1
|
Boos AM, Nagelli CV, Okoroha KR, Sierra RJ, Krych AJ, Hevesi M. Primary Hip Arthroscopy in Patients With Acetabular Dysplasia: A Systematic Review of Published Clinical Outcomes at Minimum 5-Year Follow-up. Am J Sports Med 2024; 52:2148-2158. [PMID: 38333917 DOI: 10.1177/03635465231197177] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/10/2024]
Abstract
BACKGROUND Hip arthroscopy in patients with borderline hip dysplasia has satisfactory outcomes at short-term follow-up; however, the data on midterm outcomes are inconsistent, and failure rates are high in some studies, limiting understanding of the role and utility of hip arthroscopy in this patient cohort. PURPOSE To provide an up-to-date, evidence-based review of the clinical outcomes of primary hip arthroscopy in patients with frank or borderline hip dysplasia at ≥5-year follow-up and report the failure rate and progression to total hip arthroplasty in this cohort. STUDY DESIGN Systematic review; Level of evidence, 4. METHODS A comprehensive literature search was performed according to the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines. Studies were included if they evaluated outcomes of primary hip arthroscopy in patients with lateral center-edge angle (LCEA) <25° at ≥5-year follow-up. Risk of bias assessment was performed using the methodological index for non-randomized studies scoring system. Level of evidence was determined using criteria from the Oxford Centre for Evidence-Based Medicine. RESULTS Nine studies were included in this review. Patients with LCEA <25° demonstrated satisfactory clinical outcomes, high patient satisfaction, and significant postoperative improvements in patient-reported outcomes (PROs) at follow-up ranging from a ≥5 to 10 years. Studies comparing patients with dysplasia to those without did not demonstrate significant differences in preoperative, postoperative, or delta PROs or in failure, reoperation, or revision rates. There was no overall significant correlation between outcomes and LCEA stratification. CONCLUSION Hip arthroscopy in carefully selected patients with LCEA <25° can be successful at mid- to long-term follow-up and may provide clinical outcomes and failure rates comparable with patients with normal LCEA, understanding that this is a singular, 2-dimensional radiographic measure that does not differentiate instability from impingement or combinations thereof, warranting future studies delineating these differences. These findings suggest that hip dysplasia may not be an absolute contraindication for isolated hip arthroscopy and may serve as a viable intervention with consideration of staged future periacetabular osteotomy (PAO). Importantly, this review does not suggest that hip arthroscopy alters the natural history of dysplasia; therefore, patients with dysplasia should be counseled on the potential utility of PAO by appropriate hip preservation specialists.
Collapse
Affiliation(s)
- Alexander M Boos
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, Minnesota, USA
| | | | - Kelechi R Okoroha
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, Minnesota, USA
| | - Rafael J Sierra
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, Minnesota, USA
| | - Aaron J Krych
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, Minnesota, USA
| | - Mario Hevesi
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, Minnesota, USA
| |
Collapse
|
2
|
Kim DNW, Fong S, Park N, Simington J, Atadja L, Pettinelli N, Lee MS, Gillinov SM, Maldonado DR, Jimenez AE. Mid- to Long-Term Outcomes in Patients After Hip Arthroscopy With Labral Reconstruction: A Systematic Review. Orthop J Sports Med 2024; 12:23259671241232306. [PMID: 38831872 PMCID: PMC11144364 DOI: 10.1177/23259671241232306] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/14/2023] [Accepted: 08/16/2023] [Indexed: 06/05/2024] Open
Abstract
Background There is a paucity of aggregate data documenting mid- to long-term outcomes of patients after hip arthroscopy with labral reconstruction. Purpose To report mid- to long-term outcomes in patients after undergoing either primary or revision hip arthroscopy with labral reconstruction for the treatment of irreparable labral tears. Study Design Systematic review; Level of evidence, 4. Methods A systematic review of the PubMed, Cochrane, and Scopus databases in May 2022 was conducted with the following keywords: "hip arthroscopy,""labral reconstruction,""irreparable,""labrum,""reconstruction,""five-year,""midterm,""5 year,""long-term,""10 year," ten-year," and "femoroacetabular impingement" using the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses criteria. Midterm was defined as mean 5-year follow-up, and long-term was defined as mean 10-year or longer follow-up. For each included article, the demographic, radiographic, intraoperative, and surgical variables, as well as patient-reported outcomes (PROs), psychometric thresholds, and secondary surgeries were recorded. Forest plots were created for PROs that were reported in ≥3 studies; heterogeneity was assessed using I2 values. Results Out of 463 initial articles, 5 studies including 178 hips with primary and 41 hips with revision surgeries were included. One study had an average 5-year follow-up, three studies had a minimum 5-year follow-up and one study had a minimum 10-year follow-up. The most common indications for hip arthroscopy with labral reconstruction were irreparable labral tears. The most common PRO was the modified Harris Hip Score (mHHS), which was reported in all 5 studies. The mean preoperative mHHS ranged from 58.9 to 66, and the mean postoperative mHHS at minimum 5-year follow-up ranged from 80.2 to 89. The preoperative and postoperative mHHSs for the single long-term follow-up study were 60 and 82, respectively. All 5 studies demonstrated significant improvements in reported PROs. All 5 studies reported secondary surgery rates, with 1 study reporting rates at both 5- and 10-year follow-up. Conversion to total hip arthroplasty ranged from 0% to 27%, while overall secondary surgery rates ranged from 0% to 36%. Conclusion Findings demonstrated that patients undergoing primary and revision hip arthroscopy with labral reconstruction experienced favorable outcomes and high rates of clinical benefit and survivorship at mid- to long-term follow-up.
Collapse
Affiliation(s)
- David Nam-Woo Kim
- Department of Orthopaedics and Rehabilitation, Yale School of Medicine, New Haven, Connecticut, USA
| | - Scott Fong
- Case Western Reserve University School of Medicine, Cleveland, Ohio, USA
| | - Nancy Park
- Department of Orthopaedics and Rehabilitation, Yale School of Medicine, New Haven, Connecticut, USA
| | - Jacquelyn Simington
- Department of Orthopaedics and Rehabilitation, Yale School of Medicine, New Haven, Connecticut, USA
| | - Louise Atadja
- Department of Orthopaedics and Rehabilitation, Yale School of Medicine, New Haven, Connecticut, USA
| | | | | | - Stephen M. Gillinov
- Department of Orthopaedics and Rehabilitation, Yale School of Medicine, New Haven, Connecticut, USA
| | - David R. Maldonado
- Department of Orthopedic Surgery, McGovern Medical School, Houston, Texas, USA
| | - Andrew E. Jimenez
- Department of Orthopaedics and Rehabilitation, Yale School of Medicine, New Haven, Connecticut, USA
| |
Collapse
|
3
|
Lee MS, Owens JS, Fong S, Kim DN, Gillinov SM, Mahatme RJ, Simington J, Monahan PF, Islam W, Moran J, Grimm NL, Jimenez AE. Mid- and Long-Term Outcomes Are Favorable for Patients With Borderline Dysplasia Undergoing Primary Hip Arthroscopy: A Systematic Review. Arthroscopy 2023; 39:1060-1073. [PMID: 36596369 DOI: 10.1016/j.arthro.2022.12.030] [Citation(s) in RCA: 10] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/23/2022] [Revised: 10/19/2022] [Accepted: 12/22/2022] [Indexed: 01/02/2023]
Abstract
PURPOSE To evaluate midterm outcomes, long-term outcomes, and survivorship in the borderline dysplastic population after primary hip arthroscopy. METHODS A systematic review of current literature was performed with the following key words: "hip, "arthroscopy," "borderline dysplasia," "borderline hip dysplasia," "developmental dysplasia," "ten-year," "survivorship," "10-year," "5-year," "five year," "mid-term," "long-term," "outcomes," "arthroscopic," and "femoroacetabular impingement" in PubMed, Cochrane, and Scopus in March 2022 using the Preferred Reporting Items for Systematic Reviews and Meta-analyses guidelines. The following information was recorded: title, author, publication date, study design, demographic, number of hips, follow-up time, study period, indications for hip arthroscopy, patient-reported outcomes (PROs), characteristics of patients converting to total hip arthroplasty (THA), and rates of secondary surgeries and conversion to THA were recorded. Survivorship was defined as not converting to THA. Kappa values for the title/abstract and full-text screening were calculated. Forest plots were created for PROs that were included in 3 or more studies. RESULTS Six articles comprising 413 hips were included in the study. Three studies were Level III evidence, and 3 studies were Level IV evidence. Average follow-up ranged from 5.7 to 12.2 years. One study defined borderline hip dysplasia as lateral center-edge angle 18-25° and 5 defined it as lateral center-edge angle 20-25°. All studies included PROs and reported significant improvement after surgery in at least one PRO. Three studies reported clinical benefit and across the studies at least 70% of patients achieved minimum clinically important difference in at least one PRO. Rates of undergoing revision hip arthroscopy and THA ranged from 2.1% to 7% and 0% to 24%, respectively. Tönnis grade 2, Tönnis angle >15, and Outerbridge Grade IV cartilage damage were identified as predictors of conversion to THA. CONCLUSIONS Patients with borderline hip dysplasia undergoing primary hip arthroscopy demonstrated significant improvement in PROs at midterm and long-term follow-up. Survivorship at midterm follow-up was 98.2% (328/334 hips) and 76.3% (29/38 hips) at long-term follow-up. LEVEL OF EVIDENCE Level IV, systematic review of Level III and Level IV studies.
