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Kamono E, Kobayashi N, Yamamoto Y, Yukizawa Y, Honda H, Choe H, Ike H, Kumagai K, Inaba Y. Multivariate linear-mixed analysis of changes in anterior inferior iliac spine impingement incidence with posterior pelvic tilt: a computer simulation study. J Hip Preserv Surg 2024; 11:125-131. [PMID: 39070215 PMCID: PMC11272635 DOI: 10.1093/jhps/hnae003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/19/2023] [Revised: 10/30/2023] [Accepted: 01/15/2024] [Indexed: 07/30/2024] Open
Abstract
It is well known that increased posterior tilt of the pelvis is an effective strategy for avoiding impingement of the femur with the pelvis during movement. Daily repetitive collisions become mechanical loads, and the more frequently they occur, the more tissue damage and pain they cause. Therefore, reducing the rate of occurrence of impingement is important to avoid aggravation of symptoms. This study aimed to evaluate the effects of changes in posterior pelvic tilt on the risk of impingement between the femur and the anterior inferior iliac spine (AIIS)/subspine in various functional postures. Patients with femoroacetabular impingement syndrome (FAIS) who were candidates for hip arthroscopic osteochondroplasty between October 2013 and June 2020 were included. A three-dimensional reconstructed model was used to simulate the incidence of impingement at 12 hip positions required for activities of daily living. We predicted value of the spatial incidence of impingement assumed that hip motion should exceed 130/30 degrees without impingement. Impingement was measured at three pelvic positions: an anterior tilt of 10°, in the functional pelvic plane and a posterior tilt of 10°. Multivariate linear-mixed models were used to assess the effect of covariate-adjusted posterior pelvic tilt on the impingement incidence in the AIIS region. AIIS type, center-edge angle, acetabular version and femoral version were used as covariates. The impingement rates and locations of the three pelvic tilt postures were assessed. Seventy-eight patients (60 males and 18 females; average age, 46 ± 15.1 years) with FAIS were analyzed. A multivariate linear-mixed model revealed a coefficient of -0.8% (95% confidence interval -0.9 to -0.7%; P < 0.001) for posterior pelvic tilt. Thus, posterior pelvic tilt affects AIIS impingement incidence. After adjusting for anatomical effects, the posterior pelvic tilt should be addressed to avoid impingement.
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Affiliation(s)
- Emi Kamono
- Department of Orthopaedic Surgery, Yokohama City University Medical Center, 4-57 Urafune-cho, Minami-ku, Yokohama, Japan
| | - Naomi Kobayashi
- Department of Orthopaedic Surgery, Yokohama City University Medical Center, 4-57 Urafune-cho, Minami-ku, Yokohama, Japan
| | - Yuya Yamamoto
- Department of Orthopaedic Surgery, Yokohama City University Medical Center, 4-57 Urafune-cho, Minami-ku, Yokohama, Japan
- Department of Orthopaedic Surgery, Yokohama City University, 3-9 Fukuura, Kanazawa-ku, Yokohama, Japan
| | - Yohei Yukizawa
- Department of Orthopaedic Surgery, Yokohama City University Medical Center, 4-57 Urafune-cho, Minami-ku, Yokohama, Japan
| | - Hideki Honda
- Department of Orthopaedic Surgery, Yokohama City University Medical Center, 4-57 Urafune-cho, Minami-ku, Yokohama, Japan
| | - Hyonmin Choe
- Department of Orthopaedic Surgery, Yokohama City University, 3-9 Fukuura, Kanazawa-ku, Yokohama, Japan
| | - Hiroyuki Ike
- Department of Orthopaedic Surgery, Yokohama City University, 3-9 Fukuura, Kanazawa-ku, Yokohama, Japan
| | - Ken Kumagai
- Department of Orthopaedic Surgery, Yokohama City University, 3-9 Fukuura, Kanazawa-ku, Yokohama, Japan
| | - Yutaka Inaba
- Department of Orthopaedic Surgery, Yokohama City University, 3-9 Fukuura, Kanazawa-ku, Yokohama, Japan
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Chapman R, Horner N, Ziauddin L, Hevesi M, Nho SJ. Patients Undergoing Revision Hip Arthroscopy Demonstrate Comparable Survivability and Improvement but Worse Postoperative Outcomes Compared to Patients Undergoing Primary Hip Arthroscopy: A Propensity Matched Study at Five-Year Follow-Up. Arthroscopy 2024; 40:802-809. [PMID: 37567488 DOI: 10.1016/j.arthro.2023.07.047] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/17/2023] [Revised: 07/02/2023] [Accepted: 07/28/2023] [Indexed: 08/13/2023]
Abstract
PURPOSE To compare mid-term clinical outcomes between patients undergoing primary hip arthroscopy (HA) versus revision hip arthroscopy (RHA) for femoroacetabular impingement syndrome (FAIS). METHODS A retrospective cohort study was conducted on 1,862 patients who underwent hip arthroscopy for FAIS from January 2012 to April 2017. Patients who underwent RHA were propensity matched in a 1:4 ratio by age, sex, body mass index (BMI), and exercise status to patients who underwent primary HA. Preoperative and postoperative radiographs were assessed. Patient-reported outcomes before and at 5 years after surgery, including the Hip Outcome Score Activities of Daily Living subscale (HOS-ADL) and Sports subscale (HOS-SS), modified Harris Hip Score (mHHS), international Hip Outcome Tool (iHOT-12), and Visual Analog Scale (VAS) for Pain and Satisfaction, were compared between groups. Minimally clinically important difference and patient-acceptable symptomatic state (PASS) achievement rates were compared using previously published thresholds. RESULTS Fifty-one patients who underwent RHA (35 female, 16 male; age 36.2 ± 10.2 years; BMI 26.5 ± 5.9) were followed up for 63.9 ± 9.2 months and then propensity matched in a 1:4 ratio by sex, age, and BMI to 204 control patients who underwent primary HA. At midterm follow-up, patients in the RHA cohort had significantly lower scores for HOS-SS (RHA 64.9 ± 32.5 vs HA 75.3 ± 26.2, P = .044), mHHS (RHA 72.2 ± 22.4 vs HA 80.1 ± 18.1, P = .039), and iHOT-12 (RHA 61.4 ± 29.3 vs HA 71 ± 27.6, P = .043) compared to primary HA patients. Rates of achieving PASS were significantly decreased for HOS-SS (RHA 38.3% vs HA 55.4%, P = .039) and iHOT-12 (RHA 41.9% vs HA 59.9%, P = .035) in the RHA cohort. There were no significant differences in rates of conversion to THA or subsequent reoperation on the index hip between groups. CONCLUSIONS Patients undergoing revision hip arthroscopy demonstrate comparable survivability and magnitude of improvement but may experience worse overall outcome scores and meet thresholds for clinically significant outcomes less often when compared to primary hip arthroscopy patients. LEVEL OF EVIDENCE Level III; retrospective comparative study.
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Affiliation(s)
- Reagan Chapman
- Section of Young Adult Hip Surgery, Division of Sports Medicine, Department of Orthopedic Surgery, Rush University Medical Center, Chicago, Illinois, U.S.A
| | - Nolan Horner
- Section of Young Adult Hip Surgery, Division of Sports Medicine, Department of Orthopedic Surgery, Rush University Medical Center, Chicago, Illinois, U.S.A
| | - Lubna Ziauddin
- Section of Young Adult Hip Surgery, Division of Sports Medicine, Department of Orthopedic Surgery, Rush University Medical Center, Chicago, Illinois, U.S.A
| | - Mario Hevesi
- Section of Young Adult Hip Surgery, Division of Sports Medicine, Department of Orthopedic Surgery, Rush University Medical Center, Chicago, Illinois, U.S.A
| | - Shane J Nho
- Section of Young Adult Hip Surgery, Division of Sports Medicine, Department of Orthopedic Surgery, Rush University Medical Center, Chicago, Illinois, U.S.A.
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Morris EJ, Gray K, Gibbons PJ, Grayson J, Sullivan J, Amorim AB, Burns J, McKay MJ. Evaluating the Use of PROMs in Paediatric Orthopaedic Registries. CHILDREN (BASEL, SWITZERLAND) 2023; 10:1552. [PMID: 37761513 PMCID: PMC10528097 DOI: 10.3390/children10091552] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/14/2023] [Revised: 09/04/2023] [Accepted: 09/07/2023] [Indexed: 09/29/2023]
Abstract
Patient-reported outcome measures (PROMs) provide structured information on the patient's health experience and facilitate shared clinical decision-making. Registries that collect PROMs generate essential information about the clinical course and efficacy of interventions. Whilst PROMs are increasingly being used in adult orthopaedic registries, their use in paediatric orthopaedic registries is not well known. The purpose of this systematic review was to identify the frequency and scope of registries that collect PROMs in paediatric orthopaedic patient groups. In July 2023, six databases were systematically searched to identify studies that collected PROMs using a registry amongst patients aged under 18 years with orthopaedic diagnoses. Of 3190 identified articles, 128 unique registries were identified. Three were exclusively paediatric, 27 were majority paediatric, and the remainder included a minority of paediatric patients. One hundred and twenty-eight registries collected 72 different PROMs, and 58% of these PROMs were not validated for a paediatric population. The largest group of orthopaedic registries collected PROMs on knee ligament injuries (21%). There are few reported dedicated orthopaedic registries collecting PROMs in paediatric populations. The majority of PROMs collected amongst paediatric populations by orthopaedic registries are not validated for patients under the age of 18 years. The use of non-validated PROMs by registries greatly impedes their utility and impact. Dedicated orthopaedic registries collecting paediatric-validated PROMs are needed to increase health knowledge, improve decision-making between patients and healthcare providers, and optimise orthopaedic management.
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Affiliation(s)
- Eleanor J. Morris
- Sydney School of Health Sciences, Faculty of Medicine and Health, The University of Sydney, Sydney 2006, Australia; (E.J.M.); (J.G.); (J.S.); (A.B.A.); (M.J.M.)
- Sydney Children’s Hospitals Network, The Children’s Hospital at Westmead, Sydney 2145, Australia;
| | - Kelly Gray
- Department of Health Sciences, Faculty of Medicine, Health and Human Sciences, Macquarie University, Sydney 2109, Australia;
| | - Paul J. Gibbons
- Sydney Children’s Hospitals Network, The Children’s Hospital at Westmead, Sydney 2145, Australia;
| | - Jane Grayson
- Sydney School of Health Sciences, Faculty of Medicine and Health, The University of Sydney, Sydney 2006, Australia; (E.J.M.); (J.G.); (J.S.); (A.B.A.); (M.J.M.)
| | - Justin Sullivan
- Sydney School of Health Sciences, Faculty of Medicine and Health, The University of Sydney, Sydney 2006, Australia; (E.J.M.); (J.G.); (J.S.); (A.B.A.); (M.J.M.)
| | - Anita B. Amorim
- Sydney School of Health Sciences, Faculty of Medicine and Health, The University of Sydney, Sydney 2006, Australia; (E.J.M.); (J.G.); (J.S.); (A.B.A.); (M.J.M.)
| | - Joshua Burns
- Sydney School of Health Sciences, Faculty of Medicine and Health, The University of Sydney, Sydney 2006, Australia; (E.J.M.); (J.G.); (J.S.); (A.B.A.); (M.J.M.)
- Sydney Children’s Hospitals Network, Paediatric Gait Analysis Service of New South Wales, Sydney 2145, Australia
| | - Marnee J. McKay
- Sydney School of Health Sciences, Faculty of Medicine and Health, The University of Sydney, Sydney 2006, Australia; (E.J.M.); (J.G.); (J.S.); (A.B.A.); (M.J.M.)
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Leary SM, Westermann RW. Arthroscopic Decompression of the Anterior Inferior Iliac Spine. JBJS Essent Surg Tech 2023; 13:e22.00019. [PMID: 38274146 PMCID: PMC10807891 DOI: 10.2106/jbjs.st.22.00019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2024] Open
Abstract
Background Pathologic contact between the femoral neck and anterior inferior iliac spine (AIIS or subspine) often occurs concomitantly with femoroacetabular impingement, contributing to hip pain and dysfunction1-4. We perform arthroscopic AIIS decompression to alleviate this source of extra-articular impingement and eliminate a potential cause of persistent pain following primary hip arthroscopy5-7. Description After identifying abnormal AIIS morphology on preoperative false-profile radiographs and/or 3D computed tomography, we utilize a beaver blade to make a small incision in the proximal capsule and rectus femoris tendon. This peri-capsulotomy window grants access to the subspine region. We then shuttle an arthroscopic burr into place within this window and begin debriding the subspine deformity under direct visualization. Fluoroscopy is utilized intraoperatively to ensure adequate resection, using intraoperative false-profile views achieved by canting the C-arm approximately 40°. Resection is considered adequate when the AIIS deformity is no longer readily apparent on false-profile views and when intraoperative range-of-motion testing confirms no further impingement with hip hyperflexion. Alternatives Femoroacetabular impingement can be treated nonoperatively with use of physical therapy and activity modification8; however, outcomes following nonoperative treatment are inferior to those following hip arthroscopy, according to various studies9-12. There are no known alternative treatments specific to subspine impingement. Rationale As patients with subspine deformities progress through hip flexion, the femoral neck collides with the AIIS, limiting range of motion. As such, subspine deformities have been shown to be more common in dancers and other high-flexion athletes13,14. Additionally, studies have demonstrated that low femoral version of <5° is associated with increased contact between the distal femoral neck and the AIIS. This pathologic contact can occur even in the absence of an obvious subspine deformity15. In both of these patient populations, surgeons should have a high suspicion for subspine impingement, and a subspine decompression should be performed during hip arthroscopy in order to maximize patient outcomes. Expected Outcomes This is a safe procedure that, if performed when indicated, can improve outcomes following primary hip arthroscopy. A recent systematic review found a pooled complication risk of 1.1%, a pooled revision risk of 1.0%, and significant postoperative improvements in patient-reported outcome measures16. Important Tips Suspect subspine impingement in high-flexion athletes and patients with low femoral version, even in the absence of an obvious deformity.Ensure adequate visualization of the entire subspine deformity by creating a pericapsular window.Confirm thorough resection with use of fluoroscopic imaging intraoperatively, including false-profile views demonstrating absent subspine deformity. Acronyms and Abbreviations FAI = femoroacetabular impingementAP = anteroposterior, refers to the technique used to obtain one of the pelvic radiographs3D CT = three-dimensional computed tomographyLCEA = lateral center-edge angle, a measurement used to quantify severity of hip dysplasiaOR = operating roomAlpha = alpha angle, a measurement used to measure femoral head-neck offset and assess the severity of a cam deformityIc = iliocapsularisRFd = direct head of rectus femorisRFr = reflected head of rectus femorisCap = hip capsuleGMi = gluteus minimusmHHS = modified Harris Hip ScoreHOS-ADL = Hip Outcome Score - Activities of Daily LivingHOS-SSS = Hip Outcome Score - Sports Specific Subscale.
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Schaver AL, Leary SM, Henrichsen JL, Larson CM, Westermann RW. Outcomes of Arthroscopic Decompression of the Anterior Inferior Iliac Spine: A Systematic Review and Meta-analysis. Am J Sports Med 2023; 51:1096-1105. [PMID: 35019709 DOI: 10.1177/03635465211062903] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND Anterior inferior iliac spine (AIIS) impingement has been increasingly recognized as a source of extra-articular impingement and hip pain. However, no aggregate data analysis of patient outcomes after AIIS decompression has been performed. PURPOSE To evaluate outcomes after arthroscopic AIIS decompression. STUDY DESIGN Meta-analysis; Level of evidence, 4. METHODS A systematic review was performed according to the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines. PubMed, EMBASE, and Cochrane Central Register of Controlled Trials were queried for all English-language studies reporting outcomes of arthroscopic AIIS decompression performed in isolation or in conjunction with hip impingement correction surgery. After screening, 10 articles were included. The indications for AIIS decompression were recorded, and weighted mean improvements in patient-reported outcome (PRO) scores, complication rates, and revision rates were calculated. RESULTS A total of 547 patients (311 women; 57%) were identified, with a total of 620 operative hips. The mean age was 28.42 ± 5.6 years, and the mean follow-up was 25.22 ± 11.1 months. A total of 529 hips (85%) underwent AIIS decompression, 530 hips (85%) underwent femoral osteochondroplasty, and 458 hips (74%) underwent labral repair. Of the patients, 13% underwent bilateral AIIS decompression. The mean modified Harris Hip Score improved from 61.3 ± 6.9 to 88.7 ± 4.7 postoperatively (change, 27.4 ± 5.7 points; P < .001), the Hip Outcome Score-Activities of Daily Living improved from 67.2 ± 10.6 to 91.1 ± 3.2 postoperatively (change, 24.0 ± 8.0 points; P = .001), and the Hip Outcome Score-Sports Specific Subscale improved from 36.8 ± 19.2 to 82.8 ± 3.8 postoperatively (change, 46.0 ± 18.2 points; P = .002). The pooled risk of postoperative complications was 1.1% (95% CI, 0.1%-2.1%), and the pooled risk of needing revision surgery was 1.0% (95% CI, 0.1%-2.0%). No complication was directly attributed to the AIIS decompression portion of the procedure. CONCLUSION PROs improved significantly after hip arthroscopy with AIIS decompression, with a low risk of postoperative complications and subsequent revision surgeries. Failure to identify extra-articular sources of hip pain in outcomes of femoroacetabular impingement syndrome, including from the AIIS, could lead to poorer outcomes and future revision surgery.
