to THA were recorded. Survivorship was defined as not converting to THA. Kappa values for the title/abstract and full-text screening were calculated. Forest plots were created for PROs that were included in 3 or more studies. RESULTS Six articles comprising 413 hips were included in the study. Three studies were Level III evidence, and 3 studies were Level IV evidence. Average follow-up ranged from 5.7 to 12.2 years. One study defined borderline hip dysplasia as lateral center-edge angle 18-25° and 5 defined it as lateral center-edge angle 20-25°. All studies included PROs and reported significant improvement after surgery in at least one PRO. Three studies reported clinical benefit and across the studies at least 70% of patients achieved minimum clinically important difference in at least one PRO. Rates of undergoing revision hip arthroscopy and THA ranged from 2.1% to 7% and 0% to 24%, respectively. Tönnis grade 2, Tönnis angle >15, and Outerbridge Grade IV cartilage damage were identified as predictors of conversion to THA. CONCLUSIONS Patients with borderline hip dysplasia undergoing primary hip arthroscopy demonstrated significant improvement in PROs at midterm and long-term follow-up. Survivorship at midterm follow-up was 98.2% (328/334 hips) and 76.3% (29/38 hips) at long-term follow-up. LEVEL OF EVIDENCE Level IV, systematic review of Level III and Level IV studies.
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Affiliation(s)
- Michael S Lee
- Medical College of Wisconsin, Milwaukee, Wisconsin, U.S.A
| | - Jade S Owens
- Keck School of Medicine of the University of Southern California, Los Angeles, California
| | - Scott Fong
- Advanced Orthopaedics & Sports Medicine, San Francisco, California
| | - David N Kim
- Department of Orthopaedics and Rehabilitation, Yale School of Medicine, New Haven, Connecticut
| | - Stephen M Gillinov
- Department of Orthopaedics and Rehabilitation, Yale School of Medicine, New Haven, Connecticut
| | - Ronak J Mahatme
- University of Connecticut School of Medicine, Farmington, Connecticut
| | | | | | - Wasif Islam
- Department of Orthopaedics and Rehabilitation, Yale School of Medicine, New Haven, Connecticut
| | - Jay Moran
- Department of Orthopaedics and Rehabilitation, Yale School of Medicine, New Haven, Connecticut
| | | | - Andrew E Jimenez
- Department of Orthopaedics and Rehabilitation, Yale School of Medicine, New Haven, Connecticut.
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21
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Owens JS, Jimenez AE, Lee MS, Monahan PF, Maldonado DR, Domb BG. High-Level Athletes With Borderline Hip Dysplasia Achieve Favorable Outcomes and Return to Sport Rates Following Primary Hip Arthroscopy: Minimum 5-Year Outcomes Comparison to a Propensity-Matched Control Group. Arthroscopy 2023; 39:271-282. [PMID: 36055477 DOI: 10.1016/j.arthro.2022.08.023] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/13/2022] [Revised: 08/03/2022] [Accepted: 08/14/2022] [Indexed: 02/02/2023]
Abstract
PURPOSE (1) To report minimum 5-year patient-reported outcomes (PROs) and return to sport (RTS) rates in high-level athletes with borderline hip dysplasia (BHD) following primary hip arthroscopy for labral pathology and femoroacetabular impingement syndrome and (2) to compare results to a propensity-matched control group of athletes with normal acetabular coverage. METHODS Data were reviewed for surgeries performed between February 2009 and February 2016. Patients were eligible if they underwent primary hip arthroscopy in the setting of BHD (lateral center-edge angle [LCEA] 18-25°) and competed in professional, collegiate, or high school sports. Inclusion criteria were preoperative and minimum 5-year follow-up scores for the modified Harris Hip Score (mHHS), Non-Arthritis Hip Score, Hip Outcome Score-Sport Specific Subscale (HOS-SSS), and visual analog scale for pain. Rates of achieving the minimal clinically importance difference (MCID), patient acceptable symptomatic state (PASS), and maximum outcome improvement satisfaction threshold (MOIST) were recorded in addition to RTS. BHD athletes were matched by age at the time of surgery, sex, body mass index, Tönnis grade, follow-up time, sport type, and competition level to a control group of 58 athletes with normal acetabular coverage (LCEA 25°-40°) for comparison. RESULTS A total of 34 BHD athletes were included with a mean follow-up of 73.6 ± 10.7 months. BHD athletes showed significant improvements in all PROs, demonstrated high RTS rates (90.0%), and achieved PASS/MCID/MOIST for mHHS (MCID: 80.0%, PASS: 93.3%, MOIST: 80.0%) and HOS-SSS (MCID: 76.7%, PASS: 73.3%) at high rates. When compared to a propensity-matched group with normal acetabular coverage, BHD athletes demonstrated similar postoperative PROs, rates of achieving psychometric thresholds, and RTS rates (P > .05). Additionally, by the latest follow-up, no athlete in either group required conversion to total hip arthroplasty. CONCLUSIONS High-level athletes with BHD undergoing primary hip arthroscopy for labral pathology and femoroacetabular impingement syndrome may expect favorable midterm outcomes and high RTS rates. These results were comparable to a control group of athletes with normal coverage. LEVEL OF EVIDENCE Level III, retrospective cohort study.
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Affiliation(s)
- Jade S Owens
- American Hip Institute Research Foundation, Chicago, Illinois, U.S.A
| | - Andrew E Jimenez
- American Hip Institute Research Foundation, Chicago, Illinois, U.S.A
| | - Michael S Lee
- American Hip Institute Research Foundation, Chicago, Illinois, U.S.A
| | - Peter F Monahan
- American Hip Institute Research Foundation, Chicago, Illinois, U.S.A
| | - David R Maldonado
- American Hip Institute Research Foundation, 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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22
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Lee MS, Nam-Woo Kim D, Moran J, Gillinov SM, Mahatme RJ, Monahan PF, Islam W, Mclaughlin WM, Grimm NL, Jimenez AE. Patients Undergoing Primary Hip Arthroscopy Report Favorable Outcomes at Minimum 10 Year Follow-Up: A Systematic Review. Arthroscopy 2023; 39:459-475. [PMID: 36334852 DOI: 10.1016/j.arthro.2022.10.040] [Citation(s) in RCA: 19] [Impact Index Per Article: 19.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/27/2022] [Revised: 10/24/2022] [Accepted: 10/26/2022] [Indexed: 11/11/2022]
Abstract
PURPOSE (1) To evaluate minimum 10-year PROs (patient-reported outcomes) and survivorship after primary hip arthroscopy and (2) to identify predictors of failure for secondary arthroscopy and conversion to total hip arthroplasty (THA). METHODS A systematic review of the literature was conducted with the following key words: "hip arthroscopy," "long-term," "outcomes," "ten-year," "survivorship," "10-year," "15-year," "fifteen-year," 20-year," "twenty-year," and "femoroacetabular impingement" in PubMed and Embase in March 2022 using the Preferred Reporting Items for Systematic Reviews and Meta-analyses guidelines. Level I to Level IV evidence was included and reported on minimum 10-year outcomes or greater after primary hip arthroscopy. Long-term studies were defined as minimum 10-year follow-up in accordance with established standards in the literature. Case reports, review articles, technique articles, and opinion articles were excluded. Articles not in English were excluded. Title, author, publication date, study design, demographic, number of hips, follow-up time, study period, indications for hip arthroscopy, PROs, predictors of failure for THA, and rates of secondary surgeries were recorded. Survivorship was defined as a nonconversion to THA. P < .05 was defined as statistical significance. RESULTS Twelve studies met the inclusion criteria. In total, 4 studies were Level III, and 8 studies were Level IV. A total of 1,344 hips were included, and follow-up ranged from 10 to 20 years. Femoroacetabular impingement syndrome was the most common indication for hip arthroscopy. Ten of the 12 studies reported on PROs, and 8 studies reported significant improvement after hip arthroscopy at long-term follow-up. The remaining 2 studies reported favorable outcomes that satisfied clinical benefit thresholds at minimum 10-year follow-up. Five studies reported clinical benefit where each patient cohort achieved 80% minimal clinically important difference and 75% patient acceptable symptomatic state for at least one PRO. Rates of secondary arthroscopy ranged from 4.5% to 24%, and rates of conversion to THA varied from 0% to 44.1%. Older age and chondral damage were the most commonly cited predictors for conversion to THA. CONCLUSIONS At long-term follow-up, patients who underwent primary hip arthroscopy demonstrated favorable outcomes and variable rates of secondary surgeries. Patients undergoing hip arthroscopy within the last 20 years with Tönnis grade <1 and labral repair experienced greater than 90% survivorship. Chondral damage and older age were the most cited predictors for conversion to THA. LEVEL OF EVIDENCE Level IV, systematic review of Level III and Level IV studies.