Collapse
Affiliation(s)
- Michael S Lee
- Medical College of Wisconsin, Milwaukee, Wisconsin, U.S.A
| | - Jade S Owens
- Keck School of Medicine of the University of Southern California, Los Angeles, California
| | - Scott Fong
- Advanced Orthopaedics & Sports Medicine, San Francisco, California
| | - David N Kim
- Department of Orthopaedics and Rehabilitation, Yale School of Medicine, New Haven, Connecticut
| | - Stephen M Gillinov
- Department of Orthopaedics and Rehabilitation, Yale School of Medicine, New Haven, Connecticut
| | - Ronak J Mahatme
- University of Connecticut School of Medicine, Farmington, Connecticut
| | | | | | - Wasif Islam
- Department of Orthopaedics and Rehabilitation, Yale School of Medicine, New Haven, Connecticut
| | - Jay Moran
- Department of Orthopaedics and Rehabilitation, Yale School of Medicine, New Haven, Connecticut
| | | | - Andrew E Jimenez
- Department of Orthopaedics and Rehabilitation, Yale School of Medicine, New Haven, Connecticut.
| |
Collapse
|
4
|
Borderline Dysplastic Hips Undergoing Hip Arthroscopy Achieve Equivalent Patient Reported Outcomes When Compared With Hips With Normal Acetabular Coverage: A Systematic Review and Meta-Analysis. J Am Acad Orthop Surg 2023; 31:e336-e346. [PMID: 36730851 DOI: 10.5435/jaaos-d-22-00302] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/09/2022] [Accepted: 08/18/2022] [Indexed: 02/04/2023] Open
Abstract
PURPOSE To systematically review and meta-analyze studies reporting lateral center edge angle as it relates to patient-reported outcome (PRO) measures and clinically notable outcome assessments for patients undergoing hip arthroscopy for femoroacetabular impingement syndrome or labral pathology with borderline dysplastic hips (BDH). METHODS PubMed, EMBASE, and the Web of Science Core Collection databases were queried for articles evaluating lateral center edge angle as a predictor of PRO after hip arthroscopy. Articles were eligible for meta-analysis if they compared PROs measures between patients with normal acetabular coverage and borderline dysplasia and were at least level III evidence. Continuous random-effects models with standardized mean differences were used to compare postoperative Hip Outcome Score-Activities of Daily Living and sports subscales, modified Harris Hip Score, international Hip Outcome Tool scores, Satisfaction, and Visual Analog Scale Pain scores between normal coverage and borderline dysplastic groups. RESULTS Overall, 989 hips undergoing arthroscopy from six investigations were included in this meta-analysis, including 315 borderline dysplastic subjects (mean age 27.5 years) and 674 subjects with normal coverage (mean age 26.9 years). Borderline dysplastic and normal coverage cohorts were followed for an average of 37.0 and 36.8 months, respectively. Postoperative PRO measures (Hip Outcome Score-Activities of Daily Living, Hip Outcome Score-Sports Subscale, modified Harris Hip Score, international Hip Outcome Tool-12, Satisfaction, and Visual Analog Scale Pain) collected approximately three years after hip arthroscopy were not markedly different between subjects with BDH when compared with patients with normal coverage. CONCLUSIONS In a meta-analysis of the available literature, patients with BDH are able to equally reach statistically similar clinical outcomes after isolated hip arthroscopy as compared with control subjects without dysplasia at short-term follow-up. A BDH should not be considered a contraindication to hip arthroscopy when optimal PRO achievement is the goal. LEVEL OF EVIDENCE Level III, Systematic Review and Meta-Analysis.
Collapse
|
5
|
Migliorini F, Baroncini A, Eschweiler J, Knobe M, Tingart M, Maffulli N. Return to sport after arthroscopic surgery for femoroacetabular impingement. Surgeon 2023; 21:21-30. [PMID: 34953722 DOI: 10.1016/j.surge.2021.11.006] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2020] [Accepted: 11/19/2021] [Indexed: 02/03/2023]
Abstract
BACKGROUND Femoroacetabular impingement (FAI) is common among the active and young population. The present study analysed the rate of return to sport, related influencing factors, and the sport activity level according to the Hip Outcome Score - Sport-Specific Subscale (HOS-SSS). METHODS The literature search was performed in December 2020. All clinical trials investigating HOS-SSS and/or return to sport after arthroscopic treatment for FAI were considered for inclusion. The outcomes of interest were to analyse the rate of return to sport and the sport activity level according to the HOS-SSS in patients who underwent arthroscopic osteoplasty for FAI. RESULTS Data from 41 studies (4063 procedures) were retrieved. A total of 88.75% (581 of 655) of patients returned to sports within a mean of 37.4 ± 16.5 months. The HOS-SSS score improved from 45.0 ± 10.6 to 73.1 ± 9.5 (P < 0.0001) at last follow-up. The following baseline characteristics evidenced positive association with post-operative activity level: lighter weight (P = 0.01), younger age (P = 0.001), Tönnis angle grade I (P = 0.009), greater HHS (P = 0.01), NAHS (P < 0.0001) and HOS-ADL (P = 0.01). CONCLUSION Arthroscopic treatment for FAI resulted in excellent results in terms of return to sport. Moreover, lighter weight and younger age, greater HHS, NAHS, HOS-ADL at baseline were positively associated with post-operative sport activity level. LEVEL OF EVIDENCE IV, systematic review.
Collapse
Affiliation(s)
- Filippo Migliorini
- Department of Orthopaedic, Trauma, and Reconstructive Surgery, RWTH Aachen University Hospital, Aachen, Germany.
| | - Alice Baroncini
- Department of Orthopaedic, Trauma, and Reconstructive Surgery, RWTH Aachen University Hospital, Aachen, Germany.
| | - Jörg Eschweiler
- Department of Orthopaedic, Trauma, and Reconstructive Surgery, RWTH Aachen University Hospital, Aachen, Germany.
| | - Matthias Knobe
- Department of Orthopedics and Trauma Surgery, Lucerne Cantonal Hospital, Lucerne, Switzerland.
| | - Markus Tingart
- Department of Orthopaedic, Trauma, and Reconstructive Surgery, RWTH Aachen University Hospital, Aachen, Germany.
| | - Nicola Maffulli
- Department of Medicine, Surgery and Dentistry, University of Salerno, Via S. Allende, 84081 Baronissi, (SA), Italy; School of Pharmacy and Bioengineering, Keele University Faculty of Medicine, Thornburrow Drive, Stoke on Trent, England, United Kingdom; Queen Mary University of London, Barts and the London School of Medicine and Dentistry, Centre for Sports and Exercise Medicine, Mile End Hospital, 275 Bancroft Road, London E1 4DG, England, United Kingdom.
| |
Collapse
|
6
|
Kim DNW, Lee MS, Mahatme RJ, Gillinov SM, Islam W, Fong S, Lee AY, Abu S, Pettinelli N, Medvecky MJ, Jimenez AE. Short Symptom Duration Is Associated With Superior Outcomes in Patients Undergoing Primary Hip Arthroscopy: A Systematic Review. Arthroscopy 2023; 39:498-509. [PMID: 36395964 DOI: 10.1016/j.arthro.2022.11.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/01/2022] [Revised: 11/05/2022] [Accepted: 11/08/2022] [Indexed: 11/15/2022]
Abstract
PURPOSE To evaluate the effect of duration of preoperative hip pain symptoms on outcomes in patients undergoing primary hip arthroscopy for the treatment of femoroacetabular impingement syndrome. METHODS A systematic review of the literature was conducted with the following key words: "hip arthroscopy," "outcomes," "femoroacetabular impingement," "duration," "symptoms," "time," "delay," "earlier," and "timing" was performed in PubMed and Cochrane in May 2022. The Preferred Reporting Items for Systematic Reviews and Meta-analyses guidelines were used for this review. When available, article information including the author, study type, study period, and follow-up, demographics, preoperative duration of symptoms, surgical outcome tools, and secondary surgeries were recorded. RESULTS Six studies including 3,298 hips were included in this systematic review. Five studies had a minimum of 2 years' follow-up, and 1 study had a minimum of 5 years' follow-up. Femoroacetabular impingement (including subtypes cam and pincer impingement) was a surgical indication in all 6 studies and the most common indication for surgery. All 6 studies reported patient-reported outcome scores. All studies conducted statistical analyses comparing the duration of symptoms' effect on outcomes and found superior outcomes in patients with shorter duration of symptoms before hip arthroscopy. In 3 studies, modified Harris Hip Score, Hip Outcome Score - Activities of Daily Living, Hip Outcome Score - Sports-Specific Subscale, and visual analog scale for satisfaction ranged from 79.1-82.6, 86.3-88.4, 75-75.5. and 75.3-82.5, respectively, in cohorts with <2-year duration of symptoms, compared with 72-77.7, 79.6-84, 65.0-66.7, and 69.7-75.3 in >2-year cohort. Similarly, in one study, the <2-year duration group was reported to have a conversion to total hip arthroplasty rate of 0.6% and an overall secondary surgery rate of 0.9%, whereas the >2-year duration group had a conversion to total hip arthroplasty rate of 6.4% and an overall secondary surgery rate of 10.1%. CONCLUSIONS Patients with hip pain symptoms of less than 2 years before arthroscopic treatment of femoroacetabular impingement syndrome have better outcomes than those patients who had a longer duration of symptoms. However, significant improvements can still be expected regardless of time between onset of symptoms and surgery. LEVEL OF EVIDENCE Level IV, systematic review of Level III and Level IV studies.
