Arthroscopy Patients Research Articles

The prevalence of synovitis during hip arthroscopy for labral tears – An observational study

Objectives: Hip pain, secondary to labral tears (LT), can significantly impact the quality of life in the young adult population. LTs can be an incidental finding or can arise from underlying pathology, most commonly from femoroacetabular impingement (FAI). The cause of hip pain in young adults can represent a diagnostic challenge to clinicians. Magnetic resonance imaging (MRI)/magnetic resonance arthrography may be inconclusive in some cases. Therefore, diagnostic hip arthroscopy may be performed to provide a definitive diagnosis and to address intra-articular pathology. During hip arthroscopy, synovitis is often an initial finding. Synovitis can have multiple causes or can also be idiopathic. The aim of this study was to determine the incidence of synovitis detected during hip arthroscopy in patients with an MRI-confirmed LT. Materials and Methods: We conducted a prospective review of 50 consecutive patients undergoing hip arthroscopy who had a confirmed LT on MRI. We recorded the presence or absence of synovitis during the initial insertion of the arthroscope. In addition, we recorded demographic data and the grade of LT identified. Results: During hip arthroscopy, 31 patients had synovitis present, while 19 did not have synovitis. No significant difference was identified when comparing Visual Analog Score and EQ5D scores between both cohorts. Conclusion: Our study found that synovitis is a common finding during hip arthroscopy for FAI syndrome, with 62% of patients with an MRI diagnosis of LT associated with FAI having global hip synovitis present at the time of surgery.

Outcomes of bilateral temporomandibular joint arthroscopy: an international multicentric prospective study including 524 joints.

This study aimed to evaluate the efficacy of bilateral TMJ arthroscopy in patients with different Wilkes stages, comparing the results obtained in different arthroscopic levels on a larger scale, unifying similar populations. A multicentric prospective clinical study was conducted in three TMJ departments performing temporomandibular joint surgery in Portugal and Brazil, with an enrolling window active from January 1, 2019, to December 1, 2022. The primary clinical outcome was TMJ pain evaluated through a visual analogue scale. The secondary clinical outcome was the maximum mouth opening (MMO). TMJ arthroscopy was performed with a 1.9-mm arthroscope, including a video system with a 2.8-mm outer protective cannula. 262 patients, representing a total of 524 operated joints were enrolled. The mean age was 35.3 years. A significant decrease postoperatively in VAS pain was observed for all Wilkes stages. The lowest value of VAS pain was observed in Wilkes II compared to Wilkes III and IV. In the secondary outcome, MMO was observed to have a significant improvement in all Wilkes stages. In this multicentric study, bilateral TMJ arthroscopy was shown to be an effective procedure to reduce pain and increase maximum mouth opening in patients with different Wilkes stages, representing a valid minimally invasive solution.

Arthroscopy has a higher discriminative capacity than MRI in detecting mild cartilage lesions.

To determine whether current magnetic resonance imaging (MRI) could detect superficial cartilage lesions that are observed during diagnostic arthroscopy in patients with knee pain who have not been diagnosed with joint disease. Adult patients with knee pain of unclear origin lasting more than three months, scheduled for a therapeutic/diagnostic arthroscopy were recruited. Demographic and clinical data, pain assessment, MRI imaging, and observations of cartilage damage in the medial femoral condyle during arthroscopic procedure were documented. Patients were categorized based on the presence of cartilage damage assessed via MRI and/or direct visualization. Concordance between these assessments and its variation with age and patient-reported pain were examined. Out of the 95 patients recruited, 48 exhibited lesions in the medial femoral condyle (MFC) during arthroscopic examination, while only 24 of them showed lesions on the MRI scans. The thickness of the cartilage in the MFC was significantly lower in patients with cartilage damage detected by MRI compared with those without. Among patients with cartilage lesions identified during arthroscopy, those also showing lesions on the MRI had lower cartilage thickness and higher Outerbridge score than those without lesions on the MRI. Patients with detectable cartilage damage on the MRI were significantly older and reported higher levels of pain than those with damage detected only by arthroscopic examination. Despite significant technological advancements in MRI, arthroscopy still proves superior in identifying mild structural cartilage lesions that are not identifiable by this technique.

