scholarly journals Predictors of Failure After Surgical Treatment of Femoroacetabular Impingement: Results of a Multicenter Prospective Cohort of 621 Hips

2019 ◽  
Vol 7 (7_suppl5) ◽  
pp. 2325967119S0032
Author(s):  
Jeffrey J. Nepple ◽  
Asheesh Bedi ◽  
Ira Zaltz ◽  
Christopher M. Larson ◽  
Daniel J. Sucato ◽  
...  
Keyword(s):  
Logistic Regression ◽  
Cohort Study ◽  
Surgical Treatment ◽  
Femoroacetabular Impingement ◽  
Revision Surgery ◽  
Patient Reported Outcomes ◽  
Clinical Failure ◽  
Multivariate Logistic Regression ◽  
Multicenter Cohort ◽  
Patient Reported

Objectives: Surgical treatment of femoroacetabular impingement attempts to improve patients’ symptoms through treatment of intra-articular labrochondral pathology and correction of underlying bony deformity. The purpose of the current study was to determine independent predictors of failure after surgical treatment of femoroacetabular impingement in a large prospective multicenter cohort study. Methods: A prospective cohort study of the surgical treatment of FAI was performed. A total of 760 hips undergoing primary surgical treatment of FAI were enrolled across seven surgeons. Patient characteristics, baseline patient reported outcomes (PROs), imaging findings, intraoperative pathology, and surgical treatments were prospectively recorded. A total of 621 hips (81.6%) with minimum one year follow-up were included in the current study (mean 4.3 years). The mHHS was assessed relative to the minimally clinically important difference (MCID, 8 points) and patient acceptable symptom state (PASS, 74 points). Univariate analyses were performed to identify factors significantly associated with failure. Multivariate logistic regression was performed to identify independent predictors of failure. Results: A total of 621 hips undergoing surgical treatment of FAI were assessed at a mean 4.2 years postoperatively. This cohort had a mean age of 29.8 and included 56.8% females. Multivariate logistic regression identified independent predictors of each failure definition. Failure A (THA) was independently associated with increasing age, acetabular microfracture (both p<0.001), and femoral head chondroplasty (p=0.02). Failure B (THA or revision surgery) was independently associated only with lower preoperative mHHS (p<0.001) (p=0.01). A lower failure C (clinical failure) was independently associated with participation in competitive athletics (p=0.01), BMI (p<0.001), and male gender (p<0.001). Conclusion: This large multicenter cohort demonstrates the outcomes of FAI treatment at a mean of 4.3 years postoperative. Rates of THA and revision surgery were 4.0% and 6.9%. An additional 14.8% of patients demonstrates clinical failure based on patient-reported outcomes.

scholarly journals Higher Survival Rate Associated with Thymosin Alpha 1 use in Critical COVID-19: A Retrospective Multicenter Cohort Study

2020 ◽  
Author(s):  
Yichen Li ◽  
Jie Li ◽  
Jia Ke ◽  
Sijing Cheng ◽  
Lixin Zhu ◽  
...  
Keyword(s):  
Logistic Regression ◽  
Cohort Study ◽  
Retrospective Study ◽  
Protective Factor ◽  
Confounding Factors ◽  
Multivariate Logistic Regression ◽  
Multicenter Cohort Study ◽  
Multicenter Cohort ◽  
Thymosin Alpha 1 ◽  
Critical Patients

Abstract BackgroundCurrently no satisfactory pharmaceutical intervention is available for COVID-19. This retrospective study aimed to determine the therapeutic effect of thymosin alpha1 in critical COVID-19. ResultsWe enrolled 109 critically ill severe acute respiratory syndrome-related coronavirus-2 RNA positive patients from 15 hospitals. The mortality rate in critical patients treated with thymosin alpha1 was 11%, compared to 56% in critical patients not treated with thymosin alpha1. With confounding factors adjusted in multivariate logistic regression, thymosin alpha1 treatment was identified as a protective factor for critical COVID-19. ConclusionOur observation advocates the treatment of critical COVID-19 with thymosin alpha1.

