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Zhu Y, Zhang S, Gao G, Wang H, Luan S, Wu K, Zhang Y, Xu Y. Concomitant Ipsilateral Knee Pain Is Associated With Worse Preoperative Functional Status and Short-Term Outcomes After Hip Arthroscopy in Patients With Femoroacetabular Impingement Syndrome. Arthroscopy 2024; 40:1490-1499. [PMID: 37890544 DOI: 10.1016/j.arthro.2023.10.022] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/19/2023] [Revised: 09/29/2023] [Accepted: 10/16/2023] [Indexed: 10/29/2023]
Abstract
PURPOSE (1) To determine the effect of concomitant ipsilateral knee pain (IKP) on short-term outcomes after hip arthroscopic treatment of femoroacetabular impingement syndrome (FAIS) and (2) to determine whether IKP would improve with surgery. METHODS Data between September 2021 and May 2022 were reviewed. Patients with a diagnosis of FAIS who underwent hip arthroscopy with a minimum of 1-year follow-up were included. The exclusion criteria were prior ipsilateral hip or knee surgery, hip Tönnis grade greater than 1, knee Kellgren-Lawrence grade greater than 2, hip conditions (avascular necrosis, Legg-Calvé-Perthes disease, pigmented villonodular synovitis, osteoid osteoma, synovial chondromatosis, and developmental dysplasia of the hip), and spine diseases. All patients underwent knee magnetic resonance imaging preoperatively. Preoperative and short-term (1-year) patient-reported outcomes were collected, consisting of the Hip Sports Activity Scale score, weekly sports participation, modified Harris Hip Score (mHHS), 12-component International Hip Outcome Tool (iHOT-12) score, and visual analog pain scale (VAS) scores for the hip and the ipsilateral knee. The percentages of patients achieving the minimal clinically important difference and patient acceptable symptom state (PASS) for the mHHS and iHOT-12 score were calculated. Multivariate regression analysis was performed to determine the effect of IKP severity on postoperative outcomes. Subgroup analysis was performed between patients with IKP alleviation and those without IKP alleviation. RESULTS Among the 107 patients included, 47 presented with preoperative IKP. Compared with patients without IKP, the IKP cohort had comparable knee structural abnormalities (all with P > .05). Still, the IKP cohort showed inferior preoperative values for the mHHS (P = .003), iHOT-12 score (P = .016), hip VAS score (P = .001), and weekly sports participation (P = .039). Postoperatively, the IKP cohort had a lower mHHS (P = .046), lower iHOT-12 score (P = .037), and lower hip VAS score (P = .003) and were less likely to achieve the PASS for the mHHS (P = .021) and iHOT-12 score (P = .049). Patients with higher knee VAS scores were less likely to achieve the PASS for the mHHS (odds ratio, 0.61; P = .023). Within the IKP group, the knee VAS score improved from 2.3 to 1.0 (P < .001). Patients with alleviated IKP showed superior postoperative iHOT-12 scores (P = .038) compared with patients with persistent IKP. CONCLUSIONS Concomitant IKP at baseline negatively affected preoperative status and short-term clinical outcomes after arthroscopic treatment of FAIS. Patients with IKP were less likely to meet clinical thresholds. Most patients achieved IKP alleviation postoperatively, which was associated with superior clinical outcomes. LEVEL OF EVIDENCE Level III, retrospective cohort study.
