High Rate of Return to Running for Athletes After Hip Arthroscopy for the Treatment of Femoroacetabular Impingement and Capsular Plication

2016 ◽  
Vol 45 (1) ◽  
pp. 127-134 ◽  
Author(s):  
David M. Levy ◽  
Benjamin D. Kuhns ◽  
Rachel M. Frank ◽  
Jeffrey S. Grzybowski ◽  
Kirk A. Campbell ◽  
...  
Keyword(s):  
Femoroacetabular Impingement ◽  
Hip Arthroscopy ◽  
Daily Living ◽  
Case Series ◽  
High Rate ◽  
Harris Hip Score ◽  
Specific Information ◽  
Level Of Evidence ◽  
Capsular Plication ◽  
Modified Harris Hip Score

Background: Femoroacetabular impingement (FAI) is most commonly diagnosed in athletes who sustain repetitive flexion loading to their hips. No studies to date have focused solely on patients’ return-to-running ability after hip arthroscopy. Purpose: To evaluate patients’ ability to return to running after hip arthroscopy for FAI and capsular plication. Study Design: Case series; Level of evidence, 4. Methods: Clinical data were retrospectively retrieved for 51 consecutive patients with FAI (22 men, 29 women) who had undergone hip arthroscopy for the treatment of FAI and identified themselves as recreational or competitive runners on intake forms. Two-year outcome measures included the modified Harris Hip Score (mHHS) and the Hip Outcome Score Activities of Daily Living (HOS-ADL) and Sport-Specific (HOS-SS) subscales. A postoperative return-to-running survey was used to obtain running-specific information. Results: Patient age and body mass index (BMI) were a mean (±SD) of 26.3 ± 7.8 years and 23.7 ± 3.3 kg/m2, respectively. Before surgery, patients had refrained from running because of pain for a mean of 8.1 ± 5.7 months. After surgery, 48 patients (94%) returned to running at a mean of 8.5 ± 4.2 months. Patients who had discontinued running for more than 8 months before surgery had a longer return-to-running time than did those who had stopped for less than 8 months (10.6 ± 4.2 vs 7.6 ± 4.1 months; P = .01). After 2 years, mean preoperative distance had decreased significantly ( P < .01) from 9.5 ± 6.5 miles per week when healthy to 6.4 ± 5.8 miles postoperatively. Despite decreased mileage, all 2-year outcomes scores improved significantly ( P < .001). Conclusion: Recreational and competitive runners with FAI returned to running 94% of the time at a mean of 8.5 months after hip arthroscopy. However, runners should be counseled before their surgery that they may run fewer miles than when they were pain free. Additionally, patients with a higher BMI and/or longer preoperative lull may have a longer recovery time.

scholarly journals Treatment of cam-type femoroacetabular impingement

Joints ◽  
2015 ◽  
Vol 03 (02) ◽  
pp. 67-71 ◽  
Author(s):  
Gennaro Fiorentino ◽  
Alberto Fontanarosa ◽  
Riccardo Cepparulo ◽  
Alberto Guardoli ◽  
Luca Berni ◽  
...  
Keyword(s):  
Femoroacetabular Impingement ◽  
Hip Arthroscopy ◽  
Alpha Angle ◽  
Case Series ◽  
Arthroscopic Treatment ◽  
Correct Selection ◽  
Harris Hip Score ◽  
Radiographic Examination ◽  
Level Of Evidence

Purpose: the aim of this study was to evaluate preliminary clinical and radiographic results of arthroscopic treatment of cam-type femoroacetabular impingement (FAI). Methods: thirty-eight patients underwent hip arthroscopy for cam-type FAI between 2009 and 2012. Preoperative assessment was based on clinical examination, modified Harris Hip Score (mHHS) and radiographic examination with anteroposterior pelvis, frogleg and Lequesne views. The patients’ clinical conditions at follow-up were assessed using the mHHS administered as a telephone survey. Radiographic outcome measurements evaluated pre and postoperatively were the alpha angle and femoral head-neck offset. Results: the patients were clinically evaluated at a mean follow-up of 36 months. Radiographic follow-up was performed at an average of 12.7 months. Thirty of the 38 patients (79%) were satisfied with the results of the arthroscopic procedure. A total of nine patients subsequently underwent a total hip replacement. All 30 patients who declared themselves satisfied recorded an mHHS increase; in particular, the mHHS increased from a mean of 52.9 preoperatively (range: 27.5-82.5) to a mean of 85.6 postoperatively (range: 45.1-100.1). Three significant differences between the two groups of patients (satisfied and not satisfied) were recorded: mean age, alpha angle and BMI were all significantly greater in the patients who were not satisfied with the treatment. Conclusions: a crucial aspect in order to obtain good clinical outcomes of arthroscopic treatment of camtype impingement is correct selection of patients who are likely to benefit from this kind of surgery. Hip arthroscopy should be avoided in patients aged over 50 years with risk factors for early osteoarthritis (high BMI and a significantly increased alpha angle). Level of evidence: Level IV, therapeutic case series.

