Hip Disability And Osteoarthritis Outcome Score Research Articles

3.0 T MRI findings of 104 hips of asymptomatic adults: from non-runners to ultra-distance runners

ObjectivesTo determine and compare the health status of hip joints of individuals undertaking various lengths of long-distance running and of those who are not running.MethodsFifty-two asymptomatic volunteers underwent bilateral hip...

Locking compression plate fixation of femoral intertrochanteric fractures in patients with preexisting proximal femoral deformity: a retrospective study

BackgroundTo investigate the clinical efficacy of locking compression plate fixation for the treatment of femoral intertrochanteric fractures in patients with preexisting proximal femoral deformity.MethodsA retrospective analysis was conducted on 37 patients with femoral intertrochanteric fractures combined with preexisting proximal femoral deformity between January 2013 and July 2019. The patients included 24 males and 13 females aged from 23 to 69 years old, with an average age of 47.5 years. The preexisting proximal femoral deformities resulted from poliomyelitis sequela, proximal femoral fibrous dysplasia, malunion and implant failure combined with coxa vara after intramedullary nailing fixation. There were 6 cases of 31-A2.1, 6 cases of 31-A2.2, 20 cases of 31-A3.1, and 5 cases of 31-A3.2, determined based on the AO classification of intertrochanteric fractures. All fractures were managed through open reduction and locking plate fixation. The hip disability and osteoarthritis outcome score (HOOS) was used to assess hip function before injury and at the last postoperative follow-up. The short form 36 (SF-36) Health Survey Questionnaire was used to assess quality of life.ResultsThirty-seven patients were followed up for 12 to 27 months (average, 20.7 months). All patients achieved bone healing within 5.1 months on average (range, 3 to 6 months). Postoperative complications included deep vein thrombosis in three patients, bedsores in one and delayed union in one patient. No other complications, such as surgical site infection, fat embolism, nonunion and re-fracture, were presented. There was no significant difference in the HOOS scores and the SF-36 Health Questionnaire outcomes at pre-injury and at the last postoperative follow-up (p > 0.05).ConclusionsIt is difficult to perform intramedullary fixation of femoral intertrochanteric fractures in patients with preexisting proximal femoral deformity, while locking compression plate fixation is a simple and effective method of treatment.

Comparing Patient-Reported Outcome Measurements for Femoroacetabular Impingement Syndrome

Background: There is much debate in the current literature with regard to the most appropriate hip-specific patient-reported outcome (PRO) measurement for assessment of femoroacetabular impingement syndrome (FAIS) and outcomes after surgical treatment. Despite systematic reviews assessing the validity of classic hip-specific PROs as well as newer PROs developed to target the young, active population, there lacks a direct comparison of the question content between each PRO. Purpose: To compare the question composition and degree of overlap between commonly used PROs for FAIS. Study Design: Cross-sectional study Methods: A literature review yielded the 6 most commonly cited PROs for assessment of FAIS: modified Harris Hip Score (mHHS), Hip disability and Osteoarthritis Outcome Score (HOOS), Copenhagen Hip and Groin Outcome Score (HAGOS), Nonarthritic Hip Score (NAHS), international Hip Outcome Tool (iHOT-33), and Hip Outcome Score (HOS). Questions from each PRO were classified as identical, similar, or unique after pooled comparison, and the number of overlapping (identical or similar) questions between each PRO was determined. Questions were then classified into 5 domains: pain, symptoms, functional activities, sports, and quality of life, and variations in questions assessing each domain based on PRO were analyzed. Results: Analysis of 164 total questions from 6 PROs showed that 87 questions (53%) were identical between 2 or more PROs, 39 (24%) were similar, and 38 (23%) were unique. The iHOT-33 contained the highest number of unique questions, with 13 of 33 (39.4%), while the HOOS contained the lowest number of unique questions, with 3 of 40 (7.5%). The HOOS, HAGOS, and iHOT-33 contained questions assessing all 5 domains of patient outcomes; the NAHS did not evaluate quality of life; the mHHS only assessed pain, symptoms, and functional activities; and the HOS only assessed functional activities and sports. Conclusion: As there is a high percentage of overlapping (identical or similar) questions between the most commonly used hip-specific PROs for FAIS, multiple tests may be appropriate for use. The iHOT-33, HOOS, and HAGOS are well suited for the general population as they offer comprehensive assessments across all domains, while the HOS provides added focus to sports/activity assessments for athletes and highly active patients.

