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Kazi O, Gilat R, Alvero AB, Danilkowicz R, Williams JC, Nho SJ. Staged Hip Arthroscopy with Labral Repair, Femoroplasty, and Capsular Plication Followed by Periacetabular Osteotomy for Hip Dysplasia Results in Improved Outcomes and 100% Survivorship at Minimum 2-Year Follow-Up. Arthroscopy 2024:S0749-8063(24)00411-0. [PMID: 38876446 DOI: 10.1016/j.arthro.2024.05.029] [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: 01/29/2024] [Revised: 05/13/2024] [Accepted: 05/19/2024] [Indexed: 06/16/2024]
Abstract
PURPOSE To assess patient-reported outcomes (PROs), clinically significant outcomes (CSOs), and survivorship following staged hip arthroscopy with labral repair, femoroplasty, and capsular plication followed by periacetabular osteotomy (PAO) for the management of femoroacetabular impingement syndrome (FAIS) and hip dysplasia (lateral center edge angle ≤25°). METHODS A prospectively maintained database was queried to retrospectively identify patients who underwent staged primary hip arthroscopy and PAO between 1/2018-10/2021 and had a minimum 2-year follow-up. PROs collected included, Hip Outcome Score Activities of Daily Living/Sports Subscale (HOS-ADL/SS), international Hip Outcome Tool-12 item questionnaire (iHOT-12), and Visual Analog Scale for Pain (VAS Pain). CSO achievement for minimal clinical important difference (MCID) and patient acceptable symptom state (PASS) were determined through cohort specific thresholds. Rates of reoperation, including, revision hip arthroscopy and conversion to total hip arthroplasty (THA) were evaluated to determine short-term survivorship. RESULTS Thirty-nine hips met criteria for inclusion, of which 35 hips had minimum 2-year follow up (89.7% compliance). Mean age was 25±9.1 years and 91.7% of patients were female. Respective pre- and postoperative radiographic outcomes were: Alpha angle 59.8±5.9 to 39.7±2.6°, Tönnis angle 14.6±5.6° to -1.0±2.9°, lateral center-edge angle 16.6±5.5° to 36.6±4.6°, and anterior center-edge angle 15.6±9.1° to 36.1±3.8°, with statistically significant differences pre- to postoperatively for all (P<0.001). Patients demonstrated significant improvement in all PROs pre- to postoperatively (P ≤0.004). MCID and PASS achievement rates for any PRO were 93.9% and 78.8%, respectively. There were no revision hip surgeries or conversion to THA at a mean 2.7±1.0-year follow-up. Four patients (11.1%) underwent hardware removal. One patient (2.8%) experienced a postoperative infection treated with incision and drainage. CONCLUSIONS Staged hip arthroscopy and PAO for the management of hip dysplasia demonstrated improvement in PROs, high CSO achievement rates, and 100% survivorship at minimum 2-year follow-up.
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Affiliation(s)
- Omair Kazi
- 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, USA.
| | - Ron Gilat
- 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, USA
| | - Alexander B Alvero
- 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, USA
| | - Richard Danilkowicz
- 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, USA
| | - Joel C Williams
- 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, USA
| | - 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, USA
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Serna J, Furie K, Wong SE, Swarup I, Zhang AL, Diab M. The Use of Combined Hip Arthroscopy and Periacetabular Osteotomy for Hip Dysplasia Is Increasing and Has Low Complication Rates. Arthrosc Sports Med Rehabil 2024; 6:100929. [PMID: 39006788 PMCID: PMC11240039 DOI: 10.1016/j.asmr.2024.100929] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2023] [Accepted: 03/16/2024] [Indexed: 07/16/2024] Open
Abstract
