Short-Term Outcomes of Open Hip Preservation Surgery for Symptomatic Extraarticular Femoroacetabular Impingement

2017 ◽  
Vol 27 (6) ◽  
pp. 599-607 ◽  
Author(s):  
Benjamin F. Ricciardi ◽  
Kara G. Fields ◽  
Catherine Wentzel ◽  
Bryan T. Kelly ◽  
Ernest L. Sink
Keyword(s):  
Treatment Failure ◽  
Minimum Clinically Important Difference ◽  
Patient Reported Outcome ◽  
Harris Hip Score ◽  
Short Term ◽  
Specific Patient ◽  
Patient Reported ◽  
Open Treatment ◽  
Outcome Tool

Introduction The purposes of this study were to describe: (i) short-term disease-specific patient-reported outcome scores (PROMs); and (ii) factors associated with reoperation or treatment failure in patients undergoing open hip preservation surgery for symptomatic extraarticular FAI. Methods Patients undergoing open hip preservation surgery for symptomatic extraarticular FAI were identified from a prospective, single-centre hip preservation registry (n = 51 patients; median clinical follow-up 24 [range 11-49] months). Hip-specific PROMs were assessed preoperatively, 6 months, and each year subsequently. Patients undergoing reoperation or treatment failure (<10 point improvement in iHOT-33 postoperatively) over the study period were identified. Preoperative associated factors were explored on a univariate basis. Results International Hip Outcome Tool-33 (iHOT-33) improved from 33 (standard deviation [SD] 18) to 62 (26) at most recent follow-up and 76% of patients improved by minimum clinically important difference (MCID). Harris Hip Score improved from 53 (15) to 75 (17) at most recent follow-up and 79% of patients improved by MCID. Hip Outcome Score (HOS) Sport improved from 45 (26) to 66 (28) at most recent follow-up and 60% of patients improved by MCID. Continued improvements in mean follow-up scores were seen from 1 year to 2 years. Overall, 7 patients underwent reoperation and 9 patients failed to improve by MCID. Preoperative HOS Sport was higher in patients experiencing reoperation or treatment failure (58 [SD 19] vs. 40 [SD 27] respectively; p = 0.03). No other associated demographic, physical examination, or radiographic factors were found. Conclusions Open treatment of extraarticular FAI results in short-term improvements in hip-specific PROMs in most patients. Higher HOS Sport scores were associated with reoperation or treatment failure. Longer-term follow-up is necessary to define maximum improvements in this challenging patient population.

Concurrent femoral head reduction and periacetabular osteotomies for the treatment of severe femoral head deformities

2018 ◽  
Vol 100-B (12) ◽  
pp. 1551-1558 ◽  
Author(s):  
J. C. Clohisy ◽  
C. Pascual-Garrido ◽  
S. Duncan ◽  
G. Pashos ◽  
P. L. Schoenecker
Keyword(s):  
Femoral Head ◽  
Periacetabular Osteotomy ◽  
Alpha Angle ◽  
Young Patients ◽  
Patient Reported Outcome ◽  
Harris Hip Score ◽  
Short Term ◽  
Patient Reported ◽  
The Mean

AimsThe aims of this study were to review the surgical technique for a combined femoral head reduction osteotomy (FHRO) and periacetabular osteotomy (PAO), and to report the short-term clinical and radiological results of a combined FHRO/PAO for the treatment of selected severe femoral head deformities.Patients and MethodsBetween 2011 and 2016, six female patients were treated with a combined FHRO and PAO. The mean patient age was 13.6 years (12.6 to 15.7). Clinical data, including patient demographics and patient-reported outcome scores, were collected prospectively. Radiologicalally, hip morphology was assessed evaluating the Tönnis angle, the lateral centre to edge angle, the medial offset distance, the extrusion index, and the alpha angle.ResultsThe mean follow-up was 3.3 years (2 to 4.6). The modified Harris Hip Score improved by 33.0 points from 53.5 preoperatively to 83.4 postoperatively (p = 0.03). The Western Ontario McMasters University Osteoarthritic Index score improved by 30 points from 62 preoperatively to 90 postoperatively (p = 0.029). All radiological parameters showed significant improvement. There were no long-term disabilities and none of the hips required early conversion to total hip arthroplasty.ConclusionFHRO combined with a PAO resulted in clinical and radiological improvement at short-term follow-up, suggesting it may serve as an appropriate salvage treatment option for selected young patients with severe symptomatic hip deformities.

