Undergoing Hip Arthroscopy Research Articles

The Impact of Anterior Pelvic Tilt on Return to Duty/Return to Run in Active Duty Personnel After Hip Arthroscopy for Femoroacetabular Impingement.

Annually, 300,000 soldiers are rendered medically nondeployable because of musculoskeletal injuries (MSKIs). Of this population, nearly 10,000 (3.3%) involve injuries to the hip. Factors related to these injuries impose significant healthcare, financial, and readiness burdens on the Army system, degrading overall mission readiness. The purpose of this retrospective study was to assess for correlation between increased anterior pelvic tilt and a lower likelihood for return to duty/return to run (RTD/RTR) in active duty personnel who underwent hip arthroscopy for femoroacetabular impingement (FAI), thus identifying increased anterior pelvic tilt as a potential prognostic indicator for RTD/RTR. Ninety-two active duty U.S. Army service members aged 18 years or older who underwent hip arthroscopy for FAI at the William Beaumont Army Medical Center from September 1, 2014, to September 1, 2019, were included. Utilizing a retrospective review of existing data, the amount of anterior pelvic tilt, as estimated on a presurgical weight-bearing anterior-posterior pelvis radiograph using the distance from the pubic symphysis to the transischial line, was measured and compared to postoperative RTD/RTR statuses, assessing for correlation. The overall RTD rate was 39.1% with a 22.8% RTR rate. Only 6.5% (6/92) of subjects returned to full, unrestricted duty and running. Logistic regression analyses showed that individuals with increased anterior pelvic tilt (≥7°) were 2.6 times less likely to RTD and 2.9 times less likely to RTR compared to those with minimal or no anterior pelvic tilt (<7°) (respectively, odds ratio (OR) 2.619; 95% CI, 1.107-6.195; P = .029 and OR 2.897; 95% CI, 1.041-8.059; P = .042). Results support the study teams' hypothesis that increased anterior pelvic tilt is associated with a lower odds of RTD/RTR. Statistical analysis confirmed the correlation between an increased amount of anterior pelvic tilt and a lower odds of RTD and RTR after hip arthroscopy for FAI in active duty U.S. Army personnel. This information can be used in patient counseling to better inform shared decision-making, provide more thorough informed consent, and help determine the optimal timing for surgical intervention, thus contributing to better stewardship of medical resources and decreasing the ever-growing financial healthcare burden. These findings will spur future research to consider the causes and optimal treatment of anterior pelvic tilt, positively impacting the culture of Army medicine by focusing on preventive and targeted treatments in order to preserve and grow the force.

A retrospective cohort study: dual cannula combined with modified shoelace continuous capsular closure technique versus nonrepair in hip arthroscopic surgery of femoroacetabular impingement