Femoroacetabular Impingement in Professional Basketball Players: Return to Play, Career Length, and Performance After Hip Arthroscopy

2018 ◽  
Vol 46 (13) ◽  
pp. 3090-3096 ◽  
Author(s):  
J.P. Begly ◽  
Patrick S. Buckley ◽  
Hajime Utsunomiya ◽  
Karen K. Briggs ◽  
Marc J. Philippon
Keyword(s):  
Femoroacetabular Impingement ◽  
Hip Arthroscopy ◽  
Case Series ◽  
High Rate ◽  
Return To Play ◽  
Basketball Players ◽  
Level Of Evidence ◽  
Professional Basketball ◽  
Postoperative Performance ◽  
The Mean

Background: Previous studies have demonstrated that hip arthroscopy is an effective treatment for symptomatic femoroacetabular impingement (FAI) in professional athletes across a variety of sports. However, the return-to-play rates and postoperative performance of elite basketball players after hip arthroscopy are currently unknown. Purpose: To determine return-to-play rates and postoperative performance among professional basketball athletes after hip arthroscopy. Study Design: Case series; Level of evidence, 3. Methods: Eighteen professional basketball players underwent hip arthroscopy (24 hips) for symptomatic FAI between 2001 and 2016 by a single surgeon. Return to play was defined as competing in a single professional game of equal level after surgery. Data were retrospectively obtained for each player from basketball-reference.com , ESPN.com , eurobasket.com, and individual team websites. Matched controls were selected from the websites to compare performances. Results: The mean age at the time of surgery was 25.6 years, and the mean body mass index was 24.4 kg/m2. All players returned to their previous levels of competition, with a mean number of 4 seasons played after surgery (median, 3; range, 1-12). The mean ± SD time between the date of surgery and return to a professional game was 7.1 ± 4.4 months. There was no change in player efficiency rating when pre- and postinjury performance were compared. When compared with controls, players undergoing surgery also had no significant decline in player efficiency rating. Conclusion: Elite basketball athletes who undergo hip arthroscopy for the treatment of FAI return to their presurgical levels of competition at a high rate. These athletes demonstrate no significant overall decrease in performance upon their return to play.

High Rate of Full Duty Return to Work After Hip Arthroscopy for Femoroacetabular Impingement Syndrome in Workers Who Are Not on Workers’ Compensation

2021 ◽  
Vol 49 (3) ◽  
pp. 729-736
Author(s):  
Matthew R. Cohn ◽  
Daniel M. Wichman ◽  
Alexander C. Newhouse ◽  
Nabil Mehta ◽  
Michael C. Fu ◽  
...  
Keyword(s):  
Hip Arthroscopy ◽  
Daily Living ◽  
Arthroscopic Surgery ◽  
High Rate ◽  
Harris Hip Score ◽  
Analog Scale ◽  
Expected Time ◽  
Femoroacetabular Impingement Syndrome ◽  
Time Required ◽  
Modified Harris Hip Score

