Hip Arthroscopy Group Research Articles

The Use of Combined Hip Arthroscopy and Periacetabular Osteotomy for Hip Dysplasia Is Increasing and Has Low Complication Rates

PurposeTo analyze annual use of hip arthroscopy (HA) and Bernese periacetabular osteotomy (PAO) for the treatment of hip dysplasia (HD), as well as post-operative outcomes, including ipsilateral reoperations. MethodsNinth and Tenth Revision codes of the International Classification of Diseases were used to query the PearlDiver™ Mariner database from January 2010 through January 2022 to identify patients aged 10-59 years who had a presenting diagnosis of HD and subsequently underwent: 1) HA; 2) PAO; or 3) combined HA and PAO (HA-PAO, defined as PAO on the same day or within 28 days following HA). We analyzed annual rates for each treatment, as well as rates of post-operative emergency visits, readmissions and five-year ipsilateral secondary operations (determined via Kaplan-Meier analysis). ResultsThere were 32,068 patients who underwent surgical treatment of HD. For HA, PAO, and HA-PAO, there were 29,700, 2,083, and 285 patients, respectively. All operations had the highest percent-increase from 2015 to 2016. HA and HA-PAO peaked in 2021, while PAO peaked in 2019. For HA, PAO, and HA-PAO, the majority of cases were performed in female patients and patients aged 30-49 years, 10-19 years, and 10-29 years, respectively. The five-year incidence of ipsilateral secondary operations, which include revision HA, PAO, or conversion to total hip arthroplasty, was 9.2% (95% CI: 8.6%- 9.8%) in the HA group and 6.5% (95% CI: 4.1%- 8.8%) in the PAO group. Combining HA with PAO resulted in so few secondary operations that Kaplan-Meier analysis was infeasible. The PAO cohort had the highest 30-day emergency visit and 90-day readmission rates, with infection as the most common cause for readmission. ConclusionHA is more frequently performed than PAO for hip dysplasia. HA-PAO is rising at the greatest rate, demonstrating fewer complications and reoperations.

Comparative analysis of hip arthroscopy and open surgical dislocation for treating femoroacetabular impingement

AbstractThe purpose of this study was to compare the impact of hip arthroscopy group and open surgical dislocation group as treatments for femoroacetabular impingement (FAI) in young athletes, specifically in relation to early hip osteoarthritis. A systematic search was conducted across four databases to identify controlled trials comparing hip arthroscopy and open surgical dislocation for FAI treatment. The selected studies (9 in total) underwent rigorous literature assessment and data analysis using Review Manager (RevMan) 5.3 software. The meta‐ analysis revealed that there was no statistically significant difference between hip arthroscopy group (the test group) and the open surgical dislocation group (the control group) concerning the improvement of the alpha angle (Standardized Mean Difference [SMD]: ‐5.54; 95% Confidence Interval [CI]: ‐ 12.45,1.38; p = 0.117), the Modified Harris Hip Score (mHHS) after a 12‐ month follow‐ up (SMD:0.94; 95% CI:‐ 2.87,4.75; p = 0.629) and the complication rate (OR: 0.66; 95% CI: 0.26,1.65; p = 0.372). However, the meta‐ analysis revealed that the Nonarthritic Hip Score (NAHS) after a 12‐ month follow‐ up of the test group was significantly higher than that of the control group (SMD: 6.31; 95% CI: 0.53, 12.09; p = 0.032). In terms of the reoperation rate, it demonstrated a significantly lower rate in the test group compared to the control group (OR: 0.48; 95% CI: 0.29, 0.82; p < 0.01). These findings suggest that hip arthroscopy may have better outcomes for patients with FAI, as it is associated with improvements in hip function and a lower reoperation rate. However, these conclusions should be validated by further high‐ quality studies.

No Difference in Patient-Reported Outcomes for Periacetabular Osteotomy and Hip Arthroscopy With Capsular Plication in the Setting of Borderline Hip Dysplasia: A Propensity-Matched Multicenter Study With Minimum 5-Year Follow-Up

