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Bhale R, Kain M. Statistical fragility analysis of reported outcomes associated with surgical management of acetabular labral pathology. Hip Int 2024; 34:235-239. [PMID: 37932232 DOI: 10.1177/11207000231199387] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2023]
Abstract
INTRODUCTION The purpose of this study was to analyse the robustness of comparative research that evaluated arthroscopic labral reconstruction versus other surgical management of labral pathology. Key measures of statistical fragility include the fragility index and fragility quotient.ß. METHODS 12 comparative studies that evaluated the use of arthroscopic labral reconstruction were included in this study. Particular attention was placed on evaluating trends, either statistically significant or not, of functional improvement, complication rates, need for total hip arthroplasty (THA) and revision rates with associated p-values. The analysis involved in this study was the Fragility Index, which is the median number of events required to change the statistical significance of a particular outcome, thus changing the study conclusions. Fragility quotient was calculated for each study as the fragility index divided by sample size. RESULTS Of the 12 studies that were included for analysis, there were a total of 25 reported outcomes, 8 of which were statistically significant (p < 0.05). The statistical fragility for the significant outcomes were 2.5 (interquartile range [IQR]: 1.5-3.5), whereas the median statistical fragility for insignificant results was 6 (IQR 4-9). The overall fragility index was 4 (IQR 3-7). The median of fragility quotients was 0.04 (IQR 0.01-0.07). CONCLUSIONS This study demonstrated that comparative research regarding arthroscopic techniques of labral reconstruction may not be as statistically stable as previously hoped. In many of the reported outcomes, particularly the ones that were statistically significant, only a small percentage of event changes was required to change the significance of the study conclusions. This fragility is worrisome, since clinical decisions that rely on these reported outcomes may have a significant impact on long-term patient outcomes. It is, therefore, crucial to optimise patient outcomes by incorporating past literature and reported outcomes.
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Affiliation(s)
- Rahul Bhale
- Boston University School of Medicine, Boston, MA, USA
| | - Michael Kain
- Department of Orthopaedic Surgery, Boston Medical Center, Boston, MA, USA
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Más Martínez J, Cuenca Copete A, Verdú Román C, Jiménez Arias D, Beneito Pastor D, Sanz-Reig J. [Translated article] Hip arthroscopy for femoroacetabular impingement with 10-year minimum follow-up. Rev Esp Cir Ortop Traumatol (Engl Ed) 2024; 68:T35-T43. [PMID: 37995818 DOI: 10.1016/j.recot.2023.11.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2022] [Accepted: 06/25/2023] [Indexed: 11/25/2023] Open
Abstract
PURPOSE To determine outcomes after hip arthroscopy (HA) for femoroacetabular impingement (FAI) at a minimun 10-year follow up and identified risk factors for revision surgery. METHODS Retrospective study of a prospective database of patients undergoing HA between January 2010 and December 2011. Rim chondral injuries were evaluated using the acetabular labral articular disruptions system (ALAD). Clinical and radiological data was obtained. Cumulative survival was estimated by Kaplan-Meier and a multivariate Cox proportional hazards model. RESULTS Seventy-four patients were included in the study. Mean follow-up was 132 months. There was statistically significant improvement from preoperative PROs at latest follow-up. Seventeen patients (23.9%) underwent revision surgery. Odds ratio for revision surgery was 8.08 in a patient above 40 years old, 7.57 in a patient Tönnis greater than 1, and 4.25 in a patient ALAD 2-3. Cumulative survivorship rate at 10 years was 77.8%, with a 45.4% for patients with Tönnis grade greater than 1 in front of 85.2% for patients with Tönnis grade of 1 or less (p<.001). Risk factor for revision surgery was preoperative degree of osteoarthrosis (p=.02). CONCLUSION Cumulative survivorship rate at 10 years was 45.4% for patients with Tönnis grade greater than 1 in front of 85.2% for patients with Tönnis grade of 1 or less (p<.001). Age, chondral injuries, and degree of osteoarthrosis would increase the risk for revision surgery.
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Affiliation(s)
- J Más Martínez
- Traumatología Vistahermosa, HLA Clínica Vistahermosa, Alicante, Spain
| | - A Cuenca Copete
- Traumatología Vistahermosa, HLA Clínica Vistahermosa, Alicante, Spain
| | - C Verdú Román
- Traumatología Vistahermosa, HLA Clínica Vistahermosa, Alicante, Spain
| | - D Jiménez Arias
- Traumatología Vistahermosa, HLA Clínica Vistahermosa, Alicante, Spain
| | - D Beneito Pastor
- Traumatología Vistahermosa, HLA Clínica Vistahermosa, Alicante, Spain
| | - J Sanz-Reig
- Traumatología Vistahermosa, HLA Clínica Vistahermosa, Alicante, Spain.