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Affiliation(s)
- Yichuan Zhu
- Department of Sports Medicine, Institute of Sports Medicine of Peking University, Peking University Third Hospital, Beijing, China; Beijing Key Laboratory of Sports Injuries, Beijing, China; Engineering Research Center of Sports Trauma Treatment Technology and Devices, Ministry of Education, Beijing, China
| | - Siqi Zhang
- Department of Sports Medicine, Institute of Sports Medicine of Peking University, Peking University Third Hospital, Beijing, China; Beijing Key Laboratory of Sports Injuries, Beijing, China; Engineering Research Center of Sports Trauma Treatment Technology and Devices, Ministry of Education, Beijing, China
| | - Guanying Gao
- Department of Sports Medicine, Institute of Sports Medicine of Peking University, Peking University Third Hospital, Beijing, China; Beijing Key Laboratory of Sports Injuries, Beijing, China; Engineering Research Center of Sports Trauma Treatment Technology and Devices, Ministry of Education, Beijing, China
| | - Hongli Wang
- Department of Sports Medicine, Institute of Sports Medicine of Peking University, Peking University Third Hospital, Beijing, China; Beijing Key Laboratory of Sports Injuries, Beijing, China; Engineering Research Center of Sports Trauma Treatment Technology and Devices, Ministry of Education, Beijing, China
| | - Shuo Luan
- Department of Sports Medicine, Institute of Sports Medicine of Peking University, Peking University Third Hospital, Beijing, China; Beijing Key Laboratory of Sports Injuries, Beijing, China; Engineering Research Center of Sports Trauma Treatment Technology and Devices, Ministry of Education, Beijing, China
| | - Kesheng Wu
- Department of Sports Medicine, Institute of Sports Medicine of Peking University, Peking University Third Hospital, Beijing, China; Beijing Key Laboratory of Sports Injuries, Beijing, China; Engineering Research Center of Sports Trauma Treatment Technology and Devices, Ministry of Education, Beijing, China
| | - Yanni Zhang
- Department of Sports Medicine, Institute of Sports Medicine of Peking University, Peking University Third Hospital, Beijing, China; Beijing Key Laboratory of Sports Injuries, Beijing, China; Engineering Research Center of Sports Trauma Treatment Technology and Devices, Ministry of Education, Beijing, China
| | - Yan Xu
- Department of Sports Medicine, Institute of Sports Medicine of Peking University, Peking University Third Hospital, Beijing, China; Beijing Key Laboratory of Sports Injuries, Beijing, China; Engineering Research Center of Sports Trauma Treatment Technology and Devices, Ministry of Education, Beijing, China.
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Gursoy S, Cirdi YU, Kirac M, Chahla J. Basics of hip arthroscopy: Step-by-step technique. J Exp Orthop 2024; 11:e12021. [PMID: 38617136 PMCID: PMC11015078 DOI: 10.1002/jeo2.12021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/30/2023] [Revised: 03/07/2024] [Accepted: 03/12/2024] [Indexed: 04/16/2024] Open
Abstract
Hip arthroscopy is a surgical procedure that has a technically challenging nature, requiring advanced spatial skills and specialised instrumentation. The most common indication for hip arthroscopy is femoroacetabular impingement, which is increasing due to improved awareness and knowledge of the condition among healthcare professionals. Hip arthroscopy requires many different checkpoints from patient positioning to capsule closure to be successfully completed. Patient positioning is one of the keystones of hip arthroscopy and the probability of a surgeon achieving successful outcomes is significantly influenced by the establishment of optimal access points. The importance of the acetabular labrum and capsule has been better understood in recent years. There has been a noticeable preference towards prioritising acetabular labral repair over debridement or excision. Similarly, consistent with the literature, capsule closure restores naive hip biomechanics more successfully and improves functional outcomes following hip arthroscopy. Osteochondroplasty is a frequently employed therapeutic intervention; yet, attaining optimal osteochondroplasty outcomes might present challenges. The aim is, to restore the full perfect sphericity of the femoral head without attenuation of the head. The aim of this article is to highlight the knowledge accumulated from experiences based on previous hip arthroscopy surgeries as a solution for future troubleshooting steps. Level of Evidence: Level V.
