scholarly journals Multicentre study on capsular closure versus non-capsular closure during hip arthroscopy in Danish patients with femoroacetabular impingement (FAI): protocol for a randomised controlled trial

BMJ Open ◽  
2018 ◽  
Vol 8 (2) ◽  
pp. e019176 ◽  
Author(s):  
Christian Dippmann ◽  
Otto Kraemer ◽  
Bent Lund ◽  
Michael Krogsgaard ◽  
Per Hölmich ◽  
...  
Keyword(s):  
Femoroacetabular Impingement ◽  
Hip Joint ◽  
Hip Arthroscopy ◽  
Primary Outcome ◽  
Standard Procedure ◽  
Secondary Outcome ◽  
Group I ◽  
Femoroacetabular Impingement Syndrome ◽  
Patient Reported ◽  
Randomised Controlled

IntroductionHip arthroscopy has become a standard procedure in the treatment of hip joint pain not related to osteoarthritis or dysplasia in the young and active patient. There has been increasing focus on the contribution of the hip capsule to function and on stability following hip arthroscopy. It has been suggested that capsular closure after hip arthroscopy may prevent microinstability and macroinstability of the hip joint and reduce revision rate. However, it remains unknown whether capsular closure should be performed as a standard procedure when performing hip arthroscopies, especially in patients without additional risk factors for instability such as hypermobility or dysplasia of the hip. We hypothesised that capsular closure will lead to a superior outcome in hip arthroscopy for femoroacetabular impingement syndrome (FAIS) compared with non-capsular closure.Methods and analysisIn this randomised controlled, multicentre trial, 200 patients scheduled for hip arthroscopy for FAIS will be cluster randomised into one of two groups (group I: hip arthroscopy without capsular closure, group II: hip arthroscopy combined with capsular closure). Inclusion criteria are: age between 18 years and 50 years and FAIS according to the Warwick agreement. Exclusion criteria are: previous hip surgery in either hip, previous conditions of Legg-Calvé-Perthes or slipped capital femoral epiphysis, malignant disease, recent hip or pelvic fractures, arthritis, Ehlers-Danlos or Marfan disease, recent (within 6 weeks) application of intra-articular corticosteroids, language problems of any kind, and radiological signs of osteoarthritis, acetabular dysplasia or acetabular retroversion. Surgery will be performed in Denmark at four centres by four surgeons, all performing an interportal capsulotomy and closure with at least two absorbable sutures. Patients in both groups, who are blinded for the intervention, will receive the same standardised rehabilitation programme. As primary outcome scores, HAGOS (sport) will be used with HAGOS (symptoms, pain, function in daily living, participation in physical activities and hip and/or groin-related quality of life), Hip Sports Activity Scale, short validated version of the International Hip Outcome Tool, EQ-5D, Visual Analogue Scale for pain, complications and reoperation rate as secondary outcome tools. Using HAGOS (sport) as primary outcome parameter the power analysis required a minimum of 84 individuals per group. Together with a clinical examination performed by the patient’s surgeon 1 year after surgery, patient reported outcome measures will be completed preoperatively, as well as at 3 months, 1 year, 2 years and 5 years postoperatively. In addition, adverse effects will be recorded.Ethics and disseminationThe study is approved by the Central Denmark Region Committee on Biomedical research ethics. The results of this study will be presented at national and international congresses and published in peer-reviewed journals.Trial registration numberNCT03158454; Pre-results.

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 Predictors of Persistent Postoperative Pain at Minimum Two-years After Arthroscopic Treatment of Femoroacetabular Impingement

2019 ◽  
Vol 7 (3_suppl2) ◽  
pp. 2325967119S0020
Author(s):  
Austin V. Stone ◽  
Philip Malloy ◽  
William H. Neal ◽  
Edward Beck ◽  
Brian Robert Waterman ◽  
...  
Keyword(s):  
Mental Health ◽  
Postoperative Pain ◽  
Femoroacetabular Impingement ◽  
Hip Arthroscopy ◽  
Persistent Pain ◽  
Anxiety And Depression ◽  
Femoroacetabular Impingement Syndrome ◽  
Patient Reported ◽  
History Of ◽  
Persistent Postoperative Pain