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Más Martínez J, Cuenca Copete A, Verdú Román C, Jiménez Arias D, Beneito Pastor D, Sanz-Reig J. Hip arthroscopy for femoroacetabular impingement with 10-year minimum follow-up. Rev Esp Cir Ortop Traumatol (Engl Ed) 2024; 68:35-43. [PMID: 37406732 DOI: 10.1016/j.recot.2023.06.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2022] [Revised: 06/20/2023] [Accepted: 06/25/2023] [Indexed: 07/07/2023] Open
Abstract
PURPOSE To determine outcomes after hip arthroscopy (HA) for femoroacetabular impingement (FAI) at a minimun 10-year follow up and identified risk factors for revision surgery. METHODS Retrospective study of a prospective database of patients undergoing HA between January 2010 and December 2011. Rim chondral injuries were evaluated using the acetabular labral articular disruptions system (ALAD). Clinical and radiological data was obtained. Cumulative survival was estimated by Kaplan-Meier and a multivariate Cox proportional hazards model. RESULTS Seventy-four patients were included in the study. Mean follow-up was 132 months. There was statistically significant improvement from preoperative PROs at latest follow-up. Seventeen patients (23.9%) underwent revision surgery. Odds ratio for revision surgery was 8.08 in a patient above 40 years old, 7.57 in a patient Tönnis greater than 1, and 4.25 in a patient ALAD 2-3. Cumulative survivorship rate at 10 years was 77.8%, with a 45.4% for patients with Tönnis grade greater than 1 in front of 85.2% for patients with Tönnis grade of 1 or less (P<.001). Risk factor for revision surgery was preoperative degree of osteoarthrosis (P=.02). CONCLUSION Cumulative survivorship rate at 10 years was 45.4% for patients with Tönnis grade greater than 1 in front of 85.2% for patients with Tönnis grade of 1 or less (P<.001). Age, chondral injuries, and degree of osteoarthrosis would increase the risk for revision surgery.
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Affiliation(s)
- J Más Martínez
- Traumatología Vistahermosa, HLA Clínica Vistahermosa, Alicante, España
| | - A Cuenca Copete
- Traumatología Vistahermosa, HLA Clínica Vistahermosa, Alicante, España
| | - C Verdú Román
- Traumatología Vistahermosa, HLA Clínica Vistahermosa, Alicante, España
| | - D Jiménez Arias
- Traumatología Vistahermosa, HLA Clínica Vistahermosa, Alicante, España
| | - D Beneito Pastor
- Traumatología Vistahermosa, HLA Clínica Vistahermosa, Alicante, España
| | - J Sanz-Reig
- Traumatología Vistahermosa, HLA Clínica Vistahermosa, Alicante, España.
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Maldonado DR, Banffy MB, Huang D, Nelson TJ, Kanjiya S, Metzger MF. An Increased Allograft Width for Circumferential Labral Reconstruction Better Restores Distractive Stability of the Hip: A Cadaveric Biomechanical Analysis. Am J Sports Med 2022; 50:2462-2468. [PMID: 35722810 DOI: 10.1177/03635465221101126] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND Questions remain about whether circumferential labral reconstruction (CLR) using an iliotibial band (ITB) allograft can effectively restore the labral suction seal of the hip. HYPOTHESES (1) CLR with an ITB allograft >6.5 mm would restore distractive stability force to that of the intact labrum. (2) CLR with an ITB allograft >6.5 mm would achieve significantly superior distractive stability force compared with CLR with an ITB allograft <6.5 mm. STUDY DESIGN Controlled laboratory study. METHODS A total of 6 fresh-frozen pelves with attached femurs (n = 12 matched hemipelves) from male donors were procured and dissected free of all soft tissue, including the hip capsule but preserving the native labrum, transverse acetabular ligament, and ligamentum teres. Potted hemipelves were placed in a saline bath and securely fixed to the frame of a hydraulic testing system. A 500-N compressive load was applied, followed by femoral distraction at a rate of 5.0 mm/s until the suction seal ruptured. Force and femoral displacement were continually recorded. Force versus displacement curves were plotted, the maximum force was recorded, and the amount of femoral distraction to rupture the suction seal was determined. After intact testing, the labrum was excised, and specimens were retested using the same protocol. CLR was subsequently performed twice in a randomized fashion using (1) an ITB allograft with a width >6.5 mm (7.5-9.0 mm) and (2) an ITB allograft with a width <6.5 mm (4.5-6.0 mm). Specimens were retested after each CLR procedure. Force (in Newtons) and femoral distraction (in millimeters) required to rupture the suction seal were measured and compared between the 4 testing states (intact, deficient, CLR <6.5 mm, and CLR >6.5 mm) using repeated-measures analysis of variance. RESULTS On average, intact specimens required 148.4 ± 33.1 N of force to rupture the hip suction seal, which significantly decreased to 44.3 N in the deficient state (P < .001). CLR with ITB allografts <6.5 mm did not improve the maximum force (63 ± 62 N) from the deficient state (P = .42) and remained significantly lower than the intact state (P < .01). CLR with ITB allografts >6.5 mm recorded significantly greater force to rupture the suction seal (135.8 ± 44.6 N) compared with both the deficient and CLR <6.5 mm states (P < .01), with a mean force comparable with the intact labrum (P = .59). The amount of femoral distraction to rupture the suction seal demonstrated similar findings. CONCLUSION In a cadaveric model, CLR using ITB allografts >6.5 mm restored the distractive force and distance to the suction seal rupture to values comparable with hips with an intact labrum. CLR using ITB allografts >6.5 mm outperformed CLR with ITB allografts <6.5 mm, demonstrated by a significantly higher force to rupture the suction seal and increased distraction before the rupture. CLINICAL RELEVANCE The results of this cadaveric investigation suggest that using wider labral allografts during CLR will provide the distractive force required to rupture the suction seal and immediate postoperative stability of the hip, although further studies are required to determine if these results translate to improved clinical outcomes.
