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Vogel MJ, Jan K, Kazi O, Wright-Chisem J, Nho SJ. The Association of Preoperative Hip Pain Duration With Delayed Achievement of Clinically Significant Outcomes After Hip Arthroscopic Surgery for Femoroacetabular Impingement Syndrome. Am J Sports Med 2024; 52:2565-2573. [PMID: 39097764 DOI: 10.1177/03635465241262336] [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: 08/05/2024]
Abstract
BACKGROUND Patients with hip pain ≥2 years before hip arthroscopic surgery for femoroacetabular impingement syndrome (FAIS) have been shown to achieve inferior short-term and midterm outcomes compared with patients with a shorter pain duration, although there is limited literature that has evaluated the time to achieve clinically significant outcomes (CSOs) in this population. PURPOSE To compare the time to achieve CSOs after hip arthroscopic surgery for FAIS in patients with and without prolonged hip pain and to identify independent predictors of the delayed achievement of CSOs. STUDY DESIGN Cohort study; Level of evidence, 3. METHODS Patients who underwent primary hip arthroscopic surgery for FAIS between January 2012 and July 2019 with 6-month, 1-year, and 2-year Hip Outcome Score-Activities of Daily Living (HOS-ADL) and Hip Outcome Score-Sports Subscale (HOS-SS) scores were identified. Patients with prolonged hip pain (preoperative duration ≥2 years) were propensity score matched to a control group (preoperative duration <2 years), controlling for age, sex, and body mass index (BMI). The times to achieve the minimal clinically important difference and Patient Acceptable Symptom State were compared between groups using Kaplan-Meier survival analysis. Multivariate Cox regression considering age, sex, BMI, pain duration, activity level, and chondral status was used to identify independent predictors of the delayed achievement of CSOs. RESULTS A total of 179 patients with prolonged hip pain were matched to 179 control patients (mean pain duration, 60.5 ± 51.2 vs 9.7 ± 5.1 months, respectively; P < .001) of a similar age, sex, and BMI (P≥ .488) with similar baseline HOS-ADL and HOS-SS scores (P≥ .971). The prolonged hip pain group showed delayed achievement of the minimal clinically important difference and Patient Acceptable Symptom State for both the HOS-ADL and HOS-SS on Kaplan-Meier analysis (P≤ .020). On multivariate Cox regression, hip pain duration ≥2 years was shown to be an independent predictor of the delayed achievement of CSOs, with hazard ratios ranging from 1.32 to 1.65 (P≤ .029). Additional independent predictors of the delayed achievement of CSOs included increasing age, increasing BMI, female sex, self-endorsed weekly participation in physical activity, and high-grade chondral defects (hazard ratio range, 1.01-4.89; P≤ .045). CONCLUSION Findings from this study demonstrate that preoperative hip pain duration ≥2 years was an independent predictor of the delayed achievement of CSOs after primary hip arthroscopic surgery for FAIS.
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Affiliation(s)
- Michael J Vogel
- Section of Young Adult Hip Surgery, Division of Sports Medicine, Department of Orthopedic Surgery, Rush University Medical Center, Chicago, Illinois, USA
| | - Kyleen Jan
- Section of Young Adult Hip Surgery, Division of Sports Medicine, Department of Orthopedic Surgery, Rush University Medical Center, Chicago, Illinois, USA
| | - Omair Kazi
- Section of Young Adult Hip Surgery, Division of Sports Medicine, Department of Orthopedic Surgery, Rush University Medical Center, Chicago, Illinois, USA
| | - Joshua Wright-Chisem
- Section of Young Adult Hip Surgery, Division of Sports Medicine, Department of Orthopedic Surgery, Rush University Medical Center, Chicago, Illinois, USA
| | - Shane J Nho
- Section of Young Adult Hip Surgery, Division of Sports Medicine, Department of Orthopedic Surgery, Rush University Medical Center, Chicago, Illinois, USA
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Vogel MJ, Alvero AB, Danilkowicz R, Obioha O, Jan K, Nho SJ. Primary Hip Arthroscopy is Associated with Earlier Achievement of Substantial Clinical Benefit Compared to Revision Hip Arthroscopy for Femoroacetabular Impingement Syndrome. Arthroscopy 2024:S0749-8063(24)00498-5. [PMID: 39029813 DOI: 10.1016/j.arthro.2024.06.047] [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: 01/23/2024] [Revised: 06/15/2024] [Accepted: 06/25/2024] [Indexed: 07/21/2024]
Abstract
