Comparative Matched-Pair Analysis of Open-Wedge High Tibial Osteotomy With Versus Without an Injection of Adipose-Derived Mesenchymal Stem Cells for Varus Knee Osteoarthritis: Clinical and Second-Look Arthroscopic Results

2018 ◽  
Vol 46 (11) ◽  
pp. 2669-2677 ◽  
Author(s):  
Yong Sang Kim ◽  
Yong Gon Koh
Keyword(s):  
Clinical Outcomes ◽  
Arthroscopic Surgery ◽  
Cartilage Regeneration ◽  
Conventional Group ◽  
Tibial Osteotomy ◽  
Varus Knee ◽  
Knee Oa ◽  
Injection Group ◽  
Second Look

Background: High tibial osteotomy (HTO) is reported to be an effective treatment for varus knee osteoarthritis (OA) by redistributing the load line within the knee joint. The cell-based tissue engineering approach using mesenchymal stem cells (MSCs) has addressed the issue of articular cartilage repair in knee OA. Purpose: This study aimed to compare the clinical, radiological, and second-look arthroscopic outcomes of open-wedge HTO with versus without an MSC injection and to identify the association between cartilage regeneration and HTO outcomes. Study Design: Cohort study; Level of evidence, 3. Methods: Among 271 patients treated with HTO for varus knee OA from September 2009 to April 2014, patients treated with HTO alone (conventional group; n = 50) were pair-matched with those who underwent HTO with an MSC injection (injection group; n = 50) based on sex, age, and lesion size. Clinical outcomes were evaluated using the International Knee Documentation Committee (IKDC) score and Lysholm score. Radiological outcomes evaluated were the femorotibial angle and posterior tibial slope. At second-look arthroscopic surgery, cartilage regeneration was evaluated using the International Cartilage Repair Society (ICRS) grade. Results: At the time of second-look arthroscopic surgery (mean, 12.4 months [conventional group] and 12.7 months [injection group]), the mean IKDC and Lysholm scores in each group significantly improved: conventional group, from 38.4 ± 9.2 to 55.2 ± 15.0 and from 56.7 ± 12.2 to 79.6 ± 13.5, respectively; and injection group, from 36.5 ± 4.7 to 62.7 ± 14.1 and from 55.7 ± 11.9 to 80.6 ± 15.6, respectively ( P < .001 for all). Clinical outcomes at final follow-up (mean, 38.8 months [conventional group] and 37.2 months [injection group]) further improved from 62.7 ± 14.1 to 64.8 ± 13.4 (IKDC) and from 80.6 ± 15.6 to 84.7 ± 16.1 (Lysholm) ( P < .001 and P = .034, respectively) only in the injection group when compared with the values at second-look arthroscopic surgery. At final follow-up, there was a significant difference in the mean IKDC and Lysholm scores between groups ( P = .049 and P = .041, respectively). Overall ICRS grades, which significantly correlated with clinical outcomes, were better in the injection group than in the conventional group. Radiological outcomes at final follow-up showed improved knee joint alignment relative to patients’ preoperative conditions but showed no significant correlation with clinical outcomes or ICRS grade in either group ( P > .05 for all). Conclusion: The group that received an MSC injection scored better on the IKDC and Lysholm scales at final follow-up than the group that did not, although these differences were relatively small. When performing HTO for patients with varus knee OA, an MSC injection should be considered as an additional procedure for improved cartilage regeneration with better clinical outcomes.

Second-look arthroscopic cartilage status is related to intermediate-term outcomes after medial opening-wedge high tibial osteotomy

2021 ◽  
Vol 103-B (11) ◽  
pp. 1686-1694
Author(s):  
Hong-Yeol Yang ◽  
Woo-Kyoung Kwak ◽  
Sung Ju Kang ◽  
Eun-Kyoo Song ◽  
Jong-Keun Seon
Keyword(s):  
Clinical Outcomes ◽  
High Tibial Osteotomy ◽  
Cartilage Repair ◽  
Tibial Osteotomy ◽  
Opening Wedge ◽  
Status Group ◽  
Second Look ◽  
Wedge High Tibial Osteotomy ◽  
The Mean

