1
|
Mahatme RJ, Lee MS, Fong S, George T, Pettinelli NJ, Kardestuncer K, Gillinov SM, Park N, Surucu S, Jimenez AE. Autologous Matrix-Induced Chondrogenesis for the Treatment of Hip Acetabular Chondral Lesions Demonstrates Improved Outcomes: A Systematic Review. Arthroscopy 2024:S0749-8063(24)00334-7. [PMID: 38735412 DOI: 10.1016/j.arthro.2024.04.028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/14/2023] [Revised: 03/26/2024] [Accepted: 04/08/2024] [Indexed: 05/14/2024]
Abstract
PURPOSE To systematically investigate the outcomes of patients who underwent autologous matrix-induced chondrogenesis (AMIC) during hip arthroscopy for the treatment of acetabular chondral lesions due to femoroacetabular impingement syndrome. METHODS PubMed and Cochrane were queried in June 2022 to conduct this systematic review using the following keywords: "femoroacetabular impingement," "arthroscopy," "microfracture," and "autologous matrix-induced chondrogenesis." Articles were included if they reported on patient-reported outcomes of AMIC during hip arthroscopy to treat chondral lesions of the hip. The review adhered to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses criteria. Each study was queried for demographics, lesion classification, surgical treatment, patient-reported outcome scores, revision arthroscopy, and conversion to total hip arthroplasty (THA). A qualitative subanalysis was performed to compare patients undergoing AMIC to patients undergoing microfracture alone if included studies also assessed results of microfracture alone. RESULTS Four studies met inclusion criteria and assessed 209 hips undergoing AMIC. The included studies consisted of 99 male and 110 female patients. Mean postoperative follow-up ranged from 1 to 8 years, and mean patient age ranged from 34.3 to 45 years. Three of the 4 included studies reported the modified Harris Hip Score, and all 3 of these studies reported statistically significant improvement in the modified Harris Hip Score at final follow-up (P < .001) with mean preoperative values ranging from 44.5 to 62.8 and mean postoperative values ranging from 78.8 to 95.8. Two of the 4 studies compared patients treated with AMIC to microfracture alone. In these 2 studies, the AMIC groups reported 0 patients converting to THA while the microfracture-alone groups reported a highly variable rate of conversion to THA (2%-32.6%). CONCLUSIONS Patients who underwent hip arthroscopy and AMIC for the treatment of femoroacetabular impingement syndrome and acetabular chondral lesions demonstrated improved patient-reported outcomes and low rates of secondary surgeries at short-term follow-up. STUDY DESIGN: Level IV, systematic review of Level III and IV studies.
Collapse
Affiliation(s)
- Ronak J Mahatme
- University of Connecticut School of Medicine, Farmington, Connecticut, U.S.A
| | - Michael S Lee
- Medical College of Wisconsin, Milwaukee, Wisconsin, U.S.A
| | - Scott Fong
- Case Western Reserve University School of Medicine, Cleveland, Ohio, U.S.A
| | - Tom George
- Creighton University School of Medicine, Omaha, Nebraska, U.S.A
| | | | | | - Stephen M Gillinov
- Department of Orthopaedics and Rehabilitation, Yale School of Medicine, New Haven, Connecticut, U.S.A
| | - Nancy Park
- Department of Orthopaedics and Rehabilitation, Yale School of Medicine, New Haven, Connecticut, U.S.A
| | - Serkan Surucu
- 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..
| |
Collapse
|
2
|
Kahsai EA, O'Connor B, Khoo KJ, Ogunleye TD, Telfer S, Hagen MS. Improving Patient Understanding of Femoroacetabular Impingement Syndrome With Three-Dimensional Models. J Am Acad Orthop Surg Glob Res Rev 2024; 8:01979360-202405000-00006. [PMID: 38722846 PMCID: PMC11081616 DOI: 10.5435/jaaosglobal-d-24-00116] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2024] [Accepted: 03/27/2024] [Indexed: 05/13/2024]
Abstract
INTRODUCTION Three-dimensional (3D) printed models may help patients understand complex anatomic pathologies such as femoroacetabular impingement syndrome (FAIS). We aimed to assess patient understanding and satisfaction when using 3D printed models compared with standard imaging modalities for discussion of FAIS diagnosis and surgical plan. METHODS A consecutive series of 76 new patients with FAIS (37 patients in the 3D model cohort and 39 in the control cohort) from a single surgeon's clinic were educated using imaging and representative 3D printed models of FAI or imaging without models (control). Patients received a voluntary post-visit questionnaire that evaluated their understanding of the diagnosis, surgical plan, and visit satisfaction. RESULTS Patients in the 3D model cohort reported a significantly higher mean understanding of FAIS (90.0 ± 11.5 versus 79.8 ± 14.9 out of 100; P = 0.001) and surgery (89.5 ± 11.6 versus 81.0 ± 14.5; P = 0.01) compared with the control cohort. Both groups reported high levels of satisfaction with the visit. CONCLUSION In this study, the use of 3D printed models in clinic visits with patients with FAIS improved patients' perceived understanding of diagnosis and surgical treatment.
Collapse
Affiliation(s)
- Ermyas A. Kahsai
- From the Department of Orthopaedics and Sports Medicine, The University of Washington, Seattle, WA
| | - Bailey O'Connor
- From the Department of Orthopaedics and Sports Medicine, The University of Washington, Seattle, WA
| | - Kevin J. Khoo
- From the Department of Orthopaedics and Sports Medicine, The University of Washington, Seattle, WA
| | - Temi D. Ogunleye
- From the Department of Orthopaedics and Sports Medicine, The University of Washington, Seattle, WA
| | - Scott Telfer
- From the Department of Orthopaedics and Sports Medicine, The University of Washington, Seattle, WA
| | - Mia S. Hagen
- From the Department of Orthopaedics and Sports Medicine, The University of Washington, Seattle, WA
| |
Collapse
|
3
|
Ramkumar PN, Olsen RJ, Shaikh HJF, Nawabi DH, Kelly BT. Modern Hip Arthroscopy for FAIS May Delay the Natural History of Osteoarthritis in 25% of Patients: A 12-Year Follow-up Analysis. Am J Sports Med 2024; 52:1137-1143. [PMID: 38459690 DOI: 10.1177/03635465241232154] [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: 03/10/2024]
Abstract
BACKGROUND Little is known about the effect of modern hip arthroscopy on the natural history of femoroacetabular impingement syndrome (FAIS) with respect to joint preservation. PURPOSE To (1) characterize the natural history of FAIS and (2) understand the effect of modern hip arthroscopy by radiographically comparing the hips of patients who underwent only unilateral primary hip arthroscopy with a minimum follow-up of 10 years. STUDY DESIGN Cohort study; Level of evidence, 3. METHODS Between 2010 and 2012, 619 consecutive patients were reviewed from the practice of a single fellowship-trained hip arthroscopic surgeon. Inclusion criteria were FAIS, bilateral radiographic findings of femoroacetabular impingement, primary unilateral hip arthroscopy (labral repair, femoroplasty, or capsular closure), and minimum 10-year follow-up. The preoperative and minimum 10-year postoperative radiographs of patients were evaluated at each time point. Both operative and nonoperative hips were graded using the Tönnis classification or the presence of hip arthroplasty by 2 independent reviewers. Subgroup analyses were performed. RESULTS A total of 200 hips from 100 patients were evaluated at a mean follow-up of 12.0 years. Preoperatively, 98% and 99% of operative and nonoperative hips were evaluated as Tönnis grades 0 and 1, respectively; 5% of nonoperative hips had worse Tönnis grades than operative hips. The nonoperative hip advanced to a worse Tönnis grade in 48% (48/100) of cases compared with 28% (28/100) among operative hips. At follow-up, Tönnis grades between hips were equal in 70% (70/100) of the cases, the operative hip had a better grade 25% (25/100) of the time, and the nonoperative hip had a better grade 5% (5/100) of the time. Modern hip arthroscopy was associated with a relative risk reduction of 42% in osteoarthritis progression. Impingement with borderline dysplasia, age, preoperative Tönnis grade, and alpha angle >65° were key risk factors in the radiographic progression of osteoarthritis. CONCLUSION Although the majority of patients (70%) undergoing hip arthroscopy for FAIS did not experience differences between operative and nonoperative hips in terms of the radiographic progression of osteoarthritis, the natural history may be favorably altered for 25% of patients whose Tönnis grade was better after undergoing arthroscopic correction. Modern hip arthroscopy indications and techniques represent a valid joint-preservation procedure conferring a relative risk reduction of 42% in the progression of osteoarthritis. Arthroscopy for mixed patterns of impingement and instability were the fastest to degenerate.
