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Harding D, Cameron L, Monga A, Winter S. Is shockwave therapy effective in the management of greater trochanteric pain syndrome? A systematic review and meta-analysis. Musculoskeletal Care 2024; 22:e1892. [PMID: 38777616 DOI: 10.1002/msc.1892] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2024] [Accepted: 04/23/2024] [Indexed: 05/25/2024]
Abstract
BACKGROUND Evidence is lacking for the efficacy of shockwave therapy (SWT) in the treatment of greater trochanteric pain syndrome (GTPS). AIM To investigate the efficacy of SWT on pain and function in the management of GTPS. METHODS A systematic search of electronic databases and grey literature was conducted up to May 2023. Studies utilising SWT on adults for GTPS, providing measures of pain and/or function at baseline and at follow-up were considered for inclusion. Meta-analysis was undertaken using converted pain and functional outcomes. Studies were assessed for quality and risk of bias, and assigned a level of evidence as per the Grading of Recommendations, Assessment, Development and Evaluations criteria. RESULTS Twelve articles (n = 1121 subjects) were included, including five randomised controlled trials (RCTs) and seven non-RCTs. No statistical differences were observed for pain over time f(1,5) = 1.349 (p = 0.298) or between SWT and control f(1,5) = 1.782 (p = 0.238). No significant differences in functional outcomes in short- (H = 2.591, p = 0.181) and medium-term follow-up (H = 0.189, p = 0.664) were identified between SWT and control. Moderate magnitude treatment effects for pain (Hedges-G [HG] 0.71) favouring SWT groups over control was identified, decreasing to low for function (HG 0.20). Further pain and functional treatment effects were identified at higher magnitudes across follow-up time-points in SWT groups compared to control. CONCLUSION Moderate-quality evidence demonstrated no statistically significant improvements in pain and function post-SWT compared to control. Low-quality evidence established clinical improvements throughout all included studies favouring SWT over control. Consequently, owing to relatively low incidence of side effects, SWT should be considered a viable option for the management of GTPS. Issues with both clinical and statistical heterogeneity of studies and during meta-analysis require consideration, and more robust RCTs are recommended if the efficacy of SWT for the management of GTPS is to be comprehensively determined.
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Affiliation(s)
- Dan Harding
- Aneurin Bevan University Health Board, Caerleon, UK
| | - Lee Cameron
- Aneurin Bevan University Health Board, Caerleon, UK
| | - Aastha Monga
- School of Allied Health Professions, Keele University, Keele, UK
| | - Sara Winter
- School of Allied Health Professions, Keele University, Keele, UK
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Servant G, Bothorel H, Pernoud A, Fourchet F, Christofilopoulos P. Hip Arthroscopy Followed by 6-Month Rehabilitation Leads to Improved Periarticular Muscle Strength, Except for Abductors and External Rotators. Arthrosc Sports Med Rehabil 2024; 6:100900. [PMID: 38379599 PMCID: PMC10878845 DOI: 10.1016/j.asmr.2024.100900] [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: 09/10/2023] [Accepted: 01/17/2024] [Indexed: 02/22/2024] Open
Abstract
Purpose To evaluate the variations in hip muscles strength following arthroscopy and 6-month rehabilitation in patients treated for femoroacetabular impingement (FAI). Methods A retrospective analysis was carried out on a series of patients who were arthroscopically treated for FAI at La Tour Hospital between 2020 and 2022. Bilateral isometric strengths of 8 hip-related muscles (abductors, adductors, hamstrings, quadriceps, extensors, flexors, internal and external rotators) were assessed using a handheld dynamometer before surgery and postoperatively after 6 months of rehabilitation in terms of relative strength changes between time points. Results A total of 29 patients (aged 26.9 ± 7.1 years, 86% of women) were included. Except for the abductors, which remained of comparable strength than before surgery, a statistically significant (P < .05) increase in hip muscle strength on the operated side could be noted at 6 postoperative months for hamstrings (9% ± 17%, P = .041), quadriceps (11% ± 27%, P = .045), extensors (17% ± 32%, P = .006), flexors (17% ± 29%, P = .003), adductors (18% ± 23%, P < .001), and internal rotators (32% ± 36%, P < .001). The proportion of patients who reached a strength level above their preoperative status ranged from 62% (quadriceps) to 86% (adductors and flexors), depending on the muscle studied. The external rotators were the only muscles that remained significantly weakened at 6 months on both operated (-13% ± 26%, P = .002) and nonoperated (-17% ± 25%, P < .001) sides, with a decrease beyond 15% in almost half of the patients (45% and 48%, respectively). Conclusions Arthroscopic treatment followed by 6-month rehabilitation granted to most FAI patients a higher strength level for several hip muscles, except for abductors and external rotators, which remained comparable and weakened, respectively. Level of Evidence Level IV, therapeutic case series.
