Nonarthritic Hip Score Research Articles

Staged Hip Arthroscopy and Periacetabular Osteotomy in Active Patients 45 Years and Older Produces Comparable Improvements in Outcome Scores to Younger Patients

PurposeTo determine staged hip arthroscopy and periacetabular osteotomy (PAO) mid-term outcomes in active patients aged 45 years and older compared with a younger group. Materials and MethodsAll patients aged ≥45 years old who underwent staged arthroscopy and PAO between 2015 and 2021 were retrospectively analyzed and compared to a case-matched control of younger patients. All patients underwent at least 6 months of non-operative management prior to surgery. Prior to PAO, all patients underwent hip arthroscopy to address any intra-articular pathology. The experimental group consisted of dysplastic patients >45 years of age without significant osteoarthritis who underwent PAO and reported a minimum of 1-year postoperative PROs. Patient-reported outcomes (PROs) were quantified using the International Hip Outcomes Tool (iHOT-12) and Non-Arthritic Hip Score (NAHS). ResultsThe cohort consisted of 35 patients (44 hips) with a mean age of 49.4 ± 3.8 years. The lateral center edge angle significantly improved from preoperatively (20.1 ± 4.5 degrees) to postoperatively (33.2 ± 3.2 degrees) (p<0.001). Mean follow up in the PAO ≥45 cohort was 2.80 (±1.3) years postoperatively. Patients reported significant improvement of iHOT-12 (preoperative: 36.6 ± 14.1, latest follow-up: 81.2 ± 21.0; p<0.001) and NAHS scores (preoperative: 59.2 ± 15.5, latest follow-up: 87.4 ± 13.1; p<0.001). Compared to the control, the older cohort did not report significantly different iHOT-12 scores between groups at any point, and age did not significantly affect either outcome score (p>0.05). ConclusionsPatients ≥45 years of age reported a statistically significant improvement in hip function and pain following staged hip arthroscopy and PAO, with outcome scores comparable to a younger cohort. Our findings demonstrate that appropriately selected older dysplastic patients without significant preexisting hip osteoarthritis experience clinically meaningful improvements in hip pain and function following hip preservation surgery. Level of EvidenceIII, retrospective comparative case series

Hip shelf acetabuloplasty in borderline dysplasia, an alternative between Periacetabular Osteotomy and arthroscopic procedures.

Surgical treatments for symptomatic borderline dysplastic hips (Lateral Center-Edge Angle: LCEA 18-25°) remain challenging, instability being the primary issue. Currently, treatment options include arthroscopic procedures or peri-acetabular osteotomy (PAO). Although the popularity of the acetabular shelf bone block has declined in favor of PAO, it may still be relevant as a hip joint stabilizer and coverage area, rather than for increasing coverage area by cartilage. We analyzed clinical and radiographic outcomes of 23 borderline hips after undergoing shelf procedure with a minimum follow-up of two years. This is a retrospective descriptive study. Clinical evaluations (modified Harris Hip Score: mHHS, Non-Arthritic Hip Score: NAHS, International Hip Outcome Tool: iHOT12) and radiographic assessments were performed before and after surgery. We collected data on revision surgery rates, associated surgical procedures (labrum, impingement), complications, arthrosis progression, and conversion to total hip replacement (THR). The mean LCEA was 21°, and the mean follow-up period was five years (2 to 14 years). Clinical scores showed significant improvement at the last follow-up, mHHS increasing from 47 to 72 (p < 0.001), NAHS from 42 to 68 (p < 0.001), iHOT12 from 28 to 52 (p < 0.001), and pain levels decreasing from 7 to 3. Revision surgery rate was 13%, and complication rate was 8%. No osteoarthritis beyond Tönnis grade 2, and no cases required conversion to THR. Arthroscopic procedures and PAO have shown promising results in the treatment of borderline hips. The hip shelf procedure appears to be a simple and effective treatment for stabilizing borderline hips, with favorable outcomes for 80% of patients and a low rate of arthritic progression. Shelf procedure could be a valuable addition to the therapeutic options for painful borderline dysplasia of the hip.

Relationship Between Neighborhood-Level Socioeconomic Status and Functional Outcomes After Hip Arthroscopy

Background: Despite the growing volume of neighborhood-level health disparity research, there remains a paucity of prospective studies investigating the relationship between Area Deprivation Index (ADI) and functional outcomes for patients undergoing hip arthroscopy. Purpose: To investigate the relationship between neighborhood-level socioeconomic status and functional outcomes after hip arthroscopy. Study Design: Cohort study; Level of evidence, 3. Methods: A retrospective analysis of prospectively collected data was performed on patients aged ≥18 years with minimum 1-year follow-up who underwent hip arthroscopy for the treatment of symptomatic labral tears. The study population was divided into ADILow and ADIHigh cohorts according to ADI score: a validated measurement of neighborhood-level socioeconomic status standardized to yield a score between 1 and 100. Patient-reported outcome measures (PROMs) included the modified Harris Hip Score, Nonarthritic Hip Score, Hip Outcome Score–Activities of Daily Living, Hip Outcome Score–Sports-Specific Subscale, 33-item International Hip Outcome Tool, visual analog scale for pain, and patient satisfaction. Results: A total of 228 patients met inclusion criteria and were included in the final analysis. After patients were stratified by ADI score (mean ± SD), the ADILow cohort (n = 113; 5.8 ± 3.0; range, 1-12) and ADIHigh cohort (n = 115; 28.0 ± 14.5; range, 13-97) had no differences in baseline patient demographics. The ADIHigh cohort had significantly worse preoperative baseline scores for all 5 PROMs; however, these differences were not present by 1-year follow-up. Furthermore, the 2 cohorts achieved similar rates of the minimal clinically important difference for all 5 PROMs and the Patient Acceptable Symptom State for 4 PROMs. When controlling for patient demographics, patients with higher ADI scores had greater odds of achieving the minimal clinically important difference for all PROMs except the 33-item International Hip Outcome Tool. Conclusion: Although hip arthroscopy patients experiencing a greater neighborhood-level socioeconomic disadvantage exhibited significantly lower preoperative baseline PROM scores, this disparity resolved at 1-year follow-up. In fact, when adjusting for patient characteristics including ADI score, more disadvantaged patients achieved greater odds of achieving the minimal clinically important difference. The present study is merely a first step toward understanding health inequities among patients seeking orthopaedic care. Further development of clinical guidelines and health policy research is necessary to advance care for patients from disadvantaged communities.