Background: Femoroacetabular impingement syndrome (FAIS) is an increasingly common diagnosis among working-age adults. Hip arthroscopy provides reliable improvements in pain and may allow patients to return to physical activities. No study to date has evaluated return to work (RTW) among a general population of adults after arthroscopic surgery for FAIS. Purpose: To evaluate (1) patients’ rate of RTW, (2) time required to RTW, and (3) factors correlated with time required to RTW after arthroscopic surgery for symptomatic FAIS. Study Design: Case series; Level of evidence, 4. Methods: Consecutive patients aged 25 to 59 years who underwent arthroscopic surgery for FAIS between June 2018 and December 2018 were reviewed. Workers’ compensation cases and patients with <1-year follow-up were excluded. The following were collected at a minimum of 1 year postoperatively: demographics, employment characteristics, Hip Outcome Score (HOS; Activities of Daily Living and Sports Specific subscales), modified Harris Hip Score, 12-Item International Hip Outcome Tool (iHOT-12), visual analog scale for pain, and RTW characteristics. Work physical activity level was classified as sedentary, light, moderate, heavy, or very heavy per established criteria. Results: A total of 97 patients were selected through inclusion and exclusion criteria. RTW surveys were collected for 79 (81.4%), and 61 were employed preoperatively. Time worked per week was 42.8 ± 12.5 hours (mean ± SD). Patients’ work level was most commonly classified as sedentary (42.6%), followed by moderate (24.6%). All 61 (100%) patients returned to work at a mean 7.3 weeks (range, <1-88 weeks) postoperatively. Sixty patients (95.2%) returned to full duty. Time required to full duty RTW was strongly correlated with expected time off from work ( r = 0.900; P < .0001) and moderately correlated with work classification ( r = 0.640; P = .0001). All patients had significant pre- to postoperative improvements in the HOS–Activities of Daily Living (64.8 ± 15.3 to 87.1 ± 12.2; P < .001), HOS–Sports Specific (42.8 ± 18.8 to 76.7 ± 16.5; P < .001), iHOT-12 (31.3 ± 18.8 to 69.3 ± 21.1; P < .001), modified Harris Hip Score (61.8 ± 12.1 to 80.3 ± 14.1; P < .001), and visual analog scale for pain (5.19 ± 2.11 to 2.40 ± 1.96; P < .001). Conclusion: Patients undergoing arthroscopic treatment for FAIS demonstrated a high rate of RTW at a mean of <2 months postoperatively. A patient’s expected time off from work and the level of physical demands required for work were highly associated with time required to RTW. These results are valuable for orthopaedic surgeons, patients, and employers when establishing a timeline for expected RTW after surgery.

When Do Patients Improve After Hip Arthroscopy for Femoroacetabular Impingement? A Prospective Cohort Analysis

2018 ◽  
Vol 46 (13) ◽  
pp. 3111-3118 ◽  
Author(s):  
Sergio E. Flores ◽  
Joseph R. Sheridan ◽  
Kristina R. Borak ◽  
Alan L. Zhang
Keyword(s):  
Patient Outcomes ◽  
Femoroacetabular Impingement ◽  
Hip Arthroscopy ◽  
Short Form ◽  
Cohort Analysis ◽  
Case Series ◽  
Harris Hip Score ◽  
Physical Component Score ◽  
Level Of Evidence ◽  
Patient Reported

Background: Hip arthroscopy for femoroacetabular impingement (FAI) has been shown to improve patient outcomes, especially for returning to sport. Although previous studies often evaluated outcomes 2 years after hip arthroscopy, there has been no analysis of the progression of patient improvement over time or with respect to achieving the minimal clinically important difference (MCID). Hypothesis/Purpose: The purpose was to prospectively evaluate changes in patient-reported outcome (PRO) scores during the first 2 years after hip arthroscopy for FAI and to analyze when the MCID is achieved. It was hypothesized that clinically significant changes will be reached by 1 year after surgery. Study Design: Case series; Level of evidence, 4. Methods: Patients undergoing hip arthroscopy for FAI were prospectively enrolled, and they completed the 12-Item Short Form Health survey (SF-12), modified Harris Hip Score, and Hip disability and Osteoarthritis Outcome Score (HOOS) at preoperative baseline and 3 months, 6 months, 1 year, and 2 years after surgery. Mean scores and the percentage of patients reaching the MCID at each time point were analyzed via analysis of variance and Cochrane-Armitage trend tests. Results: A total of 129 hips from 122 patients were evaluated, revealing significant improvements after hip arthroscopy for FAI (PRO scores increased 19 to 45 points) with 95.8%, 93.6%, and 84.8% of patients achieving the MCID for HOOS-Sports, HOOS–Quality of Life (QoL), and HOOS-Pain, respectively, at 2-year follow-up. Analysis of PRO change showed that for all scores, the greatest improvement occurred from presurgery to postoperative 3 months, with lesser improvements at subsequent 6-month, 1-year, and 2-year time points ( P < .001). The SF-12 physical component score, HOOS-Sports, and HOOS-QoL continued to show statistically significant improvements through 2 years, while other scores plateaued after 3 months. The percentage of patients achieving the MCID for HOOS-Sports, HOOS-QoL, and HOOS-Pain continued to increase over 2 years, but the percentage achieving the MCID did not increase after 3 months for all other scores. Conclusion: Hip arthroscopy for FAI yields significant improvements in patient outcomes within 2 years of surgery. The majority of improvement occurs within 3 months after surgery, but certain outcomes, such as returning to sport, QoL, and pain, can continue to improve through 2 years.

