Hip-specific Scores Research Articles

The effectiveness of hydrotherapy on return to play in sports following hip arthroscopic surgery: a comparative study.

The postoperative management of femoroacetabular impingement (FAI) is variable with favourable surgical outcomes. Yet there is no evidence on the efficacy of hydrotherapy in athletes undergoing hip arthroscopy for FAI. The purpose of this study was to evaluate the role and the impact of hydrotherapy on return to sports following hip arthroscopy for symptomatic FAI. 2 cohorts of mixed level of athletes from various sports: a hydrotherapy group that followed land-based exercises in combination with hydrotherapy exercises and a control group that followed solely the same land-based exercises. Pre- and postoperative pain and hip-specific outcome scores were completed, and patient satisfaction was rated. A total of 88 hip arthroscopies were included with a minimum of 2 years follow-up; the hydrotherapy group comprised of 36 hips and the control group, 52 hips. There was a significant improvement in time to return to previous performance (HR 1.91, 95% CI, 1.21-3.01; p = 0.005) in the hydrotherapy group compared with the control. The hip-specific scores and patient satisfaction were considerably improved in the hydrotherapy group. The analysis of our data indicates that the incorporation of hydrotherapy into postoperative rehabilitation for hip arthroscopy for FAI accelerates the return of athletes to their pre-injury performance, since recovery time decreased significantly.

Clinical presentation and imaging results of patients with symptomatic gluteus medius tears.

Greater trochanteric pain syndrome (GTPS) is a common complaint. Recently, it has become well recognized that tendinopathy and tears of the gluteus medius (GM) are a cause of recalcitrant GTPS. Nevertheless, the clinical syndrome associated with GM tears is not fully characterized. We characterize the clinical history, findings on physical examination, imaging and intraoperative findings associated with symptomatic GM tears. Forty-five patients (47 hips) who underwent GM repair for the diagnosis of tear were evaluated. Pain was estimated on the visual analog scale (VAS) and hip-specific scores were administered to assess functional status. The imaging modalities were reviewed and intra operative findings were recorded. The average patient age was 54 years (17–76), 93% were females. Symptom onset was commonly insidious (75%) and the average time to diagnosis was 28 months (2–240). The most common pain location was the lateral hip (75%). The average pre-surgery VAS and modified Harris Hip Score were 6.65 (0–10) and 55.5 (12–90), respectively. All patients had pathological findings on magnetic resonance angiogram (MRA) ranging from tendinosis to complete tears of the GM tendon. There was a discrepancy between MRA interpretation by a radiologist and findings during surgery. Hip abductor tears are an under-recognized cause of hip pain and hip symptomatology. In this study, we further characterize the clinical presentation of this entity. The data we present here may facilitate early diagnosis, early orthopedic care and avoid unnecessary prolonged patient sufferings.

Outcomes of Endoscopic Gluteus Medius Repair with Minimum 2-Year Follow-up

Outcomes of Endoscopic Gluteus Medius Repair with Minimum 2-Year Follow-up

Outcomes of Endoscopic Gluteus Medius Repair With Minimum 2-Year Follow-up

Background: Gluteus medius tears may be present in as many as 25% of late middle-aged women and 10% of middle-aged men, and they are often misdiagnosed. Outcomes of endoscopic repair of gluteus medius tears have seldom been reported. Purpose: To report the early outcomes of endoscopic repair of partial- and full-thickness gluteus medius tears. Study Design: Case series; Level of evidence, 4. Methods: Between April 2009 and January 2010, data were prospectively collected for all patients undergoing endoscopic gluteus medius repair by one of the authors. Inclusion criteria for the study were patients undergoing repair for either high-grade, partial-, or full-thickness tears. Only patients with endoscopic evidence of a gluteus medius tear were treated surgically. In the case of an articular-side tear, a transtendinous repair technique was used, whereas in the presence of a full-thickness tear, the tendon was refixated to the bone directly. Results: A total of 15 patients met the inclusion criteria. The cohort included 14 women and 1 man, with an average age of 58 years (range, 44-74 years). Endoscopically, 6 cases were found to be partial-thickness tears. Nine were either full-thickness tears or near-full-thickness tears, which were completed for the repair. Follow-up was obtained on all patients at an average of 27.9 months postoperatively (range, 24-37 months). Fourteen of the 15 patients showed postoperative improvement in all 4 hip-specific scores used to assess outcome, with an average improvement of more than 30 points for all scores. Satisfaction with the surgery results was reported to be from good to excellent (scores of 7-10 out of 10) in 14 of 15 patients. Conclusion: This study demonstrates that endoscopic surgical repair, whether performed through a transtendinous or full-thickness technique, can be an effective treatment of gluteus medius tears at a minimum follow-up of 2 years. Longer term follow-up studies are necessary to determine whether these therapeutic and functional gains are maintained.

Arthroscopic Iliopsoas Tendon Release in the Treatment of Internal Snapping Hip (SS-44)

Introduction: Internal hip snapping produced by the iliopsoas tendon moving over the iliopectineal eminence or over the femoral head can cause significant pain in the hip joint. The purpose of this study was to examine the outcomes and effectiveness of arthroscopic iliopsoas tendon lengthening as a solution to internal hip snapping. Methods: Data was prospectively collected between 2009-2011 on all patients undergoing arthroscopic iliopsoas lengthening for a diagnosis of painful internal snapping hip. The exclusion criteria were revision surgeries and previous hip conditions such as LCPD, SCFE or AVN. The surgical approach used to lengthen the iliopsoas tendon involved releasing the tendinous portion at the joint level, while leaving the anterior muscular portion intact. Surgical outcome was measured according to the improvement in four hip specific scores (modified Harris Hip Score, NonArthritic Hip Score, and the two Hip Outcome Score subscales: the Sport Specific and the Activities of Daily Living), visual analog pain score (VAS), and satisfaction with surgery on a scale of 0 10. Results: A total of 28 cases met our inclusion/exclusion criteria. At the time of surgery, patient age ranged from 14 to 51, with an average age of 25. At an average follow-up of 15.4 months, 20 of the 28 cases resulted in a complete resolution of hip snapping. On average, patients showed an improvement of more than 19 points in all four hip specific scores. The pain level reduced by 3.2 points on average. All patients but six reported to have ‘good’ to ‘excellent’ (7 to 10 out of 10) level of satisfaction. One report of weakness in flexion was noted two weeks after the tendon lengthening and was found to be resolved at the three month clinical follow-up visit. Conclusion: Arthroscopic fractional lengthening of the iliopsoas tendon at the level of the joint in patients showing pre-operative internal hip snapping resulted in limited recurrence of the snapping post-operatively, no cases of unresolved weakness in flexion, as well as an overall good to excellent satisfaction and clinical improvement. Hip Arthroscopy in the Older patient (SS-45) MICHAEL MULDOON, M.D., PRESENTING AUTHOR CHRISTOPHER R. GOODING M.D. F.R.C.S.(TR&ORTH) GLENNIS MULDOON RICHARD SANTORE, M.D.