Hip Labral Repair versus Reconstruction: Meta-analysis.

The purpose of this meta-analysis is to compare the postoperative outcomes and complications of labral repair with those of labral reconstruction. An electronic search strategy was conducted from 1986 until August 2023 using the following databases: PubMed, Cochrane, and Google Scholar (pages 1-20). The primary objectives included the postoperative clinical outcomes determined by the number of patients who reached minimal clinical important difference (MCID) on the visual analog scale (VAS), modified Harris hip score (mHHS), Hip Outcome Score-Sports Subscale (HOS-SS), Hip Outcome Score-Activities of Daily Life (HOS-ADL), and International Hip Outcome Tool-12 (iHOT-12). In addition, analysis of the rate of revision arthroscopy, the rate of conversion to total hip arthroplasty (THA), the postoperative VAS, mHHS, HOS-SS, HOS-ADL, iHOT-12, nonarthritic hip score (NAHS), patient satisfaction, lower extremity function scale (LEFS), and the SF-12 (12-item shortform) was also performed. Any differences arising between the investigators were resolved by discussion. Seventeen studies were relevant to the inclusion criteria and were included in this meta-analysis. A higher rate of patients who reached MCID in the mHHS (P=0.02) as well as a higher rate of revision arthroscopy was observed for labral repair (P=0.03). The remaining studied outcomes were comparable. Despite the greater predictability of success in the reconstruction group, conduct of additional studies will be required for evaluation of the benefits of such findings. In addition, labral reconstruction is more technically demanding than a labral repair.

Victorian Institute of Sport Assessment questionnaire specifically tailored for greater trochanteric pain syndrome for the Dutch population

Abstract Greater trochanteric pain syndrome (GTPS) is a highly prevalent condition characterized by lateral hip and thigh pain. The Victorian Institute of Sport Assessment (VISA) questionnaire specifically tailored for GTPS (VISA-G) questionnaire was developed for the purpose of assessing and quantifying the severity of symptoms related to gluteal tendinopathy or GTPS. It is commonly used in research and clinical settings to evaluate the impact of GTPS on patient function and quality of life. The VISA-G questionnaire was developed for English-speaking populations. Before this questionnaire can be used in non-English-speaking populations, it has to be translated and validated for a particular population. The current study aimed to translate and validate the VISA-G questionnaire for a Dutch-speaking context (VISA-G-Dutch). In this study, we conducted a comprehensive process involving forward and back translation, along with a thorough comparison with other established hip-related questionnaires. The COSMIN checklist was used to ensure uniformity in the validation study. A sample of 100 participants, 50 symptomatic and 50 asymptomatic, completed the VISA-G-Dutch, Harris Hip Score, Hip Disability and Osteoarthritis Outcome Score, Oxford Hip Score, and Nonarthritic Hip Score questionnaires. Internal consistency and test–retest reliability were measured. Construct validity was assessed through positive correlations between the VISA-G-Dutch and gold standard questionnaires. Strong internal consistency and test–retest reliability correlations were found in both the asymptomatic and symptomatic groups. The test–retest reliability also demonstrated strong positive correlations for the symptomatic group. The standard error of measurement was ∼2.3 for the symptomatic group. These results prove that the VISA-G-Dutch is a reliable and valid tool for assessing GTPS and gluteal tendinopathy in Dutch-speaking individuals, providing clinicians with a valuable assessment tool.

Endoscopic Shelf Acetabuloplasty Combined With Hip Arthroscopic Labral Repair, Cam Osteoplasty, and Capsular Plication Enables Elite Athletes With Acetabular Dysplasia to Return to Sport: A Case Series.

To investigate clinical outcomes and return to sport timeline for athletes with acetabular dysplasia after endoscopic shelf acetabuloplasty (ESA). A retrospective review. Wakamatsu Hospital of the University of Occupational and Environmental Health, Japan between 2012 and 2019. Fifteen elite athletes (median age: 20 years) of 253 patients undergoing ESA, arthroscopic labral repair/reconstruction, cam osteochondroplasty, and capsular plication. The mean follow-up period was 27.8 months after surgery. Patient-reported outcome scales (PROSs), including the modified Harris Hip Score, Nonarthritic Hip Score, International Hip Outcome Tool 12, Hip Outcome Score-Sports, and Vail Hip Score. After ESA, all 15 elite athletes were able to return to sport effectively and compete at a preoperative level. The mean time between the operation and the first practice was 6.5 months, while the mean time between the ESA procedure and the first game was 9.6 months. Approximately 27.8 months after surgery, PROS outcomes improved significantly with no hips requiring emergency revision surgery at the final follow-up. At a mean of 47.1 months after surgery, 7 athletes decided to retire from their sport. Up to 71.1 months after surgery, the additional 8 patients continued to compete in their sport at an elite level. ESA enables elite athletes with acetabular dysplasia to return to competition at a mean of 9.6 months postsurgery. The ESA procedure is an effective and promising method of treating elite athletes with acetabular dysplasia. IV.

