Modified Harris Hip Score Research Articles

Hip Arthroscopy Patients With Lower Back Pain Show Delayed Clinical Improvement and Inferior Time-Dependent Survivorship: A Propensity Matched Study at Mid-Term Follow-Up

PurposeTo evaluate patient-reported outcomes (PROs) and survivorship at mid-term follow-up after hip arthroscopy (HA) for femoroacetabular impingement syndrome (FAIS) in patients with and without preoperative lower back pain (LBP). MethodsPatients with self-endorsed preoperative LBP who underwent HA for FAIS with mid-term follow-up were identified and propensity matched 1:1 to patients without back pain by age, sex, and body mass index. PROs collected preoperatively and at postoperative years 1, 2, and 5 included: Hip Outcome Score Activities of Daily Living (HOS-ADL) and Sports Subscale (HOS-SS), International Hip Outcome Score 12 (iHOT-12), modified Harris Hip Score (mHHS), Visual Analog Scale (VAS) for Pain. Achievement of minimal clinically important difference (MCID) and patient acceptable symptom state (PASS) were compared. Survivorship was compared with Kaplan-Meier analysis. Results119 patients with LBP were matched to 119 patients without LBP. Group demographic factors were as follows, age (37.4±11.9 years vs 37.6±12.6, p=0.880), sex (64.4% female vs 67.7%, p=0.796), and BMI (25.3±5.1 kg/m2 vs 25.3±5.4, p=0.930). Average follow-up duration was 6.0 ± 1.9 years. LBP patients showed similar preoperative PROs, yet lower 1-year scores for all PROs (p ≤ 0.044). At final follow-up, similar PROs were shown between groups (p ≥ 0.196). LBP and non-LBP patients had similar MCID achievement for HOS-ADL (59.3%vs.63.1%,p=0.640), HOS-SS (73.9%vs.70.8%,p=0.710), mHHS (66.7%vs.73.4%, p=-.544), iHOT-12 (85.1%vs.79.4%,p=0.500), and VAS-Pain (75.6%vs.69.9%,p=0.490). Groups also had similar PASS achievement for HOS-ADL (63.5%vs.61.3%,p=0.777), HOS-SS (57.0%vs.62.5%,p=0.461), mHHS (81.9%vs.79.1%, p=0.692), iHOT-12 (54.6%vs.61.2%,p=0.570), and VAS-Pain (51.0%vs.55.4%,p=0.570).with similar MCID (p ≥ 0.490) and PASS (p ≥ 0.386) achievement. Conversion to total hip arthroplasty occurred in 3.4% of hips with LBP and 0.8% of hips without LBP (p=0.370), Back pain patients demonstrated inferior time-dependent survivorship compared to patients without back pain on Kaplan-Meier survival analysis (p = 0.023). ConclusionsPatients undergoing primary hip arthroscopy for femoroacetabular impingement syndrome with LBP achieve comparable PROs and CSOs to patients without back pain at mid-term, despite lower 1-year PRO scores. LBP patients show inferior reoperation-free time-dependent survivorship compared to those without LBP.

Patients Undergoing Postless Hip Arthroscopy Demonstrate Significantly Better Patient-Reported Outcomes and Clinically Significant Outcomes Compared to Conventional Post-Assisted Hip Arthroscopy at Short-Term Follow-Up

PurposeTo prospectively compare the short-term clinical outcomes of patients undergoing hip arthroscopy with versus without the use of a perineal post. MethodsA prospective, single-surgeon cohort study was performed on a subset of patients undergoing hip arthroscopy between 2020 and 2022. A post-free hip distraction system was used at one center at which the senior author operates, and a perineal post was used at another surgical location. An electronic survey of Patient-Reported Outcome Measures (PROMs) was completed by each patient at a minimum of 1 year postoperatively. PROMs included a Visual Analogue Scale (VAS) for pain, University of California Los Angeles (UCLA) Activity Scale, modified Harris Hip Score (mHHS), Hip Outcome Score-Sports-Specific Subscale (HOS-SSS), and a Single Assessment Numeric Evaluation (SANE). Postoperative scores and clinically significant outcomes including the minimal clinically important difference (MCID), substantial clinical benefit (SCB), and patient acceptable symptom state (PASS) for each PROM were compared between groups. ResultsSixty-nine patients were reached for follow-up (41 post, 28 postless) of 87 patients eligible for the study (79%). No significant differences were found between groups in terms of sex (post: 61% female, postless: 54% female, p = 0.54), age (post: 34 years, postless: 29 years, p = 0.11), body mass index (post: 26 kg/m2, postless: 24 kg/m2, p = 0.23) or follow-up duration (post: 24.4 months, postless: 21.3 months, p = 0.16). There was a significantly higher VAS (3.1 vs 1.4, p = 0.01), significantly lower UCLA Activity Score (7.0 vs 8.4, p = 0.02), and significantly lower mHHS (73.7 vs. 82.2, p = 0.03) in the post-assisted group. A significantly higher proportion of patients in the postless group achieved a PASS for the UCLA (89.3% vs. 68.3%, p = 0.04), mHHS (84.6% vs. 61.0%, p = 0.04), and HOS-SSS (84.0% vs. 61.0%, p = 0.048), and a SCB for HOS-SSS (72.0% vs. 41.5%, p = 0.02). One patient (2.6%) in the post group underwent revision hip arthroscopy and another was indicated for total hip arthroplasty by the time of follow-up. ConclusionPostless hip arthroscopy may result in better clinical outcomes compared to post-assisted hip arthroscopy. Level of EvidenceIII, retrospective cohort study

