Improvement In mHHS Research Articles

Patient-Reported Outcome Measures After Direct Anterior Total Hip Arthroplasty Are Comparable Between Patients With Rheumatoid Arthritis and Osteoarthritis: A Propensity-Matched Analysis

Introduction: It is currently unclear whether patients with rheumatoid arthritis have similar functional outcomes after total hip arthroplasty (THA) as those with osteoarthritis, particularly given that rheumatoid arthritis may have systemic manifestations in terms of pain and function. The purpose of this study was to compare patient-reported outcome measures between patients with rheumatoid arthritis and matched control patients with osteoarthritis who underwent direct anterior THA. Methods: All patients who underwent direct anterior THA from 2010 to 2022 at a single academic institution were retrospectively reviewed. Hips with rheumatoid arthritis were propensity matched to hips with osteoarthritis on a 1:4 basis. Patient-reported outcome measures, including visual analog scale (VAS) pain at rest and with use, Hip Disability and Osteoarthritis Outcome Score Pain, and Forgotten Joint Score-12, were obtained at follow-up. In addition, modified Harris Hip Scores (mHHS) were obtained both preoperatively and at the final follow-up. Results: Forty-six hips with rheumatoid arthritis and 184 hips with osteoarthritis were followed for a mean of 6.3 ± 3.6 years. Both cohorts demonstrated notable preoperative to postoperative improvements in mHHS (P < 0.001). No differences were observed at the final follow-up between cohorts for VAS at rest (0.8 vs. 0.5, P = 0.333), VAS with use (1.3 vs. 0.9, P = 0.234), Hip Disability and Osteoarthritis Outcome Score Pain (90.4 vs. 93.6, P = 0.113), Forgotten Joint Score-12 (80.3 vs. 82.8, P = 0.529), and mHHS (86.9 vs. 89.0, P = 0.335). One patient with rheumatoid arthritis had an intraoperative periprosthetic calcar fracture, whereas none underwent subsequent revision THA. Conclusion: Patients with rheumatoid arthritis and osteoarthritis who underwent direct anterior THA achieved comparable outcomes in this propensity-matched analysis. Although patients with rheumatoid arthritis may be at an increased risk of complications and revision surgery, patients can expect reduced pain and improved functional outcomes similar to those with osteoarthritis following primary THA.

Satisfactory mid-term clinical outcomes of endoscopic tenotomy for iliopsoas tendinopathy following total hip arthroplasty.

To report 5-year outcomes of endoscopic iliopsoas tenotomy in patients with iliopsoas tendinopathy following total hip arthroplasty (THA) and determine whether clinical scores are associated with cup position. Patients who underwent endoscopic iliopsoas tenotomy for iliopsoas tendinopathy following THA (2014-2017) were contacted. Indications for endoscopic iliopsoas tenotomy after THA were groin pain during active hip flexion, exclusion of other causes of groin pain, and no pain relief after 6 months of conservative treatment. Pretenotomy cup inclination and anteversion were measured on radiographs; axial and sagittal cup overhang were measured on computed tomography (CT) scans. Oxford hip score (OHS), modified Harris hip score (mHHS), and groin pain were assessed. The initial cohort comprised 16 men (17 hips) and 31 women (32 hips), aged 60.7 ± 10.6 years. Cup inclination and anteversion were, respectively, 46.2 ± 6.2° and 14.6 ± 8.4°, while axial and sagittal cup overhang were, respectively, 4.4 ± 4.0 mm and 6.9 ± 4.5 mm. At ≥5 years follow-up, fourhips underwent cup and stem revision, twounderwent isolated cup revision and oneunderwent secondary iliopsoas tenotomy. OHS improved by 23 ± 10 and mHHS improved by 31 ± 16. Posttenotomy groin pain was slight in 20.0%, mild in 17.5% and moderate in 12.5%. Regression analyses revealed that net change in mHHS decreased with sagittal cup overhang (β = -3.1; 95% confidence interval [CI] = -4.6 to -1.7; p < 0.001), but that there were no associations between cup position and net change in OHS. Endoscopic iliopsoas tenotomy provides good mid-term clinical outcomes in patients with iliopsoas tendinopathy following THA. Furthermore, improvements in mHHS were found to decrease with increasing sagittal cup overhang, in cases for which adequate preoperative imaging was available. Level IV.

Clinical outcomes and return to dance after total hip arthroplasty or hip resurfacing in professional dancers.

Professional dancers represent a unique patient population in the setting of hip arthroplasty, given the high degree of hip strength and mobility required by their profession. We sought to determine the clinical outcomes and ability to return to professional dance after total hip arthroplasty (THA) or hip resurfacing arthroplasty (HRA). Active professional dancers who underwent primary THA or HRA at a single institution with minimum one-year follow-up were included in the study. Primary outcomes included the rate of return to professional dance, three patient-reported outcome measures (PROMs) (modified Harris Hip Score (mHHS), Hip disability and Osteoarthritis Outcome Score for Joint Replacement (HOOS-JR), and Lower Extremity Activity Scale (LEAS)), and postoperative complications. A total of 49 hips in 39 patients (mean age 56 years (SD 13); 80% female (n = 39)) were included. Mean follow-up was 4.9 years (SD 5.1). Of these 49 hips, 37 THAs and 12 HRAs were performed. In all, 96% of hips returned to professional dance activities postoperatively. With regard to PROMs, there were statistically significant improvements in mHHS, HOOS-JR, and LEAS from baseline to ≥ one year postoperatively. There were complications in 7/49 hips postoperatively (14%), five of which required revision surgery (10%). There were no revisions for instability after the index procedure. Two complications (5.4%) occurred in hips that underwent THA compared with five (42%) after HRA (p = 0.007), though the difference by procedure was not significantly different when including only contemporary implant designs (p = 0.334). Active professional dancers experienced significant improvements in functional outcome scores after THA or HRA, with a 96% rate of return to professional dance. However, the revision rate at short- to mid-term follow-up highlights the challenges of performing hip arthroplasty in this demanding patient population. Further investigation is required to determine the results of THA versus HRA using contemporary implant designs in these patients.