Collapse
Affiliation(s)
- Prem N Ramkumar
- Center for Hip Preservation, Hospital for Special Surgery, New York, New York, USA
- Long Beach Orthopaedic Institute, Long Beach, California, USA
| | - Reena J Olsen
- Center for Hip Preservation, Hospital for Special Surgery, New York, New York, USA
| | | | - Danyal H Nawabi
- Center for Hip Preservation, Hospital for Special Surgery, New York, New York, USA
| | - Bryan T Kelly
- Center for Hip Preservation, Hospital for Special Surgery, New York, New York, USA
| |
Collapse
|
4
|
Herring SA, Kibler WB, Putukian M, Boyajian-O'Neill LA, Chang CJ, Franks RR, Hutchinson M, Indelicato PA, O'Connor FG, Powell A, Roach R, Safran M, Statuta SM, Sutton K. Initial Assessment and Management of Select Musculoskeletal Injuries: A Team Physician Consensus Statement. Med Sci Sports Exerc 2024; 56:385-401. [PMID: 37847756 DOI: 10.1249/mss.0000000000003324] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2023]
Abstract
ABSTRACT Musculoskeletal injuries occur frequently in sport during practice, training, and competition. Injury assessment and management are common responsibilities for the team physician. Initial Assessment and Management of Musculoskeletal Injury-A Team Physician Consensus Statement is title 23 in a series of annual consensus documents written for the practicing team physician. This statement was developed by the Team Physician Consensus Conference, an annual project-based alliance of six major professional associations. The goal of this document is to help the team physician improve the care and treatment of the athlete by understanding the initial assessment and management of selected musculoskeletal injuries.
Collapse
|
5
|
Herring SA, Kibler WB, Putukian M, Boyajian-O'Neill LA, Chang CJ, Franks RR, Hutchinson M, Indelicato PA, O'Connor FG, Powell A, Roach R, Safran M, Statuta SM, Sutton K. Initial Assessment and Management of Select Musculoskeletal Injuries: A Team Physician Consensus Statement. Curr Sports Med Rep 2024; 23:86-104. [PMID: 38437494 DOI: 10.1249/jsr.0000000000001151] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/06/2024]
Abstract
ABSTRACT Musculoskeletal injuries occur frequently in sport during practice, training, and competition. Injury assessment and management are common responsibilities for the team physician. Initial Assessment and Management of Musculoskeletal Injury-A Team Physician Consensus Statement is title 23 in a series of annual consensus documents written for the practicing team physician. This statement was developed by the Team Physician Consensus Conference, an annual project-based alliance of six major professional associations. The goal of this document is to help the team physician improve the care and treatment of the athlete by understanding the initial assessment and management of selected musculoskeletal injuries.
Collapse
|
6
|
Hoy MK, Desai V, Mutasa S, Hoy RC, Gorniak R, Belair JA. Deep Learning-Assisted Identification of Femoroacetabular Impingement (FAI) on Routine Pelvic Radiographs. JOURNAL OF IMAGING INFORMATICS IN MEDICINE 2024; 37:339-346. [PMID: 38343231 DOI: 10.1007/s10278-023-00920-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/04/2023] [Revised: 08/08/2023] [Accepted: 08/22/2023] [Indexed: 03/02/2024]
Abstract
To use a novel deep learning system to localize the hip joints and detect findings of cam-type femoroacetabular impingement (FAI). A retrospective search of hip/pelvis radiographs obtained in patients to evaluate for FAI yielded 3050 total studies. Each hip was classified separately by the original interpreting radiologist in the following manner: 724 hips had severe cam-type FAI morphology, 962 moderate cam-type FAI morphology, 846 mild cam-type FAI morphology, and 518 hips were normal. The anteroposterior (AP) view from each study was anonymized and extracted. After localization of the hip joints by a novel convolutional neural network (CNN) based on the focal loss principle, a second CNN classified the images of the hip as cam positive, or no FAI. Accuracy was 74% for diagnosing normal vs. abnormal cam-type FAI morphology, with aggregate sensitivity and specificity of 0.821 and 0.669, respectively, at the chosen operating point. The aggregate AUC was 0.736. A deep learning system can be applied to detect FAI-related changes on single view pelvic radiographs. Deep learning is useful for quickly identifying and categorizing pathology on imaging, which may aid the interpreting radiologist.
Collapse
Affiliation(s)
| | - Vishal Desai
- Thomas Jefferson University, Philadelphia, PA, USA
| | | | - Robert C Hoy
- Temple University Hospital, Philadelphia, PA, USA
| | | | | |
Collapse
|
7
|
Ruzbarsky JJ, Comfort SM, Rutledge JC, Shelton TJ, Day HK, Dornan GJ, Matta JM, Philippon MJ. Improved Functional Outcomes of Combined Hip Arthroscopy and Periacetabular Osteotomy at Minimum 2-Year Follow-Up. Arthroscopy 2024; 40:352-358. [PMID: 37392802 DOI: 10.1016/j.arthro.2023.06.034] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/09/2023] [Revised: 06/16/2023] [Accepted: 06/17/2023] [Indexed: 07/03/2023]
Abstract
PURPOSE To evaluate patient-reported outcomes (PROs) and survivorship at minimum 2-year follow-up after combined hip arthroscopy and periacetabular osteotomy (PAO) performed in the setting of a single anesthetic event. METHODS Patients who underwent combined hip arthroscopy (M.J.P.) and PAO (J.M.M.) between January 2017 and June 2020 were identified. Preoperative and minimum 2-year postoperative PROs including Hip Outcome Score-Activities of Daily Living (HOS-ADL), HOS-Sport, modified Harris Hip Score (mHHS), Western Ontario and McMaster Universities Osteoarthritis Index, 12-Item Short Form Survey Mental Component Scores (SF-12 MCS), and 12-Item Short Form Survey Physical Component Score were collected and compared in addition to revision rate, conversion to total hip arthroplasty (THA), and patient satisfaction. RESULTS Twenty-four of 29 patients (83%) eligible for the study were available for 2-year minimum follow-up with a median follow-up time of 2.5 years (range, 2.0-5.0). There were 19 females and 5 males with mean age of 31 ± 12 years. Mean preoperative lateral center edge angle was 20° ± 5° and alpha angle was 71° ± 11°. One patient underwent reoperation for removal of a symptomatic iliac crest screw at 11.7 months after operation. Two patients, a 33-year-old woman and a 37-year-old man, were converted to THA at 2.6 and 1.3 years, respectively, following the combined procedure. Both patients had a Tönnis grade of 1 on radiographs, as well as bipolar Outerbridge grade III/IV defects requiring microfracture of the acetabulum. For patients who did not convert to THA (n = 22), there was significant improvement from before to after surgery for all scores (P < .05) except SF-12 MCS. The minimal clinically significant difference and patient-acceptable symptom state rates for HOS-ADL, HOS-Sport, and mHHS were 72%, 82%, 86%, and 95%, 91%, and 95%, respectively. Median patient satisfaction was 10 (range, 4 to 10). CONCLUSIONS Single-stage combined hip arthroscopy with periacetabular osteotomy for patients with symptomatic hip dysplasia results in improvement in PROs and arthroplasty free survivorship of 92% at median 2.5 year follow-up. LEVEL OF EVIDENCE Level IV, case series.
