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Wentzel D, Enos J, Smoak J, Goodman I, Mar D, Vopat B, Mullen S, Schroeppel JP. Benefits of a Postoperative Hip Orthosis After Routine Arthroscopy of the Hip: A Retrospective Cohort Study. Orthop J Sports Med 2023; 11:23259671231212503. [PMID: 38021301 PMCID: PMC10666821 DOI: 10.1177/23259671231212503] [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: 06/07/2023] [Accepted: 06/20/2023] [Indexed: 12/01/2023] Open
Abstract
Background No consensus currently exists among orthopaedic surgeons regarding the benefits of hip orthosis after routine hip arthroscopy. Purpose To compare patient-reported outcome measures (PROMs) and reoperation rates between patients who were braced versus those who were not braced after routine hip arthroscopy. Study Design Cohort study; Level of evidence, 3. Methods A retrospective review was conducted of 193 patients who underwent hip arthroscopy for femoroacetabular impingement (FAI) from January 1, 2018, to December 31, 2021, by 2 orthopedic surgeons at a single institution. Patients before July 1, 2019, were immobilized in a hip orthosis after hip arthroscopy (braced group; n = 101), whereas those after July 1, 2019, were not (nonbraced group; n = 92). Baseline PROMs (visual analog scale for pain, modified Harris Hip Score, Single Assessment Numeric Evaluation, and Veterans Rand 12-Item Health Survey [VR-12] Physical Component Summary and Mental Component Summary) were obtained for all patients and were repeated postoperatively at 2 weeks, 4 weeks, 3 months, 6 months, 1 year, and 2 years. The study groups were compared to evaluate differences in PROMs over time and 2-year postoperative reoperation rates. Group comparisons were also stratified by patient sex. Results There were no significant differences on any PROM between the braced and nonbraced cohorts at any timepoint. There were also no significant group differences in reoperation rates, with 8 braced patients (7.9%) undergoing reoperation and 1 nonbraced patient (2.3%) undergoing reoperation (P = .208). In the sex-stratified analyses, nonbraced male patients had significantly higher VAS pain and lower VR-12 Mental Component Summary scores at 6 months postoperatively compared with braced male patients (P = .043 and .026, respectively). Conclusion The study findings suggested that the use of an orthosis after routine hip arthroscopy for FAI does not improve patient-reported outcomes or negatively affect the 2-year reoperation rate. Postoperative bracing increases perioperative cost, and by foregoing routine bracing, patients may avoid the morbidity associated with wearing a brace for a prolonged period.
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Affiliation(s)
- Dylan Wentzel
- Department of Orthopedic Surgery and Sports Medicine, University of Kansas Medical Center, Kansas City, Kansas, USA
| | - Jake Enos
- Department of Orthopedic Surgery and Sports Medicine, University of Kansas Medical Center, Kansas City, Kansas, USA
| | - Jason Smoak
- Department of Orthopedic Surgery and Sports Medicine, University of Kansas Medical Center, Kansas City, Kansas, USA
| | - Ian Goodman
- Department of Orthopedic Surgery and Sports Medicine, University of Kansas Medical Center, Kansas City, Kansas, USA
| | - Damon Mar
- Department of Orthopedic Surgery and Sports Medicine, University of Kansas Medical Center, Kansas City, Kansas, USA
| | - Bryan Vopat
- Department of Orthopedic Surgery and Sports Medicine, University of Kansas Medical Center, Kansas City, Kansas, USA
| | - Scott Mullen
- Department of Orthopedic Surgery and Sports Medicine, University of Kansas Medical Center, Kansas City, Kansas, USA
| | - John Paul Schroeppel
- Department of Orthopedic Surgery and Sports Medicine, University of Kansas Medical Center, Kansas City, Kansas, USA
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Hip arthroscopy for femoroacetabular impingement is associated with significant improvement in early patient reported outcomes: analysis of 4963 cases from the UK non-arthroplasty registry (NAHR) dataset. Knee Surg Sports Traumatol Arthrosc 2023; 31:58-69. [PMID: 35833961 PMCID: PMC9859857 DOI: 10.1007/s00167-022-07042-y] [Citation(s) in RCA: 10] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/21/2021] [Accepted: 06/09/2022] [Indexed: 01/25/2023]