Correlation of Patient-Reported Outcomes After Periacetabular Osteotomy With Femoral Head Coverage and Acetabular Orientation: A Single-Center Cohort Study

Background: Gaining a better understanding of the underlying pattern of acetabular dysplasia 3-dimensionally can help better guide treatment and optimize clinical outcomes after periacetabular osteotomy (PAO). Purpose: (1) To examine the relationship between femoral head coverage before and after PAO for dysplasia and patient-reported outcome measure (PROM) scores and (2) to assess if the direction/orientation of correction of the acetabulum can be predicted based on the Ottawa classification. Study Design: Cohort study; Level of evidence, 3. Methods: A retrospective analysis of a prospectively collected database from a single-center institutional registry of PAO was conducted, and PROM scores at a minimum of 2 years were analyzed. A total of 79 hips (67 patients [56 female]; mean age at surgery, 27.5 years [range, 15.8-53.7 years]) were available for inclusion. According to the Ottawa classification, 54 hips (68.4%) had global deficiency, 15 hips (18.9%) had posterior deficiency, and 10 hips (12.7%) had anterior deficiency. Hip2Norm software was used to analyze the 3-dimensional coverage of the femoral head. Statistical analysis was conducted to look at significant predictors of improvements in PROMs using the minimal clinically important difference (MCID) for the Hip disability and Osteoarthritis Outcome Score (HOOS) Activities of Daily Living subscale. Results: At a mean follow-up of 3.1 years (range, 2.0-7.4 years), all functional outcome scores improved significantly. A postoperative total femoral coverage <75.7%, posterior coverage (PC) <45.2%, and femoral head extrusion index >15.5% were all associated with not reaching the MCID for the HOOS Activities of Daily Living subscale. Multivariate analysis showed that PC was the single most important significant modifier influencing functional outcomes after PAO for the treatment of acetabular dysplasia, with an odds ratio of 6.0 (95% CI, 1.8-20.4; P = .004). One-way analysis of variance showed a significant difference comparing the mean change in radiographic measurements, that is, anterior coverage, PC, and total femoral coverage, per the Ottawa classification (P < .001). Conclusion: Our study demonstrated that postoperative femoral head coverage and acetabular orientation were significant predictors of PROM scores. Classifying acetabular dysplasia into 3 groups based on the plane of instability could optimize the planning of PAO by giving a better understanding of the 3-dimensional deformity.

Is the Revision Rate Higher After Hip Arthroplasty in Teenage Patients? A Prospective Study with Long-Term Follow-Up of More Than 10 Years.

Total hip arthroplasty (THA) and hip resurfacing arthroplasty (HRA) are already proven goodfor end-stage arthritis in the older populations but it is challenging in young teenagepatients. The primary aim was to assess Hip Disability and Osteoarthritis Outcome Score (HOSS), Harris Hip Score (HHS) and secondary aim for implant survival rate. The details of 33 teenage patients (forty hips) who underwent HRA (21) and THA (19)at our institution (January 2002 to December 2013) with a mean follow-up period of 11.00years (range 7.00-18.40) were included. The study group had 25 males and eight females. The overall median HOOSs with interquartile range were 89.00 (87.63-0.00). The median HOOSs at follow-up were as follows: 95.00 (90.00-95.00) for symptoms, 92.00 (90.00-95.00) pain, 87.00 (85.00-90.00) for functions, 81.00 (75.00-85.00) for sports and 94.00 (88.00-95.00) for QOL. HHS improved significantly from 36.88 ± 6.14 to 90.12 ± 6.56 (p < 0.001). The HHS of HRA group improved from 36.29 ± 5.83 to 89.38 ± 5.23 and THA group improved from 37.26 ± 6.22 to 90.94 ± 7.84. The 5-year radiological follow-up X-rays did not show any radiolucent line wider than 2mm in all three zones of the acetabulum and no progressive subsidence or migration of > 1mm and divergent radiopaque line in femur. The Implant survival rate for HRA was 100% at 5years, 100% at 10years, 92% at 15years and THA group was 100% at 5years and 90% at 10years. Our study showed a disability rate of zero with improved HOSS and HHS. The overall implant survival rate was good with 100% at 5years, 97% at 10years and 89.9% at 15years in contrast to the previous studies with the use of modern implants and newer standard surgical techniques. A Level II study http://www.spine.org/Documents/LevelsofEvidenceFinal.pdf.

Outcome measures in total hip arthroplasty: have our metrics changed over 15years?

Consensus has not been reached regarding ideal outcome measures for total hip arthroplasty (THA) clinical evaluation and research. The goal of this review was to analyze the trends in outcome metrics within the THA literature and to discuss the potential impact of instrument heterogeneity on clinical practice. A PubMed search of all manuscripts related to THA from January 2005 to December 2019 was performed. Statistical and linear regression analyses were performed for individual outcome metrics as a proportion of total THA publications over time. There was a statistically significant increase in studies utilizing outcomes metrics between 2005 and 2019 (15.1-29.5%; P < 0.001; R2 = 98.1%). Within the joint-specific subcategory, use of the Harris Hip Score (HHS) significantly decreased from 2005 to 2019 (82.8-57.3%; P < 0.001), use of the Hip Disability and Osteoarthritis Outcome Score (HOOS) significantly increased (0-6.7%; P < 0.001), and the modified HHS significantly increased (0-10.5%; P < 0.001). In the quality of life subcategory, EQ-5D demonstrated a significant increase in usage (0-34.8%; P < 0.001), while Short Form-36 significantly decreased (100% vs. 27.3%; P = 0.008). The utilization of outcome-reporting metrics in THA has continued to increase, resulting in added complexity within the literature. The utilization rates of individual instruments have shifted over the past 15years. Additional study is required to determine which specific instruments are recommended.

