Conversion to Total Hip Arthroplasty After Hip Arthroscopy: A Cohort-Based Survivorship Study With a Minimum of 2-Year Follow-up

2020 ◽  
Vol Publish Ahead of Print ◽  
Author(s):  
Graeme Hoit ◽  
Daniel B. Whelan ◽  
Patrick Ly ◽  
Refik Saskin ◽  
Amit Atrey ◽  
...  
Keyword(s):  
Total Hip Arthroplasty ◽  
Hip Arthroplasty ◽  
Hip Arthroscopy ◽  
Total Hip

In Revision Hip Arthroscopy, Labral Reconstruction Can Address a Deficient Labrum, but Labral Repair Retains Its Role for the Reparable Labrum: A Matched Control Study

2018 ◽  
Vol 46 (14) ◽  
pp. 3437-3445 ◽  
Author(s):  
Itay Perets ◽  
Danil Rybalko ◽  
Brian H. Mu ◽  
David R. Maldonado ◽  
Gary Edwards ◽  
...  
Keyword(s):  
Decision Making ◽  
Total Hip Arthroplasty ◽  
Visual Analog Scale ◽  
Hip Arthroplasty ◽  
Hip Arthroscopy ◽  
Labral Repair ◽  
Acetabular Labrum ◽  
Analog Scale ◽  
Total Hip

Background: Revision hip arthroscopy is increasingly common and often addresses acetabular labrum pathology. There is a lack of consensus on indications or outcomes of revision labral repair versus reconstruction. Purpose: To report clinical outcomes of labral reconstruction during revision hip arthroscopy at minimum 2-year follow-up as compared with pair-matched labral repair during revision hip arthroscopy (control group) and to suggest a decision-making algorithm for labral treatment in revision hip arthroscopy. Study Design: Cohort study; Level of evidence, 3. Methods: Patients who underwent revision hip arthroscopy with labral reconstruction were matched 1:2 with patients who underwent revision arthroscopic labral repair. Patients were matched according to age, sex, and body mass index. Outcome scores, including the modified Harris Hip Score (mHHS), Non-Arthritic Hip Score, Hip Outcome Score–Sport-Specific Subscale, and a visual analog scale for pain, were collected preoperatively and at minimum 2-year follow-up. At latest follow-up, patient satisfaction on a 0-10 scale and the abbreviated International Hip Outcome Tool (iHOT-12) were collected. Complications, subsequent arthroscopies, and conversion to total hip arthroplasty were collected as well. Results: A total of 15 revision labral reconstructions were pair matched to 30 revision labral repairs. The reconstructions had fewer isolated Seldes type I detachments ( P = .008) and lower postoperative lateral center-edge angle, but there were otherwise no significant differences in demographics, radiographics, intraoperative findings, or procedures. Both groups demonstrated significant improvements in all outcomes and visual analog scale at minimum 2-year follow-up. The revision repairs trended toward better preoperative scores: mHHS (mean ± SD: 59.3 ± 16.5 vs 54.2 ± 16.0), Non-Arthritic Hip Score (61.0 ± 16.7 vs 51.2 ± 17.6), Hip Outcome Score–Sport-Specific Subscale (39.6 ± 25.1 vs 30.5 ± 22.1), and visual analog scale (5.8 ± 1.8 vs 6.2 ± 2.2). At follow-up, the revision repair group had significantly higher mHHS (84.1 ± 14.8 vs 72.0 ± 18.3, P = .043) and iHOT-12 (72.2 ± 23.3 vs 49.0 ± 27.6, P = .023) scores than the reconstruction group. The magnitudes of pre- to postoperative improvement between the groups were comparable. The groups also had comparable rates of complications: 1 case of numbness in each group ( P > .999), subsequent arthroscopies (repair: n = 2, 6.5%; revision: n = 3, 20%; P = .150), and conversion to total hip arthroplasty (1 patient in each group, P > .999). Conclusion: Labral reconstruction safely and effectively treats irreparable labra in revision hip arthroscopy. However, labral repair is another treatment option for reparable labra, yielding similar magnitude of improvement. A proposed algorithm may assist in surgical decision making to achieve optimal outcomes based on the condition and history of each patient’s acetabular labrum.