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Affiliation(s)
| | - Michael B Banffy
- Cedars-Sinai Kerlan-Jobe Institute, Los Angeles, California, USA
| | - Dave Huang
- Orthopaedic Biomechanics Laboratory, Cedars-Sinai Medical Center, Los Angeles, California, USA
| | - Trevor J Nelson
- Orthopaedic Biomechanics Laboratory, Cedars-Sinai Medical Center, Los Angeles, California, USA
| | - Shrey Kanjiya
- Cedars-Sinai Kerlan-Jobe Institute, Los Angeles, California, USA
| | - Melodie F Metzger
- Orthopaedic Biomechanics Laboratory, Cedars-Sinai Medical Center, Los Angeles, California, USA.,Department of Orthopaedic Surgery, Cedars-Sinai Medical Center, Los Angeles, California, USA
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Laboudie P, Gauthier P, Kreviazuk C, Beaulé PE. Does labral treatment technique influence the outcome of FAI surgery? A matched-pair study of labral reconstruction versus repair and debridement with a follow-up of 10 years. J Hip Preserv Surg 2022; 9:95-101. [PMID: 35854806 PMCID: PMC9291390 DOI: 10.1093/jhps/hnac017] [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: 12/07/2021] [Revised: 02/11/2022] [Accepted: 03/08/2022] [Indexed: 11/13/2022] Open
Abstract
The aim of this study was to analyze the long-term clinical outcomes of labral reconstruction in patients undergoing femoro-acetabular impingement (FAI) surgery and compare them with labral repair and debridement. This is a single-center, single-surgeon, retrospective match-paired study from a prospectively collected hip preservation database. All patients underwent a hip surgical dislocation for FAI surgery. Eight patients underwent labral reconstruction with the ligamentum teres and were matched on sex, age and body mass index with 24 labral repair and 24 labral debridement (1:3). Failure was defined as conversion to total hip replacement (THR) and patient-reported outcome measures (PROMs) were collected. Mean follow-up was 9.8 years ±2.6 (5.2–13.9). There was a significant improvement in postoperative PROMs in the three groups regarding the WOMAC total, WOMAC function, HOOS-QoL, HOOS-ADL and HOOS-SRA (P < 0.05). There was no statistical difference between the three groups regarding postoperative PROMs and change in PROMs (P > 0.05). A total of 10 hips underwent joint replacement surgery at a mean time of 7.9 ± 3.5 years (2.4–12). There was no statistically significant difference between the three groups regarding the conversion rate to THR (P = 0.64) or time between surgery and conversion to THR (P = 0.15). Compared to a match-pair group of labral repair and debridement, labral reconstruction with ligamentum teres provides similar survival with conversion to a THR as an endpoint, as well as similar improvement in PROMs. Labral treatment can be safely adapted at the nature of the labral lesion with a treatment ‘à la carte’.
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Affiliation(s)
- Pierre Laboudie
- Division of Orthopedic Surgery, The Ottawa Hospital (TOH), 501 Smyth Road, Ottawa, ON K1H 8L6, Canada
- Faculty of Medicine, The University of Ottawa, Roger Guindon Hall, 451 Smyth Rd #2044, Ottawa, ON K1H 8M5, Canada
| | - Paul Gauthier
- Division of Orthopedic Surgery, The Ottawa Hospital (TOH), 501 Smyth Road, Ottawa, ON K1H 8L6, Canada
- Faculty of Medicine, The University of Ottawa, Roger Guindon Hall, 451 Smyth Rd #2044, Ottawa, ON K1H 8M5, Canada
| | - Cheryl Kreviazuk
- Division of Orthopedic Surgery, The Ottawa Hospital (TOH), 501 Smyth Road, Ottawa, ON K1H 8L6, Canada
- Clinical Epidemiology Program, The Ottawa Hospital Research Institute, 501 Smyth Road, Ottawa, ON K1H 8L6, Canada
| | - Paul E Beaulé
- Division of Orthopedic Surgery, The Ottawa Hospital (TOH), 501 Smyth Road, Ottawa, ON K1H 8L6, Canada
- Faculty of Medicine, The University of Ottawa, Roger Guindon Hall, 451 Smyth Rd #2044, Ottawa, ON K1H 8M5, Canada
- Clinical Epidemiology Program, The Ottawa Hospital Research Institute, 501 Smyth Road, Ottawa, ON K1H 8L6, Canada
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Maldonado DR, Kyin C, Shapira J, Meghpara MB, Rosinsky PJ, Lall AC, Domb BG. Comparable Minimum 2-Year Patient-Reported Outcome Scores Between Circumferential and Segmental Labral Reconstruction for the Management of Irreparable Labral Tear and Femoroacetabular Impingement Syndrome in the Primary Setting: A Propensity-Matched Study. Arthroscopy 2022; 38:335-348. [PMID: 33940128 DOI: 10.1016/j.arthro.2021.04.037] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/16/2020] [Revised: 04/08/2021] [Accepted: 04/15/2021] [Indexed: 02/02/2023]
Abstract