scholarly journals Is There a Gender Gap in Outcomes After Hip Arthroscopy for Femoroacetabular Impingement? Assessment of Clinically Meaningful Improvements in a Prospective Cohort

2020 ◽  
Vol 8 (7) ◽  
pp. 232596711990056
Author(s):  
Sergio E. Flores ◽  
Caitlin C. Chambers ◽  
Kristina R. Borak ◽  
Alan L. Zhang
Keyword(s):  
Femoroacetabular Impingement ◽  
Gender Gap ◽  
Hip Arthroscopy ◽  
Short Form ◽  
Patient Reported Outcome ◽  
Harris Hip Score ◽  
Age Group ◽  
Level Of Evidence ◽  
Patient Reported ◽  
Modified Harris Hip Score

Background: Although patients have experienced significant improvements after hip arthroscopy for femoroacetabular impingement (FAI), prior studies suggest that women have worse outcomes than men. These previous studies lack comparisons of patient-reported outcome (PRO) scores based on gender with respect to clinical significance measurements, including the minimal clinically important difference (MCID) and patient acceptable symptom state (PASS). Purpose: To evaluate outcomes after hip arthroscopy for FAI based on patient gender by prospectively assessing changes in PRO scores, MCID, and PASS. Study Design: Cohort study; Level of evidence, 2. Methods: Women and men undergoing hip arthroscopy for FAI were prospectively enrolled, and preoperative radiographic and intraoperative findings were collected. Patients completed the following PRO surveys before surgery and 2 years postoperatively: modified Harris Hip Score (mHHS), Hip disability and Osteoarthritis Outcome Score (HOOS), and 12-Item Short Form Health Survey. Mean scores and percentage of patients reaching MCID and PASS were analyzed. Results: A total of 131 hips were included (72 women, 59 men). Women had smaller preoperative alpha angles (59.1° vs 63.7°, respectively; P < .001) and lower acetabular cartilage injury grade (6.9% vs 22.0% with grade 4 injury, respectively; P = .013). Both women and men achieved equivalent significant improvements in PRO scores after surgery (scores increased 18.4 to 45.1 points for mHHS and HOOS). Women and men reached PASS for mHHS at similar rates (76.4% and 77.2%, respectively; P = .915). MCID was also achieved at similar rates between women and men for all scores (range, 61.4%-88.9%) except the activities of daily living subscale of the HOOS, in which a greater percentage of women reached MCID compared with men (79.2% vs 62.7%, respectively; P = .037). Additional stratification by age group using the median cohort age of 34 years showed no significant differences in PRO improvement based on age group for each gender. Conclusion: Women can achieve clinically meaningful improvements in PRO scores after hip arthroscopy for FAI. Compared with men, women demonstrated equivalent high rates of achieving MCID and PASS at 2 years after surgery.

scholarly journals High Rate of Return to Cycling After Hip Arthroscopy for Femoroacetabular Impingement Syndrome

2017 ◽  
Vol 10 (3) ◽  
pp. 259-265 ◽  
Author(s):  
Rachel M. Frank ◽  
Gift Ukwuani ◽  
Ian Clapp ◽  
Jorge Chahla ◽  
Shane J. Nho
Keyword(s):  
Femoroacetabular Impingement ◽  
Hip Arthroscopy ◽  
Impingement Syndrome ◽  
High Rate ◽  
Rate Of Return ◽  
Harris Hip Score ◽  
Level Of Evidence ◽  
Femoroacetabular Impingement Syndrome ◽  
Patient Reported ◽  
Competitive Cyclists