Aims To determine the relationship between articular cartilage status and clinical outcomes after medial opening-wedge high tibial osteotomy (MOHTO) for medial compartmental knee osteoarthritis at intermediate follow-up. Methods We reviewed 155 patients (155 knees) who underwent MOHTO from January 2008 to December 2016 followed by second-look arthroscopy with a mean 5.3-year follow-up (2.0 to 11.7). Arthroscopic findings were assessed according to the International Cartilage Repair Society (ICRS) Cartilage Repair Assessment (CRA) grading system. Patients were divided into two groups based on the presence of normal or nearly normal quality cartilage in the medial femoral condyle: good (second-look arthroscopic) status (ICRS grade I or II; n = 70), and poor (second-look arthroscopic) status (ICRS grade III or IV; n = 85) groups at the time of second-look arthroscopy. Clinical outcomes were assessed using the International Knee Documentation Committee (IKDC) score, Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC), and 36-Item Short Form survey. Results Significant improvements in all clinical outcome categories were found between the preoperative and second-look arthroscopic assessments in both groups (p < 0.001). At the latest follow-up, the mean IKDC and WOMAC scores in the good status group further improved compared with those at the time of second-look arthroscopic surgery (p < 0.001), which was not shown in the poor status group. The mean IKDC (good status, 72.8 (SD 12.5); poor status, 64.7 (SD 12.1); p = 0.002) and mean WOMAC scores (good status, 15.7 (SD 10.8); poor status, 21.8 (SD 13.6); p = 0.004) significantly differed between both groups at the latest follow-up. Moreover, significant correlations were observed between ICRS CRA grades and IKDC scores (negative correlation; p < 0.001) and WOMAC scores (positive correlation; p < 0.001) at the latest follow-up. Good cartilage status was found more frequently in knees with the desired range of 2° to 6° valgus correction than in those with corrections outside this range (p = 0.019). Conclusion Second-look arthroscopic cartilage status correlated with clinical outcomes after MOHTO at intermediate-term follow-up, despite the relatively small clinical differences between groups. Cite this article: Bone Joint J 2021;103-B(11):1686–1694.

scholarly journals Risk factors of cartilage regeneration in patients who underwent high tibial osteotomy combined with microfracture

2019 ◽  
Author(s):  
Jong Keun Seon ◽  
Pramod Shaligram Ingle ◽  
Eun-Kyoo Song ◽  
Kyu-Jin Cho ◽  
Seung-Min Na ◽  
...  
Keyword(s):  
High Tibial Osteotomy ◽  
Functional Outcomes ◽  
Cartilage Regeneration ◽  
Cartilage Lesion ◽  
Lateral Compartment ◽  
Tibial Osteotomy ◽  
Second Look ◽  
Group A ◽  
Group B

Abstract Background: One of the option for treating unicompartmental osteoarthritis (OA) is high tibial osteotomy (HTO). HTO which can shift the mechanical axis to the lateral compartment, can performed with microfracture which provides cells capable of producing cartilage. And this procedure is one of the common combinations that orthopaedic surgeons are in practice recently. The purpose of this study was to evaluate the degree of regeneration of cartilage after performing microfracture (MF) with high tibial osteotomy (HTO) after 2- year follow up and identify the factors influencing the regeneration of cartilage after the procedure. We also evaluated whether the regenerated cartilage status affects clinical outcomes. Methods: A total of 81 cases that underwent second-look arthroscopy at the time of plate removal after MF and HTO with a minimum two-year follow-up were included. The patients were divided into two groups according to femoral cartilage regeneration. Multivariable logistic regression analyses were performend to identify independent factors that influence cartilage regeneration. We also compared differences in functional outcomes between the two groups. Results: On the femoral side, grade I cartilage regeneration was found in seven (8.6%), grade II in 19 (23.5%), grade III in 26 (32.1%), and grade IV in 29 cases (35.8%), resulting in 26 (32.1%) patients belonging to well regenerated group (group A) and 55 (67.9%) to the poorly regenerated group (group B). Among factors, the size of the cartilage lesion (P=.011) and the presence of kissing lesions (P=.027) significantly affected cartilage regeneration. There were no statistically significant differences between group A and group B in terms of KSS and WOMAC scores. Conclusions: A large cartilage defect and the presence of kissing lesions are associated with poor cartilage regeneration after combined MF and HTO surgery. However, the quality of regenerated cartilage does not affect functional outcomes in patients with MF and HTO. Keywords: High tibial osteotomy, Microfracture, Second-look arthroscopy, Cartilage regeneration, risk factor

scholarly journals Risk factors of poor cartilage regeneration in patients who underwent high tibial osteotomy combined with microfracture

