Predictors of Clinical Outcomes After Hip Arthroscopy: 5 Year Follow- Up Analysis of 1038 Patients

Objectives: Identify predictive factors of midterm outcomes after hip arthroscopy in a cohort of 1038 patients, whose outcomes at minimum 2-year follow-up have previously been reported. In addition, to provide a comparison of short-term and midterm predictive factors in outcome measures following hip arthroscopy. Methods: Data were prospectively collected and retrospectively reviewed on all patients undergoing hip arthroscopy between February 2008 and June 2012. Patients were included if they had minimum 5-year follow-up on 3 patient reported outcomes: Nonarthritic Hip Score (NAHS), modified Harris Hip Score (mHHS), and Hip Outcome Score-Sport Specific Subscale (HOS-SSS). Patients were excluded if they had any prior ipsilateral hip conditions. Using bivariate and multivariate analyses, we analyzed the effect of 36 preoperative and intraoperative variables on NAHS. Results: A total of 1038 patients met our listed inclusion and exclusion criteria, with a mean follow-up time of 62.0 months (range, 60.0 - 120.0 months). The bivariate analysis identified 11 variables (4 categorical and 7 continuous) that were predictive of 5-year postoperative NAHS. For the multivariate analysis, 7 variables were identified as being significant: preoperative NAHS, body mass index (BMI), age, lateral joint space, alpha angle, revision hip arthroscopy, and acetabular microfracture. These 7 variables were also predictive in the bivariate analysis. Conclusion: This study reports favorable midterm clinical outcomes in the largest cohort of hip arthroscopies with minimum 5-year follow up in the literature to date. Seven variables were identified as being significant predictors in both the bivariate and multivariate analysis: preoperative NAHS, body mass index (BMI), age, lateral joint space, alpha angle, revision hip arthroscopy, and acetabular microfracture. Of these, preoperative NAHS, BMI, age, and revision hip arthroscopy were predictive of both 2-year and 5-year postoperative NAHS. These predictive factors may prove useful to clinicians in determining indications for hip arthroscopy and counseling patients on its expected outcomes.

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Predictors of Clinical Outcomes After Hip Arthroscopy: 5-Year Follow-up Analysis of 1038 Patients

The American Journal of Sports Medicine ◽

10.1177/0363546520968896 ◽

2020 ◽

Vol 49 (1) ◽

pp. 112-120 ◽

Cited By ~ 1

Author(s):

Benjamin G. Domb ◽

Sarah L. Chen ◽

Cammille C. Go ◽

Jacob Shapira ◽

Philip J. Rosinsky ◽

...

Keyword(s):

Clinical Outcomes ◽

Predictive Factors ◽

Hip Arthroscopy ◽

Alpha Angle ◽

Joint Space ◽

Harris Hip Score ◽

Bivariate Analysis ◽

Inclusion Criteria ◽

Modified Harris Hip Score

Background: Although hip arthroscopy has been shown to have favorable results, there is a paucity of literature describing predictive factors of 5-year clinical outcomes. Purpose: To identify predictive factors of midterm outcomes after hip arthroscopy in a cohort of 1038 patients whose outcomes at minimum 2-year follow-up were previously reported. In addition, to provide a comparison of short- and midterm predictive factors in outcome measures after hip arthroscopy. Study Design: Case-control study; Level of evidence, 3. Methods: Data were prospectively collected and retrospectively reviewed on all patients undergoing hip arthroscopy between February 2008 and June 2012. Patients were included if they had minimum 5-year follow-up on 2 patient-reported outcomes: Nonarthritic Hip Score (NAHS) and modified Harris Hip Score. Patients were excluded if they had any previous ipsilateral hip conditions. Using bivariate and multivariate analyses, we analyzed the effect of 36 pre- and intraoperative variables on the NAHS, modified Harris Hip Score, and conversion to total hip arthroplasty. Results: A total of 1038 patients met the inclusion criteria for the 2-year study, and 860 met our listed inclusion criteria for the 5-year study. The mean follow-up time was 62.0 months (range, 60.0-120.0 months). The bivariate analysis identified 10 variables (4 categorical and 6 continuous) that were predictive of 5-year postoperative NAHS. For the multivariate analysis, 7 variables were identified as being significant: preoperative NAHS, body mass index (BMI), age, lateral joint space, alpha angle, revision hip arthroscopy, and acetabular microfracture. These 7 variables were also predictive in the bivariate analysis. Age, BMI, revision hip arthroscopy, Tönnis grade, sex, trochanteric bursectomy, femoral head cartilage damage, and acetabular inclination were significant predictors of conversion to total hip arthroplasty. Conclusion: This study reports favorable midterm clinical outcomes in the largest cohort of hip arthroscopies with minimum 5-year follow-up in the literature to date. Seven variables were identified as being significant predictors of postoperative NAHS in the bivariate and multivariate analyses: preoperative NAHS, BMI, age, lateral joint space, alpha angle, revision hip arthroscopy, and acetabular microfracture. Of these, preoperative NAHS, BMI, age, and revision hip arthroscopy were predictive of 2- and 5-year postoperative NAHS. These predictive factors may prove useful to clinicians in determining indications for hip arthroscopy and counseling patients on its expected outcomes.

