1
|
Kuhns BD, Domb BG. Editorial Commentary: Primary Treatment of Hip Labral, Osseous, Chondral, Capsular, and Extra-Articular Pathology Is Essential: Outcomes Following Revision Are Less Predictable. Arthroscopy 2024; 40:2018-2020. [PMID: 38342282 DOI: 10.1016/j.arthro.2024.02.007] [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: 02/02/2024] [Accepted: 02/03/2024] [Indexed: 02/13/2024]
Abstract
Appropriate labral management is one of many procedures during hip arthroscopy that affects postoperative outcomes and revision rates. Both primary labral repair and reconstruction have been shown to have superior clinical and functional outcomes compared with labral debridement when treating unstable labral tears. Arthroscopic labral reconstruction is one of the most powerful techniques in the arsenal of complex hip-preservation surgeons, and although often reserved for the revision setting, when the native labrum is irreparable, a primary reconstruction may be indicated when the only alternatives are selective labral debridement or a suboptimal repair. Labral reconstruction, either in primary or revision procedures, is indicated when the existing labrum is deemed irreparable based on an intraoperative evaluation. Current indications for primary labral reconstruction, either in the primary or revision setting, include a calcified labrum, an irreparable mixed Seldes type 1 and 2 tear, or a hypoplastic labrum with less than 3 mm of viable tissue. Primary hip arthroscopy has been shown to have superior outcomes compared with revision hip arthroscopy, whether with labral repair or reconstruction. Finally, appropriate labral management is necessary but not always sufficient. Hip arthroscopy requires management of osseous deformities, with care taken to avoid under- and over-resection during both femoroplasty and acetabuloplasty; management of chondral injury; and management of the hip capsule with repair or plication. Consideration also must be given to potential extra-articular pain generators, such as abductor insufficiency, ischiofemoral impingement, lumbar spine disease, as well as deformities requiring open surgical correction such as acetabular dysplasia or pathologic femoral version. The primary goal is getting it right the first time.
Collapse
|
2
|
Yuro MR, Kurapatti M, Carreira DS, Nho S, Martin R, Wolff AB. Secondary Hip Labral Reconstruction Yields Inferior Minimum 2-Year Functional Outcomes to Primary Reconstruction Despite Comparable Intraoperative Labral Characteristics. Arthroscopy 2024; 40:2009-2017. [PMID: 38092279 DOI: 10.1016/j.arthro.2023.11.034] [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: 06/04/2023] [Revised: 11/16/2023] [Accepted: 11/19/2023] [Indexed: 01/15/2024]
Abstract
PURPOSE To compare intraoperative labral characteristics and minimum 2-year functional outcomes of allograft labral reconstruction in primary versus revision hip arthroscopy across multiple orthopaedic centers. METHODS A retrospective multicenter hip arthroscopy registry was queried for patients with completed labral reconstruction surgeries from January 2014 to March 2023 with completed 2-year international Hip Outcome Tool-12 (iHOT-12) reports. Age, sex, and major intraoperative variables also were collected. Patients were placed in cohorts based on whether their arthroscopic allograft labral reconstruction was a primary procedure or secondary procedure (reconstruction following failed hip arthroscopy). One-way analysis of variance was performed on continuous variables. χ2 test was performed on categorical variables. Achievement of minimal clinically important difference (MCID), Patient Acceptable Symptom State (PASS), and Substantial Clinical Benefit (SCB) also was assessed. RESULTS In total, 77 patients met the inclusion and exclusion criteria and had complete information. The primary reconstruction group (n = 50) was significantly older than the secondary reconstruction group (n = 27) (47.5 ± 10.5 vs 39.1 ± 8.8 years; P = .001). In both cohorts, most patients had labral bruising, advanced labral degeneration, and/or grade III complexity of labral tearing. There was no difference in any recorded intraoperative findings (P = .160, P = .783, P = .357, respectively). Each cohort experienced significant improvement in iHOT-12 scores (P < .0001). However, patients undergoing secondary labral reconstruction reported inferior iHOT-12 scores (60.1 ± 29.2 vs 74.8 ± 27.0; P = .030). Patients undergoing primary reconstruction were more likely to reach MCID, PASS, and nearly normal SCB (92 vs 66.7%, P = .024; 68.0 vs 40.7%, P = .021; 76.0 vs 48.1%, P = .014, respectively). CONCLUSIONS Primary and secondary allograft labral reconstruction show clinical improvement, but primary reconstruction demonstrates better outcomes and greater percentage of patients reaching MCID, PASS, and nearly normal SCB than reconstruction in the revision setting. LEVEL OF EVIDENCE Level III, retrospective comparative prognostic case-control study.
Collapse
Affiliation(s)
| | | | | | - Shane Nho
- Midwest Orthopedics at Rush, Chicago, Illinois
| | - Robroy Martin
- Duquesne University, Pittsburgh, Pennsylvania, U.S.A
| | - Andrew B Wolff
- Washington Orthopaedics & Sports Medicine, Washington, DC, U.S.A
| |
Collapse
|
3
|
Maldonado DR, Padmanabhan S, George T, Domb BG. Defining the Percent Thresholds for Achieving the Maximum Outcome Improvement of the Modified Harris Hip Score, the Non-Arthritic Hip Score, the Hip Outcome Score-Sports Subscale, the Visual Analog Scale for Pain, and the International Hip Outcome Tool-12 in Revision Hip Arthroscopy at Minimum 2-Year Follow-Up. Arthroscopy 2024; 40:1143-1152. [PMID: 37906239 DOI: 10.1016/j.arthro.2023.08.023] [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: 02/12/2023] [Revised: 07/17/2023] [Accepted: 08/18/2023] [Indexed: 11/02/2023]
Abstract
PURPOSE To determine the respective percent thresholds for achieving the maximal outcome improvement (MOI) for the modified Harris Hip Score (mHHS), the Non-Arthritic Hip Score (NAHS), the Hip Outcome Score-Sports Subscale (HOS-SSS), the visual analog scale (VAS) for pain, and the International Hip Outcome Tool-12 (iHOT-12) that were associated with satisfaction following revision hip arthroscopy, and to identify predictors for achieving the MOI. METHODS An anchor question was provided to patients who underwent revision hip arthroscopy between April 2017 and July 2020. Patients were included for the final analysis if they answered the anchor question and had minimum 2-year follow-up. Receiver operating characteristic analysis was used to determine the thresholds for the percentage of the MOI predictive of satisfaction. A P-value of < .05 was considered significant. RESULTS In total, 318 patients underwent revision hip arthroscopy. Of those patients, 292 (91.8%) had minimum 2-year follow-up. Of this cohort, 68 answered the anchor question, with 49 (72.1%) female and 19 (27.9%) male patients. The mean age, and body mass index time were 32.9 ± 13 years and 25.4 ± 5.1, respectively. It was determined that 42.1%, 50%, 48.1%, 50%, and 50% of MOI were the thresholds for maximal predictability of satisfaction for mHHS, NAHS, HOS-SS, VAS for pain, and the iHOT-12, respectively. The presence of unaddressed subspine impingement was a significant predictor for achieving the MOI threshold for the VAS (odds ratio 1.40; 95% confidence interval 1.00-1.95; P = 0.0273). CONCLUSIONS Following revision hip arthroscopy, the percent thresholds for achieving the MOI at a minimum 2-year follow-up for the mHHS, NAHS, HOS-SS, VAS for pain, and iHOT-12 were 42.1%, 50%, 48.1%, 50%, and 50.9%, respectively. Addressing residual subspine impingement was identified as significant positive predictor for achieving the MOI. LEVEL OF EVIDENCE Level IV, case-series.
