Postoperative Modified Harris Hip Score Research Articles

Outcomes after hip arthroscopy in patients with workers' compensation claims.

Patients with a workers' compensation claim have been shown to have inferior outcomes after various orthopedic procedures. In hip arthroscopy, good to excellent results have been shown in the athletic and prearthritic population in short-term and long-term follow-up. In the current study, the authors' hypothesis was that patients with a workers' compensation claim would have inferior outcomes after hip arthroscopy compared with patients without a workers' compensation claim. All patients with a workers' compensation claim who underwent hip arthroscopy over a 2-year period were studied. Postoperative functional outcomes were assessed with the Hip Outcome Score and modified Harris Hip Score. A cohort of 30 patients who did not have a workers' compensation claim was selected for comparison. Twenty-six patients were identified who had a workers' compensation claim and underwent hip arthroscopy performed by a single surgeon at the authors' institution with at least 6 months of follow-up. These patients were compared with 30 patients who did not have a workers' compensation claim. The workers' compensation group had a Hip Outcome Score of 66.5±28.8 and the non-workers' compensation group had a Hip Outcome Score of 89.4±12.0. This difference was statistically significant with Wilcoxon test (P=.003). The workers' compensation group had an average modified Harris Hip Score of 72.5±20.7 (mean±SD), and the non-workers' compensation group had a modified Harris Hip Score of 75.6±15.3. This difference was not significantly significant with Wilcoxon test (P=.9). At latest follow-up, 15 patients in the workers' compensation group (58%) were working. Patients returned to work an average of 6.8 months after surgery. The current study showed that postoperative functional outcomes in the workers' compensation group, as measured by Hip Outcome Score, were significantly inferior to those in the non-workers' compensation group. No statistical difference in postoperative modified Harris Hip Score was seen.

Arthroscopic Hip Revision Surgery for Residual Femoroacetabular Impingement (FAI)

Background: There are limited data reporting outcomes after revision arthroscopic surgery for residual femoroacetabular impingement (FAI). Hypothesis: (1) Revision arthroscopic FAI correction results in improved outcomes, but they are inferior to those of primary arthroscopic FAI correction. (2) Improved postrevision radiographic parameters are predictive of better outcomes. Study Design: Cohort study; Level of evidence, 3. Methods: Patients who underwent arthroscopic hip revision for residual FAI were reviewed. Pathomorphological findings, intraoperative findings, and preoperative and postoperative modified Harris Hip Score (MHHS), Short Form–12 (SF-12), and pain on a visual analog scale (VAS) values were evaluated. Outcomes after revision arthroscopic FAI correction were compared with outcomes of a matched cohort who underwent primary arthroscopic FAI correction. Results: A total of 79 patients (85 hips) with a mean age of 29.5 years underwent arthroscopic revision FAI correction (mean follow-up, 26 months). The labrum was debrided (27 hips), repaired (49 hips), or reconstructed (7 hips). Two labrums were stable and required no treatment. The results of revision arthroscopic FAI correction were compared with those of 220 age- and sex-matched patients (237 hips) who underwent primary arthroscopic FAI correction (mean follow-up, 23 months). The mean improvement in outcome scores after revision FAI correction was 17.8 (MHHS), 12.5 (SF-12), and 1.4 (VAS) points compared with 23.4 (MHHS), 19.7 (SF-12), and 4.6 (VAS) points after primary arthroscopic FAI correction. The mean improvement was significantly better in the primary cohort compared with the revision cohort (P < .01 for MHHS, SF-12, and VAS values). Good/excellent results were achieved in 81.7% of the primary cohort and 62.7% of the revision cohort (P < .01). Greater postoperative head-neck offset (P = .024), subspine/anterior inferior iliac spine (AIIS) decompression (P = .014), labral repair/reconstruction (P = .009), and capsular plication (P = .032) were significant predictors for better outcomes after revision surgery. Conclusion: Arthroscopic hip revision surgery for residual FAI yielded significantly improved outcome measures, but these were inferior to those after primary arthroscopic FAI corrective surgery. Improved femoral head-neck offset after cam decompression, identification and treatment of subspine/AIIS impingement, labral preservation/reconstruction, and capsular preservation/plication may be paramount to achieve satisfactory outcomes.

