Hip Arthroscopy In Patients Research Articles

Arthroscopic Management of Primary Synovial Chondromatosis of the Hip

We evaluated clinical outcomes after hip arthroscopy in patients with primary synovial chondromatosis (SC). We retrospectively assessed 11 patients who underwent hip arthroscopy for primary SC at a mean follow-up of 22 months (range, 12 to 36 months). Clinical preoperative and postoperative evaluation was performed with the Harris hip score. The preoperative evaluation included plain radiographs and magnetic resonance (MR) scanning to detect number and positioning of intra-articular radiopaque loose bodies. The osteochondral damage was graded using the Kellgren-Lawrence classification. The chondral surfaces of both the acetabulum and femoral head were graded according to the Outerbridge scale. The clinical score improved postoperatively. There were statistically significant differences between preoperative and postoperative Harris hip scores (P < .05). Outcomes were rated as very satisfactory and satisfactory in 3 and 5 of 11 patients, respectively. The osteochondral damage ranged between stages 1 and 2. No complications related to surgical procedures were observed. Hip arthroscopy for the treatment of patients with primary SC showed good clinical results without any complications related to the surgical procedure. LEVELOF EVIDENCE: Level IV, therapeutic case series.

Joint Space Predicts THA After Hip Arthroscopy in Patients 50 Years and Older

All patients considering joint-preserving hip arthroscopy should be educated on the risk of THA after arthroscopy. The degree of radiographic osteoarthritis predicts subsequent THA. To provide patients with the best information, the best radiographic measure that predicts THA after hip arthroscopy should be identified. We therefore determined if Tönnis grade, Kellgren-Lawrence grade, or joint space narrowing was superior in predicting THA after hip arthroscopy. We retrospectively reviewed 203 patients 50 years of age or older treated with hip arthroscopy between March 2007 and October 2010. Of these, 96 patients met the study inclusion criteria. Sixty-five did not undergo THAs during the followup time (non-THA group) and 31 patients did (THA group). We determined Tönnis grade, Kellgren-Lawrence grade, and/or joint space narrowing before arthroscopy. The median followup for the non-THA group was 54 months (95% confidence interval, 49.9-58.9 months). In 81% of the patients, joint space accurately predicted THA or non-THA, whereas Kellgren-Lawrence was accurate in 73% and Tönnis grade was accurate in 65%. On binary logistic regression, the only predictor (r(2) = 0.45) of THA was joint space of 2 mm or less. Measuring joint space by determining if any measurement is 2 mm or less predicts patients progressing to THA after hip arthroscopy approximately 80% of the time. At this early time point, joint space measurements were the most accurate predictor of THA and should be used in patient education to define the risk of early failure from hip arthroscopy.

Antiemetic Prophylaxis with Ondansetron for Post-discharge Nausea and Vomiting after Hip Arthroscopy Performed under Neuraxial Anesthesia: A Prospective, Randomized, Placebo-controlled Trial

Background: Post-Discharge Nausea and Vomiting (PDNV) remain common complaints after ambulatory surgery. This study investigated whether continuation of an anti-emetic regimen for two days postoperatively would reduce PDNV. Methods: A prospective, randomized placebo-controlled trial of 76 patients undergoing ambulatory hip arthroscopy was initiated. All patients received a spinal or combined spinal epidural and intravenous sedation. No intraoperative opioids were given. Prophylatic anti-emetics (dexamethasone, ondansetron) were given. Postoperatively, two groups either received oral placebo or ondansetron for two days. Results: On postdischarge day 1, nausea occurred in 54% of the placebo group and 46% of the oral ondansetron group (p=0.49). On postdischarge day 2 and 3, nausea occurred in 16% and 11% of the placebo group; 18% and 10% of the oral ondansetron group (p=0.84 and p=0.94), respectively. Conclusion: Postdischarge prophylactic oral ondansetron, administered for two days, did not reduce the incidence or severity of nausea in ambulatory hip arthroscopy patients.

Paper 40: Results of Hip Arthroscopy in Patients with Gluteus Medius Tendon Tears

Paper 40: Results of Hip Arthroscopy in Patients with Gluteus Medius Tendon Tears

Outcomes of hip arthroscopy. A prospective analysis and comparison between patients under 25 and over 25 years of age

ObjectiveTo compare the results of hip arthroscopy in patients under the age of 25 with those over 25 years.DesignFrom March 2006 until May 2010, data were collected on all patients...