Systematic Review and Meta-analysis of Studies Comparing Complete Capsular Closure Against Unrepaired Hip Capsules During Hip Arthroscopy.

While the biomechanical importance of the hip capsule is well described, there remains controversy over the necessity of routine capsular closure after hip arthroscopy. To perform a meta-analysis of clinical studies to compare pooled outcomes of complete hip capsular closure cohorts against unrepaired hip capsule cohorts. Systematic review; Level of evidence, 3. The Cochrane Database of Systematic Reviews, Cochrane Register of Controlled Trials, PubMed, MEDLINE, Web of Science, CINAHL/EBSCO, and Scopus were queried in February 2022 for studies that directly compared clinical outcomes for hip arthroscopy patients treated with either complete capsular closure or an unrepaired capsule. Outcomes assessed were incidence of revision hip arthroscopy, incidence of subsequent conversion to total hip arthroplasty (THA), and improvement from baseline in modified Harris Hip Score (mHHS), Hip Outcome Score (HOS) activities of daily living (ADL), HOS sports specific (SS) subscale, Copenhagen Hip and Groin Outcome Score (HAGOS) ADL, and HAGOS SS subscale. A pooled weighted mean difference (WMD) was used to compare changes in mHHS. A pooled standardized mean difference (SMD) was used to compare changes in the ADL and SS outcomes. A pooled risk ratio (RR) was used to compare the probability of revision hip arthroscopy and conversion to THA based on capsular management. For pooled outcomes where heterogeneity was regarded as potentially unimportant, a fixed-effects model was implemented. For pooled outcomes with considerable heterogeneity, a random-effects model was implemented. Of the 1896 records identified in our search, 11 studies (1897 patients) were included. A significantly higher improvement in mHHS (WMD, -3.72; 95% CI, -4.95 to -2.50; P < .00001) and ADL outcomes (SMD, -0.30; 95% CI, -0.54 to -0.07; P = .01) were seen after complete capsular closure. There was a significantly lower probability of subsequent revision hip arthroscopy (RR, 1.67; 95% CI, 1.14 to 2.45; P = .008) and conversion to THA (RR, 2.01; 95% CI, 1.06 to 3.79; P = .03) after complete capsular repair. There was no difference in SS outcomes (SMD, -0.02; 95% CI, -0.16 to 0.13; P = .81) between the 2 groups. This meta-analysis demonstrated that routine complete capsular closure after hip arthroscopy led to superior clinical outcomes relative to unrepaired hip capsules.

Global Acetabular Retroversion Is Not Associated With Differences in Outcomes After Primary Hip Arthroscopy Among Patients With Femoroacetabular Impingement Syndrome: A Matched Cohort Study With Minimum 5-Year Follow-Up

To compare hip survivorship and patient-reported outcome measures (PROMs) after primary hip arthroscopy at 5-year follow-up between patients with femoroacetabular impingement syndrome (FAIS) with radiographic signs of global acetabular retroversion and those without. A retrospective matched-cohort study was conducted using a single-surgeon hip arthroscopy database. Patients were included if they underwent primary hip arthroscopy for treatment of FAIS, had preoperative hip x-rays, and had a minimum 5-year follow-up. Global retroversion was defined as the presence of ischial spine sign, posterior wall sign, and crossover sign on anteroposterior view. Patients with FAIS with global retroversion were matched 1:1 on age, sex, and body mass index to FAIS controls. The modified Harris Hip Score (mHHS) and Non-Arthritic Hip Score (NAHS) were administered preoperatively and at follow-up. Hip survivorship and PROMs were compared between the 2 groups using the paired t test, Wilcoxon signed rank test, and/or Cochran-Mantel-Haenszel test as appropriate. P values <.05 were considered significant. Thirty-eight patients with global retroversion (mean age 40.6 ± 10.8 years, 60.5% female) were matched to 38 controls (mean age 41.3 ± 13.6 years, 60.5% female). Reoperation rates were the same in both groups (5.3%). On average, both groups reported significant pre- to postoperative improvement in mHHS (P < .001) and NAHS (P < .001), and there was no significant intergroup differences in the change in mHHS (P= .86) or NAHS (P= .90). Achievement rates for the patient acceptable symptom state on the mHHS were higher among males compared to females (P= .04) in both the global retroversion group (93.3% vs 73.9%) and the control group (93.3% vs 73.9%). Patients with FAIS with and without global acetabular retroversion had no significant difference in outcomes after primary hip arthroscopy at a minimum 5-year minimum follow-up. Level III, retrospective comparative prognostic trial.

