Outcomes of Hip Arthroscopic Surgery in Patients With Tönnis Grade 1 Osteoarthritis With a Minimum 2-Year Follow-up

2016 ◽  
Vol 44 (7) ◽  
pp. 1781-1788 ◽  
Author(s):  
Sivashankar Chandrasekaran ◽  
Chengcheng Gui ◽  
Nader Darwish ◽  
Parth Lodhia ◽  
Carlos Suarez-Ahedo ◽  
...  
Keyword(s):  
Patient Satisfaction ◽  
Arthroscopic Surgery ◽  
Matched Pair ◽  
Harris Hip Score ◽  
Pain Patient ◽  
Vas Score ◽  
Outcome Score ◽  
Significant Difference ◽  
Tönnis Grade

Background: There are limited studies on the effect of mild osteoarthritis (OA) on outcomes of hip arthroscopic surgery. Purpose: To conduct a matched-pair analysis with a minimum 2-year follow-up to evaluate outcomes after hip arthroscopic surgery in patients with Tönnis grade 1 OA. Study Design: Cohort study; Level of evidence, 3. Methods: Data were prospectively collected on patients who underwent hip arthroscopic surgery between April 2008 and December 2012. Patients were excluded if they had previous hip conditions. The remaining patients were divided into either Tönnis 0 or 1 grade OA groups and were matched in a 1-to-1 ratio according to age within 5 years, sex, body mass index category, labral treatment, and capsular treatment. Four patient-reported outcome (PRO) scores, as well as the visual analog scale (VAS) score for pain, patient satisfaction, and rates of revision arthroscopic surgery and conversion to total hip arthroplasty (THA), were recorded. Results: A total of 1412 hip arthroscopic procedures were performed during the study period, of which 1036 met the inclusion criteria and 892 (86.1%) had 2-year follow-up. There were 738 and 154 patients with Tönnis grade 0 and 1, respectively; 93 patients were matched in each group. The Tönnis grade 0 group had a mean follow up of 28.7 months (range, 23.5-67.9 months), and the Tönnis grade 1 group had a mean follow up of 31.5 months (range, 23.6-63.5 months). Both groups demonstrated a significant improvement in all PROs and the VAS at a minimum 2-year follow-up. For the Tönnis grade 0 group, the improvements (in points) in the PROs were as follows: modified Harris Hip Score (mHHS), 15.51; Nonarthritic Hip Score (NAHS), 20.65; Hip Outcome Score–Activities of Daily Living (HOS-ADL), 16.83; and Hip Outcome Score–Sport-Specific Subscale (HOS-SSS), 20.91. The VAS score for the Tönnis grade 0 group decreased by 2.82 points. For the Tönnis grade 1 group, the improvements (in points) in the PROs were as follows: mHHS, 19.52; NAHS, 20.96; HOS-ADL, 18.20; and HOS-SSS, 21.61. The VAS score for the Tönnis grade 1 group decreased by 2.84 points. No significant difference was found between the mean change in PROs, VAS, or patient satisfaction between the groups ( P > .05). There was no significant difference in subsequent rates for revision arthroscopic surgery or conversion to THA between the groups ( P = .3 and .6, respectively). The rates for revision arthroscopic surgery and conversion to THA were 9.68% and 9.68%, respectively, in the Tönnis grade 0 group and 5.38% and 11.83%, respectively, in the Tönnis grade 1 group. Conclusion: At 2-year follow-up, patients with Tönnis grade 1 OA had improved outcomes after hip arthroscopic surgery, with no significant difference compared with a matched control group of patients with Tönnis grade 0 OA. However, further studies are underway to determine if the results of the Tönnis grade 1 cohort will deteriorate over longer term follow-up.