scholarly journals Short-term serial assessment of electronic patient-reported outcome for depression and anxiety in breast Cancer

BMC Cancer ◽  
2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Jeeyeon Lee ◽  
Jin Hyang Jung ◽  
Wan Wook Kim ◽  
Byeongju Kang ◽  
Jungmin Woo ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Treatment Period ◽  
Depression Scale ◽  
Patient Reported Outcome ◽  
Depression And Anxiety ◽  
Short Term ◽  
Web Based ◽  
Patient Reported ◽  
Patient Health

Abstract Purpose The incidence of depression and anxiety is higher in patients with breast cancer than in the general population. We evaluated the degree of depression and anxiety and investigated the changes in patients with breast cancer during the treatment period and short-term follow-up period. Methods Overall, 137 patients with breast cancer were evaluated using the Patient Health Questionnaire 9-item depression scale (PHQ-9) and Generalized Anxiety Disorder scale (GAD-7). The scales were developed as a web-based electronic patient-reported outcome measure, and serial results were assessed before the operation, after the operation, in the post-treatment period, and in the 6-month follow-up period after surgery. Results The degree of depression and anxiety increased during treatment and decreased at 6-month follow-up, even if there were no statistical differences among the four periods (PHQ-9: p = 0.128; GAD-7: p = 0.786). However, daily fatigue (PHQ-9 Q4) and insomnia (PHQ-9 Q3) were the most serious problems encountered during treatment and at 6-month follow-up, respectively. In the GAD-7, worrying too much (Q3) consistently showed the highest scores during the treatment and follow-up periods. Of the patients, 7 (5.11%) and 11 (8.03%) patients had a worsened state of depression and anxiety, respectively, after treatment compared with before treatment. Conclusion Most factors associated with depression and anxiety improved after treatment. However, factors such as insomnia and worrying too much still disturbed patients with breast cancer, even at 6-month follow-up. Therefore, serial assessment of depression and anxiety is necessary for such patients.

scholarly journals Clinical Outcomes of Revision Hip Arthroscopy for Synovial Chondromatosis

2021 ◽  
Author(s):  
Guanying Gao ◽  
Hongjie Huang ◽  
Jianquan Wang ◽  
Yingfang Ao ◽  
Yan Xu
Keyword(s):  
Clinical Outcomes ◽  
Revision Surgery ◽  
Hip Arthroscopy ◽  
Synovial Chondromatosis ◽  
Harris Hip Score ◽  
Radiographic Evaluation ◽  
Patient Reported ◽  
Before And After ◽  
Outcome Tool

Abstract Background: Synovial chondromatosis (SC) is a relatively rare disease and there were few studies on causes and clinical outcomes of revision surgery for SC. The purpose of this study was to evaluate clinical outcomes of revision hip arthroscopy for synovial chondromatosis.Methods: We evaluated consecutive patients who underwent revision hip arthroscopy for SC in our hospital between January 2008 and January 2020. Radiographic evaluation was made before and after surgery. Preoperative patient-reported outcomes (PROs) and PROs at final follow-up were obtained, including visual analog scale (VAS) for pain, the International Hip Outcome Tool-12 (iHOT-12) and modified Harris Hip Score (mHHS).Results: A total of 8 patients (mean age, 39.5 years; age range, 27-62 years; 5 males and 3 females) were included in this study. The recurrence rate of hip SC in our hospital was 6.8%. The average follow-up period after surgery was 47.3 months (range, 12–120 months). Before surgery, mean mHHS was 60.6±17.3 (range, 20-77), mean iHOT-12 was 43.8±13.7 (range, 18-69), and mean VAS was 3.1±1.7 (range, 1-7). At the final post-operative follow-up, mean mHHS was 83.8±16.6 (range, 43-91), iHOT-12 was 80.6±19.7 (range, 32-90), and mean VAS was 0.6±1.8 (range, 0-5). All results demonstrated statistically significant improvement (P < 0.05). Recurrence of SC was found in 2 patients 1 year and 4 years after revision hip arthroscopy, respectively.Conclusion: Hip arthroscopy had good clinical outcomes for revision surgery of SC.

