The Influence of Lumbosacral Spine Pathology on Minimum 2-Year Outcome After Hip Arthroscopy: A Nested Case-Control Analysis

2019 ◽  
Vol 48 (2) ◽  
pp. 403-408 ◽  
Author(s):  
Edward C. Beck ◽  
Benedict U. Nwachukwu ◽  
Reagan Chapman ◽  
Anirudh K. Gowd ◽  
Brian R. Waterman ◽  
...  
Keyword(s):  
Clinical Outcomes ◽  
Hip Arthroscopy ◽  
Harris Hip Score ◽  
Lumbosacral Spine ◽  
Control Analysis ◽  
Level Of Evidence ◽  
Outcome Score ◽  
Femoroacetabular Impingement Syndrome ◽  
Spine Pathology ◽  
History Of

Background: Previous literature has examined the association between lumbosacral pathology and hip pathomechanics. However, the effect of lumbosacral pathologies and previous lumbosacral surgery on achieving meaningful outcomes after hip arthroscopy for femoroacetabular impingement syndrome (FAIS) has yet to be studied conclusively. Purpose: To determine whether a history of lumbosacral spine pathology has an influence on achieving minimal clinically important differences (MCIDs) after hip arthroscopy for FAIS. Study Design: Cohort study; Level of evidence, 3. Methods: Patients undergoing hip arthroscopy for FAIS by a single, fellowship-trained orthopaedic surgeon between January 2012 and April 2017 with minimum 2-year follow-up were retrospectively reviewed. Patients with a history of lumbosacral spine pathology (eg, lumbosacral fusion, disc or vertebral pathology, or history of lumbosacral fractures) were matched 1:2 by age, body mass index, and sex to patients without spine pathology. Clinical outcomes including the Hip Outcome Score–activities of daily living subscale (HOS-ADL), HOS–sports subscale (HOS-SS), modified Harris Hip Score (mHHS), international Hip Outcome Tool–12 (iHOT-12), visual analog scale (VAS) pain, and VAS satisfaction were compared between the groups using an independent t test. The threshold of every outcome score for achieving MCID was calculated separately for each group and frequencies were compared. Results: A total of 83 of 108 eligible patients with lumbosacral pathology were identified and matched to 166 patients without any spine pathology. When compared with the non–spine pathology group, the lumbosacral pathology group had significantly lower 2-year postoperative outcome score averages across all reported outcome tools (all P < .001). There were significant differences in the proportion achieving the threshold for HOS-ADL (60.6% vs 80.0%; P = .004), HOS-SS (57.6% vs 82.1%; P < .001), mHHS (66.7% vs 81.7%; P = .025), and iHOT-12 (54.8% vs 87.6%; P < .001) scores for MCID when comparing the lumbosacral and nonlumbosacral pathology groups. Conclusion: Patients with a history of lumbosacral pathology achieved significantly lower short-term meaningful clinical outcomes after undergoing hip arthroscopy for FAIS when compared with patients without spine pathology. The present study findings have implications for preoperative patient screening, shared decision-making processes/expectation management, and rehabilitation strategies.

Arthroscopic Repair of the Hip Abductor Musculotendinous Unit: The Effect of Microfracture on Clinical Outcomes

2021 ◽  
pp. 036354652199967
Author(s):  
Baris Kocaoglu ◽  
Ahmet Emre Paksoy ◽  
Simone Cerciello ◽  
Matthieu Ollivier ◽  
Romain Seil ◽  
...  
Keyword(s):  
Clinical Outcomes ◽  
Surgical Repair ◽  
Gluteus Medius ◽  
Arthroscopic Repair ◽  
Harris Hip Score ◽  
Level Of Evidence ◽  
Outcome Score ◽  
Significant Difference ◽  
Hip Abductor ◽  
Tendon Tears