Abstract
PURPOSE Results from recent randomised controlled trials demonstrate the superiority of surgery over physiotherapy in patients with femoroacetabular impingement (FAI) of the hip in early follow-up. However, there is paucity of evidence regarding which factors influence outcomes of FAI surgery, particularly notable is the lack of information on the effect of impingement subtype (cam or pincer or mixed) on patient reported outcomes measures (PROMs). This study aims to evaluate the early outcomes of hip arthroscopy for FAI, and their determinants. METHODS This is a retrospective analysis of prospectively collected data from the UK Non-Arthroplasty Hip Registry (NAHR) of patients undergoing arthroscopic intervention for FAI between 2012 and 2019. The null hypothesis was that there is no difference in PROMs, based on morphological subtype of FAI treated or patient characteristics, at each follow-up timepoint. The outcome measures used for the study were the iHOT-12 score and the EQ5D Index and VAS 6- and 12-month follow-up. RESULTS A cohort of 4963 patients who underwent arthroscopic treatment of FAI were identified on the NAHR database. For all FAI pathology groups, there was significant improvement from pre-operative PROMs when compared to those at 6 and 12 months. Overall, two-thirds of patients achieved the minimum clinically important difference (MCID), and almost half achieved substantial clinical benefit (SCB) for iHOT-12 by 12 months. Pre-operatively, and at 12-month follow-up, iHOT-12 scores were significantly poorer in the pincer group compared to the cam and mixed pathology groups (p < 0.01). Multivariable analysis revealed PROMS improvement in the setting of a higher-grade cartilage lesion. CONCLUSION This registry study demonstrates that hip arthroscopy is an effective surgical treatment for patients with symptomatic FAI and results in a statistically significant improvement in PROMs which are maintained through 12 months follow-up. LEVEL OF EVIDENCE III.
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Lall AC, Ankem HK, Ryan MK, Beason DP, Diulus SC, Roach RP, Rosinsky PJ, Maldonado DR, Emblom BA, Domb BG. In-line Pullout Strength of 2 Acetabular Fixation Methods for Ligamentum Teres Reconstruction of the Hip: A Cadaveric Study. Orthop J Sports Med 2021; 9:23259671211052533. [PMID: 34881346 PMCID: PMC8646775 DOI: 10.1177/23259671211052533] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/22/2021] [Accepted: 08/02/2021] [Indexed: 01/23/2023] Open
Abstract
Background: Ligamentum teres (LT) reconstruction is an appropriate alternative in select cases of LT full-thickness tears, resulting in hip micro- or macroinstability. Graft fixation at the acetabular fossa is critical to achieving the best functional results. Purpose: The purpose of this study is to compare the pullout strength of 2 graft fixation methods used for LT reconstruction of the hip. Study Design: Controlled laboratory study. Methods: In 7 cadaveric specimens, the acetabular socket was prepared after the native LT was transected and the femoral head was removed. Seven separate tibialis anterior grafts were then prepared by suturing a running-locking No. 2 suture on each tail of the graft. Three specimens had fixation of the graft to the acetabulum using an adjustable cortical suspension suture button; the remaining 4 were fixed to the acetabulum using a knotless suture anchor. Specimens were then mounted onto a custom jig within a mechanical test frame to allow for the in-line pull of the graft fixation construct. After a preload of 5 N, each specimen was loaded to failure at 0.5 mm/s. Stiffness and load to failure were measured for each specimen construct. Results: Suture button fixation had a higher mean load to failure when compared with the knotless anchor fixation method (mean ± SD, 438.1 ± 114.3 vs 195.9 ± 50.0 N; P = .01). There was no significant difference in mean stiffness between the methods of fixation (24.5 ± 1.4 vs 26.5 ± 5.8 N/mm; P = .6). Conclusion: In this cadaveric study, the suture button fixation demonstrated greater load to failure than the knotless anchor fixation. Clinical Relevance: Results of this study can guide surgical decision making when selecting an acetabular fixation method for LT reconstruction.