Outcomes of Hip Arthroscopic Surgery in Patients With Tönnis Grade 1 Osteoarthritis at a Minimum 5-Year Follow-up: A Matched-Pair Comparison With a Tönnis Grade 0 Control Group

2017 ◽  
Vol 45 (10) ◽  
pp. 2294-2302 ◽  
Author(s):  
Benjamin G. Domb ◽  
Edwin O. Chaharbakhshi ◽  
Danil Rybalko ◽  
Mary R. Close ◽  
Jody Litrenta ◽  
...  
Keyword(s):  
Arthroscopic Surgery ◽  
Arthroscopic Treatment ◽  
Matched Pair ◽  
Harris Hip Score ◽  
Control Group ◽  
Pair Comparison ◽  
Labral Tears ◽  
Vas Scores ◽  
Tönnis Grade

Background: Studies on midterm outcomes of the arthroscopic treatment of femoroacetabular impingement (FAI) and labral tears with mild osteoarthritis (OA) are limited. Purpose: To evaluate outcomes of the arthroscopic treatment of FAI and labral tears in patients with mild preoperative OA (Tönnis grade 1) at a minimum 5-year follow-up, and to perform a matched-pair comparison to a control group with Tönnis grade 0. Study Design: Cohort study; Level of evidence, 3. Methods: Data were prospectively collected on patients who underwent hip arthroscopic surgery between February 2008 and April 2011. Inclusion criteria were arthroscopic treatment for FAI and labral tears and having preoperative patient-reported outcome (PRO) scores, including the modified Harris Hip Score (mHHS), Non-Arthritic Hip Score (NAHS), and Hip Outcome Score–Sports-Specific Subscale (HOS-SSS), and visual analog scale (VAS) scores for pain. Exclusion criteria were workers’ compensation claims, preoperative Tönnis grade ≥2, and previous hip conditions (ipsilateral surgery, slipped capital femoral epiphysis, avascular necrosis, and dysplasia). Patients with minimum 5-year outcomes were eligible for matching on a 1:1 ratio (Tönnis grade 0 vs 1) based on age ±5 years, body mass index ±5 kg/m2, sex, labral treatment, and capsular treatment. Results: Of 356 eligible hips, 292 hips had minimum 5-year outcomes (82%). Eighty-five hips with Tönnis grade 1 were evaluated. At 5-year follow-up, patients with Tönnis grade 1 had significant improvements in all PRO and VAS scores ( P < .0001). The overall satisfaction score was 8.2. The survivorship rate with respect to conversion to total hip arthroplasty for the Tönnis grade 1 group was 69.4% at 5 years, while in the Tönnis grade 0 group, it was 88.4% ( P = .0002). Sixty-two hips with Tönnis grade 0 were matched to 62 hips with Tönnis grade 1. Both groups demonstrated improvements in all PRO and VAS scores from preoperatively to postoperatively ( P < .0001). No significant differences existed between preoperative or postoperative scores or survivorship between the groups. Conclusion: The arthroscopic treatment of FAI and labral tears in patients with Tönnis grade 1 had good results at 5-year follow-up. After controlling for other variables using a matched-pair comparison, patients with Tönnis grade 1 had similar, durable improvements to those with Tönnis grade 0. While strict surgical indications and appropriate expectations are recommended for patients with mild OA, Tönnis grade 1 alone should not be considered a contraindication to hip arthroscopic surgery.

scholarly journals Influence of Femoral Version on the Outcomes of Hip Arthroscopic Surgery for Femoroacetabular Impingement or Labral Tears: A Systematic Review and Meta-analysis

2021 ◽  
Vol 9 (6) ◽  
pp. 232596712110091
Author(s):  
Chenghui Wang ◽  
Yaying Sun ◽  
Zheci Ding ◽  
Jinrong Lin ◽  
Zhiwen Luo ◽  
...  
Keyword(s):  
Systematic Review ◽  
Patient Satisfaction ◽  
Femoroacetabular Impingement ◽  
Arthroscopic Surgery ◽  
Harris Hip Score ◽  
Cochrane Library ◽  
Femoral Version ◽  
Labral Tears ◽  
Significant Difference ◽  
Secondary Outcomes