Functional improvement in hip pathology is related to improvement in anxiety, depression, and pain catastrophizing: an intricate link between physical and mental well-being

BackgroundPain catastrophizing, anxiety, and depression are risk factors for poor functional outcomes and worse post-treatment pain that can be treated alongside physical care given to orthopedic patients. While these factors have been shown to be common in patients with hip pathology, there is limited literature that follows these conditions throughout treatment. The purpose of this study was to track psychological factors in patients with various hip pathology to determine if they improved alongside functional measures following treatment.MethodsPatients presenting to a specialist hip clinic were prospectively evaluated for outcomes of pain catastrophizing, anxiety, depression, and hip function. Pre- and post-treatment assessments were undertaken: Pain Catastrophizing Scale, the Hospital Anxiety Depression Scale, the Hip Outcome Survey, and Hip Disability and Osteoarthritis Outcome Score (HOOS). Patient characteristics were recorded. A correlation analysis, using the Spearman partial correlation coefficient (rs), was conducted to evaluate the relationship between change in psychological factors with change in functional outcomes.ResultsA total of 201 patients (78 male, 123 female) with a mean age of 53.75 ± 18.97 years were included, with diagnoses of hip dysplasia (n = 35), femoroacetabular impingement (n = 35), lateral trochanteric pain syndrome (n = 9), osteoarthrosis (n = 109), and avascular necrosis of the hip (n = 13). Statistical analysis revealed a significant negative relationship between change in function level (as measured by HOOS ADL) and change in pain catastrophizing (rs = − 0.373, p < 0.0001), depression (rs = − 0.363, p < 0.0001), and anxiety (rs = − 0.264, p = 0.0002). Pain catastrophizing, depression, and anxiety improved with function. Spearman correlation coefficients also revealed that pain catastrophizing, HADS anxiety, and HADS depression improved with improvement in other patient-reported functional outcomes.ConclusionsPatients with hip pathology often exhibit pain catastrophizing, anxiety, and depression, but improvements in hip functionality are associated with decreased severity of these psychological comorbidities. Exploring this connection demonstrates the correlation between musculoskeletal impairment and psychosocial outcomes and mental health. Perioperative multidisciplinary assessment may be a beneficial part of comprehensive orthopaedic hip care.

Capsular resection versus capsular repair in direct anterior approach for total hip arthroplasty: a randomized controlled trial

Optimal exposure through the direct anterior approach (DAA) for total hip arthroplasty (THA) conducted on a regular operating theatre table is achieved with a standardized capsular releasing sequence in which the anterior capsule can be preserved or resected. We hypothesized that clinical outcomes and implant positioning would not be different in case a capsular sparing (CS) technique would be compared to capsular resection (CR). In this prospective trial, 219 hips in 190 patients were randomized to either the CS (n = 104) or CR (n = 115) cohort. In the CS cohort, a medial based anterior flap was created and sutured back in place at the end of the procedure. The anterior capsule was resected in the CR cohort. Primary outcome was defined as the difference in patient-reported outcome measures (PROMs) after one year. PROMs (Harris Hip Score (HHS), Hip disability and Osteoarthritis Outcome Score (HOOS), and Short Form 36 Item Health Survey (SF-36)) were collected preoperatively and one year postoperatively. Radiological parameters were analyzed to assess implant positioning and implant ingrowth. Adverse events were monitored. At one year, there was no difference in HSS (p = 0.728), HOOS (Activity Daily Life, p = 0.347; Pain, p = 0.982; Quality of Life, p = 0.653; Sport, p = 0.994; Symptom, p = 0.459), or SF-36 (p = 0.338). Acetabular component inclination (p = 0.276) and anteversion (p = 0.392) as well as femoral component alignment (p = 0.351) were similar in both groups. There were no dislocations, readmissions, or reoperations in either group. The incidence of psoas tendinitis was six cases in the CS cohort (6%) and six cases in the CR cohort (5%) (p = 0.631). No clinical differences were found between resection or preservation of the anterior capsule when performing a primary THA through the DAA on a regular theatre table. In case of limited visibility during the learning curve, it might be advisable to resect a part of the anterior capsule. Cite this article: Bone Joint J 2021;103-B(2):321-328.

Patient Factors That Matter in Predicting Hip Arthroplasty Outcomes: A Machine-Learning Approach

BackgroundDespite the success of total hip arthroplasty (THA), approximately 10%-15% of patients will be dissatisfied with their outcome. Identifying patients at risk of not achieving meaningful gains postoperatively is critical to pre-surgical counseling and clinical decision support. Machine learning has shown promise in creating predictive models. This study used a machine-learning model to identify patient-specific variables that predict the postoperative functional outcome in THA. MethodsA prospective longitudinal cohort of 160 consecutive patients undergoing total hip replacement for the treatment of degenerative arthritis completed self-reported measures preoperatively and at 3 months postoperatively. Using four types of independent variables (patient demographics, patient-reported health, cognitive appraisal processes and surgical approach), a machine-learning model utilizing Least Absolute Shrinkage Selection Operator (LASSO) was constructed to predict postoperative Hip Disability and Osteoarthritis Outcome Score (HOOS) at 3 months. ResultsThe most predictive independent variables of postoperative HOOS were cognitive appraisal processes. Variables that predicted a worse HOOS consisted of frequent thoughts of work (β = −0.34), frequent comparison to healthier peers (β = −0.26), increased body mass index (β = −0.17), increased medical comorbidities (β = −0.19), and the anterior surgical approach (β = −0.15). Variables that predicted a better HOOS consisted of employment at the time of surgery (β = 0.17), and thoughts related to family interaction (β = 0.12), trying not to complain (β = 0.13), and helping others (β = 0.22). ConclusionsThis clinical prediction model in THA revealed that the factors most predictive of outcome were cognitive appraisal processes, demonstrating their importance to outcome-based research. Level of evidencePrognostic Level 1.