Purpose To analyze the annual use of hip arthroscopy (HA) and Bernese periacetabular osteotomy (PAO) for the treatment of hip dysplasia (HD), as well as postoperative outcomes, including ipsilateral reoperations. Methods International Classification of Diseases, Ninth and Tenth Revision, codes were used to query the PearlDiver Mariner database from January 2010 through January 2022 to identify patients aged 10 to 59 years who had a presenting diagnosis of HD and subsequently underwent (1) HA; (2) PAO; or (3) combined HA and PAO (HA-PAO, defined as PAO on the same day or within 28 days after HA). We analyzed annual rates for each treatment, as well as rates of postoperative emergency visits, readmissions, and 5-year ipsilateral secondary operations (determined via Kaplan-Meier analysis). Results There were 32,068 patients who underwent surgical treatment of HD. For HA, PAO, and HA-PAO, there were 29,700, 2,083, and 285 patients, respectively. All operations had the greatest percent-increase from 2015 to 2016. HA and HA-PAO peaked in 2021, whereas PAO peaked in 2019. For HA, PAO, and HA-PAO, most cases were performed in female patients and patients aged 30 to 49 years, 10 to 19 years, and 10 to 29 years, respectively. The 5-year incidence of ipsilateral secondary operations, which include revision HA, PAO, or conversion to total hip arthroplasty, was 9.2% (95% confidence interval 8.6%-9.8%) in the HA group and 6.5% (95% confidence interval 4.1%-8.8%) in the PAO group. Combining HA with PAO resulted in so few secondary operations that Kaplan-Meier analysis was infeasible. The PAO cohort had the greatest 30-day emergency visit and 90-day readmission rates, with infection as the most common cause for readmission. Conclusions HA is more frequently performed than PAO for hip dysplasia. HA-PAO is increasing at the greatest rate, demonstrating fewer complications and reoperations. Level of Evidence Level III, retrospective comparative trial.
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Affiliation(s)
- Juan Serna
- Department of Orthopaedic Surgery, University of California, San Francisco, San Francisco, California, U.S.A
| | - Kira Furie
- Department of Orthopaedic Surgery, University of California, San Francisco, San Francisco, California, U.S.A
| | - Stephanie E Wong
- Department of Orthopaedic Surgery, University of California, San Francisco, San Francisco, California, U.S.A
| | - Ishaan Swarup
- Department of Orthopaedic Surgery, University of California, San Francisco, San Francisco, California, U.S.A
| | - Alan L Zhang
- Department of Orthopaedic Surgery, University of California, San Francisco, San Francisco, California, U.S.A
| | - Mohammad Diab
- Department of Orthopaedic Surgery, University of California, San Francisco, San Francisco, California, U.S.A
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Hapa O, Hevesi M, Lee SH, Trousdale RT, Sierra RJ. Making the cut: a technical note and literature review of Bernese periacetabular osteotomy techniques with special attention to ischial osteotomy initiation and completion with an inside to anterior curved osteotomy. EUROPEAN JOURNAL OF ORTHOPAEDIC SURGERY & TRAUMATOLOGY : ORTHOPEDIE TRAUMATOLOGIE 2024; 34:1691-1697. [PMID: 38055056 DOI: 10.1007/s00590-023-03787-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/19/2023] [Accepted: 11/15/2023] [Indexed: 12/07/2023]
Abstract
Periacetabular osteotomy includes a fluoroscopy-guided ischial cut without direct visualization. Previously described techniques include a mediolateral ischial cortex cut, which is associated with the risk of injuring nearby nerves. Another drawback of that technique is the difficulty connecting an ischial cortex cut with a retroacetabular cut due to orthogonal nature of the osteotomy. In general, an additional cut from medial to lateral is required. The present study aimed to describe a technique that eliminates those problems due to use of only a central cut of the ischium and the curved nature of the osteotomy.
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Affiliation(s)
- Onur Hapa
- Department of Orthopedic Surgery, Dokuz Eylül University, İzmir, Turkey.
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, MN, USA.
