scholarly journals Achieving Successful Outcomes of Hip Arthroscopy in the Setting of Generalized Ligamentous Laxity with Labral Preservation and Appropriate Capsular Management: A Matched Pair Controlled Study

2020 ◽  
Vol 8 (7_suppl6) ◽  
pp. 2325967120S0045
Author(s):  
Benjamin Domb ◽  
Jeffrey Chen ◽  
Philip Rosinsky ◽  
Jacob Shapira ◽  
Ajay Lall ◽  
...  
Keyword(s):  
Hip Arthroscopy ◽  
Matched Pair ◽  
Harris Hip Score ◽  
Controlled Study ◽  
Control Group ◽  
Sample Population ◽  
Ligamentous Laxity ◽  
Center Edge ◽  
Labral Tears

Objectives: (1) To report minimum two-year PROs in patients with generalized ligamentous laxity (GLL) who underwent hip arthroscopy and (2) to compare clinical results to a matched-pair control group without GLL. Methods: Data from a prospectively collected database was 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 (FAI). Inclusion criteria included preoperative and minimum two-year follow-up scores for the following PROs: modified Harris Hip Score (mHHS), Non-Arthritic Hip Score (NAHS), Hip Outcome Score-Sports Specific Scale (HOS-SSS), and Visual Analogue Scale (VAS). Patients were excluded if they had preoperative Tönnis ≥ 2, ipsilateral hip condition, prior hip surgery, worker’s compensation status, or dysplasia. From the sample population, two groups were created: the GLL group (Beighton ≥ 4) and the control group (Beighton < 4). Patients were matched in a 1:2 ratio via propensity-score matching according to age, gender, body mass index (BMI), acetabular and femoral head Outerbridge grade, and preoperative lateral center-edge angle (LCEA). Patient Acceptable Symptomatic State (PASS) and Minimal Clinically Important Difference (MCID) for mHHS and HOS-SSS were calculated. PASS was also calculated for International Hip Outcome Tool-12 (iHOT-12) as well as MCID for VAS. Significant differences were noted if P < 0.05. Results: 95 patients with GLL were matched to 143 control patients. Age, gender, BMI, and follow-up times were not different (P > 0.05). Preoperative radiographic measurements demonstrated no difference. Intraoperative findings and procedures between groups were similar except for capsular treatment, with the GLL group receiving more plications (P = 0.004). Both groups reported similar baseline PROs and VAS. At minimum two-year follow-up both groups showed significant improvement in PROs and VAS (P < 0.001), furthermore, the postoperative PROs at minimum two-year follow-up showed no difference (P > 0.05) and the magnitude of improvement (delta value) was similar for mHHS (P = 0.93), NAHS (P = 0.809), HOS-SSS (0.398) and VAS (P = 0.824). Moreover, groups reached comparable rates of MCID and/or PASS for mHHS, HOS-SSS, iHOT-12, and VAS. Conclusions: Patients with GLL following hip arthroscopy for symptomatic FAI and labral tears, may expect favorable outcomes with appropriate labral and capsular management at minimum two-year follow-up. When compared to a pair-matched control group without GLL, results were comparable for mHHS, NAHS, HOS-SSS, VAS and reaching PASS and/or MCID for mHHS, HOS-SSS, iHOT-12 and VAS.

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

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.

scholarly journals Minimum 5-Year Outcomes of Arthroscopic Hip Labral Reconstruction with Nested Matched-Pair Benchmarking Against a Labral Repair Control Group

2019 ◽  
Vol 7 (7_suppl5) ◽  
pp. 2325967119S0043
Author(s):  
Benjamin G. Domb ◽  
Muriel R. Battaglia ◽  
Itay Perets ◽  
Ajay C. Lall ◽  
Austin Chen ◽  
...  
Keyword(s):  
Patient Satisfaction ◽  
Hip Arthroscopy ◽  
Labral Repair ◽  
Matched Pair ◽  
Harris Hip Score ◽  
Control Group ◽  
Labral Tears ◽  
Point Increase ◽  
Patient Reported