PURPOSE To compare minimum 2-year follow-up patient-reported outcome scores (PROs) in patients who underwent primary acetabular circumferential and segmental labral reconstruction for irreparable labral tears and femoroacetabular impingement syndrome (FAIS). METHODS Data were reviewed from August 2010 to December 2017. Patients with primary labral reconstruction and minimum 2-year follow-up for the modified Harris Hip Score (mHHS), Non-Arthritic Hip Score (NAHS), Hip Outcome Score-Sports Specific Subscale (HOS-SSS), and visual analog scale (VAS) for pain were included. Circumferential and segmental reconstruction were selected in each case based on the extent of the labral pathology. Exclusion criteria were previous ipsilateral hip surgery/conditions, dysplasia, or Tönnis grade >1. Patients were propensity matched 1:1 based on age, sex, and body mass index. Secondary surgeries were reported. The P value was set at <.05. RESULTS In total, 144 hips were eligible, and 17 hips were lost to follow-up, leaving 127 hips (88.2%) for analysis. Eighty hips underwent a segmental reconstruction, and 47 hips underwent a circumferential reconstruction. Forty-seven hips with circumferential reconstruction were matched to 47 hips with segmental reconstruction. The average follow-up and age for the segmental and circumferential groups were 29.0 ± 7.8 and 27.9 ± 7.0 months (P = .732) and 43.1 ± 9.4 and 44.7 ± 10.2 years (P = .442) respectively. The segmental and circumferential groups were 48.9% and 51.1% female, respectively. The groups achieved significant and comparable improvement for all PROs and rates of secondary surgeries. No differences were found for achieving the minimal clinically important difference (MCID) and the patient acceptable symptomatic state (PASS). The MCIDs for the segmental and circumferential groups were 76.7% and 77.8% for the mHHS, 64.9% and 77.8% for the HOS-SSS, 71.1% and 68.9% for the VAS, and 68.9% and 73.9% for the NAHS, respectively. The PASSs for the segmental and circumferential groups were 78.3% and 73.3% for the mHHS, 55.3% and 55.0% for the HOS-SSS, and 75.6% and 71.1% for the International Hip Outcome Tool 12, respectively. CONCLUSIONS At minimum 2-year follow-up, patients who underwent primary hip arthroscopy for either circumferential or segmental labral reconstruction for irreparable labra and FAIS reported significant improvement and similar postoperative scores for all PROs, with no difference in psychometric outcomes and rate of secondary surgeries. A customized approach, using the extent of the irreparable labral tear, seems to be an appropriate strategy. LEVEL OF EVIDENCE Level III, retrospective comparative therapeutic trial.
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Affiliation(s)
- David R Maldonado
- American Hip Institute Research Foundation, Chicago, Illinois, U.S.A
| | - Cynthia Kyin
- American Hip Institute Research Foundation, Chicago, Illinois, U.S.A
| | - Jacob Shapira
- American Hip Institute Research Foundation, Chicago, Illinois, U.S.A
| | - Mitchell B Meghpara
- American Hip Institute Research Foundation, Chicago, Illinois, U.S.A.; AMITA Health St. Alexius Medical Center, Hoffman Estates, Illinois
| | - Philip J Rosinsky
- American Hip Institute Research Foundation, Chicago, Illinois, U.S.A
| | - Ajay C Lall
- American Hip Institute Research Foundation, Chicago, Illinois, U.S.A.; American Hip Institute, Chicago, Illinois, U.S.A.; AMITA Health St. Alexius Medical Center, Hoffman Estates, Illinois
| | - Benjamin G Domb
- American Hip Institute Research Foundation, Chicago, Illinois, U.S.A.; American Hip Institute, Chicago, Illinois, U.S.A.; AMITA Health St. Alexius Medical Center, Hoffman Estates, Illinois.
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Minimum 2-Year Outcomes Following Arthroscopic Hip Labral Reconstruction in Adolescents and Young Adults. J Pediatr Orthop 2022; 42:83-89. [PMID: 34657092 DOI: 10.1097/bpo.0000000000001984] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
BACKGROUND Labral repair is generally preferred when facing labral tears. When an irreparable labral tear in the context of femoroacetabular impingement syndrome is present, arthroscopic labral reconstruction has been proven to be a valid option for labral restoration. However, data on this procedure for the adolescent population is scarce. The purpose of the present study was to report minimum 2-year follow-up patient-reported outcome measures (PROMs) on adolescents and young adults following arthroscopic acetabular labral reconstruction. METHODS Data were prospectively collected and retrospectively reviewed on adolescents and young adults who underwent hip arthroscopy between March 2009 and June 2018. Inclusion criteria were labral reconstruction, baseline and minimum 2-year follow-up PROMs. Patients were excluded if they were unwilling to participate in the study, had Tönnis grade >1, or dysplasia. RESULTS Twenty-three hips (22 patients) that underwent labral reconstruction were included. Ten hips (10 patients) underwent primary labral reconstruction, and 13 hips (12 patients) underwent revision reconstruction. The mean age was 19.3 years and 56.5% of patients were males. All patients improved significantly at minimum 2 years for all PROMs (P<0.001) with high satisfaction. Patients in both groups demonstrated improvement for all PROMs, patient satisfaction, and a rate of achieving the minimal clinically important difference. CONCLUSION Arthroscopic labral reconstruction in adolescents and young adults demonstrated significant improvement and high patient satisfaction at minimum 2-year follow-up in the setting of irreparable labral tear. Favorable outcomes, high patient satisfaction, and high achievement rate for the minimal clinically important difference were obtained following labral reconstruction in this population the primary and revision scenarios. LEVEL OF EVIDENCE Level IV, case-series.
