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Ruff G, Nwakoby E, Lehane K, Moore M, Kaplan DJ, Youm T. Female Sex Increases Susceptibility for the Negative Impacts of Advanced Age and Obesity on Patient-Reported Functional Outcomes 10 Years after Primary Hip Arthroscopy for Femoroacetabular Impingement Syndrome. Arthroscopy 2025:S0749-8063(25)00137-9. [PMID: 40010519 DOI: 10.1016/j.arthro.2025.02.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/30/2024] [Revised: 01/28/2025] [Accepted: 02/10/2025] [Indexed: 02/28/2025]
Abstract
PURPOSE This study aims to evaluate patient-reported outcomes (PROs) and reoperation rates in patients undergoing primary hip arthroscopy for femoroacetabular impingement syndrome (FAIS) over a minimum 10-year follow-up stratified by sex, age, and body mass index (BMI). METHODS Primary hip arthroscopies performed for FAIS between 2010 and 2013, with a minimum 10-year follow-up, were reviewed. Procedures consisting of microfracture, or labral debridement without repair, were excluded. Ten-year PROs were assessed using the modified Harris Hip Score (mHHS) and Non-Arthritic Hip Score (NAHS). Patients were categorized into three groups by age (<30, 30-44, >45 years) and BMI (<25.0, 25.0-29.9, ≥ 30). Minimum clinically important difference (MCID) was set to half the preoperative standard deviation of the cohort. Reoperation rates and PROs were compared, and regression analysis identified independent predictors of PROs. RESULTS At minimum 10-year follow-up (mean: 11.6 [10.0-13.9] years), 59.2% follow-up was achieved, representing 154 hips (141 patients). The cohort had a mean age of 38.5 years, BMI of 24.4, and was 68.2% female. At follow-up, 91.6% of the cohort achieved MCID with a 9.7% reoperation rate. In the middle-aged group, males had higher mHHS (mean: 92.8 vs 85.2; P = .015) and NAHS (mean: 91.6 vs 83.4; P = .008) scores compared to females. In the BMI ≥30 group, males had higher mHHS (mean: 83.3 vs 66.4; P = .030) and NAHS scores (mean: 83.0 vs 58.5; P = .035). Only 72.7% of females with BMI ≥30 achieved MCID for mHHS and NAHS, compared to BMI <25 (96.6% and 94.9%, respectively) and 25-29.9 (87.5% and 83.3%) (mHHS: P = .016; NAHS: P = .038). Similarly, 78.8% of females aged ≥45 achieved MCID for NAHS, compared to 92.9% of those aged <30 and 97.1% of those 30-44 (P = .040). Multivariable regression identified older age (mHHS: P = .019; NAHS: P = .042) and higher BMI (mHHS: P = .007; NAHS: P < .001) as independently predictive of worse 10-year PROs. CONCLUSION Older age and greater BMI independently predicted poorer long-term functional outcomes after hip arthroscopy for FAIS. Female sex, while not independently predictive, may make patients more susceptible to the negative effects of older age and BMI. No significant association was observed for reoperation rates. LEVEL OF EVIDENCE Level IV, retrospective therapeutic case series.
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Affiliation(s)
- Garrett Ruff
- Department of Orthopedic Surgery, NYU Langone Health, New York, NY, U.S.A
| | | | - Kevin Lehane
- Department of Orthopedic Surgery, NYU Langone Health, New York, NY, U.S.A
| | - Michael Moore
- Department of Orthopedic Surgery, NYU Langone Health, New York, NY, U.S.A
| | - Daniel J Kaplan
- Department of Orthopedic Surgery, NYU Langone Health, New York, NY, U.S.A
| | - Thomas Youm
- Department of Orthopedic Surgery, NYU Langone Health, New York, NY, U.S.A..
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Alrashedan BS, Remedios S, Wong I. Patients with associated spine or other major joint pain have equivalent outcomes to patients with isolated hip pain after hip arthroscopy. J ISAKOS 2025; 10:100368. [PMID: 39586541 DOI: 10.1016/j.jisako.2024.100368] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2024] [Revised: 11/19/2024] [Accepted: 11/20/2024] [Indexed: 11/27/2024]
Abstract
OBJECTIVES This study aims to evaluate the outcomes of patients following surgery diagnosed with femoroacetabular impingement syndrome (FAIS) who also experience low back and other joint pain compared to those with isolated hip pain. METHODS This is a retrospective cohort study of patients diagnosed with FAIS, with or without other joint pain, treated with hip arthroscopy from 2016 to 2020. Excluded cases were patients who had significant arthritis, irreparable labral tear requiring reconstruction, or were lost follow-up. Analysis was carried out in two ways, the first was according to the musculoskeletal morbidity (MSKM) scheme where patients were stratified into four different groups, and the second was according to the presence of any other joint or back pain (MSKM 2-4) compared to hip pain only (MSKM 1). Demographic data was analyzed between the groups. International Hip Outcome Tool 33 (iHOT-33) and Hip Outcome Score (HOS) were used as the primary and secondary outcome measures pre-operatively and a minimum of two years postoperatively. RESULTS A total of 131 patients were included in the study with 37 % males and 63 % females. Age (years) and body mass index (kg/m2) were similar between groups, whereas a statistically greater number of male participants were seen in the hip pain only group (MSKM 1). Pre-operatively, patients with isolated hip pain (MSKM 1), had a higher iHOT-33 scores (p < 0.05), but no statistically significant differences were observed postoperatively between the groups. All groups demonstrated a statistically significant improvement in iHOT-33 and HOS scores postoperatively compared to pre-operatively (p < 0.05), with 76 % meeting the threshold for minimum clinically important difference. CONCLUSION Patient-reported outcomes following hip arthroscopy for FAIS were significantly greater postoperatively for all patients, despite the presence of other joint or back pain. This study can assist in driving patient expectations following hip arthroscopy for FAIS. LEVEL OF EVIDENCE IV.
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Affiliation(s)
- Bandar S Alrashedan
- Department of Orthopaedic Surgery, Ministry of Health (MOH), King Saud Medical City, Riyadh, Saudi Arabia
| | - Sarah Remedios
- School of Physiotherapy, Faculty of Health, Dalhousie University, Halifax, Nova Scotia, Canada; Division of Orthopaedic Surgery, Nova Scotia Health, Halifax, Nova Scotia, Canada.
| | - Ivan Wong
- Division of Orthopaedic Surgery, Nova Scotia Health, Halifax, Nova Scotia, Canada; Department of Orthopaedic Surgery, Dalhousie University, Halifax, Nova Scotia, Canada.
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Warden SJ, Coburn SL, Fuchs RK, Surowiec RK, Carballido-Gamio J, Kemp JL, Jalaie PK, Hanff DF, Palmer AJR, Fernquest SJ, Crossley KM, Heerey JJ. Asymptomatic female softball pitchers have altered hip morphology and cartilage composition. Sci Rep 2025; 15:3262. [PMID: 39863740 PMCID: PMC11762768 DOI: 10.1038/s41598-025-87839-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2024] [Accepted: 01/22/2025] [Indexed: 01/27/2025] Open
Abstract
Few studies have explored hip morphology and cartilage composition in female athletes or the impact of asymmetric repetitive loading, such as occurs during softball pitching. The current cross-sectional study assessed bilateral bony hip morphology on computed tomography imaging in collegiate-level softball pitchers ('Pitch1', n = 25) and cross-country runners ('Run', n = 13). Magnetic resonance imaging was used to assess cartilage relaxation times in a second cohort of pitchers ('Pitch2', n = 10) and non-athletic controls ('Con', n = 4). Pitch1 had 52% greater maximum alpha angle than Run (p < 0.001) and were 21.3 (95% CI 2.4 to 192.0) times more likely to have an alpha angle ≥ 60° within at least one hip. Pitch2 had longer T2 relaxation times in the superior femoral cartilage of the drive leg (same side as the throwing arm) and stride leg than Con (all p < 0.02). The drive leg in Pitch2 had longer T1ρ and T2 relaxation times in the superior femoral cartilage compared to the stride leg (all p ≤ 0.03). Asymptomatic softball pitchers exhibit altered bony hip morphology and cartilage composition compared to cross-country runners and non-athletic controls, respectively. They also exhibit asymmetry in cartilage composition. Further studies with larger sample sizes are warranted and any potential long-term consequences of the changes in terms of symptom and osteoarthritis development requires investigation.
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Affiliation(s)
- Stuart J Warden
- Department of Physical Therapy, School of Health and Human Sciences, Indiana University Indianapolis, 1050 Wishard Blvd, RG-3147, Indianapolis, IN, 46202, USA.
| | - Sally L Coburn
- La Trobe Sport & Exercise Medicine Research Centre, School of Allied Health, Human Services and Sport, La Trobe University, Melbourne, VIC, Australia
| | - Robyn K Fuchs
- Tom and Julia Wood College of Osteopathic Medicine, Marian University, Indianapolis, IN, USA
| | - Rachel K Surowiec
- Weldon School of Biomedical Engineering, Purdue University, West Lafayette, IN, USA
| | - Julio Carballido-Gamio
- Department of Radiology, School of Medicine, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
| | - Joanne L Kemp
- La Trobe Sport & Exercise Medicine Research Centre, School of Allied Health, Human Services and Sport, La Trobe University, Melbourne, VIC, Australia
| | - Peter K Jalaie
- Weldon School of Biomedical Engineering, Purdue University, West Lafayette, IN, USA
| | - David F Hanff
- Department of Radiology and Nuclear Medicine, Erasmus University Medical Centre, Rotterdam, The Netherlands
| | - Antony J R Palmer
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, UK
| | - Scott J Fernquest
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, UK
| | - Kay M Crossley
- La Trobe Sport & Exercise Medicine Research Centre, School of Allied Health, Human Services and Sport, La Trobe University, Melbourne, VIC, Australia
| | - Joshua J Heerey
- La Trobe Sport & Exercise Medicine Research Centre, School of Allied Health, Human Services and Sport, La Trobe University, Melbourne, VIC, Australia
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Walsh EG, Wallace IA, Becker N, Flynn M, Domb A, Quesada-Jimenez R. With Proper Surgical Indications, Sex-Based Differences in Pathology Do Not Impact Hip Arthroscopy Outcomes or Complications: A Systematic Review. Arthroscopy 2025:S0749-8063(24)01116-2. [PMID: 39755180 DOI: 10.1016/j.arthro.2024.12.031] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/31/2024] [Revised: 12/17/2024] [Accepted: 12/21/2024] [Indexed: 01/06/2025]
Abstract
PURPOSE To identify sex-based differences in pathology, outcomes, and complications after hip arthroscopy for femoroacetabular impingement (FAI), and to compare patient-reported outcomes (PRO) scores between male and female patients. METHODS The PubMed and MEDLINE databases were searched in September 2024, according to Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Included studies had data stratified by sex, minimum 2-year PRO scores for hip arthroscopy in the setting of FAI and labral pathology, and a 2014 or later publication date. Patient demographic information, preoperative radiographic measurements, and surgical procedure information was also recorded. PROs were recorded when discussed. Information on the minimum clinically important difference, patient acceptable symptomatic state, and substantial clinical benefit was recorded when available. RESULTS In total, 21 studies were included in the systematic review. The systematic review found that there are sex-based differences in preoperative characteristics, such as male patients having a significantly greater incidence of acetabular injury, larger alpha angle, complex labral tearing, and greater grade LT villar classification, leading to differences in surgical indication, and female patients being indicated for capsular repair or plication at a greater frequency. There was a significant heterogeneity between male and female patients for preoperative modified Harris Hip Score (mHHS) (male: 55.7-83; female: 49-64.45; I2 = 0.78), Non-Arthritic Hip Score (NAHS) (male: 62.54-78.1; female: 47.2-66; I2 = 0.77), Hip Outcome Score-Sport-Specific Subscale (HOS-SSS) (male: 46.72-52.3; female: 22.8-45.7; I2 = 0.96), as well as postoperative HOS-SSS (male: 72.2-91; female: 62.6-82.4; I2 = 0.66). Despite these differences, both male and female patients experienced similar magnitudes of improvement for mHHS (male: 13-20.14; female: 20.6-30.2; I2 = 0.00), NAHS (male: 18-19.93; female: 18.75-33.5; I2 = 0.00), and HOS-SSS (male: 27.7-31.4; female: 26.75-39.8; I2 = 0.42), as well as postoperative scores for mHHS (male: 82.445-96; female: 79.2-89.6; I2 = 0.00) and NAHS (male: 82.445-94.5; female: 81.2-89.2; I2 = 0.00). No differences were consistently identified in regard to survival rates and complications. CONCLUSIONS Male and female patients present with different preoperative characteristics that affect surgical treatment. With proper surgical indication, both male and female patients achieve significant postoperative improvement after hip arthroscopy and demonstrate comparable survival rates. LEVEL OF EVIDENCE Level IV, systematic review of Level II-IV studies.
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Affiliation(s)
- Elizabeth G Walsh
- American Hip Institute Research Foundation, Chicago, Illinois, U.S.A..
| | | | - Nils Becker
- American Hip Institute Research Foundation, Chicago, Illinois, U.S.A.; Department of Orthopedic Surgery, Hannover Medical School, Hannover, Germany
| | - Megan Flynn
- American Hip Institute Research Foundation, Chicago, Illinois, U.S.A
| | - Arie Domb
- American Hip Institute Research Foundation, Chicago, Illinois, U.S.A
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Kazi O, Alvero AB, Wright-Chisem J, Nho SJ. Hip Pain in the Young Athlete: Femoroacetabular Impingement Syndrome. Sports Health 2024; 16:920-922. [PMID: 38304963 PMCID: PMC11531005 DOI: 10.1177/19417381231223515] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2024] Open
Affiliation(s)
- Omair Kazi
- Section of Young Adult Hip Surgery, Division of Sports Medicine, Department of Orthopedic Surgery, Rush Medical College of Rush University, Rush University Medical Center, Chicago, Illinois
| | - Alexander B. Alvero
- Section of Young Adult Hip Surgery, Division of Sports Medicine, Department of Orthopedic Surgery, Rush Medical College of Rush University, Rush University Medical Center, Chicago, Illinois
| | - Joshua Wright-Chisem
- Section of Young Adult Hip Surgery, Division of Sports Medicine, Department of Orthopedic Surgery, Rush Medical College of Rush University, Rush University Medical Center, Chicago, Illinois
| | - Shane J. Nho
- Section of Young Adult Hip Surgery, Division of Sports Medicine, Department of Orthopedic Surgery, Rush Medical College of Rush University, Rush University Medical Center, Chicago, Illinois
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Lewis CL, Shefelbine SJ. Lost in research translation: Female athletes are not male athletes, especially at the hip. J Orthop Res 2024; 42:2054-2060. [PMID: 38644357 DOI: 10.1002/jor.25860] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/05/2023] [Revised: 03/22/2024] [Accepted: 04/03/2024] [Indexed: 04/23/2024]
Abstract
Altered shape of the proximal femur (cam morphology) or acetabulum (pincer morphology) is indicative of femoroacetabular impingement, which can result in hip pain and osteoarthritis of the hip. As mechanical load during growth affects the resulting bone shape, there is strong evidence in males that cam morphology develops during skeletal growth while physes are open, rather than as an adaptation after growth plates are closed (skeletal maturity). This adaptation is particularly evident in athletes who participate at elite levels prior to skeletal maturity. The research providing this evidence, however, has primarily focused on male athletes. Despite the lack of inclusion in the research, females consistently comprise two thirds of the clinical and surgical populations with structural hip pain or pathology. Knowledge gained from male-dominated cohorts may not appropriately transfer to female athletes, especially at the hip. This perspectives article briefly reviews differences between females and males in femoral and acetabular structure, hormones, timing of puberty/maturation, hypermobility, activity level and movement control-factors which affect hip structure development and loading. Without female-focused research, the application of research findings from male athletes to female athletes may lead to ineffective or even inappropriate recommendations and treatments. Thus, there is a critical need for investment in research to promote life-long hip health for females.