PURPOSE To compare time to achievement of clinically significant outcomes (CSOs) between patients undergoing primary and revision hip arthroscopy (HA) for femoroacetabular impingement syndrome (FAIS). METHODS Patients undergoing primary and revision HA for FAIS with complete 6-month, 1-year, and 2-year Hip Outcome Score - Activities of Daily Living (HOS-ADL) and Sport Subscale (HOS-SS) were identified. Revision patients were propensity matched 1:4 to primary HA patients, controlling for age, sex, and body mass index (BMI). Time to achievement of minimal clinically important difference (MCID) and substantial clinical benefit (SCB) were compared alongside cumulative CSO achievement at 6, 12, and 24 months. Hazard ratios (HR) for predictors of earlier CSO achievement were identified with multivariate Cox regressions. RESULTS Fifty revision HA patients were propensity-matched to 200 primary HA patients of similar age, sex, and BMI. Primary HA patients demonstrated a greater prevalence of regular preoperative physical activity (87% vs. 59%, p<0.001). Primary HA patients showed significantly greater SCB achievement for HOS-ADL at 6, 12, and 24 months (p<0.001) and significantly greater SCB achievement for HOS-SS at 12 and 24 months (p≤0.001) compared to revision HA patients. Primary HA patients achieved SCB for HOS-ADL (p<0.001) and HOS-SS (p=0.015) quicker than revision HA patients. Predictors of earlier CSO achievement included preoperative PRO score (HR: 0.98-1.02, p≤0.007), lower BMI (HR: 0.97, p=0.038), presence of physical activity (HR: 1.51, p=0.038), and absence of revision status (HR: 0.52-0.56, p≤0.019). CONCLUSIONS Primary HA patients showed a quicker time to SCB achievement for HOS-ADL and HOS-SS compared to revision HA patients. Preoperative PRO score, lower BMI, regular physical activity, and primary HA status predicted earlier CSO achievement. LEVEL OF EVIDENCE Level III, retrospective comparative series.
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Affiliation(s)
- Michael J Vogel
- 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, IL, USA.
| | - Alexander B Alvero
- 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, IL, USA
| | - Richard Danilkowicz
- 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, IL, USA
| | - Obianuju Obioha
- 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, IL, USA
| | - Kyleen Jan
- 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, IL, 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, IL, USA
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Vogel MJ, Jan K, Alvero AB, Gilat R, Ebersole JW, Nho SJ. Gluteus Repair Yields Satisfactory Clinically Significant Outcome Achievement by 1 Year in Mostly Partial-Thickness Tears With Preoperative Hip Abduction Weakness Associated With Delayed Achievement. Arthroscopy 2024:S0749-8063(24)00231-7. [PMID: 38508287 DOI: 10.1016/j.arthro.2024.02.044] [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: 12/22/2023] [Revised: 02/21/2024] [Accepted: 02/29/2024] [Indexed: 03/22/2024]
Abstract
PURPOSE To define the time to achievement of clinically significant outcomes (CSOs) after primary gluteus medius and/or minimus (GM) repair and to identify factors associated with delayed CSO achievement. METHODS Patients who underwent primary GM repair between January 2012 and June 2021 with complete preoperative, 6-month, 1-year, and 2-year Hip Outcome Score-Activities of Daily Living (HOS-ADL) were retrospectively identified. Cohort-specific minimal clinically important difference (MCID) and patient acceptable symptom state (PASS) were calculated. The time to achievement of MCID and PASS was analyzed using Kaplan-Meier survival analysis. Median time to MCID and PASS achievement was recorded. Multivariate stepwise Cox regressions were used to identify factors associated with delayed CSO achievement. RESULTS Fifty GM repairs were identified (age 59.4 ± 9.7 years, body mass index 27.9 ± 6.2, 94% female). Tears were grade 1 in 39 cases, grade 2 in 7 cases, and grade 3 in 4 cases. Endoscopic repair was performed in 35 cases, and open repair was performed in 15 cases. Labral debridement and repair were each performed in 15 cases. Median time to CSO achievement was 5.7 months for MCID and 11.0 months for PASS. The 2-year cumulative probability of MCID and PASS achievement was 92.7% and 66.7%, respectively. Preoperative hip abduction weakness on physical examination was associated with delayed achievement of MCID (hazard ratio 2.27, confidence interval 1.067-7.41, P = .039) and PASS (hazard ratio 3.89, confidence interval 1.341-11.283, P = .012). CONCLUSIONS This study demonstrated that in patients undergoing repair of primarily grade 1 GM tears, most achieved MCID by 6 months, and more than one half achieved PASS by 12 months. Preoperative hip abduction weakness on physical examination was associated with delayed CSO achievement. LEVEL OF EVIDENCE Level IV, retrospective case series.