Background: Femoroacetabular impingement syndrome (FAIS) is most commonly diagnosed in athletes who sustain repetitive flexion and rotational loading to their hip. The purpose of this study was to evaluate a patient’s ability to return to cycling after hip arthroscopy for FAIS. Hypothesis: There is a high rate of return to cycling after hip arthroscopy. Study Design: Retrospective analysis. Level of Evidence: Level 4. Methods: Consecutive patients who had identified themselves as cyclists and had undergone hip arthroscopy for the treatment of FAIS were reviewed. Pre- and postoperative physical examinations, imaging, and patient-reported outcomes (PROs) scores, including the modified Harris Hip Score (mHHS), Hip Outcome Score Activities of Daily Living (HOS-ADL) and Sports-Specific (HOS-SS) subscales, and visual analog scale for pain, as well as a cycling-specific questionnaire, were assessed for all patients. Results: A total of 58 patients (62% female; mean age, 30.0 ± 7.1 years; mean body mass index, 23.2 ± 2.7 kg/m2) were included. Prior to surgery, patients averaged 30 ± 42 miles per week (range, 2-300 miles). Fifty-five patients (95%) were forced to discontinue cycling at an average of 7.5 ± 6.2 months prior to surgery due to hip pain. Fifty-six patients (97%) returned to cycling at an average of 4.5 ± 2.5 months after surgery, with 33 (59%) returning to a better level of cycling and 23 (41%) to the same cycling level. Postoperatively, there was no difference in the average number of miles patients completed per week compared with preoperative values ( P = 0.08). At a mean follow-up of 31.14 ± 0.71 months (range, 24-48 months), all patients experienced significant improvements in mHHS, HOS-ADL, and HOS-SS PROs (all P < 0.0001), with an overall satisfaction rate of 91% ± 13%. Conclusion: Recreational and competitive cyclists return to cycling 97% of the time after hip arthroscopy for FAIS, with most of these patients returning at an average of 4.5 months after surgery. This information is helpful in counseling patients on their expectations with regard to returning to cycling after hip arthroscopy for FAIS. Clinical Relevance: Cyclists return to sport 97% of the time at an average of 4.5 months after hip arthroscopy for FAIS.

Does the Modified Harris Hip Score Reflect Patient Satisfaction After Hip Arthroscopy?

2012 ◽  
Vol 40 (11) ◽  
pp. 2557-2560 ◽  
Author(s):  
Alessandro Aprato ◽  
Narlaka Jayasekera ◽  
Richard N. Villar
Keyword(s):  
Patient Satisfaction ◽  
Predictive Value ◽  
Hip Arthroscopy ◽  
Case Series ◽  
Harris Hip Score ◽  
Current Standard ◽  
Level Of Evidence ◽  
Negative Results ◽  
Modified Harris Hip Score ◽  
A Prospective Study

Background: No published studies have explored the relationship between commonly reported clinical outcomes and patient satisfaction after hip arthroscopy. Purpose: To compare the modified Harris Hip Score (mHHS) with patient satisfaction in a prospective study over a 2-year period. Study Design: Case series; Level of evidence, 4. Methods: We reviewed our institutional database for prospectively collected mHHS and patient satisfaction data from 697 patients. Patients were evaluated preoperatively and at 1 and 2 years after surgery. Results: The mHHS correlated with patient satisfaction at 1 year ( P < .001, Pearson R = 0.451) and at 2 years ( P < .001, Pearson R = .454). Considering scores from excellent to good as positive results and from fair to poor as negative results, sensitivity was 73% at 1 year and 77% at 2 years. Respectively, the specificity was 64% and 73%, positive predictive value 86% and 91%, negative predictive value 45% and 46%, and accuracy 71% and 76%. At 1- and 2-year follow-up, a respective 55% and 54% of patients with fair to poor mHHS were satisfied with the outcome of hip arthroscopy. In contrast, for those patients with an excellent to good mHHS at 1 and 2 years after surgery, 14% and 9%, respectively, were dissatisfied with their outcome. Conclusion: Our results show a correlation between patient satisfaction and the mHHS but also demonstrate a limitation of the mHHS as an outcome measure in the prediction of patient satisfaction. Further investigation is required to assess factors beyond current standard orthopaedic clinical outcome measures that may influence patient satisfaction after hip arthroscopy.