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Affiliation(s)
- Cara L Lewis
- Department of Physical Therapy, Sargent College of Health & Rehabilitation Sciences, Boston University, Boston, Massachusetts, USA
| | - Sandra J Shefelbine
- Department of Mechanical and Industrial Engineering and Department of Bioengineering, Northeastern University, Boston, Massachusetts, USA
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Bisciotti GN, Bisciotti A, Auci A, Bisciotti A, Volpi P. Anatomical Features in Inguinal-Pubic-Adductor Area That May Contribute to Gender Difference in Susceptibility to Groin Pain Syndrome. J Pers Med 2024; 14:860. [PMID: 39202051 PMCID: PMC11355124 DOI: 10.3390/jpm14080860] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2024] [Revised: 07/31/2024] [Accepted: 08/12/2024] [Indexed: 09/03/2024] Open
Abstract
Groin pain syndrome (GPS) is often a diagnostic challenge for sport physicians. Despite this diagnostic difficulty, the incidence of GPS in athletes is relatively high, afflicting 10-20% of the total sports population. In the literature, a certain number of studies demonstrate an important gender-based difference in the incidence of GPS in both sexes, with a ratio of female:male athletes clearly in favor of the female gender being relatively less prone to GPS. Indeed, some anatomical differences between the two sexes seem to represent a protective factor against the onset of GPS in women, although the current literature still needs to clarify the validity of these findings. It is the aim of this systematic review to examine all the anatomical differences between men and women that may be responsible for the difference in the onset of GPS in the two sexes.
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Affiliation(s)
| | - Andrea Bisciotti
- IRCCS Humanitas Research Hospital, 20089 Milan, Italy; (A.B.); (P.V.)
| | - Alessio Auci
- Dipartimento delle Diagnostiche, Azienda USL Toscana Nord Ovest, 56121 Massa, Italy;
| | | | - Piero Volpi
- IRCCS Humanitas Research Hospital, 20089 Milan, Italy; (A.B.); (P.V.)
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González-de-la-Flor Á. A New Clinical Examination Algorithm to Prescribe Conservative Treatment in People with Hip-Related Pain. Pain Ther 2024; 13:457-479. [PMID: 38698256 PMCID: PMC11111658 DOI: 10.1007/s40122-024-00604-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2024] [Accepted: 04/04/2024] [Indexed: 05/05/2024] Open
Abstract
Hip-related pain is a common issue in active adults affecting their quality of life, mobility, and overall function, and it can lead to persistent disability. However, diagnosing hip-related pain is challenging due to the many potential sources and causes, including intra-articular and extra-articular pathology, and referred pain from other areas (lumbar or groin related pain). To address this, there is a need for a clinical algorithm based on the best available evidence and expert consensus. This algorithm could guide healthcare professionals in assessing and managing patients with hip-related pain, during the diagnosis, test selection, intervention, monitoring, and promoting collaboration among various healthcare providers. This clinical algorithm for hip-related pain is a comprehensive, flexible, adaptable to different settings, and regularly updated to incorporate new research findings. This literature review aims to establish a clinical algorithm specifically for prescribing exercise treatment to patients with hip-related pain, addressing their individual needs and enhancing their overall care.
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Affiliation(s)
- Ángel González-de-la-Flor
- Faculty of Sport Sciences, Universidad Europea de Madrid, Calle Tajo s/n, 28670, Villaviciosa de Odón, Madrid, Spain.
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González-de-la-Flor Á, Valera-Calero JA, García-Fernández P, López-de-Uralde-Villanueva I, Fernández-de-Las-Peñas C, Plaza-Manzano G. Clinical Presentation Differences Among Four Subtypes of Femoroacetabular Impingement: A Case-Control Study. Phys Ther 2024; 104:pzad179. [PMID: 38157293 DOI: 10.1093/ptj/pzad179] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/04/2023] [Revised: 08/21/2023] [Accepted: 11/07/2023] [Indexed: 01/03/2024]
Abstract
OBJECTIVE The aims of this study were to assess the psychological, functional, and physical differences between patients with femoroacetabular impingement (FAI) syndrome and individuals who were asymptomatic (controls) to analyze clinical differences among 4 subtypes of FAI (cam type, cam type with labral tear, pincer type, and pincer type with labral tear), to calculate the correlations among the variables described, and to identify risk factors contributing to the hip function variance. METHODS A case-control study was conducted at a hospital rehabilitation unit with a cohort of individuals who were asymptomatic (controls) and a cohort of patients with FAI. Sociodemographic characteristics, pain intensity, psychological health status, hip range of motion (RoM), hip isometric strength, and hip function were assessed. RESULTS A total of 69 controls and 69 patients with FAI were analyzed. Although sociodemographic characteristics were comparable between samples, poorer hip RoM, strength, and psychological health were found for the cases. FAI subtypes showed no significant pain intensity, psychological health, or RoM differences (except for hip adduction), but hip strength differed among FAI subtypes. Multiple significant correlations between psychological health, pain intensity, RoM, strength, and hip function were found. The variance values of the International Hip Outcome Tool, Hip Outcome Score (HOS) for daily living activities, and HOS for sports activities were partially explained (47.6%, 36.0%, and 21.6%, respectively) on the basis of kinesiophobia, hip strength, self-efficacy, and anxiety. CONCLUSION Patients with FAI showed poorer psychological health, hip RoM, and strength than individuals who were asymptomatic and had similar sociodemographic characteristics. FAI subtype influenced the patients' clinical presentations. Hip strength, kinesiophobia, anxiety, and self-efficacy should be targeted for improving hip function, as they have been demonstrated to be important contributors to hip disability. IMPACT This study demonstrated that pain catastrophizing, hip strength, and hip adduction differed among FAI subtypes. However, hip function and pain intensity were comparable between FAI subtypes.
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Affiliation(s)
- Ángel González-de-la-Flor
- Department of Physical Therapy and Sport Medicine, Hospital Universitario Quironsalud Madrid, Madrid, Spain
- Department of Physiotherapy, Faculty of Sport Sciences, Universidad Europea de Madrid, Madrid, Spain
| | - Juan Antonio Valera-Calero
- Department of Radiology, Rehabilitation and Physiotherapy, Faculty of Nursery, Physiotherapy and Podiatry, Universidad Complutense de Madrid, Madrid, Spain
- Grupo InPhysio, Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IdISSC), Madrid, Spain
| | - Pablo García-Fernández
- Department of Radiology, Rehabilitation and Physiotherapy, Faculty of Nursery, Physiotherapy and Podiatry, Universidad Complutense de Madrid, Madrid, Spain
- Grupo InPhysio, Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IdISSC), Madrid, Spain
| | - Ibai López-de-Uralde-Villanueva
- Department of Radiology, Rehabilitation and Physiotherapy, Faculty of Nursery, Physiotherapy and Podiatry, Universidad Complutense de Madrid, Madrid, Spain
- Grupo InPhysio, Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IdISSC), Madrid, Spain
| | - César Fernández-de-Las-Peñas
- Department of Physical Therapy, Occupational Therapy, Rehabilitation and Physical Medicine, Universidad Rey Juan Carlos, Alcorcón, Spain
- Cátedra Institucional en Docencia, Clínica e Investigación en Fisioterapia: Terapia Manual, Punción Seca y Ejercicio Terapéutico, Universidad Rey Juan Carlos, Alcorcón, Madrid, Spain
| | - Gustavo Plaza-Manzano
- Department of Radiology, Rehabilitation and Physiotherapy, Faculty of Nursery, Physiotherapy and Podiatry, Universidad Complutense de Madrid, Madrid, Spain
- Grupo InPhysio, Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IdISSC), Madrid, Spain
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Crofts H, Proceviat C, Bone J, Leith J, McConkey M, Ayeni OR, Lodhia P. Outcomes After Hip Arthroscopy Show No Differences Between Sexes: A Systematic Review. Arthroscopy 2023; 39:2211-2227. [PMID: 37116550 DOI: 10.1016/j.arthro.2023.03.034] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/22/2022] [Revised: 03/19/2023] [Accepted: 03/29/2023] [Indexed: 04/30/2023]
Abstract
PURPOSE To assess differences in postoperative outcomes between male and female patients following hip arthroscopy. METHODS A systematic review was performed following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Medline, Embase, Cochrane, and PubMed databases were searched. Key words included "hip," "arthroscopy," "outcome," "gender difference," "sex difference," "gender," and "patient-reported outcome." Studies were included that reported sex-specific analysis of outcomes following primary hip arthroscopy with minimum 2-year follow-up. Methodological Index for Non-Randomized Studies criteria were applied to each study. Data collected included patient-reported outcome measures (PROMs), complications, rates of revision arthroscopy (RA), and conversion to total hip arthroplasty (THA). Forest plots were generated for the most frequently reported PROMs, RA, and THA rates. RESULTS In total, 38 studies met the inclusion criteria, with 40,194 (57% female) hips included. The most common indications for hip arthroscopy were femoroacetabular impingement and labral tears. Eighteen studies reported PROMs, with no clear trend towards sex differences. Eleven studies reported on RA rates, with 4 showing a significantly greater rate of RA in female patients. Seventeen studies reported on conversion to THA, with an overall conversion rate of 9.64%. There were no clear sex differences in conversion to THA. CONCLUSIONS There was no difference between sexes for postoperative PROM scores. Male patients were less likely to reach the MCID for the HOS-SSS than female patients in the majority of studies, and there were no sex differences for PASS rates. There were no significant differences between sexes in revision arthroscopy rates and conversion to total hip arthroplasty. LEVEL OF EVIDENCE Level IV, systematic review of Level II, III and IV studies.
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Affiliation(s)
- Helen Crofts
- Department of Orthopaedic Surgery, University of British Columbia, Diamond Health Care Centre, Vancouver, British Columbia, Canada
| | - Cameron Proceviat
- Department of Orthopaedic Surgery, University of British Columbia, Diamond Health Care Centre, Vancouver, British Columbia, Canada
| | - Jeffrey Bone
- Department of Orthopaedic Surgery, University of British Columbia, Diamond Health Care Centre, Vancouver, British Columbia, Canada
| | - Jordan Leith
- Department of Orthopaedic Surgery, University of British Columbia, Diamond Health Care Centre, Vancouver, British Columbia, Canada
| | - Mark McConkey
- Department of Orthopaedic Surgery, University of British Columbia, Diamond Health Care Centre, Vancouver, British Columbia, Canada
| | - Olufemi R Ayeni
- Division of Orthopaedic Surgery, McMaster University, Hamilton, Ontario, Canada
| | - Parth Lodhia
- Department of Orthopaedic Surgery, University of British Columbia, Diamond Health Care Centre, Vancouver, British Columbia, Canada.
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Owen MM, Gohal C, Angileri HS, Hartwell MJ, Plantz MA, Tjong VK, Terry MA. Sex-Based Differences in Prevalence, Outcomes, and Complications of Hip Arthroscopy for Femoroacetabular Impingement: A Systematic Review and Meta-analysis. Orthop J Sports Med 2023; 11:23259671231188332. [PMID: 37547081 PMCID: PMC10403993 DOI: 10.1177/23259671231188332] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/23/2023] [Accepted: 04/11/2023] [Indexed: 08/08/2023] Open
Abstract
Background Trends between the sexes have been reported regarding prevalence, patient-reported outcomes (PROs), and complications of hip arthroscopy (HA) for femoroacetabular impingement syndrome (FAIS), yet current results lack consensus. Purpose To evaluate sex-based differences after HA for FAIS in (1) prevalence of cam and pincer morphology in FAIS and (2) PROs, pain scores, and postoperative complication rates. Study Design Systematic review; Level of evidence, 4. Methods The EMBASE, PubMed, and Ovid (MEDLINE) databases were searched from establishment to February 28, 2022, according to PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines. Included studies had sex-based data on prevalence, outcomes, and complications of HA for FAIS. Reviews and commentaries were excluded. Data were combined, and between-sex differences were analyzed. Meta-analyses using random-effects models were performed when possible. Pooled risk ratios (RRs) and standardized mean differences were calculated. Results A total of 74 studies were included (213,059 patients; 132,973 female hips [62.4%] and 80,086 male hips [37.6%]). The mean age was 30.7 ± 7.7 years among male patients and 31.1 ± 7.8 years among female patients. Male patients experienced mixed-type impingement significantly more often (39.4% vs 27.2% for female patients; RR = 0.69 [95% confidence interval [CI], 0.58-0.81]; P < .001), whereas female patients experienced pincer-type impingement more often (50.6% vs 30.8% for male patients; RR = 2.35 [95% CI, 1.14-4.86]; P = .02). Male patients had higher likelihoods of undergoing femoroplasty (89.8% vs 77.4% for female patients; RR = 0.90 [95% CI, 0.83-0.97]; P = .006), acetabuloplasty (67.1% vs 59.3% for female patients; RR = 0.87 [95% CI, 0.79-0.97]; P = .01), or combined femoroplasty/acetabuloplasty (29.2% vs 14.5% for female patients; RR = 0.63 [95% CI, 0.44-0.90]; P = .01). Although female patients showed greater improvements in Hip Outcome Score-Sport-Specific subscale (P = .005), modified Harris Hip Score (P = .006), and visual analog scale pain (P < .001), both sexes surpassed the minimal clinically important difference at 1, 2, and 5 years postoperatively. Female patients had higher complication rates (P = .003), although no sex-based differences were found in total hip arthroplasty conversion rates (P = .21). Conclusion Male patients undergoing HA for FAIS had a higher prevalence of mixed-type FAIS while female patients had more pincer-type FAIS. Female patients gained greater improvements in PROs, although both sexes exceeded the minimal clinically important difference, suggesting that both male and female patients can benefit from HA.
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Affiliation(s)
- Madeline M. Owen
- Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Chetan Gohal
- Division of Orthopaedic Surgery, Northwestern University, Chicago, Illinois, USA
| | - Hunter S. Angileri
- Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Matthew J. Hartwell
- Division of Orthopaedic Surgery, Northwestern University, Chicago, Illinois, USA
| | - Mark A. Plantz
- Division of Orthopaedic Surgery, Northwestern University, Chicago, Illinois, USA
| | - Vehniah K. Tjong
- Division of Orthopaedic Surgery, Northwestern University, Chicago, Illinois, USA
| | - Michael A. Terry
- Division of Orthopaedic Surgery, Northwestern University, Chicago, Illinois, USA
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Gillinov SM, Kim DN, Moran J, Lee MS, Fong S, Mahatme RJ, Simington J, Owens JS, McLaughlin WM, Grauer JN, Jimenez AE. Low Rates of 5-Year Secondary Surgery and Postoperative Complications After Primary Hip Arthroscopy in More Than 30,000 Patients. Arthroscopy 2023; 39:1639-1648. [PMID: 37286283 DOI: 10.1016/j.arthro.2023.01.100] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/06/2022] [Revised: 12/12/2022] [Accepted: 01/24/2023] [Indexed: 06/09/2023]
Abstract
PURPOSE To evaluate 90-day complications, 5-year secondary surgery rates, and risk factors for secondary surgery following primary hip arthroscopy performed for femoroacetabular impingement and/or labral tears using a large national dataset. METHODS A retrospective analysis was conducted using the PearlDiver Mariner151 database. Patients with International Classification of Diseases, Tenth Revision, diagnosis codes for femoroacetabular impingement and/or labral tear undergoing primary hip arthroscopy with femoroplasty, acetabuloplasty, and/or labral repair between 2015 and 2021 were identified. Those with concomitant International Classification of Diseases, Tenth Revision, codes for infection, neoplasm, or fracture were excluded, as were patients with a history of previous hip arthroscopy or total hip arthroplasty, or age ≥70 years. Rates of complications within 90 days of surgery were assessed. Five-year rates of secondary surgery-revision hip arthroscopy or conversion to total hip arthroplasty-were determined by Kaplan-Meier analysis, and risk factors for secondary surgery were identified by multivariate logistic regression. RESULTS A total of 31,623 patients underwent primary hip arthroscopy from October 2015 to April 2021, with annual volumes ranging from 5,340 to 6,343 surgeries per year. Femoroplasty was the most frequent surgical procedure (performed in 81.1% of surgical encounters), followed by labral repair (72.6%) and acetabuloplasty (33.0%). Ninety-day postoperative complication rates were low, with 1.28% of patients experiencing any complication. The 5-year secondary surgery rate was 4.9% (N = 915 patients). Multivariate logistic regression identified age <20 years (odds ratio [OR] 1.50; P < .001), female sex (OR 1.33; P < .001), class I obesity (body mass index 30-34.9: OR 1.30; P = .04), and class II/III obesity (body mass index ≥35.0: OR 1.29; P = .02) as independent predictors of secondary surgery. CONCLUSIONS In this study of primary hip arthroscopy, 90-day adverse events were low at 1.28%, and the 5-year secondary surgery rate was 4.9%. Age younger than 20 years, female sex, and obesity were risk factors for secondary surgery, suggesting the need for increased surveillance in these patient groups. LEVEL OF EVIDENCE Level IV, case series.
