scholarly journals Effect of Sex and Age on Achieving Meaningful Clinical Outcomes at 5-years after Hip Arthroscopy for Femoroacetabular Impingement: A Comparative Match-Group Analysis

2020 ◽  
Vol 8 (7_suppl6) ◽  
pp. 2325967120S0043
Author(s):  
Edward Beck ◽  
Justin Drager ◽  
Benedict Nwachukwu ◽  
Kyleen Jan ◽  
Shane Nho ◽  
...  
Keyword(s):  
Clinical Outcomes ◽  
Femoroacetabular Impingement ◽  
Hip Arthroscopy ◽  
Female Patients ◽  
Outcome Score ◽  
Modifiable Factors ◽  
Functional Scores ◽  
Male Patients ◽  
Age And Sex

Objectives: Non-modifiable factors including age and sex have been shown to effect outcomes following hip arthroscopy in patients with femoroacetabular impingement syndrome (FAIS) at short-term follow-up. However, their effect on achieving long-term meaningful outcomes has not been evaluated. As such, the purpose of this study is to compare clinical outcomes, including achieving meaningful clinical important difference (MCID) and the patient acceptable symptomatic state (PASS) at 5-years, by age and sex. Methods: 150 patients undergoing hip arthroscopy for femoroacetabular impingement by a single fellowship trained surgeon were prospectively analyzed, with 25 patients in each of the following groups: female patients younger than 30 years of age, female patients 30 to 45 years of age, female patients older than 45 years of age, male patients younger than 30 years of age, male patients 30 to 45 years of age, and male patients older than 45 years of age. Pre and postoperative functional scores were collected including the Hip Outcome Score Activities of Daily Living Subscale (HOS-ADL), Hip Outcome Score Sport-Specific Subscale (HOS-Sport), the modified Harris hip score (mHHS), and visual analog scale (VAS) satisfaction and pain at 5-year follow-up. MCID and PASS was calculated for each functional measure and compared by gender and age category. Results: At 5-year follow-up, all groups demonstrated statistically significant improvement in the functional outcome score averages and pain (p<0.001 for all). Both within gender and within age category analysis of postoperative functional scores did not demonstrate any statistically significant differences (p>0.05).Analysis of achieving MCID and PASS demonstrated that females had a higher rate of reaching the HOS-SS and mHHS threshold for achieving MCID as compared to their male counterparts (48.3% vs 58%%; p=0.008 and 54% vs 75.4%; p=0.012, respectively). Furthermore, patients <30 years old had higher rates of reaching the HOS-ADL and mHHS for achieving PASS than the two older age groups (p>0.05 for both). Conclusions: Non-modifiable factors, including age and sex, influence the rate of achieving meaningful clinical outcomes at 5-year follow up. Female patients are more likely to reach the HOS-SS and mHHS threshold for achieving MCID, while those <30 years of age are more likely to reach the HOS-ADL and mHHS threshold for achieving PASS as compared to older patients.

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

2018 ◽  
Vol 46 (6) ◽  
pp. 1324-1330 ◽  
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.

Does Iliopsoas Lengthening Adversely Affect Clinical Outcomes After Hip Arthroscopy? A Multicenter Comparative Study

2018 ◽  
Vol 46 (11) ◽  
pp. 2624-2631 ◽  
Author(s):  
David R. Maldonado ◽  
Aaron J. Krych ◽  
Bruce A. Levy ◽  
David E. Hartigan ◽  
Joseph R. Laseter ◽  
...  
Keyword(s):  
Cohort Study ◽  
Clinical Outcomes ◽  
Hip Arthroscopy ◽  
Labral Tear ◽  
Harris Hip Score ◽  
Pain Patient ◽  
Control Group ◽  
Safe Procedure ◽  
Outcome Score