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Affiliation(s)
- Andrew L Schaver
- Department of Orthopedics & Rehabilitation, University of Iowa Hospitals and Clinics, Iowa City, Iowa, USA
| | - Steven M Leary
- Carver College of Medicine, University of Iowa, Iowa City, Iowa, USA
| | - Jacob L Henrichsen
- Department of Orthopedics & Rehabilitation, University of Iowa Hospitals and Clinics, Iowa City, Iowa, USA
| | | | - Robert W Westermann
- Department of Orthopedics & Rehabilitation, University of Iowa Hospitals and Clinics, Iowa City, Iowa, USA
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Femoral Version May Impact Hip Arthroscopy Outcomes in Select Patient Populations: A Systematic Review. Arthroscopy 2023; 39:114-127. [PMID: 35810977 DOI: 10.1016/j.arthro.2022.06.026] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/07/2022] [Revised: 06/14/2022] [Accepted: 06/23/2022] [Indexed: 02/02/2023]
Abstract
PURPOSE To provide further clarity regarding the management of patients with abnormal femoral version in the setting of hip arthroscopy and will discuss the definition of femoral version, the diagnostic and clinical evaluation of abnormal femoral version, and several described measurement techniques. METHODS A systematic review was conducted in literature published before August 2021 that measured femoral version and reported patient-reported outcomes measures or rates of subsequent procedures following hip arthroscopy. Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines were followed and the electronic databases, PubMed, OvidMedLine, Scopus, and Web of Science were searched. Two blinded reviews screened and evaluated data quality using the Newcastle-Ottawa Scale. RESULTS Eighteen studies were included with 11 studies reporting patient outcomes and 7 studies reporting rates of subsequent procedures. The most commonly used definition of femoral version was 5° to 20° of femoral anteversion. Computed tomography scan was the most commonly used imaging modality. The majority of studies (7 of 11) demonstrated that femoral version does not have an impact on patient-reported outcomes measures and is not predictive of clinically meaningful improvement scores. However, in select studies, patients with femoral retroversion were found to experience slightly inferior outcomes following hip arthroscopy for femoroacetabular impingement. While femoral retroversion may be a risk factor for subsequent procedures, 3 of 7 studies refute this claim. Although in patients with borderline hip dysplasia, excessive femoral anteversion led to greater rates of subsequent hip procedures. CONCLUSIONS While the majority of studies show that femoral version does not have an impact on patient-reported outcomes following hip arthroscopy, those with femoral retroversion and with excessive anteversion with coexisting borderline hip dysplasia need to be educated on their increased risk of subsequent operation. Ultimately, this review suggests that clinical improvement can likely be achieved regardless of femoral version. LEVEL OF EVIDENCE IV; systematic review of Level I-IV studies.
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Ruzbarsky JJ, Seiter MN, Comfort SM, Soares RW, Briggs KK, Philippon MJ. Arthroscopic Hip Capsular Reconstruction Using Iliotibial Band Allograft as a Salvage Option for Unrepairable Capsular Defects Demonstrates Good Survivorship and Improved Patient-Reported Outcomes. Arthroscopy 2022; 38:2219-2226. [PMID: 34990758 DOI: 10.1016/j.arthro.2021.12.035] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/16/2021] [Revised: 12/16/2021] [Accepted: 12/21/2021] [Indexed: 02/02/2023]
Abstract
PURPOSE To describe patient outcomes 3 to 5 years after arthroscopic hip capsule reconstruction. METHODS Between January 2007 and December 2016, patients aged 18 to 50 years who underwent arthroscopic hip capsular reconstruction using an Iliotibial band allograft by the senior author and had minimum of 3-year follow-up were identified. Patients were excluded if they had previous open hip surgery, advanced osteoarthritis (Tönnis grade >2), significant acetabular dysplasia (lateral center edge angle <20°), avascular necrosis, or Legg-Calve-Perthes disease. Outcome scores including the Hip Outcome Score (HOS)-Activities of Daily Living scale, modified Harris Hip Score, HOS-Sports scale, SF-12, and Western Ontario & McMaster Universities Osteoarthritis Index were compared in addition to failure rate, revision rate, and patient satisfaction rate with the outcome (range, 1-10). All patients were assessed by the senior author pre- and postoperatively. RESULTS Thirty-nine patients met the inclusion criteria. The mean age of the cohort was 32 ± 10 years, with 6 male and 33 female patients. The average number of previous hip arthroscopy surgeries was 2 ± 1. Six patients (15%) converted to total hip arthroplasty at an average of 2.1 years (range 7 months to 6 years) following capsular reconstruction. Four patients required revision hip arthroscopy after the arthroscopic capsular reconstruction. All arthroscopic revisions occurred in female patients with the primary intraoperative finding of capsulolabral adhesions at the time of revision. At mean follow-up of 4.3 years (range 3-6.8 years), the 29 patients who did not require subsequent surgery had significant improvements from preoperatively to postoperatively in HOS-Activities of Daily Living and HOS-Sport with 90% reaching minimal clinically important difference. All other scores showed significant improvement. Survival for patients not requiring total hip arthroplasty was 86% at 3 years, with a mean survival of 5.7 years (95% confidence interval 4.97-6.4). CONCLUSIONS Arthroscopic hip capsular reconstruction with iliotibial band allograft is a successful treatment option for patients with symptomatic capsular defects, demonstrating improved patient-reported outcomes maintained at mean follow-up time of 4 years. This technique offers restoration of the anatomic structure and function of the capsular ligaments to improve pain and instability. LEVEL OF EVIDENCE IV, case series.
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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
| | - Max N Seiter
- 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
| | | | - Rui W Soares
- Steadman Philippon Research Institute, Vail, Colorado, U.S.A
| | - Karen K Briggs
- 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..
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Atzmon R, Safran MR. Arthroscopic Treatment of Mild/Borderline Hip Dysplasia with Concomitant Femoroacetabular Impingement-Literature Review. Curr Rev Musculoskelet Med 2022; 15:300-310. [PMID: 35708882 PMCID: PMC9276885 DOI: 10.1007/s12178-022-09765-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 05/09/2022] [Indexed: 11/26/2022]
Abstract
Purpose of Review This literature review aims to survey the current knowledge about the management FAI in the setting of borderline hip dysplasia. Recent Findings With better understanding, hip arthroscopy has recently been advocated for treating mild or borderline hip dysplasia (BDH) with concomitant femoroacetabular impingement (FAI) despite early studies that condemned its use. Recent outcome data have demonstrated that hip arthroscopy is a viable option in BDH, with and without FAI, and has been gaining wider acceptance. Hip arthroscopy can address the concomitant soft tissue and bony intra-articular pathologies and obviate the necessity for other surgeries. Moreover, hip arthroscopy may be used as an adjuvant treatment to other procedures such as a periacetabular osteotomy (PAO). Summary Hip arthroscopy for BDH is an evolving procedure with promising short- and mid-term outcomes. The combination of BDH and FAI is becoming recognized as a problem in its own right, requiring dedicated treatment.
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Affiliation(s)
- Ran Atzmon
- Department of Orthopaedics Surgery, Stanford University, 450 Broadway, Redwood City, CA 94063 USA
| | - Marc R Safran
- Department of Orthopaedics Surgery, Stanford University, 450 Broadway, Redwood City, CA 94063 USA
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Monahan PF, Jimenez AE, Owens JS, Saks BR, Maldonado DR, Ankem HK, Sabetian PW, Lall AC, Domb BG. Revision Hip Arthroscopy in High-Level Athletes: Minimum 2-Year Outcomes Comparison to a Propensity-Matched Primary Hip Arthroscopy Control Group. Am J Sports Med 2021; 49:3582-3591. [PMID: 34591692 DOI: 10.1177/03635465211041760] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND Outcomes of revision hip arthroscopy in the athletic population have not been well established. PURPOSE (1) To report clinical outcomes for high-level athletes undergoing revision hip arthroscopy in the setting of femoroacetabular impingement syndrome (FAIS) or labral tears and (2) to compare these outcomes against a propensity-matched group of high-level athletes undergoing primary hip arthroscopy. STUDY DESIGN Cohort study; Level of evidence, 3. METHODS Data for professional, college, and high school athletes were prospectively collected and retrospectively reviewed between January 2012 and October 2018. Patients were included if they underwent revision or primary hip arthroscopy and had preoperative and minimum 2-year patient-reported outcome (PRO) scores for modified Harris Hip Score (mHHS), Non-Arthritic Hip Score (NAHS), Hip Outcome Score Sports-Specific Subscale (HOS-SSS), and visual analog scale (VAS) for pain. The findings and outcomes of revision athletes were compared with a propensity-matched control group of high-level athletes undergoing primary hip arthroscopy. RESULTS A total of 32 hips (29 patients) undergoing revision hip arthroscopy and 92 hips (88 patients) undergoing primary hip arthroscopy were included in our final analysis with a median follow-up time of 29.5 months (95% CI, 27.2-32.1 months) and 36.5 months (95% CI, 33.5-37.7 months), respectively. Athletes undergoing revision surgery showed significant improvement in all recorded PRO measurements and achieved patient acceptable symptomatic state (PASS) and minimal clinically important difference (MCID) for mHHS at high rates (80.6% and 83.9%, respectively). When compared with a propensity-matched primary control group, patients undergoing revision surgery demonstrated lower preoperative and postoperative scores for mHHS, NAHS, and HOS-SSS, but the magnitude of improvement in functional scores was similar between groups. Athletes undergoing revision surgery achieved PASS for HOS-SSS at lower rates than the control group (P = .005), and they were less likely to attempt to return to sport compared with the control group (62.5% vs 87.0%; P < .01). CONCLUSION Revision hip arthroscopy is a viable treatment option to improve PROs in high-level athletes at minimum 2-year follow-up. The study group showed significant improvement in functional scores and a high rate of successful outcomes. They experienced similar magnitude of improvement as that of a propensity-matched control group; however, they achieved lower postoperative PRO scores and attempted to return to sport at lower rates.
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Affiliation(s)
- Peter F Monahan
- American Hip Institute Research Foundation, Chicago, Illinois, USA
| | - Andrew E Jimenez
- American Hip Institute Research Foundation, Chicago, Illinois, USA
| | - Jade S Owens
- American Hip Institute Research Foundation, Chicago, Illinois, USA
| | - Benjamin R Saks
- American Hip Institute Research Foundation, Chicago, Illinois, USA.,AMITA Health St Alexius Medical Center, Hoffman Estates, Illinois, USA
| | | | - Hari K Ankem
- American Hip Institute Research Foundation, Chicago, Illinois, USA
| | - Payam W Sabetian
- American Hip Institute Research Foundation, Chicago, Illinois, USA
| | - Ajay C Lall
- American Hip Institute Research Foundation, Chicago, Illinois, USA.,AMITA Health St Alexius Medical Center, Hoffman Estates, Illinois, USA.,American Hip Institute, Chicago, Illinois, USA
| | - Benjamin G Domb
- American Hip Institute Research Foundation, Chicago, Illinois, USA.,AMITA Health St Alexius Medical Center, Hoffman Estates, Illinois, USA.,American Hip Institute, Chicago, Illinois, USA
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Bai H, Li CB, Zhao H, Yin QF. Subspine Hypertrophy: Higher Incidence of Symptomatic versus Asymptomatic Hips in Patients with Unilateral Femoroacetabular Impingement. Orthop Surg 2021; 13:2216-2226. [PMID: 34643337 PMCID: PMC8654673 DOI: 10.1111/os.13128] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/02/2021] [Revised: 05/16/2021] [Accepted: 06/07/2021] [Indexed: 11/28/2022] Open
Abstract
Objective To compare the difference of anterior inferior iliac spine (AIIS) and subspine hypertrophic deformity between symptomatic and asymptomatic hips in patients traditionally diagnosed with femoroacetabular impingement (FAI), and investigate the correlation of subspine decompression with AIIS variation and subspine hypertrophic deformity. Methods We retrospectively reviewed 70 patients with unilateral symptomatic FAI who underwent hip arthroscopy. The operative hips and contralateral hips naturally formed the symptomatic groups and asymptomatic control groups, respectively. The morphometric comparison of the hip joint was performed between the operative and contralateral sides of each patient. Radiological assessment was performed by two observers (an experienced musculoskeletal radiologist and an experienced surgeon). Three‐dimensional (3D)‐CT images of each patient were blindly reviewed to determine the AIIS variation and subspine hypertrophic deformity. Reformatted two‐dimensional (2D)‐CT images and anterior–posterior (AP) pelvic plain radiographs were blindly reviewed to determine FAI‐related morphological measurements. Moreover, the surgical assessment was reviewed by one experienced surgeon to interpret whether subspine decompression was performed. The correlation of subspine decompression with AIIS variation and subspine hypertrophy was analyzed. Results Out of 70 patients with unilateral symptomatic FAI, 37 were males (52.9%) and 23 (32.9%) had symptoms involving the left hip. The mean age was 39.3 ± 10.4 years and the mean BMI was 24.3 ± 3.6. The distribution of AIIS variants in symptomatic hips did not differ significantly from that in asymptomatic hips (χ2 = 3.092, P = 0.213). Twenty‐nine hips in the symptomatic group (41.4%) and 12 hips in the asymptomatic group (17.1%) were identified as positive for subspine hypertrophy. The incidence of positive subspine hypertrophy was significantly higher in the symptomatic hips compared to the asymptomatic hips (χ2 = 9.968, P = 0.002). FAI‐related morphological parameters including α angle, lateral center‐edge angle, acetabular anteversion, crossover sign, and Tonnis grade were highly symmetrical and did not show significant differences between symptomatic and asymptomatic hips. Fifty‐four of 70 hips (77.1%) had labral tears extended to the acetabular rim corresponding to the AIIS. Forty‐seven hips of 70 hips (67.1%) underwent subspine decompression, which was significantly correlated with AIIS variation and subspine hypertrophic deformity (P = 0.019 and 0.001, respectively). Conclusion Subspine hypertrophic deformity was found to be more common in symptomatic side vs asymptomatic side in patients with unilateral symptomatic femoroacetabular impingement. Subspine hypertrophy may be considered as an underlying indication for subspine decompression besides low‐lying AIIS.
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Affiliation(s)
- Hui Bai
- Department of Radiology, The Second Hospital of Shandong University, Jinan, China
| | - Chun-Bao Li
- Department of Orthopaedics, The Fourth medical center, Chinese PLA General Hospital, Beijing, China
| | - Heng Zhao
- Department of Orthopaedics, The Second Hospital of Shandong University, Jinan, China
| | - Qing-Feng Yin
- Department of Orthopaedics, The Second Hospital of Shandong University, Jinan, China
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Haeberle HS, Ramkumar PN, Karnuta JM, Sullivan S, Sink EL, Kelly BT, Ranawat AS, Nwachukwu BU. Predicting the Risk of Subsequent Hip Surgery Before Primary Hip Arthroscopy for Femoroacetabular Impingement Syndrome: A Machine Learning Analysis of Preoperative Risk Factors in Hip Preservation. Am J Sports Med 2021; 49:2668-2676. [PMID: 34232753 DOI: 10.1177/03635465211024964] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND The number of patients requiring reoperation has increased as the volume of hip arthroscopy for femoroacetabular impingement syndrome (FAIS) has increased. The factors most important in determining patients who are likely to require reoperation remain elusive. PURPOSE To leverage machine learning to better characterize the complex relationship across various preoperative factors (patient characteristics, radiographic parameters, patient-reported outcome measures [PROMs]) for patients undergoing primary hip arthroscopy for FAIS to determine which features predict the need for future ipsilateral hip reoperation, namely, revision hip arthroscopy, total hip arthroplasty (THA), hip resurfacing arthroplasty (HRA), or periacetabular osteotomy (PAO). STUDY DESIGN Cohort study; Level of evidence, 3. METHODS A cohort of 3147 patients undergoing 3748 primary hip arthroscopy procedures were included from an institutional hip preservation registry. Preoperative computed tomography of the hip was obtained for each patient, from which the following parameters were calculated: the alpha angle; the coronal center-edge angle; the neck-shaft angle; the acetabular version angle at 1, 2, and 3 o'clock; and the femoral version angle. Preoperative PROMs included the modified Harris Hip Score (mHHS), the Hip Outcome Score (HOS)-Activities of Daily Living subscale (HOS-ADL) and the Sport Specific subscale, and the international Hip Outcome Tool (iHOT-33). Random forest models were created for revision hip arthroscopy, the THA, the HRA, and the PAO. Area under the curve (AUC) for the receiver operating characteristic curve and accuracy were calculated to evaluate each model. RESULTS A total of 171 patients (4.6%) underwent subsequent hip surgery after primary hip arthroscopy for FAIS. The AUC and accuracy, respectively, were 0.77 (fair) and 76% for revision hip arthroscopy (mean, 26.4-month follow-up); 0.80 (good) and 81% for THA (mean, 32.5-month follow-up); 0.62 (poor) and 69% for HRA (mean, 45.4-month follow-up); and 0.76 (fair) and 74% for PAO (mean, 30.4-month follow-up). The most important factors in predicting reoperation after primary hip arthroscopy were higher body mass index (BMI) and lower preoperative HOS-ADL for revision hip arthroscopy, greater age and lower preoperative iHOT-33 for THA, increased BMI for HRA, and larger neck-shaft angle and lower preoperative mHHS for PAO. CONCLUSION Despite the low failure rate of hip arthroscopy for FAIS, our study demonstrated that machine learning has the capability to identify key preoperative risk factors that may predict subsequent ipsilateral hip surgery before the index hip arthroscopy. Knowledge of these demographic, radiographic, and patient-reported outcome data may aid in preoperative counseling and expectation management to better optimize hip preservation.
