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Maldonado DR, Diulus SC, Lee MS, Owens JS, Jimenez AE, Perez-Padilla PA, Domb BG. Propensity-Matched Patients Undergoing Revision Hip Arthroscopy Older Than the Age of 40 Years Had Greater Risk of Conversion to Total Hip Arthroplasty Compared With Their Primary Counterparts. Arthroscopy 2023; 39:54-63. [PMID: 35764206 DOI: 10.1016/j.arthro.2022.06.014] [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: 02/15/2022] [Revised: 04/11/2022] [Accepted: 06/03/2022] [Indexed: 02/09/2023]
Abstract
PURPOSE To report patient-reported outcomes (PROs) and survivorship following revision hip arthroscopy in patients aged ≥40 years and to compare these results with a propensity-matched primary hip arthroscopy control group. METHODS Data were prospectively collected and retrospectively reviewed for all patients who underwent revision hip arthroscopy between June 2008 and January 2019. Patients were included if they were ≥40 years of age at the time of surgery and had minimum 2-year follow-up for the modified Harris Hip Score, Nonarthritic Hip Score, Visual Analog Scale for pain, and the Hip Outcome Score-Sports Specific Subscale. Patients who had a previous hip condition, or those who lacked minimum 2-year follow-up, were excluded. The revision group was further analyzed by conducting a 1:1 propensity-matched sub-analysis to a primary hip arthroscopy control group based on age, sex, body mass index, and acetabular labrum articular disruption grade. Statistical significance was set at P < .05. RESULTS Eighty-nine hips (92.7% follow-up) were included, with 66.3% being females. The mean age, body mass index, and follow-up time were 49.4 ± 8.0 years, 26.6 ± 4.1, and 62.7 ± 38.5 months, respectively. Significant improvement in all PROs (P < .001) was reported, and 71.8%, 58 74.4%, and 65.2% achieved the minimal clinically important difference for the modified Harris Hip Score, Nonarthritic Hip Score, and Hip Outcome Score-Sports Specific Subscale, respectively. Eighty-seven revision hips were successfully propensity-matched to 87 primary hips. Both groups reported similar improvement for all PROs, but the relative risk of conversion to total hip arthroplasty was 2.63 times greater (95% confidence interval 1.20-5.79) for the revision group. CONCLUSIONS Patients aged ≥40 years who underwent revision hip arthroscopy reported significant improvement in all PROs at a mean follow-up of 62.7 months with favorable rates of achieving the minimal clinically important difference. When compared to the propensity-matched control group, both achieved similar rates of improvement, but the revision group was 2.63 times more likely to convert to total hip arthroplasty. LEVEL OF EVIDENCE III. case-control study.
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Affiliation(s)
| | | | | | | | | | | | - Benjamin G Domb
- American Hip Institute Research Foundation; American Hip Institute, Chicago, Illinois, U.S.A..
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Matsuda DK. Editorial Commentary: Incremental Decompression of Cam Femoroacetabular Impingement Must Be Assessed in Real Time by Arthroscopic Dynamic Examination: Playbook for the Perfect Femoroplasty. Arthroscopy 2022; 38:1164-1165. [PMID: 35369919 DOI: 10.1016/j.arthro.2021.11.038] [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: 11/17/2021] [Accepted: 11/18/2021] [Indexed: 02/02/2023]
Abstract
The perfect femoroplasty varies with the individual patient's pathoanatomy and is a prime example of the art and science of surgery. Radiographs are two-dimensional representations of a three-dimensional reality and can miss detection of cam impingement. Cam impingement may occur without cam morphology as femoral retrotorsion and/or supraphysiological range of motion (e.g., dancers and martial artists) may cause cam impingement with normal α-angles and anterior offset. Acetabuloplasty or acetabular reorientation osteotomy may change the dynamic interaction between the proximal femur and acetabular rim and may alter the location and extent of cam decompression. Although much is discussed about the α-angle, restoration of anterior offset is also important. Incremental femoroplasty assessed in real time by arthroscopic dynamic examination is key, as the surgeon sculpts a nonimpinging proximal femur using a burr rather than a chisel in creating a customized surgical masterpiece.