Application of 3D-printed individualized porous tantalum buttress in shelf acetabuloplasty for developmental dysplasia of the hip

Shelf acetabuloplasty is a viable treatment for developmental dysplasia of the hip (DDH), yet autologous bone grafts have faced challenges such as morphological mismatch, imprecise placement, and long-term graft resorption. The rapid advancement of three-dimensional (3D) printing technology in orthopedics has enabled the acquisition of digital image correlation method (DICM) data from patient pelvic to bilateral femoral proximal regions through computed tomography (CT) scans. This data is then utilized by software to create 3D models and design individualized metal implants. Using tantalum-based TA1 type I spherical powder as the raw material, a porous tantalum buttress with a pore size of 600 microns and a porosity of 75% was fabricated employing the selective electron beam melting (SEBM) technology. Our Center has applied this 3D-printed individualized porous tantalum buttress in shelf acetabuloplasty for 21 DDH patients (25 hips), including 6 males and 15 females, with a mean age of (21.38&amp;plusmn;7.39) years. The follow-up period ranged from 12 to 47 months, averaging (22.64&amp;plusmn;10.86) months. At the final follow-up, patient-reported outcomes (PROs) were used to assess patient&amp;rsquo;s subjective feelings. Significant improvements were observed in the Non-Arthritic Hip Score (NAHS), modified Harris Hip Score (mHHS), Hip Outcome Score-Sports Subscale (HOS-SSS), International Hip Outcome Tool-12 (iHOT-12), and Visual Analog Scale (VAS) compared with preoperative levels (P&lt;0.01). Radiographic assessments showed that postoperative lateral center edge (LCE) angle, Tonnis angle, acetabular angle (Sharp&amp;rsquo;s angle), and femoral head coverage all trended towards normal, with statistically significant differences (P&lt;0.01). There was no implant displacement or bone resorption in any case, and no progression in Tonnis grading for hip osteoarthritis (OA) was noted postoperatively, with an 84% patient satisfaction rate. The early follow-up results of 3D-printed individualized porous tantalum buttress in shelf acetabuloplasty are satisfactory, indicating a reliable application prospect for the treatment of DDH patients.

FEMORAL HEAD REDUCTION OSTEOTOMY APPROACH FOR SEVERE PROXIMAL FEMUR DEFORMITIES: SURGICAL TECHNIQUE AND MINIMUM TWO-YEAR RESULTS

Executing an extended retinacular flap containing the blood supply for the femoral head, reduction osteotomy (FHO) can be performed, increasing the potential of correction of complex hip morphologies. The aim of this study was to analyse the safety of the procedure and report the clinical and radiographic results in skeletally mature patients with a minimum follow up of two years.Twelve symptomatic patients (12 hips) with a mean age of 17 years underwent FHO using surgical hip dislocation and an extended soft tissue flap. Radiographs and magnetic resonance imaging producing radial cuts (MRI) were obtained before surgery and radiographs after surgery to evaluate articular congruency, cartilage damage and morphologic parameters. Clinical functional evaluation was done using the Non-Arthritic Hip Score (NAHS), the Hip Outcome Score (HOS), and the modified Harris Hip Score (mHHS).After surgery, at the latest follow-up no symptomatic avascular necrosis was observed and all osteotomies healed without complications. Femoral head size index improved from 120 ± 10% to 100 ± 10% (p&lt;0,05). Femoral head sphericity index improved from 71 ± 10% before surgery to 91 ± 7% after surgery (p&lt;0,05). Femoral head extrusion index improved from 37 ± 17% to 5 ± 6% (p&lt; 0,05). Twenty five percent of patients had an intact Shenton line before surgery. After surgery this percentage was 75% (p&lt;0,05). The NAHS score improved from a mean of 41 ± 18 to 69 ± 9 points after surgery (p&lt; 0,05). The HOS score improve from 56 ± 24 to 83 ± 17 points after surgery (p&lt; 0,05) and the mHHS score improved from 46 ± 15 before surgery to 76 ± 13 points after surgery (p&lt; 0,05).In this series, femoral head osteotomy could be considered as safe procedure with considerable potential to correct hip deformities and improve patients reported outcome measures (PROMS).Level of evidence - Level IV, therapeutic studyKeywords - Femoral head osteotomy, Perthes disease, acetabular dysplasia, coxa plana

Patient Factors Influencing Outcomes at 12-Year Follow-up of Hip Arthroscopy for Femoroacetabular Impingement

Background: Arthroscopic treatment of femoroacetabular impingement has increased in popularity since the early 2000s when it was first described, although only a few midterm follow-up studies have been published. Purpose: To describe the outcomes of patients undergoing hip arthroscopy for femoroacetabular impingement at a mean 12-year follow-up and to determine the risk factors for failure. Study Design: Case-control study; Level of evidence, 3. Methods: The Non-Arthritic Hip Score (NAHS) and a radiographic evaluation were completed preoperatively and at midterm follow-up. Participants were divided into 2 groups according to their clinical evolution. The success group consisted of patients whose NAHS at the final follow-up was above the established Patient Acceptable Symptom State (PASS) threshold of 81.9, whereas patients who underwent a second surgical intervention or did not reach the PASS threshold at final follow-up were assigned to the failure group. These groups were compared to identify preoperative differences in demographic, pathological, and surgical factors. Results: A total of 95 hips were included, after 23 were lost to follow-up (80.5% follow-up). At a mean follow-up of 12.1 years (range, 9.2-16.0 years), 9 hips required total hip arthroplasty (9.5%), 5 required revision hip arthroscopy (5.3%), 29 did not achieve the NAHS PASS threshold (30.5%), and 52 achieved the NAHS PASS threshold (54.7%). The mean NAHS was 82.4 at final follow-up compared with 66.9 preoperatively (mean difference = 15.5; P < .001). Higher mean body mass index (24.9 vs 23.0; P = .030), older age (30.0 vs 27.2; P = .035), and inferior preoperative lateral joint space width (3.9 vs 4.4; P = .019) were associated with inferior prognosis in the failure group versus success group. Osteoarthritis progression was observed in 69.2% of the failure group and in 34.8% of the success group (P = .082). Labral ossification was observed in 78.3% of all patients, and its lateral projection length was statistically associated with failure (P = .015). Conclusion: At a mean 12-year follow-up, hip arthroscopy for femoroacetabular impingement led to significant clinical improvement, with 55% PASS achievement. In total, 31% of patients were below the PASS threshold, 5% had revision arthroscopy, and only 9% had conversion to total hip arthroplasty for a 45% global failure rate. Increased body mass index, older age, and smaller preoperative lateral joint space width were significant negative prognostic factors. Postoperative degenerative changes were highly prevalent and demonstrated association with failure.