To compare minimum 5-year patient-reported outcome measures after hip arthroscopy (HA) and periacetabular osteotomy (PAO) for borderline hip dysplasia. Hips with a lateral center-edge angle (LCEA) between 18° and less than 25° that underwent either PAO or HA were selected from 2 institutions. The exclusion criteria were as follows: LCEA less than 18°, Tönnis osteoarthritis grade greater than 1, prior hip surgical procedures, active inflammatory disease, Workers' Compensation, and concomitant surgery. Patients underwent propensity matching based on age, sex, body mass index, and Tönnis osteoarthritis grade. Patient-reported outcome measures included the modified Harris Hip Score, as well as calculation of the minimal clinically important difference, patient acceptable symptom state, and maximum outcome improvement satisfaction threshold. Preoperative radiographic predictors included comparison of the Femoro-epiphyseal Acetabular Roof index and ligamentum teres lesions. A total of 28 PAO patients underwent propensity matching to 49 HA patients. The 2 groups were similar in terms of mean age, sex, preoperative body mass index, and LCEA. The PAO group had a longer mean follow-up period (95.8 months vs 81.3 months, P= .001). The mean Femoro-epiphyseal Acetabular Roof index was significantly lower preoperatively in the HA group (P < .001). The 2 groups showed similar and significant improvements in the mean modified Harris Hip Score from preoperatively to latest follow-up (P < .001). The relative risk of subsequent surgery in the PAO group was 3.49 (P= .024), mostly attributed to hardware removal (25%). The revision rate was 3.6% in the PAO group and 8.2% in the HA group (P= .65). One patient in the PAO group required revision HA for intra-articular adhesions. Three of the patients requiring revision in the HA group underwent PAO because of persistent pain, and one underwent revision HA alone. Conversion to total hip arthroplasty was required in 1 patient in the HA group and no patients in the PAO group. Both PAO and HA with capsular plication provide borderline hip dysplasia patients with clinically significant improvements and low revision rates at a minimum of 5 years postoperatively. Level III, retrospective, comparative therapeutic trial.

Femoral de-rotation osteotomy versus hip arthroscopy for management of femoroacetabular impingement in adult patients with decreased femoral anteversion: a matched retrospective cohort study.

ABSTRACTFemoral de-rotation osteotomy (FDO) and hip arthroscopy are both recognized surgical options for the management of femoroacetabular impingement (FAI) in the setting of decreased femoral anteversion (<5°). Minimal comparative data exist regarding the difference in outcomes between these two techniques, and we believe this is the first study to provide that comparison. This retrospective cohort study included a total of 20 patients with such pathology, matched for age, gender and body mass index. A total of 10 patients were included in the FDO group [median anteversion −0.5° (true retroversion); average follow-up 17.9 months]. In total, 10 patients were included in the hip arthroscopy group [median anteversion −0.5° (true retroversion); average follow-up 28.5 months]. Both groups demonstrated statistically and clinically significant improvement in the post-operative International Hip Outcome Tool (iHOT-33) scores [median improvement: FDO group, 37.7 points (r 14–58.8; P < 0.041); hip arthroscopy group, 35.9 points (r 11.1–81; P < 0.05)], noting that the minimal clinically important difference for the iHOT-33 is 6.1 points. However, the study was not adequately powered to delineate a difference in improvement between the two groups. The findings suggest significant improvement in patient-reported outcomes, and clinical findings can be achieved with either FDO or hip arthroscopy for FAI in the setting of decreased femoral anteversion. However, selection of the most suitable surgical procedure using a patient-specific approach may optimize outcomes in this challenging population.

Arthroscopic hip surgery offers better early patient-reported outcome measures than targeted physiotherapy programs for the treatment of femoroacetabular impingement syndrome: a systematic review and meta-analysis of randomized controlled trials

ABSTRACTTargeted physiotherapy programs (TPP), and surgery, using either open surgical hip dislocation or hip arthroscopy (HA), are the treatment modalities available for femoroacetabular impingement syndrome (FAIS). Randomized controlled trials have recently been performed to compare these treatment options. This review was performed to provide a focused synthesis of the available evidence regarding the relative value of treatment options. A systematic search was performed of Medline, Embase, Cochrane Library and ClinicalTrials.gov databases. Inclusion criteria were randomized controlled trials comparing treatment methods. The Cochrane Risk of Bias assessment tool (RoB2) was used to assess the selected studies. A meta-analysis was performed between homogenous studies. Four trials were identified including 749 patients (392 males). The mean ages of the cohorts ranged between 30.1 and 36.2 years old. Three hundred thirty-five patients underwent HA by 46 surgeons among all trials. Fifty-two patients crossed over from the TPP to the HA group. One of the trials was found to have a high risk of bias, while the other three were between low risk and some concerns. The iHOT-33 was the most commonly used patient-reported outcome measure followed by the HOS ADL and EQ-5D-5L. Others scores were also identified. Scores from two trials could be pooled together for meta-analysis. Apart from SF-12 and GRC, all other scores have shown significantly better outcomes with HA in comparison to TPP at 8- and 12-months follow-up points. HA offers better patient-reported outcomes than TPP for management of FAIS at 8- and 12-months follow-up.