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Maldonado DR, Diulus SC, Shapira J, Rosinsky PJ, Kyin C, Ankem HK, Lall AC, Domb BG. Hip Arthroscopic Surgery in the Context of Femoroacetabular Impingement Syndrome, Labral Tear, and Acetabular Overcoverage: Minimum 5-Year Outcomes With a Subanalysis Against Patients Without Overcoverage. Am J Sports Med 2021; 49:55-65. [PMID: 33237818 DOI: 10.1177/0363546520969985] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND Improvement in patient-reported outcomes (PROs) has been reported in the short term after hip arthroscopy for femoroacetabular impingement syndrome (FAIS) and labral tear in the setting of acetabular overcoverage. Yet, there is a paucity of information in the literature on midterm PROs. PURPOSE To (1) report minimum 5-year PROs in patients who underwent primary hip arthroscopy for FAIS and acetabular labral tears in the context of acetabular overcoverage and (2) compare outcomes with those of a propensity-matched control group without acetabular overcoverage. STUDY DESIGN Cohort study; Level of evidence, 3. METHODS Data were prospectively collected and retrospectively analyzed on all patients who underwent hip arthroscopy for FAIS and labral tears between February 2008 and November 2013. Inclusion criteria were lateral center-edge angle >40° and minimum 5-year follow-up for the modified Harris Hip Score (mHHS), Nonarthritic Hip Score (NAHS), and the Hip Outcome Score-Sports-Specific Subscale (HOS-SSS). Exclusion criteria were previous ipsilateral hip surgery or conditions, active workers' compensation claims, or lack of minimum 5-year outcomes. A 1:1 propensity-matched comparison was made between the study group and a control group without acetabular overcoverage (lateral center-edge angle, 25°-40°) based on age at surgery, sex, body mass index, Tönnis grade, laterality, and follow-up time. The minimal clinically important difference (MCID) was calculated for the mHHS, HOS-SSS, and NAHS. Secondary surgical procedures were recorded. RESULTS A total of 54 patients satisfied the inclusion criteria for the study group, of whom 45 (83.3%; 45 hips) had a minimum 5-year follow-up and were matched without differences in age at surgery, sex, body mass index, or follow-up time. The study and control groups demonstrated significant and comparable improvements for the mHHS (mean ± SD Δ, 24.06 ± 24.19 vs 26.33 ± 17.27; P = .625), NAHS (Δ, 31.22 ± 25.31 vs 27.15 ± 17.61; P = .399), and HOS-SSS (Δ, 33.16 ± 34.73 vs 34.75 ± 26.15; P = .557). The rates for achieving the MCID were similar for the study and control groups for the mHHS (76.7% vs 84.2%; P = .399), HOS-SSS (79.1% vs 75.8%; P = .731), and NAHS (81.4% vs 84.2%; P = .738). Need for revision surgery was similar (P = .748). A lower conversion rate to total hip arthroplasty was reported for the study than for the control group (2.2% vs 15.6%; P = .026). CONCLUSION In the context of FAIS, labral tears, and acetabular overcoverage, patients who underwent hip arthroscopy reported significant improvement in several PROs at minimum 5-year follow-up. Moreover, outcomes were comparable with those of a propensity-matched control group without acetabular overcoverage. Furthermore, the rate of achieving the MCID for the mHHS, HOS-SSS, and NAHS was similar between these groups.