Objectives: Labral reconstruction has demonstrated short-term benefit for the treatment of irreparable labral tears. Nonetheless, there is a scarcity of evidence for mid-term outcomes of this treatment. The purpose of our study was to report 5-year outcomes in patients who underwent segmental labral reconstruction. In addition, we compared 5-year outcomes of patients who underwent primary segmental labral reconstruction (PLRECON) with a matched-pair control group that underwent primary labral repair (PLREPAIR). We hypothesized that arthroscopic segmental reconstruction in the setting of irreparable labral tears would show improvement in patient-reported outcomes (PROs) and high patient satisfaction at minimum 5-year follow-up. Secondly, PLRECON would experience similar improvement in PROs at minimum 5-year follow-up when compared to a matched-pair PLREPAIR control group. Methods: Data from February 2008 to April 2013 was retrospectively reviewed. Patients were included if they underwent hip arthroscopy for segmental labral reconstruction in the setting of irreparable labral tear and femoro-acetabular impingement (FAI), with minimum 5-year follow-up for modified Harris Hip Score (mHHS), Non-Arthritic Hip Score (NAHS), Hip Outcome Score-Sports Specific Subscale (HOS-SSS), and Visual Analogue Scale (VAS) for pain. Exclusion criteria were Tönnis osteoarthritis grade >1, prior hip conditions, or Workers’ Compensation claims. PLRECON were matched in a 1:3 ratio to a PLREPAIR group based on age ±5 years, gender, and body mass index (BMI) ±5 kg/m2. Results: Twenty-eight patients were eligible for the study, of which 23 (82.14%) had minimum 5-year follow-up. We found significant improvement from preoperative to latest follow-up in all outcome measures recorded: 17.8-point increase in mHHS (P=0.002), 22-point increase in NAHS (P<0.001), 25.4-point increase in HOS-SSS (P=0.003), and a 2.9-point decrease in VAS pain ratings (P<0.001). Average patient satisfaction was 7.1 out of 10. In the nested matched-pair analysis, 17 PLRECON were matched to a control group of 51 PLREPAIR patients. PLRECON demonstrated comparable survivorship and comparable improvements in all PROs with the exception of patient satisfaction. Conclusion: Hip arthroscopy with segmental labral reconstruction resulted in significant improvement in PROs at minimum 5-year follow-up. PLRECON reached comparable functional outcomes when compared to a benchmark PLREPAIR control group, but demonstrated lower patient satisfaction at latest follow-up. [Figure: see text]

Hip Arthroscopic Surgery in the Context of Femoroacetabular Impingement Syndrome, Labral Tear, and Acetabular Overcoverage: Minimum 5-Year Outcomes With a Subanalysis Against Patients Without Overcoverage

2020 ◽  
Vol 49 (1) ◽  
pp. 55-65 ◽  
Author(s):  
David R. Maldonado ◽  
Samantha C. Diulus ◽  
Jacob Shapira ◽  
Philip J. Rosinsky ◽  
Cynthia Kyin ◽  
...  
Keyword(s):  
Hip Arthroscopy ◽  
Control Group ◽  
Center Edge ◽  
Labral Tears ◽  
Femoroacetabular Impingement Syndrome ◽  
Age At Surgery ◽  
And Control ◽  
Lateral Center Edge Angle ◽  
Acetabular Overcoverage