Background: It remains controversial whether abnormal femoral version (FV) affects the outcomes of hip arthroscopic surgery for femoroacetabular impingement (FAI) or labral tears. Purpose: To review the outcomes of hip arthroscopic surgery for FAI or labral tears in patients with normal versus abnormal FV. Study Design: Systematic review; Level of evidence, 4. Methods: Embase, PubMed, and the Cochrane Library were searched in July 2020 for studies reporting the outcomes after primary hip arthroscopic surgery for FAI or labral tears in patients with femoral retroversion (<5°), femoral anteversion (>20°), or normal FV (5°-20°). The primary outcome was the modified Harris Hip Score (mHHS), and secondary outcomes were the visual analog scale (VAS) for pain, Hip Outcome Score–Sport-Specific Subscale (HOS-SSS), Non-Arthritic Hip Score (NAHS), failure rate, and patient satisfaction. The difference in preoperative and postoperative scores (Δ) was also calculated when applicable. Results: Included in this review were 5 studies with 822 patients who underwent hip arthroscopic surgery for FAI or labral tears; there were 166 patients with retroversion, 512 patients with normal version, and 144 patients with anteversion. Patients with retroversion and normal version had similar postoperative mHHS scores (mean difference [MD], 2.42 [95% confidence interval (CI), –3.42 to 8.26]; P = .42) and ΔmHHS scores (MD, –0.70 [96% CI, –8.56 to 7.15]; P = .86). Likewise, the patients with anteversion and normal version had similar postoperative mHHS scores (MD, –3.09 [95% CI, –7.66 to 1.48]; P = .18) and ΔmHHS scores (MD, –1.92 [95% CI, –6.18 to 2.34]; P = .38). Regarding secondary outcomes, patients with retroversion and anteversion had similar ΔNAHS scores, ΔHOS-SSS scores, ΔVAS scores, patient satisfaction, and failure rates to those with normal version, although a significant difference was found between the patients with retroversion and normal version regarding postoperative NAHS scores (MD, 5.96 [95% CI, 1.66-10.26]; P = .007) and postoperative HOS-SSS scores (MD, 7.32 [95% CI, 0.19-14.44]; P = .04). Conclusion: The results of this review indicated that abnormal FV did not significantly influence outcomes after hip arthroscopic surgery for FAI or labral tears.

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

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.

scholarly journals Effect of Cigarette Smoking on Patient-Reported Outcomes in Hip Arthroscopic Surgery: A Matched-Pair Controlled Study With a Minimum 2-Year Follow-up

2019 ◽  
Vol 7 (1) ◽  
pp. 232596711882283 ◽  
Author(s):  
Ajay C. Lall ◽  
Jon E. Hammarstedt ◽  
Asheesh G. Gupta ◽  
Joseph R. Laseter ◽  
Mitchell R. Mohr ◽  
...  
Keyword(s):  
Patient Reported Outcomes ◽  
Smoking Status ◽  
Arthroscopic Surgery ◽  
Matched Pair ◽  
Harris Hip Score ◽  
Controlled Study ◽  
Control Group ◽  
Patient Reported ◽  
Smoking Group

Background: The rate of hip arthroscopic surgery has recently increased; however, there is limited literature examining patient-reported outcomes (PROs) in cigarette smokers. Purpose/Hypothesis: The purpose of this study was to evaluate whether smoking status for patients undergoing hip arthroscopic surgery affects clinical findings and PRO scores. We hypothesized that patients who smoke and undergo primary hip arthroscopic surgery will have similar clinical examination findings and preoperative and postoperative PRO scores compared with nonsmoking patients. Study Design: Cohort study; Level of evidence, 3. Methods: Data were collected on all patients who underwent primary hip arthroscopic surgery from February 2008 to July 2015. A retrospective analysis of the data was then conducted to identify patients who reported cigarette use at the time of the index procedure. Patients were matched 1:2 (smoking:nonsmoking) based on sex, age within 5 years, labral treatment (repair vs reconstruction vs debridement), workers’ compensation status, and body mass index within 5 kg/m2. All patients were assessed preoperatively and postoperatively using 4 PRO measures: the modified Harris Hip Score (mHHS), Non-Arthritic Hip Score (NAHS), Hip Outcome Score–Sport-Specific Subscale (HOS-SSS), and International Hip Outcome Tool–12 (iHOT-12). Pain was estimated using a visual analog scale. Satisfaction was measured on a scale from 0 to 10. Significance was set at P < .05. Results: A total of 75 hips were included in the smoking group, and 150 hips were included in the control group. Preoperatively, the smoking group had significantly lower PRO scores compared with the control group for the mHHS, NAHS, and HOS-SSS. Both groups demonstrated significant improvement from preoperative levels. A minimum 2-year follow-up was achieved, with a mean of 42.5 months for the smoking group and 47.6 months for the control group ( P = .07). At the latest follow-up, the smoking group reported inferior results for all outcome measures compared with controls. The improvement in PRO scores and rates of treatment failure, revision arthroscopic surgery, and complications was not statistically different between the groups. Conclusion: Patients who smoke had lower PRO scores preoperatively and at the latest follow-up compared with nonsmokers. Both groups demonstrated significant improvement in all PRO scores. These results show that while hip arthroscopic surgery may still yield clinical benefit in smokers, these patients may ultimately achieve an inferior functional status. To optimize results, physicians should advise patients to cease smoking before undergoing hip arthroscopic surgery.