Effects of vitamin E on calcium signaling and oxidative injury in neutrophils of patients with ischemia/reperfusion (surgical arthroscopy) under sevoflurane anesthesia

Sevoflurane is an anesthetic, and it acts on oxidative activity by activating Ca2+ influx. In human neutrophils, oxidative stress activates the voltage-gated calcium channels (VGCC) and the TRPM2 channel; on the other hand, these channels are inhibited by 2-aminoethoxydiphenyl borate (2-APB) and verapamil plus diltiazem (V+D), respectively. Under sevoflurane anesthesia, surgical arthroscopy poses a significant risk to oxidative stress and Ca2+ influx-induced neutrophil infiltration and injury of patients. However, vitamin E may inhibit lipid peroxidation (LP) by upregulating reduced glutathione (GSH) and glutathione peroxidase (GSH-Px) but downregulating TRPM2 and VGCC in the neutrophils of surgical arthroscopy patients. This topic was examined in the current study. We enrolled 20 patients in the current study, separating them into two primary groups: patients and patients plus vitamin E. Ten patients were divided into two groups: preoperative (N1) and postoperative (N2), both of which were not given vitamin E therapy. The remaining ten patients were given 300 IU of vitamin E two hours prior to their surgical arthroscopy (E1), and their blood was again drawn following the procedure (E2). Prior to fMLP stimulation, the isolated neutrophils from each of the four groups were cultured with 10 uM V+D and 100 uM 2-APB. In the neutrophils, there was an increase in intracellular free Ca2+ ([Ca2+]i) concentration and LP levels due to the downregulation of GSH and GSH-Px; however, following vitamin E treatment, GSH concertation and GSH-Px activity increased in the E2 group. While 2-APB and V+D treatment reduced the concentration of [Ca2+]i in the neutrophils, vitamin E administration had no effect on this measurement. In summary, vitamin E treatment mitigated the GSH and GSH-Px alterations induced by I/R damage, while TRPM2 and VGCC inhibition reduced the [Ca2+]i rise induced by I/R injury. One potential treatment approach for I/R-induced oxidative neutrophil damage is the suppression of TRPM2 and VGCC.

Imaging characteristics of hip joint microinstability: a case-control study of hip arthroscopy patients.

Hip microinstability is a clinical entity increasingly recognized and treated but challenging to diagnose with a lack of objective criteria. This study assessed the prevalence and diagnostic accuracy of different imaging findings for hip microinstability on radiograph and MR. A retrospective case-control study of 224 hips treated with arthroscopic surgery by a single orthopedic surgeon, 112 hips with clinical microinstability and 112 controls without. Pre-operative radiograph and MRI/MRA imaging were evaluated by two musculoskeletal radiologists to assess morphological parameters and imaging signs reportedly associated with hip microinstability. Four imaging features reached significance as predictors of microinstability via three-step logistic regression: labral hyperplasia and decreased lateral center edge angle on MR (OR 2.45 and 0.93, respectively) and the absence of positive ischial spine sign and absence of osteophytes on radiographs (OR 0.47 and 0.28, respectively). Increased acetabular anteversion and absence of cam lesions were more likely in the microinstability group (p = 0.02 and 0.04, respectively), but not independent predictors. Labral tears, chondral loss, abnormal ligamentum teres, anterior capsule thinning, iliocapsularis to rectus femoris ratio, posterior crescent sign, cliff sign, and femoro-epiphyseal acetabular roof (FEAR) index were not associated with microinstabillity. Imaging features may be predictive of hip microinstability in some cases. Decreased LCEA, increased acetabular anteversion, and labral hyperplasia were associated with microinstability in this study, while many other published imaging findings were not. Imaging remains complementary, but not definitive, in the diagnosis of hip microinstability.

Relationship Between Neighborhood-Level Socioeconomic Status and Functional Outcomes After Hip Arthroscopy