Background: Iliopsoas fractional lengthening (IFL) continues to be a controversial procedure in hip arthroscopy. Hypothesis: Patients who underwent arthroscopic surgery for femoroacetabular impingement (FAI) and a labral tear either with or without IFL would experience favorable outcomes, and there would be no difference in postoperative patient-reported outcomes (PROs) between the 2 groups at minimum 2-year follow-up. Study Design: Cohort study; Level of evidence, 3. Methods: Data from July 2009 and April 2015 were retrospectively reviewed. Patients were eligible if they had hip arthroscopy for both FAI and labral tear treatment with IFL and without IFL. IFL was indicated for painful internal snapping. Minimum postoperative follow-up was set to 2 years. The authors calculated the modified Harris Hip Score, International Hip Outcome Tool–12, Hip Outcome Score–Activity of Daily Living Score, Hip Outcome Score–Sports Specific Subscale, Non-Arthritic Hip Score, visual analog scale for pain, patient satisfaction, minimal clinically important difference (MCID), and the percentage of patients who achieved patient acceptable symptomatic state (PASS). Revision surgeries and conversions to total hip arthroplasty (THA) were documented. Results: 351 hips (307 patients) met the necessary inclusion criteria in the IFL cohort, with a mean ± SD follow-up time of 42.5 ± 18.1 months. For the control cohort, 392 hips (354 patients) were included, with a mean ± SD follow-up time of 43.9 ± 19.6 months. Both groups showed significant postoperative improvement in 2-year follow-up PROs. The group with iliopsoas lengthening showed comparable results to the control group with respect to PRO improvement, MCID, PASS, and rates of revision or THA conversion. Conclusion: This comparative cohort study demonstrated that treatment of painful internal snapping syndrome with arthroscopic IFL, in the setting of FAI and a labral tear, is a safe procedure with good short- to mid-term follow-up results and associated improvement in PROs. Patients who underwent IFL showed similar outcomes compared with a control group treated for FAI and labral tear without IFL. In appropriately selected patients, arthroscopic IFL did not adversely affect clinical outcomes compared with patients who did not need IFL.

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

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

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

scholarly journals Prolonged Postoperative Opioid Use after Arthroscopic Femoroacetabular Impingement Syndrome Surgery: Predictors and Outcomes at Minimum Two Year Follow-up

2020 ◽  
Vol 8 (7_suppl6) ◽  
pp. 2325967120S0043
Author(s):  
Edward Beck ◽  
Benedict Nwachukwu ◽  
Justin Drager ◽  
Kyleen Jan ◽  
Shane Nho ◽  
...  
Keyword(s):  
Logistic Regression ◽  
Femoroacetabular Impingement ◽  
Hip Arthroscopy ◽  
Opioid Use ◽  
Opioid Prescription ◽  
Time Of Surgery ◽  
Femoroacetabular Impingement Syndrome ◽  
Functional Scores ◽  
Preoperative Predictors

Objectives: To identify preoperative predictors for patients requiring at least one postoperative opioid refill after undergoing hip arthroscopy for femoroacetabular impingement and 2) to determine 2-year reported outcomes in those requiring opioid refills. Methods: Data from consecutive patients undergoing hip arthroscopy for FAIS from January 2012 to December 2016 was analyzed. Baseline demographics were recorded, including preoperative opioid use, as well as pre- and 2-year postoperative functional scores specifically the Hip Outcome Score-Activity of Daily Living (HOS-ADL), HOS-Sports Subscale (HOS-SS), modified hip Harris score (mHHS), international hip outcome tool (iHOT-12), and visual analog score (VAS) for pain and satisfaction were recorded. A correlation analysis was used to identify preoperative demographic and clinical variables associated with requiring postoperative opioid refill. Variables with a statistically significant association (p<0.05) were included in a final logistic regression model. Results: A total of 775 patients with postoperative opioid use and 2-year follow-up were included in the analysis. 141 (18.2%) patients required at least one preoperative opioid prescription refill in addition to the routine opioid total prescription postoperatively to every patient after hip arthroscopy. Patients requiring opioid refills had significantly lower HOS-ADL (79.9+20.3 vs 88.7+14.9), HOS-SS (64.6+29.5 vs 78.2+23.7), mHHS (74.2+21.1 vs 83.6+15.9), iHOT-12(63.6+27.9 vs 74.9+24.8), and VAS satisfaction (73.4+30.3 vs 82.2+24.9) averages, as well as higher pain (26.8+23.4 vs 17.9+21.8) when compared to patients without additional opioid refills with p<0.001 for all outcomes. Logistic regression analysis demonstrated that preoperative predictors of requiring additional postoperative opioids included patients with a history of opioid use prior to surgery (OR: 4.04; 95%CI: 1.99-8.19) and larger preoperative alpha angles (OR:1.04; 95%CI: 1.01-1.07). Sub-analysis by past versus current opioid use at the time of surgery demonstrated that current use was a predictive of requiring additional postoperative opioids (OR:3.12; 95%CI: 1.06-9.21; p=0.039), while past opioid use for was not. Conclusion: Patients requiring at least one postoperative opioid refill after undergoing hip arthroscopy for FAIS have lower 2-year functional scores when compared to patients not requiring refills. Additionally, active pre-operative opioid use at the time of surgery, as well as larger preoperative alpha angles are predictors of requiring additional opioids for pain management.

