Age-Associated Pathology and Functional Outcomes After Hip Arthroscopy in Female Patients: Analysis With 2-Year Follow-up

2020 ◽  
Vol 48 (13) ◽  
pp. 3265-3271
Author(s):  
David A. Bloom ◽  
Jordan W. Fried ◽  
Andrew S. Bi ◽  
Daniel J. Kaplan ◽  
Nainisha Chintalapudi ◽  
...  
Keyword(s):  
Analysis Of Variance ◽  
Femoroacetabular Impingement ◽  
Hip Arthroscopy ◽  
Functional Outcomes ◽  
Statistical Significance ◽  
Female Patients ◽  
Significant Difference ◽  
Patient Reported ◽  
Outcome Scores

Background: Previous research has demonstrated a statistically significant relationship between hip arthroscopy outcomes and age. Purpose: To investigate the link, if any, between hip arthroscopy outcomes and intraoperative pathology as well as with patient age and sex. Study Design: Cohort study; Level of evidence, 3. Methods: Of 272 female patients aged ≥14 years undergoing primary hip arthroscopy for femoroacetabular impingement between August 2010 and September 2017, and with 2-year patient-reported outcome scores, a total of 194 (71.3%) were included for final analysis. These patients were separated into 3 age-based cohorts: <30 years (n = 44), 30 to 45 years (n = 74), and >45 years (n = 76). Their data were then analyzed and compared with respect to patient characteristic information, intraoperative pathology, and functional outcome scores for statistical significance, which was set at P < .05. Results: When an analysis of variance was conducted for the 3 age groups at 2-year follow-up, there was a statistically significant difference for modified Hip Harris Score ( P = .0003; <30 years, 88.26 ± 13.1 [mean ± SD]; 30-45 years, 82.68 ± 18.0; >45 years, 75.03 ± 19.5). The results of an analysis of variance comparing 2-year Non-arthritic Hip Score were also statistically significant ( P = .0002; <30 years, 89.9 ± 13.7; 30-45 years, 85.8 ± 15.8; >45 years, 78.1 ± 17.2). Results of logistic regression demonstrated that the odds of a cam-type lesion decreased by 0.971 for every additional year in age among female patients. The odds of achieving the patient-acceptable symptomatic state decreased by a factor of 0.96 for each additional year in age ( P < .0004). Conclusion: Surgical treatment of femoroacetabular impingement in females led to improved functional outcomes at 2 years of follow-up, although older female patients did worse after hip arthroscopy as compared with their younger counterparts. There may be an age-dependent decrease in incidence of cam-type lesions in female patients.

scholarly journals Does capsular closure influence patient-reported outcomes in hip arthroscopy for femoroacetabular impingement and labral tear?

2019 ◽  
Vol 6 (3) ◽  
pp. 199-206 ◽  
Author(s):  
Ran Atzmon ◽  
Zachary T Sharfman ◽  
Barak Haviv ◽  
Michal Frankl ◽  
Gilad Rotem ◽  
...  
Keyword(s):  
Clinical Outcome ◽  
Femoroacetabular Impingement ◽  
Hip Arthroscopy ◽  
Demographic Data ◽  
Labral Tear ◽  
Harris Hip Score ◽  
Patient Reported ◽  
Outcome Scores ◽  
The Mean

Abstract Capsulotomy is necessary to facilitate instrument manoeuvrability within the joint capsule in many arthroscopic hip surgical procedures. In cases where a clear indication for capsular closure does not exist, surgeon’s preference and experience often determines capsular management. The purpose of this study was to assess the influence of capsular closure on clinical outcome scores and satisfaction in patients who underwent hip arthroscopy surgery for femoroacetabular impingement (FAI) and labral tear. Data were prospectively collected and retrospectively analysed for hip arthroscopy surgeries with a minimum 2 years follow-up. Patients with developmental dysplasia of the hip, previous back or hip surgeries, and degenerative changes to this hip and secondary gains were excluded. Demographic data, intraoperative findings and patient-reported outcome scores were recorded, including the Modified Harris Hip Score (MHHS) and Hip Outcome Score (HOS). A total of 29 and 35 patients were included in the non-closure and closure groups, respectively. The mean follow-up time was over 3 years for both groups. The mean pre-operative and post-operative HOS scores and MHHS scores did not significantly differ between groups (pre-operative HOS: 65.6 and 66.3, P = 0.898; post-operative HOS: 85.4 and 87.2, P = 0.718; pre-operative MHHS: 63.2 and 58.4, P = 0.223; post-operative MHHS: 85.7 and 88.7, P = 0.510). Overall patient satisfaction did not differ significantly between groups (non-closure 86.3%, closure group 88.6%; P = 0.672). Capsular closure did not significantly influence satisfaction or clinical outcome scores in patients who underwent arthroscopic hip surgery for FAI or labral tear.