Background: Despite the growing volume of neighborhood-level health disparity research, there remains a paucity of prospective studies investigating the relationship between Area Deprivation Index (ADI) and functional outcomes for patients undergoing hip arthroscopy. Purpose: To investigate the relationship between neighborhood-level socioeconomic status and functional outcomes after hip arthroscopy. Study Design: Cohort study; Level of evidence, 3. Methods: A retrospective analysis of prospectively collected data was performed on patients aged ≥18 years with minimum 1-year follow-up who underwent hip arthroscopy for the treatment of symptomatic labral tears. The study population was divided into ADILow and ADIHigh cohorts according to ADI score: a validated measurement of neighborhood-level socioeconomic status standardized to yield a score between 1 and 100. Patient-reported outcome measures (PROMs) included the modified Harris Hip Score, Nonarthritic Hip Score, Hip Outcome Score–Activities of Daily Living, Hip Outcome Score–Sports-Specific Subscale, 33-item International Hip Outcome Tool, visual analog scale for pain, and patient satisfaction. Results: A total of 228 patients met inclusion criteria and were included in the final analysis. After patients were stratified by ADI score (mean ± SD), the ADILow cohort (n = 113; 5.8 ± 3.0; range, 1-12) and ADIHigh cohort (n = 115; 28.0 ± 14.5; range, 13-97) had no differences in baseline patient demographics. The ADIHigh cohort had significantly worse preoperative baseline scores for all 5 PROMs; however, these differences were not present by 1-year follow-up. Furthermore, the 2 cohorts achieved similar rates of the minimal clinically important difference for all 5 PROMs and the Patient Acceptable Symptom State for 4 PROMs. When controlling for patient demographics, patients with higher ADI scores had greater odds of achieving the minimal clinically important difference for all PROMs except the 33-item International Hip Outcome Tool. Conclusion: Although hip arthroscopy patients experiencing a greater neighborhood-level socioeconomic disadvantage exhibited significantly lower preoperative baseline PROM scores, this disparity resolved at 1-year follow-up. In fact, when adjusting for patient characteristics including ADI score, more disadvantaged patients achieved greater odds of achieving the minimal clinically important difference. The present study is merely a first step toward understanding health inequities among patients seeking orthopaedic care. Further development of clinical guidelines and health policy research is necessary to advance care for patients from disadvantaged communities.

The Impact of Preoperative Intra-articular Injections on Postoperative Outcomes in Hip Arthroscopy

Introduction: Hip arthroscopy is a minimally invasive procedure commonly performed to treat various hip conditions. Preoperative intra-articular injections, such as local anesthetics and corticosteroids, are frequently used to alleviate pain and as a diagnostic tool before hip arthroscopy. However, studies have shown conflicting information; some demonstrate better patient outcomes, while others have found an increased risk of complications and negative effects on postoperative recovery. This retrospective study evaluated the association between preoperative injections and postoperative outcomes in hip arthroscopy patients. Materials and Methods: A retrospective review of 1400 patients who underwent hip arthroscopy between 2014 and 2021 at our institution was performed. The patients were allocated into two cohorts based on whether they received a cortisone injection with local anesthetic within 1 year before the surgery. Outcomes during the study follow-up period (average: 437 days, max: 3018 days) were compared. Further analysis looked at subgroups at 30-day increments. Results: The results showed that 35.5% of the patients had received a preoperative injection. Although patients who received injections were more likely to be female (68.3% injected vs. 60.8% not injected, P = 0.019) and have asthma (12.5% injected vs. 7.3% not injected, P = 0.008), there were no significant differences in 90-day complications, 90-day emergency department visits, 90-day readmissions, any complications (wound infection, re-injury, recurrent pain or weakness, deep vein thrombosis, or pulmonary embolism), prolonged pain or recovery, reoperation, total hip arthroplasty, 6-month Patient-Reported Outcomes Measurement Information System Physical Function, 6-month Hip Dysfunction and Osteoarthritis Outcome Score Joint Replacement, or follow-up time between the injection and noninjection groups. There were no other differences in demographics, comorbidities, or physical function between the groups. Conclusion: Our study suggests that preoperative corticosteroid injections with local anesthetics do not significantly affect postoperative outcomes in hip arthroscopy patients or increase the risk of adverse effects. Careful evaluation of these risks and benefits is crucial to minimize potential adverse effects and maximize patient outcomes.

Analgesic effects of intraarticular anaesthetic lidocaine and methylprednisolone versus methylprednisolone alone following knee arthroscopy.

Knee arthroscopy is a widely practiced orthopaedic procedure known for its minimally invasive approach, allowing quicker recovery times and less postoperative discomfort than traditional open surgeries. However, managing postoperative pain remains a critical aspect of patient care and satisfaction. The main objective of this research is to examine the relationships between patient demographics (age, gender, BMI) and early postoperative outcomes, including pain, physiotherapy, and walking. Randomized data collection, clinical trial study of 2 groups of patients. The patients were split into lidocaine 1 % 16 ml + methylprednisolone 160 mg 4 ml) and (methylprednisolone only 160 mg 4 ml) groups. All patients in both groups were queried about age, gender, BMI, and pain on the first, third, and 15th days following surgery. All patients were tested for physiotherapy on the second, third, and fourth postop days. After surgery, walking was tested on the third, fourth, and fifth days. Significant differences in postoperative pain relief and physiotherapy initiation times were observed. There are notable associations between treatment groups and recovery metrics, such as pain levels and mobility on various days' post-surgery. Significant demographic influences (age, gender, BMI) on recovery outcomes are observed, particularly in walking and pain at day 15 post-operation. lidocaine and methylprednisolone improve postoperative pain relief and functional recovery in knee arthroscopy patients, with most experiencing reduced pain early post-surgery (early physiotherapy) and an expedited return to walking (decreased morbidity). Patients taking just methylprednisolone recovered slower. Age, gender, and BMI affected pain and walking abilities post-operation but not physiotherapy time, underscoring the personalised approach needed in postoperative treatment.