Six-Month Outcomes Correlate With 10-Year Outcomes After Hip Arthroscopy for Femoroacetabular Impingement Syndrome

To identify whether 6-month outcomes after hip arthroscopy for femoroacetabular impingement syndrome (FAIS) correlate with outcomes at minimum 10-year follow-up. Patients who underwent primary hip arthroscopy for FAIS from 2012 to 2013 were reviewed and included if they had 6-month and minimum 10-year follow-up. Patient-reported outcome (PRO) measures included the Hip Outcome Score Activities of Daily Living (HOS-ADL) subscale, Hip Outcome Score Sports-Specific (HOS-SS) subscale, modified Harris Hip Score (mHHS), visual analog scale (VAS) for pain, and VAS for satisfaction. We compared 6-month and 10-year outcome scores and analyzed the relations between 6-month and 1-, 2-, 5-, and 10-year outcome scores using Pearson correlation coefficients (r). Six-month scores and clinically significant outcome achievement were then compared with 10-year clinically significant outcome achievement and reoperations, including revision hip arthroscopy and conversion to total hip arthroplasty (THA), using logistic regressions and the Fisher exact test. This study included 60 patients (60.0% female sex; mean age, 36.0 ± 12.2 years). The mHHS, VAS pain score, and VAS satisfaction score significantly improved from 6-month to 10-year follow-up (P ≤ .021), whereas the HOS-ADL and HOS-SS did not (P ≥ .072). There were significant correlations between 6-month and 10-year scores for the HOS-ADL (r= 0.505), HOS-SS (r= 0.592), and mHHS (r= 0.362) (P ≤ .022 for all), as well as significant correlations between 6-month and 1-, 2-, and 5-year scores (P ≤ .014 for all). The 6-month HOS-ADL, HOS-SS, and mHHS were all significantly associated with their respective 10-year achievement of the patient acceptable symptom state (PASS) (P ≤ .044). Furthermore, 6-month HOS-ADL and mHHS were significantly associated with THA conversion (P ≤ .041). Comparable 6-month and 10-year achievement of the minimal clinically important difference (96.5% vs 97.8%, P > .999) and PASS (85.2% vs 87.5%, P > .999) for any PRO was observed. After hip arthroscopy for FAIS, patients' 6-month HOS-ADL and mHHS were significantly associated with their 10-year PROs, PASS achievement, and THA conversion, although correlation strengths decreased with increasing time from surgery. Level IV, case series.

Reemplazo total de cadera en pacientes menores de 50 años: ¿tiene la fijación no cementada mejores resultados?

BackgroundCementless fixation for hip arthroplasties has increased in the last decades, particularly in younger patients. The purpose of this study was to compare the long-term results three different types of fixations in patients under 50years old. MethodsCemented, hybrid and cementless fixations were assessed in patients under 50years old with a minimum follow-up of 8years. Loosening, demarcation, complications, and prosthesis survival were assessed. Functional analysis was performed with the modified Harris Hip Score and Visual analogue scale was collected. ResultsFinal series consisted in 222 patients. Significant improvement was observed regarding mHHS and VAS score in each group. We observed statistically significant difference regarding demarcation between the groups (P<.001). The higher rate of acetabular and femoral stem loosening was observed in the cemented (20.0%) and hybrid (18.9%) group. The lowest prosthesis survival rate after 16 years was observed in hybrid group (P<.001). ConclusionTotal hip replacement has good long-term clinical and functional outcomes. The lowest rate of prosthesis survival was observed in hybrid group with 84.2% after 16years.