Ultrasound-guided hydrodilatation for adhesive capsulitis of the hip is a safe and effective treatment

PurposeAdhesive capsulitis of the hip (ACH) is likely that this condition had been previously encountered, but easily unrecognised. We investigated the clinical features of patients with ACH, the efficacy of ultrasound-guided intra-articular hydrodilatation, and the patients’ prognosis.MethodsWe enrolled 84 patients (93 hips) who visited the outpatient clinic from August 2018 to November 2019. ACH was diagnosed by restricted range of motion and sharp pain when turning with the affected leg fixed on the ground. We evaluated patient demographics and associated intra-articular pathologies found on magnetic resonance angiography (MRA) images. Injections were performed twice at two week intervals with a mixture of 0.5% lidocaine (25 mL) and triamcinolone (40 mg; 1 mL) with capsular distension under ultrasound guidance. Patients were assessed before and after treatment using a visual analogue scale (VAS), hip disability and osteoarthritis outcome score (HOOS), hip range of motion (ROM), and distance from floor to knee (DFK) when sitting in the cross-legged position.ResultsOn MRA, 18 patients had abnormal findings (eight labral tears, seven abductor tendinosis, three primary arthrosis). The mean VAS decreased from 7.1 ± 1.1 to 0.8 ± 0.9 after the last injection, and the HOOS improved in all subsets. The mean DFK decreased from 17.9 ± 4.8 to 9.7 ± 2.8 cm, and passive ROM showed improvement, especially in flexion and rotation. In seven patients, symptom recurrence was reported a mean of 4.1 months after the latest injection, but no independent risk factor for recurrence was identified.ConclusionBased on these current observations, patients with ACH may receive relief from hip joint pain and experience improved function with a timely diagnosis and effective treatment.

Sex Differences in Clinical Outcomes Following Surgical Treatment of Femoroacetabular Impingement.

Sex-based differences in clinical outcomes following surgical treatment of femoroacetabular impingement remain largely uncharacterized; this prospective, multicenter study evaluated these differences both directly and adjusted for covariates. Hips undergoing surgical treatment of symptomatic femoroacetabular impingement were prospectively enrolled in a multicenter cohort. Patient demographics, radiographic parameters, intraoperatively assessed disease severity, and history of surgical procedures, as well as patient-reported outcome measures, were collected preoperatively and at a mean follow-up of 4.3 years. A total of 621 (81.6%) of 761 enrolled hips met the minimum 1 year of follow-up and were included in the analysis; 56.7% of analyzed hips were female. Univariate and multivariable statistics were utilized to assess the direct and adjusted differences in outcomes, respectively. Male hips had greater body mass index and larger α angles. Female hips had significantly lower preoperative and postoperative scores across most patient-reported outcome measures, but also had greater improvement from preoperatively to postoperatively. The preoperative differences between sexes exceeded the threshold for the minimal clinically important difference of the modified Harris hip score (mHHS) and all Hip disability and Osteoarthritis Outcome Score (HOOS) domains except quality of life. Preoperative sex differences in mHHS, all HOOS domains, and Short Form-12 Health Survey physical function component score were greater than the postoperative differences. A greater proportion of female hips achieved the minimal clinically important difference for the mHHS, but male hips were more likely to meet the patient acceptable symptom state for this outcome. After adjusting for relevant covariates with use of multiple regression analysis, sex was not identified as an independent predictor of any outcome. Preoperative patient-reported outcome scores were a strong and highly significant predictor of all outcomes. Significant differences in clinical outcomes were observed between sexes in a large cohort of hips undergoing surgical treatment of femoroacetabular impingement. Despite female hips exhibiting lower baseline scores, sex was not an independent predictor of outcome or reoperation. Prognostic Level II. See Instructions for Authors for a complete description of levels of evidence.