Collapse
Affiliation(s)
- Joseph J Ruzbarsky
- Steadman Philippon Research Institute, Vail, Colorado, U.S.A.; Steadman Clinic and United States Coalition for the Prevention of Illness and Injury in Sport, Vail, Colorado, U.S.A
| | | | - Joan C Rutledge
- Steadman Philippon Research Institute, Vail, Colorado, U.S.A
| | - Trevor J Shelton
- Steadman Philippon Research Institute, Vail, Colorado, U.S.A.; Steadman Clinic and United States Coalition for the Prevention of Illness and Injury in Sport, Vail, Colorado, U.S.A
| | - Hannah K Day
- Steadman Philippon Research Institute, Vail, Colorado, U.S.A
| | - Grant J Dornan
- Steadman Philippon Research Institute, Vail, Colorado, U.S.A
| | - Joel M Matta
- Steadman Philippon Research Institute, Vail, Colorado, U.S.A
| | - Marc J Philippon
- Steadman Philippon Research Institute, Vail, Colorado, U.S.A.; Steadman Clinic and United States Coalition for the Prevention of Illness and Injury in Sport, Vail, Colorado, U.S.A..
| |
Collapse
|
8
|
Schamberger CT, Tuffs C, Suda AJ, Grossner T, Schmidmaier G, Stein S. Association of Chondrolabral Lesions with Ultrasound-Guided Detection of Pathological Head-Neck Contour. Diagnostics (Basel) 2023; 13:3334. [PMID: 37958230 PMCID: PMC10649636 DOI: 10.3390/diagnostics13213334] [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: 10/17/2023] [Accepted: 10/25/2023] [Indexed: 11/15/2023] Open
Abstract
OBJECTIVE This study aimed to investigate whether the asphericity of the neck-head junction of the femur confirmed via ultrasound is associated with further pathology due to femoro-acetabular impingement (FAI). METHODOLOGY After a clinical examination with positive FAI tests, an ultrasound examination of the hip was performed. In the case of asphericity, a quantitative ultrasound-assisted assessment of the hip was performed, followed by contrast-enhanced arthro-MRI with the question of cartilage or labral damage. RESULTS AND CONCLUSIONS We included 51 patients with a mean age of 35.25. According to the examination algorithm, asphericity was present in all patients via ultrasonography. The average anterior alpha angle (AAA) determined in ultrasonography was 43.49°. The average AAA on the arthro-MRI was 44.19°. The mean anterior head neck offset (AHNO) in ultrasound was 5.27 mm, and in arthro-MRI, it was 5.36 mm. Arthro-MRI confirmed a bump in 47 patients and a talization disorder in 4 patients. In 49 patients, a labral lesion was found, with one being a re-rupture. Furthermore, in one patient, labral degeneration was identified. Cartilage damage to the hip joint was found in 25 patients. Two patients had neither labral nor cartilage damage in the arthro-MRI. In our study, sonographically confirmed asphericity of the head-neck junction was found in 49 cases, which was associated with further pathology and, according to the current doctrine, was attributable to the FAI and required surgical intervention. This study shows that the detection of a pathologic head and neck contour via ultrasound in combination with positive clinical signs, as present in FAI, is associated with chondrolabral lesions detected via arthro-MRI in 96.1% of cases.
Collapse
Affiliation(s)
- Christian T. Schamberger
- Clinic for Trauma and Reconstructive Surgery, University Hospital Heidelberg, 69118 Heidelberg, Germany
| | - Christopher Tuffs
- Department of General, Visceral and Transplantation Surgery, University Hospital Heidelberg,
69120 Heidelberg, Germany
| | - Arnold J. Suda
- Department of Orthopaedics and Trauma Surgery, AUVA Trauma Center Salzburg, 5010 Salzburg, Austria
| | - Tobias Grossner
- Clinic for Trauma and Reconstructive Surgery, University Hospital Heidelberg, 69118 Heidelberg, Germany
| | - Gerhard Schmidmaier
- Clinic for Trauma and Reconstructive Surgery, University Hospital Heidelberg, 69118 Heidelberg, Germany
| | - Stephan Stein
- Clinic for Trauma and Reconstructive Surgery, University Hospital Heidelberg, 69118 Heidelberg, Germany
| |
Collapse
|
9
|
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.
Collapse
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.
| |
Collapse
|
10
|
Ramkumar PN, Berrier AS, Helm JM, Koolmees DS, Pareek A, Krych AJ, Makhni EC, Harris JD, Nwachukwu BU. Evaluating the Need for Preoperative MRI Before Primary Hip Arthroscopy in Patients 40 Years and Younger With Femoroacetabular Impingement Syndrome: A Multicenter Comparative Analysis. Orthop J Sports Med 2023; 11:23259671221144776. [PMID: 36655021 PMCID: PMC9841845 DOI: 10.1177/23259671221144776] [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: 09/11/2022] [Accepted: 09/26/2022] [Indexed: 01/13/2023] Open
Abstract
Background Routine hip magnetic resonance imaging (MRI) before arthroscopy for patients with femoroacetabular impingement syndrome (FAIS) offers questionable clinical benefit, delays surgery, and wastes resources. Purpose To assess the clinical utility of preoperative hip MRI for patients aged ≤40 years who were undergoing primary hip arthroscopy and who had a history, physical examination findings, and radiographs concordant with FAIS. Study Design Cohort study; Level of evidence, 3. Methods Included were 1391 patients (mean age, 25.8 years; 63% female; mean body mass index, 25.6) who underwent hip arthroscopy between August 2015 and December 2021 by 1 of 4 fellowship-trained hip surgeons from 4 referral centers. Inclusion criteria were FAIS, primary surgery, and age ≤40 years. Exclusion criteria were MRI contraindication, reattempt of nonoperative management, and concomitant periacetabular osteotomy. Patients were stratified into those who were evaluated with preoperative MRI versus those without MRI. Those without MRI received an MRI before surgery without deviation from the established surgical plan. All preoperative MRI scans were compared with the office evaluation and intraoperative findings to assess agreement. Time from office to arthroscopy and/or MRI was recorded. MRI costs were calculated. Results Of the study patients, 322 were not evaluated with MRI and 1069 were. MRI did not alter surgical or interoperative plans. Both groups had MRI findings demonstrating anterosuperior labral tears treated intraoperatively (99.8% repair, 0.2% debridement, and 0% reconstruction). Compared with patients who were evaluated with MRI and waited 63.0 ± 34.6 days, patients who were not evaluated with MRI underwent surgery 6.5 ± 18.7 days after preoperative MRI. MRI delayed surgery by 24.0 ± 5.3 days and cost a mean $2262 per patient. Conclusion Preoperative MRI did not alter indications for primary hip arthroscopy in patients aged ≤40 years with a history, physical examination findings, and radiographs concordant with FAIS. Rather, MRI delayed surgery and wasted resources. Routine hip MRI acquisition for the younger population with primary FAIS with a typical presentation should be challenged.
