Open Hip Abductor Repair Hitting the Sack-Abductor Tendon Repair Significantly Improves Sleep Quality.

Alexander Zimmerer,Luis Navas,Matthias Hauschild,Dominic Pfeil

doi:10.3390/jcm10215164

Abstract

Purpose: To (1) describe the prevalence of abnormal sleep quality in patients with hip abductor tears (HAT), to (2) determine whether sleep quality improves after open HAT repair, and to (3) to report clinical short-term outcomes in patients undergoing open HAT repair. Methods: The data of 28 patients (29 hips) who underwant open HAT repair were prospectively analyzed at midterm follow-up. The Pittsburgh Sleep Quality Index (PSQI), modified Harris Hip Score (mHHS), the University of California, Los Angeles activity scale (UCLA), and Visual Analog Scale (VAS) for pain were determined via questionnaire. Paired t-tests were applied to compare preoperative and post-operative Patient-reported Outcome Measures (PROMs). Logistic regression was performed to determine the association between PSQI improvement achievement and demographic variables (laterality, sex, age, body-mass-index (BMI), and preoperative mHHS). The minimal clinically important difference (MCID) was calculated for the mHHS. Results: A total of 28 patients were included. Four patients (14.3%) suffered post-operative complications after open HAT repair. The predominance of patients was female (77.4%), with a mean age of 60 ± 13 years. The average follow-up was 30.35 ± 16.62 months. Preoperatively, 27 (96.4%) patients experienced poor sleep quality (PSQI > 5); at follow-up, 7 (25%) patients experienced poor sleep quality. Univariate logistical regression analysis demonstrated no significant association between preoperative demographic data and achieving postoperative PSQI < 5. The MCID of mHHS was calculated to be 12.5. Overall, 90% of patients achieved MCID for mHHS. Conclusion: Preoperative sleep quality was impaired in 96.4% of HAT patients (PSQI > 5). However, these patients showed an improvement in sleep disturbances after open HAT repair in the early postoperative period. Ninety percent of patients showed significant improvements in mHHS and achieved the corresponding MCID. Level of Evidence: Case series; Level IV.

Highlights

Hip abductor tear (HAT) is an increasingly diagnosed cause of refractory lateral hip pain and dysfunction in the aging population [1,2,3,4,5,6]
Recent publications have further shown that approximately 80% of surgically treated patients achieved the minimal clinically important difference (MCID) for the modified Harris Hip Score after open or endoscopic HAT repair [13,14]
Exclusion criteria included a history of pediatric hip malformatios, prior surgery of ipsilateral HAT, partial-thickness gluteus medius and/or minimus tears, a follow-up period shorter than 12 months, or inability to consent to the study

Summary

Introduction

Hip abductor tear (HAT) is an increasingly diagnosed cause of refractory lateral hip pain and dysfunction in the aging population [1,2,3,4,5,6]. Patients with HAT present with lateral hip pain, hypersensivity to palpation of the greater trochanter, debilitated hip abduction against resistance, and a positive Trendelenburg sign. These symptoms are excacerbated by walking long distances, walking up and down stairs, or sleeping on the affected side [11,12,13]. Recent publications have further shown that approximately 80% of surgically treated patients achieved the minimal clinically important difference (MCID) for the modified Harris Hip Score (mHHS) after open or endoscopic HAT repair [13,14]

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Methods

Conclusion