Radiological predictors of outcomes in hip arthroscopy for femoroacetabular impingement.

Hip arthroscopy has gained prominence as a primary surgical intervention for symptomatic femoroacetabular impingement (FAI). This study aimed to identify radiological features, and their combinations, that predict the outcome of hip arthroscopy for FAI. A prognostic cross-sectional cohort study was conducted involving patients from a single centre who underwent hip arthroscopy between January 2013 and April 2021. Radiological metrics measured on conventional radiographs and magnetic resonance arthrography were systematically assessed. The study analyzed the relationship between these metrics and complication rates, revision rates, and patient-reported outcomes. Out of 810 identified hip arthroscopies, 359 hips were included in the study. Radiological risk factors associated with unsatisfactory outcomes after cam resection included a dysplastic posterior wall, Tönnis grade 2 or higher, and over-correction of the α angle. The presence of acetabular retroversion and dysplasia were also significant predictors for worse surgical outcomes. Notably, over-correction of both cam and pincer deformities resulted in poorer outcomes than under-correction. We recommend caution in performing hip arthroscopy in patients who have three positive acetabular retroversion signs. Acetabular dysplasia with a lateral centre-edge angle of less than 20° should not be treated with isolated hip arthroscopy. Acetabular rim-trimming should be avoided in patients with borderline dysplasia, and care should be taken to avoid over-correction of a cam deformity and/or pincer deformity.

Preoperative Hip Injection Response Does Not Reliably Predict 2-Year Postoperative Outcomes After Hip Arthroscopy for Femoroacetabular Impingement

PurposeTo determine whether response to preoperative local anesthetic or corticosteroid intra-articular injections can predict 2-year postoperative outcomes in patients undergoing hip arthroscopy for femoroacetabular impingement syndrome (FAIS). MethodsThis was a retrospective analysis of patients undergoing hip arthroscopy for FAIS at a single institution from 2014-2020. Patients who underwent preoperative intra-articular hip injection were classified based on injection type (local anesthetic, corticosteroid) and whether they experienced pain relief following injection (responders, non-responders). Responders were matched 2:1 by age, BMI, and sex with non-responders. Patient reported outcomes (PROs) including Hip Disability and Osteoarthritis Outcome Score (HOOS), 12-item Short-Form Survey mental (SF-12-MCS) and physical component summary (SF-12-PCS) and visual analogue scale (VAS) pain were collected preoperatively and 2-years postoperatively. Mean score change and Minimal Clinically Important Difference (MCID) achievement were calculated and compared between groups. ResultsThe matched cohort included 126 total patients (42 non-responders, 84 responders; 74.6% female; mean ± SD age: 30.9 ± 9.9 years; BMI: 24.7 ± 3.7 kg/m2) with no differences in demographic or radiographic hip variables. Both groups demonstrated significant 2-year postoperative score improvements across all PROs, except SF-12-MCS, which remained unchanged. There was no difference in mean score change or MCID achievement across all PROs between corticosteroid injection responder and non-responder groups. In the local anesthetic group, MCID achievement was similar across all PROs, except VAS pain which showed greater percentage of MCID achievement among local anesthetic non-responders relative responders (Responders: 55.0%, Non-responders: 89.5%; p = 0.03). Significant ceiling effects were most readily apparent among the injection responders group with greater percentages of patients achieving maximal 2-year postoperative survey scores (36.9% HOOS-ADL, 19.0% HOOS-Pain, 15.5% HOOS-QoL, 32.1% HOOS-Sport). ConclusionsResponse to preoperative injection with either corticosteroid or local anesthetic did not predict 2-year outcomes after hip arthroscopy in patients with FAIS. Level of EvidenceLevel III, retrospective matched cohort study.

Borderline Developmental Dysplasia of the Hip With Osseous Impingement as Distinct From Femoroacetabular Impingement and Developmental Dysplasia of the Hip.