Minimum 5-Year Outcomes of Arthroscopic Hip Labral Reconstruction With Nested Matched-Pair Benchmarking Against a Labral Repair Control Group

2019 ◽  
Vol 47 (9) ◽  
pp. 2045-2055 ◽  
Author(s):  
Benjamin G. Domb ◽  
Muriel R. Battaglia ◽  
Itay Perets ◽  
Ajay C. Lall ◽  
Austin W. Chen ◽  
...  
Keyword(s):  
Patient Satisfaction ◽  
Labral Repair ◽  
Matched Pair ◽  
Harris Hip Score ◽  
Control Group ◽  
Analog Scale ◽  
Labral Tears ◽  
Point Increase ◽  
Modified Harris Hip Score

Background: Labral reconstruction has demonstrated short-term benefit for the treatment of irreparable labral tears. Nonetheless, there is a scarcity of evidence for midterm outcomes of this treatment. Hypotheses: Arthroscopic segmental reconstruction in the setting of irreparable labral tears would show improvement in patient-reported outcomes (PROs) and high patient satisfaction at minimum 5-year follow-up. Second, primary labral reconstruction (PLRECON) would result in similar improvement in PROs at minimum 5-year follow-up when compared with a matched-pair primary labral repair (PLREPAIR) control group. Study Design: Cohort study; Level of evidence, 3. Methods: Data from February 2008 to April 2013 were retrospectively reviewed. Patients were included if they underwent hip arthroscopy for segmental labral reconstruction in the setting of irreparable labral tear and femoroacetabular impingement, with minimum 5-year follow-up for modified Harris Hip Score, Nonarthritic Hip Score, Hip Outcome Score–Sports Specific Subscale, patient satisfaction, and visual analog scale for pain. Exclusion criteria were Tönnis osteoarthritis grade >1, prior hip conditions, or workers’ compensation claims. PLRECON cases were matched in a 1:3 ratio to a PLREPAIR control group based on age ±5 years, sex, and body mass index ±5 kg/m2. Results: Twenty-eight patients were eligible for the study, of which 23 (82.14%) had minimum 5-year follow-up. The authors found significant improvement from preoperative to latest follow-up in all outcome measures recorded: 17.8-point increase in modified Harris Hip Score ( P = .002), 22-point increase in Nonarthritic Hip Score ( P < .001), 25.4-point increase in Hip Outcome Score–Sports Specific Subscale ( P = .003), and a 2.9-point decrease in visual analog scale pain ratings ( P < .001). Mean patient satisfaction was 7.1 out of 10. In the nested matched-pair analysis, 17 patients who underwent PLRECON were matched to a control group of 51 patients who underwent PLREPAIR. PLRECON demonstrated comparable survivorship and comparable improvements in all PROs with the exception of patient satisfaction (6.7 vs 8.5, P = .04). Conclusion: Hip arthroscopy with segmental labral reconstruction resulted in significant improvement in PROs at minimum 5-year follow-up. PLRECON reached comparable functional outcomes when compared with a benchmark PLREPAIR control group but demonstrated lower patient satisfaction at latest follow-up.