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Affiliation(s)
- Stephen M Gillinov
- Department of Orthopaedics and Rehabilitation, Yale School of Medicine, New Haven, Connecticut, U.S.A..
| | - David N Kim
- Department of Orthopaedics and Rehabilitation, Yale School of Medicine, New Haven, Connecticut, U.S.A
| | - Jay Moran
- Department of Orthopaedics and Rehabilitation, Yale School of Medicine, New Haven, Connecticut, U.S.A
| | - Michael S Lee
- Medical University of Wisconsin, Milwaukee, Wisconsin, U.S.A
| | - Scott Fong
- Advanced Orthopedics and Sports Medicine, San Francisco, California, U.S.A
| | - Ronak J Mahatme
- University of Connecticut School of Medicine, Farmington, Connecticut, U.S.A
| | | | - Jade S Owens
- Keck School of Medicine of University of Southern California, Los Angeles, California, U.S.A
| | - William M McLaughlin
- Department of Orthopaedics and Rehabilitation, Yale School of Medicine, New Haven, Connecticut, U.S.A
| | - Jonathan N Grauer
- Department of Orthopaedics and Rehabilitation, Yale School of Medicine, New Haven, Connecticut, U.S.A
| | - Andrew E Jimenez
- Department of Orthopaedics and Rehabilitation, Yale School of Medicine, New Haven, Connecticut, U.S.A
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13
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Cannon J, Rankin JW, Lewton KL, Liu J, Powers CM. Femoral and acetabular features explain acetabular contact pressure sensitivity to hip internal rotation in persons with cam morphology: A finite element analysis. Clin Biomech (Bristol, Avon) 2023; 107:106025. [PMID: 37302302 DOI: 10.1016/j.clinbiomech.2023.106025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/07/2023] [Revised: 05/09/2023] [Accepted: 05/30/2023] [Indexed: 06/13/2023]
Abstract
BACKGROUND Femoroacetabular impingement is characterized by premature contact between the proximal femur and acetabulum. The loss of femoral head-neck concavity associated with cam morphology leads to mechanical impingement during hip flexion and internal rotation. Other femoral and acetabular features have been linked with mechanical impingement but have not been comprehensively investigated. This study sought to determine which bony features are most influential in contributing to mechanical impingement in persons with a cam morphology. METHODS Twenty individuals (10 female, 10 male) with a cam morphology participated. Finite element analyses incorporating subject-specific bony geometry derived from computed tomography scans were used to determine which femoral (alpha angle and femoral neck-shaft angle) and acetabular (anteversion angle, inclination angle, depth, and lateral center-edge angle) features accentuate acetabular contact pressure with increasing degrees of hip internal rotation with the hip flexed to 90°. To determine the best predictors of acetabular contact pressure sensitivity to internal rotation, all morphological variables were included in a stepwise regression with the final model subjected to a bootstrapping procedure. FINDINGS The stepwise regression revealed that femoral neck-shaft angle, acetabular anteversion angle, acetabular inclination angle, and acetabular depth were the best combination of variables to predict contact pressure sensitivity to internal rotation, explaining 55% of the variance. Results of the bootstrap analysis revealed that a median value of 65% [37%, 89%] variance in sensitivity could be explained by these morphological variables. INTERPRETATION Mechanical impingement and the concomitant acetabular contact pressure are modulated by multiple femoral and acetabular features in persons with a cam morphology.
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Affiliation(s)
- Jordan Cannon
- Jacquelin Perry Musculoskeletal Biomechanics Research Laboratory, Division of Biokinesiology and Physical Therapy, University of Southern California, Los Angeles, CA, USA; Department of Integrative Anatomical Sciences, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | - Jeffery W Rankin
- Rancho Research Institute, Rehabilitation Engineering Program, Downey, CA, USA
| | - Kristi L Lewton
- Jacquelin Perry Musculoskeletal Biomechanics Research Laboratory, Division of Biokinesiology and Physical Therapy, University of Southern California, Los Angeles, CA, USA; Department of Integrative Anatomical Sciences, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | - Jia Liu
- Department of Biomedical Engineering, Lerner Research Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Christopher M Powers
- Jacquelin Perry Musculoskeletal Biomechanics Research Laboratory, Division of Biokinesiology and Physical Therapy, University of Southern California, Los Angeles, CA, USA.
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Hirata K, Murata Y, Hatakeyama A, Takahashi M, Quinn PM, Uchida S. Biomechanical Analysis of Hip Braces after Hip Arthroscopic Surgery for Femoroacetabular Impingement Syndrome: An Observational Study. Biomimetics (Basel) 2023; 8:225. [PMID: 37366820 DOI: 10.3390/biomimetics8020225] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2023] [Revised: 04/26/2023] [Accepted: 05/25/2023] [Indexed: 06/28/2023] Open
Abstract
Currently, hip braces are recommended and typically worn by femoroacetabular impingement (FAI) patients after hip arthroscopic surgery. However, there is currently a lack of literature regarding the biomechanical effectiveness of hip braces. The purpose of this study was to investigate the biomechanical effect of hip braces after hip arthroscopic surgery for FAI. Overall, 11 patients who underwent arthroscopic FAI correction and labral preservation surgery were included in the study. Standing-up and walking tasks in unbraced and braced conditions were performed at 3 weeks postoperatively. For the standing-up task, videotaped images of the hip's sagittal plane were recorded while patients stood from a seated position. After each motion, the hip flexion-extension angle was calculated. For the walking task, acceleration of the greater trochanter was measured using a triaxial accelerometer. For the standing-up motion, the mean peak hip flexion angle was found to be significantly lower in the braced condition than in the unbraced condition. Furthermore, the mean peak acceleration of the greater trochanter was significantly lower in the braced condition than in the unbraced condition. Patients undergoing arthroscopic FAI correction surgery would benefit from usage of a hip brace in terms of protecting repaired tissues during early postoperative recovery.
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Affiliation(s)
- Kai Hirata
- Research and Development Department, Nippon Sigmax Co., Ltd., Tokyo 160-0023, Japan
| | - Yoichi Murata
- Department of Orthopaedic Surgery, Wakamatsu Hospital of University of Occupational and Environmental Health, Kitakyushu 808-0024, Japan
| | | | - Makoto Takahashi
- Department of Rehabilitation Medicine, Wakamatsu Hospital of University of Occupational and Environmental Health, Kitakyushu 808-0024, Japan
| | - Patrick M Quinn
- Department of Orthopaedic Surgery, Wakamatsu Hospital of University of Occupational and Environmental Health, Kitakyushu 808-0024, Japan
| | - Soshi Uchida
- Department of Orthopaedic Surgery, Wakamatsu Hospital of University of Occupational and Environmental Health, Kitakyushu 808-0024, Japan
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15
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Gomes D, de Brito Fontana H, da Costa GV, Ribeiro DC, Canella RP, Ferreira T, Ruschel C, de Castro MP. Differences in hip torque ratios between individuals with femoroacetabular impingement syndrome and asymptomatic individuals: A cross-sectional study. Clin Biomech (Bristol, Avon) 2022; 100:105809. [PMID: 36335663 DOI: 10.1016/j.clinbiomech.2022.105809] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/02/2022] [Revised: 10/03/2022] [Accepted: 10/21/2022] [Indexed: 02/07/2023]
Abstract
BACKGROUND Hip torque ratios are considered a useful measure for patients with hip pain. However, evidence regarding this measure for patients with femoroacetabular impingement syndrome is scarce. The primary aim of this study was to compare hip external-internal rotation and abduction-adduction torque ratios between patients with femoroacetabular impingement syndrome and asymptomatic individuals. The secondary aim was to compare hip torque ratios between the asymptomatic group and femoroacetabular impingement syndrome patients grouped according to the severity of symptoms and functional limitations. METHODS Hip abduction-adduction and external-internal rotation torque ratios of 134 individuals with femoroacetabular impingement syndrome and 134 asymptomatic matched controls was assessed through isokinetic testing. Severity of symptoms and functional limitations was assessed through the iHOT-33. Mann Whitney U and Kruskall-Wallis tests were used to compare hip torque ratios between asymptomatic individuals and patients with femoroacetabular impingement syndrome and to patients with femoroacetabular impingement syndrome with different severities of symptoms and functional limitations. FINDINGS No differences were identified in hip abduction-adduction (U = 7659.5, p = 0.192) and external-internal rotation (U = 8787.5, p = 0.764) torque ratios between patients with femoroacetabular impingement syndrome and asymptomatic individuals. Hip abduction-adduction torque ratio was higher (p = 0.0127) in patients with a severe state (median = 1.80, IQR = 0.61) when compared to asymptomatic individuals (median = 1.52, IQR = 0.45) (moderate effect size, r = 0.45). INTERPRETATION Patients with severe symptoms and functional limitations related to FAI syndrome presented greater hip abduction-adduction torque ratio than asymptomatic individuals, suggesting a decreased adduction torque capacity relative to abduction torque in this subgroup of femoroacetabular impingement.
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Affiliation(s)
- Diogo Gomes
- Morphological Sciences Department, Biomechanics Laboratory, Federal University of Santa Catarina, Florianópolis, Brazil
| | - Heiliane de Brito Fontana
- Morphological Sciences Department, Biomechanics Laboratory, Federal University of Santa Catarina, Florianópolis, Brazil
| | - Guilherme V da Costa
- Center of Health and Sports Science, University of the State of Santa Catarina, Florianópolis, Brazil
| | - Daniel C Ribeiro
- Centre for Health, Activity and Rehabilitation Research (CHARR) School of Physiotherapy, University of Otago, New Zealand
| | - Richard P Canella
- Core Centre of Orthopedics and Rehabilitation, Florianópolis, Brazil
| | | | - Caroline Ruschel
- Center of Health and Sports Science, University of the State of Santa Catarina, Florianópolis, Brazil
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Falk Brekke A, Overgaard S, Mussmann B, Poulsen E, Holsgaard-Larsen A. Exercise in patients with acetabular retroversion and excessive anterior pelvic tilt: A feasibility and intervention study. Musculoskelet Sci Pract 2022; 61:102613. [PMID: 35777262 DOI: 10.1016/j.msksp.2022.102613] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/02/2022] [Revised: 06/15/2022] [Accepted: 06/18/2022] [Indexed: 10/17/2022]
Abstract
BACKGROUND Acetabular retroversion is associated with femoroacetabular impingement syndrome (FAIS). Anterior pelvic tilt enhances risk of FAIS. OBJECTIVES To investigate feasibility and change in patient-reported symptoms of a home-based exercise intervention in patients with acetabular retroversion and excessive anterior pelvic tilt, in comparison with a prior control period. DESIGN Prospective intervention study. METHODS Patients (18-40 years) not eligible for surgery, with radiographic signs of acetabular retroversion and excessive anterior pelvic tilt were recruited. An 8-week control period was followed by an 8-week training period. The home-based intervention consisted of education and exercises for core stability, muscle strengthening and stretching for reducing anterior pelvic tilt. Feasibility assessments were dropout (≤10%), adherence (≥75% of sessions), exercise-related pain, and adverse events. Primary outcome was change in the Copenhagen Hip and Groin Outcome Score (HAGOS) pain-subscale. Pelvic tilt was measured by EOS scanning. RESULTS Forty-two patients (93% female, mean age 22.2 ± 4.2 years) were included. Dropout rate was 7% and satisfactory adherence was demonstrated by 85%. Exercise-related pain and adverse events were acceptable. Between-period mean change score for HAGOS-PAIN was 5.2 points (95% CI: -0.3-10.6) and -1.6° (95% CI: -3.9-0.7) of anterior pelvic tilt. Patients responding positively (≥10 points) (n = 10, 26%), had pre-exercise moderate pain (HAGOS-PAIN 47.5-70 points). CONCLUSIONS Current exercise intervention was feasible. However, we found no clinically relevant changes in self-reported hip-related pain or anterior pelvic tilt. Post hoc responder analysis revealed that patients with moderate pain at baseline might benefit from this exercise.
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Affiliation(s)
- Anders Falk Brekke
- Department of Orthopaedic Surgery and Traumatology, Odense University Hospital, Denmark; Department of Clinical Research, University of Southern Denmark, Denmark; University College Absalon, Center of Nutrition and Rehabilitation, Department of Physiotherapy, Region Zealand, Denmark.
| | - Søren Overgaard
- Department of Orthopaedic Surgery and Traumatology, Odense University Hospital, Denmark; Department of Clinical Research, University of Southern Denmark, Denmark.
| | - Bo Mussmann
- Department of Clinical Research, University of Southern Denmark, Denmark; Department of Radiology, Odense University Hospital, Denmark; Faculty of Health Sciences, Oslo Metropolitan University, Norway.
| | - Erik Poulsen
- Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, Denmark.
| | - Anders Holsgaard-Larsen
- Department of Orthopaedic Surgery and Traumatology, Odense University Hospital, Denmark; Department of Clinical Research, University of Southern Denmark, Denmark.
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Mas Martinez J, Bustamante Suarez de Puga D, Verdu-Roman C, Martinez Gimenez E, Morales Santias M, Sanz-Reig J. Significant improvement after hip arthroscopy for femoroacetabular impingement in women. Knee Surg Sports Traumatol Arthrosc 2022; 30:2181-2187. [PMID: 34839368 DOI: 10.1007/s00167-021-06802-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/11/2021] [Accepted: 11/11/2021] [Indexed: 11/30/2022]
Abstract
PURPOSE This study was designed to evaluate outcomes in women after hip arthroscopy (HA) for femoroacetabular impingement syndrome (FAIS) and compare these results with men. METHODS Retrospective study of a prospective database of patients undergoing hip arthroscopy between 2015 and 2018. Inclusion criteria were patients between 18 and 50 years of age, diagnosis of FAIS, complete clinical patient-reported outcomes (PROs), radiographic measurements, and underwent at least a 2-year HA follow-up. For each woman, two men underwent HA were matched in a 1:2 ratio based on age within 5 years, and date of surgery within 6 months. Diagnostic arthroscopy was performed to evaluate labral and chondral status. Radiographic evaluation, a self-administered Hip Outcome Score (HOS) questionnaire, with activity of daily living (ADL) and sports subscale (SSS), and a self-administered short version of the International Hip Outcome Tool (iHOT-12) were assessed at 6 months, 12 months, and then yearly. Clinical relevance was measured with the minimal clinical important difference (MCID), patient acceptable symptom state (PASS), and substantial clinical benefit (SCB) for HOS-ADL, HOS-SSS, and iHOT-12. RESULTS One hundred and eighty-five patients met the inclusion criteria. Fifty-two women were matched with 104 men. Significant differences in terms of demographics, radiographic results, intraoperative findings and arthroscopic procedures were found between women and men. Mean follow-up was 48.4 months in women and 50.2 months in men. Both groups showed significant improvement from preoperative PROs to the latest follow-up. There were no significant differences between groups in preoperative PROs, latest follow-up PROs and PROs improvements. The difference in frequency of patients achieving MCID, PASS, and SCB was only significant greater for iHOT-12 PASS in women compared with men. CONCLUSION Significant improvements in PROs in women after HA for FAIS at 4-year follow-up were found. Differences between women and men in PROs and rates of achieving MCID, SCB and PASS were only significant for iHOT-12 PASS. LEVEL OF EVIDENCE IV.