Importance of Retaining Sufficient Acetabular Depth: Successful 2-Year Outcomes of Hip Arthroscopy for Patients With Pincer Morphology as Compared With Matched Controls

2020 ◽  
Vol 48 (10) ◽  
pp. 2471-2480 ◽  
Author(s):  
Claudia R. Brick ◽  
Catherine J. Bacon ◽  
Matthew J. Brick
Keyword(s):  
Total Hip Arthroplasty ◽  
Femoroacetabular Impingement ◽  
Hip Arthroplasty ◽  
Hip Arthroscopy ◽  
Patient Reported Outcomes ◽  
Control Group ◽  
Total Hip ◽  
Patient Reported ◽  
Acetabular Overcoverage

Background: Patients with pincer-type femoroacetabular impingement are commonly treated with arthroscopic reduction of acetabular depth as measured by the lateral center-edge angle (LCEA). The optimal amount of rim reduction has not been established, although large resections may increase contact pressures through the hip. A recent publication demonstrated inferior surgical outcomes in patients with acetabular overcoverage as compared with normal acetabular coverage. Casual observation of our database suggested equivalent improvements, prompting a similar analysis. Purpose: To analyze patient-reported outcomes after hip arthroscopy for femoroacetabular impingement in patients with acetabular overcoverage who were matched with controls with normal coverage, as well as to analyze associations with reduction in LCEA. Study Design: Cohort study; Level of evidence, 3. Methods: Data were collected prospectively from patients with a minimum 2-year follow-up after receiving hip arthroscopy for femoroacetabular impingement by a single surgeon. Cases were reviewed to identify those with pincer-type morphology (LCEA >40°) and matched according to sex, age, chondral damage, and surgery date in a 1:1 ratio with controls with an LCEA of 25° to 40°. The surgical goal was to reduce the LCEA to the upper end of the normal range with minimal rim resection, usually 35° to 37°. Radiographic measurements of coverage, intraoperative findings, procedures, and patient-reported outcomes were recorded, including the 12-Item International Hip Outcome Tool, Non-arthritic Hip Score, Hip Disability and Osteoarthritis Outcome Score, visual analog scale for pain, rates of revision or reoperation, and conversion to total hip arthroplasty. Results: A total of 114 hips (93 patients) for the pincer group were matched 1:1 from 616 hips (541 patients) for the control group. The pincer group (mean ± SD age, 34.5 ± 12.2 years) did not differ in age, body mass index, or follow-up from controls. LCEA was reduced in both groups pre- to postoperatively: the pincer group from 44.0° ± 2.8° to 34.2° ± 3.5° and the controls from 32.9° ± 3.9° to 31.0° ± 3.0°. No differences in improvement were observed: iHOT-12 improved by 35.7 points in both groups ( P = .9 for analysis of variance interaction) and Nonarthritic Hip Score by 22.3 points ( P = .6). From all eligible surgical procedures, 2-year follow up rates were 2.5% and 2.6% for the pincer and control cohorts, respectively, and 1.2% and 0.3% for conversion to total hip arthroplasty. Conclusion: Arthroscopic management of acetabular overcoverage can achieve excellent results, equivalent to arthroscopy for other causes of symptomatic femoroacetabular impingement. A key finding was smaller rim resections producing a mean postoperative LCEA of 34.2° with a small standard deviation.

Does Concomitant Lumbar Spine Disease Adversely Affect the Outcomes of Patients Undergoing Hip Arthroscopy?