Background: Endoscopic surgical repair has become a common procedure for treating patients with hip abductor tendon tears. Considering that retear rates are high after the repair of gluteus medius and minimus tendons, exploring alternative strategies to enhance structural healing is important. Purpose/Hypothesis: The purpose of this study was to evaluate the effect of adding microfracture to single-row repair (SR) on outcomes after the surgical repair of gluteus medius and minimus tendons and compare with SR and double-row repair (DR) without microfracture. We hypothesized that microfracture of the trochanteric footprint with SR would lead to superior clinical outcomes and lower clinically evident retear rates compared with SR and DR without the addition of microfracture. Study Design: Cohort study; Level of evidence, 3. Methods: A total of 50 patients who underwent primary arthroscopic repair of hip gluteus medius and minimus tendon tears were investigated. Patients were divided into 3 groups: DR, 16 patients; SR, 14 patients; and SR with microfracture (SRM), 20 patients. Patients were evaluated with a visual analog scale (VAS) for pain as well as the Hip Outcome Score–Activities of Daily Living (HOS-ADL), Hip Outcome Score–Sport Specific (HOS-SS), and modified Harris Hip Score (mHHS) both preoperatively and at a minimum 2-year follow-up (mean, 30 months). Results: Among the SR, SRM, and DR groups, the greatest decrease in VAS scores and increase in mHHS, HOS-ADL, and HOS-SS scores were seen in the SRM group, and all the differences were significant ( P < .001 to P = .006). The abductor tendon retear rates were 31.3%, 35.7%, and 15.0% in the DR, SR, and SRM groups, respectively. Retear rates were lower in the SRM group compared with the SR and DR groups ( P = .042); however, there was no significant difference between the SR and DR groups ( P = .32) in terms of retear rates. Conclusion: Endoscopic SR with microfracture was a safe, practical, and effective technique and had the potential advantage of enhancing biological healing at the footprint. The addition of microfracturing the trochanteric footprint significantly lowered the retear rate and provided better functional outcomes than SR and DR without microfracture.

Comparing Midterm Outcomes of High-Level Athletes Versus Nonathletes Undergoing Primary Hip Arthroscopy: A Propensity-Matched Comparison With Minimum 5-Year Follow-up

2021 ◽  
pp. 036354652110417
Author(s):  
Andrew E. Jimenez ◽  
Peter F. Monahan ◽  
David R. Maldonado ◽  
Benjamin R. Saks ◽  
Hari K. Ankem ◽  
...  
Keyword(s):  
Hip Arthroscopy ◽  
Statistical Significance ◽  
Arthroscopic Surgery ◽  
Harris Hip Score ◽  
Control Group ◽  
Level Of Evidence ◽  
Femoroacetabular Impingement Syndrome ◽  
Patient Reported ◽  
High Level

Background: High-level athletes (HLAs) have been shown to have better short-term outcomes than nonathletes (NAs) after hip arthroscopy. Purpose: (1) To report midterm outcomes of HLAs after primary hip arthroscopy and (2) to compare their results with a propensity-matched cohort of NA patients. Study Design: Cohort study; Level of evidence, 3. Methods: Data were prospectively collected and retrospectively reviewed between February 2008 and November 2015 for HLAs (professional, college, or high school) who underwent primary hip arthroscopy in the setting of femoroacetabular impingement syndrome (FAIS). HLAs were included if they had preoperative, minimum 2-year, and minimum 5-year follow-up data for the modified Harris Hip Score (mHHS), Non-Arthritic Hip Score (NAHS), and Hip Outcome Score Sports-Specific Subscale (HOS-SSS). Radiographic and intraoperative findings, surgical procedures, patient-reported outcomes (PROs), patient acceptable symptomatic state (PASS), minimal clinically important difference (MCID), and return to sport were reported. The HLA study group was propensity-matched to a control group of NA patients for comparison. Results: A total 65 HLA patients (67 hips) were included in the final analysis with mean follow-up time of 74.6 ± 16.7 months. HLAs showed significant improvement in all PROs recorded, achieved high rates of MCID and PASS for mHHS (74.6% and 79.4%, respectively) and HOS-SSS (67.7% and 66.1%, respectively), and returned to sport at high rates (80.4%). When compared with the propensity-matched NA control group, HLAs reported higher baseline but comparable postoperative scores for the mHHS and NAHS. HLA patients achieved MCID and PASS for mHHS at similar rates as NA patients, but the HLA patients achieved PASS for HOS-SSS at higher rates that trended toward statistical significance (66.1% vs 48.4%; P = .07). NA patients underwent revision arthroscopic surgery at similar rates as HLA patients (14.9% vs 9.0%, respectively; P = .424). Conclusion: Primary hip arthroscopy results in favorable midterm outcomes in HLAs. When compared with a propensity-matched NA control group, HLAs demonstrated a tendency toward higher rates of achieving PASS for HOS-SSS but similar arthroscopic revision rates at minimum 5-year follow-up.