Patient reported outcomes 6 to 12 months after interpersonal violence: A multicenter cohort study

2021 ◽  
Vol 91 (2) ◽  
pp. 260-264
Author(s):  
Manuel Castillo-Angeles ◽  
Juan P. Herrera-Escobar ◽  
Alexander Toppo ◽  
Sabrina E. Sanchez ◽  
Haytham M. Kaafarani ◽  
...  
Keyword(s):  
Cohort Study ◽  
Interpersonal Violence ◽  
Patient Reported Outcomes ◽  
Multicenter Cohort Study ◽  
Multicenter Cohort ◽  
Patient Reported

Hip Arthroscopy for Femoroacetabular Impingement in Adolescents: 10-Year Patient-Reported Outcomes

2020 ◽  
Vol 49 (1) ◽  
pp. 76-81 ◽  
Author(s):  
Travis J. Menge ◽  
Karen K. Briggs ◽  
Michael D. Rahl ◽  
Marc J. Philippon
Keyword(s):  
Patient Satisfaction ◽  
Femoroacetabular Impingement ◽  
Revision Surgery ◽  
Hip Arthroscopy ◽  
Patient Reported Outcomes ◽  
Labral Repair ◽  
Harris Hip Score ◽  
Duration Of Symptoms ◽  
Patient Reported

Background: Previous studies have demonstrated hip arthroscopy to be an effective treatment for femoroacetabular impingement (FAI) in individuals 18 years of age and older. Long-term outcome data in the adolescent population, however, are limited. Purpose: To report 10-year outcomes after hip arthroscopy in adolescents with symptomatic FAI. Study Design: Case series; Level of evidence, 4. Methods: Prospectively collected data were analyzed on adolescent patients younger than 18 years of age who had hip arthroscopy between March 2005 and 2009 with a minimum 10-year follow-up. Patients were included if they were diagnosed with symptomatic FAI and an associated labral tear that was treated with repair. Patients were excluded if they had previous hip procedures, acetabular dysplasia (lateral center-edge angle, <20°), avascular necrosis, previous hip fracture or dislocation, or Legg-Calve-Perthes disease, or refused to participate. The primary patient-reported outcome measure was the Hip Outcome Score (HOS) Activities of Daily Living (ADL) subscale. In addition, the HOS—Sport, modified Harris Hip Score (mHHS), 12-Item Short Form Health Survey (SF-12), and patient satisfaction were collected. Failure was defined as patients having to undergo revision arthroscopy. Results: There were 60 patients (70 hips) who met inclusion criteria and had a 10-year follow-up. The mean age of the cohort was 16 ± 1.2 years, with 21 male and 49 female hips. Seven hips (10%) required revision hip arthroscopy. All revisions occurred in female patients and were associated with global laxity as well as longer duration of symptoms before time of surgery. At a mean follow-up of 12 years (range, 10-14 years), patients who did not undergo revision surgery had significant improvements from preoperatively to postoperatively in HOS-ADL (from 64 to 92; P < .01), HOS–Sport (from 40 to 86; P < .01), mHHS (from 56 to 88; P < .01), and SF-12 Physical Component Summary (from 41 to 54; P < .01). The median patient satisfaction was 10 out of 10 (very satisfied). Conclusion: Hip arthroscopy for FAI with labral repair resulted in excellent patient-reported outcomes and satisfaction at a minimum of 10 years of follow-up. There was a 10% rate of revision surgery, which was associated with global laxity and longer duration of symptoms before surgery, which should be considered in patient selection.

scholarly journals A Controlled Comparison of Microfracture, Debridement, and No Treatment of Concomitant Full-Thickness Cartilage Lesions in Anterior Cruciate Ligament–Reconstructed Knees: A Nationwide Prospective Cohort Study From Norway and Sweden of 368 Patients With 5-Year Follow-up

2018 ◽  
Vol 6 (8) ◽  
pp. 232596711878776 ◽  
Author(s):  
Svend Ulstein ◽  
Asbjørn Årøen ◽  
Lars Engebretsen ◽  
Magnus Forssblad ◽  
Stein Håkon Låstad Lygre ◽  
...  
Keyword(s):  
Anterior Cruciate Ligament ◽  
Cohort Study ◽  
Surgical Treatment ◽  
Patient Reported Outcomes ◽  
Cruciate Ligament ◽  
Full Thickness ◽  
Cartilage Lesions ◽  
Patient Reported ◽  
Anterior Cruciate