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Affiliation(s)
- Ajay C Lall
- American Hip Institute, Des Plaines, Illinois, USA.,American Hip Institute Research Foundation, Des Plaines, Illinois, USA
| | - Hari K Ankem
- American Hip Institute Research Foundation, Des Plaines, Illinois, USA
| | - Michael K Ryan
- Andrews Sport Medicine and Orthopaedic Center, Birmingham, Alabama, USA
| | - David P Beason
- American Sports Medicine Institute, Birmingham, Alabama, USA
| | - Samantha C Diulus
- American Hip Institute Research Foundation, Des Plaines, Illinois, USA
| | - Ryan P Roach
- American Sports Medicine Institute, Birmingham, Alabama, USA
| | - Philip J Rosinsky
- American Hip Institute Research Foundation, Des Plaines, Illinois, USA
| | - David R Maldonado
- American Hip Institute Research Foundation, Des Plaines, Illinois, USA
| | - Benton A Emblom
- Andrews Sport Medicine and Orthopaedic Center, Birmingham, Alabama, USA.,American Sports Medicine Institute, Birmingham, Alabama, USA
| | - Benjamin G Domb
- American Hip Institute, Des Plaines, Illinois, USA.,American Hip Institute Research Foundation, Des Plaines, Illinois, USA.,AMITA Health St Alexius Medical Center, Hoffman Estates, Illinois, USA
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Marín-Pena O, Ayeni OR, Tey-Pons M, Mas-Martinez J, Dantas P, Khanduja V. The case of 'A Rhino Horn': case report and proposal for modification to the Hetsroni and Kelly classification. J Hip Preserv Surg 2021; 8:i51-i59. [PMID: 34178372 PMCID: PMC8221379 DOI: 10.1093/jhps/hnab020] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/25/2021] [Revised: 03/11/2021] [Accepted: 03/12/2021] [Indexed: 11/13/2022] Open
Abstract
Subspine impingement syndrome by definition involves a prominent antero-inferior iliac spine (AIIS) which can lead to impingement on the femoral neck thereby causing symptoms. We present the case of a 22-year-old semi-professional athlete who presented with a Type III AIIS morphology leading to subspine impingement syndrome and was managed via a mini open anterior approach. Radiological examination revealed a fairly prominent left AIIS resembling the 'horn of a rhino' extending to the trochanteric region anteriorly. A mini-anterior surgical approach was utilized for the resection of the 'rhino horn' and the rectus femoris was reattached. The patient remained asymptomatic at the one-year follow-up and had resumed weightlifting. Following this case, we propose a new classification of the type III AIIS morphology in view of the clinical presentation. The AIIS type III-Standard represents an extension from the acetabular rim to less than 1 cm (type III-S) and type III-Large, with an extension from the acetabular rim beyond 1 cm (type III-L). The type III-L will further be divided into two groups based on its relation to the ilium, type III-Lr ('rib shape') and type III-Lrh ('rhino horn').
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Affiliation(s)
- Oliver Marín-Pena
- Orthopedic and Traumatology Department, Hospital Universitario Infanta Leonor, Gran via del Este 80. 28031, Madrid, Spain
- Grupo Ibérico de Cirugía de Preservación de Cadera (GIPCA), José Abascal, 44 – 1º 28003, Madrid, Spain
| | - Olufemi R Ayeni
- Division of Orthopaedic Surgery, Department of Surgery, McMaster University Medical Centre, McMaster University, 1200 Main St West, 4E15, Hamilton, ON L8N 3Z5, Canada
| | - Marc Tey-Pons
- Grupo Ibérico de Cirugía de Preservación de Cadera (GIPCA), José Abascal, 44 – 1º 28003, Madrid, Spain
- Hospital del Mar y la Esperanza. Hip Unit, iMove Traumatología, Clínica Mi Tres Torres, Passeig Marítim 25-29 Barcelona 08003, Spain
| | - Jesús Mas-Martinez
- Grupo Ibérico de Cirugía de Preservación de Cadera (GIPCA), José Abascal, 44 – 1º 28003, Madrid, Spain
- HLA Clinica Vistahermosa, Hip Unit, Department of Orthopedic Surgery, Av de Denia 76, 03016, Alicante, Spain
| | - Pedro Dantas
- Grupo Ibérico de Cirugía de Preservación de Cadera (GIPCA), José Abascal, 44 – 1º 28003, Madrid, Spain
- Centro Hospitalar Lisboa Central. Hospital CUF Descobertas. Alameda Santo António dos Capuchos, 1169-050 Lisboa, Portugal
| | - Vikas Khanduja
- Department of Trauma and Orthopaedics, Addenbrooke's Hospital, Cambridge University Hospitals NHS Foundation Trust, Cambridge, CB2 0QQ, UK
- University of Cambridge, Trinity Ln, Cambridge CB2 1TN, UK
