1
|
Domb BG, Prabhavalkar ON, Maldonado DR, Perez-Padilla PA. Long-Term Outcomes of Arthroscopic Labral Treatment of Femoroacetabular Impingement in Adolescents: A Nested Propensity-Matched Analysis. J Bone Joint Surg Am 2024; 106:1062-1068. [PMID: 38662811 DOI: 10.2106/jbjs.23.00648] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/21/2024]
Abstract
BACKGROUND Hip arthroscopy has demonstrated effectiveness as a treatment for femoroacetabular impingement (FAI) in adult patients, with promising long-term outcomes. However, there is a paucity of literature regarding the adolescent population. The purposes of our study were to report on survivorship and patient-reported outcomes (PROs) at a minimum 10-year follow-up in adolescent patients who underwent hip arthroscopy for FAI and labral tears and to compare the survivorship and outcomes of this population with those of a nested, propensity-matched adult control group. METHODS Data regarding adolescent patients who underwent primary hip arthroscopy between February 2008 and January 2012 were reviewed. Patients with a minimum 10-year follow-up for the modified Harris hip score (mHHS), Non-Arthritic Hip Score (NAHS), Hip Outcome Score Sport-Specific Subscale (HOS-SSS), International Hip Outcome Tool-12 (iHOT-12), and visual analog scale (VAS) for pain were eligible. The exclusion criteria were previous ipsilateral hip conditions or surgical procedures, a Tönnis grade of >1, or dysplasia. In the subanalysis, adolescent patients were matched to young adult patients with use of a 1:1 ratio on the basis of sex, body mass index, Tönnis grade, lateral center-edge angle (LCEA), labral treatment, capsular treatment, and additional procedures performed during the surgery. RESULTS A total of 74 patients (61 female and 13 male; 74 hips) with a mean (and standard deviation) age of 16.7 ± 1.4 years and a minimum follow-up of 10 years were included. The latest follow-up occurred at a mean of 125.4 ± 5.3 months (range, 120.0 to 144.1 months). Significant improvement in all PROs from baseline and 100% survivorship were demonstrated at the 10-year follow-up. In the subanalysis, 58 adolescent hips were propensity-matched to 58 young adult hips. The adolescent group had higher postoperative scores for the HOS-SSS (p = 0.021), NAHS (p = 0.021), and iHOT-12 (p = 0.042) than the young adult group. Patient satisfaction at the latest follow-up was also significantly higher in the adolescent group (p = 0.00061). The rate of survivorship free from conversion to THA was similar between the adolescent and control groups (100% versus 96.6%; p = 0.200). CONCLUSIONS Adolescents undergoing hip arthroscopy for the treatment of FAI and labral tears demonstrated excellent outcomes and a high rate of survivorship. These outcomes were superior to those seen in a matched adult group. The results of this study indicate that hip arthroscopy in adolescents is a safe procedure that leads to improvement in outcomes at long-term follow-up. LEVEL OF EVIDENCE Therapeutic Level IV . See Instructions for Authors for a complete description of levels of evidence.
Collapse
Affiliation(s)
- Benjamin G Domb
- American Hip Institute Research Foundation, Chicago, Illinois
- American Hip Institute, Chicago, Illinois
| | | | | | | |
Collapse
|
2
|
Acar E, Hapa O, Gürsan O, Balcı A, Aydemir S, Mukat A, Ağca S, Çeltik M, Gedik G. Effect of cam resection depth on clinical outcomes after primary hip arthroscopy. Hip Int 2024; 34:228-234. [PMID: 37661665 DOI: 10.1177/11207000231197358] [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: 09/05/2023]
Abstract
BACKGROUND The amount of resection or the starting point of the resection on the femoral head for cam lesions in femoroacetabular impingement (FAI) is controversial. AIM The purpose of this study was to study the effect of postoperative resection depth, and resection arc ratio of cam lesion on the frequency of achieving substantial clinical benefit (SCB), patient acceptable state (PASS) in modified Harris Hip Score (mHHS) and Hip Outcome Score Activity of Daily Living (HOSADL), 2 years postoperatively. PATIENTS AND METHODS All patients who underwent first-time hip arthroscopy for FAI with a 2-year follow-up were included in this study. Patient-reported outcomes included the mHHS, HOSADL, and visual analogue scale for pain (Pain VAS). Radiological parameters such as alpha angletraditional (αT), alpha anglecartilage (αC), resection arc ratio (% alpha anglecartilage-alpha angletraditional/360°), resection depth (''D''mm) and resection depth ratio 'D%' (D/femoral head diameter %) were measured using the 45° Dunn view. RESULTS We identified 26 patients (27 hips) with 2-year follow-up. There were 10 female and 16 male patients. The mean age of the patients was 33 ± 12 years.Higher frequency of achieving SCB threshold for mHHS was related to labrum repair (73% vs. debridement '27%' p = 0.03), lower preoperative αT (64° vs. 76°, p = 0.04), lower preoperative mHHS (54 vs. 81, p < 0.001) and higher preoperative VAS scores (8 vs. 7, p = 0.02). Higher frequency of reaching PASS threshold for mHHS was associated with lower αC (82°vs. 92° p:0.02), lower RA (8% vs. 11%, p = 0.03), lower D (2.8 mm vs. 4.5 mm p:0.03), lower D% (4.7% vs. 8.4% p = 0.04) and higher postoperative mHHS (97 vs. 82 p < 0.001). CONCLUSIONS A higher frequency of achieving SCB for HOSADL was related to lower D% (5% vs. 10.5%, p = 0.04).Cam resection depth affects the frequency of achieving clinically meaningful scores and resection depth less than 6% of the femoral head diameter seems to be appropriate for optimal results. The starting point of resection on head cartilage needs to be <90° when alpha angle is used for reference.
Collapse
Affiliation(s)
- Emre Acar
- Department of Orthopaedics and Traumatology, Dokuz Eylül University Hospital, İzmir, Turkey
| | - Onur Hapa
- Department of Orthopaedics and Traumatology, Dokuz Eylül University Hospital, İzmir, Turkey
| | - Onur Gürsan
- Department of Orthopaedics and Traumatology, Dokuz Eylül University Hospital, İzmir, Turkey
| | - Ali Balcı
- Department of Radiology, Dokuz Eylül University Hospital, İzmir, Turkey
| | - Selahaddin Aydemir
- Department of Orthopaedics and Traumatology, Dokuz Eylül University Hospital, İzmir, Turkey
| | - Alaa Mukat
- Department of Orthopaedics and Traumatology, Dokuz Eylül University Hospital, İzmir, Turkey
| | - Selahattin Ağca
- Department of Orthopaedics and Traumatology, Dokuz Eylül University Hospital, İzmir, Turkey
| | - Mustafa Çeltik
- Department of Orthopaedics and Traumatology, Dokuz Eylül University Hospital, İzmir, Turkey
| | - Gökay Gedik
- Department of Radiology, Dokuz Eylül University Hospital, İzmir, Turkey
| |
Collapse
|
3
|
Parnes N, Scanaliato JP, Dunn JC, Fink WA, Sandler A, Fares AB. Obesity negatively affects outcomes following arthroscopic rotator cuff repair at four-year follow-up. Shoulder Elbow 2023; 15:46-52. [PMID: 37974610 PMCID: PMC10649479 DOI: 10.1177/17585732221095846] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/28/2022] [Revised: 03/30/2022] [Accepted: 04/03/2022] [Indexed: 11/19/2023]
Abstract
Introduction The purpose is to evaluate the influence of obesity (BMI 30 to 39.9 kg/m2) on surgical outcomes following arthroscopic rotator cuff repair surgery. Materials and Methods A retrospective review was performed examining the outcomes of arthroscopic rotator cuff repair in both a normal weight (BMI 18.5 to 24.9 kg/m2) and an obese (BMI 30 to 39.9 kg/m2) patient population, specifically looking at functional outcomes and range of motion. Secondary variables analyzed were surgical time, complications, and medical comorbidities. Results 52 normal weight patients (mean BMI 23.7 ± 2.1) and 59 obese patients (mean BMI 34.0 ± 2.4) were included. Both groups demonstrated statistically significant improvements in VAS, SANE and ASES scores (P < 0.0001), however there were significantly better outcomes in the normal weight group in VAS (0.56 ± 0.96 vs 1.42 ± 2.22; P = 0.0108), ASES (96.1 ± 5.8 vs 90.6 ± 15.6; P = 0.0192), and internal rotation (9.2 ± 3.0 vs 10.9 ± 2.3; P = 0.0010). Additionally, the obese cohort had more complications, longer surgical times, and a greater comorbid background. Conclusions Obesity is associated with significantly more comorbid conditions, surgical complications, longer surgical time, and worse patient reported outcomes than normal weight patients undergoing arthroscopic rotator cuff repair.
Collapse
Affiliation(s)
- Nata Parnes
- Department of Orthopaedic Surgery, Carthage Area Hospital. Carthage, NY, USA
| | - John P Scanaliato
- Department of Orthopaedic Surgery, Texas Tech University Health Sciences Center-El Paso, El Paso, Texas, USA
| | - John C Dunn
- Department of Orthopaedic Surgery, Texas Tech University Health Sciences Center-El Paso, El Paso, Texas, USA
| | - Walter A Fink
- Department of Orthopaedic Surgery, Carson Tahoe Health, Carson City, Nevada, USA
| | - Alexis Sandler
- Department of Orthopaedic Surgery, George Washington University School of Medicine, Washington, DC, USA
| | - Austin B Fares
- Department of Orthopaedic Surgery, Texas Tech University Health Sciences Center-El Paso, El Paso, Texas, USA
| |
Collapse
|
4
|
Niehaus R, Zingg PO, Hoch A, Luttenberger M, Stefan R. Hip arthroscopy versus total hip arthroplasty-A study on patients with obesity above 40 years of age. Clin Obes 2023; 13:e12590. [PMID: 36919471 DOI: 10.1111/cob.12590] [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] [Received: 07/26/2022] [Revised: 02/06/2023] [Accepted: 03/01/2023] [Indexed: 03/16/2023]
Abstract
Patients older than 40 years with a body-mass-index (BMI) >30 kg/m2 , a femoroacetabular-impingement (FAI) and little cartilage damage are a challenge for hip surgeons. Hip-arthroscopy (HAS) or conservative therapy until a total hip arthroplasty (THA) is needed are possible treatments. Our research purpose was to compare the clinical results and complication/reoperation rate after HAS and THA in patients with obesity over 40 years. This retrospective study includes a consecutive series of patients with obesity (BMI >30 kg/m2 ) who underwent HAS (19 hips) and THA (37 hips) over 40 years of age between 2007 and 2013 at our institution with a minimum of 12-months follow-up. Outcome measures were WOMAC (Western Ontario und McMaster Universities Arthritis Index), subjective-hip-value (SHV), residual complaints and the reoperation rate. Patient data and scores were collected pre-operative, 12 months post-operatively and at the last follow-up. Both groups showed a comparable age (mean 48 years). Regarding SHV-Scores the THA-group shows continuous significant improvements. Reaching 87% (range 50%-100%), the HAS-group showed in case of the SHV no significant change after 1 year and an improvement from preoperative to the last follow-up reaching 72% (range 30%-100%) at the last follow-up. Residual groin pain was significant higher in the HAS-group. Two deep infections (5.4%) requiring reoperations were reported in the THA-group. The conversion rate to THA after a mean time of 60 months was 26% (5 of 19). Patients with obesity over 40 years demonstrated inferior SHV, more often residual pain and revision surgery after HAS, when compared to THA at short-term, with conversions rate of one fourth. However, THA in this patient group showed high infection rate of 5%. This information is relevant for counselling above-mentioned patients.
Collapse
Affiliation(s)
- Richard Niehaus
- Department of Orthopedics, University Hospital Balgrist, University of Zürich, Zürich, Switzerland
| | - Patrick O Zingg
- Department of Orthopedics, University Hospital Balgrist, University of Zürich, Zürich, Switzerland
| | - Armando Hoch
- Department of Orthopedics, University Hospital Balgrist, University of Zürich, Zürich, Switzerland
| | - Martin Luttenberger
- Department of Orthopedics, University Hospital Balgrist, University of Zürich, Zürich, Switzerland
| | - Rahm Stefan
- Department of Orthopedics, University Hospital Balgrist, University of Zürich, Zürich, Switzerland
| |
Collapse
|
5
|
Shankar DS, Bi AS, Lan R, Buzin S, Youm T. Reprint of: Class I Obesity Delays Achievement of Patient-Acceptable Symptom State but Not Minimum Clinically Important Difference or Substantial Clinical Benefit After Primary Hip Arthroscopy for Femoroacetabular Impingement Syndrome. Arthroscopy 2023; 39:1971-1979. [PMID: 37543382 DOI: 10.1016/j.arthro.2023.06.028] [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: 06/28/2022] [Accepted: 01/31/2023] [Indexed: 08/07/2023]
Abstract
PURPOSE To identify differences in the time taken to achieve the minimum clinically important difference (MCID), substantial clinical benefit (SCB), and patient-acceptable symptom state (PASS) following primary hip arthroscopy for the treatment of femoroacetabular impingement syndrome (FAIS) among patients of different body mass index (BMI) categories. METHODS We conducted a retrospective comparative study of hip arthroscopy patients with minimum 2-year follow-up. BMI categories were defined as normal (18.5 ≤ BMI < 25.0), overweight (25.0 ≤ BMI <30.0), or class I obese (30.0≤BMI<35.0). All subjects completed the modified Harris Hip Score (mHHS) prior to surgery and at 6 months, 1 year, and 2 years postoperative. MCID and SCB cutoffs were defined as pre-to-postoperative increases in mHHS by ≥8.2 and ≥19.8, respectively. PASS cutoff was set at postoperative mHHS ≥74. Time to achievement of each milestone was compared using the interval-censored EMICM algorithm. The effect of BMI was adjusted for age and sex using an interval-censored proportional hazards model. RESULTS 285 patients were included in the analysis: 150 (52.6%) normal BMI, 99 (34.7%) overweight, and 36 (12.6%) obese. Obese patients had lower mHHS at baseline (P = .006) and at 2-year follow-up (P = .008). There were no significant intergroup differences in time to achievement for MCID (P = .92) or SCB (P = .69), but obese patients had longer time to PASS than normal BMI patients (P = .047). Multivariable analysis found obesity to be predictive of longer time to PASS (HR = .55; P = .007) but not MCID (HR = 0.91; P = .68) or SCB (HR = 1.06; P = .30). CONCLUSIONS Class I obesity is associated with delays in achieving a literature-defined PASS threshold after primary hip arthroscopy for FAIS. LEVEL OF EVIDENCE Level III, retrospective comparative study.
Collapse
Affiliation(s)
- Dhruv S Shankar
- Department of Orthopedic Surgery, New York University Langone Health, New York, New York, U.S.A
| | - Andrew S Bi
- Department of Orthopedic Surgery, New York University Langone Health, New York, New York, U.S.A
| | - Rae Lan
- Department of Orthopedic Surgery, New York University Langone Health, New York, New York, U.S.A
| | - Scott Buzin
- Department of Orthopedic Surgery, New York University Langone Health, New York, New York, U.S.A
| | - Thomas Youm
- Department of Orthopedic Surgery, New York University Langone Health, New York, New York, U.S.A..
| |
Collapse
|
6
|
Gürsan O, Hapa O, Matsuda DK, Aydemir S, Çeltik M, Cici H, Acan AE. Postoperative alpha angle seems to be important for the achievement of clinical significance at a minimum 5-year follow-up after primary hip arthroscopy. J Hip Preserv Surg 2023; 10:123-128. [PMID: 37900884 PMCID: PMC10604047 DOI: 10.1093/jhps/hnad010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/24/2022] [Revised: 02/20/2023] [Accepted: 04/08/2023] [Indexed: 10/31/2023] Open
Abstract
The purpose of the present study was to clarify whether there is an association of postoperative alpha value with functional scores or progression of osteoarthritis at X-rays at the midterm after arthroscopic treatment of femoroacetabular impingement (FAI) syndrome with femoral osteoplasty, labral repair or debridement and rim trimming. A retrospective review of prospectively gathered data from 2013 to 2017 was performed. All patients who underwent first-time unilateral hip arthroscopy for FAI resection with 5-year follow-up were included. Patient-reported outcomes included the modified Harris Hip Score (mHHS) and Visual Analog Scale for Pain (Pain VAS). The progression of osteoarthritis (Tönnis grade) and radiological parameters (alpha angle, lateral center-edge angle [LCEA] and head-neck offset) were evaluated. A receiver operating characteristic (ROC) analysis was used to evaluate the correlation between significant variables and achievement of patient-acceptable symptomatic state (PASS) and degree of osteoarthritis. We identified 52 patients with a minimum 5-year follow-up (average, 6.7 years). The average patient age was 33.9 ± 11.5 years. There were 19 (36.5%) female patients. The mHHS improved from 60.1 ± 13.4 before surgery to 86.8 ± 14 after surgery (P < 0.001). The Pain VAS decreased from 6.21 before surgery to 2 after surgery (P < 0.001). Overall, 69% achieved the PASS for mHHS. The ROC curve for postoperative alpha angle demonstrated acceptable discrimination between patients achieving a fifth-year PASS value and those who did not have an area under the curve of 0.72. Patients having a postoperative alpha angle of ≤48.3° achieved the fifth-year PASS value at a significantly higher rate than patients having a postoperative alpha angle of >48.3° (P = 0.002). The postoperative alpha angle is a predictor of the achievement of the fifth-year PASS value for the mHHS. A threshold of ≤48.3° had a sensitivity of 0.75 and a specificity of 0.69 to predict positivity. Level of evidence IV.
