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

2018 ◽  
Vol 46 (14) ◽  
pp. 3437-3445 ◽  
Author(s):  
Itay Perets ◽  
Danil Rybalko ◽  
Brian H. Mu ◽  
David R. Maldonado ◽  
Gary Edwards ◽  
...  
Keyword(s):  
Decision Making ◽  
Total Hip Arthroplasty ◽  
Visual Analog Scale ◽  
Hip Arthroplasty ◽  
Hip Arthroscopy ◽  
Labral Repair ◽  
Acetabular Labrum ◽  
Analog Scale ◽  
Total Hip

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

No Correlation Between Depth of Acetabuloplasty or Postoperative Lateral Center-Edge Angle on Midterm Outcomes of Hip Arthroscopy With Acetabuloplasty and Labral Repair

2020 ◽  
Vol 49 (1) ◽  
pp. 49-54 ◽  
Author(s):  
Adam M. Johannsen ◽  
Joseph J. Ruzbarsky ◽  
Lauren A. Pierpoint ◽  
Rui W. Soares ◽  
Karen K. Briggs ◽  
...  
Keyword(s):  
Total Hip Arthroplasty ◽  
Hip Arthroplasty ◽  
Hip Arthroscopy ◽  
Labral Repair ◽  
Total Hip ◽  
Center Edge ◽  
Lateral Center Edge Angle ◽  
Resection Depth ◽  
Center Edge Angle

Background: The treatment of pincer deformity in hip arthroscopy remains controversial, with some authors advocating that over resection may risk early joint deterioration. The role of acetabular resection depth and postoperative acetabular morphology on postoperative outcomes has yet to be defined. Purpose/Hypothesis: This study measures the influence of acetabular resection depth and postoperative lateral center-edge angle (LCEA) on minimum 5-year patient-reported outcomes (PROs), revision rates, and conversion to total hip arthroplasty using a single surgeon’s prospective database. We hypothesized that patients with acetabular resections >10°, as measured by LCEA, or patients with postoperative LCEA outside the normal range of 25° to 35° would have lower PROs, higher revision rates, and higher conversion to total hip arthroplasty at midterm follow-up. Study Design: Cohort study; Level of evidence, 2. Methods: A total of 192 patients who underwent primary hip arthroscopy with acetabuloplasty and labral repair by a single surgeon with a minimum 5-year follow-up met the inclusion criteria. Preoperative and postoperative LCEAs were measured on supine anteroposterior radiographs, and patients were divided into cohorts based on LCEA and acetabular resection depth. Cohorts for postoperative LCEA were <20° (dysplasia), 20° to 25° (borderline dysplasia), 25° to 35° (normal), and >35° (borderline overcoverage). Cohorts for acetabular resection depth were <5°, 5° to 10°, and >10° difference from preoperative to postoperative LCEA. Outcome measures included the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC), 12-Item Short Form Health Survey, modified Harris Hip Score, Hip Outcome Score, satisfaction scores, revision rates, and conversion to arthroplasty rates. Results: Patients significantly improved in all outcome score measures at final follow-up. There were no statistically significant differences in PRO scores or conversion to total hip arthroplasty between any cohorts in the postoperative LCEA group. There were more revisions in the 25° to 35° cohort than the other cohorts ( P = .02). The 5-10° resection depth cohort demonstrated a higher postoperative WOMAC score ( P = .03), but otherwise no statistically significant differences were seen between resection depth cohorts in the remaining postoperative outcomes scores, revision rates, or conversion to total hip arthroplasty rates. Conclusion: Patients with postoperative LCEA values outside the normal reference range and with large resections perform similar to those with normal postoperative LCEA values and smaller resections at a minimum 5-year follow-up.