2020 ◽  
Vol 48 (9) ◽  
pp. 2178-2184
Author(s):  
Jonathan D. Haskel ◽  
Samuel L. Baron ◽  
Mikhail Zusmanovich ◽  
Thomas Youm
Keyword(s):  
Lumbar Spine ◽  
Total Hip Arthroplasty ◽  
Hip Arthroplasty ◽  
Hip Arthroscopy ◽  
Low Back ◽  
Lumbar Radiculopathy ◽  
Total Hip ◽  
History Of ◽  
Spine Disease

Background: The practice of hip arthroscopy is increasing in popularity, which has highlighted the importance of identifying risk factors that predict hip arthroscopy outcomes. The literature suggests that lumbar spine disease is an independent risk factor for poorer outcomes following total hip arthroplasty; however, the effect of lumbar spine disease on hip arthroscopy outcomes has not been fully investigated. At present, there is a paucity of literature investigating the effect of coexisting hip and lumbar spine disease on outcomes after hip arthroscopy. Purpose: To evaluate the outcomes of hip arthroscopy in patients with concomitant lumbar spine disease compared with those without a history of lumbar spine disease. Study Design: Cohort study; Level of evidence, 3. Methods: A retrospective review of a prospectively collected, single-surgeon database was performed to identify patients who underwent hip arthroscopy with subjective and objective evidence of lumbar disease. Patients were included if they were skeletally mature; had hip disease that failed nonoperative treatment; had symptoms of low back pain, lumbar radiculopathy, or lumbar stenosis at the time of surgery; and had advanced imaging of the lumbar spine (computed tomography or magnetic resonance imaging) confirming lumbar spine disease. Patients were excluded if they had any previous hip surgery or evidence of osteoarthritis of Tönnis grade 2 or higher. The hip-spine cohort was matched by age, sex, and body mass index in a 1:3 fashion to a control cohort consisting of patients without symptoms of low back pain, lumbar radiculopathy, or lumbar stenosis at the time of surgery or a history of lumbar spine disease who underwent hip arthroscopy over the same time period. Baseline preoperative modified Harris Hip Score (mHHS) and Non-Arthritic Hip Score (NAHS) were compared with scores at 3-, 6-, 12-, and 24-month follow-up, and rates of revision arthroscopy or total hip arthroplasty were assessed. Statistical analysis was performed with the Student t test. Results: A total of 38 patients with radiographically confirmed lumbar disease were matched with 111 control patients. Preoperative mHHS and NAHS were significantly lower in the hip-spine cohort ( P = .01 and P = .02, respectively); however, no significant differences were found in mHHS or NAHS between the cohorts at 3, 6, 12, and 24 months postoperatively. A 89.8% increase in mHHS was found in the hip-spine cohort, compared with a 74.4% increase in the control cohort ( P = .0475). No significant differences in the rates of revision or total hip arthroplasty conversion were identified between the hip-spine and control cohorts (23.7% vs 18.0%, respectively; P = .44). Conclusion: Patients with known lumbar spine disease who underwent hip arthroscopy had a significantly greater percentage improvement at 24-month follow-up compared with those without a history of lumbar spine disease, and outcomes were ultimately not significantly different. No increased risk of reoperation was noted in patients with concomitant lumbar spine disease.

Pre-existing osteoarthritis remains a key feature of arthroscopy patients who convert to total hip arthroplasty

2020 ◽  
pp. jisakos-2020-000492
Author(s):  
Renuka M Vesey ◽  
Catherine J Bacon ◽  
Matthew J Brick
Keyword(s):  
New Zealand ◽  
Total Hip Arthroplasty ◽  
Hip Arthroplasty ◽  
Hip Arthroscopy ◽  
Conversion Rate ◽  
Duration Of Symptoms ◽  
Chondral Lesions ◽  
Total Hip ◽  
Patient Reported