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Sabetian PW, Owens JS, Maldonado DR, Miecznikowski KB, Saks BR, Jimenez AE, Ankem HK, Lall AC, Domb BG. Circumferential and Segmental Arthroscopic Labral Reconstruction of the Hip Utilizing the Knotless Pull-Through Technique with All-Suture Anchors. Arthrosc Tech 2021; 10:e2245-e2251. [PMID: 34754730 PMCID: PMC8556550 DOI: 10.1016/j.eats.2021.05.029] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/09/2021] [Accepted: 05/27/2021] [Indexed: 02/03/2023] Open
Abstract
Appropriate labral tear management is one of the principal priorities of hip-preservation surgery. The labrum's role in the stability and biomechanics of the hip and preservation of the suction seal has been thoroughly demonstrated. Favorable patient-reported outcomes with labral reconstruction and, more recently, labral augmentation have shown that these are viable reconstructive procedures in the setting of irreparable labra. A wide variety of grafts have been used for these advanced labral restoration techniques. The present Technical Note will describe a detailed arthroscopic circumferential labral reconstruction using the pull-through technique with knotless all-suture anchors. The benefits of such can be applied to both segmental and circumferential labral reconstruction procedures, as well as labral augmentation, based on the intraoperative findings and preference of the surgeon.
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Affiliation(s)
| | | | | | | | - Benjamin R. Saks
- American Hip Institute Research Foundation, Chicago,AMITA Health St. Alexius Medical Center, Hoffman Estates, Illinois, U.S.A
| | | | | | - Ajay C. Lall
- American Hip Institute Research Foundation, Chicago,American Hip Institute, Chicago,AMITA Health St. Alexius Medical Center, Hoffman Estates, Illinois, U.S.A
| | - Benjamin G. Domb
- American Hip Institute Research Foundation, Chicago,American Hip Institute, Chicago,AMITA Health St. Alexius Medical Center, Hoffman Estates, Illinois, U.S.A.,Address correspondence to Dr. Benjamin G. Domb, M.D., 999 E Touhy Ave., Suite 450, Des Plaines, IL 60018.
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The lateral joint space width is essential for the outcome after arthroscopically assisted mini-open arthrotomy for treatment of a femoroacetabular impingement: an analysis of prognostic factors for the success of this hip-preserving technique. INTERNATIONAL ORTHOPAEDICS 2021; 46:205-214. [PMID: 34410478 DOI: 10.1007/s00264-021-05181-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/15/2021] [Accepted: 08/02/2021] [Indexed: 10/20/2022]
Abstract
PURPOSE The purpose of this study was to analyze predicting factors for a conversion to a total hip replacement (THR) after mini-open arthrotomy for treatment of femoroacetabular impingement (FAI). METHODS Between 2011 and 2016, we identified 32 patients, who were treated for FAI with a mini-open arthrotomy and received after mean time of 2.1 ± 1.4 years a THR. These patients were compared to 47 cases who did not receive a THR (mean follow-up: 4.3 ± 0.7 years) to explore pre- and intra-operative factors associated with a conversion to THR. The results were presented in separated Kaplan-Meier curves with log rank test for significance and hazard ratios. RESULTS A lateral joint space width of > 4 mm showed a higher THR-free survival rate compared to < 4 mm (p = 0.001); analogously one-sided (acetabular/femoral) 3-4° cartilage damage had a comparable THR-free survival rate than 1-2° kissing lesions (p = 0.001). Furthermore, an intact labrum without treatment and good cartilage status, a refixed labrum after rim resection in case of a pincer type FAI, or a refixed teared labrum were associated with a longer THR-free time than an untreated labrum accompanied by a poor cartilage status or an ossified labrum (p = 0.002). The strongest independent factor for a conversion to THR was femoral cartilage damage grade 1 and higher (p = 0.046). However, the rate of available patients was 53.0%. CONCLUSION The success of a joint-preserving mini-open arthrotomy seems to be dependent on the status of the radiological joint space width and the intra-operative cartilage status of the lateral edge.
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10
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Domb BG, Kyin C, Go CC, Shapira J, Rosinsky PJ, Lall AC, Maldonado DR. Arthroscopic Circumferential Acetabular Labral Reconstruction for Irreparable Labra in the Revision Setting: Patient-Reported Outcome Scores and Rate of Achieving the Minimal Clinically Important Difference at a Minimum 2-Year Follow-up. Am J Sports Med 2021; 49:1750-1758. [PMID: 33861650 DOI: 10.1177/03635465211005742] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
BACKGROUND There is a paucity in the literature reporting patient-reported outcome (PRO) scores and the minimal clinically important difference (MCID) after revision hip arthroscopic surgery with circumferential labral reconstruction. PURPOSE To report minimum 2-year PRO scores and the rate of achieving the MCID in patients who underwent revision hip arthroscopic surgery with circumferential labral reconstruction in the setting of irreparable labral tears. STUDY DESIGN Case series; Level of evidence, 4. METHODS Data were retrospectively reviewed for all patients who underwent revision hip arthroscopic surgery between February 2016 and November 2017. Patients were included if they had undergone circumferential labral reconstruction and had preoperative and postoperative scores for the modified Harris Hip Score (mHHS), Non-Arthritic Hip Score (NAHS), Hip Outcome Score Sport-Specific Subscale (HOS-SSS), International Hip Outcome Tool (iHOT-12), 12-Item Short Form Health Survey physical and mental components (SF-12 P and SF-12 M, respectively), Veterans RAND 12-Item Health Survey physical and mental components (VR-12 P and VR-12 M, respectively), and visual analog scale (VAS) for pain. Exclusion criteria were Tönnis grade >1, Legg-Calve-Perthes disease, slipped capital femoral epiphysis, fractures, hip dysplasia, or revision labral treatment different from circumferential labral reconstruction. The MCID was calculated. Secondary surgical procedures were documented. RESULTS A total of 26 hips (26 patients; 61.5% female) were included. The mean age and body mass index were 33.2 ± 10.4 years and 25.5 ± 4.9, respectively. Significant improvements were reported for the mHHS (17.0 ± 19.5; P = .0002), NAHS (17.9 ± 16.7; P < .0001), HOS-SSS (21.7 ± 23.1; P = .0005), VAS (-2.2 ± 3.0; P = .006), iHOT-12 (25.8 ± 32.5; P = .0007), SF-12 P (8.5 ± 11.2; P = .001), and VR-12 P (8.9 ± 11.6; P = .001). Rates of meeting the MCID for the mHHS, NAHS, HOS-SSS, iHOT-12, and VAS were 76.9%, 80.0%, 65.0%, 62.5%, and 69.2%, respectively. No case of re-revision arthroscopic surgery was documented, but 1 case of conversion to total hip arthroplasty was documented at 38.6 months. CONCLUSION In the setting of revision hip arthroscopic surgery and irreparable labral tears, circumferential labral reconstruction resulted in significant improvements in all PRO and VAS scores at a minimum 2-year follow-up with a high rate of achieving the MCID.
