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Fischer M, Nonnenmacher L, Sobau C, Zimmerer A. Postoperative hip bracing reduces kinesiophobia in patients undergoing hip arthroscopy: a randomized-controlled trial. Arch Orthop Trauma Surg 2024:10.1007/s00402-024-05437-9. [PMID: 38980377 DOI: 10.1007/s00402-024-05437-9] [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: 03/24/2024] [Accepted: 06/27/2024] [Indexed: 07/10/2024]
Abstract
INTRODUCTION Detailed postoperative rehabilitation protocols after hip arthroscopy for femoroacetabular impingement syndrome (FAIS) are still a matter of debate. Adjunctive hip bracing represents a promising tool to improve early patients' mobilization. To present, the effect of hip brace therapy on postoperative functional outcomes and specific patient individual psychologic factors remains controversially discussed. Consequently, we aimed to report postoperative outcomes focusing on hip function, pain and kinesiophobia between braced and unbraced patients. MATERIALS AND METHODS A prospective, randomized-controlled trial was conducted, including patients undergoing hip arthroscopy for FAIS. After exclusion, a final study cohort of 36 patients in the intervention group (postoperative hip brace) and 36 patients in the control group (no hip brace) were compared for kinesiophobia (Tampa Scale of Kinesiophobia), pain (Visual analog scale) and joint function (International Hip Outcome Tool-12) within the first six postoperative months. RESULTS Hip arthroscopy significantly improved all patient-reported outcomes in both groups. Intergroup analysis revealed significantly lower levels of kinesiophobia in braced patients at 6-months follow up (30.7 vs. 34.1, p = 0.04) while not negatively affecting pain and joint function. No intra- and postoperative complications occurred within both groups. CONCLUSIONS This study could demonstrate that bracing after hip arthroscopy can positively influence kinesiophobia, while the brace did not negatively impact postoperative pain and quality of life. Thus, hip bracing could be a viable assistive therapy in the postoperative rehabilitation phase after hip arthroscopy.
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Affiliation(s)
- Maximilian Fischer
- Center for Orthopaedics, Trauma Surgery and Rehabilitation Medicine, University Medicine Greifswald, Greifswald, Germany
| | - Lars Nonnenmacher
- Center for Orthopaedics, Trauma Surgery and Rehabilitation Medicine, University Medicine Greifswald, Greifswald, Germany
| | | | - Alexander Zimmerer
- Center for Orthopaedics, Trauma Surgery and Rehabilitation Medicine, University Medicine Greifswald, Greifswald, Germany.
- Diakonieklinikum Stuttgart, Orthopädische Klinik Paulinenhilfe, Stuttgart, Germany.
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Boos AM, Nagelli CV, Okoroha KR, Sierra RJ, Krych AJ, Hevesi M. Primary Hip Arthroscopy in Patients With Acetabular Dysplasia: A Systematic Review of Published Clinical Outcomes at Minimum 5-Year Follow-up. Am J Sports Med 2024; 52:2148-2158. [PMID: 38333917 DOI: 10.1177/03635465231197177] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/10/2024]
Abstract
BACKGROUND Hip arthroscopy in patients with borderline hip dysplasia has satisfactory outcomes at short-term follow-up; however, the data on midterm outcomes are inconsistent, and failure rates are high in some studies, limiting understanding of the role and utility of hip arthroscopy in this patient cohort. PURPOSE To provide an up-to-date, evidence-based review of the clinical outcomes of primary hip arthroscopy in patients with frank or borderline hip dysplasia at ≥5-year follow-up and report the failure rate and progression to total hip arthroplasty in this cohort. STUDY DESIGN Systematic review; Level of evidence, 4. METHODS A comprehensive literature search was performed according to the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines. Studies were included if they evaluated outcomes of primary hip arthroscopy in patients with lateral center-edge angle (LCEA) <25° at ≥5-year follow-up. Risk of bias assessment was performed using the methodological index for non-randomized studies scoring system. Level of evidence was determined using criteria from the Oxford Centre for Evidence-Based Medicine. RESULTS Nine studies were included in this review. Patients with LCEA <25° demonstrated satisfactory clinical outcomes, high patient satisfaction, and significant postoperative improvements in patient-reported outcomes (PROs) at follow-up ranging from a ≥5 to 10 years. Studies comparing patients with dysplasia to those without did not demonstrate significant differences in preoperative, postoperative, or delta PROs or in failure, reoperation, or revision rates. There was no overall significant correlation between outcomes and LCEA stratification. CONCLUSION Hip arthroscopy in carefully selected patients with LCEA <25° can be successful at mid- to long-term follow-up and may provide clinical outcomes and failure rates comparable with patients with normal LCEA, understanding that this is a singular, 2-dimensional radiographic measure that does not differentiate instability from impingement or combinations thereof, warranting future studies delineating these differences. These findings suggest that hip dysplasia may not be an absolute contraindication for isolated hip arthroscopy and may serve as a viable intervention with consideration of staged future periacetabular osteotomy (PAO). Importantly, this review does not suggest that hip arthroscopy alters the natural history of dysplasia; therefore, patients with dysplasia should be counseled on the potential utility of PAO by appropriate hip preservation specialists.
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Affiliation(s)
- Alexander M Boos
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, Minnesota, USA
| | | | - Kelechi R Okoroha
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, Minnesota, USA
| | - Rafael J Sierra
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, Minnesota, USA
| | - Aaron J Krych
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, Minnesota, USA
| | - Mario Hevesi
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, Minnesota, USA
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AlShehri Y, McConkey M, Lodhia P. ChatGPT has Educational Potential: Assessing ChatGPT Responses to Common Patient Hip Arthroscopy Questions. Arthroscopy 2024:S0749-8063(24)00452-3. [PMID: 38914299 DOI: 10.1016/j.arthro.2024.06.017] [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: 02/27/2024] [Revised: 05/24/2024] [Accepted: 06/09/2024] [Indexed: 06/26/2024]
Abstract
PURPOSE To assess the ability of ChatGPT to answer common patient questions regarding hip arthroscopy, and to analyze the accuracy and appropriateness of its responses. METHODS Ten questions were selected from well-known patient education websites, and ChatGPT (version 3.5) responses to these questions were graded by two fellowship-trained hip preservation surgeons. Responses were analyzed, compared to the current literature, and graded from A to D (A being the highest, and D being the lowest) in a grading scale based on the accuracy and completeness of the response. If the grading differed between the two surgeons, a consensus was reached. Inter-rater agreement was calculated. The readability of responses was also assessed using the Flesch-Kincaid Reading Ease Score (FRES) and Flesch-Kincaid Grade Level (FKGL). RESULTS Responses received the following consensus grades: A (50%, n=5), B (30%, n=3), C (10%, n=1), D (10%, n=1) (Table 2). Inter-rater agreement based on initial individual grading was 30%. The mean FRES was 28.2 (SD± 9.2), corresponding to a college graduate level, ranging from 11.7 to 42.5. The mean FKGL was 14.4 (SD±1.8), ranging from 12.1 to 18, indicating a college student reading level. CONCLUSION ChatGPT can answer common patient questions regarding hip arthroscopy with satisfactory accuracy graded by two high-volume hip arthroscopists, however, incorrect information was identified in more than one instance. Caution must be observed when using ChatGPT for patient education related to hip arthroscopy. CLINICAL RELEVANCE Given the increasing number of hip arthroscopies being performed annually, ChatGPT has the potential to aid physicians in educating their patients about this procedure and address any questions they may have.
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Affiliation(s)
- Yasir AlShehri
- Department of Orthopaedics, Faculty of Medicine, The University of British Columbia, Vancouver, BC, Canada; Department of Orthopedics, College of Medicine, Imam Abdulrahman Bin Faisal University, Dammam, Saudi Arabia
| | - Mark McConkey
- Department of Orthopaedics, Faculty of Medicine, The University of British Columbia, Vancouver, BC, Canada
| | - Parth Lodhia
- Department of Orthopaedics, Faculty of Medicine, The University of British Columbia, Vancouver, BC, Canada.
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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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Tian J, Li Y, Tong Y, Ji L, Zhang W, Zhong X, Zhu S, Kang Y, Bi Q. Unveiling hotspots and trends in hip arthroscopy research: A bibliometric and visualized analysis (1900-2022). Medicine (Baltimore) 2024; 103:e38198. [PMID: 38788035 PMCID: PMC11124675 DOI: 10.1097/md.0000000000038198] [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] [Received: 12/07/2023] [Accepted: 04/19/2024] [Indexed: 05/26/2024] Open
Abstract
Over the past 10 years, hip arthroscopy has been increasingly employed to effectively diagnose and safely treat a range of hip pathologies. With research related to hip arthroscopy continually expanding, the number of articles connected with hip arthroscopy has also consistently grown. We aimed to investigate trends and hotspots in hip arthroscopy-related research, and analyze the top 100 most-cited articles on hip arthroscopy. We searched for ("hip arthroscopy") AND ("article" OR "review") AND "English" in the Web of Science database from 1900 to 2022, which was used to obtain all publications relating to hip arthroscopy. Distribution of country, affiliated institution, journal, authors, citation frequency and keywords were analyzed using VOSviewer. A total of 1094 articles were selected from the Web of Science Core Collection (WoSCC) from 1900 to 2022. The number of publications concerning hip arthroscopy displayed an ascending trend over time. Among the countries, the United States emerged as the largest contributor to the number of articles. The highest prolific institution was American Hip Institute. Among the journals, the highest-ranking journal was "Arthroscopy-the Journal of Arthroscopic and Related Surgery," with 8316 citation counts and 262 articles. The area of greatest research interest was diagnosis and therapy in the field. The scientific articles on the subject of hip arthroscopy have risen continuously in recent years. The United States was the most influential country and made the most significant contributions to this field globally. We identified the research direction and trend for the first time and provided the most recent bibliometric analysis on hip arthroscopy, which may assist researchers in conducting studies on hip arthroscopy.
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Affiliation(s)
- Jinlong Tian
- Center for Rehabilitation Medicine, Department of Orthopedics, Zhejiang Provincial People’s Hospital (Affiliated People’s Hospital, Hangzhou Medical College), Hangzhou, China
- Bengbu Medical College, Bengbu, Anhui, China
| | - Yanlei Li
- Center for Rehabilitation Medicine, Department of Orthopedics, Zhejiang Provincial People’s Hospital (Affiliated People’s Hospital, Hangzhou Medical College), Hangzhou, China
- Bengbu Medical College, Bengbu, Anhui, China
| | - Yu Tong
- Center for Rehabilitation Medicine, Department of Orthopedics, Zhejiang Provincial People’s Hospital (Affiliated People’s Hospital, Hangzhou Medical College), Hangzhou, China
| | - Lichen Ji
- Department of Joint Surgery, Shanghai East Hospital, Tongji University School of Medicine, Shanghai, China
| | - Wei Zhang
- Department of Orthopedics, Taizhou Hospital of Zhejiang Province affiliated to Wenzhou Medical University, Linhai, Zhejiang, China
| | - Xugang Zhong
- Center for Rehabilitation Medicine, Department of Orthopedics, Zhejiang Provincial People’s Hospital (Affiliated People’s Hospital, Hangzhou Medical College), Hangzhou, China
| | - Senbo Zhu
- Center for Rehabilitation Medicine, Department of Orthopedics, Zhejiang Provincial People’s Hospital (Affiliated People’s Hospital, Hangzhou Medical College), Hangzhou, China
| | - Yao Kang
- Center for Rehabilitation Medicine, Department of Orthopedics, Zhejiang Provincial People’s Hospital (Affiliated People’s Hospital, Hangzhou Medical College), Hangzhou, China
| | - Qing Bi
- Center for Rehabilitation Medicine, Department of Orthopedics, Zhejiang Provincial People’s Hospital (Affiliated People’s Hospital, Hangzhou Medical College), Hangzhou, China
- Bengbu Medical College, Bengbu, Anhui, China
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Aprato A, Caruso R, Reboli M, Giachino M, Massè A. Surgical Technique: Arthroscopic Reduction and Fixation of Partial Posterior Wall Acetabular Fractures. Arthrosc Tech 2024; 13:102932. [PMID: 38690352 PMCID: PMC11056782 DOI: 10.1016/j.eats.2024.102932] [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: 08/24/2023] [Accepted: 12/05/2023] [Indexed: 05/02/2024] Open
Abstract
Partial posterior wall fractures are usually fixed with open reduction-internal fixation through an open posterolateral approach, but when the fragment may be fixed without a plate (with screws only), reduction and fixation may also be achieved via hip arthroscopy with the patient in the prone position. This article presents all the surgical steps to perform this procedure.
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Spencer AD, Hagen MS. Predicting Outcomes in Hip Arthroscopy for Femoroacetabular Impingement Syndrome. Curr Rev Musculoskelet Med 2024; 17:59-67. [PMID: 38182802 PMCID: PMC10847074 DOI: 10.1007/s12178-023-09880-w] [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] [Accepted: 12/14/2023] [Indexed: 01/07/2024]
Abstract
PURPOSE OF REVIEW Arthroscopic treatment of femoroacetabular impingement syndrome (FAIS) continues to rise in incidence, and thus there is an increased focus on factors that predict patient outcomes. The factors that impact the outcomes of arthroscopic FAIS treatment are complex. The purpose of this review is to outline the current literature concerning predictors of patient outcomes for arthroscopic treatment of FAIS. RECENT FINDINGS Multiple studies have shown that various patient demographics, joint parameters, and surgical techniques are all correlated with postoperative outcomes after arthroscopic FAIS surgery, as measured by both validated patient-reported outcome (PRO) scores and rates of revision surgery including hip arthroplasty. To accurately predict patient outcomes for arthroscopic FAIS surgery, consideration should be directed toward preoperative patient-specific factors and intraoperative technical factors. The future of accurately selecting patient predictors for outcomes will only improve with increased data, improved techniques, and technological advancement.
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Affiliation(s)
- Andrew D Spencer
- University of Washington School of Medicine, 1959 NE Pacific St, Seattle, WA, 98195, USA
| | - Mia S Hagen
- Department of Orthopaedics and Sports Medicine, University of Washington, 3800 Montlake Blvd NE, Box 354060, Seattle, WA, 98195, USA.