Collapse
Affiliation(s)
- Onur Gürsan
- Department of Orthopedic Surgery, Dokuz Eylül University, Izmir 35340, Turkey
| | - Onur Hapa
- Department of Orthopedic Surgery, Dokuz Eylül University, Izmir 35340, Turkey
| | - Dean K Matsuda
- DISC Sports and Spine Center, Premier Hip Arthroscopy, Marina del Rey, CA 90292, USA
| | - Selahaddin Aydemir
- Department of Orthopedic Surgery, Dokuz Eylül University, Izmir 35340, Turkey
| | - Mustafa Çeltik
- Department of Orthopedic Surgery, Dokuz Eylül University, Izmir 35340, Turkey
| | - Hakan Cici
- Department of Orthopedic Surgery, Democracy University, Izmir 35390, Turkey
| | - Ahmet Emrah Acan
- Department of Orthopedic Surgery, Balıkesir University, Balıkesir 10145, Turkey
| |
Collapse
|
7
|
Gillinov SM, Kim DN, Moran J, Lee MS, Fong S, Mahatme RJ, Simington J, Owens JS, McLaughlin WM, Grauer JN, Jimenez AE. Low Rates of 5-Year Secondary Surgery and Postoperative Complications After Primary Hip Arthroscopy in More Than 30,000 Patients. Arthroscopy 2023; 39:1639-1648. [PMID: 37286283 DOI: 10.1016/j.arthro.2023.01.100] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/06/2022] [Revised: 12/12/2022] [Accepted: 01/24/2023] [Indexed: 06/09/2023]
Abstract
PURPOSE To evaluate 90-day complications, 5-year secondary surgery rates, and risk factors for secondary surgery following primary hip arthroscopy performed for femoroacetabular impingement and/or labral tears using a large national dataset. METHODS A retrospective analysis was conducted using the PearlDiver Mariner151 database. Patients with International Classification of Diseases, Tenth Revision, diagnosis codes for femoroacetabular impingement and/or labral tear undergoing primary hip arthroscopy with femoroplasty, acetabuloplasty, and/or labral repair between 2015 and 2021 were identified. Those with concomitant International Classification of Diseases, Tenth Revision, codes for infection, neoplasm, or fracture were excluded, as were patients with a history of previous hip arthroscopy or total hip arthroplasty, or age ≥70 years. Rates of complications within 90 days of surgery were assessed. Five-year rates of secondary surgery-revision hip arthroscopy or conversion to total hip arthroplasty-were determined by Kaplan-Meier analysis, and risk factors for secondary surgery were identified by multivariate logistic regression. RESULTS A total of 31,623 patients underwent primary hip arthroscopy from October 2015 to April 2021, with annual volumes ranging from 5,340 to 6,343 surgeries per year. Femoroplasty was the most frequent surgical procedure (performed in 81.1% of surgical encounters), followed by labral repair (72.6%) and acetabuloplasty (33.0%). Ninety-day postoperative complication rates were low, with 1.28% of patients experiencing any complication. The 5-year secondary surgery rate was 4.9% (N = 915 patients). Multivariate logistic regression identified age <20 years (odds ratio [OR] 1.50; P < .001), female sex (OR 1.33; P < .001), class I obesity (body mass index 30-34.9: OR 1.30; P = .04), and class II/III obesity (body mass index ≥35.0: OR 1.29; P = .02) as independent predictors of secondary surgery. CONCLUSIONS In this study of primary hip arthroscopy, 90-day adverse events were low at 1.28%, and the 5-year secondary surgery rate was 4.9%. Age younger than 20 years, female sex, and obesity were risk factors for secondary surgery, suggesting the need for increased surveillance in these patient groups. LEVEL OF EVIDENCE Level IV, case series.
Collapse
Affiliation(s)
- Stephen M Gillinov
- Department of Orthopaedics and Rehabilitation, Yale School of Medicine, New Haven, Connecticut, U.S.A..
| | - David N Kim
- Department of Orthopaedics and Rehabilitation, Yale School of Medicine, New Haven, Connecticut, U.S.A
| | - Jay Moran
- Department of Orthopaedics and Rehabilitation, Yale School of Medicine, New Haven, Connecticut, U.S.A
| | - Michael S Lee
- Medical University of Wisconsin, Milwaukee, Wisconsin, U.S.A
| | - Scott Fong
- Advanced Orthopedics and Sports Medicine, San Francisco, California, U.S.A
| | - Ronak J Mahatme
- University of Connecticut School of Medicine, Farmington, Connecticut, U.S.A
| | | | - Jade S Owens
- Keck School of Medicine of University of Southern California, Los Angeles, California, U.S.A
| | - William M McLaughlin
- Department of Orthopaedics and Rehabilitation, Yale School of Medicine, New Haven, Connecticut, U.S.A
| | - Jonathan N Grauer
- Department of Orthopaedics and Rehabilitation, Yale School of Medicine, New Haven, Connecticut, U.S.A
| | - Andrew E Jimenez
- Department of Orthopaedics and Rehabilitation, Yale School of Medicine, New Haven, Connecticut, U.S.A
| |
Collapse
|
8
|
Maldonado DR, Lee MS, Kyin C, Jimenez AE, Owens JS, Perez-Padilla PA, Domb BG. Survivorship, Outcomes, and Risk Factors for Conversion to Total Hip Arthroplasty After Revision Hip Arthroscopic Surgery in Obese Patients: Results at a Minimum 5-Year Follow-up. Orthop J Sports Med 2023; 11:23259671231154921. [PMID: 37056451 PMCID: PMC10087662 DOI: 10.1177/23259671231154921] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/13/2022] [Accepted: 11/08/2022] [Indexed: 04/15/2023] Open
Abstract
Background There is a paucity of literature reporting outcomes after revision hip arthroscopic surgery in obese patients. Purpose To report the minimum 5-year survivorship, patient-reported outcomes (PROs), clinical benefit, and risk factors for conversion to total hip arthroplasty (THA) in obese patients after revision hip arthroscopic surgery. Study Design Case series; Level of evidence, 4. Methods Data were prospectively collected and retrospectively reviewed for patients who underwent revision hip arthroscopic surgery by a single surgeon between April 2010 and August 2016. Inclusion criteria were a body mass index ≥30 and baseline and minimum 5-year postoperative values for the modified Harris Hip Score (mHHS), Nonarthritic Hip Score (NAHS), Hip Outcome Score-Sport-Specific Subscale (HOS-SSS), and visual analog scale (VAS) for pain. Exclusion criteria were Tönnis grade >1 and hip dysplasia. Survivorship was defined as no conversion to THA. Clinical benefit was measured using the minimal clinically important difference (MCID). Survivors and nonsurvivors underwent further bivariate and regression analyses to determine the predictors of conversion to THA. Results Included were 24 hips in 24 patients. The mean patient age was 39.3 ± 12.7 years, and the mean follow-up was 83.9 ± 26.5 months. The survivorship rate was 75.0%, and patients demonstrated a significant improvement in all PROs (P < .01). At 5-year follow-up, the MCID for the mHHS, NAHS, HOS-SSS, and VAS was achieved by 70.6%, 94.1%, 92.9%, and 64.7%, respectively, of the patients. Older age, higher grade ligamentum teres tears, and acetabuloplasty were significant on bivariate analysis for conversion to THA, and increased age was identified as a significant variable for conversion to THA on regression analysis (odds ratio, 1.297 [95% CI, 1.045-1.609]; P = .018), with a 29.7% greater risk for every additional year of age at the time of revision. Conclusion In this study, 25.0% of obese patients who underwent revision hip arthroscopic surgery required conversion to THA. The study patients who did not need conversion to THA had a significant improvement in all PROs, with >90% achieving MCID for one or more outcome measures. Older age was identified as a significant predictor of conversion to THA.
Collapse
Affiliation(s)
- David R. Maldonado
- Department of Orthopaedic Surgery,
McGovern Medical School, University of Texas Health Science Center at Houston,
Houston, Texas, USA
| | - Michael S. Lee
- American Hip Institute Research
Foundation, Chicago, Illinois, USA
| | - Cynthia Kyin
- American Hip Institute Research
Foundation, Chicago, Illinois, USA
| | | | - Jade S. Owens
- American Hip Institute Research
Foundation, Chicago, Illinois, USA
| | | | - Benjamin G. Domb
- American Hip Institute Research
Foundation, Chicago, Illinois, USA
- American Hip Institute, Chicago,
Illinois, USA
- Benjamin G. Domb, MD,
American Hip Institute, 999 East Touhy Avenue, Suite 450, Chicago, IL 60018, USA
()
| |
Collapse
|
9
|
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
|
10
|
Class I Obesity Delays Achievement of Patient-Acceptable Symptom State but not Minimum Clinically Important Difference or Substantial Clinical Benefit After Primary Hip Arthroscopy for Femoroacetabular Impingement Syndrome. Arthroscopy 2023:S0749-8063(23)00173-1. [PMID: 36809817 DOI: 10.1016/j.arthro.2023.01.106] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/28/2022] [Revised: 01/16/2023] [Accepted: 01/31/2023] [Indexed: 02/24/2023]
Abstract
PURPOSE The aim of our study was to identify differences in the time taken to achieve the minimum clinically important difference (MCID), substantial clinical benefit (SCB), and patient-acceptable symptom state (PASS) following primary hip arthroscopy for the treatment of femoroacetabular impingement syndrome (FAIS) among patients of different body mass index (BMI) categories. METHODS We conducted a retrospective comparative study of hip arthroscopy patients with minimum 2-year follow-up. BMI categories were defined as normal (18.5 ≤ BMI < 25.0), overweight (25.0 ≤ BMI <30.0), or class I obese (30.0≤BMI<35.0). All subjects completed the modified Harris Hip Score (mHHS) prior to surgery and at 6 months, 1 year, and 2 years postoperative. MCID and SCB cutoffs were defined as pre-to-postoperative increases in mHHS by ≥8.2 and ≥19.8, respectively. PASS cutoff was set at postoperative mHHS ≥74. Time to achievement of each milestone was compared using the interval-censored EMICM algorithm. The effect of BMI was adjusted for age and sex using an interval-censored proportional hazards model. RESULTS 285 patients were included in the analysis: 150 (52.6%) normal BMI, 99 (34.7%) overweight, and 36 (12.6%) obese. Obese patients had lower mHHS at baseline (P = .006) and at 2-year follow-up (P = .008). There were no significant intergroup differences in time to achievement for MCID (P = .92) or SCB (P = .69), but obese patients had longer time to PASS than normal BMI patients (P = .047). Multivariable analysis found obesity to be predictive of longer time to PASS (HR = .55; P = .007) but not MCID (HR = 0.91; P = .68) or SCB (HR = 1.06; P = .30). CONCLUSIONS Class I obesity is associated with delays in achieving a literature-defined PASS threshold after primary hip arthroscopy for FAIS. However, future research should consider incorporating PASS anchor questions to determine whether obesity truly carries a risk of delayed achievement of a satisfactory state of health as it pertains to the hip. LEVEL OF EVIDENCE III, retrospective comparative study.
Collapse
|
11
|
Migliorini F, Baroncini A, Eschweiler J, Knobe M, Tingart M, Maffulli N. Return to sport after arthroscopic surgery for femoroacetabular impingement. Surgeon 2023; 21:21-30. [PMID: 34953722 DOI: 10.1016/j.surge.2021.11.006] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2020] [Accepted: 11/19/2021] [Indexed: 02/03/2023]
Abstract
BACKGROUND Femoroacetabular impingement (FAI) is common among the active and young population. The present study analysed the rate of return to sport, related influencing factors, and the sport activity level according to the Hip Outcome Score - Sport-Specific Subscale (HOS-SSS). METHODS The literature search was performed in December 2020. All clinical trials investigating HOS-SSS and/or return to sport after arthroscopic treatment for FAI were considered for inclusion. The outcomes of interest were to analyse the rate of return to sport and the sport activity level according to the HOS-SSS in patients who underwent arthroscopic osteoplasty for FAI. RESULTS Data from 41 studies (4063 procedures) were retrieved. A total of 88.75% (581 of 655) of patients returned to sports within a mean of 37.4 ± 16.5 months. The HOS-SSS score improved from 45.0 ± 10.6 to 73.1 ± 9.5 (P < 0.0001) at last follow-up. The following baseline characteristics evidenced positive association with post-operative activity level: lighter weight (P = 0.01), younger age (P = 0.001), Tönnis angle grade I (P = 0.009), greater HHS (P = 0.01), NAHS (P < 0.0001) and HOS-ADL (P = 0.01). CONCLUSION Arthroscopic treatment for FAI resulted in excellent results in terms of return to sport. Moreover, lighter weight and younger age, greater HHS, NAHS, HOS-ADL at baseline were positively associated with post-operative sport activity level. LEVEL OF EVIDENCE IV, systematic review.
Collapse
Affiliation(s)
- Filippo Migliorini
- Department of Orthopaedic, Trauma, and Reconstructive Surgery, RWTH Aachen University Hospital, Aachen, Germany.
| | - Alice Baroncini
- Department of Orthopaedic, Trauma, and Reconstructive Surgery, RWTH Aachen University Hospital, Aachen, Germany.
| | - Jörg Eschweiler
- Department of Orthopaedic, Trauma, and Reconstructive Surgery, RWTH Aachen University Hospital, Aachen, Germany.
| | - Matthias Knobe
- Department of Orthopedics and Trauma Surgery, Lucerne Cantonal Hospital, Lucerne, Switzerland.
| | - Markus Tingart
- Department of Orthopaedic, Trauma, and Reconstructive Surgery, RWTH Aachen University Hospital, Aachen, Germany.
| | - Nicola Maffulli
- Department of Medicine, Surgery and Dentistry, University of Salerno, Via S. Allende, 84081 Baronissi, (SA), Italy; School of Pharmacy and Bioengineering, Keele University Faculty of Medicine, Thornburrow Drive, Stoke on Trent, England, United Kingdom; Queen Mary University of London, Barts and the London School of Medicine and Dentistry, Centre for Sports and Exercise Medicine, Mile End Hospital, 275 Bancroft Road, London E1 4DG, England, United Kingdom.
| |
Collapse
|
12
|
Yang F, Huang HJ, Zhang Z, Zhang X, Wang JQ. Hyperlipidemia does not influence clinical outcome in arthroscopic treatment of femoroacetabular impingement syndrome. J Orthop Surg Res 2022; 17:398. [PMID: 36045389 PMCID: PMC9429662 DOI: 10.1186/s13018-022-03290-3] [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: 07/21/2022] [Accepted: 08/15/2022] [Indexed: 11/24/2022] Open
Abstract
Background Cholesterol can trigger degenerative processes in the chondrocytes. The internal layer of the hip labral consists of cartilage-specific type II collagen-positive fibrocartilage. The purpose of this study was to compare outcomes after arthroscopy labral repair in FAIS patients with preoperative hyperlipidemia to a control group with no hyperlipidemia. Methods Data were prospectively collected and retrospectively reviewed for FAIS patients who had arthroscopy 2019. Patients with hyperlipidemia were 1:1 propensity-score matched to patients without hyperlipidemia. Patient-reported outcomes (HOS-ADL, iHOT-12, mHHS), VAS scores, radiographic measures, performed procedures, complications, and revision surgery were compared and analyzed for both groups. Results A total of 41 patients with hyperlipidemia and 41 patients without hyperlipidemia were found using propensity-score matching. When compared to preoperative levels, both groups demonstrated significant improvements in PROs and VAS scores at the final follow-up. Besides, there were no significant differences in preoperative scores and final outcome scores between the groups. Besides, there were no other differences in revision rate and the rate of meeting the PASS and MCID between the study and the control groups. Conclusion It was demonstrated in this study that FAIS patients with hyperlipidemia can expect to experience similar good short-term patient-reported outcomes as compared with patients without hyperlipidemia. Level of evidence Case-series study; Level of Evidence: Level III.
