The incidence and pattern of iliopsoas tendinitis following hip arthroscopy

Background: Iliopsoas tendinitis is a known source of extra-articular hip pain and it has been shown to be a common cause of continued hip pain following total hip arthroplasty. While iliopsoas tendinitis after hip arthroscopy is a well-known phenomenon amongst hip arthroscopists, its presentation, course, and treatment has yet to be elucidated. Methods: An IRB-approved chart review was performed of patients undergoing hip arthroscopy for femoroacetabular impingement (FAI) between March 2015 and July 2017. No cases of dysplasia were included. All patients had combined cam/pincer impingement as well as labral pathology. Tendinitis patients were identified. Patient demographics, surgical data, time to onset/diagnosis of iliopsoas tendinitis, treatment (oral anti-inflammatories, corticosteroid injection, physical therapy), and resolution of symptoms were recorded. These cases were age- and sex-matched to a control group that did not develop postoperative iliopsoas tendinitis for comparison. Patient outcomes were measured with the modified Harris Hip Score (mHHS) and Nonarthritic Hip Score (NAHS) recorded from the preoperative and 1-year postoperative visits. Results: Of 258 hip arthroscopy cases, 18 cases (7.0%) of postoperative iliopsoas tendinitis were diagnosed under high resolution ultrasound. On average, iliopsoas tendinitis was diagnosed 2.8 ± 1.8 months after surgery. There were no significant differences in age, sex, and BMI between patients that developed IP tendinitis compared to those that did not. No specific procedures were found to be significantly associated with incidence of postoperative IP tendinitis, including capsular closure. 18 patients were treated with corticosteroid injection, which provided mild to moderate improvement for 5 (27.8%) patients and completely resolved symptoms for 13 patients (72.2%). Of all 18 patients with postoperative iliopsoas tendinitis confirmed by response to a diagnostic injection, 10 (55.6%) had symptoms improve within 3 months of diagnosis, 2 (11.1%) between 3 and 6 months, 4 (22.2%) between 6 and 12 months, and 2 (11.1%) after 1 year. No patients went on to have surgery for this problem. Patients with iliopsoas tendinitis had lower MHHS ( p = 0.04) and NAHS ( p = 0.09) scores at their 1-year postoperative visits. Conclusions: Iliopsoas tendinitis is a common source of pain following arthroscopic hip surgery and can be effectively diagnosed and treated with ultrasound-guided injection. Therefore, surgeons performing arthroscopic procedures of the hip must remain aware of and include it in their differential when encountering patients with hip flexion pain after surgery. Research should be continued to further evaluate the long-term outcomes and return to sport rates of these patients.

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Revision Hip Arthroscopy in High-Level Athletes: Minimum 2-Year Outcomes Comparison to a Propensity-Matched Primary Hip Arthroscopy Control Group

The American Journal of Sports Medicine ◽

10.1177/03635465211041760 ◽

2021 ◽

pp. 036354652110417

Author(s):

Peter F. Monahan ◽

Andrew E. Jimenez ◽

Jade S. Owens ◽

Benjamin R. Saks ◽

David R. Maldonado ◽

...

Keyword(s):