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Affiliation(s)
- Heather S Haeberle
- Orthopaedic Machine Learning Laboratory, Cleveland Clinic, Cleveland, Ohio, USA.,Sports Medicine & Hip Preservation Service, Hospital for Special Surgery, New York, New York, USA
| | - Prem N Ramkumar
- Orthopaedic Machine Learning Laboratory, Cleveland Clinic, Cleveland, Ohio, USA.,Sports Medicine & Hip Preservation Service, Hospital for Special Surgery, New York, New York, USA.,Department of Orthopaedics, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Jaret M Karnuta
- Orthopaedic Machine Learning Laboratory, Cleveland Clinic, Cleveland, Ohio, USA
| | - Spencer Sullivan
- Sports Medicine & Hip Preservation Service, Hospital for Special Surgery, New York, New York, USA
| | - Ernest L Sink
- Sports Medicine & Hip Preservation Service, Hospital for Special Surgery, New York, New York, USA
| | - Bryan T Kelly
- Sports Medicine & Hip Preservation Service, Hospital for Special Surgery, New York, New York, USA
| | - Anil S Ranawat
- Sports Medicine & Hip Preservation Service, Hospital for Special Surgery, New York, New York, USA
| | - Benedict U Nwachukwu
- Sports Medicine & Hip Preservation Service, Hospital for Special Surgery, New York, New York, USA
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12
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Kunze KN, Olsen RJ, Sullivan SW, Nwachukwu BU. Revision Hip Arthroscopy in the Native Hip: A Review of Contemporary Evaluation and Treatment Options. Front Surg 2021; 8:662720. [PMID: 34291077 PMCID: PMC8287031 DOI: 10.3389/fsurg.2021.662720] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2021] [Accepted: 06/03/2021] [Indexed: 11/28/2022] Open
Abstract
Hip arthroscopy is a reproducible and efficacious procedure for the treatment of femoroacetabular impingement syndrome (FAIS). Despite this efficacy, clinical failures are observed, clinical entities are challenging to treat, and revision hip arthroscopy may be required. The most common cause of symptom recurrence after a hip arthroscopy that leads to a revision arthroscopy is residual cam morphology as a result of inadequate femoral osteochondroplasty and restoration of head–neck offset, though several other revision etiologies including progressive chondral and labral pathologies also exist. In these cases, it is imperative to perform a comprehensive examination to identify the cause of a failed primary arthroscopy as to assess whether or not a revision hip arthroscopy procedure is indicated. When a secondary procedure is indicated, approaches may consist of revision labral repair, complete labral reconstruction, or labral augmentation depending on labral integrity. Gross instability or imaging-based evidence of microinstability may necessitate capsular augmentation or plication. If residual cam or pincer morphology is present, additional resection of the osseous abnormalities may be warranted. This review article discusses indications, the evaluation of patients with residual symptoms after primary hip arthroscopy, and the evaluation of outcomes following revision hip arthroscopy through an evidence-based discussion. We also present a case example of a revision hip arthroscopy procedure to highlight necessary intraoperative techniques during a revision hip arthroscopy.
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Affiliation(s)
- Kyle N Kunze
- Hospital for Special Surgery, New York, NY, United States
| | - Reena J Olsen
- Hospital for Special Surgery, New York, NY, United States
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13
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Beck EC, Nwachukwu BU, Chahla J, Clapp IM, Jan K, Nho SJ. Complete Capsular Closure Provides Higher Rates of Clinically Significant Outcome Improvement and Higher Survivorship Versus Partial Closure After Hip Arthroscopy at Minimum 5-Year Follow-Up. Arthroscopy 2021; 37:1833-1842. [PMID: 33529782 DOI: 10.1016/j.arthro.2021.01.035] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/20/2020] [Revised: 01/06/2021] [Accepted: 01/12/2021] [Indexed: 02/08/2023]
Abstract
PURPOSE To (1) compare the rates of reaching threshold hip-specific outcome scores for achieving the minimal clinically important difference (MCID) and patient acceptable symptomatic state (PASS) in patients who underwent partial versus complete T-capsulotomy repair and (2) identify the failure rates in each group 5 years after undergoing hip arthroscopy for femoroacetabular impingement syndrome (FAIS). METHODS Data from consecutive patients who underwent hip arthroscopy for FAIS performed by a single fellowship-trained surgeon from January 2011 to March 2013 were collected and analyzed. Baseline data, hip-specific outcomes, and clinical failure rates were recorded at a minimum of 5 years postoperatively. Patients with partial T-capsulotomy repair were matched 1:3 by age, body mass index, and sex to patients with complete T-capsulotomy repair. Threshold scores for achieving the MCID and PASS were calculated and compared between the 2 groups. Additionally, rates of revision and conversion to total hip arthroplasty (THA) were compared between the groups. RESULTS A total of 379 patients were available for analysis (39 partial and 340 complete repairs), with 100 patients included in the matching process (25 in the partial-repair group and 75 in the complete-repair group). Comparison of radiographic parameters, including the Tönnis grade, alpha angle, and lateral center-edge angle, between the 2 groups showed no statistically significant difference (P > .05 for all). Comparison of postoperative score averages between the partial- and complete-closure groups showed a significant difference in the Hip Outcome Score-Activities of Daily Living Subscale (85.4 ± 17.7 vs 94.6 ± 7.8, P < .001), Hip Outcome Score-Sports Subscale (76.6 ± 26.2 vs 89.3 ± 16.8, P = .034), modified Harris Hip Score (83.2 ± 19.7 vs 90.5 ± 11.2, P = .035), and visual analog scale pain score (24.5 ± 30.8 vs 13.4 ± 15.8, P = .035). A total of 65 complete-repair patients (95.6%) achieved the MCID for at least 1 outcome measure versus 18 patients with partial repair (78.3%) (P = .04). A total of 69 complete-repair patients (92%) achieved the PASS for at least 1 outcome measure versus 18 partial-repair patients (72%) (P = .017). Of the 39 partial-repair patients, 35.9% (n = 14) underwent revision or conversion to THA, as compared with 2.9% (n = 10) in the overall cohort. CONCLUSIONS At a minimum 5-year follow-up, patients with complete capsular closure after hip arthroscopy for FAIS show superior long-term outcomes and achieve higher rates of meaningful clinical success when compared with patients with partial capsular closure. Furthermore, patients with partial capsular repair undergo revision or conversion to THA at high rates. LEVEL OF EVIDENCE Level III, retrospective comparative study.
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Affiliation(s)
- Edward C Beck
- Department of Orthopedic Surgery, Wake Forest Baptist Health, Winston-Salem, North Carolina, U.S.A..
| | - Benedict U Nwachukwu
- Division of Sports Medicine Surgery, Department of Orthopedic Surgery, Hospital for Special Surgery, New York, New York, U.S.A
| | - Jorge Chahla
- Division of Sports Medicine Surgery, Department of Orthopedic Surgery, Rush University Medical Center, Chicago, Illinois, U.S.A
| | - Ian M Clapp
- Division of Sports Medicine Surgery, Department of Orthopedic Surgery, Rush University Medical Center, Chicago, Illinois, U.S.A
| | - Kyleen Jan
- Division of Sports Medicine Surgery, Department of Orthopedic Surgery, Rush University Medical Center, Chicago, Illinois, U.S.A
| | - Shane J Nho
- Division of Sports Medicine Surgery, Department of Orthopedic Surgery, Rush University Medical Center, Chicago, Illinois, U.S.A
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14
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Lerch TD, Zwingelstein S, Schmaranzer F, Boschung A, Hanke MS, Todorski IAS, Steppacher SD, Gerber N, Zeng G, Siebenrock KA, Tannast M. Posterior Extra-articular Ischiofemoral Impingement Can Be Caused by the Lesser and Greater Trochanter in Patients With Increased Femoral Version: Dynamic 3D CT-Based Hip Impingement Simulation of a Modified FABER Test. Orthop J Sports Med 2021; 9:2325967121990629. [PMID: 34104657 PMCID: PMC8167016 DOI: 10.1177/2325967121990629] [Citation(s) in RCA: 24] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/03/2020] [Accepted: 10/02/2020] [Indexed: 11/29/2022] Open
Abstract
Background: Posterior extra-articular hip impingement has been described for valgus hips
with increased femoral version (FV). These patients can present clinically
with lack of external rotation (ER) and extension and with a positive
posterior impingement test. But we do not know the effect of the combination
of deformities, and the impingement location in early flexion is
unknown. Purpose: To evaluate patient-specific 3-dimensional computed tomography (3D CT) scans
of hips with increased FV and control hips for differences in range of
motion, location and prevalence of osseous posterior intra- and
extra-articular hip impingement. Study Design: Case series; Level of evidence, 4. Methods: Osseous 3D models based on segmentation of 3D CT scans were analyzed for 52
hips (38 symptomatic patients) with positive posterior impingement test and
increased FV (>35°). There were 26 hips with an increased McKibbin
instability index >70 (unstable hips). Patients were mainly female (96%),
with an age range of 18 to 45 years. Of them, 21 hips had isolated increased
FV (>35°); 22 hips had increased FV and increased acetabular version (AV;
>25°); and 9 valgus hips (caput-collum-diaphyseal angle >139°) had
increased FV and increased AV. The control group consisted of 20 hips with
normal FV, normal AV, and no valgus (caput-collum-diaphyseal angle
<139°). Validated 3D CT–based collision detection software for
impingement simulation was used to calculate impingement-free range of
motion and location of hip impingement. Surgical treatment was performed
after the 3D CT–based impingement simulation in 27 hips (52%). Results: Hips with increased FV had significantly (P < .001)
decreased extension and ER at 90° of flexion as compared with the control
group. Posterior impingement was extra-articular (92%) in hips with
increased FV. Valgus hips with increased FV and AV had combined intra- and
extra-articular impingement. Posterior hip impingement occurred between the
ischium and the lesser trochanter at 20° of extension and 20° of ER.
Impingement was located between the ischium and the greater trochanter or
intertrochanteric area at 20° of flexion and 40° of ER, with a modification
of the flexion-abduction-ER (FABER) test. Conclusion: Posterior extra-articular ischiofemoral hip impingement can be caused by the
lesser and greater trochanter or the intertrochanteric region. We recommend
performing the modified FABER test during clinical examination in addition
to the posterior impingement test for female patients with high FV. In
addition, 3D CT can help for surgical planning, such as femoral derotation
osteotomy and/or hip arthroscopy or resection of the lesser trochanter.
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Affiliation(s)
- Till D Lerch
- Department of Orthopaedic Surgery, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland.,Department of Diagnostic, Interventional and Paediatric Radiology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Sébastien Zwingelstein
- Department of Orthopaedic Surgery, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland.,Department of Diagnostic, Interventional and Paediatric Radiology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Florian Schmaranzer
- Department of Orthopaedic Surgery, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland.,Department of Diagnostic, Interventional and Paediatric Radiology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Adam Boschung
- Department of Orthopaedic Surgery, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Markus S Hanke
- Department of Orthopaedic Surgery, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Inga A S Todorski
- Department of Diagnostic, Interventional and Paediatric Radiology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Simon D Steppacher
- Department of Orthopaedic Surgery, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Nicolas Gerber
- sitem Center for Translational Medicine and Biomedical Entrepreneurship, University of Bern, Bern, Switzerland
| | - Guodong Zeng
- sitem Center for Translational Medicine and Biomedical Entrepreneurship, University of Bern, Bern, Switzerland
| | - Klaus A Siebenrock
- Department of Orthopaedic Surgery, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Moritz Tannast
- Department of Orthopaedic Surgery, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland.,Department of Orthopaedic Surgery and Traumatology, Fribourg Cantonal Hospital, University of Fribourg, Fribourg, Switzerland
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15
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Clinical outcomes after revision hip arthroscopy in patients with femoroacetabular impingement syndrome (FAIS) are inferior compared to primary procedures. Results from the Danish Hip Arthroscopy Registry (DHAR). Knee Surg Sports Traumatol Arthrosc 2021; 29:1340-1348. [PMID: 32653932 DOI: 10.1007/s00167-020-06135-w] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/02/2020] [Accepted: 06/26/2020] [Indexed: 10/23/2022]
Abstract
PURPOSE As many as 10% of primary hip arthroscopies end up with a revision arthroscopy procedure when treating patients suffering from femoroacetabular impingement syndrome (FAIS). In general, revision procedures are indicated because of residual impingement, but only a few studies present outcome data from revision hip arthroscopy after failed FAIS surgical treatment. The purpose of this study was to evaluate clinical outcomes after revision hip arthroscopy in a FAIS cohort and compare outcomes with a primary FAIS hip arthroscopy cohort and describe potential causes of failure after the primary hip arthroscopy. It was hypothesized that subjective outcomes improve after revision hip arthroscopy although outcomes were expected to be inferior to primary hip arthroscopic outcomes. METHODS Three-hundred and thirty-one arthroscopic revision hip FAIS patients were included from the Danish Hip Arthroscopy Registry (DHAR). Patient-related outcome measures (PROM's), Copenhagen Hip and Groin Outcome Scores (HAGOS), Hip Sports Activity Scale (HSAS), EQ-5D and Numeric Rating Scale (NRS) pain, were assessed in the study cohort prior to the primary procedure and at revision and at follow-up one year after the revision procedure. These data were compared with 4154 primary hip arthroscopic FAIS patients. RESULTS One-year after revision surgery, mean follow-up (in months ± SD): 12.3 ± 1.6, significant improvements (p < 0.05) in all PROMs was demonstrated, but FAIS patients in the primary hip arthroscopic cohort demonstrated significantly higher outcomes, in all PROMs, when compared at one-year follow-up. Scar tissue, residual osseous impingement and insufficient healing of the labral repair were reported as the main reasons for revision surgery. The conversion to total hip arthroplasty was low (6.4%). CONCLUSION Revision hip arthroscopy in FAIS patients improves subjective outcomes significantly, although they are poorer than after primary FAIS hip arthroscopy. Main reasons for revision arthroscopy was scar tissue, residual femoroacetabular impingement and insufficient healing of labral repair. LEVEL OF EVIDENCE Level III.
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16
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Lerch TD, Ambühl D, Schmaranzer F, Todorski IAS, Steppacher SD, Hanke MS, Haefeli PC, Liechti EF, Siebenrock KA, Tannast M. Biochemical MRI With dGEMRIC Corresponds to 3D-CT Based Impingement Location for Detection of Acetabular Cartilage Damage in FAI Patients. Orthop J Sports Med 2021; 9:2325967120988175. [PMID: 33816640 PMCID: PMC7988263 DOI: 10.1177/2325967120988175] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/01/2020] [Accepted: 09/30/2020] [Indexed: 01/20/2023] Open
Abstract
Background Anterior femoroacetabular impingement (FAI) is associated with labral tears and acetabular cartilage damage in athletic and young patients. Delayed gadolinium-enhanced magnetic resonance imaging of cartilage (dGEMRIC) is an imaging method for detecting early damage to cartilage. Purpose We evaluated the following questions: (1) What is the sensitivity and specificity of morphological magnetic resonance imaging (MRI) and dGEMRIC for detecting cartilage damage? Do the mean acetabular and femoral dGEMRIC indices differ between (2) superior acetabular clock positions with and without impingement and (3) between cam- and pincer-type FAI? Study Design Cohort study (diagnosis); Level of evidence, 2. Methods This was a retrospective comparative study of 21 hips (20 patients with symptomatic anterior FAI) without osteoarthritis on anteroposterior radiographs. Morphological MRI and dGEMRIC (3.0-T, 3-dimensional [3D] T1 maps, dual-flip angle technique) of the same hip joint were compared. Intraoperative acetabular cartilage damage was assessed in patients who underwent surgical treatment. Computed tomography (CT)-based 3D bone models of the same hip joint were used as the gold standard for the detection of impingement, and dGEMRIC indices and zones of morphologic damage were compared with the CT-based impingement zones. Results Of the 21 hips, 10 had cam-type FAI and 8 had pincer-type FAI according to radiographs. The mean age was 30 ± 9 years (range, 17-48 years), 71% were female, and surgical treatment was performed in 52%. We found a significantly higher sensitivity (69%) for dGEMRIC compared with morphological MRI (42%) in the detection of cartilage damage (P < .001). The specificity of dGEMRIC was 83% and accuracy was 78%. The mean peripheral acetabular and femoral dGEMRIC indices for clock positions with impingement (485 ± 141 and 440 ± 121 ms) were significantly lower compared with clock positions without impingement (596 ± 183 and 534 ± 129 ms) (P < .001). Hips with cam-type FAI had significantly lower acetabular dGEMRIC indices compared with hips with pincer-type FAI on the anterosuperior clock positions (1 to 3 o'clock) (P = .018). Conclusion MRI with dGEMRIC was more sensitive than morphological MRI, and lower dGEMRIC values were found for clock positions with impingement as detected on 3D-CT. This could aid in patient-specific diagnosis of FAI, preoperative patient selection, and surgical decision making to identify patients with cartilage damage who are at risk for inferior outcomes after hip arthroscopy.