Collapse
Affiliation(s)
- Fan Yang
- Department of Sports Medicine, Beijing Key Laboratory of Sports Injuries, Institute of Sports Medicine of Peking University, Peking University Third Hospital, 49 North Garden Rd., Haidian District, Beijing, 100191, People's Republic of China
| | - Hong-Jie Huang
- Department of Sports Medicine, Beijing Key Laboratory of Sports Injuries, Institute of Sports Medicine of Peking University, Peking University Third Hospital, 49 North Garden Rd., Haidian District, Beijing, 100191, People's Republic of China
| | - Zhu Zhang
- Department of Sports Medicine, Beijing Key Laboratory of Sports Injuries, Institute of Sports Medicine of Peking University, Peking University Third Hospital, 49 North Garden Rd., Haidian District, Beijing, 100191, People's Republic of China
| | - Xin Zhang
- Department of Sports Medicine, Beijing Key Laboratory of Sports Injuries, Institute of Sports Medicine of Peking University, Peking University Third Hospital, 49 North Garden Rd., Haidian District, Beijing, 100191, People's Republic of China.
| | - Jian-Quan Wang
- Department of Sports Medicine, Beijing Key Laboratory of Sports Injuries, Institute of Sports Medicine of Peking University, Peking University Third Hospital, 49 North Garden Rd., Haidian District, Beijing, 100191, People's Republic of China.
| |
Collapse
|
13
|
The minimal clinically important difference for the nonarthritic hip score at 2-years following hip arthroscopy. Knee Surg Sports Traumatol Arthrosc 2022; 30:2419-2423. [PMID: 34738159 DOI: 10.1007/s00167-021-06756-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/15/2020] [Accepted: 09/27/2021] [Indexed: 10/19/2022]
Abstract
PURPOSE The purpose of this study was to determine and establish the MCID for the NAHS at 2 years in patients undergoing hip arthroscopy for femoroacetabular impingement syndrome (FAIS). METHODS Patients that underwent primary hip arthroscopy for FAIS between 2010 and 2016 were analyzed for eligibility. Data were collected from a single surgeon's hip arthroscopy database. MCID was calculated for the NAHS utilizing a distribution-based method. RESULTS The study included 298 patients (184 females) with an average age of 40.4 ± 13.0 years and average body mass index (BMI) of 25.7 ± 4.2 kg/m2. At baseline, the cohort's average NAHS score was 48.7 ± 13.6 and demonstrated an improvement of 36.5 ± 17.0 for NAHS at follow-up. This resulted in MCID values of + 8.5 for NAHS. CONCLUSION This is the first study to report the MCID (+ 8.5) for NAHS following primary hip arthroscopy, and as such, is a valuable contribution to future hip arthroscopy research. LEVEL OF EVIDENCE IV.
Collapse
|
14
|
Robinson PG, Lu H, Williamson T, Maempel JF, Murray I, MacDonald DJ, Hamilton DF, Gaston P. Do the outcomes of hip arthroscopy for femoroacetabular impingement change over time? Orthop Traumatol Surg Res 2022; 108:103157. [PMID: 34856404 DOI: 10.1016/j.otsr.2021.103157] [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: 03/03/2021] [Revised: 11/05/2021] [Accepted: 11/23/2021] [Indexed: 02/03/2023]
Abstract
BACKGROUND The purpose of this study was to search for changes in functional outcomes of patients undergoing hip arthroscopy for femoroacetabular impingement (FAI) between short and medium-term follow-up. Secondary aims included reporting rates of revision surgery and total hip arthroplasty (THA) at medium-term follow-up. HYPOTHESIS We hypothesised that patients' functional outcomes would improve between short and medium-term follow-up. PATIENTS AND METHODS Consecutive patients undergoing hip arthroscopy with a diagnosis of femoroacetabular impingement with labral tears between February 2013 and June 2015 were included. Twelve item international hip outcome tool (iHOT-12) and EuroQol 5D-5L (EQ-5D) scores were collected preoperatively, at short-term and medium-term follow-up. Short-term scores were recorded at a minimum of one year postoperatively and medium-term scores at a minimum of five years postoperatively. Survivorship was assessed with Kaplan-Meier analysis. RESULTS Short-term outcome data (at median follow-up 1.6 year, Interquartile range [IQR] 1-2.5) was available for 70 of 87 patients (80.5%) and medium-term outcome data (at median follow-up of 6.5 years, IQR 6-7.1) was available for 68 patients (78.2%). Median age at the time of surgery was 31 years (IQR 25-37). The median iHOT-12 scores at short and medium-term follow-up were 72 (IQR 48.75-91.25) and 85.8 (IQR 66.7-96.7) respectively (p<0.001). Medium-term survivorship was 91.2%. Survivorship following labral repair was 94.2%, and 81.3% following labral debridement (p=0.09). DISCUSSION Patients undergoing hip arthroscopy for FAI reported continued improvement in iHOT-12 scores between short and medium-term follow-up. Medium-term survivorship following FAI surgery may be greater when the labrum is repaired, although comparisons are limited by their differing indications. Conversion to THA was low with just 4 patients (4.6%) undergoing or being listed for THA at final follow-up. LEVEL OF EVIDENCE IV, Case series.
Collapse
Affiliation(s)
| | - Helen Lu
- Edinburgh Medical School, The University of Edinburgh, Edinburgh, UK
| | - Tom Williamson
- Edinburgh Medical School, The University of Edinburgh, Edinburgh, UK
| | - Julian F Maempel
- Department of Trauma & Orthopaedics, Mater Dei Hospital, Msida, Malta
| | - Iain Murray
- Edinburgh Orthopaedics, Royal Infirmary of Edinburgh, Edinburgh, UK
| | | | - David F Hamilton
- Edinburgh Orthopaedics, Royal Infirmary of Edinburgh, Edinburgh, UK
| | - Paul Gaston
- Edinburgh Orthopaedics, Royal Infirmary of Edinburgh, Edinburgh, UK
| |
Collapse
|
15
|
Kunze KN, Polce EM, Clapp IM, Alter T, Nho SJ. Association Between Preoperative Patient Factors and Clinically Meaningful Outcomes After Hip Arthroscopy for Femoroacetabular Impingement Syndrome: A Machine Learning Analysis. Am J Sports Med 2022; 50:746-756. [PMID: 35006010 DOI: 10.1177/03635465211067546] [Citation(s) in RCA: 15] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND The International Hip Outcome Tool 12-Item Questionnaire (IHOT-12) has been proposed as a more appropriate outcome assessment for hip arthroscopy populations. The extent to which preoperative patient factors predict achieving clinically meaningful outcomes among patients undergoing hip arthroscopy for femoroacetabular impingement syndrome (FAIS) remains poorly understood. PURPOSE To determine the predictive relationship of preoperative imaging, patient-reported outcome measures, and patient demographics with achievement of the minimal clinically important difference (MCID), Patient Acceptable Symptom State (PASS), and substantial clinical benefit (SCB) for the IHOT-12 at a minimum of 2 years postoperatively. STUDY DESIGN Case-control study; Level of evidence, 3. METHODS Data were analyzed for consecutive patients who underwent hip arthroscopy for FAIS between 2012 and 2018 and completed the IHOT-12 preoperatively and at a minimum of 2 years postoperatively. Fifteen novel machine learning algorithms were developed using 47 potential demographic, clinical, and radiographic predictors. Model performance was evaluated with discrimination, calibration, decision-curve analysis and the brier score. RESULTS A total of 859 patients were identified, with 685 (79.7%) achieving the MCID, 535 (62.3%) achieving the PASS, and 498 (58.0%) achieving the SCB. For predicting the MCID, discrimination for the best-performing models ranged from fair to excellent (area under the curve [AUC], 0.69-0.89), although calibration was excellent (calibration intercept and slopes: -0.06 to 0.02 and 0.24 to 0.85, respectively). For predicting the PASS, discrimination for the best-performing models ranged from fair to excellent (AUC, 0.63-0.81), with excellent calibration (calibration intercept and slopes: 0.03-0.18 and 0.52-0.90, respectively). For predicting the SCB, discrimination for the best-performing models ranged from fair to good (AUC, 0.61-0.77), with excellent calibration (calibration intercept and slopes: -0.08 to 0.00 and 0.56 to 1.02, respectively). Thematic predictors for failing to achieve the MCID, PASS, and SCB were presence of back pain, anxiety/depression, chronic symptom duration, preoperative hip injections, and increasing body mass index (BMI). Specifically, thresholds associated with lower likelihood to achieve a clinically meaningful outcome were preoperative Hip Outcome Score-Activities of Daily Living <55, preoperative Hip Outcome Score-Sports Subscale >55.6, preoperative IHOT-12 score ≥48.5, preoperative modified Harris Hip Score ≤51.7, age >41 years, BMI ≥27, and preoperative α angle >76.6°. CONCLUSION We developed novel machine learning algorithms that leveraged preoperative demographic, clinical, and imaging-based features to reliably predict clinically meaningful improvement after hip arthroscopy for FAIS. Despite consistent improvements after hip arthroscopy, meaningful improvements are negatively influenced by greater BMI, back pain, chronic symptom duration, preoperative mental health, and use of hip corticosteroid injections.
Collapse
Affiliation(s)
- Kyle N Kunze
- Department of Orthopedic Surgery, Hospital for Special Surgery, New York, New York, USA
| | - Evan M Polce
- University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin, USA
| | - Ian Michael Clapp
- Department of Orthopedic Surgery, Division of Sports Medicine, Rush University Medical Center, Chicago, Illinois, USA
| | - Thomas Alter
- Department of Orthopedic Surgery, Division of Sports Medicine, Rush University Medical Center, Chicago, Illinois, USA
| | - Shane J Nho
- Department of Orthopedic Surgery, Division of Sports Medicine, Rush University Medical Center, Chicago, Illinois, USA
| |
Collapse
|
16
|
Migliorini F, Maffulli N, Baroncini A, Eschweiler J, Tingart M, Betsch M. Revision Surgery and Progression to Total Hip Arthroplasty After Surgical Correction of Femoroacetabular Impingement: A Systematic Review. Am J Sports Med 2022; 50:1146-1156. [PMID: 34081552 PMCID: PMC8980457 DOI: 10.1177/03635465211011744] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND Femoroacetabular impingement (FAI) is a major cause of hip pain in young adults and athletes. Surgical treatment of FAI is recommended in cases of failed nonoperative treatment that have the typical clinical and radiographic findings. At present, the role of risk factors for revision surgery and progression to total hip arthroplasty (THA) in patients with FAI is still unclear. PURPOSE To investigate the possible association between (1) rate of revision and progression to THA and (2) patient characteristics, type of lesion, family history of hip disease, type of intervention, radiographic parameters, physical examination, and pre- and postoperative scores. STUDY DESIGN Systematic review; Level of evidence, 4. METHODS The present systematic review was performed according to the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines. In October 2020, the main online databases were accessed. All articles concerning surgical correction for selected patients with FAI were accessed. Patient characteristics, type of intervention, radiographic parameters, physical examination, and pre- and postoperative scores were assessed. The outcomes of interest were the possible association between these variables and the rate of revision and subsequent progression to THA using a multivariate analysis through the Pearson product-moment correlation coefficient. RESULTS Data from 99 studies (9357 procedures) were collected. The median follow-up was 30.9 months (interquartile range, 24.0-45.0). The mean ± SD age was 33.4 ± 9.3 years; mean body mass index (BMI), 24.8 ± 4.8; percentage right side, 55.8% ± 8.0%; and percentage female sex, 47.5% ± 20.4%. The overall rate of revision was 5.29% (351 of 6641 patients), while the rate of subsequent progression to THA was 3.78% (263 of 6966 patients). Labral debridement (P < .0001), preoperative acetabular index (P = .01), and BMI (P = .03) all showed evidence of a statistically positive association with increased rates of THA. No other statistically significant associations were found between patient characteristics, type of lesion, family history of hip disease, type of intervention, radiographic parameters, physical examination, or pre- and postoperative scores and the rate of revision and/or progression to THA. CONCLUSION Although surgical procedures to treat FAI led to satisfactory outcomes, there was a revision rate of 5.29% in the 9357 procedures in the present systematic review. The rate of progression to THA after a median follow-up of 30 months was 3.78%. Patients who have a higher BMI and/or have a pathologic acetabular index and/or undergo labral debridement during correction of FAI are more at risk for a subsequent THA. We advocate additional education of this patient population in terms of expected outcomes and suggest surgical labral repair instead of debridement if needed.
Collapse
Affiliation(s)
- Filippo Migliorini
- Department of Orthopedics and Trauma Surgery, RWTH Aachen University Clinic, Aachen, Germany,Filippo Migliorini, MD, MBA, Orthopaedics and Trauma Surgery, RWTH Aachen University Clinic, Pauwelsstraße 30, Aachen, 52074, Germany ()
| | - Nicola Maffulli
- Department of Medicine, Surgery and Dentistry, University of Salerno, Baronissi, Italy,Queen Mary University of London, Barts and the London School of Medicine and Dentistry, Centre for Sports and Exercise Medicine, Mile End Hospital, London, UK,School of Pharmacy and Bioengineering, Faculty of Medicine, Keele University, Stoke on Trent, UK
| | - Alice Baroncini
- Department of Orthopedics and Trauma Surgery, RWTH Aachen University Clinic, Aachen, Germany
| | - Jörg Eschweiler
- Department of Orthopedics and Trauma Surgery, RWTH Aachen University Clinic, Aachen, Germany
| | - Markus Tingart
- Department of Orthopedics and Trauma Surgery, RWTH Aachen University Clinic, Aachen, Germany
| | - Marcel Betsch
- Department of Orthopaedics and Trauma Surgery, University Medical Centre Mannheim of the University Heidelberg, Mannheim, Germany
| |
Collapse
|
17
|
Jimenez AE, Fox JD, Monahan PF, Lee MS, George T, Maldonado DR, Saks BR, Lall AC, Domb BG. High Body Mass Index Does Not Adversely Affect Outcomes in High-Level Athletes Undergoing Primary Hip Arthroscopy: A Propensity-Matched Comparison With Minimum 2-Year Follow-up. Am J Sports Med 2022; 50:507-514. [PMID: 35049397 DOI: 10.1177/03635465211062910] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND The effect of high body mass index (BMI) on outcomes in athletes has not been established. PURPOSE (1) To report minimum 2-year patient-reported outcome (PRO) scores and return to sports (RTS) for high-level athletes with high BMI undergoing hip arthroscopy for femoroacetabular impingement syndrome (FAIS) and (2) to compare results with a propensity-matched control group of high-level athletes with a normal BMI. STUDY DESIGN Cohort study; Level of evidence, 3. METHODS Data were collected on all professional, collegiate, and high school athletes who had a high BMI (>30) and who had undergone primary hip arthroscopy for FAIS between January 2010 and December 2018. RTS status and minimum 2-year PROs were collected for the modified Harris Hip Score (mHHS), Non-Arthritic Hip Score (NAHS), Hip Outcome Score-Sports Specific Subscale (HOS-SSS), and visual analog scale (VAS) for pain. The percentage of patients achieving the minimal clinically important difference (MCID) and Patient Acceptable Symptom State (PASS) were also recorded. These patients were propensity matched in a 1:3 ratio to high-level athletes with a normal BMI for comparison. RESULTS A total of 30 high-level athletes with a high BMI were included with a mean follow-up of 49.4 ± 29.5 months. They demonstrated significant improvement from preoperatively to latest follow-up for mHHS, NAHS, HOS-SSS, and VAS (P < .001). When outcomes were compared with a propensity-matched control group of 90 athletes with a normal BMI, athletes with a high BMI had worse acetabular cartilage injury and were more likely to undergo acetabular microfracture (P < .001). Athletes with a high BMI demonstrated lower postoperative scores for NAHS when compared with athletes with a normal BMI (88.06 ± 9.37 [range, 60-100] and 90.25 ± 10.79 [range, 48.75-100], respectively; P = .049). Athletes with a high BMI also demonstrated worse postoperative scores for HOS-SSS when compared with athletes with a normal BMI (77.22 ± 18.31 [range, 22.22-100] and 82.38 ± 22.79 [range, 2.78-100], respectively; P = .038). Rates of achieving MCID for the high-BMI and normal-BMI groups were comparable in mHHS (90.0% and 77.8%, respectively; P = .185) and HOS-SSS (90.0% and 82.2%, respectively; P = .397). PASS rates were also comparable between the high- and normal-BMI groups for mHHS (90.0% and 87.8%, respectively; P > .999) and HOS-SSS (70.0% and 71.1%, respectively; P = .908). Athletes with a high BMI also returned to sports at a lower rate compared with athletes with a normal BMI, but this did not reach statistical significance (P = .479). CONCLUSION Athletes with a high BMI undergoing primary hip arthroscopy for FAIS demonstrated significant improvement in PROs and favorable rates achieving clinically meaningful improvement. When compared with a control group of high-level athletes with a normal BMI, they exhibited similar rates of achieving psychometric thresholds and RTS rates. At short-term follow-up, high BMI did not adversely affect outcomes of high-level athletes undergoing primary hip arthroscopy.