Collapse
Affiliation(s)
- Prem N. Ramkumar
- Department of Orthopaedic Surgery, Brigham & Women’s Hospital, Boston, Massachusetts, USA
- Center for Hip Preservation, Hospital for Special Surgery, New York, New York, USA
- Prem N. Ramkumar, MD, MBA, Department of Orthopaedic Surgery, Brigham & Women’s Hospital, 75 Francis Street, Boston, MA 02115, USA () (Twitter: @prem_ramkumar)
| | - Ava S. Berrier
- Department of Orthopaedic Surgery, Baylor College of Medicine, Houston, Texas, USA
| | - J. Matthew Helm
- Department of Orthopaedic Surgery, McGovern Medical School University of Texas Health Science Center, Houston, Texas, USA
| | - Dylan S. Koolmees
- Department of Orthopaedic Surgery, Henry Ford Hospital, Detroit, Michigan, USA
| | - Ayoosh Pareek
- Department of Orthopedic Surgery & Sports Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | - Aaron J. Krych
- Department of Orthopedic Surgery & Sports Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | - Eric C. Makhni
- Department of Orthopaedic Surgery, Henry Ford Hospital, Detroit, Michigan, USA
| | - Joshua D. Harris
- Houston Methodist Orthopedics & Sports Medicine, Houston, Texas, USA
| | | |
Collapse
|
11
|
Hassan MM, Farooqi AS, Feroe AG, Lee A, Cusano A, Novais E, Wuerz TH, Kim YJ, Parisien RL. Open and arthroscopic management of femoroacetabular impingement: a review of current concepts. J Hip Preserv Surg 2022; 9:265-275. [PMID: 36908557 PMCID: PMC9993460 DOI: 10.1093/jhps/hnac043] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/07/2022] [Revised: 08/09/2022] [Accepted: 10/05/2022] [Indexed: 03/14/2023] Open
Abstract
Femoroacetabular impingement (FAI) is a common femoral and/or acetabular abnormality that can cause progressive damage to the hip and osteoarthritis. FAI can be the result of femoral head/neck overgrowth, acetabular overgrowth or both femoral and acetabular abnormalities, resulting in a loss of native hip biomechanics and pain upon hip flexion and rotation. Radiographic evidence can include loss of sphericity of the femoral neck (cam impingement) and/or acetabular retroversion with focal or global overcoverage (pincer impingement). Operative intervention is indicated in symptomatic patients after failed conservative management with radiographic evidence of impingement and minimal arthritic changes of the hip, with the goal of restoring normal hip biomechanics and reducing pain. This is done by correcting the femoral head-neck relationship to the acetabulum through femoral and/or acetabular osteoplasty and treatment of concomitant hip pathology. In pincer impingement cases with small lunate surfaces, reverse periacetabular osteotomy is indicated as acetabular osteoplasty can decrease an already small articular surface. While surgical dislocation is regarded as the traditional gold standard, hip arthroscopy has become widely utilized in recent years. Studies comparing both open surgery and arthroscopy have shown comparable long-term pain reduction and improvements in clinical measures of hip function, as well as similar conversion rates to total hip arthroplasty. However, arthroscopy has trended toward earlier improvement, quicker recovery and faster return to sports. The purpose of this study was to review the recent literature on open and arthroscopic management of FAI.
Collapse
Affiliation(s)
- Mahad M Hassan
- TRIA Orthopedic Center, 8100 Northland Dr, Bloomington, MN 55431, USA.,Department of Orthopaedic Surgery, University of Minnesota Medical School, 2450 Riverside Ave, Suite R200, Minneapolis, MN 55454, USA
| | - Ali S Farooqi
- Perelman School of Medicine at the University of Pennsylvania, 3400 Civic Center Blvd, Philadelphia, PA 19104, USA
| | - Aliya G Feroe
- Department of Orthopedic Surgery, Mayo Clinic, 200 1st St SW, Rochester, MN 55905, USA.,Department of Orthopaedic Surgery, Boston Children's Hospital, Harvard Medical School, 300 Longwood Avenue, Boston, MA 02115, USA
| | - Alexander Lee
- Perelman School of Medicine at the University of Pennsylvania, 3400 Civic Center Blvd, Philadelphia, PA 19104, USA
| | - Antonio Cusano
- University of Connecticut School of Medicine, 200 Academic Way, Farmington, CT 06032, USA
| | - Eduardo Novais
- Department of Orthopaedic Surgery, Boston Children's Hospital, Harvard Medical School, 300 Longwood Avenue, Boston, MA 02115, USA
| | - Thomas H Wuerz
- Boston Sports & Shoulder Center, 840 Winter St, Waltham, MA 02451, USA
| | - Young-Jo Kim
- Department of Orthopaedic Surgery, Boston Children's Hospital, Harvard Medical School, 300 Longwood Avenue, Boston, MA 02115, USA
| | - Robert L Parisien
- Department of Orthopaedic Surgery and Sports Medicine, 5 East 98th Street, Mount Sinai, New York, NY 10029, USA
| |
Collapse
|
12
|
Ramkumar PN, Helm JM, Berrier AS, Vega JF, Yalcin S, Kunze KN, Harris JD, Nwachukwu BU. Preoperative Magnetic Resonance Imaging Offers Questionable Clinical Utility, Delays Time to Hip Arthroscopy, and Lacks Cost-Effectiveness in Patients Aged ≤40 Years With Femoroacetabular Impingement Syndrome: A Retrospective 5-Year Analysis. Arthroscopy 2022; 38:3013-3019. [PMID: 35364263 DOI: 10.1016/j.arthro.2022.03.025] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/06/2022] [Revised: 03/11/2022] [Accepted: 03/11/2022] [Indexed: 02/02/2023]
Abstract
PURPOSE To assess the clinical utility of preoperative magnetic resonance imaging (MRI) and quantify the delay in surgical care for patients aged ≤40 years undergoing primary hip arthroscopy with history, physical examination, and radiographs concordant with femoroacetabular impingement syndrome (FAIS). METHODS From August 2015 to December 2020, 1,786 consecutive patients were reviewed from the practice of 1 fellowship-trained hip arthroscopist. Inclusion criteria were FAIS, primary surgery, and age ≤40 years. Exclusion criteria were MRI contraindication, reattempt of conservative management, or concomitant periacetabular osteotomy. After nonoperative treatment options were exhausted and a surgical plan was established, patients were stratified by those who presented with versus without MRI. Those without existing MRI received one, and any deviations from the surgical plan were noted. All preoperative MRIs were compared with office evaluation and intraoperative findings to assess agreement. Demographic data, Hip Disability and Osteoarthritis Outcome Score (HOOS)-Pain, and time from office to MRI or arthroscopy were recorded. RESULTS Of the patients indicated by history, physical examination, and radiographs alone (70% female, body mass index 24.8 kg/m2, age 25.9 years), 198 patients presented without MRI and 934 with MRI. None of the 198 had surgical plans altered after MRI. Patients in both groups had MRI findings demonstrating anterosuperior labral tears that were visualized and repaired intraoperatively. Mean time from office to arthroscopy for patients without MRI versus those with was 107.0 ± 67 and 85.0 ± 53 days, respectively (P < .001). Time to MRI was 22.8 days. No difference between groups was observed among the 85% of patients who surpassed the HOOS-Pain minimal clinically important difference (MCID). CONCLUSION Once indicated for surgery based on history, physical examination, and radiographs, preoperative MRI did not alter the surgical plan for patients aged ≤40 years with FAIS undergoing primary hip arthroscopy. Moreover, preoperative MRI delayed time to arthroscopy. The necessity of routine preoperative MRI in the young primary FAIS population should be challenged.
Collapse
Affiliation(s)
- Prem N Ramkumar
- Department of Orthopaedic Surgery, Brigham & Women's Hospital, Boston, Massachusetts, U.S.A.; Center for Hip Preservation, Hospital for Special Surgery, New York, New York, U.S.A..
| | - J Matthew Helm
- Department of Orthopaedic Surgery, McGovern Medical School University of Texas Health Science Center, Houston, Texas, U.S.A
| | - Ava S Berrier
- Department of Orthopaedic Surgery, Baylor College of Medicine, Houston, Texas, U.S.A
| | - Jose F Vega
- Sports Health Center, Cleveland Clinic, Cleveland, Ohio, U.S.A
| | - Sercan Yalcin
- Department of Sports Medicine, Yale School of Medicine, New Haven, Connecticut, U.S.A
| | - Kyle N Kunze
- Center for Hip Preservation, Hospital for Special Surgery, New York, New York, U.S.A
| | - Joshua D Harris
- Houston Methodist Orthopedics & Sports Medicine, Houston, Texas, U.S.A
| | - Benedict U Nwachukwu
- Center for Hip Preservation, Hospital for Special Surgery, New York, New York, U.S.A
| |
Collapse
|
13
|
Fortier LM, Popovsky D, Durci MM, Norwood H, Sherman WF, Kaye AD. An Updated Review of Femoroacetabular Impingement Syndrome. Orthop Rev (Pavia) 2022; 14:37513. [PMID: 36034731 PMCID: PMC9404268 DOI: 10.52965/001c.37513] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2023] Open
Abstract
Femoroacetabular impingement (FAI) is a chronic hip condition caused by femoral head and acetabular malformations resulting in abnormal contact across the joint. FAI often leads to labral, cartilaginous, and tissue damage that predispose this patient population to early osteoarthritis (OA). There are a variety of factors that increase the risk for FAI including younger age, Caucasian background, familial FAIS morphology, and competing in high-intensity sports during adolescence. Slow-onset, persistent groin pain is the most frequent initial presenting symptom. On physical examination, patients will typically have a positive FADIR test (flexion, adduction, internal rotation), also known as a positive impingement sign. FAI syndrome can be organized into three classifications; cam, pincer, or mixed. This classification refers to the characteristic morphological changes of the bony structures. The primary imaging modality for diagnosing FAI is a plain radiograph of the pelvis, which can be used to measure the alpha angle and the lateral center edge angle used to quantify severity. Conservative treatment is typically considered first-line treatment for mild to moderate FAI syndrome; however, the outcomes following postoperative surgical intervention have demonstrated excellent results. The most common surgical treatment option for FAI is done arthroscopically.