Arthroscopic Fractional Lengthening After Total Hip Arthroplasty Results in Improved Patient-Reported Outcomes and Low Rates of Revision Total Hip Arthroplasty

PurposeTo report the clinical outcomes and reoperation rates of arthro- and endo-scopic iliopsoas release at short-term follow-up following ipsilateral total hip arthroplasty from two separate medical institutions, and to evaluate whether demographic and radiographic parameters are associated with postoperative patient reported outcomes. MethodsPatients with iliopsoas tendinitis in the setting of prior THA that underwent arthroscopic iliopsoas fractional lengthening from 1988 – 2023 at two academic institutions were reviewed. Patients were included if they had 12 months of follow-up and evaluated for preoperative anterior acetabular component overhang, surgery satisfaction, postoperative subjective hip flexion strength and anterior groin pain improvement, modified Harris Hip Score (mHHS), Single Assessment Numeric Evaluation (SANE) score, Tegner activity scale, visual analog scale (VAS), and revision hip arthroplasty. ResultsSixty hips in 58 patients (19 males, 39 females) were followed for a mean of 39.3 (12.0-105.9) months postoperatively. 77% of patients reported feeling “much” or “slightly better”, 75% reported improved anterior groin pain, and 60% reported improved subjective hip flexion strength. Surgery satisfaction was 7.2 ± 3.3 (scale of 0 to 10). Mean postoperative mHHS, VAS pain at rest, VAS pain with use, and SANE scores were 73.9 ± 19.4, 1.3 ± 2.4, 3.8 ± 2.9, and 71.9 ± 21.9 respectively. Preoperative anterior acetabular component overhang was 3.3 ± 6.5 mm and didn’t significantly correlate with postoperative PROs (p ≥ 0.45). Tegner score improved to 2.9 ± 1.4 from 2.5 ± 1.7 preoperatively (p = 0.0253). Three patients underwent revision arthroplasty at a mean of 25.3 (11.6 – 40.4) months postoperatively, with an acetabular component revision rate of 3.3%. ConclusionsSatisfactory outcomes and low revision arthroplasty rates were observed in patients undergoing arthroscopic iliopsoas lengthening following THA. There was no statistically significant relationship between anterior acetabular component overhang and final PROs.

Long-term Outcomes of Primary Hip Arthroscopy: Multicenter Analysis at Minimum 10-Year Follow-up With Attention to Labral and Capsular Management

Background: Hip arthroscopy is rapidly advancing, with positive published outcomes at short- and midterm follow-up; however, available long-term data remain limited. Purpose: To evaluate outcomes of primary hip arthroscopy at a minimum 10-year follow-up at 2 academic centers by describing patient-reported outcomes and determining reoperation and total hip arthroplasty (THA) rates. Study Design: Case series; Level of evidence, 4. Methods: Patients with primary hip arthroscopy performed between January 1988 and April 2013 at 2 academic centers were evaluated for postoperative patient-reported outcomes—including the visual analog scale, Tegner Activity Scale score, Hip Outcome Score Activities of Daily Living and Sport Specific subscales, modified Harris Hip Score, Nonarthritic Hip Score, 12-item International Hip Outcome Tool, surgery satisfaction, and reoperations. Results: A total of 294 patients undergoing primary hip arthroscopy (age, 40 ± 14 years; 66% women; body mass index, 27 ± 6) were followed for 12 ± 3 years (range, 10-24 years) postoperatively. Labral debridement and repair were performed in 41% and 59% of patients, respectively. Of all patients who underwent interportal capsulotomy, 2% were extended to a T-capsulotomy, and 11% underwent capsular repair. At final follow-up, patients reported a mean visual analog scale at rest of 2 ± 2 and with use of 3 ± 3, a 12-item International Hip Outcome Tool of 68 ± 27, a Nonarthritic Hip Score of 81 ± 18, a modified Harris Hip Score of 79 ± 17, and a Hip Outcome Score Activities of Daily Living of 82 ± 19 and Sport Specific subscale of 74 ± 25. The mean surgical satisfaction was 8.4 ± 2.4 on a 10-point scale, with 10 representing the highest level of satisfaction. In total, 96 hips (33%) underwent reoperation—including 65 hips (22%) converting to THA. THA risk factors included older age, higher body mass index, lower lateral center-edge angle, larger alpha angle, higher preoperative Tönnis grade, as well as labral debridement and capsular nonrepair (P≤ .039). Patients undergoing combined labral and capsular repair demonstrated a THA conversion rate of 3% compared with 31% for patients undergoing combined labral debridement and capsular nonrepair (P = .006). Labral repair trended toward increased 10-year THA-free survival (84% vs 77%; P = .085), while capsular repair demonstrated significantly increased 10-year THA-free survival (97% vs 79%; P = .033). Conclusion: At a minimum 10-year follow-up, patients undergoing primary hip arthroscopy demonstrated high satisfaction and acceptable outcome scores. In total, 33% of patients underwent reoperation—including 22% who underwent THA. Conversion to THA was associated with patient factors including older age, higher Tönnis grade, and potentially modifiable surgical factors such as labral debridement and capsular nonrepair.