Revision Surgery ◽

Hip Arthroscopy ◽

Matched Control ◽

Return To Sport ◽

Harris Hip Score ◽

Control Group ◽

Matched Control Group ◽

Functional Scores ◽

High Level

Background: Outcomes of revision hip arthroscopy in the athletic population have not been well established. Purpose: (1) To report clinical outcomes for high-level athletes undergoing revision hip arthroscopy in the setting of femoroacetabular impingement syndrome (FAIS) or labral tears and (2) to compare these outcomes against a propensity-matched group of high-level athletes undergoing primary hip arthroscopy. Study Design: Cohort study; Level of evidence, 3. Methods: Data for professional, college, and high school athletes were prospectively collected and retrospectively reviewed between January 2012 and October 2018. Patients were included if they underwent revision or primary hip arthroscopy and had preoperative and minimum 2-year patient-reported outcome (PRO) scores for modified Harris Hip Score (mHHS), Non-Arthritic Hip Score (NAHS), Hip Outcome Score Sports-Specific Subscale (HOS-SSS), and visual analog scale (VAS) for pain. The findings and outcomes of revision athletes were compared with a propensity-matched control group of high-level athletes undergoing primary hip arthroscopy. Results: A total of 32 hips (29 patients) undergoing revision hip arthroscopy and 92 hips (88 patients) undergoing primary hip arthroscopy were included in our final analysis with a median follow-up time of 29.5 months (95% CI, 27.2-32.1 months) and 36.5 months (95% CI, 33.5-37.7 months), respectively. Athletes undergoing revision surgery showed significant improvement in all recorded PRO measurements and achieved patient acceptable symptomatic state (PASS) and minimal clinically important difference (MCID) for mHHS at high rates (80.6% and 83.9%, respectively). When compared with a propensity-matched primary control group, patients undergoing revision surgery demonstrated lower preoperative and postoperative scores for mHHS, NAHS, and HOS-SSS, but the magnitude of improvement in functional scores was similar between groups. Athletes undergoing revision surgery achieved PASS for HOS-SSS at lower rates than the control group ( P = .005), and they were less likely to attempt to return to sport compared with the control group (62.5% vs 87.0%; P < .01). Conclusion: Revision hip arthroscopy is a viable treatment option to improve PROs in high-level athletes at minimum 2-year follow-up. The study group showed significant improvement in functional scores and a high rate of successful outcomes. They experienced similar magnitude of improvement as that of a propensity-matched control group; however, they achieved lower postoperative PRO scores and attempted to return to sport at lower rates.

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

The American Journal of Sports Medicine ◽

10.1177/03635465211041763 ◽

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.

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Return to Play After Hip Arthroscopy Among Tennis Players: Outcomes with Minimum Five-Year Follow-up

10.21203/rs.2.14819/v4 ◽

2020 ◽

Author(s):

David R. Maldonado ◽

Mitchell J. Yelton ◽

Philip J. Rosinsky ◽

Jacob Shapira ◽

Mitchell Meghpara ◽

...

Keyword(s):

Hip Arthroscopy ◽

Cartilage Damage ◽

Arthroscopic Surgery ◽

Return To Sport ◽

Return To Play ◽

Harris Hip Score ◽

Level Of Evidence ◽

Tennis Players ◽

Patient Reported

Abstract Background: Playing tennis is associated with various movements that can lead to labral injuries and may require arthroscopic surgery. While hip arthroscopies have demonstrated good outcomes in athletes, there is limited literature reporting Patient Reported Outcomes (PROs) and return to play in competitive or recreational tennis players after hip arthroscopic surgery. Therefore, the purpose of the present study was to (1) report minimum five-year PROs and return to sport in tennis players who underwent hip arthroscopic surgery and (2) compare outcomes between recreational and competitive tennis players.Methods: Data for patients who underwent hip arthroscopy surgery in the setting of femoroacetabular impingement (FAI) and labral tears between March 2009 and January 2014 and who played tennis at any level within one-year of surgery were retrospectively reviewed. Patients with preoperative and minimum five-year postoperative scores for the following PROs were included: modified Harris Hip Score (mHHS), Non-Arthritic Hip Score (NAHS), Hip Outcome Score-Sport Specific Subscale (HOS-SSS), and visual analog scale (VAS) for pain. Patients with preoperative Tönnis osteoarthritis Grade >1, Workers’ Compensation claims, age > 60 years old, or previous ipsilateral hip surgeries or conditions were excluded. Patient Acceptable Symptomatic State (PASS) and Minimal Clinically Important Difference (MCID) for mHHS and HOS-SSS were calculated. Results: Of 28 patients, 31 hips met all inclusion and exclusion criteria of which 28 (90.3%) had minimum 5-year follow-up (mean: 72.8 ± 13.9 months). There were 3 professional, 3 collegiate, 2 high school, 2 organized amateur, and 18 recreational level tennis players. All PROs significantly improved at latest follow-up: mHHS from 67.0 to 86.7 (P < 0.001), NAHS from 65.9 to 87.2 (P < 0.001), HOS-SSS from 50.0 to 77.9 (P = 0.009), and VAS from 5.4 to 1.8 (P < 0.001). There was a 75.0% return to sport rate. Additionally, 66.7% of patients achieved MCID and 83.3% achieved PASS for mHHS, and 63.6% achieved MCID and 58.3% achieved PASS for HOS-SSS.Conclusion: Regardless of the level of participation, tennis players who underwent hip arthroscopic surgery reported statistically significant PRO improvements. A favorable rate of return to sport was also achieved by players with a continued interest in playing. The severity of cartilage damage was shown to not influence rate of returned to sport nor PROs in this population. The data here may be useful in counseling tennis players of various levels who are considering arthroscopic treatment of a hip injury. Level of Evidence: IV