Background: Improvement in patient-reported outcomes (PROs) has been reported in the short term after hip arthroscopy for femoroacetabular impingement syndrome (FAIS) and labral tear in the setting of acetabular overcoverage. Yet, there is a paucity of information in the literature on midterm PROs. Purpose: To (1) report minimum 5-year PROs in patients who underwent primary hip arthroscopy for FAIS and acetabular labral tears in the context of acetabular overcoverage and (2) compare outcomes with those of a propensity-matched control group without acetabular overcoverage. Study Design: Cohort study; Level of evidence, 3. Methods: Data were prospectively collected and retrospectively analyzed on all patients who underwent hip arthroscopy for FAIS and labral tears between February 2008 and November 2013. Inclusion criteria were lateral center-edge angle >40° and minimum 5-year follow-up for the modified Harris Hip Score (mHHS), Nonarthritic Hip Score (NAHS), and the Hip Outcome Score–Sports-Specific Subscale (HOS-SSS). Exclusion criteria were previous ipsilateral hip surgery or conditions, active workers’ compensation claims, or lack of minimum 5-year outcomes. A 1:1 propensity-matched comparison was made between the study group and a control group without acetabular overcoverage (lateral center-edge angle, 25°-40°) based on age at surgery, sex, body mass index, Tönnis grade, laterality, and follow-up time. The minimal clinically important difference (MCID) was calculated for the mHHS, HOS-SSS, and NAHS. Secondary surgical procedures were recorded. Results: A total of 54 patients satisfied the inclusion criteria for the study group, of whom 45 (83.3%; 45 hips) had a minimum 5-year follow-up and were matched without differences in age at surgery, sex, body mass index, or follow-up time. The study and control groups demonstrated significant and comparable improvements for the mHHS (mean ± SD Δ, 24.06 ± 24.19 vs 26.33 ± 17.27; P = .625), NAHS (Δ, 31.22 ± 25.31 vs 27.15 ± 17.61; P = .399), and HOS-SSS (Δ, 33.16 ± 34.73 vs 34.75 ± 26.15; P = .557). The rates for achieving the MCID were similar for the study and control groups for the mHHS (76.7% vs 84.2%; P = .399), HOS-SSS (79.1% vs 75.8%; P = .731), and NAHS (81.4% vs 84.2%; P = .738). Need for revision surgery was similar ( P = .748). A lower conversion rate to total hip arthroplasty was reported for the study than for the control group (2.2% vs 15.6%; P = .026). Conclusion: In the context of FAIS, labral tears, and acetabular overcoverage, patients who underwent hip arthroscopy reported significant improvement in several PROs at minimum 5-year follow-up. Moreover, outcomes were comparable with those of a propensity-matched control group without acetabular overcoverage. Furthermore, the rate of achieving the MCID for the mHHS, HOS-SSS, and NAHS was similar between these groups.

Outcomes of Hip Arthroscopic Surgery in Patients With Tönnis Grade 1 Osteoarthritis at a Minimum 5-Year Follow-up: A Matched-Pair Comparison With a Tönnis Grade 0 Control Group

2017 ◽  
Vol 45 (10) ◽  
pp. 2294-2302 ◽  
Author(s):  
Benjamin G. Domb ◽  
Edwin O. Chaharbakhshi ◽  
Danil Rybalko ◽  
Mary R. Close ◽  
Jody Litrenta ◽  
...  
Keyword(s):  
Arthroscopic Surgery ◽  
Arthroscopic Treatment ◽  
Matched Pair ◽  
Harris Hip Score ◽  
Control Group ◽  
Pair Comparison ◽  
Labral Tears ◽  
Vas Scores ◽  
Tönnis Grade

Background: Studies on midterm outcomes of the arthroscopic treatment of femoroacetabular impingement (FAI) and labral tears with mild osteoarthritis (OA) are limited. Purpose: To evaluate outcomes of the arthroscopic treatment of FAI and labral tears in patients with mild preoperative OA (Tönnis grade 1) at a minimum 5-year follow-up, and to perform a matched-pair comparison to a control group with Tönnis grade 0. Study Design: Cohort study; Level of evidence, 3. Methods: Data were prospectively collected on patients who underwent hip arthroscopic surgery between February 2008 and April 2011. Inclusion criteria were arthroscopic treatment for FAI and labral tears and having preoperative patient-reported outcome (PRO) scores, including the modified Harris Hip Score (mHHS), Non-Arthritic Hip Score (NAHS), and Hip Outcome Score–Sports-Specific Subscale (HOS-SSS), and visual analog scale (VAS) scores for pain. Exclusion criteria were workers’ compensation claims, preoperative Tönnis grade ≥2, and previous hip conditions (ipsilateral surgery, slipped capital femoral epiphysis, avascular necrosis, and dysplasia). Patients with minimum 5-year outcomes were eligible for matching on a 1:1 ratio (Tönnis grade 0 vs 1) based on age ±5 years, body mass index ±5 kg/m2, sex, labral treatment, and capsular treatment. Results: Of 356 eligible hips, 292 hips had minimum 5-year outcomes (82%). Eighty-five hips with Tönnis grade 1 were evaluated. At 5-year follow-up, patients with Tönnis grade 1 had significant improvements in all PRO and VAS scores ( P < .0001). The overall satisfaction score was 8.2. The survivorship rate with respect to conversion to total hip arthroplasty for the Tönnis grade 1 group was 69.4% at 5 years, while in the Tönnis grade 0 group, it was 88.4% ( P = .0002). Sixty-two hips with Tönnis grade 0 were matched to 62 hips with Tönnis grade 1. Both groups demonstrated improvements in all PRO and VAS scores from preoperatively to postoperatively ( P < .0001). No significant differences existed between preoperative or postoperative scores or survivorship between the groups. Conclusion: The arthroscopic treatment of FAI and labral tears in patients with Tönnis grade 1 had good results at 5-year follow-up. After controlling for other variables using a matched-pair comparison, patients with Tönnis grade 1 had similar, durable improvements to those with Tönnis grade 0. While strict surgical indications and appropriate expectations are recommended for patients with mild OA, Tönnis grade 1 alone should not be considered a contraindication to hip arthroscopic surgery.