2019 ◽  
Author(s):  
Ik-Sun Choi ◽  
Pramod Shaligram Ingle ◽  
Jong Keun Seon ◽  
Eun-Kyoo Song ◽  
Kyu-Jin Cho ◽  
...  
Keyword(s):  
High Tibial Osteotomy ◽  
Functional Outcomes ◽  
Cartilage Regeneration ◽  
Cartilage Lesion ◽  
Lateral Compartment ◽  
Tibial Osteotomy ◽  
Second Look ◽  
Group A ◽  
Group B

Abstract Background: One of the option for treating unicompartmental osteoarthritis (OA) is high tibial osteotomy (HTO). HTO which can shift the mechanical axis to the lateral compartment, can performed with microfracture which provides cells capable of producing cartilage. And this procedure is one of the common combinations that orthopaedic surgeons are in practice recently. The purpose of this study was to evaluate the degree of regeneration of cartilage after performing microfracture (MF) with high tibial osteotomy (HTO) after 2- year follow up and identify the factors influencing the regeneration of cartilage after the procedure. We also evaluated whether the regenerated cartilage status affects clinical outcomes. Methods: A total of 81 cases that underwent second-look arthroscopy at the time of plate removal after MF and HTO with a minimum two-year follow-up were included. The patients were divided into two groups according to femoral cartilage regeneration. Multivariable logistic regression analyses were performend to identify independent factors that influence cartilage regeneration. We also compared differences in functional outcomes between the two groups. Results: On the femoral side, grade I cartilage regeneration was found in seven (8.6%), grade II in 19 (23.5%), grade III in 26 (32.1%), and grade IV in 29 cases (35.8%), resulting in 26 (32.1%) patients belonging to well regenerated group (group A) and 55 (67.9%) to the poorly regenerated group (group B). Among factors, the size of the cartilage lesion (P=.011) and the presence of kissing lesions (P=.027) significantly affected cartilage regeneration. There were no statistically significant differences between group A and group B in terms of KSS and WOMAC scores. Conclusions: A large cartilage defect and the presence of kissing lesions are associated with poor cartilage regeneration after combined MF and HTO surgery. However, the quality of regenerated cartilage does not affect functional outcomes in patients with MF and HTO. Keywords: High tibial osteotomy, Microfracture, Second-look arthroscopy, Cartilage regeneration, risk factor

scholarly journals Factors Influencing Clinical and MRI Outcomes of Mesenchymal Stem Cell Implantation With Concomitant High Tibial Osteotomy for Varus Knee Osteoarthritis

2021 ◽  
Vol 9 (2) ◽  
pp. 232596712097998
Author(s):  
Yong Sang Kim ◽  
Dong Suk Suh ◽  
Dae Hyun Tak ◽  
Pill Ku Chung ◽  
Yoo Beom Kwon ◽  
...  
Keyword(s):  
Knee Osteoarthritis ◽  
High Tibial Osteotomy ◽  
Cartilage Regeneration ◽  
Tibial Osteotomy ◽  
Varus Knee ◽  
Patient Age ◽  
Knee Oa ◽  
Radiographic Outcomes ◽  
Factors Influencing ◽  
Patient Âgé