Collapse
Affiliation(s)
- David Nam-Woo Kim
- Department of Orthopaedics and Rehabilitation, Yale School of Medicine, New Haven, Connecticut, U.S.A
| | - Michael S Lee
- Medical College of Wisconsin, Milwaukee, Wisconsin, U.S.A
| | - Ronak J Mahatme
- University of Connecticut School of Medicine, Farmington, Connecticut, U.S.A
| | - Stephen M Gillinov
- Department of Orthopaedics and Rehabilitation, Yale School of Medicine, New Haven, Connecticut, U.S.A
| | - Wasif Islam
- Department of Orthopaedics and Rehabilitation, Yale School of Medicine, New Haven, Connecticut, U.S.A
| | - Scott Fong
- Advanced Orthopaedics and Sports Medicine, San Francisco, California, U.S.A
| | - Amy Y Lee
- Medical College of Wisconsin, Milwaukee, Wisconsin, U.S.A
| | - Seyi Abu
- Department of Orthopaedics and Rehabilitation, Yale School of Medicine, New Haven, Connecticut, U.S.A
| | | | - Michael J Medvecky
- Department of Orthopaedics and Rehabilitation, Yale School of Medicine, New Haven, Connecticut, U.S.A
| | - Andrew E Jimenez
- Department of Orthopaedics and Rehabilitation, Yale School of Medicine, New Haven, Connecticut, U.S.A.
| |
Collapse
|
7
|
Presence of a Posterior Wall Sign in the Treatment of Femoroacetabular Impingement Syndrome: A Matched Comparative Cohort Analysis at Minimum 2-Year Follow-Up. J Arthroplasty 2022; 37:1520-1525. [PMID: 35405263 DOI: 10.1016/j.arth.2022.04.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/01/2021] [Revised: 03/30/2022] [Accepted: 04/02/2022] [Indexed: 02/02/2023] Open
Abstract
BACKGROUND Acetabular retroversion may predispose to more severe femoroacetabular impingement syndrome (FAIS) and early labral damage given impaction of the femoral head-neck junction on the retroverted acetabular rim. The cross-over sign (COS), posterior wall sign (PWS), and ischial spine sign (ISS) are markers of acetabular retroversion (AR) on plain radiographs. METHODS Patients who underwent primary hip arthroscopy for FAIS from January 2012 to December 2018 with a positive PWS were matched in a 1:1 ratio by age, gender, and body mass index (BMI) to controls with a negative PWS. Preoperative and postoperative patient-reported outcomes (PROs; HOS-ADL, HOS-SS, mHHS, and iHOT-12) were compared using independent t-tests. Achievement of a Patient Acceptable Symptom State (PASS) or Minimal Clinically Important Difference (MCID) was compared using Fisher's exact test. RESULTS Two hundred and seventy five patients with a positive PWS and 275 controls were included in the final analysis. Most patients (64%) were female, with average age, and BMI of 37.6 (SD 8.6) and 25.1 (SD 4.4), respectively. PROs improved significantly for both groups from preoperatively to 2 years postoperatively. There were no statistically significant differences (P ≥ .05) in PROs or achievement of MCID or PASS. On a subgroup analysis, patients with all three positive signs had significantly lower postoperative PROs and lower rates of achievement of MCID and PASS. CONCLUSION Patients with an isolated PWS achieve similar outcomes following hip arthroscopy at 2 years. However, patients with a concomitant PWS, ISS, and COS demonstrate less favorable outcomes, suggesting the need for increased perioperative counseling and potential evaluation for planned concurrent or serial open procedures such as periacetabular osteotomy.
Collapse
|
8
|
Holleyman RJ, Lyman S, Bankes MJK, Board TN, Conroy JL, McBryde CW, Andrade AJ, Malviya A, Khanduja V. Comparison of early outcomes of arthroscopic labral repair or debridement. Bone Jt Open 2022; 3:291-301. [PMID: 35369718 PMCID: PMC9044091 DOI: 10.1302/2633-1462.34.bjo-2022-0003.r1] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
Aims This study uses prospective registry data to compare early patient outcomes following arthroscopic repair or debridement of the acetabular labrum. Methods Data on adult patients who underwent arthroscopic labral debridement or repair between 1 January 2012 and 31 July 2019 were extracted from the UK Non-Arthroplasty Hip Registry. Patients who underwent microfracture, osteophyte excision, or a concurrent extra-articular procedure were excluded. The EuroQol five-dimension (EQ-5D) and International Hip Outcome Tool 12 (iHOT-12) questionnaires were collected preoperatively and at six and 12 months post-operatively. Due to concerns over differential questionnaire non-response between the two groups, a combination of random sampling, propensity score matching, and pooled multivariable linear regression models were employed to compare iHOT-12 improvement. Results A total of 2,025 labral debridements (55%) and 1,659 labral repairs (45%) were identified. Both groups saw significant (p < 0.001) EQ-5D and iHOT-12 gain compared to preoperative scores at 12 months (iHOT-12 improvement: labral repair = +28.7 (95% confidence interval (CI) 26.4 to 30.9), labral debridement = +24.7 (95% CI 22.5 to 27.0)), however there was no significant difference between procedures after multivariable modelling. Overall, 66% of cases achieved the minimum clinically important difference (MCID) and 48% achieved substantial clinical benefit at 12 months. Conclusion Both labral procedures were successful in significantly improving early functional outcome following hip arthroscopy, regardless of age or sex. Labral repair was associated with superior outcomes in univariable analysis, however there was no significant superiority demonstrated in the multivariable model. Level of evidence: III Cite this article: Bone Jt Open 2022;3(4):291–301.
Collapse
Affiliation(s)
| | - Stephen Lyman
- Hospital for Special Surgery, New York, New York, USA
- Kyushu University School of Medicine, Fukuoka, Japan
| | - Marcus J. K. Bankes
- Guy’s and St Thomas’ NHS Foundation Trust, London, UK
- Fortius Clinic, London, UK
| | | | | | | | | | - Ajay Malviya
- Northumbria Healthcare NHS Foundation Trust, Newcastle upon Tyne, UK
- Newcastle University, Newcastle upon Tyne, United Kingdom
| | - Vikas Khanduja
- Addenbrooke’s Hospital - The Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
| |
Collapse
|
9
|
Beals TR, Soares RW, Briggs KK, Day HK, Philippon MJ. Ten-Year Outcomes After Hip Arthroscopy in Patients With Femoroacetabular Impingement and Borderline Dysplasia. Am J Sports Med 2022; 50:739-745. [PMID: 35133204 DOI: 10.1177/03635465211068109] [Citation(s) in RCA: 31] [Impact Index Per Article: 15.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND The role of hip arthroscopy in the treatment of patients with borderline hip dysplasia is controversial and evolving. PURPOSE To evaluate outcomes at a minimum 10-year follow-up in patients who underwent hip arthroscopy for femoroacetabular impingement in a hip with borderline dysplasia. STUDY DESIGN Case series; Level of evidence, 4. METHODS All hips that underwent labral repair between June 2006 and March 2009 for femoroacetabular impingement with borderline dysplasia were included if they had a lateral center-edge angle of 20° to 25°, had primary hip arthroscopy for the diagnosis of femoroacetabular impingement, and were aged 18 to 70 years. Patients were excluded if they had previous hip surgery, avascular necrosis, or fracture. Kaplan-Meier survivorship was performed, with survivorship defined as avoidance of conversion to total hip arthroplasty (THA). RESULTS A total of 45 patients met the inclusion criteria, and 38 were contacted at a minimum 10 years postoperatively (84%; mean ± SD, 12 ± 1.3 years). There were 23 women and 15 men with an average age of 41 ± 9.6 years (range, 25-69). Twenty patients were ≥40 years of age. In this patient cohort, survivorship was 87% at 5 years and 79% at 10 years for conversion to THA. Of the 38 patients included, 9 were converted to THA (24%), and 3 required revision hip arthroscopy (7%). Patient age, Tönnis grade, microfracture of cartilage lesions, and Tönnis angle >15° were associated with conversion to THA. No statistically significant differences were found between those who underwent conversion to THA and those who did not regarding lateral center-edge angle, Sharp angle, or alpha angle. Significant improvements were seen at follow-up of 12 years (range, 10-13) for the modified Harris Hip Score (58 to 83; P = .002), Hip Outcome Score-Activities of Daily Living (70 to 87; P = .003), Hip Outcome Score-Sport (47 to 76; P = .004), and Western Ontario and McMaster Universities Osteoarthritis Index (31 to 10; P = .001). At follow-up, >80% maintained the minimal clinically important difference for the Hip Outcome Score (Activities of Daily Living and Sport) with no differences between patients aged <40 and ≥40 years. CONCLUSION Risk factors for conversion to THA after hip arthroscopy in the borderline dysplastic hip included older age, higher Tönnis grades, grade 4 chondral lesions that were microfractures, and Tönnis angle >15°. In those patients who did not convert to THA, improvement in outcome measures was seen at 10 years. Careful patient selection is critical to the success of this procedure.
