Survivorship Rate and Clinical Outcomes 10 Years After Arthroscopic Correction of Symptomatic Femoroacetabular Impingement

Background: Femoroacetabular impingement (FAI) is a common mechanical hip condition, prevalent in both the athletic and the general population. Surgical intervention is an effective treatment option that improves both symptoms and function in short- to medium-term follow-up. Few studies within the literature have reported the longer-term success of arthroscopic surgery. Purpose: The aim of this study was to quantify the 10-year survivorship and clinical outcome for patients treated arthroscopically for symptomatic FAI. Study Design: Case series; Level of evidence, 4. Methods: Patients from our hip registry (n = 119) completed patient-reported outcome measures (PROMs) including the modified Harris Hip Score (mHHS), University of California Los Angeles (UCLA) activity scale, 36-Item Short Form Health Survey (SF-36), and Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) at a minimum of 10 years after arthroscopy (range, 10-12 years). Results were compared with baseline scores using the Wilcoxon signed rank test. The associations among several prognostic factors, which included age, sex, Tönnis grade, and labral treatment, and subsequent conversion to total hip replacement (THR) or repeat hip arthroscopy (RHA) were analyzed using the chi-square analysis. Relationships between range of motion and radiological findings with clinical outcome were also examined using Pearson correlation analysis. Minimal clinically important difference (MCID) was calculated using a distribution method (0.5 standard deviation of the change score), and substantial clinical benefit (SCB) was determined using an anchor method. Finally, receiver operating characteristic curves with subsequent Youden index were used to determine cutoffs for PROMs, which equated to a Patient Acceptable Symptom State (PASS). Results: A total of 8.4% of cases required conversion to THR, and 5.9% required RHA. Statistically significant improvements in mHHS, SF-36, and WOMAC scores, with high satisfaction (90%), were observed 10 years after surgery. No significant change was seen in activity level (UCLA score) despite patients being 10 years older. A high percentage of patients achieved MCID for mHHS (88%), SF-36 (84%), and WOMAC (60%). The majority of patients also achieved PASS (62% for mHHS, 85% for UCLA, 78% for SF-36, and 84% for WOMAC) and SCB (74% for mHHS, 58% for UCLA, 52% for SF-36, and 56% for WOMAC). Conclusion: Arthroscopic intervention is a safe and viable treatment option for patients with symptomatic FAI, and patients can expect long-term improvements and high satisfaction. Results indicated a high satisfaction (90%) and survivorship rate (91.6%), with excellent clinical outcome, 10 years after the initial procedure.

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Defining the Minimal Clinically Important Difference in Athletes Undergoing Arthroscopic Correction of Sports-Related Femoroacetabular Impingement: The Percentage of Possible Improvement

Orthopaedic Journal of Sports Medicine ◽

10.1177/2325967119894747 ◽

2020 ◽

Vol 8 (1) ◽

pp. 232596711989474 ◽

Cited By ~ 1

Author(s):

Patrick Carton ◽

David Filan

Keyword(s):