scholarly journals Effect of Cigarette Smoking on Patient-Reported Outcomes in Hip Arthroscopic Surgery: A Matched-Pair Controlled Study With a Minimum 2-Year Follow-up

2019 ◽  
Vol 7 (1) ◽  
pp. 232596711882283 ◽  
Author(s):  
Ajay C. Lall ◽  
Jon E. Hammarstedt ◽  
Asheesh G. Gupta ◽  
Joseph R. Laseter ◽  
Mitchell R. Mohr ◽  
...  
Keyword(s):  
Patient Reported Outcomes ◽  
Smoking Status ◽  
Arthroscopic Surgery ◽  
Matched Pair ◽  
Harris Hip Score ◽  
Controlled Study ◽  
Control Group ◽  
Patient Reported ◽  
Smoking Group

Background: The rate of hip arthroscopic surgery has recently increased; however, there is limited literature examining patient-reported outcomes (PROs) in cigarette smokers. Purpose/Hypothesis: The purpose of this study was to evaluate whether smoking status for patients undergoing hip arthroscopic surgery affects clinical findings and PRO scores. We hypothesized that patients who smoke and undergo primary hip arthroscopic surgery will have similar clinical examination findings and preoperative and postoperative PRO scores compared with nonsmoking patients. Study Design: Cohort study; Level of evidence, 3. Methods: Data were collected on all patients who underwent primary hip arthroscopic surgery from February 2008 to July 2015. A retrospective analysis of the data was then conducted to identify patients who reported cigarette use at the time of the index procedure. Patients were matched 1:2 (smoking:nonsmoking) based on sex, age within 5 years, labral treatment (repair vs reconstruction vs debridement), workers’ compensation status, and body mass index within 5 kg/m2. All patients were assessed preoperatively and postoperatively using 4 PRO measures: the modified Harris Hip Score (mHHS), Non-Arthritic Hip Score (NAHS), Hip Outcome Score–Sport-Specific Subscale (HOS-SSS), and International Hip Outcome Tool–12 (iHOT-12). Pain was estimated using a visual analog scale. Satisfaction was measured on a scale from 0 to 10. Significance was set at P < .05. Results: A total of 75 hips were included in the smoking group, and 150 hips were included in the control group. Preoperatively, the smoking group had significantly lower PRO scores compared with the control group for the mHHS, NAHS, and HOS-SSS. Both groups demonstrated significant improvement from preoperative levels. A minimum 2-year follow-up was achieved, with a mean of 42.5 months for the smoking group and 47.6 months for the control group ( P = .07). At the latest follow-up, the smoking group reported inferior results for all outcome measures compared with controls. The improvement in PRO scores and rates of treatment failure, revision arthroscopic surgery, and complications was not statistically different between the groups. Conclusion: Patients who smoke had lower PRO scores preoperatively and at the latest follow-up compared with nonsmokers. Both groups demonstrated significant improvement in all PRO scores. These results show that while hip arthroscopic surgery may still yield clinical benefit in smokers, these patients may ultimately achieve an inferior functional status. To optimize results, physicians should advise patients to cease smoking before undergoing hip arthroscopic surgery.

