Borderline Dysplastic Female Patients With Painful Internal Snapping Improve Clinical Outcomes At Minimum Two-Year Follow-Up Following Hip Arthroscopy With Femoroplasty, Labral Repair, Iliopsoas Fractional Lengthening And Capsular Plication: A Propensity-Matched Controlled Comparison

Objectives: Controversy still exists on closing the capsule following hip arthroscopy. It is unclear if capsular closure at the end of hip arthroscopy results in better clinical outcomes compared to non-closure. The purpose of this study was to compare the clinical outcomes in patients who had a closed capsule to those without a closed capsule following hip arthroscopic labral repair by a single surgeon. Methods: Patients who did not have capsular closure were identified by reviewing arthroscopy video (non-closure group). Fifty consecutive patients without capsular closure were matched with fifty patients who had capsular closure. All patients underwent primary hip arthroscopy and labral repair. The primary patient-reported outcome measure was Hip Outcome Score(HOS)-ADL. Secondary outcome measures included the modified Harris hip score(MHHS), HOS-Sport, WOMAC, general health, and patient satisfaction with outcome. Patients with lateral center edge angle less than 25º were excluded. Results: There were 23 females and 27 males with an average age of 36 years (range:14 to 77) in each group. The average lateral center edge angle was 34º (range, 27 to 48) in both groups. The alpha angle was 68º (range, 40 to 134) in the non-closure group and 70º (range, 41 to 98) in the closure group. No patient had microfractures at the time of surgery. The average follow-up time was 5 years (non-closure group range: 3-10; closure group range 3-9). Eight patients (16%) in the non-closure group required total hip arthroplasty(THA), while 4 patients (8%) in the closure group required THA. Six patients in the non-closure group and 3 patients in the closure group required revision hip arthroscopy. Of those patients who did not require revision or THA, there was a significant difference in the HOS ADL score and the secondary outcome measures (see table). Capsular closure resulted in superior clinical outcomes compared to non-closure. Conclusion: There were twice as many conversion to THA and twice as many hip arthroscopy revisions in patients undergoing hip arthroscopic labral repair without capsular closure compared to those with closure. In addition, the closure group showed significantly higher outcomes scores compared to the non-closure at 5-year follow-up time. [Table: see text]

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Predictors of Poor Clinical Outcome After Arthroscopic Labral Preservation, Capsular Plication, and Cam Osteoplasty in the Setting of Borderline Hip Dysplasia

The American Journal of Sports Medicine ◽

10.1177/0363546517730583 ◽

2017 ◽

Vol 46 (1) ◽

pp. 135-143 ◽

Cited By ~ 45

Author(s):

Akihisa Hatakeyama ◽

Hajime Utsunomiya ◽

Shoichi Nishikino ◽

Shiho Kanezaki ◽

Dean K. Matsuda ◽

...

Keyword(s):