Borderline developmental dysplasia of the hip (BDDH) accompanied by cam deformity and subspinous impingement has been found to benefit from arthroscopic surgery. However, the research comparing BDDH combined with osseous impingement to femoroacetabular impingement (FAI) without borderline dysplasia remains limited. To compare the clinical symptoms, intraoperative findings, and outcomes of hip arthroscopy in patients with BDDH and osseous impingement versus cam-type FAI. It was hypothesized that BDDH with osseous impingement could be classified as a distinct entity between FAI and developmental dysplasia of the hip (DDH). Cohort study; Level of evidence, 3. Data were collected from patients 18 to 50 years old who underwent primary hip arthroscopy between September 2016 and October 2020. Patients were divided based on preoperative lateral center-edge angle (LCEA) into 2 groups: (1) BDDH group (LCEA 18°-25°; n = 67); and (2) cam-type FAI group without BDDH (FAI group; LCEA 25°-40° and alpha angle >55°; n = 145). Disparities in symptoms, preoperative examination, intraoperative findings and procedures, and patient-reported outcome (PRO) scores were compared. Follow-up was available for 61 (91.0%) patients in the BDDH group and 125 (86.2%) patients in the FAI group. The incidence of cam deformity in BDDH patients was 91.8%. The preoperative characteristics and intraoperative findings were similar between the groups; however, preoperative internal and external hip rotation, Tönnis angle, femoroepiphyseal acetabular roof index, labral size, capsule thickness, and percentage of ligamentum teres tear were significantly higher in the BDDH group than the FAI group, and the percentage of pain aggravating factor, cam deformity, and anterior inferior iliac spine types 2 and 3 were also significantly different between groups (P < .05 for all). The percentage of intraoperative minimal acetabuloplasty, subspinous decompression, labral repair, ligamentum teres debridement, and capsular closure was significantly higher in the BDDH group than the FAI group, while the percentage of femoroplasty was higher in the FAI group (P < .05). Pre- to postoperative improvement on PRO scores was seen in both groups. Given the differences in etiology and surgical procedures between the 2 conditions, it is suggested that BDDH with osseous impingement be classified as an entity distinct from FAI and DDH (and separate from BDDH without impingement) while excluding joint instability.

Social Determinants of Health Disparities Increase 5-Year Revision Rates but Not Postoperative Complications After Primary Hip Arthroscopy

To investigate the impact of social determinants of health (SDOH) disparities on 30-day emergency department (ED) visits, 90-day postoperative complications, and five-year secondary surgery rates after primary hip arthroscopy using a large national database. A national administrative claims database was used to identify patients who underwent primary hip arthroscopy with femoroplasty, acetabuloplasty, and/or labral repair between 2015 and 2022. Patients were queried for whether they experienced any SDOH disparities, including economic, educational, environmental, or social disparities; those experiencing SDOH within 1 year prior to primary hip arthroscopy were matched 1:1 by age, sex, Elixhauser Comorbidity Index score, diabetes, obesity, and tobacco use to patients not experiencing any lifetime SDOH disparities. Odds of 90-day complications and 30-day ED visits were compared using multivariable logistic regression. Rates of five-year revision hip arthroscopy and of any secondary surgery (revision hip arthroscopy or total hip arthroplasty) were compared by Kaplan-Meier analysis. A total of 3,383 primary hip arthroscopy patients who experienced SDOH disparities were matched 1:1 to a control cohort of 3,383 patients who had not experienced SDOH (age, 41.0 years, 79.6% female, for both cohorts). Odds of adverse events following arthroscopy were low and not different between cohorts (SDOH: 1.51%, vs. No SDOH: 1.57%; P=0.09). Additionally, there was no difference in odds of 30-day ED visits (SDOH: 5.65%, vs. No SDOH: 4.79%; P=0.10). The rate of five-year revision hip arthroscopy was significantly greater among patients experiencing SDOH disparities (5.4% vs. 4.1%; P=0.02); however, there was no difference in rates of any secondary surgery between cohorts (11.8% vs. 10.4%; P=0.10). Patients experiencing SDOH disparities had similar odds of postoperative complications and ED visits after primary hip arthroscopy but greater rates of five-year revision hip arthroscopy compared to a matched-control cohort of patients not experiencing SDOH disparities. 3; retrospective case-control study.

VDR Gene Polymorphisms (BsmI, FokI, TaqI, ApaI) in Total Hip Arthroplasty Outcome Patients.