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.

Surgical Hip Dislocation in the Era of Hip Arthroscopy Demonstrates High Survivorship and Improvements in Patient-reported Outcomes for Complex Femoroacetabular Impingement.

Surgical Hip Dislocation in the Era of Hip Arthroscopy Demonstrates High Survivorship and Improvements in Patient-reported Outcomes for Complex Femoroacetabular Impingement.

Assessment of fatty infiltration of the hamstring muscles in chronic proximal hamstring ruptures and effect on clinical outcomes after surgical repair: a novel application of the Goutallier classification.

Increased time to surgery has been previously associated with poorer clinical outcomes after surgical treatment of proximal hamstring ruptures, though the etiology remains unclear. The purpose of this study was to evaluate whether degree of muscle atrophy, as assessed using the Goutallier classification system, is associated with worse outcomes following surgical treatment of chronic proximal hamstring ruptures. This was a retrospective case series of patients who underwent repair of proximal hamstring ruptures from 2012 to 2020 with minimum 2-year follow-up. Patients were included if they underwent primary repair of a proximal hamstring rupture ≥ 6weeks after the date of injury and had accessible preoperative magnetic resonance imaging (MRI). Exclusion criteria were allograft reconstruction, endoscopic repair, or prior ipsilateral hip surgery. Patients were administered validated surveys: the modified Harris Hip Score (mHHS) and Perth Hamstring Assessment Tool (PHAT). Fatty atrophy on preoperative MRI was independently graded by two musculoskeletal radiologists using the Goutallier classification. Multivariate regression analysis was performed to evaluate associations of preoperative characteristics with muscle atrophy, as well as mHHS and PHAT scores. Complete data sets were obtained for 27 patients. A majority of this cohort was male (63.0%), with a mean age of 51.5 ± 11.8years and BMI of 26.3 ± 3.8. The mean follow-up time was 62.6 ± 23.1months, and the mean time from injury-to-surgery was 20.4 ± 15.3weeks. The Goutallier grading inter-reader weighted kappa coefficient was 0.655. Regression analysis demonstrated that atrophy was not significantly associated with PHAT (p = 0.542) or mHHS (p = 0.574) at latest follow-up. Increased age was significantly predictive of muscle atrophy (β = 0.62, p = 0.005) and was also found to be a significant predictor of poorer mHHS (β = - 0.75; p = 0.037). The degree of atrophy was not found to be an independent predictor of clinical outcomes following repair of chronic proximal hamstring ruptures. Increasing age was significantly predictive of increased atrophy and poorer patient-reported outcomes.

Hip Resurfacing in the Setting of Retained Proximal Femoral Instrumentation or Complex Deformity

AbstractTotal hip arthroplasty (THA) in the setting of significant retained femoral instrumentation or complex proximal femoral deformity may be challenging and published reports of THA in this setting reveal sobering results. Hip resurfacing arthroplasty (HRA) is an alternative to THA and may avoid complex hardware removal or deformity correction at the time of hip arthroplasty. Twenty-three patients who underwent elective HRA in the setting of significant proximal femoral deformity and/or retained femoral instrumentation were identified from a prospectively maintained registry. Pre- and postoperative Lower Extremity Assessment Scores (LEAS), modified Harris Hip Scores (mHHS), Hip Disability and Osteoarthritis Outcome Scores for Joint Replacement (HOOS, JR) scores, Visual Analog Scale (VAS) pain levels, and metal ion levels were obtained. Median (interquartile range [IQR]) follow-up was 5.03 (2.07 − 7.91) years, and no patients had undergone revision surgery at their latest follow-up. The mean (standard deviation [SD]) surgical duration was 94.40 (12.00) minutes, and postoperative length of stay was 1.74 (1.80) days. There were no intraoperative complications, and all patients were discharged home. Median (IQR) postoperative LEAS, VAS pain scale, mHHS, and HOOS, JR scores were 13.00 (9.25 − 13.00), 2.50 (0.75 − 10.00), 92.60 (92.40 − 100.00), and 92.34 (85.26 − 100.00), respectively. Fourteen patients completed postoperative serum metal ion level testing at a mean (SD) of 4.24 (2.85) years, where cobalt and chromium levels were 1.22 (0.36) and 2.01 (0.80) parts per billion, respectively. HRA is a viable option for patients with significant proximal femoral deformity or retained instrumentation, and excellent results at mid-term follow-up can be achieved utilizing this strategy in this complex patient population.

