Complete Capsule Closure Provides Clinically Significant Outcome Improvement and Higher Survivorship After Hip Arthroscopy at Minimum 5-year Follow-up

2021 ◽  
Author(s):  
Edward C. Beck ◽  
Benedict U. Nwachukwu ◽  
Jorge Chahla ◽  
Ian Clapp ◽  
Kyleen Jan ◽  
...  
Keyword(s):  
Hip Arthroscopy ◽  
Outcome Improvement ◽  
Clinically Significant

scholarly journals Effect of Capsular Closure After Hip Arthroscopy for Femoroacetabular Impingement Syndrome on Achieving Clinically Meaningful Outcomes: A Meta-analysis of Prospective and Comparative Studies

2021 ◽  
Vol 9 (6) ◽  
pp. 232596712110174
Author(s):  
Kyle N. Kunze ◽  
Amar Vadhera ◽  
Annie Devinney ◽  
Benedict U. Nwachukwu ◽  
Bryan T. Kelly ◽  
...  
Keyword(s):  
Femoroacetabular Impingement ◽  
Comparative Studies ◽  
Hip Arthroscopy ◽  
Meta Analysis ◽  
Impingement Syndrome ◽  
Harris Hip Score ◽  
Femoroacetabular Impingement Syndrome ◽  
Outcome Improvement ◽  
Clinically Significant

Background: Recent literature has demonstrated conflicting evidence as to whether capsular closure after hip arthroscopy for femoroacetabular impingement syndrome (FAIS) results in superior outcomes compared with capsulotomy without repair. Additionally, these studies have not explored the effect of capsular management on clinically significant outcome improvement. Purpose: To perform a meta-analysis of prospective and comparative studies to determine whether capsular management influences the rate of clinically significant outcome improvement after hip arthroscopy for FAIS. Study Design: Systematic review; Level of evidence, 3. Methods: PubMed, OVID/Medline, EMBASE, and Cochrane databases were queried in September 2020 for studies with evidence levels 1 to 3 that directly compared capsular management cohorts and reported rates of achieving the minimal clinically important difference (MCID) at a minimum follow-up of 2 years. Studies of level 4 evidence, those not describing or directly comparing capsular management techniques as well as those not reporting the MCID were excluded. Methodological quality was assessed using the methodological index for nonrandomized studies tool. Mantel-Haenszel fixed-effects models were constructed to quantitatively evaluate the association between capsular management and achievement of the MCID by generating effect estimates in the form of relative risk (RR) with 95% CIs. Results: A total of 6 studies with 1611 patients were included. The overall pooled rate of MCID achievement for the modified Harris Hip Score (mHHS), Hip Outcome Score Activities of Daily Living (HOS-ADL), and HOS Sports Subscale (HOS-SS) were 84.4%, 80.3%, and 82.5%, respectively, at a mean follow-up of 40.8 months (range, 24-87.6 months). Capsular closure was associated with a significantly higher rate of MCID achievement for the mHHS (RR, 1.06; 95% CI, 1.01-1.10; P = .001) and trended toward statistical significance for the HOS-ADL (RR, 1.11; 95% CI, 1.0-1.24; P = .055) and the HOS-SS (RR, 1.09; 95% CI, 0.99-1.21; P = .094). Conclusion: Although capsular closure appeared to result in higher rates of clinically significant outcome improvement in hip function, there was no definitively increased likelihood of achieving clinically significant improvement in relevant hip outcome scores with capsular closure.

Time Required to Achieve Minimal Clinically Important Difference and Substantial Clinical Benefit After Arthroscopic Treatment of Femoroacetabular Impingement

2018 ◽  
Vol 46 (11) ◽  
pp. 2601-2606 ◽  
Author(s):  
Benedict U. Nwachukwu ◽  
Brenda Chang ◽  
Joshua Adjei ◽  
William W. Schairer ◽  
Anil S. Ranawat ◽  
...  
Keyword(s):  
Femoroacetabular Impingement ◽  
Clinical Benefit ◽  
Hip Arthroscopy ◽  
Minimal Clinically Important Difference ◽  
Arthroscopic Treatment ◽  
Clinically Important Difference ◽  
Substantial Clinical Benefit ◽  
Outcome Improvement ◽  
Clinically Significant