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Yang J, Wang X, Zeng X, Wang R, Ma Y, Fu Z, Wan Z, Wang Z, Yang L, Chen G, Gong X. One-step stromal vascular fraction therapy in osteoarthritis with tropoelastin-enhanced autologous stromal vascular fraction gel. Front Bioeng Biotechnol 2024; 12:1359212. [PMID: 38410163 PMCID: PMC10895027 DOI: 10.3389/fbioe.2024.1359212] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2023] [Accepted: 02/01/2024] [Indexed: 02/28/2024] Open
Abstract
Background: Osteoarthritis (OA) is a debilitating degenerative joint disease, leading to significant pain and disability. Despite advancements, current regenerative therapies, such as mesenchymal stem cells (MSCs), face challenges in clinical efficacy and ethical considerations. This study aimed to evaluate the therapeutic potential of stromal vascular fraction gel (SVF-gel) in comparison to available treatments like hyaluronic acid (HA) and adipose-derived stem cells (ADSCs) and to assess the enhancement of this potential by incorporating tropoelastin (TE). Methods: We conducted a comparative laboratory study, establishing an indirect co-culture system using a Transwell assay to test the effects of HA, ADSCs, SVF-gel, and TE-SVF-gel on osteoarthritic articular chondrocytes (OACs). Chondrogenic and hypertrophic markers were assessed after a 72-hour co-culture. SVF-gel was harvested from rat subcutaneous abdominal adipose tissue, with its mechanical properties characterized. Cell viability was specifically analyzed for SVF-gel and TE-SVF-gel. The in vivo therapeutic effectiveness was further investigated in a rat model of OA, examining MSCs tracking, effects on cartilage matrix synthesis, osteophyte formation, and muscle weight changes. Results: Cell viability assays revealed that TE-SVF-gel maintained higher cell survival rates than SVF-gel. In comparison to the control, HA, and ADSCs groups, SVF-gel and TE-SVF-gel significantly upregulated the expression of chondrogenic markers COL 2, SOX-9, and ACAN and downregulated the hypertrophic marker COL 10 in OACs. The TE-SVF-gel showed further improved expression of chondrogenic markers and a greater decrease in COL 10 expression compared to SVF-gel alone. Notably, the TE-SVF-gel treated group in the in vivo OA model exhibited the most MSCs on the synovial surface, superior cartilage matrix synthesis, increased COL 2 expression, and better muscle weight recovery, despite the presence of fewer stem cells than other treatments. Discussion: The findings suggest that SVF-gel, particularly when combined with TE, provides a more effective regenerative treatment for OA by enhancing the therapeutic potential of MSCs. This combination could represent an innovative strategy that overcomes limitations of current therapies, offering a new avenue for patient treatment. Further research is warranted to explore the long-term benefits and potential clinical applications of this combined approach.
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Affiliation(s)
- Junjun Yang
- Center for Joint Surgery, Southwest Hospital, Army Medical University (Third Military Medical University), Chongqing, China
- Key Laboratory of Biorheological Science and Technology, Ministry of Education College of Bioengineering, Chongqing University, Chongqing, China
| | - Xin Wang
- Center for Joint Surgery, Southwest Hospital, Army Medical University (Third Military Medical University), Chongqing, China
| | - XueBao Zeng
- Chongqing Yan Yu Medical Beauty Clinic, Chongqing, China
| | - Rong Wang
- Center for Joint Surgery, Southwest Hospital, Army Medical University (Third Military Medical University), Chongqing, China
| | - Yanming Ma
- Center for Joint Surgery, Southwest Hospital, Army Medical University (Third Military Medical University), Chongqing, China
| | - Zhenlan Fu
- Center for Joint Surgery, Southwest Hospital, Army Medical University (Third Military Medical University), Chongqing, China
| | - Zu Wan
- Center for Joint Surgery, Southwest Hospital, Army Medical University (Third Military Medical University), Chongqing, China
| | - Zhi Wang
- Center for Joint Surgery, Southwest Hospital, Army Medical University (Third Military Medical University), Chongqing, China
| | - Liu Yang
- Center for Joint Surgery, Southwest Hospital, Army Medical University (Third Military Medical University), Chongqing, China
| | - Guangxing Chen
- Center for Joint Surgery, Southwest Hospital, Army Medical University (Third Military Medical University), Chongqing, China
| | - Xiaoyuan Gong
- Center for Joint Surgery, Southwest Hospital, Army Medical University (Third Military Medical University), Chongqing, China
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Rana P, Brennan JC, Johnson AH, Turcotte JJ, Petre BM. Social Determinants of Health in Maryland Hip Arthroscopy Patients. Cureus 2024; 16:e52576. [PMID: 38371015 PMCID: PMC10874623 DOI: 10.7759/cureus.52576] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/18/2024] [Indexed: 02/20/2024] Open
Abstract
Background Prior studies have demonstrated racial and socioeconomic disparities in patient-reported outcome measure (PROM) completion rates, and improvement exists across multiple orthopedic conditions. The purpose of this study was to assess whether these disparities are present in patients undergoing hip arthroscopy (HA) procedures. Methods A retrospective study of 306 patients undergoing HA from 2021 to 2023 was performed. Social determinants of health (SDOH) were compared between HA patients and the general Maryland population. Patients were then classified by whether they completed baseline and six-month PROMs (Patient-Reported Outcomes Measurement Information System Physical Function (PROMIS-PF) instrument). Patients who completed PROMIS-PF were classified by whether or not they achieved minimal clinically important difference (MCID) at six months. Demographics and SDOH were compared using univariate analyses between patients who did and did not complete PROMs and between those who did and did not achieve MCID. SDOH were evaluated at the zip-code level using regional health information exchange measures. Results Compared to the Maryland population, HA patients resided in areas of lower social vulnerability. Preoperative and six-month PROMs were completed by 102 (33%) patients. No significant differences in demographics or any SDOH were found between patients who did and did not complete PROMs. Six-month MCID was achieved in 75 of 102 (74%) patients with complete PROMs; no significant differences in demographics or SDOH were observed between patients who did and did not achieve MCID. Conclusions For patients undergoing HA, disparities in patient-reported outcome completion rates and postoperative functional improvement do not appear to be present across demographics and SDOH, indicating equitable care is being delivered.
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Affiliation(s)
- Parimal Rana
- Orthopedic Research, Anne Arundel Medical Center, Annapolis, USA
| | - Jane C Brennan
- Orthopedic Research, Anne Arundel Medical Center, Annapolis, USA
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Wentzel D, Enos J, Smoak J, Goodman I, Mar D, Vopat B, Mullen S, Schroeppel JP. Benefits of a Postoperative Hip Orthosis After Routine Arthroscopy of the Hip: A Retrospective Cohort Study. Orthop J Sports Med 2023; 11:23259671231212503. [PMID: 38021301 PMCID: PMC10666821 DOI: 10.1177/23259671231212503] [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: 06/07/2023] [Accepted: 06/20/2023] [Indexed: 12/01/2023] Open
Abstract
Background No consensus currently exists among orthopaedic surgeons regarding the benefits of hip orthosis after routine hip arthroscopy. Purpose To compare patient-reported outcome measures (PROMs) and reoperation rates between patients who were braced versus those who were not braced after routine hip arthroscopy. Study Design Cohort study; Level of evidence, 3. Methods A retrospective review was conducted of 193 patients who underwent hip arthroscopy for femoroacetabular impingement (FAI) from January 1, 2018, to December 31, 2021, by 2 orthopedic surgeons at a single institution. Patients before July 1, 2019, were immobilized in a hip orthosis after hip arthroscopy (braced group; n = 101), whereas those after July 1, 2019, were not (nonbraced group; n = 92). Baseline PROMs (visual analog scale for pain, modified Harris Hip Score, Single Assessment Numeric Evaluation, and Veterans Rand 12-Item Health Survey [VR-12] Physical Component Summary and Mental Component Summary) were obtained for all patients and were repeated postoperatively at 2 weeks, 4 weeks, 3 months, 6 months, 1 year, and 2 years. The study groups were compared to evaluate differences in PROMs over time and 2-year postoperative reoperation rates. Group comparisons were also stratified by patient sex. Results There were no significant differences on any PROM between the braced and nonbraced cohorts at any timepoint. There were also no significant group differences in reoperation rates, with 8 braced patients (7.9%) undergoing reoperation and 1 nonbraced patient (2.3%) undergoing reoperation (P = .208). In the sex-stratified analyses, nonbraced male patients had significantly higher VAS pain and lower VR-12 Mental Component Summary scores at 6 months postoperatively compared with braced male patients (P = .043 and .026, respectively). Conclusion The study findings suggested that the use of an orthosis after routine hip arthroscopy for FAI does not improve patient-reported outcomes or negatively affect the 2-year reoperation rate. Postoperative bracing increases perioperative cost, and by foregoing routine bracing, patients may avoid the morbidity associated with wearing a brace for a prolonged period.
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Affiliation(s)
- Dylan Wentzel
- Department of Orthopedic Surgery and Sports Medicine, University of Kansas Medical Center, Kansas City, Kansas, USA
| | - Jake Enos
- Department of Orthopedic Surgery and Sports Medicine, University of Kansas Medical Center, Kansas City, Kansas, USA
| | - Jason Smoak
- Department of Orthopedic Surgery and Sports Medicine, University of Kansas Medical Center, Kansas City, Kansas, USA
| | - Ian Goodman
- Department of Orthopedic Surgery and Sports Medicine, University of Kansas Medical Center, Kansas City, Kansas, USA
| | - Damon Mar
- Department of Orthopedic Surgery and Sports Medicine, University of Kansas Medical Center, Kansas City, Kansas, USA
| | - Bryan Vopat
- Department of Orthopedic Surgery and Sports Medicine, University of Kansas Medical Center, Kansas City, Kansas, USA
| | - Scott Mullen
- Department of Orthopedic Surgery and Sports Medicine, University of Kansas Medical Center, Kansas City, Kansas, USA
| | - John Paul Schroeppel
- Department of Orthopedic Surgery and Sports Medicine, University of Kansas Medical Center, Kansas City, Kansas, USA
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11
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Alkan H, Erdoğan Y, Veizi E, Sezgin BS, Çepni Ş, Mert HÇ, Fırat A. Better sex after hip arthroscopy; Sexual dysfunction in patients with femoro-acetabular impingement syndrome. Orthop Traumatol Surg Res 2023:103693. [PMID: 37776950 DOI: 10.1016/j.otsr.2023.103693] [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: 12/14/2022] [Revised: 07/30/2023] [Accepted: 08/30/2023] [Indexed: 10/02/2023]
Abstract
BACKGROUND Femoro-acetabular impingement syndrome (FAIS) is a common cause of hip pain and functional decline. The quality of life of affected patients has been shown to be significantly diminished, with potential alterations in the ability to perform activities of daily living and recreation, including sexual function. Hip arthroscopy is the surgical technique recognized as the gold standard in FAIS. The aim of this study was to research the relationship between hip arthroscopy due to FAIS and pre- and postoperative sexual function. HYPOTHESIS The hypothesis of the study was that sexual dysfunction would be common during the preoperative period but would significantly improve after surgery. MATERIALS AND METHODS This retrospective study included 96 patients aged 18 to 55 years, who underwent hip arthroscopy for a FAIS diagnosis between 2015 and 2021, with a minimum follow-up of one year. Exclusion criteria were a bilateral symptomatic hip condition, history of ipsilateral hip or knee surgery, history of urological or gynecological conditions, sexual dysfunction, or a history of hip osteonecrosis or osteoarthritis. The Female Sexual Function Scale (FSFI) was used to evaluate sexual dysfunction in females and the International Erectile Function Index (IIEF-5) for males. RESULTS The patients comprised 56.3% males and 43.82% females with a mean age of 35.3±8.3 years. Sexual dysfunction was determined preoperatively in 85.2% of the males and in 57.1% of the females. Overall improvement after surgery was statistically significant. Signs of pudendal nerve damage were seen during the postoperative period in 29 (30.2%) patients. The change in total sexual scores was significantly correlated with nerve symptoms and regression analysis showed that traction time was a significant risk factor for pudendal nerve symptoms. DISCUSSION Sexual dysfunction is a common trait of patients suffering from FAIS and the majority of patients significantly benefit from the procedure. Sexual dysfunction persists in a category of patients during the postoperative period, regardless of the type of lesion, and this phenomenon is associated with transient pudendal nerve symptoms, which are more likely to occur with longer traction times and thus represent a clear risk factor. LEVEL OF EVIDENCE IV.