High Survival Rate and Satisfaction at More Than 11-Year Follow-Up After Hip Arthroscopy for Femoroacetabular Impingement Syndrome: Impact of Preoperative Functional Scores, Osteoarthritis, and Chondrolabral Junction Damage on Failure

The purpose of the study was to investigate the survival and durability of clinical improvements following hip arthoscopy (HA) for femoroacetabular impingement syndrome (FAIS) at a minimum of 10-year follow-up. The primary objective was to determine the long-term survival, defined as: lack of conversion to total hip replacement (THR) or subsequent hip joint preservation surgery (HJPS). The secondary objective was to determine which preoperative factors were predictive of failure. Data from patients who underwent HA for FAIS between March 2003 and May 2012 were collected and retrospectively reviewed. Patients who underwent evaluation at a minimum 10-year follow-up, assessed according to hip outcome score - activities of daily living (HOS-ADL) and sport-specific subscale (HOS-SSS), and non-arthritic hip score (NAHS) were included. Satisfaction ratings were collected. Statistical analysis assessed within-group differences and survival. 95 patients with an average follow-up of 11.8 years were included. Mean age was 39.5 ± 11.0 years. Overall THR conversion rate was 24.2%, with a mean time of 3.4 ± 3.2 years. 3.2% required HJPS revision at a mean 3.2 ± 3 years. Survivorship was 72.6% at ten years. 28 patients (73.6% and 75.6%) achieved the minimal clinically important difference (MCID) for HOS-ADL and HOS-SSS, while 33 (84.6%) for NAHS. Patient Acceptable Symptom State (PASS) was achieved by 42 (61.7%), 43 (65.1%) and 44 (64.7%) patients respectively. Comparative analysis between patients who preserved their hip and those who underwent HJPS revision or THR highlighted that Tönnis ≥ 2, chondrolabral junction damage, and lower preoperative scores are associated with failure. HA for FAIS demonstrated durable results, with an accepatable THR conversion rate and sustained clinical benefits. 91.3% of the patients who preserved their hip were satisfied. Tönnis 2, MRA signs of chondrolabral junction damage and lower preoperative functional status are strongly associated with failure.

Midterm Outcomes After Simultaneous Hip Arthroscopic Surgery for Bilateral Femoroacetabular Impingement

Background: Bilateral hip arthroscopic surgery for the treatment of femoroacetabular impingement (FAI) has demonstrated good outcomes at short-term follow-up, with significant improvements in pain, hip function, and patient-reported outcomes, coupled with a complication rate similar to that of unilateral surgery. Purpose: To investigate whether, in patients with bilateral symptomatic FAI, simultaneous bilateral hip arthroscopic surgery is an efficacious option that produces effective midterm outcomes. Study Design: Cohort study; Level of evidence, 3. Methods: A prospective database of patients who underwent primary hip arthroscopic surgery between August 2012 and October 2020 was used to collect clinical data on 2 groups. Group 1 consisted of patients who underwent simultaneous bilateral hip arthroscopic surgery for the treatment of FAI. Group 2 represented a matched-pair control group of patients selected based on sex and age with signs and symptoms of unilateral FAI and in whom a single side was evaluated and treated. Differences in the International Hip Outcome Tool–12 and Non-Arthritic Hip Score scores were evaluated up to 5 years postoperatively. Results: In total, 171 patients (235 hips) were included, of whom 64 underwent simultaneous bilateral hip arthroscopic surgery (128 hips) and a control group of 107 patients (107 hips) underwent unilateral hip arthroscopic surgery. No significant differences were observed in International Hip Outcome Tool–12 scores between the 2 groups at 6 weeks, 3 months, 1 year, 2 years, and 5 years postoperatively. No significant differences were observed in Non–Arthritic Hip Score scores between the simultaneous bilateral and control groups at 6 weeks, 3 months, 6 months, 1 year, 2 years, and 5 years postoperatively. Overall, 18% of hips in the simultaneous bilateral group reported lateral femoral cutaneous nerve palsy at 2-week follow-up in comparison to 16% of hips in the control group. Conclusion: Simultaneous bilateral hip arthroscopic surgery for the treatment of FAI represents a safe treatment option, producing effective midterm outcomes in appropriately selected patients.