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Affiliation(s)
- Jesus Mas Martinez
- Hip Unit, Department of Orthopedic Surgery, HLA Clinica Vistahermosa, Av de Denia 76, 03016, Alicante, Spain
| | | | - Carmen Verdu-Roman
- Hip Unit, Department of Orthopedic Surgery, HLA Clinica Vistahermosa, Av de Denia 76, 03016, Alicante, Spain
| | - Enrique Martinez Gimenez
- Hip Unit, Department of Orthopedic Surgery, HLA Clinica Vistahermosa, Av de Denia 76, 03016, Alicante, Spain
| | - Manuel Morales Santias
- Hip Unit, Department of Orthopedic Surgery, HLA Clinica Vistahermosa, Av de Denia 76, 03016, Alicante, Spain
| | - Javier Sanz-Reig
- Hip Unit, Department of Orthopedic Surgery, HLA Clinica Vistahermosa, Av de Denia 76, 03016, Alicante, Spain.
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Alter TD, Knapik DM, Lambers F, Guidetti M, Chahla J, Malloy P, Nho SJ. Sex-Based Differences in Femoroacetabular Impingement Syndrome and the Effect of Cam Deformity Location on the Extent of Labral Tearing: A 3-Dimensional Computed Tomography Study. Orthop J Sports Med 2022; 10:23259671221095174. [PMID: 38115855 PMCID: PMC10728605 DOI: 10.1177/23259671221095174] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/09/2022] [Accepted: 02/25/2022] [Indexed: 12/21/2023] Open
Abstract
Background Sex-specific quantification of cam morphology in patients with femoroacetabular impingement syndrome may improve diagnostics, surgical planning, and outcomes. Purpose To (1) examine differences between men and women with symptomatic cam deformities based on deformity location, magnitude, and extent; (2) assess the association between cam deformity and labral pathology; and (3) evaluate the relationship between cam deformity and patient-reported outcome measures after hip arthroscopy. Study Design Cohort study; Level of evidence, 3. Methods Computed tomography (CT) scans were acquired in 98 consecutive patients before hip arthroscopy for femoroacetabular impingement syndrome. Custom software was used to generate 3-dimensional bone models and align them to a standard coordinate system. The alpha angle was measured at the 12-, 1-, 2-, and 3-o'clock positions, with 12 and 3 o'clock corresponding to the superior and anterior aspects of the femur, respectively. These alpha angle measurements were used to define the cam midpoint and extent. The labral tear midpoint and extent were evaluated intraoperatively. Bivariate correlation analysis was used to evaluate the association between the cam and labral tear midpoints and between the extent of the cam morphology and labral tearing. Results The 3-dimensional models were analyzed in a cohort of 69 female and 29 male patients. Male patients were older (mean ± SD, 38.9 ± 12.6 vs 30.7 ± 12.2 years, P = .006) and had a greater body mass index (27.8 ± 4.4 vs 25.3 ± 5.6 kg/m2, P = .005). Male patients had greater alpha angle measures at 12, 1, and 3 o'clock (P < .05) and a greater maximum alpha angle (69.0° ± 18.8° vs 62.1° ± 21.0°, P = .031); the location of their maximum cam impingement was also significantly different (P < .05) when compared with female patients. Cam impingement (2:06 ± 1:09 vs 1:33 ± 1:16 clockfaces, P = .032) and labral tearing (3:02 ± 0:35 vs 2:34 ± 0:53 clockfaces, P = .003) in men extended over a greater region of the femoral clockface when compared with women. Significant correlations were demonstrated between the cam and labral tear midpoint locations (r = 0.190, P = .032) and the extent of the cam deformity and labral tearing (r = 0.203, P = .024). There were no sex-based differences in patient-reported outcome measures at baseline or 2-year follow-up. Conclusion Male patients possessed greater cam deformity magnitude and extent when compared with female patients. Cam pathomorphology was associated with the location and extent of labral tearing.
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Affiliation(s)
- Thomas D. Alter
- Section of Young Adult Hip Surgery, Division of Sports Medicine, Department of Orthopedic Surgery, Hip Preservation Center, Rush University Medical Center, Chicago, Illinois, USA
| | - Derrick M. Knapik
- Division of Sports Medicine, Department of Orthopedic Surgery, Washington University, St Louis, Missouri, USA
| | - Floor Lambers
- Section of Young Adult Hip Surgery, Division of Sports Medicine, Department of Orthopedic Surgery, Hip Preservation Center, Rush University Medical Center, Chicago, Illinois, USA
| | - Martina Guidetti
- Section of Young Adult Hip Surgery, Division of Sports Medicine, Department of Orthopedic Surgery, Hip Preservation Center, Rush University Medical Center, Chicago, Illinois, USA
| | - Jorge Chahla
- Section of Young Adult Hip Surgery, Division of Sports Medicine, Department of Orthopedic Surgery, Hip Preservation Center, Rush University Medical Center, Chicago, Illinois, USA
| | - Philip Malloy
- Section of Young Adult Hip Surgery, Division of Sports Medicine, Department of Orthopedic Surgery, Hip Preservation Center, Rush University Medical Center, Chicago, Illinois, USA
| | - Shane J. Nho
- Section of Young Adult Hip Surgery, Division of Sports Medicine, Department of Orthopedic Surgery, Hip Preservation Center, Rush University Medical Center, Chicago, Illinois, USA
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Dynamic Assessment of Femoroacetabular Impingement Syndrome Hips. Arthroscopy 2022; 38:404-416.e3. [PMID: 34126220 DOI: 10.1016/j.arthro.2021.05.062] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/21/2021] [Revised: 05/18/2021] [Accepted: 05/29/2021] [Indexed: 02/02/2023]
Abstract
PURPOSE The purpose of our study was to compare lower extremity rotational kinematics and kinetics (angles, torques, and powers) and hip muscle electromyography (EMG) activity between cam-type femoroacetabular impingement syndrome (FAIS) and age- and sex-matched controls during walking, fast walking, stair ascent, stair descent, and sit-to-stand. METHODS This study included 10 males with unilateral FAIS and 10 control males with no FAIS. We measured kinematics, kinetics, and electromyographic signals during stair ascent/descent, sit-to-stand, self-selected walk, and fast walk. Peak signal differences between groups were compared with independent t-tests with statistical significance when P < .05. RESULTS FAIS hips showed significant differences compared to controls, including increased hip flexion during walking (+4.9°, P = .048) and stair ascent (+7.8°, P =.003); diminished trunk rotation during stair ascent (-3.4°; P = .015), increased knee flexion during self-selected walking (+5.1°, P = .009), stair ascent (+7.4°, P = .001), and descent (+5.3°, P = .038); and increased knee valgus during fast walking (+4.7°, P = .038). gMed and MedHam showed significantly decreased activation in FAIS during walking (gMed: -12.9%, P = .002; MedHam: -7.4%, P = .028) and stair ascent (gMed: -16.7%, P = .036; MedHam: -13.0%, P = .041); decreased gMed activation during sit-to-stand (-8.8%, P = .004) and decreased MedHam activation during stair descent (-8.0%, P = .039). CONCLUSIONS Three-dimensional motion analysis and EMG evaluation of functional kinematics and kinetics in subjects with symptomatic unilateral cam-type FAIS across a spectrum of provocative tasks demonstrated significant differences compared to controls in hip flexion, trunk rotation, knee flexion, and valgus. FAIS hips had significantly decreased gMed and MedHam activity. These findings may explain altered torso-pelvic, hip, and knee mechanics in FAIS patients and suggest that evaluation of FAIS should include the patient's hip, knee, and torso-pelvic relationships and muscle function. CLINICAL RELEVANCE The clinical and functional manifestation of FAIS hip pathomechanics is not entirely understood, and previous literature to date has not clearly described the alterations in gait and functional movements seen in patients with cam-type FAIS. The current study used 3D motion analysis and EMG evaluation of functional kinematics and kinetics to identify a number of differences between FAIS and control hips, which help us better understand the lower extremity kinematics and kinetics and muscle activation in FAIS.
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Hip Arthroscopy Volume and Reoperations in a Large Cross-Sectional Population: High Rate of Subsequent Revision Hip Arthroscopy in Young Patients and Total Hip Arthroplasty in Older Patients. Arthroscopy 2021; 37:3445-3454.e1. [PMID: 33901509 DOI: 10.1016/j.arthro.2021.04.017] [Citation(s) in RCA: 36] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/17/2021] [Revised: 03/03/2021] [Accepted: 04/15/2021] [Indexed: 02/02/2023]
Abstract
PURPOSE To report contemporary trends in hip arthroscopy case volume in the United States using a large cross-sectional cohort with accurate laterality tracking for assessment of revision surgery and rates of conversion to total hip arthroplasty (THA). METHODS Using Current Procedural Terminology codes, we queried the Mariner PearlDiver dataset for patients who underwent hip arthroscopy from 2010 to 2017. Patient demographics were recorded and subsequent hip arthroscopy procedures and THA conversion within 2 years after surgery were tracked using International Classification of Diseases, Tenth Revision codes to accurately identify laterality. Emergency department and hospital admission within 30 days after surgery were queried. RESULTS Of the 53,103 patients undergoing hip arthroscopy procedures, hip arthroscopy case volume increased 2-fold from 2010 to 2014 but remained relatively unchanged from 2014 to 2017. The most common age group undergoing surgery was 40 to 49 years, and female patients represented 70% of cases. Two-year subsequent surgery rate was 19%, with 15.1% undergoing a revision arthroscopy and 3.9% converting to THA. The most common revision arthroscopy procedures were femoroplasty (9.5%), labral repair (8.5%), and acetabuloplasty (4.3%). Younger patients were more likely to undergo revision arthroscopy (18% age 10-19 years; 15% age 20-29 years). Older patients had a significant risk for conversion to THA within 2 years (36% age 60-69 years; 28% age 50-59 years). Female patients also demonstrated a slightly greater rate of conversion to THA (4.1% female, 3.5% male, P <.0001). Patients 20 to 29 years had the greatest risk of emergency department admission (5.4%) and hospital admission (0.8%) within 30 days of surgery. CONCLUSIONS The rise in hip arthroscopy procedures may be starting to plateau in the United States. Cross-sectional data also indicate that there is a greater than previously reported rate of revision hip arthroscopy in patients younger than 30 years of age and conversion to THA in patients older than 50 years of age. LEVEL OF EVIDENCE III, cross-sectional study.
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21
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Lower Back Injury Prevention and Sensitization of Hip Hinge with Neutral Spine Using Wearable Sensors during Lifting Exercises. SENSORS 2021; 21:s21165487. [PMID: 34450929 PMCID: PMC8402067 DOI: 10.3390/s21165487] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/12/2021] [Revised: 08/07/2021] [Accepted: 08/11/2021] [Indexed: 12/26/2022]
Abstract
The popularization and industrialization of fitness over the past decade, with the rise of big box gyms and group classes, has reduced the quality of the basic formation and assessment of practitioners, which has increased the risk of injury. For most lifting exercises, a universal recommendation is maintaining a neutral spine position. Otherwise, there is a risk of muscle injury or, even worse, of a herniated disc. Maintaining the spine in a neutral position during lifting exercises is difficult, as it requires good core stability, a good hip hinge and, above all, observation of the posture in order to keep it correct. For this reason, in this work the authors propose the prevention of lumbar injuries with two inertial measurement units. The relative rotation between two sensors was measured for 39 voluntary subjects during the performance of two lifting exercises: the American kettlebell swing and the deadlift. The accuracy of the measurements was evaluated, especially in the presence of metals and for fast movements, by comparing the obtained results with those from an optical motion capture system. Finally, in order to develop a tool for improving sport performance and preventing injury, the authors analyzed the recorded motions, seeking to identify the most relevant parameters for good and safe lifting execution.
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22
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Spiker AM. Editorial Commentary: Hip Arthroscopy Evolution and Causes of Failure. Arthroscopy 2021; 37:1829-1832. [PMID: 33745935 DOI: 10.1016/j.arthro.2021.03.027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/09/2021] [Accepted: 03/11/2021] [Indexed: 02/02/2023]
Abstract
Hip arthroscopy use has grown as a result of expanding indications; improved imaging including higher resolution magnetic resonance imaging with stronger magnetic fields and the advent of 3-dimensional computed tomography revealing the nuances of hip joint morphology; increased specialized training; improvements in instruments and implants; a record of successful outcomes; and increased understanding of microinstability, focal acetabular undercoverage or occult dysplasia, indications for labral reconstruction and capsular plication, and, most of all, femoroacetabular impingement syndrome, the leading diagnosis for which hip arthroscopy is performed, in the orthopaedic community as well as the general medical and athletic communities. We now know that labral repair results in better outcomes than labral debridement, and evidence suggests that capsule closure leads to better long-term success. Osteoarthritis and its correlate, advanced age, result in inferior survivorship after hip arthroscopy, which is unsurprising; hip preservation surgery is not designed to treat irreparable cartilage damage. Association of female sex with hip arthroscopy failure requires additional investigation. More females undergo hip arthroscopy than males, and females initially present with greater disability. Females tend to have smaller alpha angles, greater femoral and acetabular anteversion, and lower center edge angles than males, consistent with increased prevalence of hip dysplasia. Thus surgeons indicating females for hip arthroscopy should be aware of atypical locations of cam lesions, borderline dysplasia, or ligamentous laxity, all of which must be appropriately respected at the time of surgery. With all of the improvements we have made in techniques, patient diagnosis and surgical indications, and our overall understanding of complex anatomy and a technically challenging surgery, we can speculate that our long-term survivorship will only improve. I await with interest the long-term outcomes we will see 10 years from today, with the addition of insight from patient-reported outcome measures to answer these questions with greater certainty.
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Bisciotti A, Pogliacomi F, Cepparulo R, Fiorentino G, DI Pietto F, Sconfienza LM, Bisciotti A, Bisciotti GN. Femoroacetabular impingement: correlation between imaging parameters, sport activity, and chondral damage. J Sports Med Phys Fitness 2021; 62:803-811. [PMID: 33871244 DOI: 10.23736/s0022-4707.21.12274-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
BACKGROUND Femoroacetabular impingement is characterised by an abnormal contact between the acetabulum and the femoral head-neck junction. Femoroacetabular impingement shows three main clinical frameworks: Pincer-FAI, Cam-FAI and Cam-Pincer mixed form. The aim of the study was to investigate the correlation between femoroacetabular impingement, imaging, activity and chondral damages. METHODS Forty-one patients, undergoing arthroscopic chondroartroplasty for Cam and Cam-Pincer mixed form were considered. All patients underwent an X-ray hip evaluation (G1 group), while 15 patients also underwent a pelvis MRI evaluation (G2 subgroup). For G1 patients, the superior-inferior offset ratio and alpha angle were calculated from the X-ray examinations. For G2 patients, the antero-posterior offset ratio was also calculated from pelvis MRI. Chondral damage was classified according to the Outerbridge classification. RESULTS The superior-inferior offset ratio and the antero-posterior offset ratio were respectively 0.50 ± 0.23 and 0.33 ± 0.19. The α angle predictive for a chondral damage of IV degree was 81.5°.The chondral damage of the patients suffering from Cam-FAI and Cam-Pincer mixed form were respectively 3.53±0.80 and 3.00±1.41. CONCLUSIONS From the results was possible to: - Elaborate two tables providing a reliable indirect calculation of the alpha angle. - Establish an alpha angle cut-off value indicative for a IV degree chondral damage. - Show that Pincer-FAI does not represent an aggravating factor for chondral damage - Show that the level of sports activity was related to the severity of chondral damage. - Show that a physically demanding occupation was not an aggravating factor for chondral damage.