scholarly journals Predictors of Inferior Outcomes Following Hip Arthroscopy for Femoroacetabular Impingement

2017 ◽  
Vol 5 (3_suppl3) ◽  
pp. 2325967117S0011 ◽  
Author(s):  
Gregory L. Cvetanovich ◽  
Ben Kuhns ◽  
Alexander E. Weber ◽  
Jennifer Alter ◽  
Richard C. Mather ◽  
...  
Keyword(s):  
Clinical Outcome ◽  
Femoroacetabular Impingement ◽  
Hip Arthroscopy ◽  
Joint Space ◽  
Older Age ◽  
Workers Compensation ◽  
Psychiatric History ◽  
Outcome Score ◽  
Outcome Group

Objectives: Hip arthroscopy for femoroacetabular impingement (FAI) provides reliable pain relief and functional improvement in the majority of patients. Although a small percentage of patients will go on to subsequent revision hip arthroscopy or conversion to arthroplasty, some patients will also have inferior clinical outcome without revision surgery. The purpose of this study is to identify clinical and radiographic characteristics predictive of inferior outcomes 2-years following hip arthroscopy for FAI. Methods: A clinical repository containing patients undergoing primary hip arthroscopy for femoroacetabular impingement (FAI) between 1/1/2012-1/1/2014 with a minimum follow up of two years was queried to include patients in this study. Operative procedures generally included labral debridement and repair, acetabular rim trimming, femoral osteochondroplasty and capsular plication. The primary outcome measure was the Hip Outcome Score Activities of Daily Living (HOS-ADL) questionnaire. Secondary outcome measures included the Hip Outcome Score Sports Subscale (HOS-SS) and modified Harris Hip Score (MHHS). Patients requiring revision hip arthroscopy or hip arthroplasty were excluded from this study. Patients were organized into superior and inferior outcome groups based on the top and bottom quartiles of the postoperative HOS-ADL score. Demographic, preoperative, intraoperative and postoperative variables between these groups were compared to identify predictors for inferior outcomes using bivariate and multivariate analyses. Results: Of 482 patients undergoing hip arthroscopy for FAI there was two year outcome data for 392 patients (81.5%) with an average follow up of 2.3 ± 0.6 years. The superior group contained 98 patients with an HOS-ADL score of 97.06 or higher while the inferior group contained 98 patients with an HOS-ADL score of 80.5 or lower. Patients in the superior outcome group were younger (30.7 ± 12.8 vs 38.0 ± 11.8 p<0.001) with a lower BMI (24.1 ± 4.1 vs. 26.5 ± 5.1 p=0.005) and higher preoperative average joint space width (4.2 ± 0.5 mm vs. 3.7 ± 0.4 mm; p=0.009) and lower Tonnis grade (p<0.001; Table 1 ). Patients in the inferior outcome group also had a higher incidence of smoking (p=0.005), workers compensation claims (p=0.04) and prior psychiatric history (p=0.007). A stepwise multivariate logistic regression analysis revealed that older age (p=0.00674), higher BMI (p=0.02629), and smoking (p=0.01863) were independent predictive factors of inferior outcome ( Table 1 ). Both groups demonstrated significant improvements in HOS-ADL, and MHHS scores, however the inferior outcome group did not have significantly improved HOS-SS scores (p=0.06). [Table: see text] Conclusion: Older age, higher BMI, and smoking were independent predictors of inferior clinical outcomes at 2-years following hip arthroscopy for FAI, although both superior and inferior outcome groups experienced significantly improved clinical outcome scores. In addition, lower preoperative joint space, workers compensation status, and psychiatric history were significant factors for inferior outcomes on bivariate analysis. These factors can be considered in preoperative patient counseling about the expected outcome of hip arthroscopy for FAI.