Longitudinal Assessment of Clinical Outcomes After Arthroscopic Treatment for Hip Synovial Chondromatosis and the Effect of Residual Loose Bodies: Minimum 4-Year and 8-Year Follow-up

Background: Arthroscopic treatment is recommended for hip synovial chondromatosis. However, evidence regarding long-term clinical outcomes is limited. Purpose: To evaluate long-term patient-reported outcomes (PROs) and survival, and to determine the potential effect of residual loose bodies, as evaluated by immediate postoperative computed tomography (CT), on clinical outcomes. Study Design: Case series; Level of evidence, 4. Methods: A consecutive cohort of patients undergoing arthroscopic treatment and diagnosed with synovial chondromatosis between March 2010 and May 2015 were included in the study. Preoperative radiography, CT, and magnetic resonance imaging were performed. Preoperative, midterm (minimum of 4 years), and long-term (minimum of 8 years) PROs were collected for visual analog scale for pain, modified Harris Hip Score (mHHS), Non-Arthritic Hip Score (NAHS), and 12-item international Hip Outcome Tool (iHOT-12). The percentages achieving minimal clinically important difference (MCID) were calculated. PROs and survival were compared between patients with and without residual loose bodies evident on immediate postoperative CT scan. Results: A total of 28 patients (20% of patients were lost to follow-up) were included in the study with a mean follow-up period of 104.9 months (range, 96-139 months). PROs including visual analog scale for pain (preoperative, 3.8 ± 1.2; midterm, 0.9 ± 1.7; long-term, 0.8 ± 1.4), mHHS (preoperative, 66.4 ± 14.4; midterm, 92.8 ± 12.3; long-term, 93.5 ± 10.5), NAHS (preoperative, 45.2 ± 16.2; midterm, 81.8 ± 15.3; long-term, 83.1 ± 12.9), and iHOT-12 (preoperative, 48.4 ± 15.6; midterm, 69.3 ± 11.7; long-term, 72.7 ± 11.4) were improved at both midterm and long-term follow-up (all with P < .001). In total, 27 (96.4%), 28 (100%), and 26 (92.9%) patients achieved MCID for mHHS, NAHS and iHOT-12, respectively, at the long-term follow-up. No significant difference was found in any of the PROs and the rate of achieving MCID between midterm and long-term follow-up (all with P > .05). One patient (3.6%) underwent revision surgery. Among the 23 patients who had loose bodies on preoperative CT or radiographs, 14 patients (60.9%) with residual loose bodies evident on immediate postoperative CT demonstrated lower NAHS (P = .045) and iHOT-12 (P = .037) scores but a comparable survival (P > .05) at long-term follow-up compared with those who did not have loose bodies. Conclusion: Arthroscopic treatment for hip synovial chondromatosis achieved satisfactory long-term clinical outcomes with strong survival. Most patients maintained or improved their overall functional status between midterm and long-term follow-up. Furthermore, patients with residual loose bodies had less favorable clinical outcomes, although the survival rate was comparable.

Poster 181: Hip Arthroscopy with Concomitant Periacetabular Osteotomy Demonstrates Excellent Outcomes and Survivorship at Minimum 10-Year Follow-Up

Objectives: Multiple studies have shown that hip arthroscopy with concomitant periacetabular osteotomy (PAO) is a safe and effective treatment option for patients presenting with Symptomatic acetabular dysplasia and intra-articular pathology. While excellent short- and mid-term outcomes have been previously reported, there exists a paucity of literature investigating long-term outcomes of hip arthroscopy with concomitant PAO. The purpose of this study was to report minimum 10-year follow-up results and survivorship of hip arthroscopy with concomitant PAO to treat acetabular dysplasia and intraarticular pathologies such as femoroacetabular impingement (FAI) and labral tears. Methods: Data from October 2010 to December 2012 was prospectively collected and retrospectively reviewed to identify patients undergoing hip arthroscopy with concomitant PAO. Patients were included in the present analysis if they had preoperative and minimum 10-year patient reported outcomes (PROs) documented for the modified Harris Hip Score (mHHS), Nonarthritic Hip Score (NAHS), Hip Outcome Scored Sports-Specific Subscale (HOS-SSS), and pain on a visual analog scale (VAS), as well as the International Hip Outcome Tool (iHOT-12) and patient satisfaction score on a 0-10 scale. Results: Fifteen patients were eligible for analysis and 12 had complete minimum 10-year follow-up (80.0%) at mean 10.2 years postoperation. There were 10 females (83.3%) and 2 males (16.7%) included in the study with a mean age and BMI of 24.4 years and 24.5 kg/m2, respectively. The mean lateral center-edge angle (LCEA) of all included hips in the analysis increased from 13.8° to 29.8° postoperatively ( P&lt;0.05) and the anterior center-edge angle (ACEA) increased from 14° to 28.8° postoperatively ( P&lt;0.05). Additionally, the Tönnis angle of acetabular inclination decreased from 17.9° to 7.3° postoperatively ( P&lt;0.05) and the alpha angle decreased from 56.5° to 52.1° postoperatively ( P&lt;0.05). There was significant improvement in all PROs from baseline to minimum 10-year follow-up (mHHS; NAHS; HOS-SSS, P&lt; 0.05). All patients achieved high rates of MCID for mHHS, NAHS, and HOS-SSS, as well as high rates of PASS for mHHS and VAS. The 10-year survivorship for all patients included in the analysis was 83.3% with 2 patients (16.7%) progressing to total hip arthroplasty (THA) at mean 58.0 months postoperatively. Additionally, 2 patients (16.7%) underwent subsequent ipsilateral revision hip arthroscopy at mean 79.5 months postoperatively. Conclusions: Patients with dysplasia and intra-articular pathology such as labral tears and FAI can be safely treated using hip arthroscopy with concomitant PAO. These patients can achieve excellent long-term outcomes and high rates of survivorship at minimum 10 years postoperation.