Effects of Platelet-Rich Plasma (PRP) on the Management of Early Postoperative Pain and Inflammation Following Hip Arthroscopy in Patients with Femoroacetabular Impingement (FAI): A Prospective, Double Blind Study (SS-61)

IntroductionDetermine if employment of Platelet-Rich Plasma in patients subject to hip arthroscopy diminishes postoperative pain, morphine requirements, edema and ecchymosis.MethodsA randomized, prospective, double blinded, placebo controlled clinical trial was conducted. Patients undergoing hip arthroscopy for FAI were offered participation in the study. 60 patients were randomly assigned to receive PRP clot (PRP-C), PRP spray (PRP-S) or saline control (C), wich was located or instilled over the femoral neck osteoplasty. Pain was measured with Visual Analogue Scale (VAS) at 12, 24 hours and 7 days PO. Morphine requirements were registered in the period between 0-12 and 12-24 hours. Diameter of the thigh was assessed preoperatively, 7 and 14 days PO. Ecchymosis at 7 and 14 days PO was graded and registered.ResultsThere were no difference between the groups regarding pain, morphine requirements or edema p>0,05. We found ecchymosis in 66% of the control group at 7 days and 56% at 14 days. In PRP-S group, 55% and 25% had ecchymosis at 7 and 14 days. In PRP-C group, 22% and none had ecchymosis at 7 and 14 days, respectively, with p=0,025 to control group.ConclusionThe use of PRP clot may have some advantages in the postoperative management of patients who undergo hip arthroscopy. The lower ecchymosis suggests an anti-inflammatory effect that may reflect on long term results. IntroductionDetermine if employment of Platelet-Rich Plasma in patients subject to hip arthroscopy diminishes postoperative pain, morphine requirements, edema and ecchymosis. Determine if employment of Platelet-Rich Plasma in patients subject to hip arthroscopy diminishes postoperative pain, morphine requirements, edema and ecchymosis. MethodsA randomized, prospective, double blinded, placebo controlled clinical trial was conducted. Patients undergoing hip arthroscopy for FAI were offered participation in the study. 60 patients were randomly assigned to receive PRP clot (PRP-C), PRP spray (PRP-S) or saline control (C), wich was located or instilled over the femoral neck osteoplasty. Pain was measured with Visual Analogue Scale (VAS) at 12, 24 hours and 7 days PO. Morphine requirements were registered in the period between 0-12 and 12-24 hours. Diameter of the thigh was assessed preoperatively, 7 and 14 days PO. Ecchymosis at 7 and 14 days PO was graded and registered. A randomized, prospective, double blinded, placebo controlled clinical trial was conducted. Patients undergoing hip arthroscopy for FAI were offered participation in the study. 60 patients were randomly assigned to receive PRP clot (PRP-C), PRP spray (PRP-S) or saline control (C), wich was located or instilled over the femoral neck osteoplasty. Pain was measured with Visual Analogue Scale (VAS) at 12, 24 hours and 7 days PO. Morphine requirements were registered in the period between 0-12 and 12-24 hours. Diameter of the thigh was assessed preoperatively, 7 and 14 days PO. Ecchymosis at 7 and 14 days PO was graded and registered. ResultsThere were no difference between the groups regarding pain, morphine requirements or edema p>0,05. We found ecchymosis in 66% of the control group at 7 days and 56% at 14 days. In PRP-S group, 55% and 25% had ecchymosis at 7 and 14 days. In PRP-C group, 22% and none had ecchymosis at 7 and 14 days, respectively, with p=0,025 to control group. There were no difference between the groups regarding pain, morphine requirements or edema p>0,05. We found ecchymosis in 66% of the control group at 7 days and 56% at 14 days. In PRP-S group, 55% and 25% had ecchymosis at 7 and 14 days. In PRP-C group, 22% and none had ecchymosis at 7 and 14 days, respectively, with p=0,025 to control group. ConclusionThe use of PRP clot may have some advantages in the postoperative management of patients who undergo hip arthroscopy. The lower ecchymosis suggests an anti-inflammatory effect that may reflect on long term results. The use of PRP clot may have some advantages in the postoperative management of patients who undergo hip arthroscopy. The lower ecchymosis suggests an anti-inflammatory effect that may reflect on long term results.