Collapse
Affiliation(s)
- David R Maldonado
- Department of Orthopaedic Surgery, McGovern Medical School, University of Texas Health Science Center at Houston, Houston, Texas, U.S.A
| | | | - Tracy George
- American Hip Institute Research Foundation, Chicago, Illinois, U.S.A
| | - Benjamin G Domb
- American Hip Institute Research Foundation, Chicago, Illinois, U.S.A.; American Hip Institute, Chicago, Illinois, U.S.A..
| |
Collapse
|
4
|
DeClercq MG, Martin MD, Whalen RJ, Cote MP, Midtgaard KS, Peebles LA, Di Giacomo G, Provencher MT. Postoperative Radiographic Outcomes Following Primary Open Coracoid Transfer (Bristow-Latarjet) Vary in Definition, Classification, and Imaging Modality: A Systematic Review. Arthroscopy 2024; 40:1311-1324.e1. [PMID: 37827435 DOI: 10.1016/j.arthro.2023.09.032] [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: 04/29/2022] [Revised: 08/10/2023] [Accepted: 09/17/2023] [Indexed: 10/14/2023]
Abstract
PURPOSE To analyze radiographic outcomes by conventional radiography, computed tomography (CT), or both and complication rates of open coracoid transfer at a minimum of 12-months follow-up. METHODS A literature search was performed according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines, using PubMed, Medline (Ovid), and EMBASE library databases. Inclusion criteria were clinical studies reporting on open Latarjet as the primary surgical procedure(revision coracoid transfer after failed prior stabilization excluded) with postoperative radiographic outcomes at a minimum mean 1-year follow-up. Patient demographics, type of postoperative imaging modality, and radiographic outcomes and complications including graft union, osteoarthritis, and osteolysis were systematically reviewed. Data were summarized as ranges of reported values for each outcome metric. Each radiographic outcome was graphically represented in a Forest plot with point estimates of the incidence of radiographic outcomes with corresponding 95% confidence intervals and I2. RESULTS Thirty-three studies met inclusion criteria, with a total of 1,456 shoulders. The most common postoperative imaging modality was plain radiography only (n = 848 [58.2%]), both CT and radiography (n = 287 [19.7%]), and CT only (n = 321 [22.1%]). Overall, the reported graft union rate ranged from 75% to 100%, of which 79.8% (n = 395) were detected on plain radiography. The most common reported postoperative radiographic complications after the open coracoid transfer were osteoarthritis (range, 0%-100%, pooled mean 28%), graft osteolysis (range, 0%-100%, pooled mean 30%), nonunion (range, 0%-32%, pooled mean 5.1%), malpositioned graft (range, 0%-75%, pooled mean 14.75%), hardware issues (range, 0%-9.1%, pooled mean 5%), and bone block fracture (range, 0%-8%, pooled mean 2.1%). Graft healing was achieved in a majority of cases (range, 75%-100%). CONCLUSION Postoperative radiographic outcomes after open coracoid transfer vary greatly in definition, classification, and imaging modality of choice. Greater consistency in postoperative radiographic outcomes is essential to evaluate graft healing, osteolysis, and nonunion. LEVEL OF EVIDENCE Level IV, systematic review of Level III-IV studies.
Collapse
Affiliation(s)
| | | | - Ryan J Whalen
- Steadman Philippon Research Institute, Vail, Colorado
| | - Mark P Cote
- Department of Orthopaedic Surgery, University of Connecticut, Farmington, Connecticut, U.S.A
| | - Kaare S Midtgaard
- Steadman Philippon Research Institute, Vail, Colorado; Steadman Clinic, Vail, Colorado; Norwegian Armed Forces Joint Medical Services, Oslo, Norway; Division of Orthopaedic Surgery, Oslo University Hospital, Oslo, Norway
| | | | | | - Matthew T Provencher
- Steadman Philippon Research Institute, Vail, Colorado; Steadman Clinic, Vail, Colorado.
| |
Collapse
|
5
|
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.
Collapse
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.