Minimum 5-Year Outcomes of Arthroscopic Hip Labral Reconstruction With Nested Matched-Pair Benchmarking Against a Labral Repair Control Group

2019 ◽  
Vol 47 (9) ◽  
pp. 2045-2055 ◽  
Author(s):  
Benjamin G. Domb ◽  
Muriel R. Battaglia ◽  
Itay Perets ◽  
Ajay C. Lall ◽  
Austin W. Chen ◽  
...  
Keyword(s):  
Patient Satisfaction ◽  
Labral Repair ◽  
Matched Pair ◽  
Harris Hip Score ◽  
Control Group ◽  
Analog Scale ◽  
Labral Tears ◽  
Point Increase ◽  
Modified Harris Hip Score

Background: Labral reconstruction has demonstrated short-term benefit for the treatment of irreparable labral tears. Nonetheless, there is a scarcity of evidence for midterm outcomes of this treatment. Hypotheses: Arthroscopic segmental reconstruction in the setting of irreparable labral tears would show improvement in patient-reported outcomes (PROs) and high patient satisfaction at minimum 5-year follow-up. Second, primary labral reconstruction (PLRECON) would result in similar improvement in PROs at minimum 5-year follow-up when compared with a matched-pair primary labral repair (PLREPAIR) control group. Study Design: Cohort study; Level of evidence, 3. Methods: Data from February 2008 to April 2013 were retrospectively reviewed. Patients were included if they underwent hip arthroscopy for segmental labral reconstruction in the setting of irreparable labral tear and femoroacetabular impingement, with minimum 5-year follow-up for modified Harris Hip Score, Nonarthritic Hip Score, Hip Outcome Score–Sports Specific Subscale, patient satisfaction, and visual analog scale for pain. Exclusion criteria were Tönnis osteoarthritis grade >1, prior hip conditions, or workers’ compensation claims. PLRECON cases were matched in a 1:3 ratio to a PLREPAIR control group based on age ±5 years, sex, and body mass index ±5 kg/m2. Results: Twenty-eight patients were eligible for the study, of which 23 (82.14%) had minimum 5-year follow-up. The authors found significant improvement from preoperative to latest follow-up in all outcome measures recorded: 17.8-point increase in modified Harris Hip Score ( P = .002), 22-point increase in Nonarthritic Hip Score ( P < .001), 25.4-point increase in Hip Outcome Score–Sports Specific Subscale ( P = .003), and a 2.9-point decrease in visual analog scale pain ratings ( P < .001). Mean patient satisfaction was 7.1 out of 10. In the nested matched-pair analysis, 17 patients who underwent PLRECON were matched to a control group of 51 patients who underwent PLREPAIR. PLRECON demonstrated comparable survivorship and comparable improvements in all PROs with the exception of patient satisfaction (6.7 vs 8.5, P = .04). Conclusion: Hip arthroscopy with segmental labral reconstruction resulted in significant improvement in PROs at minimum 5-year follow-up. PLRECON reached comparable functional outcomes when compared with a benchmark PLREPAIR control group but demonstrated lower patient satisfaction at latest follow-up.

scholarly journals Is Hip Arthroscopy Effective in Patients With Combined Excessive Femoral Anteversion and Borderline Dysplasia? A Match-Controlled Study

2018 ◽  
Vol 47 (1) ◽  
pp. 123-130 ◽  
Author(s):  
Edwin O. Chaharbakhshi ◽  
David E. Hartigan ◽  
Itay Perets ◽  
Benjamin G. Domb
Keyword(s):  
Hip Arthroscopy ◽  
Femoral Anteversion ◽  
Harris Hip Score ◽  
Control Group ◽  
Edge Angle ◽  
Center Edge ◽  
Modified Harris Hip Score ◽  
Lateral Center Edge Angle ◽  
Center Edge Angle