| | - Mario Hevesi
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, MN, USA
| | - Sheng-Hsun Lee
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, MN, USA
| | | | - Rafael J Sierra
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, MN, USA
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Orner CA, Haws BE, Reuter J, Kenney R, Cook PC, Giordano BD. Patient-Reported Outcomes are Similar in the First Two Years after Staged versus Combined Hip Arthroscopy and Periacetabular Osteotomy for Hip Dysplasia. Arthroscopy 2023:S0749-8063(23)00197-4. [PMID: 36868528 DOI: 10.1016/j.arthro.2023.02.017] [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: 08/09/2022] [Revised: 01/31/2023] [Accepted: 02/15/2023] [Indexed: 03/05/2023]
Abstract
PURPOSE The purpose of this study was to compare early patient reported outcomes after staged versus combined hip arthroscopy and periacetabular osteotomy for hip dysplasia. METHODS A prospective database was retrospectively reviewed to identify patients that underwent combined or staged hip arthroscopy and PAO from 2012-2020. Patients were excluded if they were >40 years of age, had prior ipsilateral hip surgery, or did not have at least 12-24 month postoperative PRO data. PROs included the Hip Outcomes Score (HOS) Activities of Daily Living (ADL) and Sports Subscale (SS), Non-Arthritic Hip Score (NAHS), and the Modified Harris Hip Score (mHHS). Paired t-tests were used to compare preoperative to postoperative scores for both groups. Outcomes were compared using linear regression adjusted for baseline characteristics including age, obesity, cartilage damage, acetabular index, and procedure timing (early vs. late practice). RESULTS Sixty-two hips were included in this analysis (39 combined, 23 staged). The average length of follow up was similar between the combined and staged groups (20.8 vs. 19.6 months, p=0.192). Both groups reported significant improvements in PROs at final follow up compared to preoperative scores (p<0.05 for all). There were no significant differences in HOS-ADL, HOS-SS, NAHS, or mHHS scores between groups preoperatively or at 3, 6, or 12 months postoperatively (p>0.05 for all). There was no significant difference in PROs between the combined and staged groups at the final postoperative time point: HOS-ADL (84.5 vs. 84.3, p=0.77), HOS-SS (76.0 vs. 79.2, p=0.68), NAHS (82.2 vs. 84.5, p=0.79), mHHS (71.0 vs. 71.0, p=0.75) respectively. CONCLUSION Staged hip arthroscopy and PAO for hip dysplasia leads to similar PROs at 12-24 months compared to combined procedures. This suggests that with careful and informed patient selection, staging these procedures is an acceptable option for these patients and does not change early outcomes. LEVEL OF EVIDENCE Level III Retrospective Comparative.
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Affiliation(s)
- Caitlin A Orner
- Cedars Sinai Kerlan Jobe Institute, Department of Orthopaedics, 6801 Park Terrace, Suite 140, Los Angeles, CA 90045, U.S.A
| | - Brittany E Haws
- University of Rochester Medical Center, Department of Orthopaedics and Rehabilitation, 601 Elmwood Ave, Rochester, New York 14642, U.S.A
| | - John Reuter
- University of Rochester Medical Center, Department of Orthopaedics and Rehabilitation, 601 Elmwood Ave, Rochester, New York 14642, U.S.A
| | - Raymond Kenney
- University of Rochester Medical Center, Department of Orthopaedics and Rehabilitation, 601 Elmwood Ave, Rochester, New York 14642, U.S.A
| | - P Christopher Cook
- University of Rochester Medical Center, Department of Orthopaedics and Rehabilitation, 601 Elmwood Ave, Rochester, New York 14642, U.S.A
| | - Brian D Giordano
- University of Rochester Medical Center, Department of Orthopaedics and Rehabilitation, 601 Elmwood Ave, Rochester, New York 14642, U.S.A
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Megerian MF, Strony JT, Mengers SR, Joseph NM, Salata MJ, Wetzel RJ. Use of Anatomic Radiographic Horizons for the Lateral Center-Edge Angle in the Classification of Hip Dysplasia. Am J Sports Med 2022; 50:3610-3616. [PMID: 36220151 DOI: 10.1177/03635465221125784] [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 The lateral center-edge angle of Wiberg (LCEA) and Tönnis angle (TA) rely on a "horizon" that functions as a reference point for measurements of hip dysplasia on weightbearing anteroposterior pelvis radiographs. There are 3 different horizons that are currently utilized depending on surgeon preference: (1) a line parallel to the radiographic floor (F), (2) a line that connects the inferior portions of the acetabular teardrops (ATs), or (3) a line that connects the ischial tuberosities (ITs). It is imperative to accurately assess the degree of hip dysplasia on initial