Clinical and Functional Outcome After Acetabular Labral Repair in Patients Aged Older Than 50 Years

To assess the clinical and functional outcome of labral repair in patients aged older than 50 years. We performed a prospective analysis of 20 patients aged older than 50 years who had undergone arthroscopic repair of a torn acetabular labrum (6 men and 14 women; mean age, 58 years). The indication for surgery was groin pain due to various causes with or without associated mechanical symptoms that did not respond to nonoperative treatment for more than 6 months. Intraoperatively, all patients were diagnosed with labral pathology. The mean duration of symptoms was 3.1 years (range, 0.5 to 15 years). The mean follow-up period was 22 months (range, 12 to 35 months). The outcome was prospectively measured with the modified Harris Hip Score (MHHS) and Hip Outcome Score (HOS). The indication for surgery was femoroacetabular impingement (FAI) with cam deformity and a labral tear in 4 patients, FAI with pincer deformity and a labral tear in 1 patient, FAI with both deformities in 1 patient, a gluteus medius tear in 2 patients, and an isolated labral tear in 12 patients. Acetabular chondral lesions were present in 11 patients (55%). The mean preoperative and postoperative MHHS was 62.5 and 87.2, respectively (P < .001); the mean preoperative and postoperative HOS was 42.7 and 86.3, respectively (P < .001); and the mean preoperative and postoperative level of function during usual activities of daily living according to the HOS was 46.0% and 73.7%, respectively (P < .001). No significant difference was identified in MHHS and HOS between gender groups. Arthroscopic management of FAI and labral repair in patients aged older than 50 years without significant arthritis (Tönnis grade 1 or better) are associated with significant improvement in outcome. Because of the potential importance of the labrum for long-term hip joint integrity, we advocate repair of the labrum in patients aged older than 50 years when possible. Level IV, therapeutic case series.

Capsular Repair for Instability Following Hip Arthroscopy for Femoroacetabular Impingement: Preliminary Outcomes and Description of Surgical Technique

Hip instability is a known complication after hip arthroscopy for femoroacetabular impingement (FAI). The incidence of this complication varies depending upon surgical technique and patient factors. We hypothesized that capsular repair in patients with symptoms of instability after arthroscopy and/or dislocation would lead to improved functional outcomes. These cases are chosen from a cohort of 324 patients who have undergone hip arthroscopy at our institution. This series includes 13 patients (14 hips) that had revision hip arthroscopy for instability after arthroscopy for FAI. Patients had a minimum follow up of six months from their revision procedure. They all underwent an arthroscopic capsular repair to address this instability. Patients had preoperative and postoperative modified Harris hip scores (mHHS) and Hip Outcome Scores (HOS) from both their index procedure and their capsular repair. All had a seven-level likert scale of perceived improvement from much worse to much improved after their revision surgery. Significance of improvement in outcomes scores was determined using a paired t-test. Revision surgery occurred at a mean of seventeen months after their index procedure (range, 10-32 months). The mHHS before the patients original procedure was 52.1 and improved to 62.5 before revision surgery (P=0.254). Similarly, HOS activities of daily living (ADL) scores means went from 60.6 to 67.2 (P=0.364) and the HOS Sports scale went from 29.4 to 37.8 (P=0.333) before revision surgery. The mean final follow up was twelve months from revision surgery (range, 6 to 24 months). Mean mHHS improved from 55.2 pre-revision to 88.2 at last follow up (p=0.001). Similarly, mean HOS ADL improved from 63.3 to 86.6 (P=0.002) and the HOS Sports scale improved from 30.4 to 66.9 (P=0.006). There were two patients without outcomes scores before their original procedure due to the fact that they were referred from elsewhere. At final follow up one HOS was missing. On the likert scale, one patient reported they were slightly improved, three reported being improved, nine reported being much improved, and one patient reported that they were significantly worse. Some patients who suffer instability after hip arthroscopy for FAI do not show improved outcomes after surgery. However, after their instability is addressed, most patients improve significantly. This study shows preliminary data that arthroscopic capsular repair for instability resulting from hip arthroscopy for FAI in properly selected patients is safe, effective, and reproducible. It provides good functional outcome and early recovery. Larger cohorts and longer follow-up are needed for further validation of this preliminary data.

The Analgesic Impact of Preoperative Lumbar Plexus Blocks for Hip Arthroscopy. A Retrospective Review

This study aimed to examine the impact of preoperative lumbar plexus blockade on perioperative analgesia and opioid consumption following hip arthroscopy. The records of patients (n = 236) who underwent hip arthroscopy between July 27, 2004 and November 15, 2009 were reviewed (118 patients with preoperative lumbar plexus block and 118 procedure matched patients without a preoperative block). Baseline patient characteristics were similar between groups. Immediate post-anaesthesia care unit (PACU) pain scores, peak PACU pain scores, perioperative opioid administration, and PACU antiemetic administration favoured preoperative block placement. Postoperative modified Harris Hip scores and postoperative day one pain scores were similar between groups. Total hospital time following the surgical procedure was longer in the block group. While preoperative lumbar plexus blockade may be helpful for analgesia following hip arthroscopy, more research needs to be done to determine the ideal analgesic regimen for these patients.