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Affiliation(s)
| | - David Nam-Woo Kim
- Department of Orthopaedics and Rehabilitation, Yale School of Medicine, New Haven, Connecticut
| | - Jay Moran
- Department of Orthopaedics and Rehabilitation, Yale School of Medicine, New Haven, Connecticut
| | - Stephen M Gillinov
- Department of Orthopaedics and Rehabilitation, Yale School of Medicine, New Haven, Connecticut
| | - Ronak J Mahatme
- University of Connecticut School of Medicine, Farmington, Connecticut
| | | | - Wasif Islam
- Department of Orthopaedics and Rehabilitation, Yale School of Medicine, New Haven, Connecticut
| | - William M Mclaughlin
- Department of Orthopaedics and Rehabilitation, Yale School of Medicine, New Haven, Connecticut
| | | | - Andrew E Jimenez
- Department of Orthopaedics and Rehabilitation, Yale School of Medicine, New Haven, Connecticut.
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23
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Domb BG, Lee MS, Annin S, Owens JS, Jimenez AE, Sabetian PW, Maldonado DR. Minimum 10-year Survivorship and Clinical Outcomes Following Primary Hip Arthroscopy with Acetabular Microfracture. Arthroscopy 2022; 39:1185-1194. [PMID: 36628692 DOI: 10.1016/j.arthro.2022.11.018] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/11/2022] [Revised: 09/12/2022] [Accepted: 11/14/2022] [Indexed: 12/14/2022]
Abstract
PURPOSE To report minimum 10-year follow-up survivorship, defined as non-conversion to total hip arthroplasty (THA), and patient-reported outcome scores (PROS) after primary hip arthroscopy with acetabular microfracture in the setting of femoroacetabular impingement syndrome (FAIS) and acetabular chondral lesions, respectively. METHODS Data were prospectively collected and retrospectively analyzed on all patients who underwent a primary hip arthroscopy and received an acetabular microfracture between June 2009 and January 2011. Patients with a minimum 10-year follow-up for the modified Harris Hip Score (mHHS), Nonarthritic Hip Score (NAHS), and the visual analog scale (VAS) for pain were included. If available, the minimum 10-year follow-up for the Hip Outcome Score-Sport-Specific Subscale was reported. The demographics, intraoperative findings, surgical procedures, PROS, rate of achieving the minimal clinical important difference (MCID), and secondary surgeries were analyzed and reported. RESULTS Twenty-two hips (20 patients) were included in the study, and the mean follow-up time was 124.5 ± 2.2 months. There were 17 hips (77.3%) from males and 5 hips (22.7%) from females. The average patient age at the time of surgery was 42.3 years ± 9.6. All patients on average experienced statistically significant improvement (P < .05) between preoperative and minimum 10-year follow-up scores for all PROs. In total, 77.3% of the patients did not require conversion to THA. Additionally, 83.3% of the patients achieved the MCID for the mHHS, NAHS, and VAS for pain. CONCLUSION At a minimum 10-year follow-up, survivorship of 77.3% was reported for patients who underwent primary hip arthroscopy with acetabular microfracture for the treatment of FAIS and focal/full-thickness acetabular cartilage lesions. Further, in the patients that did not require THA conversion, significant improvement in all PROS was demonstrated. LEVEL OF EVIDENCE IV, case-series study.
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Affiliation(s)
- Benjamin G Domb
- American Hip Institute Research Foundation, Chicago, Illinois, U.S.A.; American Hip Institute (B.G.D.), Chicago, Illinois, U.S.A..
| | - Michael S Lee
- American Hip Institute Research Foundation, Chicago, Illinois, U.S.A
| | - Shawn Annin
- American Hip Institute Research Foundation, Chicago, Illinois, U.S.A
| | - Jade S Owens
- American Hip Institute Research Foundation, Chicago, Illinois, U.S.A
| | - Andrew E Jimenez
- 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
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24
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Jimenez AE, Lee MS, Owens JS, Paraschos OA, Maldonado DR, Domb BG. Competitive Athletes Who Underwent Hip Arthroscopy With Capsular Repair Showed Greater Improvement in Patient-Reported Outcome Scores Compared With Those Who Did Not Undergo Repair. Arthroscopy 2022; 38:3030-3040. [PMID: 35561872 DOI: 10.1016/j.arthro.2022.04.010] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/13/2022] [Revised: 03/03/2022] [Accepted: 04/20/2022] [Indexed: 02/02/2023]
Abstract
PURPOSE To compare minimum 2-year postoperative patient-reported outcome (PRO) scores and return to sport between competitive athletes undergoing primary hip arthroscopy for femoroacetabular impingement syndrome with interportal capsulotomy repair and competitive athletes with an unrepaired interportal capsulotomy. METHODS Data on all consecutive competitive athletes who underwent primary hip arthroscopy for femoroacetabular impingement syndrome between February 2012 and December 2018 were collected. Athletes were divided into 2 groups: those who underwent repair and those without repair. Athletes were considered eligible if they participated in sports within 1 year prior to surgery. Patients were eligible if the return-to-sport status and the following preoperative and minimum 2-year postoperative PROs were available: modified Harris Hip Score, Nonarthritic Hip Score (NAHS), Hip Outcome Score-Sport-Specific Subscale (HOS-SSS), and visual analog scale (VAS) score for pain. Patients were excluded if they underwent prior hip surgery, had Workers' Compensation, were unwilling to consent, had a Tönnis grade greater than 1, or had a previous hip condition. The percentages of patients achieving the minimal clinically important difference (MCID) and maximum outcome improvement satisfaction threshold were recorded. Athletes who underwent interportal capsulotomy repair were propensity score matched in a ratio of 2:1 to athletes without interportal capsulotomy repair according to age, sex, body mass index, sport level, and acetabular labrum articular disruption grade. RESULTS Forty-nine athletes (53 hips) without repair with an average follow-up time of 36.5 ± 10.2 months and age of 32.1 ± 13.3 years were matched to 79 athletes (84 hips) with repair with an average follow-up time of 41.3 ± 9.4 months and age of 30.1 ± 12.1 years. Athletes in the repaired group showed significantly greater improvements in the NAHS, HOS-SSS, and VAS score and significantly higher rates of achievement of the MCID for the HOS-SSS compared with athletes in the unrepaired group. CONCLUSIONS Competitive athletes who underwent primary hip arthroscopy with interportal capsulotomy repair showed a significantly greater magnitude of improvement in PRO scores (NAHS, HOS-SSS, and VAS score) and rates of achieving the MCID (HOS-SSS) compared with a propensity score-matched control group of competitive athletes with an unrepaired interportal capsulotomy. LEVEL OF EVIDENCE Level III, retrospective comparative therapeutic trial.