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Affiliation(s)
- Benjamin G Domb
- American Hip Institute Research Foundation, Chicago, Illinois, USA.,American Hip Institute, Chicago, Illinois, USA.,AMITA Health St Alexius Medical Center, Hoffman Estates, Illinois, USA
| | - Cynthia Kyin
- American Hip Institute Research Foundation, Chicago, Illinois, USA
| | - Cammille C Go
- American Hip Institute Research Foundation, Chicago, Illinois, USA
| | - Jacob Shapira
- American Hip Institute Research Foundation, Chicago, Illinois, USA
| | | | - Ajay C Lall
- American Hip Institute Research Foundation, Chicago, Illinois, USA.,American Hip Institute, Chicago, Illinois, USA.,AMITA Health St Alexius Medical Center, Hoffman Estates, Illinois, USA
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11
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Zimmerer A, Ramoser A, Streit M, Janz V, Sobau C, Wassilew GI, Miehlke W. Osteoarthrosis, Advanced Age, and Female Sex Are Risk Factors for Inferior Outcomes After Hip Arthroscopy and Labral Debridement for Femoroacetabular Impingement Syndrome: Case Series With Minimum 10-Year Follow-Up. Arthroscopy 2021; 37:1822-1828.e1. [PMID: 33515737 DOI: 10.1016/j.arthro.2021.01.024] [Citation(s) in RCA: 28] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/15/2020] [Revised: 01/05/2021] [Accepted: 01/08/2021] [Indexed: 02/02/2023]
Abstract
PURPOSE (1) To determine the cumulative survivorship using the endpoint of total hip arthroplasty (THA) correlated with osteoarthrosis (Tönnis grade ≤ 1 vs Tönnis grade > 1) at a minimum 10-year follow-up and (2) to identify risk factors for THA conversion. METHODS This study examined 112 patients who underwent hip arthroscopy for femoroacetabular impingement syndrome (FAIS) between 2007 and 2009. The inclusion criterion was primary hip arthroscopy to treat FAIS with corresponding chondrolabral pathologies. The exclusion criteria were secondary hip pathologies, revision hip arthroscopy, or dysplasia. The mean follow-up period was 11 years. Cumulative survival was estimated by Kaplan-Meier analysis using the endpoint of THA. Risk factors for THA conversion were identified using a multivariate Cox proportional hazards model. RESULTS Forty patients underwent THA. The cumulative survivorship rate at 11 years was 86% for patients with a Tönnis grade of 1 or less and 46% for those with a Tönnis grade greater than 1. Osteoarthrosis, advanced age, and female sex were associated with lower hip survival rates. In particular, the risk of THA conversion was 24% higher for patients with an advanced age at the time of surgery, 97% higher for female patients, and 133% higher for hips with a Tönnis grade greater than 1. CONCLUSIONS The survivorship rate at a mean 11-year follow-up after arthroscopic FAIS therapy was 86.3% in the group with a Tönnis grade of 1 or less and 46.4% in the group with a Tönnis grade greater than 1. The presence of osteoarthrosis, advanced age, and female sex adversely affected the outcome. LEVEL OF EVIDENCE Level III, retrospective comparative study.
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Affiliation(s)
- Alexander Zimmerer
- ARCUS Sportklinik Pforzheim, Pforzheim, Germany; Department of Orthopaedics and Orthopaedic Surgery, University Medicine Greifswald, Greifswald, Germany.