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Affiliation(s)
| | | | - Jacob Shapira
- American Hip Institute Research Foundation, Chicago, Illinois, USA
| | | | - Cynthia Kyin
- 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.,American Hip Institute, Chicago, Illinois, USA.,AMITA Health St. Alexius Medical Center, Hoffman Estates, Illinois, USA
| | - Benjamin G Domb
- American Hip Institute Research Foundation, Chicago, Illinois, USA.,American Hip Institute, Chicago, Illinois, USA.,AMITA Health St. Alexius Medical Center, Hoffman Estates, Illinois, USA
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4
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Maldonado DR, Rosinsky PJ, Shapira J, Domb BG. Stepwise Safe Access in Hip Arthroscopy in the Supine Position: Tips and Pearls From A to Z. J Am Acad Orthop Surg 2020; 28:651-659. [PMID: 32769716 DOI: 10.5435/jaaos-d-19-00856] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023] Open
Abstract
Hip arthroscopy is rapidly growing as a treatment with good outcomes for pathologic conditions such as femoroacetabular impingement syndrome and labral tears. At the same time, it is one of the most technically challenging and demanding procedures in orthopaedics with a technically demanding skill. The first challenge is to safely access the joint, which requires accurate anatomical knowledge, a strong sense of spatial orientation, and repeated practice. Iatrogenic chondrolabral injury has been reported as the most common complication in hip arthroscopy and most frequently occurs during hip joint access. As such, basic foundations cannot be overstated. These complications can be minimized with adequate patient positioning, reproducible hip joint access techniques, and proper portals placement. Nonetheless, these three points are perhaps the greatest hurdles that orthopaedic surgeons face when entering the hip arthroscopy field. In this review, we outlined a stepwise approach for a safe access to hip arthroscopy.
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Affiliation(s)
- David R Maldonado
- From American Hip Institute Research Foundation (Dr. Maldonado, Dr. Rosinsky, Dr. Shapira, and Dr. Domb), and American Hip Institute (Dr. Domb), Des Plaines, IL
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Matsuda DK, Ching K, Matsuda NA. Simultaneous Bilateral Hip Arthroscopy. Arthrosc Tech 2017; 6:e913-e919. [PMID: 29487780 PMCID: PMC5800958 DOI: 10.1016/j.eats.2017.03.002] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/15/2016] [Accepted: 03/02/2017] [Indexed: 02/03/2023] Open
Abstract
Many patients are afflicted with painful conditions affecting both hips, most commonly femoroacetabular impingement. Some patients prefer the advantage of undergoing a single surgical procedure and anesthetic followed by a single postoperative rehabilitation program. We present a Technical Note on single-stage bilateral hip arthroscopy. This Technical Note reports on key steps enabling safe and efficient performance of bilateral arthroscopic acetabuloplasty, labral refixation, femoroplasty, and dynamic testing while limiting traction times and facilitating rapid transition to the second hip arthroscopic surgery. Enabling factors include supine positioning with bilateral mobile leg spars, rapid surgical and hip traction times, and postoperative rehabilitation with immediate weight bearing as tolerated. A rationale for deciding which hip should undergo arthroscopy first is also offered. Concurrent bilateral hip arthroscopy is a viable option for select patients and experienced surgical teams, enabling potentially expedited recovery and return to work or sport with inherent cost savings.
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Affiliation(s)
- Dean K. Matsuda
- Department of Orthopedics, DISC Sports and Spine, Marina del Rey, California, U.S.A.,Address correspondence to Dean K. Matsuda, M.D., Department of Orthopedics, DISC Sports and Spine, 13160 Mindanao Way, Suite 300, Marina del Rey, CA 90292, U.S.A.Department of OrthopedicsDISC Sports and Spine13160 Mindanao Way, Suite 300Marina del ReyCA90292U.S.A.
| | - Kaycee Ching
- University of California, Berkeley, California, U.S.A
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Cuéllar A, Albillos X, Cuéllar A, Cuéllar R. Screw Fixation of Os Acetabuli: An Arthroscopic Technique. Arthrosc Tech 2017; 6:e801-e806. [PMID: 28706834 PMCID: PMC5495954 DOI: 10.1016/j.eats.2017.02.012] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/18/2016] [Accepted: 02/15/2017] [Indexed: 02/03/2023] Open
Abstract
An os acetabuli (OA) increases the contact area and surface area of the acetabulum and is important to maintain congruity of the hip joint. Thus preservation of this ossicle is important to prevent loss of contact area and ensure containment of the femoral head. We describe an all-arthroscopic approach to the fixation of OA with a compression screw. Initially, the fibrous tissue is debrided between the acetabular rim and the OA, a guidewire is placed through the OA up to the acetabular rim, and a screw is inserted over the wire. Compression of the OA is achieved with bone-to-bone contact. This technique prevents loss of femoral head coverage, reducing the risk of subluxation and subsequent osteoarthritis.