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Kumar P, Palanisamy Y, Verma A, Maini L, Dhillon MS, Shetty V. Status of Hip Arthroscopy in India: A Short Questionnaire Based Survey and Review of Literature. Indian J Orthop 2021; 55:325-332. [PMID: 33927810 PMCID: PMC8046872 DOI: 10.1007/s43465-020-00346-6] [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: 10/29/2020] [Accepted: 12/30/2020] [Indexed: 02/04/2023]
Abstract
BACKGROUND Hip arthroscopy is a minimally invasive technology for diagnostic and therapeutic interventions in various hip disorders. Over the past decade or so, the technology and understanding related to this surgery have improved by leaps and bounds; however, in India the overall pace has been limited. The present review highlights the status of hip arthroscopy in the Indian context. METHODOLOGY A small survey with five questions related to practice of hip arthroscopy among Indian orthopaedic surgeons was conducted. Additionally a PubMed database search was conducted to recognise and assess studies pertaining to hip arthroscopy originating from India. RESULTS Forty-two responses were received for the questionnaire, out of which 38 surgeons performed hip arthroscopy in their practice; the overall numbers were very low with only one respondent performing more than 50 surgeries in a year. For 84.2% of the respondents, the practice was limited to less than ten surgeries per year. 63.2% of the surgeons affirmed that there has been no change in their practice of hip arthroscopies over the past 5 years, signifying the slow growth and limited application of the technique. Only nine studies pertaining to the topic were available in the literature search, out of which five were case reports. The most common indication was removal of intraarticular foreign bodies, followed by joint debridement and lavage, synovial biopsies and femoroacetabular impingement (FAI). The outcomes in all the studies were satisfactory. CONCLUSION Hip arthroscopy is in its nascent stages in India and much is still needed to be done for better implementation of the technique on a wider scale. Adequate training and continued medical education programme, with exposure to the experts in the field, will go a long way in better utilisation of the surgery in India.
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Affiliation(s)
- Prasoon Kumar
- Department of Orthopaedics, PGIMER, Chandigarh, 160012 India
| | | | | | - Lalit Maini
- Maulana Azad Medical College, New Delhi, India
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Fukushima K, Inoue G, Kawakubo A, Uchida K, Koyama T, Ohashi Y, Uchiyama K, Takahira N, Takaso M. Assessment of the duration and effectiveness of intra-articular lidocaine injections for groin pain in patients with labral tears involving early osteoarthritis. SICOT J 2021; 7:4. [PMID: 33433324 PMCID: PMC7802518 DOI: 10.1051/sicotj/2020049] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/27/2020] [Accepted: 12/14/2020] [Indexed: 11/15/2022] Open
Abstract
Introduction: Intra-articular lidocaine injections have been used to confirm the hip pathology and may predict the efficacy of arthroscopic surgery. We have routinely performed the injections as a surgical indicator. The aim of this study was to assess the duration and effectiveness of these diagnostic intra-articular lidocaine injections on groin pain in patients with labral tears involving early osteoarthritis. Methods: A total of 113 patients were included in this study. All patients received one injection of 10 ml of 1% lidocaine into the hip joint under fluoroscopy. The duration and effectiveness of the injection were assessed 2 weeks after the injection and at a minimum of 1 year of follow-up. The effect of the injection was graded as 0: unchanged or worse; 1: an effect only on the day of injection; 2: the effect lasted a few days; 3: the effect lasted about a week; and 4: symptom remission. In addition, we recorded whether hip arthroscopic surgery was eventually performed. Results: The effect was rated as 0 in 19 patients (16.8%), as 1 in 30 patients (26.5%), as 2 in 38 patients (33.6%), as 3 in 13 patients (11.5%), and as 4 in 13 patients (11.5%). Seventy-two patients (63.7%) underwent hip arthroscopic surgery. No relationship with patients’ characteristics was found. Conclusion: In total, 83% of patients experienced some effect of the lidocaine injection. Furthermore, 11.5% of patients experienced complete remission of their symptoms.