Weight loss before total joint arthroplasty using a remote dietitian and mobile app: study protocol for a multicenter randomized, controlled trial

BackgroundThe months prior to elective surgery may present an opportunity for patients to initiate behavior changes that will simultaneously ready them for surgery and improve their overall health status. An upcoming elective total joint arthroplasty (TJA) may serve as motivation for patients with severe obesity (body mass index [BMI]> 40 kg/m2) to lose weight, as it may optimize clinical outcomes following TJA and help them become eligible for TJA since some surgeons use a BMI of 40 kg/m2 as a cut-off for offering surgery in an effort to optimize outcomes.MethodsThe purpose of this multicenter randomized, controlled trial is to assess the feasibility and efficacy of a 12-week remote dietitian (RD) supervised dietary and physical activity weight loss intervention and mobile app for 60 patients with severe obesity prior to undergoing TJA. Intervention participants will receive access to a smartphone app and connect with an RD who will contact these participants weekly or bi-weekly via video calls for up to nine video calls. Together, participants and RDs will set goals for lifestyle modifications, and RDs will check on progress towards achieving these goals using in-app tools such as food logs and text messages between video calls. All patients will be encouraged to lose at least 20 pounds with a goal BMI < 40 kg/m2 after 12 weeks. Individuals randomized to the control group will receive clinical standard of care, such as nutritionist and/or physical therapy referrals. Outcome and demographic data will be collected from blood serology, chart review, mobile app user data, pre- and postintervention surveys, and phone interviews. The primary outcome measure will be weight change from baseline. Secondary outcome measures will include percentage of patients eligible to undergo TJA, number of sessions completed with dietitians, self-reported global health status (PROMIS Global Health scale), self-reported joint-specific pain and function (Knee injury and Osteoarthritis Outcome Score (KOOS) or Hip disability and Osteoarthritis Outcome Score (HOOS)), and serologies such as hemoglobin A1c, total lymphocyte count, albumin, and transferrin. Qualitative responses transcribed from phone interviews about the intervention will also be analyzed.DiscussionThis will be the first study to assess pre-operative weight loss in patients with severe obesity anticipating orthopaedic surgery using an RD and mobile app intervention aimed at helping patients become eligible for TJA.Trial registrationRegistered on 1 April 2020 at Clincialtrials.gov. Trial number is NCT04330391.

Can Chiari Osteotomy Favorably Influence Long-term Hip Degradation in Multiple Epiphyseal Dysplasia and Pseudoachondroplasia?

Multiple epiphyseal dysplasia (MED) and pseudoachondroplasia (PSACH) are congenital skeletal disorders characterized by irregular epiphyses, mild or severe short stature and early-onset osteoarthritis which frequently affect the hips. The current study evaluates the long-term results of the Chiari osteotomy in MED and PSACH patients. Twenty patients (14 MED and 6 PSACH) were retrospectively included. Clinical assessment used the Postel Merle d'Aubigné (PMA) score and the Hip disability and Osteoarthritis Outcome Score (HOOS). Risser index, Sharp angle, acetabular depth index, center-edge angle, Tönnis angle, and femoral head coverage were measured on the preoperative radiographs and at last follow-up. The Treble index, which identifies the hip at risk in MED patients, was also determined. Stulberg classification (grades I to V) was used to evaluate the risk of osteoarthritis in the mature hips.Statistical analyses determined differences between preoperative and postoperative data. The Kaplan Meier method was used to calculate the survival rate of the operated hips using total hip arthroplasty as the endpoint. Thirty-three hips which underwent a Chiari osteotomy were reviewed. The average follow-up was 20.1 years. The PMA scores were significantly better at last follow-up than preoperatively. All radiographic parameters significantly improved. Moreover, the Sharp angle, center-edge angle, and femoral head coverage improved to a normal value at hip maturity. All of the operated hips had a Treble index of type I. At hip maturity, a majority of hip were aspherical congruent (Stulberg grades of III and IV). The survival rate of the operated hips was 80.7% at 24 years postoperative. The Chiari osteotomy is a satisfying solution for severe symptomatic hip lesions in MED and PSACH patients. At long-term follow-up, this procedure lessens pain and improves hip function, which delays total hip arthroplasty indication. Level IV.

Rate of Surgery and Baseline Characteristics Associated With Surgery Progression in Young Athletes With Prearthritic Hip Disorders.

Background:Prearthritic hip disorders (PAHD), such as femoroacetabular impingement (FAI), acetabular dysplasia, and acetabular labral tears, are a common cause of pain and dysfunction in adolescent and young adult athletes, and optimal patient-specific treatment has not been defined. Operative management is often recommended, but conservative management may be a reasonable approach for some athletes.Purpose:To identify (1) the relative rate of progression to surgery in self-reported competitive athletes versus nonathletes with PAHD and (2) baseline demographic, pain, and functional differences between athletes who proceeded versus those who did not proceed to surgery within 1 year of evaluation.Study Design:Cohort study; Level of evidence, 3.Methods:An electronic medical record review was performed of middle school, high school, and college patients who were evaluated for PAHD at a single tertiary-care academic medical center between June 22, 2015, and May 1, 2018. Extracted variables included patients’ self-reported athlete status, decision to choose surgery within 1 year of evaluation, and baseline self-reported pain and functional scores on Patient-Reported Outcomes Measurement Information System (PROMIS) domains, the Hip disability and Osteoarthritis Outcome Score (HOOS), and the modified Harris Hip Score.Results:Of 260 eligible patients (289 hips), 203 patients (78%; 227 hips) were athletes. Athletes were no more likely to choose surgery than nonathletes (130/227 hips [57%] vs 36/62 hips [58%]; relative risk [RR], 0.99 [95% CI, 0.78-1.25]). Among athletes, those who proceeded to surgery over conservative care were more likely to be female (81% vs 69%; RR, 1.34 [95% CI, 0.98-1.83]) and had more known imaging abnormalities (FAI: 82% vs 69%, RR, 1.47 [95% CI, 1.09-1.99]; dysplasia: 48% vs 27%, RR, 1.44 [95% CI, 1.16-1.79]; mixed deformity: 30% vs 10%, RR, 2.91 [95% CI, 1.53-5.54]; known labral tear: 84% vs 40%, RR, 2.79 [95% CI, 2.06-3.76]). Athletes who chose surgery also reported worse baseline hip-specific symptoms on all HOOS subscales (mean difference, 10.8-17.7; P < .01 for all).Conclusion:Similar to nonathletes, just over half of athletes with PAHD chose surgical management within 1 year of evaluation. Many competitive athletes with PAHD continued with conservative management and deferred surgery, but more structural hip pathology and worse hip-related baseline physical impairment were associated with the choice to pursue surgery.

