1
|
Bindi VE, Hao KA, Freeman DA, Olowofela BO, Moser MW, Farmer KW, Pazik M, Roach RP. Comparison of Pain Scores and Functional Outcomes of Patients Undergoing Arthroscopic Hip Labral Repair and Concomitant Capsular Repair or Plication Versus No Closure. Orthop J Sports Med 2024; 12:23259671241243303. [PMID: 38646603 PMCID: PMC11032060 DOI: 10.1177/23259671241243303] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/24/2023] [Accepted: 10/11/2023] [Indexed: 04/23/2024] Open
Abstract
Background The need for capsular closure during arthroscopic hip labral repair is debated. Purpose To compare pain and functional outcomes in patients undergoing arthroscopic hip labral repair with concomitant repair or plication of the capsule versus no closure. Study Design Cohort study. Methods Outcomes were compared between patients undergoing arthroscopic hip labral repair with concomitant repair or plication of the capsule versus no closure at up to 2 years postoperatively and with stratification by age and sex. Patients with lateral center-edge angle <20°, a history of instability, a history of prior arthroscopic surgery in the ipsilateral hip, or a history of labral debridement only were excluded. Subanalysis was performed between patients undergoing no capsular closure who were propensity score matched 1:1 with patients undergoing repair or plication based on age, sex, and preoperative Modified Harris Hip Score (MHHS). We compared patients who underwent T-capsulotomy with concomitant capsular closure matched 1:5 with patients who underwent an interportal capsulotomy with concomitant capsular repair based on age, sex, and preoperative MHHS. Results Patients undergoing capsular closure (n = 1069), compared with the no-closure group (n = 230), were more often female (68.6% vs 53.0%, respectively; P < .001), were younger (36.4 ± 13.3 vs 47.9 ± 14.7 years; P < .001), and had superior MHHS scores at 2 years postoperatively (85.8 ± 14.5 vs 81.8 ± 18.4, respectively; P = .020). In the matched analysis, no difference was found in outcome measures between patients in the capsular closure group (n = 215) and the no-closure group (n = 215) at any follow-up timepoint. No significant difference was seen between the 2 closure techniques at any follow-up timepoint. Patients with closure of the capsule achieved the minimal clinically important difference (MCID) and the patient acceptable symptom state (PASS) for the 1-year MHHS at a similar rate as those without closure (MCID, 50.3% vs 44.9%, P = .288; PASS, 56.8% vs 51.1%, P = .287, respectively). Patients with T-capsulotomy achieved the MCID and the PASS for the 1-year MHHS at a similar rate compared with those with interportal capsulotomy (MCID, 50.1% vs 44.9%, P = .531; PASS, 65.7% vs 61.2%, P = .518, respectively). Conclusion When sex, age, and preoperative MHHS were controlled, capsular closure and no capsular closure after arthroscopic hip labral repair were associated with similar pain and functional outcomes for patients up to 2 years postoperatively.