Clinical and Radiographic Predictors for Unsalvageable Labral Tear at the Time of Initial Hip Arthroscopic Management for Femoroacetabular Impingement

2019 ◽  
Vol 47 (9) ◽  
pp. 2029-2037 ◽  
Author(s):  
Hirotaka Nakashima ◽  
Manabu Tsukamoto ◽  
Yasuo Ohnishi ◽  
Hajime Utsunomiya ◽  
Shiho Kanezaki ◽  
...  
Keyword(s):  
Risk Factors ◽  
Patient Reported Outcome ◽  
Labral Tear ◽  
Harris Hip Score ◽  
Patient Reported ◽  
Outcome Scores ◽  
The Mean ◽  
Modified Harris Hip Score ◽  
Reconstruction Group

Background:The acetabular labrum plays important roles in proprioception, nociception, synovial fluid seal effect, and static and dynamic joint stability and as a shock absorber. Clinical and radiographic risk factors for unsalvageable labral tear in femoroacetabular impingement (FAI) are not well established.Purpose:To identify predictors of unsalvageable labral tear during initial hip arthroscopic management of FAI.Study Design:Case-control study; Level of evidence, 3.Methods:Patients were included who underwent primary hip arthroscopic treatment for FAI between March 2009 and March 2014. Patients were excluded who had <2-year follow-up, underwent bilateral surgery, or had a history of surgery, osteoarthritis (Tönnis grade 2 or 3), and other diagnoses, including lateral center-edge angle <25° diagnosed as developmental hip dysplasia. Patients were divided into 2 groups according to their labral condition: reconstruction and refixation. Unsalvageable labral tear was defined as any irreparable labral tear, including severe degenerative tear, frayed labrum, labral ossification, flattened labrum, and failed prior repair during surgery. Univariate and multivariate analyses identified risk factors for segmental labral reconstruction. Patient-reported outcome scores and postoperative revision rates were also assessed.Results:Twenty-five hips (18 male, 7 female) and 126 hips (65 male, 61 female) were included in the reconstruction and refixation groups, respectively. The mean ± SD ages were 52.6 ± 15.0 and 36.5 ± 16.1 years in the reconstruction and refixation groups, respectively. In the reconstruction group, the mean modified Harris Hip Score significantly improved from 67.3 ± 14.9 preoperatively to 95.0 ± 8.1 at final follow-up ( P < .001), and the mean Nonarthritic Hip Score improved from 63.0 ± 18.3 preoperatively to 89.5 ± 10.1 at final follow-up ( P < .001). In the refixation group, the mean modified Harris Hip Score significantly improved from 69.2 ± 18.6 preoperatively to 93.0 ± 11.2 at final follow-up ( P < .001), and the mean Nonarthritic Hip Score improved from 60.7 ± 18.8 preoperatively to 88.6 ± 15.0 at final follow-up ( P < .001). No significant difference was noted in patient-reported outcome scores and revision hip arthroscopy rates. The rate of conversion of total hip arthroplasty was higher in the reconstruction group than in the refixation group. Risk factors for unsalvageable labral tear were age ≥45 years (odds ratio [OR], 8.83; P < .007), body mass index ≥23.1 kg/m2(OR, 13.05; P < .001), and vertical center anterior angle ≥36° (OR, 19.03; P < .001). Furthermore, in this study, unsalvageable labral tears were present in cases with at least 2 of the 3 risk factors.Conclusion:Age ≥45 years, body mass index ≥23.1 kg/m2, and vertical center anterior angle ≥36° are risk factors for unsalvageable labral tear at initial hip arthroscopic surgery for patients with FAI.

scholarly journals Midterm Outcomes Following Hip Labral Augmentation

2021 ◽  
Vol 9 (7_suppl4) ◽  
pp. 2325967121S0024
Author(s):  
Joseph Ruzbarsky ◽  
Justin Arner ◽  
Karen Briggs ◽  
Marc Philippon ◽  
Rui Soares
Keyword(s):  
Patient Satisfaction ◽  
Treatment Option ◽  
Patient Reported Outcomes ◽  
Patient Reported Outcome ◽  
Harris Hip Score ◽  
Iliotibial Band ◽  
Patient Reported ◽  
Modified Harris Hip Score ◽  
Suction Seal