Objectives: To evaluate predictors for persistent postoperative pain following hip arthroscopy for femoroacetabular impingement syndrome (FAIS). We hypothesized that patients with chronic preoperative pain, smokers, and those with co-morbid mental health disease would have greater persistent postoperative pain. Methods: Patients undergoing hip arthroscopy for FAIS were identified in a prospectively collected database with a minimum of two-year follow-up with patient reported outcomes (PROs). Previous open hip surgery and diagnoses other than FAIS were excluded. Patients were grouped by VAS-Pain scores as limited (≤30) and persistent (>30). Patient factors and outcomes were analyzed with univariate and correlation analyses to build a logistic regression to identify predictors of postoperative pain. Results: The limited pain (n=514) and persistent pain (n=174) groups totaled 688 patients (449 females). The persistent pain group was significantly older with a greater proportion of revision arthroscopy, worker’s compensation cases, smokers, hypertension, a history of a psychiatric diagnosis and preoperative narcotic use. Both collegiate sport participation [odds ratio (OR) -6.09 (95% CI: -1.23--30.3, p=0.027) and frequent running (OR -1.75, 95% CI: -1.09--2.81; p=0.021) decreased risk for pain. Smokers were 2.22 times more likely to have persistent pain (p=0.032; 95% CI: 1.07-4.46). A history of anxiety and depression is associated with 2.87 greater risk for persistent pain (p=0.030; 95% CI: 1.11-7.45). Conclusion: Independent predictors for persistent postoperative pain include current smoking and mental health history positive for anxiety and depression. Running as a primary form of exercise and high-level athletic participation are protective against persistent pain. Additional risk factors for increased pain include increased age, workers’ compensation claim, previous comorbid disease treated with surgery, and decreased preoperative PROs. Our analysis demonstrated significant improvements in both pain and functional PROs in both the limited pain and persistent pain groups; however, those with persistent pain demonstrated significantly inferior PROs.

scholarly journals Return to Pilates following hip arthroscopy for treatment of femoroacetabular impingement syndrome

2019 ◽  
Author(s):  
Timothy C Keating ◽  
Jorge Chahla ◽  
Edward C Beck ◽  
Andrew J Riff ◽  
Ian M Clapp ◽  
...  
Keyword(s):  
Femoroacetabular Impingement ◽  
Hip Arthroscopy ◽  
Demographic Data ◽  
Exercise Program ◽  
Patient Reported Outcome ◽  
The Body ◽  
Impingement Syndrome ◽  
Femoroacetabular Impingement Syndrome ◽  
Patient Reported ◽  
Hip Function

Abstract The Pilates Method is a common exercise program which focuses on strength, flexibility and control of the body. While the effects of Pilates have been shown to benefit, limited research has investigated its effect on patients with symptomatic femoroacetabular impingement syndrome (FAIS). As such, the purpose of this study was to examine the rate of return to Pilates following hip arthroscopy after undergoing hip arthroscopy for FAIS. The study evaluated consecutive patients who identified themselves as participating in Pilates and had undergone hip arthroscopy for the treatment of FAIS by a single fellowship-trained surgeon between 2012 and 2015 were reviewed. Demographic data, baseline physical examination, imaging, pre- and postoperative patient-reported outcome scores at a minimum of 2-years following surgery as well as a Pilates-specific questionnaire were assessed for all patients. A total of 25 patients (all female) with mean age 38 ± 11 years were identified. Preoperatively, 12 patients had discontinued Pilates due to activity-related hip complaints, 11 patients had scaled back involvement, and 2 patients maintained their baseline routine. Postoperatively, 23 of 25 patients (92%) returned to Pilates at an average of 7.7 ± 4.2 months following surgery (range, 3–14 months). Postoperatively, 96% returned to Pilates at the same level or better than preinjury. Preinjury and postoperative involvement in Pilates were comparable (2.2 h v. 1.8 h per week, P = 0.8). Loss of interest and fear of reinjury were the most common reasons for reduced Pilates involvement. All patients had significant improvements in HOS-ADL (pre 56.52 ± 21.6; post 86.1 ± 18.8; P < 0.001), HOS-SS (30.1 ± 20.0, 63.8 ± 34.8; P < 0.001), mHHS scores (57.6 ± 12.8; 79.2 ± 19.6; P < 0.001), and VAS pain (68.8 ± 15.4; 21.4 ± 26.5; P < 0.001). In conclusion, arthroscopic treatment of FAIS in Pilates participants resulted in significant improvements in hip function and predictably high rates of satisfaction.