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Affiliation(s)
- Kensuke Fukushima
- Department of Orthopaedic Surgery, Kitasato University School of Medicine, 1-15-1 Kitasato Minami-ku, Sagamihara, Kanagawa 252-0374, Japan
| | - Gen Inoue
- Department of Orthopaedic Surgery, Kitasato University School of Medicine, 1-15-1 Kitasato Minami-ku, Sagamihara, Kanagawa 252-0374, Japan
| | - Ayumu Kawakubo
- Department of Orthopaedic Surgery, Kitasato University School of Medicine, 1-15-1 Kitasato Minami-ku, Sagamihara, Kanagawa 252-0374, Japan
| | - Kentaro Uchida
- Department of Orthopaedic Surgery, Kitasato University School of Medicine, 1-15-1 Kitasato Minami-ku, Sagamihara, Kanagawa 252-0374, Japan
| | - Tomohisa Koyama
- Department of Orthopaedic Surgery, Kitasato University School of Medicine, 1-15-1 Kitasato Minami-ku, Sagamihara, Kanagawa 252-0374, Japan
| | - Yoshihisa Ohashi
- Department of Orthopaedic Surgery, Kitasato University School of Medicine, 1-15-1 Kitasato Minami-ku, Sagamihara, Kanagawa 252-0374, Japan
| | - Katsufumi Uchiyama
- Department of Orthopaedic Surgery, Kitasato University School of Medicine, 1-15-1 Kitasato Minami-ku, Sagamihara, Kanagawa 252-0374, Japan
| | - Naonobu Takahira
- Department of Rehabilitation, Kitasato University School of Allied Health Sciences, 1-15-1 Kitasato Minami-ku, Sagamihara, Kanagawa 252-0373, Japan
| | - Masashi Takaso
- Department of Orthopaedic Surgery, Kitasato University School of Medicine, 1-15-1 Kitasato Minami-ku, Sagamihara, Kanagawa 252-0374, Japan
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Ankem HK, Yelton MJ, Lall AC, Bendersky AM, Rosinsky PJ, Maldonado DR, Shapira J, Meghpara MB, Domb BG. Structured physical therapy protocols following hip arthroscopy and their effect on patient-reported outcomes-a systematic review of the literature. J Hip Preserv Surg 2020; 7:357-377. [PMID: 33948193 PMCID: PMC8081410 DOI: 10.1093/jhps/hnaa042] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/08/2020] [Revised: 07/21/2020] [Accepted: 08/15/2020] [Indexed: 02/06/2023] Open
Abstract
The purpose of this study was to analyze the effect of structured physical therapy protocols on patient-reported outcomes (PROs) following hip arthroscopy. A literature search was completed in October 2019 according to Preferred Reporting Items for Systematic Reviews and Meta-analyses guidelines to identify articles reporting specific rehabilitation protocols following hip arthroscopy that document PROs. Studies meeting all inclusion and exclusion were reviewed and data were extracted. Six studies were included in analysis. The mean age was 34.7% and 56.6% were males. Five studies described rehabilitation protocols in phases with specific goals and progression criteria. All studies included range of motion (ROM) and weight-bearing (WB) precautions. Return to sport (RTS)/activity varied between 7 and 32 weeks. The studies used variations of 21 different PROs. Significant improvements in baseline and post-operative PROs noted across studies. Rehabilitation protocols following hip arthroscopy typically consist of 4–5 phase programs with set goals and progression criteria. Several commonalities existed between studies on WB, ROM precautions and gait normalization. However, timing and recommendations for RTS/return to work varied between studies and were dependent on the concomitant procedures performed as well as type of patient population. Clinically significant improvement in PROs from baseline noted in majority of the studies reviewed that involved a structured rehabilitation program following arthroscopic management of femoroacetabular impingement. As there is heterogeneity in patient-specific characteristics across the included studies, no determination can be made as to which protocol is most effective and further high-quality comparative studies are needed. Clinical relevance Adopting phase-based rehabilitation protocols following arthroscopic femoroacetabular impingement treatment help achieve improved outcomes that are predictable
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Affiliation(s)
- Hari K Ankem
- American Hip Institute Research Foundation, Des Plaines, IL 60018, USA
| | - Mitchell J Yelton
- American Hip Institute Research Foundation, Des Plaines, IL 60018, USA
| | - Ajay C Lall
- American Hip Institute Research Foundation, Des Plaines, IL 60018, USA.,American Hip Institute, 999 E Touhy Ave, Suite 450, Des Plaines, IL 60018, USA
| | | | - Philip J Rosinsky
- American Hip Institute Research Foundation, Des Plaines, IL 60018, USA
| | - David R Maldonado
- American Hip Institute Research Foundation, Des Plaines, IL 60018, USA
| | - Jacob Shapira