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Affiliation(s)
- Safa Gursoy
- Department of Orthopaedics and Traumatology, Faculty of MedicineAcibadem Mehmet Ali Aydinlar UniversityIstanbulTurkey
| | - Yigit Umur Cirdi
- Department of Orthopaedics and TraumatologyAcibadem Atasehir HospitalIstanbulTurkey
| | - Muge Kirac
- Department of Orthopaedics and Traumatology, Faculty of MedicineAcibadem Mehmet Ali Aydinlar UniversityIstanbulTurkey
| | - Jorge Chahla
- Department of Orthopaedic SurgeryRush UniversityChicagoIllinoisUSA
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Tomschi F, Schmidt A, Soffner M, Hilberg T. Hypoalgesia after aerobic exercise in healthy subjects: A systematic review and meta-analysis. J Sports Sci 2024; 42:574-588. [PMID: 38726662 DOI: 10.1080/02640414.2024.2352682] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2024] [Accepted: 04/30/2024] [Indexed: 06/01/2024]
Abstract
Exercise-Induced Hypoalgesia (EIH) refers to an acute reduced pain perception after exercise. This systematic review and meta-analysis investigated the effect of a single aerobic exercise session on local and remote EIH in healthy individuals, examining the role of exercise duration, intensity, and modality. Pressure pain thresholds (PPT) are used as the main measure, applying the Cochrane risk of bias tool and GRADE approach for certainty of evidence assessment. Mean differences (MD; Newton/cm²) for EIH effects were analysed. Thirteen studies with 23 exercises and 14 control interventions are included (498 participants). Most studies used bicycling, with only two including running/walking and one including rowing. EIH occurred both locally (MD = 3.1) and remotely (MD = 1.8), with high-intensity exercise having the largest effect (local: MD = 7.5; remote: MD = 3.0) followed by moderate intensity (local: MD = 3.1; remote: MD = 3.0). Low-intensity exercise had minimal impact. Neither long nor short exercise duration induced EIH. Bicycling was found to be effective in eliciting EIH, in contrast to the limited research observed in other modalities. The overall evidence quality was moderate with many studies showing unclear risk biases.
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Affiliation(s)
- Fabian Tomschi
- Department of Sports Medicine, University of Wuppertal, Wuppertal, Germany
| | - Alexander Schmidt
- Department of Sports Medicine, University of Wuppertal, Wuppertal, Germany
| | - Markus Soffner
- Department of Sports Medicine, University of Wuppertal, Wuppertal, Germany
| | - Thomas Hilberg
- Department of Sports Medicine, University of Wuppertal, Wuppertal, Germany
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Martins EC, Gomes DA, de Brito Fontana H, Fernandes DA. Does response to preoperative intra-articular anesthetic injections predict outcomes of femoroacetabular impingement syndrome? Arch Orthop Trauma Surg 2023; 143:6283-6294. [PMID: 37316693 DOI: 10.1007/s00402-023-04927-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/20/2023] [Accepted: 05/21/2023] [Indexed: 06/16/2023]
Abstract
INTRODUCTION Some patients with femoroacetabular impingement syndrome (FAIS) who undergo surgery do not show satisfactory outcomes. Reliable tests that can inform prognosis of FAIS surgery are needed for optimized indications and contraindications to surgery. We aimed to review and critically appraise available literature on the capability of patient response to preoperative intra-articular anesthetic injections (PIAI) to predict post-surgical outcomes in patients with FAIS. MATERIALS AND METHODS This study was conducted in accordance with the PRISMA statement. Studies that assessed the patient pain response to PIAI and post-surgical outcomes in patients with FAIS were considered eligible. Study selection and data collection were performed by three independent reviewers. Main outcomes evaluated were those measured by hip outcome scales often used in assessing postoperative pain and functional recovery, such as the modified Harris Hip Score (mHHS) and international Hip Outcome Tool (iHOT). The likelihood ratio of achieving satisfactory postoperative outcomes at the mHHS (LHR) was extracted or calculated-for patients with significant response to PIAI and for those without a significant response to PIAI. The risk of bias was assessed using the Quality In Prognosis Studies (QUIPS) tool. RESULTS Six studies were considered eligible for analysis. Five studies indicated that patient response to PIAI are associated to surgical outcomes for patients with FAIS, with a greater reduction in pain typically indicating a better surgical outcome. Additionally, the LHR ranged from 1.15 to 1.92 for patients with significant response to PIAI (I2 = 90.6%). For patients without a significant response, the LHR ranged from 0.18 to 0.65 (I2 = 87.5). An overall high risk of bias was observed for all studies included in the analysis. Study attrition, the prognostic factor measurement and the presence of confounding factors were the main sources of bias. CONCLUSIONS Greater reductions in pain with preoperative intra-articular anesthetic injections were found to be associated to better outcomes after FAIS surgery, but all available studies contain a high risk of bias.
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Affiliation(s)
- Eduardo Campos Martins
- Biomechanics Laboratory, School of Sports, Federal University of Santa Catarina, Florianópolis, Santa Catarina, CEP: 88040-900, Brazil.