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Achieving Successful Outcomes of Hip Arthroscopy in the Setting of Generalized Ligamentous Laxity With Labral Preservation and Appropriate Capsular Management: A Propensity Matched Controlled Study

The American Journal of Sports Medicine ◽

10.1177/0363546520914604 ◽

2020 ◽

Vol 48 (7) ◽

pp. 1625-1635

Author(s):

David R. Maldonado ◽

Jeffery W. Chen ◽

Mitchell J. Yelton ◽

Philip J. Rosinsky ◽

Jacob Shapira ◽

...

Keyword(s):

Body Mass Index ◽

Body Mass ◽

Femoroacetabular Impingement ◽

Hip Arthroscopy ◽

Matched Pair ◽

Control Group ◽

Beighton Score ◽

Ligamentous Laxity ◽

Labral Tears

Background: Association among generalized ligamentous laxity (GLL), hip microinstability, and patient-reported outcomes (PROs) after hip arthroscopy has yet to be completely established. Purposes: (1) To report minimum 2-year PROs in patients with GLL who underwent hip arthroscopy in the setting of symptomatic labral tears and femoroacetabular impingement syndrome and (2) to compare clinical results with a matched-pair control group without GLL. Study Design: Cohort study; Level of evidence, 3. Methods: Data from a prospectively collected database were retrospectively reviewed between August 2014 and December 2016. Patients were considered eligible if they received primary arthroscopic treatment for symptomatic labral tears and femoroacetabular impingement. Inclusion criteria included preoperative and minimum 2-year follow-up scores for the following PROs: modified Harris Hip Score (mHHS), Non-arthritic Hip Score (NAHS), and visual analog scale for pain (VAS). From the sample population, 2 groups were created: the GLL group (Beighton score ≥4) and the control group (Beighton score <4). Patients were matched in a 1:2 ratio via propensity score matching according to age, sex, body mass index, Tönnis grade, and preoperative lateral center-edge angle. Patient acceptable symptomatic state (PASS) and minimal clinically important difference (MCID) for mHHS, Hip Outcome Score–Sports Specific Scale (HOS-SSS), and International Hip Outcome Tool–12 (iHOT-12) were calculated. Results: A total of 57 patients with GLL were matched to 88 control patients. Age, sex, body mass index, and follow-up times were not different between groups ( P > .05). Preoperative radiographic measurements demonstrated no difference between groups. Intraoperative findings and procedures between groups were similar except for capsular treatment, with the GLL group receiving a greater percentage of capsular plications ( P = .04). At minimum 2-year follow-up, both groups showed significant improvement in PROs and VAS ( P < .001). Furthermore, the postoperative PROs at minimum 2-year follow-up and the magnitude of improvement (delta value) were similar between groups for mHHS, NAHS, HOS-SSS, and VAS ( P > .05). Moreover, groups reached comparable rates of MCID and PASS for mHHS, HOS-SSS, and iHOT-12. Conclusion: Patients with GLL after hip arthroscopy for symptomatic femoroacetabular impingement and labral tears may expect favorable outcomes with appropriate labral and capsular management at minimum 2-year follow-up. When compared with a pair-matched control group without GLL, results were comparable for mHHS, NAHS, HOS-SSS, and VAS and reached PASS and/or MCID for mHHS, HOS-SSS, and iHOT-12.

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

The American Journal of Sports Medicine ◽

10.1177/0363546518763362 ◽

2018 ◽

Vol 46 (6) ◽

pp. 1324-1330 ◽

Cited By ~ 42

Author(s):

Benjamin G. Domb ◽

Timothy J. Martin ◽

Chengcheng Gui ◽

Sivashankar Chandrasekaran ◽

Carlos Suarez-Ahedo ◽

...