Risk Factors ◽

Clinical Outcomes ◽

Hip Arthroscopy ◽

Harris Hip Score ◽

Failure Group ◽

Capsular Plication ◽

Chondral Damage ◽

Success Group ◽

Tönnis Grade

Background: Borderline developmental dysplasia of the hip (BDDH) is frequently diagnosed concurrently with cam impingement. While hip arthroscopy has advanced the treatment of hip joint pathology, including femoroacetabular impingement (FAI), arthroscopic treatment for FAI in the setting of BDDH remains a challenge amid a subset of patients. The risk factors of poor clinical results after hip arthroscopic labral preservation and FAI corrections in the setting of BDDH patients have not been well established. Hypothesis: Pre- and intraoperative findings can predict the poor clinical outcomes after hip arthroscopic surgery for FAI in the setting of BDDH. Study Design: Case control study; Level of evidence, 3. Methods: Of patients with BDDH (defined as lateral center edge [LCE] angle between 20° and 25°) who underwent arthroscopic procedures for FAI between 2009 and 2014, 45 met inclusion criteria (45 hips: 15 males and 30 females). Their mean age was 31.4 years (range, 12-65 years), and the mean LCE angle was 23.2°. Clinical and radiographic follow-up evaluations up to a minimum of 2 years after surgery were performed for all patients. Failure of the procedure was defined as conversion to subsequent surgery or having a Tönnis osteoarthritis grade of 2, and success was defined as patients who did not need subsequent surgery. Univariate analysis and Cox hazard proportional analysis were performed for both cohorts. Results: Of 45 patients, 11 (24%) had revision surgery (endoscopic shelf acetabuloplasty for 5 patients, total hip arthroplasty for 2, and revision hip arthroscopy for 2) or advanced to Tönnis grade ≥2 osteoarthritis and thus constituted the failure group. In the success group, modified Harris Hip Score (median, pre- vs postoperative: 72.1 vs 100, P< .001, Wilcoxon signed-rank test) and nonarthritic hip score (58.8 vs 98.8, P< .001) were significantly improved at the minimum 2-year follow-up. The median age of the failure group was significantly higher than that of the success group (47.0 vs 20.0, P< .001, Mann-Whitney Utest). Risk factors of poor clinical outcomes were identified as follows: age ≥42 years (hazard ratio [HR], 11.6; 95% CI, 2.5-53.9; P= .002, Cox hazard model), broken Shenton line (HR, 6.4; 95% CI, 1.9-22.3; P= .003), Tönnis angle ≥15° (HR, 3.9; 95% CI, 1.2-12.9; P= .03), vertical center anterior (VCA) angle ≤17° (HR, 5.0; 95% CI, 1.5-17.1; P= .01), Tönnis grade 1 at preoperative radiograph (HR, 3.6; 95% CI, 1.1-11.7; P= .04), severe cartilage delamination at acetabulum (HR, 11.8; 95% CI, 3.0-46.1; P< .001), and mild cartilage damage at femoral head (HR, 8.1; 95% CI, 2.1-30.8; P= .002). Conclusion: Preoperative predictors of poorer outcomes from hip arthroscopic labral preservation, capsular plication, and cam osteoplasty in the setting of BDDH are age ≥42 years old, broken Shenton line, osteoarthritis, Tönnis angle ≥15°, and VCA angle ≤17° on preoperative radiographs. Intraoperative predictors of poorer outcomes are severe acetabular chondral damage and even mild femoral chondral damage. Although the patients in the setting of BDDH may have good outcomes from isolated hip arthroscopy, caution is suggested for those with the aforementioned risk factors.

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Arthroscopic Labral Treatment in Adolescents: Clinical Outcomes With Minimum 5-Year Follow-up

The American Journal of Sports Medicine ◽

10.1177/0363546519825627 ◽

2019 ◽

Vol 47 (4) ◽

pp. 870-875 ◽

Cited By ~ 3

Author(s):

Jody M. Litrenta ◽

Brian H. Mu ◽

Austin W. Chen ◽

Itay Perets ◽

Victor Ortiz-Declet ◽

...

Keyword(s):

Clinical Outcomes ◽

Outcome Measures ◽

Hip Arthroscopy ◽

Patient Reported Outcome Measures ◽

Patient Reported Outcome ◽

Labral Repair ◽

Harris Hip Score ◽

Labral Tears ◽

Patient Reported

Background: The success of hip arthroscopy has led to increased application in younger populations. However, hip arthroscopy remains a challenging procedure, and its safety and efficacy in the adolescent population have been controversial. Most existing literature on outcomes in such patients contains only short-term follow-up, and a paucity of evidence is available regarding long-term outcomes in adolescents. Purpose: To report on clinical outcomes at a minimum 5-year follow-up in patients younger than 18 years who underwent arthroscopic treatment of labral tears. Study Design: Case series; Level of evidence, 4. Methods: Data were prospectively collected and retrospectively reviewed on all patients younger than 18 years who underwent hip arthroscopy in a tertiary hip preservation setting at a single institution. Patients were excluded if they had previous ipsilateral hip conditions or surgery. All patients underwent either labral repair or debridement for treatment of a labral tear. Patient-reported outcome measures were recorded at 3 months and at 1, 2, or a minimum of 5 years. These included the modified Harris Hip Score (mHHS), Nonarthritic Hip Score, Hip Outcome Score–Sports Specific Subscale (HOS-SSS), visual analog scale, and patient satisfaction. Additionally, the abbreviated International Hip Outcome Tool and Short Form Health Survey were collected at latest follow-up. Results: The study included 44 hips in 32 patients that underwent arthroscopic labral repair (86.4%) or labral debridement (13.6%) between April 2008 and April 2011, with latest follow-up at a mean of 69.2 months (range, 60.0-89.9 months) postoperatively. The average age at surgery was 16.3 years (range, 14.2-17.9 years), and 39 hips from female patients. Statistically significant improvements were seen in all patient-reported outcome measures from preoperative to minimum 5-year follow-up. Improvements were noted at 1-year follow-up and maintained at minimum 5-year follow-up. At the latest follow-up, the Patient Acceptable Symptomatic State was achieved in 95.5% of patients for the mHHS and 72.7% for the HOS-SSS. Two patients subsequently underwent secondary arthroscopy on the ipsilateral hip; however, the survivorship of all hips was 100%. Conclusion: Hip arthroscopy for the treatment of labral tears in adolescents remains a technically challenging procedure that should be approached with appropriate caution. The results of the present study on a population treated in a specialized hip preservation center demonstrate that hip arthroscopy is a safe procedure with stable improvement in patient-reported outcome measures at 5 years.