ObjectivesTo determine the rate of conversion to total hip arthroplasty following ipsilateral hip arthroscopy by a single surgeon in New Zealand and to describe patient-related and surgical characteristics of patients who converted.MethodsA retrospective cohort analysis of hip arthroscopy patients with 2 years of minimum follow-up identified the total hip arthroplasty conversion rate using the New Zealand National Joint Registry. Prospective data collected from patients who subsequently converted to hip arthroplasty included: sex, age at arthroscopy, body mass index, side of hip arthroscopy and arthroplasty, duration of symptoms and patient-reported outcome measures. Imaging (Tönnis grade and lateral centre-edge angle) and surgical findings (labral, ligamentum teres and osteochondral pathology) along with the arthroscopic procedures performed were also documented.ResultsSixty-six out of 1856 (3.56%) primary hip arthroscopies were followed by an ipsilateral hip arthroplasty during the follow-up period (mean 87±29 months). Most patients had pre-existing osteoarthritis and/or chondral lesions (n=51). Dysplasia and over-resection of the acetabulum were also identified as contributing factors.ConclusionConversion rate by a high-volume surgeon in New Zealand was relatively low. Most patients had pre-existing osteoarthritis and/or chondral lesions that became apparent at arthroscopy. Dysplasia is also a factor to be cautious of when selecting patients for arthroscopy. Acetabular resection must be approached cautiously.Level of evidenceLevel IV.

No Correlation Between Depth of Acetabuloplasty or Postoperative Lateral Center-Edge Angle on Midterm Outcomes of Hip Arthroscopy With Acetabuloplasty and Labral Repair

2020 ◽  
Vol 49 (1) ◽  
pp. 49-54 ◽  
Author(s):  
Adam M. Johannsen ◽  
Joseph J. Ruzbarsky ◽  
Lauren A. Pierpoint ◽  
Rui W. Soares ◽  
Karen K. Briggs ◽  
...  
Keyword(s):  
Total Hip Arthroplasty ◽  
Hip Arthroplasty ◽  
Hip Arthroscopy ◽  
Labral Repair ◽  
Total Hip ◽  
Center Edge ◽  
Lateral Center Edge Angle ◽  
Resection Depth ◽  
Center Edge Angle

Background: The treatment of pincer deformity in hip arthroscopy remains controversial, with some authors advocating that over resection may risk early joint deterioration. The role of acetabular resection depth and postoperative acetabular morphology on postoperative outcomes has yet to be defined. Purpose/Hypothesis: This study measures the influence of acetabular resection depth and postoperative lateral center-edge angle (LCEA) on minimum 5-year patient-reported outcomes (PROs), revision rates, and conversion to total hip arthroplasty using a single surgeon’s prospective database. We hypothesized that patients with acetabular resections >10°, as measured by LCEA, or patients with postoperative LCEA outside the normal range of 25° to 35° would have lower PROs, higher revision rates, and higher conversion to total hip arthroplasty at midterm follow-up. Study Design: Cohort study; Level of evidence, 2. Methods: A total of 192 patients who underwent primary hip arthroscopy with acetabuloplasty and labral repair by a single surgeon with a minimum 5-year follow-up met the inclusion criteria. Preoperative and postoperative LCEAs were measured on supine anteroposterior radiographs, and patients were divided into cohorts based on LCEA and acetabular resection depth. Cohorts for postoperative LCEA were <20° (dysplasia), 20° to 25° (borderline dysplasia), 25° to 35° (normal), and >35° (borderline overcoverage). Cohorts for acetabular resection depth were <5°, 5° to 10°, and >10° difference from preoperative to postoperative LCEA. Outcome measures included the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC), 12-Item Short Form Health Survey, modified Harris Hip Score, Hip Outcome Score, satisfaction scores, revision rates, and conversion to arthroplasty rates. Results: Patients significantly improved in all outcome score measures at final follow-up. There were no statistically significant differences in PRO scores or conversion to total hip arthroplasty between any cohorts in the postoperative LCEA group. There were more revisions in the 25° to 35° cohort than the other cohorts ( P = .02). The 5-10° resection depth cohort demonstrated a higher postoperative WOMAC score ( P = .03), but otherwise no statistically significant differences were seen between resection depth cohorts in the remaining postoperative outcomes scores, revision rates, or conversion to total hip arthroplasty rates. Conclusion: Patients with postoperative LCEA values outside the normal reference range and with large resections perform similar to those with normal postoperative LCEA values and smaller resections at a minimum 5-year follow-up.