Paper 45: Effects of Platelet-Rich Plasma (PRP) on the Management of Early Postoperative Pain and Inflammation Following Hip Arthroscopy in Patients with Femoroacetabular Impingement: A Prospective, Double Blinded, Randomized, Placebo Controlled, Clinical Trial

Paper 45: Effects of Platelet-Rich Plasma (PRP) on the Management of Early Postoperative Pain and Inflammation Following Hip Arthroscopy in Patients with Femoroacetabular Impingement: A Prospective, Double Blinded, Randomized, Placebo Controlled, Clinical Trial

Hip Arthroscopy in Patients With Early Arthritis

Hip Arthroscopy in Patients With Early Arthritis

Is Hip Arthroscopy Cost-effective for Femoroacetabular Impingement?

The impact of hip arthroscopy on health-related quality of life (HRQoL) among younger patients with symptomatic femoroacetabular impingement (FAI) is unknown, but with increasing recognition of the condition there is likely to be increasing demand for arthroscopy. We describe an approach to determine the incremental cost-effectiveness of hip arthroscopy compared with observation in patients with FAI; we also identified variables that influence its cost-effectiveness. We constructed a Markov model including possible health states for 36-year-old patients with FAI using decision analysis software and compared two strategies: (1) observation and (2) hip arthroscopy, followed by THA with disease progression. We estimated the ratio of the incremental cost to the incremental benefit (reflected by HRQoL) of both strategies. We identified studies reporting Harris hip scores and complications after arthroscopy to estimate health state preferences and their probabilities. We performed sensitivity analyses on 30 input variables over a plausible range of estimates to determine the influence of uncertainty on the ICER with particular emphasis on the magnitude and duration of benefit. Among patients with FAI but no radiographic evidence of arthritis, the estimated ICER of hip arthroscopy was $21,700/QALY while the ICER for patients with preoperative arthritis was $79,500/QALY. Alteration of the natural history of arthritis by hip arthroscopy improved the ICER to $19,200/QALY and resulted in cost savings if THA was not performed until at least 16 years after arthroscopy. Although limited by available data, our model suggests hip arthroscopy in patients with FAI without arthritis may result in a favorable ICER compared with other health interventions considered cost-effective. Further studies of hip arthroscopy are needed to determine the impact on quality of life, duration of symptomatic relief, and the effect on the need for subsequent THA.

Patient-Reported Outcome questionnaires for hip arthroscopy: a systematic review of the psychometric evidence

BackgroundHip arthroscopies are often used in the treatment of intra-articular hip injuries. Patient-reported outcomes (PRO) are an important parameter in evaluating treatment. It is unclear which PRO questionnaires are specifically available for hip arthroscopy patients. The aim of this systematic review was to investigate which PRO questionnaires are valid and reliable in the evaluation of patients undergoing hip arthroscopy.MethodsA search was conducted in Pubmed, Medline, CINAHL, the Cochrane Library, Pedro, EMBASE and Web of Science from 1931 to October 2010. Studies assessing the quality of PRO questionnaires in the evaluation of patients undergoing hip arthroscopy were included. The quality of the questionnaires was evaluated by the psychometric properties of the outcome measures. The quality of the articles investigating the questionnaires was assessed by the COSMIN list.ResultsFive articles identified three questionnaires; the Modified Harris Hip Score (MHHS), the Nonarthritic Hip Score (NAHS) and the Hip Outcome Score (HOS). The NAHS scored best on the content validity, whereas the HOS scored best on agreement, internal consistency, reliability and responsiveness. The quality of the articles describing the HOS scored highest. The NAHS is the best quality questionnaire. The articles describing the HOS are the best quality articles.ConclusionsThis systematic review shows that there is no conclusive evidence for the use of a single patient-reported outcome questionnaire in the evaluation of patients undergoing hip arthroscopy. Based on available psychometric evidence we recommend using a combination of the NAHS and the HOS for patients undergoing hip arthroscopy.