Background: Appropriate patient selection is critical when hip arthroscopy is considered in the setting of borderline dysplasia (BD). It is presumable that excessive femoral anteversion (EFA) and BD may contraindicate arthroscopy. Hypothesis: Patients with combined EFA and BD (EFABD) demonstrate significantly inferior short-term outcomes after arthroscopic labral preservation and capsular closure when compared with a similar control group with normal lateral coverage and femoral anteversion. Study Design: Cohort study; Level of evidence, 3. Methods: Data were prospectively collected and retrospectively reviewed on patients undergoing hip arthroscopy between April 2010 and November 2014. The EFABD group’s inclusion criteria were BD (lateral center-edge angle, 18°-25°), labral tear, capsular closure, and femoral version ≥20°, as well as preoperative modified Harris Hip Score, Nonarthritic Hip Score, Hip Outcome Score–Sports Specific Subscale, and visual analog scale. Exclusion criteria were workers’ compensation, preoperative Tönnis grade >1, microfracture, abductor pathology, or previous ipsilateral hip surgery or conditions. Patients in the EFABD group were matched 1:2 to a similar control group with normal coverage and femoral anteversion by age at surgery ± 6 years, sex, body mass index ± 5, acetabular Outerbridge grade (0, 1 vs 2, 3, 4), and iliopsoas fractional lengthening. Results: Sixteen EFABD cases were eligible for inclusion, and 100% follow-up was obtained at ≥2 years postoperatively. Twelve EFABD cases were matched to 24 control cases. Mean femoral version was 22.4° in the EFABD group and 10.2° in the control group ( P = .01). Mean lateral center-edge angle was 22.1° in the EFABD group and 31.5° in the control group ( P < .0001). Acetabuloplasty was performed significantly more frequently in the control group ( P = .0006). No other significant differences were found regarding demographics, findings, procedures, or preoperative scores. At latest follow-up, the EFABD group demonstrated significantly lower mean modified Harris Hip Score (76.1 vs 85.9; P = .005), Nonarthritic Hip Score (74.8 vs 88.5; P < .0001), Hip Outcome Score–Sports Specific Subscale (58.3 vs 78.4; P = .02), and patient satisfaction (7.1 vs 8.3; P = .005). There were 4 secondary surgical procedures (33.3%) in the EFABD group and 1 (4.2%) in the control group ( P = .03). One patient in each group required arthroplasty. Conclusion: Patients treated with arthroscopic labral preservation and capsular closure in the setting of EFABD demonstrated significant improvements from presurgery to latest follow-up. However, their results are significantly inferior when compared with a matched-controlled group. Consideration of periacetabular osteotomy or femoral osteotomy may be warranted in the setting of EFABD to achieve optimal benefit.

scholarly journals Intact Ligamentum Teres Predicts Superior Prognosis in Borderline Dysplastic Patients: A Matched Pair Controlled Study with Minimum Five-Year Outcomes Following Hip Arthroscopy

2020 ◽  
Vol 8 (7_suppl6) ◽  
pp. 2325967120S0042
Author(s):  
Benjamin Domb ◽  
Sarah Chen ◽  
Rafael Walker-Santiago ◽  
Jacob Shapira ◽  
Philip Rosinsky ◽  
...  
Keyword(s):  
Hip Arthroscopy ◽  
Matched Control ◽  
Ligamentum Teres ◽  
Matched Pair ◽  
Controlled Study ◽  
Control Group ◽  
Matched Control Group ◽  
Center Edge ◽  
Significant Difference ◽  
Patient Reported