- American Hip Institute Research Foundation, Des Plaines, IL 60018, USA
| | - Mitchell B Meghpara
- American Hip Institute Research Foundation, Des Plaines, IL 60018, USA.,AMITA Health St. Alexius Medical Center, Hoffman Estates, IL 60169, USA
| | - Benjamin G Domb
- American Hip Institute Research Foundation, Des Plaines, IL 60018, USA.,American Hip Institute, 999 E Touhy Ave, Suite 450, Des Plaines, IL 60018, USA
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Schultz K, Osborne J, Nelson K, Potini V, Chen C, Aljuni A, Bedi A, Bookout J, Yusaf M, Bishai SK. Intra- and interobserver reliability for predicting hip preservation versus hip arthroplasty utilizing plain radiographs with comparison of surgeon specialization. J Hip Preserv Surg 2020; 7:70-76. [PMID: 32382432 PMCID: PMC7195942 DOI: 10.1093/jhps/hnaa005] [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: 05/25/2019] [Revised: 12/28/2019] [Accepted: 01/09/2020] [Indexed: 11/16/2022] Open
Abstract
Surgeon subspecialty training and practice landscape are formative in diagnostic evaluation and treatment recommendations. Varying recommendations can have substantial impact on patients’ care pathways and outcomes. We investigated intra- and interobserver reliability of treatment predictions for total hip arthroplasty (THA) between surgeons performing arthroplasty and/or arthroscopic hip preservation surgery. Anterior–posterior (AP) hip radiographs cropped to include the lateral sourcil, medial sourcil and foveal region of 53 patients with Tönnis Grade 0–3 were evaluated by five surgeons (two performing arthroplasty, two performing arthroscopic hip preservation and one performing both interventions). Surgeons predicted THA versus no THA as the treatment for each image. Predictions were repeated three times with image order randomized, and intra- and interobserver reliability were calculated. Surgeons were blinded to patient characteristics and clinical information. Interobserver reliability was 0.452 whereas intraobserver reliability ranged from 0.270 to 0.690. Arthroscopic hip preservation surgeons were more likely to predict THA (36.9%) than arthroplasty surgeons (32.7%), P = 0.041. Intra- and interobserver reliabilities of surgeons predicting THA versus no THA based on an AP hip radiograph were average at best. Arthroscopic hip preservation surgeons were more likely to predict THA than arthroplasty surgeons. Subjective surgeon interpretation can lead to variability in recommendations to patients; potentially complicating care pathways.
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Affiliation(s)
- Kyle Schultz
- Ascension Genesys Regional Medical Center, Ascension Genesys Hospital, 1 Genesys Parkway, Grand Blanc, MI 48439, USA
| | - Jeff Osborne
- Department of Orthopedics and Sports Medicine, Detroit Medical Center - Harper Hospital, 3990 John R, Box 137, Detroit, MI 48201, USA
| | - Karen Nelson
- Henry Ford Health System, Henry Ford Macob Hospital - Clinton Township, 15855 19 Mile Rd, Clinton Twp., MI 48038, USA
| | - Vishnu Potini
- Department of Orthopedics and Sports Medicine, Detroit Medical Center - Harper Hospital, 3990 John R, Box 137, Detroit, MI 48201, USA
| | - Chaoyang Chen
- Department of Orthopedics and Sports Medicine, Detroit Medical Center - Harper Hospital, 3990 John R, Box 137, Detroit, MI 48201, USA
| | - Andrew Aljuni
- Assosciated Orthopedists of Detroit, PC, 24715 Little Mack Avenue Suite 100, St. Clair Shores, MI 48080, USA.,Oakland University William Beaumont School of Medicine, 586 Pioneer Dr., Rochester, MI 48309, USA
| | - Asheesh Bedi
- MedSport. University of Michigan, 4008 Ave Maria Dr A-1000, Ann Arbor, MI 48105, USA
| | - James Bookout
- Assosciated Orthopedists of Detroit, PC, 24715 Little Mack Avenue Suite 100, St. Clair Shores, MI 48080, USA.,Oakland University William Beaumont School of Medicine, 586 Pioneer Dr., Rochester, MI 48309, USA
| | - Michael Yusaf
- Department of Orthopedics and Sports Medicine, Detroit Medical Center - Harper Hospital, 3990 John R, Box 137, Detroit, MI 48201, USA.,Center for Advanced Orthopedics, 3100 Cross Creek Pkwy, Auburn Hills, MI 48326, USA
| | - Shariff K Bishai
- Department of Orthopedics and Sports Medicine, Detroit Medical Center - Harper Hospital, 3990 John R, Box 137, Detroit, MI 48201, USA.,Assosciated Orthopedists of Detroit, PC, 24715 Little Mack Avenue Suite 100, St. Clair Shores, MI 48080, USA.,Oakland University William Beaumont School of Medicine, 586 Pioneer Dr., Rochester, MI 48309, USA.,Michigan State University College of Osteopathic Medicine, 909 Wilson Rd, Room B305, East Lansing, MI 48824, USA