Acetabular "Fleck" Sign: Outcomes of Surgical Repair.

Traumatic, posterior hip dislocations in the pediatric population are typically managed by closed reduction to achieve a concentric hip joint. The presence of an acetabular "fleck" sign, despite concentric reduction, has been shown to signify significant hip pathology. The purpose of this study was to evaluate the outcomes of open labral repair through a surgical hip dislocation (SHD) in a consecutive series of patients with an acetabular "fleck" sign associated with a traumatic hip dislocation/subluxation. A retrospective review of patients between 2008 and 2022 who presented to a single, level 1 pediatric trauma center with a traumatic posterior hip dislocation/subluxation was performed. Patients were included if they had an acetabular "fleck" sign on advanced imaging and underwent open labral repair through SHD. Medical records were reviewed for sex, age, laterality, mechanism of injury (MOI), and associated orthopaedic injuries. The modified Harris hip score (mHHS) was utilized as the primary clinical outcomes measure. Patients were assessed for the presence of heterotopic ossification (HO) and complications, including implant issues, infection, avascular necrosis (AVN), and post-traumatic dysplasia. Twenty-nine patients (23 male, average age: 13.0±2.7 y; range: 5.2 to 17.3) were identified. Eighteen injuries were sports related, 9 caused by motor vehicle accidents, and 1 pedestrian struck. All patients were found to have an acetabular "fleck" sign on CT (26 patients) or MRI (5 patients). Associated injuries included: femoral head fracture (n=6), pelvic ring injury (n=3), ipsilateral femur fracture (n=2), and ipsilateral PCL avulsion (n=1). At the latest follow-up (2.2±1.4y), all patients had returned to preinjury activity/sport. Three patients developed asymptomatic, grade 1 HO in the greater trochanter region. There was no incidence of AVN. One patient developed post-traumatic acetabular dysplasia due to early triradiate closure. mHHS scores showed excellent outcomes (n=21, 94.9±7.4, range: 81 to 100.1). The acetabular "fleck" sign indicates a consistent pattern of osteochondral avulsion of the posterior/superior labrum. Restoring native hip anatomy and stability is likely to improve outcomes. SHD with open labral repair in these patients produces excellent clinical outcomes, with no reported cases of AVN. Level IV-therapeutic.

Translation and Cross-Cultural Adaptation into French of the Harris Hip Score and the Modified Harris Hip Score.

The objective of this study was to develop a cross-cultural adaptation and translation into French of the original Harris Hip Score (HHS) and the modified Harris Hip Score (mHHS). The translation and cultural-adaptation of the questionnaire were performed following a 10-step process as recommended by the International Society for Pharmacoeconomics and Outcomes Research (ISPOR). During the cognitive debriefing, each item of the questionnaire has been rated between 1 and 10 according to the comprehension level of 8 patients who underwent total hip arthroplasty. The cross-cultural adaptation process required the modification of the walking distance item by converting the number of blocks into meters but also in walking time (minutes). All the different steps have been performed without any other important changes on the translated questionnaire which has been found highly understandable by interviewed patients (9.6 ± 1.1). This study successfully reports the French version development of the original HHS (HHS-Fr) and its modified patient-reported version (mHHS-Fr), thereby providing to clinicians a standardised version for the evaluation of French-speaking patients suffering from hip osteoarthritis.

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.

Endoscopic gluteus medius partial tear repair with collagen patch augmentation. Clinical and imaging results