BackgroundOver the years, with the improvement of diagnostic and therapeutic capabilities for hip joint diseases and the advancements in surgical technology, hip arthroscopy has been extensively used. At present, there is ongoing controversy among scholars about whether it is necessary to close the joint capsule after hip arthroscopy. In addition, the clinical effect of repairing the hip joint capsule after hip arthroscopy remains uncertain.PurposeTo evaluate the effect of our modified shoelace suture technique on postoperative hip function and to investigate whether complete closure of the hip capsule is reliable and safe.Study DesignRetrospective study; Levels of evidence: III.MethodsA retrospective review was conducted on patients undergoing hip arthroscopy by a solitary high-volume hip arthroscopic surgeon. The patients were categorized into two groups. The first group consisted of patients who underwent the modified shoelace continuous capsular closure technique. The other group consisted of those who did not receive capsular closure after hip arthroscopy. Patient-reported outcomes including modified Harris Hip Score (mHHS), Hip Outcome Score of Activities of Daily Living (HOS-ADL), Hip Outcome Score Sport-Specific Subscale (HOS-SSS), and visual analogue scale (VAS) were obtained at a minimum of 12 months. Any complications during follow-up were identified and recorded.ResultsA total of 100 patients were followed up for 12–15 months, with an average of (12.3 ± 5.3) months in the study. There were 50 patients in the shoelace capsular closure group (CC group) and 50 patients in the non-capsular closure group (NC group). The surgical time in the suture group was significantly longer than that in the non-suture group. However, there was no statistically significant disparity in the length of hospital stay between the two groups. The mHHS, HOS-SSS, HOS-ADL, and VAS of the CC and NC group were significantly improved compared to preoperative scores at 6 and 12 postoperative months (P < 0.001). Compared with the NC group, the CC group showed a significant improvement in the mHHS, HOS-SSS, HOS-ADL, and VAS at 6 postoperative months (t = 4.885, P<0.001; t = 5.984, P<0.001; t = 4.279, P<0.001; t = 3.875, P<0.001). The mHHS, HOS-SSS, HOS-ADL, and VAS at 12 postoperative months were significantly better in the CC group than in the NC group (t = 5.165, P<0.001; t = 3.697, P<0.001; t = 4.840, P<0.001; t = 3.579, P = 0.001). There were no serious complications during the perioperative period.ConclusionThe modified shoelace continuous capsular closure technique is a reliable and secure method that can be used as an alternative to the conventional capsular closure. It is recommended to perform routine intraoperative repair of the articular capsule at the end of hip arthroscopy, as this has a positive influences on the functional results at short-term follow-up.

Hip Arthroscopy for Femoroacetabular Impingement Syndrome in High-Level Athletes: A 10-Year Follow-up.

Arthroscopic treatment for femoroacetabular impingement syndrome (FAIS) has previously been reported to have favorable short-term results in high-level athletes. Less is known about long-term outcomes. To report outcomes 10 years after hip arthroscopy for FAIS in high-level athletes using validated patient-reported outcome measures (PROMs). Case series; Level of evidence, 4. Patients who underwent hip arthroscopy between November 2011 and January 2013 were included in a local hip arthroscopy registry and completed preoperative PROMs. At 10-year follow-up, the same PROMs were completed. Inclusion criteria were age <40 years at time of surgery, no prior hip surgeries, and a pre-symptomatic Hip Sports Activity Scale (HSAS) level of 7 or 8. The exclusion criterion was total hip arthroplasty at follow-up. The PROMs included the international Hip Outcome Tool-12 items (iHOT-12), the Copenhagen Hip and Groin Outcome Score (HAGOS), visual analog scale (VAS) for overall hip function, European Quality of Life-5 Dimensions questionnaire (EQ-5D) and European Quality of Life-visual analog scale (EQ-VAS), HSAS, and a single question on patient satisfaction. The rates of patients achieving minimal important change and reporting Patient Acceptable Symptom State (PASS) were reported for HAGOS and iHOT-12. For iHOT-12, preoperative results were compared with 1, 5, and 10-year follow-ups. A total of 45 patients (34 men, 11 women; 70 hips; mean age 24.4 years at time of surgery) were included, with 77 patients eligible for inclusion. Significant improvements (P < .001) were seen at 10-year follow-up in all HAGOS subscales: Symptoms, Pain, Daily Activity, Sports, Physical Activity, Quality of Life (50.3 vs 78.6, 59.2 vs 86.8, 65.9 vs 88.8, 37.1 vs 81.1, 24.4 vs 81.1, 32.1 vs 79.3), iHOT-12 (40.1 vs 81.6), EQ-5D (0.59 vs 0.89), EQ-VAS (65.6 vs 80.4), and VAS for overall hip function (48 vs 79). For iHOT-12, the largest change was seen between preoperative and 1-year follow-up values, with consistent results over time. There was no statistically significant difference between HSAS levels preoperatively and at 10-year follow-up (HSAS level 4), with 24% of patients reporting a HSAS level 7 or 8 at the follow-up. Of the patients, 93% reported satisfaction with the surgery. PASS was achieved in 82% for iHOT-12, with a range of 76% to 91% for HAGOS subscales. Furthermore, 93% exceeded the minimal important change for iHOT-12, and a range of 67% to 84% for HAGOS. In a high-level athletic population, significant improvements in long-term outcomes are reported after hip arthroscopy for FAIS, with patients reporting a high satisfaction rate. The results also show that the largest improvement occurs within the first postoperative year, with results being maintained for 10 years.

