Variability and Comprehensiveness of North American Online Available Physical Therapy Protocols Following Hip Arthroscopy for Femoroacetabular Impingement and Labral Repair

Abstract Multiple self-reported allergies have been reported as a prognostic factor for outcome the following orthopedic procedures. This relationship has not yet been evaluated in a hip arthroscopy population. The purpose of this study is to identify associations between allergies and post-operative outcome scores in patients undergoing hip arthroscopy for femoroacetabular impingement (FAI). A retrospective review of surgically treated FAI patients at our institution was performed. Patient-reported allergies and 6-month and 1-year modified Harris Hip Scores (mHHS) were recorded. Bivariate analysis was performed evaluating association between allergies and post-operative mHHS. Multivariate regression was used to identify independent factors associated with post-operative mHHS while controlling for age, sex, BMI, psychiatric comorbidity, symptom duration, labral repair versus debridement, capsular management, chondral lesions and use of adjunct platelet rich plasma (PRP). Seventy patients were analysed. Average age was 30.7 years old (SD 8.96). A 52.9% were females. Twenty-six patients (37.1%) had reported allergies. At 6 months, bivariate analysis demonstrated no significant association between allergies and postop mHHS. This was true comparing patients with 0 versus 1 versus 2 versus 3 versus 5 allergies as separate groups (medians from 83.1 to 91.0, P = 0.60) as well as when combining patients with >2 allergies into one group (0 versus 1 versus 2–5 allergies) (medians 84.7, 83.1, 86.0, respectively, P = 0.328). At 1 year, this lack of association was more pronounced (0 versus 1 versus 2 versus 3 versus 5: medians from 87.0 to 93.5, P = 0.9265 and 0 versus 1 versus 2–5: medians 93.5, 91.7, 89.0, respectively, P = 0.6450). Linear regression demonstrated preop mHHS and age were significantly associated with 1-year mHHS (logit mHHS rate = 0.026 ± 0.008 per unit, P = 0.0014 for preop mHHS and logit mHHS rate=−0.061 ± 0.018 per year, P = 0.0010 for age). After controlling for age and preop mHHS, allergies were not associated with postop mHHS. Allergies demonstrated no association with post-operative outcome following surgical treatment of FAI.

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Hip Arthroscopy for Femoroacetabular Impingement in Adolescents: 10-Year Patient-Reported Outcomes

The American Journal of Sports Medicine ◽

10.1177/0363546520973977 ◽

2020 ◽

Vol 49 (1) ◽

pp. 76-81 ◽

Cited By ~ 1

Author(s):

Travis J. Menge ◽

Karen K. Briggs ◽

Michael D. Rahl ◽

Marc J. Philippon

Keyword(s):

Patient Satisfaction ◽

Femoroacetabular Impingement ◽

Revision Surgery ◽

Hip Arthroscopy ◽

Patient Reported Outcomes ◽

Labral Repair ◽

Harris Hip Score ◽

Duration Of Symptoms ◽

Patient Reported

Background: Previous studies have demonstrated hip arthroscopy to be an effective treatment for femoroacetabular impingement (FAI) in individuals 18 years of age and older. Long-term outcome data in the adolescent population, however, are limited. Purpose: To report 10-year outcomes after hip arthroscopy in adolescents with symptomatic FAI. Study Design: Case series; Level of evidence, 4. Methods: Prospectively collected data were analyzed on adolescent patients younger than 18 years of age who had hip arthroscopy between March 2005 and 2009 with a minimum 10-year follow-up. Patients were included if they were diagnosed with symptomatic FAI and an associated labral tear that was treated with repair. Patients were excluded if they had previous hip procedures, acetabular dysplasia (lateral center-edge angle, <20°), avascular necrosis, previous hip fracture or dislocation, or Legg-Calve-Perthes disease, or refused to participate. The primary patient-reported outcome measure was the Hip Outcome Score (HOS) Activities of Daily Living (ADL) subscale. In addition, the HOS—Sport, modified Harris Hip Score (mHHS), 12-Item Short Form Health Survey (SF-12), and patient satisfaction were collected. Failure was defined as patients having to undergo revision arthroscopy. Results: There were 60 patients (70 hips) who met inclusion criteria and had a 10-year follow-up. The mean age of the cohort was 16 ± 1.2 years, with 21 male and 49 female hips. Seven hips (10%) required revision hip arthroscopy. All revisions occurred in female patients and were associated with global laxity as well as longer duration of symptoms before time of surgery. At a mean follow-up of 12 years (range, 10-14 years), patients who did not undergo revision surgery had significant improvements from preoperatively to postoperatively in HOS-ADL (from 64 to 92; P < .01), HOS–Sport (from 40 to 86; P < .01), mHHS (from 56 to 88; P < .01), and SF-12 Physical Component Summary (from 41 to 54; P < .01). The median patient satisfaction was 10 out of 10 (very satisfied). Conclusion: Hip arthroscopy for FAI with labral repair resulted in excellent patient-reported outcomes and satisfaction at a minimum of 10 years of follow-up. There was a 10% rate of revision surgery, which was associated with global laxity and longer duration of symptoms before surgery, which should be considered in patient selection.