A Superolateral Cam Lesion Location Increases Odds of Total Hip Arthroplasty 5 Years After Hip Arthroscopy

To determine if radiographic cam location is associated with hip survivorship and postoperative patient-reported outcomes (PROs) at 5-year follow-up. We conducted a review of prospectively collected data of patients with cam lesions who underwent hip arthroscopy for femoroacetabular impingement syndrome. Cam lesions were categorized into 3 locations: superolateral, anterolateral, or anterior. Conversion to total hip arthroplasty (THA), revision rates, and reoperation rates were assessed. Patient-reported outcome measures, including modified Harris Hip Scores (mHHS) and Non-Arthritic Hip Scores (NAHS), were collected preoperatively and at 5-year follow-up. Of the 156-patients, 125 met the final criteria (80.1%). Mean age was 41.1 ± 12.7 years. Seventy-one patients (56.8%) had superolateral cam lesions, 41 (32.8%) had anterolateral lesions, and 13 (10.4%) had anterior lesions. Revision rates within 5 years were 7.7% for anterior, 24.4% for anterolateral, and 14.1% for superolateral lesions; conversions to THAs were 15.4% for anterior), 7.3% for anterolateral, and 8.5% for superolateral. Reoperations were 23.1% for anterior, 29.3% for anterolateral, and 21.1% for superolateral. The superolateral cohort was younger than the anterior and anterolateral cohorts (anterior, 46.6 ± 12.2 years; anterolateral, 44.7 ± 12.2 years; superolateral, 38.1 ± 12.3 years; P= .006). Multivariable analysis showed the anterolateral group was significantly predictive of lower odds of undergoing THA compared to the superolateral group (odds ratio, 0.01; 95% CI, <0.01-0.72; P= .03). There were no differences in the 5-year improvement in mHHS (anterior, 32.4; anterolateral, 36.8; superolateral, 33.0; P= .29) or NAHS (anterior, 34.8; anterolateral, 39.0; superolateral, 37.3; P= .65). A superolateral cam lesion increases the odds of conversion to THA within 5 years of hip arthroscopy compared to those with anterolateral lesions on multivariable analysis. Those with superolateral lesions were significantly younger compared to those with anterior or anterolateral lesions. Cam lesion location did not affect improvement in PROs at 5-year follow-up. Level III, retrospective comparative prognostic trial.

Poster 232: Clinical Outcomes Among Individuals with Global Acetabular Retroversion who Underwent Hip Arthroscopy for FAI with Minimum 5-Year Follow-Up

Objectives: The purpose of this study was to compare functional outcomes and clinical threshold achievement rates of patients with radiographic signs of global acetabular retroversion who underwent hip arthroscopy for FAI with minimum follow-up of 5 years. Methods: Patients were identified from a single-surgeon prospectively-collected database who underwent primary hip arthroscopy for treatment of FAI. Patients completed patient-reported outcome (PRO) surveys at both baseline and at 5-year follow-up. Demographic data was collected including age, sex, BMI at time of surgery, and patient-reported symptom length. Intraoperative findings were recorded, including the Outerbridge grade, presence of labral tears, chondral delamination, subspine impingement, cam lesions, pincer lesions, and mixed-type FAI. Global acetabular retroversion was assessed on AP view using three radiographic signs: ischial spine, posterior wall, and crossover signs. Other radiographic measures included alpha angle measured on three view (AP, 45° Dunn, 90° Dunn), lateral center edge angle (LCEA), and Tönnis grade. Results: We identified 124 primary hip arthroscopy patients who had minimum 5-year follow-up with adequate imaging and complete 5-year PROs. Preoperative X-rays demonstrated presence of ischial spine sign in 65 patients (52.4%), posterior wall sign in 61 patients (49.2%), and crossover sign in 75 patients (60.5%). Mean alpha angle was highest on AP view (62.2°), followed by 45° Dunn view (55.9°) and 90° Dunn view (50.9°) and mean LCEA was 38.5°. A baseline comparison demonstrated no significant differences between groups in age, sex, BMI, preoperative symptom length, Tönnis grade, Outerbridge grade, and preoperative mHHS or NAHS (p&gt;0.05). At 5-year follow-up, patients reported significant improvement in both mHHS (mean 50.4 to 82.7, p&lt;0.001) and NAHS (49.4 to 85.5, p&lt;0.001). Achievement rates were high for MCID (90.3%), SCB (80.7%), and PASS (79.0%) for the mHHS. Three-way frequency comparison of acetabular retroversion signs found that all three signs tended to be present together (40 patients, 32.3%) or absent together (31 patients, 25.0%). Pairwise comparisons with tetrachoric correlation testing found all three signs to be significantly correlated with one another: ischial spine sign versus posterior wall (rtet=0.65, corrected p&lt;0.001), ischial spine sign versus crossover sign (rtet=0.74, corrected p&lt;0.001), and posterior wall sign versus crossover sign (rtet=0.51, corrected p&lt;0.001). Multivariable analysis did not find any of the three signs to be significant independent predictors of 5-year improvement in mHHS or NAHS (p&gt;0.05). Posterior wall sign was associated with lower odds of achieving the MCID (OR = 0.62, 95% CI [0.06 to 1.09]) but this did not achieve significance (χ2=3.39, p=0.07). Overall, achievement rates for MCID, SCB, and PASS did not significantly differ between the cohorts with respect to each sign (p&gt;0.05). Conclusions: Clinical outcomes and achievement rates at 5-year follow-up demonstrated no significant differences among patients with respect to each sign of acetabular retroversion based on mHHS, NAHS, MCID, SCB and PASS. Surgeons should be reassured that these patients regain function at a rate similar to the greater FAI population.