scholarly journals Small-head metal on metal total hip arthroplasty is associated with a high rate of complication and reoperation at mid-term follow-up

2021 ◽  
Vol 9 ◽  
pp. 205031212110147
Author(s):  
Nobuhiko Sumiyoshi ◽  
Kazuhiro Oinuma ◽  
Yoko Miura
Keyword(s):  
Total Hip Arthroplasty ◽  
Hip Arthroplasty ◽  
Adverse Reactions ◽  
Small Diameter ◽  
High Rate ◽  
Metal Debris ◽  
Total Hip ◽  
Metal On Metal ◽  
Small Head

Background: Adverse reactions to metal debris are significant complications after metal-on-metal total hip arthroplasty. Recently, late appearances of adverse reactions to metal debris and subsequent need for reoperations have been reported with small-diameter head metal-on-metal devices. We retrospectively investigated mid-term clinical outcomes of small-head metal-on-metal total hip arthroplasty. Methods: We reviewed 159 hips in 139 patients who had a small-head metal-on-metal total hip arthroplasty (M2a Taper; Biomet, Warsaw, IN) with a minimum 5-year follow-up and documented postoperative complications. Results: Focal osteolysis in either the femur or acetabulum was observed in 12 hips (7.5%, 44 months after surgery on average), with pseudotumor observed in 8 hips (5%, 120 months after surgery on average). Four hips (2.5%) had dislocations (84 months after surgery on average) and six hips (3.8%, 122 months after surgery on average) underwent reoperation. Conclusion: Small-head metal-on-metal total hip arthroplasty is associated with a high degree of complications at mid-term follow-up period. Considering this, we discourage the use of metal-on-metal total hip arthroplasty regardless of head size.

scholarly journals Long-term clinical and radiological outcome in patients with severe Legg-Calvé-Perthes disease after Chiari pelvic osteotomy: a mean of 14 years follow-up

2021 ◽  
pp. 112070002098815
Author(s):  
Dammerer Dietmar ◽  
Braito Matthias ◽  
Peter Ferlic ◽  
Kaufmann Gerhard ◽  
Juana Kosiol ◽  
...  
Keyword(s):  
Total Hip Arthroplasty ◽  
Hip Joint ◽  
Hip Arthroplasty ◽  
Pelvic Osteotomy ◽  
Perthes Disease ◽  
Total Hip ◽  
Joint Incongruence ◽  
Chiari Pelvic Osteotomy

Introduction: The Chiari pelvic osteotomy (CPO) has been recommended as a salvage procedure to improve head coverage in case of hip joint incongruence in paediatric hip disease. In this study, we aimed to assess the long-term results of CPO for severe Legg-Calvé-Perthes disease (LCPD). Methods: A total of 39 patients who underwent a CPO at our department between 1995 and 2010 were prospectively followed both radiologically (Stulberg classification) and clinically (Harris Hip Score [HHS], conversion into total hip arthroplasty). In this study, we retrospectively reviewed the cases of 12 hips (12 patients, 3 girls, 8 left hips) treated by CPO for severe LCPD (Catterall grade 3 or 4) with hip joint incongruence. Mean follow-up was 14.0 (range 7.6–21.3) years. Results: Mean age at surgery was 10.2 (range 8.2–17.8) years. Additional femoral osteotomy was performed in 8 patients. A good radiological result (Stulberg I or II) was achieved in 2 patients, a fair result (Stulberg III) in 4 patients, and a poor outcome (Stulberg IV or V) in 6 patients. Mean postoperative HHS averaged 93 (range 65–100) points. An excellent functional outcome (HHS 90–100 points) was achieved in 9 patients. No patient underwent total hip arthroplasty during follow-up. Postoperative limb-length discrepancy was found in 3 patients. Conclusions: CPO for severe LCPD with hip joint incongruence resulted in good long-term clinical outcome in about ⅔ of our patients after a mean of 14 years. Our results suggest that CPO can still be considered as a salvage joint-conserving procedure in this selected group of younger patients.