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Affiliation(s)
- Guillaume Servant
- Physiotherapy Department and Motion Analysis Lab, Swiss Olympic Medical Center, La Tour Hospital, Meyrin, Switzerland
| | - Hugo Bothorel
- Research Department, La Tour Hospital, Meyrin, Switzerland
| | | | - François Fourchet
- Physiotherapy Department and Motion Analysis Lab, Swiss Olympic Medical Center, La Tour Hospital, Meyrin, Switzerland
- French Society of Sports Physical Therapist (SFMKS Lab), Pierrefitte-sur-Seine, France
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Bartlett L, Tharakan S, Klein B, Trasolini RG, Sgaglione NA, Cohn RM. Capsular Repair, Labral Repair, and Femoroplasty are Increasingly Performed for the Arthroscopic Treatment of Femoroacetabular Impingement Syndrome. Arthroscopy 2024:S0749-8063(24)00069-0. [PMID: 38311271 DOI: 10.1016/j.arthro.2024.01.025] [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: 10/06/2023] [Revised: 01/15/2024] [Accepted: 01/21/2024] [Indexed: 02/10/2024]
Abstract
PURPOSE To provide an updated assessment of hip arthroscopy use by using an institutional database that is specific to the treatment of femoroacetabular impingement syndrome (FAIS). METHODS All patients undergoing hip arthroscopy for the treatment of FAIS were retrospectively identified between the years 2014 and 2022 via Current Procedural Terminology coding in a multi-institutional, single health system database. A longitudinal analysis was performed to identify trends in the use of arthroscopic techniques including capsular and labral treatment, osteoplasty, and traction set-up. RESULTS During the study, 789 arthroscopic hip procedures in 733 patients were analyzed (56 staged bilateral). Between 2016 and 2022, the number of hip arthroscopies performed each year increased by 1,490% (R2 = 0.87, P = .001). Capsular repair (R2 = 0.92, P < .001), labral repair (R2 = 0.75, P = .002), and femoroplasty (R2 = 0.70, P = .004) were performed in an increasing proportion of cases over our study period whereas labral debridement (R2 = -0.84, P < .001) became less used. Postless traction systems were employed in 84% (663/789) of hip arthroscopies overall, were used in at least 70% of hip arthroscopies each year, and did not undergo any significant changes in use (R2 = 0.02, P = .73). CONCLUSIONS Capsular repair, labral repair, and femoroplasty were increasingly performed for the arthroscopic treatment of FAIS whereas the use of labral debridement decreased significantly over our study period. Postless traction systems were used in the majority of cases each year. CLINICAL RELEVANCE As comparative literature continues to define the safety and efficacy of hip arthroscopy, understanding how novel techniques or procedures are incorporated in clinical practice is important.
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Affiliation(s)
- Lucas Bartlett
- Department of Orthopedic Surgery, Huntington Hospital, Northwell Health, Donald and Barbara Zucker School of Medicine at Hofstra, Huntington, New York, U.S.A..
| | - Shebin Tharakan
- NYIT College of Osteopathic Medicine, Westbury, New York, U.S.A
| | - Brandon Klein
- Department of Orthopedic Surgery, Huntington Hospital, Northwell Health, Donald and Barbara Zucker School of Medicine at Hofstra, Huntington, New York, U.S.A
| | - Robert G Trasolini
- Department of Orthopedic Surgery, Huntington Hospital, Northwell Health, Donald and Barbara Zucker School of Medicine at Hofstra, Huntington, New York, U.S.A
| | - Nicholas A Sgaglione
- Department of Orthopedic Surgery, Huntington Hospital, Northwell Health, Donald and Barbara Zucker School of Medicine at Hofstra, Huntington, New York, U.S.A.; Department of Orthopedic Surgery, Northwell Health, Donald and Barbara Zucker School of Medicine at Hofstra, Great Neck, New York, U.S.A
| | - Randy M Cohn
- Department of Orthopedic Surgery, Huntington Hospital, Northwell Health, Donald and Barbara Zucker School of Medicine at Hofstra, Huntington, New York, U.S.A
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Bonin N, Manzini F, Viamont-Guerra MR. No Differences in Clinical Outcomes Between Hip Arthroscopy With Versus Without Capsular Closure in Patients With Cam- or Mixed-Type Femoroacetabular Impingement: A Randomized Controlled Trial. Arthroscopy 2024:S0749-8063(23)01023-X. [PMID: 38307448 DOI: 10.1016/j.arthro.2023.12.019] [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: 08/04/2023] [Revised: 12/04/2023] [Accepted: 12/27/2023] [Indexed: 02/04/2024]
Abstract