Arthroscopic hip surgery compared with personalised hip therapy in people over 16 years old with femoroacetabular impingement syndrome: UK FASHIoN RCT.

Femoroacetabular impingement syndrome is an important cause of hip pain in young adults. It can be treated by arthroscopic hip surgery or with physiotherapist-led conservative care. To compare the clinical effectiveness and cost-effectiveness of hip arthroscopy with best conservative care. The UK FASHIoN (full trial of arthroscopic surgery for hip impingement compared with non-operative care) trial was a pragmatic, multicentre, randomised controlled trial that was carried out at 23 NHS hospitals. Participants were included if they had femoroacetabular impingement, were aged ≥ 16 years old, had hip pain with radiographic features of cam or pincer morphology (but no osteoarthritis) and were believed to be likely to benefit from hip arthroscopy. Participants were randomly allocated (1 : 1) to receive hip arthroscopy followed by postoperative physiotherapy, or personalised hip therapy (i.e. an individualised physiotherapist-led programme of conservative care). Randomisation was stratified by impingement type and recruiting centre using a central telephone randomisation service. Outcome assessment and analysis were masked. The primary outcome was hip-related quality of life, measured by the patient-reported International Hip Outcome Tool (iHOT-33) 12 months after randomisation, and analysed by intention to treat. Between July 2012 and July 2016, 648 eligible patients were identified and 348 participants were recruited. In total, 171 participants were allocated to receive hip arthroscopy and 177 participants were allocated to receive personalised hip therapy. Three further patients were excluded from the trial after randomisation because they did not meet the eligibility criteria. Follow-up at the primary outcome assessment was 92% (N = 319; hip arthroscopy, n = 157; personalised hip therapy, n = 162). At 12 months, mean International Hip Outcome Tool (iHOT-33) score had improved from 39.2 (standard deviation 20.9) points to 58.8 (standard deviation 27.2) points for participants in the hip arthroscopy group, and from 35.6 (standard deviation 18.2) points to 49.7 (standard deviation 25.5) points for participants in personalised hip therapy group. In the primary analysis, the mean difference in International Hip Outcome Tool scores, adjusted for impingement type, sex, baseline International Hip Outcome Tool score and centre, was 6.8 (95% confidence interval 1.7 to 12.0) points in favour of hip arthroscopy (p = 0.0093). This estimate of treatment effect exceeded the minimum clinically important difference (6.1 points). Five (83%) of six serious adverse events in the hip arthroscopy group were related to treatment and one serious adverse event in the personalised hip therapy group was not. Thirty-eight (24%) personalised hip therapy patients chose to have hip arthroscopy between 1 and 3 years after randomisation. Nineteen (12%) hip arthroscopy patients had a revision arthroscopy. Eleven (7%) personalised hip therapy patients and three (2%) hip arthroscopy patients had a hip replacement within 3 years. Study participants and treating clinicians were not blinded to the intervention arm. Delays were encountered in participants accessing treatment, particularly surgery. Follow-up lasted for 3 years. Hip arthroscopy and personalised hip therapy both improved hip-related quality of life for patients with femoroacetabular impingement syndrome. Hip arthroscopy led to a greater improvement in quality of life than personalised hip therapy, and this difference was clinically significant at 12 months. This study does not demonstrate cost-effectiveness of hip arthroscopy compared with personalised hip therapy within the first 12 months. Further follow-up will reveal whether or not the clinical benefits of hip arthroscopy are maintained and whether or not it is cost-effective in the long term. Current Controlled Trials ISRCTN64081839. This project was funded by the National Institute for Health Research (NIHR) Health Technology Assessment programme and will be published in full in Health Technology Assessment; Vol. 26, No. 16. See the NIHR Journals Library website for further project information.