| |
Collapse
|
6
|
Maldonado DR, George T, Padmanabhan S, Curley AJ, Domb BG. Defining Thresholds and Predictors for Achieving the Patient Acceptable Symptom State for Patient-Reported Outcome Measures After Revision Hip Arthroscopy. Am J Sports Med 2023; 51:3772-3780. [PMID: 37975493 DOI: 10.1177/03635465231209320] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2023]
Abstract
BACKGROUND The Patient Acceptable Symptom State (PASS) after primary hip arthroscopy has been determined; nonetheless, the PASS still needs to be defined for revision hip arthroscopy. PURPOSE To define minimum 2-year follow-up PASS thresholds for the modified Harris Hip Score (mHHS), Nonarthritic Hip Score (NAHS), Hip Outcome Score-Sports Specific Subscale (HOS-SSS), visual analog scale (VAS) for pain, and International Hip Outcome Tool-12 (iHOT-12) after revision hip arthroscopy, and to identify predictors of achieving the PASS. STUDY DESIGN Case-control study; Level of evidence, 3. METHODS Data were prospectively collected and retrospectively reviewed for all patients who underwent revision hip arthroscopy between April 2017 and July 2020. Patients were included if they had baseline and minimum 2-year follow-up scores for the mHHS, NAHS, HOS-SSS, VAS for pain, and iHOT-12. PASS was calculated using the anchor-based method. Receiver operating characteristic curve analysis was used to determine the thresholds for the PASS. A multivariate logistic regression was used to identify predictors for achieving the PASS. RESULTS A total of 318 patients who underwent revision hip arthroscopy met the inclusion criteria. Of those patients, 292 (91.8%) had baseline and minimum 2-year follow-up. Of this group, 68 patients (72.1% female and 27.9% male; mean age, 32.9 years) answered the PASS anchor question. Achievement PASS rates were 58.8%, 41.2%, 52.9%, 60.3%, and 52.9% for the mHHS, NAHS, HOS-SSS, VAS, and iHOT-12, respectively. The area under the curve (AUC) values for the PASS for mHHS, NAHS, HOS-SSS, VAS, and iHOT-12 were 0.912, 0.888, 0.857, 0.903, and 0.871, respectively, indicating excellent discrimination. The PASS for the mHHS was 76 (sensitivity, 0.809; specificity, 0.905), for the NAHS was 86.3 (sensitivity, 0.660; specificity, 1), for the HOS-SSS was 64.3 (sensitivity, 0.745; specificity, 0.905), for the VAS was 3 (sensitivity, 0.830; specificity, 0.905), and for the iHOT-12 was 64.3 (sensitivity, 0.745; specificity, 0.905). Body mass index (BMI) was identified as a significant predictor of achieving PASS for the NAHS (OR, 0.967; 95% CI, 0.940-0.996; P = .027), as patients with a BMI ≤25.4 had 1.03 times higher odds ratio of achieving PASS for the NAHS. CONCLUSION After revision hip arthroscopy, the minimum 2-year follow-up PASS thresholds for the mHHS, NAHS, HOS-SSS, VAS for pain, and iHOT-12 were 76, 86.3, 64.3, 3, and 64.3, respectively. The odds ratio of achieving PASS for the NAHS was 1.03 times higher for patients with a BMI ≤25.4.
Collapse
Affiliation(s)
- David R Maldonado
- American Hip Institute Research Foundation, Chicago, Illinois, USA
- Department of Orthopaedic Surgery, McGovern Medical School, University of Texas Health Science Center at Houston, Houston, Texas, USA
| | - Tracy George
- American Hip Institute Research Foundation, Chicago, Illinois, USA
| | | | - Andrew J Curley
- American Hip Institute Research Foundation, Chicago, Illinois, USA
| | - Benjamin G Domb
- American Hip Institute Research Foundation, Chicago, Illinois, USA
- American Hip Institute, Chicago, Illinois, USA
| |
Collapse
|
7
|
Maldonado DR, Lee MS, Kyin C, Jimenez AE, Owens JS, Perez-Padilla PA, Domb BG. Survivorship, Outcomes, and Risk Factors for Conversion to Total Hip Arthroplasty After Revision Hip Arthroscopic Surgery in Obese Patients: Results at a Minimum 5-Year Follow-up. Orthop J Sports Med 2023; 11:23259671231154921. [PMID: 37056451 PMCID: PMC10087662 DOI: 10.1177/23259671231154921] [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: 10/13/2022] [Accepted: 11/08/2022] [Indexed: 04/15/2023] Open
Abstract
Background There is a paucity of literature reporting outcomes after revision hip arthroscopic surgery in obese patients. Purpose To report the minimum 5-year survivorship, patient-reported outcomes (PROs), clinical benefit, and risk factors for conversion to total hip arthroplasty (THA) in obese patients after revision hip arthroscopic surgery. Study Design Case series; Level of evidence, 4. Methods Data were prospectively collected and retrospectively reviewed for patients who underwent revision hip arthroscopic surgery by a single surgeon between April 2010 and August 2016. Inclusion criteria were a body mass index ≥30 and baseline and minimum 5-year postoperative values for the modified Harris Hip Score (mHHS), Nonarthritic Hip Score (NAHS), Hip Outcome Score-Sport-Specific Subscale (HOS-SSS), and visual analog scale (VAS) for pain. Exclusion criteria were Tönnis grade >1 and hip dysplasia. Survivorship was defined as no conversion to THA. Clinical benefit was measured using the minimal clinically important difference (MCID). Survivors and nonsurvivors underwent further bivariate and regression analyses to determine the predictors of conversion to THA. Results Included were 24 hips in 24 patients. The mean patient age was 39.3 ± 12.7 years, and the mean follow-up was 83.9 ± 26.5 months. The survivorship rate was 75.0%, and patients demonstrated a significant improvement in all PROs (P < .01). At 5-year follow-up, the MCID for the mHHS, NAHS, HOS-SSS, and VAS was achieved by 70.6%, 94.1%, 92.9%, and 64.7%, respectively, of the patients. Older age, higher grade ligamentum teres tears, and acetabuloplasty were significant on bivariate analysis for conversion to THA, and increased age was identified as a significant variable for conversion to THA on regression analysis (odds ratio, 1.297 [95% CI, 1.045-1.609]; P = .018), with a 29.7% greater risk for every additional year of age at the time of revision. Conclusion In this study, 25.0% of obese patients who underwent revision hip arthroscopic surgery required conversion to THA. The study patients who did not need conversion to THA had a significant improvement in all PROs, with >90% achieving MCID for one or more outcome measures. Older age was identified as a significant predictor of conversion to THA.
Collapse
Affiliation(s)
- David R. Maldonado
- Department of Orthopaedic Surgery,
McGovern Medical School, University of Texas Health Science Center at Houston,
Houston, Texas, USA
| | - Michael S. Lee
- American Hip Institute Research
Foundation, Chicago, Illinois, USA
| | - Cynthia Kyin
- American Hip Institute Research
Foundation, Chicago, Illinois, USA
| | | | - Jade S. Owens
- American Hip Institute Research
Foundation, Chicago, Illinois, USA
| | | | - Benjamin G. Domb
- American Hip Institute Research
Foundation, Chicago, Illinois, USA
- American Hip Institute, Chicago,
Illinois, USA
- Benjamin G. Domb, MD,
American Hip Institute, 999 East Touhy Avenue, Suite 450, Chicago, IL 60018, USA
()
| |
Collapse
|
8
|
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.