Background:Cartilage repair procedures using mesenchymal stem cells (MSCs) can provide superior cartilage regeneration in the medial compartment of the knee joint when high tibial osteotomy (HTO) is performed for varus knee osteoarthritis (OA). However, few studies have reported the factors influencing the outcomes of MSC implantation with concomitant HTO.Purpose:To investigate the outcomes of MSC implantation with concomitant HTO and to identify the prognostic factors that are associated with the outcomes.Study Design:Case series; Level of evidence, 4.Methods:A total of 71 patients (75 knees) were retrospectively evaluated after MSC implantation with concomitant HTO. Clinical and radiological outcomes were evaluated, and magnetic resonance imaging (MRI) was used to assess cartilage regeneration. Statistical analyses were performed to determine the effect of different factors on clinical, radiographic, and MRI outcomes.Results:Clinical and radiographic outcomes improved significantly from preoperatively to final follow-up ( P < .001 for all), and overall cartilage regeneration was encouraging. Significant correlations were found between clinical and MRI outcomes. However, radiographic outcomes were not significantly correlated with clinical or MRI outcomes. Patient age and number of MSCs showed significant correlations with clinical and MRI outcomes. On multivariate analyses, patient age and number of MSCs showed high prognostic significance with poor clinical outcomes.Conclusion:MSC implantation with concomitant HTO provided feasible cartilage regeneration and satisfactory clinical outcomes for patients with varus knee OA. Patient age and number of MSCs were important factors that influenced the clinical and MRI outcomes of MSC implantation with concomitant HTO for varus knee OA.

scholarly journals Does postoperative quantitative bone scintigraphy reflect outcomes following medial open-wedge high tibial osteotomy?

PLoS ONE ◽  
2021 ◽  
Vol 16 (9) ◽  
pp. e0257315
Author(s):  
Jung-Kwon Bae ◽  
Kang-Il Kim ◽  
Jun-Ho Kim ◽  
Hyun-Gon Gwak ◽  
Chanwoo Kim
Keyword(s):  
Clinical Outcomes ◽  
High Tibial Osteotomy ◽  
Femoral Condyle ◽  
Cartilage Regeneration ◽  
Medial Compartment ◽  
Tibial Osteotomy ◽  
Open Wedge ◽  
Postoperative Changes ◽  
Wedge High Tibial Osteotomy

Purpose The present study evaluated changes in bone tracer uptake (BTU) after medial open-wedge high tibial osteotomy (MOWHTO) and determined whether postoperative BTU correlates with clinical symptoms, radiologic parameters, or cartilage regeneration following MOWHTO. Methods A total of 210 knees underwent MOWHTO for medial compartmental osteoarthritis (OA) were enrolled in this study. Mean follow-up period was 42.7 months. We assessed BTU for the medial compartment of the knee before MOWHTO and at the time of plate removal. Radiologic parameters included Kellgren-Lawrence (K-L) grade and Hip-Knee-Ankle angle (HKAA). Clinical evaluation included American Knee Society (AKS) score and cartilage status was graded at the time of MOWHTO and second-look arthroscopy according to the International Cartilage Repair Society (ICRS) grading system and articular cartilage regeneration stage. Statistical analysis performed to assess the relationships among postoperative BTU of the medial compartment, radiologic parameters, arthroscopic changes and clinical outcomes. Results BTU of medial femoral condyle and tibial plateau were significantly decreased at 2 years after MOWHTO (p<0.001). AKS scores and arthroscopic cartilage status were also significantly improved following MOWHTO. BMI and postoperative HKAA showed significant correlations with postoperative changes of BTU in uni- and multi-variable analysis. Meanwhile, postoperative changes of BTU did not show significant correlation with clinical outcomes or cartilage regeneration following MOWHTO. Conclusion Lower BMI and postoperative valgus alignment were significant predictor for postoperative BTU decrease of the medial compartment following MOWHTO. However, postoperative changes of BTU did not reflect cartilage regeneration or clinical outcomes until the midterm follow-up.