Rehabilitation Exercise Progression for the Gluteus Medius Muscle with Consideration for Iliopsoas Tendinitis

Background It is common for hip arthroscopy patients to demonstrate significant gluteus medius muscle weakness and concurrent iliopsoas tendinitis. Restoration of gluteus medius muscle function is essential for normal hip function. Hypothesis A progression of hip rehabilitation exercises to strengthen the gluteus medius muscle could be identified that minimize concurrent iliopsoas muscle activation to reduce the risk of developing or aggravating hip flexor tendinitis Study Design Descriptive laboratory study. Methods Electromyography (EMG) signals of the gluteus medius and iliopsoas muscles were recorded from 10 healthy participants during 13 hip rehabilitation exercises. The indwelling fine-wire EMG electrodes were inserted under ultrasound guidance. The average and peak EMG amplitudes, normalized by the peak EMG amplitude elicited during maximum voluntary contractions, were determined and rank-ordered from low to high. The ratio of iliopsoas to gluteus medius muscle activity was calculated for each exercise. Exercises were placed into respective time phases based on average gluteus medius EMG amplitude, except that exercises involving hip rotation were avoided in phase I (phase I, initial 4 or 8 weeks; phase II, subsequent 4 weeks; phase III, final 4 weeks). Results A continuum of hip rehabilitation exercises was identified. Resisted terminal knee extension, resisted knee flexion, and double-leg bridges were identified as appropriate for phase I and resisted hip extension, stool hip rotations, and side-lying hip abduction with wall-sliding for phase II. Hip clam exercises with neutral hips may be used with caution in patients with hip flexor tendinitis. Prone heel squeezes, side-lying hip abduction with internal hip rotation, and single-leg bridges were identified for phase III. Conclusion/Clinical Relevance This study identified the most appropriate hip rehabilitation exercises for each phase to strengthen the gluteus medius muscle after hip arthroscopy and those to avoid when iliopsoas pain or tendinitis is a concern.

Hip arthroscopy in patients with painful hip following resurfacing arthroplasty

Determining the etiology of persistent groin pain after hip resurfacing arthroplasty (HRA) can be very challenging, even for the experienced surgeon. The purpose of the present study was to evaluate the use of hip arthroscopy as a diagnostic and therapeutic tool for the painful hip following resurfacing arthroplasty. In the present paper, the indications for arthroscopy and the arthroscopic findings in 15 patients with persistent and incapacitating groin pain following HRA are described. In all patients, nonsurgical diagnostic investigations such as ultrasound and radiography, blood sample analysis, and technetium and leukocyte-labeled scanning were inconclusive so that a definite diagnosis could not be established. In seven patients, synovial biopsies were taken arthroscopically to rule out metal sensitivity, low-grade infection, or excessive metal wear. A definite diagnosis from histological evaluation could be made in 5 out of the 7 patients. Five patients were clinical suspicious of iliopsoas tendinitis. Diagnostic arthroscopy and histological analysis of the synovial samples provided an alternative diagnosis in 2 out of the 5 patients. Three patients underwent femoral osteoplasty for impingement due to reduced anterior femoral offset with subsequent symptom relief. Hip arthroscopy after HRA is a valuable diagnostic alternative to open procedures in case of persistent groin pain, when noninvasive investigations fail to explain the symptoms. Multiple tissue samples should always be taken for histological examination and culture, as they are crucial in the final identification of the origin of the complaints.

Paper 20: Results of Hip Arthroscopy in Patients That Sustain Iatrogenic Punctures of the Labrum

Paper 20: Results of Hip Arthroscopy in Patients That Sustain Iatrogenic Punctures of the Labrum

Influence of Femoroacetabular Impingement on Results of Hip Arthroscopy in Patients with Early Osteoarthritis