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Affiliation(s)
- Adrián Cuéllar
- Department of Traumatology and Orthopaedic Surgery, Galdakao-Usansolo Hospital, Galdácano, Spain,Address correspondence to Adrián Cuéllar, M.D., Department of Traumatology and Orthopaedic Surgery, Galdakao Hospital, University of Basque Country, c/Labeaga, s/n, 48960 Usansolo, Vizcaya, Spain.Department of Traumatology and Orthopaedic SurgeryGaldakao HospitalUniversity of Basque Countryc/Labeaga, s/n48960 UsansoloVizcayaSpain
| | - Xabier Albillos
- Department of Traumatology and Orthopaedic Surgery, Donostia University Hospital, San Sebastián, Spain
| | - Asier Cuéllar
- Department of Traumatology and Orthopaedic Surgery, Donostia University Hospital, San Sebastián, Spain
| | - Ricardo Cuéllar
- Department of Traumatology and Orthopaedic Surgery, Donostia University Hospital, San Sebastián, Spain
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Matsuda DK. Editorial Commentary: Hip Capsule: To Repair or Not? Arthroscopy 2017; 33:116-117. [PMID: 28003067 DOI: 10.1016/j.arthro.2016.10.023] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/26/2016] [Revised: 10/29/2016] [Accepted: 10/31/2016] [Indexed: 02/02/2023]
Abstract
Arthroscopic hip capsular repair is an area of intense interest. Basic science studies suggest that adverse changes in capsular stability/restraint may occur with capsulotomy and capsulectomy, that repair may ameliorate these changes, and, most recently, that the repaired capsule usually heals. Clinical studies suggest that in some conditions, most notably mild dysplasia, capsular repair or plication may improve short-term outcomes, but in general, the role of capsular closure is less clear. At present, perhaps a selective approach is merited, with capsular closure performed in patients with dysplasia, focal or generalized hyperlaxity, and/or increased femoral anteversion. The comparative outcomes from smaller, more vertically oriented capsulotomies with less violation of the iliofemoral ligament deserve investigation.
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8
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Santram K, Gupta T, Aggarwal A, Kaur R, Kaur H, Sahni D. Medial hip arthroscopy portals and their relation to the extra-articular structures: A cadaveric study. J ANAT SOC INDIA 2016. [DOI: 10.1016/j.jasi.2016.06.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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9
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Cuéllar R, Cuéllar A, Sánchez A, Cuéllar A. Anatomic Hip Capsular Reconstruction With Separate Suture Anchors. Arthrosc Tech 2016; 5:e657-66. [PMID: 27656393 PMCID: PMC5021663 DOI: 10.1016/j.eats.2016.02.031] [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: 10/03/2015] [Accepted: 02/09/2016] [Indexed: 02/03/2023] Open
Abstract
The number of reports on the use of capsule suturing techniques during hip arthroscopy has increased in the last few years because of the important function played by the iliofemoral ligament (IFL). This study describes an arthroscopic technique whereby the hip capsule is opened by a limited vertical dissection of both the capsule itself and the IFL from their footprint on the acetabular rim, and the capsulolabral junction and the IFL's deep fibers are released. After the intra-articular procedure, the capsule is closed through 2 to 4 side-to-side sutures in the vertical arm of the capsulotomy and 1 to 2 suture anchors with sutures are passed through either side of the capsular confluence. This technique prevents a full transverse section of the IFL and allows complete capsular closure through reconstruction of the capsular footprint.