Femoroacetabular Impingement ◽

Minimal Clinically Important Difference ◽

Harris Hip Score ◽

Baseline Score ◽

Clinically Important Difference ◽

Sf 36 ◽

Significant Difference ◽

Patient Reported ◽

Ceiling Effects ◽

The Impact

Background: Measures of clinically meaningful improvement in patient-reported outcomes within orthopaedics are becoming a minimum requirement to establish the success of an intervention. Purpose: To (1) define the minimal clinically important difference (MCID) at 2 years postoperatively in competitive athletes undergoing hip arthroscopic surgery for symptomatic, sports-related femoroacetabular impingement utilizing existing anchor- and distribution-based methods and (2) derive a measure of the MCID using the percentage of possible improvement (POPI) method and compare against existing techniques. Study Design: Cohort study (diagnosis); Level of evidence, 2. Methods: There were 2 objective outcome measures—the modified Harris Hip Score (mHHS) and 36-Item Short Form Health Survey (SF-36)—administered at baseline and 2 years postoperatively. External anchor questions were used to determine the MCID through mean change, mean difference, and receiver operating characteristic (ROC) techniques. Distribution-based calculations consisted of 0.5 SD, effect size, and standard error of measurement techniques. The POPI was calculated alongside each technique as an achieved percentage change of maximum available improvement for each athlete relative to the individual baseline score. The impact of the preoperative baseline score on the MCID was assessed by assigning athletes to groups determined by baseline percentiles. Statistical analysis was performed, with P < .05 considered significant. Results: There were 576 athletes (96% male; mean age, 25.9 ± 5.7 years). The MCID score change (and POPI) for the mHHS and SF-36 ranged from 2.4 to 16.7 (21.6%-63.6%) and from 3.3 to 24.9 (22.1%-57.4%), respectively. The preoperative threshold value for achieving the ROC-determined MCID was 80.5 and 86.5 for the mHHS and 70.1 and 72.4 for the SF-36 for the patient-reported outcome measure (PROM) score– and POPI-calculated MCID, respectively. Through the commonly used mean change method, 40.0% (mHHS) and 42.4% (SF-36) of athletes were unable to achieve the MCID because of high baseline scores and PROM ceiling effects compared with 0% when the POPI technique was used. A highly significant difference for the overall MCID was observed between preoperative baseline percentile groups for the mHHS ( P = .014) and SF-36 ( P = .004) (improvement in points), while there was no significant difference between groups for either the mHHS ( P = .487) or SF-36 ( P = .417) using the POPI technique. Conclusion: The MCID defined by an absolute value of improvement was unable to account for postoperative progress in a large proportion of higher functioning athletes. The POPI technique negated associated ceiling effects, was unrestricted by the baseline score, and may be more appropriate in quantifying clinically important improvement.

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

Journal of Hip Preservation Surgery ◽

10.1093/jhps/hnz025 ◽

2019 ◽

Vol 6 (3) ◽

pp. 199-206 ◽

Cited By ~ 4

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.

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Achievement of Meaningful Clinical Outcomes Is Unaffected by Capsulotomy Type During Arthroscopic Treatment of Femoroacetabular Impingement Syndrome: Results From the Multicenter Arthroscopic Study of the Hip (MASH) Study Group

The American Journal of Sports Medicine ◽

10.1177/0363546520987226 ◽

2021 ◽

Vol 49 (3) ◽

pp. 713-720

Author(s):

Kevin Parvaresh ◽

Jonathan P. Rasio ◽

RobRoy L. Martin ◽

Benjamin R. Kivlan ◽

Dominic Carreira ◽

...

Keyword(s):

Femoroacetabular Impingement ◽

Demographic Data ◽

Linear Regression Analysis ◽

Impingement Syndrome ◽

Labral Repair ◽

Harris Hip Score ◽

Multivariate Linear Regression Analysis ◽

Femoroacetabular Impingement Syndrome ◽

Patient Reported ◽

Chi Square Analysis

Background: Capsule management has emerged as an important topic in the field of hip arthroscopy. The 2 most popular techniques are interportal capsulotomy and T-type capsulotomy, but few studies have compared outcomes between these 2 techniques. Purpose: To compare 2-year (±2 months) patient-reported outcomes (PROs) between patients who underwent interportal versus T-type capsulotomy during arthroscopic labral repair for femoroacetabular impingement syndrome (FAIS). Study Design: Cohort study; Level of evidence, 3. Methods: A retrospective review of a large multicenter registry of patients undergoing arthroscopic hip preservation surgery for FAIS was performed. Data from 9 surgeons across 9 sites between January 2014 and February 2018 were included in the study. Baseline demographic data, preoperative PROs, and minimum 2-year postoperative PROs including Hip Outcome Score–Activities of Daily Living (HOS-ADL), HOS–Sports Subscale (HOS-SS), modified Harris Hip Score, and International Hip Outcome Tool–12 (iHOT-12) were recorded. Patients were divided into 2 groups based on whether interportal or T-type capsulotomy was performed according to the senior surgeon’s preference and training, and all capsulotomies were then routinely repaired. The 2 groups were matched 1:1 by age, sex, and body mass index (BMI). Achievement of minimal clinically important difference (MCID), Patient Acceptable Symptomatic State (PASS), and substantial clinical benefit (SCB) was compared for the HOS-ADL, HOS-SS, and iHOT-12 between the 2 groups. Results: The final analysis included 658 of 1483 eligible patients with a mean ± SD age of 32.6 ± 11.6 years and BMI of 24.0 ± 3.7; of these, 329 patients were treated via interportal capsulotomy, and 329 patients were treated via T-type capsulotomy. Female patients comprised 66.3% of the study population. Capsulotomy type was not a predictor of 2-year postoperative PROs on multivariate linear regression analysis when adjusted for covariates. Chi-square analysis showed no statistical difference in achievement of MCID, PASS, and SCB between the interportal and T-type groups for HOS-ADL (80.3%, 75.8%, 52.7% and 77.1%, 71.7%, 53.6%, respectively; P > .01 for all), HOS-SS (83.6%, 72.5%, 51.5% and 81.7%, 68.4%, 49.2%, respectively; P > .01 for all), and iHOT-12 (87.5%, 72.0%, 50.5% and 80.0%, 64.7%, 45.6%, respectively; P > .01 for all). Conclusion: Arthroscopic management of FAIS resulted in significant clinical improvement that was independent of capsulotomy type when the capsulotomy included repair.