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Performance and return to sport after hip arthroscopy for femoracetabular impingement syndrome in National Hockey League players

Journal of Hip Preservation Surgery ◽

10.1093/jhps/hnz030 ◽

2019 ◽

Author(s):

Kyle R Sochacki ◽

Robert A Jack ◽

Takashi Hirase ◽

Justin Vickery ◽

Joshua D Harris

Keyword(s):

Hip Arthroscopy ◽

Statistical Significance ◽

Return To Sport ◽

Performance Data ◽

National Hockey League ◽

Control Group ◽

P Value ◽

Career Length ◽

Operative Performance ◽

And Performance

Abstract Femoroacetabular impingement (FAI) syndrome is a common cause of hip pain in National Hockey League (NHL) players that may lead to decreased performance. The purpose of this study was to determine the (i) return to sport (RTS) rate in NHL players following hip arthroscopy for FAI, (ii) post-operative career length and games per season, (iii) pre- and post-operative performance and (iv) post-operative performance compared with control players. NHL athletes who underwent hip arthroscopy for FAI and matched controls were identified based on position, age (±1 year), years of experience (±1 year) and performance data prior to the surgery date. Demographic and performance data were collected. RTS was defined as playing in at least one NHL game after surgery. A Bonferroni correction was used to control for multiple comparisons with statistical significance defined by a P-value ≤ 0.007. Seventy players (77 surgeries) were analysed (mean age 29.4 ± 4.5 years; mean 8.8 ± 4.7 years NHL experience at the time of surgery). Sixty-three players (70 surgeries, 90.9%) RTS at an average of 6.8 ± 4.1 months. The 1-year NHL career survival rate for players undergoing surgery was 84.4%. Players in the control group (4.4 ± 2.7 years) had longer careers (P = 0.00002) than players that underwent surgery (3.3 ± 2.5 years). There was no significant (P > 0.007) decrease in post-operative performance compared with pre-operatively and with matched controls. The RTS rate for NHL athletes after hip arthroscopy for FAI is above 90% at less than 1 year. Following surgery, if a player returns to the NHL, then their post-operative performance is similar to pre-operatively and controls, but their careers are approximately one season less than controls.

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The utility of hip arthroscopy for patients with painful borderline hip dysplasia

Journal of Orthopaedic Surgery ◽

10.1177/2309499020923162 ◽

2020 ◽

Vol 28 (2) ◽

pp. 230949902092316

Author(s):

Deuk-Soo Hwang ◽

Chan Kang ◽

Jeong-Kil Lee ◽

Jae-Young Park ◽

Long Zheng ◽

...