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Affiliation(s)
- Andrew E Jimenez
- American Hip Institute Research Foundation, Chicago, Illinois, U.S.A
| | - Michael S Lee
- American Hip Institute Research Foundation, Chicago, Illinois, U.S.A
| | - Jade S Owens
- American Hip Institute Research Foundation, Chicago, Illinois, U.S.A
| | | | - David R Maldonado
- American Hip Institute Research Foundation, 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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25
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Zhu XM, Toobaie A, Iansavichene A, Khan M, Degen RM. Improvement in pain and patient-related outcome measures following hip arthroscopy in patients with femoroacetabular impingement syndrome and concomitant generalized ligamentous laxity: a systematic review. Knee Surg Sports Traumatol Arthrosc 2022; 30:3907-3915. [PMID: 35604426 DOI: 10.1007/s00167-022-06997-2] [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] [Received: 09/03/2021] [Accepted: 05/04/2022] [Indexed: 10/18/2022]
Abstract
PURPOSE Within orthopaedic sports medicine, concomitant ligamentous laxity is often found to be a negative prognostic factor for post-operative outcomes following various procedures. The effect of ligamentous laxity on outcomes following hip arthroscopy remains infrequently reported. Therefore, the purpose of this study is to report on the outcomes of hip arthroscopy for the treatment of femoroacetabular impingement syndrome (FAIS) with concomitant generalized ligamentous laxity (GLL). METHODS A systematic search was performed in Medline, EMBASE, CENTRAL, and SPORTDiscus (from inception to April 2021) for studies reporting outcomes following hip arthroscopy for symptomatic FAIS in patients with concomitant GLL. RESULTS Six studies representing 213 patients and 231 hips were included. Outcomes of pain and functional scores as measured by VAS, Harris Hip Score, and Hip Disability and Osteoarthritis Outcomes Score were tabulated. A mean improvement of 4.8 on VAS was observed. Improvements of 30.0 on HHS, 33.1 for ssHOS, and 23.9 for ADL-HOS were observed. CONCLUSION Hip arthroscopy is an effective method of alleviating pain and improving function with statistically significant improvements in all PROM in patients with concomitant FAIS with GLL. LEVEL OF EVIDENCE IV. PROSPERO REGISTRATION CRD42021248864.
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Affiliation(s)
- Xi Ming Zhu
- St George's University Hospitals NHS Foundation Trust, London, UK
| | - Asra Toobaie
- Department of Orthopaedic Surgery, Western University, London, Canada
| | - Alla Iansavichene
- Health Sciences Library, London Health Sciences Centre, London, ON, Canada
| | - Moin Khan
- Department of Orthopedic Surgery, McMaster University, Hamilton, Canada. .,St Joseph's Healthcare Hamilton, 50 Charlton Avenue East, Hamilton, ON, L8N 4A6, Canada.
| | - Ryan M Degen
- Department of Orthopaedic Surgery, Western University, London, Canada
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26
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Owens JS, Lee MS, Jimenez AE, Maldonado DR, Lall AC, Domb BG. Elite Female Athletes Demonstrate a Comparable Improvement in Midterm Patient-Reported Outcome Scores and Rate of Return to Sport Compared With Elite Male Athletes After Hip Arthroscopic Surgery: A Sex-Based Comparison in Professional and Collegiate Athletes. Am J Sports Med 2022; 50:3600-3609. [PMID: 36197056 DOI: 10.1177/03635465221123060] [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] [Indexed: 01/31/2023]
Abstract
BACKGROUND Few studies have compared outcomes, return to sport (RTS), and continuation of sport (CTS) after primary hip arthroscopic surgery between matched groups of male and female athletes with a minimum 5-year follow-up. PURPOSE (1) To report minimum 5-year patient-reported outcome (PRO) scores as well as RTS and CTS rates for elite female athletes undergoing hip arthroscopic surgery for femoroacetabular impingement syndrome (FAIS) and (2) to compare clinical results with those of a matched control group of elite male athletes. STUDY DESIGN Cohort study; Level of evidence, 3. METHODS Data were prospectively collected and retrospectively reviewed for elite (collegiate or professional) female athletes who underwent primary hip arthroscopic surgery for FAIS between March 2009 and March 2016. Inclusion criteria were preoperative and minimum 5-year scores for the modified Harris Hip Score, Nonarthritic Hip Score, Hip Outcome Score-Sport Specific Subscale, and visual analog scale for pain. Exclusion criteria were Tönnis grade >1, hip dysplasia, previous ipsilateral hip surgery/conditions, and those unwilling to participate. Rates of achieving the minimal clinically important difference (MCID), Patient Acceptable Symptom State (PASS), and maximum outcome improvement satisfaction threshold (MOIST) were recorded in addition to RTS. CTS was also recorded and defined as athletes reporting continued sport activity at a minimum 5-year follow-up after initially reporting returning to sport. Elite female athletes were propensity matched in a 1:1 ratio to elite male athletes for comparison. RESULTS A total of 81 hips in elite female athletes that underwent primary hip arthroscopic surgery met the inclusion criteria, and follow-up was available for 65 hips (80.2%) at a mean of 67.6 ± 6.5 months, with a mean age of 24.3 ± 6.8 years. Female athletes demonstrated significant improvements in all recorded PRO scores; achieved the MCID, PASS, and MOIST at high rates; returned to sport at a rate of 80.4%; and continued sport at a rate of 97.1%. Female athletes demonstrated lower preoperative PRO scores compared with male athletes, but postoperative PRO scores; improvements in scores; rates of achieving the MCID, PASS, MOIST; and RTS and CTS rates were similar between female and male athletes. CONCLUSION Elite female athletes undergoing primary hip arthroscopic surgery for FAIS demonstrated favorable PRO scores and high RTS and CTS rates at a minimum 5-year follow-up. These results were comparable with those of a propensity-matched control group of elite male athletes.
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Affiliation(s)
- Jade S Owens
- American Hip Institute Research Foundation, Des Plaines, Illinois, USA
| | - Michael S Lee
- American Hip Institute Research Foundation, Des Plaines, Illinois, USA
| | - Andrew E Jimenez
- American Hip Institute Research Foundation, Des Plaines, Illinois, USA
| | - David R Maldonado
- American Hip Institute Research Foundation, Des Plaines, Illinois, USA
| | - Ajay C Lall
- American Hip Institute Research Foundation, Des Plaines, Illinois, USA.,American Hip Institute, Des Plaines, Illinois, USA
| | - Benjamin G Domb
- American Hip Institute Research Foundation, Des Plaines, Illinois, USA.,American Hip Institute, Des Plaines, Illinois, USA
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27
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Editorial Commentary: The Importance of Capsular Closure Following Hip Arthroscopy-Leave No Trace: An Outdoorsman's Ramblings. Arthroscopy 2022; 38:3041-3042. [PMID: 36344060 DOI: 10.1016/j.arthro.2022.06.008] [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: 06/04/2022] [Accepted: 06/07/2022] [Indexed: 11/06/2022]
Abstract
After a decade-long paradigm shift and an evidence-based enormous increase in the prevalence of hip arthroscopic procedures, hip capsular closure following arthroscopy, once a rare procedure, is now performed in the majority of surgical cases. This results from improved surgeon experience, refined surgical technologies and techniques and an explosion of research regarding stability of the hip joint. Once viewed as inherently stable, it is become clear that meticulous capsular management and closure can not only maintain joint stability but is a treatment for and/or prevents micro-instability. Recent research shows that hip capsular closure can improve outcomes and return to sport rates in the highest demand athletes having hip arthroscopy. Close the capsule!