Acetabular Labral Tear and Postpartum Hip Pain

To educate the obstetrics community regarding postpartum labral tears, an avoidable and treatable potential complication of pregnancy in the postpartum period. From 2009 to 2011, 10 women presented to the second author's office with persistent hip pain that had begun during pregnancy or during delivery. These 10 postpartum women presented with signs and symptoms of labral tears, which were subsequently confirmed with arthroscopy and surgically repaired. Each patient experienced relief of symptoms within 4 months after the procedure. All patients were satisfied with surgery, and all patients had improvement in modified Harris hip score. The average preoperative modified Harris hip score was 53.1 and the average postoperative modified Harris hip score was 84.3 (P<.001). An acetabular labral tear should be considered part of the differential diagnosis for hip pain in postpartum women. Additionally, freeing the distal lower extremity to externally rotate during labor may prevent an acute labral tear. When nonoperative management fails, surgery may lead to positive outcomes. II.

Anterior Inferior Iliac Spine Deformity as an Extra-Articular Source for Hip Impingement: A Series of 10 Patients Treated With Arthroscopic Decompression

To describe an arthroscopic technique for decompression of a prominent anterior inferior iliac spine (AIIS) leading to extra-articular hip impingement and to provide short-term outcome after this procedure. We retrospectively reviewed office charts, imaging studies, operative reports, arthroscopic images, preoperative and postoperative hip flexion range of motion, and preoperative and postoperative modified Harris Hip Scores in a consecutive series of 10 male patients who had arthroscopic decompression of symptomatic AIIS deformities leading to extra-articular hip impingement. The procedure was performed through standard anterolateral and mid-anterior hip arthroscopy portals that were also used to explore the joint and address concomitant intra-articular pathologies. The mean age was 24.9 years, with 8 of 10 patients aged younger than 30 years. In 9 patients, an anterior cam lesion was identified and decompressed before the AIIS decompression. The mean follow-up time was 14.7 months (range, 6 to 26 months). Hip flexion range of motion improved from 99° ± 7° before surgery to 117° ± 8° after surgery (P < .001). The modified Harris Hip Score improved from 64 ± 18 before surgery to 98 ± 2 at latest follow-up after surgery (P < .001). Arthroscopic decompression of a symptomatic AIIS deformity is a reproducible procedure that can provide excellent outcomes at short-term follow-up. As opposed to using an open approach for decompressing a prominent AIIS, an arthroscopic approach may be of particular value in patients with mixed intra- and extra-articular sources of hip dysfunction, because it enables the surgeon to address all pathologies with a single arthroscopic procedure. Level IV, therapeutic case series.

Results of Arthroscopic Labral Reconstruction of the Hip in Elite Athletes (SS-39)

Results of Arthroscopic Labral Reconstruction of the Hip in Elite Athletes (SS-39)

Hip Arthroscopy Improves Symptoms Associated with FAI in Selected Adolescent Athletes

Femoroacetabular impingement (FAI) is increasingly diagnosed in young and middle-aged patients. Although arthroscopic procedures are becoming frequently used in the treatment of FAI, there are little data regarding rates of complications or the ability of hip arthroscopy to improve hip function specifically in the adolescent athlete population. Because arthroscopic treatment is being used in the treatment of FAI, it is vital to know what, if any, improvements in hip function can be expected and the potential complications. We asked (1) whether validated measures of hip function improve after arthroscopic treatment of FAI in adolescent athletes, and (2) what complications might be expected during and after arthroscopic treatment of FAI in these patients. We retrospectively reviewed the records of 27 hips in 21 patients 19 years of age or younger who underwent arthroscopic treatment for FAI between 2007 and 2008. From the records we extracted demographic data, operative details, complications, and preoperative and postoperative modified Harris hip scores (HHS) and the Hip Outcome Score (HOS). The minimum followup was 1 year (average, 1.5 years; range, 1-2.5 years). Modified HHS improved by an average of 21 points, the activities of daily living subset of the HOS improved by an average of 16 points, and the sports outcome subset of the HOS improved by an average of 32 points. All patients' self-reported ability to engage in their preoperative level of athletic competition improved. In 24 hips that underwent cam decompression, the mean alpha-angle improved from 64° ± 16° to 40° ± 5.3° postoperatively. We found short-term improvements in HOS and HHS with no complications for arthroscopic treatment of FAI in our cohort of adolescent athletes. We believe arthroscopic treatment of FAI by an experienced hip arthroscopist should be considered in selected patients when treating athletically active adolescents for whom nonoperative management fails.