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Affiliation(s)
- Till D Lerch
- Department of Orthopaedic Surgery, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland.,Department of Diagnostic, Interventional and Pediatric Radiology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Dimitri Ambühl
- Department of Orthopaedic Surgery, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland.,Department of Diagnostic, Interventional and Pediatric Radiology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Florian Schmaranzer
- Department of Orthopaedic Surgery, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland.,Department of Diagnostic, Interventional and Pediatric Radiology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Inga A S Todorski
- Department of Orthopaedic Surgery, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland.,Department of Diagnostic, Interventional and Pediatric Radiology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Simon D Steppacher
- Department of Orthopaedic Surgery, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Markus S Hanke
- Department of Orthopaedic Surgery, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Pascal C Haefeli
- Department of Orthopaedic Surgery, Lucerne Cantonal Hospital, Lucerne, Switzerland
| | - Emanuel F Liechti
- Department of Orthopaedic Surgery, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Klaus A Siebenrock
- Department of Orthopaedic Surgery, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Moritz Tannast
- Department of Orthopaedic Surgery, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland.,Department of Orthopaedic Surgery, Fribourg Cantonal Hospital, University of Fribourg, Fribourg, Switzerland
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17
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Parvaresh K, Rasio JP, Martin RL, Kivlan BR, Carreira D, Christoforetti JJ, Harris JD, Matsuda DK, Salvo J, Wolff AB, Nho SJ. Achievement of Meaningful Clinical Outcomes Is Unaffected by Capsulotomy Type During Arthroscopic Treatment of Femoroacetabular Impingement Syndrome: Results From the Multicenter Arthroscopic Study of the Hip (MASH) Study Group. Am J Sports Med 2021; 49:713-720. [PMID: 33560868 DOI: 10.1177/0363546520987226] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND Capsule management has emerged as an important topic in the field of hip arthroscopy. The 2 most popular techniques are interportal capsulotomy and T-type capsulotomy, but few studies have compared outcomes between these 2 techniques. PURPOSE To compare 2-year (±2 months) patient-reported outcomes (PROs) between patients who underwent interportal versus T-type capsulotomy during arthroscopic labral repair for femoroacetabular impingement syndrome (FAIS). STUDY DESIGN Cohort study; Level of evidence, 3. METHODS A retrospective review of a large multicenter registry of patients undergoing arthroscopic hip preservation surgery for FAIS was performed. Data from 9 surgeons across 9 sites between January 2014 and February 2018 were included in the study. Baseline demographic data, preoperative PROs, and minimum 2-year postoperative PROs including Hip Outcome Score-Activities of Daily Living (HOS-ADL), HOS-Sports Subscale (HOS-SS), modified Harris Hip Score, and International Hip Outcome Tool-12 (iHOT-12) were recorded. Patients were divided into 2 groups based on whether interportal or T-type capsulotomy was performed according to the senior surgeon's preference and training, and all capsulotomies were then routinely repaired. The 2 groups were matched 1:1 by age, sex, and body mass index (BMI). Achievement of minimal clinically important difference (MCID), Patient Acceptable Symptomatic State (PASS), and substantial clinical benefit (SCB) was compared for the HOS-ADL, HOS-SS, and iHOT-12 between the 2 groups. RESULTS The final analysis included 658 of 1483 eligible patients with a mean ± SD age of 32.6 ± 11.6 years and BMI of 24.0 ± 3.7; of these, 329 patients were treated via interportal capsulotomy, and 329 patients were treated via T-type capsulotomy. Female patients comprised 66.3% of the study population. Capsulotomy type was not a predictor of 2-year postoperative PROs on multivariate linear regression analysis when adjusted for covariates. Chi-square analysis showed no statistical difference in achievement of MCID, PASS, and SCB between the interportal and T-type groups for HOS-ADL (80.3%, 75.8%, 52.7% and 77.1%, 71.7%, 53.6%, respectively; P > .01 for all), HOS-SS (83.6%, 72.5%, 51.5% and 81.7%, 68.4%, 49.2%, respectively; P > .01 for all), and iHOT-12 (87.5%, 72.0%, 50.5% and 80.0%, 64.7%, 45.6%, respectively; P > .01 for all). CONCLUSION Arthroscopic management of FAIS resulted in significant clinical improvement that was independent of capsulotomy type when the capsulotomy included repair.
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Affiliation(s)
- Kevin Parvaresh
- Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, Illinois, USA
| | - Jonathan P Rasio
- Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, Illinois, USA
| | - RobRoy L Martin
- Rangos School of Health Sciences, Department of Physical Therapy, Duquesne University, Pittsburgh, Pennsylvania, USA.,UPMC Center for Sports Medicine, Pittsburgh, Pennsylvania, USA
| | - Benjamin R Kivlan
- Rangos School of Health Sciences, Department of Physical Therapy, Duquesne University, Pittsburgh, Pennsylvania, USA
| | | | | | - Joshua D Harris
- The Methodist Orthopedics and Sports Medicine Center, Houston, Texas, USA
| | - Dean K Matsuda
- ISC Sports and Spine Center, Marina del Rey, California, USA
| | - John Salvo
- The Sydney Kimmel Medical College at Thomas Jefferson University Hospital, Hip Arthroscopy Program, Rothman Institute, Philadelphia, Pennsylvania, USA
| | - Andrew B Wolff
- Hip Preservation and Sports Medicine, Washington Orthopaedics and Sports Medicine, Washington, DC, USA
| | - Shane J Nho
- Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, Illinois, USA
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18
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Knapik DM, Fortun CM, Schilf CRJ, Nho SJ, Salata MJ. Prevalence of Anterior Inferior Iliac Spine Dysmorphism and Development of a Novel Classification System: An Anatomic Study of 1,797 Cadaveric Specimens. Front Surg 2021; 7:587921. [PMID: 33521043 PMCID: PMC7844315 DOI: 10.3389/fsurg.2020.587921] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2020] [Accepted: 11/11/2020] [Indexed: 11/13/2022] Open
Abstract
Purpose: Subspine impingement occurs due to a morphologically abnormal anterior inferior iliac spine (AIIS), capable of causing impingement against the distal femoral neck. The purpose of this investigation was to determine the prevalence of AIIS dysmorphism based on specimen sex, race, and age, while introducing a novel anatomic-based classification system. Methods: A total of 1,797 adult cadaveric specimens (n = 3,594 hemipelvises) were analyzed. AIIS with the potential for subspine impingement (SSI) was recorded in each specimen by two independent authors. Specimens with AIIS dysmorphism were then reexamined to determine SSI subtype using a novel descriptive anatomic classification system. Results: AIIS dysmorphism was present in 6.4% (n = 115 of 1,797 specimens) of specimens and 5.2% (n = 186 of 3,594) of hemipelvises. Dysmorphism was significantly more common in male specimens (p = 0.04) and African–American specimens (p = 0.04). No significant overall difference in prevalence was appreciated based on specimen age (p = 0.89). Subtype classification found that 67% of hemipelvises possessed a columnar type AIIS, 30% were bulbous and 3% hook type. Males possessed a significantly higher prevalence of columnar type AIIS dysmorphism (p < 0.001). No significant overall differences in anatomic classification were appreciated based on race (p = 0.12) or when analyzed based on age (p = 0.34). Conclusion: AIIS dysmorphism was present in 6.4% of the 1,797 cadaveric specimens evaluated. African-American and male specimens possessed significantly higher prevalence of AIIS dysmorphism, with no significant difference based on specimen age. Columnar type AIIS dysmorphism was most common. Anatomic classification was not significantly different based on specimen race or age. Level of Evidence: Case Series, Level IV.
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Affiliation(s)
- Derrick M Knapik
- Department of Orthopaedic Surgery, University Hospitals Cleveland Medical Center, Cleveland, OH, United States
| | - Chad M Fortun
- Case Western Reserve University School of Medicine, Cleveland, OH, United States.,Carolina Sports Medicine and Orthopaedic Specialists, Wilmington, NC, United States
| | | | - Shane J Nho
- Midwest Orthopaedics at Rush University, Chicago, IL, United States
| | - Michael J Salata
- Department of Orthopaedic Surgery, University Hospitals Cleveland Medical Center, Cleveland, OH, United States.,Case Western Reserve University School of Medicine, Cleveland, OH, United States
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19
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Approach to the Patient With Failed Hip Arthroscopy for Labral Tears and Femoroacetabular Impingement. J Am Acad Orthop Surg 2020; 28:538-545. [PMID: 32574474 DOI: 10.5435/jaaos-d-16-00928] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023] Open
Abstract
There has been an exponential increase in the diagnosis and treatment of patients with femoroacetabular impingement, leading to a rise in the number of hip arthroscopies done annually. Despite reliable pain relief and functional improvements after hip arthroscopy in properly indicated patients, and due to these increased numbers, there is a growing number of patients who have persistent pain after surgery. The etiology of these continued symptoms is multifactorial, and clinicians must have a fundamental understanding of these causes to properly diagnose and manage these patients. Factors contributing to failure after surgery include those related to the patient, the surgeon, and the postoperative physical therapy. This review highlights common causes of failure, including those related to residual bony deformity as well as capsular deficiency, and provides a framework for diagnosis and treatment of these patients.
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20
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Moley PJ, Tatka J, Singh JR. Running with Femoral Acetabular Impingement: Operative Vs Nonoperative Treatment. PM R 2020; 12:817-822. [PMID: 32535998 DOI: 10.1002/pmrj.12438] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2020] [Accepted: 06/11/2020] [Indexed: 11/08/2022]
Abstract
A 31-year-old female lawyer presents with right hip pain starting approximately 3 years ago and worsening over the past 2 to 3 months. She is an avid runner, running 20 to 30 miles weekly, and noticed that her pain started after a running program training for the marathon. Her pain is primarily over the lateral aspect of her hip with some radiation into the groin. The pain is made worse with impact exercises such as running and made better with walking and cycling. She has done physical therapy for the past 3 months without any significant improvement. She has not had any injections or taken anti-inflammatories because of a history of gastric ulcer disease. On physical examination she has mild tenderness over her right greater trochanter and her range of motion tests are full in terms of flexion, internal rotation, and external rotation. She has a positive FADIR (flexion-adduction-internal rotation) impingement that causes both groin and lateral hip pain. Radiograph of the right hip revealed preservation of the joint space and an anterior cam lesion with reduced offset at the femoral head neck junction. Magnetic resonance imaging (MRI) of the right hip revealed a tear at the anterior superior labrum at the 1 to 2 o'clock position along with subjacent bone marrow edema in the femoral head that is likely reactive. Computed tomography (CT) scan of the right hip confirmed a combined cam and pincer type femoral acetabular impingement of the right hip with overcoverage of the femoral head. There was 15° of femoral anteversion and the coronal lateral center of edge angle (LCEA) is 34°. Dr. Peter Moley argues that a focused rehabilitation program to restore strength and motor control of the deep hip stabilizers will provide optimal functional recovery. Dr. Jakub Tatka argues that right hip arthroscopy with labral repair and possible osteochondralplasty are indicated in order to prevent early hip arthritis and prevent long-term sequela of femoral acetabular impingement.
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Affiliation(s)
| | - Jakub Tatka
- Department of Orthopedic Surgery, Columbia University, New York, NY, USA
| | - Jaspal Ricky Singh
- Weill Cornell Medicine, Department of Rehabilitation Medicine, Weill Cornell Center for Comprehensive Spine Care, New York, NY, USA
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21
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Ruzbarsky JJ, Soares R, Johannsen A, Philippon MJ. Survivorship Following Hip Arthroscopy: Lessons Learned from a Comprehensive Database. Curr Rev Musculoskelet Med 2020; 13:220-232. [PMID: 32377960 PMCID: PMC7251001 DOI: 10.1007/s12178-020-09622-2] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
PURPOSE OF REVIEW Hip arthroscopy and its indications continue to expand. Understanding the durability of hip arthroscopic procedures remains important not only for counseling patients, but also for determining the success of certain procedures or in certain populations. Survivorship is defined as the proportion of hip arthroscopy patients who have not yet gone on to periacetabular osteotomy (PAO), total hip arthroplasty (THA), and/or revision surgery. The purpose of this review is to summarize the recent literature pertaining to survivorship after certain hip arthroscopic procedures and certain special populations. RECENT FINDINGS There is yet to be level 1 evidence published with relation to survivorship following hip arthroscopy. The best evidence in the recent literature is contained in just rew long-term prospective studies demonstrating good to excellent survivorship following hip arthroscopy for femoroacetabular impingement (FAI). Unfortunately, the follow-up for other conditions treated by hip arthroscopy is more limited. In summary, hip arthroscopy indications continue to expand. The most common indication for surgery is FAI, and its recently published long-term survivorship demonstrates excellent durability. Other hip arthroscopic procedures, including labral reconstruction, adjunctive procedures such as capsular closure, and special populations such as athletes, also demonstrate excellent survivorship in shorter term follow-up. Further prospective research is needed to further define survivorship of various hip conditions, associated procedures, and special populations commonly treated with hip arthroscopy.
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Affiliation(s)
- Joseph J Ruzbarsky
- The Steadman Clinic and United States Coalition for the Prevention of Illness and Injury in Sport, Vail, CO, USA
| | - Rui Soares
- Steadman Philippon Research Institute, 181 W Meadow Dr, Ste 400, Vail, CO, 81657, USA
| | - Adam Johannsen
- The Steadman Clinic and United States Coalition for the Prevention of Illness and Injury in Sport, Vail, CO, USA
| | - Marc J Philippon
- The Steadman Clinic and United States Coalition for the Prevention of Illness and Injury in Sport, Vail, CO, USA.
- Steadman Philippon Research Institute, 181 W Meadow Dr, Ste 400, Vail, CO, 81657, USA.
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22
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Hammarstedt JE, Laseter JR, Gupta A, Christoforetti JJ, Lall AC, Domb BG. Identifying the Most Successful Procedures in Hip Arthroscopy. Orthopedics 2020; 43:173-181. [PMID: 32003838 DOI: 10.3928/01477447-20200129-01] [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] [Received: 11/21/2018] [Accepted: 02/25/2019] [Indexed: 02/03/2023]
Abstract
Hip arthroscopy for femoral and acetabular pathologies has increased dramatically. However, there is little literature analyzing procedures as predictors of revision arthroscopy or arthroplasty. From February 2008 to November 2015, patients undergoing hip arthroscopy for a labral tear with minimum 2-year follow-up and between 18 and 60 years old were retrospectively reviewed. Those with previous surgeries, Tönnis grade greater than 1, and previous hip conditions were excluded. Follow-up was obtained for 1118 patients (1249 hips; 81.7%) with a mean age of 38.7 years (range, 18.0-60.0 years), mean body mass index of 26.4 kg/m2 (range, 16.3-48.9 kg/m2), and mean follow-up of 50.2 months (range, 24.0-111.9 months). A total of 122 (9.8%) patients converted to total hip arthroplasty (mean, 35.3 months; range, 1.4-95.2 months). Multivariate analysis for predictors of total hip arthroplasty found age at surgery (hazard ratio, 1.064/y; P<.05), body mass index (nonlinear; P<.05), labral debridement (HR, 1.558; P=.03), and notchplasty (HR, 2.128; P<.05), with trochanteric bursectomy (HR, 0.367; P<.05) identified as associated with higher survivorship. A total of 124 (9.9%) patients underwent revision hip arthroscopy at a mean of 21.7 months (range, 0.10-83.3 months). Multivariate analysis for predictors of revision surgery found workers' compensation (HR, 3.352; P<.05), capsular repair (HR, 1.950; P<.05), and femoral head microfracture (HR, 2.844; P=.04) to be significant, with age at date of surgery (HR, 0.973/y; P<.05) and femoral head chondroplasty (HR, 0.241; P=.05) associated with higher survivorship. Understanding risk factors for conversion to total hip arthroplasty or revision is paramount during discussions with patients. [Orthopedics. 2020;43(3):173-181.].
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23
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Swarup I, Zaltz I, Robustelli S, Sink E. Outcomes of periacetabular osteotomy for borderline hip dysplasia in adolescent patients. J Hip Preserv Surg 2020; 7:249-255. [PMID: 33163209 PMCID: PMC7605771 DOI: 10.1093/jhps/hnaa012] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/04/2019] [Revised: 12/24/2019] [Accepted: 02/24/2020] [Indexed: 12/28/2022] Open
Abstract
Treatment of borderline acetabular dysplasia (lateral center edge angle ≥18°) remains controversial, and there is a paucity of literature focusing on outcomes in adolescent patients. The purpose of this study was to evaluate the outcomes of a periacetabular osteotomy (PAO) as surgical management of borderline acetabular dysplasia in adolescent patients. We performed a retrospective review of prospectively collected data and included patients ≤ 21 years of age that underwent PAO for borderline acetabular dysplasia. All patients had a minimum of 1-year follow-up. Outcomes were assessed using modified Harris Hip Scores (mHHS), Hip Outcome Scores (HOS) and international Hip Outcome Tool (iHOT-33). Descriptive and univariate statistical analyses were performed. This study included 33 adolescent patients (35 hips) with symptomatic, borderline acetabular dysplasia. The majority of patients was female (32 patients, 97%); half of all patients reported a history of hip pain for over 1 year; and seven patients had previous hip arthroscopy. In addition to PAO, seven hips (20%) underwent a concurrent hip arthroscopy at the time of surgery. There were significant improvements in mean mHHS, HOS-activities of daily living (ADL), HOS-Sport and iHOT-33 scores after surgery (P < 0.01). Minimal clinically important difference in outcome scores was achieved for over 90% of patients at a minimum of 1-year follow-up. Borderline acetabular dysplasia is a major cause of hip pain in adolescent patients. Patients with symptomatic borderline acetabular dysplasia report a significant benefit after a PAO to correct structural hip instability.