scholarly journals INSTRUMENTAL DIAGNOSIS AND PREOPERATIVE PLANNING OF HIP ARTHROSCOPY IN FEMOROACETABULAR IMPINGEMENT SYNDROME

2021 ◽  
Author(s):  
Oleg E. Bogopolskii
Keyword(s):  
Magnetic Resonance ◽  
Femoroacetabular Impingement ◽  
Hip Joint ◽  
Hip Arthroscopy ◽  
Intraoperative Complications ◽  
Impingement Syndrome ◽  
Pelvic Bone ◽  
Successful Implementation ◽  
Technical Equipment ◽  
Femoroacetabular Impingement Syndrome

Abstract. Femoroacetabular impingement syndrome (FAI) is essentially a mechanical conflict that occurs when the acetabulum edge of the pelvic bone interacts with femur head and neck with clinical symptoms. In a basis of this conflict, as a rule, is a single or bilateral anatomical bone defect that causes an irregular shape of the hip joint with congenital or acquired etiology. Radiography, performed in a direct projection and in 45 Dunn position with external rotation of 40, is traditionally considered as basic tool for the radiological diagnosis of hip joint pathology. It allows to assess the anatomical and morphological structure of joint surfaces and their relationship. Detection of severe hip deformations may require computed tomography (CT). Magnetic resonance imaging (MRI) or magnetic resonance arthrography (MRA) is used to assess the condition of soft tissue structures of hip joint, its damage is often found in patients with FAI. The modern method of treating patients with FAI is hip arthroscopy, the undeniable advantage of which is low traumatic nature of the operation, low level of intraoperative complications and short postoperative rehabilitation period. For its successful implementation, it is necessary to take into account the complexity of performing hip arthroscopy, its duration, the necessity for good technical equipment and a high skill level of the operating surgeon. However, this operation has a number of limitations, which must be taken into account when selecting patients.

scholarly journals Effect of prior ipsilateral lower extremity surgery on 2-year outcomes following hip arthroscopy for femoroacetabular impingement syndrome

2019 ◽  
Vol 6 (3) ◽  
pp. 241-248
Author(s):  
Kyle N Kunze ◽  
Edward C Beck ◽  
Kelechi R Okoroha ◽  
Jorge Chahla ◽  
Sunikom Suppauksorn ◽  
...  
Keyword(s):  
Lower Extremity ◽  
Femoroacetabular Impingement ◽  
Hip Arthroscopy ◽  
Patient Reported Outcomes ◽  
Impingement Syndrome ◽  
Prior History ◽  
Femoroacetabular Impingement Syndrome ◽  
Patient Reported ◽  
History Of ◽  
Clinically Significant

Abstract The purpose of this study was to determine the influence of prior lower extremity surgery on patient reported outcomes following hip arthroscopy for femoroacetabular impingement syndrome (FAIS). Consecutive patients who underwent hip arthroscopy for FAIS and a prior history of ipsilateral lower extremity surgery were identified and matched 2:1 by age, gender, and body mass index (BMI) to controls without a history of lower extremity surgery. The minimal clinically important difference (MCID) and patient acceptable symptomatic state (PASS) were calculated for HOS–ADL, HOS–SS, and mHHS. Preoperative and 2-year postoperative patient reported outcomes of both groups were compared, and logistic regression was performed to determine whether lower extremity surgery influenced achieving MCID and PASS. A total of 102 patients (24.94%) with prior history of ipsilateral lower extremity surgery were identified. Ipsilateral orthopaedic knee surgery accounted for more than half (53.92%) of all prior surgeries. Patients with a history of ipsilateral lower extremity surgery had significant lower 2-year PROs, satisfaction, and greater pain when compared to patients without lower extremity surgery (P &lt; 0.001 all). A history of ipsilateral lower extremity surgery was a negative predictor of achieving MCID for HOS–ADL and HOS–SS, as well as PASS for HOS–ADL, HOS–SS, and mHHS (P &lt; 0.001 all). In conclusion, patients with prior lower extremity surgery were found to have inferior outcome scores and a lower likelihood of achieving clinically significant outcome improvement compared to patients without a history of lower extremity surgery at two years postoperatively.