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Affiliation(s)
- Andrea Bisciotti
- Department of Medicine and Surgery, University of Parma, Parma, Italy
| | | | | | | | | | - Luca M Sconfienza
- IRCCS Istituto Ortopedico Galeazzi, Milan, Italy.,Dipartimento di Scienze Biomediche per la Salute, Università degli Studi di Milano, Milan, Italy
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Abrahamson J, Lindman I, Sansone M, Öhlin A, Jónasson P, Karlsson J, Baranto A. Horseback riding is common among female athletes who had arthroscopic treatment for femoroacetabular impingement syndrome. TRANSLATIONAL SPORTS MEDICINE 2021. [DOI: 10.1002/tsm2.236] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Affiliation(s)
- Josefin Abrahamson
- Department of Orthopaedics Institute of Clinical Sciences at Sahlgrenska Academy University of Gothenburg and Sahlgrenska University Hospital Gothenburg Sweden
| | - Ida Lindman
- Department of Orthopaedics Institute of Clinical Sciences at Sahlgrenska Academy University of Gothenburg and Sahlgrenska University Hospital Gothenburg Sweden
| | - Mikael Sansone
- Department of Orthopaedics Institute of Clinical Sciences at Sahlgrenska Academy University of Gothenburg and Sahlgrenska University Hospital Gothenburg Sweden
| | - Axel Öhlin
- Department of Orthopaedics Institute of Clinical Sciences at Sahlgrenska Academy University of Gothenburg and Sahlgrenska University Hospital Gothenburg Sweden
| | - Pall Jónasson
- Department of Orthopaedics Institute of Clinical Sciences at Sahlgrenska Academy University of Gothenburg and Sahlgrenska University Hospital Gothenburg Sweden
| | - Jón Karlsson
- Department of Orthopaedics Institute of Clinical Sciences at Sahlgrenska Academy University of Gothenburg and Sahlgrenska University Hospital Gothenburg Sweden
| | - Adad Baranto
- Department of Orthopaedics Institute of Clinical Sciences at Sahlgrenska Academy University of Gothenburg and Sahlgrenska University Hospital Gothenburg Sweden
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Maerz T, Nepple JJ, Bedi A, Zaltz I, Belzile É, Beaulé PE, Sink EL, Clohisy JC. Sex Differences in Clinical Outcomes Following Surgical Treatment of Femoroacetabular Impingement. J Bone Joint Surg Am 2021; 103:415-423. [PMID: 33439607 DOI: 10.2106/jbjs.20.00394] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND Sex-based differences in clinical outcomes following surgical treatment of femoroacetabular impingement remain largely uncharacterized; this prospective, multicenter study evaluated these differences both directly and adjusted for covariates. METHODS Hips undergoing surgical treatment of symptomatic femoroacetabular impingement were prospectively enrolled in a multicenter cohort. Patient demographics, radiographic parameters, intraoperatively assessed disease severity, and history of surgical procedures, as well as patient-reported outcome measures, were collected preoperatively and at a mean follow-up of 4.3 years. A total of 621 (81.6%) of 761 enrolled hips met the minimum 1 year of follow-up and were included in the analysis; 56.7% of analyzed hips were female. Univariate and multivariable statistics were utilized to assess the direct and adjusted differences in outcomes, respectively. RESULTS Male hips had greater body mass index and larger α angles. Female hips had significantly lower preoperative and postoperative scores across most patient-reported outcome measures, but also had greater improvement from preoperatively to postoperatively. The preoperative differences between sexes exceeded the threshold for the minimal clinically important difference of the modified Harris hip score (mHHS) and all Hip disability and Osteoarthritis Outcome Score (HOOS) domains except quality of life. Preoperative sex differences in mHHS, all HOOS domains, and Short Form-12 Health Survey physical function component score were greater than the postoperative differences. A greater proportion of female hips achieved the minimal clinically important difference for the mHHS, but male hips were more likely to meet the patient acceptable symptom state for this outcome. After adjusting for relevant covariates with use of multiple regression analysis, sex was not identified as an independent predictor of any outcome. Preoperative patient-reported outcome scores were a strong and highly significant predictor of all outcomes. CONCLUSIONS Significant differences in clinical outcomes were observed between sexes in a large cohort of hips undergoing surgical treatment of femoroacetabular impingement. Despite female hips exhibiting lower baseline scores, sex was not an independent predictor of outcome or reoperation. LEVEL OF EVIDENCE Prognostic Level II. See Instructions for Authors for a complete description of levels of evidence.
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Affiliation(s)
- Tristan Maerz
- Department of Orthopaedic Surgery, University of Michigan, Ann Arbor, Michigan
| | - Jeffrey J Nepple
- Department of Orthopaedic Surgery, Washington University, St Louis, Missouri
| | - Asheesh Bedi
- Department of Orthopaedic Surgery, University of Michigan, Ann Arbor, Michigan
| | - Ira Zaltz
- Department of Orthopaedic Surgery, Beaumont Health System, Royal Oak, Michigan
| | - Étienne Belzile
- Department of Orthopaedic Surgery, CHU de Québec, Quebec City, Quebec, Canada
| | - Paul E Beaulé
- Division of Orthopaedic Surgery, The Ottawa Hospital, Ottawa, Ontario, Canada
| | - Ernest L Sink
- Department of Orthopedic Surgery, Hospital for Special Surgery, New York, NY
| | - John C Clohisy
- Department of Orthopaedic Surgery, Washington University, St Louis, Missouri
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Osseous defect of the anteroinferior femoral head: is it associated with femoroacetabular impingement (FAI)? Skeletal Radiol 2021; 50:1781-1790. [PMID: 33543340 PMCID: PMC8277648 DOI: 10.1007/s00256-021-03730-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/14/2020] [Revised: 01/21/2021] [Accepted: 01/28/2021] [Indexed: 02/02/2023]
Abstract
OBJECTIVE To evaluate the prevalence, morphology, and clinical significance of a repeatedly observed yet not examined circumscript osseous defect at the anteroinferior aspect of the femoral head, termed femoral head defect. MATERIALS AND METHODS Retrospective study with approval of the institutional review board. There was informed consent by all individuals. Magnetic resonance imaging (MRI) hip examinations of 970 individuals (age 15 to 55) were analyzed for femoral head defect. Patients with femoral head defect were matched for age and gender with patients without defect. Two readers independently assessed MRI images regarding presence, location, and morphology of the defect. MR images and radiographs were analyzed for findings of femoroacetabular impingement (FAI). Femoral torsion was measured. Independent t test and chi-square test were used for statistics. RESULTS Sixty-eight (7%) of 970 MRI examinations exhibited a femoral head defect in an anteroinferior location of the femoral head (29/400 men, 7.3%; 39/570 women, 6.8%; p = 0.8). The most frequent morphology of femoral head defect was type I, dent-like (34; 50%), followed by type II, crater-like (27; 40%), and III, cystic (7; 10%). Femoral head defect was slightly more common on the right hip (39 individuals; 57%) compared to left (29 individuals; 43%), non-significantly (p = 0.115). There was no association between FAI or its subtypes and the presence of femoral head defect (p = 0.890). Femoral antetorsion was reduced in patients with femoral head defect (12.9° ± 8.6) compared to patients without defect (15.2° ± 8.5), without statistical significance (p = 0.121). CONCLUSION The femoral head defect is a common finding in MRI examinations of the hip and is situated in the anteroinferior location. There was no association with FAI yet a non-significant trend towards lower femoral antetorsion in patients with femoral head defects.
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Makovitch SA, Mills CA, Eng C. Update on Evidence-Based Diagnosis and Treatment of Acetabular Labral Tears. CURRENT PHYSICAL MEDICINE AND REHABILITATION REPORTS 2020. [DOI: 10.1007/s40141-020-00295-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Brown-Taylor L, Schroeder B, Lewis CL, Perry J, Hewett TE, Ryan J, Stasi SD. Sex-specific sagittal and frontal plane gait mechanics in persons post-hip arthroscopy for femoroacetabular impingement syndrome. J Orthop Res 2020; 38:2443-2453. [PMID: 32249962 PMCID: PMC7541416 DOI: 10.1002/jor.24680] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/18/2019] [Revised: 03/11/2020] [Accepted: 03/13/2020] [Indexed: 02/04/2023]
Abstract
Postoperative gait mechanics in persons with femoroacetabular impingement syndrome (FAIS) remain understudied as a treatment outcome despite observed, yet inconclusive, preoperative gait abnormalities. Females with FAIS demonstrate worse preoperative patient-reported hip function and altered hip mechanics when compared with males; it is unknown whether these sex differences persist postarthroscopy. The purpose of this study was to compare sex-specific gait kinematics between persons at least 1 year postarthroscopy for FAIS and healthy comparisons. General linear models with estimating equations were used to evaluate the effect of (a) limb and sex within each group, and (b) limb and group within each sex for peak sagittal and frontal plane trunk, pelvis, and hip kinematics during stance phase of gait. Analyses were covaried by gait speed. Seventeen females and eight males an average 2.5 years postarthroscopy (1.1-7.2 year) for FAIS were compared with healthy females (n = 7) and males (n = 5). Females in the FAIS group presented with an average of 4.6° more anterior pelvic tilt, and 4.8° less hip extension compared with healthy females (P ≤ .03) and 8.6° less trunk flexion, 4.8° more anterior pelvic tilt, 3.1° more pelvic drop, and 7.5° more hip flexion than males with FAIS (P ≤ .03). Males in the FAIS group presented with 2.9° less pelvic drop, and 3.2° less hip adduction than healthy males. Preoperative gait mechanics were not collected and thus changes in mechanics could not be evaluated. This study is significant to clinicians who treat patients postarthroscopy to consider sex-specific gait impairments.
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Affiliation(s)
- Lindsey Brown-Taylor
- Health and Rehabilitation Sciences Doctoral Program, School of Health and Rehabilitation Sciences, The Ohio State University, Columbus, OH, USA,Division of Physical Therapy, School of Health and Rehabilitation Sciences, The Ohio State University, Columbus, OH, USA,Sports Medicine Research Institute, The Ohio State University Wexner Medical Center, Columbus, OH, USA
| | - Brittany Schroeder
- Division of Physical Therapy, School of Health and Rehabilitation Sciences, The Ohio State University, Columbus, OH, USA
| | - Cara L Lewis
- Physical Therapy and Athletic Training, Boston University, Boston, MA, USA
| | - Jennifer Perry
- Sports Medicine Research Institute, The Ohio State University Wexner Medical Center, Columbus, OH, USA
| | | | - John Ryan
- Sports Medicine Research Institute, The Ohio State University Wexner Medical Center, Columbus, OH, USA,Department of Orthopaedics, The Ohio State University, Columbus, OH, USA
| | - Stephanie Di Stasi
- Division of Physical Therapy, School of Health and Rehabilitation Sciences, The Ohio State University, Columbus, OH, USA,Sports Medicine Research Institute, The Ohio State University Wexner Medical Center, Columbus, OH, USA
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Kamenaga T, Hashimoto S, Hayashi S, Takayama K, Niikura T, Kuroda R, Matsumoto T. Larger Acetabular Labrum Is Associated With Hip Dysplasia, Joint Incongruence, and Clinical Symptoms. Arthroscopy 2020; 36:2446-2453. [PMID: 32461021 DOI: 10.1016/j.arthro.2020.05.023] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/17/2019] [Revised: 05/13/2020] [Accepted: 05/13/2020] [Indexed: 02/02/2023]
Abstract
PURPOSE To evaluate the association of labral length with acetabular morphology and clinical symptoms. METHODS Patients treated at our hip joint clinic between January 2015 and December 2018 were retrospectively enrolled in the study. Our sample included patients who received a diagnosis of one or more of the following: hip labral tear, femoroacetabular impingement (FAI), and developmental dysplasia of the hip. Patients with osteoarthritis and/or osteonecrosis were excluded. Bilateral labral length was measured as the distance from the acetabular rim to the edge of the labrum at the level of the central coronal T1-weighted magnetic resonance imaging scan cross-referenced to the axial plane (3- to 9-o'clock position). The lateral center-edge angle (LCEA) and acetabular roof obliquity (ARO) were evaluated with plain radiographs. An LCEA of 25° or less was defined as developmental dysplasia of the hip, whereas a positive crossover sign in the presence of an LCEA of 30° or greater, an LCEA greater than 40°, or acetabular inclination lower 0° was defined as pincer FAI. An alpha angle greater than 50° or head-neck offset lower 8 mm was considered cam FAI. The severity of hip symptoms was evaluated bilaterally using the Japanese Orthopaedic Association pain scale, on which hips scoring full points (i.e., a perfect score) were defined as asymptomatic whereas hips with all other scores were considered symptomatic. We used simple linear regression to examine the correlations of labral length with the LCEA and ARO. Labral length was also compared according to patient hip symptom status using the Mann-Whitney U test. RESULTS The study included 102 patients (14 with bilateral symptoms and 88 with unilateral symptoms). Labral length was strongly correlated with the LCEA (r = -0.612, P < .001) and ARO (r = 0.635, P < .001). Additionally, patients with symptomatic hips had significantly larger labra (9.5 ± 3.0 mm) than those with asymptomatic hips (7.9 ± 2.1 mm, P = .004). CONCLUSIONS Acetabular labral length is significantly greater in dysplastic, irregularly congruent, symptomatic hips. LEVEL OF EVIDENCE Level Ⅳ, retrospective cross-sectional study.
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Affiliation(s)
- Tomoyuki Kamenaga
- Department of Orthopaedic Surgery, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Shingo Hashimoto
- Department of Orthopaedic Surgery, Kobe University Graduate School of Medicine, Kobe, Japan.
| | - Shinya Hayashi
- Department of Orthopaedic Surgery, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Koji Takayama
- Department of Orthopaedic Surgery, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Takahiro Niikura
- Department of Orthopaedic Surgery, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Ryosuke Kuroda
- Department of Orthopaedic Surgery, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Tomoyuki Matsumoto
- Department of Orthopaedic Surgery, Kobe University Graduate School of Medicine, Kobe, Japan
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Haselhorst A, Rho M. Musculoskeletal Issues and Care Specific to the Female Athlete. CURRENT PHYSICAL MEDICINE AND REHABILITATION REPORTS 2020. [DOI: 10.1007/s40141-020-00279-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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van Klij P, Reiman MP, Waarsing JH, Reijman M, Bramer WM, Verhaar JAN, Agricola R. Classifying Cam Morphology by the Alpha Angle: A Systematic Review on Threshold Values. Orthop J Sports Med 2020; 8:2325967120938312. [PMID: 32844100 PMCID: PMC7418265 DOI: 10.1177/2325967120938312] [Citation(s) in RCA: 45] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Background The alpha angle is the most often used measure to classify cam morphology. There is currently no agreement on which alpha angle threshold value to use. Purpose To systematically investigate the different alpha angle threshold values used for defining cam morphology in studies aiming to identify this threshold and to determine whether data are consistent enough to suggest an alpha angle threshold to classify cam morphology. Study Design Systematic review; Level of evidence, 3. Methods The Embase, Medline (Ovid), Web of Science, Cochrane Central, and Google Scholar databases were searched from database inception to February 28, 2019. Studies aiming at identifying an alpha angle threshold to classify cam morphology were eligible for inclusion. Results We included 4 case-control studies, 10 cohort studies, and 1 finite-element study from 2437 identified publications. Studies (n = 3) using receiver operating characteristic (ROC) curve analysis to distinguish asymptomatic people from patients with femoroacetabular impingement syndrome consistently observed alpha angle thresholds between 57° and 60°. A 60° threshold was also found to best discriminate between hips with and without cam morphology in a large cohort study based on a bimodal distribution of the alpha angle. Studies (n = 8) using the upper limit of the 95% reference interval as threshold proposed a wide overall threshold range between 58° and 93°. When stratified by sex, thresholds between 63° and 93° in male patients and between 58° and 94° in female patients were reported. Conclusion Based on the available evidence, mostly based on studies using ROC curve analysis, an alpha angle threshold of ≥60° is currently the most appropriate to classify cam morphology. Further research is required to fully validate this threshold.