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Affiliation(s)
- Ishaan Swarup
- Division of Pediatric Orthopaedic Surgery, UCSF Benioff Children's Hospital, 747 52nd Street, Oakland, CA 94609, USA
| | - Ira Zaltz
- Division of Pediatric Orthopaedic Surgery, William Beaumont Hospital, 3501 West 13, Mile Road, Royal Oak, MI 48073, USA
| | - Stacy Robustelli
- Division of Pediatric Orthopaedic Surgery, Hospital for Special Surgery, 535 East 70th Street, New York, NY 10021, USA
| | - Ernest Sink
- Division of Pediatric Orthopaedic Surgery, Hospital for Special Surgery, 535 East 70th Street, New York, NY 10021, USA
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24
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O'Connor M, Steinl GK, Padaki AS, Duchman KR, Westermann RW, Lynch TS. Outcomes of Revision Hip Arthroscopic Surgery: A Systematic Review and Meta-analysis. Am J Sports Med 2020; 48:1254-1262. [PMID: 31503501 DOI: 10.1177/0363546519869671] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND While the indications for primary hip arthroscopic surgery in treating femoroacetabular abnormalities continue to be defined, the indications and outcomes for revision hip arthroscopic surgery remain ambiguous. However, revision hip arthroscopic surgery is performed in 5% to 14% of patients after their index procedure. While patient-reported outcomes (PROs) generally improve after revision procedures, the extent of their improvement is not well defined. PURPOSE To determine the outcomes and efficacy of revision hip arthroscopic surgery in patients who remain symptomatic after their index procedure. STUDY DESIGN Meta-analysis and systematic review. METHODS The terms "hip arthroscopy,""revisions,""outcomes," and "femoroacetabular impingement" were searched in PubMed, Web of Science, Scopus, Cochrane Library, and Google Scholar. After screening, 15 studies were included for review. In addition to hip-specific metrics, functional outcome measures were included. Pooled estimates and 95% CIs were calculated using inverse variance methods. RESULTS A total of 4765 hips in 4316 patients were identified. The most common indication for revision surgery was inadequate bony resection during the index procedure. Meta-analysis showed that all PROs improved significantly from baseline to final follow-up after revision hip arthroscopic surgery. Notably, the modified Harris Hip Score (mHHS) increased a mean of 17.20 points after revision hip arthroscopic surgery, the Hip Outcome Score-Activities of Daily Living (HOS-ADL) improved by 13.98, and the visual analog scale (VAS) for pain decreased by 3.16. However, when compared with primary hip arthroscopic surgery, the mean PRO scores after revision hip arthroscopic surgery were lower. After revision hip arthroscopic surgery, the rates of conversion to total hip arthroplasty ranged from 0% to 14.3%, and the rates of further arthroscopic revision ranged from 2% to 14%. CONCLUSION Inadequate bony resection represents the most common indication for revision hip arthroscopic surgery. PROs improve significantly after revision hip arthroscopic surgery but remain lower than those of patients undergoing primary hip arthroscopic surgery.
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Affiliation(s)
| | | | - Ajay S Padaki
- Columbia University Irving Medical Center, New York, New York, USA
| | | | | | - T Sean Lynch
- Columbia University Irving Medical Center, New York, New York, USA
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25
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Nwachukwu BU, Beck EC, Lee EK, Cancienne JM, Waterman BR, Paul K, Nho SJ. Application of Machine Learning for Predicting Clinically Meaningful Outcome After Arthroscopic Femoroacetabular Impingement Surgery. Am J Sports Med 2020; 48:415-423. [PMID: 31869249 DOI: 10.1177/0363546519892905] [Citation(s) in RCA: 49] [Impact Index Per Article: 12.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND Hip arthroscopy has become an important tool for surgical treatment of intra-articular hip pathology. Predictive models for clinically meaningful outcomes in patients undergoing hip arthroscopy for femoroacetabular impingement syndrome (FAIS) are unknown. PURPOSE To apply a machine learning model to determine preoperative variables predictive for achieving the minimal clinically important difference (MCID) at 2 years after hip arthroscopy for FAIS. STUDY DESIGN Case-control study; Level of evidence, 3. METHODS Data were analyzed for patients who underwent hip arthroscopy for FAIS by a high-volume fellowship-trained surgeon between January 2012 and July 2016. The MCID cutoffs for the Hip Outcome Score-Activities of Daily Living (HOS-ADL), HOS-Sport Specific (HOS-SS), and modified Harris Hip Score (mHHS) were 9.8, 14.4, and 9.14, respectively. Predictive models for achieving the MCID with respect to each were built with the LASSO algorithm (least absolute shrinkage and selection operator) for feature selection, followed by logistic regression on the selected features. Study data were analyzed with PatientIQ, a cloud-based research and analytics platform for health care. RESULTS Of 1103 patients who met inclusion criteria, 898 (81.4%) had a minimum of 2-year reported outcomes and were entered into the modeling algorithm. A total of 74.0%, 73.5%, and 79.9% met the HOS-ADL, HOS-SS, and mHHS threshold scores for achieving the MCID. Predictors of not achieving the HOS-ADL MCID included anxiety/depression, symptom duration for >2 years before surgery, higher body mass index, high preoperative HOS-ADL score, and preoperative hip injection (all P < .05). Predictors of not achieving the HOS-SS MCID included anxiety/depression, preoperative symptom duration for >2 years, high preoperative HOS-SS score, and preoperative hip injection, while running at least at the recreational level was a predictor of achieving HOS-SS MCID (all P < .05). Predictors of not achieving the mHHS MCID included history of anxiety or depression, high preoperative mHHS score, and hip injections, while being female was predictive of achieving the MCID (all P < .05). CONCLUSION This study identified predictive variables for achieving clinically meaningful outcome after hip arthroscopy for FAIS. Patient factors including anxiety/depression, symptom duration >2 years, preoperative intra-articular injection, and high preoperative outcome scores are most consistently predictive of inability to achieve clinically meaningful outcome. These findings have important implications for shared decision-making algorithms and management of preoperative expectations after hip arthroscopy for FAI.
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Affiliation(s)
- Benedict U Nwachukwu
- Division of Sports Medicine, Department of Orthopedic Surgery, Hospital for Special Surgery, New York, New York, USA
| | - Edward C Beck
- Division of Sports Medicine, Department of Orthopedic Surgery, Wake Forest Baptist Health, Winston-Salem, North Carolina, USA
| | | | - Jourdan M Cancienne
- Division of Sports Medicine, Department of Orthopedic Surgery, Rush University Medical Center, Chicago, Illinois, USA
| | - Brian R Waterman
- Division of Sports Medicine, Department of Orthopedic Surgery, Wake Forest Baptist Health, Winston-Salem, North Carolina, USA
| | - Katlynn Paul
- Division of Sports Medicine, Department of Orthopedic Surgery, Rush University Medical Center, Chicago, Illinois, USA
| | - Shane J Nho
- Division of Sports Medicine, Department of Orthopedic Surgery, Rush University Medical Center, Chicago, Illinois, USA
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26
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Arthroscopic anterior inferior iliac spine decompression does not alter postoperative muscle strength. Knee Surg Sports Traumatol Arthrosc 2020; 28:2763-2771. [PMID: 29955931 PMCID: PMC7471103 DOI: 10.1007/s00167-018-5026-z] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/08/2017] [Accepted: 06/21/2018] [Indexed: 02/02/2023]
Abstract
PURPOSE The purpose of this study was to assess the additional effect of anterior inferior iliac spine (AIIS) decompression on knee extensor and hip flexor strength and compare functional outcomes after arthroscopic FAI correction with and without AIIS decompression. METHODS Sixty patients who underwent arthroscopic FAI correction surgery were divided into two groups matched for AIIS morphology: 31 patients who underwent arthroscopic FAI surgery only (without AIIS decompression) (FAI group) (AIIS Type I; n = 5, Type II; n = 26, Type III; n = 0) and 29 patients who underwent arthroscopic FAI surgery with AIIS decompression (AIIS group) (AIIS Type I; n = 5, Type II; n = 24, Type III; n = 0). Knee extensor and hip flexor strength were evaluated preoperatively and at 6 months after surgery. Patient-reported outcome (PRO) scores using the modified Harris hip score (MHHS), the nonarthritic hip score (NAHS) and iHOT-12 were obtained preoperatively and at 6 months after surgery. RESULTS In the AIIS group, there was no significant difference between knee extensor strength pre- and postoperatively (n.s.). In the AIIS group, hip flexor strength was significantly improved postoperatively compared to preoperative measures (p < 0.05). In the FAI group, there were no significant improvements regarding muscle strength (n.s.). While there were no significant differences of preoperative and postoperative MHHS and NAHS between both groups (MHHS; n.s., NAHS; n.s.), the mean postoperative iHOT-12 in the FAI group was inferior to that in the AIIS group. (p < 0.01). The revision surgery rate for the AIIS group was significantly lower compared with that in the FAI group (p < 0.05). CONCLUSION Anterior inferior iliac spine decompression, as a part of an arthroscopic FAI corrective procedure, had a lower revision surgery rate and did not compromise knee extensor and hip flexor strength, and it improved clinical outcomes comparable to FAI correction without AIIS decompression. AIIS decompression for FAI correction improved postoperative PRO scores without altering the muscle strength of hip flexor and knee extensor. LEVEL OF EVIDENCE III.
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27
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Stone AV, Beck EC, Malloy P, Chahla J, Nwachukwu BU, Neal WH, Nho SJ. Preoperative Predictors of Achieving Clinically Significant Athletic Functional Status After Hip Arthroscopy for Femoroacetabular Impingement at Minimum 2-Year Follow-Up. Arthroscopy 2019; 35:3049-3056.e1. [PMID: 31395395 DOI: 10.1016/j.arthro.2019.05.022] [Citation(s) in RCA: 33] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/21/2019] [Revised: 05/09/2019] [Accepted: 05/10/2019] [Indexed: 02/02/2023]
Abstract
PURPOSE To identify predictors of achieving clinically significant sport function in athletic patients undergoing hip arthroscopy for femoroacetabular impingement syndrome (FAIS). METHODS Data were analyzed for all patients who treated for FAIS between 2012 to 2016 and reported being athletes, including recreational and competitive athletes. All patients had a minimum of 2-year follow-up with patient-reported athletic function in the form of the Hip Outcome Score-Sport Specific (HOS-SS), visual analog score-pain, and patient satisfaction. Achieving clinically significant sports function was defined as either reaching the minimally clinical important difference (MCID) or the patient acceptable symptomatic state (PASS) for HOS-SS at 2-year follow-up. An exploratory factor analysis was used to determine specific domains for the predictor variables and to reduce the redundancy in these variables. A logistic regression analysis was used to identify significant predictors of achieving clinically significant sports function [corrected]. RESULTS Of 780 qualifying patients, 626 completed the 2-year minimum follow-up (80%), with a mean age and body mass index of 31.6 ± 11.9 years and 24.6 ± 8.6, respectively. A total of 500 patients (86.5%) achieved high functional status, with 77.9% achieving MCID HOS-SS and 68.7% achieving PASS HOS-SS. Logistic regression analysis identified increased the α angle (odds ratio [OR] 0.976; P = .027), preoperative pain duration (OR 0.729; P = .011), and body mass index (BMI) (OR 0.919; P = .018), as well as the presence of femoral chondral defects (OR 0.769; P = .013), as negative predictors for achieving MCID. Negative predictors for achieving PASS HOS-SS included the presence of a preoperative limp (OR 0.384; P = .013), anxiety or depression (OR 0.561; P = .041), and increased BMI (OR 0.945; P = .018) and preoperative pain duration (OR 0.987; P < .001). CONCLUSIONS Several predictors of achieving clinically significant sport function performance exist, including a history of anxiety or depression, BMI, preoperative α angle, limp, femoral chondral damage, *and preoperative symptom duration. Our results suggest there are both modifiable and nonmodifiable preoperative factors that have the potential to predict achieving high athletic function after hip arthroscopy for FAIS. LEVEL OF EVIDENCE IV, Case Series.
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Affiliation(s)
- Austin V Stone
- Department of Orthopaedic Surgery, University of Kentucky, Lexington, Kentucky, U.S.A
| | - Edward C Beck
- Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, Illinois, U.S.A
| | - Philip Malloy
- Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, Illinois, U.S.A
| | - Jorge Chahla
- Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, Illinois, U.S.A
| | - Benedict U Nwachukwu
- Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, Illinois, U.S.A
| | - William H Neal
- Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, Illinois, U.S.A
| | - Shane J Nho
- Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, Illinois, U.S.A..
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28
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Barahona M, Guzman M, Barrientos C, Zamorano A, Palet M, Infante C, Hinzpeter J. A Novel Approach to Lower-limb Axial Alignment Analysis: A CT Study. J Am Acad Orthop Surg Glob Res Rev 2019; 3:e10.5435. [PMID: 31875191 PMCID: PMC6903811 DOI: 10.5435/jaaosglobal-d-19-00139] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
To analyze the torsion of the lower extremities in a healthy cohort and to determine the contribution of different segments of the femur and tibia to the torsion of both bones. METHODS In this cross-sectional study, 32 patients with nonjoint or bone-related symptoms were analyzed by CT angiography. Lower-limb torsion, femoral torsion, proximal femoral torsion, femoral shaft torsion, distal femoral torsion, tibial torsion, proximal tibial torsion, and distal tibial torsion were measured. RESULTS The median total limb torsion was 25° external torsion, with the median femoral torsion being -9° and the median tibial torsion 30°. Both femoral metaphyses had internal torsion, with the internal torsion of the proximal metaphysis being approximately three times greater than that of the distal femoral metaphysis. The shaft was found to compensate with an external torsion of approximately two-thirds of the internal torsion of both femoral metaphyses. The proximal metaphysis of the tibia accounted for approximately one-third of the external torsion, with the segment from the distal to the tibial tubercle accounting for the remaining two-thirds of the tibial torsion. CONCLUSIONS The diaphysis and distal metaphysis are the major contributors to external torsion of the tibia, whereas the proximal metaphysis is the major contributor to the internal torsion of the femur.
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Affiliation(s)
- Maximiliano Barahona
- Orthopaedic Department (Dr. Barahona, Dr. Barrientos, Dr. Zamorano, Dr. Palet, Dr. Infante, and Dr. Hinzpeter) and the Radiology Department (Dr. Guzman), Hospital Clinico Universidad de Chile, Santiago, Chile
| | - Mauricio Guzman
- Orthopaedic Department (Dr. Barahona, Dr. Barrientos, Dr. Zamorano, Dr. Palet, Dr. Infante, and Dr. Hinzpeter) and the Radiology Department (Dr. Guzman), Hospital Clinico Universidad de Chile, Santiago, Chile
| | - Cristian Barrientos
- Orthopaedic Department (Dr. Barahona, Dr. Barrientos, Dr. Zamorano, Dr. Palet, Dr. Infante, and Dr. Hinzpeter) and the Radiology Department (Dr. Guzman), Hospital Clinico Universidad de Chile, Santiago, Chile
| | - Alvaro Zamorano
- Orthopaedic Department (Dr. Barahona, Dr. Barrientos, Dr. Zamorano, Dr. Palet, Dr. Infante, and Dr. Hinzpeter) and the Radiology Department (Dr. Guzman), Hospital Clinico Universidad de Chile, Santiago, Chile
| | - Miguel Palet
- Orthopaedic Department (Dr. Barahona, Dr. Barrientos, Dr. Zamorano, Dr. Palet, Dr. Infante, and Dr. Hinzpeter) and the Radiology Department (Dr. Guzman), Hospital Clinico Universidad de Chile, Santiago, Chile
| | - Carlos Infante
- Orthopaedic Department (Dr. Barahona, Dr. Barrientos, Dr. Zamorano, Dr. Palet, Dr. Infante, and Dr. Hinzpeter) and the Radiology Department (Dr. Guzman), Hospital Clinico Universidad de Chile, Santiago, Chile
| | - Jaime Hinzpeter
- Orthopaedic Department (Dr. Barahona, Dr. Barrientos, Dr. Zamorano, Dr. Palet, Dr. Infante, and Dr. Hinzpeter) and the Radiology Department (Dr. Guzman), Hospital Clinico Universidad de Chile, Santiago, Chile
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Abstract
PURPOSE OF REVIEW To assess the outcomes of modern techniques for arthroscopic surgery in the treatment of femoroacetabular impingement. RECENT FINDINGS While initially approached by means of open surgical hip dislocation, recent literature has shown generally good outcomes of arthroscopic treatment for femoroacetabular impingement. Modern advances in hip arthroscopy technique and implants now allow for labral repair or reconstruction when indicated. Arthroscopic treatment of femoroacetabular impingement results in significant improvements in patient pain and function, with low complication rates and high patient satisfaction. A majority of improvements in these patients occur within 1 to 2 years post-operatively. Hip arthroscopy for femoroacetabular impingement yields the best results in patients without significant arthritis or hip dysplasia.
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Affiliation(s)
- Caitlin C. Chambers
- Department of Orthopaedic Surgery, University of Minnesota, 2450 Riverside Ave, Minneapolis, MN 55454 USA
| | - Alan L. Zhang
- Department of Orthopaedic Surgery, University of California San Francisco, San Francisco, CA USA
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Dukas AG, Gupta AS, Peters CL, Aoki SK. Surgical Treatment for FAI: Arthroscopic and Open Techniques for Osteoplasty. Curr Rev Musculoskelet Med 2019; 12:281-290. [PMID: 31264173 PMCID: PMC6684728 DOI: 10.1007/s12178-019-09572-4] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
Abstract
PURPOSE OF REVIEW To review the relevant literature and techniques regarding arthroscopic and open treatment of femoroacetabular impingement (FAI). To discuss both the senior authors' preferred method of arthroscopic and open treatment of FAI. RECENT FINDINGS Routine treatment of FAI has moved away from open techniques and is more focused arthroscopic methods. Arthroscopic treatment of FAI has more recently focused on differing techniques of hip access and capsular management. Open techniques still have a role in FAI, but indications for open management are focused on cases with more severe pathology. While arthroscopic techniques have shown better outcomes in the short term and higher return to play, it is not without risk and is a procedure with a steep learning curve. In cases of complex joint pathology, such as FAI coupled with dysplasia or Legg-Calve-Perthes, arthroscopy may be not indicated and an open approach preferred. We outline various techniques for both arthroscopic and open treatment of FAI and their outcomes when possible.