Clinical Outcomes of the Arthroscopic Capsular Suture-Lifting Technique in the Treatment of Femoroacetabular Impingement in Patients With Borderline Developmental Dysplasia of the Hip

Background: Patients with femoroacetabular impingement (FAI) are likely to present with borderline developmental dysplasia of the hip (BDDH). Considering the prolonged risk of negative prognosis in these patients, the need for surgical management of the capsule has been emphasized. Although previous studies have advocated different techniques of capsular closure during surgery, no consensus has been achieved. Therefore, the aim of this study was to evaluate the clinical outcomes of a new arthroscopic capsular suture-lifting technique for the treatment of FAI combined with BDDH. Hypothesis: The arthroscopic capsular suture-lifting technique would achieve better anterior stability and show better clinical outcomes compared with routine capsular closure. Study Design: Cohort study; Level of evidence, 3. Methods: Consecutive patients diagnosed with FAI and BDDH and who underwent hip arthroscopy in our hospital between September 1, 2017, and April 30, 2021, were evaluated. Data were collected prospectively and analyzed retrospectively. Patients were divided into 2 groups according to the capsule closure methods used: capsular suture-lifting technique (lifting group) and routine capsular closure (control group). Anteroposterior hip radiography, Dunn view radiography, and computed tomography imaging were carried out for all patients preoperatively and postoperatively. Patient-reported outcomes, including the modified Harris Hip Score (mHHS) and visual analog scale (VAS) for pain, were collected preoperatively and at least 1 year after surgery and compared between the 2 groups. The Wilcoxon signed-rank test was used to evaluate changes in preoperative to postoperative mHHS scores and VAS. Mann-Whitney U test was used to evaluate significant differences in postoperative mHHS and VAS scores in the 2 groups. Results: In all, 144 patients were included in this study, of whom 77 (53.5%) underwent the arthroscopic capsular suture-lifting technique and 67 (46.5%) underwent routine arthroscopic surgery. The patients in both groups had significant improvement in postoperative mHHS and VAS compared with the preoperative assessment ( P &lt; .05). The postoperative VAS score of patients in the suture-lifting group was significantly lower (2.6 vs 3.8; P &lt; .05) and the mHHS score was significantly higher (75.2 vs 68.5; P &lt; .05) than those of patients in the control group. Of the 77 patients in the suture-lifting group, 68 (88.3%) surpassed the minimal clinically important difference (MCID) and 49 (63.6%) achieved the Patient Acceptable Symptom State (PASS). Of the 67 patients in the control group, 26 (38.8%) surpassed MCID and 32 (47.8%) achieved PASS. The percentage of patients achieving MCID and PASS in the suture-lifting group was significantly greater than that in the control group ( P = .007 for MCID; P = .03 for PASS). Conclusion: The study demonstrated that the arthroscopic capsular suture-lifting technique provided good clinical outcomes in the treatment of patients with FAI combined with BDDH. This technique showed better improvement of postoperative clinical outcomes than routine capsular closure.