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Affiliation(s)
- Hilmi Alkan
- Department of Orthopedics and Traumatology, Ankara City Hospital, 06000 Ankara, Turkey
| | - Yasin Erdoğan
- Department of Orthopedics and Traumatology, Ankara City Hospital, 06000 Ankara, Turkey
| | - Enejd Veizi
- Department of Orthopedics and Traumatology, Ankara City Hospital, 06000 Ankara, Turkey.
| | - Başak Sinem Sezgin
- Department of Orthopedics and Traumatology, Ankara City Hospital, 06000 Ankara, Turkey
| | - Şahin Çepni
- Department of Orthopedics and Traumatology, Ankara City Hospital, 06000 Ankara, Turkey
| | | | - Ahmet Fırat
- Department of Orthopedics and Traumatology, Ankara City Hospital, 06000 Ankara, Turkey
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Chen Q, Zou J, Wang F, Qiao K, Li H, Zhang W, Tian K. Portal Selection for Suture Anchor Placement During Hip Arthroscopic Labral Repair: A Study Based on 3-Dimensional Model Reconstruction. Orthop J Sports Med 2023; 11:23259671231189729. [PMID: 37655241 PMCID: PMC10467395 DOI: 10.1177/23259671231189729] [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: 03/29/2023] [Accepted: 04/26/2023] [Indexed: 09/02/2023] Open
Abstract
Background Arthroscopic suture repair is the main treatment option for hip labral tears; however, anchor insertion and placement from arthroscopic portals is difficult. Purpose To quantitatively evaluate the safety of various arthroscopic portals for suture anchor placement during hip labral repair. Study Design Descriptive laboratory study. Methods The computed tomography scans of 20 patients with normally developed hip joints were used to create 3-dimensional models. The distances from the anchor to the articular cartilage (DAC) and from the acetabular insertion point to the cortical bone (DCB) were measured in the anterolateral portal (AL), posterolateral portal (PL), midanterior portal (MAP), medial MAP, and 3 distal anterolateral accessory portals (DALAs): DALA-proximal, DALA-middle, and DALA-distal. Labral tears were divided into anterior (4, 3, and 2 o'clock), lateral (1, 12, and 11 o'clock), and posterior (10, 9, and 8 o'clock) acetabular zones, and the Kruskal-Wallis and Mann-Whitney U test were used to compare DAC and DCB in the zones. The success rate was defined as anchors placed with DAC ≥1 mm and DCB ≥15 mm. Results The DAC was significantly smaller in the AL at 1 o'clock (0.68 ± 0.32 mm; P < .001) and 12 o'clock (0.37 ± 0.30 mm; P < .001), and in the PL at 12 o'clock (-0.35 ± 0.38 mm; P < .001) and 11 o'clock (0.60 ± 0.24 mm; P < .001). The DCB was significantly smaller in the DALA-P at 3 o'clock (8.93 ± 2.12 mm; P < .001) and 11 o'clock (9.59 ± 2.84 mm; P < .001), the MAP at 12 o'clock (13.76 ± 3.89 mm; P < .001) and 11 o'clock (0.27 ± 0.27 mm; P < .001), and the MMA at 12 o'clock (5.96 ± 2.31 mm; P < .001) and 11 o'clock (0 mm; P < .001). Success rates were high for MAP and MMA between 4 o'clock and 1 o'clock, for DALA-proximal at 12 o'clock, for AL at 11 o'clock, and for PL between 10 o'clock and 8-o'clock. Conclusion There were significant differences in the success rate of anchor placement using different portals during hip arthroscopic labral repair. Clinical Relevance MAP is recommended for labral repair between 4 o'clock and 1 o'clock, DALA-P is recommended between 2 o'clock and 12 o'clock, AL is suitable at 11 o'clock, and PL is suitable between 10 o'clock and 8 o'clock.
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Affiliation(s)
- Qi Chen
- Department of Joint and Sports Medicine, The First Affiliated Hospital of Dalian Medical University, Dalian, Liaoning, China
| | - Jiyang Zou
- Department of Joint and Sports Medicine, The First Affiliated Hospital of Dalian Medical University, Dalian, Liaoning, China
| | - Fusheng Wang
- Department of Joint and Sports Medicine, The First Affiliated Hospital of Dalian Medical University, Dalian, Liaoning, China
| | - Kai Qiao
- Department of Joint and Sports Medicine, The First Affiliated Hospital of Dalian Medical University, Dalian, Liaoning, China
- Cardiac and Osteochondral Tissue Engineering (COTE) Group, School of Medicine, The Chinese University of Hong Kong, Shenzhen, China
| | - Han Li
- Department of Joint and Sports Medicine, The First Affiliated Hospital of Dalian Medical University, Dalian, Liaoning, China
| | - Weiguo Zhang
- Department of Joint and Sports Medicine, The First Affiliated Hospital of Dalian Medical University, Dalian, Liaoning, China
- Key Laboratory of Molecular Mechanism for Repair and Remodeling of Orthopaedic Diseases, Liaoning Province, Dalian Liaoning, China
| | - Kang Tian
- Department of Joint and Sports Medicine, The First Affiliated Hospital of Dalian Medical University, Dalian, Liaoning, China
- Key Laboratory of Molecular Mechanism for Repair and Remodeling of Orthopaedic Diseases, Liaoning Province, Dalian Liaoning, China
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13
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Kohli A, Xia S, Wells JE, Chhabra A. Three-Dimensional CT and 3D MRI of Hip- Important Aids to Hip Preservation Surgery. Semin Ultrasound CT MR 2023; 44:252-270. [PMID: 37437966 DOI: 10.1053/j.sult.2023.03.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/14/2023]
Abstract
Common hip internal derangements include femoroacetabular impingement (FAI), developmental dysplasia of hip (DDH) dysplasia, and avascular necrosis (AVN) of the femoral head. These are initially screened by radiographs. For preoperative planning of hip preservation, 3-dimensional (3D) CT is commonly performed to assess bony anatomy and its alterations. Magnetic resonance imaging (MRI) is used to evaluate labrum, hyaline cartilage, tendons, synovium, and loose bodies, and provides vital information for surgical decision-making. However, conventional 2D MRI techniques are limited by lack of isotropic multiplanar reconstructions and partial volume artifacts. With advancements in hardware and software, novel isotropic 3D MR Proton Density images are acquired with acceptable acquisition times leading to improved visualization of soft tissue and osseous structures for various hip conditions. Three-Dimensional MRI allows multiplanar non-gap reconstructions along the structures of interest. It results in detection of small, otherwise inconspicuous labral tears without the need for MR arthrogram, which can be subsequently measured. In addition, radial reconstructions of the femoral head can be performed from original 3D volume MR imaging and CT imaging without the need for individual different plane acquisitions. Three-Dimensional MRI thus impacts surgical decision-making for the important common hip derangement conditions. For example, femoral head hyaline cartilage loss may make hip preservation difficult or impossible. In this review, we discuss the advantages and technical details of 3D CT and MRI and their significant role in aiding hip preservation surgery for common hip conditions. The conditions discussed in this article include FAI, DDH, AVN, synovial disorders, cartilaginous tumors, and hip fractures.
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Affiliation(s)
- Ajit Kohli
- Department of Radiology, UT Southwestern, Dallas, TX
| | - Shuda Xia
- Department of Radiology, UT Southwestern, Dallas, TX
| | - Joel E Wells
- Baylor Scott & White Comprehensive Hip Center and Associate Professor Texas A&M School of Medicine
| | - Avneesh Chhabra
- Department of Radiology, UT Southwestern, Dallas, TX; Department of Orthopedic Surgery, UT Southwestern, Dallas, TX.
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14
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Gillinov SM, Kim DN, Moran J, Lee MS, Fong S, Mahatme RJ, Simington J, Owens JS, McLaughlin WM, Grauer JN, Jimenez AE. Low Rates of 5-Year Secondary Surgery and Postoperative Complications After Primary Hip Arthroscopy in More Than 30,000 Patients. Arthroscopy 2023; 39:1639-1648. [PMID: 37286283 DOI: 10.1016/j.arthro.2023.01.100] [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: 09/06/2022] [Revised: 12/12/2022] [Accepted: 01/24/2023] [Indexed: 06/09/2023]
Abstract
PURPOSE To evaluate 90-day complications, 5-year secondary surgery rates, and risk factors for secondary surgery following primary hip arthroscopy performed for femoroacetabular impingement and/or labral tears using a large national dataset. METHODS A retrospective analysis was conducted using the PearlDiver Mariner151 database. Patients with International Classification of Diseases, Tenth Revision, diagnosis codes for femoroacetabular impingement and/or labral tear undergoing primary hip arthroscopy with femoroplasty, acetabuloplasty, and/or labral repair between 2015 and 2021 were identified. Those with concomitant International Classification of Diseases, Tenth Revision, codes for infection, neoplasm, or fracture were excluded, as were patients with a history of previous hip arthroscopy or total hip arthroplasty, or age ≥70 years. Rates of complications within 90 days of surgery were assessed. Five-year rates of secondary surgery-revision hip arthroscopy or conversion to total hip arthroplasty-were determined by Kaplan-Meier analysis, and risk factors for secondary surgery were identified by multivariate logistic regression. RESULTS A total of 31,623 patients underwent primary hip arthroscopy from October 2015 to April 2021, with annual volumes ranging from 5,340 to 6,343 surgeries per year. Femoroplasty was the most frequent surgical procedure (performed in 81.1% of surgical encounters), followed by labral repair (72.6%) and acetabuloplasty (33.0%). Ninety-day postoperative complication rates were low, with 1.28% of patients experiencing any complication. The 5-year secondary surgery rate was 4.9% (N = 915 patients). Multivariate logistic regression identified age <20 years (odds ratio [OR] 1.50; P < .001), female sex (OR 1.33; P < .001), class I obesity (body mass index 30-34.9: OR 1.30; P = .04), and class II/III obesity (body mass index ≥35.0: OR 1.29; P = .02) as independent predictors of secondary surgery. CONCLUSIONS In this study of primary hip arthroscopy, 90-day adverse events were low at 1.28%, and the 5-year secondary surgery rate was 4.9%. Age younger than 20 years, female sex, and obesity were risk factors for secondary surgery, suggesting the need for increased surveillance in these patient groups. LEVEL OF EVIDENCE Level IV, case series.
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Affiliation(s)
- Stephen M Gillinov
- Department of Orthopaedics and Rehabilitation, Yale School of Medicine, New Haven, Connecticut, U.S.A..
| | - David N Kim
- Department of Orthopaedics and Rehabilitation, Yale School of Medicine, New Haven, Connecticut, U.S.A
| | - Jay Moran
- Department of Orthopaedics and Rehabilitation, Yale School of Medicine, New Haven, Connecticut, U.S.A
| | - Michael S Lee
- Medical University of Wisconsin, Milwaukee, Wisconsin, U.S.A
| | - Scott Fong
- Advanced Orthopedics and Sports Medicine, San Francisco, California, U.S.A
| | - Ronak J Mahatme
- University of Connecticut School of Medicine, Farmington, Connecticut, U.S.A
| | | | - Jade S Owens
- Keck School of Medicine of University of Southern California, Los Angeles, California, U.S.A
| | - William M McLaughlin
- Department of Orthopaedics and Rehabilitation, Yale School of Medicine, New Haven, Connecticut, U.S.A
| | - Jonathan N Grauer
- 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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15
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Ranzoni LV, Guberovich MA, Ejnisman L, Miyahara HS, Rath E, Gurgel HMDC, Jacomo AL. Proximal endoscopic repair of the hamstring tendons: a cadaveric anatomical study of posterior hip portals. J Hip Preserv Surg 2023; 10:75-79. [PMID: 37900891 PMCID: PMC10604049 DOI: 10.1093/jhps/hnad001] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/30/2022] [Revised: 12/06/2022] [Accepted: 01/10/2023] [Indexed: 10/31/2023] Open
Abstract
Arthroscopy and endoscopic hip surgery have attracted increasing attention in the orthopedic field. In the case of arthroscopy, portals and their relationships with neurovascular bundle structures at risk are well established. However, studies on endoscopic portals used for the repair of hamstring tendon injuries are insufficient. Hamstring injuries are the most common muscle injury in sports medicine, and up to 12% can present as a tendon rupture. Endoscopic surgery is advantageous because it has a lower rate of bleeding and avoids excessive handling of the gluteal muscles. The objective of this study is to perform an anatomical evaluation of endoscopic portals for hamstring repair and measure their distance to neurovascular structures-mainly sciatic nerve and posterior femoral cutaneous nerve (PFCN). Fifteen hips from frozen and formalized cadavers were evaluated. Specimens that showed any modification in their anatomy were excluded. Portals were simulated using Steinmann pins, and anatomical dissection was performed. Distances from neurovascular structures were measured using a digital caliper. Four male cadaver hips (26%) and eleven female cadaver hips (74%) were included. Two dissected hips presented PFCN injury through the posterolateral portal- mean 20.28 mm (±8.14), and one through the distal accessory portal- 21.87 mm (±12.03). The injury rate for PFCN was 3/15 or 20%. None of the portals presented sciatic nerve injury. Conclusion: There is an imminent risk of nerve injury to the PFCN by performing the lateral portals for hamstring repair. To avoid this, we recommend starting the procedure through the most medial (posteromedial) portal, and the other portals must be performed under direct visualization.
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Affiliation(s)
- Lucas Verissimo Ranzoni
- Department of Pathophysiology, Faculty of Medicine, USP, Av. Dr. Arnaldo, 455 - Cerqueira César, São Paulo, SP 01246-903, Brazil
| | - Matheus Almeida Guberovich
- Department of Pathophysiology, Faculty of Medicine, USP, Av. Dr. Arnaldo, 455 - Cerqueira César, São Paulo, SP 01246-903, Brazil
| | - Leandro Ejnisman
- Orthopedics Department, Hospital Israelita Albert Einstein, Dr. Ovídio Pires de Campos Street, 333, Cerqueira Cesar, São Paulo, SP 05403-010, Brazil
| | - Helder Souza Miyahara
- Orthopedics Department, Hospital das Clínicas—FMUSP, Dr. Ovídio Pires de Campos Street, 333, Cerqueira Cesar, São Paulo, SP 05403-010 Brazil
| | - Ehud Rath
- Orthopedics Department, Tel Aviv University School of Medicine, Tel Aviv-Yafo 6997801, Israel
| | - Henrique Melo de Campos Gurgel
- Orthopedics Department, Hospital das Clínicas—FMUSP, Dr. Ovídio Pires de Campos Street, 333, Cerqueira Cesar, São Paulo, SP 05403-010 Brazil
| | - Alfredo Luiz Jacomo
- Department of Surgery, Faculty of Medicine, USP, Av. Dr. Arnaldo, 455 - Cerqueira César, São Paulo, SP 01246-903, Brazil
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16
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Gaio NM, Turner EH, Spiker AM. Hip Manipulation Under Anesthesia for Post-Hip Arthroscopy Pericapsular Scarring: Indications and Techniques. Arthrosc Tech 2023; 12:e983-e989. [PMID: 37424664 PMCID: PMC10323974 DOI: 10.1016/j.eats.2023.02.036] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/19/2022] [Revised: 02/01/2023] [Accepted: 02/14/2023] [Indexed: 07/11/2023] Open
Abstract
Hip arthroscopy has become an increasingly common procedure with expanding indications over the last several decades. With the increase in number of procedures performed a complication profile has emerged, although there is yet to be a formal classification system for complications. The most cited complications include lateral femoral cutaneous nerve neuropraxia, other sensory deficits, chondral or labral iatrogenic damage, superficial infection and deep vein thrombosis. One complication that has not yet been well documented in the literature is pericapsular scarring/adhesions resulting in decreased hip range of motion and function. If this complication is noted to persist after adequate impingement resection and a rigorous post-operative physical therapy regimen, the senior author has addressed this with a hip manipulation under anesthesia. Therefore, this techniques paper aims to describe pericapsular scarring as a post hip-arthroscopy condition which may cause pain and demonstrate our technique to address this diagnosis through hip manipulation under anesthesia.