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POS1455-HPR RELATIONSHIP BETWEEN PSYCHOLOGICAL FACTORS AND MEASURES OF RHEUMATOID ARTHRITIS ACTIVITY

Annals of the Rheumatic Diseases ◽

10.1136/annrheumdis-2021-eular.760 ◽

2021 ◽

Vol 80 (Suppl 1) ◽

pp. 1011.2-1011

Author(s):

Y. Olyunin ◽

V. Rybakova ◽

E. Likhacheva ◽

E. Nasonov

Keyword(s):

Quality Of Life ◽

Rheumatoid Arthritis ◽

Psychological Factors ◽

Global Assessment ◽

Activity Level ◽

Anxiety And Depression ◽

Tender Joint Count ◽

Sf 36 ◽

Patient Reported

Background:The patient-reported outcomes are important components of quantitative methods of rheumatoid arthritis (RA) activity assessment which are used to choose the appropriate drug therapy. The value of these parameters can be significantly affected not only by the inflammatory process, but also by the psychological characteristics of the patient and, in particular, by hardiness [1].Objectives:To study the relationship between psychological factors and signs of RA activity.Methods:Patients with RA who met the EULAR/ACR 2010 criteria, and observed at the V. A. Nasonova Research Institute of Rheumatology were included. Clinical examination was performed including patient global assessment (PGA), physician global assessment (PhGA), pain measurement on a visual analog scale, tender joint count (TJC), swollen joint count (SJC). The functional status was determined by HAQ, the quality of life – by SF-36 EQ-5D, the nature of pain – by painDETECT, the presence of anxiety and depression – by HADS. Patients also completed Hardiness Survey questionnaire to assess hardiness (HDS) and 3 components of the HDS – commitment (CMT), control (CT) and challenge (CLN). Disease activity was evaluated with DAS28, CDAI, and RAPID3. All patients signed informed consent to participate in the study. Analysis of the data was performed using Spearman’s rank test, Fisher exact test, qui-square and t-tests.Results:85 patients with RA were included. There were 69 women and 16 men. Mean age was 56.7±13.1 years, disease duration – 7.6±2.7 years. 72 patients were positive for rheumatoid factor, 75 – for anti-cyclic citrullinated peptide antibody. CDAI showed high activity in 15, moderate – in 37, low – in 30, and remission in 3 patients, DAS 28 – in 10, 55, 12, and 8, and RAPID3 – in 24, 25, 15, and 21, respectively. 24 patients had subclinically or clinically expressed anxiety and 15 –subclinically or clinically expressed depression (≥8 according to HADS). In 31 patients, the painDETECT questionnaire revealed possible or probable neuropathic pain. Mean HDS was 84.8±21.7, CMT – 38.9±9.2, CT – 29.4±8.6, CLN – 17.3±7.1. These values were comparable with the corresponding population data for this age group. There was a significant inverse correlation between HDS and RA activity measures, including SJC, TJC, DAS28 (p<0.05), pain, PGA, PhGA, CDAI, RAPID3, and HAQ (p<0.01). In addition, HDS and all its components positively correlated with quality of life, assessed by SF-36 and EQ-5D (p<0.01). In patients with subclinically and clinically expressed anxiety and depression, HDS, CMT, and CT were significantly lower than in patients without anxiety and depression (p<0.01), while the values of CLN in these groups did not differ significantly.Conclusion:The results of the present study suggest that low HDS may be one of the significant factors determining RA activity level because it does not allow patients to adapt adequately to a stressful situation produced by the disease.References:[1]Maddi SR. Am Psychol. 2008 Sep;63(6):563-4.Disclosure of Interests:None declared

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

Orthopaedic Journal of Sports Medicine ◽

10.1177/23259671211034588 ◽

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.