| | | | | | - Viktor Janz
- Department of Orthopaedics and Orthopaedic Surgery, University Medicine Greifswald, Greifswald, Germany
| | | | - Georgi I Wassilew
- Department of Orthopaedics and Orthopaedic Surgery, University Medicine Greifswald, Greifswald, Germany
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12
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Safran N, Rath E, Haviv B, Atzmon R, Amar E. The Efficacy of Labral Reconstruction: A Systematic Review. Orthop J Sports Med 2021; 9:2325967120977088. [PMID: 33644246 PMCID: PMC7894601 DOI: 10.1177/2325967120977088] [Citation(s) in RCA: 12] [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: 08/14/2020] [Accepted: 09/04/2020] [Indexed: 11/21/2022] Open
Abstract
Background: With a greater understanding of the importance of the acetabular labrum in the function of the hip, labral repair is preferred over debridement. However, in some scenarios, preservation or repair of the labrum is not possible, and labral reconstruction procedures have been growing in popularity as an alternative to labral resection. Purpose: To provide an up-to-date analysis of the literature to determine the overall efficacy of labral reconstruction when compared with labral repair or resection. Study Design: Systematic review; Level of evidence, 3. Methods: PubMed, Embase, and MEDLINE databases were searched for literature regarding labral reconstruction in the hip before July 21, 2020. The results were screened and evaluated by 2 reviewers, and a third reviewer resolved any discrepancies. The final studies were evaluated using the MINORS (Methodological Index for Non-randomized Studies) score. Results: There were 7 comparative studies that fit the inclusion criteria, with 228 hips from 197 patients. The mean follow-up was 34.6 months, and the mean age of all patients was 38.34 years. There were slightly more female patients than male patients (105 vs 92). Arthroscopic reconstruction was performed in 86% of studies (6/7); open surgical techniques, in 14% (1/7). A variety of grafts was used in the reconstructions. The indications for labral reconstruction and outcome measures varied in these publications. Nine patients were lost follow-up, and 6 patients converted to total hip replacement postlabral reconstruction. The assessment of these comparative studies illustrated statistically equivalent results between labral reconstruction and labral repair. Comparisons of labral reconstruction with labral resection also showed statistically equivalent postoperative patient-reported outcome scores; however, the rates of conversion to total hip arthroplasty were significantly higher in the population undergoing resection. Conclusion: The review of current available comparative literature, which consists entirely of level 3 studies, suggests that labral reconstruction does improve postoperative outcomes but does not demonstrate superiority over repair. There may, however, be benefit to performing labral reconstruction over resection owing to the higher rate of conversion to total hip arthroplasty in the labral resection group.
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Affiliation(s)
| | - Ehud Rath
- Tel-Aviv University, Tel-Aviv, Israel
| | | | | | - Eyal Amar
- Tel-Aviv University, Tel-Aviv, Israel
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13
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Maldonado DR, Glein RM, Domb BG. Arthroscopic acetabular labral reconstruction: a review. J Hip Preserv Surg 2020; 7:611-620. [PMID: 34377505 PMCID: PMC8349583 DOI: 10.1093/jhps/hnab003] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/14/2020] [Revised: 01/06/2021] [Accepted: 01/13/2021] [Indexed: 12/17/2022] Open
Abstract
The function and importance of the acetabular labrum in hip biomechanics have been determined. A labral tear is one of the most common findings in the hip preservation field, commonly associated with femoroacetabular impingement (FAI) syndrome. It has been established that the restoration of labral anatomy and function are key factors to improve patient-reported outcome measurements (PROMs) and psychometric tools following arthroscopic hip arthroscopy in the context of FAI syndrome. Labral repair or refixation is currently the gold-standard surgical option when facing labral tears, with clinical mid to long-term data supporting its use. Labral selective debridement has proven to be a valid alternative in selective patients. Acetabular labral reconstruction has risen as an alternative to labral excision or resection when repair is not an option due to labral tissue deficiency. Restoring the labral sealing mechanism is the goal behind the acetabular labral reconstruction. It has been proven that labral reconstruction leads to superior PROMs when compared with resection. This review presents an analysis of the indications, techniques, and outcomes for arthroscopic acetabular labral reconstruction.
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Affiliation(s)
| | - Rachel M Glein
- American Hip Institute Research Foundation, 999 E Touhy Ave, Des Plaines, Chicago, IL 60018, USA
| | - Benjamin G Domb
- American Hip Institute Research Foundation, 999 E Touhy Ave, Des Plaines, Chicago, IL 60018, USA
- American Hip Institute, 999 E Touhy Ave, Des Plaines, Chicago, IL 60018, USA
- Department of Orthopedics, AMITA Health St. Alexius Medical Center, 1555 Barrington Rd, Hoffman Estates, IL 60169, USA
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14
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Watanabe N, Murakami S, Uchida S, Tateishi S, Ohara H, Yamamoto Y, Kojima T. Validity of the Japanese Orthopaedic Association Hip Disease Evaluation Questionnaire (JHEQ) for Japanese patients with labral tear. J Hip Preserv Surg 2020; 7:466-473. [PMID: 33948202 PMCID: PMC8081416 DOI: 10.1093/jhps/hnaa038] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/20/2020] [Revised: 06/29/2020] [Accepted: 08/15/2020] [Indexed: 11/14/2022] Open
Abstract
The Japanese Orthopaedic Association Hip Disease Evaluation Questionnaire (JHEQ) was created for patient-reported outcome measures (PROMs) and to evaluate the conditions of patients with hip disease. Nevertheless, the validity of the JHEQ for patients with hip labral tears remains unclear. Therefore, we validated the JHEQ in patients with labral tears. There were 51 patients (mean age 44.5, range 18-60 years; 31 women). Thirty-two patients had right-sided tears, 29 underwent hip arthroscopy, 32 had femoroacetabular impingement and 15 had developmental hip dysplasia. Five PROMs included in the JHEQ were evaluated using test-retest methods. Statistical analysis was performed using SPSS software according to the COnsensus-based Standards for the selection of health status Measurement Instruments checklist. The intra-class correlation coefficient (1, 2) of all JHEQ scores (84 points) was 0.88 and Cronbach's α was 0.94. Bland-Altman analysis revealed good test-retest reliability for the JHEQ. The Spearman's rank test, including the SF-36 subscale, showed a high correlation with physical functioning [1, 0.67 (P < 0.01); 2, 0.65 (P < 0.01)], body pain [1, 0.54 (P < 0.01); 2, 0.53 (P < 0.01)] and physical component summary [1, 0.55 (P < 0.01); 2, 0.55 (P < 0.01)]. The value of minimal important change (22.9) was higher than that of smallest detectable change (3.21), suggesting that the JHEQ has adequate responsiveness. We demonstrated the reliability, validity and responsiveness of the JHEQ in Japanese patients with hip labral tears. JHEQ is a valid assessment tool not only for patients with hip osteoarthritis or osteonecrosis but also for those with hip labral tears.