Collapse
Affiliation(s)
- Andrew E Jimenez
- American Hip Institute Research Foundation, Chicago, Illinois, USA
| | - James D Fox
- American Hip Institute Research Foundation, Chicago, Illinois, USA
| | - Peter F Monahan
- American Hip Institute Research Foundation, Chicago, Illinois, USA
| | - Michael S Lee
- American Hip Institute Research Foundation, Chicago, Illinois, USA
| | - Tom George
- American Hip Institute Research Foundation, Chicago, Illinois, USA
| | | | - Benjamin R Saks
- American Hip Institute Research Foundation, Chicago, Illinois, USA.,AMITA Health St Alexius Medical Center, Hoffman Estates, Illinois, USA
| | - Ajay C Lall
- American Hip Institute Research Foundation, Chicago, Illinois, USA.,American Hip Institute, Chicago, Illinois, USA.,AMITA Health St Alexius Medical Center, Hoffman Estates, Illinois, USA
| | - Benjamin G Domb
- American Hip Institute Research Foundation, Chicago, Illinois, USA.,American Hip Institute, Chicago, Illinois, USA.,AMITA Health St Alexius Medical Center, Hoffman Estates, Illinois, USA
| |
Collapse
|
18
|
Jimenez AE, Glein RM, Owens JS, George T, Maldonado DR, Saks BR, Lall AC, Domb BG. Low Body Mass Index in Females May Portend Inferior Outcomes After Primary Hip Arthroscopy: A Propensity-Matched Analysis With Minimum 2-Year Follow-up. Am J Sports Med 2022; 50:499-506. [PMID: 35049391 DOI: 10.1177/03635465211063189] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND There is a paucity of literature evaluating the effect of low body mass index (BMI) in female patients undergoing primary hip arthroscopy. PURPOSE (1) To report minimum 2-year patient-reported outcome scores for female patients with low BMI who underwent primary hip arthroscopy for femoroacetabular impingement syndrome and (2) to compare these results with a propensity-matched control group of female patients with normal BMI. STUDY DESIGN Cohort study; Level of evidence, 3. METHODS Data were collected on all female patients who had low BMI (<18.5) and underwent primary hip arthroscopy between April 2008 and January 2019. Patients were excluded if they had a previous hip arthroscopy; had workers' compensation; were unwilling to participate in the study; or had Tönnis osteoarthritis grade >1, acetabular dysplasia, or a previous hip condition. Minimum 2-year patient-reported outcomes were collected for the modified Harris Hip Score (mHHS), Non-Arthritic Hip Score, Hip Outcome Score-Sport Specific Subscale (HOS-SSS), visual analog scale for pain, and satisfaction. The percentage of patients achieving the minimal clinically important difference (MCID), Patient Acceptable Symptom State (PASS), and maximum outcome improvement satisfaction threshold (MOIST) was also recorded. These patients were propensity matched in a 1:2 ratio to female patients with normal BMI for comparison. RESULTS A total of 43 patients (49 hips) were included with a mean ± SD follow-up of 26.9 ± 8.3 months, age of 24.1 ± 12.6 years, and BMI of 17.7 ± 0.67. These patients demonstrated significant improvement from presurgery to minimum 2-year follow-up for the mHHS, Non-Arthritic Hip Score, HOS-SSS, and visual analog scale (P < .05). When outcomes were compared with 93 control patients (97 hips), female patients with low BMI demonstrated lower rates of achieving the PASS for the mHHS (61.2% vs 77.3%; P = .041) and HOS-SSS (39.5% vs 57.1%; P = .031). Rates of achieving the MCID and MOIST were similar between the groups (P > .05). Female patients with low BMI also had higher rates of revision when compared with the control group, but this did not reach statistical significance (14.2% vs 7.2%; P = .171). CONCLUSION Female patients with low BMI undergoing primary hip arthroscopy for femoroacetabular impingement syndrome demonstrated significant improvement in patient-reported outcomes at minimum 2-year follow-up. When compared with a propensity-matched control group with normal BMI, these patients demonstrated lower rates of achieving the PASS for the mHHS and HOS-SSS. Low BMI in females undergoing primary hip arthroscopy for FAIS may adversely affect outcomes at short-term follow-up.
Collapse
Affiliation(s)
- Andrew E Jimenez
- American Hip Institute Research Foundation, Chicago, Illinois, USA
| | - Rachel M Glein
- American Hip Institute Research Foundation, Chicago, Illinois, USA
| | - Jade S Owens
- American Hip Institute Research Foundation, Chicago, Illinois, USA
| | - Tom George
- American Hip Institute Research Foundation, Chicago, Illinois, USA
| | | | - Benjamin R Saks
- American Hip Institute Research Foundation, Chicago, Illinois, USA.,AMITA Health St Alexius Medical Center, Hoffman Estates, Illinois, USA
| | - Ajay C Lall
- American Hip Institute Research Foundation, Chicago, Illinois, USA.,AMITA Health St Alexius Medical Center, Hoffman Estates, Illinois, USA.,American Hip Institute, Chicago, Illinois, USA
| | - Benjamin G Domb
- American Hip Institute Research Foundation, Chicago, Illinois, USA.,AMITA Health St Alexius Medical Center, Hoffman Estates, Illinois, USA.,American Hip Institute, Chicago, Illinois, USA
| |
Collapse
|
19
|
Martin SD, Kucharik MP, Abraham PF, Nazal MR, Meek WM, Varady NH. Functional Outcomes of Arthroscopic Acetabular Labral Repair with and without Bone Marrow Aspirate Concentrate. J Bone Joint Surg Am 2022; 104:4-14. [PMID: 34648479 DOI: 10.2106/jbjs.20.01740] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND Osteoarthritis (OA) of the hip is a debilitating condition associated with inferior outcomes in patients undergoing hip arthroscopy. To provide symptom relief and improve outcomes in these patients, bone marrow aspirate concentrate (BMAC) has been applied as an adjuvant therapy with the hope of halting progression of cartilage damage. The current study examined the clinical efficacy of BMAC application in patients undergoing arthroscopic acetabular labral repair by comparing patient-reported outcome measures (PROMs) between groups with and without BMAC application. METHODS Patients who received BMAC during arthroscopic acetabular labral repair from December 2016 to June 2019 were compared with a control cohort that underwent the same procedure but did not receive BMAC from November 2013 to November 2016. Patients in both cohorts were asked to prospectively complete PROMs prior to surgery and at 3, 6, 12, and 24-month follow-up intervals; those who completed the PROMs at enrollment and the 12-month follow-up were included in the study. An a priori subgroup analysis was performed among patients with moderate cartilage damage (Outerbridge grade 2 or 3). The analyses were adjusted for any differences in baseline factors between groups. RESULTS Sixty-two patients with BMAC application were compared with 62 control patients without BMAC application. When compared with the no-BMAC cohort, the BMAC cohort did not report significantly different mean International Hip Outcome Tool-33 (iHOT-33) scores at any postoperative time point. However, when patients with moderate cartilage damage were compared across groups, the BMAC cohort reported significantly greater mean (95% confidence interval) scores than the no-BMAC cohort at the 12-month (78.6 [72.4 to 84.8] versus 69.2 [63.3 to 75.2]; p = 0.035) and 24-month (82.5 [73.4 to 91.6] versus 69.5 [62.1 to 76.8]; p = 0.030) follow-up. Similarly, these patients reported greater score improvements at 12 months (37.3 [30.3 to 44.3] versus 25.4 [18.7 to 32.0]; p = 0.017) and 24 months (39.6 [30.4 to 48.7] versus 26.4 [19.1 to 33.8]; p = 0.029). CONCLUSIONS Patients with moderate cartilage injury undergoing arthroscopic acetabular labral repair with BMAC application reported significantly greater functional improvements when compared with similar patients without BMAC application. LEVEL OF EVIDENCE Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence.
Collapse
Affiliation(s)
- Scott D Martin
- Sports Medicine, Department of Orthopedic Surgery, Massachusetts General Hospital, Mass General Brigham Integrated Health Care System, Boston, Massachusetts
| | - Michael P Kucharik
- Sports Medicine, Department of Orthopedic Surgery, Massachusetts General Hospital, Mass General Brigham Integrated Health Care System, Boston, Massachusetts
| | - Paul F Abraham
- Department of Orthopaedic Surgery, University of Southern California, Los Angeles, California
| | - Mark R Nazal
- Department of Orthopedic Surgery, University of Kentucky, Lexington, Kentucky
| | - Wendy M Meek
- Sports Medicine, Department of Orthopedic Surgery, Massachusetts General Hospital, Mass General Brigham Integrated Health Care System, Boston, Massachusetts
| | | |
Collapse
|
20
|
Jimenez AE, Monahan PF, Owens JS, Maldonado DR, Saks BR, Ankem HK, Sabetian PW, Lall AC, Domb BG. Clinical Outcomes and Reoperation Rates After Hip Arthroscopy in Female Athletes With Low Versus Normal Body Mass Index: A Propensity-Matched Comparison With Minimum 2-Year Follow-up. Am J Sports Med 2022; 50:58-67. [PMID: 34817243 DOI: 10.1177/03635465211055175] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND The effect of low body mass index (BMI) on outcomes in female athletes is unknown. PURPOSE (1) To report minimum 2-year patient-reported outcomes and return to sports for high-level female athletes with low BMI undergoing hip arthroscopy for femoroacetabular impingement syndrome and (2) to compare results with those of a propensity-matched control group of high-level female athletes with a normal BMI. STUDY DESIGN Cohort study; Level of evidence, 3. METHODS Data were collected on all professional, collegiate, and high school female athletes who had a low BMI and underwent primary hip arthroscopy between September 2009 and March 2017 at our institute. Return-to-sports status and minimum 2-year patient-reported outcomes were collected for the modified Harris Hip Score (mHHS), Nonarthritic Hip Score, Hip Outcome Score-Sport Specific Subscale, and visual analog scale (VAS) for pain. The percentage of patients achieving the minimal clinically important difference (MCID), Patient Acceptable Symptom State (PASS), and maximum outcome improvement satisfaction threshold (MOIST) was also recorded. These patients were propensity matched to high-level female athletes with a normal BMI for comparison. RESULTS A total of 21 high-level female athletes (25 hips) with a mean ± SD follow-up of 58.9 ± 31.5 months were included. They demonstrated significant improvement from preoperatively to latest follow-up for the mHHS, Nonarthritic Hip Score, Hip Outcome Score-Sport Specific Subscale, and VAS (P < .001). When outcomes were compared with those of the control group, female athletes with low BMI demonstrated lower rates of achieving the MCID for the mHHS (54.5% vs 77.4%; P = .041), PASS for the International Hip Outcome Tool-12 (45.5% vs 72.6%; P = .022), and MOIST for the VAS (31.8% vs 56.5%; P = .047). There were no other significant differences in the rate of achieving the MCID, PASS, or MOIST between the groups (P > .05). Female athletes with low BMI also had higher rates of revision when compared with the control group (27.2% vs 10.6%; P = .049), but there were comparable return-to-sports rates (75.0% vs 74.5%; P > .05). CONCLUSION High-level female athletes with low BMI undergoing primary hip arthroscopy for femoroacetabular impingement syndrome demonstrated significant improvement in patient-reported outcomes and acceptable rates of return to play. When compared with a control group with normal BMI, they exhibited higher rates of revision and lower rates of achieving the MCID for the mHHS, PASS for the International Hip Outcome Tool-12, and MOIST for the VAS.
Collapse
Affiliation(s)
- Andrew E Jimenez
- American Hip Institute Research Foundation, Chicago, Illinois, USA
| | - Peter F Monahan
- American Hip Institute Research Foundation, Chicago, Illinois, USA
| | - Jade S Owens
- American Hip Institute Research Foundation, Chicago, Illinois, USA
| | | | - Benjamin R Saks
- American Hip Institute Research Foundation, Chicago, Illinois, USA.,AMITA Health St Alexius Medical Center, Hoffman Estates, Illinois, USA
| | - Hari K Ankem
- American Hip Institute Research Foundation, Chicago, Illinois, USA
| | - Payam W Sabetian
- American Hip Institute Research Foundation, Chicago, Illinois, USA
| | - Ajay C Lall
- American Hip Institute Research Foundation, Chicago, Illinois, USA.,AMITA Health St Alexius Medical Center, Hoffman Estates, Illinois, USA.,American Hip Institute, Chicago, Illinois, USA
| | - Benjamin G Domb
- American Hip Institute Research Foundation, Chicago, Illinois, USA.,AMITA Health St Alexius Medical Center, Hoffman Estates, Illinois, USA.,American Hip Institute, Chicago, Illinois, USA
| |
Collapse
|
21
|
Browning RB, Clapp IM, Alter TD, Nwachukwu BU, Nho SJ. Pain Catastrophizing and Kinesiophobia Affect Return to Sport in Patients Undergoing Hip Arthroscopy for the Treatment of Femoroacetabular Impingement. Arthrosc Sports Med Rehabil 2021; 3:e1087-e1095. [PMID: 34430888 PMCID: PMC8365207 DOI: 10.1016/j.asmr.2021.03.014] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2020] [Accepted: 03/30/2021] [Indexed: 11/25/2022] Open
Abstract
Purpose To assess whether pain catastrophizing and kinesiophobia affect return to sport (RTS) or clinically significant outcome (CSO) achievement in patients undergoing hip arthroscopy for the treatment of femoroacetabular impingement (FAI). Methods Patients undergoing primary hip arthroscopy at a single institution between January 2017 and March 2017 were prospectively enrolled. Patients received the Tampa Scale of Kinesiophobia-11 (TSK-11) and Pain Catastrophizing Scale (PCS) questionnaires preoperatively, 3 weeks, 6 weeks, 3 months, 6 months, and 1 year postoperatively. Patients also received the Hip Outcome Score Sport-Specific (HOS-SS) questionnaire preoperatively and 1 year and 2 years' postoperatively. An RTS questionnaire was completed at final follow-up. Bivariate correlations were conducted between PCS and TSK-11 scores and RTS status and achievement of CSOs of HOS-SS, based on patient acceptable symptom state (PASS) and substantial clinical benefit (SCB). Results Fifty-eight patients with an average age of 31.9 ± 12.2 and body mass index of 24.0 ± 3.8 participated in sport prior to surgery and were included in the study. Forty-two (72.4%) patients returned to sport at 10.5 ± 7.1 months following surgery. There was a significant reduction in TSK-11 and PCS scores at 1-year follow-up (TSK-11, 26.1 ± 6.0 vs 18.6 ± 6.1, P < .001; PCS, 17.7 ± 10.5 vs 4.3 ± 6.8, P < .001) as well as a significant improvement in HOS-SS (P < .001). At 1 year, fair correlations were demonstrated between PCS (r = -0.446, P = .010) and TSK (r = -0.330, P = .029) scores and RTS. Patient who returned to sport had lower PCS (8.5 ± 11.7 vs 3.0 ± 3.7, P = .010) and TSK-11 (21.8 ± 8.5 vs 17.6 ± 4.8, P = .029) scores at 1 year. At 1-year follow-up, PCS (r = -0.572, P = .001) and TSK-11 (r = -0.441, P = .012) scores demonstrated fair correlations with achieving PASS for HOS-SS at 2-year follow-up. Conclusions Patient kinesiophobia and pain catastrophizing at 1-year follow-up were negatively correlated with RTS and achievement of a CSO in sport-related activities at 2-year follow-up. Level of Evidence III, prospective cohort study.