A total hip arthroplasty (THA) can improve quality of life, but loosening of the hip prosthesis is a complex problem in which vitamin D may also play a role. The Vitamin D Receptor (VDR) is involved in the response of cells to the action of vitamin D, and its genetic variability raises the question of whether individual differences could influence the risk of prosthesis loosening. The aim of this study was to investigate the relationship between VDR single nucleotide polymorphisms (SNPs) (ApaI, BsmI, FokI and TaqI) and the serum VDR and 25(OH)D levels in three groups of patients: (1) arthroscopy patients after THA without loosening of the prosthesis (CA-Control Arthroplasty), (2) patients after THA with loosened hip prostheses (L-Loosening) and (3) the control group (C-Control). Our results suggest that the genotypes tt of TaqI, BB of BsmI, and FF of FokI may influence the VDR effect in patients with loosened protheses. Our results showed that the ACAC haplotype (AtBF) was over two times more frequent in the L group than in CA + C: OR =2.35 [95% CI 1.44-3.83; p = 0.001]. There was no significant correlation between the VDR and serum 25(OH)D levels, but there were differences between studied groups.

Poster 205: Long-Term Outcomes for Patients Undergoing Revision Hip Arthroscopy

Objectives: Previous studies have reported outcomes after revision hip arthroscopy at mid-term follow-up. These studies demonstrate that patients can expect clinical improvement and low rates of reoperation following their revision surgery. However, in comparison to primary hip arthroscopy patients they experience worse outcomes. The purpose of this study was (1) To evaluate long-term outcomes after revision hip arthroscopy and (2) to identify factors that contribute to poorer outcomes. Methods: Patients who underwent revision hip arthroscopy for FAIS between 1/2012-9/2015 were reviewed. Patients were excluded if they underwent revision hip arthroscopy for a reason other than FAIS, underwent staged or prior PAO, had Tönnis grade &gt; 1, had a history of congenital hip disorder (e.g., slipped capital femoral epiphysis), or were missing 8+ year follow-up. Patient-reported outcome (PRO) measures were collected both pre- and post-operatively including Hip Outcome Score Activities of Daily Living (HOS-ADL) and Sports Scale (HOS-SS), modified Harris Hip Score (mHHS), and international Hip Outcome Tool (iHOT-12). Minimal clinically important difference (MCID) and patient acceptable symptom state (PASS) thresholds were calculated using the distribution and anchor methods, respectively. Rates of MCID and PASS achievement were then evaluated. Rates of reoperation including repeat revision hip arthroscopy and conversion to total hip arthroplasty (THA) were evaluated. Patients were also divided into clinical successes and failures and compared. A clinical failure was defined as failure to achieve MCID or PASS for any PRO or undergoing a reoperation. Results: A total of 43 patients (72% female; age: 30.1 ± 10.3 years; BMI: 25.8 ± 6.0 kg/m2) met criteria for inclusion. Average follow-up was 9.3 years. At last follow-up there were significant improvements across all PROs (p &lt; 0.001, for all). MCID achievement at final follow-up for each PRO was ≥ 56.5%, with achievement of MCID in any PRO occurring in 73.9% of patients. PASS achievement at final follow-up for each PRO was ≥ 29.6%, with achievement of PASS in any PRO occurring in 63.0% of patients. PASS achievement was 75.7% at two years and 75.8% at five years. Incidence of secondary revision hip arthroscopy was 23.3% and THA was 14.0%, occurring at mean 3.9 ± 2.8 years and 4.2 ± 3.0 years following index revision, respectively. 22 patients were considered clinical successes, and 21 patients were determined to be clinical failures. Both groups demonstrated similar age (28.6 ± 8.5 years vs 31.6 ± 11.9, p = 0.351), sex (77.3% female vs 66.7% female, p = 0.438), and BMI (25.7 ± 7.9 vs 25.9 ± 3.6, p = 0.915). Additionally, clinical successes and failures had similar preoperative PROs (p ≥ 0.133, for all). Presence of preoperative pain for over two years occurred more frequently in clinical failures (45.5% vs 76.2%, p = 0.039). Tönnis grade 1 was also present at a higher rate amongst clinical failures (0% vs 23.8%, p = 0.015). Conclusions: Patients undergoing revision hip arthroscopy can see significant clinical improvement, particularly within the first five years following surgery. However, some patients may see clinical decline beyond eight years post-operatively. Revision hip arthroscopy is associated with relatively high reoperation rate. Those with greater Tönnis grade on preoperative radiographs and increased prevalence of chronic preoperative pain were less likely to achieve a clinical success.

Subpectineal obturator nerve block reduces opioid consumption after hip arthroscopy: a triple-blind, randomized, placebo-controlled trial

BackgroundHip arthroscopy causes severe pain during the first few hours in the postoperative care unit. This is probably due to the intraoperative stretching of the hip joint capsule. Pain relief...

Postoperative Infection Following Hip Arthroscopy in Patients Receiving Preoperative Intra-articular Injections: A Systematic Review and Meta-Analysis.