Arthroscopic Treatment for Symptomatic Bilateral Cam-Type Femoroacetabular Impingement

Arthroscopic femoral osteochondroplasty improves clinical outcome in patients with unilateral cam-type femoroacetabular impingement. The goal of this study was to evaluate the clinical outcome and pathological similarities in patients who have had bilateral arthroscopic femoral osteochondroplasy for cam-type femoroacetabular impingement. The study group included 82 patients who had sequential bilateral hip arthroscopies for symptomatic cam-type femoroacetabular impingement with a minimum of 12 months follow-up. All patients had bilateral restricted hips at presentation. We differentiated between patients who had bilateral painful hips and those with unilateral pain at presentation. Scores and surgical findings were compared between the 2 study groups and between bilateral surgeries in each group. Pre- and postoperative Modified Harris Hip Scores and Non-Arthritic Hip Scores were undertaken prospectively by an independent observer. Mean patient age at the first surgery was 29 years (range, 14-63 years). The average time difference between arthroscopies was 5 months (range, 0.3-30 months). Postoperative scores improved significantly in both study groups in the first and second (contralateral) surgeries. Intra-articular pathologies between sides were linearly correlated for both groups. The time interval between surgeries had a linear correlation to age, reverse correlation to chondral damage, and reverse correlation to postoperative scores at the first surgery. Our results suggest that symptomatic patients with cam-type femoroacetabular impingement have similar accompanied pathologies on both sides and can benefit from sequential arthroscopic osteochondroplasty.

The Endoscopic Treatment of Sciatic Nerve Entrapment/Deep Gluteal Syndrome

The purpose of this study was to investigate the historical, clinical, and radiographic presentation of deep gluteal syndrome (DGS) patients, describe the endoscopic anatomy associated with DGS, and assess the effectiveness of endoscopic surgical decompression for DGS. Sciatic nerve entrapment was diagnosed in 35 patients (28 women and 7 men). Portals for inspection of the posterior peritrochanteric space (subgluteal space) of the hip were used as well as an auxiliary posterolateral portal. Patients were treated with sciatic nerve decompression by resection of fibrovascular scar bands, piriformis tendon release, obturator internus, or quadratus femoris or by hamstring tendon scarring. Postoperative outcomes were evaluated with the modified Harris Hip Score (MHHS), verbal analog scale (VAS) pain score, and a questionnaire related specifically to sciatic hip pain. The mean patient age was 47 years (range, 20 to 66 years). The mean duration of symptoms was 3.7 years (range, 1 to 23 years). The mean preoperative VAS score was 6.9 ± 2.0, and the mean preoperative MHHS was 54.4 ± 13.1 (range, 25.3 to 79.2). Of the patients, 21 reported preoperative use of narcotics for pain; 2 continued to take narcotics postoperatively (unrelated to initial complaint). The mean time of follow-up was 12 months (range, 6 to 24 months). The mean postoperative MHHS increased to 78.0 and VAS score decreased to 2.4. Eighty-three percent of patients had no postoperative sciatic sit pain (inability to sit for >30 minutes). Endoscopic decompression of the sciatic nerve appears useful in improving function and diminishing hip pain in sciatic nerve entrapment/DGS.

Hip Arthroscopy for Labral Tears

Background Arthroscopy of the hip joint is a relatively new diagnostic and therapeutic option for labral tears. Purpose More data are needed to characterize the utility and effectiveness of hip arthroscopy and identify patient-related factors that might predict functional outcome. Study Design Case series; Level of evidence, 4. Methods This retrospective study with prospective follow-up examined the clinical outcomes of 52 consecutive patients undergoing hip arthroscopy for labral tears. Outcomes measures included clinical outcome and the modified Harris hip score. Any complications associated with the procedure were recorded. Exclusion criteria included age younger than 18 years or prior ipsilateral hip surgery. Results Mean patient age was 42 years. Mean follow-up was 4.8 years. Twenty-one patients (40.4%) had a traumatic cause of the labral tears. Eight patients (15.4%) had possible secondary gain issues. Four (7.7%) patients suffered transient nerve palsies; in 1 case, the guide wire broke during initial cannulation. Three patients (5.8%) went on to total hip arthroplasty after hip arthroscopy. On multivariate analysis, left-sided surgery, a higher preoperative activity level, and duration of symptoms greater than 18 months were found to be positive predictors of good or excellent outcomes. Smoking and secondary gain issues were significant negative predictors of good or excellent outcomes. Only prior level of activity was a significant positive predictor of return to activity after surgery. A traumatic cause of the labral tear was a significant negative predictor of return to activity. Chondromalacia and osteoarthritis were not significant predictors of negative outcome. Postoperative modified Harris hip score improved 40% from 56.8 preoperatively to 80.4 (P < .001). No cases of patients with secondary gain issues achieved good or excellent outcomes. Overall percentage of good or excellent outcomes was 56%, or 66% when those with secondary gain issues were excluded; 84% of patients were able to return to sports or equivalent level of preoperative recreational activity. Neither preoperative radiographic osteoarthritis nor grade of intraoperative chondromalacia predicted postoperative outcome. Conclusion This series supports the hypothesis that hip arthroscopy provides safe and reliable improvement of labral symptoms in the majority of patients.