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28
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Owens JS, Saks BR, Fox JD, Jimenez AE, Lall AC, Domb BG. The Circumferential Femoroplasty: An All-Arthroscopic Technique for Addressing a Challenging Hip Deformity. Arthrosc Tech 2022; 11:e1737-e1745. [PMID: 36311314 PMCID: PMC9596604 DOI: 10.1016/j.eats.2022.06.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/04/2022] [Accepted: 06/17/2022] [Indexed: 02/03/2023] Open
Abstract
Femoroacetabular impingement is recognized as a common cause of hip pain. Cam-type femoroacetabular impingement results from abnormal contact between an aspherical femoral head and the acetabular rim during hip range of motion, leading to labral tearing, cartilage damage, and, eventually, osteoarthritis. Arthroscopic correction of this bony deformity has been well described, particularly in the anterolateral quadrant of the femoral neck. Some deformities extend well beyond this quadrant, involving most or all of the circumference of the femoral neck, making arthroscopic decompression a challenge. We present a post-less, all-arthroscopic technique for performing a circumferential cam decompression using 3-dimensional preoperative planning software and interactive fluoroscopy-integrated computer vision interface.
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Affiliation(s)
- Jade S. Owens
- American Hip Institute Research Foundation, Chicago, Illinois, USA
| | - Benjamin R. Saks
- American Hip Institute Research Foundation, Chicago, Illinois, USA
| | - James D. Fox
- American Hip Institute Research Foundation, Chicago, Illinois, USA
| | | | - Ajay C. Lall
- American Hip Institute Research Foundation, Chicago, Illinois, USA,American Hip Institute, Chicago, Illinois, USA
| | - Benjamin G. Domb
- American Hip Institute Research Foundation, Chicago, Illinois, USA,American Hip Institute, Chicago, Illinois, USA,Address correspondence to Dr. Benjamin G. Domb, M.D., 999 E Touhy Ave., Suite 450, Des Plaines, IL 60018
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29
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Owens JS, Jimenez AE, Lee MS, George T, Maldonado DR, Domb BG. Determining Clinically Meaningful Thresholds for the Hip Outcome Score Sport-Specific Subscale in Athletes Undergoing Hip Arthroscopy for Femoroacetabular Impingement Syndrome. Am J Sports Med 2022; 50:3009-3018. [PMID: 35971944 DOI: 10.1177/03635465221114400] [Citation(s) in RCA: 6] [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 The minimal clinically important difference (MCID), Patient Acceptable Symptom State (PASS), substantial clinical benefit (SCB), and maximum outcome improvement (MOI) satisfaction threshold for the Hip Outcome Score Sport-Specific Subscale (HOS-SSS) have not been established in athletes undergoing hip arthroscopy for femoroacetabular impingement syndrome (FAIS). PURPOSE To determine threshold MCID, PASS, SCB, and MOI satisfaction threshold values for the HOS-SSS in athletes undergoing hip arthroscopy for FAIS at minimum 2-year follow-up. STUDY DESIGN Cohort study (Diagnosis); Level of evidence, 3. METHODS Anchor questions were administered to recreational, organized amateur, high school, college, and professional athletes who underwent primary hip arthroscopy for FAIS between May 2015 and March 2019. Patients were included if they were younger than 50 years, answered the anchor questions, and had preoperative and minimum 2-year follow-up for the HOS-SSS, modified Harris Hip Score (mHHS), Non-Arthritic Hip Score (NAHS), and visual analog scale (VAS) for pain. Exclusion criteria were Tönnis grade >1, hip dysplasia (lateral center-edge angle <18°), and previous ipsilateral hip surgery or conditions. Receiver operating characteristic (ROC) analysis was used to determine PASS, SCB, and MOI satisfaction for the HOS-SSS. Two distribution methods were used to calculate MCID for HOS-SSS. RESULTS A total of 225 athletes who underwent primary hip arthroscopy met the inclusion criteria. Of those athletes, 200 (88.9%) who had minimum 2-year follow-up and information regarding return to sport (RTS) were included. The cohort included 124 (62.0%) women and 76 (38.0%) men with a mean ± standard deviation age of 29.4 ± 10.4 years, body mass index of 25.6 ± 5.4, and follow-up of 29.5 ± 5.1 months. Athletes experienced significant improvements in HOS-SSS, mHHS, NAHS, and VAS from preoperative to latest postoperative follow-up (P < .001), and mean satisfaction was 8.2. The RTS rate was 83.7%. ROC analysis determined that the PASS, MOI satisfaction threshold, SCB absolute score, SCB change score, and MCID (baseline/change score methods) for the HOS-SSS were 77.0, 44.6%, 92.7, 30.6, and 10.6, respectively, with athletes achieving thresholds at high rates (80.0%, 80.5%, 45.0%, 54.0%, and 79.5%, respectively). CONCLUSION This study identified values for the HOS-SSS that can be used to define clinically meaningful outcomes in athletes after primary hip arthroscopy for FAIS. The PASS, MOI satisfaction threshold, SCB absolute score, SCB change score, and MCID for the HOS-SSS at minimum 2-year follow-up in athletes after primary hip arthroscopy were 77.0, 44.6%, 92.7, 30.6, and 10.6, respectively.
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Affiliation(s)
- Jade S Owens
- American Hip Institute Research Foundation, Chicago, Illinois, USA
| | - Andrew E Jimenez
- American Hip Institute Research Foundation, Chicago, Illinois, USA
| | - Michael S Lee
- American Hip Institute Research Foundation, Chicago, Illinois, USA
| | - Tom George
- American Hip Institute Research Foundation, Chicago, Illinois, USA
| | | | - Benjamin G Domb
- American Hip Institute Research Foundation, Chicago, Illinois, USA.,American Hip Institute, Chicago, Illinois, USA
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30
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Jimenez AE, Monahan PF, Owens JS, Maldonado DR, Curley AJ, Domb BG, Lall AC, Domb BG. Earlier Treatment Yields Superior Outcomes in Competitive Athletes Undergoing Primary Hip Arthroscopy. Arthroscopy 2022; 38:2183-2191. [PMID: 34915141 DOI: 10.1016/j.arthro.2021.11.053] [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: 07/26/2021] [Revised: 11/15/2021] [Accepted: 11/30/2021] [Indexed: 02/02/2023]
Abstract
PURPOSE To report minimum 2-year patient-reported outcome scores (PROs) and return to sport (RTS) for competitive athletes undergoing primary hip arthroscopy for femoroacetabular impingement syndrome within 1 year of symptom onset and to compare these results with a propensity-matched control group of competitive athletes with symptoms for over 1 year. METHODS Data on professional, collegiate, high-school, and organized amateur athletes who underwent primary hip arthroscopy within 1 year of symptom onset between April 2008 and November 2017 were collected. RTS and minimum 2-year PROs were collected for the modified Harris Hip Score (mHHS), Non-arthritic Hip Score (NAHS), Hip Outcome Score-Sport Specific Subscale (HOS-SSS), International Hip Outcome Tool (iHOT-12), and visual analog pain scale (VAS). Rates of achieving minimal clinically important difference (MCID) were also evaluated. These patients were propensity-matched to a control group of competitive athletes with symptoms for over one year for comparison. RESULTS Fifty competitive athletes (51 hips, 54.9% female) were included in the study group with a mean follow-up of 70.9 ± 29.1 months and age of 23.6 ± 11.3 years. They demonstrated significant improvement from preoperative to latest follow-up for all recorded PROs (P < .001) and RTS at a rate of 72.9%. When outcomes were compared to the control group, the study group demonstrated similar preoperative scores for all PROs but significantly better minimum 2-year postoperative scores for NAHS (93.8 vs 85.1, P = .0001), HOS-SSS (89.1 vs 77.2, P = .001), iHOT-12 (87.7 vs 76.4, P = 0.011), and VAS (1.5 vs 2.4, P = 0.027). Rates of achieving MCID for HOS-SSS and mHHS were comparable between groups. Further, RTS rates were similar between groups (P = .301). CONCLUSION Competitive athletes undergoing primary hip arthroscopy with symptoms for less than 1 year demonstrated superior 2-year PROs compared to a propensity-matched control group with symptoms for over 1 year, but the rates achieving MCID and RTS were similar between groups. LEVEL OF EVIDENCE Level III, retrospective comparative study.