Five-Year Outcomes of Primary Hip Arthroscopy for Femoroacetabular Impingement Syndrome Among Female Patients: Higher Body Mass Index Is Associated With Reduced Clinically Significant Outcomes

To evaluate the impact of age, body mass index (BMI), and symptom duration on 5-year clinical outcomes among females following primary hip arthroscopy for femoroacetabular impingement syndrome (FAIS). We conducted a retrospective review of a prospectively collected database of hip arthroscopy patients with a minimum 5-year follow-up. Patients were stratified by age (<30, 30-45, ≥45 years), BMI (<25.0, 25.0-29.9, ≥30.0), and preoperative symptom duration (<1 vs ≥1 year). Patient-reported outcomes were assessed using the modified Harris Hip Score (mHHS) and Non-Arthritic Hip Score (NAHS). Pre- to postoperative improvement in mHHS and NAHS was compared between groups using the Mann-Whitney U test or Kruskal-Wallis test. Hip survivorship rates and minimum clinically important difference (MCID) achievement rates were compared with Fisher exact test. Predictors of outcomes were identified using multivariable linear and logistic regression. P values <.05 were considered significant. In total, 103 patients were included in the analysis with a mean age of 42.0 ± 12.6 years (range, 16-75) and mean BMI of 24.9 ± 4.8 (range, 17.2-38.9). Most patients had symptoms of duration ≥1 year (60.2%). Six patients (5.8%) had arthroscopic revisions, and 2 patients (1.9%) converted to total hip arthroplasty by 5-year follow-up. Patients with BMI ≥30.0 had significantly lower postoperative mHHS (P= .03) and NAHS (P= .04) than those with BMI <25.0. Higher BMI was associated with reduced improvement in mHHS (β= -1.14, P= .02) and NAHS (β= -1.34, P < .001) and lower odds of achieving the mHHS MCID (odds ratio [OR]= 0.82, P= .02) and NAHS MCID (OR= 0.88, P= .04). Older age was predictive of reduced improvement in NAHS (β= -0.31, P= .046). Symptom duration ≥1 year was predictive of higher odds of achieving the NAHS MCID (OR= 3.98, P= .02). Female patients across a wide range of ages, BMIs, and symptom durations experience satisfactory 5-year outcomes following primary hip arthroscopy, but higher BMI is associated with reduced improvement in patient-reported outcomes. Level III, retrospective comparative prognostic trial.

CLINICAL OUTCOMES AND RETURN TO DANCE AFTER TOTAL HIP ARTHROPLASTY OR HIP RESURFACING IN COMPETITIVE (PROFESSIONAL) DANCERS

Competitive dancers represent a unique patient population in the setting of hip arthroplasty given the high degree of hip strength and mobility required by their profession. We sought to determine the clinical outcomes and ability to return to competitive dance after total hip arthroplasty (THA) or hip resurfacing arthroplasty (HRA) among competitive dancers.Active competitive dancers who underwent primary THA or HRA at a single institution with minimum one-year follow-up were included in the study. Primary outcomes included (1) the rate of return to competitive dance, (2) three PROMs (modified Harris Hip Score [mHHS], Hip Disability and Osteoarthritis Outcome Score for Joint Replacement [HOOS-JR], and Lower Extremity Activity Scale [LEAS]), and (3) post-operative complications.Forty-nine hips in 39 patients (mean age 56±13 years; 80% female) were included. Mean follow-up was 4.9±5.1 years. Thirty-seven THAs and 12 HRAs were performed. Ninety-six percent of patients returned to competitive dance activities post-operatively. With respect to PROMs, there were statistically significant improvements in mHHS, HOOS-JR, and LEAS from baseline to ≥ 1 year post-operatively. There were complications in 9/49 (18%) hips post-operatively, five (10%) of which required revision surgery.Active competitive dancers experienced significant improvements in functional outcome scores after THA or HRA, with a rate of return to competitive dance of 96%.

Endoscopic iliopsoas lengthening for treatment of recalcitrant iliopsoas tendinitis after total hip arthroplasty.

Iliopsoas (IP) tendinitis from impingement upon the acetabular component after total hip arthroplasty (THA) has been treated with open and endoscopic IP tenotomy or acetabular component revision. This study describes the results of a consecutive series of patients treated with endoscopic IP tenotomy as a less invasive alternative. Twenty-eight patients with IP impingement after THA underwent endoscopic IP lengthening from 2012 to 2021 at a single-center academic institution. The follow-up of 24 of these patients was achieved with a mean follow-up of 7.6 months (range 1-28). Outcomes included the modified Harris Hip Score (mHHS), visual analog pain scale (VAS), satisfaction, component positioning and complications. Seventy-one percent of patients were satisfied or very satisfied after their operation. The median mHHS preoperatively was 57 (Interquartile range [IQR] 43-60) and postoperatively was 75 (IQR 66-92, P < 0.001). Clinically meaningful improvements in mHHS were seen in patients with VAS pain scores <5, cup prominence >8 mm, body mass index >30, and less than 2 years from their index THA. Two patients developed a deep infection 7 and 10 months postoperatively (neither related to the release), and one patient underwent open psoas release for persistent impingement. Endoscopic IP tenotomy is a safe and effective treatment for impingement after THA. Patients with cup prominence >8 mm, body mass index >30 and less than 2 years since their index THA may have more clinically meaningful improvements in pain and function.