Introduction: Gluteus medius (GM) partial and total tears are often the cause of lateral hip pain. Non-surgical management is the first approach, however, open and endoscopic repair techniques have been described in refractory cases. The use of collagen patches has been proposed as an augmentation to enhance healing. This study aims to describe our technique for repairing partial tears of the GM tendon and present clinical and imaging results. Materials and methods: Prospective cohort on 15 hips with lateral hip pain and a positive Trendelenburg test, who had a partial thickness tear of the GM tendon on MRI. The patients had not responded to non-surgical treatment for at least 6 months and underwent endoscopic repair with a collagen patch augmentation between 2019 and 2022. The postoperative Modified Harris Hip Score (mHHS), International Hip Outcomes Tool-12 (iHOT-12), Visual Analogue Score (VAS), patient satisfaction, Trendelembug test, and control MRI to assess healing at 3 months were obtained. Results: 100% female, mean age of 56.66 years. Mean follow-up was 11 (4-24) months. Median mHHS improved significantly from 68 to 82 points (p=0.001). The median iHOT-12 improved significantly from 70 to 83 points (p=0.001). Median VAS decreased significantly from 6 to 2 (p&lt;0.001). All patients had a negative Trendelenburg test at the end of the follow-up, and all reported being satisfied. There were no complications and all cases showed healing. Conclusion: Our endoscopic technique has shown positive clinical outcomes for patients with partial ruptures, resulting in complete healing without short-term complications.

Choice of Entry Point Does Not Affect Clinical and Radiological Outcomes in Antegrade Intra-medullary Nailing in Patients with Shaft of Femur Fracture: A Prospective Randomized Controlled Trial.

The choice of entry point, Greater trochanter (GT), or Piriformis entry (PE) for antegrade intramedullary nailing (IMN) of the femur is crucial. This study was performed to compare these two entry points in the patients with shaft of femur fractures regarding intra-operative parameters, radiological and functional outcomes. Twenty-four patients underwent GT entry nailing, while 25 patients underwent PE nailing. Surgical time, Intra-operative blood units transfused, Intra-operative fluoroscopy exposure by number of C-arm shots taken, mean drop in hemoglobin, and incidence of iatrogenic fracture were recorded. Patients were followed up at 4weeks, 6weeks, and 6months to look for radiological healing and improvements in functional outcome using Modified Harris Hip Score (MHHS). MRI of bilateral hips with pelvis was done in 25 patients at 6months of follow-up to detect any preliminary signs of AVN. The mean drop in hemoglobin in the GT group was significantly lesser than the PE group (p = 0.02). Mean MHHS at 4weeks post-op was also significantly higher in the GT group (p = 0.01). There was no significant difference between both the groups regarding surgical duration, fluoroscopy exposure, radiological and functional outcomes in the long term. None of the patients who underwent MRI displayed any preliminary sign of AVN. GT entry nails lead to lesser surgical time, fluoroscopy exposure, and intra-operative blood loss. Both the nailing systems achieve excellent fracture unions and comparable functional outcomes in the long term, and there is a minuscule risk of AVN in adult patients undergoing IMN.

Patients with Borderline Hip Dysplasia Undergoing Primary Hip Arthroscopy for Femoroacetabular Impingement Syndrome Demonstrate Lower Outcome Scores but Comparable Survivorship to Non-Dysplastic Controls: A Propensity-Matched Study with Minimum 10-Year Follow-up