Keyword(s):

Clinical Outcomes ◽

Predictive Factors ◽

Hip Arthroscopy ◽

Multivariate Analyses ◽

Harris Hip Score ◽

Duration Of Symptoms ◽

Outcome Instrument ◽

Outcome Score ◽

Patient Reported

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

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Outcomes of arthroscopic femoroplasty in patients with cam lesions: Minimum 2-year follow-up

Journal of Orthopaedic Surgery ◽

10.1177/2309499020942049 ◽

2020 ◽

Vol 28 (2) ◽

pp. 230949902094204

Author(s):

Yong-Chan Ha ◽

Jae-Young Lim ◽

Yoo-Sun Won ◽

Young-Kyun Lee ◽

Kyung-Hoi Koo ◽

...

Keyword(s):

Los Angeles ◽

Clinical Outcomes ◽

Hip Arthroscopy ◽

Alpha Angle ◽

Visual Analog Scale Score ◽

Harris Hip Score ◽

Preoperative Pain ◽

Military Population ◽

Modified Harris Hip Score

Purpose: Successful arthroscopic femoroplasty in patients with cam lesions have been reported in Western countries in the last two decades. However, the outcomes after arthroscopic femoroplasty in Asia have thus far only been reported in patients with borderline dysplasia and in the military population. This retrospective study was designed to evaluate the short-term clinical outcomes and radiologic outcomes after hip arthroscopy in patients with cam-type femoroacetabular impingement (FAI) at a minimum postoperative follow-up of 2 years. Methods: From January 2013 to December 2016, 204 hip arthroscopy procedures were performed. Of these cases, 62 patients (73 hips) underwent hip arthroscopy for cam-type FAI. Results: Of the 73 hips, 65 (89.0%) achieved gratified reduction or elimination of preoperative pain. The clinical outcomes showed improvement in scores from before surgery to the last follow-up: 67.1 ± 15.0 to 90.2 ± 6.3 for the modified Harris hip score ( p < 0.001), 4.7 ± 2.5 to 7.1 ± 1.4 for the University of California Los Angeles score ( p < 0.001), and 7.4 ± 1.9 to 1.8 ± 1.5 for the visual analog scale score ( p < 0.001). In radiologic assessments, significant improvement was observed in the alpha angle from a mean 60.9° to 49.5° ( p < 0.001) and in the head–neck offset from a mean of 3.3 mm to 6.3 mm ( p < 0.001). Of the 73 hips, 65 (89.0%) achieved satisfactory reduction or elimination of preoperative pain. In subgroup analysis for the sufficiency of femoroplasty (alpha angle < 55°), the clinical outcomes were not different between the two groups. Conclusion: Arthroscopic femoroplasty resulted in an 89% satisfaction at the 2-year follow-up. Therefore, hip arthroscopic femoroplasty might be an excellent alternative to open surgery and offers a greater probability of good to excellent results.

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The Influence of Body Mass Index on Outcomes After Hip Arthroscopic Surgery With Capsular Plication for the Treatment of Femoroacetabular Impingement

The American Journal of Sports Medicine ◽

10.1177/0363546517705617 ◽

2017 ◽

Vol 45 (10) ◽

pp. 2303-2311 ◽

Cited By ~ 26

Author(s):

Bryan M. Saltzman ◽

Benjamin D. Kuhns ◽

Bryce Basques ◽

Timothy Leroux ◽

Jennifer Alter ◽

...

Keyword(s):