Collapse
Affiliation(s)
| | | | - Maggie M Durci
- Louisiana State University Shreveport School of Medicine
| | - Haley Norwood
- Louisiana State University Shreveport School of Medicine
| | | | - Alan D Kaye
- Department of Anesthesiology, Louisiana State University Health Shreveport
| |
Collapse
|
14
|
Outcomes in Pediatric Hip FAI Surgery: a Scoping Review. Curr Rev Musculoskelet Med 2022; 15:362-368. [PMID: 35917094 DOI: 10.1007/s12178-022-09771-6] [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: 06/01/2022] [Indexed: 10/16/2022]
Abstract
PURPOSE OF REVIEW Femoracetabular impingement (FAI) is a common source of hip pain in children and adolescents. While nonoperative therapies and open surgical procedures can be effective, hip arthroscopy is a minimally invasive treatment option with substantial benefit. The purpose of this paper is to evaluate the current role of hip arthroscopy in treating FAI within the pediatric population. This article examines its efficacy through a review of hip arthroscopy outcomes in the contemporary orthopaedic literature. RECENT FINDINGS Morphologic changes in the acetabulum and proximal femur seen in FAI can be attributed to a multitude of etiologies-including idiopathic FAI, Legg-Calve-Perthes, and slipped capital femoral epiphysis. In general, arthroscopic treatment of FAI secondary to these conditions leads to statistically significant improvements in pain and patient-reported outcomes in the short and long term. In the pediatric athlete, repetitive stress on the hip perpetuates FAI and can drastically hinder performance. Hip arthroscopy allows for a high rate of return to sport with minimal morbidity in this population. Overall, pediatric hip arthroscopy is effective in treating FAI secondary to a wide variety of conditions. Despite its clinical benefits, patients and their families should be counseled regarding alternative treatments, potential complications, and return to play.
Collapse
|
15
|
Cheah JW, Danilkowicz R, Hutyra C, Lewis B, Olson S, Poehlein E, Green CL, Mather R. High Prevalence of Sleep Disturbance Is Associated with Femoroacetabular Impingement Syndrome. Arthrosc Sports Med Rehabil 2022; 4:e495-e501. [PMID: 35494310 PMCID: PMC9042751 DOI: 10.1016/j.asmr.2021.11.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2021] [Accepted: 11/01/2021] [Indexed: 10/24/2022] Open
|
16
|
Buzin S, Shankar D, Vasavada K, Youm T. Hip Arthroscopy for Femoroacetabular Impingement-Associated Labral Tears: Current Status and Future Prospects. Orthop Res Rev 2022; 14:121-132. [PMID: 35480069 PMCID: PMC9037737 DOI: 10.2147/orr.s253762] [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: 01/18/2022] [Accepted: 04/02/2022] [Indexed: 12/03/2022] Open
Abstract
Femoroacetabular impingement (FAI) has emerged as a common cause of hip pain, especially in young patients. While the exact cause of FAI is unknown, it is thought to result from repetitive microtrauma to the proximal femoral epiphysis leading to abnormal biomechanics. Patients typically present with groin pain that is exacerbated by hip flexion and internal rotation. Diagnosis of FAI is made through careful consideration of patient presentation as well as physical exam and diagnostic imaging. Use of radiographs can help diagnose both cam and pincer lesions, while the use of MRI can diagnose labral tears and cartilage damage associated with FAI. Both non-operative and surgical options have their role in the treatment of FAI and its associated labral tears; however, hip arthroscopy has had successful outcomes when compared with physical therapy alone. Unfortunately, chondral lesions associated with FAI have had poorer outcomes with a higher conversion rate to arthroplasty. Capsular closure following hip arthroscopy has shown superior clinical outcomes and therefore should be performed if possible. More recently, primary labral reconstruction has emerged in the literature as a good option for irreparable labral tears. While non-operative management may have its role in treating patients with FAI, hip arthroscopy has developed a successful track record in being able to treat cam and pincer lesions, chondral damage, and labral injuries.
Collapse
Affiliation(s)
- Scott Buzin
- Department of Orthopaedic Surgery, NYU Langone Health, New York, NY, USA
| | - Dhruv Shankar
- Department of Orthopaedic Surgery, NYU Langone Health, New York, NY, USA
| | - Kinjal Vasavada
- Department of Orthopaedic Surgery, NYU Langone Health, New York, NY, USA
| | - Thomas Youm
- Department of Orthopaedic Surgery, NYU Langone Health, New York, NY, USA
- Correspondence: Thomas Youm, Department of Orthopaedic Surgery, NYU Langone Health, New York, NY, USA, Tel +1 212-348-3636, Email
| |
Collapse
|
17
|
Vasavada K, Ross KA, Lott A, Shankar D, Marulanda D, Mojica ES, Carter CW, Borowski L, Gonzalez-Lomas G. Characterizing femoroacetabular impingement in professional Nordic Skiers. PHYSICIAN SPORTSMED 2022; 51:285-290. [PMID: 35324395 DOI: 10.1080/00913847.2022.2056770] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
OBJECTIVE Studies have shown a high prevalence of femoroacetabular impingement (FAI) among elite athletes yet there is a paucity of data on FAI in Nordic skiers. The purpose of this study was to determine the prevalence of radiographic FAI in professional Nordic Combined Skiers and Ski jumpers compared to controls and assess functional outcomes including hip range of motion (ROM) and pain in patients with radiographic evidence of FAI compared to those without it. METHODS A cohort of elite Nordic Skiers underwent medical history, physical examination, and pelvic radiographs at their visit with a fellowship-trained sports medicine physician. On pelvis radiographs, Alpha angle>55 degrees was deemed cam-positive, and positive crossover signs, Tönnis<0, or LCEA>40 were deemed pincer positive. Further stratification was performed by sex, ski event type, hip pain, presence of cam lesions, and presence of pincer lesions. Spearman correlation matrix was performed to measure the association between radiographic measurements and ROM. RESULTS Nineteen Nordic skiers and nineteen age, sex, and BMI matched controls were included in the study. There were no significant differences in age, sex, BMI, and hip pain between groups. While Nordic skiers demonstrated decreased ROM bilaterally on external rotation compared to controls, skiers had larger ROM bilaterally on extension, abduction, adduction compared to controls. Skiers were significantly more likely to have bilateral crossover sign and alpha angles>55 compared to controls. Subgroup analysis showed that Cam positive patients had higher flexion and adduction ROM and pincer positive patients had significantly higher flexion and abduction ROM compared to patients without cam and pincer lesions respectively. Patients with hip pain had significantly lower right hip abduction ROM compared to patients without hip pain. No significant correlations were seen between radiographic measurements and ROM. CONCLUSION Similar to other elite 'hip heavy' sport athletes, Nordic skiers gave a notably higher prevalence of radiographic cam and pincer type morphology and significantly higher ROM compared to nonathletic controls. Clinicians evaluating Nordic skiers should be aware of these baseline findings with respect to a possible elevated long-term risk of symptomatic FAI in these athletes as well as other conditions related to radiographic FAI.