PURPOSE To compare 2-year clinical outcomes of primary hip arthroscopy with versus without capsular closure after interportal capsulotomy in patients with cam- or mixed-type femoroacetabular impingement (FAI). METHODS Patients with cam- or mixed-type FAI undergoing primary hip arthroscopy with interportal capsulotomy were prospectively enrolled in this randomized controlled trial (RCT) and allocated into either capsular closure or no capsular closure groups. Patients were blinded to group allocation. Clinical outcomes were assessed preoperatively and at 2-year follow-up using the 12-item International Hip Outcome Tool (iHOT-12), modified Harris Hip Score (mHHS), and 6 subsections of the Copenhagen Hip and Groin Outcome Score (HAGOS). Complications and reoperations were noted. RESULTS Eighty-four patients (100 hips) were enrolled, 49 hips in the capsular closure group and 51 in the no capsular closure group, with no significant differences in age (28.5 ± 7.5 vs 30.4 ± 8.4, P = .261), body mass index (23.5 ± 3.0 vs 23.4 ± 1.9, P = .665), and sex distribution (female: 10.2% vs 13.7%, P = .760). Four patients were lost to follow-up (2.0% vs 5.9%, P = .618) and 6 had reoperations (6.1% vs 5.9%, P = 1.000), which left 45 hips per group for clinical assessment. There were no significant differences between groups in the net change of iHOT-12 (28.3 ± 19.6 vs 32.5 ± 22.7, P = .388), mHHS (7.6 ± 13.1 vs 7.5 ± 10.2, P = .954), and subsections of HAGOS (P > .05). Complication rates were also similar between groups (P > .05). CONCLUSIONS The present RCT compared primary hip arthroscopy with versus without capsular closure after interportal capsulotomy in a male-dominated, non-dysplastic, non-arthritic cohort with cam- or mixed-type FAI and found no significant differences in patient-reported clinical outcomes, complication rates, or reoperation rates. LEVEL OF EVIDENCE Level I, randomized controlled trial.
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Affiliation(s)
- Nicolas Bonin
- Lyon Ortho Clinic, Clinique de la Sauvegarde, Lyon, France
| | | | - Maria-Roxana Viamont-Guerra
- Lyon Ortho Clinic, Clinique de la Sauvegarde, Lyon, France; Hospital Israelita Albert Einstein, São Paulo, Brazil
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Fenn TW, Chan JJ, Larson JH, Allahabadi S, Kaplan DJ, Nho SJ. Patients Aged 40 Years and Older Demonstrate Durable and Comparable Results to Patients Aged Less Than 40 Years After Primary Hip Arthroscopy for Femoroacetabular Impingement Syndrome: A Propensity Matched Study at Minimum 10-Year Follow-Up. Arthroscopy 2024:S0749-8063(24)00006-9. [PMID: 38190946 DOI: 10.1016/j.arthro.2024.01.004] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/02/2023] [Revised: 12/18/2023] [Accepted: 01/02/2024] [Indexed: 01/10/2024]
Abstract
PURPOSE The purpose of the present study was to compare clinical outcomes and rates of secondary surgery, including revision hip arthroscopy and conversion to total hip arthroplasty (THA), after primary hip arthroscopy for femoroacetabular impingement syndrome (FAIS) in patients ≥40 years of age at minimum 10-year follow-up compared with a propensity-matched control group of patients <40 years. METHODS A retrospective cohort study was performed for patients who underwent primary hip arthroscopy for FAIS between January 2012 and February 2013. Patients ≥40 years old were propensity matched in a 1:1 ratio by sex and body mass index to patients <40 years old. Patient-reported outcomes (PROs) including Hip Outcome Score for Activities of Daily Living and Sports-Specific subscales, modified Harris Hip, International Hip Outcome Tool-12, and Visual Analog Scale for Pain and Satisfaction were collected. Rates of minimal clinically important difference (MCID) and patient-acceptable symptomatic state (PASS) achievement at 10 years were evaluated and compared between groups. Rates of secondary surgery including revision hip arthroscopy and conversion to THA were evaluated. Gross survivorship between cohorts was evaluated using a Kaplan-Meier curve. RESULTS Fifty-three patients aged ≥40 (age 48.3 ± 5.8 years) were successfully matched to 53 patients aged <40 (age: 28.9 ± 7.2, <0.001). There were no other preoperative group differences regarding patient demographics, characteristics, or radiographic findings. Both groups demonstrated significant improvement regarding all PROs at a minimum of 10 years' follow-up (P < .001 for all). No significant difference was noted between cohorts regarding any delta (preoperative to 10-year postoperative) scores (P > .05 for all). High rates of MCID and PASS achievement were achieved in both cohorts, with no significant differences in any PRO measure (P > .05 for all). No significant differences in rates of complications (age ≥40: 2.0%, age <40: 7.7%, P = .363), rates of revision (age ≥40: 7.5%, age <40: 9.4%, P = .999), or conversion to THA (age ≥40: 13.2%, age <40: 3.8%, P = .161) were identified. On Kaplan-Meier analysis, no significant difference (P = .321) was demonstrated in overall gross survivorship between cohorts. CONCLUSION Patients with age ≥40 with FAIS undergoing primary hip arthroscopy demonstrated durable and comparable 10-year PRO and rates of MCID and PASS achievement compared with a propensity-matched cohort of age <40 counterparts. LEVEL OF EVIDENCE Level III, retrospective comparative prognostic trial.