Treatment of Labral Calcification in the Setting of Femoroacetabular Impingement Syndrome With Arthroscopic Calcification Excision, Labral Repair, and Osteoplasty Improves Outcomes

To describe the diagnosis and 2-year outcomes of arthroscopic treatment for labral calcification in the setting of femoroacetabular impingement syndrome (FAIS). A retrospective analysis was performed from a prospectively collected database of patients with FAIS undergoing hip arthroscopy. Patients with FAIS with labral calcification were differentiated radiographically from patients with other paralabral radiopaque densities such as os acetabuli, acetabular rim fractures, and labral ossification. Patients with FAIS with labral calcification were treated with arthroscopic calcification excision, labral repair, and osteoplasty and matched by age, sex, and body mass index with a cohort of patients with FAIS without labral calcifications who underwent labral repair and osteoplasty. Pre- and 2 years postoperatively, patients completed patient-reported outcome (PRO) scores including the modified Harris Hip Score, Hip disability and Osteoarthritis Outcome Score (HOOS), 12-item Short-Form survey, and visual analog scale. In total, 40 hips (21 male, 19 female) with FAIS and labral calcification were included (age 36.8 ± 8.1, body mass index, 25.9 ± 4.5). Patients with FAIS with labral calcification demonstrated similar significant PRO score improvements compared with a matched cohort of patients with FAIS without labral calcification at 2 years after surgery (visual analog scale: (-)2.3 ± 0.4, (-)2.7 ± 0.5, modified Harris Hip Score: 16.1 ± 2.6, 17.1 ± 3.2; HOOS symptoms: 21.9 ± 3.7, 18.6 ± 3.6; HOOS pain: 22.1 ± 3.0, 25.0 ± 3.5; HOOS activities of daily living: 20.2 ± 2.8, 23.8 ± 3.3; HOOS sport: 35.6 ± 5.0, 35.6 ± 4.1; HOOS quality of life: 36.9 ± 4.5, 37.5 ± 4.4; 12-item Short-Form survey physical component summary: 15.5 ± 2.3, 20.1 ± 2.1, respectively). Both cohorts achieved minimal clinically important differences at equivalent rates (60%-82.5%) for all PRO scores. Patients with labral calcification in the setting of FAIS can be effectively treated with arthroscopic calcification excision, labral repair, and osteoplasty. These patients demonstrate significant improvements in patient-reported outcomes and achievement of minimal clinically important differences at 2 years similar to patients undergoing arthroscopic treatment for FAIS without labral calcification. Level III, matched cohort study.

The Learning Curve for Hip Arthroscopic Surgery: A Prospective Evaluation With 2-Year Outcomes in Patients With Femoroacetabular Impingement

Background:The use of hip arthroscopic surgery in the treatment of femoroacetabular impingement (FAI) is increasing, but it is universally known as a technically demanding procedure with a “steep” learning curve. There are limited data investigating the correlation between surgeon experience and patient-reported outcomes (PROs) as well as procedure and traction times.Purpose:To prospectively evaluate the relationship between surgeon experience and PROs after hip arthroscopic surgery for the treatment of FAI.Study Design:Cohort study; Level of evidence, 2.Methods:A total of 190 patients undergoing primary hip arthroscopic surgery for FAI were prospectively enrolled during a sports medicine fellowship–trained surgeon’s first 36 months of practice. A radiographic evaluation as well as PRO surveys including the 12-Item Short Form Health Survey (SF-12), the modified Harris Hip Score (mHHS), and the Hip disability and Osteoarthritis Outcome Score (HOOS) were administered preoperatively and at 2 years postoperatively. Logistic regression as well as analysis of variance was performed to evaluate for correlations between surgical experience and PROs, procedure time, and traction time.Results:Of the 190 patients, 168 (88%; mean age, 35.3 ± 9.6 years; mean body mass index, 25.07 ± 3.98) completed a 2-year follow-up and were included for analysis. The mean procedure time was 91.5 ± 23.9 minutes, and the mean traction time was 54.0 ± 17.7 minutes. Patients demonstrated significant improvements at 2 years after surgery for all PRO scores (mHHS, HOOS, and SF-12 physical component summary; P < .001), except the SF-12 mental component summary, which had no change (P = .43). The procedure time significantly decreased after 70 cases, while the traction time continued to decrease until 110 cases (R 2 = 0.99; P < .0001). There was no correlation between increasing case volume and 2-year PRO scores (P > .2 for mHHS, HOOS, and SF-12). There was also no difference with increasing case volume and amount of improvement from preoperative to 2-year postoperative PRO scores for the SF-12 and HOOS. Case volume did not affect the complication rate, as this cohort experienced 4 minor cases of neurapraxia.Conclusion:Surgical efficiency in hip arthroscopic surgery for the treatment of FAI was maximized after 110 cases in this cohort. However, significant PRO improvements can be achieved early in a surgeon’s practice prior to maximizing surgical efficiency.