Collapse
Affiliation(s)
- Kinjal Vasavada
- Department of Orthopedic Surgery, New York University School of Medicine, New York, NY, USA
| | - Keir Alexander Ross
- Department of Orthopedic Surgery, New York University School of Medicine, New York, NY, USA
| | - Ariana Lott
- Department of Orthopedic Surgery, New York University School of Medicine, New York, NY, USA
| | - Dhruv Shankar
- Department of Orthopedic Surgery, New York University School of Medicine, New York, NY, USA
| | - David Marulanda
- Department of Orthopedic Surgery, New York University School of Medicine, New York, NY, USA
| | - Edward S Mojica
- Department of Orthopedic Surgery, New York University School of Medicine, New York, NY, USA
| | - Cordelia W Carter
- Department of Orthopedic Surgery, New York University School of Medicine, New York, NY, USA
| | - Lauren Borowski
- Department of Orthopedic Surgery, New York University School of Medicine, New York, NY, USA
| | - Guillem Gonzalez-Lomas
- Department of Orthopedic Surgery, New York University School of Medicine, New York, NY, USA
| |
Collapse
|
18
|
Riedl M, Fickert S. Bedeutung des femoroazetabulären Impingements im Sport. ARTHROSKOPIE 2022. [DOI: 10.1007/s00142-022-00522-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
|
19
|
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: 73] [Impact Index Per Article: 36.5] [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.
Collapse
Affiliation(s)
| | | | - Brian Serrano
- Cedars Sinai-Kerlan Jobe Institute, Los Angeles, California
| | - Michael Banffy
- Cedars Sinai-Kerlan Jobe Institute, Los Angeles, California
| |
Collapse
|
20
|
Ratcliff TL, Chhabra A, Okpara SO, Lawson P, Kayfan S, Xi Y, Mulligan EP, Wells JE. Correlation of the Imaging Features of Femoroacetabular Impingement Syndrome With Clinical Findings and Patient Functional Scores. Orthopedics 2021; 44:e577-e582. [PMID: 34292835 DOI: 10.3928/01477447-20210618-20] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
The relationship among the severity of the imaging features of femoroacetabular impingement syndrome (FAIS), patient symptoms, and function has not been elucidated. Understanding this relationship helps to improve the prognostic value of imaging. The goal of this study was to examine the correlation of clinical findings, patient pain, and function with severity, as measured with radiographic and 3-dimensional magnetic resonance imaging (3D-MRI). Data collected prospectively through a longitudinally maintained hip database were reviewed, and 37 hips from 31 patients were included. All patients were examined by an experienced orthopedic surgeon, and preoperative radiographs and 3D-MRI were obtained. Preoperatively, the patients completed validated patient-reported outcome measures (PROMs). Mean±SD alpha angles were 69.4°±10.3°, 70.0°±10.3°, 70.6°±8.4°, and 74.8°±9.2° at 12 o'clock, 1 o'clock, 2 o'clock, and 3 o'clock, respectively. Mean lateral center edge angle was 30.1°±5.3°. The authors did not observe a statistically significant correlation between PROMs and the features measured by radiographs and 3D-MRI (P>.05). In this subset of prospectively imaged patients with FAIS, the authors did not find a correlation between the severity of symptoms measured by PROMs and features on radiographs and 3D-MRI. The severity of dysfunction is multifactorial, and anatomic severity, as measured radiographically and with 3D-MRI, may not correlate with symptoms. Further investigation is necessary to address the sources of patient pain. [Orthopedics. 2021;44(4):e577-e582.].
Collapse
|
21
|
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.
Collapse
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
| |
Collapse
|
22
|
Migliorini F, Liu Y, Catalano G, Trivellas A, Eschweiler J, Tingart M, Maffulli N. Medium-term results of arthroscopic treatment for femoroacetabular impingement. Br Med Bull 2021; 138:68-84. [PMID: 33454746 DOI: 10.1093/bmb/ldaa038] [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: 05/16/2020] [Revised: 05/16/2020] [Accepted: 10/24/2020] [Indexed: 11/14/2022]
Abstract
INTRODUCTION Femoroacetabular impingement (FAI) is a dynamic pathomechanical process of the femoral head-neck junction. Arthroscopic surgery for FAI has increased exponentially in the last decade, and this trend is expected to increase. SOURCE OF DATA Recent published literatures. AREAS OF AGREEMENT FAI promotes quick rehabilitation and low complication rates in the short-term follow-up. AREAS OF CONTROVERSY Despite the growing interest on arthroscopic surgery for FAI, current evidence regarding the medium- and long-term role of arthroscopy are unsatisfactory. GROWING POINTS Systematically summarize current evidences, analyse the quantitative available data and investigate the medium- and long-term outcomes of arthroscopic surgery for FAI. AREAS TIMELY FOR DEVELOPING RESEARCH Arthroscopic surgery achieves very satisfactory outcomes for patients with FAI at a mean follow-up of 4 years.
Collapse
Affiliation(s)
- Filippo Migliorini
- Department of Orthopaedics, University Clinic Aachen, RWTH Aachen University Clinic, 52074 Aachen, Germany
| | - Yu Liu
- Department of Orthopaedics, University Clinic Aachen, RWTH Aachen University Clinic, 52074 Aachen, Germany
| | - Giovanni Catalano
- Department of Orthopaedics, University Clinic Aachen, RWTH Aachen University Clinic, 52074 Aachen, Germany
| | - Andromahi Trivellas
- Department of Orthopaedics, David Geffen School of Medicine at UCLA, 90095 Los Angeles, CA, USA
| | - Jörg Eschweiler
- Department of Orthopaedics, University Clinic Aachen, RWTH Aachen University Clinic, 52074 Aachen, Germany
| | - Markus Tingart
- Department of Orthopaedics, University Clinic Aachen, RWTH Aachen University Clinic, 52074 Aachen, Germany
| | - Nicola Maffulli
- Department of Medicine, Surgery and Dentistry, University of Salerno, Via S. Allende, Baronissi, SA 84081, Italy.,School of Pharmacy and Bioengineering, Keele University School of Medicine, Thornburrow Drive, ST5 5BG Stoke on Trent, UK.,Queen Mary University of London, Barts and the London School of Medicine and Dentistry, Centre for Sports and Exercise Medicine, Mile End Hospital, 275 Bancroft Road, E1 4DG London, UK
| |
Collapse
|
23
|
Endoscopic Iliotibial Band Release During Hip Arthroscopy for Femoroacetabular Impingement Syndrome and External Snapping Hip Had Better Patient-Reported Outcomes: A Retrospective Comparative Study. Arthroscopy 2021; 37:1845-1852. [PMID: 33539977 DOI: 10.1016/j.arthro.2021.01.040] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/18/2020] [Revised: 01/09/2021] [Accepted: 01/12/2021] [Indexed: 02/02/2023]
Abstract
PURPOSE To compare patient-reported outcomes (PROs) in patients with femoroacetabular impingement (FAI) syndrome and external snapping hip (ESH) treated with hip arthroscopy with or without endoscopic iliotibial band (ITB) release. METHODS Retrospective review case series with both FAI syndrome and ESH who underwent surgical treatment under same indications. According to the primary operation that was determined by patients themselves, the patients undergoing ITB release during hip arthroscopy for FAI syndrome were enrolled in the ITB-R group, and patients undergoing hip arthroscopy without ITB release were enrolled in non-ITB-R group. Patients with dysplasia, severe osteoarthritis, revision, and bilateral surgery were excluded. PROs including international Hip Outcome Tool (iHOT-33), modified Harris Hip Score (mHHS), visual analog scale for pain (VAS-pain) and VAS-satisfaction, and the rates of achieving minimal clinically important difference, patient acceptable symptomatic state (PASS), and substantial clinical benefit for the PROs at 2 years operatively were comparative analyzed. RESULTS The prevalence of ESH in patients with FAI syndrome who underwent hip arthroscopy in our institution was 4.9% (30 of 612 hips). The mean age at the time of surgery was 33.1 ± 6.9 years (range 22-48 years). After exclusion, 16 patients (16 hips) were enrolled into ITB-R group and 11 patients (11 hips) enrolled into non-ITB-R group. PROs including iHOT-33, mHHS, VAS-pain, and VAS-satisfaction in patients in ITB-R group were better than that in non-ITB-R group at 2 years postoperatively (P = .013, .016, .002, and .005, respectively). The rates of achieving PASS for mHHS, PASS for VAS-pain, and substantial clinical benefit for iHOT-33 of patients in ITB-R group were significantly better than that in non-ITB-R group (P = .009, .006, and .027, respectively). CONCLUSIONS Patients with both FAI syndrome and ESH undergoing ITB release during hip arthroscopy had better PROs than those undergoing hip arthroscopy without ITB release. LEVEL OF EVIDENCE Level III, retrospective comparative study.