Collapse
Affiliation(s)
- Victoria E. Bindi
- College of Medicine, University of Florida, Gainesville, Florida, USA
| | - Kevin A. Hao
- College of Medicine, University of Florida, Gainesville, Florida, USA
| | - David A. Freeman
- College of Medicine, University of Florida, Gainesville, Florida, USA
| | | | - Michael W. Moser
- Department of Orthopaedic Surgery & Sports Medicine, University of Florida, Gainesville, Florida, USA
| | - Kevin W. Farmer
- Department of Orthopaedic Surgery & Sports Medicine, University of Florida, Gainesville, Florida, USA
| | - Marissa Pazik
- Department of Orthopaedic Surgery & Sports Medicine, University of Florida, Gainesville, Florida, USA
| | - Ryan P. Roach
- Department of Orthopaedic Surgery & Sports Medicine, University of Florida, Gainesville, Florida, USA
| |
Collapse
|
2
|
Fenn TW, Chan JJ, Larson JH, Allahabadi S, Kaplan DJ, Nho SJ. Patients Aged 40 Years and Older Demonstrate Durable and Comparable Results to Patients Aged Less Than 40 Years After Primary Hip Arthroscopy for Femoroacetabular Impingement Syndrome: A Propensity Matched Study at Minimum 10-Year Follow-Up. Arthroscopy 2024:S0749-8063(24)00006-9. [PMID: 38190946 DOI: 10.1016/j.arthro.2024.01.004] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/02/2023] [Revised: 12/18/2023] [Accepted: 01/02/2024] [Indexed: 01/10/2024]
Abstract
PURPOSE The purpose of the present study was to compare clinical outcomes and rates of secondary surgery, including revision hip arthroscopy and conversion to total hip arthroplasty (THA), after primary hip arthroscopy for femoroacetabular impingement syndrome (FAIS) in patients ≥40 years of age at minimum 10-year follow-up compared with a propensity-matched control group of patients <40 years. METHODS A retrospective cohort study was performed for patients who underwent primary hip arthroscopy for FAIS between January 2012 and February 2013. Patients ≥40 years old were propensity matched in a 1:1 ratio by sex and body mass index to patients <40 years old. Patient-reported outcomes (PROs) including Hip Outcome Score for Activities of Daily Living and Sports-Specific subscales, modified Harris Hip, International Hip Outcome Tool-12, and Visual Analog Scale for Pain and Satisfaction were collected. Rates of minimal clinically important difference (MCID) and patient-acceptable symptomatic state (PASS) achievement at 10 years were evaluated and compared between groups. Rates of secondary surgery including revision hip arthroscopy and conversion to THA were evaluated. Gross survivorship between cohorts was evaluated using a Kaplan-Meier curve. RESULTS Fifty-three patients aged ≥40 (age 48.3 ± 5.8 years) were successfully matched to 53 patients aged <40 (age: 28.9 ± 7.2, <0.001). There were no other preoperative group differences regarding patient demographics, characteristics, or radiographic findings. Both groups demonstrated significant improvement regarding all PROs at a minimum of 10 years' follow-up (P < .001 for all). No significant difference was noted between cohorts regarding any delta (preoperative to 10-year postoperative) scores (P > .05 for all). High rates of MCID and PASS achievement were achieved in both cohorts, with no significant differences in any PRO measure (P > .05 for all). No significant differences in rates of complications (age ≥40: 2.0%, age <40: 7.7%, P = .363), rates of revision (age ≥40: 7.5%, age <40: 9.4%, P = .999), or conversion to THA (age ≥40: 13.2%, age <40: 3.8%, P = .161) were identified. On Kaplan-Meier analysis, no significant difference (P = .321) was demonstrated in overall gross survivorship between cohorts. CONCLUSION Patients with age ≥40 with FAIS undergoing primary hip arthroscopy demonstrated durable and comparable 10-year PRO and rates of MCID and PASS achievement compared with a propensity-matched cohort of age <40 counterparts. LEVEL OF EVIDENCE Level III, retrospective comparative prognostic trial.
Collapse
Affiliation(s)
- Thomas W Fenn
- Section of Young Adult Hip Surgery, Division of Sports Medicine, Department of Orthopaedic Surgery, Rush Medical College of Rush University, Rush University Medical Center, Chicago, Illinois, U.S.A
| | - Jimmy J Chan
- Section of Young Adult Hip Surgery, Division of Sports Medicine, Department of Orthopaedic Surgery, Rush Medical College of Rush University, Rush University Medical Center, Chicago, Illinois, U.S.A
| | - Jordan H Larson
- Section of Young Adult Hip Surgery, Division of Sports Medicine, Department of Orthopaedic Surgery, Rush Medical College of Rush University, Rush University Medical Center, Chicago, Illinois, U.S.A
| | - Sachin Allahabadi
- Section of Young Adult Hip Surgery, Division of Sports Medicine, Department of Orthopaedic Surgery, Rush Medical College of Rush University, Rush University Medical Center, Chicago, Illinois, U.S.A.; Division of Sports Medicine, Department of Orthopaedic Surgeon, Houston Methodist, Houston, Texas, U.S.A
| | - Daniel J Kaplan
- Section of Young Adult Hip Surgery, Division of Sports Medicine, Department of Orthopaedic Surgery, Rush Medical College of Rush University, Rush University Medical Center, Chicago, Illinois, U.S.A.; Division of Sports Medicine, Department of Orthopaedic Surgery, NYU Langone Orthopaedic Hospital, New York, New York, U.S.A
| | - Shane J Nho
- Section of Young Adult Hip Surgery, Division of Sports Medicine, Department of Orthopaedic Surgery, Rush Medical College of Rush University, Rush University Medical Center, Chicago, Illinois, U.S.A..