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Affiliation(s)
- Alex G Dukas
- Department of Orthopaedic Surgery, University of Utah Health Center, 590 Wakara Way, Salt Lake City, UT, 84108, USA
| | - Andrew S Gupta
- Department of Orthopaedic Surgery, University of Utah Health Center, 590 Wakara Way, Salt Lake City, UT, 84108, USA
| | - Christopher L Peters
- Department of Orthopaedic Surgery, University of Utah Health Center, 590 Wakara Way, Salt Lake City, UT, 84108, USA
| | - Stephen K Aoki
- Department of Orthopaedic Surgery, University of Utah Health Center, 590 Wakara Way, Salt Lake City, UT, 84108, USA.
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Cvetanovich GL, Levy DM, Beck EC, Weber AE, Kuhns BD, Khair MM, Nho SJ. A T-capsulotomy provides increased hip joint visualization compared with an extended interportal capsulotomy. J Hip Preserv Surg 2019; 6:157-163. [PMID: 31660201 PMCID: PMC6662960 DOI: 10.1093/jhps/hnz021] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/30/2018] [Accepted: 05/05/2019] [Indexed: 11/23/2022] Open
Abstract
The purpose of this study was to compare the cross-sectional area (CSA) of joint visualization between extended interportal and T-capsulotomies. Twenty fresh-frozen cadaveric hips were dissected to their capsuloligamentous complexes and fixed in a custom apparatus in neutral hip position. Ten hips underwent sequential interportal capsulotomies at lengths of 2, 4, 6, and 8 cm. Ten hips underwent sequential T-capsulotomies starting from a 4 cm interportal capsulotomy, creating a 2 cm T-capsulotomy (Half-T), and finally a 4 cm T-capsulotomy (Full-T). Following each sequential capsule change in both groups, a high-resolution digital photograph was taken to measure the visualized intra-articular cross-sectional area (CSA). Independent t-test was used to compare CSA interportal and T-capsulotomy groups. Analysis demonstrated a statistically significant increase in CSA visualization with each sequential increase in interportal capsulotomy length up to 6 cm (2cm: 0.6 ± 0.2 cm2; 4cm: 2.1 ± 0.5 cm2 (p<0.001); 6cm: 3.6 ± 1.0 cm2 (p=0.001)), and no difference at 8cm (4.2 ± 1.2 cm2 (p=0.20)). For the T-capsulotomy group the average CSA visualization significantly increased from 3.2 ± 0.9 cm2 for the Half-T to 7.1 ± 1.0 cm2 for the Full-T (p<0.001). The Half-T CSA visualization was not statistically different from the 6 cm capsulotomy (p=0.4) and the 8cm capsulotomy (p=0.05). The Full-T had significantly superior CSA visualization area as compared to the 6 cm and 8 cm interportal capsulotomies (p<0.001 for both). In conclusion, T-capsulotomy resulted in improved cross-sectional area of joint visualization compared to an extended (8cm) interportal capsulotomy in a cadaveric model. Surgeons must weigh the benefits of greater visualization from T-capsulotomy that may help to avoid residual FAI while ensuring to completely repair the capsulotomy to avoid iatrogenic instability.
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Affiliation(s)
- Gregory L Cvetanovich
- Section of Young Adult Hip Surgery, Division of Sports Medicine, Department of Orthopedic Surgery, Rush Medical College of Rush University, Rush University Medical Center, Chicago, IL, USA
| | - David M Levy
- Section of Young Adult Hip Surgery, Division of Sports Medicine, Department of Orthopedic Surgery, Rush Medical College of Rush University, Rush University Medical Center, Chicago, IL, USA
| | - Edward C Beck
- Section of Young Adult Hip Surgery, Division of Sports Medicine, Department of Orthopedic Surgery, Rush Medical College of Rush University, Rush University Medical Center, Chicago, IL, USA
| | - Alexander E Weber
- Section of Young Adult Hip Surgery, Division of Sports Medicine, Department of Orthopedic Surgery, Rush Medical College of Rush University, Rush University Medical Center, Chicago, IL, USA
| | - Benjamin D Kuhns
- Section of Young Adult Hip Surgery, Division of Sports Medicine, Department of Orthopedic Surgery, Rush Medical College of Rush University, Rush University Medical Center, Chicago, IL, USA
| | - Mahmoud M Khair
- Section of Young Adult Hip Surgery, Division of Sports Medicine, Department of Orthopedic Surgery, Rush Medical College of Rush University, Rush University Medical Center, Chicago, IL, USA
| | - Shane J Nho
- Section of Young Adult Hip Surgery, Division of Sports Medicine, Department of Orthopedic Surgery, Rush Medical College of Rush University, Rush University Medical Center, Chicago, IL, USA
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Nho SJ, Beck EC, Nwachukwu BU, Cvetanovich GL, Neal WH, Harris JD, Weber AE, Mather RC. Survivorship and Outcome of Hip Arthroscopy for Femoroacetabular Impingement Syndrome Performed With Modern Surgical Techniques. Am J Sports Med 2019; 47:1662-1669. [PMID: 31145663 DOI: 10.1177/0363546519843936] [Citation(s) in RCA: 75] [Impact Index Per Article: 15.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND Hip arthroscopy for femoroacetabular impingement syndrome (FAIS) is a rapidly growing field in sports surgery; however, factors associated with poor outcomes and identification of predictor models of inferior clinical outcomes is unclear. PURPOSE To analyze predictors of clinical failure and inferior clinical outcomes among patients undergoing hip arthroscopy for treatment of FAIS. STUDY DESIGN Case-control study; Level of evidence, 3. METHODS Data were collected and analyzed from consecutive patients who underwent primary hip arthroscopy with routine capsular closure for the treatment of FAIS from a single fellowship-trained surgeon between January 2012 and November 2015. Baseline data, postoperative patient-reported outcomes, and rates of clinical failure and inferior clinical outcomes were recorded at 2 years postoperatively. Clinical failure was defined by revision hip arthroscopy or conversion to total hip arthroplasty. Inferior clinical outcome was defined as not reaching the minimal clinically important difference (MCID) or patient acceptable symptomatic state for Hip Outcome Score-Activities of Daily Living. A multivariate logistic regression analysis was used to identify significant predictors of clinical failure and inferior clinical outcome. RESULTS Out of 1161 eligible patients, 935 (80.5%) completed 2-year postoperative patient-reported outcomes. The mean ± SD age and body mass index were 33.3 ± 12.3 years and 25.4 ± 8.2 kg/m2, respectively. The overall clinical failure rate was 3.6% (n = 34), including 23 cases (2.5%) of revision hip arthroscopy and 11 cases (1.2%) of conversion to total hip arthroplasty. Predictors of clinical failure were lower preoperative International Hip Outcome Tool score ( P = .016), chronic preoperative pain ( P = .001), and chondromalacia in the affected hip ( P = .04). The inferior clinical outcome group, consisting of those who failed to reach the MCID for Hip Outcome Score-Activities of Daily Living, included 256 patients (27.4%). Predictors of inferior clinical outcomes were Tönnis grade >1 ( P = .01), workers' compensation ( P < .001), and increased body mass index ( P = .02). CONCLUSION This study demonstrates that 73% of all patients treated for symptomatic FAIS with primary hip arthroscopy and routine capsular closure achieved the MCID. Clinical failure is predicted by a number of modifiable and nonmodifiable factors, including chronic preoperative pain and presence of chondromalacia. The current study updates the midterm failure rates and outcomes achievable with hip arthroscopy for FAIS.
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Affiliation(s)
- Shane J Nho
- Section of Young Adult Hip Surgery, Division of Sports Medicine, Department of Orthopaedic Surgery, Rush Medical College of Rush University, Rush University Medical Center, Chicago, Illinois, USA
| | - Edward C Beck
- Section of Young Adult Hip Surgery, Division of Sports Medicine, Department of Orthopaedic Surgery, Rush Medical College of Rush University, Rush University Medical Center, Chicago, Illinois, USA
| | - Benedict U Nwachukwu
- Section of Young Adult Hip Surgery, Division of Sports Medicine, Department of Orthopaedic Surgery, Rush Medical College of Rush University, Rush University Medical Center, Chicago, Illinois, USA
| | - Gregory L Cvetanovich
- Department of Orthopaedics, The Ohio State University Wexner Medical Center, Columbus, Ohio, USA
| | - William H Neal
- Section of Young Adult Hip Surgery, Division of Sports Medicine, Department of Orthopaedic Surgery, Rush Medical College of Rush University, Rush University Medical Center, Chicago, Illinois, USA
| | - Joshua D Harris
- Department of Orthopedic Surgery, Houston Methodist University, Houston, Texas, USA
| | - Alexander E Weber
- Department of Orthopedic Surgery, University of Southern California, Los Angeles, California, USA
| | - Richard C Mather
- Department of Orthopedic Surgery, Duke University, Durham, North Carolina, USA
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Hip Arthroscopy for Femoroacetabular Impingement and Labral Tears in Patients Younger than 50 Years: Minimum Five-year Outcomes, Survivorship, and Risk Factors for Reoperations. J Am Acad Orthop Surg 2019; 27:e173-e183. [PMID: 30260911 DOI: 10.5435/jaaos-d-17-00258] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023] Open
Abstract
INTRODUCTION There is a paucity of literature on mid-term outcomes for hip arthroscopy for femoroacetabular impingement and labral tears. METHODS Inclusion criteria were age at surgery <50 years and documented preoperative patient-reported outcomes. Patients with a Tönnis grade >0 or previous ipsilateral hip conditions were excluded. RESULTS Of 407 eligible cases, 327 hips (295 patients) had minimum 5-year follow-up. Mean age was 32.4 years. All mean patient-reported outcomes and visual analog scale improved at follow-up (P < 0.001). Mean satisfaction was 7.9. Thirty-eight hips (11.6%) required secondary arthroscopy at a mean of 25.1 months. Survivorship at minimum 5 years was 92.4%. The complication rate was 7.0%. CONCLUSIONS Hip arthroscopy for management of femoroacetabular impingement and labral tears in patients aged <50 demonstrates favorable and safe mid-term outcomes. Several risk factors for conversion to total hip arthroplasty in this age group warrant cautious patient selection for arthroscopy.
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Clinical outcomes and causes of arthroscopic hip revision surgery. Sci Rep 2019; 9:1230. [PMID: 30718558 PMCID: PMC6362113 DOI: 10.1038/s41598-018-37708-y] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2018] [Accepted: 12/12/2018] [Indexed: 11/08/2022] Open
Abstract
Hip arthroscopic surgery has become a common technique during the past decade, leading to an increased number of arthroscopic hip revision surgeries. This study aimed to evaluate the clinical outcomes in a series of revision hip arthroscopies to analyse the causes of reoperation in the short to medium-term follow-up. We retrospectively analysed 22 patients who underwent arthroscopic hip revision surgery in our institute. All patients accepted a detailed physical examination and obtained radiographs to measure the centre edge angle, the alpha angle and the offset. Three-dimensional computed tomography was used to evaluate the deformities. The modified Harris Hip Score, visual analogue scale and patient self-reported satisfaction were collected and analysed preoperatively and postoperatively. Our results demonstrated that the modified Harris Hip Score improved from 52.8 to 81.6, and the visual analogue scale decreased from 5.0 to 1.1. Patient self-reported satisfaction was 8.5. In conclusion, patients who underwent arthroscopic hip revision surgery exhibited significant improvement in patient-centred outcomes in the short- to medium-term follow-up, and the outcomes indicated the effectiveness of revision surgery. Residual femoroacetabular impingement and extra-articular impingement are common reasons for arthroscopic hip revision surgery. Misdiagnosis of osteoid osteoma and relapse of synovial chondromatosis are also important reasons for revision.
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35
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Frank RM, Romeo AA, Bush-Joseph CA, Bach BR. Injuries to the Female Athlete in 2017: Part II: Upper and Lower-Extremity Injuries. JBJS Rev 2019; 5:e5. [PMID: 29028751 DOI: 10.2106/jbjs.rvw.17.00031] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Affiliation(s)
- Rachel M Frank
- Department of Orthopedics, University of Colorado School of Medicine, Aurora, Colorado
| | - Anthony A Romeo
- Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, Illinois
| | - Charles A Bush-Joseph
- Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, Illinois
| | - Bernard R Bach
- Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, Illinois
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36
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Anterior Inferior Iliac Spine Morphology: Comparison of Symptomatic Hips With Femoroacetabular Impingement and Asymptomatic Hips. AJR Am J Roentgenol 2018; 212:166-172. [PMID: 30403530 DOI: 10.2214/ajr.18.19655] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
OBJECTIVE The objective of our study was to compare anterior inferior iliac spine (AIIS) morphology in symptomatic hips with femoroacetabular impingement (FAI) and in asymptomatic hips, determine the prevalence of impingement morphology in patients with a radiographic "crossover" sign, and identify potential risk factors for having impingement morphology. MATERIALS AND METHODS For this retrospective study, we identified consecutive symptomatic hips with FAI (n = 54) and asymptomatic hips (n = 35) in patients who underwent CT from 2015 to 2017. Two radiologists blindly and independently evaluated 3D CT images of each hip and graded the AIIS morphology according to the Hetsroni classification scheme. The prevalence of AIIS morphology types was calculated. Associations of AIIS morphology types with symptoms and the crossover sign were evaluated with a chi-square test. A multivariable logistic regression determined risk factors for abnormal AIIS morphology (i.e., type 2 or 3). RESULTS There was no difference in the prevalence of AIIS morphology types for symptomatic hips with FAI versus asymptomatic hips (p = 0.44) or for hips with a positive versus those with a negative crossover sign (p = 0.21). There was moderate interobserver agreement (κ = 0.44) and good-to-excellent intraobserver agreement (κ = 0.67 and 0.90) for grading AIIS morphology. Age, sex, femoral version, acetabular version, alpha angle, lateral center edge angle, and the crossover sign were not significant risk factors for abnormal AIIS morphology in patients with FAI (p = 0.11-0.79). CONCLUSION There is no difference in AIIS morphology between symptomatic hips with FAI versus asymptomatic hips or between hips with and those without the radiographic crossover sign. Age, sex, and other FAI parameters are not risk factors for developing AIIS impingement morphology.
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Woodward RM, Philippon MJ. Persistent or recurrent symptoms after arthroscopic surgery for femoroacetabular impingement: A review of imaging findings. J Med Imaging Radiat Oncol 2018; 63:15-24. [DOI: 10.1111/1754-9485.12822] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2018] [Accepted: 09/26/2018] [Indexed: 11/28/2022]
Affiliation(s)
- Rebecca M Woodward
- Steadman Philippon Research Institute Vail Colorado USA
- Auckland Radiology Group Auckland New Zealand
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Haynes JA, Pascual-Garrido C, An TW, Nepple JJ, Clohisy JC. Trends of hip arthroscopy in the setting of acetabular dysplasia. J Hip Preserv Surg 2018; 5:267-273. [PMID: 30393554 PMCID: PMC6206703 DOI: 10.1093/jhps/hny026] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/30/2017] [Revised: 05/30/2018] [Accepted: 07/08/2018] [Indexed: 11/12/2022] Open
Abstract
Hip arthroscopy is increasingly utilized in the treatment of symptomatic intra-articular hip pathology. Unaddressed development dysplasia of the hip (DDH) is thought to be associated with failure after hip arthroscopy. The aims of this study were (i) to identify the prevalence of previous failed hip arthroscopy in patients undergoing a periactebaular osteotomy (PAO) for the treatment of symptomatic acetabular dysplasia, (ii) report on the temporal trend of failed ipsilateral hip arthroscopy in patients undergoing PAO and (iii) to determine clinical and radiographic characteristics associated with utilization of isolated hip arthroscopy in patients with acetabular dysplasia. We identified 139 patients undergoing PAO who had a history of a prior ipsilateral hip arthroscopy. A comparison group of 1505 patients with a diagnosis of acetabular dysplasia, who underwent PAO alone without any prior ipsilateral surgery during the study period was used. Clinical characteristics, radiographic and intraoperative findings were compared between cohorts. From 2008 to 2015, the rate of previous failed hip arthroscopy in patients undergoing subsequent PAO increased steadily until 2013 with a maximum of 12%. Patients in the study group had mild dysplasia with significantly higher LCEA (17.2° versus 11.3°; P < 0.001) and ACEA (15.6° versus 10.8°; P < 0.001), a lower acetabular inclination (14.0° versus 19.0°; P < 0.001). The findings illustrate a constant increase in the rate of failed hip arthroscopy in the setting of acetabular dysplasia from 2008 till 2013. Female sex and mild dysplasia were associated with use of isolated hip arthroscopy in the setting of acetabular dysplasia.