Does acetabular coverage influence the clinical outcome of arthroscopically treated cam-type femoroacetabular impingement (FAI)?

2018 ◽  
Vol 100-B (7) ◽  
pp. 831-838 ◽  
Author(s):  
M. M. Ibrahim ◽  
S. Poitras ◽  
A. C. Bunting ◽  
E. Sandoval ◽  
P. E. Beaulé
Keyword(s):  
Functional Outcome ◽  
Femoroacetabular Impingement ◽  
Alpha Angle ◽  
3D Analysis ◽  
Acetabular Coverage ◽  
Crossover Sign ◽  
Significant Difference ◽  
Patient Reported ◽  
Outcome Scores

Aims What represents clinically significant acetabular undercoverage in patients with symptomatic cam-type femoroacetabular impingement (FAI) remains controversial. The aim of this study was to examine the influence of the degree of acetabular coverage on the functional outcome of patients treated arthroscopically for cam-type FAI. Patients and Methods Between October 2005 and June 2016, 88 patients (97 hips) underwent arthroscopic cam resection and concomitant labral debridement and/or refixation. There were 57 male and 31 female patients with a mean age of 31.0 years (17.0 to 48.5) and a mean body mass index (BMI) of 25.4 kg/m2 (18.9 to 34.9). We used the Hip2Norm, an object-oriented-platform program, to perform 3D analysis of hip joint morphology using 2D anteroposterior pelvic radiographs. The lateral centre-edge angle, anterior coverage, posterior coverage, total femoral coverage, and alpha angle were measured for each hip. The presence or absence of crossover sign, posterior wall sign, and the value of acetabular retroversion index were identified automatically by Hip2Norm. Patient-reported outcome scores were collected preoperatively and at final follow-up with the Hip Disability and Osteoarthritis Outcome Score (HOOS). Results At a mean follow-up of 2.7 years (1 to 8, sd 1.6), all functional outcome scores significantly improved overall. Radiographically, only preoperative anterior coverage had a negative correlation with the improvement of the HOOS symptom subscale (r = -0.28, p = 0.005). No significant difference in relative change in HOOS subscale scores was found according to the presence or absence of radiographic signs of retroversion. Discussion Our study demonstrated the anterior coverage as an important modifier influencing the functional outcome of arthroscopically treated cam-type FAI. Cite this article: Bone Joint J 2018;100-B:831–8.

Capsular closure versus unrepaired interportal capsulotomy after hip arthroscopy in patients with femoroacetabular impingement, results of a patient-blinded randomised controlled trial

2021 ◽  
pp. 112070002110057
Author(s):  
Niels H Bech ◽  
Inger N Sierevelt ◽  
Sheryl de Waard ◽  
Boudijn S H Joling ◽  
Gino M M J Kerkhoffs ◽  
...  
Keyword(s):  
Randomised Controlled Trial ◽  
Femoroacetabular Impingement ◽  
Hip Arthroscopy ◽  
Controlled Trial ◽  
Poor Quality ◽  
Control Group ◽  
Treatment Groups ◽  
Significant Difference ◽  
Randomised Controlled

Background: Hip capsular management after hip arthroscopy remains a topic of debate. Most available current literature is of poor quality and are retrospective or cohort studies. As of today, no clear consensus exists on capsular management after hip arthroscopy. Purpose: To evaluate the effect of routine capsular closure versus unrepaired capsulotomy after interportal capsulotomy measured with NRS pain and the Copenhagen Hip and Groin Outcome Score (HAGOS). Materials and methods: All eligible patients with femoroacetabular impingement who opt for hip arthroscopy ( n = 116) were randomly assigned to one of both treatment groups and were operated by a single surgeon. Postoperative pain was measured with the NRS score weekly the first 12 weeks after surgery. The HAGOS questionnaire was measured at 12 and 52 weeks postoperatively. Results: Baseline characteristics and operation details were comparable between treatment groups. Regarding the NRS pain no significant difference was found between groups at any point the first 12 weeks after surgery ( p = 0.67). Both groups significantly improved after surgery ( p < 0.001). After 3 months follow-up there were no differences between groups for the HAGOS questionnaire except for the domain sport ( p = 0.02) in favour of the control group. After 12 months follow-up there were no differences between both treatment groups on all HAGOS domains ( p  > 0.05). Conclusions: The results of this randomised controlled trial show highest possible evidence that there is no reason for routinely capsular closure after interportal capsulotomy at the end of hip arthroscopy. Trial Registration: This trial was registered at the CCMO Dutch Trial Register: NL55669.048.15.