Body Mass Index ◽

Multivariate Analysis ◽

Clinical Outcomes ◽

Body Mass ◽

Femoroacetabular Impingement ◽

Arthroscopic Surgery ◽

Morbidly Obese ◽

Obese Patients ◽

Pain Scores ◽

Capsular Plication

Background: It remains unknown how variations in body mass index (BMI) influence outcomes after primary hip arthroscopic surgery with capsular plication for femoroacetabular impingement (FAI). Purpose: To evaluate the effect that abnormal BMI (namely, overweight, obese, morbidly obese, and underweight) versus normal weight has on patient-reported clinical outcomes more than 2 years postoperatively from primary hip arthroscopic surgery with capsular plication by a single surgeon. Study Design: Cohort study; Level of evidence, 3. Methods: A clinical repository containing patients undergoing primary hip arthroscopic surgery for FAI between January 1, 2012, and January 1, 2014, with a minimum 2-year follow-up was queried. Outcome measures included the Hip Outcome Score (HOS)–Activities of Daily Living (ADL), HOS-Sports, modified Harris Hip Score (mHHS), visual analog scale (VAS) for pain; satisfaction, and Patient Acceptable Symptomatic State (PASS) for the HOS-ADL; scores were collected preoperatively and at 3 months, 1 year, and minimum 2 years postoperatively. Included patients were segregated by preoperative BMI into the following categories: underweight (<18.5 kg/m2), normal (18.5-24.9 kg/m2), overweight (25.0-29.9 kg/m2), obese (30.0-34.9 kg/m2), and morbidly obese (≥35.0 kg/m2). A multivariate logistic regression model controlling for patient demographics and disease severity was used to identify independent associations between BMI categories and outcomes. A Bonferroni adjustment lowered the threshold for significance to P < .01. Results: There were 409 hips in 381 patients appropriate for study inclusion: 7 underweight, 197 normal BMI, 130 overweight, 31 obese, and 16 morbidly obese. The mean age was 33.1 ± 12.1 years, with 232 (61%) female patients. At 2 years postoperatively, significant differences in the trend among HOS-ADL, HOS-Sports, and mHHS scores were evident, with normal BMI patients, followed by underweight patients, demonstrating greater scores than their overweight, obese, and morbidly obese counterparts. Obese patients demonstrated lower satisfaction scores than normal BMI patients. Overweight, obese, and morbidly obese patients had lower improvements in VAS pain scores compared with normal BMI patients. Increasing BMI (not subdivided into the 5 BMI categories) was associated with a higher infection risk (mean BMI for infections: 32.3 ± 9.8 kg/m2 vs mean BMI for noninfections: 25.2 ± 4.8 kg/m2; P = .0035). However, with multivariate analysis, no significant differences in patient clinical outcomes between the BMI categories met the threshold for significance. Among obese patients (BMI ≥30.0 kg/m2), no specific risk factors were found to be significantly associated with decreases in the change in VAS, HOS-ADL, HOS-Sports, mHHS, satisfaction, or PASS for the HOS-ADL scores. However, because of the small cohort sizes at the extremes of the BMI categories, this analysis may have been underpowered to identify a significant difference in underweight or morbidly obese patients. Conclusion: In the current cohort, there were multiple potential confounding variables, and while some clinical differences were observed initially (higher HOS-ADL, HOS-Sports, and mHHS scores for normal BMI patients than overweight and obese patients at 2 years postoperatively; lower satisfaction scores for obese patients than normal BMI patients; and lower improvement in VAS pain scores for overweight, obese, and morbidly obese patients when compared with normal BMI patients), after multivariate analysis, no associations were observed between BMI and clinical outcomes after hip arthroscopic surgery with capsular plication for FAI.

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Hip arthroscopy has good clinical outcomes in the treatment of osteoid osteoma of the acetabulum

BMC Musculoskeletal Disorders ◽

10.1186/s12891-021-04384-5 ◽

2021 ◽

Vol 22 (1) ◽

Author(s):

Guanying Gao ◽

Ruiqi Wu ◽

Rongge Liu ◽

Yingfang Ao ◽

Jianquan Wang ◽

...

Keyword(s):