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Effect of Sex and Age on Achieving Meaningful Clinical Outcomes at 5-years after Hip Arthroscopy for Femoroacetabular Impingement: A Comparative Match-Group Analysis

Orthopaedic Journal of Sports Medicine ◽

10.1177/2325967120s00438 ◽

2020 ◽

Vol 8 (7_suppl6) ◽

pp. 2325967120S0043

Author(s):

Edward Beck ◽

Justin Drager ◽

Benedict Nwachukwu ◽

Kyleen Jan ◽

Shane Nho ◽

...

Keyword(s):

Clinical Outcomes ◽

Femoroacetabular Impingement ◽

Hip Arthroscopy ◽

Female Patients ◽

Outcome Score ◽

Modifiable Factors ◽

Functional Scores ◽

Male Patients ◽

Age And Sex

Objectives: Non-modifiable factors including age and sex have been shown to effect outcomes following hip arthroscopy in patients with femoroacetabular impingement syndrome (FAIS) at short-term follow-up. However, their effect on achieving long-term meaningful outcomes has not been evaluated. As such, the purpose of this study is to compare clinical outcomes, including achieving meaningful clinical important difference (MCID) and the patient acceptable symptomatic state (PASS) at 5-years, by age and sex. Methods: 150 patients undergoing hip arthroscopy for femoroacetabular impingement by a single fellowship trained surgeon were prospectively analyzed, with 25 patients in each of the following groups: female patients younger than 30 years of age, female patients 30 to 45 years of age, female patients older than 45 years of age, male patients younger than 30 years of age, male patients 30 to 45 years of age, and male patients older than 45 years of age. Pre and postoperative functional scores were collected including the Hip Outcome Score Activities of Daily Living Subscale (HOS-ADL), Hip Outcome Score Sport-Specific Subscale (HOS-Sport), the modified Harris hip score (mHHS), and visual analog scale (VAS) satisfaction and pain at 5-year follow-up. MCID and PASS was calculated for each functional measure and compared by gender and age category. Results: At 5-year follow-up, all groups demonstrated statistically significant improvement in the functional outcome score averages and pain (p<0.001 for all). Both within gender and within age category analysis of postoperative functional scores did not demonstrate any statistically significant differences (p>0.05).Analysis of achieving MCID and PASS demonstrated that females had a higher rate of reaching the HOS-SS and mHHS threshold for achieving MCID as compared to their male counterparts (48.3% vs 58%%; p=0.008 and 54% vs 75.4%; p=0.012, respectively). Furthermore, patients <30 years old had higher rates of reaching the HOS-ADL and mHHS for achieving PASS than the two older age groups (p>0.05 for both). Conclusions: Non-modifiable factors, including age and sex, influence the rate of achieving meaningful clinical outcomes at 5-year follow up. Female patients are more likely to reach the HOS-SS and mHHS threshold for achieving MCID, while those <30 years of age are more likely to reach the HOS-ADL and mHHS threshold for achieving PASS as compared to older patients.

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Clinical Outcomes of Shoulder Stabilization in Females With Glenoid Bone Loss

Orthopaedic Journal of Sports Medicine ◽

10.1177/23259671211007525 ◽

2021 ◽

Vol 9 (5) ◽

pp. 232596712110075

Author(s):

Rachel M. Frank ◽

Hytham S. Salem ◽

Catherine Richardson ◽

Michael O’Brien ◽

Jon M. Newgren ◽

...

Keyword(s):