Objectives: Arthroscopic hip labral preservation techniques have evolved over the last decade. Arthroscopic hip labral augmentation with iliotibial band (ITB) autograft placed into a labral defect with viable circumferential fibers is a novel treatment option to restore the hip suction seal and improve functionality. The purpose of this study is to determine midterm (3-5 year follow up) outcomes of arthroscopic hip labral augmentation procedure. Methods: Patients who underwent arthroscopic hip labral augmentation from August 2011 to March 2017 were prospectively evaluated. Pre- and post-operative patient reported outcome scores were compared and included SF12 PCS, SF12 MCS, Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC), Modified Harris Hip Score (mHHS), Hip Outcome Score (HOS) (Activities of Daily Living (ADL) and Sport). Post-operative Tegner Activity Scale and patient satisfaction (1 – 10) were also evaluated. Results: One hundred and six patients underwent arthroscopic hip labral augmentation with minimum 3-year follow-up. Mean follow-up was 5-year follow-up (range, 3 to 9.2 years). All patient reported outcomes improved after labral augmentation (SF12 PCS 39±8 vs. 50±10, p>0.01; mHHS 59±15 vs. 79±21, p<0.01; WOMAC 31±16 vs. 16±17, p<0.01; HOS ADL 64±17 vs. 84±21, p<0.01; HOS Sport 41±22 vs. 71±29, p<0.01). Median post-operative Tegner score was 4. Median post-operative patient satisfaction was 9 out of 10 (range, 1-10). In terms of survivorship, 12 patients (11%) required revision surgery and 6 (5.7%) converted to total hip arthroplasty (THA). Conclusions: Arthroscopic hip labral augmentation is a successful treatment option for patients that have viable circumferential fibers present at the time of arthroscopy. This technique continues to show improved patient reported outcomes and is another hip labral preservation technique that may help reestablish the intra-articular fluid suction seal.

Acetabular microfracture in hip arthroscopy: clinical outcomes with minimum 5-year follow-up

2018 ◽  
Vol 28 (6) ◽  
pp. 649-656 ◽  
Author(s):  
Benjamin G Domb ◽  
Danil Rybalko ◽  
Brian Mu ◽  
Jody Litrenta ◽  
Austin W Chen ◽  
...  
Keyword(s):  
Patient Satisfaction ◽  
Hip Arthroscopy ◽  
Patient Reported Outcomes ◽  
Harris Hip Score ◽  
Significant Deterioration ◽  
Patient Reported ◽  
Outcome Tool ◽  
Modified Harris Hip Score ◽  
Mid Term Results

Introduction: There is a paucity in the literature regarding mid-term results of microfracture in hip arthroscopy. We aim to assess 5-year outcomes of patients who underwent acetabular microfracture for full-thickness chondral lesions as a part of hip arthroscopy. Methods: Between August 2008 and September 2011, data were prospectively gathered for patients undergoing acetabular microfracture during hip arthroscopy with minimum 5-year follow-up. All patients were assessed pre- and postoperatively, with modified Harris Hip Score (mHHS), Non-Arthritic Hip Score (NAHS), Hip Outcome Score – Sports Specific Subscale (HOS-SSS), and visual analog scale (VAS). International Hip Outcome Tool (iHOT-12) and satisfaction were collected postoperatively. Exclusion criteria included previous hip conditions, or preoperative Tönnis grade ≥2. Results: Fifty three hips were eligible for this study. Of these, 43 (81.1%) hips in 42 patients had follow-up. The study group had a male majority (65.1%) and an average age of 44.4 ± 9.5 years. There was statistically significant improvement in all patient-reported outcomes (PROs) and VAS at follow-up. Patient satisfaction was 7.6 ± 2.6. A comparison of 2-year to minimum 5-year follow-up results identified no statistically significant deterioration in PROs, VAS, and patient satisfaction. Survivorship was 72.1% with 12 patients converted to total hip arthroplasty (THA). 4 patients (10.8%) underwent secondary arthroscopy. Conclusions: In the mid-term, microfracture as a part of hip arthroscopy demonstrated favourable outcomes and 72% survivorship. Careful patient selection is warranted to limit the risk of conversion to THA.