Multicenter Analysis of Midterm Clinical Outcomes of Arthroscopic Labral Repair in the Hip: Minimum 5-Year Follow-up

2017 ◽  
Vol 46 (2) ◽  
pp. 280-287 ◽  
Author(s):  
Mario Hevesi ◽  
Aaron J. Krych ◽  
Nick R. Johnson ◽  
John M. Redmond ◽  
David E. Hartigan ◽  
...  
Keyword(s):  
Clinical Outcomes ◽  
Periacetabular Osteotomy ◽  
Arthroscopic Surgery ◽  
Hip Surgery ◽  
Labral Repair ◽  
Harris Hip Score ◽  
Level Of Evidence ◽  
Multicenter Analysis ◽  
Tönnis Grade

Background: The technique of hip arthroscopic surgery is advancing and becoming more commonly performed. However, most current reported results are limited to short-term follow-up, and therefore, the durability of the procedure is largely unknown. Purpose: To perform a multicenter analysis of mid-term clinical outcomes of arthroscopic hip labral repair and determine the risk factors for patient outcomes. Study Design: Cohort study; Level of evidence, 3. Methods: Prospectively collected data of primary hip arthroscopic labral repair performed at 4 high-volume centers between 2008 and 2011 were reviewed retrospectively. Patients were assessed preoperatively and postoperatively with the visual analog scale (VAS), modified Harris Hip Score (mHHS), and Hip Outcome Score–Sports-Specific Subscale (HOS-SSS) at a minimum of 5 years’ follow-up. Factors including age, body mass index (BMI), Tönnis grade, and cartilage grade were analyzed in relation to outcome scores, and revision rates were determined. Failure was defined as subsequent ipsilateral hip surgery, including revision arthroscopic surgery and open hip surgery. Results: A total of 303 patients (101 male, 202 female) with a mean age of 32.0 years (range, 10.7-58.9 years) were followed for a mean of 5.7 years (range, 5.0-7.9 years). Patients achieved mean improvements in VAS of 3.5 points, mHHS of 20.1 points, and HOS-SSS of 29.3 points. Thirty-seven patients (12.2%) underwent revision arthroscopic surgery, and 12 (4.0%) underwent periacetabular osteotomy, resurfacing, or total hip arthroplasty during the study period. Patients with a BMI >30 kg/m2 had a mean mHHS score 9.5 points lower and a mean HOS-SSS score 15.9 points lower than those with a BMI ≤30 kg/m2 ( P < .01). Patients aged >35 years at surgery had a mean mHHS score 4.5 points lower and a HOS-SSS score 6.7 points lower than those aged ≤35 years ( P = .03). Patients with Tönnis grade 2 radiographs demonstrated a 12.5-point worse mHHS score ( P = .02) and a 23.0-point worse HOS-SSS score ( P < .01) when compared with patients with Tönnis grade 0. Conclusion: Patients demonstrated significant improvements in VAS, mHHS, and HOS-SSS scores after arthroscopic labral repair. However, those with Tönnis grade 2 changes preoperatively, BMI >30 kg/m2, and age >35 years at the time of surgery demonstrated significantly decreased mHHS and HOS-SSS scores at final follow-up.

scholarly journals Minimum 5-Year Outcomes of Arthroscopic Hip Labral Reconstruction with Nested Matched-Pair Benchmarking Against a Labral Repair Control Group

2019 ◽  
Vol 7 (7_suppl5) ◽  
pp. 2325967119S0043
Author(s):  
Benjamin G. Domb ◽  
Muriel R. Battaglia ◽  
Itay Perets ◽  
Ajay C. Lall ◽  
Austin Chen ◽  
...  
Keyword(s):  
Patient Satisfaction ◽  
Hip Arthroscopy ◽  
Labral Repair ◽  
Matched Pair ◽  
Harris Hip Score ◽  
Control Group ◽  
Labral Tears ◽  
Point Increase ◽  
Patient Reported