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Affiliation(s)
| | - Peter F Monahan
- American Hip Institute Research Foundation, Chicago, Illinois
| | - Jade S Owens
- American Hip Institute Research Foundation, Chicago, Illinois
| | | | - Andrew J Curley
- American Hip Institute Research Foundation, Chicago, Illinois
| | - Benjamin G Domb
- American Hip Institute Research Foundation, Chicago, Illinois; American Hip Institute, Chicago, Illinois; AMITA Health St. Alexius Medical Center, Hoffman Estates, Illinois, U.S.A..
| | - Ajay C Lall
- American Hip Institute Research Foundation, Chicago, IL 60018; American Hip Institute, Chicago, IL 60018; AMITA Health St. Alexius Medical Center, Hoffman Estates, IL 60169
| | - Benjamin G Domb
- American Hip Institute Research Foundation, Chicago, IL 60018; American Hip Institute, Chicago, IL 60018; AMITA Health St. Alexius Medical Center, Hoffman Estates, IL 60169.
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Owens JS, Jimenez AE, Lee MS, Maldonado DR, Lall AC, Domb BG. Outcomes and Return-to-Sport Rates for Elite Athletes With Femoral Retroversion Undergoing Hip Arthroscopy: A Propensity-Matched Analysis With Minimum 2-Year Follow-up. Orthop J Sports Med 2022; 10:23259671221099840. [PMID: 35677020 PMCID: PMC9168879 DOI: 10.1177/23259671221099840] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/10/2022] [Accepted: 03/22/2022] [Indexed: 11/16/2022] Open
Abstract
Background: Return to sports (RTS) and patient-reported outcomes (PROs) for elite
athletes with femoral version abnormalities undergoing hip arthroscopy have
not been well established. Purposes: To (1) report minimum 2-year PROs and RTS rates in elite athletes with
femoral retroversion who underwent primary hip arthroscopy and (2) compare
clinical results to those of a propensity-matched control group of elite
athletes with normal femoral version who underwent primary hip
arthroscopy. Study Design: Cohort study; Level of evidence, 3. Methods: Data were prospectively collected and retrospectively reviewed for elite
(professional and collegiate) athletes with femoral version <5°, as
measured on magnetic resonance imaging scans, who underwent hip arthroscopy
for femoroacetabular impingement syndrome between March 2010 and April 2018.
Inclusion criteria were preoperative and minimum 2-year follow-up PROs for
the modified Harris Hip Score, Nonarthritic Hip Score, Hip Outcome
Score–Sports Specific Subscale (HOS-SSS), and visual analog scale for pain.
Exclusion criteria were Tönnis grade >1, hip dysplasia, and previous
ipsilateral hip surgery or conditions. Rates of achieving the minimal
clinically important difference (MCID), Patient Acceptable Symptom State
(PASS), and maximum outcome improvement satisfaction threshold were recorded
in addition to RTS. Athletes with retroversion were propensity matched in a
1:2 ratio to elite athletes with normal femoral version (5°-20°) for
comparison. Results: A total of 33 elite athletes (33 hips) with femoral retroversion who
underwent hip arthroscopy met the inclusion criteria, and follow-up was
available for 30 hips in 30 athletes (90.9%) at an average of 36.1 ± 25.6
months. Elite athletes with femoral retroversion demonstrated significant
improvements in all recorded PROs, achieved the MCID and PASS for the
HOS-SSS at high rates (86.7%), and returned to sports at a rate of 83.3%.
PROs, rates of achieving MCID and PASS for the HOS-SSS, and RTS rates were
similar between the study and propensity-matched control group. Conclusion: Elite athletes with femoral retroversion undergoing primary hip arthroscopy
demonstrated favorable PROs and high RTS rates at a minimum 2-year
follow-up. These results were comparable with those of a propensity-matched
control group of elite athletes with normal femoral version.
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Affiliation(s)
- Jade S. Owens
- American Hip Institute Research Foundation, Chicago, Illinois, USA
| | | | - Michael S. Lee
- American Hip Institute Research Foundation, Chicago, Illinois, USA
| | | | - Ajay C. Lall
- American Hip Institute Research Foundation, Chicago, Illinois, USA
- American Hip Institute, Chicago, Illinois, USA
| | - Benjamin G. Domb
- American Hip Institute Research Foundation, Chicago, Illinois, USA
- American Hip Institute, Chicago, Illinois, USA
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32
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Banke IJ, Ezechieli M. [Persistent or recurrent symptoms after surgery for femoroacetabular impingement syndrome (FAIS) : Pathology, diagnostics and therapy]. ORTHOPADIE (HEIDELBERG, GERMANY) 2022; 51:483-493. [PMID: 35925373 DOI: 10.1007/s00132-022-04255-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 04/06/2022] [Indexed: 06/15/2023]
Abstract
BACKGROUND Femoroacetabular impingement syndrome (FAIS) has gained vast importance in the last two decades. Multiple studies have shown that if untreated, early osteoarthritis of the hip joint may result. Hip arthroscopy is one of the fastest growing procedures in the orthopedic cosmos, having already replaced the majority of (mini) open techniques in FAIS surgery. However, with the recent remarkable increase in the volume of hip arthroscopies performed worldwide, the number of patients with persistent or recurrent symptoms after FAIS surgery is also growing. PATHOLOGY Potential underlying pathologies are misresection of the bony deformity, insufficiency fracture of the femoral head neck junction or the femoral subchondral head itself (SIFFH), adhesions, failed chondrolabral or capsular treatment, septic arthritis, heterotopic ossification or a wrong indication in the case of osteoarthritis that is already too advanced. Most of these occur more often during the extensive learning curve for hip arthroscopy. DIAGNOSTICS High-quality imaging plays a key role in determining the need for revision surgery vs. further conservative treatment. Therapeutical avenues are shown with the common goal of proper detection and correction of the underlying pathology to address unsatisfactory FAIS treatment outcomes and ensure long-term survival of the native hip joint.