Five-Year Outcomes and Return to Sport of Runners Undergoing Hip Arthroscopy for Labral Tears With or Without Femoroacetabular Impingement

2019 ◽  
Vol 47 (6) ◽  
pp. 1459-1466 ◽  
Author(s):  
Austin W. Chen ◽  
Matthew J. Craig ◽  
Leslie C. Yuen ◽  
Victor Ortiz-Declet ◽  
David R. Maldonado ◽  
...  
Keyword(s):  
High School ◽  
Femoroacetabular Impingement ◽  
Hip Arthroscopy ◽  
Rate Of Return ◽  
Professional Athletes ◽  
Harris Hip Score ◽  
Long Distance ◽  
Outcome Score ◽  
Modified Harris Hip Score

Background: Recent evidence has demonstrated a high rate of return to running after hip arthroscopy for femoroacetabular impingement at short-term follow-up. The midterm outcomes and rates of continued running of these patients are unknown. Purpose: To evaluate midterm rates of return to running and outcomes after hip arthroscopy. Study Design: Case series; Level of evidence, 4. Methods: Data were prospectively collected for patients who underwent hip preservation surgery between July 2008 and November 2011. Patients were excluded for preoperative Tönnis osteoarthritis grade ≥2, previous ipsilateral hip conditions or hip surgery, or workers’ compensation status. All patients who participated in mid- to long-distance running before their surgery and intended on returning after their operation were considered for inclusion. Preoperative and minimum 5-year postoperative measures for the following patient-reported outcome scores (PROs) were necessary for inclusion in the final cohort: the modified Harris Hip Score, Non-arthritic Hip Score, Hip Outcome Score–Sports Specific Subscale, and visual analog scale (VAS) for pain. All patients were counseled about the risks of continued running after hip arthroscopy. Results: Sixty patients (62 hips) were eligible for inclusion, of which 50 (83.3%; 52 hips) had minimum 5-year follow-up. There were 10 male hips and 42 female hips. Mean ± SD age at surgery was 32.4 ± 12.4 years (range, 14.9-62.4), and mean body mass index was 22.9 ± 3.2 (range, 17.7-30.1). Latest follow-up was recorded at a mean 69.3 ± 8.5 months (range, 60.0-92.1 months). Level of competition included 39 recreational, 7 high school, 4 collegiate, and 2 professional athletes. There were significant improvements in all PROs and VAS scores preoperatively to latest follow-up. Mean modified Harris Hip Score improved from 67.5 to 88.2; mean Non-arthritic Hip Score, from 65.9 to 88.3; mean Hip Outcome Score–Sports Specific Subscale, from 49.5 to 81.0; and mean VAS, from 5.2 to 1.5. At latest follow-up, patient satisfaction was 8.4. Thirty-nine patients (78.0%, 41 hips) had returned to running postoperatively. When stratified by level of competition, 79% (31 of 39) of recreational, 100% (7 of 7) of high school, 50% (2 of 4) of collegiate, and 50% (1 of 2) of professional athletes returned to running. Conclusion: Hip arthroscopy for all levels of runners is associated with a significant increase in PROs and a low risk of complications. The rate of return to running is moderately high after hip arthroscopy at midterm follow-up. Hip arthroscopy may be considered for runners presenting with symptoms of femoroacetabular impingement that fail nonoperative treatments. Patients should be educated on the rate of return to running over time and the risks of continued running after hip arthroscopy.