Importance of Retaining Sufficient Acetabular Depth: Successful 2-Year Outcomes of Hip Arthroscopy for Patients With Pincer Morphology as Compared With Matched Controls

2020 ◽  
Vol 48 (10) ◽  
pp. 2471-2480 ◽  
Author(s):  
Claudia R. Brick ◽  
Catherine J. Bacon ◽  
Matthew J. Brick
Keyword(s):  
Total Hip Arthroplasty ◽  
Femoroacetabular Impingement ◽  
Hip Arthroplasty ◽  
Hip Arthroscopy ◽  
Patient Reported Outcomes ◽  
Control Group ◽  
Total Hip ◽  
Patient Reported ◽  
Acetabular Overcoverage

Background: Patients with pincer-type femoroacetabular impingement are commonly treated with arthroscopic reduction of acetabular depth as measured by the lateral center-edge angle (LCEA). The optimal amount of rim reduction has not been established, although large resections may increase contact pressures through the hip. A recent publication demonstrated inferior surgical outcomes in patients with acetabular overcoverage as compared with normal acetabular coverage. Casual observation of our database suggested equivalent improvements, prompting a similar analysis. Purpose: To analyze patient-reported outcomes after hip arthroscopy for femoroacetabular impingement in patients with acetabular overcoverage who were matched with controls with normal coverage, as well as to analyze associations with reduction in LCEA. Study Design: Cohort study; Level of evidence, 3. Methods: Data were collected prospectively from patients with a minimum 2-year follow-up after receiving hip arthroscopy for femoroacetabular impingement by a single surgeon. Cases were reviewed to identify those with pincer-type morphology (LCEA >40°) and matched according to sex, age, chondral damage, and surgery date in a 1:1 ratio with controls with an LCEA of 25° to 40°. The surgical goal was to reduce the LCEA to the upper end of the normal range with minimal rim resection, usually 35° to 37°. Radiographic measurements of coverage, intraoperative findings, procedures, and patient-reported outcomes were recorded, including the 12-Item International Hip Outcome Tool, Non-arthritic Hip Score, Hip Disability and Osteoarthritis Outcome Score, visual analog scale for pain, rates of revision or reoperation, and conversion to total hip arthroplasty. Results: A total of 114 hips (93 patients) for the pincer group were matched 1:1 from 616 hips (541 patients) for the control group. The pincer group (mean ± SD age, 34.5 ± 12.2 years) did not differ in age, body mass index, or follow-up from controls. LCEA was reduced in both groups pre- to postoperatively: the pincer group from 44.0° ± 2.8° to 34.2° ± 3.5° and the controls from 32.9° ± 3.9° to 31.0° ± 3.0°. No differences in improvement were observed: iHOT-12 improved by 35.7 points in both groups ( P = .9 for analysis of variance interaction) and Nonarthritic Hip Score by 22.3 points ( P = .6). From all eligible surgical procedures, 2-year follow up rates were 2.5% and 2.6% for the pincer and control cohorts, respectively, and 1.2% and 0.3% for conversion to total hip arthroplasty. Conclusion: Arthroscopic management of acetabular overcoverage can achieve excellent results, equivalent to arthroscopy for other causes of symptomatic femoroacetabular impingement. A key finding was smaller rim resections producing a mean postoperative LCEA of 34.2° with a small standard deviation.

Description of load progression and pain response during progressive resistance training early after total hip arthroplasty: secondary analyses from a randomized controlled trial

2016 ◽  
Vol 31 (1) ◽  
pp. 11-22 ◽  
Author(s):  
Lone R Mikkelsen ◽  
Annemette K Petersen ◽  
Inger Mechlenburg ◽  
Søren Mikkelsen ◽  
Kjeld Søballe ◽  
...  
Keyword(s):  
Resistance Training ◽  
Total Hip Arthroplasty ◽  
Visual Analog Scale ◽  
Hip Arthroplasty ◽  
Intervention Group ◽  
Pain Response ◽  
Progressive Resistance Training ◽  
Analog Scale ◽  
Total Hip ◽  
Progressive Resistance

Objective: To describe a progressive resistance training intervention implemented shortly after total hip arthroplasty, including a detailed description of load progression, pain response and adverse events to the training. Design: Secondary analyses of data from the intervention group in a randomized controlled trial. Subjects: This study reports data from the intervention group ( n = 37). Interventions: The protocol described supervised progressive resistance training of the operated leg two days/week in addition to home-based exercise five days/week and for 10 weeks. The relative load progressed from 12 repetition maximum to 8 repetition maximum during 10 weeks for the exercises: knee extension, hip abduction, -flexion and -extension. Main measures: Training load in kilograms (kg) for each exercise, hip pain during, before and after exercise using the Visual Analog Scale and adverse events during the initial four weeks of training. Results: The majority of patients experienced only moderate hip pain during exercise (range in median across exercises and sessions: 5–35 mm Visual Analog Scale) and mild pain at rest (median: 1–18 mm Visual Analog Scale), both of which decreased over time ( p < 0.001), despite a substantial increase in absolute training load (67%–166 % across exercises, p < 0.001). Out of 152 training sessions, short term pain response (an increase >20 mm Visual Analog Scale) occurred in 13 patients in 24 training sessions. Conclusion: Progressive resistance training as described in the present study can be implemented shortly following total hip arthroplasty with substantial load progression and no overall exacerbation of postoperative pain. Some patients may experience a short term pain response. Trial Registration (primary trial): NCT01214954