scholarly journals Determining the Correlation Between Lateral Radiograph Morphology and the Outcome Following Surgically Treated Intra-Articular Calcaneal Fractures

2020 ◽  
pp. 193864001989722 ◽  
Author(s):  
Lynn E. Nooijen ◽  
Kimberley E. Spierings ◽  
Fay R. K. Sanders ◽  
Siem A. Dingemans ◽  
Jens A. Halm ◽  
...  
Keyword(s):  
Patient Reported Outcome Measures ◽  
Patient Reported Outcome ◽  
Lateral Radiograph ◽  
Wound Complications ◽  
P Value ◽  
Calcaneal Fractures ◽  
Specific Patient ◽  
Patient Reported ◽  
American Orthopaedic

Purpose. It is currently still common practice to obtain conventional radiographs in the follow-up of surgically treated displaced intra-articular calcaneal fractures at regular intervals. There is, however, insufficient evidence that these radiographs can be used to predict functional outcome. The aim of the current study was to evaluate the correlation between the most commonly used angles on lateral radiographs and disease-specific patient-reported outcome measures (PROMs). Methods. Two available databases, containing a total of 233 patients, were used in this study. Eleven angles on the lateral images of the preoperative and at 1-year follow-up radiographs were measured. The 6 most commonly used angles were also measured immediately postoperatively. These 6 most commonly used angles were correlated with PROMs (American Orthopaedic Foot and Ankle Society hindfoot score, Foot Function Index) by a Spearman’s rho analysis. After a Bonferroni correction was applied, a P value of <.0042 was considered to be statistically significant. Results. After exclusion of bilateral fractures, primary arthrodesis, open fractures, wound infections, other wound complications, nonavailable radiographs, and nonresponders, 86 patients remained. No significant correlations were found between the measured angles on the preoperative and at 1-year follow-up radiographs and the PROMs. Conclusion. No apparent correlation between lateral radiograph morphology and outcome was detected. Therefore, long-term follow-up radiographs after confirmed healing may be restricted to patients with persistent complaints on indication. Levels of Evidence: Prognostic, Level IV: Retrospective

scholarly journals Prospective Validation of Patient-Reported Outcomes Measurement Information Systems (PROMIS) CAT Scores in a Hip Preservation Population

2018 ◽  
Vol 6 (7_suppl4) ◽  
pp. 2325967118S0010
Author(s):  
Robert Kollmorgen ◽  
Brian Lewis ◽  
Richard C. Mather ◽  
Steven Olson
Keyword(s):  
Pain Intensity ◽  
Physical Function ◽  
Patient Reported Outcome ◽  
Ceiling Effect ◽  
Harris Hip Score ◽  
Measurement Information ◽  
Excellent Correlation ◽  
Significant Difference ◽  
Patient Reported ◽  
Outcome Tool