| |
Collapse
|
3
|
Allahabadi S, Chapman RS, Fenn TW, Brusalis CM, Kaplan DJ, Nho SJ. Hip Arthroscopic Surgery With Chondrolabral Refixation, Osteochondroplasty, and Routine Capsular Closure for Femoroacetabular Impingement Syndrome: Clinical Outcomes at a Minimum 10-Year Follow-up. Am J Sports Med 2024; 52:24-33. [PMID: 38164682 DOI: 10.1177/03635465231212663] [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: 01/03/2024]
Abstract
BACKGROUND Hip arthroscopic surgery for femoroacetabular impingement syndrome (FAIS) has proven to be an effective surgical intervention, with high rates of return to sport and work as well as favorable outcomes at short- and midterm follow-up. However, limited data exist on outcomes at long-term follow-up. PURPOSE To evaluate patient-reported outcomes (PROs) at a minimum 10-year follow-up after primary hip arthroscopic surgery including labral repair, femoral osteochondroplasty, acetabular osteochondroplasty, and capsular closure for FAIS. STUDY DESIGN Case series; Level of evidence, 4. METHODS Patients who underwent primary hip arthroscopic surgery for FAIS between June 2012 and January 2013 were identified. PROs were collected preoperatively and at a minimum of 10 years postoperatively, including the Hip Outcome Score-Activities of Daily Living (HOS-ADL), Hip Outcome Score-Sports Subscale (HOS-SS), modified Harris Hip Score (mHHS), International Hip Outcome Tool-12 (iHOT-12), and visual analog scale (VAS) for pain and satisfaction. Unique minimal clinically important difference (MCID) and patient acceptable symptom state (PASS) thresholds were calculated, and their rates of achievement were analyzed. An alpha level of <.05 was used to determine statistical significance. RESULTS A total of 94 patients (55 female; mean age, 34.3 ± 12.4 years) were analyzed with a mean follow-up of 10.1 ± 0.3 years (range, 10.0-10.7 years). Patients demonstrated significant 10-year improvement across all PRO measures (P < .001). MCID and PASS thresholds were calculated as follows: HOS-ADL (10.4 and 85.3, respectively), HOS-SS (14.6 and 60.2, respectively), mHHS (8.8 and 76.0, respectively), VAS pain (14.6 and 27.5, respectively), and iHOT-12 (PASS: 71.4). The majority of patients achieved the MCID and PASS for each PRO measure: HOS-ADL (73.4% and 70.9%, respectively), HOS-SS (78.5% and 77.2%, respectively), mHHS (81.0% and 70.9%, respectively), VAS pain (88.6% and 70.9%, respectively), and iHOT-12 (PASS: 73.4%). Overall, 9 patients (9.6%) underwent subsequent revision hip arthroscopic surgery at a mean 4.9 ± 3.7 years (range, 1.1-10.1 years) postoperatively, and 6 patients (6.4%) underwent conversion to total hip arthroplasty at a mean 4.1 ± 3.1 years (range, 0.9-9.3 years) postoperatively. CONCLUSION Patients who underwent primary hip arthroscopic surgery for FAIS utilizing contemporary methods of labral repair, acetabular and/or femoral osteochondroplasty, and capsular closure commonly experienced sustained clinical improvement and reported high levels of satisfaction at a minimum 10-year follow-up with low rates of reoperation.