Background: Minimal clinically important difference (MCID) defines the minimum degree of quantifiable outcome improvement that a patient perceives as the result of an intervention or in the process of healing. Substantial clinical benefit (SCB) defines the amount of quantifiable outcome improvement that is needed for a patient to feel substantially better. Little is known about when clinically significant outcome improvement is achieved. Purpose: To investigate the time-dependent nature of MCID and SCB after hip arthroscopy for femoroacetabular impingement (FAI). Study Design: Cohort study; Level of evidence, 2. Methods: An institutional hip preservation registry was queried. The modified Harris Hip Score, Hip Outcome Score, and 33-item International Hip Outcome Tool (iHOT-33) were administered to patients undergoing hip arthroscopy for FAI. Follow-up times for outcome measures were classified into 3 periods: 5 to 11 months (6 months), 12 to 23 months (1 year), and 24 to 35 months (2 years). Cumulative probabilities for achieving MCID and SCB were calculated with Kaplan-Meier survival curve analysis and interval censoring. A Weibull parametric regression analysis evaluated the odds of achieving earlier MCID. Results: A total of 719 patients undergoing primary hip arthroscopy were included. The mean ± SD age was 32.5 ± 10.5 years, and the majority were female (n = 380, 52.9%). Across all 4 outcome instruments, patients had the highest probability for achieving MCID and SCB by the 6-month postoperative period. The iHOT-33 demonstrated the highest probability for capturing MCID and SCB improvement at each of the 3 periods, with 76.0%, 84.8%, and 93.6% achieving MCID by 6 months, 1 year, and 2 years, respectively. Similarly, the probabilities of achieving SCB on the iHOT-33 were as follows: 57.1%, 68.0%, and 71.7%. A similar trend was demonstrated across other outcome tools. Older male patients and those with Outerbridge classification 1 to 4 (vs grade 0) had a significantly increased risk for taking a longer time to achieve MCID and SCB. Additionally, patients with higher preoperative outcome scores took a longer time to achieve MCID and SCB. Conclusion: At least half of patients treated with hip arthroscopy for FAI achieve MCID and SCB within the first 6 months after the procedure. However, clinically significant outcome improvement continues to be attained until 2 years postoperatively. Female patients, younger individuals, and those without chondral defects achieve faster clinical outcome improvement. These findings can be helpful for establishing shared decision-making aids and follow-up guidelines for arthroscopic treatment of FAI.

scholarly journals Defining the MCID, PASS and SCB for Arthroscopic Hip Preservation Surgery at Minimum Five-Year Follow-up

2020 ◽  
Vol 8 (7_suppl6) ◽  
pp. 2325967120S0035
Author(s):  
Benedict Nwachukwu ◽  
Edward Beck ◽  
Kyle Kunze ◽  
Jorge Chahla ◽  
Justin Drager ◽  
...  
Keyword(s):  
Hip Arthroscopy ◽  
Demographic Data ◽  
Patient Reported Outcome ◽  
Femoroacetabular Impingement Syndrome ◽  
Patient Reported ◽  
Outcome Improvement ◽  
Clinically Significant ◽  
One Year ◽  
The One

Objectives: Minimal clinically important difference (MCID), substantial clinical benefit (SCB) and patient acceptable symptomatic state (PASS) have gained prominence as important variables in the orthopedic outcomes literature. In hip preservation surgery, much attention has been given to defining early clinically significant outcome, however, it is unknown what represents meaningful patient reported outcome improvement in the medium to long-term. The purpose of the present study was to define MCID, PASS and SCB at a minimum five years after hip arthroscopy for femoroacetabular impingement syndrome (FAIS). Secondarily, we sought to evaluate the time dependent nature of MCID, PASS and SCB. Methods: Patients undergoing 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 at 1-, 2-, and 5- years. MCID was calculated using a distribution-based method while PASS and SCB were calculated using an anchor method. Results: Two hundred and eighty-three patients were included with an average age of 34.2+11.9 years. The one year, two year and five-year MCID scores were as follows respectively: 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). PASS scores 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). 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 two-year follow-up than at one-year follow-up. However, 79.3% of the patients achieved MCID by 5 years. Conclusion: The greatest proportion of patients achieve clinically significant outcome improvement at two-year follow-up after arthroscopic treatment of FAIS. Improvements are maintained out to five-year follow-up although there is a slight decrease in the proportion of patients achieving clinical significance. [Table: see text]

scholarly journals Clinically Significant Outcome Improvement After Hip Arthroscopy in Patients With Femoroacetabular Impingement Syndrome and Severe Femoral Torsion

2021 ◽  
Vol 9 (10) ◽  
pp. 232596712110345
Author(s):  
Steven F. DeFroda ◽  
Thomas D. Alter ◽  
Blake M. Bodendorfer ◽  
Alexander C. Newhouse ◽  
Felipe S. Bessa ◽  
...  
Keyword(s):  
Femoroacetabular Impingement ◽  
Hip Arthroscopy ◽  
Impingement Syndrome ◽  
Harris Hip Score ◽  
Femoral Torsion ◽  
Outcome Score ◽  
Femoroacetabular Impingement Syndrome ◽  
Patient Reported ◽  
Outcome Improvement ◽  
Clinically Significant