Hip Arthroscopy for Femoroacetabular Impingement: 1-Year Outcomes Predict 5-Year Outcomes

2020 ◽  
Vol 49 (1) ◽  
pp. 104-111 ◽  
Author(s):  
Berkcan Akpinar ◽  
Lawrence J. Lin ◽  
David A. Bloom ◽  
Thomas Youm
Keyword(s):  
Body Mass Index ◽  
Survival Rate ◽  
Body Mass ◽  
Femoroacetabular Impingement ◽  
Hip Arthroscopy ◽  
Survival Rates ◽  
Cox Proportional Hazards Model ◽  
Harris Hip Score ◽  
Femoroacetabular Impingement Syndrome ◽  
Patient Reported

Background: Limited evidence exists comparing short- and long-term patient-reported outcomes (PROs) and overall survival rates after hip arthroscopy for femoroacetabular impingement syndrome (FAIS). Hypothesis: Patients with high improvement (HI) versus low improvement (LI) at 1 year postoperatively would achieve higher PROs and better index procedure survival rates at 5-year follow-up. Study Design: Cohort study; Level of evidence, 3. Methods: Patients who underwent primary hip arthroscopy for FAIS between September 2012 and March 2014 with minimum 5-year outcome data were identified. Using the median 1-year change in modified Harris Hip Score (mHHS) as a threshold, HI and LI subcohorts were determined. Analysis of variance was used to compare PROs. Failure rates were determined using Kaplan-Meier and Cox proportional hazards model analyses. Regression analysis was used to identify factors associated with increasing 5-year change in mHHS and Nonarthritic Hip Score (NAHS). Results: Out of 108 eligible consecutive patients, 89 (82.4%) were included (mean [SD]: age, 43.3 [14.6] years; body mass index, 25.4 [4.5]). As compared with the LI group (n = 45), the HI group (n = 44) had a longer 5-year index surgery survival rate (mean ± SEM: 83.7 ± 3.3 months vs 68.5 ± 4.6 months; P = .012) and 5-year estimated survival rate (89% vs 71%). The HI group had a decreased risk of failure versus the LI group (hazard ratio, 0.15; P = .002). The HI group also had greater PROs than did the LI group at 1 year (mHHS: 94.8 ± 1.2 vs 72.6 ± 2.7, P < .001; NAHS: 94.0 ± 1.3 vs 75.6 ± 2.2, P < .001) and 5 years (mHHS: 86.9 ± 2.0 vs 77.6 ± 3.4, P = .017; NAHS: 92.6 ± 1.8 vs 82.7 ± 4.1, P = .020). As compared with the LI group, the HI group achieved higher rates of the Patient Acceptable Symptomatic State (PASS) and minimal clinically important difference (MCID) at 1 year (PASS: 95% vs 42%, P < .001; MCID: 100% vs 89%, P = .056) and 5 years (PASS: 77% vs 45%, P = .002; MCID: 86% vs 64%, P = .014). Linear regression demonstrated that being in the HI group (ΔmHHS, P = .041; ΔNAHS, P = .017) and decreasing body mass index (ΔmHHS, P = .055; ΔNAHS, P = .023) were associated with higher 5-year ΔPROs. Conclusion: Patients with FAIS and significant improvement in the first year after hip arthroscopy had superior 5-year outcomes versus patients with persistent symptom severity. Survival rates and PROs were significantly better in patients who achieved high early outcomes at the 1-year mark.

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