Patient-Reported Outcomes and Survivorship Are Not Different for Primary Hip Arthroscopy Patients of Age 50 Years and Older Compared With a 20- to 35-Year-Old Matched Cohort at Minimum 5-Year Follow-Up

To assess clinical outcomes among patients aged 50 years or older after primary hip arthroscopy for femoroacetabular impingement (FAI) with or without labral tears compared with a matched control group of younger patients aged 20 to 35 years old at minimum 5-year follow-up. We conducted a retrospective comparative prognostic study using a prospectively collected database of patients who underwent hip arthroscopy with minimum 5-year follow-up. Subjects completed the modified Harris Hip Score (mHHS) and Non-Arthritic Hip Score (NAHS) before surgery and at 5-year follow-up. Patients aged ≥50 years were propensity score matched on sex, body mass index, and preoperative mHHS to controls aged 20 to 35 years. Pre- to postoperative changes in mHHS and NAHS were compared between groups using the Mann-Whitney U test. Hip survivorship rates and minimum clinically important difference achievement rates were compared between groups using the Fisher exact test. P values <.05 were considered statistically significant. In total, 35 older patients (mean age 58.3 years) were matched to 35 younger controls (mean age 29.2 years). Both groups were mostly female (65.7%) and had equal mean body mass index (26.0). Acetabular chondral lesions of Outerbridge grades III-IV were more prevalent in the older group (older 28.6% vs younger 0%, P < .001). Five-year reoperation rates were not significantly different between the groups (older 8.6% vs younger 2.9%, P= .61). There were no significant intergroup differences in 5-year improvement in mHHS (older 32.7 vs younger 30.6, P= .46) or NAHS (older 34.4 vs younger 37.9, P= .70) or in 5-year minimum clinically important difference achievement rates for the mHHS (older 93.6% vs younger 93.6%, P= 1.00) or NAHS (older 87.1% vs younger 96.8%, P= .35). There are no significant differences in reoperation rates and patient-reported outcomes between patients aged ≥50 years versus matched controls aged 20 to 35 years after primary hip arthroscopy for FAI. LevelIII, retrospective comparative prognostic study.

Patients With Low-Grade Lumbosacral Transitional Vertebrae Demonstrate No Difference in Achievement of Clinical Thresholds After Hip Arthroscopy for Femoroacetabular Impingement Syndrome

The purpose of our study was to compare clinical outcomes at 2 years following primary hip arthroscopy (HA) for femoroacetabular impingement syndrome (FAIS) between patients with and without low-grade lumbosacral transitional vertebra (LSTV). We performed a retrospective matched-cohort analysis of patients who underwent primary HA for FAIS from 2011-2018 with minimum 2-year follow-up. LSTV was graded on preoperative radiographs using the Castellvi classification. Patients with grades I and II LSTV were matched 1:1 with controls on age, sex, and BMI. Radiographic markers of FAIS morphology were measured. Pre-to-postoperative improvement in the modified Harris Hip Score (mHHS) and Non-Arthritic Hip Score (NAHS), and 2-year achievement rates for the Minimum Clinically-Important Difference (MCID), Substantial Clinical Benefit (SCB), and Patient Acceptable Symptom State (PASS) were compared between patients with versus without LSTV. The Wilcoxon signed-rank test was used for intergroup mean comparisons and the Cochran-Mantel-Haenszel test for categorical variables. 58 patients with LSTV were matched to 58 controls. Among LSTV patients, 48 were Castellvi type 1 (82.8%) and 32 (55.2%) had bilateral findings. No significant differences were found between groups with respect to radiographic markers of FAIS, including alpha angle (p=0.88), lateral center edge angle (LCEA) (p=0.42), or crossover sign (p=0.71). While LSTV patients had greater improvement in NAHS at 2-year follow-up compared to controls (p=0.04), there were no significant differences in mHHS improvement (p=0.31) or achievement of the MCID (p=0.73), SCB (p=0.61), or PASS (p=0.16). Patients with low-grade LSTV had greater 2-year improvement in NAHS than controls, while no significant differences were observed in achievement of clinical thresholds at 2-year follow-up. There were no differences between groups with respect to any measured radiographic markers of FAIS morphology. Importantly, the findings of this study are underpowered and should be viewed with caution in the greater context of the LSTV literature. III; Retrospective comparative study.