scholarly journals Total Hip Arthroplasty: Minimal Clinically Important Difference and Patient Acceptable Symptom State for the Forgotten Joint Score 12

2021 ◽  
Vol 18 (5) ◽  
pp. 2267
Author(s):  
Umile Giuseppe Longo ◽  
Sergio De Salvatore ◽  
Ilaria Piergentili ◽  
Anna Indiveri ◽  
Calogero Di Naro ◽  
...  
Keyword(s):  
Total Hip Arthroplasty ◽  
Hip Arthroplasty ◽  
Validity And Reliability ◽  
Total Hip ◽  
Forgotten Joint Score ◽  
Post Surgery ◽  
Clinically Important Difference ◽  
Patient Reported ◽  
Patient Acceptable Symptom State

The Forgotten Joint Score-12 (FJS-12) is a valid patient-reported outcome measures (PROMs) used to assess prosthesis awareness during daily activities after total hip arthroplasty (THA). The minimum clinically important difference (MCID) can be defined as the smallest change or difference that is evaluated as beneficial and could change the patient’s clinical management. The patient acceptable symptom state (PASS) is considered the minimum PROMs cut-off value that corresponds to a patient’s satisfactory state of health. Despite the validity and reliability of the FJS-12 having been already demonstrated, the MCID and the PASS of this score have not previously been defined. Patients undergoing THA from January 2019 to October 2019 were assessed pre-operatively and six months post-surgery using the FJS-12, the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) and the Oxford Hip Score (OHS). Pre-operative and follow-up questionnaires were completed by 50 patients. Both distribution-based approaches and anchor approaches were used to estimate MCID. The aim of this paper was to assess the MCID and PASS values of FJS-12 after total hip replacement. The FJS-12 MCID from baseline to 6 months post-operative follow-up was 17.5. The PASS calculated ranged from 69.8 to 91.7.

Safety of vitamin E-infused highwall liners for routine use in primary total hip arthroplasty: single centre, short-term follow-up of 1221 cases

2020 ◽  
pp. 112070002096964
Author(s):  
Kirill Gromov ◽  
Nanna H Sillesen ◽  
Thomas Kallemose ◽  
Henrik Husted ◽  
Henrik Malchau ◽  
...  
Keyword(s):  
Patient Safety ◽  
Vitamin E ◽  
Total Hip Arthroplasty ◽  
Hip Arthroplasty ◽  
Single Centre ◽  
Short Term ◽  
Total Hip ◽  
Arthroplasty Registry ◽  
Primary Total Hip Arthroplasty

Background: Introduction of new implants should be monitored closely to capture any signs of compromising patient safety. Vitamin E infused highly-crosslinked polyethylene liners (VEPE) offer the potential for reduced wear. Highwall liners have been hypothesised to result in increased wear and potential liner fractures. The aim of this study was to determine the 3–7-year follow-up of highwall VEPE for primary total hip arthroplasty (THA), focusing on liner-related complications. Methods: We included 1221 consecutive THA operations from July 2010 to May 2014 with minimum follow-up of 3 (3.1–6.8) years Data collected included demographics, implant data, complications, reoperations, and deaths. Data were cross-referenced with the Danish Hip Arthroplasty Registry in order to ensure validity and completeness. Acetabular shell position was measured using Martell Hip Analysis Suite in a subgroup of 931 THAs. Results: Cumulative stem revision and shell revision at 3-year follow-up was 3.4% and 0.4% respectively. There were no revisions due to liner failure. Reason for revision included 11 dislocations, 15 soft-tissue revisions for infection, 44 stem revisions of which 34 were periprosthetic fractures and 13 shell revisions of which 6 were combined shell and stem revisions. Conclusion: Early follow-up of VEPE liners for primary THA have not shown any revisions associated with liner failure. Continued monitoring of new materials are necessary to capture any signs of compromised patient safety.

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