Comparing Outcomes of Competitive Athletes Versus Nonathletes Undergoing Hip Arthroscopy for Treatment of Femoroacetabular Impingement Syndrome

2019 ◽  
Vol 48 (1) ◽  
pp. 159-166 ◽  
Author(s):  
Ian M. Clapp ◽  
Benedict U. Nwachukwu ◽  
Edward C. Beck ◽  
Kyleen Jan ◽  
Anirudh K. Gowd ◽  
...  
Keyword(s):  
Clinical Outcomes ◽  
Femoroacetabular Impingement ◽  
Clinical Benefit ◽  
Hip Arthroscopy ◽  
Impingement Syndrome ◽  
Outcome Score ◽  
Substantial Clinical Benefit ◽  
Femoroacetabular Impingement Syndrome ◽  
Competitive Athletes ◽  
Chi Square Analysis

Background: A growing number of studies have examined return to sport in competitive athletes after undergoing hip arthroscopy for femoroacetabular impingement syndrome (FAIS); however, few have evaluated the rate of achieving meaningful clinical outcomes in this group. Purpose: To determine if competitive athletes (professional, semiprofessional, or collegiate) have better 2-year patient-reported outcomes and achieve the minimal clinically important difference (MCID) and substantial clinical benefit at higher rates when compared with nonathletes undergoing hip arthroscopy for the treatment of FAIS. Study Design: Cohort study; Level of evidence, 3. Methods: The study was a retrospective analysis of all consecutive patients who identified as either a competitive athlete or a nonathlete and had undergone hip arthroscopy for FAIS by a single fellowship-trained surgeon between January 2012 and April 2017. Patients in the 2 groups were matched 1:2 by age, sex, and body mass index. Baseline and clinical outcomes, including the Hip Outcome Score–Activities of Daily Living, Hip Outcome Score–Sports Subscale (HOS-SS), modified Harris Hip Score, and international Hip Outcome Tool-12, were collected preoperatively and at 2 years postoperatively and compared between the groups. The MCID and substantial clinical benefit were calculated for each group separately and compared using chi-square analysis. Results: A total of 59 competitive athletes and 118 nonathletes were included in the final analysis. Most of the competitive athletes were soccer players (23.7%), followed by softball players (10.2%) and runners (10.2%). Postoperative score comparison between competitive athletes and nonathletes demonstrated a statistically significant difference in the HOS-SS (mean ± SD, 84.5 ± 19.0 vs 76.1 ± 23.8; P = .02). Meaningful outcome analysis demonstrated that competitive athletes had a higher rate of achieving the HOS-SS threshold for the MCID (97.4% vs 82.5%; P = .021). There was no other difference in frequency of achieving the threshold for any other meaningful clinical outcome between the groups. Conclusion: Hip arthroscopy for the treatment of FAIS in competitive athletes and nonathletes produced clinically meaningful outcomes in both patient groups. However, competitive athletes achieved the MCID on the HOS-SS at higher rates than nonathletes and had significantly higher scores at 2 years postoperatively on the HOS-SS.

Early Hip Arthroscopy for Femoroacetabular Impingement Syndrome Provides Superior Outcomes When Compared With Delaying Surgical Treatment Beyond 6 Months

2019 ◽  
Vol 47 (9) ◽  
pp. 2038-2044 ◽  
Author(s):  
Kyle N. Kunze ◽  
Edward C. Beck ◽  
Benedict U. Nwachukwu ◽  
Junyoung Ahn ◽  
Shane J. Nho
Keyword(s):  
Femoroacetabular Impingement ◽  
Hip Arthroscopy ◽  
Minimal Clinically Important Difference ◽  
Surgical Intervention ◽  
Impingement Syndrome ◽  
Symptom Duration ◽  
Clinically Important Difference ◽  
Outcome Score ◽  
Femoroacetabular Impingement Syndrome