Collapse
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
| |
Collapse
|
9
|
Maldonado DR, Diulus SC, Lee MS, Owens JS, Jimenez AE, Perez-Padilla PA, Domb BG. Propensity-Matched Patients Undergoing Revision Hip Arthroscopy Older Than the Age of 40 Years Had Greater Risk of Conversion to Total Hip Arthroplasty Compared With Their Primary Counterparts. Arthroscopy 2023; 39:54-63. [PMID: 35764206 DOI: 10.1016/j.arthro.2022.06.014] [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: 02/15/2022] [Revised: 04/11/2022] [Accepted: 06/03/2022] [Indexed: 02/09/2023]
Abstract
PURPOSE To report patient-reported outcomes (PROs) and survivorship following revision hip arthroscopy in patients aged ≥40 years and to compare these results with a propensity-matched primary hip arthroscopy control group. METHODS Data were prospectively collected and retrospectively reviewed for all patients who underwent revision hip arthroscopy between June 2008 and January 2019. Patients were included if they were ≥40 years of age at the time of surgery and had minimum 2-year follow-up for the modified Harris Hip Score, Nonarthritic Hip Score, Visual Analog Scale for pain, and the Hip Outcome Score-Sports Specific Subscale. Patients who had a previous hip condition, or those who lacked minimum 2-year follow-up, were excluded. The revision group was further analyzed by conducting a 1:1 propensity-matched sub-analysis to a primary hip arthroscopy control group based on age, sex, body mass index, and acetabular labrum articular disruption grade. Statistical significance was set at P < .05. RESULTS Eighty-nine hips (92.7% follow-up) were included, with 66.3% being females. The mean age, body mass index, and follow-up time were 49.4 ± 8.0 years, 26.6 ± 4.1, and 62.7 ± 38.5 months, respectively. Significant improvement in all PROs (P < .001) was reported, and 71.8%, 58 74.4%, and 65.2% achieved the minimal clinically important difference for the modified Harris Hip Score, Nonarthritic Hip Score, and Hip Outcome Score-Sports Specific Subscale, respectively. Eighty-seven revision hips were successfully propensity-matched to 87 primary hips. Both groups reported similar improvement for all PROs, but the relative risk of conversion to total hip arthroplasty was 2.63 times greater (95% confidence interval 1.20-5.79) for the revision group. CONCLUSIONS Patients aged ≥40 years who underwent revision hip arthroscopy reported significant improvement in all PROs at a mean follow-up of 62.7 months with favorable rates of achieving the minimal clinically important difference. When compared to the propensity-matched control group, both achieved similar rates of improvement, but the revision group was 2.63 times more likely to convert to total hip arthroplasty. LEVEL OF EVIDENCE III. case-control study.
Collapse
Affiliation(s)
| | | | | | | | | | | | - Benjamin G Domb
- American Hip Institute Research Foundation; American Hip Institute, Chicago, Illinois, U.S.A..
| |
Collapse
|
10
|
Guidetti M, Malloy P, Alter TD, Newhouse AC, Nho SJ, Espinoza Orías AA. Noninvasive shape-fitting method quantifies cam morphology in femoroacetabular impingement syndrome: Implications for diagnosis and surgical planning. J Orthop Res 2022; 41:1256-1265. [PMID: 36227086 DOI: 10.1002/jor.25469] [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: 02/01/2022] [Revised: 09/30/2022] [Accepted: 10/08/2022] [Indexed: 02/04/2023]
Abstract
There are considerable limitations associated with the standard 2D imaging currently used for the diagnosis and surgical planning of cam-type femoroacetabular impingement syndrome (FAIS). The aim of this study was to determine the accuracy of a new patient-specific shape-fitting method that quantifies cam morphology in 3D based solely on preoperative MRI imaging. Preoperative and postoperative 1.5T MRI scans were performed on n = 15 patients to generate 3D models of the proximal femur, in turn used to create the actual and the virtual cam. The actual cams were reconstructed by subtracting the postoperative from the preoperative 3D model and used as reference, while the virtual cams were generated by subtracting the preoperative 3D model from the virtual shape template produced with the shape-fitting method based solely on preoperative MRI scans. The accuracy of the shape-fitting method was tested on all patients by evaluating the agreement between the metrics of height, surface area, and volume that quantified virtual and actual cams. Accuracy of the shape-fitting method was demonstrated obtaining a 97.8% average level of agreement between these metrics. In conclusion, the shape-fitting technique is a noninvasive and patient-specific tool for the quantification and localization of cam morphology. Future studies will include the implementation of the technique within a clinically based software for diagnosis and surgical planning for cam-type FAIS.