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Hip Arthroscopy vs Physical Therapy for Acetabular Labral Tears: Analysis of a Prospective Randomized Controlled Trial

Orthopaedic Journal of Sports Medicine ◽

10.1177/2325967118s00071 ◽

2018 ◽

Vol 6 (7_suppl4) ◽

pp. 2325967118S0007 ◽

Cited By ~ 1

Author(s):

John W. Stelzer ◽

Ravi Agrawal ◽

William Conaway ◽

Noah J. Quinlan ◽

Shivam Upadhyaya ◽

...

Keyword(s):

Physical Therapy ◽

Surgical Management ◽

Hip Arthroscopy ◽

Older Patients ◽

Surgical Intervention ◽

Labral Tear ◽

Labral Repair ◽

Labral Tears ◽

Tönnis Grade

Objectives: Hip arthroscopy is an effective surgical intervention for patients with symptomatic labral tears of the hip. However, there is debate as to which patients benefit from this procedure. Studies have shown that outcomes following arthroscopic labral repair in older patients have been unpredictable compared to the more predictable, positive outcomes commonly seen in younger populations. These older patients, who often have variable degrees of osteoarthritis, may benefit from non-surgical management, such as physical therapy, as a viable treatment modality. The purpose of this study was to compare the efficacy of physical therapy to hip arthroscopy for patients age 40 and older with a symptomatic labral tear. Methods: After IRB approval, patients were prospectively identified and randomized into one of two study arms: arthroscopic surgery (AS) or physical therapy (PT). A third study arm, dependent upon improvement with PT, was created as patients crossed over (CO) from PT to AS after a lack of improvement after a minimum of 8 weeks of PT. Criteria for eligibility included patients over the age of 40 with an MRI-confirmed symptomatic acetabular labral tear and limited radiographic arthritis, with exclusion of Tonnis grade 3 arthritis. AS consisted of labral repair or debridement if repair was not possible, and PT consisted of a uniform, comprehensive PT protocol guided by designated physical therapists. Demographic information, imaging studies, and baseline patient reported outcome measures (PROM) including the Modified Harris Hip Score (mHHS), Hip Outcome Score (HOS), Non-Arthritic Hip Score (NAHS), International Hip Outcome Tool (iHOT-33), and the Lower Extremity Function Score (LEFS) were collected at enrollment and at intervals of 6, 12, and 24 months after initiation of treatment. Statistical analysis was used to compare the AS, PT, and CO groups with respect to PROMs. Results: Of the 72 patients currently enrolled, 53 (73.6%) patients have completed at least 6-month follow-up, with an average follow-up of 15.2 months. Mean age was 47.0±4.8, and the mean Tonnis grade arthritis was 0.72±0.68 (range, 0-2). At the time of analysis, 13 (44.8%) of the 29 patients originally enrolled in the PT group crossed over (CO) to surgery. The AS and CO groups showed statistically significant improvements from enrollment to follow-up in all 6 PROMs; however, the PT group only showed statistically significant improvement from enrollment to follow-up in 1 PROM (Tables 1-3). When improvements of all three cohorts (AS, PT, CO) were compared, a statistically significant difference among the groups was observed in 4 of the 6 PROMs, and the surgical groups (AS and CO) outperformed the PT group (Table 4). Analysis of improvement between groups showed that CO significantly outperformed PT, while the data only approached statistical significance when AS outperformed PT. Conclusion: Although patients who undergo non-surgical management, such as PT, have shown potential to improve, results indicate that surgical intervention may be preferred over PT for patients over the age of 40 with symptomatic acetabular labral tears and limited radiographic arthritis. Additional patients and longer follow-up is necessary to confirm these findings. [Table: see text][Table: see text][Table: see text][Table: see text]

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Transition to Telehealth Physical Therapy After Hip Arthroscopy for Femoroacetabular Impingement: A Pilot Study With Retrospective Matched-Cohort Analysis

Orthopaedic Journal of Sports Medicine ◽

10.1177/2325967121997469 ◽

2021 ◽

Vol 9 (4) ◽

pp. 232596712199746

Author(s):

Brandy S. Horton ◽

Jennifer D. Marland ◽

Hugh S. West ◽

James D. Wylie

Keyword(s):