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The association of body mass index with same-day hospital admission, postoperative complications, and 30-day readmission following day-case eligible joint arthroscopy: A national registry analysis. J Clin Anesth 2020; 59:26-31. [DOI: 10.1016/j.jclinane.2019.06.012] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2019] [Revised: 05/08/2019] [Accepted: 06/02/2019] [Indexed: 11/19/2022]
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Hassebrock JD, Krych AJ, Domb BG, Levy BA, Neville MR, Hartigan DE. Bilateral Hip Arthroscopy: Can Results From Initial Arthroscopy for Femoroacetabular Impingement Predict Future Contralateral Results? Arthroscopy 2019; 35:1837-1844. [PMID: 30979623 DOI: 10.1016/j.arthro.2018.12.033] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/24/2018] [Revised: 12/07/2018] [Accepted: 12/12/2018] [Indexed: 02/02/2023]
Abstract
PURPOSE To determine the degree of correlation of radiographic measurements, degree of correlation of intraoperative pathology, and difference in outcomes between sides of patients requiring staged bilateral hip arthroscopy. METHODS Two high-volume hip preservation centers retrospectively reviewed hip preservation databases for staged bilateral hip arthroscopies conducted between 2008 and 2015. Patients were separated into those who presented with bilateral hip pain and those that presented with unilateral pain and developed contralateral pain >2 years later. Patients were analyzed for radiographic correlation (alpha angle, lateral center edge angle, anterior center edge angle, magnetic resonance imaging alpha angle, Tönnis grade) and correlation of intraoperative pathology (acetabular labrum articular disruption grade, Outerbridge grade/location, Villar class ligamentum teres tears, labral tear location, symmetry of Seldes tear types, and the differences between operative procedures). Patient-reported outcomes were analyzed (modified Harris Hip Score, Non-Arthritic Hip Score, International Hip Outcome Tool-12, hip outcome score-sport specific subscale, visual analog scale, patient satisfaction). Correlative tests included Pearson and Spearman; univariate and multivariate analysis for differences included χ-square test and Student t tests for ordinal and continuous variables respectively. RESULTS A total of 133 of 2,705 patients (4.6%) underwent bilateral hip arthroscopy. Radiographic alpha angle, magnetic resonance imaging alpha angle, lateral center edge angle, and anterior center edge angle demonstrated strong correlation (Pearson's coefficients 0.651, 0.648, 0.644, 0.667, respectively, P < .0001). Tönnis grade was weakly correlated (Pearson's coefficient 0.286, P = .001). Intraoperative pathology was moderately correlated (Pearson's coefficients for acetabular Outerbridge location, 0.300, P = .0170; acetabular labrum articular disruption, 0.490, P < .0001; acetabular Outerbridge; 0.530; P < .0001; femoral head Outerbridge, 0.459, P < .0001; Villar class, 0.393, P < .0001; and labral tear location, 0.468, P < .0001). Labral tear Seldes type was compared with Bowker's symmetry test and there was no significant difference between sides. There were no significant differences in surgical interventions performed between sides. Patients with bilateral hip arthroscopies significantly improved in all measured patient-reported outcomes and had a high patient satisfaction after both procedures. Final patient-reported outcomes and change in patient-reported outcomes were not different between procedures; follow up ranged from 3 months to 8 years. CONCLUSIONS This study demonstrated an incidence of 4.6% of patients who require bilateral hip arthroscopy. These patients can expect significant improvement after surgical intervention. Patients that had 1 side done gained similar improvement when the contralateral side was performed. Preoperative radiographic, intraoperative pathology, and procedures performed were similar between hips. LEVEL OF EVIDENCE Level III, retrospective cohort study.
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Affiliation(s)
- Jeffrey D Hassebrock
- Department of Orthopedics, Sports Medicine, Mayo Clinic Arizona, Phoenix, Arizona, U.S.A
| | - Aaron J Krych
- Department of Orthopedics, Mayo Clinic Rochester, Rochester, Minnesota, U.S.A
| | - Benjamin G Domb
- Department of Orthopedics, Hinsdale Orthopaedic Associates, Hinsdale, Illinois, U.S.A
| | - Bruce A Levy
- Department of Orthopedics, Mayo Clinic Rochester, Rochester, Minnesota, U.S.A
| | - Matthew R Neville
- Department of Biostatistics, Mayo Clinic Arizona, Glendale, Phoenix, U.S.A
| | - David E Hartigan
- Department of Orthopedics, Sports Medicine, Mayo Clinic Arizona, Phoenix, Arizona, U.S.A..