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

The American Journal of Sports Medicine ◽

10.1177/0363546519888894 ◽

2019 ◽

Vol 48 (1) ◽

pp. 188-196 ◽

Cited By ~ 1

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.

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Effect of Psychotropic Medications on Hammertoe Reconstruction Outcomes

Foot & Ankle Orthopaedics ◽

10.1177/2473011420944133 ◽

2020 ◽

Vol 5 (3) ◽

pp. 247301142094413

Author(s):

Samuel D. Maidman ◽

Amalie E. Nash ◽

Amanda Fantry ◽

Shay Tenenbaum ◽

Yahya Daoud ◽

...

Keyword(s):

Short Form ◽

Medication Use ◽

Psychotropic Medications ◽

Activity Level ◽

Mood Stabilizers ◽

Level Of Evidence ◽

Sf 36 ◽

Significant Difference ◽

Patient Reported ◽

Before And After

Background: Hammertoe deformities can seriously affect activity level and footwear. The use of prescription, mood-altering medications is very common, with some estimates as high as 25% of the population. Mood disorders, especially depression, negatively affect the results of medical and operative treatments. This study assessed the relationship of mood-altering medication use with the outcomes and complications of operative reconstruction of hammertoes. Methods: Data were prospectively collected from 116 patients who underwent hammertoe reconstruction, including demographic information, medical history, the use of mood-altering psychotropic medications (antidepressants, anxiolytics, hypnotics, and mood stabilizers), and postoperative complications. Preoperative patient-reported outcomes were measured using the visual analog scale (VAS) for pain and Short Form Health Survey (SF-36), which were repeated at 1-year follow-up. Results: A total of 36.2% of patients were taking psychotropic medications. Medication and nonmedication groups had similar pain VAS and SF-36 Physical Component Summary (PCS) scores before and after surgery. Compared with nonmedication patients, patients on psychotropic medications had significantly lower SF-36 Mental Component Summary (MCS) scores preoperatively ( P = .001) and postoperatively ( P = .006), but no significant difference in the change in MCS (ΔMCS) from preoperative to postoperative. Psychotropic medication use was associated with superficial wound infections ( P = .048), but not other complications. Conclusions: Patients taking psychotropic medications were equally likely to benefit from forefoot reconstruction as nonmedication patients. Preoperative and postoperative PCS and VAS were not significantly different between medication and nonmedication groups. Although the medication group had lower absolute MCS, they reported the same magnitude of improvement in MCS (ΔMCS) as the nonmedication group. Level of Evidence: Level II, prospective cohort study.

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Fast Starters and Slow Starters After Hip Arthroscopy for Femoroacetabular Impingement: Correlation of Early Postoperative Pain and 2-Year Outcomes

The American Journal of Sports Medicine ◽

10.1177/0363546520952406 ◽

2020 ◽

Vol 48 (12) ◽

pp. 2903-2909

Author(s):

Thu Quynh Nguyen ◽

James M. Friedman ◽

Sergio E. Flores ◽

Alan L. Zhang

Keyword(s):