Objectives: (1) To report minimum five-year patient reported outcomes (PROs) in borderline dysplastic patients with ligamentum teres (LT) tears who underwent hip arthroscopy and (2) to compare these PROs to a pair-matched control group of borderline dysplastic hips without LT tears. Methods: Data was prospectively collected for patients who underwent hip arthroscopy during September 2008 and August 2013. Patients were included if had a preoperative diagnosis of borderline dysplasia [lateral center-edge angle (LCEA) of 18°- 25°] and had preoperative and minimum five-year postoperative modified Harris Hip Scores (mHHS), Non-Arthritic Hip Scores (NAHS), and Visual Analogue Scale for pain (VAS) scores. Exclusion criteria were Tönnis grade osteoarthritis >1, previous hip conditions, any prior ipsilateral hip surgery, or workers’ compensation status. Two borderline dysplastic groups were created. An LT tear group was matched 1:1 to a control group (no LT tear) with similar age, sex, body mass index (BMI), and laterality via propensity score matching. Significance was set at P < 0.05. Results: 24 LT tear patients (24 hips) were matched 24 patients (24 hips) without an LT tear. There was no significant difference in age, sex, BMI, or laterality between groups. Mean age was 36.2 ± 17.2 and 34.9 ± 15.9 years for the control and LT tear group, respectively (P = 0.783). There were 17 (70.8%) and 16 (66.7%) females in the control and LT tear group, respectively and the mean preoperative LCEA was 23.3° and 22.2° in the control and LT tear group, respectively. No differences were observed between groups in baseline PROs, intraoperative findings, or surgical procedures, except for LT treatment. Five-year postoperative PROs were comparable in both groups, with the control group exhibiting superior Veterans RAND 12-Item Health Survey Mental Component (VR-12M) (P = 0.041) and Short Format 12 Mental Health (SF-12M) (P = 0.042). The control group exhibited less pain and higher satisfaction with surgery; however, this trend was not significant. Finally, the LT tear group was significantly less likely to achieve the patient acceptable symptomatic state (PASS) for mHHS (P = 0.022). Conclusion: Following hip arthroscopy, patients with borderline dysplasia and LT tears demonstrated favorable PROs at minimum five-year follow-up. Outcomes were similar to a pair-matched control group without LT tears, with the control group showing higher VR-12M and SF-12M scores. Furthermore, borderline dysplastic patients with LT tears were significantly less likely to achieve the PASS for mHHS.

Hips With Acetabular Retroversion Can Be Safely Treated With Advanced Arthroscopic Techniques Without Anteverting Periacetabular Osteotomy: Midterm Outcomes With Propensity-Matched Control Group

2020 ◽  
Vol 48 (7) ◽  
pp. 1636-1646 ◽  
Author(s):  
David R. Maldonado ◽  
Jeffery W. Chen ◽  
Cynthia Kyin ◽  
Philip J. Rosinsky ◽  
Jacob Shapira ◽  
...  
Keyword(s):  
Hip Arthroscopy ◽  
Matched Control ◽  
Periacetabular Osteotomy ◽  
Acetabular Retroversion ◽  
Harris Hip Score ◽  
Control Group ◽  
Matched Control Group ◽  
Labral Tears ◽  
Patient Reported

Background: Different options, from reverse (anteverting) periacetabular osteotomy to hip arthroscopy, have been proposed for surgical treatment of femoroacetabular impingement syndrome (FAIS) in the setting of acetabular retroversion. Purpose: (1) To report and analyze midterm patient-reported outcome scores (PROs) in patients with FAIS and labral tears in the setting of acetabular retroversion after isolated hip arthroscopy and (2) to compare these PROs with those of a propensity-matched control group without acetabular retroversion. Study Design: Cohort study; Level of evidence, 3. Methods: Prospectively collected data were retrospectively reviewed for patients who underwent hip arthroscopy for FAIS and labral tear treatment between June 2008 and March 2014. Inclusion criteria were as follows: acetabular retroversion, pre- and postoperative PROs for modified Harris Hip Score (mHHS), Non-arthritic Hip Score, Hip Outcome Score–Sports Specific Scale (HOS-SSS), and visual analog scale (VAS). Propensity score matching was utilized to identify a control group without acetabular retroversion matched 1:1 with similar age, sex, body mass index, acetabular and femoral head Outerbridge grade, preoperative lateral center-edge angle, and labral treatment. Patient acceptable symptomatic state (PASS) and/or minimal clinically important difference (MCID) for the mHHS, HOS-SSS, International Hip Outcome Tool–12, and VAS was calculated. Results: A total of 205 hips with acetabular retroversion were matched to a control group. The groups showed no difference in demographic variables. The retroversion group was composed of 139 female and 66 male hips, with a mean ± SD age of 23.81 ± 7.28 years and follow-up time of 65.24 ± 20.31 months. Intraoperative diagnostic data and procedures performed were similar between groups, except more femoroplasties were performed in the retroversion group. Significant improvements for the mHHS, Non-arthritic Hip Score, HOS-SSS, and VAS were seen for both groups at a mean 5-year follow-up. The proportion of patients who reached the PASS and MCID were similar. Conclusion: In the setting of FAIS and labral tears, patients with acetabular retroversion can be safely treated with advanced hip arthroscopic techniques without reverse (anteverting) periacetabular osteotomy in a high-volume surgeon’s hands. Patients with acetabular retroversion demonstrated favorable PROs at midterm follow-up. Furthermore, the proportion of patients reaching the MCID and PASS for several PROs were comparable with those of a propensity-matched control group without acetabular retroversion.