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 Acetabular Morphologic Characteristics Predict Early Conversion to Arthroplasty After Isolated Hip Arthroscopy for Femoroacetabular Impingement

2019 ◽  
Vol 48 (1) ◽  
pp. 188-196 ◽  
Author(s):  
Brian D. Giordano ◽  
Benjamin D. Kuhns ◽  
Itay Perets ◽  
Leslie Yuen ◽  
Benjamin G. Domb
Keyword(s):  
Femoroacetabular Impingement ◽  
Hip Arthroscopy ◽  
Odds Ratio ◽  
Preoperative Imaging ◽  
Harris Hip Score ◽  
Center Edge ◽  
Patient Reported ◽  
Outcome Scores ◽  
Outerbridge Grade ◽  
Tönnis Grade

Background: Hip arthroscopy in the setting of dysplasia and borderline dysplasia is controversial. Dysplasia severity is most often defined by the lateral center edge angle (LCEA) but can also be evaluated radiographically by the acetabular inclination (AI). Purpose/Hypothesis: The purpose was to determine the effect of AI on outcomes after isolated hip arthroscopy for femoroacetabular impingement (FAI). We hypothesized that patients with dysplasia would have higher rates of arthroplasty as well as inferior clinical and functional outcomes compared with patients who did not have dysplasia. Study Design: Cohort study; Level of evidence, 3. Methods: A hip arthroscopy registry was reviewed for participants undergoing arthroscopic correction of FAI from February 28, 2008, to June 10, 2013. Participants required a clinical diagnosis and isolated arthroscopic correction of FAI with preoperative imaging and intraoperative cartilage status recorded. AI dysplasia was defined as an AI greater than 10°, LCEA dysplasia as LCEA less than 18°, and borderline LCEA dysplasia as LCEA 18° to 25°. Patients without an acetabular deformity (LCEA 25°-40°; AI <10°) served as a control population. Postoperative variables included patient-reported outcome surveys with conversion to arthroplasty as the primary endpoint. Minimum 5-year outcome scores were obtained for 337 of 419 patients (80.4%) with an average follow-up of 75.2 ± 12.7 months. Results: This study included 419 patients: 9 (2%) with LCEA dysplasia, 42 (10%) with AI dysplasia, and 51 (12%) with borderline dysplasia. The AI but not LCEA was significantly correlated with lower outcome scores on the modified Harris Hip Score ( r = 0.13; P = .01), Non-Arthritic Hip Score ( r = 0.10; P = .04), and Hip Outcome Score–Sports Subscale ( r = 0.11; P = .04). A total of 58 patients (14%) underwent arthroplasty at 31 ± 20 months postoperatively. Patients with LCEA dysplasia had an arthroplasty rate of 56% (odds ratio, 8.4), whereas patients with AI dysplasia had an arthroplasty rate of 31% (odds ratio, 3.3), which was significantly greater than the rate for the nondysplastic cohort (13.5%; P < .0001). Patients with borderline LCEA dysplasia did not have increased rates of arthroplasty. A multivariate analysis found increasing age, increasing AI, Tönnis grade higher than 1, and femoral Outerbridge grade higher than 2 to be most predictive of conversion to arthroplasty. Conclusion: We found that an elevated AI, along with increasing age, Tönnis grade, and femoral Outerbridge grade significantly predict early conversion to arthroplasty after isolated hip arthroscopy. We recommend using the AI, in addition to the LCEA, in evaluating hip dysplasia before hip arthroscopy.

scholarly journals Short Term Radiographic and Patient Outcomes of a Novel Biplanar Plating System for Hallux Valgus Correction

2019 ◽  
Vol 4 (4) ◽  
pp. 2473011419S0029
Author(s):  
Kshitij Manchanda ◽  
Stephen Blake Wallace ◽  
Junho Ahn ◽  
George T. Liu ◽  
Michael D. Van Pelt ◽  
...  
Keyword(s):  
Hallux Valgus ◽  
Statistical Significance ◽  
Retrospective Chart Review ◽  
Complication Rates ◽  
Time Of Surgery ◽  
Radiographic Parameters ◽  
Valgus Angle ◽  
Patient Reported ◽  
Outcome Scores