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Affiliation(s)
- Ricardo Cuéllar
- Department of Traumatology and Orthopaedic Surgery of the Donostia Universitary Hospital, San Sebastián, Spain
| | - Asier Cuéllar
- Department of Traumatology and Orthopaedic Surgery of the Donostia Universitary Hospital, San Sebastián, Spain
| | - Alberto Sánchez
- Department of Traumatology and Orthopaedic Surgery of the Galdakao-Usansolo Hospital, Galdácano, Spain
| | - Adrián Cuéllar
- Department of Traumatology and Orthopaedic Surgery of the Galdakao-Usansolo Hospital, Galdácano, Spain,Address correspondence to Adrián Cuéllar, M.D., Department of Traumatology and Orthopaedic Surgery, Galdakao-Usánsolo Hospital, c./Labeaga, s/n, 48960 Usansolo, Vizcaya, Spain.Department of Traumatology and Orthopaedic SurgeryGaldakao-Usánsolo Hospitalc./Labeaga, s/n, 48960 UsansoloVizcayaSpain
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10
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Matsuda DK, Matsuda NA. Endoscopic hip osteotomies: less invasive approaches to peri-acetabular, proximal femoral and pubic symphyseal procedures. J Hip Preserv Surg 2016; 2:108-15. [PMID: 27011827 PMCID: PMC4718487 DOI: 10.1093/jhps/hnv025] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/16/2015] [Revised: 02/24/2015] [Accepted: 02/25/2015] [Indexed: 11/14/2022] Open
Abstract
Beyond the recent expansion of extra-articular hip arthroscopy into the peri-trochanteric and subgluteal space, this instructional course lecture introduces three innovative procedures: endoscopy-assisted periacetabular osteotomy, closed derotational proximal femoral osteotomy and endoscopic pubic symphysectomy. Supportive rationale, evolving indications, key surgical techniques and emerging outcomes are presented for these innovative less invasive procedures.
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Affiliation(s)
- Dean K Matsuda
- 1. DISC Sports and Spine Center, Marina del Rey, CA, USA
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11
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Al-Qarni A, Lewington MR, Wong IH. Reconstruction of Focal Femoral Head Cartilage Defects With a Chitin-Based Scaffold. Arthrosc Tech 2016; 5:e257-62. [PMID: 27354944 PMCID: PMC4912569 DOI: 10.1016/j.eats.2015.12.005] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/13/2015] [Accepted: 12/08/2015] [Indexed: 02/03/2023] Open
Abstract
It is well known that articular cartilage defects have little capability to heal. For grade III or IV cartilage defects, surgical intervention may be required for symptomatic patients. Microfracture is a commonly used surgical technique to address these injuries. However, microfracture has drawbacks, which include the risk of ossification of the newly formed tissue, as well as the imperfect and fragile nature of the fibrous cartilage. Given the challenges associated with microfracture, BST-CarGel (Piramal Healthcare, Laval, Quebec, Canada) has been developed to stabilize and support the nascent clot. This chitin-based polymer is mixed with the patient's own blood and inserted onto the microfractured defect. The polymer allows normal clot formation and provides a matrix to strengthen the clot, prevent retraction, and increase its adhesiveness to the natural tissue. We present, with a video example, a detailed arthroscopic technique for using BST-CarGel to fill a focal femoral head cartilage defect.
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Affiliation(s)
| | | | - Ivan H. Wong
- Address correspondence to Ivan H. Wong, M.D., M.Sc., F.R.C.S.C., Dip. Sports Medicine, Dalhousie University, Second Floor, Room 2106, Camp Hill Veterans' Memorial Building, 5655 Veterans' Memorial Lane, Halifax, Nova Scotia, Canada B3H2E1.Dalhousie UniversitySecond FloorRoom 2106Camp Hill Veterans' Memorial Building5655 Veterans' Memorial LaneHalifaxNova ScotiaCanada B3H2E1
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12
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Matsuda DK, Gupta N, Burchette RJ, Sehgal B. Arthroscopic surgery for global versus focal pincer femoroacetabular impingement: are the outcomes different? J Hip Preserv Surg 2015; 2:42-50. [PMID: 27011813 PMCID: PMC4718481 DOI: 10.1093/jhps/hnv010] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/17/2014] [Revised: 10/23/2014] [Accepted: 11/30/2014] [Indexed: 11/17/2022] Open
Abstract
To determine outcomes from arthroscopic surgery for global pincer femoroacetabular impingement (FAI), a large multicenter prospective study investigating arthroscopic surgical outcomes was performed with minimum 2-year follow-up. Global (center-edge angle 40+ degrees) and Focal (center-edge angle 25-39 degrees) cohorts were based on pre-operative radiographs. Pre-operative and intra-operative findings, surgical procedures, post-operative nonarthritic hip score (NAHS) and satisfaction (5-point Likert scale), complications and conversion arthroplasties were compared. A nested case-control study was also performed. The Global cohort consisted of 15 patients (18 hips) of mean age 37.2 years. Pre-operative NAHS was 51.5 and 74.1 at 24+ months post-surgery. The change in NAHS was significant (P = 0.01). Mean satisfaction was 4.2. There was one total hip arthroplasty (THA) conversion (5.6%), no revision surgeries or complications. The Focal cohort consisted of 125 patients (129 hips) of mean age 39.8 years. Pre-operative NAHS was 54.8 and 77.8 at 24+ months post-surgery. The change in NAHS was significant (P < 0.0001). Mean satisfaction was 4.2. There were eight THA conversions (6.2%), three complications (2.3%) and two revision surgeries (1.5%). Cohort comparisons revealed no statistically significant difference in NAHS (P = 0.30), satisfaction (P = 0.92) or THA conversion rate (P = 0.91). The nested case-control study found mean post-operative change in NAHS was +22.2 and +20.4, respectively, at 24+ months (P = 0.76). Arthroscopic treatment of global pincer FAI is a safe and effective procedure. With outcomes comparable to those observed in the arthroscopic treatment of lesser focal deformities, arthroscopic surgery provides a less invasive option for the treatment of global pincer FAI.