Collapse
Affiliation(s)
- Martina Guidetti
- Section of Young Adult Hip Surgery, Department of Orthopedic Surgery, Division of Sports Medicine, Rush Medical College of Rush University, Rush University Medical Center, Chicago, Illinois, USA
| | - Philip Malloy
- Section of Young Adult Hip Surgery, Department of Orthopedic Surgery, Division of Sports Medicine, Rush Medical College of Rush University, Rush University Medical Center, Chicago, Illinois, USA.,Department of Physical Therapy, Arcadia University, Glenside, Pennsylvania, USA
| | - Thomas D Alter
- Section of Young Adult Hip Surgery, Department of Orthopedic Surgery, Division of Sports Medicine, Rush Medical College of Rush University, Rush University Medical Center, Chicago, Illinois, USA
| | - Alexander C Newhouse
- Section of Young Adult Hip Surgery, Department of Orthopedic Surgery, Division of Sports Medicine, Rush Medical College of Rush University, Rush University Medical Center, Chicago, Illinois, USA
| | - Shane J Nho
- Section of Young Adult Hip Surgery, Department of Orthopedic Surgery, Division of Sports Medicine, Rush Medical College of Rush University, Rush University Medical Center, Chicago, Illinois, USA
| | - Alejandro A Espinoza Orías
- Section of Young Adult Hip Surgery, Department of Orthopedic Surgery, Division of Sports Medicine, Rush Medical College of Rush University, Rush University Medical Center, Chicago, Illinois, USA
| |
Collapse
|
11
|
Scanaliato JP, Green CK, Salfiti CE, Patrick CM, Wolff AB. Primary Arthroscopic Labral Management: Labral Repair and Complete Labral Reconstruction Both Offer Durable, Promising Results at Minimum 5-Year Follow-up. Am J Sports Med 2022; 50:2622-2628. [PMID: 35850143 DOI: 10.1177/03635465221109237] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND Increased understanding of the acetabular labrum's role in hip joint biomechanics has led to a greater focus on the conservation and restoration of normal labral anatomic characteristics; however, labral repair is often not possible in the setting of severe intrasubstance damage or deficiency. PURPOSE To compare 5-year postoperative patient-reported outcomes between hips treated with primary complete arthroscopic labral reconstruction and those treated with primary labral repair. STUDY DESIGN Cohort study; Level of evidence, 3. METHODS All hips that underwent primary labral repair or reconstruction by the senior surgeon between January 2015 and December 2015 were included. Hips that had undergone a previous intra-articular procedure were excluded. Visual analog scales and patient-reported outcome (PRO) instruments were completed by patients within 1 week before surgery as a baseline measurement, between 22 and 26 months postoperatively for 2-year outcomes, and between 58 and 62 months for 5-year outcomes. PRO scores collected included the modified Harris Hip Score (mHHS), the 12-Item International Hip Outcome Tool, and the visual analog scale for pain and satisfaction. Pain and satisfaction were assessed using visual analog scales. RESULTS A total of 68 primary labral repairs and 62 primary complete labral reconstructions were included in the final analysis. Patients in the reconstruction cohort were older (38.3 vs 29.9 years; P < .001), had a higher incidence of severe labral tearing (62.90% vs 5.88%; P < .001), required a greater number of concomitant procedures (P < .001), and were more likely to have Beck grade III or IV chondral damage (12.94% vs 1.47%; P < .001). Both groups demonstrated statistically significant increases in outcome scores at minimum 5-year follow-up. Patients who underwent labral reconstruction had a significantly greater increase in mHHS from the preoperative assessment to latest follow-up compared with patients undergoing labral repair (27.43 vs 17.13; P = .04). No statistically significant differences between the 2 cohorts were found in achievement of minimal clinically important difference, Patient Acceptable Symptom State, maximum outcome improvement, and substantial clinical benefit at latest follow-up (P > .05). In total, 2 patients in the repair cohort and 3 patients in the reconstruction cohort required revision arthroscopy (P = .574). Further, 1 patient from each group converted to arthroplasty (P = .947). CONCLUSION The results of this study suggest that primary complete labral reconstruction is a viable surgical option for hips with moderate to severe labral pathology. At minimum 5-year follow-up, labral reconstruction produced similar outcomes to labral repair despite less favorable preoperative patient characteristics in the reconstruction cohort.
Collapse
Affiliation(s)
| | - Clare K Green
- Washington Orthopaedics and Sports Medicine, Washington, DC, USA
| | | | - Cole M Patrick
- Texas Tech University Health Sciences Center, El Paso, Texas USA
| | - Andrew B Wolff
- Washington Orthopaedics and Sports Medicine, Washington, DC, USA
| |
Collapse
|
12
|
Maldonado DR, Kyin C, Owens JS, Rosinsky PJ, Jimenez AE, Lee MS, Domb BG. Predictors of Achieving the Maximal Outcome Improvement Threshold for Willingness to Undergo Revision Hip Arthroscopy. Am J Sports Med 2022; 50:2174-2180. [PMID: 35612846 DOI: 10.1177/03635465221096872] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND The maximal outcome improvement threshold for willingness to undergo revision hip arthroscopy (MOWT) has not been defined yet. PURPOSE To determine the percentage MOWT in patients who underwent revision hip arthroscopy and to identify predictors of achieving the MOWT. STUDY DESIGN Case-control study; Level of evidence, 3. METHODS An anchor question was provided to patients who underwent revision hip arthroscopy between April 2008 and June 2020 who returned for follow-up between August 2019 and June 2021 at one institution. Patients were included if they underwent revision hip arthroscopy, had answered the anchor question, and had baseline and postoperative minimum 1-year follow-up scores for the modified Harris Hip Score (mHHS), Nonarthritic Hip Score (NAHS), and the visual analog scale (VAS) for pain. Exclusion criteria were Tönnis grade >1, hip dysplasia, previous hip conditions, or unwillingness to participate. Receiver operating characteristic analysis was used to determine the MOWT. Multivariate logistic regression was used to determine intraoperative predictors of achieving the MOWT. RESULTS In total, 153 patients (163 hips) were included, with 117 female hips (71.8%), a mean patient age of 34.3 ± 12.4 years, and an average follow-up time of 61.6 ± 42.7 months. It was determined that 77.3% of the patients reported that they would choose to undergo the revision hip arthroscopy again. The MOWT for the mHHS, NAHS, and VAS was 43.1%, 53%, and 33.4%, respectively. The probability of choosing to undergo revision surgery if the MOWT was achieved was 77.5%, 77.6%, and 79.2%, for the mHHS, NAHS, and VAS, respectively. Patients with residual cam-type morphology, which was addressed during the revision, were 2.3 times more likely to achieve the MOWT for the VAS (P = .014). CONCLUSION Patients who improved 43.1%, 53%, and 33.4% of their MOWT for the mHHS, NAHS, and VAS, respectively, were likely to be willing to undergo revision hip arthroscopy again. Moreover, the presence of residual cam-type femoroacetabular impingement morphology before their revision surgery was identified as a predictor to achieve the MOWT for the VAS.