Category: Bunion, Midfoot/Forefoot Introduction/Purpose: Hallux valgus is a complex deformity of the great toe and is a major cause of pain for patients. Despite the variety of techniques, traditional osteotomies often do not address rotational deformities. A novel biplanar plating system was used to perform correction of metatarsal rotation at our institution starting in 2017. The purpose of this study was to determine the correction of rotational deformity and of radiographic parameters, maintenance of this correction (versus recurrence of hallux valgus), complication rates and patient-reported objective survey scores. We sought to determine prognostic factors for successful correction, including age, gender, and time of surgery. Methods: By retrospective chart review, we identified all patients treated by the novel biplanar plating at our institution. We recorded patient demographics, pre-operative range of motion and maltracking, surgical details, operative complications, and any subsequent surgery. Imaging was reviewed at pre-operative and post-operative visits to approximate the hallux valgus angle (HVA), intermetatarsal angle (IMA), and tibial sesamoid position (TSP). Outcome scores (AOFAS, FAAM, SF12 PCS and MCS) pre- operatively and post-operatively at 3 months, 6 months and 12 months were also recorded. The changes in these radiographic parameters and scores were then computed and analyzed to determine if there was an improvement with surgery. Results: Fifty-seven procedures (in 55 patients) were performed and evaluated. There were 8 complications and average follow- up time was 27.1 weeks (+13.8 weeks). Older age was significantly associated with more complications (p = 0.018). Gender and time of surgery did not show any significant association with complications. Radiographic parameters including HVA, IMA, and TSP were analyzed. At 3 and 6 months post-operatively, these parameters were significantly reduced from pre-operative values. At 12 months, there was a trend towards significant reduction (p values of 0.06, 0.06, and 0.053 respectively); however, there were fewer patients who maintained follow-up during this period. The Outcome scores showed improvement post-operatively, but only the AOFAS score showed statistical significance at 3 and 6 months. Conclusion: Although statistical analysis was limited due to our population size and the retrospective nature of the study, there was an overall improvement in both radiographic parameters and clinical outcome scores. Older patients are also at higher risk of complications. Malrotation correction with this biplanar plating system is a novel technique and does require meticulous training. With continued expansion of our patient database and further longitudinal analysis, we hope to determine not only if correction is maintained over time, but also if the steepness of the learning curve affects the number of complications earlier versus later in each individual surgeon’s experience.

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.

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.

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.

scholarly journals Hip arthroscopy for femoroacetabular impingement (FAI) patients with self-reported allergies: do multiple allergies have an effect on outcome?

2019 ◽  
Author(s):  
Nicholas Ramos ◽  
Michael Gerhardt ◽  
Michael Banffy
Keyword(s):  
Femoroacetabular Impingement ◽  
Hip Arthroscopy ◽  
Platelet Rich Plasma ◽  
Labral Repair ◽  
Orthopedic Procedures ◽  
Bivariate Analysis ◽  
Symptom Duration ◽  
Patient Reported ◽  
Outcome Scores ◽  
Operative Outcome

Abstract Multiple self-reported allergies have been reported as a prognostic factor for outcome the following orthopedic procedures. This relationship has not yet been evaluated in a hip arthroscopy population. The purpose of this study is to identify associations between allergies and post-operative outcome scores in patients undergoing hip arthroscopy for femoroacetabular impingement (FAI). A retrospective review of surgically treated FAI patients at our institution was performed. Patient-reported allergies and 6-month and 1-year modified Harris Hip Scores (mHHS) were recorded. Bivariate analysis was performed evaluating association between allergies and post-operative mHHS. Multivariate regression was used to identify independent factors associated with post-operative mHHS while controlling for age, sex, BMI, psychiatric comorbidity, symptom duration, labral repair versus debridement, capsular management, chondral lesions and use of adjunct platelet rich plasma (PRP). Seventy patients were analysed. Average age was 30.7 years old (SD 8.96). A 52.9% were females. Twenty-six patients (37.1%) had reported allergies. At 6 months, bivariate analysis demonstrated no significant association between allergies and postop mHHS. This was true comparing patients with 0 versus 1 versus 2 versus 3 versus 5 allergies as separate groups (medians from 83.1 to 91.0, P = 0.60) as well as when combining patients with >2 allergies into one group (0 versus 1 versus 2–5 allergies) (medians 84.7, 83.1, 86.0, respectively, P = 0.328). At 1 year, this lack of association was more pronounced (0 versus 1 versus 2 versus 3 versus 5: medians from 87.0 to 93.5, P = 0.9265 and 0 versus 1 versus 2–5: medians 93.5, 91.7, 89.0, respectively, P = 0.6450). Linear regression demonstrated preop mHHS and age were significantly associated with 1-year mHHS (logit mHHS rate = 0.026 ± 0.008 per unit, P = 0.0014 for preop mHHS and logit mHHS rate=−0.061 ± 0.018 per year, P = 0.0010 for age). After controlling for age and preop mHHS, allergies were not associated with postop mHHS. Allergies demonstrated no association with post-operative outcome following surgical treatment of FAI.

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