Objectives: Current Hip Patient Reported Outcome Scores (PROs) are not universally obtained, centers use different forms to try to interpret treatment outcomes, and are limited by floor and ceiling effects. Legacy scores of Modified Harris Hip Score (mHHS), International Hip Outcome Tool (iHOT), and Hip Outcomes Score (HOS) are common place and used in the literature. Patient compliance for legacy PROs have been shown to limit proper data collection. PROMIS measures were developed through NIH funding, vetted against a population norm and PROMIS Computer Adaptive Testing (CAT) has been shown in recent literature to compare well with knee and shoulder legacy scores, and are completed in a quicker amount of time. We hypothesize that in a hip preservation population, the CAT PROMIS Profile V2.0 and PROMIS physical function (PF) would show high correlation with legacy scores of (mHHS, iHOT, and HOS). Methods: After obtaining IRB approval, power analysis revealed 86 patients were needed to detect a significant difference. 100 patients were prospectively enrolled. Patients were asked to complete the iHOT-12, mHHS, HOS and then complete the CAT PROMIS Profile v 2.0. Inclusion criteria for the current study included all Initial encounter and single follow-up patients that have completed the CAT portion and started the legacy scores before opting out. Exclusion criteria will be any patient with a repeat encounter, patients under the age of 18 or a patient that did not complete the legacy or CAT scores. Repeat encounters were excluded due to statistical analysis assuming independence among observers. Correlation between instruments was defined as excellent (>0.7), excellent-good (0.7-0.61), good (0.6-0.4), and poor (0.3-0.2). Results: Demographics of 75 females and 25 males, mean BMI 26.3, and mean age 36.1 (range 18-67). The PROMIS Physical function, Pain Intensity, and Ability to Participate in Social Roles showed excellent correlation with the iHOT-12 (r=0.71 P<0.001), mHHS (r=0.8 P<0.001) and HOS (r=0.82 P<0.001). Patients averaged 21.6 questions to complete all seven arms of the PROMIS Profile. No patient experienced a ceiling effect utilizing the PROMIS Profile CAT. Conclusion: The PROMIS Profile allows for an in-depth look at patients’ dysfunction, not asked in current legacy scores. The PROMIS Physical function and Pain Intensity show excellent correlation with iHOT-12, mHHS and HOS. The CAT PROMIS Profile, shows no observed ceiling effect and can be considered to replace current legacy measures in hip preservation.

scholarly journals Six Month Follow-Up of Patient Reported Outcomes Following Third Generation Minimally Invasive Chevron Akin Osteotomies (MICA) in Hallux Valgus Surgery

2020 ◽  
Vol 5 (4) ◽  
pp. 2473011420S0033
Author(s):  
Thomas L. Lewis ◽  
Robbie Ray ◽  
David Gordon
Keyword(s):  
Minimally Invasive ◽  
Hallux Valgus ◽  
Patient Reported Outcomes ◽  
Case Series ◽  
Third Generation ◽  
Short Term ◽  
Specific Patient ◽  
Patient Reported ◽  
The Mean

Category: Bunion Introduction/Purpose: The aim of this study was to explore the short-term results of third generation (using screw fixation) Minimally Invasive Chevron and Akin osteotomies (MICA) for hallux valgus correction. There is a paucity of published data regarding the outcomes of this relatively new technique. We present the largest series in the literature, using three separate validated patient-reported outcome measures (EQ-5DL, VAS Pain and Manchester Oxford Foot Questionnaire (MOXFQ), for this time point. Methods: A single surgeon case series of patients with hallux valgus underwent primary third generation minimally invasive chevron and akin osteotomies for hallux valgus correction. Between August 2015 and July 2019, 478 MICAs were performed in 328 patients that were eligible for 6 month follow up. Baseline and 6 month post-operative patient reported outcomes were collected for 340 feet in 267 patients (247 females; 20 males). Paired t-tests were used to determine the statistical significance of the difference between pre- and post-operative scores. Results: The mean age was 54.9 (range 16.3-84.9, standard deviation (s.d.) 12.8). At 6 month follow up, the mean MOXFQ scores had improved for each domain: Pain; baseline 42.5 (range 0-100, s.d. 22.6), reduced to 16.3 (range 0-100, s.d. 18.4, p<0.001); Walking; baseline 35.5 (range 0-100, s.d. 24.8), reduced to 12.2 (range s.d. 19.1, p<0.001); Social interaction; baseline 45.4 (range 0- 100, s.d. 22.6), reduced to 10.9 (range 0-100.0, s.d. 16.9, p<0.001). Mean VAS Pain score improved from 30.5 (range 0.0-90.0, s.d. 22.1) to 10.5 (range 0.00-78.0, s.d. 14.8, p<0.001). Mean EQ-5D index score improved from 0.752 (range 0.066-1.000, s.d. 0.133) to 0.872 (range 0.122-1.000, s.d. 0.133, p<0.001). Mean EQ-5D VAS score remained static from 82.7 (range 0-100, s.d. 13.3) to 83.7 (range 0-100, s.d. 17.8, p=0.386). Conclusion: This is the largest prospective case series of short-term patient reported outcomes using a validated assessment method for hallux valgus, following third generation MICA to date. These data show that this technique is effective at improving foot and ankle specific patient reported outcomes at 6 months. This cohort is being followed over the longer term.

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