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Affiliation(s)
- Natalie M. Gaio
- Department of Orthopedic Surgery, University of Wisconsin—Madison, Madison, Wisconsin, U.S.A
| | | | - Andrea M. Spiker
- Department of Orthopedic Surgery, University of Wisconsin—Madison, Madison, Wisconsin, U.S.A
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17
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Burt J, Smith V, Gee CW, Clarke JV, Hall AJ. The role of outpatient needle arthroscopy in the diagnosis and management of musculoskeletal complaints: A systematic review of the Arthrex NanoScope. Knee 2023; 42:246-257. [PMID: 37105012 DOI: 10.1016/j.knee.2023.04.003] [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: 10/19/2022] [Revised: 02/02/2023] [Accepted: 04/03/2023] [Indexed: 04/29/2023]
Abstract
BACKGROUND The aim was to review the literature regarding needle arthroscopy using the Arthrex NanoScope system and evaluate: (1) the diagnostic indications, utility, and efficacy compared to conventional methods, and (2) the therapeutic indications, safety, and reported outcomes. METHODS Searches of three databases (MEDLINE, Embase and PubMed) were conducted in November 2021 using MeSH terms: 'needle arthroscopy', 'human', 'in office arthroscopy', 'needle arthroscope', 'nanoscopic', 'surgery', 'nanoscope' and 'percutaneous arthroscopy'. The included studies were catalogued, quality-assessed using Methodological Index for Non-Randomised Studies (MINORS), and analysed using the Cochrane data collection templates for randomised control trials (RCT) and non-randomised control trials (non-RCT). The majority of studies were non-numerical and were examined using qualitative analysis. RESULTS The search yielded 314 studies, 22 of which were included for analysis. MINORS assessment was applicable to four studies. Mean MINORS was 10.7/16 with the most frequent limitations being lack of unbiased endpoint or sample size calculation. The level of evidence ranged from level IV-V. Diagnostic and therapeutic indications were described in relation to the: knee (n = 10); shoulder (n = 6); foot/ankle (n = 3); elbow (n = 2), and miscellaneous (n = 1). CONCLUSIONS Needle arthroscopy can augment the diagnostic process in patients presenting with musculoskeletal complaints, and may provide benefits in terms of diagnostic accuracy, cost efficiency, timeliness of investigation, and a visually impactful patient-centred consultation. Therapeutic interventions are reported by a small number of pioneer groups who report some benefits over conventional arthroscopy. The available literature remains small and of low quality, and more evidence is needed with regards to patient selection, efficacy, safety, and cost. LEVEL OF EVIDENCE Level V (based on the weakest study included in the Systematic Review).
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Affiliation(s)
- J Burt
- Department of Orthopaedics, Golden Jubilee University National Hospital, Clydebank, UK
| | - V Smith
- Department of Orthopaedics, Golden Jubilee University National Hospital, Clydebank, UK
| | - C W Gee
- Department of Orthopaedics, Golden Jubilee University National Hospital, Clydebank, UK; University of Glasgow, Glasgow, UK. https://twitter.com/@ChrisGeeOrtho
| | - J V Clarke
- Department of Orthopaedics, Golden Jubilee University National Hospital, Clydebank, UK; University of Strathclyde, Glasgow, UK
| | - A J Hall
- Department of Orthopaedics, Golden Jubilee University National Hospital, Clydebank, UK; University of Edinburgh, Edinburgh, UK. https://twitter.com/@andrewhallortho
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18
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Emami A, Namdari H, Parvizpour F, Arabpour Z. Challenges in osteoarthritis treatment. Tissue Cell 2023; 80:101992. [PMID: 36462384 DOI: 10.1016/j.tice.2022.101992] [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: 09/22/2022] [Revised: 11/16/2022] [Accepted: 11/25/2022] [Indexed: 11/30/2022]
Abstract
Osteoarthritis (OA) is the most common form of arthritis and a degenerative joint cartilage disease that is the most common cause of disability in the world among the elderly. It leads to social, psychological, and economic costs with financial consequences. The principles of OA treatment are to reduce pain and stiffness as well as maintain function. In recent years, due to a better understanding of the underlying pathophysiology of OA, a number of potential therapeutic advances have been made, which include tissue engineering, immune system manipulation, surgical technique, pharmacological, and non-pharmacological treatments. Despite this, there is still no certain cure for OA, and different OA treatments are usually considered in relation to the stage of the disease. The purpose of the present review is to summarize and discuss the latest results of new treatments for OA and potential targets for future research.
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Affiliation(s)
- Asrin Emami
- Iranian tissue bank and research center, Tehran University of Medical Sciences, Tehran, Iran
| | - Haideh Namdari
- Iranian tissue bank and research center, Tehran University of Medical Sciences, Tehran, Iran
| | - Farzad Parvizpour
- Iranian tissue bank and research center, Tehran University of Medical Sciences, Tehran, Iran; Molecular Medicine department, Kurdistan University of Medical Sciences, Sanandaj, Iran.
| | - Zohreh Arabpour
- Iranian tissue bank and research center, Tehran University of Medical Sciences, Tehran, Iran
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19
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The traction force of the pulled limb in hip arthroscopic surgery is determined by stiffness coefficient which is significantly related to muscle volume. Knee Surg Sports Traumatol Arthrosc 2022:10.1007/s00167-022-07261-3. [PMID: 36477348 DOI: 10.1007/s00167-022-07261-3] [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: 04/24/2022] [Accepted: 11/25/2022] [Indexed: 12/13/2022]
Abstract
PURPOSE To verify the relationship between muscle volume, lateral centre-edge angle (LCEA), alpha angle (AA), body mass index (BMI) and Beighton score with stiffness coefficient (SC). To analyse the difference of traction force at different physical states of hip joint capsule. METHODS Thirty-six patients who underwent hip arthroscopy operation were included. The volumes of some related muscles were measured in MRI images by 3D Slicer. We recorded and tested differences in traction force of five joint capsule physical states, including before (State 1) and after joint capsule puncture (State 2), after the establishment of anterolateral and mid-anterior approaches (State 3) and after incision of the joint capsule through these two approaches (States 4, 5). The correlation between muscle volume, BMI, LCEA, AA and SC was verified by Spearman test. Poisson regression was used to explain confounding variables. RESULTS The average force at State 1 was 531.8 N. There were significant differences in traction force between these five states (p < 0.001). There was a significant positive correlation between muscle volumes and SC (p < 0.001). BMI had no correlation with SC (n.s.). The preoperative LCEA of the affected side was correlated with SC (p = 0.043). AA and SC were not correlated (n.s.). CONCLUSION The physical states of the hip joint capsule affected traction force. Muscle volume rather than BMI is an ideal index to estimate preoperative traction force. LCEA affected traction force, whilst AA and Beighton score did not. Measuring the muscle volume can help estimate the most suitable traction force for the patient. LEVELS OF EVIDENCE IV.
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20
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Carreira DS, Shaw DB, Ueland TE, Wolff AB, Christoforetti JJ, Salvo JP, Kivlan BR, Matsuda DK. Acetabular Cartilage Lesions Predict Inferior Mid-Term Outcomes for Arthroscopic Labral Repair and Treatment of Femoroacetabular Impingement Syndrome. Arthroscopy 2022; 38:3152-3158. [PMID: 35716988 DOI: 10.1016/j.arthro.2022.05.013] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/21/2021] [Revised: 05/24/2022] [Accepted: 05/24/2022] [Indexed: 02/02/2023]
Abstract
PURPOSE To analyze the effect of acetabular chondrosis at a minimum of 2 years following hip arthroscopy in patients undergoing labral repair and treatment of femoroacetabular impingement. METHODS From 2014 to 2017, patients undergoing arthroscopic labral repair were prospectively enrolled in a multicenter hip arthroscopy registry. The registry was retrospectively queried for primary labral repair patients with complete 2-year outcomes and a Tonnis grade of less than 2. Patients were grouped according to severity of articular cartilage damage noted intraoperatively using the Beck classification system: none, low-grade (Grade 1 or 2), or high-grade (Grade 3 or 4) damage. A Kruskal-Wallis test and post hoc Dunn's test with Holm correction compared 2-year postoperative outcome scores of the iHOT-12 scale between groups. The proportion of patients in each cohort who achieved the clinically significant thresholds of the minimum clinically important difference (MCID), patient-acceptable symptom scale, and substantial clinical benefit (SCB) were analyzed. Multivariate logistic regression models identified predictors of achieving clinical thresholds while controlling for demographic variation. RESULTS 422 patients met inclusion criteria, from which 347 completed 2-year outcomes. All groups experienced improvement in iHOT-12 scores from baseline to follow-up (P < .001). iHOT-12 scores at follow-up were inferior for Low-Grade Damage and High-Grade Damage Groups relative to the No Damage Group (P = .04; P = .03). When accounting for age, body mass index, gender, and preoperative iHOT-12 scores in logistic regression models, the presence of high-grade lesions was a negative predictor for achieving SCB (OR [95% CI], 0.54 [0.29-0.96]) and low-grade lesions a negative predictor for achieving MCID (0.50 [0.27-0.92]. Among patients with high-grade lesions, there was no significant difference in 2-year iHOT-12 scores between those undergoing chondroplasty (n = 50) and those undergoing microfracture (n = 14) (P = .14). CONCLUSIONS Acetabular cartilage damage portends inferior patient-reported outcomes 2 years after primary labral repair and treatment of femoroacetabular impingement. The presence of cartilage lesions was a negative predictor of individual achievement of several clinical thresholds. LEVEL OF EVIDENCE III, Retrospective comparative cohort.
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Affiliation(s)
| | | | | | - Andrew B Wolff
- Hip Preservation and Sports Medicine, Washington Orthopaedics and Sports Medicine, Washington D.C., U.S.A
| | - John J Christoforetti
- Hip Preservation and Sports Medicine, Texas Health Physicians Group, Dallas, Texas, U.S.A
| | - John P Salvo
- Rothman Orthopaedic Institute: Philadelphia, Pennsylvania, U.S.A
| | | | - Dean K Matsuda
- DISC Sports and Spine Center: Marina del Rey, California, U.S.A
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Symptom duration predicts inferior mid-term outcomes following hip arthroscopy. INTERNATIONAL ORTHOPAEDICS 2022; 46:2837-2843. [PMID: 36088416 DOI: 10.1007/s00264-022-05579-8] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/02/2022] [Accepted: 09/04/2022] [Indexed: 01/22/2023]
Abstract
INTRODUCTION Studies have demonstrated a negative relationship between the length of time with symptoms and patient-reported outcome measures in primary hip arthroscopy. Our aim was to expand the generalizability of this finding with a multi-center cohort. METHODS A multi-center hip arthroscopy registry was queried for patients undergoing primary hip arthroscopy from 2014 to 2017. Patients were stratified according to whether pre-operative symptom duration exceeded two years or did not exceed two years. A Wilcoxon rank sum test was performed for differences in two year post-operative outcome scores. Logistic regression models analyzed the influence of symptom duration on achieving clinically meaningful thresholds (minimum clinically important difference, patient-acceptable symptom state, substantial clinical benefit) when controlling for baseline scores, age, BMI, and sex. RESULTS Seven hundred forty-four patients met the inclusion criteria, from which 620 had complete outcomes information. The mean ± SD 2-year iHOT-12 scores of patients with symptom duration greater than two years (69 ± 26) were significantly lower than patients with symptom duration less than two years (77 ± 23) (Dunn test, p < 0.001). Chronic duration of pain was a negative predictor of achieving iHOT-12 MCID (0.47 [0.31-0.72]), PASS (0.53 [0.37-0.76]), and SCB (0.67 [0.47-0.94]). CONCLUSION When controlling for differences in baseline demographic factors and pre-operative iHOT-12 scores, patients with chronic pain report poorer functional outcomes at mid-term follow-up. These results suggest that chronic pain predicts inferior outcomes from primary hip arthroscopy and that surgical intervention at earlier time points may be beneficial in achieving better outcomes.
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Arciero E, Kakazu R, Garvin P, Crepeau AE, Coyner K. Favorable Patient-Reported Outcomes and High Return to Sport Rates Following Hip Arthroscopy in Adolescent Athletes: A Systematic Review. Arthroscopy 2022; 38:2730-2740. [PMID: 35247510 DOI: 10.1016/j.arthro.2022.02.022] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/16/2021] [Revised: 02/16/2022] [Accepted: 02/16/2022] [Indexed: 02/02/2023]
Abstract
PURPOSE The purpose of this systematic review is to synthesize the existing literature surrounding hip arthroscopy in the adolescent athlete population to determine patient-reported outcomes, return to sport rates, complications, and reoperations associated with this intervention. METHODS A systematic literature review was performed using PubMed (MEDLINE), Cochrane Library, and Embase according to PRISMA guidelines. Studies were included if they were published in English with greater than 2 participants, contained patients aged 10-19 years old or classified as "high school athletes" or "middle school athletes," and reported postoperative patient-reported outcomes and return to sport. Patient-reported outcomes (PROs) and their associated P values were recorded. Finally, return-to-sport outcomes and sports played were also extracted from the included studies. Weighted kappa was used to assess inter-reviewer agreement. RESULTS Eleven studies included in the final analysis, resulting in 344 patients and 408 hips were analyzed by this review. Patient-reported outcomes (PROs) were reported in all studies. The modified Harris Hip Score (mHHS) was used in all but 1 study. Six of the 11 studies reported a 100% return-to-sport rate, for a total of 98/98 athletes returning to sport. Fabricant et al. did note that a majority of athletes who returned to sport were able to do so at a subjective "nearly normal" level. Only 4 of the studies reported complications, with the majority being transient neuropraxias. CONCLUSIONS Adolescent athletes who undergo hip arthroscopy demonstrate favorable postoperative patient-reported outcome scores, high rates of return to sport, and an overall low complication rate. The heterogeneity in both surgical methodology and outcome measures used for evaluation and treatment leads to continued ambiguity with regard to the optimal method for managing adolescent athletes with hip pathology. LEVEL OF EVIDENCE V, systematic review of Level II-V studies.