scholarly journals Clinically Significant Outcome Improvement After Hip Arthroscopy in Patients With Femoroacetabular Impingement Syndrome and Severe Femoral Torsion

2021 ◽  
Vol 9 (10) ◽  
pp. 232596712110345
Author(s):  
Steven F. DeFroda ◽  
Thomas D. Alter ◽  
Blake M. Bodendorfer ◽  
Alexander C. Newhouse ◽  
Felipe S. Bessa ◽  
...  
Keyword(s):  
Femoroacetabular Impingement ◽  
Hip Arthroscopy ◽  
Impingement Syndrome ◽  
Harris Hip Score ◽  
Femoral Torsion ◽  
Outcome Score ◽  
Femoroacetabular Impingement Syndrome ◽  
Patient Reported ◽  
Outcome Improvement ◽  
Clinically Significant

Background: The influence of femoral torsion on clinically significant outcome improvement after hip arthroscopy for femoroacetabular impingement syndrome (FAIS) has not been well-studied. Purpose: To quantify femoral torsion in FAIS patients using magnetic resonance imaging (MRI) and explore the relationship between femoral torsion and clinically significant outcome improvement after hip arthroscopy. Study Design: Cohort study; Level of evidence, 3. Methods: Included were patients who underwent hip arthroscopy for FAIS between January 2012 and August 2018 and had 2-year follow-up and preoperative MRI scans containing transcondylar slices of the knee. Participants were categorized as having severe retrotorsion (SR; <0°), normal torsion (NT; 0°-25°), and severe antetorsion (SA; >25°) as measured on MRI. Patient-reported outcomes (PROs) included the Hip Outcome Score–Activities of Daily Living, Hip Outcome Score–Sports Subscale, modified Harris Hip Score, 12-item International Hip Outcome Tool (iHOT-12), and visual analog scale (VAS) for pain and satisfaction. Achievement of Patient Acceptable Symptom State (PASS) and substantial clinical benefit (SCB) were analyzed among cohorts. Results: Included were 183 patients (SR, n = 13; NT, n = 154; SA, n = 16) with a mean age, body mass index, and femoral torsion of 30.6 ± 12.1 years, 24.0 ± 4.4 kg/m2, and 12.55° ± 9.58°, respectively. The mean torsion was –4.5° ± 2.6° for the SR, 12.1° ± 6.8° for the NT, and 31.0° ± 3.6° for the SA group. There were between-group differences in the proportion of patients who achieved PASS and SCB on the iHOT-12, pain VAS, and any PRO ( P < .05). Post hoc analysis indicated that the SA group achieved lower rates of PASS and SCB on the iHOT-12 and pain VAS, and lower rates of PASS on any PRO versus the SR group ( P < .05); the SR group achieved higher rates of PASS and SCB on pain VAS scores versus the NT group ( P = .003). Conclusion: The orientation and severity of femoral torsion during hip arthroscopy influenced the propensity for clinically significant outcome improvement. Specifically, patients with femoral retrotorsion and femoral antetorsion had higher and lower rates of clinically significant outcome improvement, respectively.

Predictors of Clinical Outcomes After Hip Arthroscopy: A Prospective Analysis of 1038 Patients With 2-Year Follow-up

2018 ◽  
Vol 46 (6) ◽  
pp. 1324-1330 ◽  
Author(s):  
Benjamin G. Domb ◽  
Timothy J. Martin ◽  
Chengcheng Gui ◽  
Sivashankar Chandrasekaran ◽  
Carlos Suarez-Ahedo ◽  
...  
Keyword(s):  
Clinical Outcomes ◽  
Predictive Factors ◽  
Hip Arthroscopy ◽  
Multivariate Analyses ◽  
Harris Hip Score ◽  
Duration Of Symptoms ◽  
Outcome Instrument ◽  
Outcome Score ◽  
Patient Reported