Clinical Outcomes ◽

Osteoid Osteoma ◽

Hip Arthroscopy ◽

Alpha Angle ◽

Harris Hip Score ◽

Center Edge ◽

Patient Reported ◽

The Mean ◽

Outcome Tool

Abstract Background Osteoid osteoma (OO) of the acetabulum is a relatively rare disease. However, the the clinical outcomes of hip arthroscopy for treatment of OO of the acetabulum are still uncertain. Methods We evaluated consecutive patients who were diagnosed with OO of the acetabulum and who underwent hip arthroscopy at our hospital between January 2013 and March 2020. All patients underwent a preoperative physical examination. Preoperative supine anteroposterior hip radiography, cross-table lateral radiographs, computed tomography (CT), and magnetic resonance imaging were performed in all patients. The alpha angle and lateral center-edge angle were measured before surgery. Supine anteroposterior hip radiography and CT were performed in all patients postoperatively. Preoperative patient-reported outcomes (PROs), including Visual Analog Scale (VAS), the International Hip Outcome Tool-12 (iHOT-12) and modified Harris Hip Score (mHHS), and PROs at final follow-up were evaluated. Results A total of 6 patients (mean age, 18.7 years; age range, 6–31 years; 5 males and 1 females) were included in this study. The average follow-up period after surgery was 28.3 months (range, 6–90 months). Before surgery, the mean mHHS was 45.2 ± 10.5 (range, 33–56), the mean iHOT-12 was 33.3 ± 14.5 (range, 13–49), and mean VAS was 8.2 ± 1.0 (range, 7–9). At one month after surgery, mean mHHS was 78.7 ± 1.9 (range, 77–81), iHOT-12 was 71.0 ± 4.5 (range, 68–80), and mean VAS was 0. At the final post-operative follow-up, mean mHHS was 89.2 ± 2.1 (range, 86–91), iHOT-12 was 93.5 ± 5.0 (range, 88–98), and mean VAS was 0. All results, except VAS between one month after surgery and at final follow-up, demonstrated statistically significant improvement (P < 0.05). One patient underwent revision surgery. Conclusions Hip arthroscopy has good clinical outcomes in the treatment of OO of the acetabulum. Further study on the mechanism of secondary femoroacetabular impingement (FAI) caused by OO of the acetabulum is needed. More cases of arthroscopic excision and longer follow-up are also needed to better prove the clinical outcomes of hip arthroscopy for OO of the acetabulum.

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Hip Arthroscopy has Good Clinical Outcomes in the Treatment of Osteoid Osteoma of the Acetabulum

10.21203/rs.3.rs-141789/v1 ◽

2021 ◽

Author(s):

Guanying Gao ◽

Ruiqi Wu ◽

Rongge Liu ◽

Yingfang Ao ◽

Jianquan Wang ◽

...

Keyword(s):

Clinical Outcomes ◽

Osteoid Osteoma ◽

Hip Arthroscopy ◽

Alpha Angle ◽

Ct Images ◽

Harris Hip Score ◽

Center Edge ◽

Patient Reported ◽

Outcome Tool

Abstract Background: Osteoid osteoma (OO) of the acetabulum is a relatively rare disease. The clinical outcomes of hip arthroscopy for treatment of OO of the acetabulum is still uncertain.Methods: We evaluated consecutive patients who were diagnosed with OO of the acetabulum and underwent hip arthroscopy for treatment in our hospital between January 2013 and March 2020. All patients underwent preoperative physical examination. Preoperative supine anteroposterior hip radiographs, cross-table lateral radiographs, CT images, and MR images were obtained for all patients. Alpha angle and lateral center-edge angle were measured before surgery. Supine anteroposterior hip radiographs and CT images were obtained for all patients postoperatively. Preoperative patient-reported outcomes (PROs), including visual analog scale (VAS), the International Hip Outcome Tool-12 (iHOT-12) and modified Harris Hip Score (mHHS), and PROs at final follow-up were evaluated.Results: A total of 6 patients (mean age, 18.7 years; age range, 6-31 years; 5 males and 1 females) were included in this study. The average follow-up period after surgery was 28.3 months (range, 6–90 months). Before surgery, mean mHHS was 45.2±10.5 (range, 33-56), mean iHOT-12 was 33.3±14.5 (range, 13-49), and mean VAS was 8.2±1.0 (range, 7-9). At one month after surgery, mean mHHS was 78.7±1.9 (range, 77-81), iHOT-12 was 71.0±4.5 (range, 68-80), and mean VAS was 0. At the final post-operative follow-up, mean mHHS was 89.2±2.1 (range, 86-91), iHOT-12 was 93.5±5.0 (range, 88-98), and mean VAS was 0. All results, except VAS between one month after surgery and at final follow-up, demonstrated statistically significant improvement (P < 0.05). One patient underwent revision surgery.Conclusion: Hip arthroscopy has good clinical outcomes in the treatment of OO of the acetabulum.

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Prediction of pancreatic fistula after distal pancreatectomy: Is it necessary to place prophylactic drain?