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Affiliation(s)
- Emily Arciero
- University of Connecticut School of Medicine, Farmington Connecticut, U.S.A
| | - Rafael Kakazu
- Department of Orthopaedic Surgery, University of Connecticut, Farmington Connecticut, U.S.A
| | - Patrick Garvin
- Department of Orthopaedic Surgery, University of Connecticut, Farmington Connecticut, U.S.A
| | - Allison E Crepeau
- Department of Orthopaedic Surgery, University of Connecticut, Farmington Connecticut, U.S.A; Connecticut Children's Sports Medicine, Farmington Connecticut, U.S.A
| | - Katherine Coyner
- Department of Orthopaedic Surgery, University of Connecticut, Farmington Connecticut, U.S.A.
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The Surgical Treatment of Osteoarthritis. LIFE (BASEL, SWITZERLAND) 2022; 12:life12070982. [PMID: 35888072 PMCID: PMC9319328 DOI: 10.3390/life12070982] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/16/2022] [Revised: 06/20/2022] [Accepted: 06/28/2022] [Indexed: 11/17/2022]
Abstract
Osteoarthritis is a degenerative condition affecting the whole joint with the underlying bone, representing a major source of pain, disability, and socioeconomic cost worldwide. Age is considered the strongest risk factor, albeit abnormal biomechanics, morphology, congenital abnormality, deformity, malalignment, limb-length discrepancy, lifestyle, and injury may further increase the risk of the development and progression of osteoarthritis as well. Pain and loss of function are the main clinical features that lead to treatment. Although early manifestations of osteoarthritis are amenable to lifestyle modification, adequate pain management, and physical therapy, disease advancement frequently requires surgical treatment. The symptomatic progression of osteoarthritis with radiographical confirmation can be addressed either with arthroscopic interventions, (joint) preservation techniques, or bone fusion procedures, whereas (joint) replacement is preferentially reserved for severe and end-stage disease. The surgical treatment aims at alleviating pain and disability while restoring native biomechanics. Miscellaneous surgical techniques for addressing osteoarthritis exist. Advanced computer-integrated surgical concepts allow for patient personalization and optimization of surgical treatment. The scope of this article is to present an overview of the fundamentals of conventional surgical treatment options for osteoarthritis of the human skeleton, with emphasis on arthroscopy, preservation, arthrodesis, and replacement. Contemporary computer-assisted orthopaedic surgery concepts are further elucidated.
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Berlinberg EJ, Forlenza EM, Patel HH, Ross R, Mascarenhas R, Chahla J, Nho SJ, Forsythe B. Increased Readmission Rates but No Difference in Complication Rates in Patients Undergoing Inpatient Versus Outpatient Hip Arthroscopy: A Large Matched-Cohort Insurance Database Analysis. Arthrosc Sports Med Rehabil 2022; 4:e975-e988. [PMID: 35747635 PMCID: PMC9210381 DOI: 10.1016/j.asmr.2022.02.001] [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: 11/11/2021] [Accepted: 02/08/2022] [Indexed: 11/29/2022] Open
Abstract
Purpose Methods Results Conclusions Level of Evidence
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Affiliation(s)
- Elyse J. Berlinberg
- Midwest Orthopedics at Rush, Chicago, Illinois, U.S.A
- NYU Grossman School of Medicine, New York, New York, U.S.A
| | | | | | - Ruby Ross
- NYU Grossman School of Medicine, New York, New York, U.S.A
| | | | - Jorge Chahla
- Midwest Orthopedics at Rush, Chicago, Illinois, U.S.A
| | - Shane J. Nho
- Midwest Orthopedics at Rush, Chicago, Illinois, U.S.A
| | - Brian Forsythe
- Midwest Orthopedics at Rush, Chicago, Illinois, U.S.A
- Address correspondence to Brian Forsythe, M.D., Midwest Orthopedics at Rush, 1611 W Harrison St, Ste 360, Chicago, IL 60621, U.S.A.
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25
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Murata Y, Fukase N, Brady AW, Douglass BW, Bryniarski AR, Dornan GJ, Utsunomiya H, Uchida S, Philippon MJ. Biomechanical Evaluation of 4 Suture Techniques for Hip Capsular Closure. Orthop J Sports Med 2022; 10:23259671221089946. [PMID: 35757238 PMCID: PMC9218465 DOI: 10.1177/23259671221089946] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/06/2022] [Accepted: 01/21/2022] [Indexed: 11/17/2022] Open
Abstract
Background: The most reliable suture technique for capsular closure after a capsulotomy remains unknown. Purpose: To determine which suture technique best restores native stability after a 5-cm interportal capsulotomy. Study Design: Controlled laboratory study. Methods: Ten human cadaveric hip specimens were tested using a 6-degrees-of-freedom robotic arm in 7 states: intact, capsular laxity, 5-cm capsulotomy, standard suture, shoelace, double shoelace, and Quebec City slider (QCS). Rotational range of motion (ROM) was measured across 9 tests: flexion, extension, abduction, abduction at 45° of flexion, adduction, external rotation, internal rotation, anterior impingement, and log roll. Distraction (ie, femoral head translation [FHT]) was measured across a range of flexion and abduction angles. Results: When compared with the native state, the 5-cm capsulotomy state showed the largest laxity increases on all tests, specifically in external rotation ROM (+13.4°), extension ROM (+11.5°), and distraction FHT (+4.5 mm) (P < .001 for all). The standard suture technique was not significantly different from the 5-cm capsulotomy on any test and demonstrated significantly more flexion ROM than the double shoelace suture (+1.41°; P = .049) and more extension ROM (+5.51°; P = .014) and external rotation ROM (+6.03°; P = .021) than the QCS. The standard suture also resulted in significantly higher distraction FHT as compared with the shoelace suture (+1.0 mm; P = .005), double shoelace suture (+1.4 mm; P < .001), and QCS (+1.1 mm; P = .003). The shoelace, double shoelace, and QCS techniques significantly reduced hip laxity when compared with the 5-cm capsulotomy state, specifically in external rotation ROM (respectively, –8.1°, –7.8°, and –10.2°), extension ROM (–6.3°, –7.3°, and –8.1°), and distraction FHT (–1.8, –2.2, and –1.9 mm) (P ≤ .003 for all). These 3 techniques restored native stability (no significant difference from intact) on some but not all tests, and no significant differences were observed among them on any test. Conclusion: Hip capsule closure with the standard suture technique did not prevent postoperative hip instability after a 5-cm capsulotomy, and 3 suture techniques were found to be preferable; however, none perfectly restored native stability at time zero. Clinical Relevance: The shoelace, double shoelace, and QCS suture techniques are recommended when closing the hip capsule.
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Affiliation(s)
- Yoichi Murata
- Steadman Philippon Research Institute and the Steadman Clinic, Vail, Colorado, USA
| | - Naomasa Fukase
- Steadman Philippon Research Institute and the Steadman Clinic, Vail, Colorado, USA
| | - Alex W Brady
- Steadman Philippon Research Institute and the Steadman Clinic, Vail, Colorado, USA
| | - Brenton W Douglass
- Steadman Philippon Research Institute and the Steadman Clinic, Vail, Colorado, USA
| | - Anna R Bryniarski
- Steadman Philippon Research Institute and the Steadman Clinic, Vail, Colorado, USA
| | - Grant J Dornan
- Steadman Philippon Research Institute and the Steadman Clinic, Vail, Colorado, USA
| | - Hajime Utsunomiya
- Department of Orthopaedic Surgery and Sports Medicine, Wakamatsu Hospital of University of Occupational and Environmental Health, Kitakyushu, Japan
| | - Soshi Uchida
- Department of Orthopaedic Surgery and Sports Medicine, Wakamatsu Hospital of University of Occupational and Environmental Health, Kitakyushu, Japan
| | - Marc J Philippon
- Steadman Philippon Research Institute and the Steadman Clinic, Vail, Colorado, USA
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Mengers SR, Strony JT, Vakharia A, Su CA, Edwards G, Salata MJ. Surgical Technique of the "Up-The-Neck" View During Hip Arthroscopy for Femoroacetabular Impingement. Arthrosc Tech 2022; 11:e923-e928. [PMID: 35646568 PMCID: PMC9134677 DOI: 10.1016/j.eats.2022.01.011] [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] [Indexed: 02/03/2023] Open
Abstract
In the setting of femoroacetabular impingement, arthroscopy versus open surgery confers many advantages. However, inadequate bony resection remains a concern and is the leading cause of revision surgery. Several strategies have been described to ensure a more-complete resection during hip arthroscopy. In this current technique article, the authors describe a modified anterior portal site view called the "up-the-neck" view. This view allows for greater visualization of the femoral head-neck junction and alleviates challenges faced when assessing resection intraoperatively. The "up-the-neck" view is achieved by placing a 70° arthroscope in the anterior lateral portal and subsequently rotating the camera 90°. The head-neck junction will appear horizontally, rather than vertically, on this view, which allows for the easy identification of missed imperfections. This may reduce the need for revision surgery and future investigation is necessary to determine the reoperation rates following this technique.
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Affiliation(s)
- Sunita R. Mengers
- Department of Orthopaedic Surgery, Cleveland, Ohio, U.S.A.,University Hospitals Cleveland Medical Center and Case Western Reserve University School of Medicine, Cleveland, Ohio, U.S.A
| | - John T. Strony
- Department of Orthopaedic Surgery, Cleveland, Ohio, U.S.A.,University Hospitals Cleveland Medical Center and Case Western Reserve University School of Medicine, Cleveland, Ohio, U.S.A.,Address correspondence to John T. Strony, M.D., Department of Orthopaedic Surgery, University Hospitals Cleveland Medical Center, Case Western Reserve University School of Medicine, 11100 Euclid Ave., Cleveland, OH 44106.
| | - Ajit Vakharia
- Department of Orthopaedic Surgery, Cleveland, Ohio, U.S.A.,University Hospitals Cleveland Medical Center and Case Western Reserve University School of Medicine, Cleveland, Ohio, U.S.A
| | - Charles A. Su
- Department of Orthopaedic Surgery, Cleveland, Ohio, U.S.A.,University Hospitals Cleveland Medical Center and Case Western Reserve University School of Medicine, Cleveland, Ohio, U.S.A
| | - Gary Edwards
- Department of Orthopaedic Surgery, Cleveland, Ohio, U.S.A.,Sports Medicine Institute, Cleveland, Ohio, U.S.A
| | - Michael J. Salata
- Department of Orthopaedic Surgery, Cleveland, Ohio, U.S.A.,Sports Medicine Institute, Cleveland, Ohio, U.S.A.,University Hospitals Cleveland Medical Center and Case Western Reserve University School of Medicine, Cleveland, Ohio, U.S.A
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Blaeser AM, Mojica ES, Mannino BJ, Youm T. Return to Work After Primary Hip Arthroscopy: A Systematic Review and Meta-analysis. Am J Sports Med 2022; 51:1340-1346. [PMID: 35384746 DOI: 10.1177/03635465211064271] [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 Hip arthroscopy is a procedure commonly performed to correct various hip pathologies such as femoroacetabular impingement and labral tears. These hip pathologies commonly affect young, otherwise healthy patients. The recovery after hip arthroscopy can prevent patients from returning to work and impair performance levels, having significant economic repercussions. To date, there has been no cumulative analysis of the existing literature on return to work after hip arthroscopy. PURPOSE The purpose of this study was to perform a systematic review of the existing literature regarding return to work after hip arthroscopy and analysis of factors associated with the ability to return to work and time to return to work. STUDY DESIGN Systematic review and meta-analysis; Level of evidence, 4. METHODS A literature search of the MEDLINE, EMBASE, and Cochrane Library databases was performed based on the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines. Studies assessing functional outcomes and return to work, including return to military duty, after hip arthroscopy were included. Patients' ability to return to work, as well as time to return, was compared between selected studies. Where available, workers' compensation status as well as type of work was compared. All statistical analysis was performed using SPSS, Version 22. P < .05 was considered statistically significant. RESULTS Twelve studies with 1124 patients were included. Patients were followed for an average of 17.6 months. Using weighted means, the average rate of return to work was 71.35%, while full return to previous work duties was achieved at a rate of 50.89%. Modification to work duties was required at a rate of 15.48%. On average, the time to return to work was 115 days (range, 17-219 days). Rate of return by patients with workers' compensation status was found to be 85.15% at an average of 132 days (range, 37-211 days). Rate of return to work in workers performing professions reported as strenuous vs light (ie, mostly sedentary) jobs showed a statistically higher return to work in light professions (risk ratio, 0.53; 95% CI, 0.41-0.69). CONCLUSION After hip arthroscopy, there is a high rate of return to work at an average of 115 days after surgery. However, full return to work was achieved by only half of patients upon final follow-up.
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Affiliation(s)
- Anna M Blaeser
- Division of Sports Medicine, Department of Orthopedic Surgery, NYU Langone Orthopedic Hospital, New York, NY, USA
| | - Edward S Mojica
- Division of Sports Medicine, Department of Orthopedic Surgery, NYU Langone Orthopedic Hospital, New York, NY, USA
| | - Brian J Mannino
- Division of Sports Medicine, Department of Orthopedic Surgery, NYU Langone Orthopedic Hospital, New York, NY, USA
| | - Thomas Youm
- Division of Sports Medicine, Department of Orthopedic Surgery, NYU Langone Orthopedic Hospital, New York, NY, USA
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Alam S, Yousaf A, Alborno Y, Shujauddin M, Ghouri SI, Abdelazeem B, Yasin ALF, Shabistan S, Ahmed G. Edema of the Ligamentum Teres as a Novel MRI Marker for Non-Traumatic Painful Hip Pathology: A Retrospective Observational Study. Cureus 2022; 14:e23388. [PMID: 35475106 PMCID: PMC9022606 DOI: 10.7759/cureus.23388] [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] [Accepted: 03/22/2022] [Indexed: 12/03/2022] Open
Abstract
Background The ligamentum teres has been recognized as an important stabilizer of the hip joint and can be affected by various hip pathologies. This study aims to introduce ligamentum teres edema as an MRI marker to diagnose the underlying cause of hip pathology, mainly femoral acetabular impingement (FAI) and adult developmental dysplasia of the hip (ADDH), in non-traumatic patients. Methodology Adult patients presenting with non-traumatic hip pain of variable duration and ligamentum teres edema on MRI between 2014 and 2020 were included. A high-resolution standard MRI hip protocol was used for all patients in this series. MRI and plain radiographs were assessed. Ligamentum teres edema, alpha angle, center edge angle of Wiberg, and retroversion were assessed. Results In total, 55 patients with 110 hip joints (males: 29 (52.7%), females: 26 (47.3%)) of different ethnicities were included in this study. Out of the 55 patients with ligamentum teres edema, one had only unilateral right-sided FAI, seven had only unilateral left-sided FAI, and 46 (94 hip joints) had either bilateral FAI or ADDH. Therefore, eight (14.5%) patients with unilateral FAI had the absence of the contralateral FAI or ADDH (6.5% false-positive) despite the presence of ligamentum teres edema bilaterally, and the rest of the patients with bilateral ligamentum teres edema (102 joints: 92.7% positive predictive value) had findings of either FAI or ADDH. Conclusions Ligamentum teres edema can be considered as an early MRI marker to diagnose the underlying pathology of symptomatic painful hip disorders, especially FAI.