Collapse
Affiliation(s)
- Sachin Allahabadi
- Section of Young Adult Hip Surgery, Division of Sports Medicine, Department of Orthopaedic Surgery, Rush University Medical Center, Rush Medical College of Rush University, Chicago, Illinois, USA
- Division of Sports Medicine, Department of Orthopedic Surgery, Houston Methodist, Houston, Texas, USA
| | - Reagan S Chapman
- Section of Young Adult Hip Surgery, Division of Sports Medicine, Department of Orthopaedic Surgery, Rush University Medical Center, Rush Medical College of Rush University, Chicago, Illinois, USA
| | - Thomas W Fenn
- Section of Young Adult Hip Surgery, Division of Sports Medicine, Department of Orthopaedic Surgery, Rush University Medical Center, Rush Medical College of Rush University, Chicago, Illinois, USA
| | - Christopher M Brusalis
- Section of Young Adult Hip Surgery, Division of Sports Medicine, Department of Orthopaedic Surgery, Rush University Medical Center, Rush Medical College of Rush University, Chicago, Illinois, USA
- Division of Sports Medicine, Department of Orthopedic Surgery, Hospital for Special Surgery, New York, New York, USA
| | - Daniel J Kaplan
- Section of Young Adult Hip Surgery, Division of Sports Medicine, Department of Orthopaedic Surgery, Rush University Medical Center, Rush Medical College of Rush University, Chicago, Illinois, USA
- Division of Sports Medicine, Department of Orthopedic Surgery, New York University Langone, New York, New York, USA
| | - Shane J Nho
- Section of Young Adult Hip Surgery, Division of Sports Medicine, Department of Orthopaedic Surgery, Rush University Medical Center, Rush Medical College of Rush University, Chicago, Illinois, USA
| |
Collapse
|
4
|
Fenn TW, Kaplan DJ, Brusalis CM, Chapman RS, Larson JH, Nho SJ. Functional Outcome Scores and Conversion to Total Hip Arthroplasty After Hip Arthroscopy for Femoroacetabular Impingement Syndrome in Patients With Tönnis Grade 1 Versus Grade 0 Arthritis: A Propensity-Matched Study at Minimum 10-Year Follow-up. Am J Sports Med 2024; 52:34-44. [PMID: 38164672 DOI: 10.1177/03635465231210958] [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: 01/03/2024]
Abstract
BACKGROUND Hip arthroscopy has become the mainstay surgical intervention for the treatment of femoroacetabular impingement syndrome (FAIS). However, postoperative outcomes and rates of secondary surgery are mixed in patients with differing levels of preoperative osteoarthritis (OA). Furthermore, there is a paucity of literature comparing patients with and without OA at long-term follow-up. PURPOSE To compare outcomes and rates of secondary surgery at minimum 10-year follow-up, including revision hip arthroscopy and conversion to total hip arthroplasty (THA), in patients with Tönnis grade 1 undergoing hip arthroscopy for FAIS compared with a propensity-matched control group of patients with Tönnis grade 0. STUDY DESIGN Cohort study; Level of evidence, 3. METHODS Patients who underwent primary hip arthroscopy for FAIS between January 2012 and February 2013 were identified. Patients with Tönnis grade 1 were propensity matched in a 1:2 ratio by age, sex, and body mass index (BMI) to patients with Tönnis grade 0. Patient-reported outcomes (PROs) were collected at varying timepoints including preoperatively and 1, 2, 5, and 10 years postoperatively and compared between the 2 cohorts. Rates of minimal clinically important difference (MCID) and Patient Acceptable Symptom State (PASS) achievement at 10 years were evaluated and compared between groups. Rates of secondary surgery including revision hip arthroscopy and conversion to total hip arthroplasty (THA) were evaluated. Gross survivorship between cohorts was evaluated using a Kaplan-Meier gross survivorship curve. A subanalysis was performed comparing patients with Tönnis grade 1 who converted to THA and those who did not. RESULTS A total of 31 patients with Tönnis grade 1 (age, 42.6 ± 9.0 years; BMI, 28.0 ± 6.3) were successfully matched to 62 patients with Tönnis grade 0 (age, 42.1 ± 8.5, P = .805; BMI, 26.1 ± 3.9, P = .117). Both the Tönnis grade 1 and Tönnis grade 0 groups demonstrated significant improvements regarding all PROs at minimum 10 years (P < .05 for all), except for the Hip Outcome Score Activities of Daily Living subscale (HOS-ADL) (P = .066) in the Tönnis grade 1 cohort. No significant difference (P > .05 for all) was noted between cohorts regarding any 10-year PRO. When the authors evaluated comparisons between preoperative and 1-, 2-, 5-, and 10-year PRO measures, significant differences were noted between cohorts regarding 2-year HOS-ADL (P = .021), Hip Outcome Score Sports-Specific subscale (P = .016), and modified Harris Hip Score (P = .026); otherwise, differences did not reach significance. High rates of 10-year MCID and PASS achievement were seen, with no significant differences between groups. Patients with Tönnis grade 1 had significantly higher rates of conversion to THA compared with patients who had Tönnis grade 0 (25.8% vs 4.8%; P = .006). Patients with Tönnis grade 1 had significantly lower gross survivorship compared with those who had Tönnis grade 0 (71.0% vs 85.5%, respectively; P = .04). CONCLUSION Hip arthroscopy confers comparable postoperative clinical improvements to patients who have FAIS with and without mild OA; however, the benefits among patients with mild OA may be less durable. Patients with Tönnis grade 1 had significantly higher conversion to THA and reduced gross survivorship compared with patients with no evidence of preoperative OA, suggesting that patients with evidence of OA may need to be cautioned on the higher rate of conversion surgery.