Pilot Study ◽

Physical Therapy ◽

Femoroacetabular Impingement ◽

Hip Arthroscopy ◽

Cohort Analysis ◽

Significant Difference ◽

Group 3 ◽

Group 2 ◽

Therapy Team ◽

Group 1

Background: Telehealth use has increased significantly of late. However, outside of total hip and knee arthroplasty, there is minimal evidence regarding its efficacy in orthopaedics and postoperative rehabilitation. Purpose: To determine the efficacy and cost-effectiveness of a transition to postoperative telehealth physical therapy in patients undergoing hip arthroscopy for femoroacetabular impingement (FAI). Study Design: Cohort study; Level of evidence, 3. Methods: Included were 51 patients undergoing postoperative physical therapy after hip arthroscopy for FAI. The intervention group consisted of patients undergoing initial in-person visits followed by a transition to telehealth physical therapy for 3 months postoperatively (group 1; n = 17). Comparison groups included patients undergoing in-person physical therapy with the same physical therapy team as the telehealth group (group 2; n = 17) and patients undergoing in-person therapy with a different therapy team at the same facility (group 3; n = 17). All groups were matched 1-to-1 by patient age and sex. All patients completed the short version of the International Hip Outcome Tool (iHOT-12) both preoperatively and at 3 months postoperatively. At 3 months postoperatively, it was determined whether patients met the minimally clinically important difference (MCID; ≥13 points) or substantial clinical benefit (SCB; ≥28 points) or whether they reached a Patient Acceptable Symptomatic State (PASS; ≥64 points). Billed charges were recorded as a measure of cost. Results: The overall mean age of the study patients ranged from 33 to 34 years. Among the 3 groups, there was no significant difference in the preoperative, postoperative, or pre- to postoperative change in iHOT-12 scores or in the percentage of patients meeting MCID, SCB, or PASS at 3 months. Group 1 had significantly lower mean costs ($1015.67) compared with group 2 ($1555.62; P = .011) or group 3 ($1896.38; P < .001). Conclusion: In this pilot study, telehealth physical therapy after hip arthroscopy was found to lead to similar short-term outcomes and was cost-effective compared with in-person physical therapy.

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Physical therapy aimed at self-management versus usual care physical therapy after hip arthroscopy for femoroacetabular impingement: study protocol for a randomized controlled trial

Trials ◽

10.1186/s13063-016-1222-7 ◽

2016 ◽

Vol 17 (1) ◽

Cited By ~ 7

Author(s):

M. Tijssen ◽

R. E. H. van Cingel ◽

J. B. Staal ◽

S. Teerenstra ◽

E. de Visser ◽

...

Keyword(s):

Randomized Controlled Trial ◽

Physical Therapy ◽

Usual Care ◽

Femoroacetabular Impingement ◽

Study Protocol ◽

Hip Arthroscopy ◽

Controlled Trial ◽

Self Management ◽

Randomized Controlled

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Autologous matrix-induced chondrogenesis and bone marrow aspirate concentrate compared with microfracture for arthroscopic treatment of femoroacetabular impingement and chondral lesions of the hip: bridging the osteoarthritis gap and facilitating enhanced recovery

Journal of Hip Preservation Surgery ◽

10.1093/jhps/hnaa047 ◽

2020 ◽

Author(s):

Anshul S Sobti ◽

Kwaku W Baryeh ◽

Rex Woolf ◽

Rishi Chana

Keyword(s):

Bone Marrow ◽

Femoroacetabular Impingement ◽

Hip Arthroscopy ◽

Bone Marrow Aspirate ◽

Enhanced Recovery ◽

Arthroscopic Surgery ◽

Labral Repair ◽

Cartilage Defects ◽

Survivorship Analysis ◽

Biological Reconstruction

Abstract In an attempt to bridge the osteoarthritis (OA) gap, this study compared biological reconstruction with traditional microfracture (MF) techniques in patients with femoroacetabular impingement and focal cartilage defects. Cohorts of two groups were investigated; age, gender and Tonnis grade matched comparison for outcomes between MF and newer biological reconstruction techniques hip arthroscopy surgery using autologous matrix-induced chondrogenesis and bone marrow aspirate combination. Outcomes investigated were pre-op and post-op mean iHOT-12 scores up to 18 months after surgery with a Kaplan–Meier survivorship analysis. Of 111 patients, 46 patients underwent MF and 65 biological reconstruction hip arthroscopy including cam/pincer osteoplasty and labral repair surgery. Age range was 20–69, mean age 45 years for both groups, Tonnis grading was as follows: Grade 0: 26% versus 30%, Grade 1: 52% versus 47% and Grade 2: 22% versus 23% in MF and biological reconstruction groups, respectively. The mean post-operative iHOT-12 score differences between MF and biological reconstruction were significant at 1-year minimum follow-up (P = 0.01, SD 2.8). Biological reconstruction allowed for an enhanced recovery protocol. The MF group had a 67.4% survivorship for conversion to hip replacement at 18 months (32.6% failure rate for any reason) and biological reconstruction had 100% survivorship at 18 months post-operatively with no failures for any reason. This study provides further support to the evidence base for biological reconstructive techniques as superior to MF in combination with joint preservation arthroscopic surgery, even in the face of focal cartilage defects and offers both surgeons and patients a potential bridging of the OA gap.

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