Ten-Year Results of Medial Open-Wedge High Tibial Osteotomy and Chondral Resurfacing in Severe Medial Osteoarthritis and Varus Malalignment

2018 ◽  
Vol 46 (6) ◽  
pp. 1362-1370 ◽  
Author(s):  
Philipp Schuster ◽  
Markus Geßlein ◽  
Michael Schlumberger ◽  
Philipp Mayer ◽  
Raul Mayr ◽  
...  
Keyword(s):  
Functional Outcome ◽  
Cartilage Regeneration ◽  
Tibial Osteotomy ◽  
Open Wedge ◽  
Varus Malalignment ◽  
Medial Osteoarthritis ◽  
Ikdc Score ◽  
Chondral Resurfacing

Background: High tibial osteotomy (HTO) is a widely used treatment option for medial osteoarthritis and varus malalignment, especially in young patients with early osteoarthritis. Limited outcome data are available for this procedure in severe osteoarthritis, and no long-term data are available using newer implants. Purpose: To determine survivorship and functional results of medial open-wedge HTO combined with a chondral resurfacing (CR) procedure (abrasion plus microfracture) in severe medial osteoarthritis (Kellgren-Lawrence grade 3 and 4) and varus malalignment. Furthermore, factors that potentially influence the outcome were analyzed. Study Design: Case series; Level of evidence, 4. Methods: From September 2005 to December 2008, all cases of HTO (fixation with an angular-stable internal fixator) combined with CR were prospectively surveyed with regard to survival (Kaplan-Meier-method, not requiring arthroplasty) and functional outcome (subjective International Knee Documentation Committee [IKDC] score). Cartilage regeneration at the time of hardware removal, tibial bone varus angle (TBVA), pre- and postoperative mechanical medial proximal tibial angle (MPTA), and postoperative alignment were analyzed with regard to the result. Results: Seventy-nine knees were included (73 patients; mean age 50.9 ± 7.6 years). The follow-up rate was 90% at 10.0 ± 1.2 years (range, 8.3-12.1 years). Pre- and postoperative mechanical tibiofemoral axis were 9.6° ± 3.0° of varus and 0.6° ± 2.7° of valgus, respectively. Survival rate was 81.7% (95% CI, 72.5%-90.9%) at 10 years. Subjective IKDC score significantly improved from 44 ± 11 preoperatively to 70 ± 13 at one, 66 ± 15 at three, 66 ± 15 at five, and 65 ± 17 at ten years ( P < .001 at any point of follow-up). Poor cartilage regeneration and low preoperative IKDC score (<40) were associated with decreased survival. High preoperative TBVA was associated with better and an overcorrected MPTA (>95°) with inferior functional outcome at final follow-up, respectively. Conclusion: Even in cases of severe medial osteoarthritis and varus malalignment, HTO in combination with a CR procedure is a good to excellent treatment option. The role of the CR procedure remains unclear. Although good results are obtained with overcorrected MPTA, long-term functional outcome is inferior.

scholarly journals Prognostic Factors Influencing Outcomes of High Tibial Osteotomy in The Varus Knee: The Role of The Deformity

2020 ◽  
Vol 8 (7_suppl6) ◽  
pp. 2325967120S0046
Author(s):  
Carola Pilone ◽  
Federico Verdone ◽  
Roberto Rossi ◽  
Davide Bonasia ◽  
Federica Rosso
Keyword(s):  
Prognostic Factors ◽  
Regression Model ◽  
High Tibial Osteotomy ◽  
Womac Score ◽  
Tibial Osteotomy ◽  
Varus Knee ◽  
Inclusion Criteria ◽  
Opening Wedge