Bone Loss ◽

Clinical Outcomes ◽

Shoulder Instability ◽

Glenoid Bone Loss ◽

Anterior Shoulder Instability ◽

Latarjet Procedure ◽

Shoulder Stabilization ◽

Simple Shoulder Test ◽

Female Patients

Background: Nearly all studies describing shoulder stabilization focus on male patients. Little is known regarding the clinical outcomes of female patients undergoing shoulder stabilization, and even less is understood about females with glenoid bone loss. Purpose: To assess the clinical outcomes of female patients with recurrent anterior shoulder instability treated with the Latarjet procedure. Study Design: Case series; Level of evidence, 4. Methods: All cases of female patients who had recurrent anterior shoulder instability with ≥15% anterior glenoid bone loss and underwent the Latarjet procedure were analyzed. Patients were evaluated after a minimum 2-year postoperative period with scores of the American Shoulder and Elbow Surgeons form, Simple Shoulder Test, and pain visual analog scale. Results: Of the 22 patients who met our criteria, 5 (22.7%) were lost to follow-up, leaving 17 (77.2%) available for follow-up with a mean ± SD age of 31.7 ± 12.9 years. Among these patients, 16 (94.1%) underwent 1.6 ± 0.73 ipsilateral shoulder operations (range, 1-3) before undergoing the Latarjet procedure. Preoperative indications for surgery included recurrent instability with bone loss in all cases. After a mean follow-up of 40.2 ± 22.9 months, patients experienced significant score improvements in the American Shoulder and Elbow Surgeons form, Simple Shoulder Test, and pain visual analog scale ( P < .05 for all). There were 2 reoperations (11.8%). There were no cases of neurovascular injuries or other complications. Conclusion: Female patients with recurrent shoulder instability with glenoid bone loss can be successfully treated with the Latarjet procedure, with outcomes similar to those of male patients in the previously published literature. This information can be used to counsel female patients with recurrent instability with significant anterior glenoid bone loss.

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In Revision Hip Arthroscopy, Labral Reconstruction Can Address a Deficient Labrum, but Labral Repair Retains Its Role for the Reparable Labrum: A Matched Control Study

The American Journal of Sports Medicine ◽

10.1177/0363546518809063 ◽

2018 ◽

Vol 46 (14) ◽

pp. 3437-3445 ◽

Cited By ~ 10

Author(s):

Itay Perets ◽

Danil Rybalko ◽

Brian H. Mu ◽

David R. Maldonado ◽

Gary Edwards ◽

...

Keyword(s):

Decision Making ◽

Total Hip Arthroplasty ◽

Visual Analog Scale ◽

Hip Arthroplasty ◽

Hip Arthroscopy ◽

Labral Repair ◽

Acetabular Labrum ◽

Analog Scale ◽

Total Hip

Background: Revision hip arthroscopy is increasingly common and often addresses acetabular labrum pathology. There is a lack of consensus on indications or outcomes of revision labral repair versus reconstruction. Purpose: To report clinical outcomes of labral reconstruction during revision hip arthroscopy at minimum 2-year follow-up as compared with pair-matched labral repair during revision hip arthroscopy (control group) and to suggest a decision-making algorithm for labral treatment in revision hip arthroscopy. Study Design: Cohort study; Level of evidence, 3. Methods: Patients who underwent revision hip arthroscopy with labral reconstruction were matched 1:2 with patients who underwent revision arthroscopic labral repair. Patients were matched according to age, sex, and body mass index. Outcome scores, including the modified Harris Hip Score (mHHS), Non-Arthritic Hip Score, Hip Outcome Score–Sport-Specific Subscale, and a visual analog scale for pain, were collected preoperatively and at minimum 2-year follow-up. At latest follow-up, patient satisfaction on a 0-10 scale and the abbreviated International Hip Outcome Tool (iHOT-12) were collected. Complications, subsequent arthroscopies, and conversion to total hip arthroplasty were collected as well. Results: A total of 15 revision labral reconstructions were pair matched to 30 revision labral repairs. The reconstructions had fewer isolated Seldes type I detachments ( P = .008) and lower postoperative lateral center-edge angle, but there were otherwise no significant differences in demographics, radiographics, intraoperative findings, or procedures. Both groups demonstrated significant improvements in all outcomes and visual analog scale at minimum 2-year follow-up. The revision repairs trended toward better preoperative scores: mHHS (mean ± SD: 59.3 ± 16.5 vs 54.2 ± 16.0), Non-Arthritic Hip Score (61.0 ± 16.7 vs 51.2 ± 17.6), Hip Outcome Score–Sport-Specific Subscale (39.6 ± 25.1 vs 30.5 ± 22.1), and visual analog scale (5.8 ± 1.8 vs 6.2 ± 2.2). At follow-up, the revision repair group had significantly higher mHHS (84.1 ± 14.8 vs 72.0 ± 18.3, P = .043) and iHOT-12 (72.2 ± 23.3 vs 49.0 ± 27.6, P = .023) scores than the reconstruction group. The magnitudes of pre- to postoperative improvement between the groups were comparable. The groups also had comparable rates of complications: 1 case of numbness in each group ( P > .999), subsequent arthroscopies (repair: n = 2, 6.5%; revision: n = 3, 20%; P = .150), and conversion to total hip arthroplasty (1 patient in each group, P > .999). Conclusion: Labral reconstruction safely and effectively treats irreparable labra in revision hip arthroscopy. However, labral repair is another treatment option for reparable labra, yielding similar magnitude of improvement. A proposed algorithm may assist in surgical decision making to achieve optimal outcomes based on the condition and history of each patient’s acetabular labrum.