Self-Reported Cannabis Use Is Not Associated With Increased Opioid Use or Costs After Hip Arthroscopy

Our purpose is to determine the difference in cost, opioid use, and complication rates following hip arthroscopy with or without perioperative cannabis use. Data were collected from a large commercial insurance database (PearlDiver) between the years 2010 and 2019. Patients who underwent hip arthroscopy with reported cannabis use were identified using Common Procedural Terminology codes and the appropriate International Classification of Diseases codes. This group was then matched by age, procedure, gender, Charleston Comorbidity Index, Elixhauser Comorbidity Index), obesity, tobacco use, diabetes to a group of similar patients without self-reported cannabis use. Opioid use over the episode of care, evaluated by morphine milligram equivalents (MME), and 30-day cost were compared between groups using unequal variance t-test. Of queried patients, 360 (.71%) had a diagnosis of preoperative cannabis use, abuse, or dependence within 5 years prior to their hip arthroscopy. A total of 300 patients (172 female, 128 male) were matched into each hip arthroscopy group, with and without cannabis. Of those patients, 171 without cannabis use and 174 with cannabis use had full financial and opioid use data for analysis. Prescription opioid use was not significantly different over the episode of care in patients with reported cannabis use (1,840 ± 2,743 MME) than those without reported cannabis use (2,129 ± 3,383 MME) (P= .3848). Additionally, episode of care reimbursement cost following hip arthroscopy did not differ significantly between patients with cannabis use ($2957 ± $4428) and those without reported cannabis use ($2,651 ± $3,762) (P= .3620). Following hip arthroscopy, patients with reported cannabis use do not appear to have significantly different postoperative opioid use or cost of hip arthroscopy episode of care compared with patients without reported cannabis use. III, cohort study.

Acute and Subacute Changes in Dynamic Postural Control After Hip Arthroscopy and Postoperative Rehabilitation.

Hip pain is associated with impairments in postural control and balance. The Star Excursion Balance Test (SEBT) is a reliable and valid method for measuring dynamic postural control. To examine changes in dynamic postural control after hip arthroscopy and subsequent rehabilitation from baseline to 3 and 6 months postsurgery. Case series. Physiotherapy department. Sixty-seven individuals (47 men, 20 women; age = 31 ± 8 years, height = 1.78 ± 0.09 m, mass = 83 ± 15 kg) scheduled for hip arthroscopy to address chondrolabral conditions were matched with 67 healthy individuals serving as controls (47 men, 20 women; age = 31 ± 8 years, height = 1.77 ± 0.09 m, mass = 80 ± 16 kg). The hip arthroscopy group underwent postoperative rehabilitation including SEBT training. The SEBT reach normalized to limb length was collected before surgery (baseline) and at 3 and 6 months after arthroscopy and compared with that of the healthy matched control group. Repeated-measures analysis of variance was used to evaluate whether SEBT reach differed among the 3 time points, and t tests were used to evaluate between-limbs and between-groups differences. The SEBT reach in the hip arthroscopy group at baseline was less than that of the control group in all directions (P values < .001). At 3 months after arthroscopy, SEBT reach increased in the posteromedial (PM; P = .007), posterolateral (PL; P < .001), and anterolateral (AL; P < .001) directions from baseline. At 6 months after arthroscopy, all directions of reach had increased (P values < .001) from baseline. The anteromedial (mean difference [MD] = -2.9%, P = .02), PM (MD = -5.2%, P = .002), and AL (MD = -2.5%, P = .04) reach distances remained shorter at 6 months after surgery in the hip arthroscopy group than in the control group. No difference existed between the control and hip arthroscopy groups for reach in the PL direction (MD = -3.6%; P = .06). Dynamic balance control in the hip arthroscopy group at baseline was poorer than in a matched control group as measured using the SEBT. At 3 months after hip arthroscopy, we observed improvements in dynamic balance in the PM, PL, and AL SEBT directions. By 6 months after arthroscopy, all directions of SEBT reach had improved, but only the PL reach improved to the level of healthy control individuals.

A comparison of 6-month outcomes between periacetabular osteotomy with concomitant hip arthroscopy to isolated hip arthroscopy for femoroacetabular impingement.