International Surgery ◽

10.9738/intsurg-d-19-00008.1 ◽

2020 ◽

Author(s):

Kazuhiro Suzumura ◽

Kenjiro Iida ◽

Hideaki Iwama ◽

Yusuke Kawabata

Keyword(s):

Body Mass Index ◽

Multivariate Analysis ◽

Confidence Interval ◽

Pancreatic Fistula ◽

Distal Pancreatectomy ◽

Body Mass ◽

Predictive Factors ◽

Odds Ratio ◽

Drain Placement ◽

Pancreatic Thickness

The aim of this study was to determine the predictive factors for pancreatic fistula (PF) after distal pancreatectomy (DP) among preoperative and intraoperative parameters, and to clarify the patients who did not require drain placement. Between July 2009 and April 2017, 102 consecutive patients underwent DP at Hyogo College of Medicine. Preoperative and intraoperative data were collected, and the predictors of PF after DP were identified. PF was identified in 35 (34%) patients. In the multivariate analysis, 3 factors (body mass index [BMI] ≥22.4, contiguous organ resection, and pancreatic thickness ≥11 mm) were found to be independent predictors of PF (odds ratio, 5.7; 95% confidence interval, 1.9-17, p=0.002, odds ratio, 6.7; 95% confidence interval, 1.6-28, p=0.009, odds ratio, 11.6; 95% confidence interval, 3.7-36, p<0.001, respectively). A scoring scale for the prediction of PF was developed. BMI ≥22.4 (score: 1), contiguous organ resection (score: 1), and pancreatic thickness ≥11 mm (score: 2) were included in the scoring scale. Patients with a score of 0 never developed PF, while PF occurred in all patients with a score of 4. BMI ≥22.4, contiguous organ resection, and pancreatic thickness ≥11 mm were predictive factors for PF after DP. No patients with BMI <22.4, no contiguous organ resection, and a pancreatic thickness of <11 mm developed PF after DP, indicating that such patients may not require drain placement.

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Minimum 5-Year Outcomes for Revision Hip Arthroscopy With a Prospective Subanalysis Against a Propensity-Matched Control Primary Group

The American Journal of Sports Medicine ◽

10.1177/03635465211013006 ◽

2021 ◽

pp. 036354652110130

Author(s):

David R. Maldonado ◽

Cynthia Kyin ◽

Philip J. Rosinsky ◽

Jacob Shapira ◽

Samantha C. Diulus ◽

...

Keyword(s):

Body Mass Index ◽

Body Mass ◽

Hip Arthroscopy ◽

Matched Control ◽

Harris Hip Score ◽

Control Group ◽

Primary Group ◽

Matched Control Group ◽

Before And After

Background: There is a paucity of midterm outcome data on hip revision arthroscopic surgery. Purpose: (1) To report minimum 5-year patient-reported outcome measurement scores (PROMSs) in patients who underwent revision hip arthroscopy, (2) to compare minimum 5-year PROMSs with a propensity-matched control group that underwent primary hip arthroscopy, and (3) to compare the rate of achieving the minimal clinically important difference (MCID) at minimum 5-year follow-up between the revision group and the propensity-matched control primary group. Study Design: Cohort study; Level of evidence, 3. Methods: Data were prospectively collected between June 2008 and April 2014. Patients were included who underwent revision hip arthroscopy with preoperative and minimum 5-year follow-up scores for the 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. Patients with Tönnis grade >1 or with hip conditions such as avascular necrosis, Legg-Calve-Perthes disease, Ehlers-Danlos syndrome, and pigmented villonodular synovitis were excluded. A subanalysis was performed against a propensity-matched control group that underwent primary surgery. Groups were propensity matched in a 1:2 ratio for sex, age, body mass index, and follow-up time. Results: A total of 127 revision arthroscopies (113 patients) were included, and the mean ± SD follow-up time was 72.8 ± 23.3 months. The revision group was 74.0% female, and the average age and body mass index were 34.9 ± 12.4 years and 24.8 ± 4.2, respectively. The revision group demonstrated improvement for all PROMSs and reached the MCID for the mHHS (66.1%), HOS-SSS (68.4%), NAHS (66.9%), and VAS (80.0%). All revision cases were propensity matched to 254 primary arthroscopy cases. PROMSs in the revision group were lower than those of the control group before and after surgery. Delta values were similar between groups for all PROMSs. There were no differences in rates of achieving the MCID. The relative risk of arthroplasty conversion was 2.6 (95% CI, 1.5-4.6) for the revision group as compared with the primary group. Conclusion: Significant improvement in all PROMSs, including the VAS, and high patient satisfaction at minimum 5-year follow-up were reported after revision hip arthroscopy. A high proportion of patients in the revision cohort reached the MCID for the mHHS, HOS-SSS, NAHS, and VAS, with similar rates and magnitudes of improvement relative to the control group. As expected, these data indicate that patients undergoing primary hip arthroscopy have higher PROMSs before and after surgery and lower rates of conversion to arthroplasty.

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