workup to select the appropriate surgical intervention. PURPOSE To assess how the choice of a radiographic horizon affects the measurements of the LCEA and TA. The secondary purpose was to assess how the horizon affected the classification of hips as either normal, borderline dysplastic, or dysplastic. STUDY DESIGN Cohort study (diagnosis); Level of evidence, 3. METHODS The LCEA and TA were measured on all preoperative weightbearing anteroposterior pelvis radiographs for 186 consecutive patients who underwent hip preservation surgery between February 2016 and November 2020 (140 hip arthroscopic procedures, 46 combined hip arthroscopic procedures with periacetabular osteotomy), 3 times per hip, each time using an F, AT, and IT horizon. The Student t test was used to analyze the differences in the measurements of the LCEA and TA, and discordance rates in the dysplasia classification between horizons were quantified. RESULTS For the entire study population, the mean LCEAF (23.4°± 7.4°) was significantly greater than the mean LCEAIT (23.1°± 7.2°) (95% CI, -0.634 to -0.003; P = .047) and mean LCEAAT (23.0°± 7.1°) (95% CI, -0.723 to -0.139; P = .004). There was no difference between the LCEAIT and LCEAAT (95% CI, -0.305 to 0.080; P = .251). When stratified by hip arthroscopic surgery, the mean LCEAF (26.3°± 5.6°) was significantly greater than the mean LCEAAT (25.8°± 5.3°) (95% CI, -0.845 to -0.162; P = .004). Overall, there was a 17.7% and 18.3% discordance rate in the dysplasia classification using the LCEAIT and LCEAAT compared with the LCEAF, respectively. There were no statistically significant differences between the mean TAIT, TAAT, and TAF for the entire study population, the arthroscopic surgery group, and the combined arthroscopic surgery and periacetabular osteotomy group. CONCLUSION There was no statistical difference between the AT and IT horizons for LCEA measurements. The dysplasia classification was in better agreement between the 2 anatomic horizons compared with the F horizon. The TA was not affected by changes in the horizon.
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Affiliation(s)
- Mark F Megerian
- Case Western Reserve University School of Medicine, Cleveland, Ohio, USA
| | - John T Strony
- Department of Orthopaedic Surgery, University Hospitals Cleveland Medical Center, Cleveland, Ohio, USA
| | - Sunita R Mengers
- Department of Orthopaedic Surgery, University Hospitals Cleveland Medical Center, Cleveland, Ohio, USA
| | - Noah M Joseph
- Department of Orthopaedic Surgery, University Hospitals Cleveland Medical Center, Cleveland, Ohio, USA
| | - Michael J Salata
- Department of Orthopaedic Surgery, University Hospitals Cleveland Medical Center, Cleveland, Ohio, USA.,Sports Medicine Institute, University Hospitals Cleveland Medical Center, Cleveland, Ohio, USA
| | - Robert J Wetzel
- Department of Orthopaedic Surgery, University Hospitals Cleveland Medical Center, Cleveland, Ohio, USA
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Treatment of Concomitant Intra-articular Pathology and Hip Dysplasia With Combined Hip Arthroscopy and Periacetabular Osteotomy Using a Single Radiolucent Traction Table Attachment Without a Perineal Post. Arthrosc Tech 2022; 11:e1843-e1849. [PMID: 36457376 PMCID: PMC9705270 DOI: 10.1016/j.eats.2022.06.023] [Citation(s) in RCA: 2] [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: 04/10/2022] [Accepted: 06/19/2022] [Indexed: 11/19/2022] Open
Abstract
Combined hip arthroscopy and periacetabular osteotomy are used for the treatment of concomitant intra-articular hip pathology and acetabular dysplasia or instability. Traditionally, the procedure has been achieved with the use of a traction table or table attachment for the arthroscopic portion and then subsequent transfer of the patient to a fully radiolucent flat bed. In this article, we highlight the technique of a combined hip arthroscopy and periacetabular osteotomy procedure using a single bed attachment system.
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Breckling A, Katrikh AZ, Jones MW, Ferrigno C. Iliocapsularis: An Exploration of the Muscle and Its Omission in Education. J Morphol 2022; 283:899-907. [DOI: 10.1002/jmor.21468] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2021] [Revised: 03/07/2022] [Accepted: 03/19/2022] [Indexed: 11/06/2022]
Affiliation(s)
- Abbey Breckling
- Department of Anatomy and Cell Biology UIC College of Medicine Chicago USA
| | | | - Michael W. Jones
- Department of Biological Sciences California Polytechnic State University San Luis Obispo USA
| | - Christopher Ferrigno
- Department of Anatomy and Cell Biology Rush University Medical Center Chicago USA
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