To compare early outcomes of periacetabular osteotomy (PAO) with concomitant hip arthroscopy to isolated hip arthroscopy for femoroacetabular impingement (FAI) and chondrolabral pathology using patient-reported outcomes measurement information system (PROMIS). Consecutive patients scheduled for PAO with concomitant hip arthroscopy (PAO + HA) or isolated hip arthroscopy (HA) between the ages of 15 and 30years old were prospectively included in the study. Based on power analysis, subjects were recruited until there were 22 subjects in the PAO + HA group. These subjects were then gender matched to the HA group. The PROMIS, with six subscales and two global health measures, were completed during preoperative and 6-month follow-up visits. One-way ANOVA was performed to compare intake information of age, symptom duration, body mass index, and Beighton scores as well as preoperative and 6-month postoperative PROMIS scores between the PAO + HA and HA. 22 consecutive subjects undergoing PAO + HA were all females (average age 20.0years) and matched to 22 consecutive females (average age 22.6) in the HA group. ANOVA did not find a significant difference between the two groups when comparing intact information, with exception of age (p = 0.04). A significant difference was also not identified (p ≥ 0.05) between the two groups on preoperative or 6-month postoperative PROMIS scores. The largest difference in 6-month postoperative scores between the two groups was 4.4 points on physical function subscale. Outcomes at 6months were not significantly different when comparing PAO + HA to HA for FAI and chondrolabral pathology in females under 30years of age. The more extensive surgery with a prolonged protective period associated with PAO do not seem to negatively impact outcomes at 6months when compared to HA. These finding support the use of PAO + HA, particularly if the patient and/or surgeon were concerned about prolonged disability, metal health issues, and/or higher pain levels that might be associated with the PAO procedure.

Hip Arthroplasty After Hip Arthroscopy: Are Short-term Outcomes Affected? A Systematic Review

To systematically review the published literature regarding intraoperative measures, patient reported outcomes, and complications of THA in patients with or without a history of prior hip arthroscopy. PubMed and Cochrane Library databases were searched for all publications regarding patients who had undergone a THA after a prior ipsilateral hip arthroscopy. Included studies were comparative in nature and included post-operative outcome measures. Excluded studies were opinion articles, review articles, cadaveric studies, case reports, or technique articles. Patient demographics, surgical outcomes, complications, and patient reported outcome measures (PROMs) were recorded. Eight studies were included in this systematic review. These included 305 hips with a THA following a prior hip arthroscopy, with 502 matched control hips. Mean time for conversion from prior hip arthroscopy was 23 months and mean follow-up was 35.9 vs 36.1, for the prior arthroscopy and control groups respectively. No significant differences were found regarding intra-operative measures and PROMs. There was no difference in rate of revisions at latest follow-up. However, there was a trend towards higher rates of dislocations and infections in the prior hip arthroscopy group. The short-term patient-reported outcomes of patients who underwent total hip arthroplasty with a prior history of an ipsilateral hip arthroscopy are comparable to those of patients undergoing primary THA. Although a conclusion could not be made regarding differences in complication rates between patients with a history of prior arthroscopy and patients undergoing primary THA it is still imperative to consider the possible implications of a prior hip procedure on postoperative stability and infection rates. In summary, hip arthroplasty following a prior hip arthroscopy is a safe procedure with comparable short-term outcomes to primary arthroplasty

Hip arthroscopy versus total hip arthroplasty in patients above 40 differences: outcome and residual complain.

This study aimed to compare patient outcomes and residual complains after hip arthroscopy (HAS) and total hip arthroplasty (THA) to improve patient counseling. It includes 140 hips/129 HAS-patients and 77 hips/62 THA-patients aged 40 to 55years with a BMI under 30. All patients underwent primary HAS or primary THA in our hospital from 2007 until 2014. Exclusion criteria were a history of prior hip surgery or suffering sequels of childhood's hip disease, systemic inflammatory disease or avascular hip osteonecrosis. Outcome measures were WOMAC, subjective hip value, residual complains, the need of infiltrations and the complication and conversion rate. Patient data and scores were collected pre-operative, after one year and at the last follow-up. Scores indicated significant patient benefits in both groups (p < 0.0001). Variability of outcome was significantly higher and less predictable in the HAS group (HAS: 1.9 vs. THA: 0.9). While THA showed significant improvement mainly after one year, HAS showed significant improvements after one year and the latest follow-up. Residual complains were more frequent after HAS (p = 0.026). Groin pain was the main complain after HAS, limping and disturbing leg length discrepancy after THA. THA more predictably improves patient's outcome with shorter recovery time. Limping and leg length discrepancy are predominant after THA.