Does Concomitant Lumbar Spine Disease Adversely Affect the Outcomes of Patients Undergoing Hip Arthroscopy?

2020 ◽  
Vol 48 (9) ◽  
pp. 2178-2184
Author(s):  
Jonathan D. Haskel ◽  
Samuel L. Baron ◽  
Mikhail Zusmanovich ◽  
Thomas Youm
Keyword(s):  
Lumbar Spine ◽  
Total Hip Arthroplasty ◽  
Hip Arthroplasty ◽  
Hip Arthroscopy ◽  
Low Back ◽  
Lumbar Radiculopathy ◽  
Total Hip ◽  
History Of ◽  
Spine Disease

Background: The practice of hip arthroscopy is increasing in popularity, which has highlighted the importance of identifying risk factors that predict hip arthroscopy outcomes. The literature suggests that lumbar spine disease is an independent risk factor for poorer outcomes following total hip arthroplasty; however, the effect of lumbar spine disease on hip arthroscopy outcomes has not been fully investigated. At present, there is a paucity of literature investigating the effect of coexisting hip and lumbar spine disease on outcomes after hip arthroscopy. Purpose: To evaluate the outcomes of hip arthroscopy in patients with concomitant lumbar spine disease compared with those without a history of lumbar spine disease. Study Design: Cohort study; Level of evidence, 3. Methods: A retrospective review of a prospectively collected, single-surgeon database was performed to identify patients who underwent hip arthroscopy with subjective and objective evidence of lumbar disease. Patients were included if they were skeletally mature; had hip disease that failed nonoperative treatment; had symptoms of low back pain, lumbar radiculopathy, or lumbar stenosis at the time of surgery; and had advanced imaging of the lumbar spine (computed tomography or magnetic resonance imaging) confirming lumbar spine disease. Patients were excluded if they had any previous hip surgery or evidence of osteoarthritis of Tönnis grade 2 or higher. The hip-spine cohort was matched by age, sex, and body mass index in a 1:3 fashion to a control cohort consisting of patients without symptoms of low back pain, lumbar radiculopathy, or lumbar stenosis at the time of surgery or a history of lumbar spine disease who underwent hip arthroscopy over the same time period. Baseline preoperative modified Harris Hip Score (mHHS) and Non-Arthritic Hip Score (NAHS) were compared with scores at 3-, 6-, 12-, and 24-month follow-up, and rates of revision arthroscopy or total hip arthroplasty were assessed. Statistical analysis was performed with the Student t test. Results: A total of 38 patients with radiographically confirmed lumbar disease were matched with 111 control patients. Preoperative mHHS and NAHS were significantly lower in the hip-spine cohort ( P = .01 and P = .02, respectively); however, no significant differences were found in mHHS or NAHS between the cohorts at 3, 6, 12, and 24 months postoperatively. A 89.8% increase in mHHS was found in the hip-spine cohort, compared with a 74.4% increase in the control cohort ( P = .0475). No significant differences in the rates of revision or total hip arthroplasty conversion were identified between the hip-spine and control cohorts (23.7% vs 18.0%, respectively; P = .44). Conclusion: Patients with known lumbar spine disease who underwent hip arthroscopy had a significantly greater percentage improvement at 24-month follow-up compared with those without a history of lumbar spine disease, and outcomes were ultimately not significantly different. No increased risk of reoperation was noted in patients with concomitant lumbar spine disease.