Collapse
Affiliation(s)
- Robert B Browning
- Section of Young Adult Hip Surgery, Division of Sports Medicine, Department of Orthopedic Surgery, Hip Preservation Center, Rush University Medical Center, Chicago, Illinois, U.S.A
| | - Ian M Clapp
- Section of Young Adult Hip Surgery, Division of Sports Medicine, Department of Orthopedic Surgery, Hip Preservation Center, Rush University Medical Center, Chicago, Illinois, U.S.A
| | - Thomas D Alter
- Section of Young Adult Hip Surgery, Division of Sports Medicine, Department of Orthopedic Surgery, Hip Preservation Center, Rush University Medical Center, Chicago, Illinois, U.S.A
| | - Benedict U Nwachukwu
- Department of Orthopaedic Surgery, Hospital for Special Surgery, New York, New York, U.S.A
| | - Shane J Nho
- Section of Young Adult Hip Surgery, Division of Sports Medicine, Department of Orthopedic Surgery, Hip Preservation Center, Rush University Medical Center, Chicago, Illinois, U.S.A
| |
Collapse
|
22
|
Annin S, Lall AC, Yelton MJ, Shapira J, Rosinsky PJ, Meghpara MB, Maldonado DR, Ankem H, Domb BG. Patient-Reported Outcomes in Athletes Following Hip Arthroscopy for Femoroacetabular Impingement With Subanalysis on Return to Sport and Performance Level: A Systematic Review. Arthroscopy 2021; 37:2657-2676. [PMID: 33887407 DOI: 10.1016/j.arthro.2021.03.064] [Citation(s) in RCA: 23] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/28/2020] [Revised: 03/25/2021] [Accepted: 03/29/2021] [Indexed: 02/02/2023]
Abstract
PURPOSE To identify present trends in demographics, surgical indications, preoperative findings, and surgical treatment of athletes undergoing hip arthroscopy for femoroacetabular impingement and (2) to investigate the outcomes in this patient population, including patient-reported outcome scores (PROS), return-to-sport, complications, and reoperation data at minimum 2-year follow-up in the athletic population. METHODS Cochrane, Embase, and PubMed databases were searched according to the Preferred Reporting Items for Systematic Reviews and Meta-analyses guidelines to distinguish articles that reported PROS after hip arthroscopy in athletes. Athletes were defined as anyone who played a sport for minimum 2 years at any level. The standardized mean difference was calculated to compare the effect size of hip arthroscopy on various PROS. RESULTS Eighteen studies, with 904 athlete hips and a collective study period of January 1993 to April 2017, were included in this systematic review. Across all studies, the mean age and body mass index ranged from 15.7-36.7 years and 20.3-26.3, respectively. The follow-up range was 24-240 months. Mean preoperative alpha angle ranged from 57.7° to 80.0°. Athletes most commonly underwent femoroplasty and labral management. At latest follow-up, the modified Harris Hip Score were excellent in 6 studies (range, 92.1-98), good in 10 studies (range, 84.2-88.5), and fair in 1 study (77.1). Each studies' individual athletic cohort showed significant improvement on the modified Harris Hip Score, Nonarthritic Hip Score, the Hip Outcome Score-Activities of Daily Living, the Hip Outcome Score-Sport-Specific Subscale, visual analog scale for pain, and International Hip Outcome Tool at latest follow-up (P < .05). The return-to-sport rate ranged from 72.7% to 100%, with 74.2-100% of these athletes returning to preinjury or greater level. CONCLUSIONS Athletes undergoing arthroscopic hip surgery in the setting of femoroacetabular impingement, not only exhibit significant functional improvement, but also have a high rate of return to sport at the same or greater competition level compared with preinjury level. LEVEL OF EVIDENCE IV, systematic review of Level III and IV studies.
Collapse
Affiliation(s)
- Shawn Annin
- American Hip Institute Research Foundation, Chicago
| | - Ajay C Lall
- American Hip Institute Research Foundation, Chicago; AMITA Health St. Alexius Medical Center, Hoffman Estates; American Hip Institute, Chicago, Illinois, U.S.A
| | | | | | | | - Mitchell B Meghpara
- American Hip Institute Research Foundation, Chicago; AMITA Health St. Alexius Medical Center, Hoffman Estates
| | | | - Hari Ankem
- American Hip Institute Research Foundation, Chicago
| | - Benjamin G Domb
- American Hip Institute Research Foundation, Chicago; AMITA Health St. Alexius Medical Center, Hoffman Estates; American Hip Institute, Chicago, Illinois, U.S.A..
| |
Collapse
|
23
|
Migliorini F, Liu Y, Catalano G, Trivellas A, Eschweiler J, Tingart M, Maffulli N. Medium-term results of arthroscopic treatment for femoroacetabular impingement. Br Med Bull 2021; 138:68-84. [PMID: 33454746 DOI: 10.1093/bmb/ldaa038] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/16/2020] [Revised: 05/16/2020] [Accepted: 10/24/2020] [Indexed: 11/14/2022]
Abstract
INTRODUCTION Femoroacetabular impingement (FAI) is a dynamic pathomechanical process of the femoral head-neck junction. Arthroscopic surgery for FAI has increased exponentially in the last decade, and this trend is expected to increase. SOURCE OF DATA Recent published literatures. AREAS OF AGREEMENT FAI promotes quick rehabilitation and low complication rates in the short-term follow-up. AREAS OF CONTROVERSY Despite the growing interest on arthroscopic surgery for FAI, current evidence regarding the medium- and long-term role of arthroscopy are unsatisfactory. GROWING POINTS Systematically summarize current evidences, analyse the quantitative available data and investigate the medium- and long-term outcomes of arthroscopic surgery for FAI. AREAS TIMELY FOR DEVELOPING RESEARCH Arthroscopic surgery achieves very satisfactory outcomes for patients with FAI at a mean follow-up of 4 years.
Collapse
Affiliation(s)
- Filippo Migliorini
- Department of Orthopaedics, University Clinic Aachen, RWTH Aachen University Clinic, 52074 Aachen, Germany
| | - Yu Liu
- Department of Orthopaedics, University Clinic Aachen, RWTH Aachen University Clinic, 52074 Aachen, Germany
| | - Giovanni Catalano
- Department of Orthopaedics, University Clinic Aachen, RWTH Aachen University Clinic, 52074 Aachen, Germany
| | - Andromahi Trivellas
- Department of Orthopaedics, David Geffen School of Medicine at UCLA, 90095 Los Angeles, CA, USA
| | - Jörg Eschweiler
- Department of Orthopaedics, University Clinic Aachen, RWTH Aachen University Clinic, 52074 Aachen, Germany
| | - Markus Tingart
- Department of Orthopaedics, University Clinic Aachen, RWTH Aachen University Clinic, 52074 Aachen, Germany
| | - Nicola Maffulli
- Department of Medicine, Surgery and Dentistry, University of Salerno, Via S. Allende, Baronissi, SA 84081, Italy.,School of Pharmacy and Bioengineering, Keele University School of Medicine, Thornburrow Drive, ST5 5BG Stoke on Trent, UK.,Queen Mary University of London, Barts and the London School of Medicine and Dentistry, Centre for Sports and Exercise Medicine, Mile End Hospital, 275 Bancroft Road, E1 4DG London, UK
| |
Collapse
|
24
|
Obesity is associated with less favorable outcomes following hip arthroscopic surgery: a systematic review and meta-analysis. Knee Surg Sports Traumatol Arthrosc 2021; 29:1483-1493. [PMID: 33474626 DOI: 10.1007/s00167-021-06435-9] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/20/2020] [Accepted: 01/05/2021] [Indexed: 01/20/2023]
Abstract
PURPOSE The aim of this study was to systematically review the existing literature comparing the postoperative outcomes after following hip arthroscopy in obese and non-obese patients. METHODS Studies comparing the outcomes following hip arthroscopy of obese and non-obese patients were systematically identified via a computer-assisted literature search of Pubmed (Medline), EMBASE, and Cochrane Library using the preferred reporting items for systematic reviews and meta-analyses (PRISMA) guidelines. Studies comparing the outcome of hip arthroscopy in different body mass index (BMI) groups were included. Data including patient-reported outcome measures (PROMs), revision arthroscopy rate, conversion rate to total hip arthroplasty (THA), and complications were collected. The methodological index for non-randomized studies (MINORS) and Newcastle-Ottawa Scale (NOS) were used to assess the quality of each study quality. The effect of heterogeneity was quantified by calculating the I2 value. RESULTS A total of eight studies were finally included in the qualitative analysis, and three studies of high quality involving 373 hips were included in the quantitative assessment. All the studies defined obesity as a BMI of ≥ 30 kg/m2. The modified Harris Hip Score and the Non-Arthritic Hip Score were 5.1 (95% CI 1.1-9.1) and 9.0 (95% CI 5.0-13.1) points lower, respectively, in the obese group than in the non-obese group. The pooled odds ratios were 1.2 (95% CI 0.5-2.7) for revision arthroscopy, 2.4 (95% CI 1.3-4.6) for conversion to THA, and 3.2 (95% CI 1.2-8.6 for complications in favor of the non-obese group. The heterogeneity was low in all outcome assessments (I2 0-18%). CONCLUSION Obese patients had significantly lower PROMs than non-obese patients following hip arthroscopic surgery, and the THA conversion and complication rates were 2.4 times and 3.2 times higher, respectively. Understanding the effect of obesity on hip arthroscopy will allow appropriate surgical indications for surgery to be further refined and help obese patients to understand their individual risk profile. LEVEL OF EVIDENCE Systematic review of Level III-IV studies, Level IV.
Collapse
|
25
|
Lindman I, Nikou S, Öhlin A, Senorski EH, Ayeni O, Karlsson J, Sansone M. Evaluation of outcome reporting trends for femoroacetabular impingement syndrome- a systematic review. J Exp Orthop 2021; 8:33. [PMID: 33893563 PMCID: PMC8065071 DOI: 10.1186/s40634-021-00351-0] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/05/2021] [Accepted: 04/08/2021] [Indexed: 11/10/2022] Open
Abstract
PURPOSE The aim of this systematic review was to evaluate the trends in the literature regarding surgical treatment for femoroacetabular impingement syndrome (FAIS) and to present which patient-reported outcome-measures (PROMs) and surgical approaches are included. METHODS This systematic review was conducted with the PRISMA guidelines. The literature search was performed on PubMed and Embase, covering studies from 1999 to 2020. Inclusion criteria were clinical studies with surgical treatment for FAIS, the use of PROMs as evaluation tool and studies in English. Exclusion criteria were studies with patients < 18 years, cohorts with < 8 patients, studies with primarily purpose to evaluate other diagnoses than FAIS and studies with radiographs as only outcomes without using PROMs. Data extracted were author, year, surgical intervention, type of study, level of evidence, demographics of included patients, and PROMs. RESULTS The initial search yielded 2,559 studies, of which 196 were included. There was an increase of 2,043% in the number of studies from the first to the last five years (2004-2008)-(2016-2020). There were 135 (69%) retrospective, 55 (28%) prospective and 6 (3%) Randomized Controlled Trials. Level of evidence ranged from I-IV where Level III was most common (44%). More than half of the studies (58%) originated from USA. Arthroscopic surgery was the most common surgical treatment (85%). Mean follow-up was 27.0 months (± 17 SD), (range 1.5-120 months). Between 1-10 PROMs were included, and the modified Harris Hip Score (mHHS) was most commonly used (61%). CONCLUSION There has been a continuous increase in the number of published studies regarding FAIS with the majority evaluating arthroscopic surgery. The mHHS remains being the most commonly used PROM.
Collapse
Affiliation(s)
- Ida Lindman
- Department of Orthopaedics, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, 413 45, Gothenburg, Sweden.
| | - Sarantos Nikou
- Department of Orthopaedic Surgery, South Älvsborg Hospital, 501 82, Borås, Sweden
| | - Axel Öhlin
- Department of Orthopaedics, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, 413 45, Gothenburg, Sweden
| | - Eric Hamrin Senorski
- Department of Health and Rehabilitation, Institute of Neuroscience and Physiology, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Olufemi Ayeni
- Division of Orthopaedic Surgery, McMaster University, Hamilton, ON, L8N 3Z5, Canada
| | - Jon Karlsson
- Department of Orthopaedics, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, 413 45, Gothenburg, Sweden
| | - Mikael Sansone
- Department of Orthopaedics, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, 413 45, Gothenburg, Sweden
| |
Collapse
|
26
|
Migliorini F, Liu Y, Eschweiler J, Baroncini A, Tingart M, Maffulli N. Increased range of motion but otherwise similar clinical outcome of arthroscopy over open osteoplasty for femoroacetabular impingement at midterm follow-up: A systematic review. Surgeon 2021; 20:194-208. [PMID: 33731304 DOI: 10.1016/j.surge.2021.01.016] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2020] [Revised: 01/10/2021] [Accepted: 01/27/2021] [Indexed: 12/29/2022]
Abstract
BACKGROUND A systematic review was conducted comparing patient reported outcomes measures (PROMs), functional scores, and the rate of complications between arthroscopic and open treatment for femoroacetabular impingement (FAI) at mid-term follow-up. MATERIAL AND METHODS This systematic review was performed according to the PRISMA guidelines. The literature search was performed in October 2020. All clinical trials treating FAI using open osteoplasty or arthroscopic surgery were considered for inclusion. Only articles reporting >12 months follow-up were included. RESULTS Data from 97 articles (9981 procedures) were collected. At a mean 19.2 months follow-up there was no difference between the two cohorts. At a mean follow-up of 38 months, the external rotation was increased in the arthroscopic group (P < 0.0001). The modified Harris Hip Score scored greater in favour of the open osteoplasty group (P = 0.04), as did the Hip Outcome Score - Activities of Daily Living subscale (P = 0.01). At a mean 45.1 months the arthroscopic group presented greater external rotation (P < 0.0001) and SF-12 Mental (P = 0.04). The modified Harris Hip Score was greater in favour of the open osteoplasty group (P = 0.03), as was the HOS-ADL (P = 0.01). Regarding complications, the arthroscopic group experienced lower rates of subsequent revisions (P < 0.0001). CONCLUSION Based on the significant reduction of revisions-rate and significant increase in range of motion, arthroscopy treatment for the management of FAI may be recommended.