Collapse
Affiliation(s)
| | - Cynthia Kyin
- American Hip Institute Research Foundation, Chicago, IL, USA
| | - Jade S Owens
- American Hip Institute Research Foundation, Chicago, IL, USA
| | | | | | - Michael S Lee
- American Hip Institute Research Foundation, Chicago, IL, USA
| | - Benjamin G Domb
- American Hip Institute Research Foundation, Chicago, IL, USA
- American Hip Institute, Chicago, IL, USA
| |
Collapse
|
13
|
Alter TD, Knapik DM, Guidetti M, Espinoza A, Chahla J, Nho SJ, Malloy P. Three-Dimensional Quantification of Cam Resection Using MRI Bone Models: A Comparison of 2 Techniques. Orthop J Sports Med 2022; 10:23259671221095417. [PMID: 35547617 PMCID: PMC9083056 DOI: 10.1177/23259671221095417] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/17/2022] [Accepted: 02/25/2022] [Indexed: 11/15/2022] Open
Abstract
Background: The current clinical standard for the evaluation of cam deformity in femoroacetabular impingement syndrome is based on radiographic measurements, which limit the ability to quantify the complex 3-dimensional (3D) morphology of the proximal femur. Purpose: To compare magnetic resonance imaging (MRI)–based metrics for the quantification of cam resection as derived using a best-fit sphere alpha angle (BFS-AA) method and using 3D preoperative-postoperative surface model subtraction (PP-SMS). Study Design: Descriptive laboratory study. Methods: Seven cadaveric hemipelvises underwent 1.5-T MRI before and after arthroscopic femoral osteochondroplasty, and 3D bone models of the proximal femur were reconstructed from the MRI scans. The alpha angles were measured radially along clockfaces using a BFS-AA method from the literature and plotted as continuous curves for the pre- and postoperative models. The difference between the areas under the curve for the pre- and postoperative models was then introduced in the current study as the BFS-AA–based metric to quantify the cam resection. The cam resection was also quantified using a 3D PP-SMS method, previously described in the literature using the metrics of surface area (FSA), volume (FV), and height (maximum [FHmax] and mean [FHmean]). Bivariate correlation analyses were performed to compare the metrics quantifying the cam resection as derived from the BFS-AA and PP-SMS methods. Results: The mean ± standard deviation maximum pre- and postoperative alpha angle measurements were 59.73° ± 15.38° and 48.02° ± 13.14°, respectively. The mean for each metric quantifying the cam resection with the PP-SMS method was as follows: FSA, 540.9 ± 150.7 mm2; FV, 1019.2 ± 486.2 mm3; FHmax, 3.6 ± 1.0 mm; and FHmean, 1.8 ± 0.5 mm. Bivariate correlations between the BFS-AA–based and PP-SMS–based metrics were strong: FSA (r = 0.817, P = .012), FV (r = 0.888, P = .004), FHmax (r = 0.786, P = .018), and FHmean (r = 0.679, P = .047). Conclusion: Strong positive correlations were appreciated between the BFS-AA and PP-SMS methods quantifying the cam resection. Clinical Relevance: The utility of the BFS-AA technique is primarily during preoperative planning. The utility of the PP-SMS technique is in the postoperative setting when evaluating the adequacy of resection or in patients with persistent hip pain with suspected residual impingement. In combination, the techniques allow surgeons to develop a planned resection while providing a means to evaluate the depth of resection postoperatively.
Collapse
Affiliation(s)
- Thomas D. Alter
- Section of Young Adult Hip Surgery, Division of Sports Medicine, Department of Orthopedic Surgery, Hip Preservation Center, Rush University Medical Center, Chicago, Illinois, USA
- Thomas D. Alter, MS, Department of Orthopedic Surgery, Rush University Medical Center, 1611 W Harrison St, Chicago, IL 60612, USA ()
| | - Derrick M. Knapik
- Division of Sports Medicine, Department of Orthopedic Surgery, Washington University, St Louis, Missouri, USA
| | - Martina Guidetti
- Section of Young Adult Hip Surgery, Division of Sports Medicine, Department of Orthopedic Surgery, Hip Preservation Center, Rush University Medical Center, Chicago, Illinois, USA
| | - Alejandro Espinoza
- Section of Young Adult Hip Surgery, Division of Sports Medicine, Department of Orthopedic Surgery, Hip Preservation Center, Rush University Medical Center, Chicago, Illinois, USA
| | - Jorge Chahla
- Section of Young Adult Hip Surgery, Division of Sports Medicine, Department of Orthopedic Surgery, Hip Preservation Center, Rush University Medical Center, Chicago, Illinois, USA
| | - Shane J. Nho
- Section of Young Adult Hip Surgery, Division of Sports Medicine, Department of Orthopedic Surgery, Hip Preservation Center, Rush University Medical Center, Chicago, Illinois, USA
| | - Philip Malloy
- Section of Young Adult Hip Surgery, Division of Sports Medicine, Department of Orthopedic Surgery, Hip Preservation Center, Rush University Medical Center, Chicago, Illinois, USA
- Arcadia University, Glenside, Pennsylvania, USA
| |
Collapse
|
14
|
Hansen L, de Raedt S, Jørgensen PB, Mygind-Klavsen B, Rømer L, Kaptein B, Søballe K, Stilling M. Hip joint motion does not change one year after arthroscopic osteochondroplasty in patients with femoroacetabular impingement evaluated with dynamic radiostereometry. J Exp Orthop 2022; 9:4. [PMID: 34985680 PMCID: PMC8733129 DOI: 10.1186/s40634-021-00427-x] [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: 06/30/2021] [Accepted: 11/10/2021] [Indexed: 11/14/2022] Open
Abstract
Purpose Dynamic radiostereometric analysis (dRSA) enables precise non-invasive three-dimensional motion-tracking of bones for assessment of joint kinematics. Hereby, the biomechanical effects of arthroscopic osteochondroplasty of the hip (ACH) can be evaluated in patients with femoroacetabular impingement (FAI). The aim was to investigate the pre- and postoperative range of motion (ROM) and the CT bone volume removed (BV) after ACH. We hypothesize increase in ROM 1 year after surgery. Methods Thirteen patients (6 female) with symptomatic FAI were included prospectively. The patient’s hips were CT-scanned and CT-bone models were created. Preoperative dRSA recordings were acquired during passive flexion to 90°, adduction, and internal rotation (FADIR). ACH was performed, CT and dRSA were repeated 3 months and 1 year postoperatively. Hip joint kinematics before, and 3 months and 1 year after ACH were compared pairwise. The bone volume removal was quantified and compared to change in ROM. Results Mean hip internal rotation, adduction and flexion were all unchanged after ACH at 1-year follow-up (p > 0.84). HAGOS scores revealed improvement of quality of life (QOL) from 32 to 60 (p = 0.02). The BV was between 406 and 1783 mm3 and did not correlate to post-operative ROM. Conclusions ACH surgery in FAI patients had no impact of ROM at 1-year follow-up. QOL improved significantly. This indicates that the positive clinical effects reported after ACH might be a result of reduced labral stress and cartilage pressure during end-range motion rather than increased ROM. Level of evidence Therapeutic prospective cohort study, level II.