Fast Starters and Slow Starters After Hip Arthroscopy for Femoroacetabular Impingement: Correlation of Early Postoperative Pain and 2-Year Outcomes

Background: Patients experience varying degrees of pain and symptoms during the early recovery period after hip arthroscopy for femoroacetabular impingement (FAI). Some “fast starters” report minimal discomfort and are eager to advance activities, while “slow starters” describe severe pain and limitations. The relationship between these early postoperative symptoms and 2-year outcomes after hip arthroscopy is unknown. Purpose: To analyze the relationship between early postoperative pain and 2-year patient-reported outcomes (PROs) after hip arthroscopy for FAI. Study Design: Cohort study; Level of evidence, 2. Methods: Patients without arthritis or dysplasia who were undergoing primary hip arthroscopy for FAI were prospectively enrolled and completed validated PROs. Scores for visual analog scale (VAS) for pain were collected preoperatively and at 1 week, 6 weeks, and 2 years postoperatively. Scores for the modified Harris Hip Score (mHHS), Hip disability and Osteoarthritis Outcome Score (HOOS), and 12-Item Short Form Health Survey (SF-12) were collected preoperatively and 2 years postoperatively. Paired t tests were used to evaluate PRO score changes, and correlation analyses were used to assess relationships between early postoperative pain and 2-year postoperative outcomes. Results: A total of 166 patients were included (55% female; mean ± SD age, 35.29 ± 9.6 years; mean body mass index, 25.07 ± 3.98 kg/m2). Patients demonstrated significant improvements in PRO scores (VAS, SF-12 Physical Component Score, mHHS, and all HOOS subscales) at 2 years after hip arthroscopy for FAI (P < .001). There was a significant correlation between lower 1-week VAS pain level (fast starters) and lower 2-year VAS pain level (R = 0.31; P < .001) as well as higher 2-year PRO scores (SF-12 Physical Component Score, mHHS, and all HOOS subscales: R = −0.21 to −0.3; P < .001). There was no correlation between 1-week VAS pain and 2-year SF-12 Mental Component Score (P = .17). Preoperative VAS pain levels showed positive correlations with 1-week postoperative pain scores (R = 0.39; P < .001) and negative correlations with 2-year patient outcomes (R = −0.15 to −0.33, P < .01). There was no correlation between 6-week postoperative pain scores and 2-year PRO scores. Conclusion: Fast starters after hip arthroscopy for FAI experience sustained improvements in outcomes at 2 years after surgery. Patient pain levels before surgery may delineate potential fast starters and slow starters.

Acetabular reconstruction using a composite layer of impacted cancellous allograft bone and cement: minimum 5-year follow-up study.

Revision total hip arthroplasty (rTHA) is often complex and has a less reliable outcome than primary total hip arthroplasty. Acetabular reconstruction remains a challenge because of the variable amount of bone loss. This study describes and evaluates a novel technique of acetabular reconstruction using composite bone grafting. Between June 2005 and January 2012, 108 consecutive patients underwent revision hip arthroplasty in which the acetabular component was revised using composite bone grafting. Of these, 24 were lost to follow-up leaving 84 in the study with a minimum 5-year follow-up. There were 54 women and 30 men with a mean age of 70.1 (31-91) years. All patients were assessed clinically and radiologically after a minimum of 5 years. The primary outcome measures were rate of re-revision, patient-reported outcomes and radiological evidence of loosening. The mean follow-up after revision surgery was 6.9 years (5-10). At operation, 60 patients had an acetabular defect of AAOS stage 3 or more. There was no evidence of loosening in 69 revision acetabular components; 12 showed evidence of non-progressive loosening and 3 patients underwent a re-revision procedure (2 for infection, 1 recurrent dislocation).The mean postoperative Hip Disability and Osteoarthritis Outcome Score (HOOS) was 89.11/100 (95% CI, 87.8-90.5). Scores were significantly improved in patients with a more extensive preoperative defect (p = 0.006). The overall patient satisfaction rate at final follow-up was very high. Composite impaction grafting using a layered cement and bone graft technique can give satisfactory clinical and radiological outcomes in the medium- to long-term.

Correlation of hip capsule morphology with patient symptoms from femoroacetabular impingement.