Collapse
Affiliation(s)
- Filippo Migliorini
- Department of Orthopaedics, University Clinic Aachen, RWTH Aachen University Clinic, Aachen, Germany.
| | - Yu Liu
- Department of Orthopaedics, University Clinic Aachen, RWTH Aachen University Clinic, Aachen, Germany.
| | - Jörg Eschweiler
- Department of Orthopaedics, University Clinic Aachen, RWTH Aachen University Clinic, Aachen, Germany.
| | - Alice Baroncini
- Department of Orthopaedics, University Clinic Aachen, RWTH Aachen University Clinic, Aachen, Germany.
| | - Markus Tingart
- Department of Orthopaedics, University Clinic Aachen, RWTH Aachen University Clinic, Aachen, Germany.
| | - Nicola Maffulli
- Department of Medicine, Surgery and Dentistry, University of Salerno, Via S. Allende, 84081, Baronissi, SA, Italy; School of Pharmacy and Bioengineering, Keele University Faculty of Medicine, Thornburrow Drive, Stoke on Trent, England; Queen Mary University of London, Barts and the London School of Medicine and Dentistry, Centre for Sports and Exercise Medicine, Mile End Hospital, 275 Bancroft Road, London, E1 4DG, England.
| |
Collapse
|
27
|
Zimmerer A, Janz V, Sobau C, Wassilew GI, Miehlke W. Defining the Clinically Meaningful Outcomes for Arthroscopic Treatment of Femoroacetabular Impingement Syndrome at Minimum 10-Year Follow-up: The Timing of Surgery Is Crucial. Orthop J Sports Med 2021; 9:2325967120985140. [PMID: 33718501 PMCID: PMC7922622 DOI: 10.1177/2325967120985140] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/27/2020] [Accepted: 09/21/2020] [Indexed: 11/16/2022] Open
Abstract
Background Arthroscopic treatment of femoroacetabular impingement syndrome (FAIS) has become a common procedure. However, meaningful long-term clinical outcomes have not been defined. Purpose To define the minimal clinically important difference (MCID), substantial clinical benefit (SCB), and patient acceptable symptomatic state (PASS) for the modified Harris Hip Score (mHHS) at a minimum 10-year follow-up in patients undergoing arthroscopic treatment for FAIS and identify preoperative predictors for achievement of the MCID, SCB, and PASS. Study Design Case-control study; Level of evidence, 3. Methods A consecutive series of patients undergoing arthroscopic treatment for FAIS between 2007 and 2009 with a minimum 10-year follow-up was analyzed. Patient data included patient characteristics, radiographic parameters, and the pre- and postoperative mHHS and visual analog scale (VAS) for pain score. Paired t tests were used to compare the patient-reported outcome measures (PROMs). The MCID was determined by calculating half of the standard deviation, and SCB and PASS were calculated by the anchor method. Correlation and logistic regression analyses were conducted to identify predictors for the achievement of the MCID, SCB, and PASS. Results A total of 44 patients (27 men, 17 women) were included. The mean age and body mass index were 42.2 years (range, 16-67 years) and 22.3 kg/m2 (range, 16.76-29.78 kg/m2), respectively. The MCID, absolute SCB, net change SCB, and PASS of the mHHS were calculated to be 19.6, 90.1, 31.5, and 84.4 points, respectively. Preoperative symptom duration was identified as an independent predictor for the achievement of meaningful clinical outcomes. The median symptom durations for patients who achieved the MCID, absolute SCB, net change SCB, and PASS were 11.7, 9.1, 9.0, and 10.8 months, respectively. The median symptom duration for patients who did not achieve the MCID, absolute SCB, net change SCB, and PASS were 15.8, 17.4, 17.3, and 18.4 months, respectively. No other statistically significant correlations were found. Conclusion The preoperative duration of symptoms was identified as an independent predictor for achievement of the MCID, SCB, and PASS. These findings can be helpful in accelerating the transition to surgical treatment of FAIS.
Collapse
Affiliation(s)
- Alexander Zimmerer
- ARCUS Sportklinik Pforzheim, Germany.,Department of Orthopaedics, University Medicine Greifswald, Greifswald, Germany
| | - Viktor Janz
- Department of Orthopaedics, University Medicine Greifswald, Greifswald, Germany
| | | | - Georgi I Wassilew
- Department of Orthopaedics, University Medicine Greifswald, Greifswald, Germany
| | | |
Collapse
|
28
|
Domb BG, Chen SL, Go CC, Shapira J, Rosinsky PJ, Meghpara MB, Maldonado DR, Lall AC. Predictors of Clinical Outcomes After Hip Arthroscopy: 5-Year Follow-up Analysis of 1038 Patients. Am J Sports Med 2021; 49:112-120. [PMID: 33151746 DOI: 10.1177/0363546520968896] [Citation(s) in RCA: 73] [Impact Index Per Article: 24.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND Although hip arthroscopy has been shown to have favorable results, there is a paucity of literature describing predictive factors of 5-year clinical outcomes. PURPOSE To identify predictive factors of midterm outcomes after hip arthroscopy in a cohort of 1038 patients whose outcomes at minimum 2-year follow-up were previously reported. In addition, to provide a comparison of short- and midterm predictive factors in outcome measures after hip arthroscopy. STUDY DESIGN Case-control study; Level of evidence, 3. METHODS Data were prospectively collected and retrospectively reviewed on all patients undergoing hip arthroscopy between February 2008 and June 2012. Patients were included if they had minimum 5-year follow-up on 2 patient-reported outcomes: Nonarthritic Hip Score (NAHS) and modified Harris Hip Score. Patients were excluded if they had any previous ipsilateral hip conditions. Using bivariate and multivariate analyses, we analyzed the effect of 36 pre- and intraoperative variables on the NAHS, modified Harris Hip Score, and conversion to total hip arthroplasty. RESULTS A total of 1038 patients met the inclusion criteria for the 2-year study, and 860 met our listed inclusion criteria for the 5-year study. The mean follow-up time was 62.0 months (range, 60.0-120.0 months). The bivariate analysis identified 10 variables (4 categorical and 6 continuous) that were predictive of 5-year postoperative NAHS. For the multivariate analysis, 7 variables were identified as being significant: preoperative NAHS, body mass index (BMI), age, lateral joint space, alpha angle, revision hip arthroscopy, and acetabular microfracture. These 7 variables were also predictive in the bivariate analysis. Age, BMI, revision hip arthroscopy, Tönnis grade, sex, trochanteric bursectomy, femoral head cartilage damage, and acetabular inclination were significant predictors of conversion to total hip arthroplasty. CONCLUSION This study reports favorable midterm clinical outcomes in the largest cohort of hip arthroscopies with minimum 5-year follow-up in the literature to date. Seven variables were identified as being significant predictors of postoperative NAHS in the bivariate and multivariate analyses: preoperative NAHS, BMI, age, lateral joint space, alpha angle, revision hip arthroscopy, and acetabular microfracture. Of these, preoperative NAHS, BMI, age, and revision hip arthroscopy were predictive of 2- and 5-year postoperative NAHS. These predictive factors may prove useful to clinicians in determining indications for hip arthroscopy and counseling patients on its expected outcomes.
Collapse
Affiliation(s)
- Benjamin G Domb
- American Hip Institute Research Foundation, Chicago, Illinois, USA.,American Hip Institute, Chicago, Illinois, USA.,AMITA Health St Alexius Medical Center, Hoffman Estates, Illinois, USA
| | - Sarah L Chen
- Sidney Kimmel Medical College, Philadelphia, Pennsylvania, USA
| | - Cammille C Go
- Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Jacob Shapira
- American Hip Institute Research Foundation, Chicago, Illinois, USA
| | | | - Mitchell B Meghpara
- American Hip Institute Research Foundation, Chicago, Illinois, USA.,AMITA Health St Alexius Medical Center, Hoffman Estates, Illinois, USA
| | | | - Ajay C Lall
- American Hip Institute Research Foundation, Chicago, Illinois, USA.,American Hip Institute, Chicago, Illinois, USA.,AMITA Health St Alexius Medical Center, Hoffman Estates, Illinois, USA
| |
Collapse
|
29
|
What Is the Survivorship After Hip Arthroscopy for Femoroacetabular Impingement? A Large-database Study. Clin Orthop Relat Res 2020; 478:2266-2273. [PMID: 32604156 PMCID: PMC7491898 DOI: 10.1097/corr.0000000000001370] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND Patients with femoroacetabular impingement (FAI) may experience lasting clinical improvement after hip arthroscopy; however, some patients will still eventually undergo early conversion to THA due to unresolved symptoms and progression of arthritis. However, the risk of this has been only incompletely characterized in prior studies. QUESTIONS/PURPOSES Using a large healthcare claims database over a 5-year period (2011-2016), we asked: (1) What is the survivorship free from THA after arthroscopic osteoplasty performed for FAI? (2) What identifiable demographic factors and patient characteristics are associated with early conversion to THA after hip arthroscopy performed for FAI? METHODS We included all patients who underwent hip arthroscopy for FAI, between the ages of 12 years and 63 years, with 3 months of claims data before hip arthroscopy and minimum 2-year follow-up. A total of 4730 hip arthroscopy patients from 2011 to 2014 were retrieved from a US commercial claims database. Hip arthroscopy incidence doubled over time from 1.2 to 2.1 persons per 100,000. Temporal trends, patient demographics, diagnoses at time of arthroscopy, and patient comorbidities were retrieved and logistic regression performed. Survivorship analysis on 11,323 patients (lifting the 2-year follow-up requirement) was also performed to identify independent variables associated with early risk of conversion to THA. RESULTS In patients undergoing hip arthroscopy for FAI, the overall proportion of conversion to THA within 2 years after hip arthroscopy was 7% (338 of 4730). After controlling for confounding variables such as sex, obesity, and depression, we found the following were independently associated with increased odds of conversion to THA: older age (odds ratio 1.08 [95% CI 1.01 to 1.10]; p < 0.001), osteoarthritis (OR 2.91 [95% CI 2.27 to 3.77]; p < 0.001), joint inflammation (OR 1.89 [95% CI 1.16 to 3.09]; p = 0.01), and a history of opioid use (OR 2.17 [95% CI 1.69 to 2.79]; p < 0.001). Survivorship analysis similarly revealed that older age (hazard ratio 1.08 [95% CI 1.07 to 1.09]; p < 0.001), osteoarthritis (HR 2.53 [95% CI 2.13 to 3.01]; p < 0.001), joint inflammation (HR 1.53 [95% CI 1.10 to 2.11]; p = 0.01), a history of opioid use (HR 2.02 [95% CI 1.71 to 2.38]; p < 0.001), and smoking (HR 1.55 [95% CI 1.14 to 2.11]; p = 0.005), were independently associated with increased odds of conversion to THA within 2 years after hip arthroscopy for FAI. CONCLUSIONS Although the findings of this study are limited and should not be taken in isolation, patients with FAI who are older, carry diagnoses of inflammatory or degenerative articular disease, or who use opioids or smoke should be counseled about a potentially increased risk of undergoing early conversion to THA after hip arthroscopy. Future studies to further examine the effect of these diagnoses in prospectively collected cohorts, incorporating radiographic and patient-reported outcome measures, are needed. LEVEL OF EVIDENCE Level III, prognostic study.
Collapse
|
30
|
Uchida S, Yukizawa Y, Nakashima H, Matsuda DK, Sakai A. Cystoscopy as a tool for hip arthroscopy for treating morbidly obese patients: a case report of treating a Sumo wrestler. J Hip Preserv Surg 2020; 7:345-350. [PMID: 33163221 PMCID: PMC7605781 DOI: 10.1093/jhps/hnaa029] [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: 03/11/2020] [Revised: 04/17/2020] [Accepted: 06/12/2020] [Indexed: 11/15/2022] Open
Abstract
Sports medicine surgeons sometimes encounter morbidly obese athletes with femoroacetabular impingement, such as Sumo wrestlers. In such cases, traditional arthroscopic equipment will not reach the joint. This case report describes the use of a cystoscope to perform arthroscopy to treat borderline developmental dysplasia of the hip combined with cam impingement in a morbidly obese athlete. The cystoscope enables hip arthroscopy to be performed when traditional instruments are not of sufficient length to access the hip and/or an extra-long arthroscope is not available. The use of the cystoscope provides a practical, feasible and minimally invasive option to treat non-arthritic intraarticular hip pathology in the morbidly obese or extremely muscular athletes.
Collapse
Affiliation(s)
- Soshi Uchida
- Department of Orthopaedic Surgery, Wakamatsu Hospital of University of Occupational and Environmental Health, 1-17-1, Hamamachi, Wakamatsu, Kitakyushu, Fukuoka 808-0024, Japan
| | - Yohei Yukizawa
- Department of Orthopaedic Surgery, Wakamatsu Hospital of University of Occupational and Environmental Health, 1-17-1, Hamamachi, Wakamatsu, Kitakyushu, Fukuoka 808-0024, Japan
| | - Hirotaka Nakashima
- Department of Orthopaedic Surgery, Wakamatsu Hospital of University of Occupational and Environmental Health, 1-17-1, Hamamachi, Wakamatsu, Kitakyushu, Fukuoka 808-0024, Japan
| | | | - Akinori Sakai
- Department of Orthopaedic Surgery, Wakamatsu Hospital of University of Occupational and Environmental Health, 1-17-1, Hamamachi, Wakamatsu, Kitakyushu, Fukuoka 808-0024, Japan
| |
Collapse
|
31
|
Maldonado DR, Chen JW, Kyin C, Rosinsky PJ, Shapira J, Karom JM, Lall AC, Domb BG. Hips With Acetabular Retroversion Can Be Safely Treated With Advanced Arthroscopic Techniques Without Anteverting Periacetabular Osteotomy: Midterm Outcomes With Propensity-Matched Control Group. Am J Sports Med 2020; 48:1636-1646. [PMID: 32407160 DOI: 10.1177/0363546520916737] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND Different options, from reverse (anteverting) periacetabular osteotomy to hip arthroscopy, have been proposed for surgical treatment of femoroacetabular impingement syndrome (FAIS) in the setting of acetabular retroversion. PURPOSE (1) To report and analyze midterm patient-reported outcome scores (PROs) in patients with FAIS and labral tears in the setting of acetabular retroversion after isolated hip arthroscopy and (2) to compare these PROs with those of a propensity-matched control group without acetabular retroversion. STUDY DESIGN Cohort study; Level of evidence, 3. METHODS Prospectively collected data were retrospectively reviewed for patients who underwent hip arthroscopy for FAIS and labral tear treatment between June 2008 and March 2014. Inclusion criteria were as follows: acetabular retroversion, pre- and postoperative PROs for modified Harris Hip Score (mHHS), Non-arthritic Hip Score, Hip Outcome Score-Sports Specific Scale (HOS-SSS), and visual analog scale (VAS). Propensity score matching was utilized to identify a control group without acetabular retroversion matched 1:1 with similar age, sex, body mass index, acetabular and femoral head Outerbridge grade, preoperative lateral center-edge angle, and labral treatment. Patient acceptable symptomatic state (PASS) and/or minimal clinically important difference (MCID) for the mHHS, HOS-SSS, International Hip Outcome Tool-12, and VAS was calculated. RESULTS A total of 205 hips with acetabular retroversion were matched to a control group. The groups showed no difference in demographic variables. The retroversion group was composed of 139 female and 66 male hips, with a mean ± SD age of 23.81 ± 7.28 years and follow-up time of 65.24 ± 20.31 months. Intraoperative diagnostic data and procedures performed were similar between groups, except more femoroplasties were performed in the retroversion group. Significant improvements for the mHHS, Non-arthritic Hip Score, HOS-SSS, and VAS were seen for both groups at a mean 5-year follow-up. The proportion of patients who reached the PASS and MCID were similar. CONCLUSION In the setting of FAIS and labral tears, patients with acetabular retroversion can be safely treated with advanced hip arthroscopic techniques without reverse (anteverting) periacetabular osteotomy in a high-volume surgeon's hands. Patients with acetabular retroversion demonstrated favorable PROs at midterm follow-up. Furthermore, the proportion of patients reaching the MCID and PASS for several PROs were comparable with those of a propensity-matched control group without acetabular retroversion.