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12
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Ekhtiari S, Khan M, Burrus T, Madden K, Gagnier J, Rogowski JP, Maerz T, Bedi A. Hip and Groin Injuries in Professional Basketball Players: Impact on Playing Career and Quality of Life After Retirement. Sports Health 2019; 11:218-222. [PMID: 31013191 DOI: 10.1177/1941738119838274] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023] Open
Abstract
BACKGROUND Professional basketball players are at increased risk of hip and groin pain. Epidemiologic data exist on the prevalence of hip and groin issues among players in the National Basketball Association (NBA), but little is known about how these injuries affect athletes after retirement. HYPOTHESIS A high proportion of retired NBA athletes would have hip and/or groin pain. STUDY DESIGN Cross-sectional survey. LEVEL OF EVIDENCE Level 4. METHODS A survey was developed through an interdisciplinary focus group. The survey was developed to capture data regarding demographics, collegiate and professional athletic injuries, and current quality of life and musculoskeletal health. The questionnaire was electronically distributed to all members of the National Basketball Players Association using SurveyMonkey (N = 900). RESULTS A total of 108 (12%) retired NBA players completed the survey. More than one-third (36.3%) of athletes report currently experiencing hip and/or groin pain, and 17.6% had received injections for hip or groin conditions since retiring from the NBA. Since retiring, 14.7% of respondents had undergone total hip arthroplasty. The median Tegner activity level scale was 3 out of 10. Nearly one-third (32.4%) of athletes report moderate to severe problems with mobility, and close to half (48%) had moderate to extreme pain/discomfort. CONCLUSION Hip and groin injuries are common among NBA athletes, affecting players throughout their careers and into retirement. A subset of athletes may exist in whom intra-articular hip pathology is not appropriately identified and treated while playing in the NBA. CLINICAL RELEVANCE Retired NBA athletes are at high risk of hip and groin pain after retirement and are more likely to require total hip arthroplasty compared with the general population.
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Affiliation(s)
- Seper Ekhtiari
- Division of Orthopaedic Surgery, McMaster University, Hamilton, Ontario, Canada
| | - Moin Khan
- Division of Orthopaedic Surgery, McMaster University, Hamilton, Ontario, Canada
| | - Tyrrell Burrus
- Department of Orthopaedic Surgery, University of Michigan, Ann Arbor, Michigan
| | - Kim Madden
- Department of Health Research Methods, McMaster University, Hamilton, Ontario, Canada
| | - Joel Gagnier
- Department of Orthopaedic Surgery, University of Michigan, Ann Arbor, Michigan
| | | | - Tristan Maerz
- Department of Orthopaedic Surgery, University of Michigan, Ann Arbor, Michigan
| | - Asheesh Bedi
- MedSport, Department of Orthopaedic Surgery, University of Michigan, Ann Arbor, Michigan
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13
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Said HG, El-Radi MA, Hassanein MY, Said GZ. Orthopaedic publications from Egypt in the last five years: a bibliometric report. INTERNATIONAL ORTHOPAEDICS 2018; 42:2507-2511. [DOI: 10.1007/s00264-018-4152-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/02/2018] [Accepted: 09/06/2018] [Indexed: 12/11/2022]
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14
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Geada NG, Dantas P, Mascarenhas V, Campos V, Gonçalves S. Is It Safe to Perform an Early Arthroscopy After a Traumatic Hip Dislocation With an Associated Pelvic Ring Injury? Report of Our Technique. Arthrosc Tech 2018; 7:e679-e684. [PMID: 30013910 PMCID: PMC6020009 DOI: 10.1016/j.eats.2018.02.016] [Citation(s) in RCA: 3] [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: 12/23/2017] [Accepted: 02/23/2018] [Indexed: 02/03/2023] Open
Abstract
Hip arthroscopy is useful in the treatment of several intra-articular pathologies, however, its use in high-energy hip and pelvis injuries raises concerns about fluid extravasion and stability of the pelvic ring. We present our arthroscopic surgical technique (initial access to the peripheral compartment) to remove intra-articular loose bodies and treat associated lesions, as well as our concerns with the technique, in case of a traumatic hip dislocation associated with a contralateral pelvic ring injury.
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Affiliation(s)
- Nuno Gonçalves Geada
- Orthopaedic and Traumatology Department, Hospital Garcia de Orta, Almada, Portugal,Address correspondence to Nuno Gonçalves Geada, M.D., Hospital Garcia de Orta, Av. Torrado da Silva, 2801-951 Almada, Portugal.
| | - Pedro Dantas
- Orthopaedic and Traumatology Department, Hospital Curry Cabral, Lisbon, Portugal
| | | | - Vicente Campos
- Orthopaedic and Traumatology Department, Hospital Curry Cabral, Lisbon, Portugal
| | - Sérgio Gonçalves
- Orthopaedic and Traumatology Department, Hospital Curry Cabral, Lisbon, Portugal
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