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Affiliation(s)
- Thomas W Fenn
- Section of Young Adult Hip Surgery, Division of Sports Medicine, Department of Orthopaedic Surgery, Rush Medical College of Rush University, Rush University Medical Center, Chicago, Illinois, U.S.A
| | - Jimmy J Chan
- Section of Young Adult Hip Surgery, Division of Sports Medicine, Department of Orthopaedic Surgery, Rush Medical College of Rush University, Rush University Medical Center, Chicago, Illinois, U.S.A
| | - Jordan H Larson
- Section of Young Adult Hip Surgery, Division of Sports Medicine, Department of Orthopaedic Surgery, Rush Medical College of Rush University, Rush University Medical Center, Chicago, Illinois, U.S.A
| | - Sachin Allahabadi
- Section of Young Adult Hip Surgery, Division of Sports Medicine, Department of Orthopaedic Surgery, Rush Medical College of Rush University, Rush University Medical Center, Chicago, Illinois, U.S.A.; Division of Sports Medicine, Department of Orthopaedic Surgeon, Houston Methodist, Houston, Texas, U.S.A
| | - Daniel J Kaplan
- Section of Young Adult Hip Surgery, Division of Sports Medicine, Department of Orthopaedic Surgery, Rush Medical College of Rush University, Rush University Medical Center, Chicago, Illinois, U.S.A.; Division of Sports Medicine, Department of Orthopaedic Surgery, NYU Langone Orthopaedic Hospital, New York, New York, U.S.A
| | - Shane J Nho
- Section of Young Adult Hip Surgery, Division of Sports Medicine, Department of Orthopaedic Surgery, Rush Medical College of Rush University, Rush University Medical Center, Chicago, Illinois, U.S.A..
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Dove JH, Laperche J, Schiller J, Tabaddor R, Cohen E. Older age and smaller joint space width are associated with conversion to total hip arthroplasty following hip arthroscopy. J Orthop 2023; 46:174-177. [PMID: 38031628 PMCID: PMC10682505 DOI: 10.1016/j.jor.2023.11.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/01/2023] [Accepted: 11/03/2023] [Indexed: 12/01/2023] Open
Abstract
Purpose The goal of this study was to define the outcomes of patients following hip arthroscopy and to identify potential factors, found during hip arthroscopy, that were associated with patients' eventual conversion to total hip arthroplasty (THA). Methods Patients who had undergone hip arthroscopy from January 2010 to January 2015 were retrospectively reviewed and patients were reported if they had a THA in the same hip. Patients were followed up to December 2022 resulting in between 7 and 12 years of follow-up. Measures from the hip scope including joint space width and cartilage grades were reported. Differences in these measures and demographics were compared between patients who had THA after hip arthroscopy and those who did not with T-tests. Results Patients who had hip arthroscopy and were then converted to THA were significantly older than those patients who did not have THA (50.3 vs 42.0 years) (p = 0.039). The average time of conversion to THA from index hip arthroscopy was 3.59 years with a range of 0.48-8.91 years. Joint space width in patients converted to THA was significantly less, 3.08 mm ± 1.93 mm, compared to non-THA converted patients, 3.62 mm ± 0.88 mm (p < 0.001). Conclusions Older age and smaller joint space width of the hip was associated with patients who were converted to THA following hip arthroscopy. Level of evidence Level III.
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Affiliation(s)
- James H. Dove
- Brown University Department of Orthopedics, Providence, RI, USA
| | - Jacob Laperche
- Frank H. Netter School of Medicine Quinnipiac University, North Haven, CT, USA
- University Orthopedics, East Providence, RI, USA
| | - Jonathan Schiller
- Brown University Department of Orthopedics, Providence, RI, USA
- University Orthopedics, East Providence, RI, USA
| | - Ramin Tabaddor
- Brown University Department of Orthopedics, Providence, RI, USA
- University Orthopedics, East Providence, RI, USA
| | - Eric Cohen
- Brown University Department of Orthopedics, Providence, RI, USA
- University Orthopedics, East Providence, RI, USA
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