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Ni M, Wen X, Chen W, Zhao Y, Yuan Y, Zeng P, Wang Q, Wang Y, Yuan H. A Deep Learning Approach for MRI in the Diagnosis of Labral Injuries of the Hip Joint. J Magn Reson Imaging 2022; 56:625-634. [PMID: 35081273 DOI: 10.1002/jmri.28069] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2021] [Revised: 12/24/2021] [Accepted: 12/28/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The diagnosis of labral injury on MRI is time-consuming and potential for incorrect diagnoses. PURPOSE To explore the feasibility of applying deep learning to diagnose and classify labral injuries with MRI. STUDY TYPE Retrospective. POPULATION A total of 1016 patients were divided into normal (n = 168, class 0) and abnormal labrum (n = 848) groups. The abnormal group consisted of n = 111 with class 1 (degeneration), n = 437 with class 2 (partial or complete tear), and n = 300 with unclassified injury. Patients were randomly divided into training, validation, and test cohort according to the ratio of 55%:15%:30%. FIELD STRENGTH/SEQUENCE Fat-saturation proton density-weighted fast spin-echo sequence at 3.0 T. ASSESSMENT Convolutional neural network-6 (CNN-6) was used to extract, discriminate, and detect oblique coronal (OCOR) and oblique sagittal (OSAG) images. Mask R-CNN was used for segmentation. LeNet-5 was used to diagnose and classify labral injuries. The weighting method combined the models of OCOR and OSAG. The output-input connection was used to correlate the whole diagnosis/classification system. Four radiologists performed subjective diagnoses to obtain the diagnosis results. STATISTICAL TESTS CNN-6 and LeNet-5 were evaluated by area under the receiver operating characteristic (ROC) curve and related parameters. The mean average precision (MAP) evaluated the Mask R-CNN. McNemar's test was used to compare the radiologists and models. A P value < 0.05 was considered statistically significant. RESULTS The area under the curve (AUC) of CNN-6 was 0.99 for extraction, discrimination, and detection. MAP values of Mask R-CNN for OCOR and OSAG image segmentation were 0.96 and 0.99. The accuracies of LeNet-5 in the diagnosis and classification were 0.94/0.94 (OCOR) and 0.92/0.91 (OSAG), respectively. The accuracy of the weighted models in the diagnosis and classification were 0.94 and 0.97, respectively. The accuracies of radiologists in the diagnosis and classification of labrum injuries ranged from 0.85 to 0.92 and 0.78 to 0.94, respectively. DATA CONCLUSION Deep learning can assist radiologists in diagnosing and classifying labrum injuries. EVIDENCE LEVEL 3 TECHNICAL EFFICACY: Stage 2.
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Affiliation(s)
- Ming Ni
- Department of Radiology, Peking University Third Hospital, 49 Huayuan North Road, Haidian District, Beijing, China
| | - Xiaoyi Wen
- Institute of Statistics and Big Data, Renmin University of China, 59 Zhongguancun Street, Haidian District, Beijing, China
| | - Wen Chen
- Department of Radiology, Peking University Third Hospital, 49 Huayuan North Road, Haidian District, Beijing, China
| | - Yuqing Zhao
- Department of Radiology, Peking University Third Hospital, 49 Huayuan North Road, Haidian District, Beijing, China
| | - Yuan Yuan
- Department of Radiology, Peking University Third Hospital, 49 Huayuan North Road, Haidian District, Beijing, China
| | - Piaoe Zeng
- Department of Radiology, Peking University Third Hospital, 49 Huayuan North Road, Haidian District, Beijing, China
| | - Qizheng Wang
- Department of Radiology, Peking University Third Hospital, 49 Huayuan North Road, Haidian District, Beijing, China
| | - Yong Wang
- Department of Radiology, He Bei Gu Cheng Xian Yi Yuan, 55 East Kangning Road, Zhengkou Town, Gucheng County, Hebei, China
| | - Huishu Yuan
- Department of Radiology, Peking University Third Hospital, 49 Huayuan North Road, Haidian District, Beijing, China
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Zusmanovich M, Haselman W, Serrano B, Banffy M. The Incidence of Hip Arthroscopy in Patients With Femoroacetabular Impingement Syndrome and Labral Pathology Increased by 85% Between 2011 and 2018 in the United States. Arthroscopy 2022; 38:82-87. [PMID: 33964383 DOI: 10.1016/j.arthro.2021.04.049] [Citation(s) in RCA: 71] [Impact Index Per Article: 35.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/10/2020] [Revised: 04/14/2021] [Accepted: 04/22/2021] [Indexed: 02/02/2023]
Abstract
PURPOSE The purpose of this study was to investigate the incidence of hip arthroscopy in patients with labral pathology in the United States from 2011-2018 using a large national database. METHODS Patients who underwent hip arthroscopy from 2011-2018 were identified using Current Procedural Terminology (CPT) codes in the PearlDiver Patients Records Database (Colorado Springs, CO), which is a national database of orthopedic insurance records, including Medicare patients. The incidence of surgeries, age, and gender were all recorded. Groups were analyzed using SPSS version 24 (IBM, Armonk NY). CPT codes 29914/15/16 were introduced January 1, 2011 which is when we began our analysis. CPT-29999 and laterality were not assessed. RESULTS In total, 35,966 arthroscopies were identified between 2011 and 2018 from a randomly selected sample of 30 million orthopaedic patients from the PearlDiver Mariner dataset. The incidence increased by 85% from 2011 to 2018 (7.31 cases vs 13.54 cases per 100,000 patients). The distribution of the age of patients undergoing hip arthroscopy was bimodal with the mode of each peak at 18 years old and 42 years old, respectively. Females underwent surgery more frequently (67.9%) than males (32.1%). The most common CPT code for hip arthroscopy was 29914 (43.9) which corresponds to a hip arthroscopy with femoroplasty. CONCLUSIONS Our findings corroborate those of previous studies and support the increase in incidence of hip arthroscopy in the United States. We indicate an overall increase of 85% from 2011 to 2018 and support previous trends, such as higher incidence of hip arthroscopy in women. Our study also supports a decreasing mean age for patients, likely due to improved diagnostics and surgeon familiarity and comfort with the procedure. LEVEL OF EVIDENCE Level 3, Retrospective Comparative Study.
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Affiliation(s)
| | | | - Brian Serrano
- Cedars Sinai-Kerlan Jobe Institute, Los Angeles, California
| | - Michael Banffy
- Cedars Sinai-Kerlan Jobe Institute, Los Angeles, California
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Preoperative Dynamic Hip Examination Under Fluoroscopic Guidance Enhances the Understanding of Femoroacetabular Impingement Pathology and Treatment Planning. Arthrosc Sports Med Rehabil 2021; 3:e1599-e1606. [PMID: 34977611 PMCID: PMC8689150 DOI: 10.1016/j.asmr.2021.07.015] [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: 03/07/2021] [Accepted: 07/22/2021] [Indexed: 11/20/2022] Open
Abstract
Purpose To review the relative accuracy of preoperative magnetic resonance imaging (MRI) and fluoroscopically guided examination-under-sedation (EUS) findings and to explore the validity of the anterior acetabular sector angle (AASA) as a radiologic MRI-based marker of anterior acetabular coverage in pincer-type impingement. Methods A cohort of 150 consecutive patients undergoing primary hip arthroscopy for femoroacetabular impingement (FAI) in 2018 to 2019 was reviewed. The inclusion criteria were pure FAI unilateral symptomatic pathology and the availability of complete data sets (MRI, EUS, and intraoperative records). Preoperative MRI and EUS findings were compared with gold-standard intraoperative arthroscopic findings, specifically evaluating the alpha angle in the presence of cam lesions, AASA in the presence of pincer lesions, as well as soft-tissue lesions. An alpha angle greater than 50° and an AASA greater than 65° were deemed pathologic. Results The patient cohort included 78 women and 72 men with an average age of 38 years (range, 18-53 years). Intraoperatively, pincer lesions were present in 20% of patients; cam lesions, 26%; and mixed impingement, 54%. MRI versus EUS correctly identified pincer lesions in 36% versus 89% of cases and identified cam lesions in 44% versus 77% of cases. MRI findings characterizing labral tears and articular cartilage pathology were accurate in 80% and 10% of cases, respectively. Although there was no difference in the AASA between pure pincer- and mixed-type impingements (62° and 63°, respectively; P = .62), there was a statistically significant difference in reported AASA values between pure cam-type impingement and impingement involving the presence of pincer lesions (57° and 63°, respectively; P = .03). Furthermore, 31% of patients with intraoperatively identified pincer lesions had an AASA of 60° to 65°. Conclusions Fluoroscopic EUS is accurate in characterizing FAI pathology. In addition, MRI is useful to diagnose or rule out non-FAI pathology, ascertain labral pathology, and outline hip alignment. These methods of preoperative planning are complementary. Level of Evidence Level IV, therapeutic case series.
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Murena L, Colin G, Dussi M, Canton G. Is intraoperative neuromonitoring effective in hip and pelvis orthopedic and trauma surgery? A systematic review. J Orthop Traumatol 2021; 22:40. [PMID: 34647237 PMCID: PMC8514601 DOI: 10.1186/s10195-021-00605-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/12/2021] [Accepted: 09/26/2021] [Indexed: 11/10/2022] Open
Abstract
Introduction Sciatic nerve injury is an uncommon but potentially devastating complication in hip and pelvis surgery. Intraoperative nerve monitoring (IONM) was applied since the seventies in neurosurgery and spine surgery. Nowadays, IONM has gained popularity in other surgical specialities including orthopaedic and trauma surgery. Aim of this systematic review is to resume the literature evidences about the effectiveness of intraoperative monitoring of sciatic nerve during pelvic and hip surgery. Methods Two reviewers (GC and MD) independently identified studies by a systematic search of PubMed and Google Scholar from inception of database to 10 January 2021. Inclusion criteria were: (a) English written papers, (b) use of any type of intraoperative nerve monitoring during traumatic or elective pelvic and hip surgery, (c) comparison of the outcomes between patients who underwent nerve monitoring and patient who underwent standard procedures, (d) all study types including case reports. The present review was conducted in accordance with the 2009 PRISMA statement. Results The literature search produced 224 papers from PubMed and 594 from Google Scholar, with a total amount of 818 papers. The two reviewer excluded 683 papers by title or duplicates. Of the 135 remaining, 72 were excluded after reading the abstract, and 31 by reading the full text. Thus, 32 papers were finally included in the review. Conclusions The use of IONM during hip and pelvis surgery is debated. The review results are insufficient to support the routine use of IONM in hip and pelvis surgery. The different IONM techniques have peculiar advantages and disadvantages and differences in sensitivity and specificity without clear evidence of superiority for any. Results from different studies and different interventions are often in contrast. However, there is general agreement in recognizing a role for IONM to define the critical maneuvers, positions or pathologies that could lead to sciatic nerve intraoperative damage. Level of evidence Level 2.
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Affiliation(s)
- Luigi Murena
- Orthopaedics and Traumatology Unit, Cattinara Hospital-ASUGI, Strada di Fiume 447, 34149, Trieste, Italy
| | - Giulia Colin
- Orthopaedics and Traumatology Unit, Cattinara Hospital-ASUGI, Strada di Fiume 447, 34149, Trieste, Italy.
| | - Micol Dussi
- Orthopaedics and Traumatology Unit, Cattinara Hospital-ASUGI, Strada di Fiume 447, 34149, Trieste, Italy
| | - Gianluca Canton
- Orthopaedics and Traumatology Unit, Cattinara Hospital-ASUGI, Strada di Fiume 447, 34149, Trieste, Italy
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Li S, Li C, Wang H, Luo Y, Li H, Zhang M. Utility of Ultrasound-Guided Anesthetic Intra-articular Injection to Estimate the Outcome of Hip Arthroscopy in Patients with Femoroacetabular Impingement Syndrome. Orthop Surg 2021; 13:1810-1817. [PMID: 34409739 PMCID: PMC8523756 DOI: 10.1111/os.13104] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/13/2021] [Revised: 04/28/2021] [Accepted: 05/17/2021] [Indexed: 12/01/2022] Open
Abstract
Objective To investigate the effectiveness of ultrasound (US) guided intra‐hip joint injection to estimate the outcome of hip arthroscopy in patients with femoroacetabular impingement (FAI) syndrome. Methods Patients with FAI syndrome (n = 60) were prospectively enrolled in our study. Before hip arthroscopy, a mix of 4 mL 2% lidocaine and 4 mL 1% ropivacaine were injected into the hip joint under the guidance of US. The clinical efficacy of the intra‐articular injection was evaluated by comparing the visual analog scale (VAS) and international hip outcome tool 12 (iHOT‐12) results before and after the injection. The outcome of hip arthroscopy was evaluated by iHOT‐12, the modified Harris hip score (MHHS), and the patient's satisfaction 12 months after the operation. The outcome of intra‐articular injection and hip arthroscopy were compared. Factors related to the outcomes of hip arthroscopy were evaluated. The correlation between the efficacy of intra‐hip joint injection and arthroscopy was evaluated. Results The VAS of patients decreased from 11.3 ± 7.7 to 3.3 ± 4.5, and the iHOT‐12 increased from 52.1 ± 23.2 to 84.1 ± 18.1 after intra‐articular injection (all P < 0.001). The iHOT‐12 score increased from 52.1 ± 23.2 to 78.9 ± 19.2, and the MHHS increased from 66.5 ± 6.8 to 81.6 ± 8.1 after hip arthroscopy (all P < 0.001). The satisfaction rate of arthroscopy, including very satisfied and effective patients, was 93.3%. Multi‐variable logistic regression showed that only iHOT‐12 improved value after injection was included in the regression formula of satisfaction, with the β of −0.154, standard error of 0.071, Wald value of 4.720, and OR of 0.857 (95%CI 0.746–0.985) (P = 0.03). Significant correlation was detected between iHOT‐12 scores after intra‐articular anesthesia and at 12 months after arthroscopy (r = 0.784, P < 0.001). So was the iHOT‐12 improved value (r = 0.781, P < 0.001) and the iHOT‐12 improved ratio (r = 0.848, P < 0.001). If we had performed arthroscopy only on patients with post‐injection iHOT‐12 score improvement ≥10, the satisfaction rate of arthroscopy would have increased to 96.6%. Conclusions US‐guided intra‐hip joint injection may provide a feasible way to estimate the outcome of hip arthroscopy in patients with FAI syndrome, and could be used as a method for indication selection of hip arthroscopy.