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Affiliation(s)
- Michael J Vogel
- Section of Young Adult Hip Surgery, Division of Sports Medicine, Department of Orthopedic Surgery.
| | - Kyleen Jan
- Section of Young Adult Hip Surgery, Division of Sports Medicine, Department of Orthopedic Surgery
| | - Alexander B Alvero
- Section of Young Adult Hip Surgery, Division of Sports Medicine, Department of Orthopedic Surgery
| | - Ron Gilat
- Section of Young Adult Hip Surgery, Division of Sports Medicine, Department of Orthopedic Surgery; Department of Orthopaedic Surgery, Shamir Medical Center and Tel Aviv University, Tel Aviv, Israel
| | - John W Ebersole
- Department of Musculoskeletal Radiology, Rush Medical College of Rush University, 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
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Glover MA, Restrepo A, Recker AJ, Beck EC, Bullock GS, Trasolini NA, Waterman BR. An Expedited Sling Immobilization Protocol After Isolated Biceps Tenodesis Results in Clinical and Patient-Reported Postoperative Outcomes Equivalent to a Standard Rehabilitation Protocol. Arthrosc Sports Med Rehabil 2024; 6:100840. [PMID: 38187952 PMCID: PMC10770724 DOI: 10.1016/j.asmr.2023.100840] [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: 07/19/2023] [Accepted: 11/07/2023] [Indexed: 01/09/2024] Open
Abstract
Purpose To characterize clinical and patient-reported outcomes for patients after isolated biceps tenodesis (BT) who underwent either standard or expedited sling immobilization protocols following surgery. Methods This retrospective cohort study compared patients who were assigned to use a sling for either 4 to 6 weeks (standard) or 0 to 2 weeks (expedited) following an isolated BT. Primary endpoint included rate of re-rupture, surgical revision, loss of fixation, and Popeye deformity. Secondary endpoints included shoulder range of motion (ROM) as well as pre- and postoperative patient-reported outcomes (PROs) of pain and function. Missing data were managed via multiple imputation with chained equations. Complication prevalence 95% confidence intervals were calculated using the Clopper Pearson method and a series of hierarchical mixed effects linear regressions were performed to assess differences between sling interventions in PROs and ROM. Results The average age of the standard cohort (n = 66) was 49 years (±14 years), and the average age of the expedited cohort (n = 69) was 47 years (±14 years). The expedited and standardized cohorts demonstrated 0.4 and 0.3 complications per 10,000 exposure days, respectively, with no significant difference between groups (1.4 [95% confidence interval 0.2-10.0], P = .727). There was no demonstrated difference in forward flexion, abduction, or external ROM. The expedited group had less improvement in visual analog scale for pain scores that was not clinically significant and there were no differences in PROs of function. Conclusions No statistically significant difference in the rate of re-rupture, surgical revision, loss of fixation, or Popeye deformity was noted between protocols after isolated BT. Furthermore, there were no clinically significant differences in ROM or PROs identified between protocols after isolated BT. This study suggests that patients who have undergone isolated BT may safely discontinue sling use within 2 weeks after surgery. Level of Evidence Level III, retrospective comparative study.