Females have Higher Return to Sport Rate than Males Among Collegiate Athletes Following Hip Arthroscopy for Femoroacetabular Impingement Due to the Difference in the Type of Sports, Type of Impingement, Prevalence of Severe Cartilage Damage

To investigate the return to sport (RTS) rate and the sex-based difference of collegiate athletes following arthroscopic treatment for FAI. Patients who were collegiate athletes at the time of surgery and underwent hip arthroscopy for treatment of FAI between January 2009 and June 2020 were included. Patients were excluded if they were in their final year of eligibility, graduated, retired, or had plans to retire from collegiate play prior to surgery. Publicly available data was collected regarding each patient's collegiate team and division, and RTS status after surgery. Comparisons were made based on the RTS status and gender. Of the 181 hips (144 athletes) who met the inclusion criteria, 114 were male (63%) and 67 female (37%) hips with a median age of 20.4 (Range: 18.0-24.5). Eighty-six percent (155 hips) returned to sport at the collegiate level following hip arthroscopy. Males were significantly less likely to return to sport compared to females (82% vs 93%, OR = 2.8, 95% CI [1.003, 7.819], p=0.042). Males participated in more contact sports (26% vs 1.5%, p < 0.001) and had more mixed-type FAI (95.6% vs 80.6%, P=0.003) compared to females. In addition, males had more grade 3/4 chondral defects (28% vs 13%, p=0.023) and underwent microfracture more frequently (11% vs 3%, p=0.047). Further, males had significantly larger postoperative alpha angles (46.2 vs 43.6, p< .001). Collegiate athletes were found to have a high return to sport rate of 86% following arthroscopy for the treatment of FAI, however, males were less likely to return to sport compared to females. Sex-based differences were identified in the type of sports, type of FAI, prevalence of severe cartilage damage, and postoperative alpha angle. Retrospective case series, Level IV.

A Multicenter Analysis of 3 Decades of Hip Arthroscopy: Evolving Techniques and Growing Patient Volumes From 1988 to 2022.

The number of hip arthroscopies performed in the United States has grown significantly over the past several decades, with evolving indications and emerging techniques. To (1) examine the evolution of hip arthroscopy at 3 tertiary referral centers between 1988 and 2022 and (2) quantify trends in patient demographics and procedures performed. Case series; Level of evidence, 4. A retrospective analysis was performed of all patients undergoing hip arthroscopy at 3 academic centers between 1988 and 2022. Demographic data were collected using standardized forms and operative notes, and intraoperative images were manually reviewed for each patient to determine the specific procedures performed at the time of the hip arthroscopy. Surgical procedures were plotted over time to evaluate trends. Patients were divided into 3 time periods for comparison: early hip arthroscopy from 1988 to 2008, 2009 (the time of the first labral repair in our cohort) to 2015, and 2016 to 2022. A total of 3000 patients (age, 35.7 ± 13.8 years; age range, 10-89 years; female sex, 2109 (70.3%); body mass index, 27.4 ± 6.3 kg/m2) underwent arthroscopic hip procedures between 1988 and 2022. The mean number of cases increased from a mean of 3.2 per year in 1988-2008 to 285.9 per year in 2016-2022 (P < .001). Labral treatment at the time of primary hip arthroscopy evolved from 100% debridement and 0% repair in 1988-2008 to 5.0% debridement, 94.0% repair, and 1.0% labral reconstruction in 2016-2022 (P < .001). Cam resection increased from 4.1% in 1988-2008 to 86.9% in 2016-2022 (P < .001). By 2022, 45 out of 325 cases (13.8%) were revisions. The rate of capsular repair at the time of primary hip arthroscopy increased from 0.0% in 1988-2008 up to 81.0% in 2016-2022. There has been a significant growth of hip arthroscopy volumes as well as a significant transition from use as a tool for diagnosis and labral debridement to procedures restoring native anatomy including labral repair, cam resection, capsular repair, periacetabular osteotomy, and gluteal repair.

Borderline Hip Dysplasia - Best Treated with Hip Arthroscopy or Periacetabular Osteotomy?