Background: Patients with borderline hip dysplasia (BHD) have demonstrated similar outcomes following primary hip arthroscopy for femoroacetabular impingement syndrome (FAIS) compared to equivalent patients without dysplasia at short- and mid-term follow-up. However, outcomes in these groups have not yet been compared at long-term follow-up. Objectives: To compare long-term clinical outcomes following primary hip arthroscopy for FAIS between patients with BHD and non-dysplastic matched controls. Methods: A retrospective review was conducted of patients who underwent primary hip arthroscopy for FAIS from January 2012 through February 2013. Patients with BHD, defined as a lateral center edge angle (LCEA) between 18° and 25°, were propensity matched in a 1:3 ratio by sex, age, and body mass index (BMI) to non-dysplastic controls. Preoperative and postoperative radiographs were assessed. Patient-reported outcomes (PROs) were collected preoperatively and 10 years postoperatively, and achievement rates of Minimal Clinically Important Difference (MCID) and Patient-Acceptable Symptom State (PASS) were calculated. PRO measures included the Hip Outcome Score Activities of Daily Living (HOS-ADL) and Sports-Specific (HOS-SS) subscales, modified Harris Hip Score (mHHS), 12-item international Hip Outcome Tool (iHOT-12), and Visual Analog Scales (VAS) for Pain and Satisfaction. Gross survivorship was assessed using Kaplan-Meier curves. PROs, MCID and PASS achievement rates, and survivorship were compared between groups. Results: Twenty-eight patients with BHD (71.4% female; age: 30.8 ± 10.8 years, BMI: 24.2 ± 3.9 kg/m2) were matched to 84 controls (66.7% female, age: 34.4 ± 10.5 years, BMI: 24.9 ± 5.1 kg/m2; p ≥ 0.135). Mean follow-up was 10.3 ± 0.3 years. There were no significant differences between groups in any demographic characteristics, radiographic measurements, or intraoperative findings (p ≥ 0.096), except pre- and post-operative LCEA and Tönnis angle, which were lower and higher, respectively, among BHD patients (p &lt; 0.001). Both groups demonstrated significant improvement in all PROs between the preoperative and 10-year postoperative time points (p &lt; 0.001 for all). Preoperative, 10-year postoperative, and magnitude of change (delta) in PRO scores were similar between groups for all measures (p ≥ 0.072), except 10-year postoperative HOS-SS (BHD: 62.9 ± 31.9 vs. Controls: 80.1 ± 26.0, p = 0.030) and change in VAS Pain (BHD: -34.2 ± 27.2 vs. Controls: -48.5 ± 26.1, p = 0.047). Rates of MCID achievement were similar between groups for all PRO measures, but rates of PASS achievement were significantly lower among BHD patients for HOS-ADL (BHD: 39.1% vs. Controls: 77.4%, p = 0.002), HOS-SS (BHD: 45.5% vs. Controls: 84.7%, p = 0.001), and VAS Pain (BHD: 50.0% vs. Controls: 78.5%, p = 0.015). There was no difference in reoperation rate between groups (BHD: 14.3% vs. Controls: 17.9%, p = 0.778). Kaplan-Meier survival analysis demonstrated comparable gross survivorship at long-term follow-up (p = 0.645). Conclusions: Patients with BHD undergoing primary hip arthroscopy for FAIS demonstrated significantly lower sports-specific PRO scores than propensity-matched controls at 10-year follow-up, with a trend toward significantly worse scores for measures assessing activities of daily living, pain, and satisfaction. Rates of MCID achievement were similar between groups, but BHD patients demonstrated lower rates of PASS achievement for the majority of PRO measures. However, patients with BHD had similar long-term hip survivorship compared to controls, with no significant differences in rates of revision hip arthroscopy or conversion to total hip arthroplasty.

No Differences in Clinical Outcomes Between Hip Arthroscopy With Versus Without Capsular Closure in Patients With Cam- or Mixed-Type Femoroacetabular Impingement: A Randomized Controlled Trial

PurposeTo compare two-year clinical outcomes of primary hip arthroscopy with versus without capsular closure after interportal capsulotomy in patients with cam- or mixed- type femoroacetabular impingement (FAI). MethodsPatients with cam- or mixed-type FAI undergoing primary hip arthroscopy with interportal capsulotomy were prospectively enrolled in this randomised controlled trial (RCT) and allocated into either capsular closure or no capsular closure groups. Patients were blinded to group allocation. Clinical outcomes were assessed preoperatively and at 2 years follow-up using the International Hip Outcome Tool (iHOT-12), modified Harris Hip Score (mHHS), and six subsections of the Copenhagen Hip and Groin Outcome Score (HAGOS). Complications and reoperations were noted. ResultsEighty-four patients (100 hips) were enrolled, 49 hips in the capsular closure group and 51 in the no capsular closure group, with no significant differences in age (28.5±7.5 vs 30.4±8.4, p=0.261), BMI (23.5±3.0 vs 23.4±1.9, p=0.665), and sex distribution (F: 10.2% vs 13.7%, p=0.760). Four patients were lost to follow-up (2.0% vs 5.9%, p=0.618) and 6 had reoperations (6.1% vs 5.9%, p=1.000), which left 45 hips per group for clinical assessment. There were no significant differences between groups in the net change of iHOT-12 (28.3±19.6 vs 32.5±22.7, p=0.388), mHHS (7.6±13.1 vs 7.5±10.2, p=0.954), and subsections of HAGOS (p>0.05). Complication rates were also similar between groups (p>0.05). ConclusionThe present RCT compared primary hip arthroscopy with versus without capsular closure after interportal capsulotomy in a male-dominated, non-dysplastic, non-arthritic cohort with cam- or mixed- type FAI, and found no significant differences in patient-reported clinical outcomes, complication rates, or reoperation rates. Level of EvidenceLevel I, Randomised Controlled Trial

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

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

Outcomes of Isolated Endoscopic Gluteal Tendon Repair Compared With Concomitant Endoscopic Gluteal Tendon Repair and Arthroscopic Hip Labral Repair: A Propensity-Matched Analysis With Minimum 2-Year Follow-up.