Pre-existing osteoarthritis remains a key feature of arthroscopy patients who convert to total hip arthroplasty

2020 ◽  
pp. jisakos-2020-000492
Author(s):  
Renuka M Vesey ◽  
Catherine J Bacon ◽  
Matthew J Brick
Keyword(s):  
New Zealand ◽  
Total Hip Arthroplasty ◽  
Hip Arthroplasty ◽  
Hip Arthroscopy ◽  
Conversion Rate ◽  
Duration Of Symptoms ◽  
Chondral Lesions ◽  
Total Hip ◽  
Patient Reported

ObjectivesTo determine the rate of conversion to total hip arthroplasty following ipsilateral hip arthroscopy by a single surgeon in New Zealand and to describe patient-related and surgical characteristics of patients who converted.MethodsA retrospective cohort analysis of hip arthroscopy patients with 2 years of minimum follow-up identified the total hip arthroplasty conversion rate using the New Zealand National Joint Registry. Prospective data collected from patients who subsequently converted to hip arthroplasty included: sex, age at arthroscopy, body mass index, side of hip arthroscopy and arthroplasty, duration of symptoms and patient-reported outcome measures. Imaging (Tönnis grade and lateral centre-edge angle) and surgical findings (labral, ligamentum teres and osteochondral pathology) along with the arthroscopic procedures performed were also documented.ResultsSixty-six out of 1856 (3.56%) primary hip arthroscopies were followed by an ipsilateral hip arthroplasty during the follow-up period (mean 87±29 months). Most patients had pre-existing osteoarthritis and/or chondral lesions (n=51). Dysplasia and over-resection of the acetabulum were also identified as contributing factors.ConclusionConversion rate by a high-volume surgeon in New Zealand was relatively low. Most patients had pre-existing osteoarthritis and/or chondral lesions that became apparent at arthroscopy. Dysplasia is also a factor to be cautious of when selecting patients for arthroscopy. Acetabular resection must be approached cautiously.Level of evidenceLevel IV.

scholarly journals The Efficacy of Labral Reconstruction: A Systematic Review

2021 ◽  
Vol 9 (2) ◽  
pp. 232596712097708
Author(s):  
Nathan Safran ◽  
Ehud Rath ◽  
Barak Haviv ◽  
Ran Atzmon ◽  
Eyal Amar
Keyword(s):  
Systematic Review ◽  
Total Hip Arthroplasty ◽  
Hip Arthroplasty ◽  
Comparative Studies ◽  
Surgical Techniques ◽  
Labral Repair ◽  
Total Hip ◽  
Patient Reported ◽  
The Mean

Background: With a greater understanding of the importance of the acetabular labrum in the function of the hip, labral repair is preferred over debridement. However, in some scenarios, preservation or repair of the labrum is not possible, and labral reconstruction procedures have been growing in popularity as an alternative to labral resection. Purpose: To provide an up-to-date analysis of the literature to determine the overall efficacy of labral reconstruction when compared with labral repair or resection. Study Design: Systematic review; Level of evidence, 3. Methods: PubMed, Embase, and MEDLINE databases were searched for literature regarding labral reconstruction in the hip before July 21, 2020. The results were screened and evaluated by 2 reviewers, and a third reviewer resolved any discrepancies. The final studies were evaluated using the MINORS (Methodological Index for Non-randomized Studies) score. Results: There were 7 comparative studies that fit the inclusion criteria, with 228 hips from 197 patients. The mean follow-up was 34.6 months, and the mean age of all patients was 38.34 years. There were slightly more female patients than male patients (105 vs 92). Arthroscopic reconstruction was performed in 86% of studies (6/7); open surgical techniques, in 14% (1/7). A variety of grafts was used in the reconstructions. The indications for labral reconstruction and outcome measures varied in these publications. Nine patients were lost follow-up, and 6 patients converted to total hip replacement postlabral reconstruction. The assessment of these comparative studies illustrated statistically equivalent results between labral reconstruction and labral repair. Comparisons of labral reconstruction with labral resection also showed statistically equivalent postoperative patient-reported outcome scores; however, the rates of conversion to total hip arthroplasty were significantly higher in the population undergoing resection. Conclusion: The review of current available comparative literature, which consists entirely of level 3 studies, suggests that labral reconstruction does improve postoperative outcomes but does not demonstrate superiority over repair. There may, however, be benefit to performing labral reconstruction over resection owing to the higher rate of conversion to total hip arthroplasty in the labral resection group.