Collapse
Affiliation(s)
- Lars Hansen
- Aarhus University Hospital, Aarhus, Denmark.
| | | | | | | | - Lone Rømer
- Aarhus University Hospital, Aarhus, Denmark
| | - Bart Kaptein
- Aarhus University Hospital, Aarhus, Denmark.,Leiden University Medical Center, Leiden, Netherlands
| | | | | |
Collapse
|
15
|
DeClercq MG, Fiorentino AM, Lengel HA, Ruzbarsky JJ, Robinson SK, Oberlohr VT, Whitney KE, Millett PJ, Huard J. Systematic Review of Platelet-Rich Plasma for Rotator Cuff Repair: Are We Adhering to the Minimum Information for Studies Evaluating Biologics in Orthopaedics? Orthop J Sports Med 2021; 9:23259671211041971. [PMID: 34901286 PMCID: PMC8655472 DOI: 10.1177/23259671211041971] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/06/2021] [Accepted: 05/19/2021] [Indexed: 01/08/2023] Open
Abstract
Background The therapeutic efficacy of orthobiologic therapies for rotator cuff repair is difficult to evaluate owing to reporting inconsistences. In response, the Minimum Information for Studies Evaluating Biologics in Orthopaedics (MIBO) guidelines were developed to ensure standard reporting on orthobiologic therapies. Purpose To systematically review clinical studies evaluating platelet-rich plasma (PRP) for full-thickness rotator cuff repair and adherence to MIBO guidelines. Study Design Scoping review; Level of evidence, 4. Methods A search was performed according to the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines using PubMed, EMBASE, and the Cochrane Library databases. Inclusion criteria were clinical studies reporting on rotator cuff tears (≥1 cm) surgically repaired with PRP. Patient demographics, biologic intervention, and adherence to the MIBO guidelines were systematically reviewed. Results A total of 19 studies (1005 patients) were included in this review. Across all studies, 58.5% of the MIBO checklist items for PRP were reported. Out of 47 checklist items, 19 were reported in over 85% of studies, whereas 22 were reported in less than half of studies. Details of whole-blood processing and characteristics, as well as PRP processing and characteristics, were reported inconsistently, and no study provided adequate information to enable the precise replication of preparation protocols for PRP. Conclusion This systematic review highlights the current reporting deficiencies within the scientific literature of important variables for evaluating PRP for full-thickness rotator cuff repair. There was widespread variability among published studies that evaluate PRP for this application and, more specifically, studies were limited by inconsistent universal reporting of whole-blood and PRP processing and postprocessing characteristics. To improve our understanding of biologic efficacy and to promote repeatability, stricter adherence to the MIBO guidelines is necessary. We propose that the checklist limitations be addressed and that modification of the MIBO guidelines be considered to improve the reporting of individual components within certain categories.
Collapse
Affiliation(s)
- Madeleine G DeClercq
- Center for Regenerative Sports Medicine, Steadman Philippon Research Institute, Vail, Colorado, USA
| | - Alyson M Fiorentino
- Center for Regenerative Sports Medicine, Steadman Philippon Research Institute, Vail, Colorado, USA
| | | | | | - Sara K Robinson
- Center for Regenerative Sports Medicine, Steadman Philippon Research Institute, Vail, Colorado, USA
| | - Verena T Oberlohr
- Center for Regenerative Sports Medicine, Steadman Philippon Research Institute, Vail, Colorado, USA
| | - Kaitlyn E Whitney
- Center for Regenerative Sports Medicine, Steadman Philippon Research Institute, Vail, Colorado, USA
| | | | - Johnny Huard
- Center for Regenerative Sports Medicine, Steadman Philippon Research Institute, Vail, Colorado, USA
| |
Collapse
|
16
|
Alter TD, Malloy P, Newhouse AC, Suppauksorn S, Orias AE, Chahla J, Inoue N, Nho SJ. Three-Dimensional Measures of Bony Resection During Femoral Osteochondroplasty Are Related to Alpha Angle Measures: A Cadaveric Study. Arthrosc Sports Med Rehabil 2021; 3:e1857-e1863. [PMID: 34977641 PMCID: PMC8689252 DOI: 10.1016/j.asmr.2021.08.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2021] [Accepted: 08/19/2021] [Indexed: 11/29/2022] Open
Abstract
Purpose Methods Results Conclusions Clinical Relevance
Collapse
Affiliation(s)
- Thomas D. Alter
- Section of Young Adult Hip Surgery, Division of Sports Medicine, Department of Orthopedic Surgery, Hip Preservation Center, Rush University, Chicago, Illinois
- Address correspondence to Thomas Alter, 1611 W Harrison St, Chicago, IL 60612.
| | - Philip Malloy
- Section of Young Adult Hip Surgery, Division of Sports Medicine, Department of Orthopedic Surgery, Hip Preservation Center, Rush University, Chicago, Illinois
- Department of Physical Therapy, Arcadia University, Pennsylvania, U.S.A
| | - Alex C. Newhouse
- Section of Young Adult Hip Surgery, Division of Sports Medicine, Department of Orthopedic Surgery, Hip Preservation Center, Rush University, Chicago, Illinois
| | - Sunikom Suppauksorn
- Section of Young Adult Hip Surgery, Division of Sports Medicine, Department of Orthopedic Surgery, Hip Preservation Center, Rush University, Chicago, Illinois
| | - Alejandro Espinzoa Orias
- Section of Young Adult Hip Surgery, Division of Sports Medicine, Department of Orthopedic Surgery, Hip Preservation Center, Rush University, Chicago, Illinois
| | - Jorge Chahla
- Section of Young Adult Hip Surgery, Division of Sports Medicine, Department of Orthopedic Surgery, Hip Preservation Center, Rush University, Chicago, Illinois
| | - Nozomu Inoue
- Section of Young Adult Hip Surgery, Division of Sports Medicine, Department of Orthopedic Surgery, Hip Preservation Center, Rush University, Chicago, Illinois
| | - Shane J. Nho
- Section of Young Adult Hip Surgery, Division of Sports Medicine, Department of Orthopedic Surgery, Hip Preservation Center, Rush University, Chicago, Illinois
| |
Collapse
|
17
|
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.