Background: As hip arthroscopy has expanded in popularity and volume, more information is needed about indications for the procedure and the predictive factors of clinical outcomes. Purpose: To evaluate clinical outcomes of hip arthroscopy in a prospective study and to analyze the cohort to identify factors that are predictive of improvement. Study Design: Case-control study; Level of evidence, 3. Methods: Data were collected prospectively on all patients undergoing hip arthroscopy between February 2008 and June 2012. We included all patients undergoing hip arthroscopy who agreed to participate and who completed 4 patient-reported outcome (PRO) instruments at a minimum 2-year follow-up: the modified Harris Hip Score (mHHS), Nonarthritic Hip Score (NAHS), Hip Outcome Score–Activities of Daily Living (HOS-ADL), and Hip Outcome Score–Sport-Specific Subscale. The NAHS was selected as our primary outcome instrument. All patients with any previous hip conditions were excluded. We analyzed 34 preoperative and intraoperative variables using bivariate and multivariate analyses compared with NAHS. Results: The cohort consisted of 1038 patients with a mean follow-up of 30.1 months (range, 24.0-61.2 months). Mean age was 36.4 years (range, 13.2-76.4 years). All postoperative PRO scores showed significant improvement ( P < .001) at 2 years compared with preoperative scores. Bivariate analysis identified 15 variables (7 categorical and 8 continuous) and multivariate analysis identified 10 variables that were predictive of 2-year postoperative NAHS. Preoperative NAHS, preoperative HOS-ADL, preoperative mHHS, age, duration of symptoms, body mass index (BMI), and revision hip arthroscopy were identified as predictive factors in both bivariate and multivariate analyses. The predictive value of preoperative NAHS was accentuated for patients with higher BMI. Conclusion: This study reports favorable clinical outcomes in the largest cohort of hip arthroscopies with a minimum 2-year follow-up in the literature to date. Factors identified as predictive in both bivariate and multivariate analyses included preoperative NAHS, HOS-ADL, and mHHS; age; duration of symptoms; BMI; and revision hip arthroscopy. These predictive factors may be useful to the clinician in determining prognosis and operative indications for hip arthroscopy.

scholarly journals Preoperative Symptom Duration Is Associated With Outcomes After Hip Arthroscopy

2018 ◽  
Vol 47 (1) ◽  
pp. 131-137 ◽  
Author(s):  
Bryce A. Basques ◽  
Brian R. Waterman ◽  
Gift Ukwuani ◽  
Edward C. Beck ◽  
William H. Neal ◽  
...  
Keyword(s):  
Cohort Study ◽  
Hip Arthroscopy ◽  
Patient Reported Outcomes ◽  
Harris Hip Score ◽  
Duration Of Symptoms ◽  
Outcome Score ◽  
Femoroacetabular Impingement Syndrome ◽  
Patient Reported ◽  
Outcome Scores

Background: Prolonged disease chronicity has been implicated as a cause of suboptimal clinical outcomes after hip arthroscopy for femoroacetabular impingement syndrome (FAIS), possibly due to disease progression, deconditioning, and the development of compensatory pathomechanics. Purpose: To evaluate the effect of increasing duration of preoperative symptoms on patient-reported outcomes, reoperation, and clinical failure of hip arthroscopy for FAIS. Study Design: Cohort study; Level of evidence, 3. Methods: A retrospective cohort study was performed to identify all patients undergoing primary hip arthroscopy between January 1, 2012, and July 30, 2014, by a single surgeon, with minimum follow-up of 2 years. Patient demographics, comorbid medical conditions, and preoperative outcome scores were compared between patients with preoperative symptoms lasting less than 2 years and those with symptoms lasting 2 years or longer. Multivariate regressions were used to compare Hip Outcome Score Activities of Daily Living (HOS-ADL), Hip Outcome Score Sport-Specific (HOS-SS), and modified Harris Hip Score (mHHS) between the 2 cohorts at 2 years of follow-up. Results: A total of 624 patients were included, with an average age of 34.0 ± 13.5 years; 235 (37.7%) patients had experienced preoperative symptoms 2 years or longer. Patients with symptoms lasting less than 2 years had statistically significant higher outcome scores than those with symptoms lasting 2 or more years for the HOS-ADL (86.3 ± 16.4 vs 80.3 ± 19.9, respectively), HOS-SS (75.0 ± 25.3 vs 65.1 ± 29.0), and mHHS (79.1 ± 16.6 vs 74.0 ± 18.8), as well as higher satisfaction (82.1 ± 30.7 vs 71.1 ± 31.6) and lower pain scores (2.6 ± 2.3 vs 3.5 ± 2.6). On multivariate analysis, patients with symptoms 2 years or longer had significantly higher visual analog scale–Pain score (β = 0.6, P = .039) and lower HOS-ADL (β = −3.4, P = .033), HOS-SS (β = −6.3, P = .012), and satisfaction (β = −6.7, P = .028) at 2-year follow-up. Patients with longer duration of symptoms also demonstrated less improvement in HOS-SS (β = −10.3, P = .001) at 2 years after surgery. Patients with symptoms for 2 years or longer were significantly less likely to achieve a patient acceptable symptomatic state for HOS-ADL (relative risk [RR] = 0.8, P = .024) and HOS-SS (RR = 0.8, P = .032) at 2 years of follow-up. Patients with symptoms 2 years or longer also demonstrated significantly higher rates of revision arthroscopy (RR = 10.1, P = .046). Conclusion: Patients with untreated, FAIS-related symptoms lasting 2 years or longer before arthroscopic management had significantly worse patient-reported outcomes and higher rates of reoperation at 2 years after surgery when compared with those patients with a shorter duration of preoperative symptoms.