Risk of Conversion to Arthroplasty After Hip Arthroscopy: Validation of a Published Risk Score Using an Independent, Prospectively Collected Database

2021 ◽  
pp. 036354652199382
Author(s):  
Mario Hevesi ◽  
Devin P. Leland ◽  
Philip J. Rosinsky ◽  
Ajay C. Lall ◽  
Benjamin G. Domb ◽  
...  
Keyword(s):  
Risk Score ◽  
Roc Curve ◽  
Hip Arthroscopy ◽  
External Validation ◽  
Area Under The Curve ◽  
Harris Hip Score ◽  
Brier Score ◽  
Level Of Evidence ◽  
Center Edge ◽  
Modified Harris Hip Score

Background: Hip arthroscopy is rapidly advancing and increasingly commonly performed. The most common surgery after arthroscopy is total hip arthroplasty (THA), which unfortunately occurs within 2 years of arthroscopy in up to 10% of patients. Predictive models for conversion to THA, such as that proposed by Redmond et al, have potentially substantial value in perioperative counseling and decreasing early arthroscopy failures; however, these models need to be externally validated to demonstrate broad applicability. Purpose: To utilize an independent, prospectively collected database to externally validate a previously published risk calculator by determining its accuracy in predicting conversion of hip arthroscopy to THA at a minimum 2-year follow-up. Study Design: Cohort study (diagnosis); Level of evidence, 1. Methods: Hip arthroscopies performed at a single center between November 2015 and March 2017 were reviewed. Patients were assessed pre- and intraoperatively for components of the THA risk score studied—namely, age, modified Harris Hip Score, lateral center-edge angle, revision procedure, femoral version, and femoral and acetabular Outerbridge scores—and followed for a minimum of 2 years. Conversion to THA was determined along with the risk score’s receiver operating characteristic (ROC) curve and Brier score calibration characteristics. Results: A total of 187 patients (43 men, 144 women, mean age, 36.0 ± 12.4 years) underwent hip arthroscopy and were followed for a mean of 2.9 ± 0.85 years (range, 2.0-5.5 years), with 13 patients (7%) converting to THA at a mean of 1.6 ± 0.9 years. Patients who converted to THA had a mean predicted arthroplasty risk of 22.6% ± 12.0%, compared with patients who remained arthroplasty-free with a predicted risk of 4.6% ± 5.3% ( P < .01). The Brier score for the calculator was 0.04 ( P = .53), which was not statistically different from ideal calibration, and the calculator demonstrated a satisfactory area under the curve of 0.894 ( P < .001). Conclusion: This external validation study supported our hypothesis in that the THA risk score described by Redmond et al was found to accurately predict which patients undergoing hip arthroscopy were at risk for converting to subsequent arthroplasty, with satisfactory discriminatory, ROC curve, and Brier score calibration characteristics. These findings are important in that they provide surgeons with validated tools to identify the patients at greatest risk for failure after hip arthroscopy and assist in perioperative counseling and decision making.

Clinical and Radiographic Presentation of Capsular Iatrogenic Hip Instability After Previous Hip Arthroscopy

2020 ◽  
Vol 48 (12) ◽  
pp. 2927-2932
Author(s):  
Dillon C. O’Neill ◽  
Alexander J. Mortensen ◽  
Peter C. Cannamela ◽  
Stephen K. Aoki
Keyword(s):  
Hip Arthroscopy ◽  
Daily Living ◽  
Patient Reported Outcomes ◽  
Harris Hip Score ◽  
Hip Instability ◽  
Computer Adaptive Test ◽  
Adaptive Test ◽  
Patient Reported ◽  
Modified Harris Hip Score