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Affiliation(s)
- Shoupeng Li
- Department of Ultrasound, The First Medical Center, General Hospital of Chinese PLA, Beijing, China
| | - Chunbao Li
- Department of Orthopedics, The Fourth Medical Center, General Hospital of Chinese PLA, Beijing, China
| | - Huanfang Wang
- Department of Ultrasound, The First Medical Center, General Hospital of Chinese PLA, Beijing, China
| | - Yukun Luo
- Department of Ultrasound, The First Medical Center, General Hospital of Chinese PLA, Beijing, China
| | - Haipeng Li
- Department of Orthopedics, The Fourth Medical Center, General Hospital of Chinese PLA, Beijing, China
| | - Mingbo Zhang
- Department of Ultrasound, The First Medical Center, General Hospital of Chinese PLA, Beijing, China
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Shi RM, Yuan LB, Tan CJ, Li AX, Qiu X, Yang B, Tan HB. Hip Arthroscopic Reduction and Fixation for Adolescent Acetabular Posterior Wall Fracture: A Case Report. Orthop Surg 2021; 13:1934-1938. [PMID: 34351054 DOI: 10.1111/os.13051] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/21/2021] [Revised: 02/27/2021] [Indexed: 11/29/2022] Open
Abstract
BACKGROUND Posterior wall fracture is the most common type of acetabular fracture, the traditional open reduction and fixation through the Kocher-Langenbeck approach required a large incision and extensive muscle and soft tissue dissection, resulting in more blood loss, more complications and delayed recovery after the operation. Hip arthroscopy has been widely used in clinical practice but rarely reported in acetabular fractures. CASE PRESENTATION We present the case of a 14-year-old boy with acetabular posterior wall fracture who was treated with hip arthroscopy reduction and fixation using anchors. He began to walk with partial weight-bearing assisted by double crutches, and returned to school with crutches at 3 days after surgery. Although hip arthroscopy is technically more demanding, it's an optimal choice for selected patients of acetabular fracture with the advantages of less invasive and faster postoperative recovery.
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Affiliation(s)
- Rong-Mao Shi
- Department of Orthopaedic Surgery, 920th Hospital of Joint Logistics Support Force, Kunming, China
| | - Li-Bo Yuan
- Department of Orthopaedic Surgery, 920th Hospital of Joint Logistics Support Force, Kunming, China
| | - Chao-Jun Tan
- Department of Orthopaedic Surgery, Yunnan Boya Hospital, Kunming, China
| | - An-Xu Li
- Department of Orthopaedic Surgery, 920th Hospital of Joint Logistics Support Force, Kunming, China
| | - Xiong Qiu
- Department of Orthopaedic Surgery, 920th Hospital of Joint Logistics Support Force, Kunming, China
| | - Bing Yang
- Jointsurgery, Orthopedics Department, Peking University International Hospital, Beijing, China
| | - Hong-Bo Tan
- Department of Orthopaedic Surgery, 920th Hospital of Joint Logistics Support Force, Kunming, China
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Zeman P, Rafi M, Kautzner J. Evaluation of primary hip arthroscopy complications in mid-term follow-up: a multicentric prospective study. INTERNATIONAL ORTHOPAEDICS 2021; 45:2525-2529. [PMID: 34223924 DOI: 10.1007/s00264-021-05114-1] [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: 02/18/2021] [Accepted: 06/14/2021] [Indexed: 11/26/2022]
Abstract
INTRODUCTION Hip arthroscopy is a common procedure in hip preservation surgery. Its complication rate is relatively low. This prospective multicentric study evaluates complication rate in patients undergoing primary hip arthroscopy. MATERIALS AND METHODS The study cohort consisted of 908 patients mean age of 37 years (14-67 years). Patients were prospectively included in the study in the years 2009-2017. All complications were recorded and evaluated. The minimum follow-up was 36 months. Results were statistically evaluated and risk factors for complications were identified. RESULTS The overall complication rate was 7.3% (67/908 cases), the minor complication rate of 4.9% (45/908 cases) and the major complication rate 2.4% (22/908 cases). The most common severe complications were iatrogenic cartilage damage and instrument breakage, while the most common minor complications were perineal hypoaesthesia and heterotopic ossifications. The conversion rate to total hip replacement was 4.2% (39/908 patients). CONCLUSION Hip arthroscopy is a safe procedure with low complication rates. Surgeon training and experience greatly influence the complication rates.
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Affiliation(s)
- Petr Zeman
- Orthopaedics and Traumatology Department, University Hospital Pilsen, Pilsen, Czech Republic
| | - Moheb Rafi
- Orthopaedic Department, Kromeriz Hospital, Kromeriz, Czech Republic
| | - Jakub Kautzner
- Department of Childrens and Adults Orthopaedics and Traumatology 2Nd Medical Faculty, Charles University and Motol Hospital, V Uvalu 84, Prague, 15006, Czech Republic.
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Editorial Commentary: Hip Arthroscopists Can Reduce Postoperative Opioid Use. Arthroscopy 2021; 37:537-540. [PMID: 33546792 DOI: 10.1016/j.arthro.2020.11.035] [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: 11/04/2020] [Revised: 11/09/2020] [Accepted: 11/13/2020] [Indexed: 02/02/2023]
Abstract
Despite the harrowing opioid crisis in the United States, the use of opioids to combat musculoskeletal pain continues to be widespread. In the setting of hip arthroscopy, approximately one-third of patients are on opioids while awaiting surgery to address the pain that results from femoracetabular impingement syndrome. In addition, the use of opioids to address pain postoperatively is common practice. With the rapid rise of hip arthroscopy in the United States, it is paramount that other modes of pain relief are promoted by surgeons in conjunction with allied health professionals, such as physical therapists. In fact, early physical therapy has been shown to decrease the use of postoperative opioids by 10%. The use of complementary and alternative therapies should be common practice in the in the orthopaedic setting to assist in reducing the number of opioids used for both pre and postoperative pain management. While this may be a small piece of the opioid crisis puzzle, it is up to all of us in the medical community to do our part and change the direction of the current opioid crisis.
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Ueland TE, Disantis A, Carreira DS, Martin RL. Patient-Reported Outcome Measures and Clinically Important Outcome Values in Hip Arthroscopy: A Systematic Review. JBJS Rev 2021; 9:e20.00084. [PMID: 33512970 DOI: 10.2106/jbjs.rvw.20.00084] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
BACKGROUND Defining success in hip arthroscopy through patient-reported outcome measures (PROMs) is complicated by the wide range of available questionnaires and overwhelming amount of information on how to interpret scores. The minimal clinically important difference (MCID), patient acceptable symptom state (PASS), and substantial clinical benefit (SCB) are collectively known as clinically important outcome values (CIOVs). These CIOVs provide benchmarks for meaningful improvement. The aims of this review were to update the evidence regarding joint-specific PROMs used for hip arthroscopy and to collate available CIOVs in this population. METHODS A systematic review of MEDLINE and Embase databases was performed to identify studies reporting measurement properties of PROMs utilized for hip arthroscopy. Metrics of reliability, validity, and responsiveness were extracted and graded according to an international Delphi study. Questionnaire interpretability was evaluated through CIOVs. RESULTS Twenty-six studies were reviewed. One study validated a novel questionnaire, 3 studies validated existing questionnaires, and 22 studies reported CIOVs. The most evidence supporting interpretability was found for the Hip Outcome Score (HOS, 11 studies), modified Harris hip score (mHHS, 10 studies), and International Hip Outcome Tool-12 (iHOT-12, 9 studies). Scores indicative of the smallest perceptible versus substantial clinically relevant changes were reported for the iHOT-12 (12 to 15 versus 22 to 28), iHOT-33 (10 to 12 versus 25 to 26), HOS-Activities of Daily Living (HOS-ADL, 9 to 10 versus 10 to 16), HOS-Sports (14 to 15 versus 25 to 30), and mHHS (7 to 13 versus 20 to 23). Absolute postoperative scores indicative of an unsatisfactory versus a desirable outcome were reported for the iHOT-12 (below 56 to 63 versus above 86 to 88), iHOT-33 (below 58 versus above 64 to 82), HOS-ADL (below 87 to 92 versus above 94), HOS-Sports (below 72 to 80 versus above 78 to 86), and mHHS (below 74 to 85 versus above 83 to 95). CONCLUSIONS Six questionnaires had reported clinically important outcome thresholds, with the HOS, mHHS, and iHOT-12 having the most information to support score interpretation. Thresholds for the HOS, mHHS, iHOT-12, and iHOT-33 describe desirable absolute PROM scores and minimum and substantial change scores within 5 years following hip arthroscopy. Despite substantial heterogeneity in calculation methodology, included cohorts, and follow-up time, available interpretability values could be meaningfully summarized. CLINICAL RELEVANCE In light of increasing use of PROMs in orthopaedics, a summary of the available CIOVs provides guidance for clinicians in mapping numerical scores from PROMs onto clinical benchmarks.
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Affiliation(s)
| | - Ashley Disantis
- Department of Physical Therapy, Duquesne University, Pittsburgh, Pennsylvania
| | | | - RobRoy L Martin
- Department of Physical Therapy, Duquesne University, Pittsburgh, Pennsylvania.,UPMC Center for Sports Medicine, Pittsburgh, Pennsylvania
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Chona DV, Bonano JC, Ayeni OR, Safran MR. Definitions of Return to Sport After Hip Arthroscopy: Are We Speaking the Same Language and Are We Measuring the Right Outcome? Orthop J Sports Med 2020; 8:2325967120952990. [PMID: 33015214 PMCID: PMC7509720 DOI: 10.1177/2325967120952990] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/21/2020] [Accepted: 03/09/2020] [Indexed: 11/17/2022] Open
Abstract
Background: Return to sport is a commonly studied outcome of hip arthroscopy that is relevant to both patients and providers. There exists substantial variability in criteria used to define successful return to sport. Purpose: To review and evaluate the definitions used in the literature so as to establish a single standard to enable comparison of outcomes in future studies. Study Design: Systematic review; Level of evidence, 4. Methods: The PubMed, MEDLINE, and Embase databases were searched from inception to June 1, 2019, for studies relating to hip arthroscopy and return to sport. Articles included were those that met the following criteria: (1) contained 2 or more patients, (2) studied patients 18 years of age and older, (3) reported postoperative outcomes after hip arthroscopy, (4) clearly defined return to play, and (5) were written in English. Excluded articles (1) reported outcomes for nonoperative or open treatments, (2) did not clearly define return to play, or (3) were review articles, meta-analyses, or survey-based studies. Return-to-play definitions and additional metrics of postoperative performance and outcome were recorded. Results: A total of 185 articles were identified, and 28 articles were included in the final review, of which 18 involved elite athletes and 10 involved recreational athletes. Of articles studying elite athletes, 6 (33%) defined return to play as participation in regular or postseason competition, 3 (17%) extended the criteria to the preseason, and 2 (11%) used participation in sport-related activities and training. The remaining 7 (39%) reported rates of return to the preoperative level of competition but did not specify preseason versus regular season. All 10 articles evaluating recreational athletes defined return to play based on patient-reported outcomes. Four (40%) did so qualitatively, while 6 (60%) did so quantitatively. Conclusion: There exists significant variability in criteria used to define successful return to sport after hip arthroscopy, and these criteria differ among elite and recreational athletes. For elite athletes, return to the preoperative level of competition is most commonly used, but there exists no consensus on what type of competition—regular season, preseason, or training—is most appropriate. For recreational athletes, patient-reported data are most commonly employed, although there are clear differences between authors on the ways in which these are being used as well.
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Affiliation(s)
- Deepak V Chona
- Department of Orthopaedic Surgery, Stanford University, Redwood City, California, USA
| | - John C Bonano
- Department of Orthopaedic Surgery, Stanford University, Redwood City, California, USA
| | - Olufemi R Ayeni
- Division of Orthopaedic Surgery, Department of Surgery, McMaster University, Hamilton, Ontario, Canada
| | - Marc R Safran
- Department of Orthopaedic Surgery, Stanford University, Redwood City, California, USA
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Karelson MC, Jokihaara J, Launonen AP, Huttunen T, Mattila VM. Lower nationwide rates of arthroscopic procedures in 2016 compared with 1997 (634925 total arthroscopic procedures): has the tide turned? Br J Sports Med 2020; 55:1018-1023. [PMID: 32241819 PMCID: PMC8408579 DOI: 10.1136/bjsports-2019-101844] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/15/2020] [Indexed: 11/08/2022]
Abstract
Objectives To assess the rates and secular trends of different joint arthroscopies—shoulder, elbow, wrist, hip, knee and ankle—in Finland between 1997 and 2016. Design Retrospective nationwide registry study. Participants All adults in Finland with any arthroscopic intervention procedure code for knee, shoulder, ankle, wrist, elbow or hip arthroscopy between 1 January 1997 and 31 December 2016 were included. Main outcome measures Incidence rate of arthroscopic surgery per 100 000 person-years. Results The rate of knee and shoulder arthroscopies declined after reaching a peak in 2006 and 2007, respectively. The rates of wrist, elbow and hip joint arthroscopies declined after their 2014 peak. At the same time, the median age of patients who had knee, ankle and hip arthroscopy decreased, whereas the age of patients who had shoulder arthroscopy increased. Conclusions Numerous randomised controlled trials point to lack of efficacy of the most common knee and shoulder arthroscopic procedures. It should not be assumed that this has contributed to decreased rates of arthroscopic surgery. The concurrent decrease in most of the other joint arthroscopic procedures was unexpected.