Keyword(s):

Patient Satisfaction ◽

Hip Arthroscopy ◽

Hip Dysplasia ◽

Reoperation Rate ◽

Labral Repair ◽

Harris Hip Score ◽

Control Group ◽

The Mean ◽

Tönnis Grade

Purpose: We measured the width of the acetabular labra in, and the clinical outcomes of, patients with borderline hip dysplasia (HD) who underwent arthroscopy. Methods: A total of 1436 patients who underwent hip arthroscopy to treat symptomatic, acetabular labral tears were enrolled. From this cohort, we extracted a borderline HD group (162 cases). Lateral labral widths were evaluated using preoperative magnetic resonance imaging scans. Clinical data including the modified Harris hip score (mHHS), non-arthritic hip score (NAHS), hip outcome score–activity of daily living (HOS-ADL) score, visual analog scale (VAS) pain score, and Tönnis grade were collected. In addition, patient satisfaction with arthroscopy outcomes was rated. All complications and reoperations were noted. Results: The mean follow-up time was 87.4 months. The lateral labral width was 7.64 mm in those with normal hips and 7.73 mm in borderline HD patients, respectively ( p = 0.870). The Tönnis grade progressed mildly from 0.46 to 0.76 ( p = 0.227). At the last follow-up, clinical outcome scores (mHHS, NAHS, and HOS-ADL scores) and the VAS score were improved ( p < 0.001). The mean patient satisfaction was scored at 8.2. The reoperation rate was higher in those who underwent labral debridement (25.6%) than labral repair (4.1%). Conclusions: The lateral labral width did not differ significantly between the borderline HD group and the nondysplastic control group. Arthroscopy relieved the symptoms of painful borderline HD and did not accelerate osteoarthritis. Therefore, if such patients do not respond to conservative treatment, hip arthroscopy can be considered for further treatment.

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Revision Hip Arthroscopy in the Borderline Dysplastic Population: Reporting Outcomes With Minimum 2-Year Follow-up, With a Subanalysis Against a Propensity-Matched Nondysplastic Control Group

The American Journal of Sports Medicine ◽

10.1177/0363546520969878 ◽

2020 ◽

Vol 49 (1) ◽

pp. 66-75 ◽

Cited By ~ 1

Author(s):

David R. Maldonado ◽

Cynthia Kyin ◽

Jacob Shapira ◽

Philip J. Rosinsky ◽

Mitchell B. Meghpara ◽

...

Keyword(s):

Revision Surgery ◽

Hip Arthroscopy ◽

Matched Control ◽

Arthroscopic Surgery ◽

Harris Hip Score ◽

Control Group ◽

Study Group ◽

Matched Control Group ◽

Patient Reported

Background: Hip arthroscopy in patients with borderline dysplasia continues to be surrounded by controversy. Even more controversial is the management of the failed hip arthroscopy in this population. There is a paucity of studies in contemporary literature regarding outcomes after arthroscopic revision surgery. Purpose: (1) To report minimum 2-year patient-reported outcome (PRO) scores in patients with borderline dysplasia who underwent revision hip arthroscopy and (2) to compare these PRO scores with those of a propensity-matched control group without dysplasia who underwent revision hip arthroscopy. Study Design: Cohort study; Level of evidence, 3. Methods: Data were prospectively collected between August 2009 and November 2017. Inclusion criteria were revision arthroscopic surgery, capsular plication, and baseline and minimum 2-year follow-up for the following PROs: modified Harris Hip Score (mHHS), Nonarthritic Hip Score (NAHS), Hip Outcome Score–Sports Specific Subscale (HOS-SSS), and visual analog scale (VAS) for pain. Patients with Tönnis grade >1 or previous hip conditions were excluded. Two groups were created: a study group with borderline dysplasia (lateral center-edge angle [LCEA], 18°-25°) and a control group without dysplasia (LCEA, 25°-40°). Groups were propensity-matched in a 1:3 ratio for sex, age, body mass index, and follow-up time. Results: A total of 22 revision borderline dysplastic hips (21 patients) had a minimum 2-year follow-up during the study period. Patients in this group reported significant improvements for all PROs from baseline and achieved the minimal clinically important difference (MCID) for the mHHS at a rate of 70%. Moreover, 21 borderline dysplastic hips (21 patients) were matched to 63 control hips (63 patients). Mean LCEA for the study and control groups was 22.6 ± 1.7 and 32.0 ± 5.0, respectively. Both groups reported similar improvement in all PROs. The rate for achieving the MCID for the mHHS and VAS was similar between groups; however, the control group had higher rates of meeting the MCID for the HOS-SSS and NAHS ( P = .042 and P = .025, respectively). The rates of conversion to hip arthroplasty were 7.9% (n = 5) in the control group and 23.8% (n = 5) in the borderline dysplasia propensity-matched group ( P = .052). The rate of re-revision arthroscopy was 11.1% (n = 7) in the control group and 19.0% (n = 4) on the borderline dysplasia group ( P = .350). Conclusion: After revision hip arthroscopy, significant improvement was obtained for all PROs in patients with borderline dysplasia at a minimum 2-year follow-up. Moreover, outcomes, patient satisfaction, the rate for achieving the MCID for the mHHS and VAS, and the rate for secondary surgery were similar to those of a propensity-matched control group without dysplasia. Nevertheless, there was a nonsignificant trend toward higher secondary procedures in the study group; therefore, arthroscopic revision surgery in the borderline patients should be approached with measured prognosis.