Intra-articular injections prior to hip arthroscopy are often used to diagnose and conservatively manage hip pathologies, such as femoroacetabular impingement, labral tears, and chondral lesions. As a diagnostic tool, the relief of hip pain following an intra-articular injection helps pinpoint the primary source of pain and assists surgeons in recommending arthroscopic intervention for underlying intra-articular pathologies. However, when injections are not sufficiently spaced apart in time prior to hip arthroscopy, there is an elevated risk of postoperative infection. This systematic review aims to assess whether preoperative intra-articular injections prior to hip arthroscopy are associated with an increased risk of postoperative infection and to determine the safety timeframe for administering such injections prior to the procedure. A comprehensive search was conducted in the PubMed, Embase, and Cochrane Library databases to identify studies examining the relationship between preoperative intra-articular injections and postoperative infection following hip arthroscopy. A meta-analysis was conducted to compare the risk of infection between patients who received injections prior to hip arthroscopy at varying intervals and those who did not receive any preoperative injections. Five studies were included (four level III and one level IV), which consisted of 58,576 patients (58.4% female). Injections administered anytime prior to hip arthroscopy posed a significantly higher risk of infection compared to no history of prior injections (risk ratio: 1.45, 95% confidence interval: 1.14-1.85, P = 0.003). However, upon subanalysis, the risk of infection was significantly higher among patients who received injections within three months prior to hip arthroscopy compared to those who did not receive injections (risk ratio: 1.55, 95% confidence interval: 1.19-2.01, P = 0.001). Additionally, no significant difference in infection risk was observed when injections were administered more than three months before hip arthroscopy compared to no injections (risk ratio: 1.05, 95% confidence interval: 0.56-1.99, P = 0.87). The findings suggest that patients undergoing hip arthroscopy who have previously received intra-articular injections may face a statistically higher risk of postoperative infection, particularly when the injection is administered within three months prior to hip arthroscopy. Consequently, surgeons should exercise caution and avoid administering intra-articular injections to patients scheduled for hip arthroscopy within the subsequent three months to mitigate the increased risk of infection.

The role and place of arthroscopy in the early diagnosis of monoarthrosis (literature review)

Background. Knee osteoarthritis is a progressive incurable disease that in severe cases leads to total joint replacement, which requires significant economic costs and medical and social adaptation, has a number of postoperative complications and adverse outcomes. Therefore, special attention has recently been paid to the prevention and treatment of the early stages of the disease. The purpose of the study was to conduct a systematic analysis of scientific literature on the prospects and possibilities of using arthroscopy in the early diagnosis of monoarthrosis. Material and methods. A literature search was conducted in the PubMed and MEDLINE databases for 2010–2024 using the following medical subject headings and keywords: “deforming osteoarthritis of the knee joint”, “osteoarthritis of the knee joint”, “unilateral deforming osteoarthritis of the knee joint”, “unilateral osteoarthritis of the knee joint”, “gonarthrosis”, “monoarthrosis”, “arthroscopy”, “diagnosis”, “treatment”. If necessary, literature sources beyond the search period were used in some cases. A general search revealed 48 references on the use of arthroscopy as a diagnostic and therapeutic method in the early stages of monoarthrosis. The primary exclusion concerned the literature in which arthroscopy was used for the diagnosis and treatment of late-stage knee osteoarthritis (n = 38). The secondary exclusion included literature sources that contained only background information (summary, figures, references) (n = 12). As a result, only relevant full-text articles in professional journals remained (n = 15). Results. The lack of correlation between clinical symptoms and radiological signs of knee osteoarthritis causes low availability of orthopaedic care: more than 30 % of newly diagnosed patients have a severe stage of the disease, and in some cases the pathology is detected only in connection with the manifestation of complications; the diagnosis of osteoarthritis due to a large percentage of painless development of the disease (40 %) is often established at terminal stages. All of this suggests the need for further research into the various factors that influence the frequency, prevalence, economic and social burden of knee osteoarthritis. Arthroscopy is potentially the gold standard for validating non-invasive assessment methods such as magnetic resonance imaging, as it provides high magnification and direct view of articular cartilage with non-destructive interactive assessment of its structure and functional properties. Arthroscopy allows for a more detailed description of the depth and extent of lesions, as well as the detection of subtle changes such as cartilage softening, fibrillations, and tangential peeling. Clinical symptoms and structural changes in the knee joint elements visualised during arthroscopy in patients with monoarthrosis are covered in a few studies, some of which were published 10 years ago. The results of modern arthroscopic studies can be an important contribution to the development of diagnostic and differential diagnostic criteria for the early stages of monoarthrosis. Conclusions. Based on information and analytical studies of modern scientific literature, it has been found that knee osteoarthritis is accompanied by persistent pain, significant limitation of the lower limb function, and reduced ability to work, which often leads to joint replacement. Diagnosis of osteoarthritis in the early stages is difficult due to the absence of pathognomonic clinical, radiological and laboratory parameters, and in case of monoarthrosis with synovitis, it is complicated by differentiation with specific arthritis of the knee joint. Arthroscopy allows performing the necessary scope of diagnostic and therapeutic measures with verification of the pathological process and determination of gonarthrosis stage.