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Affiliation(s)
- Jacob A Haynes
- Anderson Orthopaedic Clinic - Mount Vernon, 2501 Parker's Ln, 200, Alexandria, VA, USA
| | | | - Tonya W An
- Cedar Sinai Medical Center, 444 S. San Vicente Blvd, Ste 603, Los Angeles, CA, USA
| | - Jeffrey J Nepple
- Washington University School of Medicine, 660 S. Euclid Ave CB 8233, St. Louis, MO, USA
| | | | - John C Clohisy
- Washington University School of Medicine, 660 S. Euclid Ave CB 8233, St. Louis, MO, USA
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Sochacki KR, Brown L, Cenkus K, Di Stasi S, Harris JD, Ellis TJ. Preoperative Depression Is Negatively Associated With Function and Predicts Poorer Outcomes After Hip Arthroscopy for Femoroacetabular Impingement. Arthroscopy 2018; 34:2368-2374. [PMID: 29789247 DOI: 10.1016/j.arthro.2018.03.020] [Citation(s) in RCA: 52] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/30/2017] [Revised: 03/04/2018] [Accepted: 03/04/2018] [Indexed: 02/02/2023]
Abstract
PURPOSE (1) To determine the prevalence of depression in patients undergoing hip arthroscopy for the treatment of femoroacetabular impingement (FAI) syndrome and (2) to determine whether depression has a statistically significant and clinically relevant effect on preoperative and postoperative patient-reported outcome scores. METHODS Consecutive subjects undergoing hip arthroscopy for FAI syndrome were retrospectively reviewed. The Beck Depression Inventory-II (BDI-II), Hip Outcome Score (HOS), and 33-item International Hip Outcome Tool (iHOT-33) were administered preoperatively and postoperatively. Clinically relevant differences were defined by the minimal clinically important difference, substantial clinical benefit, and patient acceptable symptom state. Comparisons between preoperative and postoperative scores were completed. The Spearman correlation coefficient (r) was used to determine the degree of correlation between the BDI-II score, HOS, and iHOT-33 score preoperatively and postoperatively. RESULTS We analyzed 77 patients (72.7% female patients; mean age, 35.2 ± 12.5 years). Depressive symptoms were reported as minimal (75.3%), mild (11.7%), moderate (6.5%), or severe (6.5%). Patients with minimal or mild depression had a superior HOS Activities of Daily Living (Δ17.3 preoperatively [P < .001] and Δ37.8 postoperatively [P < .001]), HOS Sport-Specific Subscore (Δ12.8 preoperatively [P = .002] and Δ52.1 postoperatively [P < .0001]), and iHOT-33 score (Δ15.4 preoperatively [P < .0001] and Δ51.3 postoperatively [P < .0001]) compared with patients with moderate or severe depression. There was a weak to moderate negative correlation between the BDI-II score and iHOT-33 score (r = -0.4614, P < .0001 preoperatively; r = -0.327, P < .0001 at 1 year), HOS Activities of Daily Living (r = -0.531, P < .0001 preoperatively), and HOS Sport-Specific Subscore (r = -0.379, P < .0017 at 1 year). CONCLUSIONS Most patients undergoing hip arthroscopy for FAI have minimal depressive symptoms with the overall prevalence higher than the general population. Patients with minimal or mild depressive symptoms have statistically and clinically better preoperative and postoperative patient-reported outcomes, are more likely to obtain substantial clinical benefit from surgery, and are more likely to reach a patient acceptable symptom state after surgery than patients with moderate to severe depressive symptoms. LEVEL OF EVIDENCE Level III, case-control study.
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Affiliation(s)
- Kyle R Sochacki
- Houston Methodist Orthopedic and Sports Medicine, Houston, Texas, U.S.A
| | - Lindsey Brown
- Sports Medicine Research Institute, Wexner Medical Center, The Ohio State University, Columbus, Ohio, U.S.A.; School of Health and Rehabilitation Sciences, The Ohio State University, Columbus, Ohio, U.S.A
| | - Kathleen Cenkus
- Department of Plastic Surgery, The Ohio State University, Columbus, Ohio, U.S.A
| | - Stephanie Di Stasi
- Sports Medicine Research Institute, Wexner Medical Center, The Ohio State University, Columbus, Ohio, U.S.A.; School of Health and Rehabilitation Sciences, The Ohio State University, Columbus, Ohio, U.S.A
| | - Joshua D Harris
- Houston Methodist Orthopedic and Sports Medicine, Houston, Texas, U.S.A..
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40
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Bonazza NA, Homcha B, Liu G, Leslie DL, Dhawan A. Surgical Trends in Arthroscopic Hip Surgery Using a Large National Database. Arthroscopy 2018; 34:1825-1830. [PMID: 29580743 DOI: 10.1016/j.arthro.2018.01.022] [Citation(s) in RCA: 98] [Impact Index Per Article: 16.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/19/2017] [Revised: 01/09/2018] [Accepted: 01/12/2018] [Indexed: 02/02/2023]
Abstract
PURPOSE To assess the practice trends in hip arthroscopy, including femoroplasty, acetabuloplasty, and labral repair Current Procedure Terminology, 4th edition (CPT-4), codes that have been implemented since many of the previous studies were published, without concerns for Hawthorne or observer effect as can be seen during a board collection window, and in a larger volume of patients with a more comprehensive database than previous published data. METHODS The MarketScan Commercial Claims and Encounters database was searched using CPT-4 codes to identify patients who underwent any arthroscopic hip procedure from 2008 to 2013. Patients identified were characterized by gender, age group, and year of the initial procedure. Regression analysis was used to evaluate differences in surgical trends between individual patient groups delineated by age and gender. The Cochran-Armitage trend test was used to identify significant differences in surgical trends seen yearly. RESULTS A total of 62,782 arthroscopic hip procedures in 31,569 surgeries in 27,997 patients were identified and included from 2008 through 2013. The number of surgeries in the database increased every year. After changes to CPT coding in 2011, femoroplasty became the most common procedure in 2012, comprising 28% of all procedures performed in 2013. Patients ages 40 to 49 underwent the most procedures (7,467, 27%). Females were more likely to undergo any arthroscopic procedure during the study period (.068% vs .041%, P < .0001). A total of 2,754 patients (10%) underwent a second surgery during the study period. A total of 1,625 patients (6%) underwent a total hip arthroplasty following an arthroscopic procedure during the study period. CONCLUSIONS Arthroscopic hip procedures continue to increase, with femoroplasty, labral repair, and acetabuloplasty being the 3 most common procedures performed. Females are more likely to undergo any procedure, and labral repair is now performed more commonly than labral debridement. LEVEL OF EVIDENCE Level IV, cross-sectional study.
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Affiliation(s)
- Nicholas A Bonazza
- Department of Orthopaedics and Rehabilitation, Milton S. Hershey Medical Center, Penn State Health, Hershey, Pennsylvania, U.S.A
| | - Brittany Homcha
- Department of Orthopaedics and Rehabilitation, Milton S. Hershey Medical Center, Penn State Health, Hershey, Pennsylvania, U.S.A
| | - Guodong Liu
- Department of Public Health Sciences, Pennsylvania State University College of Medicine, Hershey, Pennsylvania, U.S.A
| | - Douglas L Leslie
- Department of Public Health Sciences, Pennsylvania State University College of Medicine, Hershey, Pennsylvania, U.S.A
| | - Aman Dhawan
- Department of Orthopaedics and Rehabilitation, Milton S. Hershey Medical Center, Penn State Health, Hershey, Pennsylvania, U.S.A..
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Hevesi M, Hartigan DE, Wu IT, Levy BA, Domb BG, Krych AJ. Are Results of Arthroscopic Labral Repair Durable in Dysplasia at Midterm Follow-up? A 2-Center Matched Cohort Analysis. Am J Sports Med 2018; 46:1674-1684. [PMID: 29723044 DOI: 10.1177/0363546518767399] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND Studies assessing dysplasia's effect on hip arthroscopy are often limited to the short term and unable to account for demographic factors that may vary between dysplastic and nondysplastic populations. PURPOSE To determine the midterm failure rate and patient-reported outcomes of arthroscopic labral repair in the setting of dysplasia and make subsequent failure and outcome comparisons with a rigorously matched nondysplastic control group. STUDY DESIGN Cohort study; Level of evidence, 3. METHODS Primary arthroscopic labral repair cases at 2 centers from 2008 to 2011 were reviewed. Patients with lateral center edge angle (LCEA) <25° were matched to nondysplastic controls by age, sex, laterality, body mass index (BMI), Tönnis grade, and capsular repair per a 1:2 matching algorithm. Groups were compared with a visual analog scale (VAS) for pain, modified Harris Hip Score (mHHS), and Hip Outcome Score-Sports Specific Subscale (HOS-SSS) to determine predictors of outcome and failure. RESULTS Forty-eight patients with dysplasia (mean LCEA, 21.6°; range, 13.0°-24.9°; n = 25 with capsular repair) were matched to 96 controls (mean LCEA, 32.1°; range, 25°-52°; n = 50 with capsular repair) and followed for a mean of 5.7 years (range, 5.0-7.7 years). Patients achieved mean VAS improvements of 3.3 points, mHHS of 19.5, and HOS-SSS of 29.0 points ( P < .01) with no significant differences between the dysplasia and control populations ( P > .05). Five-year failure-free survival was 83.3% for patients with dysplasia and 78.1% for controls ( P = .53). No survival or outcomes difference was observed between patients with dysplasia who did or did not have capsular repair ( P ≥ .45) or when comparing LCEA <20° and LCEA 20° to 25° ( P ≥ .60). BMI ≤30 was associated with increased revision surgery risk ( P < .01). Age >35 years ( P < .05) and Tönnis grade 0 radiographs ( P < .01) predicted failure to reach minimal clinically important differences. CONCLUSION With careful selection and modern techniques, patients with dysplasia can benefit significantly and durably from arthroscopic labral repair. The dysplastic cohort had outcomes and failure rates similar to those of rigorously matched controls at midterm follow-up. Subanalyses comparing LCEA <20° and LCEA 20° to 25° are presented for completeness; however, this study was not designed to detect differences in dysplastic subpopulations. BMI ≤30 was associated with increased revision risk. Age >35 years and Tönnis grade 0 radiographs predicted failure to achieve minimal clinically important differences.
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Affiliation(s)
- Mario Hevesi
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, Minnesota, USA
| | - David E Hartigan
- Department of Orthopedic Surgery and Sports Medicine, Mayo Clinic, Phoenix, Arizona, USA
| | - Isabella T Wu
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, Minnesota, USA
| | - Bruce A Levy
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, Minnesota, USA
| | | | - Aaron J Krych
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, Minnesota, USA
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Nwachukwu BU, Chang B, Rotter BZ, Kelly BT, Ranawat AS, Nawabi DH. Minimal Clinically Important Difference and Substantial Clinical Benefit After Revision Hip Arthroscopy. Arthroscopy 2018; 34:1862-1868. [PMID: 29653791 DOI: 10.1016/j.arthro.2018.01.050] [Citation(s) in RCA: 64] [Impact Index Per Article: 10.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/05/2017] [Revised: 01/31/2018] [Accepted: 01/31/2018] [Indexed: 02/02/2023]
Abstract
PURPOSE To define minimal clinically important difference (MCID) and substantial clinical benefit (SCB) in revision hip arthroscopy. METHODS The modified Harris Hip Score (mHHS), the Hip Outcome Score (HOS), and the international Hip Outcome Tool (iHOT-33) were administered to revision hip arthroscopy patients. At 1 year postoperatively, patients graded their hip function based on anchor responses. SCB was defined as both a net change and an absolute value. Receiver operating characteristic analysis with area under the curve was used to confirm psychometric values. A distribution-based method was used for MCID. RESULTS Forty-nine patients were included with a mean age of 29.7 (±8.6) years. The most common indication for revision hip arthroscopy was residual femoroacetabular impingement (FAI; N = 34; 69.4%) followed by capsular management (N = 8; 16.3%). At 1-year follow-up, 34 patients reported feeling improved. Outcome score change corresponding to MCID and SCB net change for the mHHS, HOS Activities of Daily Living (ADL), HOS Sports, and iHOT-33 was 7.9/23.1, 7.9/16.2, 13.1/25.0, and 12.8/25.5, respectively. A higher proportion of patients with residual FAI achieved MCID compared with patients with other diagnoses. On the preoperative HOS ADL, HOS Sports, and iHOT-33, patients scoring below 67.7 (0.78), 55.6 (0.81), and 35.7 (0.73) were significantly more likely to achieve SCB postoperatively. Thirty-four patients (73.9%) were classified as receiving physical function improvement, and on the HOS Sports, MCID was achieved by 65% whereas 43% met the SCB criteria. CONCLUSIONS MCID values ranged from 7.9 on the mHHS and the HOS ADL to 13.1 on the HOS Sports. SCB net change ranged from 16.2 on the HOS ADL to 25.2 on the iHOT-33, whereas absolute SCB ranged from 82.4 on the iHOT-33 to 84.7 on the mHHS. Residual FAI and capsular management were the most common indications for revision surgery with patients who underwent surgery for the former found to be most likely to achieve clinically significant improvement. LEVEL OF EVIDENCE Level IV, case series.
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Affiliation(s)
- Benedict U Nwachukwu
- Department of Orthopaedic Surgery, Hospital for Special Surgery, New York, New York, U.S.A..
| | - Brenda Chang
- Department of Orthopaedic Surgery, Hospital for Special Surgery, New York, New York, U.S.A
| | - Ben-Zion Rotter
- Department of Orthopaedic Surgery, Hospital for Special Surgery, New York, New York, U.S.A
| | - Bryan T Kelly
- Department of Orthopaedic Surgery, Hospital for Special Surgery, New York, New York, U.S.A
| | - Anil S Ranawat
- Department of Orthopaedic Surgery, Hospital for Special Surgery, New York, New York, U.S.A
| | - Danyal H Nawabi
- Department of Orthopaedic Surgery, Hospital for Special Surgery, New York, New York, U.S.A
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Lansdown DA, Ukwuani G, Kuhns B, Harris JD, Nho SJ. Self-reported Mental Disorders Negatively Influence Surgical Outcomes After Arthroscopic Treatment of Femoroacetabular Impingement. Orthop J Sports Med 2018; 6:2325967118773312. [PMID: 29796402 PMCID: PMC5960865 DOI: 10.1177/2325967118773312] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Background Femoroacetabular impingement (FAI) is responsible for hip pain and dysfunction, and surgical outcomes depend on multiple factors. The presence of mental disorders negatively influences outcomes of multiple orthopaedic conditions, although the impact on FAI surgery is unclear. Hypothesis The authors hypothesized that a preoperative self-reported history of mental disorders would negatively influence patient-reported outcome measures after FAI surgery. Study Design Cohort study; Level of evidence, 3. Methods A matched-cohort study was performed by reviewing a prospectively collected database of cases of arthroscopic management of FAI with a single surgeon over a 2-year period. Demographics and radiographic parameters were recorded for all patients. Patients completed the Hip Outcome Score-Activity of Daily Living Subscale (HOS-ADL), Hip Outcome Score-Sport-Specific Subscale (HOS-SSS), and modified Harris Hip Score (mHHS) prior to surgery and 2 years after surgery. Unpaired and paired t tests were used to compare results between and within cohorts at baseline and follow-up. Statistical significance was defined as P < .05. Results The cohort included 301 patients, with 75 and 226 patients reporting and not reporting a history of mental disorders, respectively. Before treatment, all patient-reported outcome measures were significantly lower among patients reporting a history of mental disorders (P < .01 for HOS-ADL, HOS-SSS, and mHHS). Patients in both groups demonstrated significant improvements (P < .0001) in HOS-ADL, HOS-SSS, and mHHS when preoperative outcome measures were compared with follow-up. Patients with reported mental disorders had significantly lower scores after surgery as compared with patients without mental disorders (P < .0001 for HOS-ADL, HOS-SSS, and mHHS). Conclusion The presence of a reported mental disorder is associated with lower patient-reported outcomes before and after surgical management of FAI. Statistically significant and clinically relevant improvements were observed for patients who reported mental disorders. The magnitude of these improvements was not as large as that for an age- and sex-matched control group without a self-reported mental disorder.