Postoperative Pain ◽

Femoroacetabular Impingement ◽

Hip Arthroscopy ◽

Harris Hip Score ◽

Physical Component Score ◽

Pain Level ◽

Component Score ◽

Pain Scores ◽

Patient Reported ◽

The Relationship

Background: Patients experience varying degrees of pain and symptoms during the early recovery period after hip arthroscopy for femoroacetabular impingement (FAI). Some “fast starters” report minimal discomfort and are eager to advance activities, while “slow starters” describe severe pain and limitations. The relationship between these early postoperative symptoms and 2-year outcomes after hip arthroscopy is unknown. Purpose: To analyze the relationship between early postoperative pain and 2-year patient-reported outcomes (PROs) after hip arthroscopy for FAI. Study Design: Cohort study; Level of evidence, 2. Methods: Patients without arthritis or dysplasia who were undergoing primary hip arthroscopy for FAI were prospectively enrolled and completed validated PROs. Scores for visual analog scale (VAS) for pain were collected preoperatively and at 1 week, 6 weeks, and 2 years postoperatively. Scores for the modified Harris Hip Score (mHHS), Hip disability and Osteoarthritis Outcome Score (HOOS), and 12-Item Short Form Health Survey (SF-12) were collected preoperatively and 2 years postoperatively. Paired t tests were used to evaluate PRO score changes, and correlation analyses were used to assess relationships between early postoperative pain and 2-year postoperative outcomes. Results: A total of 166 patients were included (55% female; mean ± SD age, 35.29 ± 9.6 years; mean body mass index, 25.07 ± 3.98 kg/m2). Patients demonstrated significant improvements in PRO scores (VAS, SF-12 Physical Component Score, mHHS, and all HOOS subscales) at 2 years after hip arthroscopy for FAI ( P < .001). There was a significant correlation between lower 1-week VAS pain level (fast starters) and lower 2-year VAS pain level ( R = 0.31; P < .001) as well as higher 2-year PRO scores (SF-12 Physical Component Score, mHHS, and all HOOS subscales: R = −0.21 to −0.3; P < .001). There was no correlation between 1-week VAS pain and 2-year SF-12 Mental Component Score ( P = .17). Preoperative VAS pain levels showed positive correlations with 1-week postoperative pain scores ( R = 0.39; P < .001) and negative correlations with 2-year patient outcomes ( R = −0.15 to −0.33, P < .01). There was no correlation between 6-week postoperative pain scores and 2-year PRO scores. Conclusion: Fast starters after hip arthroscopy for FAI experience sustained improvements in outcomes at 2 years after surgery. Patient pain levels before surgery may delineate potential fast starters and slow starters.

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Clinical Outcomes of ProChondrix® Osteochondral Allograft in the Knee: A Case Series

10.21203/rs.3.rs-625313/v1 ◽

2021 ◽

Author(s):

Michael S. Barnum ◽

Evan D. Boyd ◽

Annabelle P. Davey ◽

Andrew Slauterbeck ◽

James R. Slauterbeck

Keyword(s):

Clinical Outcome ◽

Clinical Outcomes ◽

Cartilage Defect ◽

Femoral Condyle ◽

Case Series ◽

Activity Level ◽

Osteochondral Allograft ◽

Cartilage Restoration ◽

Patient Reported

Abstract PurposeFocal articular cartilage injuries are common and may lead to progression of osteoarthritis. The complications associated with traditional treatment strategies have influenced the development of new biotechnologies, such as the ProChondrix® osteochondral allograft. Clinical evidence on the outcomes associated with ProChondrix® osteochondral allografts are limited. Thus, the primary purpose of this study was to evaluate the clinical outcomes following treatment of an isolated cartilage defect with a ProChondrix® osteochondral allograft implant.MethodsRetrospective analysis of patients who underwent a cartilage restoration procedure using ProChondrix® osteochondral allograft has been performed. Patients completed patient-reported outcome surveys which included the Knee injury and Osteoarthritis Outcome Score (KOOS), consisting of the 5 subscales of Pain, Symptoms, Activities of Daily Living, Sports and Recreation, and Quality of Life, the Marx Activity Scale, and the visual analog pain scale.ResultsSix patients underwent a cartilage restoration procedure using ProChondrix® between January 2016 and December 2019. Three males and three females were included with a median age of 33.5 years (range 18–48 years). The median follow-up duration was 15 months (range 9–24 months). There were 4 patellar grafts, 1 medial femoral condyle graft, and 1 lateral femoral condyle graft, with a median defect size of 18.5mm (range 13-20mm). At the most recent clinical follow-up, all six patients were pain free and all patients had returned to pre-op activity level.ConclusionTo our knowledge, this is the first study to report the clinical outcome, activity level, and patient orientated outcomes in a case series of patients following treatment of an isolated cartilage defect with a ProChondrix® osteochondral allograft implant. Our study demonstrates promising short-term results in patient reported clinical outcome scores.

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

Journal of Hip Preservation Surgery ◽

10.1093/jhps/hnaa013 ◽

2020 ◽

Vol 7 (2) ◽

pp. 225-232

Author(s):

Claire E Fernandez ◽

Allison M Morgan ◽

Ujash Sheth ◽

Vehniah K Tjong ◽

Michael A Terry

Keyword(s):

Systematic Review ◽

Femoroacetabular Impingement ◽

Hip Arthroscopy ◽

Case Reports ◽

Case Series ◽

Return To Sport ◽

Harris Hip Score ◽

Study Patient ◽

Significant Difference ◽

Patient Reported

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

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