Objectives: Labral reconstruction has demonstrated short-term benefit for the treatment of irreparable labral tears. Nonetheless, there is a scarcity of evidence for mid-term outcomes of this treatment. The purpose of our study was to report 5-year outcomes in patients who underwent segmental labral reconstruction. In addition, we compared 5-year outcomes of patients who underwent primary segmental labral reconstruction (PLRECON) with a matched-pair control group that underwent primary labral repair (PLREPAIR). We hypothesized that arthroscopic segmental reconstruction in the setting of irreparable labral tears would show improvement in patient-reported outcomes (PROs) and high patient satisfaction at minimum 5-year follow-up. Secondly, PLRECON would experience similar improvement in PROs at minimum 5-year follow-up when compared to a matched-pair PLREPAIR control group. Methods: Data from February 2008 to April 2013 was retrospectively reviewed. Patients were included if they underwent hip arthroscopy for segmental labral reconstruction in the setting of irreparable labral tear and femoro-acetabular impingement (FAI), with minimum 5-year follow-up for modified Harris Hip Score (mHHS), Non-Arthritic Hip Score (NAHS), Hip Outcome Score-Sports Specific Subscale (HOS-SSS), and Visual Analogue Scale (VAS) for pain. Exclusion criteria were Tönnis osteoarthritis grade >1, prior hip conditions, or Workers’ Compensation claims. PLRECON were matched in a 1:3 ratio to a PLREPAIR group based on age ±5 years, gender, and body mass index (BMI) ±5 kg/m2. Results: Twenty-eight patients were eligible for the study, of which 23 (82.14%) had minimum 5-year follow-up. We found significant improvement from preoperative to latest follow-up in all outcome measures recorded: 17.8-point increase in mHHS (P=0.002), 22-point increase in NAHS (P<0.001), 25.4-point increase in HOS-SSS (P=0.003), and a 2.9-point decrease in VAS pain ratings (P<0.001). Average patient satisfaction was 7.1 out of 10. In the nested matched-pair analysis, 17 PLRECON were matched to a control group of 51 PLREPAIR patients. PLRECON demonstrated comparable survivorship and comparable improvements in all PROs with the exception of patient satisfaction. Conclusion: Hip arthroscopy with segmental labral reconstruction resulted in significant improvement in PROs at minimum 5-year follow-up. PLRECON reached comparable functional outcomes when compared to a benchmark PLREPAIR control group, but demonstrated lower patient satisfaction at latest follow-up. [Figure: see text]

Does Iliopsoas Lengthening Adversely Affect Clinical Outcomes After Hip Arthroscopy? A Multicenter Comparative Study

2018 ◽  
Vol 46 (11) ◽  
pp. 2624-2631 ◽  
Author(s):  
David R. Maldonado ◽  
Aaron J. Krych ◽  
Bruce A. Levy ◽  
David E. Hartigan ◽  
Joseph R. Laseter ◽  
...  
Keyword(s):  
Cohort Study ◽  
Clinical Outcomes ◽  
Hip Arthroscopy ◽  
Labral Tear ◽  
Harris Hip Score ◽  
Pain Patient ◽  
Control Group ◽  
Safe Procedure ◽  
Outcome Score

Background: Iliopsoas fractional lengthening (IFL) continues to be a controversial procedure in hip arthroscopy. Hypothesis: Patients who underwent arthroscopic surgery for femoroacetabular impingement (FAI) and a labral tear either with or without IFL would experience favorable outcomes, and there would be no difference in postoperative patient-reported outcomes (PROs) between the 2 groups at minimum 2-year follow-up. Study Design: Cohort study; Level of evidence, 3. Methods: Data from July 2009 and April 2015 were retrospectively reviewed. Patients were eligible if they had hip arthroscopy for both FAI and labral tear treatment with IFL and without IFL. IFL was indicated for painful internal snapping. Minimum postoperative follow-up was set to 2 years. The authors calculated the modified Harris Hip Score, International Hip Outcome Tool–12, Hip Outcome Score–Activity of Daily Living Score, Hip Outcome Score–Sports Specific Subscale, Non-Arthritic Hip Score, visual analog scale for pain, patient satisfaction, minimal clinically important difference (MCID), and the percentage of patients who achieved patient acceptable symptomatic state (PASS). Revision surgeries and conversions to total hip arthroplasty (THA) were documented. Results: 351 hips (307 patients) met the necessary inclusion criteria in the IFL cohort, with a mean ± SD follow-up time of 42.5 ± 18.1 months. For the control cohort, 392 hips (354 patients) were included, with a mean ± SD follow-up time of 43.9 ± 19.6 months. Both groups showed significant postoperative improvement in 2-year follow-up PROs. The group with iliopsoas lengthening showed comparable results to the control group with respect to PRO improvement, MCID, PASS, and rates of revision or THA conversion. Conclusion: This comparative cohort study demonstrated that treatment of painful internal snapping syndrome with arthroscopic IFL, in the setting of FAI and a labral tear, is a safe procedure with good short- to mid-term follow-up results and associated improvement in PROs. Patients who underwent IFL showed similar outcomes compared with a control group treated for FAI and labral tear without IFL. In appropriately selected patients, arthroscopic IFL did not adversely affect clinical outcomes compared with patients who did not need IFL.