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Return to Sport Rates and Functional Outcomes Following Bilateral Hip Arthroscopy in High-Level Athletes

Orthopaedic Journal of Sports Medicine ◽

10.1177/2325967120s00435 ◽

2020 ◽

Vol 8 (7_suppl6) ◽

pp. 2325967120S0043

Author(s):

Benjamin Domb ◽

Cynthia Kyin ◽

Jacob Shapira ◽

David Maldonado ◽

Ajay Lall ◽

...

Keyword(s):

Hip Arthroscopy ◽

Patient Reported Outcomes ◽

Return To Sport ◽

Harris Hip Score ◽

Complication Rates ◽

Professional Athlete ◽

Patient Reported ◽

High Level ◽

Modified Harris Hip Score

Objectives: To determine the rate of return to sport (RTS) in high-level athletes undergoing bilateral hip arthroscopy and report minimum 1-year patient-reported outcomes (PROs) for this cohort. We hypothesized that RTS rates, as well as sport-specific PROs, will be lower than the rates and scores previously reported in the literature for unilateral hip arthroscopy. Methods: Data were prospectively collected on all patients undergoing hip arthroscopy at our institution from November 2011 to July 2018. Patients were included if they underwent bilateral hip arthroscopy and were either a high school, collegiate, or professional athlete prior to their first surgery. RTS was defined as a patient’s return to competitive participation in their respective sport. Additional PROs, including modified Harris Hip Score (mHHS), nonarthritic hip score (NAHS), and Hip Outcome Score-Sports Specific Subscale (HOS-SSS), as well as complication rates and future surgeries were documented and compared for all patients. Results: A total of 87 patients met inclusion criteria, for which follow-up was available for 82 (94.3%). At latest follow-up, 44 (53.7%) patients returned to sport. Of patients returning, 56% did so at the same level or higher. The most common reasons for not returning to sport were due to graduation/lifestyle change (47.4%) and hip symptoms (44.7%). Patients returning to sport had significantly higher PROs at latest follow-up relative to those who did not return, including for mHHS (93.7 vs. 87.5), NAHS (94.4 vs. 88.2), HOS-SSS (90.9 vs. 78.2) (P < 0.05). Rates of achieving PASS and MCID for mHHS were not significantly different. However, for HOS-SSS, patients who returned had significantly higher rates of achieving the MCID and PASS. Conclusion: Rates of RTS after bilateral hip arthroscopy are lower than those after unilateral hip arthroscopy. When comparing patients that returned to sports and those who did not return, we show that although both groups show a significant improvement in PROs following surgery, those that returned to sport achieved significantly higher scores in all outcome measures. In addition, patients returning to sports showed a significantly higher rate of attaining MCID and PASS scores for the HOS-SSS, possibly attesting to the validity of this score and its thresholds.