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Affiliation(s)
- Nobuyuki Watanabe
- Department of Orthopaedic Surgery, Tosei General Hospital, Seto City, Aichi 489-0065, Japan.,Department of Orthopaedic Surgery, Graduate School of Medical Sciences, Nagoya City University, Nagoya City, Aichi 467-8602, Japan
| | - Satona Murakami
- Department of Rehabilitation Medicine, Graduate School of Medical Sciences, Nagoya City University, Nagoya City, Aichi 467-8602, Japan
| | - Soshi Uchida
- Department of Orthopaedic Surgery, Wakamatsu Hospital of the University of Occupational and Environmental Health, Kitakyusyu City, Fukuoka 808-0024, Japan
| | - Satoshi Tateishi
- Department of Rehabilitation Medicine, Wakamatsu Hospital of the University of Occupational and Environmental Health, Kitakyusyu City, Fukuoka 808-0024, Japan
| | - Hidetsugu Ohara
- Department of Orthopaedic Surgery, Hirakata City Hospital, Hirakata City, Osaka 573-1013, Japan
| | - Yasuhiro Yamamoto
- Department of Occupational Therapy, Health Science University, Minamitsuru-gun, Yamanashi 401-0380, Japan
| | - Taiki Kojima
- Department of Anesthesiology, Aichi Children's Health and Medical Center, Cincinnati, Ohbu City, Aichi 474-8710, Japan
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15
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Kollmorgen R. Editorial Commentary: Hip Hypotrophic Labrum Should Not Change Our Treatment Algorithm: Welcome to the Augmented Reality of the Hip-Preservation Zone. Arthroscopy 2020; 36:2621-2622. [PMID: 33039037 DOI: 10.1016/j.arthro.2020.07.030] [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: 07/12/2020] [Accepted: 07/14/2020] [Indexed: 02/02/2023]
Abstract
Current treatment for labral pathology continues to be of some debate; debride, repair, or reconstruct. There are many factors hip preservationists consider when treating the labrum, and the size of the labrum is one. Some feel that small labral tissue with tears cannot function as well as larger tissue when repaired, and others feel that all labrum need removed and reconstructed in a primary setting. This conundrum leads us to continued research to define the best practices in hip preservation.
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Maldonado DR, Chen JW, Walker-Santiago R, Rosinsky PJ, Shapira J, Lall AC, Kyin C, Domb BG. Radiographic and Demographic Factors Can Predict the Need for Primary Labral Reconstruction in Hip Arthroscopic Surgery: A Predictive Model Using 1398 Hips. Am J Sports Med 2020; 48:173-180. [PMID: 31877107 DOI: 10.1177/0363546519887749] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND Labral tears are the most common findings in patients with symptomatic femoroacetabular impingement (FAI). The restoration of labral function is critical, and labral reconstruction has been proposed as an alternative for irreparable tears. PURPOSE To compare preoperative radiographic measurements and demographics of patients who underwent primary arthroscopic labral reconstruction versus primary labral repair and to identify factors that are predictive of the need for reconstruction. STUDY DESIGN Case-control study; Level of evidence, 3. METHODS Patients who underwent their index hip arthroscopic procedure between October 2010 and November 2018 and underwent either labral reconstruction or repair were included in the study. A total of 18 variables (14 radiographic and 4 demographic) were assessed in a bivariate comparison and analyzed in a multivariate logistic model. RESULTS A total of 251 primary reconstruction and 1147 primary repair procedures were included. The logistic model selected age, body mass index (BMI), Tönnis grade, lateral center-edge angle (LCEA), and alpha angle. The odds of reconstruction were 2.52 times higher in patients with Tönnis grade 1 than 0 (odds ratio [OR], 2.52 [95% CI, 1.82-3.49]). Each additional degree in the LCEA was associated with a 6% increase in the odds of reconstruction (OR, 1.06 [95% CI, 1.04-1.09]) and 4% for each additional degree in the alpha angle (OR, 1.04 [95% CI, 1.03-1.05]). Higher age (per log 10 unit) and BMI also increased the likelihood of reconstruction (OR, 11.29 [95% CI, 4.23-30.10] and OR, 1.03 [95% CI, 1.00-1.06], respectively). CONCLUSION In a multivariate analysis, factors identified as preoperative predictors for primary arthroscopic labral reconstruction in the setting of FAI and labral tears were Tönnis grade, LCEA, age, and BMI. These predictive factors may be useful for the clinician in determining the preoperative likelihood of primary labral reconstruction.
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Affiliation(s)
| | | | | | | | | | - Ajay C Lall
- American Hip Institute, Des Plaines, Illinois, USA
| | - Cynthia Kyin
- American Hip Institute, Des Plaines, Illinois, USA
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