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Affiliation(s)
- Drew A Lansdown
- Division of Sports Medicine, Department of Orthopaedic Surgery, University of California, San Francisco, San Francisco, California, USA
| | - Gift Ukwuani
- Division of Sports Medicine, Department of Orthopaedic Surgery, Rush University Medical Center / Midwest Orthopedics, Chicago, Illinois, USA
| | - Benjamin Kuhns
- Department of Orthopaedic Surgery, University of Rochester, Rochester, New York, USA
| | - Joshua D Harris
- Houston Methodist Orthopedic and Sports Medicine, Houston, Texas, USA
| | - Shane J Nho
- Division of Sports Medicine, Department of Orthopaedic Surgery, Rush University Medical Center / Midwest Orthopedics, Chicago, Illinois, USA
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Mehta N, Chamberlin P, Marx RG, Hidaka C, Ge Y, Nawabi DH, Lyman S. Defining the Learning Curve for Hip Arthroscopy: A Threshold Analysis of the Volume-Outcomes Relationship. Am J Sports Med 2018; 46:1284-1293. [PMID: 29337602 DOI: 10.1177/0363546517749219] [Citation(s) in RCA: 111] [Impact Index Per Article: 18.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND Hip arthroscopy has emerged as a successful option for the treatment of femoroacetabular impingement and related hip disorders, but the procedure is technically challenging. PURPOSE To define the learning curve through which surgeons become proficient at hip arthroscopy. STUDY DESIGN Cohort study; level of evidence, 3. METHODS The authors identified hip arthroscopy procedures performed by surgeons through a New York State database (Statewide Planning and Research Cooperative System) and followed those cases for additional hip surgery (total hip arthroplasty, hip resurfacing, or ipsilateral hip arthroscopy) within 5 years of the original procedure. Career volume for each case was calculated as the number of hip arthroscopy procedures that the surgeon had performed. Volume strata were identified via the stratum-specific likelihood ratio method. A Cox proportional hazards model was used to measure the effect of surgeon career volume on risk of additional hip surgery, adjusting for the following patient characteristics: age, sex, race/ethnicity, insurance type, and concurrent diagnosis of hip osteoarthritis. RESULTS Among 8041 hip arthroscopies performed by 251 surgeons, 989 (12.3%) cases underwent additional hip surgery within 5 years. Four strata of surgeon career volume associated with distinct frequencies of reoperation were identified: cases in the lowest stratum (0-97) had the highest frequency of additional surgery (15.4%). Frequencies declined for cases in the medium (98-388), high (389-518), and highest (≥519) strata (13.8%, 10.1%, and 2.6%, respectively). There was an increased risk of subsequent surgery in each stratum when compared with the highest stratum (hazard ratio [95% CI]: low volume, 3.22 [2.29-4.54]; medium, 3.40 [2.41-4.82]; high, 2.81 [1.86-4.25]; P < .0001 for all). Patients with a diagnosis of hip osteoarthritis had increased risk of subsequent hip arthroplasty or resurfacing (2.46 [2.09-2.89], P < .0001) . Risk also increased with age: 30 to 39 vs ≤29 years (5.12 [3.29-8.00], P < .0001), 40 to 49 vs ≤29 years (11.30 [7.43-17.190], P < .0001), ≥50 vs ≤29 years (18.39 [12.10-27.96], P < .0001). Increased age and osteoarthritis were not risk factors for revision hip arthroscopy. CONCLUSION The learning curve for hip arthroscopy was unexpectedly demanding. Cases performed by surgeons with career volumes ≥519 had significantly lower risk of subsequent hip surgery than those performed by lower-volume surgeons.
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Affiliation(s)
- Nabil Mehta
- Hospital for Special Surgery, New York, New York, USA
| | | | - Robert G Marx
- Hospital for Special Surgery, New York, New York, USA
| | - Chisa Hidaka
- Hospital for Special Surgery, New York, New York, USA
| | - Yile Ge
- Hospital for Special Surgery, New York, New York, USA
| | | | - Stephen Lyman
- Hospital for Special Surgery, New York, New York, USA
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Radiologic Correlation Between the Ischiofemoral Space and Morphologic Characteristics of the Hip in Hips With Symptoms of Dysplasia. AJR Am J Roentgenol 2018; 210:608-614. [DOI: 10.2214/ajr.17.18465] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
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Smith KM, Duplantier NL, Crump KH, Delgado DA, Sullivan SL, McCulloch PC, Harris JD. Fluoroscopy Learning Curve in Hip Arthroscopy-A Single Surgeon's Experience. Arthroscopy 2017; 33:1804-1809. [PMID: 28969816 DOI: 10.1016/j.arthro.2017.03.026] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/06/2016] [Revised: 03/04/2017] [Accepted: 03/29/2017] [Indexed: 02/02/2023]
Abstract
PURPOSE To determine if (1) absorbed radiation dose and (2) fluoroscopy time decreased with experience over the first 100 cases of a single surgeon's hip arthroscopy practice. METHODS Subjects who underwent hip arthroscopy for symptomatic femoroacetabular impingement and labral injury were eligible for analysis. Inclusion criteria included the first 100 subjects who underwent hip arthroscopy by a single surgeon (December 2013 to December 2014). Subject demographics, procedure details, fluoroscopy absorbed dose (milligray [mGy]), and time were recorded. Subjects were categorized by date of surgery to one of 4 possible groups (25 per group). One-way analysis of variance was used to determine if a significant difference in dose (mGy) or time was present between groups. Simple linear regression analysis was performed to determine the relation between case number and both radiation dose and fluoroscopy time. RESULTS Subjects underwent labral repair (n = 93), cam osteoplasty (n = 90), and pincer acetabuloplasty (n = 65). There was a significant (P < .001 for both) linear regression between case number and both radiation dose and fluoroscopy time. A significant difference in mGy was observed between groups, group 1 the highest and group 4 the lowest amounts of radiation (P = .003). Comparing individual groups, group 4 was found to have a significantly lower amount of radiation than group 1 (P = .002), though it was not significantly lower than that of group 2 (P = .09) or group 3 (P = .08). A significant difference in fluoroscopy time was observed between groups, group 1 the highest and group 4 the lowest times (P = .05). Comparing individual groups, group 4 was found to have a significantly lower fluoroscopy time than group 1 (P = .039). Correction for weight, height, and body mass index all revealed the same findings: significant (P < .05) differences in both dose and time across groups. CONCLUSIONS The absorbed dose of radiation and fluoroscopy time decreased significantly over the first 100 cases of a single surgeon's hip arthroscopy practice learning curve. LEVEL OF EVIDENCE Level IV, therapeutic, retrospective, noncomparative case series.
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Affiliation(s)
- Kevin M Smith
- Houston Methodist Orthopedics & Sports Medicine, Houston, Texas, U.S.A
| | - Neil L Duplantier
- Houston Methodist Orthopedics & Sports Medicine, Houston, Texas, U.S.A
| | - Kimbelyn H Crump
- Houston Methodist Orthopedics & Sports Medicine, Houston, Texas, U.S.A
| | | | | | | | - Joshua D Harris
- Houston Methodist Orthopedics & Sports Medicine, Houston, Texas, U.S.A..
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Ricciardi BF, Fields KG, Wentzel C, Kelly BT, Sink EL. Early Functional Outcomes of Periacetabular Osteotomy After Failed Hip Arthroscopic Surgery for Symptomatic Acetabular Dysplasia. Am J Sports Med 2017; 45:2460-2467. [PMID: 28617619 DOI: 10.1177/0363546517710011] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND Persistent acetabular dysplasia is a common reason for the failure of hip arthroscopic surgery; however, the effect of prior hip arthroscopic surgery on functional outcomes after subsequent periacetabular osteotomy (PAO) is unknown. Hypothesis/Purpose: The purpose of this study was to (1) compare demographic and radiological findings in patients who had and had not undergone previous hip arthroscopic surgery before PAO for symptomatic acetabular dysplasia and (2) compare the short-term, hip-specific patient-reported outcomes in these same patient populations. It was hypothesized that prior hip arthroscopic surgery is associated with worse early functional outcomes in PAO. STUDY DESIGN Cohort study; Level of evidence, 3. METHODS A retrospective cohort study design was utilized. Patients undergoing PAO were enrolled from a single-center, prospective hip preservation registry from March 2011 to April 2015. Patients with a minimum of 1-year clinical follow-up with preoperative and postoperative outcome scores undergoing PAO were eligible for inclusion (n = 93 patients; mean clinical follow-up, 24 months [range, 11-58 months]). The study group consisted of patients undergoing PAO for symptomatic hip dysplasia after prior hip arthroscopic surgery (PREVSCOPE group; 22 patients, 25 hips). Patients undergoing PAO without prior hip arthroscopic surgery (PAOALONE group; 71 patients, 85 hips) were included as a comparison group. Demographic and radiological variables were recorded. Postoperative functional outcome scores (modified Harris Hip Score [mHHS], Hip Outcome Score [HOS], and International Hip Outcome Tool [iHOT-33]) were recorded at 6 months and annually postoperatively. RESULTS There were no demographic differences between the 2 groups at baseline. Acetabular version, femoral version, Tönnis grade, preoperative lateral center edge angle, and intraoperative procedures were not different between the 2 groups. At 1-year follow-up from the last hip surgical procedure, the mean (±SD) mHHS (73 ± 14 vs 86 ± 14, respectively; P < .001), HOS-Activities of Daily Living (84 ± 12 vs 93 ± 11, respectively; P = .007), HOS-Sport (62 ± 25 vs 85 ± 18, respectively; P < .001), and iHOT-33 (62 ± 21 vs 79 ± 20, respectively; P = .004) were decreased in the PREVSCOPE group versus the PAOALONE group. At last follow-up (mean, 18 months from the last hip surgical procedure), the mHHS and HOS-Sport were lower in the PREVSCOPE group versus the PAOALONE group. There was no difference in complication or reoperation rates between the 2 groups. CONCLUSION Failed hip arthroscopic surgery before PAO for symptomatic hip dysplasia is associated with lower hip-specific functional outcomes within the first 1 year of follow-up despite similar baseline demographic and radiological characteristics. These differences persisted in certain outcome scores (mHHS, HOS-Sport) at last follow-up but were less pronounced than at 1 year.
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Affiliation(s)
- Benjamin F Ricciardi
- Center for Hip Pain and Preservation, Hospital for Special Surgery, New York, New York, USA
| | - Kara G Fields
- Healthcare Research Institute, Hospital for Special Surgery, New York, New York, USA
| | - Catherine Wentzel
- Center for Hip Pain and Preservation, Hospital for Special Surgery, New York, New York, USA
| | - Bryan T Kelly
- Center for Hip Pain and Preservation, Hospital for Special Surgery, New York, New York, USA
| | - Ernest L Sink
- Center for Hip Pain and Preservation, Hospital for Special Surgery, New York, New York, USA
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Nwachukwu BU, Chang B, Fields K, Rinzler J, Nawabi DH, Ranawat AS, Kelly BT. Outcomes for Arthroscopic Treatment of Anterior Inferior Iliac Spine (Subspine) Hip Impingement. Orthop J Sports Med 2017; 5:2325967117723109. [PMID: 28840150 PMCID: PMC5555511 DOI: 10.1177/2325967117723109] [Citation(s) in RCA: 37] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND Femoroacetabular hip impingement (FAI) is now well recognized; however, anterior inferior iliac spine (AIIS; or subspine) impingement is a form of hip impingement that is underrecognized and can be an important source of hip disability and functional limitation. PURPOSE To investigate the outcomes after arthroscopic treatment of AIIS/subspine-related hip impingement in the absence of FAI surgery. STUDY DESIGN Case series; Level of evidence, 4. METHODS A prospective institutional hip preservation registry was reviewed to identify patients who underwent arthroscopic AIIS decompression without concurrent treatment of FAI. Primary outcome tools captured in the registry included the modified Harris Hip Score (mHHS), the Hip Outcome Score (HOS), and the International Hip Outcome Tool-33 (iHOT-33). Patients with minimum 1-year follow-up were included. Meaningful outcome improvement was determined per minimal clinically important difference (MCID). Statistical analyses were primarily descriptive. RESULTS Thirty-three patients with a mean follow-up of 19.1 months (range, 12-44 months) were identified. All patients were female, with a mean ± SD age of 26.1 ± 10.3 years. All patients were found to have an associated labral tear, and the mean acetabular version was increased at 2 and 3 o'clock (14.5° and 19.8°, respectively). Mean preoperative outcome scores on the mHHS, HOS ADL (activities of daily living), HOS sport, and iHOT-33 were 57.2 ± 15.3, 66.9 ± 18.8, 43.9 ± 23.6, and 33.5 ± 18.3, respectively. At final available follow-up, mean scores on these outcome measures were 79.5 ± 19.0, 86.8 ± 15.8, 70.4 ± 32.8, and 65.0 ± 31.0, respectively. By the 1-year follow-up, MCID had been achieved in the majority of patients across all 4 tools. CONCLUSION There is a paucity of outcomes evidence on AIIS/subspine-related hip impingement. This study demonstrates that isolated subspine impingement can be a cause of hip disability, even in the absence of FAI. Patients with isolated subspine impingement are more likely to be women and to present with low patient-reported outcome scores. However, meaningful outcome improvement can be achieved with arthroscopic AIIS decompression.
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Affiliation(s)
- Benedict U Nwachukwu
- Department of Orthopaedic Surgery, Hospital for Special Surgery, New York, New York, USA
| | - Brenda Chang
- Department of Orthopaedic Surgery, Hospital for Special Surgery, New York, New York, USA
| | - Kara Fields
- Department of Orthopaedic Surgery, Hospital for Special Surgery, New York, New York, USA
| | - Jeremy Rinzler
- Department of Orthopaedic Surgery, Hospital for Special Surgery, New York, New York, USA
| | - Danyal H Nawabi
- Department of Orthopaedic Surgery, Hospital for Special Surgery, New York, New York, USA
| | - Anil S Ranawat
- Department of Orthopaedic Surgery, Hospital for Special Surgery, New York, New York, USA
| | - Bryan T Kelly
- Department of Orthopaedic Surgery, Hospital for Special Surgery, New York, New York, USA
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Shibahara M, Ohnishi Y, Honda E, Matsuda DK, Uchida S. Arthroscopic Treatment of a Displaced Nonunion of the Anterior Inferior Iliac Spine Causing Extra-articular Impingement. Orthopedics 2017; 40:e725-e728. [PMID: 28437548 DOI: 10.3928/01477447-20170418-06] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/06/2016] [Accepted: 03/07/2017] [Indexed: 02/03/2023]
Abstract
This report describes a case of nonunion of an anterior inferior iliac spine (AIIS) apophyseal avulsion fracture with resultant subspine impingement combined with symptomatic femoroacetabular impingement (FAI). A 16-year-old male soccer player presented with a 6-month history of right groin pain exacerbated by kicking and running. The patient was diagnosed with a displaced nonunion of the AIIS apophysis avulsion fracture causing secondary extra-articular impingement beyond cam-type FAI by physical examination and radiological findings. The authors performed arthroscopic AIIS decompression, with concurrent FAI correction and labral repair and capsular closure. At 4 months after surgery, a radiograph and a computed tomography scan showed complete bony union of the AIIS apophyseal nonunion. Modified Harris Hip Sore and Nonarthritic Hip Score improved from 74.8 and 61, respectively, to 100 for both at final follow-up. The effectiveness of arthroscopic decompression of the AIIS as part of a comprehensive minimally invasive surgery including FAI correction and labral repair resulted in complete union of the AIIS and pain-free return to sport and bony union. [Orthopedics. 2017; 40(4):e725-e728.].
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Nwachukwu BU, Fields K, Chang B, Nawabi DH, Kelly BT, Ranawat AS. Preoperative Outcome Scores Are Predictive of Achieving the Minimal Clinically Important Difference After Arthroscopic Treatment of Femoroacetabular Impingement. Am J Sports Med 2017; 45:612-619. [PMID: 27765733 DOI: 10.1177/0363546516669325] [Citation(s) in RCA: 178] [Impact Index Per Article: 25.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND There is increasing interest in defining meaningful improvement in patient-reported outcomes. Knowledge of the thresholds and determinants for successful femoroacetabular impingement (FAI) outcomes is evolving. PURPOSE To define preoperative outcome score thresholds and determine clinical/demographic patient factors predictive for achieving the minimal clinically important difference (MCID) after arthroscopic FAI surgery. STUDY DESIGN Cohort study (diagnosis); Level of evidence, 2. METHODS A prospective institutional hip preservation registry was reviewed to identify patients undergoing arthroscopic FAI surgery. The modified Harris Hip Score (mHHS), the Hip Outcome Score (HOS), and the international Hip Outcome Tool (iHOT-33) were administered at baseline and 1 year postoperatively. The MCID was calculated using a distribution-based method. Receiver operating characteristic (ROC) analysis was used to calculate cohort-based threshold values predictive of achieving the MCID. The area under the curve (AUC) was used to define predictive ability, with AUC >0.7 considered acceptably predictive. Multivariable analysis identified patient factors associated with achieving the MCID. Sensitivity analysis was performed to derive the MCID by an alternative anchor-based method. RESULTS There were 364 patients (mean [±SD] age, 32.5 ± 10.3 years), and 57.1% were female. The MCID for the mHHS, HOS-Activities of Daily Living (HOS-ADL), HOS-Sports, and iHOT-33 was 8.2, 8.3, 14.5, and 12.1, respectively. ROC analysis findings (threshold, percentage achieving the MCID, and strength of association) for these tools were as follows: mHHS (60.5, 77.2%, and 0.68, respectively), HOS-ADL (83.3, 68.1%, and 0.85, respectively), HOS-Sports (58.3, 65.9%, and 0.76, respectively), and iHOT-33 (53.9, 81.9%, and 0.65, respectively). The likelihood for achieving the MCID significantly declined above these thresholds. In multivariable analysis, a higher sagittal center-edge angle (CEA) (odds ratio [OR], 1.04; 95% CI, 1.01-1.08) was a positive predictor of achieving the MCID on the iHOT-33, while a higher Outerbridge grade for the acetabulum was a negative predictor (OR, 0.56; 95% CI, 0.32-0.99) on the mHHS. Sensitivity analysis confirmed these variables and identified relative femoral retroversion as another negative predictor (OR, 0.40; 95% CI, 0.17-0.94). CONCLUSION The HOS had excellent predictive ability for identifying patient thresholds of achieving the MCID; patients with preoperative scores below identified thresholds were most likely to achieve the MCID. Additionally, anterior acetabular undercoverage, chondral injuries, and relative femoral retroversion were clinically significant negative modifiers of outcomes. These findings have implications for managing preoperative expectations of FAI surgery.
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Affiliation(s)
| | - Kara Fields
- Hospital for Special Surgery, New York, New York, USA
| | - Brenda Chang
- Hospital for Special Surgery, New York, New York, USA
| | | | - Bryan T Kelly
- Hospital for Special Surgery, New York, New York, USA
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