Multicenter Outcomes After Revision Hip Arthroscopy: Comparative Analysis of 2-Year Outcomes After Labral Repair Versus Labral Reconstruction

2021 ◽  
pp. 036354652110305
Author(s):  
Blake M. Bodendorfer ◽  
Thomas D. Alter ◽  
Andrew B. Wolff ◽  
Dominic S. Carreira ◽  
John J. Cristoforetti ◽  
...  
Keyword(s):  
Hip Arthroscopy ◽  
A Priori ◽  
Cartilage Damage ◽  
Labral Repair ◽  
Harris Hip Score ◽  
Level Of Evidence ◽  
Outcome Score ◽  
Center Edge ◽  
Labral Tears ◽  
Patient Reported

Background: There is a paucity of literature evaluating patient outcomes in patients undergoing revision labral repair and labral reconstruction. Purpose: To compare outcomes in patients undergoing revision hip arthroscopy for treatment of labral tears by labral repair or labral reconstruction. Study Design: Cohort study; Level of evidence, 3. Methods: A retrospective review of a prospectively maintained multicenter database of patients undergoing hip arthroscopy was performed. An a priori power analysis determined that a total of 62 patients were required. Patients undergoing revision hip arthroscopy for labral tears with completed 2-year outcome scores were included. Patients undergoing primary hip arthroscopy, labral debridement, concomitant gluteal repair, and patients with hip dysplasia (lateral center-edge angle <20°) were excluded. Patients were grouped into revision labral repair and labral reconstruction groups. Patient demographics and patient-reported outcomes (PROs) including Hip Outcome Score – Activities of Daily Living, Hip Outcome Score – Sport Subscale, modified Harris Hip Score, international Hip Outcome Tool-12, visual analog scale for pain and satisfaction, and achievement of minimal clinically important difference (MCID) and Patient Acceptable Symptom State (PASS) were analyzed. Results: A total of 40 patients underwent revision labral repair and 55 patients underwent labral reconstruction. Patients undergoing revision labral repair were younger (mean age, 30.0 ± 10.7 years vs 34.4 ± 9.7 years; P = .048), had lower rates of labral degeneration (25.0% vs 62.7%; P = .004), and had lower rates of severe complexity of tears (21.1% vs 66.0%; P = .003). However, the labral repair group had higher rates of articular cartilage damage (62.5% vs 33.3%; P = .009). There were no differences in any preoperative or 2-year postoperative PROs. Furthermore, no differences were seen in achievement of MCID or PASS in any PRO. Conclusion: In this multicenter study on revision hip arthroscopy, patients undergoing revision labral repair were younger and had better labral characteristics but greater cartilage damage compared with patients undergoing labral reconstructions. Despite these differences, patients who underwent labral repair reported similar outcomes to those undergoing labral reconstruction.

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.