Collapse
Affiliation(s)
- Thomas W Fenn
- Section of Young Adult Hip Surgery, Division of Sports Medicine, Department of Orthopaedic Surgery, Rush Medical College of Rush University, Rush University Medical Center, Chicago, Illinois, USA
| | - Daniel J Kaplan
- Section of Young Adult Hip Surgery, Division of Sports Medicine, Department of Orthopaedic Surgery, Rush Medical College of Rush University, Rush University Medical Center, Chicago, Illinois, USA
- Department of Orthopaedic Surgery, Division of Sports Medicine, NYU Langone Orthopaedic Hospital, New York, New York, USA
| | - Christopher M Brusalis
- Section of Young Adult Hip Surgery, Division of Sports Medicine, Department of Orthopaedic Surgery, Rush Medical College of Rush University, Rush University Medical Center, Chicago, Illinois, USA
- Department of Orthopaedic Surgery, Division of Sports Medicine, Hospital for Special Surgery, New York, New York, USA
| | - Reagan S Chapman
- Section of Young Adult Hip Surgery, Division of Sports Medicine, Department of Orthopaedic Surgery, Rush Medical College of Rush University, Rush University Medical Center, Chicago, Illinois, USA
| | - Jordan H Larson
- Section of Young Adult Hip Surgery, Division of Sports Medicine, Department of Orthopaedic Surgery, Rush Medical College of Rush University, Rush University Medical Center, Chicago, Illinois, USA
| | - Shane J Nho
- Section of Young Adult Hip Surgery, Division of Sports Medicine, Department of Orthopaedic Surgery, Rush Medical College of Rush University, Rush University Medical Center, Chicago, Illinois, USA
| |
Collapse
|
5
|
Wang AS, Lamba A, Okoroha KR, Levy BA, Krych AJ, Hevesi M. Long-Term Outcomes of Primary Hip Arthroscopy With Labral Repair for Femoroacetabular Impingement: Results at Minimum 9-Year Follow-up. Orthop J Sports Med 2023; 11:23259671231204337. [PMID: 37822420 PMCID: PMC10563472 DOI: 10.1177/23259671231204337] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/03/2023] [Accepted: 05/19/2023] [Indexed: 10/13/2023] Open
Abstract
Background Hip arthroscopy continues to advance and become increasingly commonly performed. With the evolution of techniques and instrumentation, labral repair rather than debridement has emerged as the treatment of choice for labral pathology. There remains a lack of data on long-term outcomes after labral repair. Purpose To (1) evaluate long-term patient-reported outcomes of primary hip arthroscopy with labral repair for femoroacetabular impingement, (2) report achievement rates of Patient Acceptable Symptom State (PASS) and minimal clinically important difference (MCID), and (3) investigate rates of reoperation and progression to total hip arthroplasty (THA). Study Design Case series; Level of evidence, 4. Methods Prospectively collected data were reviewed for patients who underwent primary hip arthroscopy with labral repair between 2010 and 2013. Patients' medical records were reviewed for demographic characteristics, intraoperative findings, reoperation, and progression to THA. Patients were assessed pre- and postoperatively using the following scales: visual analog scale (VAS) for pain; Tegner activity scale; modified Harris Hip Score (mHHS); 12-item International Hip Outcome Tool (iHOT-12); Hip Outcome Score-Activities of Daily Living (HOS-ADL); HOS-Sport-Specific Subscale (HOS-SSS); and Non-Arthritic Hip Score. Patients were also surveyed for satisfaction, subjective improvement, and level of function. Results A total of 32 patients (n = 24 women; n = 8 men) with a mean age of 27.7 years (range, 