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Affiliation(s)
- Pim van Klij
- Department of Orthopaedic Surgery, Erasmus MC, University Medical Center Rotterdam, the Netherlands
| | - Michael P Reiman
- Department of Orthopaedic Surgery, Duke University School of Medicine, Durham, North Carolina, USA
| | - Jan H Waarsing
- Department of Orthopaedic Surgery, Erasmus MC, University Medical Center Rotterdam, the Netherlands
| | - Max Reijman
- Department of Orthopaedic Surgery, Erasmus MC, University Medical Center Rotterdam, the Netherlands
| | - Wichor M Bramer
- Medical Library, Erasmus MC, University Medical Center Rotterdam, the Netherlands
| | - Jan A N Verhaar
- Department of Orthopaedic Surgery, Erasmus MC, University Medical Center Rotterdam, the Netherlands
| | - Rintje Agricola
- Department of Orthopaedic Surgery, Erasmus MC, University Medical Center Rotterdam, the Netherlands
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Haneda M, Rai MF, Cai L, Brophy RH, O’Keefe RJ, Clohisy JC, Pascual-Garrido C. Distinct Pattern of Inflammation of Articular Cartilage and the Synovium in Early and Late Hip Femoroacetabular Impingement. Am J Sports Med 2020; 48:2481-2488. [PMID: 32736506 PMCID: PMC8906441 DOI: 10.1177/0363546520935440] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND The molecular mechanism of how femoroacetabular impingement (FAI) morphology leads to hip osteoarthritis (OA) is yet to be determined. The expression and location of inflammation-related molecules during early- and late-stage FAI have not been previously described. Moreover, the characterization of intra-articular inflammation away from the cam deformity as well as the nature of adjacent synovial tissue have also not been extensively reported. HYPOTHESIS Early-stage FAI has a similar expression of inflammation-related markers in the head-neck and acetabular cartilage but less synovitis than late-stage FAI. STUDY DESIGN Controlled laboratory study. METHODS Head-neck cartilage, acetabular cartilage, and synovial samples were obtained from patients undergoing hip preservation surgery for the treatment of symptomatic cam FAI (early FAI group; n = 15) and advanced OA secondary to cam FAI (late FAI group; n = 15). Samples procured from healthy young adult donors served as the control group (n = 7). Cartilage degeneration was assessed by histology, and the expression of inflammation-related proteins (interleukin-1 beta [IL-1β], matrix metalloproteinase-13 [MMP-13], a disintegrin and metalloproteinase with thrombospondin motifs-4 [ADAMTS-4], type II collagen [COL2], and aggrecan neoepitope [NITEGE]) was measured by immunostaining. Synovial samples in the early and late FAI groups were examined for synovitis and the expression of IL-1β. RESULTS Head-neck cartilage in the early FAI group showed significantly more degeneration than the control group and an increased expression of inflammation-related proteins (IL-1β: 69.7% ± 18.1% vs 20.2% ± 4.9%, respectively; MMP-13: 79.6% ± 12.6% vs 25.3% ± 9.5%; ADAMTS-4: 83.9% ± 12.2% vs 24.3% ± 11.1%; NITEGE: 89.7% ± 7.7% vs 39.8% ± 20.5%) (P < .001). Head-neck and acetabular cartilage in the early and late FAI groups showed a similar degree of degeneration. Moreover, a similar expression of inflammation-related proteins was observed between the early and late FAI groups for head-neck cartilage (IL-1β: 69.7% ± 18.1% vs 72.5% ± 13.2%; MMP-13: 79.6% ± 12.6% vs 71.4% ± 18.8%; ADAMTS-4: 83.9% ± 12.2% vs 82.6% ± 12.5%; COL2: 93.6% ± 3.9% vs 92.5% ± 5.8%; NITEGE: 89.7% ± 7.7% vs 95.7% ± 4.7%) and acetabular cartilage (IL-1β: 83.3% ± 24.8% vs 80.7% ± 15.6%; MMP-13: 94.3% ± 9.7% vs 85.2% ± 12.3%; ADAMTS-4: 98.5% ± 2.3% vs 98.4% ± 3.4%; COL2: 99.8% ± 0.7% vs 99.7% ± 1.1%; NITEGE: 96.7% ± 6.7% vs 99.2% ± 2.2%). In contrast, synovitis was minimal with a low expression of IL-1β in the early FAI group compared with the late FAI group. CONCLUSION Hip cartilage exhibited an OA phenotype in patients with early-stage FAI, similar to what was observed in hip OA secondary to FAI. Severe synovitis was only evident with late-stage FAI. CLINICAL RELEVANCE This study supports the concept that early hip impingement is associated with cartilage degeneration and catabolism.
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Affiliation(s)
- Masahiko Haneda
- Department of Orthopaedic Surgery, Musculoskeletal Research Center, Washington University School of Medicine, St Louis, Missouri, USA
| | - Muhammad Farooq Rai
- Department of Orthopaedic Surgery, Musculoskeletal Research Center, Washington University School of Medicine, St Louis, Missouri, USA.,Department of Cell Biology & Physiology, Washington University School of Medicine, St Louis, Missouri, USA
| | - Lei Cai
- Department of Orthopaedic Surgery, Musculoskeletal Research Center, Washington University School of Medicine, St Louis, Missouri, USA
| | - Robert H. Brophy
- Department of Orthopaedic Surgery, Musculoskeletal Research Center, Washington University School of Medicine, St Louis, Missouri, USA
| | - Regis J. O’Keefe
- Department of Orthopaedic Surgery, Musculoskeletal Research Center, Washington University School of Medicine, St Louis, Missouri, USA
| | - John C. Clohisy
- Department of Orthopaedic Surgery, Musculoskeletal Research Center, Washington University School of Medicine, St Louis, Missouri, USA
| | - Cecilia Pascual-Garrido
- Department of Orthopaedic Surgery, Musculoskeletal Research Center, Washington University School of Medicine, St Louis, Missouri, USA.,Address correspondence to Cecilia Pascual-Garrido, MD, PhD, Department of Orthopaedic Surgery, Musculoskeletal Research Center, Washington University School of Medicine, 660 South Euclid Avenue, Campus Box 8233, St Louis, MO 63110, USA ()
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Flores SE, Chambers CC, Borak KR, Zhang AL. Is There a Gender Gap in Outcomes After Hip Arthroscopy for Femoroacetabular Impingement? Assessment of Clinically Meaningful Improvements in a Prospective Cohort. Orthop J Sports Med 2020; 8:2325967119900561. [PMID: 32704505 PMCID: PMC7361492 DOI: 10.1177/2325967119900561] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/10/2019] [Accepted: 10/18/2019] [Indexed: 01/10/2023] Open
Abstract
Background Although patients have experienced significant improvements after hip arthroscopy for femoroacetabular impingement (FAI), prior studies suggest that women have worse outcomes than men. These previous studies lack comparisons of patient-reported outcome (PRO) scores based on gender with respect to clinical significance measurements, including the minimal clinically important difference (MCID) and patient acceptable symptom state (PASS). Purpose To evaluate outcomes after hip arthroscopy for FAI based on patient gender by prospectively assessing changes in PRO scores, MCID, and PASS. Study Design Cohort study; Level of evidence, 2. Methods Women and men undergoing hip arthroscopy for FAI were prospectively enrolled, and preoperative radiographic and intraoperative findings were collected. Patients completed the following PRO surveys before surgery and 2 years postoperatively: modified Harris Hip Score (mHHS), Hip disability and Osteoarthritis Outcome Score (HOOS), and 12-Item Short Form Health Survey. Mean scores and percentage of patients reaching MCID and PASS were analyzed. Results A total of 131 hips were included (72 women, 59 men). Women had smaller preoperative alpha angles (59.1° vs 63.7°, respectively; P < .001) and lower acetabular cartilage injury grade (6.9% vs 22.0% with grade 4 injury, respectively; P = .013). Both women and men achieved equivalent significant improvements in PRO scores after surgery (scores increased 18.4 to 45.1 points for mHHS and HOOS). Women and men reached PASS for mHHS at similar rates (76.4% and 77.2%, respectively; P = .915). MCID was also achieved at similar rates between women and men for all scores (range, 61.4%-88.9%) except the activities of daily living subscale of the HOOS, in which a greater percentage of women reached MCID compared with men (79.2% vs 62.7%, respectively; P = .037). Additional stratification by age group using the median cohort age of 34 years showed no significant differences in PRO improvement based on age group for each gender. Conclusion Women can achieve clinically meaningful improvements in PRO scores after hip arthroscopy for FAI. Compared with men, women demonstrated equivalent high rates of achieving MCID and PASS at 2 years after surgery.
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Affiliation(s)
- Sergio E Flores
- Department of Orthopaedic Surgery, University of California, San Francisco, San Francisco, California, USA
| | - Caitlin C Chambers
- Department of Orthopaedic Surgery, University of Minnesota, Minneapolis, Minnesota, USA
| | - Kristina R Borak
- Department of Orthopaedic Surgery, University of California, San Francisco, San Francisco, California, USA
| | - Alan L Zhang
- Department of Orthopaedic Surgery, University of California, San Francisco, San Francisco, California, USA
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Kuroda Y, Saito M, Çınar EN, Norrish A, Khanduja V. Patient-related risk factors associated with less favourable outcomes following hip arthroscopy. Bone Joint J 2020; 102-B:822-831. [PMID: 32600150 DOI: 10.1302/0301-620x.102b7.bjj-2020-0031.r1] [Citation(s) in RCA: 42] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
AIMS This paper aims to review the evidence for patient-related factors associated with less favourable outcomes following hip arthroscopy. METHODS Literature reporting on preoperative patient-related risk factors and outcomes following hip arthroscopy were systematically identified from a computer-assisted literature search of Pubmed (Medline), Embase, and Cochrane Library using Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) guidelines and a scoping review. RESULTS Assessment of these texts yielded 101 final articles involving 90,315 hips for qualitative analysis. The most frequently reported risk factor related to a less favourable outcome after hip arthroscopy was older age and preoperative osteoarthritis of the hip. This was followed by female sex and patients who have low preoperative clinical scores, severe hip dysplasia, altered hip morphology (excess acetabular retroversion or excess femoral anteversion or retroversion), or a large cam deformity. Patients receiving workers' compensation or with rheumatoid arthritis were also more likely to have a less favourable outcome after hip arthroscopy. There is evidence that obesity, smoking, drinking alcohol, and a history of mental illness may be associated with marginally less favourable outcomes after hip arthroscopy. Athletes (except for ice hockey players) enjoy a more rapid recovery after hip arthroscopy than non-athletes. Finally, patients who have a favourable response to local anaesthetic are more likely to have a favourable outcome after hip arthroscopy. CONCLUSION Certain patient-related risk factors are associated with less favourable outcomes following hip arthroscopy. Understanding these risk factors will allow the appropriate surgical indications for hip arthroscopy to be further refined and help patients to comprehend their individual risk profile. Cite this article: Bone Joint J 2020;102-B(7):822-831.
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Affiliation(s)
- Yuichi Kuroda
- Young Adult Hip Service, Department of Trauma and Orthopaedic Surgery, Addenbrooke's - Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK.,Mobius Hip and Knee Clinic, Cambridge Nuffield Hospital, Cambridge, UK
| | - Masayoshi Saito
- Young Adult Hip Service, Department of Trauma and Orthopaedic Surgery, Addenbrooke's - Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK.,Mobius Hip and Knee Clinic, Cambridge Nuffield Hospital, Cambridge, UK
| | - Ece Nur Çınar
- Young Adult Hip Service, Department of Trauma and Orthopaedic Surgery, Addenbrooke's - Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK.,Mobius Hip and Knee Clinic, Cambridge Nuffield Hospital, Cambridge, UK
| | - Alan Norrish
- Department of Academic Orthopaedics, Trauma and Sports Medicine, Queens Medical Centre, University of Nottingham, Nottingham, UK
| | - Vikas Khanduja
- Young Adult Hip Service, Department of Trauma and Orthopaedic Surgery, Addenbrooke's - Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK.,Mobius Hip and Knee Clinic, Cambridge Nuffield Hospital, Cambridge, UK
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Cannon J, Weber AE, Park S, Mayer EN, Powers CM. Pathomechanics Underlying Femoroacetabular Impingement Syndrome: Theoretical Framework to Inform Clinical Practice. Phys Ther 2020; 100:788-797. [PMID: 31899497 DOI: 10.1093/ptj/pzz189] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/03/2020] [Revised: 05/16/2019] [Accepted: 10/20/2019] [Indexed: 02/06/2023]
Abstract
Over the last decade, there has been a marked increase in attention to, and interest in, femoroacetabular impingement syndrome (FAIS). Despite continued efforts by researchers and clinicians, the development, progression, and appropriate treatment of FAIS remains unclear. While research across various disciplines has provided informative work in various areas related to FAIS, the underlying pathomechanics, time history, and interaction between known risk factors and symptoms remain poorly understood. The purpose of this perspective is to propose a theoretical framework that describes a potential pathway for the development and progression of FAIS. This paper aims to integrate relevant knowledge and understanding from the growing literature related to FAIS to provide a perspective that can inform future research and intervention efforts.
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Affiliation(s)
- Jordan Cannon
- Musculoskeletal Biomechanics Research Laboratory, Division of Biokinesiology and Physical Therapy, University of Southern California, Los Angeles, California
| | - Alexander E Weber
- Department of Orthopaedic Surgery, Keck School of Medicine, University of Southern California
| | - Seol Park
- Musculoskeletal Biomechanics Research Laboratory, Division of Biokinesiology and Physical Therapy, University of Southern California, Los Angeles, California
| | - Erik N Mayer
- Department of Orthopaedic Surgery, Keck School of Medicine, University of Southern California
| | - Christopher M Powers
- Musculoskeletal Biomechanics Research Laboratory, Division of Biokinesiology and Physical Therapy, University of Southern California, 1540 East Alcazar St, CHP-155, Los Angeles, CA (USA)
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Comparison of the open versus the arthroscopic approach in the treatment of femoroacetabular shock. Rev Esp Cir Ortop Traumatol (Engl Ed) 2020. [DOI: 10.1016/j.recote.2020.03.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
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Hip muscle strength asymmetries and their associations with hip morphology and symptoms are sex-specific in patients with femoroacetabular impingement syndrome. Phys Ther Sport 2020; 42:131-138. [DOI: 10.1016/j.ptsp.2020.01.010] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2019] [Revised: 01/15/2020] [Accepted: 01/16/2020] [Indexed: 01/19/2023]
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Haug EC, Novicoff WM, Cui Q. Corrections in alpha angle following two different operative approaches for CAM-type femoral acetabular impingement - Ganz surgical hip dislocation vs anterior mini-open. World J Orthop 2020; 11:27-35. [PMID: 31966967 PMCID: PMC6960304 DOI: 10.5312/wjo.v11.i1.27] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/07/2019] [Revised: 05/16/2019] [Accepted: 11/07/2019] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Femoroacetabular impingement (FAI) is a predisposing factor for secondary osteoarthritis of the hip joint. The two extensively described impingement mechanisms of FAI are CAM and Pincer-type. Initially managed conservatively, operative intervention should be offered to the persistently symptomatic patient. The measurement of the alpha angle is considered a standard method of assessing the severity of pathology in Cam-type FAI on pre-operative plain radiographs. The radiological correction of the alpha angle has not been previously compared between different surgical approaches. We hypothesize that there is no difference in alpha angle correction between Ganz surgical hip dislocation and the anterior mini-open approach.
AIM To compare the magnitude of alpha angle correction achieved by using the Ganz surgical hip dislocation and the anterior mini-open approach.
METHODS This is a retrospective study assessing seventy-nine patients identified in a 5-year period. These patients had preoperative radiographic evidence of FAI and underwent surgery by a single surgeon at our institution, a tertiary care center. Patients with missing radiographic documentation, radiographs with insufficient quality which then precluded accurate measurement of the angle α, a diagnosed congenital condition, isolated type II pathology (Pincer), and history of prior surgery were excluded from the study. Either the Ganz surgical hip dislocation or the anterior mini open approach was used. Postoperative radiographic evaluation of the alpha angle between the two surgical methods was done and corrected for age and gender using two-sample t-tests and Chi-square analyses.
RESULTS A total of 79 patients met the inclusion and exclusion criteria. Forty-seven males (mean age of 35.3, range 16-53) and 32 females (mean age 36.7, range 16-60) were enrolled. Forty-seven patients underwent the anterior mini-open approach, and 32 underwent the Ganz surgical hip dislocation. There were no significant differences in age between the two surgical groups or in pre- and post-operative alpha angles based on patient gender. The mean pre-operative alpha angle for the Ganz surgical hip dislocation group was 88.0 degrees (SD 12.3) and 99.4 degrees (SD 7.2) for the anterior mini-open group. Mean post-operative angles were 49.9 degrees (SD 4.3) for the Ganz surgical hip dislocation and 43.8 (SD 4.3) degrees for the anterior mini-open group. There was a statistically significant difference in patient’s pre-operative and post-operative angles (P = 0.000) with both surgical approaches.
CONCLUSION Statistically significant decreases in alpha angle were noted for both surgical techniques, with larger decreases seen in the anterior mini-open group.