Background: The influence of femoral torsion on clinically significant outcome improvement after hip arthroscopy for femoroacetabular impingement syndrome (FAIS) has not been well-studied. Purpose: To quantify femoral torsion in FAIS patients using magnetic resonance imaging (MRI) and explore the relationship between femoral torsion and clinically significant outcome improvement after hip arthroscopy. Study Design: Cohort study; Level of evidence, 3. Methods: Included were patients who underwent hip arthroscopy for FAIS between January 2012 and August 2018 and had 2-year follow-up and preoperative MRI scans containing transcondylar slices of the knee. Participants were categorized as having severe retrotorsion (SR; <0°), normal torsion (NT; 0°-25°), and severe antetorsion (SA; >25°) as measured on MRI. Patient-reported outcomes (PROs) included the Hip Outcome Score–Activities of Daily Living, Hip Outcome Score–Sports Subscale, modified Harris Hip Score, 12-item International Hip Outcome Tool (iHOT-12), and visual analog scale (VAS) for pain and satisfaction. Achievement of Patient Acceptable Symptom State (PASS) and substantial clinical benefit (SCB) were analyzed among cohorts. Results: Included were 183 patients (SR, n = 13; NT, n = 154; SA, n = 16) with a mean age, body mass index, and femoral torsion of 30.6 ± 12.1 years, 24.0 ± 4.4 kg/m2, and 12.55° ± 9.58°, respectively. The mean torsion was –4.5° ± 2.6° for the SR, 12.1° ± 6.8° for the NT, and 31.0° ± 3.6° for the SA group. There were between-group differences in the proportion of patients who achieved PASS and SCB on the iHOT-12, pain VAS, and any PRO ( P < .05). Post hoc analysis indicated that the SA group achieved lower rates of PASS and SCB on the iHOT-12 and pain VAS, and lower rates of PASS on any PRO versus the SR group ( P < .05); the SR group achieved higher rates of PASS and SCB on pain VAS scores versus the NT group ( P = .003). Conclusion: The orientation and severity of femoral torsion during hip arthroscopy influenced the propensity for clinically significant outcome improvement. Specifically, patients with femoral retrotorsion and femoral antetorsion had higher and lower rates of clinically significant outcome improvement, respectively.

scholarly journals Evaluation of a multidisciplinary lipid clinic to improve the care of individuals with severe lipid conditions: a RE-AIM framework analysis

2021 ◽  
Vol 2 (1) ◽  
Author(s):  
Laney K. Jones ◽  
Megan McMinn ◽  
David Kann ◽  
Michael Lesko ◽  
Amy C. Sturm ◽  
...  
Keyword(s):  
Primary Care ◽  
Program Effectiveness ◽  
Primary Care Providers ◽  
Care Providers ◽  
Lipid Levels ◽  
Framework Analysis ◽  
Lipid Clinic ◽  
Adherence Counseling ◽  
Clinically Significant

Abstract Background Individuals with complex dyslipidemia, or those with medication intolerance, are often difficult to manage in primary care. They require the additional attention, expertise, and adherence counseling that occurs in multidisciplinary lipid clinics (MDLCs). We conducted a program evaluation of the first year of a newly implemented MDLC utilizing the RE-AIM (reach, effectiveness, adoption, implementation, and maintenance) framework to provide empirical data not only on program effectiveness, but also on components important to local sustainability and future generalizability. Methods The purpose of the MDLC is to increase the uptake of guideline-based care for lipid conditions. Established in 2019, the MDLC provides care via a centralized clinic location within the healthcare system. Primary care providers and cardiologists were invited to refer individuals with lipid conditions. Using a pre/post-study design, we evaluated the implementation outcomes from the MDLC using the RE-AIM framework. Results In 2019, 420 referrals were made to the MDLC (reach). Referrals were made by 19% (148) of the 796 active cardiology and primary care providers, with an average of 35 patient referrals per month in 2019 (SD 12) (adoption). The MDLC saw 83 patients in 2019 (reach). Additionally, 50% (41/82) had at least one follow-up MDLC visit, and 12% (10/82) had two or more follow-up visits in 2019 (implementation). In patients seen by the MDLC, we found an improved diagnosis of specific lipid conditions (FH (familial hypercholesterolemia), hypertriglyceridemia, and dyslipidemia), increased prescribing of evidence-based therapies, high rates of medication prior authorization approvals, and significant reductions in lipid levels by lipid condition subgroup (effectiveness). Over time, the operations team decided to transition from in-person follow-up to telehealth appointments to increase capacity and sustain the clinic (maintenance). Conclusions Despite limited reach and adoption of the MDLC, we found a large intervention effect that included improved diagnosis, increased prescribing of guideline-recommended treatments, and clinically significant reduction of lipid levels. Attention to factors including solutions to decrease the large burden of unseen referrals, discussion of the appropriate number and duration of visits, and sustainability of the clinic model could aid in enhancing the success of the MDLC and improving outcomes for more patients throughout the system.