Collapse
Affiliation(s)
| | - Jeffery W Chen
- School of Medicine, Vanderbilt University, Nashville, Tennessee, USA
| | - Cynthia Kyin
- American Hip Institute, Des Plaines, Illinois, USA
| | | | | | | | - Ajay C Lall
- American Hip Institute, Des Plaines, Illinois, USA
| | | |
Collapse
|
32
|
Gao F, Zhang B, Hu B, Lu M, An M, Liu Y, Fang Y, Zhao G, Shi C, Zhou J, Liu Y, Li C. Outcomes of Hip Arthroscopy for Femoroacetabular Impingement in Chinese Patients Aged 50 Years or Older. Orthop Surg 2020; 12:843-851. [PMID: 32458575 PMCID: PMC7307262 DOI: 10.1111/os.12688] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/27/2019] [Revised: 03/15/2020] [Accepted: 03/27/2020] [Indexed: 01/17/2023] Open
Abstract
Objective To investigate the outcomes of hip arthroscopy for femoroacetabular impingement (FAI) in patients over the age of 50 years. Method This is a therapeutic case series study. A total of 27 FAI patients over the age of 50 years who met inclusion and exclusion criteria and were being followed up for at least 2 years in the orthopaedics department at our hospital between January 2015 and October 2017 were recruited for a prospective analysis on the outcomes of hip arthroscopy. All patients underwent unilateral surgery. Of the patients included, there were 15 men and 12 women, who were aged 50–74 years old (57 ± 6.4 years). The outcomes were assessed using the visual analog scale (VAS), the modified Harris hip score (mHHS), and the International Hip Outcome Tool (iHOT‐12). Results A total of 27 patients were followed up for at least 2 years. The postoperative center‐edge angle, the alpha angle, and the offset decreased significantly compared with preoperative measurements (P < 0.01). The mHHS before surgery and at 1 year and 2 years after surgery was 62.19 ± 7.47, 86.70 ± 5.80, and 87.89 ± 5.08, respectively; iHOT‐12 scores were 30.44 ± 4.22, 73.56 ± 3.89, and 73.77 ± 3.72, respectively; VAS scores were 6.07 ± 0.78, 1.93 ± 0.73, and 1.59 ± 0.64, respectively. As compared with the condition before surgery, there was a significant improvement in the mHHS, iHOT‐12, and VAS scores at 1 year and 2 years after surgery (P < 0.01). The mHHS score at 2‐year follow up after surgery was higher than that at 1 year after surgery, and the difference observed was statistically significant (P = 0.04). One patient with severe acetabular and femoral cartilage damage underwent total hip replacement 11 months after surgery. Conclusion Hip arthroscopy considerably improved hip symptoms and function in Chinese FAI patients aged 50 years or older who did not have severe radiographic osteoarthritis. The conversion to THA and complications were low. Strict surgical indications and appropriate surgical strategies lay the foundation for satisfactory postoperative results in elderly patients with FAI.
Collapse
Affiliation(s)
- Feng Gao
- Medical School of Chinese PLA, Beijing, China.,Department of Sports Injury and Arthroscopy Surgery, National Institute of Sports Medicine, Beijing, China
| | | | - Bo Hu
- Medical School of Chinese PLA, Beijing, China
| | - Ming Lu
- Medical School of Chinese PLA, Beijing, China
| | - Mingyang An
- Medical School of Chinese PLA, Beijing, China
| | - Yufeng Liu
- Medical School of Chinese PLA, Beijing, China
| | - Yehan Fang
- Medical School of Chinese PLA, Beijing, China
| | - Gang Zhao
- Medical School of Chinese PLA, Beijing, China
| | - Chao Shi
- Xinjiang Uyghur Autonomous Region Changji Hui Autonomous Prefecture Qitai County Peoples Hospital, Xinjiang, China
| | - Jingbin Zhou
- Medical School of Chinese PLA, Beijing, China.,Department of Sports Injury and Arthroscopy Surgery, National Institute of Sports Medicine, Beijing, China
| | - Yujie Liu
- Medical School of Chinese PLA, Beijing, China.,Department of Orthopedics, Chinese PLA General Hospital, Beijing, China
| | - Chunbao Li
- Medical School of Chinese PLA, Beijing, China.,Department of Orthopedics, Chinese PLA General Hospital, Beijing, China
| |
Collapse
|
33
|
Hammarstedt JE, Laseter JR, Gupta A, Christoforetti JJ, Lall AC, Domb BG. Identifying the Most Successful Procedures in Hip Arthroscopy. Orthopedics 2020; 43:173-181. [PMID: 32003838 DOI: 10.3928/01477447-20200129-01] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/21/2018] [Accepted: 02/25/2019] [Indexed: 02/03/2023]
Abstract
Hip arthroscopy for femoral and acetabular pathologies has increased dramatically. However, there is little literature analyzing procedures as predictors of revision arthroscopy or arthroplasty. From February 2008 to November 2015, patients undergoing hip arthroscopy for a labral tear with minimum 2-year follow-up and between 18 and 60 years old were retrospectively reviewed. Those with previous surgeries, Tönnis grade greater than 1, and previous hip conditions were excluded. Follow-up was obtained for 1118 patients (1249 hips; 81.7%) with a mean age of 38.7 years (range, 18.0-60.0 years), mean body mass index of 26.4 kg/m2 (range, 16.3-48.9 kg/m2), and mean follow-up of 50.2 months (range, 24.0-111.9 months). A total of 122 (9.8%) patients converted to total hip arthroplasty (mean, 35.3 months; range, 1.4-95.2 months). Multivariate analysis for predictors of total hip arthroplasty found age at surgery (hazard ratio, 1.064/y; P<.05), body mass index (nonlinear; P<.05), labral debridement (HR, 1.558; P=.03), and notchplasty (HR, 2.128; P<.05), with trochanteric bursectomy (HR, 0.367; P<.05) identified as associated with higher survivorship. A total of 124 (9.9%) patients underwent revision hip arthroscopy at a mean of 21.7 months (range, 0.10-83.3 months). Multivariate analysis for predictors of revision surgery found workers' compensation (HR, 3.352; P<.05), capsular repair (HR, 1.950; P<.05), and femoral head microfracture (HR, 2.844; P=.04) to be significant, with age at date of surgery (HR, 0.973/y; P<.05) and femoral head chondroplasty (HR, 0.241; P=.05) associated with higher survivorship. Understanding risk factors for conversion to total hip arthroplasty or revision is paramount during discussions with patients. [Orthopedics. 2020;43(3):173-181.].
Collapse
|
34
|
Kunze KN, Nwachukwu BU, Beck EC, Chahla J, Gowd AK, Rasio J, Nho SJ. Preoperative Duration of Symptoms Is Associated With Outcomes 5 Years After Hip Arthroscopy for Femoroacetabular Impingement Syndrome. Arthroscopy 2020; 36:1022-1029. [PMID: 31901396 DOI: 10.1016/j.arthro.2019.08.032] [Citation(s) in RCA: 30] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/08/2019] [Revised: 08/19/2019] [Accepted: 08/19/2019] [Indexed: 02/02/2023]
Abstract
PURPOSE To determine the effect of the preoperative duration of femoroacetabular impingement syndrome (FAIS)-associated symptoms on clinical outcomes at a minimum of 5 years after hip arthroscopy. METHODS We identified FAIS patients who underwent primary hip arthroscopy between January 2012 and January 2014 with a minimum of 5 years' follow-up. Patient demographic characteristics and clinical outcomes, comprising the Hip Outcome Score-Activities of Daily Living (HOS-ADL), Hip Outcome Score-Sports Subscale (HOS-SS), modified Harris Hip Score (mHHS), pain score, and satisfaction score, were analyzed. The minimal clinically important difference, patient acceptable symptomatic state, and substantial clinical benefit were calculated. Patients were stratified based on the preoperative duration of symptoms: less than 2 years versus 2 years or longer. Multivariate regressions were constructed to determine the association between the preoperative symptom duration and clinical outcomes at 5 years after hip arthroscopy. RESULTS A total of 310 patients were included with a mean age (±standard deviation) of 34.1 ± 11.9 years and body mass index of 25.3 ± 5.1. The study group showed statistically significant improvements in the HOS-ADL, HOS-SS, mHHS, pain score, and satisfaction score (P < .001 for all). A preoperative duration of symptoms of 2 or more years was an independent predictor of worse HOS-ADL, HOS-SS, mHHS, and pain score (P < .05 for all). Furthermore, a longer duration of symptoms was associated with a lower likelihood of achieving the minimal clinically important difference for the HOS-ADL (odds ratio [OR], 0.53; P = .037), HOS-SS (OR, 0.38; P = .003), and mHHS (OR, 0.43; P = .009); the patient acceptable symptomatic state for the HOS-SS (OR, 0.44; P = .006) and mHHS (OR, 0.46; P = .006) but not the HOS-ADL despite trending toward significance (OR, 0.59; P = .098); and substantial clinical benefit for the HOS-ADL (OR, 0.50; P = .011), HOS-SS (OR, 0.52; P = .020), and mHHS (OR, 0.47; P = .007). CONCLUSIONS Patients with a preoperative duration of FAIS-associated symptoms of 2 or more years prior to hip arthroscopy experience inferior outcomes and a lower frequency of clinically significant outcome improvement than patients with a shorter duration of symptoms at medium-to long-term follow-up. LEVEL OF EVIDENCE Level III, retrospective comparative trial.
Collapse
Affiliation(s)
- Kyle N Kunze
- Section of Young Adult Hip Surgery, Division of Sports Medicine, Department of Orthopedic Surgery, Rush University Medical Center, Chicago, Illinois
| | - Benedict U Nwachukwu
- Section of Young Adult Hip Surgery, Division of Sports Medicine, Department of Orthopedic Surgery, Rush University Medical Center, Chicago, Illinois
| | - Edward C Beck
- Section of Young Adult Hip Surgery, Division of Sports Medicine, Department of Orthopedic Surgery, Rush University Medical Center, Chicago, Illinois
| | - Jorge Chahla
- Section of Young Adult Hip Surgery, Division of Sports Medicine, Department of Orthopedic Surgery, Rush University Medical Center, Chicago, Illinois
| | - Anirudh K Gowd
- Department of Orthopaedic Surgery, Wake Forest School of Medicine, Winston-Salem, North Carolina, U.S.A
| | - Jonathan Rasio
- Section of Young Adult Hip Surgery, Division of Sports Medicine, Department of Orthopedic Surgery, Rush University Medical Center, Chicago, Illinois
| | - Shane J Nho
- Section of Young Adult Hip Surgery, Division of Sports Medicine, Department of Orthopedic Surgery, Rush University Medical Center, Chicago, Illinois.
| |
Collapse
|
35
|
Scott BL, Lee C, Athiviraham A. Response to Letter to the Editor on "Non-Operative Management of Hip Labral Tears Yields Similar THA Conversion Rate to Arthroscopic Treatment". J Arthroplasty 2020; 35:906-907. [PMID: 31826836 DOI: 10.1016/j.arth.2019.11.014] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/06/2019] [Accepted: 11/07/2019] [Indexed: 02/01/2023] Open
Affiliation(s)
- Bryan L Scott
- Department of Orthopaedic and Rehabilitation Medicine, University of Chicago, Chicago, IL
| | - Cody Lee
- Department of Orthopaedic and Rehabilitation Medicine, University of Chicago, Chicago, IL
| | - Aravind Athiviraham
- Department of Orthopaedic and Rehabilitation Medicine, University of Chicago, Chicago, IL
| |
Collapse
|
36
|
Nwachukwu BU, Beck EC, Kunze KN, Chahla J, Rasio J, Nho SJ. Defining the Clinically Meaningful Outcomes for Arthroscopic Treatment of Femoroacetabular Impingement Syndrome at Minimum 5-Year Follow-up. Am J Sports Med 2020; 48:901-907. [PMID: 32167843 DOI: 10.1177/0363546520902736] [Citation(s) in RCA: 116] [Impact Index Per Article: 29.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND Minimal clinically important difference (MCID), substantial clinical benefit (SCB), and patient acceptable symptomatic state (PASS) have gained prominence as important variables in the orthopaedic outcomes literature. In hip preservation surgery, much attention has been given to defining early clinically meaningful outcome; however, it is unknown what represents meaningful patient-reported outcome improvement in the medium to long term. PURPOSE (1) To define MCID, PASS, and SCB at a minimum 5 years after hip arthroscopy for femoroacetabular impingement syndrome (FAIS) and (2) to evaluate the time-dependent nature of MCID, PASS, and SCB. STUDY DESIGN Case series; Level of evidence, 4. METHODS Patients undergoing primary hip arthroscopy for FAIS between January 2012 and March 2014 were included. Clinical and demographic data were collected in an institutional hip preservation registry. MCID, PASS, and SCB were calculated for each outcome score including the Hip Outcome Score-Activities of Daily Living subscale (HOS-ADL), Hip Outcome Score-Sport-Specific subscale (HOS-SS), modified Harris Hip Score (mHHS), and International Hip Outcome Tool (iHOT-12) at 1, 2, and 5 years. MCID was calculated by use of a distribution-based method, whereas PASS and SCB were calculated by use of an anchor method. RESULTS The study included 283 patients with a mean ± SD age of 34.2 ± 11.9 years. The mean changes in 1-year, 2-year, and 5-year scores, respectively, required to achieve MCID were as follows: HOS-ADL (8.8, 9.7, 10.2); HOS-SS (13.9, 14.3, 15.2); mHHS (6.9, 9.2, 11.4); and iHOT-12 (15.1, 13.9, 15.1). The threshold scores for achieving PASS were as follows: HOS-ADL (89.7, 88.2, 99.2); HOS-SS (72.2, 76.4, 80.9); mHHS (84.8, 83.3, 83.6); and iHOT-12 (69.1, 72.2, 74.3). Last, the threshold scores for achieving SCB scores were as follows: HOS-ADL (89.7, 91.9, 94.6); HOS-SS (78.1, 77.9, 85.8); mHHS (86.9, 85.8, 94.4); and iHOT-12 (72.6, 76.8, 87.5). More patients achieved MCID, SCB, and PASS at 2-year compared with 1-year follow-up; however, by 5 years, fewer patients had achieved clinically meaningful outcome (minimum 1-, 2-, and 5-year follow-up, respectively: MCID, 82.6%, 87.3%, 79.3%; PASS, 67.6%, 74.9%, 67.5%; SCB, 62.3%, 67.2%, 56.6%). CONCLUSION The greatest proportion of patients achieved MCID, PASS, and SCB at 2-year follow-up after arthroscopic treatment of FAIS compared with 1- and 5-year time points. Improvements were maintained out to 5-year follow-up, although the proportion of patients achieving clinical significance was slightly decreased.
Collapse
Affiliation(s)
- Benedict U Nwachukwu
- Division of Sports Medicine, Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, Illinois, USA
| | - Edward C Beck
- Division of Sports Medicine, Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, Illinois, USA
| | - Kyle N Kunze
- Division of Sports Medicine, Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, Illinois, USA
| | - Jorge Chahla
- Division of Sports Medicine, Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, Illinois, USA
| | - Jonathan Rasio
- Division of Sports Medicine, Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, Illinois, USA
| | - Shane J Nho
- Division of Sports Medicine, Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, Illinois, USA
| |
Collapse
|
37
|
Jones DM, Crossley KM, Ackerman IN, Hart HF, Dundules KL, O'Brien MJ, Mentiplay BF, Heerey JJ, Kemp JL. Physical Activity Following Hip Arthroscopy in Young and Middle-Aged Adults: A Systematic Review. SPORTS MEDICINE-OPEN 2020; 6:7. [PMID: 31993831 PMCID: PMC6987281 DOI: 10.1186/s40798-020-0234-8] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/01/2019] [Accepted: 01/02/2020] [Indexed: 01/31/2023]
Abstract
Background Hip arthroscopy is a common surgical intervention for young and middle-aged adults with hip-related pain and dysfunction, who have high expectations for returning to physical activity following surgery. The purpose of this review was to evaluate the impact of hip arthroscopy on physical activity post-arthroscopy. Methods A systematic search of electronic databases was undertaken in identifying studies from January 1st 1990 to December 5th 2019. The search included English language articles reporting physical activity as an outcome following hip arthroscopy in adults aged 18-50 years. Quality assessment, data extraction and synthesis of included studies were undertaken. Results Full text articles (n = 234) were assessed for eligibility following screening of titles and abstracts (n = 2086), yielding 120 studies for inclusion. The majority (86%) of the studies were level 4 evidence. One study reported objective activity data. The most frequently occurring patient-reported outcome measure was the Hip Outcome Score-sport-specific subscale (HOS-SS, 84% of studies). Post--arthroscopy improvement was indicated by large effect sizes for patient-reported outcome measures (standard paired difference [95% confidence interval] −1.35[−1.61 to −1.09] at more than 2 years post-arthroscopy); however, the majority of outcome scores for the HOS-SS did not meet the defined level for a patient-acceptable symptom state. Conclusion The current level of available information regarding physical activity for post arthroscopy patients is limited in scope. Outcomes have focused on patients’ perceived difficulties with sport-related activities with a paucity of information on the type, quality and quantity of activity undertaken. Level of Evidence Level IV, systematic review of Level 2 through to Level 4 studies
Collapse
Affiliation(s)
- Denise M Jones
- La Trobe Sport and Exercise Medicine Research Centre, School of Allied Health, College of Science, Health and Engineering, La Trobe University, Melbourne, Victoria, Australia.