Collapse
Affiliation(s)
- Tim R Beals
- Steadman Philippon Research Institute, Vail, Colorado, USA.,Sports Medicine Oregon, Tigard, Oregon, USA
| | - Rui W Soares
- Steadman Philippon Research Institute, Vail, Colorado, USA.,Cleveland Clinic, Cleveland, Ohio, USA
| | - Karen K Briggs
- Steadman Philippon Research Institute, Vail, Colorado, USA
| | - Hannah K Day
- Steadman Philippon Research Institute, Vail, Colorado, USA
| | - Marc J Philippon
- Steadman Philippon Research Institute, Vail, Colorado, USA.,The Steadman Clinic, Vail, Colorado, USA
| |
Collapse
|
10
|
Shapira J, Chen JW, Yelton MJ, Rosinsky PJ, Maldonado DR, Meghpara MB, Lall AC, Domb BG. The Inverse Relationship Between Labral Size and Acetabular Coverage: Does It Protect the Cartilage in the Dysplastic Hip? Arthroscopy 2022; 38:385-393. [PMID: 33964389 DOI: 10.1016/j.arthro.2021.04.052] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/27/2020] [Revised: 04/21/2021] [Accepted: 04/24/2021] [Indexed: 02/02/2023]
Abstract
PURPOSE The aims of this study were to confirm the relationship between osseous coverage and labral size and to investigate the severity of intra-articular damage in borderline dysplastic hips in correlation to labral size. METHODS Patients treated with primary hip arthroscopy for symptomatic labral tears between 2010 and 2018 were considered for this study. Patients were included if they had preoperative radiographic measures and intraoperative assessments of the labra and cartilage. The study group was divided into borderline dysplastic and nondysplastic groups via 3 measurements: lateral center edge angle (LCEA), acetabular index (Ax), and anterior center edge angle (ACEA). Undercoverage was defined as LCEA ≤ 25°, Ax ≥ 10°, and ACEA ≤ 20°. The labrum was measured in four quadrants: anterosuperior (AS), anteroinferior (AI), posterosuperior (PS), and posteroinferior (PI). Additionally, to assess cartilage damage in borderline dysplastic hips, hips with average labral size in the top quartile were compared to hips with average labral size in the bottom quartile. RESULTS A total of 1765 hips (1589 patients) were included in the study. The mean LCEA, Ax, and ACEA between the borderline dysplastic and nondysplastic groups were significantly different (P < .001). According to the Ax classification, there was significant evidence that borderline dysplastic hips had larger labra (P < .05). Among the dysplastic group, there was significantly more cartilage damage according to the Outerbridge classifications along both the acetabulum and femoral head in hips with labra in the upper quartile (P =.011 and .005, respectively). CONCLUSION An inverse relationship may exist between acetabular depth and labral size. Additionally, specifically in borderline dysplastic hips, a relatively large labrum correlates with worse intra-articular damage compared to borderline dysplastic hips with a relatively small labrum. Larger labral size may indicate a higher degree of instability in patients with borderline dysplasia. LEVEL OF EVIDENCE Level III, case-control study.
Collapse
Affiliation(s)
- Jacob Shapira
- American Hip Institute Research Foundation, Chicago, Illinois
| | - Jeffrey W Chen
- Vanderbilt University School of Medicine, Nashville, Tennessee
| | | | | | | | - Mitchell B Meghpara
- American Hip Institute Research Foundation, Chicago, Illinois; AMITA Health St. Alexius Medical Center, Hoffman Estates, Illinois, U.S.A
| | - Ajay C Lall
- American Hip Institute Research Foundation, Chicago, Illinois; American Hip Institute, Chicago, Illinois; AMITA Health St. Alexius Medical Center, Hoffman Estates, Illinois, U.S.A
| | - Benjamin G Domb
- American Hip Institute Research Foundation, Chicago, Illinois; American Hip Institute, Chicago, Illinois; AMITA Health St. Alexius Medical Center, Hoffman Estates, Illinois, U.S.A..
| |
Collapse
|
11
|
Migliorini F, Liu Y, Catalano G, Trivellas A, Eschweiler J, Tingart M, Maffulli N. Medium-term results of arthroscopic treatment for femoroacetabular impingement. Br Med Bull 2021; 138:68-84. [PMID: 33454746 DOI: 10.1093/bmb/ldaa038] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/16/2020] [Revised: 05/16/2020] [Accepted: 10/24/2020] [Indexed: 11/14/2022]
Abstract
INTRODUCTION Femoroacetabular impingement (FAI) is a dynamic pathomechanical process of the femoral head-neck junction. Arthroscopic surgery for FAI has increased exponentially in the last decade, and this trend is expected to increase. SOURCE OF DATA Recent published literatures. AREAS OF AGREEMENT FAI promotes quick rehabilitation and low complication rates in the short-term follow-up. AREAS OF CONTROVERSY Despite the growing interest on arthroscopic surgery for FAI, current evidence regarding the medium- and long-term role of arthroscopy are unsatisfactory. GROWING POINTS Systematically summarize current evidences, analyse the quantitative available data and investigate the medium- and long-term outcomes of arthroscopic surgery for FAI. AREAS TIMELY FOR DEVELOPING RESEARCH Arthroscopic surgery achieves very satisfactory outcomes for patients with FAI at a mean follow-up of 4 years.
Collapse
Affiliation(s)
- Filippo Migliorini
- Department of Orthopaedics, University Clinic Aachen, RWTH Aachen University Clinic, 52074 Aachen, Germany
| | - Yu Liu
- Department of Orthopaedics, University Clinic Aachen, RWTH Aachen University Clinic, 52074 Aachen, Germany
| | - Giovanni Catalano
- Department of Orthopaedics, University Clinic Aachen, RWTH Aachen University Clinic, 52074 Aachen, Germany
| | - Andromahi Trivellas
- Department of Orthopaedics, David Geffen School of Medicine at UCLA, 90095 Los Angeles, CA, USA
| | - Jörg Eschweiler
- Department of Orthopaedics, University Clinic Aachen, RWTH Aachen University Clinic, 52074 Aachen, Germany
| | - Markus Tingart
- Department of Orthopaedics, University Clinic Aachen, RWTH Aachen University Clinic, 52074 Aachen, Germany
| | - Nicola Maffulli
- Department of Medicine, Surgery and Dentistry, University of Salerno, Via S. Allende, Baronissi, SA 84081, Italy.,School of Pharmacy and Bioengineering, Keele University School of Medicine, Thornburrow Drive, ST5 5BG Stoke on Trent, UK.,Queen Mary University of London, Barts and the London School of Medicine and Dentistry, Centre for Sports and Exercise Medicine, Mile End Hospital, 275 Bancroft Road, E1 4DG London, UK
| |
Collapse
|
12
|
Hevesi M, Leland DP, Rosinsky PJ, Lall AC, Domb BG, Hartigan DE, Levy BA, Krych AJ. Risk of Conversion to Arthroplasty After Hip Arthroscopy: Validation of a Published Risk Score Using an Independent, Prospectively Collected Database. Am J Sports Med 2021; 49:1192-1198. [PMID: 33635085 DOI: 10.1177/0363546521993829] [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 Hip arthroscopy is rapidly advancing and increasingly commonly performed. The most common surgery after arthroscopy is total hip arthroplasty (THA), which unfortunately occurs within 2 years of arthroscopy in up to 10% of patients. Predictive models for conversion to THA, such as that proposed by Redmond et al, have potentially substantial value in perioperative counseling and decreasing early arthroscopy failures; however, these models need to be externally validated to demonstrate broad applicability. PURPOSE To utilize an independent, prospectively collected database to externally validate a previously published risk calculator by determining its accuracy in predicting conversion of hip arthroscopy to THA at a minimum 2-year follow-up. STUDY DESIGN Cohort study (diagnosis); Level of evidence, 1. METHODS Hip arthroscopies performed at a single center between November 2015 and March 2017 were reviewed. Patients were assessed pre- and intraoperatively for components of the THA risk score studied-namely, age, modified Harris Hip Score, lateral center-edge angle, revision procedure, femoral version, and femoral and acetabular Outerbridge scores-and followed for a minimum of 2 years. Conversion to THA was determined along with the risk score's receiver operating characteristic (ROC) curve and Brier score calibration characteristics. RESULTS A total of 187 patients (43 men, 144 women, mean age, 36.0 ± 12.4 years) underwent hip arthroscopy and were followed for a mean of 2.9 ± 0.85 years (range, 2.0-5.5 years), with 13 patients (7%) converting to THA at a mean of 1.6 ± 0.9 years. Patients who converted to THA had a mean predicted arthroplasty risk of 22.6% ± 12.0%, compared with patients who remained arthroplasty-free with a predicted risk of 4.6% ± 5.3% (P < .01). The Brier score for the calculator was 0.04 (P = .53), which was not statistically different from ideal calibration, and the calculator demonstrated a satisfactory area under the curve of 0.894 (P < .001). CONCLUSION This external validation study supported our hypothesis in that the THA risk score described by Redmond et al was found to accurately predict which patients undergoing hip arthroscopy were at risk for converting to subsequent arthroplasty, with satisfactory discriminatory, ROC curve, and Brier score calibration characteristics. These findings are important in that they provide surgeons with validated tools to identify the patients at greatest risk for failure after hip arthroscopy and assist in perioperative counseling and decision making.