Poster 204: Periacetabular Osteotomy: A Case Series of More Than 500 Cases with Sub-Analysis Based on Patient Age at Surgery

Objectives: The purpose of this study is to report outcomes of a unique periacetabular osteotomy (PAO) technique for hip dysplasia developed at our institution. Methods: This was a retrospective, single-surgeon case series of prospectively collected data on all primary PAOs performed by the senior surgeon between April 2015 and April 2023. The technique has previously been described in the literature. This technique provides direct visualization of the sciatic nerve during the ischial osteotomy and allows for immediate weight bearing postoperatively. All patients underwent hip arthroscopy for treatment of intra-articular pathology and cam-type femoroacetabular impingement 3 to 10 days prior to PAO. Some patients also underwent de-rotational femoral osteotomy (DFO) for treatment of femoral torsion abnormalities. Revision PAOs or cases with concomitant hamstring or gluteus repair were excluded. Follow-up occurred at 6 weeks; 3 and 6 months; and 1, 2, and 5 years postoperatively. Patient-reported outcomes (PROs) included the Non-Arthritic Hip Score (NAHS) and the 12-item International Hip Outcome Tool (iHOT-12). A subanalysis was performed to compare 2-year PROs between 3 groups of patients based on age at the time of surgery: 13 to 29 years old, 30 to 39 years old, and &gt;40 years old. Results: A total of 511 hips underwent primary PAO during the study period. The mean age at the time of surgery was 31 years old (range, 13 to 61 years old). Female patients accounted for 90% of hips included in this study. A concomitant DFO was performed in 25 hips (4.9%). The mean NAHS improved from 58.7 preoperatively to 85.9 at 2-year follow-up (p &lt; 0.0001) and 83.4 at 5-year follow-up (p &lt; 0.0001). The mean iHOT-12 improved from 41.0 preoperatively to 77.5 at 2-year follow-up (p &lt; 0.0001) and 72.7 at 5-year follow-up (p &lt; 0.0001). No significant differences were found in postoperative NAHS (p = 0.82) or iHOT-12 scores (p = 0.73) between age groups. Conclusions: PAO enables corrective realignment of symptomatic acetabular dysplasia with good outcomes up to 5 years postoperatively. Careful patient selection can result in good outcomes regardless of patient age at the time of surgery.

Paper 16: Long-term Outcomes of Primary Hip Arthroscopy: Multicenter Analysis at Minimum 10-Year Follow-Up with Attention to Labral and Capsular Management

Objectives: Hip arthroscopy is rapidly advancing, with literature increasingly reporting positive outcomes at short- and mid-term follow-up; however, available long-term data remains limited. The purpose of this study is to evaluate long-term outcomes of primary hip arthroscopy at minimum 10-year follow-up at two academic centers by describing patient-reported outcomes (PROs) and determining reoperation, revision, and total hip arthroplasty (THA) rates. Methods: Primary hip arthroscopies performed between January 1988 and April 2013 at 2 academic centers were evaluated for postoperative PROs including Visual Analogue Scale (VAS), Tegner Activity Scale score, Hip Outcome Score Activities of Daily Living and Sport Scale (HOS-ADL/HOS-SS), modified Harris Hip Score (mHHS), Nonarthritic Hip Score (NAHS), 12-item International Hip Outcome Tool (iHOT-12), surgery satisfaction, function, and reoperations. Results: Two-hundred ninety-four primary hip arthroscopies with a mean age of 40±14 years; 66% female; and a mean body mass index (BMI) of 27±6 kg/m2 were followed for mean 12±3 years (range: 10-24). Labral debridement and repair were performed in 41% and 59% of patients, respectively. All patients underwent interportal capsulotomy and 2% underwent T-capsulotomy. Eleven percent of patients underwent capsular repair. At final follow-up, patients reported mean VAS at rest of 2±2, with use of 3±3, iHOT-12 of 68±27, NAHS of 81±18, mHHS of 79±17, HOS-ADL of 82±19, and HOS-SS of 74±25. Mean surgical satisfaction was 8.4±2.4 (Table 1). Sixty-five hips (23%) underwent THA and 33 (11%) underwent revision arthroscopy (Table 2). Risk factors for THA included older age (p&lt;0.001), higher BMI (p&lt;0.001), lower lateral center-edge angle (p=0.039), larger alpha angle (p=0.001), higher Tönnis grade (p=0.011), labral debridement (p=0.004), and capsular nonrepair (p=0.030). Patients undergoing combined labral and capsular repair demonstrated a THA conversion rate of 3% compared to 31% for patients undergoing combined labral debridement and capsular nonrepair (p=0.006) (Table 3). Labral repair trended towards increased 10-year THA-free survival (84% vs. 77%, p=0.085) while capsular repair demonstrated significantly increased 10-year THA-free survival (97% vs 79%, p=0.032) (Figure 1). Conclusions: At minimum 10-year follow-up, patients undergoing primary hip arthroscopy demonstrated high rates of satisfaction and acceptable outcome scores. In total, 11% of patients underwent revision hip arthroscopic surgery with a THA conversion rate of 23%. Conversion to THA was associated with patient factors including older age and higher Tönnis grade as well as potentially modifiable surgical factors including labral debridement and capsular nonrepair.

Is Arthroscopic Management of Synovial Chondromatosis of the Hip Enough?

Abstract Study Design: The design of the study was a retrospective case series. Objective: This study evaluated the clinical and radiological manifestations of synovial chondromatosis (SC) of the hip, along with the role of hip arthroscopy in the diagnosis and treatment of this pathologic condition and its postoperative curative effect. Patients and Methods: With a minimum 1-year follow-up, 13 hips with SC received arthroscopic surgery. Preoperatively and postoperatively, patients were assessed for hip pain using the modified Harris Hip Score and Nonarthritic Hip Score. Results: Considerable reduction in postoperative hip pain was observed in all cases, along with sufficient improvement in hip range of motion. Conclusion: Hip arthroscopy is a trusted and adequate treatment option for hip SC.