| | - Kay M Crossley
- La Trobe Sport and Exercise Medicine Research Centre, School of Allied Health, College of Science, Health and Engineering, La Trobe University, Melbourne, Victoria, Australia
| | | | - Harvi F Hart
- La Trobe Sport and Exercise Medicine Research Centre, School of Allied Health, College of Science, Health and Engineering, La Trobe University, Melbourne, Victoria, Australia.,Department of Physical Therapy, The University of Western Ontario, London, Ontario, Canada
| | - Karen L Dundules
- La Trobe Sport and Exercise Medicine Research Centre, School of Allied Health, College of Science, Health and Engineering, La Trobe University, Melbourne, Victoria, Australia
| | - Michael J O'Brien
- La Trobe Sport and Exercise Medicine Research Centre, School of Allied Health, College of Science, Health and Engineering, La Trobe University, Melbourne, Victoria, Australia
| | - Benjamin F Mentiplay
- La Trobe Sport and Exercise Medicine Research Centre, School of Allied Health, College of Science, Health and Engineering, La Trobe University, Melbourne, Victoria, Australia
| | - Joshua J Heerey
- La Trobe Sport and Exercise Medicine Research Centre, School of Allied Health, College of Science, Health and Engineering, La Trobe University, Melbourne, Victoria, Australia
| | - Joanne L Kemp
- La Trobe Sport and Exercise Medicine Research Centre, School of Allied Health, College of Science, Health and Engineering, La Trobe University, Melbourne, Victoria, Australia
| |
Collapse
|
38
|
Clapp IM, Nwachukwu BU, Beck EC, Rasio JP, Alter T, Allison B, Nho SJ. What is the Role of Kinesiophobia and Pain Catastrophizing in Outcomes After Hip Arthroscopy for Femoroacetabular Impingement Syndrome? Arthrosc Sports Med Rehabil 2020; 2:e97-e104. [PMID: 32368745 PMCID: PMC7190542 DOI: 10.1016/j.asmr.2019.12.001] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2019] [Accepted: 12/12/2019] [Indexed: 12/15/2022] Open
Abstract
Purpose To (1) investigate trends in kinesiophobia and pain catastrophizing after hip arthroscopy for femoroacetabular impingement syndrome (FAIS), and (2) determine whether kinesiophobia and pain catastrophizing scores are associated with achieving minimal clinically important difference (MCID) for any of the hip-specific patient-reported outcome questionnaires. Methods Patients undergoing primary hip arthroscopy for treatment of FAIS between December 2016 and March 2017 were prospectively enrolled. Patients received the Tampa Scale of Kinesiophoibia-11 (TSK-11) and Pain Catastrophizing Scale (PCS) questionnaires preoperatively, 6 months, and 1 year postoperatively. They also received the hip-specific patient-reported outcome questionnaires (Hip Outcome Score Activities of Daily Living and Sport-Specific subscales, modified Harris Hip Score, and International Hip Outcome Tool-12), as well as visual analog scale for satisfaction and pain preoperatively and 1-year postoperatively. The threshold for achieving MCID was determined for each hip outcome tool, and patients achieving MCID were compared with those who did not. Results A total of 85 (80.2%) patients (mean age: 33.7 ± 12.4 years; female: 75.3%) were included in the final analysis. At 1-year follow-up, there was a significant reduction in TSK-11 scores (26.22 ± 5.99 to 18.70 ± 6.49; P < .001) and PCS scores (17.81 ± 10.13 to 4.77 ± 7.57; P < .001) when compared with preoperative scores. 1-year PCS scores were significantly lower in patients achieving MCID compared with patients failing to achieve MCID (3.2 ± 4.4 vs 10.8 ± 15.2; P = .006). There were no significant differences in TSK-11 scores between those achieving and not achieving MCID. Conclusions Patient kinesiophobia and pain catastrophizing both show significant improvements 1 year after undergoing hip arthroscopy for FAIS. However, pain catastrophizing scores at 1 year are significantly greater in patients not achieving MCID, whereas no association was identified between kinesiophobia and likelihood for MCID achievement. This suggests PCS may be a more useful tool than TSK-11 during postoperative rehabilitation for identifying patients at risk for not achieving MCID. Level of Evidence Level II, prospective case series.
Collapse
Affiliation(s)
- Ian M Clapp
- Department of Orthopedic Surgery, Rush University Medical Center, Chicago, Illinois, U.S.A
| | - Benedict U Nwachukwu
- Department of Orthopedic Surgery, Rush University Medical Center, Chicago, Illinois, U.S.A
| | - Edward C Beck
- Department of Orthopedic Surgery, Wake Forest Baptist Health, Winston-Salem, North Carolina, U.S.A
| | - Jonathan P Rasio
- Department of Orthopedic Surgery, Rush University Medical Center, Chicago, Illinois, U.S.A
| | - Thomas Alter
- Department of Orthopedic Surgery, Rush University Medical Center, Chicago, Illinois, U.S.A
| | - Bradley Allison
- Department of Orthopedic Surgery, Rush University Medical Center, Chicago, Illinois, U.S.A
| | - Shane J Nho
- Department of Orthopedic Surgery, Rush University Medical Center, Chicago, Illinois, U.S.A
| |
Collapse
|
39
|
Scott BL, Lee CS, Shi LL, Lee MJ, Athiviraham A. Nonoperative Management of Hip Labral Tears Yields Similar Total Hip Arthroplasty Conversion Rate to Arthroscopic Treatment. J Arthroplasty 2020; 35:23-27.e1. [PMID: 31526697 DOI: 10.1016/j.arth.2019.08.042] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/26/2019] [Revised: 08/12/2019] [Accepted: 08/19/2019] [Indexed: 02/01/2023] Open
Abstract
BACKGROUND Arthroscopic treatment of hip labral tears has increased significantly in recent years. There is limited evidence comparing nonoperative management to arthroscopic treatment. The purpose of this study is to evaluate the progression to total hip arthroplasty (THA), as well as the cost associated with arthroscopic management of labral tears compared to nonoperative treatment. METHODS The Humana claims database was queried from 2007 through 2016. International Classification of Diseases and Current Procedural Terminology codes were used to identify patients with hip labral tears and hip arthroscopy and THA procedures. Two cohorts were created: a nonoperative group and an operative group. Following propensity score matching, the rate of conversion and time to THA conversion were calculated. Cost was calculated using the total cost reimbursed for encounters within 6 months. Continuous variables were analyzed using Student t-test and Mann-Whitney test, and categorical variables were analyzed using chi-square test. RESULTS After propensity matching, 864 patients were included in the analysis. The conversion rate to THA in the operative group (6.7%) and the nonoperative group (5.3%) was not statistically different (P = .391). The operative group had a longer time to THA (21.5 ± 16.8 months) than the nonoperative group (15.9 ± 19.5 months; P = .044). The cost for the operative group was significantly higher ($14,266.55 ± $7187.96) compared to the nonoperative group ($2941.96 ± $2664.00; P < .001). CONCLUSION This study did not find a difference in the rate of conversion to THA for operative vs nonoperative groups. Time to THA in the operative group was longer, however, at the expense of higher costs.
Collapse
Affiliation(s)
- Bryan L Scott
- Department of Orthopaedic and Rehabilitation Medicine, University of Chicago, Chicago, IL
| | - Cody S Lee
- Department of Orthopaedic and Rehabilitation Medicine, University of Chicago, Chicago, IL
| | - Lewis L Shi
- Department of Orthopaedic and Rehabilitation Medicine, University of Chicago, Chicago, IL
| | - Michael J Lee
- Department of Orthopaedic and Rehabilitation Medicine, University of Chicago, Chicago, IL
| | - Aravind Athiviraham
- Department of Orthopaedic and Rehabilitation Medicine, University of Chicago, Chicago, IL
| |
Collapse
|
40
|
Lall AC, Battaglia MR, Maldonado DR, Perets I, Laseter JR, Go CC, Domb BG. Does Femoral Retroversion Adversely Affect Outcomes After Hip Arthroscopy for Femoroacetabular Impingement Syndrome? A Midterm Analysis. Arthroscopy 2019; 35:3035-3046. [PMID: 31629582 DOI: 10.1016/j.arthro.2019.03.046] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/13/2018] [Revised: 03/13/2019] [Accepted: 03/19/2019] [Indexed: 02/02/2023]
Abstract
PURPOSE To report 5-year outcomes of arthroscopic treatment of femoroacetabular impingement syndrome in patients with femoral retroversion compared with a control group of patients with normal femoral anteversion. METHODS Data were prospectively collected and retrospectively reviewed for all patients who underwent hip arthroscopy between August 2008 and April 2013. Patients were included in analysis if they underwent hip arthroscopy during this period and had femoral version ≤0° calculated using magnetic resonance imaging. Exclusion criteria included prior ipsilateral hip conditions/surgeries or Tönnis grade >1. These patients were pair matched with patients having femoral anteversion between 10° and 20° based on gender, body mass index ± 10, and age ± 10 years. Patient-reported outcomes (PROs) were collected at 3 months and 1 year postoperatively and annually thereafter. An a priori power analysis was performed. RESULTS A total of 59 patients were identified as the experimental group out of 69 eligible for inclusion (86%). All 59 patients were matched, with a mean age of 37.4 years and mean body mass index of 26.9. Twenty patients were female, and 39 were male. These patients demonstrated significant improvement from their preoperative state in all patient-reported outcomes and visual analog score scores (P < .001). Thirty-eight patients met the threshold for minimal clinically important difference, and 35 achieved patient acceptable symptomatic state for the modified Harris Hip Score questionnaire. Seven patients converted to total hip replacement. No differences were noted between retroverted and control patients in any of the outcome measures collected, in pain or satisfaction ratings, in the frequency of or duration to secondary surgeries or in complication rate (P > .05). CONCLUSIONS Patients with femoral retroversion demonstrated significantly higher outcomes at minimum 5-year follow-up after undergoing arthroscopic hip surgery. These outcomes were not different from those of patients with normal femoral version. While femoral retroversion should not be considered a contraindication to hip arthroscopy, it should be carefully considered as a factor in patient selection and surgical planning. LEVEL OF EVIDENCE Level III, retrospective comparative study.
Collapse
Affiliation(s)
- Ajay C Lall
- American Hip Institute, Des Plaines, Illinois, U.S.A
| | - Muriel R Battaglia
- American Hip Institute, Des Plaines, Illinois, U.S.A.; University of Chicago Pritzker School of Medicine, Chicago, Illinois, U.S.A
| | | | - Itay Perets
- Hadassah Hebrew University Hospital, Jerusalem, Israel
| | - Joseph R Laseter
- American Hip Institute, Des Plaines, Illinois, U.S.A.; Case Western Reserve University School of Medicine, Cleveland, Ohio, U.S.A
| | - Cammille C Go
- American Hip Institute, Des Plaines, Illinois, U.S.A
| | | |
Collapse
|
41
|
Rosinsky PJ, Go CC, Shapira J, Maldonado DR, Lall AC, Domb BG. Validation of a Risk Calculator for Conversion of Hip Arthroscopy to Total Hip Arthroplasty in a Consecutive Series of 1400 Patients. J Arthroplasty 2019; 34:1700-1706. [PMID: 31060916 DOI: 10.1016/j.arth.2019.04.013] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/05/2019] [Revised: 03/21/2019] [Accepted: 04/06/2019] [Indexed: 02/01/2023] Open
Abstract
BACKGROUND A previously published calculator used age, preoperative modified Harris Hip Score, femoral anteversion, preoperative lateral center-edge angle, revision surgery, and acetabular and femoral cartilage damage to provide risk estimates for conversion rate of hip arthroscopy to total hip arthroplasty (THA). Validation for this calculator has not been established. The purpose of this study is to (1) validate the previously published hazard ratios for the predictor factors in a new cohort of hip arthroscopies with minimum 2-year follow-up and (2) determine the accuracy of the calculator at determining conversion rates to THA at 2 and 4 years of follow-up. METHODS Hazard ratios for THA conversion were calculated using data between February 2008 and November 2016 and compared to the previously published results, which comprised the training set. Actual conversion to THA data was used to evaluate the accuracy of the calculator. RESULTS Of the 1400 patients examined, THA conversion occurred in 101 (7.2%) patients at an average of 28.4 ± 22.9 months (0.2-115.8) after hip arthroscopy. The hazard ratios for the validation set compared to the training set were as follows: age 1.06 versus 1.06; modified Harris Hip Score 0.97 versus 0.98; femoral anteversion 0.99 versus 0.97; lateral center-edge angle 0.98 versus 0.93; and revision surgery 1.77 versus 2.40. Accuracy of the risk calculator at 2 years was 75% (Harrell C-statistic 0.806) and at 4 years was 73% (C-statistic 0.797). CONCLUSION This study found 75% and 73% accuracy at 2 and 4 years respectively in calculating risk of conversion of hip arthroscopy to THA using a previously published calculator. As this calculator relies on intraoperative data, the major benefit it provides is information regarding patient prognosis postoperatively. Furthermore, it could potentially enable the surgeon, after receiving proper surgical consent, to decide on immediate conversion to THA. LEVEL OF EVIDENCE III, retrospective cohort.
Collapse
Affiliation(s)
| | - Cammille C Go
- Department of Orthopedics, American Hip Institute, Des Plaines, IL
| | - Jacob Shapira
- Department of Orthopedics, American Hip Institute, Des Plaines, IL
| | | | - Ajay C Lall
- Department of Orthopedics, American Hip Institute, Des Plaines, IL
| | - Benjamin G Domb
- Department of Orthopedics, American Hip Institute, Des Plaines, IL
| |
Collapse
|
42
|
Abstract
PURPOSE OF REVIEW To assess the outcomes of modern techniques for arthroscopic surgery in the treatment of femoroacetabular impingement. RECENT FINDINGS While initially approached by means of open surgical hip dislocation, recent literature has shown generally good outcomes of arthroscopic treatment for femoroacetabular impingement. Modern advances in hip arthroscopy technique and implants now allow for labral repair or reconstruction when indicated. Arthroscopic treatment of femoroacetabular impingement results in significant improvements in patient pain and function, with low complication rates and high patient satisfaction. A majority of improvements in these patients occur within 1 to 2 years post-operatively. Hip arthroscopy for femoroacetabular impingement yields the best results in patients without significant arthritis or hip dysplasia.
Collapse
Affiliation(s)
- Caitlin C. Chambers
- Department of Orthopaedic Surgery, University of Minnesota, 2450 Riverside Ave, Minneapolis, MN 55454 USA
| | - Alan L. Zhang
- Department of Orthopaedic Surgery, University of California San Francisco, San Francisco, CA USA
| |
Collapse
|
43
|
Maldonado DR, Chen JW, Walker-Santiago R, Rosinsky PJ, Shapira J, Lall AC, Domb BG. Forget the Greater Trochanter! Hip Joint Access With the 12 O'clock Portal in Hip Arthroscopy. Arthrosc Tech 2019; 8:e575-e584. [PMID: 31334013 PMCID: PMC6620541 DOI: 10.1016/j.eats.2019.01.017] [Citation(s) in RCA: 54] [Impact Index Per Article: 10.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/07/2018] [Accepted: 01/30/2019] [Indexed: 02/03/2023] Open
Abstract
Most surgeons rely on the greater trochanter as the reference point to establish the anterolateral portal. Nevertheless, we believe that the anterosuperior iliac spine is a more reliable landmark. Unlike the greater trochanter, it is unaffected by leg rotation and is more easily identified by palpation. Abiding by the central tenet of medicine to "do no harm," the technique described herein presents in detail the concept of the 12 o'clock portal placement, a hip joint access method based on identifying specific anatomic points under fluoroscopy and by palpation. To accomplish this goal, this Technical Note presents a step-by-step approach, including tips and pearls for patient positioning and fluoroscopic guidance. We believe this method ensures a reproducible and safe way to start hip arthroscopy in the supine position.
Collapse
|
44
|
CORR Insights®: Can Dynamic Ultrasonography of the Hip Reliably Assess Anterior Femoral Head Translation? Clin Orthop Relat Res 2019; 477:1099-1100. [PMID: 30247234 PMCID: PMC6494320 DOI: 10.1097/corr.0000000000000500] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
|