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Affiliation(s)
- Ingo J Banke
- Klinik und Poliklinik für Orthopädie und Sportorthopädie, Klinikum rechts der Isar der TU München, Ismaninger Str. 22, 81675, München, Deutschland.
| | - Marco Ezechieli
- Vincenz Krankenhaus Paderborn, Standort Salzkotten, Salzkotten, Deutschland
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33
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Maldonado DR, Kyin C, Simpson JR, Annin S, Jimenez AE, Saks BR, Lall AC, Domb BG. Minimum 5-Year Outcomes After Primary Segmental Labral Reconstruction for Irreparable Labral Tears in the Hip With Hamstring Grafts: With a Subanalysis Comparing Autograft Versus Allograft. Am J Sports Med 2022; 50:1876-1887. [PMID: 35486521 DOI: 10.1177/03635465221091192] [Citation(s) in RCA: 6] [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 Comparable short-term outcomes have been obtained using hamstring allografts versus autografts after primary segmental labral reconstruction (SLR). Midterm results have not yet been determined. PURPOSE (1) To evaluate minimum 5-year patient-reported outcome (PRO) scores in patients who underwent primary SLR with hamstring grafts in the setting of femoroacetabular impingement syndrome (FAIS) and irreparable labral tears and (2) to compare the outcomes of hamstring autografts versus allografts in a subanalysis using propensity-matched groups. STUDY DESIGN Cohort study; Level of evidence, 3. METHODS Prospectively collected data were retrospectively reviewed for patients who underwent primary hip arthroscopy between September 2010 and November 2015. Patients were included if they underwent SLR using hamstring autografts or allografts and had preoperative and minimum 5-year PROs. The exclusion criteria were previous ipsilateral hip surgery or conditions, dysplasia, or Tönnis grade >1. Patients with autograft SLR were propensity matched 1 to 1 based on age, sex, and body mass index (BMI) to patients who underwent SLR using hamstring allografts. The minimal clinically important difference (MCID) and the Patient Acceptable Symptom State (PASS) were calculated. RESULTS Overall, 48 patients (N = hips 48) were eligible to be included in this study, and 41 patients (n = 41 hips [85.4%]) had a minimum 5-year follow-up reporting significant improvements in all PROs. Within the entire cohort, 9.8% required a secondary arthroscopy, with a mean time of 19 ± 1.8 months, and survivorship was 82.9%. Of the 41 included patients, 15 underwent an SLR with a hamstring autograft and were matched to 15 patients with labral reconstruction using a hamstring allograft. Groups were similar for sex (P > .999), age (P = .775), and BMI (P = .486). The mean follow-up times were 80.8 ± 25.5 and 66.1 ± 8.3 months (P = .223) for the autograft and allograft groups, respectively. Baseline PROs, preoperative radiographic measurements, surgical findings, and intraoperative procedures were similar. The groups achieved significant and comparable improvements for all PROs (P < .0001), satisfaction (P = .187), and the rate of achieving the MCID and the PASS. However, a tendency for higher postoperative PROs favoring allograft reconstruction was found. CONCLUSION At a minimum 5-year follow-up, patients who underwent primary arthroscopic SLR in the context of FAIS and irreparable labra, with either autograft or allograft hamstring tendons, reported significant improvements and comparable postoperative scores for all PROs, patient satisfaction, MCID, and PASS.
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Affiliation(s)
| | - Cynthia Kyin
- American Hip Institute Research Foundation, Chicago, Illinois, USA.,University of Central Florida College of Medicine, Orlando, Florida, USA
| | - Jeffrey R Simpson
- American Hip Institute Research Foundation, Chicago, Illinois, USA.,University of Central Florida College of Medicine, Orlando, Florida, USA
| | - Shawn Annin
- American Hip Institute Research Foundation, Chicago, Illinois, USA
| | - Andrew E Jimenez
- American Hip Institute Research Foundation, Chicago, Illinois, USA
| | - Benjamin R Saks
- American Hip Institute Research Foundation, Chicago, Illinois, USA
| | - Ajay C Lall
- American Hip Institute Research Foundation, Chicago, Illinois, USA.,American Hip Institute, Chicago, Illinois, USA
| | - Benjamin G Domb
- American Hip Institute Research Foundation, Chicago, Illinois, USA.,American Hip Institute, Chicago, Illinois, USA
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34
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Harris WT, Jimenez AE, Owens JS, Delgado-Arellanes I, Lall AC, Domb BG. X-Grab: An Arthroscopic Maneuver to Efficiently and Accurately Track the Post for Knot Tying. Arthrosc Tech 2022; 11:e947-e950. [PMID: 35782850 PMCID: PMC9243617 DOI: 10.1016/j.eats.2022.01.014] [Citation(s) in RCA: 1] [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: 12/02/2021] [Accepted: 01/15/2022] [Indexed: 02/03/2023] Open
Abstract
Numerous studies have analyzed techniques for producing reliable and efficient arthroscopic knots. All aspects have been explored, from the biomechanics and strength to the ability to teach and replicate at all levels of training. This technique article describes an additional maneuver (X-grab) for efficiently marking the post side of the arthroscopic knot without having to do this separately outside of the joint. This is most useful for procedures such as rotator cuff repair and capsular repair or plication in hip arthroscopy in which the location of the knot (i.e., the post) is critical. The aim of this Technical Note is to describe the X-grab maneuver, which shortens this process to a single step, limiting the see-sawing of sutures and over-instrumentation of the joint seen with other techniques.
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Affiliation(s)
- W. Taylor Harris
- American Hip Institute Research Foundation, Chicago, Illinois, U.S.A
| | - Andrew E. Jimenez
- American Hip Institute Research Foundation, Chicago, Illinois, U.S.A
| | - Jade S. Owens
- 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.,Address correspondence to Benjamin G. Domb, M.D., 999 E Touhy Ave, Ste 450, Des Plaines, IL 60018, U.S.A.
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35
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Martin H, Robinson PG, Maempel JF, Hamilton D, Gaston P, Safran MR, Murray IR. Pre- and intraoperative decision-making challenges in hip arthroscopy for femoroacetabular impingement. Bone Joint J 2022; 104-B:532-540. [PMID: 35491576 DOI: 10.1302/0301-620x.104b5.bjj-2021-1553.r1] [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] [Indexed: 11/05/2022]
Abstract
There has been a marked increase in the number of hip arthroscopies performed over the past 16 years, primarily in the management of femoroacetabular impingement (FAI). Insights into the pathoanatomy of FAI, and high-level evidence supporting the clinical effectiveness of arthroscopy in the management of FAI, have fuelled this trend. Arthroscopic management of labral tears with repair may have superior results compared with debridement, and there is now emerging evidence to support reconstructive options where repair is not possible. In situations where an interportal capsulotomy is performed to facilitate access, data now support closure of the capsule in selective cases where there is an increased risk of postoperative instability. Preoperative planning is an integral component of bony corrective surgery in FAI, and this has evolved to include computer-planned resection. However, the benefit of this remains controversial. Hip instability is now widely accepted, and diagnostic criteria and treatment are becoming increasingly refined. Instability can also be present with FAI or develop as a result of FAI treatment. In this annotation, we outline major current controversies relating to decision-making in hip arthroscopy for FAI. Cite this article: Bone Joint J 2022;104-B(5):532-540.