Both gluteal and labral tears are common sources of hip pain, but no studies have evaluated how concomitant arthroscopic labral repair and correction of femoroacetabular impingement syndrome (FAIS) affect outcomes after endoscopic gluteus/minimus repair. (1) To compare patient-reported outcomes (PROs) and clinically significant outcomes achievements between patients who underwent endoscopic gluteus medius/minimus and arthroscopic hip labral repair with correction of FAIS versus endoscopic gluteus medius/minimus repair without labral repair and (2) to define threshold scores required to achieve the minimal clinically important difference (MCID) and the Patient Acceptable Symptom State (PASS) for the Hip Outcome Score-Activities of Daily Living, Hip Outcome Score-Sports Specific, modified Harris Hip Score (mHHS), 12-item international Hip Outcome Tool, and visual analog scale for pain in these patients. Cohort study; Level of evidence, 3. Patients who underwent primary endoscopic gluteus medius/minimus repair between 2012 and 2020 were identified. Those who underwent concomitant arthroscopic labral repair and correction of FAIS with femoroplasty or acetabuloplasty as indicated were propensity matched in a 1 to 1 ratio by sex, age, and body mass index to patients who underwent gluteus medius/minimus repair without labral repair. Patients who completed the study PROs were assessed preoperatively and at 2 years postoperatively. Threshold scores required to achieve the MCID and PASS thresholds were calculated. A total of 32 patients who underwent simultaneous gluteal and labral repair (G+L) were matched to 32 patients who underwent gluteal repair without labral repair (G); 75% of patients in the G cohort underwent labral debridement, while 25% in this cohort received no labral treatment. A significant difference was observed between groups in preoperative mHHS scores (G+L, 54.4 ± 12.9 vs G, 46.3 ± 14; P = .048) but no differences in any other PRO scores (P≥ .207). The MCID/PASS thresholds were as follows: Hip Outcome Score-Activities of Daily Living (11.14/83.82), Hip Outcome Score-Sports Specific (16.07/59.72), mHHS (11.47/70.95), 12-item international Hip Outcome Tool (13.73/45.49), and visual analog scale for pain (14.30/22). There were no significant differences in MCID or PASS achievement rates between the 2 groups (P≥ .108). Patients who underwent combined G+L demonstrated comparable PROs and clinically significant outcomes achievement rates to patients who underwent G, highlighting sustained successful outcomes for patients with gluteal tendon pathology and concomitant FAIS and labral tears.

Hip Arthroscopy in Recreational Athletes: Risk Factors For Failure to Return to Sport and Factors That Influence Psychological Readiness to Return to Sport

Objective: High level athletes achieve high rates of return to play and improved patient reported outcomes (PROMs) after hip arthroscopy for femoroacetabular impingement (FAI). However, few studies have evaluated return to sport rates in recreational athletes, risk factors for failure to return to sport, and the effect of psychological readiness to return to sport (RTS) within this population. We hypothesize that recreational athletes undergoing hip arthroscopy for FAI achieve high PROMs and rates of RTS and that psychological readiness is a risk factor for failure to RTS. Additionally, we hypothesize that male athletes and younger age are positively associated with psychological readiness to RTS. Methods: Retrospective review of prospectively collected data in our institution's Center for Hip Pain and Preservation Outcomes Registry identified recreational athletes with a minimum of 12 months follow-up, who underwent hip arthroscopy for FAI between 2008-2018. The primary outcome was RTS. The secondary outcomes were ---Hip-RSI (SF) score, modified Harris Hip Score (mHHS), Hip Outcome Score Activities of Daily Living (HOS-ADL), Hip Outcome Score Sport (HOS-Sport), and International Hip Outcome Tool (iHOT33). Results: 84.8% of recreational athletes returned to sport with 70.52% returning to the same level of play. Athletes who failed to RTS were younger (p-value=0.0427), last participated 9-12 months prior to surgery (32.26%) or had stopped participating in sports altogether (70.97%) (p-value=0.0002 and p-value=0.0013). Hip-RSI Score was a statistically significant predictor of failure to RTS at one and two years respectively (OR 0.915 (95%CI 0.87, 0.962) and OR 0.904 (95%CI 0.818, 0.999)). Increasing age had a positive effect on psychological readiness to RTS (0.5004-point increase in RSI score (p-value=0.0002)) while sex, BMI, additional ipsilateral surgery, and last participation in sport were not predictive of psychological readiness (p-values&gt;0.05). Conclusions: Recreational athletes undergoing hip arthroscopy achieve high rates of RTS, return to the same level of play, and demonstrate significant improvements in PROMs. The Hip-RSI-score was a statistically significant predictor of failure to RTS at 1 and 2 years post operatively. Lastly, higher psychological readiness for return to sport was seen in older recreational athletes undergoing hip arthroscopy for FAI.