Background: The clinical and radiographic features of iatrogenic hip instability following hip arthroscopy have been described. However, the prevalence of presenting symptoms and associated imaging findings in patients with hip instability has not been reported. Purpose: To detail the prevalence of clinical and magnetic resonance arthrogram (MRA) findings in a cohort of patients with isolated hip instability and to determine midterm patient-reported outcomes in this patient population. Study Design: Case series; Level of evidence, 4. Methods: We retrospectively reviewed patients from 2014 to 2016 who underwent an isolated capsular repair in the revision hip arthroscopy setting. Patients were excluded if they underwent any concomitant procedures, such as labral repair, reconstruction, femoral osteoplasty, or any other related procedure. Several clinical data points were reviewed, including painful activities, mechanical symptoms, subjective instability, Beighton scores, axial distraction testing (pain, toggle, and apprehension), and distractibility under anesthesia. Patient-reported outcomes—including modified Harris Hip Score, Hip Outcome Score–Sports Subscale, Patient-Reported Outcome Measurement Information System (PROMIS) Physical Function Computer Adaptive Test, and a return patient hip questionnaire—were collected pre- and postoperatively. Pre-revision radiographs were obtained, and lateral center-edge angle and alpha angle were measured on anteroposterior and frog-leg lateral views, respectively. Pre-revision MRAs were reviewed and evaluated for capsular changes. Capsular changes were defined as follows: 0, normal; 1, capsular redundancy; 2, focal capsular rent; and 3, gross extravasation of fluid from the capsule. Results: A total of 31 patients met inclusion criteria (5 male, 26 female; 14 right and 17 left hips). The mean age of patients was 36 years (range, 20-58 years). Overall, 27 (87%) reported hip pain with activities of daily living, and 31 (100%) experienced pain with sports or exercise. In addition, 24 (77%) had at least 1 positive finding on axial distraction testing. All patients had evidence of capsular changes on review of pre-revision MRAs. Out of 31 patients, 23 (74%) were available for follow-up at a minimum of 3.3 years and a mean ± SD of 4.6 ± 0.8 years. On average, modified Harris Hip Score improved by 20.3, Hip Outcome Score–Sports Subscale by 25.1, and PROMIS Physical Function Computer Adaptive Test by 6.4. Additionally, 20 (87%) patients reported improved or much improved physical ability, and 18 (78%) reported improved or much improved pain. Conclusion: The current study suggests that patients with hip instability demonstrate high rates of pain with activities of daily living and exercise, positive findings on axial distraction testing, and evidence of capsular changes on magnetic resonance imaging. Furthermore, these patients improve with revision surgery for capsular repair at midterm follow-up.

scholarly journals Bilateral versus unilateral hip arthroscopy for femoroacetabular impingement: a systematic review

2020 ◽  
Vol 7 (2) ◽  
pp. 225-232
Author(s):  
Claire E Fernandez ◽  
Allison M Morgan ◽  
Ujash Sheth ◽  
Vehniah K Tjong ◽  
Michael A Terry
Keyword(s):  
Systematic Review ◽  
Femoroacetabular Impingement ◽  
Hip Arthroscopy ◽  
Case Reports ◽  
Case Series ◽  
Return To Sport ◽  
Harris Hip Score ◽  
Study Patient ◽  
Significant Difference ◽  
Patient Reported

Abstract One in four patients presenting with femoroacetabular impingement (FAI) has bilateral symptoms, and despite excellent outcomes reported after arthroscopic treatment of FAI, there remains a paucity of data on the outcomes following bilateral hip arthroscopy. This systematic review aims to examine the outcomes following bilateral (either ‘simultaneous’ or ‘staged’) versus unilateral hip arthroscopy for FAI. A systematic review of multiple electronic databases was conducted using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines and checklist. All studies comparing simultaneous, staged and/or unilateral hip arthroscopy for FAI were eligible for inclusion. Case series, case reports and reviews were excluded. All study, patient and hip-specific data were extracted and analyzed. The Newcastle–Ottawa Scale was used to assess study quality. A meta-analysis was not performed due to heterogeneity among outcome measures. A total of six studies, including 722 patients (42.8% male) and 933 hips were eligible for inclusion. The mean age across patients was 35.5. The average time between staged procedures was 7.7 months. Four of the six studies were retrospective cohort studies, while the remaining two were prospective in nature. The overall quality of the eligible studies was found to be good. No significant difference was noted among patient-reported outcomes (modified Harris hip score, hip outcome score and non-arthritic hip score), visual analog scale, return to sport, traction time and complications between those undergoing bilateral (simultaneous or staged) versus unilateral hip arthroscopy. Based on the current available evidence, bilateral hip arthroscopy (whether simultaneous or staged) exhibits similar efficacy and safety when compared with unilateral hip arthroscopy. However, further prospective study is required to confirm this finding.

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