13.6-51 years) were evaluated for a mean of 9.4 years (range, 9-12.1 years). Patients achieved significant mean improvements in VAS pain at rest of 2 points, VAS pain with use of 1.9, mHHS of 19.9 points, iHOT-12 of 33.5 points, HOS-ADL of 17.4 points, and HOS-SSS of 29.5 points (P≤ .015 for all). Eleven patients (34.4%) underwent reoperation and 4 (12.5%) progressed to THA during the study period. At the final follow-up, the MCID achievement rate was ≥68%, the PASS achievement rates ranged from 39% to 65%, and the mean patient satisfaction was 8.1 on a 1 to 10 scale, with 10 denoting most satisfied. Conclusion Patients demonstrated significant postoperative improvements in pain, mHHS, iHOT-12, HOS-ADL, and HOS-SSS scores at 9 years postoperatively. The all-cause reoperation rate was 34.4%, and 12.5% of patients progressed to THA.
Collapse
Affiliation(s)
- Allen S. Wang
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, Minnesota, USA
| | - Abhinav Lamba
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, Minnesota, USA
| | - Kelechi R. Okoroha
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, Minnesota, USA
| | - Bruce A. Levy
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, Minnesota, USA
| | - Aaron J. Krych
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, Minnesota, USA
| | - Mario Hevesi
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, Minnesota, USA
| |
Collapse
|
6
|
Mullins K, Filan D, Carton P. High survivorship and excellent 5-year outcomes in patients older than 40 years undergoing arthroscopy for femoroacetabular impingement. Knee Surg Sports Traumatol Arthrosc 2023; 31:2123-2130. [PMID: 36912924 DOI: 10.1007/s00167-023-07369-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/21/2022] [Accepted: 02/24/2023] [Indexed: 03/14/2023]
Abstract
PURPOSE To assess 5-year clinical outcome, in adults > 40 years of age, following hip arthroscopy for femoroacetabular impingement compared to a younger, matched, control group. METHODS All primary arthroscopies for FAI between 2009 and 2016 were considered (n = 1762). Hips presenting with Tönnis > 1, lateral centre edge angle < 25°, or prior hip surgery were excluded. Younger (< 40 years) and older hips (> 40 years) were matched for gender, Tönnis grade, capsular repair and radiological parameters. Survival (avoidance of total hip replacement {THR}) was compared between the groups. Patient reported outcome measures (PROMs) were also completed at baseline and 5 years to assess changes in functional capacity. Additionally, hip range of motion (ROM) was assessed at baseline and review. The minimal clinically important difference (MCID) was determined and compared between groups. RESULTS Ninety-seven older hips were matched to 97 younger controls (78% male in both groups). The average age of the older group at the time of surgery was 48.0 ± 5.7 years, compared to 26.7 ± 6.0. Six (6.2%) of the older hips and 1 (1%) of younger hips converted to THR (p = 0.043, effect size = 0.74, large). There were statistically significant improvements in all PROMs. At follow-up, there were no differences in PROMs between groups; significant improvements in hip ROM were also observed with no difference in ROM between groups at either time point. Similar achievement of MCIDs was observed in both groups. CONCLUSIONS Older patients experience a high survivorship rate at 5 years, although this may be lower than younger patients. Where THR is avoided, large clinically significant improvements in pain and function are observed. LEVEL OF EVIDENCE Level IV.