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Affiliation(s)
- Hannah Martin
- Edinburgh Orthopaedics, Royal Infirmary of Edinburgh, Edinburgh, UK.,Department of Orthopaedic Surgery, The University of Edinburgh, Edinburgh, UK
| | - Patrick G Robinson
- Edinburgh Orthopaedics, Royal Infirmary of Edinburgh, Edinburgh, UK.,Department of Orthopaedic Surgery, The University of Edinburgh, Edinburgh, UK
| | | | - David Hamilton
- Edinburgh Orthopaedics, Royal Infirmary of Edinburgh, Edinburgh, UK.,Department of Orthopaedic Surgery, The University of Edinburgh, Edinburgh, UK.,School of Health and Social Care, Edinburgh Napier University, Edinburgh, UK
| | - Paul Gaston
- Edinburgh Orthopaedics, Royal Infirmary of Edinburgh, Edinburgh, UK.,Department of Orthopaedic Surgery, The University of Edinburgh, Edinburgh, UK
| | - Marc R Safran
- Department of Orthopaedic Surgery, Stanford University, Redwood City, California, USA
| | - Iain R Murray
- Edinburgh Orthopaedics, Royal Infirmary of Edinburgh, Edinburgh, UK.,Department of Orthopaedic Surgery, The University of Edinburgh, Edinburgh, UK
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36
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Jimenez AE, Lee MS, George T, Owens JS, Maldonado DR, Saks BR, Lall AC, Domb BG. Effect of Cigarette Smoking on Outcomes in Patients Undergoing Primary Hip Arthroscopy and Labral Reconstruction: A Propensity-Matched Controlled Study With Minimum 2-Year Follow-up. Orthop J Sports Med 2022; 10:23259671221075642. [PMID: 35237697 PMCID: PMC8882953 DOI: 10.1177/23259671221075642] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/05/2021] [Accepted: 11/12/2021] [Indexed: 11/16/2022] Open
Abstract
Background: There is a paucity of literature evaluating the effect of cigarette smoking
on outcomes in patients undergoing hip arthroscopy and labral
reconstruction. Purpose: (1) To report minimum 2-year patient-reported outcome (PRO) scores for
patients who smoke cigarettes and underwent primary hip arthroscopic labral
reconstruction and (2) to compare these results with those of a
propensity-matched control group of patients who have never smoked. Study Design: Cohort study; Level of evidence, 3. Methods: Data were collected for all patients who underwent primary hip arthroscopy
for labral reconstruction between January 2011 and January 2019. Patients
were eligible for the study if they indicated that they smoked cigarettes
within 1 month of surgery and had minimum 2-year postoperative outcome
scores for the modified Harris Hip Score (mHHS), Nonarthritic Hip Score
(NAHS), and the visual analog scale (VAS) for pain. The percentage of
patients achieving the minimal clinically important difference (MCID) and
patient-acceptable symptom state (PASS) was recorded. Rates of revision
surgery were also documented. These patients were then propensity matched in
a 1:3 ratio to patients who had never smoked (controls) for comparison. Results: A total of 20 patients (20 hips) were included with a mean follow-up of 39.9
± 13.0 months and mean age of 41.4 ± 10.4 years. These patients demonstrated
significant improvement from preoperatively to the minimum 2-year follow-up
for mHHS, NAHS, and VAS (P < .05). They also achieved
MCID for mHHS and VAS at acceptable rates, 70% for both. When outcomes were
compared with those of 60 control patients (60 hips), patients who smoke
demonstrated lower preoperative PRO scores but similar minimum 2-year
postoperative PRO scores for mHHS and NAHS. Patients who smoke demonstrated
lower rates of achieving PASS for mHHS (55% vs 75%) and NAHS (40% vs 61.7%)
compared with controls; however, these findings were not statistically
significant. Rates of secondary surgery were statistically significantly
higher in the smoking group compared with controls (25% vs 5%;
P = .031). Survivorship for the smoking patients was
80% and 98.3% for the control group. At the two-year mark survivorship was
90% for the smoking group and 100% for the control group (P
= .06) Conclusion: While smokers can still derive significant improvement from hip arthroscopy,
their ultimate functional outcome and rate of secondary surgeries are
inferior to those of nonsmokers. As smoking is a significant and modifiable
risk factor, we should continue to counsel smokers on smoking cessation
prior to and after surgery
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Affiliation(s)
| | - Michael S. Lee
- American Hip Institute Research Foundation, Chicago, Illinois, USA
| | - Tom George
- American Hip Institute Research Foundation, Chicago, Illinois, USA
| | - Jade S. Owens
- American Hip Institute Research Foundation, Chicago, Illinois, USA
| | | | - Benjamin R. Saks
- American Hip Institute Research Foundation, Chicago, Illinois, USA
| | - Ajay C. Lall
- American Hip Institute Research Foundation, Chicago, Illinois, USA
- American Hip Institute, Chicago, Illinois, USA
| | - Benjamin G. Domb
- American Hip Institute Research Foundation, Chicago, Illinois, USA
- American Hip Institute, Chicago, Illinois, USA
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37
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Perry AK, Trasolini NA, Gursoy S, Vadhera AS, Williams J, Nho SJ, Chahla J. Revision Hip Arthroscopy for Graft Retear and Residual Cam Lesion in a Previously Labral Reconstructed Hip. Arthrosc Tech 2022; 11:e139-e145. [PMID: 35155105 PMCID: PMC8821039 DOI: 10.1016/j.eats.2021.10.003] [Citation(s) in RCA: 1] [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: 08/09/2021] [Accepted: 10/07/2021] [Indexed: 02/03/2023] Open
Abstract
Persistent pain after hip arthroscopy may be due to residual impingement, hip dysplasia, osteoarthritis progression, labral injury, or insufficient capsular closure. A patient's history, physical examination findings, and imaging studies should be used to determine whether revision hip arthroscopy is indicated. If surgical management is chosen, careful preoperative planning is essential. During revision hip arthroscopy, the presence and location of adhesions should be considered during interportal capsulotomy and T-capsulotomy creation and while applying traction sutures. The presence of a residual cam or pincer lesion and the adequacy of the labrum or labral graft should be assessed and properly addressed. If capsular redundancy is recognized, capsular plication may be performed. The purpose of this Technical Note is to describe an approach to revision hip arthroscopy for labral repair and residual cam lesion resection.
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Affiliation(s)
| | | | | | | | | | | | - Jorge Chahla
- Address correspondence to Jorge Chahla, M.D., Ph.D., Division of Sports Medicine, Midwest Orthopaedics at Rush, Rush University Medical Center, 1611 W Harrison St, Chicago, IL 60616, U.S.A.