Arthroscopic Labral Base Repair in the Hip: 5-Year Minimum Clinical Outcomes

2017 ◽  
Vol 45 (12) ◽  
pp. 2882-2890 ◽  
Author(s):  
Benjamin G. Domb ◽  
Leslie C. Yuen ◽  
Victor Ortiz-Declet ◽  
Jody Litrenta ◽  
Itay Perets ◽  
...  
Keyword(s):  
Patient Satisfaction ◽  
Clinical Outcomes ◽  
Arthroscopic Surgery ◽  
Slipped Capital Femoral Epiphysis ◽  
Harris Hip Score ◽  
Severe Dysplasia ◽  
Patient Satisfaction Score ◽  
Patient Reported ◽  
The Mean

Background: Arthroscopic labral base repair (LBR) in the hip is a previously described technique designed to restore the native functional anatomy of the labrum by reproducing its seal against the femoral head. LBR has been shown to have good short-term outcomes. Hypothesis/Purpose: The purpose was to evaluate clinical outcomes of an LBR cohort with a minimum 5-year follow-up. It was hypothesized that patients who underwent LBR would continue to have significant improvement from their preoperative scores and maintain scores similar to their 2-year outcomes. Study Design: Case series; Level of evidence, 4. Methods: Data for patients undergoing primary hip arthroscopic surgery with LBR from February 2008 to May 2011 with a minimum 5-year follow-up were prospectively collected and retrospectively reviewed. Patients with preoperative Tonnis osteoarthritis grade ≥2, previous hip conditions (slipped capital femoral epiphysis, avascular necrosis, Legg-Calv-Perthes disease), severe dysplasia (lateral center-edge angle <18°), or previous ipsilateral hip surgery were excluded. Statistical equivalence tests evaluated patient-reported outcomes (PROs) including the modified Harris Hip Score (mHHS), Non-Arthritic Hip Score (NAHS), Hip Outcome Score–Sport-Specific Subscale (HOS-SSS), visual analog scale (VAS) for pain, and patient satisfaction (0-10 scale; 10 = very satisfied). Results: Of the 70 patients (74 hips) who met inclusion and exclusion criteria, 60 (85.7%) patients (64 hips) were available at a minimum 5-year follow-up. All PRO scores significantly improved from preoperative values with a mean follow-up of 67.8 ± 7.4 months (range, 60.0-89.7 months). The mean mHHS increased from 64.4 ±13.8 to 85.3 ± 17.7 ( P < .001), the mean NAHS from 63.7 ± 17.0 to 87.0 ± 14.7 ( P < .001), and the mean HOS-SSS from 47.1 ± 23.2 to 76.5 ± 25.9 ( P < .001). The mean VAS score decreased from 5.9 ± 2.4 to 2.0 ± 2.1 ( P < .001). The mean patient satisfaction score was 8.1 ± 2.0. The improvement in PRO scores was sustained from 2- to 5-year follow-up. At 2 and 5 years, survivorship rates were 96.9% and 90.6%, respectively, and the respective secondary arthroscopic surgery rates were 10.9% (7/64) and 17.2% (11/64). Conclusion: At a minimum 5-year follow-up, arthroscopic LBR continued to be a successful procedure and valid technique based on 3 PROs, the VAS, patient satisfaction, and survivorship. Significantly improved outcome scores were maintained compared with preoperative values and showed no signs of deterioration from the 2-year scores. The long-term survivorship of hip arthroscopic surgery has yet to be determined; however, these midterm results demonstrate the rates of additional procedures (both secondary arthroscopic surgery and conversion to total hip arthroplasty), that may be necessary after 2 years.