Collapse
Affiliation(s)
- Karen Mullins
- UPMC Sports Medicine Clinic, WIT Arena, Cork Road, Waterford, Ireland.
| | - David Filan
- UPMC Sports Medicine Clinic, WIT Arena, Cork Road, Waterford, Ireland
| | - Patrick Carton
- UPMC Sports Medicine Clinic, WIT Arena, Cork Road, Waterford, Ireland.,The Hip and Groin Clinic, UPMC Whitfield, Butlerstown North, Cork Road, Waterford, Ireland
| |
Collapse
|
7
|
Lee MS, Nam-Woo Kim D, Moran J, Gillinov SM, Mahatme RJ, Monahan PF, Islam W, Mclaughlin WM, Grimm NL, Jimenez AE. Patients Undergoing Primary Hip Arthroscopy Report Favorable Outcomes at Minimum 10 Year Follow-Up: A Systematic Review. Arthroscopy 2023; 39:459-475. [PMID: 36334852 DOI: 10.1016/j.arthro.2022.10.040] [Citation(s) in RCA: 19] [Impact Index Per Article: 19.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/27/2022] [Revised: 10/24/2022] [Accepted: 10/26/2022] [Indexed: 11/11/2022]
Abstract
PURPOSE (1) To evaluate minimum 10-year PROs (patient-reported outcomes) and survivorship after primary hip arthroscopy and (2) to identify predictors of failure for secondary arthroscopy and conversion to total hip arthroplasty (THA). METHODS A systematic review of the literature was conducted with the following key words: "hip arthroscopy," "long-term," "outcomes," "ten-year," "survivorship," "10-year," "15-year," "fifteen-year," 20-year," "twenty-year," and "femoroacetabular impingement" in PubMed and Embase in March 2022 using the Preferred Reporting Items for Systematic Reviews and Meta-analyses guidelines. Level I to Level IV evidence was included and reported on minimum 10-year outcomes or greater after primary hip arthroscopy. Long-term studies were defined as minimum 10-year follow-up in accordance with established standards in the literature. Case reports, review articles, technique articles, and opinion articles were excluded. Articles not in English were excluded. Title, author, publication date, study design, demographic, number of hips, follow-up time, study period, indications for hip arthroscopy, PROs, predictors of failure for THA, and rates of secondary surgeries were recorded. Survivorship was defined as a nonconversion to THA. P < .05 was defined as statistical significance. RESULTS Twelve studies met the inclusion criteria. In total, 4 studies were Level III, and 8 studies were Level IV. A total of 1,344 hips were included, and follow-up ranged from 10 to 20 years. Femoroacetabular impingement syndrome was the most common indication for hip arthroscopy. Ten of the 12 studies reported on PROs, and 8 studies reported significant improvement after hip arthroscopy at long-term follow-up. The remaining 2 studies reported favorable outcomes that satisfied clinical benefit thresholds at minimum 10-year follow-up. Five studies reported clinical benefit where each patient cohort achieved 80% minimal clinically important difference and 75% patient acceptable symptomatic state for at least one PRO. Rates of secondary arthroscopy ranged from 4.5% to 24%, and rates of conversion to THA varied from 0% to 44.1%. Older age and chondral damage were the most commonly cited predictors for conversion to THA. CONCLUSIONS At long-term follow-up, patients who underwent primary hip arthroscopy demonstrated favorable outcomes and variable rates of secondary surgeries. Patients undergoing hip arthroscopy within the last 20 years with Tönnis grade <1 and labral repair experienced greater than 90% survivorship. Chondral damage and older age were the most cited predictors for conversion to THA. 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
| | - Jay Moran
- 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
| | - William M Mclaughlin
- 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
|
8
|
Migliorini F, Maffulli N, Bell A, Cuozzo F, Hildebrand F, Weber CD. Midterm results after arthroscopic femoral neck osteoplasty combined with labral debridement for cam type femoroacetabular impingement in active adults. J Orthop Surg Res 2023; 18:67. [PMID: 36707868 PMCID: PMC9880366 DOI: 10.1186/s13018-023-03543-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/28/2022] [Accepted: 01/14/2023] [Indexed: 01/28/2023] Open