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Affiliation(s)
- Emanuel C Haug
- Department of Orthopedic Surgery, University of Virginia School of Medicine, Charlottesville, VA 22908, United States
| | - Wendy M Novicoff
- Department of Orthopedic Surgery, University of Virginia School of Medicine, Charlottesville, VA 22908, United States
| | - Quanjun Cui
- Department of Orthopedic Surgery, University of Virginia School of Medicine, Charlottesville, VA 22908, United States
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Campoamor González M, Martínez Aznar C, Martín Martínez A, Martín Hernández C, Mateo Agudo JJ, Panisello Sebastiá JJ. Comparison of the open versus the arthroscopic approach in the treatment of femoroacetabular shock. Rev Esp Cir Ortop Traumatol (Engl Ed) 2020; 64:185-190. [PMID: 31952934 DOI: 10.1016/j.recot.2019.11.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2018] [Revised: 06/03/2019] [Accepted: 11/21/2019] [Indexed: 12/21/2022] Open
Abstract
OBJECTIVE To compare clinical and imaging results and complications between patients treated for femoroacetabular impingement who underwent either open surgery or an arthroscopic approach. METHODS This retrospective study included patients who underwent femoroacetabular impingement surgical treatment between June 2009 and January 2018. Patients treated with open surgery were compared with those treated with arthroscopy. Patients were radiographically and clinically assessed by alpha angle, degree of arthritis, Harris Hip Score, hospital stay and complications, as well as progression to total hip arthroplasty. RESULTS 57 patients with FAI were included; 27 (45.6%) underwent open surgery and 31 (54.4%) underwent arthroscopy. Statistically significant differences were observed in hospital stay, where the patients who underwent arthroscopic surgery showed better outcomes. There were no other statistically significant differences, the results were similar in both groups. CONCLUSIONS Arthroscopy and open surgery treatments for femoroacetabular impingement provided comparable clinical and radiographic results. However, the latter surgery provides better results in surgery time, hospital stay and postoperative recovery.
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Abstract
Hip pathology is common amongst athletes and the general population. The mechanics of cycling have the potential to exacerbate symptomatic hip pathology and progress articular pathology in patients with morphologic risk factors such as femoroacetabular impingement. A professional fit of the bicycle to the individual which aims to optimize hip joint function can allow patients with hip pathology to exercise in comfort when alternative high impact exercise such as running may not be possible. Conversely improper fit of the bicycle can lead to hip symptoms in otherwise healthy individuals who present with risk factors for hip pain. Accordingly a bike fit can form part of the overall management strategy in a cyclist with hip symptoms. The purpose of this clinical commentary is to discuss hip pathomechanics with respect to cycling, bicycle fitting methodology and the options available to a physical therapist to optimize hip mechanics during the pedaling action.
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Maupin JJ, Steinmetz G, Thakral R. Management of femoroacetabular impingement syndrome: current insights. Orthop Res Rev 2019; 11:99-108. [PMID: 31695520 PMCID: PMC6717725 DOI: 10.2147/orr.s138454] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2018] [Accepted: 07/10/2019] [Indexed: 12/23/2022] Open
Abstract
Since the description of femoroacetabular impingement (FAI) by Ganz in 2003, our understanding of the pathophysiology, management options, and outcomes has evolved and literature continues to be generated on this condition at a rapid rate. FAI has been identified as a primary source of hip pain as well as a generator of secondary osteoarthritis. Improvements in the radiographic detection of cam and pincer morphologies as well as a better understanding of the structural impact of these morphologies have led to improved preoperative planning. Advancements in hip arthroscopy techniques have also led to a higher rate of arthroscopic management of this condition over the initially described open surgical dislocation technique. While arthroscopic management of this condition has become the most common form of surgical management for FAI, inadequate bony resection has been shown to be a frequent source of revision surgery. Therefore, roles for open surgical dislocation and combined mini-open approaches remain, particularly in cases where concern for the inability to fully access the morphology arthroscopically exists.
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Affiliation(s)
- Jeremiah J Maupin
- Department of Orthopedics and Rehabilitation, University of Oklahoma College of Medicine, Oklahoma City, OK, USA
| | - Garrett Steinmetz
- Department of Orthopedics and Rehabilitation, University of Oklahoma College of Medicine, Oklahoma City, OK, USA
| | - Rishi Thakral
- Department of Orthopedics and Rehabilitation, University of Oklahoma College of Medicine, Oklahoma City, OK, USA
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Casartelli NC, Bizzini M, Maffiuletti NA, Sutter R, Pfirrmann CW, Leunig M, Naal FD. Exercise Therapy for the Management of Femoroacetabular Impingement Syndrome: Preliminary Results of Clinical Responsiveness. Arthritis Care Res (Hoboken) 2019; 71:1074-1083. [PMID: 30133164 DOI: 10.1002/acr.23728] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2018] [Accepted: 08/14/2018] [Indexed: 11/12/2022]
Abstract
OBJECTIVE To investigate the responsiveness to exercise therapy of patients with femoroacetabular impingement syndrome (FAIS), and to investigate differences in hip function, strength, and morphology between responders versus nonresponders. METHODS Patients with FAIS underwent 12 weeks of semi-standardized and progressive exercise therapy. A good therapy outcome (responders) versus a poor therapy outcome (nonresponders) was determined at week 18 with the Global Treatment Outcome questionnaire for hip pain. Hip function was evaluated using the Hip Outcome Score (HOS) activities of daily living (ADL) and Sport at baseline, and at weeks 6, 12, and 18. Hip muscle strength and dynamic pelvic control were evaluated using dynamometry and video analysis, respectively, at baseline, week 12, and week 18. Hip morphology was evaluated with imaging at baseline. RESULTS Thirty-one patients (mean age 24 years) were included. Sixteen patients (52%) were responsive and 15 patients (48%) were not responsive to exercise therapy. Only responders improved HOS ADL and HOS Sport by 10 points (95% confidence interval [95% CI] 7, 14; P < 0.001) and by 20 points (95% CI 15, 25; P < 0.001), respectively, and hip abductor strength by 0.27 Nm/kg (95% CI 0.18, 0.36; P < 0.001). The prevalence of patients showing good dynamic pelvic control only increased in responders (44%; P = 0.029). The prevalence of severe cam morphology was higher in nonresponders than in responders (40% versus 6%; P = 0.037). CONCLUSION Half of patients with FAIS benefit from exercise therapy in the short term. Responsiveness to hip abductor strength and dynamic pelvic control improvements is associated with a good therapy outcome, whereas the presence of severe cam morphology is associated with a poor therapy outcome.
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Affiliation(s)
- Nicola C Casartelli
- Schulthess Clinic and Laboratory of Exercise and Health, Swiss Federal Institute of Technology, Zurich, Switzerland
| | | | | | - Reto Sutter
- Orthopaedic University Hospital Balgrist and University of Zurich, Zurich, Switzerland
| | - Christian W Pfirrmann
- Orthopaedic University Hospital Balgrist and University of Zurich, Zurich, Switzerland
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A Prospective, Randomized, Controlled Trial Comparing Conservative Treatment With Trunk Stabilization Exercise to Standard Hip Muscle Exercise for Treating Femoroacetabular Impingement: A Pilot Study. Clin J Sport Med 2019; 29:267-275. [PMID: 31241527 PMCID: PMC6613832 DOI: 10.1097/jsm.0000000000000516] [Citation(s) in RCA: 27] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
OBJECTIVE To assess the efficacy of conservative management of women with femoroacetabular impingement (FAI) using trunk stabilization. DESIGN Randomized controlled trial (level of evidence: I). SUBJECTS Twenty FAI female patients who met the inclusion FAI criteria. METHODS A prospective, randomized, controlled study was performed on 20 female patients with symptomatic FAI comprising 2 groups (10 hips in trunk stabilization exercise group vs 10 hips in control group). We evaluated hip range of motion, isometric muscle strength using a handheld dynamometer (μ-TasMF-01; Anima, Co), and patient-reported outcome measures, including modified Harris hip score, Vail hip score, and international hip outcome tool 12 (iHOT12) before and at 4 weeks and 8 weeks after the intervention. RESULTS There was a significant improvement in the range of motion of hip flexion in the trunk training group detected as early as 4 weeks after the intervention compared with the control group (P < 0.05). Hip abductor strength significantly improved in the trunk training group at 4 weeks after the intervention, whereas it did not improve in the control group (P < 0.05). Vail hip score and iHOT12 were significantly increased at 8 weeks after the intervention in the trunk training group compared with the control group (iHOT12: 78.7 ± 22.4 vs 53.0 ± 22.3; P < 0.01, Vail hip score: 81.6 ± 18.5 vs 61.1 ± 11.6; P < 0.05). There was no significant difference in the modified Harris hip score between both the groups at 4 and 8 weeks after the intervention. CONCLUSIONS The addition of trunk stabilization exercise to a typical hip rehabilitation protocol improves short-term clinical outcomes and may augment nonoperative and postoperative rehabilitation.
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Rhon DI, Greenlee TA, Sissel CD, Reiman MP. The two-year incidence of hip osteoarthritis after arthroscopic hip surgery for femoroacetabular impingement syndrome. BMC Musculoskelet Disord 2019; 20:266. [PMID: 31153368 PMCID: PMC6545211 DOI: 10.1186/s12891-019-2646-5] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/28/2019] [Accepted: 05/20/2019] [Indexed: 12/30/2022] Open
Abstract
Background One of the reported goals of hip preservation surgery is to prevent or delay the onset of osteoarthritis. This includes arthroscopic surgery to manage Femoroacetabular Impingement (FAI) Syndrome. The purpose of this study was to describe the prevalence of clinically-diagnosed hip OA within 2 years after hip arthroscopy for FAI syndrome, and 2) determine which variables predict a clinical diagnosis of OA after arthroscopy. Methods Observational analysis of patients undergoing hip arthroscopy between 2004 and 2013, utilizing the Military Health System Data Repository. Individuals with prior cases of osteoarthritis were excluded. Presence of osteoarthritis was based on diagnostic codes rendered by a medical provider in patient medical records. Adjusted odds ratios (95% CI) for an osteoarthritis diagnosis were reported for relevant clinical and demographic variables. Results Of 1870 participants in this young cohort (mean age 32.2 years), 21.9% (N = 409) had a postoperative clinical diagnosis of hip osteoarthritis within 2 years. The 3 significant predictors in the final model were older age (OR = 1.04; 95%CI = 1.02, 1.05), male sex (OR = 1.31; 95%CI = 1.04, 1.65), and having undergone an additional hip surgery (OR = 2.33; 95% CI = 1.72, 3.16). Military status and post-surgical complications were not risk factors. Conclusion A clinical diagnosis of hip osteoarthritis was found in approximately 22% of young patients undergoing hip arthroscopy in as little as 2 years. These rates may differ when using alternate criteria to define OA, such as radiographs, and likely underestimate the prevalence. A more comprehensive approach, considering various criteria to detect OA will likely be necessary to accurately identify the true rates. Females were at lower risk, while increasing age and multiple surgeries increased the risk for an OA diagnosis. OA onset still occurs after “hip preservation” surgery in a substantial number of individuals within 2 years. This should be considered when estimating rates of disease prevention after surgery. Prospective trials with sound methodology are needed to determine accurate rates and robust predictors of osteoarthritis onset after hip preservation surgery.
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Affiliation(s)
- Daniel I Rhon
- Physical Performance Service Line, G 3/5/7, US Army Office of the Surgeon General, Falls Church, VA, USA. .,Baylor University, Road, Bldg 2841, Suite 1301; JBSA Fort Sam Houston, Stanley, TX, 3630, USA.
| | - Tina A Greenlee
- Center for the Intrepid, Brooke Army Medical Center, 3551 Roger Brooke Drive, San Antonio, TX, USA
| | | | - Michael P Reiman
- Department of Orthopaedic Surgery, Duke University Medical Center, Durham, NC, USA
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Malloy P, Stone AV, Kunze KN, Neal WH, Beck EC, Nho SJ. Patients With Unilateral Femoroacetabular Impingement Syndrome Have Asymmetrical Hip Muscle Cross-Sectional Area and Compensatory Muscle Changes Associated With Preoperative Pain Level. Arthroscopy 2019; 35:1445-1453. [PMID: 30926193 DOI: 10.1016/j.arthro.2018.11.053] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/28/2017] [Revised: 11/15/2018] [Accepted: 11/21/2018] [Indexed: 02/02/2023]
Abstract
PURPOSE To compare the symptomatic hip muscle cross-sectional area (CSA) in patients with unilateral femoroacetabular impingement syndrome (FAIS) with the asymptomatic-side hip muscle CSA and to determine whether correlations exist between the hip muscle CSA and preoperative pain level, preoperative symptom duration, and postoperative function. METHODS We performed a retrospective review of magnetic resonance imaging data of patients who underwent hip arthroscopy from January 2012 through June 2015 for the treatment of unilateral FAIS and who had a minimum of 2 years' follow-up after hip arthroscopy for FAIS. A picture archiving and communication system workstation with an embedded region-of-interest tool was used to measure the muscle CSA of both the symptomatic and asymptomatic sides in FAIS patients. One-way repeated-measures analyses of variance were used to determine differences between symptomatic and asymptomatic hip muscle CSAs. Spearman rank correlations were used to determine relations between the symptomatic-side hip muscle CSA and preoperative pain level, preoperative symptom duration, and multiple validated patient-reported outcomes to quantify the level of function. RESULTS A total of 50 patients met the inclusion criteria and were analyzed. The mean age of the patients was 34.22 ± 14.12 years, and 64% were women. Specific muscles of the symptomatic hip displaying significantly decreased CSAs compared with the asymptomatic hip included the gluteus maximus (P = .007), gluteus minimus (P = .022), and rectus femoris (P = .028). The tensor fascia lata (ρ = 0.358; P = .011), pectineus (ρ = 0.369, P = .008), adductor longus (ρ = 0.286, P = .044), and obturator externus (ρ = 0.339, P = .016) showed a moderate positive correlation with preoperative pain level on a visual analog scale in unilateral FAIS patients. No associations were found between the symptomatic-side hip muscle CSA in patients with unilateral FAIS and symptom duration or patient-reported function. CONCLUSIONS Patients with unilateral FAIS have a significantly decreased muscle CSA in the symptomatic hip compared with the asymptomatic hip. The symptomatic-side hip muscle CSA was correlated with the preoperative pain level on a visual analog scale. The association between the muscle CSA and preoperative pain level may represent a compensatory change in muscle function around the hip joint in patients with unilateral FAIS. LEVEL OF EVIDENCE Level IV, therapeutic case series.
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Affiliation(s)
- Philip Malloy
- Section of Young Adult Hip Surgery, Division of Sports Medicine, Department of Orthopedic Surgery, Rush University Medical Center, Chicago, Illinois, U.S.A
| | - Austin V Stone
- Section of Young Adult Hip Surgery, Division of Sports Medicine, Department of Orthopedic Surgery, Rush University Medical Center, Chicago, Illinois, U.S.A
| | - Kyle N Kunze
- Section of Young Adult Hip Surgery, Division of Sports Medicine, Department of Orthopedic Surgery, Rush University Medical Center, Chicago, Illinois, U.S.A
| | - William H Neal
- Section of Young Adult Hip Surgery, Division of Sports Medicine, Department of Orthopedic Surgery, Rush University Medical Center, Chicago, Illinois, U.S.A
| | - Edward C Beck
- Section of Young Adult Hip Surgery, Division of Sports Medicine, Department of Orthopedic Surgery, Rush University Medical Center, Chicago, Illinois, U.S.A
| | - Shane J Nho
- Section of Young Adult Hip Surgery, Division of Sports Medicine, Department of Orthopedic Surgery, Rush University Medical Center, Chicago, Illinois, U.S.A..