Conversion to Total Hip Arthroplasty After Hip Arthroscopy: A Cohort-Based Survivorship Study With a Minimum of 2-Year Follow-up

2020 ◽  
Vol Publish Ahead of Print ◽  
Author(s):  
Graeme Hoit ◽  
Daniel B. Whelan ◽  
Patrick Ly ◽  
Refik Saskin ◽  
Amit Atrey ◽  
...  
Keyword(s):  
Total Hip Arthroplasty ◽  
Hip Arthroplasty ◽  
Hip Arthroscopy ◽  
Total Hip

scholarly journals Small-head metal on metal total hip arthroplasty is associated with a high rate of complication and reoperation at mid-term follow-up

2021 ◽  
Vol 9 ◽  
pp. 205031212110147
Author(s):  
Nobuhiko Sumiyoshi ◽  
Kazuhiro Oinuma ◽  
Yoko Miura
Keyword(s):  
Total Hip Arthroplasty ◽  
Hip Arthroplasty ◽  
Adverse Reactions ◽  
Small Diameter ◽  
High Rate ◽  
Metal Debris ◽  
Total Hip ◽  
Metal On Metal ◽  
Small Head

Background: Adverse reactions to metal debris are significant complications after metal-on-metal total hip arthroplasty. Recently, late appearances of adverse reactions to metal debris and subsequent need for reoperations have been reported with small-diameter head metal-on-metal devices. We retrospectively investigated mid-term clinical outcomes of small-head metal-on-metal total hip arthroplasty. Methods: We reviewed 159 hips in 139 patients who had a small-head metal-on-metal total hip arthroplasty (M2a Taper; Biomet, Warsaw, IN) with a minimum 5-year follow-up and documented postoperative complications. Results: Focal osteolysis in either the femur or acetabulum was observed in 12 hips (7.5%, 44 months after surgery on average), with pseudotumor observed in 8 hips (5%, 120 months after surgery on average). Four hips (2.5%) had dislocations (84 months after surgery on average) and six hips (3.8%, 122 months after surgery on average) underwent reoperation. Conclusion: Small-head metal-on-metal total hip arthroplasty is associated with a high degree of complications at mid-term follow-up period. Considering this, we discourage the use of metal-on-metal total hip arthroplasty regardless of head size.

scholarly journals Long-term clinical and radiological outcome in patients with severe Legg-Calvé-Perthes disease after Chiari pelvic osteotomy: a mean of 14 years follow-up

2021 ◽  
pp. 112070002098815
Author(s):  
Dammerer Dietmar ◽  
Braito Matthias ◽  
Peter Ferlic ◽  
Kaufmann Gerhard ◽  
Juana Kosiol ◽  
...  
Keyword(s):  
Total Hip Arthroplasty ◽  
Hip Joint ◽  
Hip Arthroplasty ◽  
Pelvic Osteotomy ◽  
Perthes Disease ◽  
Total Hip ◽  
Joint Incongruence ◽  
Chiari Pelvic Osteotomy

Introduction: The Chiari pelvic osteotomy (CPO) has been recommended as a salvage procedure to improve head coverage in case of hip joint incongruence in paediatric hip disease. In this study, we aimed to assess the long-term results of CPO for severe Legg-Calvé-Perthes disease (LCPD). Methods: A total of 39 patients who underwent a CPO at our department between 1995 and 2010 were prospectively followed both radiologically (Stulberg classification) and clinically (Harris Hip Score [HHS], conversion into total hip arthroplasty). In this study, we retrospectively reviewed the cases of 12 hips (12 patients, 3 girls, 8 left hips) treated by CPO for severe LCPD (Catterall grade 3 or 4) with hip joint incongruence. Mean follow-up was 14.0 (range 7.6–21.3) years. Results: Mean age at surgery was 10.2 (range 8.2–17.8) years. Additional femoral osteotomy was performed in 8 patients. A good radiological result (Stulberg I or II) was achieved in 2 patients, a fair result (Stulberg III) in 4 patients, and a poor outcome (Stulberg IV or V) in 6 patients. Mean postoperative HHS averaged 93 (range 65–100) points. An excellent functional outcome (HHS 90–100 points) was achieved in 9 patients. No patient underwent total hip arthroplasty during follow-up. Postoperative limb-length discrepancy was found in 3 patients. Conclusions: CPO for severe LCPD with hip joint incongruence resulted in good long-term clinical outcome in about ⅔ of our patients after a mean of 14 years. Our results suggest that CPO can still be considered as a salvage joint-conserving procedure in this selected group of younger patients.

Sign in / Sign up

Export Citation Format

Share Document