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Affiliation(s)
- Mark A. Glover
- Wake Forest University School of Medicine, Winston-Salem, North Carolina, U.S.A
| | - Alexis Restrepo
- Wake Forest University School of Medicine, Winston-Salem, North Carolina, U.S.A
| | - Andrew J. Recker
- Department of Orthopaedic Surgery and Rehabilitation, Atrium Health Wake Forest Baptist Health, Winston-Salem, North Carolina, U.S.A
| | - Edward C. Beck
- Department of Orthopaedic Surgery and Rehabilitation, Atrium Health Wake Forest Baptist Health, Winston-Salem, North Carolina, U.S.A
| | - Garrett S. Bullock
- Department of Orthopaedic Surgery and Rehabilitation, Atrium Health Wake Forest Baptist Health, Winston-Salem, North Carolina, U.S.A
| | - Nicholas A. Trasolini
- Department of Orthopaedic Surgery and Rehabilitation, Atrium Health Wake Forest Baptist Health, Winston-Salem, North Carolina, U.S.A
| | - Brian R. Waterman
- Department of Orthopaedic Surgery and Rehabilitation, Atrium Health Wake Forest Baptist Health, Winston-Salem, North Carolina, U.S.A
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Nie JW, Federico VP, Hartman TJ, Zheng E, Oyetayo OO, MacGregor KR, Massel DH, Sayari AJ, Singh K. Time to achievement of minimum clinically important difference after lumbar decompression. Acta Neurochir (Wien) 2023; 165:2625-2631. [PMID: 37488399 DOI: 10.1007/s00701-023-05709-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2023] [Accepted: 06/29/2023] [Indexed: 07/26/2023]
Abstract
OBJECTIVE The objective of this study is to examine factors associated with delayed time to achieve minimum clinically important difference (MCID) in patients undergoing lumbar decompression (LD) for the Patient-Reported Outcomes (PROs) of Oswestry Disability Index (ODI), Visual Analog Scale (VAS) back, and VAS leg pain. METHODS Patients undergoing LD with preoperative and postoperative ODI, VAS back, and VAS leg scores were retrospectively reviewed from April 2016 to January 2021. MCID values from previously established studies were utilized to determine MCID achievement. Kaplan-Meier survival analysis determined the time to achieve MCID. Hazard ratios from multivariable Cox regression were utilized to determine the preoperative factors predictive of MCID achievement. RESULTS Three-hundred and forty-three patients were identified undergoing LD. Overall MCID achievement rates were 67.4% for ODI, 67.1% for VAS back, and 65.0% for VAS leg. The mean time in weeks for MCID achievement was 22.52 ± 30.48 for ODI, 18.90 ± 27.43 for VAS back, and 20.96 ± 29.81 for VAS leg. Multivariable Cox regression revealed active smoker status, preoperative Patient-Reported Outcomes Measurement Information System Physical Function (PROMIS-PF), ODI, VAS Back, and VAS Leg (HR 1.03-2.14) as predictors of early MCID achievement, whereas an American Society of Anesthesiologist (ASA) classification of 2, Black ethnicity, workers' compensation, private insurance, and diagnosis of foraminal stenosis were predictors of late MCID achievement (HR 0.34-0.58). CONCLUSION Most patients undergoing LD achieved MCID within 6 months of surgery. Significant factors for early MCID achievement were active smoking status and baseline PROs. Significant factors for late MCID achievement were ASA = 2, Black ethnicity, type of insurance, and foraminal stenosis diagnosis. These factors may be considered by surgeons in setting patient expectations.
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Affiliation(s)
- James W Nie
- Department of Orthopaedic Surgery, Rush University Medical Center, 1611 W. Harrison St. Suite #300, Chicago, IL, 60612, USA
| | - Vincent P Federico
- Department of Orthopaedic Surgery, Rush University Medical Center, 1611 W. Harrison St. Suite #300, Chicago, IL, 60612, USA
| | - Timothy J Hartman
- Department of Orthopaedic Surgery, Rush University Medical Center, 1611 W. Harrison St. Suite #300, Chicago, IL, 60612, USA
| | - Eileen Zheng
- Department of Orthopaedic Surgery, Rush University Medical Center, 1611 W. Harrison St. Suite #300, Chicago, IL, 60612, USA
| | - Omolabake O Oyetayo
- Department of Orthopaedic Surgery, Rush University Medical Center, 1611 W. Harrison St. Suite #300, Chicago, IL, 60612, USA
| | - Keith R MacGregor
- Department of Orthopaedic Surgery, Rush University Medical Center, 1611 W. Harrison St. Suite #300, Chicago, IL, 60612, USA
| | - Dustin H Massel
- Department of Orthopaedic Surgery, Rush University Medical Center, 1611 W. Harrison St. Suite #300, Chicago, IL, 60612, USA
| | - Arash J Sayari
- Department of Orthopaedic Surgery, Rush University Medical Center, 1611 W. Harrison St. Suite #300, Chicago, IL, 60612, USA
| | - Kern Singh
- Department of Orthopaedic Surgery, Rush University Medical Center, 1611 W. Harrison St. Suite #300, Chicago, IL, 60612, USA.
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