Collapse
Affiliation(s)
- Mario Hevesi
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, Minnesota, USA
| | - Devin P Leland
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, Minnesota, USA
| | | | - Ajay C Lall
- American Hip Institute, Westmont, Illinois, 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
| |
Collapse
|
13
|
Migliorini F, Liu Y, Eschweiler J, Baroncini A, Tingart M, Maffulli N. Increased range of motion but otherwise similar clinical outcome of arthroscopy over open osteoplasty for femoroacetabular impingement at midterm follow-up: A systematic review. Surgeon 2021; 20:194-208. [PMID: 33731304 DOI: 10.1016/j.surge.2021.01.016] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2020] [Revised: 01/10/2021] [Accepted: 01/27/2021] [Indexed: 12/29/2022]
Abstract
BACKGROUND A systematic review was conducted comparing patient reported outcomes measures (PROMs), functional scores, and the rate of complications between arthroscopic and open treatment for femoroacetabular impingement (FAI) at mid-term follow-up. MATERIAL AND METHODS This systematic review was performed according to the PRISMA guidelines. The literature search was performed in October 2020. All clinical trials treating FAI using open osteoplasty or arthroscopic surgery were considered for inclusion. Only articles reporting >12 months follow-up were included. RESULTS Data from 97 articles (9981 procedures) were collected. At a mean 19.2 months follow-up there was no difference between the two cohorts. At a mean follow-up of 38 months, the external rotation was increased in the arthroscopic group (P < 0.0001). The modified Harris Hip Score scored greater in favour of the open osteoplasty group (P = 0.04), as did the Hip Outcome Score - Activities of Daily Living subscale (P = 0.01). At a mean 45.1 months the arthroscopic group presented greater external rotation (P < 0.0001) and SF-12 Mental (P = 0.04). The modified Harris Hip Score was greater in favour of the open osteoplasty group (P = 0.03), as was the HOS-ADL (P = 0.01). Regarding complications, the arthroscopic group experienced lower rates of subsequent revisions (P < 0.0001). CONCLUSION Based on the significant reduction of revisions-rate and significant increase in range of motion, arthroscopy treatment for the management of FAI may be recommended.
Collapse
Affiliation(s)
- Filippo Migliorini
- Department of Orthopaedics, University Clinic Aachen, RWTH Aachen University Clinic, Aachen, Germany.
| | - Yu Liu
- Department of Orthopaedics, University Clinic Aachen, RWTH Aachen University Clinic, Aachen, Germany.
| | - Jörg Eschweiler
- Department of Orthopaedics, University Clinic Aachen, RWTH Aachen University Clinic, Aachen, Germany.
| | - Alice Baroncini
- Department of Orthopaedics, University Clinic Aachen, RWTH Aachen University Clinic, Aachen, Germany.
| | - Markus Tingart
- Department of Orthopaedics, University Clinic Aachen, RWTH Aachen University Clinic, Aachen, Germany.
| | - Nicola Maffulli
- Department of Medicine, Surgery and Dentistry, University of Salerno, Via S. Allende, 84081, Baronissi, SA, Italy; School of Pharmacy and Bioengineering, Keele University Faculty of Medicine, Thornburrow Drive, Stoke on Trent, England; Queen Mary University of London, Barts and the London School of Medicine and Dentistry, Centre for Sports and Exercise Medicine, Mile End Hospital, 275 Bancroft Road, London, E1 4DG, England.
| |
Collapse
|
14
|
Large Heterogeneity Among Minimal Clinically Important Differences for Hip Arthroscopy Outcomes: A Systematic Review of Reporting Trends and Quantification Methods. Arthroscopy 2021; 37:1028-1037.e6. [PMID: 33186696 DOI: 10.1016/j.arthro.2020.10.050] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/14/2020] [Revised: 08/18/2020] [Accepted: 10/25/2020] [Indexed: 02/02/2023]
Abstract
PURPOSE To perform a systematic review of reporting trends and quantification methods for the minimal clinically important difference (MCID) within the hip arthroscopy literature. METHODS Cochrane, PubMed, and OVID/MEDLINE databases were queried for hip arthroscopy articles that reported the MCID. Studies were classified as (1) calculating new MCID values for their specific study-population or (2) referencing previously established MCID values. Data pertaining to patient demographics, study characteristics, outcome measures, method of MCID quantification, MCID value, anchor questions, measurement error, and study from which referenced MCID values were obtained were extracted. RESULTS A total of 59 articles with 18,830 patients (19,867 hips) was included. A total of 19 unique outcome measures was reported. A total of 33 (n = 55.9%) studies (follow-up range 6-60 months) used previously established MCID values to assess their study population (MCID values established at a follow-up range 6-31 months). The remaining 26 studies (44.1%) performed new MCID calculations. The MCID values were inconsistent and varied widely (Hip Outcome Score-Activities of Daily Living: 5.0-15.4; Hip Outcome Score-Sports Subscale: 6-25; modified Harris hip score: 2.4-20.9). Among the 33 studies that used previously established MCID values, 10 different studies were cited as the reference. Among the remaining 26 studies that calculated a new MCID value, the most common method was 0.5 standard deviation method (n = 21, 80.8%). Only 3 of 26 (11.5%) studies reported a measurement of error in conjunction with their MCID values. CONCLUSIONS Inconsistencies in MCID reporting and quantification methods led to a wide range of MCID values for commonly administered outcome measures within the hip arthroscopy literature-even for the same outcome measures. The majority of studies referenced previously established MCID values with variable ranges of follow-up and applied those values to assess their specific study population at varying follow-ups. LEVEL OF EVIDENCE IV, systematic review.
Collapse
|
15
|
Hassebrock JD, Wyles CC, Hevesi M, Maradit-Kremers H, Christensen AL, Levey BA, Trousdale RT, Sierra RJ, Bingham JS. Costs of open, arthroscopic and combined surgery for developmental dysplasia of the hip. J Hip Preserv Surg 2020; 7:570-574. [PMID: 33948212 PMCID: PMC8081411 DOI: 10.1093/jhps/hnaa048] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/24/2020] [Revised: 08/24/2020] [Accepted: 08/29/2020] [Indexed: 11/14/2022] Open
Abstract
A variety of options exist for management of patients with developmental dysplasia of the hip (DDH). Most studies to date have focused on clinical outcomes; however, there are currently no data on comparative cost of these techniques. The purpose of this study was to evaluate in-hospital costs between patients managed with periacetabular osteotomy, hip arthroscopy or a combination for DDH. One hundred and nine patients were included: 35 PAO + HA, 32 PAO and 42 HA. There were no significant differences in the demographic parameters. Operative times were significantly different between groups with a mean of 52 min for PAO, 100 min for HA and 155 min for PAO + HA, (P < 0.001). Total direct medical costs were calculated and adjusted to nationally representative unit costs in 2017 inflation-adjusted dollars. Total in-hospital costs were significantly different between each of the three treatment groups. PAO + HA was the most expensive with a median of $21 852, followed by PAO with a median of $15 124, followed by HA with a median of $11 582 (P < 0.001). There was a significant difference between outpatient median costs of $11 385 compared with $24 320 for inpatients (P < 0.001). Procedures with greater complexity were more expensive. However, a change from outpatient to inpatient status with HA moved that group from the least expensive to similar to PAO and PAO + HA. These data provide an important complement to clinical outcomes reports as surgeons and policymakers aim to provide optimal value.