Repaired or unrepaired capsulotomy after hip arthroscopy: a systematic review and meta-analysis of comparative studies

2019 ◽  
Vol 30 (3) ◽  
pp. 256-266 ◽  
Author(s):  
Yipeng Lin ◽  
Tao Li ◽  
Xinghao Deng ◽  
Xihao Huang ◽  
KaiBo Zhang ◽  
...  
Keyword(s):  
Systematic Review ◽  
Clinical Outcomes ◽  
Narrative Analysis ◽  
Comparative Studies ◽  
Hip Arthroscopy ◽  
Meta Analysis ◽  
Surgical Techniques ◽  
Harris Hip Score ◽  
Outcome Score ◽  
Published Evidence

Purpose: To conduct a systematic review and meta-analysis comparing the surgical techniques, clinical outcomes, rates of revision and conversion to arthroplasty and complications between a repaired and unrepaired capsulotomy after hip arthroscopy. Methods: A search of the PubMed, Embase and Google Scholar databases was performed to identify comparative articles published prior to 10 July 2019 that reported the capsule management strategy and clinical outcomes after hip arthroscopy. A narrative analysis and meta-analysis were performed to integrate and compare the results of the 2 groups. Results: 12 comparative studies ( n = 1185 hips) with an average (methodological index for non-randomized studies) MINORS score of 17.45 ± 2.02 were identified for analysis, of which 5 were included in the meta-analysis. The pre- to postoperative improvements in the modified Harris Hip Score (mHHS), Hip Outcome Score–Sport-Specific Subscale (HOS-SS), and Hip Outcome Score–Activities of Daily Living (HOS-ADL) revealed no significant differences between the repaired and unrepaired groups ( p = 0.40, 0.26 and 0.61, respectively). The risk ratio of the revision rate for the 2 groups was 0.66 ( p = 0.21). Evaluation of the MRI scans and the rate of heterotopic ossification also showed no significant differences. The most preferred capsulotomy techniques were interportal and T-shape. No postoperative hip instability was reported in any of the 12 studies. Conclusion: The currently published evidence is still not strong enough to confirm the superiority of repairing the capsule after hip arthroscopy; hence, routine repair of the capsule during surgery cannot be suggested.

scholarly journals Hip Arthroscopy for Femoroacetabular Impingement Syndrome Performed with Modern Surgical Techniques Provides High Survivorship and Durable Outcome

2019 ◽  
Vol 7 (7_suppl5) ◽  
pp. 2325967119S0031
Author(s):  
Shane Jay Nho ◽  
Gregory Louis Cvetanovich ◽  
Edward C. Beck ◽  
William H. Neal ◽  
Joshua David Harris ◽  
...  
Keyword(s):  
Back Pain ◽  
Hip Arthroscopy ◽  
Iliotibial Band ◽  
Symptom Duration ◽  
Clinical Failure ◽  
P Values ◽  
Femoroacetabular Impingement Syndrome ◽  
Spine Pathology ◽  
History Of ◽  
A Current

Objectives: To analyze predictors of clinical failure as defined by revision hip arthroscopy or conversion to total hip arthroplasty (THA) as well as predictors of inferior outcomes defined as the not reaching Minimally Clinical Important Difference (MCID) or Patient Acceptable Symptomatic State (PASS) for Hip Outcome Score-Activities of Daily Living Subscale (HOS-ADL). Methods: Prospective data on all patients who underwent primary hip arthroscopy with routine capsular closure for the treatment of femoroacetabular impingement syndrome (FAIS) by a single, fellowship-trained surgeon between January 2012 and November 2015 were collected and analyzed. Inclusion criteria consisted of clinical and radiographic diagnosis of symptomatic FAIS, failed conservative management, and undergoing hip arthroscopy to correct FAIS with a minimum of two-year follow-up. Exclusion criteria consisted of prior ipsilateral hip surgery and hip arthroscopy for an indication other than FAIS. Baseline demographic data and radiographic parameters were collected and patient-reported outcomes (PROs) were obtained at baseline and at a minimum of two-years postoperatively. Rates of clinical failure and inferior clinical outcomes were recorded at a minimum of two-years postoperatively then stepwise linear regression was used to identify patient-related and imaging-related factors as predictors of each, respectively. Results: Out of 1,161 eligible patients, 949 (81.7%) completed PROs at a minimum of two-years postoperatively. The average age was 32.8 ± 12.4 years with a mean BMI of 25.4 ± 10.7 kg/m2. The overall clinical failure rate was 2.2% (n=21) including eleven cases of revision hip arthroscopy and eleven cases of conversion to THA (one patient underwent revision then subsequent THA). The inferior clinical outcome group consisting of patients who failed to reach MCID for HOS-ADL included164 patients while those who failed to reach PASS for HOS-ADL included 353 patients. In the regression model, poor articular cartilage, hypertension, lateral rim impingement on physical exam, history of back pain/spine pathology, limp on presentation, decreased daily physical activity, greater preoperative alpha angle, weakness in abduction with knees extended, and prolonged symptom duration were predictive of clinical failure (all p-values<0.05). Predictors of failing to reach MCID for HOS-ADL included: prolonged symptom duration, history of back pain/spine pathology, Tonnis grade >1, being a current/former smoker, pain with ischial palpation, lateral rim impingement, snapping iliotibial band, and pain with resisted sit-up and over the greater trochanter. Predictors of failing to reach PASS for HOS-ADL included: prolonged symptom duration, decreased daily physical activity, workman’s compensation, history of anxiety and/or depression, snapping iliotibial band, limp on examination, and pain with palpation of the spine/sacroiliac joint (all p-values<0.05). Conclusion: The clinical failure rate of hip arthroscopy may be lower than previously reported. Reoperation is predicted by medical comorbidity, lack of preoperative athletic activity, and multiple positive physical exams. Inferior clinical outcomes are predicted by prolonged symptom duration, back pain, being a current/former smoker, a history of a psychiatric comorbidity, as well as numerous signs on physical examination.