To ascertain whether better results could be obtained using hip arthroscopy, we retrospectively reviewed the radiographic and clinical aspects of anterior femoroacetabular impingement in 43 patients diagnosed with early osteoarthritis with acetabular labral tears who previously had arthroscopic treatment. The average followup was 50 months. The patients were divided into two groups: patients who had no osteoarthritis seen on simple radiographs, but had degenerative changes of the labrum and cartilage seen on magnetic resonance arthrograms and arthroscopy, and patients who had osteoarthritic findings seen on simple radiographs. Both groups were examined retrospectively for signs of anterior femoroacetabular impingement at the acetabulum and proximal femur. Postoperative improvement was evaluated using the Japanese Orthopaedic Association pain score. Six of 21 patients in Group I and 12 of 22 of patients in Group II showed radiographic evidence of femoroacetabular impingement. The score improved from 0.76 preoperatively to 2.38 postoperatively in Group I and from 0.75 preoperatively to 1.90 postoperatively in Group II. Arthroscopic débridement produced improved results seen during short-term and midterm followups. However, in patients with femoroacetabular impingement the results were considered inadequate. We found that arthroscopic treatment of osteoarthritis of the hip fails if there is detectable femoroacetabular impingement.

129 Area of pain presentation in hip arthroscopy patients

Introduction: Hip arthroscopy is becoming a more common procedure in sports and musculoskeletal medicine. It is common practice for clinicians to use the location of pain in diagnosing potential source(s) of pathology. There is a dearth of literature detailing the area of pain of hip arthroscopy patients. Methodology: Patients undergoing hip arthroscopy were recruited from three orthopaedic surgeons and two sports medicine practices in Melbourne. 100 consenting patients were given a questionnaire with 9 possible sites of pain. Each patient was asked to rate their average pain for the preceding week for each of the 9 sites using a visual analogue scale (0 = no pain to 10 = worst possible). The questionnaire was anonymously returned to the research,assistant. This data was then collated and analysed to determine the area of pain that patients commonly describe when presenting with internal hip pathology. Within that group there was a cohort of 30 subjects that had their operative findings recorded (as part of another study). This group is separately discussed. Result and conclusions: (final data analysis incomplete) Groin pain is a common finding in patients presenting with hip pathology, however pain in the buttock and lower back regions also were common presentations. The result of our paper has clinical implications for practitioners managing patients presenting with any back/pelvis/thigh or leg pain. The cohort of 30 was too small to establish if different types of hip pathology presents with on different areas of pain.

Diagnostic Accuracy of Clinical Assessment, Magnetic Resonance Imaging, Magnetic Resonance Arthrography, and Intra-Articular Injection in Hip Arthroscopy Patients

Background Hip arthroscopy has defined elusive causes of hip pain. Hypothesis/Purpose It is postulated that the reliability of various investigative methods is inconsistent. The purpose of this study is to evaluate the diagnostic accuracy of these methods. Study Design Retrospective review of prospectively collected data. Methods Five parameters were assessed in 40 patients: clinical assessment, high-resolution magnetic resonance imaging, magnetic resonance imaging with gadolinium arthrography, intra-articular bupivacaine injection, and arthroscopy. Using arthroscopy as the definitive diagnosis, the other parameters were evaluated for reliability. Results Hip abnormality was clinically suspected in all cases with 98% accuracy (1 false positive). However, the nature of the abnormality was identified in only 13 cases with 92% accuracy. Magnetic resonance imaging variously demonstrated direct or indirect evidence of abnormality but overall demonstrated a 42% false-negative and a 10% false-positive interpretation. Magnetic resonance arthrography demonstrated an 8% false-negative and 20% false-positive interpretation. Response to the intra-articular injection of anesthetic was 90% accurate (3 false-negative and 1 false-positive responses) for detecting the presence of intra-articular abnormality. Conclusions In this series, clinical assessment accurately determined the existence of intra-articular abnormality but was poor at defining its nature. Magnetic resonance arthrography was much more sensitive than magnetic resonance imaging at detecting various lesions but had twice as many false-positive interpretations. Response to an intra-articular injection of anesthetic was a 90% reliable indicator of intra-articular abnormality.