OUTCOME OF SURGICAL TREATMENT IN PATIENTS WITH BORDERLINE ACETABULAR DYSPLASIA: A COMPARATIVE ANALYSIS OF HIP ARTHROSCOPY AND PERIACETABULAR OSTEOTOMY

Background:Optimal treatments of patients with borderline hip dysplasia, defined as LCEA 20°-25°, is controversial. These patients can have symptomatic impingement and/or instability. The optimal treatment of either hip arthroscopy (HA) alone or periacetabular osteotomy (PAO) (with/without hip arthroscopy) has not been established.Purpose:The purpose of this study was to evaluate surgical outcomes of patients with borderline hip dysplasia at a minimum of 2-year follow-up.Methods:A longitudinal cohort was utilized to identify patients with borderline acetabular dysplasia defined via prospective radiographic measurements. Demographics and radiographic measurements were recorded. Patient evaluation, diagnosis and treatment decisions (PAO v HA) were made by one treating surgeon. Outcome were assessed at baseline and a minimum 2 years postoperative. Descriptive and comparative statistics were performed. Failure was defined as reoperation, or failure to reach mHHS MCID (8 points) or PASS (mHHS <74).Results:Total of 113 hips were included at 4.7 years postoperatively (range 2.0-11.2 years). Overall, 76% were female and 42% of hips had PAO (65% combined with hip arthroscopy), while 58% had isolated hip arthroscopy (HA). For PAO group, mHHS improved from 57.9 to 82.8 postoperatively, compared to 62.6 to 84.0 for the HA group. Similarly, HOOS pain (PAO 48.2 to 79.1, HA 61.2 to 82.0) and HOOS Sports (PAO 36.5 to 73.0, HA 47.8 to 74.4) demonstrated similar improvements. Comparing the PAO and HA groups, the change in PRO was significantly greater for the PAO group for HOOS Pain (10.5 ±23.2, p=0.02) and HOOS ADL (9.4 ±20.5, p=0.04) which was primarily due to a lower baseline score (similar final score). No significant difference was detected for other PROs. Reoperations in the PAO group were 2% (1 hip arthroscopy) and 6% for hip arthroscopy group (3 hip arthroscopies, 1 PAO). The failure rate was 17% for PAO and 15% for HA (p=0.86).Discussion:Surgical outcomes at minimum of 2 years in patients with borderline hip dysplasia in selected patients undergoing PAO or hip arthroscopy were good. Significant differences in patient characteristics and radiographic parameters were present between hips indicated for PAO vs. HA emphasizing the need for careful diagnosis and treatment decision-making.

Staged Bilateral Hip Arthroscopy Compared With a Matched Unilateral Hip Arthroscopy Group: Minimum 2-Year Follow-Up

To determine the modified Harris Hip Score (mHHS) and Non-Arthritic Hip Score (NAHS) at 2-year follow up in patients who underwent staged bilateral hip arthroscopy versus age-, sex-, and body mass index-matched patients who underwent unilateral hip arthroscopy. Patients who underwent staged bilateral primary hip arthroscopy between January 2007 and December 2017 for the indication of femoroacetabular impingement (FAI) with a minimum 2-year follow-up were identified. The control group comprised patients who underwent a unilateral hip arthroscopy for FAI. The mHHS and the NAHS were analyzed. Forty-two patients (84 hips) in the bilateral group were matched with 84 patients (84 hips) in the unilateral group. Both groups had significantly improved mHHS and NAHS when comparing preoperative scores with postoperative scores (bilateral group mHHS: 45.5 ± 15.1 to 81.7 ± 17.6, P < .0001, bilateral group NAHS: 49.5 ± 13.8 to 83.6 ± 20.0, P < .0001, unilateral group mHHS 48.5 ± 13.8 to 83.6 ± 15.9, P<.0001, unilateral group NAHS 48.8 ± 12.0 to 85.0 ± 16.6, P < .0001). The patient-acceptable symptomatic state was achieved in 57 hips (68%) in the bilateral group versus 62 hips (74%) in the unilateral group, P= .4. Patients with bilateral hip arthroscopy who had <17 months between index procedure and contralateral hip arthroscopy had significantly better mHHS and NAHS (85.5 ± 18.4 vs 75.71 ± 14.4, P= .013 for mHHS and 88.1 ± 17.1 vs 76.2 ± 22.4, P= .0074 for NAHS). Bilateral hip arthroscopy for the indication of FAI has improved mHHS and NAHS at 2 years of follow up compared to baseline. There was no difference in 2-year mHHS and NAHS in patients who underwent bilateral hip arthroscopy and unilateral hip arthroscopy. Patients in the bilateral hip arthroscopy group that had the contralateral surgery longer than 17 months from index procedure had lower 2 year follow up mHHS and NAHS scores than those that underwent the second surgery within 17 months of the index procedure. Level III, retrospective comparative study.

Previous failed hip arthroscopy negatively impacts early patient-reported outcomes of the periacetabular osteotomy: an ANCHOR Matched Cohort Study.