An Intact Ligamentum Teres Predicts a Superior Prognosis in Patients With Borderline Dysplasia: A Matched-Pair Controlled Study With Minimum 5-Year Outcomes After Hip Arthroscopic Surgery

2020 ◽  
Vol 48 (3) ◽  
pp. 673-681 ◽  
Author(s):  
David R. Maldonado ◽  
Sarah L. Chen ◽  
Rafael Walker-Santiago ◽  
Jacob Shapira ◽  
Philip J. Rosinsky ◽  
...  
Keyword(s):  
Short Form ◽  
Arthroscopic Surgery ◽  
Ligamentum Teres ◽  
Matched Pair ◽  
Harris Hip Score ◽  
Controlled Study ◽  
Control Group ◽  
Significant Difference ◽  
Patient Reported ◽  
The Mean

Background: Hip arthroscopic surgery in patients with borderline dysplasia continues to be controversial. In addition, it has been suggested that ligamentum teres (LT) tears may lead to inferior short-term patient-reported outcomes (PROs) when compared with a match-controlled group. Purposes: (1) To report minimum 5-year PROs in patients with borderline dysplasia and LT tears who underwent hip arthroscopic surgery and (2) to compare these PROs to those of a matched-pair control group of patients with borderline dysplastic hips without LT tears. Study Design: Cohort study; Level of evidence, 3. Methods: Data were prospectively collected for patients who underwent hip arthroscopic surgery between September 2008 and August 2013. Patients were included if they had a preoperative diagnosis of borderline dysplasia (lateral center-edge angle [LCEA], 18°-25°) and had preoperative and minimum 5-year postoperative modified Harris Hip Score (mHHS), Nonarthritic Hip Score (NAHS), and visual analog scale (VAS) for pain scores. Exclusion criteria were osteoarthritis of Tönnis grade >1, previous hip conditions, any previous ipsilateral hip surgery, or workers’ compensation status. There were 2 borderline dysplastic groups created. An LT tear group was matched 1:1 to a control group (no LT tear) with similar age, sex, body mass index (BMI), and laterality via propensity score matching. Significance was set at P < .05. Results: A total of 24 patients with an LT tear (24 hips) were matched to 24 patients without an LT tear (24 hips). There was no significant difference in age, sex, BMI, or laterality between groups. The mean age was 36.2 ± 17.2 and 34.9 ± 15.9 years for the control and LT tear groups, respectively ( P = .783). There were 17 (70.8%) and 16 (66.7%) female patients in the control and LT tear groups, respectively, and the mean preoperative LCEA was 23.3° and 22.2° in the control and LT tear groups, respectively. No differences were observed between groups in baseline PROs, intraoperative findings, or surgical procedures. LT debridement was performed in 17 (70.8%) patients in the LT tear group compared with 0 (0.0%) in the control group. Also, 5-year postoperative PROs were comparable in both groups, with the control group exhibiting superior Veterans RAND 12-Item Health Survey (VR-12) mental ( P = .041) and Short Form–12 (SF-12) mental ( P = .042) scores. Finally, hips with an intact LT were significantly more likely ( P = .022) to achieve the patient acceptable symptomatic state (PASS) for the mHHS (100.0% and 75.0%, respectively). No significant differences were present between the groups for the minimal clinically important difference (MCID) of the mHHS ( P = .140), MCID of the Hip Outcome Score–Sport-Specific Subscale (HOS-SSS) ( P = .550), or PASS of the HOS-SSS ( P = .390). Conclusion: After hip arthroscopic surgery, patients with borderline dysplasia and LT tears demonstrated favorable PROs at a minimum 5-year follow-up. Outcomes were similar to a matched-pair control group without LT tears, with the group with intact LTs showing higher VR-12 mental and SF-12 mental scores. Furthermore, patients with borderline dysplasia and intact LTs were significantly more likely to achieve the PASS for the mHHS.

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