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38
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Jimenez AE, Owens JS, Monahan PF, Maldonado DR, Saks BR, Sabetian PW, Ankem HK, Lall AC, Domb BG. Return to Sports and Minimum 2-Year Outcomes of Hip Arthroscopy in Elite Athletes With and Without Coexisting Low Back Pain: A Propensity-Matched Comparison. Am J Sports Med 2022; 50:68-78. [PMID: 34807750 DOI: 10.1177/03635465211056964] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND Patient-reported outcomes (PROs) and return to sports (RTS) after hip arthroscopy for femoroacetabular impingement syndrome (FAIS) have not been established in elite athletes with coexisting low back pain (LBP). PURPOSE (1) To report minimum 2-year PROs and RTS rates after primary hip arthroscopy for FAIS in elite athletes with coexisting LBP and (2) to compare clinical results with a propensity-matched control group of elite athletes without back pain. STUDY DESIGN Cohort study; Level of evidence, 3. METHODS Data were reviewed for elite athletes (college and professional) who underwent hip arthroscopy for FAIS and had coexisting LBP between October 2009 and October 2018. Inclusion criteria were preoperative and minimum 2-year follow-up for the modified Harris Hip Score, Nonarthritic Hip Score, Hip Outcome Score-Sports Specific Subscale (HOS-SSS), and visual analog scale for pain. Exclusion criteria were Tönnis grade >1, hip dysplasia (lateral center-edge angle <18°), and previous ipsilateral hip or spine surgery or conditions. Rates of achieving the minimal clinically importance difference (MCID), patient acceptable symptomatic state (PASS), and maximum outcome improvement satisfaction threshold were recorded in addition to RTS. For the subanalysis, the elite athlete study group was propensity matched to an elite athlete control group without back pain. RESULTS A total of 48 elite athletes with LBP who underwent primary hip arthroscopy met inclusion criteria, and follow-up was available for 42 (87.5%) at 53.2 ± 31.6 months (mean ± SD). Elite athletes with coexisting LBP demonstrated significant improvements in all recorded PROs and achieved the MCID and PASS for the HOS-SSS at rates of 82.5% and 67.5%, respectively. They also returned to sports at a high rate (75.8%), and 79% of them did not report LBP postoperatively. PROs, rates of achieving the MCID and PASS for the HOS-SSS, and RTS rates were similar between the study group and propensity-matched control group. CONCLUSION Elite athletes with coexisting LBP who undergo primary hip arthroscopy for FAIS may expect favorable PROs, rates of achieving the MCID and PASS for the HOS-SSS, and RTS rates at minimum 2-year follow-up. These results were comparable to those of a propensity-matched control group of elite athletes without back pain. In athletes with hip-spine syndrome, successful treatment of their hip pathology may help resolve their back pain.
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Affiliation(s)
- Andrew E Jimenez
- American Hip Institute Research Foundation, Chicago, Illinois, USA
| | - Jade S Owens
- American Hip Institute Research Foundation, Chicago, Illinois, USA
| | - Peter F Monahan
- American Hip Institute Research Foundation, Chicago, Illinois, USA
| | | | - Benjamin R Saks
- American Hip Institute Research Foundation, Chicago, Illinois, USA.,AMITA Health St Alexius Medical Center, Hoffman Estates, Illinois, USA
| | - Payam W Sabetian
- American Hip Institute Research Foundation, Chicago, Illinois, USA
| | - Hari K Ankem
- American Hip Institute Research Foundation, Chicago, Illinois, USA
| | - Ajay C Lall
- American Hip Institute Research Foundation, Chicago, Illinois, USA.,AMITA Health St Alexius Medical Center, Hoffman Estates, Illinois, USA.,American Hip Institute, Chicago, Illinois, USA
| | - Benjamin G Domb
- American Hip Institute Research Foundation, Chicago, Illinois, USA.,AMITA Health St Alexius Medical Center, Hoffman Estates, Illinois, USA.,American Hip Institute, Chicago, Illinois, USA
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39
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Meier MK, Lerch TD, Steppacher SD, Siebenrock KA, Tannast M, Vavron P, Schmaranzer E, Schmaranzer F. High prevalence of hip lesions secondary to arthroscopic over- or undercorrection of femoroacetabular impingement in patients with postoperative pain. Eur Radiol 2021; 32:3097-3111. [PMID: 34842955 PMCID: PMC9038890 DOI: 10.1007/s00330-021-08398-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2021] [Revised: 09/28/2021] [Accepted: 10/27/2021] [Indexed: 11/30/2022]
Abstract
Objectives To compare the prevalence of pre- and postoperative osseous deformities and intra-articular lesions in patients with persistent pain following arthroscopic femoroacetabular impingement (FAI) correction and to identify imaging findings associated with progressive cartilage damage. Methods Retrospective study evaluating patients with hip pain following arthroscopic FAI correction between 2010 and 2018. Pre- and postoperative imaging studies were analyzed independently by two blinded readers for osseous deformities (cam-deformity, hip dysplasia, acetabular overcoverage, femoral torsion) and intra-articular lesions (chondro-labral damage, capsular lesions). Prevalence of osseous deformities and intra-articular lesions was compared with paired t-tests/McNemar tests for continuous/dichotomous data. Association between imaging findings and progressive cartilage damage was assessed with logistic regression. Results Forty-six patients (mean age 29 ± 10 years; 30 female) were included. Postoperatively, 74% (34/46) of patients had any osseous deformity including 48% (22/46) acetabular and femoral deformities. Ninety-six percent (44/46) had an intra-articular lesion ranging from 20% (9/46) for femoral to 65% (30/46) for acetabular cartilage lesions. Prevalence of hip dysplasia increased (2 to 20%, p = 0.01) from pre- to postoperatively while prevalence of cam-deformity decreased (83 to 28%, p < 0.001). Progressive cartilage damage was detected in 37% (17/46) of patients and was associated with extensive preoperative cartilage damage > 2 h, i.e., > 60° (OR 7.72; p = 0.02) and an incremental increase in postoperative alpha angles (OR 1.18; p = 0.04). Conclusion Prevalence of osseous deformities secondary to over- or undercorrrection was high. Extensive preoperative cartilage damage and higher postoperative alpha angles increase the risk for progressive degeneration. Key Points • The majority of patients presented with osseous deformities of the acetabulum or femur (74%) and with intra-articular lesions (96%) on postoperative imaging. • Prevalence of hip dysplasia increased (2 to 20%, p = 0.01) from pre- to postoperatively while prevalence of a cam deformity decreased (83 to 28%, p < 0.001). • Progressive cartilage damage was present in 37% of patients and was associated with extensive preoperative cartilage damage > 2 h (OR 7.72; p = 0.02) and with an incremental increase in postoperative alpha angles (OR 1.18; p = 0.04). Supplementary Information The online version contains supplementary material available at 10.1007/s00330-021-08398-4.
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Affiliation(s)
- Malin K Meier
- Department of Orthopedic Surgery and Traumotology, Inselspital Bern University Hospital, University of Bern, Freiburgstrasse, 3010, Bern, Switzerland
| | - Till D Lerch
- Department of Diagnostic-, Interventional- and Pediatric Radiology, Inselspital Bern University Hospital, University of Bern, Freiburgstrasse, 3010, Bern, Switzerland
| | - Simon D Steppacher
- Department of Orthopedic Surgery and Traumotology, Inselspital Bern University Hospital, University of Bern, Freiburgstrasse, 3010, Bern, Switzerland
| | - Klaus A Siebenrock
- Department of Orthopedic Surgery and Traumotology, Inselspital Bern University Hospital, University of Bern, Freiburgstrasse, 3010, Bern, Switzerland
| | - Moritz Tannast
- Department of Orthopaedic Surgery, Fribourg Cantonal Hospital, University of Fribourg, Chemin des Pensionnats 2-6, 1752, Villars-sur-Glâne, Switzerland
| | - Peter Vavron
- Department of Orthopaedic Surgery, District Hospital St. Johann in Tirol, Bahnhofstrasse 14, 6380, St. Johann in Tirol, Austria
| | - Ehrenfried Schmaranzer
- Department of Radiology, District Hospital St. Johann in Tirol, Bahnhofstrasse 14, 6380, St. Johann in Tirol, Austria
| | - Florian Schmaranzer
- Department of Diagnostic-, Interventional- and Pediatric Radiology, Inselspital Bern University Hospital, University of Bern, Freiburgstrasse, 3010, Bern, Switzerland. .,Department of Radiology, District Hospital St. Johann in Tirol, Bahnhofstrasse 14, 6380, St. Johann in Tirol, Austria.
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