scholarly journals Trajectories of fatigue in actively treated patients with established rheumatoid arthritis starting biologic DMARD therapy

RMD Open ◽  
2020 ◽  
Vol 6 (3) ◽  
pp. e001372
Author(s):  
Sella Aarrestad Provan ◽  
Brigitte Michelsen ◽  
Joseph Sexton ◽  
Tillmann Uhlig ◽  
Hilde Berner Hammer
Keyword(s):  
Rheumatoid Arthritis ◽  
Rating Scale ◽  
Numeric Rating Scale ◽  
Tender Joint Count ◽  
Tender Joint ◽  
Logistic Regression Models ◽  
Patient Reported ◽  
Biologic Dmard ◽  
Clinically Significant

ObjectivesTo define fatigue trajectories in patients with rheumatoid arthritis (RA) who initiate biological DMARD (bDMARD) treatment, and explore baseline predictors for a trajectory of continued fatigue.MethodsOne-hundred and eighty-four patients with RA initiating bDMARDs were assessed at 0, 1, 2, 3, 6 and 12 months. Swollen and tender joint counts, patient reported outcomes (PROMs), blood samples and ultrasound examinations were collected at each time point. Fatigue was assessed by the fatigue Numeric Rating Scale (0–10) from the Rheumatoid Arthritis Impact of Disease (RAID) questionnaire. Clinically significant fatigue was predefined as fatigue ≥4. Three trajectories of interest were defined according to level of RAID fatigue: no fatigue (≤3 at 5/6 visits), improved fatigue (≥4 at start, but ≤3 at follow-up) and continued fatigue (≥4 at 5/6 visits). Baseline variables were compared between groups by bivariate analyses, and logistic regression models were used to explore baseline predictors of continued vs improved fatigue.ResultsThe majority of patients starting bDMARD therapy followed one of three fatigue trajectories, (no fatigue; n=61, improved; n=33 and continued fatigue; n=53). Patients with continued fatigue were more likely to be anti–citrullinated protein antibody and/or rheumatoid factor positive and had higher baseline PROMs compared to the other groups, while there were no differences between the groups for variables of inflammation including. Patient global, tender joint count and anxiety were predictors for the continued fatigue trajectory.DiscussionA trajectory of continued fatigue was determined by PROMs and not by inflammatory RA disease activity.

Capsular closure versus unrepaired interportal capsulotomy after hip arthroscopy in patients with femoroacetabular impingement, results of a patient-blinded randomised controlled trial

2021 ◽  
pp. 112070002110057
Author(s):  
Niels H Bech ◽  
Inger N Sierevelt ◽  
Sheryl de Waard ◽  
Boudijn S H Joling ◽  
Gino M M J Kerkhoffs ◽  
...  
Keyword(s):  
Randomised Controlled Trial ◽  
Femoroacetabular Impingement ◽  
Hip Arthroscopy ◽  
Controlled Trial ◽  
Poor Quality ◽  
Control Group ◽  
Treatment Groups ◽  
Significant Difference ◽  
Randomised Controlled

Background: Hip capsular management after hip arthroscopy remains a topic of debate. Most available current literature is of poor quality and are retrospective or cohort studies. As of today, no clear consensus exists on capsular management after hip arthroscopy. Purpose: To evaluate the effect of routine capsular closure versus unrepaired capsulotomy after interportal capsulotomy measured with NRS pain and the Copenhagen Hip and Groin Outcome Score (HAGOS). Materials and methods: All eligible patients with femoroacetabular impingement who opt for hip arthroscopy ( n = 116) were randomly assigned to one of both treatment groups and were operated by a single surgeon. Postoperative pain was measured with the NRS score weekly the first 12 weeks after surgery. The HAGOS questionnaire was measured at 12 and 52 weeks postoperatively. Results: Baseline characteristics and operation details were comparable between treatment groups. Regarding the NRS pain no significant difference was found between groups at any point the first 12 weeks after surgery ( p = 0.67). Both groups significantly improved after surgery ( p < 0.001). After 3 months follow-up there were no differences between groups for the HAGOS questionnaire except for the domain sport ( p = 0.02) in favour of the control group. After 12 months follow-up there were no differences between both treatment groups on all HAGOS domains ( p  > 0.05). Conclusions: The results of this randomised controlled trial show highest possible evidence that there is no reason for routinely capsular closure after interportal capsulotomy at the end of hip arthroscopy. Trial Registration: This trial was registered at the CCMO Dutch Trial Register: NL55669.048.15.

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