ABSTRACTSurgical treatment of hip dysplasia by arthroscopic procedures remains controversial. The aim of this study was to compare outcomes of periacetabular osteotomy (PAO) after failed hip arthroscopy to a matched-control group without previous arthroscopy. Fifty-two patients who underwent PAO after failed hip arthroscopy were matched to two subjects without arthroscopy based on age, sex, BMI and radiographic severity. Pre- and post-operative patient self-reported outcomes and radiographic parameters were compared at minimum 1-year follow-up. Prior to PAO the failed hip arthroscopy group exhibited lower modified Harris hip scores (mHHS; 57 versus 62; P = 0.04), WOMAC (59.9 versus 66.3; P = 0.08), UCLA activity (5 versus 7; P = 0.001) and SF12 physical scores (34 versus 40; P = 0.001) compared with the non-arthroscopy group. At minimum 1-year follow-up, the failed hip arthroscopy group had lower mHHS (78 versus 87; P = 0.003); worse WOMAC (84.1 versus 90.8; P = 0.02) and SF-12 physical component (46 versus 50; P = 0.02) with similar UCLA (7 versus 8; P = 0.21) compared with the non-arthroscopy group. No differences were detected regarding radiographic parameters or in patient-reported outcomes from preoperative to follow up. PAO achieved the desired radiographic correction and significant improvement in pain and function after a failed previous hip arthroscopy, however, the patient-reported outcomes were inferior to those of PAO without previous failed arthroscopy.

Hip arthroscopy versus best conservative care for the treatment of femoroacetabular impingement syndrome (UK FASHIoN): a multicentre randomised controlled trial

SummaryBackgroundFemoroacetabular impingement syndrome is an important cause of hip pain in young adults. It can be treated by arthroscopic hip surgery, including reshaping the hip, or with physiotherapist-led conservative care. We aimed to compare the clinical effectiveness of hip arthroscopy with best conservative care.MethodsUK FASHIoN is a pragmatic, multicentre, assessor-blinded randomised controlled trial, done at 23 National Health Service hospitals in the UK. We enrolled patients with femoroacetabular impingement syndrome who presented at these hospitals. Eligible patients were at least 16 years old, had hip pain with radiographic features of cam or pincer morphology but no osteoarthritis, and were believed to be likely to benefit from hip arthroscopy. Patients with bilateral femoroacetabular impingement syndrome were eligible; only the most symptomatic hip was randomly assigned to treatment and followed-up. Participants were randomly allocated (1:1) to receive hip arthroscopy or personalised hip therapy (an individualised, supervised, and progressive physiotherapist-led programme of conservative care). Randomisation was stratified by impingement type and recruiting centre and was done by research staff at each hospital, using a central telephone randomisation service. Patients and treating clinicians were not masked to treatment allocation, but researchers who collected the outcome assessments and analysed the results were masked. The primary outcome was hip-related quality of life, as measured by the patient-reported International Hip Outcome Tool (iHOT-33) 12 months after randomisation, and analysed in all eligible participants who were allocated to treatment (the intention-to-treat population). This trial is registered as an International Standard Randomised Controlled Trial, number ISRCTN64081839, and is closed to recruitment.FindingsBetween July 20, 2012, and July 15, 2016, we identified 648 eligible patients and recruited 348 participants: 171 participants were allocated to receive hip arthroscopy and 177 to receive personalised hip therapy. Three further patients were excluded from the trial after randomisation because they did not meet the eligibility criteria. Follow-up at the primary outcome assessment was 92% (319 of 348 participants). At 12 months after randomisation, mean iHOT-33 scores had improved from 39·2 (SD 20·9) to 58·8 (27·2) for participants in the hip arthroscopy group, and from 35·6 (18·2) to 49·7 (25·5) in the personalised hip therapy group. In the primary analysis, the mean difference in iHOT-33 scores, adjusted for impingement type, sex, baseline iHOT-33 score, and centre, was 6·8 (95% CI 1·7–12·0) in favour of hip arthroscopy (p=0·0093). This estimate of treatment effect exceeded the minimum clinically important difference (6·1 points). There were 147 patient-reported adverse events (in 100 [72%] of 138 patients) in the hip arthroscopy group) versus 102 events (in 88 [60%] of 146 patients) in the personalised hip therapy group, with muscle soreness being the most common of these (58 [42%] vs 69 [47%]). There were seven serious adverse events reported by participating hospitals. Five (83%) of six serious adverse events in the hip arthroscopy group were related to treatment, and the one in the personalised hip therapy group was not. There were no treatment-related deaths, but one patient in the hip arthroscopy group developed a hip joint infection after surgery.InterpretationHip arthroscopy and personalised hip therapy both improved hip-related quality of life for patients with femoroacetabular impingement syndrome. Hip arthroscopy led to a greater improvement than did personalised hip therapy, and this difference was clinically significant. Further follow-up will reveal whether the clinical benefits of hip arthroscopy are maintained and whether it is cost effective in the long term.FundingThe Health Technology Assessment Programme of the National Institute of Health Research.