Collapse
|
24
|
Femoroacetabular Impingement and Core Muscle Injury in Athletes: Diagnosis and Algorithms for Success. Sports Med Arthrosc Rev 2021; 29:9-14. [PMID: 33395224 DOI: 10.1097/jsa.0000000000000294] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Athletic hip injuries account for a substantial portion of missed time from sports in high-level athletes. For both femoroacetabular impingement (FAI) and core muscles injuries, a thorough history and physical examination are paramount to guide the treatment. While advanced imaging including computed tomography and magnetic resonance imaging are frequently obtained, a wealth of information can be ascertained from standard radiographs alone. For patients with isolated or combined FAI and core muscle injuries (CMIs), the initial treatment is often nonoperative and consists of rest, activity modification, and physical therapy of the hips, core, and trunk. Injections may then aid in both confirming diagnosis and temporary symptom abatement. Arthroscopic procedures for refractory FAI in experienced hands have been shown to be both safe and efficacious. While surgical repair options for CMIs are significantly more variable, long-term studies have demonstrated the rapid resolution of symptoms and high return to play rates. More recently, anatomic and clinical correlations between FAI and CMIs have been identified. Special attention must be paid to elite athletes as the incidence of concurrent FAI with CMI is extremely high yet with significant symptom variability. Predictable return to play in athletes with coexisting symptomatic intra-articular and extra-articular symptomatology is incumbent upon the treatment of both pathologies.
Collapse
|
25
|
Amar E, Martin RL, Tudor A, Factor S, Atzmon R, Rath E. Midterm Outcomes and Satisfaction After Hip Arthroscopy Are Associated With Postoperative Rehabilitation Factors. Orthop J Sports Med 2021; 9:2325967120981888. [PMID: 33614802 PMCID: PMC7869163 DOI: 10.1177/2325967120981888] [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: 08/25/2020] [Accepted: 11/03/2020] [Indexed: 11/16/2022] Open
Abstract
Background: Arthroscopic hip-preservation surgery is commonly performed to address
nonarthritic sources of hip pain in young, active individuals. However,
there is little evidence to support postoperative rehabilitation protocols,
including the most appropriate frequency and length of individual formal
physical therapy sessions. There is also a lack of information to look at
patients’ perceived value of their home program/self-practice in relation to
outcomes. Purpose: To investigate postoperative rehabilitation factors after hip arthroscopy
related to formal physical therapy and home program/self-practice and their
correlation with patient outcomes and satisfaction. Study Design: Cohort study; Level of evidence, 3. Methods: A total of 125 patients who underwent hip arthroscopy for femoroacetabular
impingement syndrome and a labral tear (75 men) were included. The mean age
was 34.6 ± 14.4 years, and the mean follow-up time was 4.9 ± 1.6 years. Hip
Outcome Score–Activities of Daily Living subscale (HOS-ADL) scores, overall
satisfaction scores, and factors related to supervised physical therapy and
home program/self-practice were collected. Correlations between continuous
variables and differences in the length of individual formal physical
therapy and patients’ rating of the importance of their home
program/self-practice between those who would and those who would not
undergo surgery again were assessed. Results: The frequency and length of individual formal physical therapy sessions were
significantly correlated with postoperative HOS-ADL scores
(r = 0.22, P = .014; and
r = 0.24, P = .007, respectively) and
level of satisfaction (r = 0.24, P = .007;
and r = 0.21, P = .02, respectively). The
length of individual formal physical therapy sessions was significantly
greater in those who noted they would undergo surgery again (35.3 vs 26.3;
P = .033). A significant correlation was identified
between the rating of the importance of their home program/self-practice and
postoperative HOS-ADL scores (r = 0.29; P
= .001) and their level of satisfaction (r = 0.23;
P = .009). There was a significant difference in the
rating of the importance of their home program/self-practice between those
who would undergo surgery again and those who would not (8.9 vs 7.8;
P = .007). Conclusion: Surgeons and physical therapists should emphasize the value of home
program/self-practice when it comes to outcomes and may want to encourage
their patients to participate in more frequent, longer, formal physical
therapy sessions.
Collapse
Affiliation(s)
- Eyal Amar
- Division of Orthopedic Surgery, Tel Aviv Medical Center Affiliated to Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - RobRoy L Martin
- Department of Physical Therapy, Rangos School of Health Sciences, Duquesne University, Pittsburgh, Pennsylvania, USA
| | - Adrian Tudor
- Division of Orthopedic Surgery, Tel Aviv Medical Center Affiliated to Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Shai Factor
- Division of Orthopedic Surgery, Tel Aviv Medical Center Affiliated to Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Ran Atzmon
- Department of Orthopaedic Surgery, Assuta Medical Center, Ashdod, Israel, Affiliated to Faculty of Health and Science, Ben Gurion University, Beer-Sheva, Israel
| | - Ehud Rath
- Division of Orthopedic Surgery, Tel Aviv Medical Center Affiliated to Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| |
Collapse
|
26
|
Martin C, Sorel A, Touzard P, Bideau B, Gaborit R, DeGroot H, Kulpa R. Can the Open Stance Forehand Increase the Risk of Hip Injuries in Tennis Players? Orthop J Sports Med 2020; 8:2325967120966297. [PMID: 33354579 PMCID: PMC7734511 DOI: 10.1177/2325967120966297] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/20/2020] [Accepted: 08/04/2020] [Indexed: 11/15/2022] Open
Abstract
Background The open stance forehand has been hypothesized by tennis experts (coaches, scientists, and clinicians) to be more traumatic than the neutral stance forehand as regards hip injuries in tennis. However, the influence of the forehand stance (open or neutral) on hip kinematics and loading has not been assessed. Purpose To compare the kinematics and kinetics at the hip joint during 3 common forehand stances (attacking neutral stance [ANS], attacking open stance [AOS], defensive open stance [DOS]) in advanced tennis players to determine whether the open stance forehand induces higher hip loading. Study Design Descriptive laboratory study. Methods The ANS, AOS, and DOS forehand strokes of 8 advanced right-handed tennis players were recorded with an optoelectronic motion capture system. The flexion-extension, abduction-adduction, and external-internal rotation angles as well as intersegmental forces and torques of the right hip were calculated using inverse dynamics. Results The DOS demonstrated significantly higher values than both the ANS and AOS for anterior (P < .001), medial (P < .001), and distractive (P < .001) forces as well as extension (P = .004), abduction (P < .001), and external rotation (P < .001) torques. The AOS showed higher distractive forces than the ANS (P = .048). The DOS showed more extreme angles of hip flexion (P < .001), abduction (P < .001), and external rotation (P = .010). Conclusion The findings of this study imply that the DOS increased hip joint angles and loading, thus potentially increasing the risk of hip overuse injuries. The DOS-induced hip motion could put players at a higher risk of posterior-superior hip impingement compared with the ANS and AOS. Clinical Relevance Coaches and clinicians with players who have experienced hip pain or sustained injuries should encourage them to use a more neutral stance and develop a more aggressive playing style to avoid the DOS, during which hip motion and loading are more extreme.
Collapse
Affiliation(s)
| | - Anthony Sorel
- Univ Rennes, Inria, M2S - EA 7470, F-35000 Rennes, France
| | | | - Benoit Bideau
- Univ Rennes, Inria, M2S - EA 7470, F-35000 Rennes, France
| | | | - Hugo DeGroot
- Univ Rennes, M2S - EA 7470, F-35000 Rennes, France
| | - Richard Kulpa
- Univ Rennes, Inria, M2S - EA 7470, F-35000 Rennes, France
| |
Collapse
|
27
|
Yacovelli S, Parvizi J. Return to Sports After Joint Preservation Hip Surgery. Orthop Clin North Am 2020; 51:427-439. [PMID: 32950212 DOI: 10.1016/j.ocl.2020.06.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
Femoroacetabular impingement results from a mismatch of congruency between the femoral head and the acetabulum. This condition is most common among young, active patients and may lead to pain, decreased quality of life, and inability to participate in athletics. Hip preservation surgery is widely performed is used as a definitive treatment option in athletes at all levels of competition. Athletes have reported high rates of return to play and satisfaction and expect rehabilitation to require approximately 4 to 6 months. This article provides an overview of femoroacetabular impingement, including diagnosis and treatment, with focus on athletes and return to play.