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The utility of hip arthroscopy for patients with painful borderline hip dysplasia

Journal of Orthopaedic Surgery ◽

10.1177/2309499020923162 ◽

2020 ◽

Vol 28 (2) ◽

pp. 230949902092316

Author(s):

Deuk-Soo Hwang ◽

Chan Kang ◽

Jeong-Kil Lee ◽

Jae-Young Park ◽

Long Zheng ◽

...

Keyword(s):

Patient Satisfaction ◽

Hip Arthroscopy ◽

Hip Dysplasia ◽

Reoperation Rate ◽

Labral Repair ◽

Harris Hip Score ◽

Control Group ◽

The Mean ◽

Tönnis Grade

Purpose: We measured the width of the acetabular labra in, and the clinical outcomes of, patients with borderline hip dysplasia (HD) who underwent arthroscopy. Methods: A total of 1436 patients who underwent hip arthroscopy to treat symptomatic, acetabular labral tears were enrolled. From this cohort, we extracted a borderline HD group (162 cases). Lateral labral widths were evaluated using preoperative magnetic resonance imaging scans. Clinical data including the modified Harris hip score (mHHS), non-arthritic hip score (NAHS), hip outcome score–activity of daily living (HOS-ADL) score, visual analog scale (VAS) pain score, and Tönnis grade were collected. In addition, patient satisfaction with arthroscopy outcomes was rated. All complications and reoperations were noted. Results: The mean follow-up time was 87.4 months. The lateral labral width was 7.64 mm in those with normal hips and 7.73 mm in borderline HD patients, respectively ( p = 0.870). The Tönnis grade progressed mildly from 0.46 to 0.76 ( p = 0.227). At the last follow-up, clinical outcome scores (mHHS, NAHS, and HOS-ADL scores) and the VAS score were improved ( p < 0.001). The mean patient satisfaction was scored at 8.2. The reoperation rate was higher in those who underwent labral debridement (25.6%) than labral repair (4.1%). Conclusions: The lateral labral width did not differ significantly between the borderline HD group and the nondysplastic control group. Arthroscopy relieved the symptoms of painful borderline HD and did not accelerate osteoarthritis. Therefore, if such patients do not respond to conservative treatment, hip arthroscopy can be considered for further treatment.

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Clinical outcomes of arthroscopic repair of acetabular labral tears

BMJ Open Sport & Exercise Medicine ◽

10.1136/bmjsem-2017-000328 ◽

2018 ◽

Vol 4 (1) ◽

pp. e000328 ◽

Cited By ~ 4

Author(s):

Carlos César Vassalo ◽

Antônio Augusto Guimarães Barros ◽

Lincoln Paiva Costa ◽

Euler de Carvalho Guedes ◽

Marco Antônio Percope de Andrade

Keyword(s):

Clinical Outcomes ◽

Arthroscopic Repair ◽

Final Evaluation ◽

Labral Repair ◽

Harris Hip Score ◽

Senior Surgeon ◽

Labral Tears ◽

Significant Difference ◽

The Mean

PurposeTo evaluate the primary clinical outcomes of arthroscopic labral repair.MethodsAll patients who underwent arthroscopic repair of the acetabular labrum performed by a senior surgeon between October 2010 and December 2013 were invited to participate in this prospective study. Patients included were those who had a preoperative diagnosis of labral tears, a lateral centre edge greater than 25° and a labral tear believed to be suturable during the intraoperative evaluation. Patients with Tönnis grade 2 or grade 3 hip osteoarthritis and those who had undergone a previous hip surgery were excluded. All patients were evaluated using the modified Harris Hip Score (mHHS) during the final appointment before surgery, 4 months after surgery and at the final evaluation. Interviews were conducted by the senior surgeon.ResultsEighty-four patients (90 hips) underwent arthroscopic repair. The mean age was 44.2 years and the mean follow-up period was 43.0 months (minimum of 25 months and maximum of 59 months). The mean mHHS was 80.4 preoperatively, 95.0 at 4 months postoperatively and 96.6 at final evaluation. A statistically significant difference existed among these scores (p<0.001).ConclusionArthroscopic labral repair was associated with a clinically significant improvement in mHHS after short-term (4 months) and medium-term (43 months) follow-up.Level of evidenceLevel IV, therapeutic case series.

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