Objectives: High Tibial Osteotomy (HTO) is widely performed to treat early arthiritis in the varus knee. The aim of this prospective study is to evaluate different prognostic factors affecting the outcomes of HTO and, with special attention to the role of the site of deformity. Methods: 231 Opening Wedge HTO (OWHTO) were performed in 202 patients and included in the study. Inclusion criteria were: 1) age > 18 years, 2) no major associated procedures (i.e. ACL reconstruction, major cartilage procedure, 3) only OWHTO, 4) pre-operative complete clinical and radiological evaluation available. Patients were evaluated with (1) the Knee Society score (KSS), (2) the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) score, (3) another self-evaluation scale, (4) long-leg radiographs, and (5) plain radiographs. On the x-ray different angles were evaluated, including Join Line Congruence Angle. Furthermore, the location of deformity was established. Three main outcomes were identified: Indication to Total Knee Arthroplasty (TKA), KSS poor or fair and WOMAC < 76 points), and different prognostic factors were identified (Fig. 1). All the variables were firstly tested in a single regression model to evaluate the association with each outcome. All the variables with p<0.1 were re-tested in a multiple regression model. Results: 32 patients were lost to follow-up and 31 patients did not meet the inclusion criteria, leaving 139 patients (156 OWHTOs) for the study. The average age was 52.9 ± 9.6 years, and the average follow-up was 97.7 ± 42.8 months. Post-operatively there was a significant improvement in both the KSS and WOMAC score compared to the pre-operative period (p<0.0001). The only variable related to TKA indication was a pre-operative JLCA ≥5° (OR=24.3, p=0.0483). Conversely, different variables were related to a worse KSS, including pre-operative BMI >30 Kg/m2 (OR=78.9, p=0.0028), pre-operative ROM <120° of flexion (OR=40.8, p=0.0421), pre-operative mLDFA ≥91° (OR=36,6,p=0.0401) and femoral pre-operative CORA ≥3° of varus (OR=39,9 p=0.0269). Furthermore, a pre-operative BMI >30 Kg/m2 (OR=29,5, p=0.0314) was associated to a worse WOMAC score. Conversely, patients with a pre-operative mMPTA ≤84° had lower risk to obtain a worse KSS oe WOMAC score (respectively OR= 0,2 p=0.0364 and OR=0,3 p=0.0071). The cumulative survivorship was calculated with the Kaplan-Meier method, and it resulted equal to 98.6% at 5 years and decreased to 85.5% at 10 years. Conclusion: OWHTO is a good treatment for early arthritis in the varus knee if the correct indications are applied. The outcomes can be considered good, with 85% of 10-year survivorship. It is mandatory to correctly address the location of the deformity, because the presence of a femoral varus deformity is related to worse outcomes. Similarly, presence of a pre-operative JLCA ≥5° is the only factor associated to TKA indication. [Table: see text]

Does an Injection of Adipose-Derived Mesenchymal Stem Cells Loaded in Fibrin Glue Influence Rotator Cuff Repair Outcomes? A Clinical and Magnetic Resonance Imaging Study

2017 ◽  
Vol 45 (9) ◽  
pp. 2010-2018 ◽  
Author(s):  
Yong Sang Kim ◽  
Chang Hun Sung ◽  
Sung Hoon Chung ◽  
Sang Joon Kwak ◽  
Yong Gon Koh
Keyword(s):  
Rotator Cuff ◽  
Fibrin Glue ◽  
Rotator Cuff Repair ◽  
Arthroscopic Rotator Cuff Repair ◽  
Conventional Group ◽  
Injection Group ◽  
The Mean ◽  
Arthroscopic Rotator Cuff ◽  
Cuff Repair

Background: The mesenchymal stem cell (MSC)–based tissue engineering approach has been developed to improve the treatment of rotator cuff tears. Hypothesis/Purpose: The purpose was to determine the effect of an injection of adipose-derived MSCs loaded in fibrin glue during arthroscopic rotator cuff repair on clinical outcomes and to evaluate its effect on structural integrity using magnetic resonance imaging (MRI). The hypothesis was that the application of adipose-derived MSCs would improve outcomes after the surgical repair of a rotator cuff tear. Study Design: Cohort study; Level of evidence, 3. Methods: Among 182 patients treated with arthroscopic surgery for a rotator cuff tear, 35 patients treated with arthroscopic rotator cuff repair alone (conventional group) were matched with 35 patients who underwent arthroscopic rotator cuff repair with an injection of adipose-derived MSCs loaded in fibrin glue (injection group) based on sex, age, and lesion size. Outcomes were assessed with respect to the visual analog scale (VAS) for pain, range of motion (ROM) (including forward flexion, external rotation at the side, and internal rotation at the back), and functional measures of the Constant score and University of California, Los Angeles (UCLA) shoulder rating scale. Repaired tendon structural integrity was assessed by using MRI at a minimum of 12 months after surgery, and the mean clinical follow-up was 28.8 ± 4.2 months in the conventional group and 28.3 ± 3.8 months in the injection group. Results: The mean VAS score at rest and during motion improved significantly in both groups after surgery. However, there were no significant differences between the groups at the final follow-up ( P = .256 and .776, respectively). Compared with preoperative measurements, forward flexion and external rotation at the side significantly improved at the final follow-up in both groups (all P < .05). However, no significant improvements in internal rotation at the back were observed in either group ( P = .625 and .834 for the conventional and injection groups, respectively). There were also no significant differences between the groups at the final follow-up for any of the 3 ROM positions (all P > .05). The mean Constant score and UCLA score improved significantly in both groups after surgery, but there were no significant differences between the groups at the final follow-up ( P = .634 and .302, respectively). MRI indicated a retear rate of 28.5% in the conventional group and 14.3% in the injection group ( P < .001). Conclusion: This study revealed that an injection of adipose-derived MSCs loaded in fibrin glue during rotator cuff repair could significantly improve structural outcomes in terms of the retear rate. There were, however, no clinical differences in the 28-month period of follow-up. Although still in the early stages of application, MSC augmentation of surgical rotator cuff repair appears useful for providing an adequate biological environment around the repair site.