No significant differences in 60-day postoperative complication rates between conventional and shortened stems

PurposeTo compare 60-day complication rates, radiographic outcomes, and clinical outcomes following primary THA with conventional versus shortened stems, in a large cohort study.MethodsThe authors reviewed a consecutive series of 800 primary THAs, of which 781 met the inclusion/exclusion criteria: 395 received a conventional stem and 386 received a shortened stem. Intraoperative and postoperative complications were noted. Radiographic and clinical assessments were performed preoperatively and 60 days after surgery.ResultsCompared to conventional stems, shortened stems had significantly less intraoperative complications (2.8% vs 0.3%, p = 0.006), but no significant differences in complications that did not require reoperation (1.0% vs 1.3%, p = 0.620), complications that required reoperation without stem revision (2.0% vs 1.0%, p = 0.384), and complications that required stem revision (0.5% vs 0.5%, p = 1.000). Four hips (two from each group) required stem revision and were thus excluded from 60-day assessment. There were no significant differences between groups in subsidence ≥ 3 mm (1.0% vs 0.5%, p = 0.686), alignment (90.3%vs 86.7%, p = 0.192), net change in offset (within 3 mm, 32.3% vs 30.5%, p = 0.097), and limb length discrepancy (3.0 ± 2.6 mm vs 2.9 ± 2.4 mm, p = 0.695). Compared to conventional stems, shortened stems had significantly better preoperative mHHS (56.5 ± 18.5 vs 64.5 ± 13.5, p < 0.001), and significantly lower net improvement in mHHS (29.9 ± 17.1 vs 24.4 ± 15.0, p < 0.001), but no significant differences in postoperative mHHS (87.3 ± 11.9 vs 89.4 ± 9.6, p = 0.109).ConclusionsThere were no significant differences between conventional and shortened stems in terms of postoperative complication rates, radiographic outcomes, and postoperative mHHS. However, patients implanted with shortened stems had less intraoperative complications, but lower net improvement in mHHS.Level of EvidenceLevel IV, Retrospective comparative cohort study

Does Femoral Osteoplasty Improve Long-term Clinical Outcomes and Survivorship of Hip Arthroscopy? A 15-Year Minimum Follow-up Study

Background: Although femoral osteoplasty is common practice in treating cam-type femoroacetabular impingement (FAI), long-term data are lacking that support the ability of this procedure to optimize outcomes and alter natural history. Purpose: To compare long-term clinical outcomes and survivorship of treatment for symptomatic FAI via arthroscopic correction of labral or chondral pathology with and without femoral osteoplasty. Study Design: Cohort study; Level of evidence, 3. Methods: A retrospective cohort study was performed across 2 consecutive cohorts of patients with isolated cam-type FAI who underwent hip arthroscopic treatment of labral or chondral pathology without femoral osteoplasty (HS group) or with femoral osteoplasty (HS-OST group). These unique cohorts were established at a distinct transition time in our practice before and after adoption of femoral osteoplasty for treatment of FAI. Clinical outcomes were measured using the modified Harris Hip Score (mHHS). Kaplan-Meier analysis was used to assess for total hip arthroplasty (THA)–free and reoperation-free survivorship. Results: The final HS group included 17 hips followed for 19.7 ± 1.2 years, and the final HS-OST group included 23 hips followed for 16.0 ± 0.6 years. No significant patient or morphological differences were found between groups. Compared with the HS group, the HS-OST group had significantly higher final mHHS (82.7 vs 64.7 for HS-OST vs HS, respectively; P = .002) and mHHS improvement (18.4 vs 6.1; P = .02). The HS-OST group also had significantly greater 15-year THA-free survivorship versus the HS group (78% vs 41%, respectively; P = .02) and reoperation-free survivorship (78% vs 29%; P = .003). Conclusion: This study demonstrated superior long-term clinical outcomes and survivorship with combined arthroscopy and femoral osteoplasty compared with hip arthroscopy alone. These long-term data strongly support the practice of femoral osteoplasty in patients with cam FAI morphologies and suggest that this treatment alters the natural history of FAI at long-term follow-up.

Long-Term Outcomes Following Nonoperative Treatment of Prearthritic or Extra-Articular Hip Pain in Women.

Introduction:There is an abundance of literature focusing on morphological and surgical outcomes in women with arthritic and prearthritic hip pain. However, no studies have evaluated conservative treatment outcomes, such as physical therapy (PT) and injections, in women with prearthritic or extra-articular hip pain. The purpose of this study is to assess changes in long-term patient-reported outcome measures after nonoperative treatments in women with prearthritic or extra-articular hip pain.Methods:Twenty-nine female patients (35–65 years old) who presented to a single provider between December 1, 2012 and September 1, 2017 for prearthritic or extra-articular hip pain (Tonnis 1 or less) and had baseline patient-reported outcome data (modified Harris Hip Score [mHHS], Hip Outcome Score [HOS] activities of daily living [ADL] and sport scores, International Hip Outcome Tool-33 [iHOT-33]) available from the institutional hip registry were included. Patients underwent nonoperative treatments for intra-articular or extra-articular hip pain. A follow-up questionnaire was prospectively administered at 3–5 years after the baseline visit.Results:Most patients underwent targeted PT (n = 27; 93%) to treat intra-articular or extra-articular hip pain. Targeted PT can be defined as primarily exercise-based therapy focusing on hip and lumbar stability. Twelve patients (41%) received injections; of these, 11 were also treated with PT. Overall, significant improvements in mHHS, HOS-ADL, and iHOT-33 scores were observed (p = 0.006, 0.022, and <0.001, respectively). HOS-ADL and iHOT-33 scores improved by a median of 10.3 and 18.0 points, respectively, and were clinically significant. HOS-sport scores also improved but were not statistically significant. There were no differences in patient-reported outcomes between patients who received both PT and injections versus those who received PT, injections, or other treatments.Conclusions:Nonoperative treatments for prearthritic or extra-articular hip pain in women, specifically PT and/or injections, were associated with sustained improvements in patient-reported outcomes at 3–5 years postbaseline.

Paper 44: Does femoral osteoplasty enhance clinical outcomes and survivorship of FAI surgery at long-term follow-up beyond fifteen years?