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Acute and sub-acute changes in dynamic postural control following hip arthroscopy and post-operative rehabilitation.”

Journal of Athletic Training ◽

10.4085/1062-6050-0709.20 ◽

2021 ◽

Author(s):

Matthew D Freke ◽

Matthew King ◽

Kay M Crossley ◽

Kevin J Sims ◽

Adam Semciw

Keyword(s):

Postural Control ◽

Hip Arthroscopy ◽

Balance Control ◽

Dynamic Balance ◽

Hip Pain ◽

Control Group ◽

Healthy Controls ◽

Pain Group ◽

Post Surgery ◽

Significant Difference

Abstract Context: Hip pain is associated with impairments in postural control and balance. The Star Excursion Balance Test (SEBT) is a reliable and valid method to measure dynamic postural control. Objective: Examine changes to dynamic postural control following hip arthroscopy and subsequent rehabilitation from pre-surgery to three and six months post arthroscopy. Setting: Sixty-seven individuals (47 men) scheduled for hip arthroscopy to address chondrolabral pathology were matched with sixty-seven healthy controls. The hip pain group underwent post-operative rehabilitation including SEBT training. Main outcome measures: SEBT reach normalized to limb length was collected pre-surgery and at three and six months post surgery, and compared with healthy matched controls. Repeated measure analysis of variance (ANOVA) evaluated whether SEBT reach differed between the three time points and t-tests were used to evaluate between-limb and between-group differences. Results: Pre-surgical SEBT reach was significantly less than the control group in all directions (p<0.001). At three months post surgery, SEBT reach significantly increased in the posterior-lateral (PL) (p<0.001), anterior-lateral (AL) (p<0.001) and posterior-medial (PM) (p=0.006) directions from pre-surgery. At six months post surgery, all directions of reach had significantly increased (p<0.001) from baseline. Compared to the control group, AL (−2.5 %, p=0.038), anterior medial (AM) (−2.9%, p=0.019) and posterior-medial (PM) (−5.2%, p= 0.002) reach remained significantly less at six months post surgery. No significant difference existed between the control and surgical groups for reach in the PL (−3.6%, p=0.061) direction. Conclusions: Pre-surgical dynamic balance control within a hip pain group was significantly poorer than matched controls as measured by the SEBT. At three months post hip arthroscopy, there were significant improvements in dynamic balance in the PM, PL and AL SEBT directions. By six months post surgery, all directions of SEBT reach had significantly improved but only PL reach improved to the level of healthy controls.

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Hip Arthroscopy in the Presence of Acetabular Dysplasia

The Open Orthopaedics Journal ◽

10.2174/1874325001509010185 ◽

2015 ◽

Vol 9 (1) ◽

pp. 185-187 ◽

Cited By ~ 17

Author(s):

Narlaka Jayasekera ◽

Alessandro Aprato ◽

Richard N Villar

Keyword(s):