Do Ligamentum Teres Tears Portend Inferior Outcomes in Patients With Borderline Dysplasia Undergoing Hip Arthroscopic Surgery? A Match-Controlled Study With a Minimum 2-Year Follow-up

2017 ◽  
Vol 45 (11) ◽  
pp. 2507-2516 ◽  
Author(s):  
Edwin O. Chaharbakhshi ◽  
Itay Perets ◽  
Lyall Ashberg ◽  
Brian Mu ◽  
Christopher Lenkeit ◽  
...  
Keyword(s):  
Arthroscopic Surgery ◽  
Ligamentum Teres ◽  
Harris Hip Score ◽  
Controlled Study ◽  
Control Group ◽  
Capsular Plication ◽  
Center Edge ◽  
Treatment Type ◽  
Patient Reported

Background: Arthroscopic surgery in borderline dysplastic hips remains controversial, but the role of the ligamentum teres (LT) has not been studied in this setting. Hypothesis: Borderline dysplastic patients with LT tears have worse short-term outcomes than those without LT tears. Study Design: Cohort study; Level of evidence, 3. Methods: Data were prospectively collected on patients who underwent arthroscopic surgery between February 2008 and April 2014. The inclusion criteria were borderline dysplasia (lateral center-edge angle [LCEA], 18°-25°) and labral tears; arthroscopic treatments including labral preservation and capsular plication; and preoperative patient-reported outcome scores including the modified Harris Hip Score (mHHS), Non-Arthritic Hip Score (NAHS), Hip Outcome Score–Sport-Specific Subscale, and visual analog scale for pain. Patients were excluded for preoperative Tönnis osteoarthritis grade >0, workers’ compensation claims, previous ipsilateral hip surgery and conditions, or frank dysplasia (LCEA <18°). Patients with LT tears were pair-matched to patients without tears for sex, age at surgery ±10 years, body mass index (<30 kg/m2 vs ≥30 kg/m2), labral treatment type, and microfracture. Results: Of 68 eligible patients, 63 (93%) had a minimum 2-year follow-up, and 30 (48%) had LT tears. Twenty patients in each group were pair-matched. The mean follow-up time was 54.3 months (range, 24.2-83.8 months) for the LT tear group and 38.6 months (range, 24.6-70.6 months) for the control group ( P = .002). Ninety percent were female. There were no significant differences regarding demographics or intra-operative procedures. The LT tear group trended toward lower postoperative mHHS ( P = .09) and NAHS ( P = .09) values. Mean satisfaction was 8.1 for the LT tear group and 7.9 for the control group. Preoperative and follow-up scores were not significantly different between the groups. The LT tear group had 5 revisions, with 1 revision in the control group. Three patients (15%) in the LT tear group underwent total hip arthroplasty (THA); no patients in the control group required THA. Conclusion: In borderline dysplastic patients undergoing hip arthroscopic surgery with labral treatment and capsular plication, LT tears may indicate advanced instability and portend slightly inferior outcomes when compared with a match-controlled group. Borderline dysplastic patients with LT tears may have increased propensities toward revision arthroscopic surgery and conversion to THA. LT tears in these patients may warrant consideration for additional procedures including periacetabular osteotomy and LT reconstruction.

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