Collapse
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
| |
Collapse
|
18
|
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.
Collapse
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
| | | | | |
Collapse
|
19
|
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.
Collapse
|
20
|
Lodhia P, McConkey MO, Leith JM, Maldonado DR, Brick MJ, Domb BG. Graft Options in Hip Labral Reconstruction. Curr Rev Musculoskelet Med 2021; 14:16-26. [PMID: 33501568 PMCID: PMC7930132 DOI: 10.1007/s12178-020-09690-4] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
PURPOSE OF REVIEW The last decade has seen a boom in hip arthroscopy with refined indications. Improved understanding of pathoanatomy and disease progression has allowed for the development of advanced techniques. Labral reconstruction has been developed to substitute a non-functional or absent labrum. It has become an important technique in the armamentarium of high-volume arthroscopic hip surgeons. RECENT FINDINGS Basic science studies have improved understanding of hip biomechanics in the presence and absence of a labrum with a labral reconstruction allowing for reconstitution of normalcy. Current techniques have shown success with autograft and allograft tissue options. While autograft tissue allows for easy access intra-operatively and maintains patient biology, donor site morbidity is possible. Allografts negate donor site morbidity and allow for an abundance of tissue but can be resource-intensive and face availability concerns. Recent studies support outcomes of labral reconstructions using both autograft and allograft. Promising results have also allowed for performing labral reconstruction in a primary setting. Labral reconstruction can be successfully performed using both autograft and allograft. Patient biology should be respected, and native hip biomechanics restored. The literature is plentiful for appropriate surgical decision-making allowing the surgeon with multiple graft choices depending on training, experience, and resources.
Collapse
Affiliation(s)
- Parth Lodhia
- Department of Orthopaedics, University of British Columbia, Vancouver, BC Canada
- Fraser Orthopaedic Institute, 403-233 Nelson’s Crescent, New Westminster, BC V3L 0E4 Canada
| | - Mark O. McConkey
- Department of Orthopaedics, University of British Columbia, Vancouver, BC Canada
- Pacific Orthopaedics and Sports Medicine, North Vancouver, BC Canada
| | - Jordan M. Leith
- Department of Orthopaedics, University of British Columbia, Vancouver, BC Canada
- Footbridge Centre for Integrated Orthopaedic Care, Vancouver, BC Canada
| | | | | | | |
Collapse
|
21
|
Lall AC, Ankem HK, Diulus SC, Maldonado DR, Meghpara MB, Rosinsky PJ, Shapira J, Domb BG. Capsular Management of the Hip During Arthroscopic Acetabular Chondral Resurfacing: Pearls, Pitfalls, and Optimal Surgical Technique. Arthrosc Tech 2021; 10:e587-e597. [PMID: 33680797 PMCID: PMC7917387 DOI: 10.1016/j.eats.2020.10.045] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/28/2020] [Accepted: 10/21/2020] [Indexed: 02/03/2023] Open
Abstract
Treatment of hip joint chondral damage is a well-recognized aspect of the arthroscopic management of femoroacetabular impingement syndrome. Hip chondral resurfacing has evolved from microfracture to different forms of cartilage grafting, all with variable long-term outcomes. Recent literature has focused on techniques using different cartilage sources (native and synthetic products) that are available for clinicians to choose from during hip arthroscopy. None of the published reports on cartilage grafts have commented on hip joint capsular management as part of the procedure. This is likely because of the increased difficulty of capsular closure in the dry arthroscopic environment required for graft stabilization. However, potential iatrogenic hip instability induced by an unrepaired interportal capsulotomy can be detrimental to the existing joint architecture and possibly to the cartilage graft. This article presents a step-by-step approach, including tips and pearls, for capsular closure during arthroscopic acetabular chondral resurfacing with BioCartilage (Arthrex, Naples, FL). This method is a safe and reproducible way to close the joint capsule during chondral resurfacing in patients undergoing hip preservation that can potentially enhance the chances of a successful outcome.
Collapse
Affiliation(s)
- Ajay C. Lall
- American Hip Institute Research Foundation, Chicago, Illinois, U.S.A.,American Hip Institute, Chicago, Illinois, U.S.A.,AMITA Health St. Alexius Medical Center, Hoffman Estates, Illinois, U.S.A
| | - Hari K. Ankem
- American Hip Institute Research Foundation, Chicago, Illinois, U.S.A
| | | | | | - Mitchell B. Meghpara
- American Hip Institute Research Foundation, Chicago, Illinois, U.S.A.,AMITA Health St. Alexius Medical Center, Hoffman Estates, Illinois, U.S.A
| | | | - Jacob Shapira
- American Hip Institute Research Foundation, Chicago, Illinois, U.S.A
| | - Benjamin G. Domb
- American Hip Institute Research Foundation, Chicago, Illinois, U.S.A.,American Hip Institute, Chicago, Illinois, U.S.A.,AMITA Health St. Alexius Medical Center, Hoffman Estates, Illinois, U.S.A.,Address correspondence to Benjamin G. Domb, M.D., American Hip Institute, 999 E Touhy Ave, Ste 450, Des Plaines, IL 60018, U.S.A.
| |
Collapse
|
22
|
Byrd JWT. Hip Capsular Reconstruction Made Easy: The Timing and the Technique. Arthrosc Tech 2020; 10:e73-e78. [PMID: 33532211 PMCID: PMC7823084 DOI: 10.1016/j.eats.2020.09.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/18/2020] [Accepted: 09/13/2020] [Indexed: 02/03/2023] Open
Abstract
An iatrogenic capsular defect can be a major contributing factor to macroinstability of the hip. For this circumstance, capsular reconstruction may be appropriately indicated when the capsule cannot be primarily reconstituted. Severe dysfunction may accompany previous failed arthroscopy. This dysfunction should be assessed and addressed with a properly structured rehabilitation program prior to revision surgery. We describe a simplified technique for capsular reconstruction using a dermal allograft.
Collapse
Affiliation(s)
- J. W. Thomas Byrd
- Address correspondence to J. W. Thomas Byrd, M.D., Nashville Sports Medicine Foundation, 2004 Hayes St, Ste 700, Nashville, TN 37203, U.S.A.
| |
Collapse
|