Poster 222: Long-term Survivorship in Patients with Coxa Profunda and Acetabular Overcoverage: An Average 11-Year Follow-up After Hip Arthroscopy

Objectives: A prior study investigating 2-year patient-reported outcomes (PROs) following hip arthroscopy found that patients with coxa profunda and acetabular overcoverage report worse improvements yet similar overall outcomes scores. Regarding conversion to total hip arthroplasty (THA), however, patients with coxa profunda and overcoverage experienced significantly lower rates of survivorship (88.9% vs 100%; p = 0.04). When considering long-term outcomes, a recent study by Domb et al. found an 85.7% 10-year survivorship in patients after hip arthroscopy. Currently, there remains a paucity of literature on the effects of a deep acetabular socket and pincer-type femoroacetabular impingement on patient outcomes beyond 2-years follow-up. The objective of the present study was to report the long-term survivorship, revision surgery rate, patient satisfaction, pain level, and functional outcome scores in patients with coxa profunda and acetabular overcoverage following hip arthroscopy. Methods: This was an institutional review board-approved retrospective cohort study of patients with coxa profunda and a LCE angle &gt; 40° who underwent hip arthroscopy for labral tears or FAI between November 2002 and May 2013. After failing conservative management, all patients were treated by a single surgeon and received the same capsulotomy technique and postoperative protocol. Patients with a minimum 8-years follow-up, complete PROs, the presence of coxa profunda as indicated by the acetabular wall projecting medial to the ilioischial line, and a LCE angle &gt; 40° were included (Figure 1). Patients with severe osteoarthritis (Tönnis osteoarthritis grade &gt; 2) or any previous hip surgeries were excluded. Patients meeting inclusion and exclusion criteria represented the overcoverage cohort (OC) and were matched 1:1 by sex, age within 8 years, body mass index (BMI) within 5 kg/m2, Tönnis grade, and labral treatment (repair vs debridement) to a matched control (MC) cohort that had a LCE angle between 25° and 40°. Collected postoperative outcomes include conversion to THA, revision hip arthroscopy, patient satisfaction, pain level (0-100), number of corticosteroid injections, and 6 PROs (modified Harris Hip Score (mHHS), Nonarthritic Hip Score (NAHS), Lower Extremity Functional Scale (LEFS), Hip Outcome Score (HOS)–Activities of Daily Living (HOS-ADL), HOS–Sports Specific subscale (HOS-SSS), and 33-item International Hip Outcome Tool (iHOT-33). Pearson χ2 test and Fisher exact test were used to compare categorical variables; two-sample t-tests were used to compare continuous variables. The threshold for statistical significance was set to 0.05. A survival analysis was performed using Kaplan-Meier curves. All statistical analyses were performed using Stata software (version 18.0; StataCorp). Results: A total of 38 patients in the OC cohort were 1:1 matched with 38 patients in the MC cohort. There were no differences in patient demographics including age, BMI, sex, Tönnis grade, labral treatment, follow-up duration, and Beck classification of labral damage or transition zone (chondrolabral junction) cartilage damage (Table 1). At an average of 11.3 years postoperatively (minimum 8-years follow-up), patients in the OC and MC cohort experienced similar rates of conversion to THA (OC: 11 [28.9%] vs MC: 6 [15.8%]; p = .169) and revision hip arthroscopy (OC: 4 [10.5%] vs MC: 1 [2.6%]; p = .165). The average time from primary hip arthroscopy to conversion to THA was 8.0 ± 6.5 years for OC and 3.7 ± 3.0 years for MC (p = .144) with the OC cohort converting to THA between 6.5 months to 17.14 years while the MC cohort ranged from 4.8 months to 7.8 years. Age at conversion to THA was 54.3 ± 8.0 years for the OC cohort and 59.0 ± 4.0 years for the MC cohort (p = .195). By Kaplan-Meier survival analysis, patients showed similar rates of survivorship (84.2%) at 12 years after hip arthroscopy; however, OC patients showed a 13.1% decrease in long-term survivorship (71.1%) between years 12 and 18 (Figure 2). Additionally, OC and MC patients showed similar levels of patient satisfaction, pain level, postoperative corticosteroid injections, and scores for all 6 PROs (Table 2). Conclusions: Patients with coxa profunda and overcoverage (LCE angle &gt; 40°) showed similar levels of survivorship, revision arthroscopy, patient satisfaction, pain level, number of corticosteroid injections, and PROs to a 1:1 matched cohort of patients with normal acetabular coverage (LCE angle between 25° and 40°) at a minimum 8-years after primary hip arthroscopy. When analyzing long-term survivorship after 12 years, however, patients with overcoverage showed a 13.1% decrease in long-term survivorship (71.1%) compared to a matched control cohort. Overall, a greater focus on extended follow-up care after hip arthroscopy is needed to improve long-term survivorship in patients with a deep acetabular socket and pincer-type femoroacetabular impingement.

Worker's compensation and no-fault insurance are associated with decreased patient reported outcomes and higher rates of revision at 2 and 5 years follow-up compared to patients with commercial insurance undergoing hip arthroscopy for femoroacetabular impingement.