Collapse
Affiliation(s)
- Steven Yacovelli
- The Rothman Institute, Thomas Jefferson University, 925 Chestnut Street, Philadelphia, PA 19107, USA
| | - Javad Parvizi
- The Rothman Institute, Thomas Jefferson University, 925 Chestnut Street, Philadelphia, PA 19107, USA.
| |
Collapse
|
28
|
Dick AG, Smith C, Bankes MJK, George M. The impact of mental health disorders on outcomes following hip arthroscopy for femoroacetabular impingement syndrome: a systematic review. J Hip Preserv Surg 2020; 7:195-204. [PMID: 33163204 PMCID: PMC7605775 DOI: 10.1093/jhps/hnaa016] [Citation(s) in RCA: 26] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/18/2019] [Revised: 01/15/2020] [Accepted: 02/24/2020] [Indexed: 01/11/2023] Open
Abstract
Hip arthroscopy for femoroacetabular impingement syndrome (FAI) has been shown to be beneficial in the short- to medium-term though outcomes vary between individuals. Multiple factors have been suggested to affect outcomes including pre-operative mental health disorders. We undertook a systematic review to assess the evidence relating to the effect of pre-existing mental health disorders on the outcomes following hip arthroscopy for FAI. Following PRISMA guidelines, a multi-database search was undertaken using three key concepts: 'mental health', 'FAI' and 'hip arthroscopy'. Results were screened and data extracted from relevant studies. A total of six studies met the inclusion criteria including 2248 hips, all published between 2017 and 2019. All studies were of evidence level III or IV with reasonable methodological quality. One study demonstrated pre-operative depression to be related to altered pain reduction in the short-term following surgery. Three studies reported inferior outcomes in the medium-term (1-2 years) in those with worse mental health. One study demonstrated an increased risk of persistent pain 2 years following surgery and one a reduced chance of returning to active military service following surgery in those with worse mental health. Despite inferior outcomes individuals with mental health disorders did still benefit from surgery in general. In conclusion, the presence of pre-existing poor mental health is associated with inferior outcomes in the medium-term following arthroscopic surgery for FAI. Surgeons should consider screening patients for mental health disorders before surgery and counselling them appropriately as to the potential for less satisfactory surgical outcomes.
Collapse
Affiliation(s)
- Alastair G Dick
- Department of Young Adult Hip Surgery, Guy’s & St Thomas’ NHS Foundation Trust, Great Maze Pond, London SE1 9RT, United Kingdom
| | - Christian Smith
- Department of Young Adult Hip Surgery, Guy’s & St Thomas’ NHS Foundation Trust, Great Maze Pond, London SE1 9RT, United Kingdom
| | - Marcus J K Bankes
- Department of Young Adult Hip Surgery, Guy’s & St Thomas’ NHS Foundation Trust, Great Maze Pond, London SE1 9RT, United Kingdom
| | - Marc George
- Department of Young Adult Hip Surgery, Guy’s & St Thomas’ NHS Foundation Trust, Great Maze Pond, London SE1 9RT, United Kingdom
| |
Collapse
|
29
|
Arakgi ME, Han F, Degen R. Role of Arthroscopy for Hip Osteoarthritis with Impingement. CURRENT TREATMENT OPTIONS IN RHEUMATOLOGY 2020. [DOI: 10.1007/s40674-020-00141-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
|
30
|
Garcia AS, Gobetti M, Tatei AY, Falótico GG, Arliani GG, Puertas EB. Prevalence of Radiographic Signs of Femoroacetabular Impingement in Asymptomatic Patients and Non-Athletes. Rev Bras Ortop 2019; 54:60-63. [PMID: 31363244 PMCID: PMC6424806 DOI: 10.1016/j.rbo.2017.11.004] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2017] [Accepted: 11/06/2017] [Indexed: 11/15/2022] Open
Abstract
Objective Femoroacetabular impingement has been described as an anatomical variation of the proximal femur and/or acetabular rim, impinging the hip joint. A portion of the population asymptomatic in the hip may present radiographic changes from femoroacetabular impingement. The aim of the present study was to evaluate the prevalence of these signs in asymptomatic and sedentary males. Methods This was a clinical, observational, primary, cross-sectional, controlled study. A total of 32 male volunteers aged between 18 and 40 years, asymptomatic in the hip and sedentary, were selected from a university hospital orthopedic emergency room. All patients underwent standard anteroposterior pelvic radiographs. The measurements of the alpha angle, the retroversion index, the ischial spine signal, and the posterior wall sign were analyzed. Results
The mean age was 29 years (18-40 years old). The prevalence of radiographic signs of femoroacetabular impingement using an alpha angle of 67
o
was of 53.1%; with an alpha angle of 82
o
, it was of 31.2%. The mean alpha angle was 67
o
(52.4-88.2
o
), with 35.9% of the hips classified as borderline and 6.3% as pathological. The mean alpha angle for the right side was 67.5
o
(52.5-88.2
o
), and, for the left, it was 66.6
o
(53.1-86.9
o
). The mean retroversion index was 0.048 (right side: 0.044; left side: 0.052). The spine signal was positive in 15.6%, and the posterior wall sign, in 20.3% of the cases.
Conclusion This study showed that the prevalence of radiographic signs in a population of asymptomatic and sedentary adult men was high (31.2%). New studies are required to explian the actual clinical significance of this finding.
Collapse
Affiliation(s)
- André Sousa Garcia
- Escola Paulista de Medicina (EPM), Departamento de Ortopedia e Traumatologia, Universidade Federal de São Paulo (UNIFESP), São Paulo, SP, Brasil
| | - Murilo Gobetti
- Escola Paulista de Medicina (EPM), Departamento de Ortopedia e Traumatologia, Universidade Federal de São Paulo (UNIFESP), São Paulo, SP, Brasil
| | - Anderson Yutaka Tatei
- Escola Paulista de Medicina (EPM), Departamento de Ortopedia e Traumatologia, Universidade Federal de São Paulo (UNIFESP), São Paulo, SP, Brasil
| | - Guilherme Guadagnini Falótico
- Escola Paulista de Medicina (EPM), Departamento de Ortopedia e Traumatologia, Universidade Federal de São Paulo (UNIFESP), São Paulo, SP, Brasil
| | - Gustavo Gonçalves Arliani
- Escola Paulista de Medicina (EPM), Departamento de Ortopedia e Traumatologia, Universidade Federal de São Paulo (UNIFESP), São Paulo, SP, Brasil
| | - Eduardo Barros Puertas
- Escola Paulista de Medicina (EPM), Departamento de Ortopedia e Traumatologia, Universidade Federal de São Paulo (UNIFESP), São Paulo, SP, Brasil
| |
Collapse
|
31
|
Abstract
Purpose of review This narrative review summarizes the evidence relating hip shape and risk of osteoarthritis at the hip, with a focus on the most recent body of work. Recent findings Hip OA is a prevalent and potentially disabling condition with few effective non-surgical treatment options. Risk factors for hip OA appear to differ somewhat from those at other sites. Variations in hip morphology, whether assessed through standard geometric measures or statistical modeling methods, seem to increase hip OA risk and may provide a novel approach to interventions to reduce or prevent OA. Such variations have also led to focused surgical interventions to "correct" abnormal shape, although comparisons with non-surgical management are lacking. Summary There remains a lack of understanding regarding the optimal management, whether surgical, non-surgical, or a combination, for FAI syndrome. Even less is known regarding other potential morphologic variations that may contribute to OA risk. Additionally, many individuals who have shape variations that would seem to increase their risk will never develop hip OA. Questions remain regarding key risk factors for hip OA development, which individuals should be targeted for therapies, whether directed at symptoms, function, or prevention, and which therapies should be studied and offered. Trials are underway to help address some of these questions.
Collapse
|