Background: There is literature on the association between chronic preoperative pain and worse outcomes among patients undergoing hip arthroscopy for femoroacetabular impingement syndrome (FAIS). However, there are few data on whether there is an optimum window that provides the best midterm surgical outcomes. Purpose: To assess the outcomes of hip arthroscopy for FAIS according to timing of surgical intervention. Study Design: Cohort study; Level of evidence, 3. Methods: Patients undergoing arthroscopic intervention for FAIS with a minimum 2-year follow-up were included. All patients completed the Hip Outcome Score–Activities of Daily Living (HOS-ADL), Hip Outcome Score–Sport Specific (HOS-SS), modified Harris Hip Score (mHHS), International Hip Outcome Tool–12 (iHOT-12), and visual analog scales for pain and satisfaction. Patients were stratified by preoperative symptom duration. We compared 3 to 6 months of symptoms with other subsequent time frames (>6-12, >12-24, and >24 months). Clinically significant outcome was determined with the minimal clinically important difference and patient acceptable symptomatic state. Results: A total of 1049 patients were included (mean ± SD: age, 32.3 ± 12.4 years; follow-up, 30.8 ± 6.7 months). Patients undergoing surgery at 3 to 6 months of symptoms had no significant differences in outcome when compared with those in the >6- to 12-month group except for the iHOT-12 ( P = .028). Patients with symptom duration of >12 to 24 months and >24 months had worse outcomes across all measures ( P < .001). Surgery within 3 to 6 months of symptoms was predictive for achieving the minimal clinically important difference on the HOS-ADL (odds ratio [OR], 1.81; 95% CI, 1.20-2.73) and HOS-SS (OR, 1.90; 95% CI, 1.11-3.17), as well as the patient acceptable symptomatic state on the HOS-ADL (OR, 1.85; 95% CI, 1.34-2.56) and HOS-SS (OR, 1.58; 95% CI, 1.14-2.18), when compared with the other groups. In multivariate regression analysis, symptom duration was predictive of visual analog scale for pain (β = 3.10; 95% CI, 1.56-4.63; P < .001) and satisfaction (β = −4.16; 95% CI, −6.14 to −2.18; P < .001). Conclusion: Among patients with FAIS, surgical intervention early after the onset of symptoms (3-6 months) was associated with superior postoperative outcomes when compared with patients who underwent surgical intervention beyond this time frame. This information may help guide preoperative decision making regarding delay of surgery. These findings should be confirmed in a prospective study.

scholarly journals The Clinical Outcomes of Ultrasound-Guided Hip Joint Injection in The Treatment of Persistent Pain After Hip Arthroscopy

2020 ◽  
Author(s):  
Guanying Gao ◽  
Qiang Fu ◽  
Ruiqi Wu ◽  
Rongge Liu ◽  
Ligang Cui ◽  
...  
Keyword(s):  
Clinical Outcomes ◽  
Hip Joint ◽  
Hip Arthroscopy ◽  
Persistent Pain ◽  
Joint Injection ◽  
Ultrasound Guided ◽  
Outcome Score ◽  
The Mean ◽  
Hip Injection

Abstract Background: To evaluate the short-term and long-term clinical outcomes of ultrasound-guided hip joint injection in the treatment of persistent pain after hip arthroscopy.Methods: Patients who had persistent pain after hip arthroscopy and underwent ultrasound-guided hip injection for treatment between January 2016 and February 2019 were involved. Pre-injection patient-reported outcomes (PROs) and post-injection PROs 1 month after injection and at final follow-up were obtained, including visual analog scale (VAS), modified Harris Hip Score (mHHS), Hip Outcome Score – Sport Specific Subscale (HOS - SSS) and Hip Outcome Score - Activity of Daily Living (HOS – ADL). VAS 10 minutes after injection was also recorded. Patient satisfaction with outcome of injection (graded as excellent, good, fair or poor) was documented at the end of follow-up. Results: A total of 33 patients were involved in this study. The mean follow-up time after injection was 24.1 months. The mean time between surgery and injection was 10.7 months. The VAS, mHHS, HOS-SSS and HOS-ADL improved from 5.6 ± 1.4, 56.4 ± 10.7, 59.1 ± 8.5 and 44.2 ± 17.1 to 3.3 ± 2.1, 67.3 ± 12.7, 69.1 ± 14.7 and 57.2 ± 23.0, respectively at 1 month after injection and improved to 2.4 ± 2.2, 76.4 ± 11.7, 80.3 ± 14.3 and 69.6 ± 23.0 at final follow-up. All results demonstrated statistically significant difference between different time point (P < 0.05). Three (9.1%) patients thought the outcome of ultrasound-guided hip injection was excellent, 8 (24.2%) thought the outcome was good, 9 (27.3%) thought the outcome was fair, and 13 (39.4%) thought the effect of injection was poor.Conclusion: Ultrasound-guided hip joint injection would be a feasible treatment method of persistent pain after hip arthroscopy, especially in older patients, patients with higher BMI and patents who are sensitive to intra-articular injection.Level of Evidence IV.

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