- Department of Surgery, Polydoro Ernani de São Thiago University Hospital, Federal University of Santa Catarina, Trindade, Florianópolis, Santa Catarina, CEP: 88036-800, Brazil.
| | - Diogo A Gomes
- Biomechanics Laboratory, School of Sports, Federal University of Santa Catarina, Florianópolis, Santa Catarina, CEP: 88040-900, Brazil
| | - Heiliane de Brito Fontana
- Biomechanics Laboratory, School of Sports, Federal University of Santa Catarina, Florianópolis, Santa Catarina, CEP: 88040-900, Brazil
| | - Daniel Araujo Fernandes
- Department of Surgery, Polydoro Ernani de São Thiago University Hospital, Federal University of Santa Catarina, Trindade, Florianópolis, Santa Catarina, CEP: 88036-800, Brazil
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Lamo-Espinosa JM, Mariscal G, Gómez-Álvarez J, San-Julián M. Efficacy and safety of arthroscopy in femoroacetabular impingement syndrome: a systematic review and meta-analysis of randomized clinical trials. Sci Rep 2023; 13:16493. [PMID: 37779117 PMCID: PMC10543634 DOI: 10.1038/s41598-023-43441-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2023] [Accepted: 09/24/2023] [Indexed: 10/03/2023] Open
Abstract
This study aimed to compare the efficacy and safety of arthroscopy with physiotherapy or joint lavage in patients with femoroacetabular impingement (FAI). A meta-analysis using PubMed, Embase, Scopus, and the Cochrane Collaboration Library databases was performed in September 2022. We included studies focusing on patients with FAI who underwent arthroscopic surgery versus those who underwent physiotherapy or arthroscopic lavage. The outcomes were functional scores (iHOT-33 and HOS ADL) and adverse events. Randomized clinical trials were included in the study. The risk of bias in each study was assessed according to Cochrane guidelines for clinical trials. The data were combined using Review Manager version 5.4. (PROSPERO CRD42022375273). Six RCTs were included, from a pool of 839 patients (407 females). The iHOT-33 and HOS ADL scales showed significant differences at 12 months in favor of the arthroscopy group (MD, 10.65; 95% CI 6.54-4.76) and (MD, 8.09; 95% CI 3.11-13.07). MCID was not achieved through arthroscopy in functional variables. The rates of osteoarthritis (OR, 6.18; 95% CI 1.06-36.00) and numbness (OR, 73.73; 95% CI 10.00-43.92) were significantly higher in the arthroscopy group. Arthroscopic surgery showed statistical superiority over the control group without exceeding the MCID in most studies; however, the results might have been influenced by secondary variables. Finally, arthroscopic surgery results in a high rate of conversion to osteoarthritis.
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Affiliation(s)
| | - Gonzalo Mariscal
- Institute for Research on Muscuoskeletal Disorders, Valencia Catholic University, Carrer de Quevedo, 2, 46001, Valencia, Spain.
| | - Jorge Gómez-Álvarez
- Hip, Tumors and Pediatric Orthopedic Unit, University Clinic of Navarra, Navarra, Spain
| | - Mikel San-Julián
- Hip, Tumors and Pediatric Orthopedic Unit, University Clinic of Navarra, Navarra, Spain
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Peters C, Chancellor M, Flores H, Wise A, Garrett M, Checketts J, Hanson C, Vassar M. Harms Reporting Is Inadequate in Systematic Reviews Regarding Hip Arthroscopy. Arthrosc Sports Med Rehabil 2023; 5:e75-e85. [PMID: 36866301 PMCID: PMC9971868 DOI: 10.1016/j.asmr.2022.10.010] [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: 08/02/2022] [Accepted: 10/05/2022] [Indexed: 01/11/2023] Open
Abstract
Purpose To investigate the quality of harms reporting in systematic reviews (SRs) regarding hip arthroscopy in the current literature. Methods In May 2022, an extensive search of 4 major databases was performed identifying SRs regarding hip arthroscopy: MEDLINE (PubMed and Ovid), EMBASE, Epistemonikos, and Cochrane Database of Systematic Reviews. A cross-sectional analysis was conducted, in which investigators performed screening and data extraction of the included studies in a masked, duplicate fashion. AMSTAR-2 (A Measurement Tool to Assess Systematic Reviews-2) was used to assess the methodologic quality and bias of the included studies. The corrected covered area was calculated for SR dyads. Results A total of 82 SRs were included in our study for data extraction. Of these SRs, 37 reported under 50% of the harms criteria (37 of 82, 45.1%) and 9 did not report harms at all (9 of 82, 10.9%). A significant relation was found between completeness of harms reporting and overall AMSTAR appraisal (P = .0261), as well as whether a harm was listed as a primary or secondary outcome (P = .0001). Eight SR dyads had corrected covered areas of 50% or greater and were compared for shared harms reported. Conclusions In this study, we found inadequate harms reporting in most SRs concerning hip arthroscopy. Clinical Relevance With the magnitude of hip arthroscopic procedures being performed, adequate reporting of harms-related information in the research surrounding this treatment is essential in assessing the efficacy of the treatment. This study provides data in relation to harms reporting in SRs regarding hip arthroscopy.