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Affiliation(s)
- Dean K. Matsuda
- 1. DISC Sports Medicine and Spine Centers, 13160 Mindanao Way #325, Marina del Rey, CA 90292, USA
| | - Nikhil Gupta
- 2. Jefferson Medical College, 1020 Walnut St, Philadelphia, PA 19107, USA
| | - Raoul J. Burchette
- 3. Kaiser Permanente Department of Research and Evaluation Pasadena, CA 91101, USA
| | - Bantoo Sehgal
- 4. Essentia Health, 3000 32nd Ave S Fargo, ND 58103, USA
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Matsuda DK, Bharam S, White BJ, Matsuda NA, Safran M. Anchor-induced chondral damage in the hip. J Hip Preserv Surg 2015; 2:56-64. [PMID: 27011815 PMCID: PMC4718472 DOI: 10.1093/jhps/hnv001] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/04/2014] [Revised: 12/24/2014] [Accepted: 01/01/2015] [Indexed: 01/02/2023] Open
Abstract
The purpose of this study is to investigate the outcomes from anchor-induced chondral damage of the hip, both with and without frank chondral penetration. A multicenter retrospective case series was performed of patients with chondral deformation or penetration during initial hip arthroscopic surgery. Intra-operative findings, post-surgical clinical courses, hip outcome scores and descriptions of arthroscopic treatment in cases requiring revision surgery and anchor removal are reported. Five patients (three females) of mean age 32 years (range, 16-41 years) had documented anchor-induced chondral damage with mean 3.5 years (range, 1.5-6.0 years) follow-up. The 1 o'clock position (four cases) and anterior and mid-anterior portals (two cases each) were most commonly implicated. Two cases of anchor-induced acetabular chondral deformation without frank penetration had successful clinical and radiographic outcomes, while one case progressed from deformation to chondral penetration with clinical worsening. Of the cases that underwent revision hip arthroscopy, all three had confirmed exposed hard anchors which were removed. Two patients have had clinical improvement and one patient underwent early total hip arthroplasty. Anchor-induced chondral deformation without frank chondral penetration may be treated with close clinical and radiographic monitoring with a low threshold for revision surgery and anchor removal. Chondral penetration should be treated with immediate removal of offending hard anchor implants. Preventative measures include distal-based portals, small diameter and short anchors, removable hard anchors, soft suture-based anchors, curved drill and anchor insertion instrumentation and attention to safe trajectories while visualizing the acetabular articular surface.
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Affiliation(s)
- Dean K. Matsuda
- 1. DISC Sports and Spine Center, 13160 Mindanao Way, Suite 300, Marina del Rey, CA 90292, USA
| | | | - Brian J. White
- 3. Western Orthopaedics, 1830 Franklin St #450, Denver, CO 80218, USA
| | - Nicole A. Matsuda
- 4. Westchester Enriched Science Magnet, 7400 West Manchester Avenue, Los Angeles, CA 90045, USA
| | - Marc Safran
- 5. Stanford Medical Clinics, 450 Broadway S, Pavilion A, Redwood City, CA 94063, USA
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