Collapse
Affiliation(s)
- Jeffrey D Hassebrock
- Department of Orthopedic Surgery, Mayo Clinic, 5777 E. Mayo Blvd, Phoenix, AZ 85054, USA
| | - Cody C Wyles
- Department of Orthopedic Surgery, Mayo Clinic, 200 First Street S.W, Rochester, MN 55905, USA
| | - Mario Hevesi
- Department of Orthopedic Surgery, Mayo Clinic, 200 First Street S.W, Rochester, MN 55905, USA
| | - Hilal Maradit-Kremers
- Department of Orthopedic Surgery, Mayo Clinic, 200 First Street S.W, Rochester, MN 55905, USA
| | - Austin L Christensen
- Department of Orthopedic Surgery, Mayo Clinic, 5777 E. Mayo Blvd, Phoenix, AZ 85054, USA.,Department of Orthopedic Surgery, Mayo Clinic, 200 First Street S.W, Rochester, MN 55905, USA
| | - Bruce A Levey
- Department of Orthopedic Surgery, Mayo Clinic, 200 First Street S.W, Rochester, MN 55905, USA
| | - Robert T Trousdale
- Department of Orthopedic Surgery, Mayo Clinic, 200 First Street S.W, Rochester, MN 55905, USA
| | - Rafael J Sierra
- Department of Orthopedic Surgery, Mayo Clinic, 200 First Street S.W, Rochester, MN 55905, USA
| | - Joshua S Bingham
- Department of Orthopedic Surgery, Mayo Clinic, 5777 E. Mayo Blvd, Phoenix, AZ 85054, USA
| |
Collapse
|
16
|
Mas Martinez J, Sanz-Reig J, Verdu Roman C, Martinez Gimenez E, Morales Santias M, Bustamante Suarez de Puga D. Arthroscopic management with labral preservation, femoral osteoplasty, and capsular plication in patients with borderline hip dysplasia. Results of a matched-cohort study at minimum two year follow-up. INTERNATIONAL ORTHOPAEDICS 2020; 44:2567-2575. [PMID: 32954469 DOI: 10.1007/s00264-020-04810-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/18/2020] [Accepted: 09/11/2020] [Indexed: 11/25/2022]
Abstract
PURPOSE The purpose of this study was to assess intra-operative findings, surgical procedures, and outcomes in a cohort of patients with borderline hip dysplasia treated with arthroscopic labral repair, femoral osteoplasty, and capsular plication, and compare these outcomes with those of a rigorously matched control group without dysplasia. METHODS Data were prospectively collected and retrospectively reviewed for patients with a lateral center-edge angle between 20 and 24° who underwent hip arthroscopy surgery between 2014 and 2018. Labral, chondral status, psoas impingement, ligamentum teres, and cam morphology were evaluated. Patient-reported outcomes (PROs) scores included modified Harris Hip Score (mHHS), Hip Outcome Score Activities of Daily Living Subscale (HOS-AVD) and Hip Outcome Score Sport-Specific Subscale (HOS-SSS), and International Hip Outcome Tool-12 (IHOT-12). Clinical relevance was measured with the minimal clinical important difference (MCID), patient acceptable symptom state (PASS), and substantial clinical benefit (SCB). RESULTS Twenty patients met the inclusion criteria. An age- and sex-matched control group of 40 patients was also selected. Arthroscopic intra-operative findings were similar between cohorts. At a mean follow-up of 50 months in the borderline hip dysplasia cohort, and 52 months in the control cohort, there was a significant improvement in PROs in both cohorts, and no significant differences could be detected at the latest follow-up. The difference in frequency of patients achieving the MCID, PASS, and SCB was not statistically significant between cohorts. CONCLUSION With strict patient selection criteria, hip arthroscopy may be a beneficial approach in patients with borderline hip dysplasia.
Collapse
Affiliation(s)
- Jesus Mas Martinez
- Hip Unit, Department of Orthopedic Surgery, HLA Clinica Vistahermosa, Av de Denia 76, 03016, Alicante, Spain
| | - Javier Sanz-Reig
- Hip Unit, Department of Orthopedic Surgery, HLA Clinica Vistahermosa, Av de Denia 76, 03016, Alicante, Spain.
| | - Carmen Verdu Roman
- Hip Unit, Department of Orthopedic Surgery, HLA Clinica Vistahermosa, Av de Denia 76, 03016, Alicante, Spain
| | - Enrique Martinez Gimenez
- Hip Unit, Department of Orthopedic Surgery, HLA Clinica Vistahermosa, Av de Denia 76, 03016, Alicante, Spain
| | - Manuel Morales Santias
- Hip Unit, Department of Orthopedic Surgery, HLA Clinica Vistahermosa, Av de Denia 76, 03016, Alicante, Spain
| | | |
Collapse
|
17
|
Hevesi M, Jacob G, Shimomura K, Ando W, Nakamura N, Krych AJ. Current hip cartilage regeneration/repair modalities: a scoping review of biologics and surgery. INTERNATIONAL ORTHOPAEDICS 2020; 45:319-333. [PMID: 32910240 DOI: 10.1007/s00264-020-04789-2] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/29/2020] [Accepted: 08/26/2020] [Indexed: 02/06/2023]
Abstract
PURPOSE The rapidly growing and emerging nature of biologics have made indications for regenerative and reparative hip therapies ever changing, with at times only early-stage evidence for their use. The purpose of this study was to review and summarize the currently available data on the management of hip cartilage injuries and osteoarthritis. METHODS A scoping review of the available scientific literature for hip biologics was performed, with available evidence for hyaluronic acid (HA), platelet rich plasma (PRP), stem/stromal cells, microfracture, mosaicplasty, osteochondral allograft, and cell-based therapies investigated. RESULTS To date, there exist better guidelines and further consensus concerning knee joint biologic treatments than the hip due to a greater number of studies as well as the more recent emergence of hip preservation approaches. However, increasing evidence is available for the selective implementation of biologics on an individualized basis with attention to lesion size and location. CONCLUSION Orthopedic surgeons are at an exciting crossroads in medicine, where hip biologic therapies are evolving and increasingly available. Timetested interventions such as arthroplasty have shown good results and still have a major role to play but newer, regenerative approaches have the potential to effectively delay or reduce the requirement for such invasive procedures.
Collapse
Affiliation(s)
- Mario Hevesi
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, MN, USA
| | - George Jacob
- Department of Orthopaedic Surgery, Osaka University Graduate School of Medicine, Osaka, Japan
| | - Kazunori Shimomura
- Department of Orthopaedic Surgery, Osaka University Graduate School of Medicine, Osaka, Japan
| | - Wataru Ando
- Department of Orthopaedic Medical Engineering, Osaka University Graduate School of Medicine, Osaka, Japan
| | - Norimasa Nakamura
- Institute for Medical Science in Sports, Osaka Health Science University, Osaka, Japan
| | - Aaron J Krych
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, MN, USA.
| |
Collapse
|
18
|
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.
Collapse
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.
| |
Collapse
|
19
|
Maldonado DR, Chen JW, Yelton MJ, Rosinsky PJ, Shapira J, Brayboy C, Lall AC, Domb BG. Achieving Successful Outcomes of Hip Arthroscopy in the Setting of Generalized Ligamentous Laxity With Labral Preservation and Appropriate Capsular Management: A Propensity Matched Controlled Study. Am J Sports Med 2020; 48:1625-1635. [PMID: 32374634 DOI: 10.1177/0363546520914604] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND Association among generalized ligamentous laxity (GLL), hip microinstability, and patient-reported outcomes (PROs) after hip arthroscopy has yet to be completely established. PURPOSES (1) To report minimum 2-year PROs in patients with GLL who underwent hip arthroscopy in the setting of symptomatic labral tears and femoroacetabular impingement syndrome and (2) to compare clinical results with a matched-pair control group without GLL. STUDY DESIGN Cohort study; Level of evidence, 3. METHODS Data from a prospectively collected database were retrospectively reviewed between August 2014 and December 2016. Patients were considered eligible if they received primary arthroscopic treatment for symptomatic labral tears and femoroacetabular impingement. Inclusion criteria included preoperative and minimum 2-year follow-up scores for the following PROs: modified Harris Hip Score (mHHS), Non-arthritic Hip Score (NAHS), and visual analog scale for pain (VAS). From the sample population, 2 groups were created: the GLL group (Beighton score ≥4) and the control group (Beighton score <4). Patients were matched in a 1:2 ratio via propensity score matching according to age, sex, body mass index, Tönnis grade, and preoperative lateral center-edge angle. Patient acceptable symptomatic state (PASS) and minimal clinically important difference (MCID) for mHHS, Hip Outcome Score-Sports Specific Scale (HOS-SSS), and International Hip Outcome Tool-12 (iHOT-12) were calculated. RESULTS A total of 57 patients with GLL were matched to 88 control patients. Age, sex, body mass index, and follow-up times were not different between groups (P > .05). Preoperative radiographic measurements demonstrated no difference between groups. Intraoperative findings and procedures between groups were similar except for capsular treatment, with the GLL group receiving a greater percentage of capsular plications (P = .04). At minimum 2-year follow-up, both groups showed significant improvement in PROs and VAS (P < .001). Furthermore, the postoperative PROs at minimum 2-year follow-up and the magnitude of improvement (delta value) were similar between groups for mHHS, NAHS, HOS-SSS, and VAS (P > .05). Moreover, groups reached comparable rates of MCID and PASS for mHHS, HOS-SSS, and iHOT-12. CONCLUSION Patients with GLL after hip arthroscopy for symptomatic femoroacetabular impingement and labral tears may expect favorable outcomes with appropriate labral and capsular management at minimum 2-year follow-up. When compared with a pair-matched control group without GLL, results were comparable for mHHS, NAHS, HOS-SSS, and VAS and reached PASS and/or MCID for mHHS, HOS-SSS, and iHOT-12.