Reliability and responsiveness of the Swedish short Hip-RSI.

The aim of this study was to examine test-retest reliability and responsiveness of the short version (6-item) Hip Return to Sport after Injury (Hip-RSI) scale in patients following hip arthroscopy. The study included 100 hip arthroscopy patients responding to a digital survey including the short version (6-item) Hip-RSI, International Hip Outcome Tool (short version) (iHOT-12) and RTS status 3, 6 and 9 months following surgery. The Hip-RSI was administered twice at 3-month follow-up. Test-retest reliability was evaluated using intraclass correlation coefficients. Responsiveness was tested by correlations between changes in Hip-RSI and iHOT-12 scores and by comparing change in Hip-RSI scores of patients who progressed on the return to sport (RTS) continuum (from return to any sport to return to performance) to patients who did not, using independent samples t-tests. Hip-RSI was found to have excellent test-retest reliability on the individual (intraclass correlation coefficient, ICC [95% confidence interval, CI]: 0.90 [0.83-0.94]) and group level (ICC [95% CI]: 0.95 [0.91-0.97]) with a standard error of measurement of 5.53 and smallest detectable change of 15.3 on the individual and 2.2 on the group level. Hip-RSI was found responsive to change through positive correlations of changes in scores with changes in iHOT-12 scores from 3 to 6 months (r [95% CI]: 0.51 [0.35-0.65]; p < 0.001) and from 3 to 9 months following arthroscopy (r [95% CI]: 0.61 [0.57-0.79); p < 0.001). Further responsiveness was shown by significant mean changes in scores among patients that progressed on the RTS-continuum (3-6 months: 8.6 [95% CI: 3.8- 13.5); 3-9 months: 12.6 [5.6-19.7]). The short version (6-item) Hip-RSI demonstrated excellent test-retest reliability and responsiveness to change in the evaluation of psychological readiness to RTS following hip arthroscopy. Level II.

Arthroscopy Patients in Medicare Population Became Sicker While Reimbursement Decreased From 2013 to 2020

To assess surgeon reimbursement for common arthroscopic procedures, including arthroscopic meniscal debridement and arthroscopic rotator cuff repair, in patients with differing risk profiles within the Medicare population. A publicly available Medicare database was used to identify all cases of arthroscopic meniscal debridement and arthroscopic rotator cuff repair procedures billed to Medicare from 2013 to 2020. The surgeon reimbursement from Medicare was collected and adjusted for inflation. All procedure episodes were split into 2 cohorts; those with a hierarchical condition category (HCC) risk score ≥1.5, and those with patient HCC risk scores <1.5. Reimbursement rates were compared between groups. From 2013 to 2020, a total of 624,077 meniscal debridement procedures and 567,794 arthroscopic rotator cuff repairs were billed to Medicare Part B. During this time, the mean adjusted surgeon reimbursement for arthroscopic rotator cuff repair decreased by 9.2% from 2013 to 2020. During the same time period, the adjusted mean surgeon reimbursement for arthroscopic both compartment meniscal debridement and single compartment meniscal debridement decreased by 7.9% and 9.9%, respectively. Throughout the study period, the mean HCC risk score increased from 1.19 in 2013 to 1.31 in 2020 (P < .001). Across all years in the study, the sicker cohort had a significantly greater rate of all comorbidities and a greater mean body mass index (P < .001 for all variables). The mean reimbursement across this cohort was lower for both rotator cuff repair (P= .037) and meniscal debridement procedures (P < .001) compared with the healthier cohort. This study demonstrates that from 2013 to 2020, inflation-adjusted surgeon reimbursement for arthroscopic rotator cuff repair and meniscal debridement decreased while patient complexity increased. Further, mean surgeon reimbursement was lower among patients with more complexity in comparison with their healthier counterparts for such procedures. Level III, retrospective cohort study.

Current concept of hip arthroscopy in patients with osteoarthritis: is it effective as a hip preservation surgery?

Current concept of hip arthroscopy in patients with osteoarthritis: is it effective as a hip preservation surgery?