Microfracture for grade IV chondral lesions of the hip (SS-89)

Articular lesions are the second most common pathology encountered among patients undergoing hip arthroscopy. It is postulated that the microfracture principle may have application in the hip. This study reports the results of this technique in a series of hip arthroscopy patients. Methods: All patients undergoing arthroscopy are prospectively assessed. Twenty-one patients were identified that had undergone microfracture and had achieved a minimum two year follow-up. The indications for the procedure were a well circumscribed Grade IV articular lesion with intact subchondral bone and healthy surrounding cartilage, and ability of the patient to participate in the 3 month structured postoperative rehabilitation protocol. This protocol included 10 weeks of protected weight bearing, emphasizing range of motion and low resistance exercises, followed by transition to a weight bearing program and gradual resumption of normal activities. Results: There was 100% follow-up at an average of 32.6 months. The average age was 35.0 years. Work up included radiographs in all cases, 17 MRIs, 8 intra-articular injections, 2 MRAs, 2 CT scans, and 2 bone scans. Radiographs were normal in 13 cases (62%) and revealed evidence of degenerative changes in 8 cases (38%). MRI or MRA revealed evidence of articular pathology in only 4 cases (19%) and was inadequate at grading the lesion. Indirect findings of articular damage was evidenced by subchondral cyst formation (4 cases), edema or stress reaction of the subchondral bone (4 cases), and effusion (3 cases). At arthroscopy, the Grade IV lesion addressed was on the acetabular surface in 19 cases, the femoral surface in 1 case, and both surfaces in 1 case. Among the 19 acetabular lesions, 17 had associated labral pathology, 3 had accompanying Grade III lesions of the femoral head, and there were 3 degenerate ruptures of the ligamentum teres. The mean dimensions of the Grade 4 lesions were 12.2mm2 (range 6–17.5mm2). The mean improvement was 23.9 points (preoperative 51.4; postoperative 75.2). Quantitative improvement was maintained in 18 patients (86%). There was no correlation with radiographic findings, other imaging findings, associated pathology, dimensions of the lesions, or CE angle. There were no complications and all patients demonstrated compliance with the rehabilitation process. Discussion and Conclusions: Radiographs were poorly reflective of Grade IV articular lesions amenable to microfracture. Other investigative studies were unreliable at detecting these lesions and are incapable of assessing the necessary parameters for selecting the microfracture method. The decision to perform microfracture is based on the arthroscopic appearance of the defect. Thus, the surgeon must maintain an index of suspicion and include the ramifications of the postoperative rehabilitation in the preoperative discussion. The results are encouraging, although some patients did poorly despite proper selection for the procedure and compliance with the rehabilitation. In absence of controls, it is impossible to compare these results to the natural history of this process; but it is speculated that, when successful, this technique may positively influence the expected progression of these Grade IV lesions.

Surgical dislocation of the adult hip

Surgical dislocation of the hip is rarely undertaken. The potential danger to the vascularity of the femoral head has been emphasised, but there is little information as to how this danger can be avoided. We describe a technique for operative dislocation of the hip, based on detailed anatomical studies of the blood supply. It combines aspects of approaches which have been reported previously and consists of an anterior dislocation through a posterior approach with a 'trochanteric flip' osteotomy. The external rotator muscles are not divided and the medial femoral circumflex artery is protected by the intact obturator externus. We report our experience using this approach in 213 hips over a period of seven years and include 19 patients who underwent simultaneous intertrochanteric osteotomy. The perfusion of the femoral head was verified intraoperatively and, to date, none has subsequently developed avascular necrosis. There is little morbidity associated with the technique and it allows the treatment of a variety of conditions, which may not respond well to other methods including arthroscopy. Surgical dislocation gives new insight into the pathogenesis of some hip disorders and the possibility of preserving the hip with techniques such as transplantation of cartilage.

Rehabilitation after Hip Arthroscopy

Objective:To explain the basic fundamentals of patient assessment after hip arthroscopy, formulation of a treatment plan, and detailed essentials of postoperative rehabilitation.Data Sources:Established literature and the evolution of a protocol developed in treating over 150 hip-arthroscopy patients and numerous patients with symptomatic hip disease.Data Synthesis:Although the pathological process being addressed and the surgical technique employed in its management influence the protocol, the common goals of rehabilitation are to reduce discomfort and improve function. These common goals, first realized in the postoperative rehabilitation process, have been found to have similar application in the conservative management of patients with symptomatic hip disease.Conclusions:Arthroscopy has necessitated the development of a postoperative rehabilitation protocol. Principles previously employed in other joints are now finding application in the hip.