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Affiliation(s)
- Caleb Peters
- Office of Medical Student Research, Oklahoma State University Center for Health Sciences, Tulsa, Oklahoma, U.S.A.,Address correspondence to Caleb Peters, B.S., Oklahoma State University Center for Health Sciences, 1111 W 17th St, Tulsa, OK 74107, U.S.A.
| | - Matthew Chancellor
- Office of Medical Student Research, Oklahoma State University Center for Health Sciences, Tulsa, Oklahoma, U.S.A
| | - Holly Flores
- Office of Medical Student Research, Oklahoma State University Center for Health Sciences, Tulsa, Oklahoma, U.S.A
| | - Audrey Wise
- Office of Medical Student Research, Oklahoma State University Center for Health Sciences, Tulsa, Oklahoma, U.S.A
| | - Morgan Garrett
- Office of Medical Student Research, Oklahoma State University Center for Health Sciences, Tulsa, Oklahoma, U.S.A
| | - Jake Checketts
- Department of Orthopaedic Surgery, Oklahoma State University Medical Center, Tulsa, Oklahoma, U.S.A
| | - Chad Hanson
- Department of Orthopaedic Surgery, Oklahoma State University Medical Center, Tulsa, Oklahoma, U.S.A
| | - Matt Vassar
- Office of Medical Student Research, Oklahoma State University Center for Health Sciences, Tulsa, Oklahoma, U.S.A.,Department of Psychiatry and Behavioral Sciences, Oklahoma State University Center for Health Sciences, Tulsa, Oklahoma, U.S.A
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Conservative vs. Surgical Management for Femoro-Acetabular Impingement: A Systematic Review of Clinical Evidence. J Clin Med 2022; 11:jcm11195852. [PMID: 36233719 PMCID: PMC9572846 DOI: 10.3390/jcm11195852] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2022] [Revised: 09/28/2022] [Accepted: 09/29/2022] [Indexed: 11/19/2022] Open
Abstract
Femoro-acetabular impingement (FAI) syndrome is one of the most studied conditions in sports medicine. Surgical or conservative approaches can be proposed for treating FAI, although the best standard of care is not established yet. Our aim is to provide a comprehensive review of the best treatment for FAI syndrome evaluating differences in outcomes between surgical and non-operative management. A literature search was carried out on the PubMed, EMBASE, Scopus, and PEDro databases, using the following keywords: "femoroacetabular impingement", "FAI", in association with "surgery", "arthroscopy", "surgical" and "conservative", "physiotherapy", "physical therapy", "rehabilitation", "exercise". Only Level I RCTs were included. Four articles were selected for this systematic review. Our analysis showed different therapeutic protocols, follow-up periods, and outcomes; however, three out of the four studies included favored surgery. Our study demonstrates beneficial effects for both arthroscopic treatment and a proper regimen of physical therapy, nevertheless a surgical approach seemed to offer superior short-term results when compared to conservative care only. Further trials with larger sample sizes and longer follow-ups are needed to assess the definitive approach to the FAI condition.
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Bajwa A. What the papers say. J Hip Preserv Surg 2021; 8:209-211. [PMID: 35145720 PMCID: PMC8825636 DOI: 10.1093/jhps/hnab083] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 10/25/2021] [Indexed: 11/13/2022] Open
Affiliation(s)
- Ali Bajwa
- The Villar Bajwa Practice, Princess Grace Hospital, London W1G6PU, UK. E-mail:
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