Hip Arthroscopy ◽

Acetabular Dysplasia ◽

Developmental Dysplasia ◽

Harris Hip Score ◽

Control Group ◽

Pelvic Radiograph ◽

Cam Impingement ◽

One Year ◽

Modified Harris Hip Score ◽

Painful Hip

Purpose : Hip arthroscopy is a well established therapeutic intervention for an increasing number of painful hip conditions. Developmental dysplasia of the hip (DDH) is commonly associated with intra-articular hip pathology. However, some surgeons perceive patients with hip dysplasia as poor candidates for hip arthroscopy. Our aim was to describe early outcomes of arthroscopic treatment for patients with DDH, who also had femoroacetabular impingement (FAI) treated when necessary, and to compare these outcomes against a control group of patients without DDH. Methods : Prospective case-control study of 68 consecutive hip arthroscopy patients assessed with a modified Harris Hip Score (mHHS) preoperatively and at six weeks, six months, and one year after surgery. Presence of DDH was determined using a standard anteroposterior (AP) pelvic radiograph to measure the centre-edge angle (CEA) of Wiberg, with a CEA < 20º used as threshold for diagnosis of DDH. Results : 12 patients (eight female and four male) with acetabular dysplasia and mean CEA of 15.4º (9º to 19º). The control, nondysplastic group comprised 54 patients (23 females and 31 males) with a mean CEA of 33.1º (22º to 45º). All patients in the dysplastic group had a labral tear and 11 (91.7%) had associated femoral cam impingement lesion addressed at arthroscopy. Our study demonstrates a significant (p=0.02) improvement in outcome in the dysplastic group at one year using the mHHS. Conclusion : Hip arthroscopy in the presence of DDH is effective in relieving pain for at least one year after surgery although does not address underlying acetabular abnormality.

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Return to Play After Hip Arthroscopy Among Tennis Players: Outcomes with Minimum Five-Year Follow-up

10.21203/rs.2.14819/v2 ◽

2019 ◽

Author(s):

David R. Maldonado ◽

Mitchell J. Yelton ◽

Philip J. Rosinsky ◽

Jacob Shapira ◽

Mitchell Meghpara ◽

...

Keyword(s):

Hip Arthroscopy ◽

Arthroscopic Surgery ◽

Return To Sport ◽

Return To Play ◽

Harris Hip Score ◽

Tennis Players ◽

Labral Tears ◽

Patient Reported ◽

Modified Harris Hip Score

Abstract Background: Playing tennis is associated with various movements that can lead to labral injuries and may require arthroscopic surgery. While hip arthroscopies have demonstrated good outcomes in athletes, there is limited literature reporting Patient Reported Outcomes (PROs) and return to play in competitive or recreational tennis players after hip arthroscopic surgery. Therefore, the purpose of the present study was to (1) report minimum five-year PROs and return to sport in tennis players who underwent hip arthroscopic surgery and (2) compare outcomes between recreational and competitive tennis players. Methods: Data for patients who underwent hip arthroscopy surgery in the setting of femoroacetabular impingement (FAI) and labral tears between March 2009 and January 2014 and who played tennis at any level within one-year of surgery were retrospectively reviewed. Patients with preoperative and minimum five-year postoperative scores for the following PROs were included: modified Harris Hip Score (mHHS), Non-Arthritic Hip Score (NAHS), Hip Outcome Score-Sport Specific Subscale (HOS-SSS), and visual analog scale (VAS) for pain. Patients with preoperative Tönnis osteoarthritis Grade >1, Workers’ Compensation claims, age > 60 years old, or previous ipsilateral hip surgeries or conditions were excluded. Patient Acceptable Symptomatic State (PASS) and Minimal Clinically Important Difference (MCID) for mHHS and HOS-SSS were calculated. Results: Of 28 patients, 31 hips met all inclusion and exclusion criteria of which 28 (90.3%) had minimum 5-year follow-up (mean: 72.8 ± 13.9 months). There were 3 professional, 3 collegiate, 2 high school, 2 organized amateur, and 18 recreational level tennis players. All PROs significantly improved at latest follow-up: mHHS from 67.0 to 86.7 (P < 0.001), NAHS from 65.9 to 87.2 (P < 0.001), HOS-SSS from 50.0 to 77.9 (P = 0.009), and VAS from 5.4 to 1.8 (P < 0.001). There was a 75.0% return to sport rate. Additionally, 66.7% of patients achieved MCID and 83.3% achieved PASS for mHHS, and 63.6% achieved MCID and 58.3% achieved PASS for HOS-SSS. Conclusion: Regardless of the level of participation, tennis players who underwent hip arthroscopic surgery reported statistically significant PRO improvements. A favorable rate of return to sport was also achieved.

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