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Affiliation(s)
- Margit C Karelson
- Department of Hand and Microsurgery, Tampere University Hospital, Tampere, Finland
| | - Jarkko Jokihaara
- Department of Hand and Microsurgery, Faculty of Medicine and Health Technology, Tampere University, Tampere University Hospital, Tampere, Finland
| | - Antti P Launonen
- Department of Orthopaedics and Traumatology, Tampere University Hospital, Tampere, Finland
| | - Tuomas Huttunen
- Department of Emergency, Anesthesia and Pain Medicine; Faculty of Medicine and Health Technology, Tampere University, Tampere University Hospital, Tampere, Finland
| | - Ville M Mattila
- Faculty of Medicine and Health Technology; Department of Orthopaedics and Traumatology, Tampere University Hospital, Tampere University, Tampere, Pirkanmaa, Finland.,Coxa Hospital Ltd, Tampere, Pirkanmaa, Finland
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The Top 50 Most Influential Articles in Hip Arthroscopy. Arthroscopy 2020; 36:716-722. [PMID: 31919021 DOI: 10.1016/j.arthro.2019.09.031] [Citation(s) in RCA: 36] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/11/2019] [Revised: 09/08/2019] [Accepted: 09/09/2019] [Indexed: 02/02/2023]
Abstract
PURPOSE To identify the 50 most frequently cited publications related to hip arthroscopy. METHODS The Clarivate Analytics Web of Knowledge database was used to search for publications relating to hip arthroscopy. The top 50 most cited articles that met the inclusion criteria were recorded and reviewed for various metrics. RESULTS The top 50 publications were cited a total of 8,306 times, with an average of 437.2 total citations per year. Of the 50 articles identified, 44 had been published since 2000. Case series, expert opinion articles, and review articles were the most common study types. CONCLUSIONS The majority of the most influential articles on hip arthroscopy are case series and expert opinions; however, as hip arthroscopy continues to become more widely performed, higher-level articles should supplant some of the articles included in this analysis. As indications for hip arthroscopy have expanded, so has its body of literature, with the vast majority of articles identified in our study having been published since 2000. Elucidating the 50 most cited articles in hip arthroscopy will allow practicing physicians a quick reference to the highest-yield articles and will allow residency programs to guide their education on the topic. CLINICAL RELEVANCE The top 50 list provides residents, fellows, and researchers with a comprehensive list of the major academic contributions to hip arthroscopy.
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Du JY, Knapik DM, Trivedi NN, Sivasundaram L, Mather RC, Nho SJ, Salata MJ. Unplanned Admissions Following Hip Arthroscopy: Incidence and Risk Factors. Arthroscopy 2019; 35:3271-3277. [PMID: 31785756 DOI: 10.1016/j.arthro.2019.06.021] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/16/2018] [Revised: 06/08/2019] [Accepted: 06/13/2019] [Indexed: 02/02/2023]
Abstract
PURPOSE To determine the rate of and risk factors for 30-day unplanned admissions following hip arthroscopy in a U.S. METHODS Patients undergoing hip arthroscopy were identified in the American College of Surgeons National Surgical Quality Improvement Program database using validated Current Procedural Terminology and International Classification of Diseases, Ninth Revision and Tenth Revision codes. Patient demographics, comorbidities, preoperative laboratory values, surgical details, and postoperative outcomes were compared between patients with unplanned admissions and those without. Univariate analysis comparing study cohorts was performed using 2-tailed Student t tests with Levene's test for equality of variance or χ2/Fisher exact tests as appropriate. Using variables that were significant in the univariate analysis, we created Cox proportional hazard models to identify independent predictors for unplanned admission. RESULTS A total of 1931 cases of hip arthroscopy were identified. There were 18 cases of unplanned admissions within 30 days of index procedure (0.9%). The median time to unplanned admission was 14.5 days (interquartile range: 3.875-25.125 days). The most common reasons for admission were surgical-site infection (11.1%), wound complications (11.1%), and thromboembolic events (11.1%). There were 4 patients who required reoperation (22.2%). There were 7 cases (39.0%) that were readmitted for reasons unrelated to the index hip arthroscopy procedure. Multivariate analysis identified increasing body mass index, chronic corticosteroid use, and perioperative blood transfusion as factors independently associated with increased risk for unplanned admission. CONCLUSIONS There exists a low incidence of 30-day unplanned admission, predominantly secondary to surgical-site infections, wound complications, and thromboembolic events. Independent risk factors for unplanned admission include greater body mass index, chronic corticosteroid use, and perioperative transfusions. LEVEL OF EVIDENCE Level III Retrospective Cohort Study.
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Affiliation(s)
- Jerry Y Du
- Department of Orthopedic Surgery, MetroHealth Medical Center, Cleveland, Ohio, U.S.A.; Department of Orthopedic Surgery, University Hospitals Case Medical Center, Cleveland, Ohio, U.S.A
| | - Derrick M Knapik
- Department of Orthopedic Surgery, MetroHealth Medical Center, Cleveland, Ohio, U.S.A.; Department of Orthopedic Surgery, University Hospitals Case Medical Center, Cleveland, Ohio, U.S.A
| | - Nikunj N Trivedi
- Department of Orthopedic Surgery, MetroHealth Medical Center, Cleveland, Ohio, U.S.A.; Department of Orthopedic Surgery, University Hospitals Case Medical Center, Cleveland, Ohio, U.S.A
| | - Lakshmanan Sivasundaram
- Department of Orthopedic Surgery, MetroHealth Medical Center, Cleveland, Ohio, U.S.A.; Department of Orthopedic Surgery, University Hospitals Case Medical Center, Cleveland, Ohio, U.S.A
| | - Richard C Mather
- Department of Orthopedic Surgery, Duke University School of Medicine, Durham, North Carolina, U.S.A
| | - 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, Illinois, U.S.A
| | - Michael J Salata
- Department of Orthopedic Surgery, University Hospitals Case Medical Center, Cleveland, Ohio, U.S.A..
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A Review of Hip-Spine Syndrome. CURRENT PHYSICAL MEDICINE AND REHABILITATION REPORTS 2019. [DOI: 10.1007/s40141-019-00231-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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Hassebrock JD, Krych AJ, Domb BG, Levy BA, Neville MR, Hartigan DE. Bilateral Hip Arthroscopy: Can Results From Initial Arthroscopy for Femoroacetabular Impingement Predict Future Contralateral Results? Arthroscopy 2019; 35:1837-1844. [PMID: 30979623 DOI: 10.1016/j.arthro.2018.12.033] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/24/2018] [Revised: 12/07/2018] [Accepted: 12/12/2018] [Indexed: 02/02/2023]
Abstract
PURPOSE To determine the degree of correlation of radiographic measurements, degree of correlation of intraoperative pathology, and difference in outcomes between sides of patients requiring staged bilateral hip arthroscopy. METHODS Two high-volume hip preservation centers retrospectively reviewed hip preservation databases for staged bilateral hip arthroscopies conducted between 2008 and 2015. Patients were separated into those who presented with bilateral hip pain and those that presented with unilateral pain and developed contralateral pain >2 years later. Patients were analyzed for radiographic correlation (alpha angle, lateral center edge angle, anterior center edge angle, magnetic resonance imaging alpha angle, Tönnis grade) and correlation of intraoperative pathology (acetabular labrum articular disruption grade, Outerbridge grade/location, Villar class ligamentum teres tears, labral tear location, symmetry of Seldes tear types, and the differences between operative procedures). Patient-reported outcomes were analyzed (modified Harris Hip Score, Non-Arthritic Hip Score, International Hip Outcome Tool-12, hip outcome score-sport specific subscale, visual analog scale, patient satisfaction). Correlative tests included Pearson and Spearman; univariate and multivariate analysis for differences included χ-square test and Student t tests for ordinal and continuous variables respectively. RESULTS A total of 133 of 2,705 patients (4.6%) underwent bilateral hip arthroscopy. Radiographic alpha angle, magnetic resonance imaging alpha angle, lateral center edge angle, and anterior center edge angle demonstrated strong correlation (Pearson's coefficients 0.651, 0.648, 0.644, 0.667, respectively, P < .0001). Tönnis grade was weakly correlated (Pearson's coefficient 0.286, P = .001). Intraoperative pathology was moderately correlated (Pearson's coefficients for acetabular Outerbridge location, 0.300, P = .0170; acetabular labrum articular disruption, 0.490, P < .0001; acetabular Outerbridge; 0.530; P < .0001; femoral head Outerbridge, 0.459, P < .0001; Villar class, 0.393, P < .0001; and labral tear location, 0.468, P < .0001). Labral tear Seldes type was compared with Bowker's symmetry test and there was no significant difference between sides. There were no significant differences in surgical interventions performed between sides. Patients with bilateral hip arthroscopies significantly improved in all measured patient-reported outcomes and had a high patient satisfaction after both procedures. Final patient-reported outcomes and change in patient-reported outcomes were not different between procedures; follow up ranged from 3 months to 8 years. CONCLUSIONS This study demonstrated an incidence of 4.6% of patients who require bilateral hip arthroscopy. These patients can expect significant improvement after surgical intervention. Patients that had 1 side done gained similar improvement when the contralateral side was performed. Preoperative radiographic, intraoperative pathology, and procedures performed were similar between hips. LEVEL OF EVIDENCE Level III, retrospective cohort study.
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Affiliation(s)
- Jeffrey D Hassebrock
- Department of Orthopedics, Sports Medicine, Mayo Clinic Arizona, Phoenix, Arizona, U.S.A
| | - Aaron J Krych
- Department of Orthopedics, Mayo Clinic Rochester, Rochester, Minnesota, U.S.A
| | - Benjamin G Domb
- Department of Orthopedics, Hinsdale Orthopaedic Associates, Hinsdale, Illinois, U.S.A
| | - Bruce A Levy
- Department of Orthopedics, Mayo Clinic Rochester, Rochester, Minnesota, U.S.A
| | - Matthew R Neville
- Department of Biostatistics, Mayo Clinic Arizona, Glendale, Phoenix, U.S.A
| | - David E Hartigan
- Department of Orthopedics, Sports Medicine, Mayo Clinic Arizona, Phoenix, Arizona, U.S.A..
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Iglinski-Benjamin KC, Xiao M, Safran MR, Abrams GD. Increased Prevalence of Concomitant Psychiatric Diagnoses Among Patients Undergoing Hip Arthroscopic Surgery. Orthop J Sports Med 2019; 7:2325967118822451. [PMID: 30719482 PMCID: PMC6348513 DOI: 10.1177/2325967118822451] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/05/2023] Open
Abstract
Background Active patients with musculoskeletal pain are not immune to psychological or psychiatric disease. Observations suggest that patients undergoing hip arthroscopic surgery may have an increased prevalence of comorbid psychiatric conditions. Hypothesis Patients undergoing hip arthroscopic surgery have an increased prevalence of concomitant psychiatric diagnoses compared with the general population as well as those undergoing anterior cruciate ligament (ACL) reconstruction. Study Design Case-control study; Level of evidence, 3. Methods A retrospective review of a medical claims database spanning from 2007 to 2016 was utilized to identify patients with a Current Procedural Terminology (CPT) code indicating that they had undergone hip arthroscopic surgery. This group was then dichotomized to those with or without an International Classification of Diseases, 9th Revision (ICD-9) and 10th Revision (ICD-10) diagnosis code indicating a psychological or psychiatric condition at any time before hip arthroscopic surgery or up to 2 years after hip arthrscopic surgery. As a control, ICD-9 and ICD-10 diagnosis codes for psychological or psychiatric conditions were determined in patients without a CPT code for hip arthroscopic surgery (general population) as well as for 2 surgical groups: those undergoing ACL reconstruction and those undergoing shoulder stabilization surgery. Prevalence was determined in all groups and compared using chi-square analysis. Results There were 22,676,069 patients in the database, with 2428 undergoing hip arthroscopic surgery. Those undergoing hip arthroscopic surgery had a 3-fold increased prevalence of concomitant psychiatric diagnoses compared with the general population (52% vs 17%, respectively; P < .0001). There was a significant difference in the prevalence of psychiatric diagnoses in the hip arthroscopic surgery group between male and female patients (46% vs 56%, respectively; P = .0061), with depression and anxiety being the 2 most common comorbid conditions. Those undergoing hip arthroscopic surgery also had a significantly increased prevalence of concomitant psychiatric diagnoses versus those undergoing ACL reconstruction (52% vs 28%, respectively; P < .0001) as well as those undergoing shoulder stabilization surgery (52% vs 42%, respectively; P < .0001). Conclusion Patients undergoing hip arthroscopic surgery had an increased prevalence of comorbid psychiatric conditions compared with the general population as well as those undergoing ACL reconstruction or shoulder stabilization surgery. Depression and anxiety were the most prevalent concomitant psychiatric diagnoses.
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Affiliation(s)
- Kag C Iglinski-Benjamin
- Department of Orthopaedic Surgery, Stanford University School of Medicine, Stanford, California, USA
| | - Michelle Xiao
- Department of Orthopaedic Surgery, Stanford University School of Medicine, Stanford, California, USA
| | - Marc R Safran
- Department of Orthopaedic Surgery, Stanford University School of Medicine, Stanford, California, USA
| | - Geoffrey D Abrams
- Department of Orthopaedic Surgery, Stanford University School of Medicine, Stanford, California, USA.,Veterans Affairs Palo Alto Health Care System, Palo Alto, California, USA
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Noordin S, Masri B. Editorial. Int J Surg 2018; 54:315. [DOI: 10.1016/j.ijsu.2018.06.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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