Collapse
Affiliation(s)
- David R Maldonado
- American Hip Institute Research Foundation, Des Plaines, Illinois, USA
| | - Jeffery W Chen
- School of Medicine, Vanderbilt University, Nashville, Tennessee, USA
| | - Mitchell J Yelton
- American Hip Institute Research Foundation, Des Plaines, Illinois, USA
| | - Philip J Rosinsky
- American Hip Institute Research Foundation, Des Plaines, Illinois, USA
| | - Jacob Shapira
- American Hip Institute Research Foundation, Des Plaines, Illinois, USA
| | - Ciaran Brayboy
- American Hip Institute Research Foundation, Des Plaines, Illinois, USA
| | - Ajay C Lall
- American Hip Institute Research Foundation, Des Plaines, Illinois, USA.,American Hip Institute, Des Plaines, Illinois, USA
| | - Benjamin G Domb
- American Hip Institute Research Foundation, Des Plaines, Illinois, USA.,American Hip Institute, Des Plaines, Illinois, USA
| |
Collapse
|
20
|
Shah A, Kay J, Memon M, Simunovic N, Uchida S, Bonin N, Ayeni OR. Clinical and radiographic predictors of failed hip arthroscopy in the management of dysplasia: a systematic review and proposal for classification. Knee Surg Sports Traumatol Arthrosc 2020; 28:1296-1310. [PMID: 30820605 DOI: 10.1007/s00167-019-05416-3] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/28/2018] [Accepted: 02/13/2019] [Indexed: 12/21/2022]
Abstract
PURPOSE As indications for hip arthroscopy continue to expand, its efficacy in patients with more complex deformities of the hip, such as those with acetabular dysplasia, remains controversial. The purpose of this systematic review is to identify the predictors of failed hip arthroscopy in dysplastic hips and to propose a standardize prognostic sub-classification of dysplasia. METHODS This systematic review was performed in accordance with the (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) PRISMA guidelines. Three databases [EMBASE, PubMed, and Ovid (MEDLINE)] were searched using terms including "hip arthroscopy" and "dysplasia". Studies were screened and data extracted in duplicate. Study quality was assessed using the Methodological Index for Non-Randomized Studies criteria. Due to the non-uniform nature of study data, findings were presented in descriptive summary form. RESULTS Thirteen studies were included in this systematic review, comprising 712 dysplastic patients (773 hips) with mean age 34.2 years and 74.1% females. Most studies defined hip dysplasia by a lateral centre-edge angle (LCEA) of 20°-25° (borderline) or 15°-20° (moderate). Failure was defined as progression to revision arthroscopy, peri-acetabular osteotomy, or total hip arthroplasty. Overall, failure rate was 192/743 (25.8%) at an average of 28.1 months following index arthroscopy. Smaller LCEA, larger Tönnis angle, broken Shenton line, and decreased joint space (≤ 2 mm) were radiographic predictors of failure. Severe cartilage lesions to the femoral head or acetabulum were associated with failure in five studies. Labral debridement led to more failures than labral repair. CONCLUSION Overall, hip arthroscopy yielded good outcomes in mildly dysplastic hips without severe chondral damage. Hip arthroscopy is expected to result in a failed outcome in individuals with moderate-to-severe hip dysplasia (LCEA < 15°), severe cartilage lesions, larger Tönnis angle (> 20°), broken Shenton line, and decreased joint space (≤ 2 mm). Arthroscopic surgery may be more effective in individuals with borderline-to-mild (LCEA 15°-25°) acetabular dysplasia in the absence of severe cartilaginous lesions (7-year survival: 89.6%). A standardized prognostic classification of hip dysplasia based on the LCEA and Tönnis angle is proposed. LEVEL OF EVIDENCE Systematic review of non-randomized studies, Level IV.
Collapse
Affiliation(s)
- Ajay Shah
- Michael G. DeGroote School of Medicine, McMaster University, Hamilton, ON, Canada
| | - Jeffrey Kay
- Division of Orthopaedic Surgery, Department of Surgery, McMaster University, Hamilton, ON, Canada
| | - Muzammil Memon
- Division of Orthopaedic Surgery, Department of Surgery, McMaster University, Hamilton, ON, Canada
| | - Nicole Simunovic
- Division of Orthopaedic Surgery, Department of Surgery, McMaster University, Hamilton, ON, Canada
| | - Soshi Uchida
- Department of Orthopaedic Surgery and Sports Medicine, Wakamatsu Hospital of University of Occupational and Environmental Health, Kitakyushu, Japan
| | - Nicolas Bonin
- Department of Hip Surgery, Lyon Ortho Clinic, Clinique de la Sauvegarde, 25B Avenue des Sources, 69009, Lyon, France
| | - Olufemi R Ayeni
- Division of Orthopaedic Surgery, Department of Surgery, McMaster University, Hamilton, ON, Canada. .,Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, ON, Canada. .,McMaster University Medical Centre, 1200 Main St W, Room 4E15, Hamilton, ON, L8N 3Z5, Canada.
| |
Collapse
|
21
|
Jones DM, Crossley KM, Ackerman IN, Hart HF, Dundules KL, O'Brien MJ, Mentiplay BF, Heerey JJ, Kemp JL. Physical Activity Following Hip Arthroscopy in Young and Middle-Aged Adults: A Systematic Review. SPORTS MEDICINE-OPEN 2020; 6:7. [PMID: 31993831 PMCID: PMC6987281 DOI: 10.1186/s40798-020-0234-8] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/01/2019] [Accepted: 01/02/2020] [Indexed: 01/31/2023]
Abstract
Background Hip arthroscopy is a common surgical intervention for young and middle-aged adults with hip-related pain and dysfunction, who have high expectations for returning to physical activity following surgery. The purpose of this review was to evaluate the impact of hip arthroscopy on physical activity post-arthroscopy. Methods A systematic search of electronic databases was undertaken in identifying studies from January 1st 1990 to December 5th 2019. The search included English language articles reporting physical activity as an outcome following hip arthroscopy in adults aged 18-50 years. Quality assessment, data extraction and synthesis of included studies were undertaken. Results Full text articles (n = 234) were assessed for eligibility following screening of titles and abstracts (n = 2086), yielding 120 studies for inclusion. The majority (86%) of the studies were level 4 evidence. One study reported objective activity data. The most frequently occurring patient-reported outcome measure was the Hip Outcome Score-sport-specific subscale (HOS-SS, 84% of studies). Post--arthroscopy improvement was indicated by large effect sizes for patient-reported outcome measures (standard paired difference [95% confidence interval] −1.35[−1.61 to −1.09] at more than 2 years post-arthroscopy); however, the majority of outcome scores for the HOS-SS did not meet the defined level for a patient-acceptable symptom state. Conclusion The current level of available information regarding physical activity for post arthroscopy patients is limited in scope. Outcomes have focused on patients’ perceived difficulties with sport-related activities with a paucity of information on the type, quality and quantity of activity undertaken. Level of Evidence Level IV, systematic review of Level 2 through to Level 4 studies
Collapse
Affiliation(s)
- Denise M Jones
- La Trobe Sport and Exercise Medicine Research Centre, School of Allied Health, College of Science, Health and Engineering, La Trobe University, Melbourne, Victoria, Australia.
| | - Kay M Crossley
- La Trobe Sport and Exercise Medicine Research Centre, School of Allied Health, College of Science, Health and Engineering, La Trobe University, Melbourne, Victoria, Australia
| | | | - Harvi F Hart
- La Trobe Sport and Exercise Medicine Research Centre, School of Allied Health, College of Science, Health and Engineering, La Trobe University, Melbourne, Victoria, Australia.,Department of Physical Therapy, The University of Western Ontario, London, Ontario, Canada
| | - Karen L Dundules
- La Trobe Sport and Exercise Medicine Research Centre, School of Allied Health, College of Science, Health and Engineering, La Trobe University, Melbourne, Victoria, Australia
| | - Michael J O'Brien
- La Trobe Sport and Exercise Medicine Research Centre, School of Allied Health, College of Science, Health and Engineering, La Trobe University, Melbourne, Victoria, Australia
| | - Benjamin F Mentiplay
- La Trobe Sport and Exercise Medicine Research Centre, School of Allied Health, College of Science, Health and Engineering, La Trobe University, Melbourne, Victoria, Australia
| | - Joshua J Heerey
- La Trobe Sport and Exercise Medicine Research Centre, School of Allied Health, College of Science, Health and Engineering, La Trobe University, Melbourne, Victoria, Australia
| | - Joanne L Kemp
- La Trobe Sport and Exercise Medicine Research Centre, School of Allied Health, College of Science, Health and Engineering, La Trobe University, Melbourne, Victoria, Australia
| |
Collapse
|
22
|
Batailler C, Weidner J, Wyatt M, Pfluger D, Beck M. Is the Femoro-Epiphyseal Acetabular Roof (FEAR) index on MRI a relevant predictive factor of instability in a borderline dysplastic hip? Bone Joint J 2019; 101-B:1578-1584. [PMID: 31787002 DOI: 10.1302/0301-620x.101b12.bjj-2019-0502.r1] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
AIMS A borderline dysplastic hip can behave as either stable or unstable and this makes surgical decision making challenging. While an unstable hip may be best treated by acetabular reorientation, stable hips can be treated arthroscopically. Several imaging parameters can help to identify the appropriate treatment, including the Femoro-Epiphyseal Acetabular Roof (FEAR) index, measured on plain radiographs. The aim of this study was to assess the reliability and the sensitivity of FEAR index on MRI compared with its radiological measurement. PATIENTS AND METHODS The technique of measuring the FEAR index on MRI was defined and its reliability validated. A retrospective study assessed three groups of 20 patients: an unstable group of 'borderline dysplastic hips' with lateral centre edge angle (LCEA) less than 25° treated successfully by periacetabular osteotomy; a stable group of 'borderline dysplastic hips' with LCEA less than 25° treated successfully by impingement surgery; and an asymptomatic control group with LCEA between 25° and 35°. The following measurements were performed on both standardized radiographs and on MRI: LCEA, acetabular index, femoral anteversion, and FEAR index. RESULTS The FEAR index showed excellent intraobserver and interobserver reliability on both MRI and radiographs. The FEAR index was more reliable on radiographs than on MRI. The FEAR index on MRI was lower in the stable borderline group (mean -4.2° (sd 9.1°)) compared with the unstable borderline group (mean 7.9° (sd 6.8°)). With a FEAR index cut-off value of 2°, 90% of patients were correctly identified as stable or unstable using the radiological FEAR index, compared with 82.5% using the FEAR index on MRI. The FEAR index was a better predictor of instability on plain radiographs than on MRI. CONCLUSION The FEAR index measured on MRI is less reliable and less sensitive than the FEAR index measured on radiographs. The cut-off value of 2° for radiological FEAR index predicted hip stability with 90% probability. Cite this article: Bone Joint J 2019;101-B:1578-1584.