scholarly journals Arthroscopic Diagnosis and Treatment of Chronic Hip Pain After Total Hip Arthroplasty and the Role of Anterior Capsule Disruption in Iliopsoas Tendinopathy

2019 ◽  
Vol 7 (6) ◽  
pp. 232596711985436 ◽  
Author(s):  
Mark R. Nazal ◽  
Ali Parsa ◽  
Scott D. Martin
Keyword(s):  
Total Hip Arthroplasty ◽  
Retrospective Analysis ◽  
Clinical Outcomes ◽  
Hip Arthroplasty ◽  
Arthroscopic Surgery ◽  
Strength Test ◽  
Hip Pain ◽  
Anterior Capsule ◽  
The Mean

Background: The use of hip arthroscopic surgery in patients suffering from chronic hip pain after total hip arthroplasty (THA) has a limited presence in the literature, with most studies having limited follow-up. Purpose: The first goal of this study was to evaluate hip arthroscopic surgery in the diagnosis and management of patients with chronic hip pain after THA. The second goal was to describe a new cause of iliopsoas tendinopathy (IPT) involving disruption of the anterior capsule. Study Design: Case series; Level of evidence, 4. Methods: We conducted a retrospective analysis with prospectively collected clinical outcomes of patients after THA who underwent hip arthroscopic surgery for chronic hip pain without an identifiable cause. The patients were at least 18 years old and had a minimum follow-up of 24 months. Results: The retrospective analysis found that hip arthroscopic surgery led to new diagnostic information in 8 patients (80%). Of the 10 patients diagnosed with IPT, 4 (40%) lacked an anatomic cause; however, these patients had a history of difficult exposure of the anterior capsule and/or a lack of capsular repair during index THA. The mean modified Harris Hip Score (mHHS) was 71.9 ± 15.6, and the mean 6-month postoperative visual analog scale (VAS) pain score was 0.8 ± 2.2, which was significantly lower than preoperatively ( P = .0055). There was also significantly improved forward flexion range of motion ( P = .0183) and straight leg raise (SLR) strength test results ( P = .0263). Hip arthroscopic surgery resulted in 8 patients (80%) continuing to be pain-free at a mean follow-up of 6.8 ± 1.4 years, while 2 patients (20%) progressed to revision arthroplasty. There were no major or minor complications. Conclusion: Hip arthroscopic surgery was found to have an important role in the diagnostic and therapeutic management of patients with chronic hip pain after THA, with good clinical outcomes at a mean follow-up of 6.8 years and no complications. We believe that disruption of the anterosuperior acetabular capsule, including the reflected head of the rectus femoris, can allow the iliopsoas tendon to move intra-articularly and precipitate IPT. This disruption may be appreciated on the SLR strength test. Although this study presents a small sample size that cannot substantiate a cause-effect relationship, orthopaedic surgeons performing THA should consider minimizing disruption and/or ensuring repair of the anterior capsule to decrease this potential cause of IPT.

Sign in / Sign up

Export Citation Format

Share Document