The relationship between morphological characteristics of the hip capsule and patient symptoms in the setting of femoroacetabular impingement (FAI) is undefined. In this study, patients with symptomatic FAI prospectively underwent 3T magnetic resonance (MR) imaging of the affected hip and completed the hip disability and osteoarthritis outcome score (HOOS) to determine the correlation between hip capsule anatomy and patient symptoms. Anterior hip capsule volume, posterior capsule volume, anterior-posterior capsule volume ratio, and proximal-distal volume ratio in the anterior capsule were quantified and measured using axial-oblique intermediate-weighted 3D fast spin echo MR images. A total of 35 patients (35 hips) were included for analysis (mean age: 30.6 years; mean body mass index [BMI]: 24.9 kg/m2 ; 57% male). The mean alpha angle was 62.2° ± 4.7°, the mean anterior hip capsule volume was 1705.1 ± 450.3 mm3 , the mean posterior hip capsule volume was 1284.8 ± 268.5 mm3 , the mean anterior to posterior capsule volume ratio was 1.1 ± 0.39, and the mean proximal to distal volume ratio of the anterior capsule was 0.65 ± 0.28. There was no correlation between age, gender, or BMI, and any hip capsule characteristics. Worse scores on the HOOS pain scale were correlated with increased anterior to posterior volume ratio (r = -.38; 95% confidence interval: -0.06 to -0.63). In conclusion, hip capsule morphology correlates with patient symptoms in the setting of FAI as increased anterior capsular volume, relative to posterior capsular volume, is associated with greater patient pain.

Is there a gender gap in outcomes after hip arthroscopy for femoroacetabular impingement? Assessment of clinically meaningful improvements in a prospective cohort

Objectives:Although patients have been found to have significant improvements after hip arthroscopy for femoroacetabular impingement (FAI), prior studies suggest women have worse outcomes compared to men. These previous studies lack comparisons of patient reported outcome (PRO) scores based on gender with respect to clinical significance measurements, including the minimal clinically important difference (MCID) and patient acceptable symptom state (PASS). Therefore, the purpose of this study is to evaluate outcomes following hip arthroscopy for FAI based on patient gender by prospectively assessing changes in PRO scores, MCID, and PASS.Methods:Women and men undergoing hip arthroscopy for FAI were prospectively enrolled and preoperative radiographic and intra-operative findings were collected. The cohort was stratified based on self-identified patient gender so the term gender as well as the terms women and men were used to describe the patients as opposed to sex and the terms female and male. Patients completed the following PRO surveys before surgery and 2-years postoperatively: modified Harris Hip Score (mHHS), Hip disability and Osteoarthritis Outcome Score (HOOS), and the 12-Item Short Form Health survey (SF-12). Mean scores and the percentage of patients reaching MCID and PASS were analyzed. An a priori power calculation was performed which determined 42 hips in each group were needed to adequately power the study to 95%.Results:A total of 131 hips, from 72 women and 59 men were included. The mean ± SD age for women and men was 34.2 ± 9.5 vs 35.8 ± 10.3 years, respectively; P= .347 and body mass index (BMI) of 24.9 ± 4.4 vs 25.5 ± 3.3 kg/m2, respectively; P= .379. Women had smaller preoperative alpha angles (59.1 vs 63.7, respectively; P< 0.001) and lower acetabular cartilage injury grade (6.9% vs 22.0% with grade 4 injury, respectively; P= 0.013). Both women and men achieved equivalent significant improvements in PRO scores after surgery (PRO scores increased 18.4 to 45.1 points for mHHS and HOOS). Women and men reached PASS for mHHS at similar rates (76.4% and 77.2%, respectively; P=0.915). MCID was also achieved at similar rates between women and men for all scores (ranged 61.4% to 88.9%) except HOOS-ADL in which a higher percentage of women reached MCID compared to men (79.2% vs 62.7%, respectively; P= .037). Additional stratification by age group using the median cohort age of 34 showed no significant differences in PRO improvement based on age group for each gender.Conclusions:Women can achieve clinically meaningful improvements in patient reported outcomes scores after hip arthroscopy for FAI. Compared to men, women demonstrated equivalent high rates of achieving MCID and PASS at 2 years following surgery.Table 4.Comparison of the percentage of patients reaching PASS and MCID between Women and MenPRO surveyWomena Mena P Valueb mHHS (PASS=74)76.4 (55/72)77.2 (44/57)0.915mHHS (MCID=8)70.8 (51/72)61.4 (35/57)0.259HOOS Symptoms (MCID=9)68.1 (49/72)69.5 (41/59)0.860 Pain (MCID=9)70.8 (51/72)62.7 (37/59)0.325 ADL (MCID=6)79.2 (57/72)62.7 (37/59) 0.037 Sports (MCID=10)86.1 (62/72)74.1 (43/58)0.085 QoL (MCID=11)88.9 (64/72)82.8 (48/58)0.314 aData are provided as a percentage and number of patients out of total eligible. ADL, activities of daily living; HOOS, Hip disability and Osteoarthritis Outcome Score; MCID, minimally clinical important difference; mHHS, modified Harris Hip Score; PASS, patient acceptable symptomatic state; PRO, patient-reported outcome; QoL, Quality of Life. bChi-Square Test. Bold indicates P<.05