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Frank RM, Kunze KN, Beck EC, Neal WH, Bush-Joseph CA, Nho SJ. Do Female Athletes Return to Sports After Hip Preservation Surgery for Femoroacetabular Impingement Syndrome?: A Comparative Analysis. Orthop J Sports Med 2019; 7:2325967119831758. [PMID: 30915378 PMCID: PMC6429664 DOI: 10.1177/2325967119831758] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/18/2023] Open
Abstract
Background Female patients undergoing surgery for femoroacetabular impingement syndrome (FAIS) often experience inferior clinical outcomes and higher failure rates when compared with male patients. The influence of athletic status on hip arthroscopic outcomes in female patients, however, is unclear. Purpose To compare patient-reported outcomes (PROs) of athletic and nonathletic female patients undergoing hip arthroscopic surgery for FAIS, and to determine the return-to-sports rate in the athlete group. Study Design Cohort study; Level of evidence, 3. Methods Two-year PROs were assessed in female patients who had undergone hip arthroscopic surgery for FAIS by a single surgeon. Patients who self-identified as athletes were compared with nonathletes. Preoperative and postoperative PRO scores including the Hip Outcome Score-Activities of Daily Living (HOS-ADL), Hip Outcome Score-Sport-Specific (HOS-SS), modified Harris Hip Score (mHHS), and visual analog scale (VAS) for pain and satisfaction were analyzed and compared between athletes and nonathletes. Subanalysis was performed based on patient age and body mass index (BMI). Results A total of 330 female patients undergoing hip arthroscopic surgery for FAIS were identified. Of these, 221 patients identified as athletes (mean age, 29.1 ± 11.1 years; mean BMI, 23.0 ± 3.5 kg/m2) and 109 as nonathletes (mean age, 39.3 ± 11.4 years; mean BMI, 27.8 ± 5.8 kg/m2). Both groups demonstrated improvements in HOS-ADL, HOS-SS, mHHS, VAS for pain, and VAS for satisfaction scores (P < .001 for all). Athletes had significantly higher postoperative PRO scores compared with nonathletes (P < .001 for all). A 1:1 matched-pair subanalysis of 97 athletes and 97 nonathletes controlling for age and BMI indicated that these relationships held independently of potential demographic confounders (P < .001 for all). The number of patients meeting the minimal clinically important difference (MCID) and patient acceptable symptomatic state (PASS) for the HOS-ADL, HOS-SS, and mHHS was significantly higher in athletes aged ≤25 years versus those aged >25 years and for athletes versus nonathletes (P < .05 for all). Further, 189 of 194 athletes returned to sports at a mean of 6.0 ± 3.9 months postoperatively, with 93.7% reporting returning to the same or higher level of competition. Conclusion Among female patients undergoing hip arthroscopic surgery for FAIS, patients considered athletes achieved superior clinical outcomes compared with patients considered nonathletes. In addition, younger female athletes had higher rates of achieving the MCID and PASS for all PRO measures.
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Affiliation(s)
- Rachel M Frank
- Division of Sports Medicine and Shoulder Surgery, Department of Orthopaedic Surgery, University of Colorado School of Medicine, Aurora, Colorado, USA
| | - Kyle N Kunze
- Section of Young Adult Hip Surgery, Division of Sports Medicine, Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, Illinois, USA
| | - Edward C Beck
- Section of Young Adult Hip Surgery, Division of Sports Medicine, Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, Illinois, USA
| | - William H Neal
- Section of Young Adult Hip Surgery, Division of Sports Medicine, Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, Illinois, USA
| | - Charles A Bush-Joseph
- Section of Young Adult Hip Surgery, Division of Sports Medicine, Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, Illinois, USA
| | - Shane J Nho
- Section of Young Adult Hip Surgery, Division of Sports Medicine, Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, Illinois, USA
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Stone AV, Malloy P, Beck EC, Neal WH, Waterman BR, Bush-Joseph CA, Nho SJ. Predictors of Persistent Postoperative Pain at Minimum 2 Years After Arthroscopic Treatment of Femoroacetabular Impingement. Am J Sports Med 2019; 47:552-559. [PMID: 30822125 DOI: 10.1177/0363546518817538] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND Hip arthroscopy for femoroacetabular impingement syndrome (FAIS) is a rapidly expanding field, and preoperative factors predictive of persistent postoperative pain are currently unknown. PURPOSE To identify predictors for persistent postoperative pain at the site of surgery after hip arthroscopy for FAIS. STUDY DESIGN Case-control study; Level of evidence, 3. METHODS Patients who underwent hip arthroscopy for FAIS and had a minimum 2-year follow-up with patient-reported outcomes (PROs) were included in this study. Patients with previous open hip surgery and diagnoses other than FAIS were excluded. Patients were grouped by visual analog scale scores for pain as limited (<30) and persistent (≥30). Patient factors and outcomes were analyzed with univariate and correlation analyses to build a logistic regression model to identify predictors of persistent postoperative pain. RESULTS The limited pain (n = 514) and persistent pain (n = 174) groups totaled 688 patients (449 females). There was a statistically significant difference in age between groups, with the persistent pain group being older than the low pain group (35.9 ± 12.2 vs 32.4 ± 12.6, respectively; P = .002). Patients with persistent postoperative pain demonstrated significantly lower preoperative PRO scores in the Hip Outcome Score-Activities of Daily Living (57.6 ± 21.2 vs 67.7 ± 16.8), Hip Outcome Score-Sport Specific (35.9 ± 23.9 vs 44.1 ± 22.7), modified Harris Hip Score (51.6 ± 16.2 vs 59.6 ± 12.9), and International Hip Outcome Tool (32.0 ± 16.8 vs 40.0 ± 17.82) but no significant differences in preoperative visual analog scale scores for pain (7.3 ± 1.8 vs 7.2 ± 1.7). Mean postoperative PRO differences between pain groups were all statistically significant. Bivariate logistic regression analysis demonstrated that history of anxiety or depression (odds ratio, 1.8; 95% CI, 1.02-3.32; P = .042), revision hip arthroscopy (odds ratio, 8.6; 95% CI, 1.79-40.88; P = .007), and a low preoperative modified Harris Hip Score (odds ratio, 0.97; 95% CI, 0.95-0.99; P = .30) were predictors of persistent postoperative pain. CONCLUSION Independent predictors for persistent postoperative pain include revision hip arthroscopy and mental health history positive for anxiety and depression. Our analysis demonstrated significant improvements in pain and functional PROs in the limited pain and persistent pain groups; however, those with persistent pain demonstrated significantly lower PRO scores.
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Affiliation(s)
- Austin V Stone
- Department of Orthopaedic Surgery, University of Kentucky, Lexington, Kentucky, USA
| | - Philip Malloy
- Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, Illinois, USA
| | - Edward C Beck
- Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, Illinois, USA
| | - William H Neal
- Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, Illinois, USA
| | | | - Charles A Bush-Joseph
- Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, Illinois, USA
| | - Shane J Nho
- Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, Illinois, USA
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Saito M, Utsunomiya H, Hatakeyama A, Nakashima H, Nishimura H, Matsuda DK, Sakai A, Uchida S. Hip Arthroscopic Management Can Improve Osteitis Pubis and Bone Marrow Edema in Competitive Soccer Players With Femoroacetabular Impingement. Am J Sports Med 2019; 47:408-419. [PMID: 30664355 DOI: 10.1177/0363546518819099] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND There is a dearth of knowledge regarding the correlation between femoroacetabular impingement (FAI) and osteitis pubis (OP) among symptomatic soccer players. PURPOSE To elucidate whether arthroscopic FAI correction is effective for young competitive soccer players with FAI combined with OP or perisymphyseal pubic bone marrow edema (BME). STUDY DESIGN Case series; Level of evidence, 4. METHODS A total of 577 consecutive patients who underwent arthroscopic FAI correction were retrospectively reviewed with a minimum 2-year follow-up. Competitive soccer players who were professional, college, and high school athletes were included. The authors assessed the modified Harris Hip Score and Nonarthritic Hip Score preoperatively and at 6 months, 1 year, and 2 years after surgery. In addition, players were divided into groups according to radiographic evidence of OP and BME (2 groups each). Clinical outcomes, return to play, and radiographic assessments were compared between groups. RESULTS Twenty-eight hips met the inclusion criteria. The median modified Harris Hip Score significantly improved after hip arthroscopy (81.4, preoperatively; 95.7 at 6 months, P = .0065; 100 at 1 year, P = .0098; 100 at 2 years, P = .013). The median Nonarthritic Hip Score also significantly improved (75.0, preoperatively; 96.3 at 6 months, P = .015; 98.8 at 1 year, P = .0029; 100 at 2 years, P = .015). Furthermore, 92.0% of players returned to play soccer at the same or higher level of competition at a median 5.5 months (range, 4-15 months); 67.8% had radiological confirmation of OP; and 35.7% had pubic BME. The alpha angle was significantly higher in pubic BME group than the no-pubic BME group (64.8° vs 59.2°, P = .027), although there was no significant difference between the OP and no-OP groups. The prevalence of tenderness of the pubic symphysis significantly decreased preoperatively (32.1%) to postoperatively (3.6%). Magnetic resonance imaging findings confirmed that pubic BME disappeared in all players at a median 11 months (range, 6-36) after initial surgery. CONCLUSIONS Arthroscopic management for FAI provides favorable clinical outcomes, a high rate of return to sports, and, when present, resolution of pubic BME among competitive soccer players.
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Affiliation(s)
- Masayoshi Saito
- Department of Orthopaedic Surgery and Sports Medicine, Wakamatsu Hospital of the University of Occupational and Environmental Health, Kitakyushu, Japan.,Department of Orthopaedic Surgery, St Luke's International Hospital, Tokyo, Japan
| | - Hajime Utsunomiya
- Department of Orthopaedic Surgery and Sports Medicine, Wakamatsu Hospital of the University of Occupational and Environmental Health, Kitakyushu, Japan
| | - Akihisa Hatakeyama
- Department of Orthopaedic Surgery and Sports Medicine, Wakamatsu Hospital of the University of Occupational and Environmental Health, Kitakyushu, Japan
| | - Hirotaka Nakashima
- Department of Orthopaedic Surgery and Sports Medicine, Wakamatsu Hospital of the University of Occupational and Environmental Health, Kitakyushu, Japan
| | - Haruki Nishimura
- Department of Orthopaedic Surgery and Sports Medicine, Wakamatsu Hospital of the University of Occupational and Environmental Health, Kitakyushu, Japan
| | | | - Akinori Sakai
- Department of Orthopaedic Surgery, University of Occupational and Environmental Health, Kitakyushu, Japan
| | - Soshi Uchida
- Department of Orthopaedic Surgery and Sports Medicine, Wakamatsu Hospital of the University of Occupational and Environmental Health, Kitakyushu, Japan
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Uding A, Bloom NJ, Commean PK, Hillen TJ, Patterson JD, Clohisy JC, Harris-Hayes M. Clinical tests to determine femoral version category in people with chronic hip joint pain and asymptomatic controls. Musculoskelet Sci Pract 2019; 39:115-122. [PMID: 30553987 PMCID: PMC6353568 DOI: 10.1016/j.msksp.2018.12.003] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/27/2018] [Revised: 11/06/2018] [Accepted: 12/05/2018] [Indexed: 12/19/2022]
Abstract
STUDY DESIGN Controlled laboratory cross-sectional. OBJECTIVES To investigate the relationship between femoral version (FV), measured by MRI (FVMRI), Craig's test and hip rotation range of motion (ROM). To determine rotation ROM values associated with FVMRI categories: excessive anteversion, normal version and retroversion. BACKGROUND Abnormal FV values are associated with hip disorders, such as osteoarthritis, structural instability, acetabular labral tears and femoroacetabular impingement. Clinical assessment of FV may allow clinician to identify the effect of bony abnormalities on hip rotation ROM to guide clinical decisions. METHODS Thirty-eight participants with chronic hip joint pain (CHJP) and 38 matched controls participated. MRI was used to determine FVMRI. A digital inclinometer was used to assess Craig's test, hip internal rotation (IR) and external rotation (ER) with hip flexed to 90° (90°), and hip IR/ER with hip in neutral flexion/extension (0°). ROM differences (ROMdif) were determined by subtracting ER from IR. Pearson correlation coefficients were used to assess the relationship between FVMRI and clinical variables. One-way analysis of variance (ANOVA) was used to compare rotation ROM among FVMRI categories. RESULTS There were no differences between CHJP and control groups in demographics, FVMRI, Craig's test or ROM. ROMdif0° showed the highest correlation (r = 0.63) with FVMRI, then IR90° (r = 0.61) and Craig's test (r = 0.61). Differences were noted among FVMRI categories for rotation ROM except hip ER90°. CONCLUSION Hip rotation ROM and Craig's test may be used for screening when imaging is not indicated. A 20° difference between hip IR and ER ROM would be suggestive of abnormal FV.
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Affiliation(s)
- Alexandria Uding
- Momentum Physical Therapy and Performance Training, Milford, MA, United States
| | - Nancy J. Bloom
- Program in Physical Therapy, Washington University School of Medicine, St. Louis, MO, United States,Department of Orthopaedic Surgery, Washington University School of Medicine, St Louis, MO, United States
| | - Paul K. Commean
- Electronic Radiology Lab in Mallinckrodt Institute of Radiology, Washington University School of Medicine, Campus Box 8131, St Louis, 63110, MO, United States
| | - Travis J. Hillen
- Department of Radiology, Washington University School of Medicine, 660 S. Euclid, Campus Box 8131, St Louis, MO 63110, United States
| | | | - John C. Clohisy
- Department of Orthopaedic Surgery, Washington University School of Medicine, St Louis, MO, United States
| | - Marcie Harris-Hayes
- Program in Physical Therapy, Washington University School of Medicine, St. Louis, MO, United States; Department of Orthopaedic Surgery, Washington University School of Medicine, St Louis, MO, United States.
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Minkara AA, Westermann RW, Rosneck J, Lynch TS. Systematic Review and Meta-analysis of Outcomes After Hip Arthroscopy in Femoroacetabular Impingement. Am J Sports Med 2019; 47:488-500. [PMID: 29373805 DOI: 10.1177/0363546517749475] [Citation(s) in RCA: 179] [Impact Index Per Article: 29.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND Femoroacetabular impingement (FAI) has become a more commonly recognized cause of limited hip range of motion and hip pain among young adults and athletes. Hip arthroscopy is recommended for the surgical treatment of this disorder, unless specific contraindications exist. Despite the increasing rate of published studies in this area, there remains no aggregate data for outcomes after this approach. PURPOSE To evaluate risk factors and outcomes after arthroscopic management of FAI, including return to play, revision rate, surgical and nonsurgical complications, change in α-angle, intraoperative bone resection, and patient-reported outcomes. STUDY DESIGN Meta-analysis and systematic review. METHODS A review of the current literature was performed with the terms "femoroacetabular impingement," "hip arthroscopy," and numerous variations thereof in PubMed, EMBASE, BioMed Central, Cochrane, Science Direct, and Scopus, yielding 1723 abstracts. After screening by eligibility criteria, 31 articles were included. The incidence of bilateral FAI was determined by enrollment data, and pooled estimates were calculated for postoperative patient-reported outcome measures, α-angles, return to sport, postoperative complications, and reoperation risk. RESULTS A total of 1981 hips among 1911 patients were identified, with a mean ± SD age of 29.9 ± 1.9 years and 29.5 ± 14.0 months of follow-up. The incidence of bilateral FAI in these studies that required operative intervention was 3.6%. The pooled risk of reoperation after hip arthroscopy, including revision surgery or subsequent total hip arthroplasty, was 5.5% (95% CI, 3.6%-7.5%). The risk of clinical complications was 1.7% (95% CI, 0.9%-2.5%). In total, 87.7% of patients demonstrated return to sport after surgery (95% CI, 82.4%-92.9%, P < .001), and all patient-reported outcomes improved postoperatively, with the highest increase observed in the Hip Outcome Score sports scale (41.7 points; 95% CI, 34.1-49.4; P < .001). The α-angle decreased by an average of 23.6° (95% CI, 18.2°-29.0°; P < .001). We identified 11 factors associated with the success of hip arthroscopy in FAI and 16 factors associated with failure or negative outcomes. CONCLUSION A high percentage of patients return to sport activities after hip arthroscopy for FAI, with a low rate of complications and reoperation. All patient-reported outcome measures, except for mental health, significantly improved after surgery.
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Affiliation(s)
- Anas A Minkara
- Columbia University Medical Center, New York, New York, USA
| | | | | | - T Sean Lynch
- Columbia University Medical Center, New York, New York, USA
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