Background: The effect of microfracture (MF) or surgical debridement of concomitant full-thickness cartilage lesions in anterior cruciate ligament–reconstructed knees on patient-reported outcomes remains to be determined. Purpose: To evaluate the effect of debridement or MF compared with no surgical treatment of concomitant full-thickness cartilage lesions on patient-reported outcomes 5 years after anterior cruciate ligament reconstruction (ACLR). Study Design: Cohort study; Level of evidence, 2. Methods: Included in this study were 644 patients who were registered in the Norwegian and the Swedish National Knee Ligament Registries from 2005 to 2008 as having undergone unilateral primary ACLR and having a concomitant full-thickness cartilage lesion (International Cartilage Repair Society [ICRS] grades 3-4). Of these patients, 129 were treated with debridement, 164 were treated with MF, and 351 received no surgical treatment simultaneously with ACLR. At 5-year follow-up, 368 (57%) patients completed results on the Knee injury and Osteoarthritis Outcome Score (KOOS). Multivariable linear regression was used to estimate the effect of surgical debridement or MF of concomitant full-thickness cartilage lesions on patient-reported outcomes 5 years after ACLR. Results: Compared with no surgical treatment, there were no unadjusted or adjusted effects of debridement or MF of concomitant full-thickness cartilage lesions on KOOS scores at 5-year follow-up. Conclusion: Compared with leaving concomitant full-thickness cartilage lesions untreated at the time of ACLR, debridement and MF showed no effect on patient-reported outcomes 5 years after surgery.

Can Patient-Reported Outcomes Predict the Need for Secondary Surgeries After Hip Arthroscopy?

2020 ◽  
Vol 49 (1) ◽  
pp. 97-103 ◽  
Author(s):  
Jacob Shapira ◽  
Rishika Bheem ◽  
Cynthia Kyin ◽  
Philip J. Rosinsky ◽  
Mitchell B. Meghpara ◽  
...  
Keyword(s):  
Logistic Regression ◽  
Regression Analysis ◽  
Logistic Regression Analysis ◽  
Hip Arthroscopy ◽  
Patient Reported Outcomes ◽  
Roc Analysis ◽  
Multivariate Logistic Regression Analysis ◽  
Multivariate Logistic Regression ◽  
Secondary Surgery ◽  
Patient Reported

Background: Patient-reported outcomes (PROs) capture the postoperative period and reflect the patient’s perspective of one’s own recovery. However, it is unknown if PROs can reflect and predict the need for secondary surgeries after a primary hip arthroscopy. Purpose: To examine if PROs at 3 months and 1 year after primary hip arthroscopy were correlated with future reoperations and determine the critical thresholds for significant PROs utilizing a multivariate logistic regression analysis and receiver operator characteristic (ROC) analysis. Study Design: Case-control study; Level of evidence, 3. Methods: Data on consecutive patients who underwent primary hip arthroscopy between February 2008 and August 2018 was retrospectively reviewed. Patients were included for analysis if they had the following PROs preoperatively and at 3 months and 1 year postoperatively: modified Harris Hip Score (mHHS), Nonarthritic Hip Score (NAHS), and visual analog scale (VAS) for pain. Patients were split into 2 groups: those who underwent secondary surgery and those who did not. Patient variables, intraoperative labral treatment, preoperative PROs, and postoperative PROs were compared between the 2 groups. A multivariate logistic regression analysis and ROC analysis were deployed to evaluate the correlation between PROs and the need for future surgery. Results: A total of 911 primary arthroscopy cases were included in this study. While age, body mass index, labral treatment, and 3-month and 1-year follow-up mHHS, NAHS, and VAS were significant in the bivariate analysis, the multivariate logistic regression analysis only found 1-year mHHS to be significant in the final model ( P < .05). The ROC curve for 1-year mHHS demonstrated acceptable discrimination between patients requiring secondary surgery and patients not requiring secondary surgery with an area under the curve of 0.73. Using the Youden index, a threshold of 80.5 was determined for the 1-year mHHS. Conclusion: The risk for secondary procedures may be evaluated with mHHS at 1 year after primary hip arthroscopy. Surpassing a score of 80.5 may be associated with a 74.4% reduction in risk for either a revision hip arthroscopy or a conversion to hip replacement.

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