Single-Leg Squat Performance is Impaired 1 to 2 Years After Hip Arthroscopy

ObjectiveTo evaluate single-leg squat performance 1-2 years after arthroscopy for intra-articular hip pathology compared with control subjects and the nonsurgical limb, and to investigate whether single-leg squat performance on the operated limb was associated with hip muscle strength. DesignCross-sectional study. SettingPrivate physiotherapy clinic and university laboratory. ParticipantsThirty-four participants (17 women, 36.7 ± 12.6 years) 1-2 years after hip arthroscopy and 34 gender-matched control subjects (17 women, 33.1 ± 11.9 years). MethodsParticipants performed single-leg squats using a standardized testing procedure. Squat performance was captured using video. Video footage was uploaded and reformatted for analyses. Hip muscle strength was measured with handheld dynamometry using reliable methods. Outcome MeasuresFrontal plane pelvic obliquity, hip adduction, and knee valgus were measured. Repeated measures analysis of variance evaluated between-group differences, with limb as a within-subjects factor (surgical versus nonsurgical) and gender as a between-subjects factor (P < .05). ResultsThe hip arthroscopy group demonstrated significantly greater apparent hip adduction (mean difference 2.7°, 95% confidence interval [CI] 0.7°-4.8°) and apparent knee valgus (4.0°, 95% CI 1.0°-7.1°) at peak squat depth compared with control subjects. The operated limb also demonstrated significantly greater pelvic obliquity during single-leg stance compared with the nonsurgical limb (1.2°, 95% CI 0.1°-2.3°). Women had significantly greater apparent hip adduction (standing 1.6°, 95% CI 0.5°-2.6°; peak squat depth 2.4°, 95% CI 0.3°-4.4°) and apparent knee valgus (standing 3.3°, 95% CI 1.8°-4.7°; peak squat depth 3.1°, 95% CI 0°-6.1°). Significant positive correlations were found between frontal plane angles and hip flexor and extensor peak torque (P > .05). ConclusionOne to 2 years after hip arthroscopy, deficits in single-leg squat performance exist that have the potential to increase hip joint impingement and perpetuate postoperative symptoms. Rehabilitation after hip arthroscopy should target retraining in functional single-leg positions.

The effect of education for daily physical activity level recovery of osteoarthritis patients after total knee arthroplasty. A prospective randomized controlled clinical trial using accelerometry

The effect of education for daily physical activity level recovery of osteoarthritis patients after total knee arthroplasty. A prospective randomized controlled clinical trial using accelerometry

Surgical hip dislocation versus hip arthroscopy for femoroacetabular impingement: clinical and morphological short-term results

Surgical hip dislocation (SHD) is an accepted standard to treat femoroacetabular impingement (FAI). However, arthroscopic techniques have gained widespread popularity and comparable results are reported. The purpose of this prospective comparative study was to test the hypothesis that, when compared to SHD, hip arthroscopy (HA) results in faster recovery, better short-term outcome, and equivalent morphological corrections. 38 patients presenting with clinically and morphologically verified isolated FAI were allocated to either HA or SHD. Morphological evaluation consisted of pre- and postoperative X-rays, and arthro-MRI. Demographic data, sport activities, hospital stay, complications, and the time off work were recorded. The subjective hip value, WOMAC, HHS, and hip abductor strength were measured up to 1 year. Shorter hospital stay and time off work, less pain at 3 months and 1 year, higher subjective hip values at 6 weeks and 3 months, and better WOMAC at 3 months were seen after HA. The HHS and the hip abductor strengths were higher in the HA group. However, morphological corrections at the head-neck-junction achieved by HA showed some overcorrection when compared to SHD. Labral refixation was performed less frequent in the HA group. When compared to SHD, HA results in faster recovery and better short-term outcome. However, some overcorrection of the cam deformity and limited frequency of labrum refixation with HA in this study may have a negative impact on long-term outcome.