Early outcome of hip arthroscopy for femoroacetabular impingement

There is a known association between femoroacetabular impingement and osteoarthritis of the hip. What is not known is whether arthroscopic excision of an impingement lesion can significantly improve a patient's symptoms. This study compares the results of hip arthroscopy for cam-type femoracetabular impingement in two groups of patients at one year. The study group comprised 24 patients (24 hips) with cam-type femoroacetabular impingement who underwent arthroscopic debridement with excision of their impingement lesion (osteoplasty). The control group comprised 47 patients (47 hips) who had arthroscopic debridement without excision of the impingement lesion. In both groups, the presence of femoroacetabular impingement was confirmed on pre-operative plain radiographs. The modified Harris hip score was used for evaluation pre-operatively and at one-year. Non-parametric tests were used for statistical analysis. A tendency towards a higher median post-operative modified Harris hip score was observed in the study group compared with the control group (83 vs 77, p = 0.11). There was a significantly higher proportion of patients in the osteoplasty group with excellent/good results compared with the controls (83% vs 60%, p = 0.043). Additional symptomatic improvement may be obtained after hip arthroscopy for femoroacetabular impingement by the inclusion of femoral osteoplasty.

Early Outcomes After Hip Arthroscopy for Femoroacetabular Impingement in the Athletic Adolescent Patient

Hip arthroscopy is becoming a more popular method of treatment of pediatric hip disorders. We report on the treatment of femoroacetabular impingement (FAI) in the adolescent population. Between March 2005 and May 2006, 16 patients (aged 16 years or younger) underwent hip arthroscopy for FAI. There were 14 female adolescents and 2 male adolescents, with 1 patient undergoing a bilateral procedure. Five patients had isolated pincer impingement, 2 had isolated cam impingement, and 9 had mixed pathology. All patients had labral pathology. Seven patients were treated with suture anchor repair of the labrum and 9 with partial labral debridement. Subjective data were collected from each patient during their initial visit and at follow-up after surgery. Subjective data included the modified Harris hip score (MHHS), patient satisfaction, and hip outcome score (HOS) activities of daily living (ADL), and sports subscales. The mean age at the time of arthroscopy was 15 years old (range, 11-16 years). The mean preoperative MHHS was 55 (range, 33-70), HOS ADL was 58 (range, 38-75), and HOS sport was 33 (range, 0-78). The mean time from injury to surgery was 10.6 months (range, 6 weeks-30 months). The mean time to follow-up was 1.36 years (range, 1-2 years). The mean postoperative MHHS improved 35 points to 90 (range, 70-100; P = 0.005), postoperative HOS ADL improved 36 points to 94 (range, 74-100; P = 0.001), and postoperative HOS sport score improved 56 points to 89 (range, 58-100; P = 0.001). The mean patient satisfaction score was 9 (range, 9-10). Hip arthroscopy for FAI in the adolescent population produces excellent improvement in function and a high level of patient satisfaction in the short-term.

Cementless femoral revision arthroplasty: 2- to 5-year results with a modular titanium alloy stem

Seventy-five consecutive cementless femoral revision arthroplasties were performed, using a modular titanium alloy stem (S-ROM, Joint Medical Products, Stamford, CT). Sixty-six hips were available for complete follow-up evaluation at 2 to 5 years (average, 3.4 years). Independent clinical analysis compared pre- with postoperative modified Harris hip scores and examined patient satisfaction. Independent radiographic analysis was also undertaken. There were two rerevisions, both for hematogenous sepsis. Of the rest, clinical scores improved from a preoperative value of 44 to a postoperative value of 83. Eighty-nine percent of patients were satisfied or very satisfied with the results of surgery. Fifty-two stems had solid bony ingrowth, seven were stabilized by fibrous tissue, and five were radiographically loose. Five-year survival, with rerevision as endpoint, was 96.4%.