Objectives:Cam-type femoroacetabular impingement (FAI) is now well-established as a risk factor for intra-articular damage (labrum and articular cartilage) and secondary osteoarthritis. Long-term studies of FAI surgery are critical in understanding clinical outcomes, refining surgical treatments and predicting osteoarthritis progression. Nevertheless, studies beyond 15 years are uncommon. Although femoral osteoplasty is now common practice in treating cam FAI, long-term data supportive of this procedure and its ability to alter the natural history of FAI are not available. The purpose of this study was to analyze the long-term clinical outcomes and survivorship of symptomatic FAI treatment by arthroscopic correction of labral pathology alone or in combination with femoral osteoplasty (structural FAI correction).Methods:A retrospective comparative study was performed on two consecutive, longitudinal cohorts of patients with isolated cam-type FAI that underwent surgical treatment of labral pathology either with femoral osteoplasty (HSLO group, 23 hips) or without femoral osteoplasty (HS group, 17 hips). These cohorts were captured immediately prior to and after implementation of femoral osteoplasty into our practice and have been previously reported on at mean 2-year followup. The current study investigated clinical outcomes and survivorship at minimum 15-year followup. Patients with pincer or combined cam-pincer morphologies were excluded. Clinical outcomes were measured with the modified Harris hip score (mHHS). Kaplan-Meier survival was assessed for THA-free and reoperation-free survivorship.Results:The HSLO group included 23 hips followed for a mean of 16.0 ±0.6 years, and the HS group 17 hips followed for 19.7 ±1.2. The HSLO group had a significantly higher final mHHS (82.7 vs. 64.7, p=0.002) and mHHS improvement (18.4 vs. 6.1, p=0.02) compared to the HS group. The rate of THA conversion (22% vs. 59%, P=0.02) and overall reoperation (22% vs. 70%, P=0.003) were significantly lower in the HSLO group. THA conversion occurred at a mean of 5.8 ±2.5 years postoperatively in the HSLO group, and 7.1 ±4.0 years in the HS group. The HSLO group had significantly greater 15-year THA-free survivorship (78% vs 41%, p=0.02) and reoperation-free survivorship (78% vs. 29%, p=0.003) by Kaplan-Meier analysis.Conclusions:This study demonstrates better long-term clinical outcomes and survivorship with combined arthroscopy and femoral osteoplasty compared to arthroscopy alone. These long-term data strongly support the current practice of femoral osteoplasty in patients with cam FAI morphologies and suggest that this treatment alters the natural history of FAI.Figure 1.Comparative Survival

Predictive radiological parameters of failure following surgical management of femoroacetabular impingement associated with borderline acetabular dysplasia

IntroductionThe role of arthroscopic treatment of femoroacetabular impingement (FAI) in mild or borderline hip dysplasia (lateral center edge angle=18–25) is controversial. It is recommended to combine capsular plication with femoral neck osteoplasty and suture repair of the labrum. Few studies have investigated which radiological parameters are associated with failure of this procedure. HypothesisA larger number of radiological signs of mild or borderline hip dysplasia than radiological signs of FAI negatively influence the outcomes of arthroscopic treatment. MethodsThis was a retrospective study done with data collected prospectively after a minimum of 2 years’ follow-up in patients who underwent arthroscopic treatment of FAI due to cam impingement combined with mild to moderate hip dysplasia. Patients with hip osteoarthritis graded as ≥ Tönnis 2 were excluded. Functional outcome scores (mHHS and NAHS) were determined along with the need for reoperation. Three groups were defined based on the outcomes: success (mHHS ≥ Patient Acceptable Symptomatic State [PASS]); moderate improvement (improvement in mHHS + mHHS<PASS) and failure (worsening of the mHHS). Demographic data, radiographic parameters (LCEA, Tönnis angle, alpha angle, offset, FEAR index, Shenton's line, Cliff sign, anterior wall index [AWI], posterior wall index [PWI]) and intraoperative findings were compared between these three groups. The area under the curve (AUC) for the most relevant data identified during the univariate analysis were then modeled to define which factors were the best at predicting failed arthroscopic treatment a posteriori. ResultsThe study analyzed 39 patients. The mean mHHS was 76±15 [40–92]. The “success” group consisted of 21 patients (56%, 21/39), the “moderate improvement” group of 12 patients (31%, 12/39) and the failure group of 6 patients (13%, 6/39) (2 subsequently underwent total hip replacement, 4 underwent shelf acetabuloplasty). The FEAR index was significantly higher and the AWI and VCE were significantly lower in the “failure” group. The FEAR index was the best predictive factor; an index ≥ 4° detected 100% of failures with 96% specificity. The patients in the “moderate improvement” group were significantly older (37 years±8 [18–45]<p= 0.04) with a significantly higher offset (2mm±3 [−5–5]<p=0.004); an offset ≥ 2mm could detect 73% of them with a specificity of 72%. ConclusionA FEAR index ≥ 4° and offset ≥ 2mm is best able to detect patients at risk of failure and unsatisfactory results, respectively, in the mild clinical cam-type impingement in a population of FAI patients. Level of evidenceIV, retrospective series.