To investigate the patient reported outcomes (PROs) of patients undergoing hip arthroscopy (HA) for femeroacetabular impingement syndrome (FAIS), a condition where irregular bone growth in the hip joint leads to friction and pain during movement, who have worker's compensation (WC) or no-fault insurance (NF) versus commercial insurance (CI) at both 2year and 5year follow-up. This was a single center, single surgeon, retrospective analysis performed between August 2007 and May 2023 of consecutive patients that underwent HA, a minimally invasive surgical procedure used to diagnose and treat problems inside the hip joint through small incisions, for FAIS. Patients were divided into two cohorts-those with WC/NF and those with commercial insurance (CI). Patient reported outcomes (PROs), which included modified Harris Hip Score (mHHS) and Non-Arthritic Hip Score (NAHS), were collected preoperatively, as well as at least 2-year postoperatively. Additionally, other clinically relevant outcomes variables including prevalence of revision surgery and conversion to total hip arthroplasty were recorded. Three hundred and forty three patients met inclusion criteria. There were 32 patients in the WC/NF cohort and 311 patients in the commercial cohort. When controlling for age, sex, and Body Mass Index (BMI), WC/NF status was associated with lower mHHS at both 2year (β = - 8.190, p < 0.01, R2 = 0.092) and 5year follow-up (β = - 16.60, p < 0.01, R2 = 0.179) and NAHS at 5year follow up (β = - 13.462, p = 0.03, R2 = 0.148). The WC/NF cohort had a lower rate of achieving Substantial Clinical Benefit (SCB) for mHHS at 2-years follow-up (66.7% vs. 84.1%, p = 0.02).The rate of revision hip arthroscopy was significantly higher in the worker's compensation/no fault cohort than the commercial insurance cohort (15.6% vs. 3.5%, p < 0.01). The rate of conversion to total hip arthroplasty (THA) in the WC/NF cohort was not significantly different than the rate of conversion to THA in the commercial insurance cohort (0.0% vs. 3.2%, p = 0.30). Patients with WC/NF insurance may expect a significant improvement from baseline mHHS and NAHS following HA for FAIS at short-term follow-up. However, this improvement may not be as durable as those experienced by patients with CI. Additionally, WC/NF patients should be counseled that they have a higher risk of undergoing revision hip arthroscopy than similar CI patients. III, Retrospective Comparative Prognostic Investigation.

Association Between Severity of Chondrolabral Junction Breakdown and Functional Outcomes After Hip Arthroscopy for Acetabular Labral Tears

Background: Despite focus on surgical preservation of the chondrolabral junction (CLJ), the transition zone between the acetabular cartilage and labrum, the association between severity of CLJ breakdown and functional outcomes after hip arthroscopy remains unexplored. Purpose: To assess the influence of CLJ breakdown on patient-reported outcome measures (PROMs) at a 24-month follow-up after hip arthroscopy for symptomatic labral tears. Study Design: Cohort study; Level of evidence, 3. Methods: A retrospective review of prospectively collected data was conducted to identify patients ≥18 years of age with a minimum 24-month follow-up who underwent hip arthroscopy by a single surgeon for the treatment of symptomatic labral tears secondary to femoroacetabular impingement. The Beck classification of transition zone cartilage was used to grade CLJ damage; patients with grades 0 to 2 were stratified into the mild CLJ damage cohort, and those with grades 3 and 4 were stratified into the severe CLJ damage cohort. PROMs were collected at baseline and at 3, 6, 12 months, and annually thereafter postoperatively. Linear mixed-effects models were used to compare PROMs. Rates of achieving clinically meaningful thresholds and subsequent surgery rates were also compared. Results: In total, 198 patients met the inclusion criteria, with a mean follow-up of 3.54 ± 1.26 years. A total of 95 patients with severe CLJ damage (mean age, 34.9 ± 10.5 years) were compared with 103 patients with mild CLJ damage (mean age, 38.2 ± 11.9 years). Hip Outcome Score–Activities of Daily Living (HOS-ADL), Non-Arthritic Hip Score (NAHS), and visual analog score for pain were inferior in the severe CLJ group at enrollment and all follow-up time points (P≤ .05). However, patients with severe CLJ breakdown exhibited greater improvements in HOS-ADL and NAHS at the 24-month follow-up and achieved clinically meaningful thresholds at equivalent rates to patients with mild CLJ breakdown. Subsequent surgery rates were 6.8% and 12.6% in patients with mild versus severe CLJ damage, respectively (P = .250). Conclusion: Severe CLJ breakdown is associated with increased pain and decreased functional level preoperatively and up to 24 months after hip arthroscopy. Despite this, patients with severe CLJ breakdown experienced greater improvements in functional outcomes at a 24-month follow-up and achieved clinical thresholds at similar rates to patients with mild CLJ damage. Thus, while worse baseline pain and functional levels may indicate severe CLJ breakdown, these patients still benefit substantially from hip arthroscopy.

Predictors of Clinical Outcomes After Hip Arthroscopy: 10-Year Follow-up Analysis of 1038 Patients

Background: Although hip arthroscopy has been shown to have beneficial outcomes, there is a paucity of literature examining predictive factors of 10-year clinical outcomes. Purpose: (1) To identify predictive factors of 10-year outcomes of hip arthroscopy and (2) to compare these factors with those found in 2-year and 5-year studies. Study Design: Cohort study; Level of evidence, 3. Methods: Data were prospectively collected and retrospectively reviewed on all patients undergoing hip arthroscopy between February 2008 and June 2012. Patients were included if they had a minimum 10-year follow-up on 2 patient-reported outcome measures: Nonarthritic Hip Score (NAHS) and modified Harris Hip Score. Exclusion criteria included previous ipsilateral hip conditions. Using bivariate and multivariate analyses, that authors analyzed the effects of 37 pre- and intraoperative variables on the NAHS, modified Harris Hip Score, and conversion to total hip arthroplasty. Results: Of the 883 patients who met the inclusion criteria, 734 (83.1%) had follow-up data. The mean follow-up time was 124.4 months (range, 120.0-153.1 months). Six variables were significant predictors of NAHS in both multivariate and bivariate analyses: revision status, body mass index (BMI), duration of symptoms, preoperative NAHS, age at onset of symptoms, and need for acetabular microfracture. Positive predictors of 10-year survivorship included acute injury and gluteus medius repair, while negative predictors included revision arthroscopy, Tönnis grade, acetabular inclination, iliopsoas fractional lengthening, and notchplasty Conclusion: Multiple predictive factors including age, BMI, revision status, and preoperative outcome scores were identified for long-term survivorship and functional outcomes. These may prove useful to clinicians in refining indications and guiding patients on expected outcomes of hip arthroscopy.