Comparing Outcomes of Competitive Athletes Versus Nonathletes Undergoing Hip Arthroscopy for Treatment of Femoroacetabular Impingement Syndrome

2019 ◽  
Vol 48 (1) ◽  
pp. 159-166 ◽  
Author(s):  
Ian M. Clapp ◽  
Benedict U. Nwachukwu ◽  
Edward C. Beck ◽  
Kyleen Jan ◽  
Anirudh K. Gowd ◽  
...  
Keyword(s):  
Clinical Outcomes ◽  
Femoroacetabular Impingement ◽  
Clinical Benefit ◽  
Hip Arthroscopy ◽  
Impingement Syndrome ◽  
Outcome Score ◽  
Substantial Clinical Benefit ◽  
Femoroacetabular Impingement Syndrome ◽  
Competitive Athletes ◽  
Chi Square Analysis

Background: A growing number of studies have examined return to sport in competitive athletes after undergoing hip arthroscopy for femoroacetabular impingement syndrome (FAIS); however, few have evaluated the rate of achieving meaningful clinical outcomes in this group. Purpose: To determine if competitive athletes (professional, semiprofessional, or collegiate) have better 2-year patient-reported outcomes and achieve the minimal clinically important difference (MCID) and substantial clinical benefit at higher rates when compared with nonathletes undergoing hip arthroscopy for the treatment of FAIS. Study Design: Cohort study; Level of evidence, 3. Methods: The study was a retrospective analysis of all consecutive patients who identified as either a competitive athlete or a nonathlete and had undergone hip arthroscopy for FAIS by a single fellowship-trained surgeon between January 2012 and April 2017. Patients in the 2 groups were matched 1:2 by age, sex, and body mass index. Baseline and clinical outcomes, including the Hip Outcome Score–Activities of Daily Living, Hip Outcome Score–Sports Subscale (HOS-SS), modified Harris Hip Score, and international Hip Outcome Tool-12, were collected preoperatively and at 2 years postoperatively and compared between the groups. The MCID and substantial clinical benefit were calculated for each group separately and compared using chi-square analysis. Results: A total of 59 competitive athletes and 118 nonathletes were included in the final analysis. Most of the competitive athletes were soccer players (23.7%), followed by softball players (10.2%) and runners (10.2%). Postoperative score comparison between competitive athletes and nonathletes demonstrated a statistically significant difference in the HOS-SS (mean ± SD, 84.5 ± 19.0 vs 76.1 ± 23.8; P = .02). Meaningful outcome analysis demonstrated that competitive athletes had a higher rate of achieving the HOS-SS threshold for the MCID (97.4% vs 82.5%; P = .021). There was no other difference in frequency of achieving the threshold for any other meaningful clinical outcome between the groups. Conclusion: Hip arthroscopy for the treatment of FAIS in competitive athletes and nonathletes produced clinically meaningful outcomes in both patient groups. However, competitive athletes achieved the MCID on the HOS-SS at higher rates than nonathletes and had significantly higher scores at 2 years postoperatively on the HOS-SS.

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