Collapse
Affiliation(s)
- Cécile Batailler
- CHU Lyon Croix-Rousse, Hospices Civils de Lyon, Lyon, France.,Clinic for Orthopaedic and Trauma Surgery, Luzerner Kantonsspital, Lucerne, Switzerland
| | - Jan Weidner
- Clinic for Orthopaedic and Trauma Surgery, Luzerner Kantonsspital, Lucerne, Switzerland
| | - Michael Wyatt
- Department of Trauma and Orthopaedics, Midcentral District Health Board, Palmerston North Hospital, Palmerston North, New Zealand
| | - Dominik Pfluger
- Clinic for Orthopaedic and Trauma Surgery, Luzerner Kantonsspital, Lucerne, Switzerland
| | - Martin Beck
- Clinic for Orthopaedic and Trauma Surgery, Luzerner Kantonsspital, Lucerne, Switzerland
| |
Collapse
|
23
|
Matsuda DK, Kivlan BR, Nho SJ, Wolff AB, Salvo JP, Christoforetti JJ, Ellis TJ, Carreira DS. Arthroscopic Outcomes as a Function of Acetabular Coverage From a Large Hip Arthroscopy Study Group. Arthroscopy 2019; 35:2338-2345. [PMID: 31395166 DOI: 10.1016/j.arthro.2019.01.055] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/27/2018] [Revised: 01/29/2019] [Accepted: 01/30/2019] [Indexed: 02/02/2023]
Abstract
PURPOSE To report comparative hip arthroscopic outcomes of patients with low (borderline dysplasia), normal, and high (global pincer femoroacetabular impingement [FAI]) lateral acetabular coverage. METHODS A retrospective analysis of prospectively collected data from a multicenter registry was performed. Primary hip arthroscopy patients were assigned to 1 of 3 groups based on preoperative lateral center-edge angle: borderline dysplasia (≤25°), normal (25.1°-38.9°), and pincer (≥39°). Repeated-measures analysis of variance compared preoperative with 2-year minimum postoperative International Hip Outcome Tool (iHOT-12) scores. Subsequent analysis of variance determined the effect of acetabular coverage on magnitude of change in scores. RESULTS Of 437 patients, the only statistical difference between groups was a lower prevalence of acetabuloplasty in the borderline dysplasia group (P = .001). A significant improvement in the preoperative to postoperative iHOT-12 scores for patients with normal acetabular coverage, acetabular undercoverage, and acetabular overcoverage was observed: F(1, 339) = 311.06; P <.001, with no statistical differences in preoperative (P = .505) and postoperative (P <.488) iHOT-12 scores when comparing the groups based on acetabular coverage. Mean iHOT-12 scores increased from 37.3 preoperatively to 68.7 postoperatively (P <.001) in the borderline dysplasia group, from 34.4 to 72 (P <.001) in the normal coverage group, and from 35.3 to 69.4 (P <.001) in the pincer group. These preoperative scores increased by 31.4, 37.8, and 34.1, respectively, with no effect for acetabular coverage on the magnitude of change from preoperative to postoperative iHOT-12 scores: F(2,339) = 1.18; P = .310. Ten patients (2.3%) underwent conversion arthroplasty, and 19 patients (4.4%) underwent revision arthroscopy with no significant effect of acetabular coverage on the incidence of revision or conversion surgery: χ2 (6,433) = 11.535; P = .073. CONCLUSIONS Lateral acetabular coverage did not influence outcomes from primary hip arthroscopy when performed in patients with low (borderline dysplasia), normal, and high (global pincer FAI) lateral center-edge angle. Borderline dysplasia and moderate global pincer FAI with no or minimal osteoarthritis do not compromise successful 2-year minimum outcomes or survivorship following primary hip arthroscopy when performed by experienced surgeons. LEVEL OF EVIDENCE Level III, retrospective therapeutic trial.
Collapse
Affiliation(s)
- Dean K Matsuda
- DISC Sports and Spine Center, Marina del Rey, California, U.S.A..
| | - Benjamin R Kivlan
- Department of Physical Therapy, Rangos School of Health Sciences, Duquesne University, Pittsburgh, Pennsylvania, U.S.A
| | - Shane J Nho
- Department of Orthopedic Surgery, Division of Sports Medicine, Hip Preservation Center, Rush University Medical Center, Chicago, Illinois, U.S.A
| | - Andrew B Wolff
- Hip Preservation and Sports Medicine, Washington Orthopaedics and Sports Medicine, Washington, DC, U.S.A
| | - John P Salvo
- Rothman Institute, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania, U.S.A
| | | | | | | |
Collapse
|
24
|
Hevesi M, Bernard C, Hartigan DE, Levy BA, Domb BG, Krych AJ. Is Microfracture Necessary? Acetabular Chondrolabral Debridement/Abrasion Demonstrates Similar Outcomes and Survival to Microfracture in Hip Arthroscopy: A Multicenter Analysis. Am J Sports Med 2019; 47:1670-1678. [PMID: 31091140 DOI: 10.1177/0363546519845346] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND Hip arthroscopy is becoming more advanced and commonly performed. However, significant controversy exists regarding whether high-grade acetabular cartilage lesions should be treated with debridement/abrasion or microfracture. In addition, patients treated with microfracture are subject to extended protected weightbearing rehabilitation to mitigate risk of subchondral plate fracture and to protect fibrocartilage tissue formation. PURPOSE To determine the midterm patient-reported outcomes and failure rate of patients with grade 3 and 4 acetabular labrum articular disruption (ALAD) lesions managed with debridement/abrasion or microfracture. STUDY DESIGN Cohort study; Level of evidence, 3. METHODS Primary arthroscopic labral repair cases at 2 centers from November 2008 to April 2016 were reviewed for patients aged <55 years with unipolar ALAD grade 3 and 4 chondrolabral acetabular delamination. Patients undergoing microfracture and debridement/abrasion were compared using the visual analog pain scale (VAS), modified Harris Hip Score (mHHS), and Hip Outcome Score-Sports-Specific Subscale (HOS-SSS) to determine predictors of outcomes and failure. RESULTS A total of 113 hips in 110 patients (66 males, 44 females; mean age, 34.5 ± 1.1 years) undergoing debridement/abrasion (n = 82) or microfracture (n = 31) were followed for a mean of 4.9 years (range, 2.0-8.5 years). Lesion size was not statistically different between the debridement/abrasion (1.3 ± 1.0 cm2) and microfracture cohorts (1.4 ± 1.0 cm2) ( P = .47). Patients undergoing debridement/abrasion achieved 3.6-point mean improvements in VAS ( P < .01), 21.2-point improvements in mHHS ( P < .01), and 25.4-point improvements in HOS-SSS ( P < .01), which were not significantly different from those observed in microfracture patients ( P≥ .20). The 5-year rate of survival free of revision surgery was 84.0% in the debridement/abrasion group and 85.6% in the microfracture group ( P = .78). The cartilage treatment technique was found not to be predictive of revision risk during both univariate (hazard ratio [HR], 1.01; P = .98) and multivariate (HR, 0.93; P = .90) analysis accounting for patient age, lesion grade, and acetabular coverage. CONCLUSION Patients undergoing debridement/abrasion of high-grade unipolar acetabular cartilage lesions demonstrate similar outcome scores and revision rates compared with those of patients undergoing microfracture. These outcomes support the consideration of preferential debridement/abrasion at the discretion of the treating surgeon to optimize recovery while maintaining established positive outcomes after hip arthroscopy.
Collapse
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
| | - Bruce A Levy
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, Minnesota, USA
| | | | - Aaron J Krych
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, Minnesota, USA
| |
Collapse
|
25
|
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.
Collapse
|