Abstract
INTRODUCTION Arthroscopic labral procedures are frequently undertaken in patients with femoroacetabular impingement (FAI). The role of arthroscopic femoral neck osteoplasty is well established, but less is known about labral procedures. This study evaluates the midterm efficacy and feasibility of arthroscopic osteoplasty with concomitant labral debridement for cam impingement in active adults. METHODS The present study was conducted according to the STROBE Statement. All 108 patients who underwent primary hip arthroscopy for cam type FAI combined with labral debridement were considered. Axial and anteroposterior plain radiographs of the pelvis were obtained preoperatively to identify the cam deformity and assess the presence of osteoarthritis, the lateral centre-edge angle, and the alpha angle. The ROM (flexion, extension, abduction, adduction, and intra/extra rotation) was evaluated. The following PROMs were administered: visual analogic scale (VAS), Tegner Activity Scale, non-arthritic hip score (NAHS), the international Hip Outcome Tool (iHOT-33) overall score, and related subscales: symptoms and functional limitations, sports and recreational activities, job-related concerns, and social, emotional, and lifestyle concerns. RESULTS At a mean of 2.0 ± 1.1 months, all 108 patients returned to their daily activities with no limitation. At a mean of 2.6 ± 1.4 months, all 108 patients were able to return to sport with no limitation. At 11.9 ± 2.1-month follow-up, no differences were reported in the range of motion compared to baseline: flexion (P = 0.3), extension (P = 0.09), abduction (P = 0.1), adduction (P = 0.3), internal rotation (P = 0.4), and external rotation (P = 0.6). At 72.8 ± 21.7-month follow-up, the mean VAS score was 1.7 ± 3.0, Tegner Activity Scale 3.5 ± 1.4, NAHS 92.1 ± 21.5, iHOT33 83.3 ± 27.2. At a mean of 21.7 ± 15.5 months following the index procedure, 14 of 108 patients had undergone total hip arthroplasty. No further revisions or complications were reported. CONCLUSION Arthroscopic femoral neck osteoplasty with concomitant labral debridement for cam type of FAI in active adults yields the reliable results, with a rate of progression to total hip arthroplasty of 13% (14 of 108) at 3-year follow-up. All patients returned to their daily activities with no limitation 2 months postoperatively. Within 3 months, all patients returned to sport with no limitations. No complication related to the index procedure was reported, and no further arthroscopic procedures were necessary.
Collapse
Affiliation(s)
- Filippo Migliorini
- grid.412301.50000 0000 8653 1507Department of Orthopaedic, Trauma, and Reconstructive Surgery, RWTH University Hospital, Pauwelsstraße 30, 52074 Aachen, Germany ,Department of Orthopaedic and Trauma Surgery, Eifelklinik St. Brigida, 52152 Simmerath, Germany
| | - Nicola Maffulli
- grid.11780.3f0000 0004 1937 0335Department of Medicine, Surgery and Dentistry, University of Salerno, 84081 Baronissi, SA Italy ,grid.9757.c0000 0004 0415 6205Faculty of Medicine, School of Pharmacy and Bioengineering, Keele University, Stoke on Trent, ST4 7QB England ,grid.4868.20000 0001 2171 1133Barts and the London School of Medicine and Dentistry, Centre for Sports and Exercise Medicine, Mile End Hospital, Queen Mary University of London, London, E1 4DG England
| | - Andreas Bell
- Department of Orthopaedic and Trauma Surgery, Eifelklinik St. Brigida, 52152 Simmerath, Germany
| | - Francesco Cuozzo
- grid.11780.3f0000 0004 1937 0335Department of Medicine, Surgery and Dentistry, University of Salerno, 84081 Baronissi, SA Italy
| | - Frank Hildebrand
- grid.412301.50000 0000 8653 1507Department of Orthopaedic, Trauma, and Reconstructive Surgery, RWTH University Hospital, Pauwelsstraße 30, 52074 Aachen, Germany
| | - Christian David Weber
- grid.412301.50000 0000 8653 1507Department of Orthopaedic, Trauma, and Reconstructive Surgery, RWTH University Hospital, Pauwelsstraße 30, 52074 Aachen, Germany
| |
Collapse
|