Treatment of Borderline Acetabular Dysplasia in the Adolescent Patient: Outcomes of Periacetabular Osteotomy

Introduction:The treatment of borderline acetabular dysplasia [defined as lateral center edge angle (LCEA) 18-25°] is controversial as there is limited evidence regarding the optimal surgical treatment [hip arthroscopy versus periacetabular osteotomy (PAO)]. The decision-making is particularly challenging in the adolescent patient where a durable outcome is particularly important.Purpose:To define early clinical outcomes, complications and rates of reoperation in adolescent patients undergoing PAO for the treatment of borderline acetabular dysplasia.Methods:A prospective single surgeon hip preservation database was retrospectively reviewed for adolescent patients treated with PAO for symptomatic instability in the setting of borderline acetabular dysplasia. A total of 56 hips were identified from 2010 to 2019 and followed for an average of 3.5 ±1.9 years (range, 1-7). Modified Harris hip scores (mHHS) were analyzed relative to minimal clinically important difference (MCID 8) and patient acceptable symptoms state (PASS>74). Complications and reoperations were recorded.Results:The 56 included hips (age 16.3 ±1.4 years; 89% female) had a mean preoperative LCEA of 20.9° ±.2.0° (37%, 18-20°; 63% 20-25°). Concurrent hip arthroscopy for symptomatic labral pathology was performed in 28% of cases. Major improvement in mHHS (27 ±17) from baseline to final follow-up (59 vs. 86, p<0.001) corresponded to a high observed rate of achieving MCID or PASS (91%). Two patients (3.6%) underwent subsequent arthroscopy. There were no other non-hardware removal reoperations. There were no outcome differences between those treated with and without concurrent arthroscopy (p>0.5).Conclusion:PAO surgery provides excellent pain relief and improved function in adolescent patients with symptomatic, borderline acetabular dysplasia. The observed reoperation rate (3.6%) is low for this patient population. The PAO remains our preferred treatment for borderline dysplasia with clinical signs and symptoms of hip instability.

The clinical outcomes of arthroscopic hip labral repair: a comparison between athletes and non-athletes

ABSTRACTThe objective of this study is to compare the clinical outcomes after arthroscopic hip labral repair in athletes and non-athletes. The design of this study is a retrospective comparative study. The setting of this study is an institutional study. One hundred and sixteen patients of hip labral tears who underwent arthroscopic labral repair were included. Eighty-five of these patients met the inclusion/exclusion criteria (25 athletes and 60 non-athletes). Hip labral tears underwent arthroscopic labral repair. The main outcome measures are as follows: visual analog scale (VAS) and modified Harris Hip Score (mHHS) 2 years postoperatively and the rate of return to sports at previous level. There was no significant difference in the gender, alpha angle, lateral center-edge angle between the two groups, except for the mean age (19.3 versus 42.2, P < 0.001), Marx activity rating scale (MARS) (14.6 versus 6.8, P < 0.001) and University of California, Los Angeles (UCLA) activity rating scale (9.6 versus 5.0, P < 0.001). The intraoperative findings were similar in the two groups. The VAS scores and mHHS both showed a significant improvement after surgery in both groups (VAS improvement 3.6 and mHHS improvement 22.4 in the athlete group; VAS improvement 3.9 and mHHS improvement 25.0 in the non-athlete group, all P < 0.001). There was no difference in VAS improvement or mHHS improvement between the athlete and non-athlete groups. All the patients in the athlete group return to sports at previous level 6 months after the operation. The mean time of return to sports at previous level was 5.4 months. Both athletes and non-athletes demonstrate significant VAS and mHHS improvement following arthroscopic labral repair. The VAS scores improvement and mHHS improvement were similar in the athlete and non-athlete groups after arthroscopic labral repair.

Favorable Outcomes of Revision Hip Arthroscopy Irrespective of Whether Index Surgery was Performed by the Same Surgeon or a Different Surgeon.

Introduction:The purpose of this study was to compare minimum 2-year patient-reported outcomes (PROMs) after revision hip arthroscopy between two different patient cohorts who had undergone primary hip arthroscopy with the same surgeon (SS) and a different surgeon (DS). We hypothesized no difference in clinical outcomes between the groups despite differences in intraoperative findings based on the surgical decision making in a revision setting at a high-volume center.Methods:Between January 2012 and August 2017, 71 SS patients were matched for age, sex, body mass index, and follow-up to 71 DS patients. Modified Harris hip score (mHHS), nonarthritic hip score, and hip outcome score—sports-specific subscale (HOS-SSS) were collected prospectively. The minimal clinically important difference was calculated for mHHS and HOS-SSS.Results:All the DS patients had labral tears, and 94.4% had femoroacetabular impingement from residual bony deformity (P < 0.001). The SS and DS groups demonstrated significant and comparable improvement in mHHS (Δ = 18.3 ± 21.5 versus 19 ± 20.1; P = 0.837), nonarthritic hip score (Δ = 18.8 ± 18.8 versus 18.2 ± 18.8; P = 0.850), and HOS-SSS (Δ = 22 ± 27.4 versus 17.5 ± 28.1; P = 0.275). The rates of achieving minimal clinically important difference for mHHS and HOS-SSS were similar. Furthermore, the need for revision surgery and conversion to total hip arthroplasty were comparable (P = 0.228 and P = 0.383).Conclusions:Patients undergoing revision hip arthroscopy reported notable and comparable improvement in multiple patient-reported outcomes at a minimum 2-year follow-up, irrespective of intraoperative findings or primary source of patient pool.