As the field of hip preservation evolves, the diagnosis of borderline dysplasia (defined as a lateral center edge angle between 18°-25°) has shown itself to be one of the more challenging diagnoses to treat. As the nuances of acetabular coverage have come to light, the question of whether borderline hip dysplasia is best treated with isolated hip arthroscopy, periacetabular osteotomy, or whether a combined procedure is best, is now top of mind. The goal of these procedures is to not only improve patient symptoms, but to correct underlying pathology and ideally slow the development of hip osteoarthritis. The purpose of this review is to summarize the recent literature and clinical findings regarding both isolated hip arthroscopy and periacetabular osteotomy in the surgical management of borderline hip dysplasia. Current research demonstrates improved postoperative clinical outcome scores for both patients who had isolated hip arthroscopy in the setting of borderline hip dysplasia and for those patients who underwent periacetabular osteotomy. Mid-term outcomes for patients in both groups have showed low rates of conversion to total hip arthroplasty. No gold standard in the surgical management of borderline hip arthroscopy exists. Improved clinical outcomes have been seen postoperatively in patients who undergo hip arthroscopy and in patients who undergo periacetabular osteotomy. Successful clinical outcomes seem to rely on treatment of the underlying clinical pathology and are largely based on the appropriate surgical indications and appropriate surgical techniques. Surgical decision making in this patient population should be individualized based on a comprehensive evaluation of the patient.

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.

Identifying Racial Disparities in Utilization and Clinical Outcomes of Ambulatory Hip Arthroscopy: Analysis of Temporal Trends and Causal Inference via Machine Learning.

Arthroscopic diagnosis and treatment of femoroacetabular pathology has experienced significant growth in the last 30 years; nevertheless, reduced utilization of orthopaedic procedures has been observed among the underrepresented population. The purpose of this study was to examine racial differences in case incidence rates, outcomes, and complications in patients undergoing hip arthroscopy. It was hypothesized that racial and ethnic minority patients would undergo hip arthroscopy at a decreased rate compared with their White counterparts but that there would be no differences in clinical outcomes. Cross-sectional study. The State Ambulatory Surgery and Services Database and the State Emergency Department Database of New York were queried for patients undergoing hip arthroscopy between 2011 and 2017. Patients were stratified into White and racial and ethnic minority races, and intergroup comparisons were performed for utilization over time, total charges billed per encounter, 90-day emergency department (ED) visits, and revision hip arthroscopy. Temporal trends in the utilization of hip arthroscopy were identified, and racial differences in secondary outcomes were analyzed with a semiparametric method known as targeted maximum likelihood estimation (TMLE) backed by a library of machine learning algorithms. A total of 9745 patients underwent hip arthroscopy during the study period, with 1081 patients of minority race (11.1%). White patients underwent hip arthroscopy at 5.68 (95% CI, 4.98-6.48) times the incidence rate of racial and ethnic minority patients; these incidence rates grew annually at a ratio of 1.11 in White patients compared with 1.03 in racial and ethnic minority patients (P < .001). Based on the TMLE, racial and ethnic minority patients were significantly more likely to incur higher costs (P < .001) and visit the ED within 90 days (P = .049) but had negligible differences in reoperation rates at a 2-year follow-up (P = .53). Subgroup analysis identified that higher likelihood for 90-day ED admissions among racial and ethnic minority patients compared with White patients was associated with Medicare insurance (P = .002), median income in the lowest quartile (P = .012), and residence in low-income neighborhoods (P = .006). Irrespective of insurance status, racial and ethnic minority patients undergo hip arthroscopy at a lower incidence and incur higher costs per surgical encounter.

Patients Undergoing Hip Arthroscopy With Concomitant Periacetabular Osteotomy Demonstrate Clinically Meaningful Improvement at 2 Years Using the Patient-Reported Outcome Measurement Information System and International Hip Outcome Tool 12

PurposeTo report the minimal clinically important difference (MCID) and substantial clinical benefit (SCB) values using the Patient-Reported Outcome Measurement Information System (PROMIS) and International Hip Outcome Tool 12 (iHOT-12) in patients undergoing hip arthroscopy (HA) with concomitant periacetabular osteotomy (PAO), HA+PAO for acetabular dysplasia and intra-articular pathology with minimum 2-year follow up. MethodsData from patients who underwent HA+PAO was prospectively collected and retrospectively analyzed. Inclusion criteria consisted of patients who had a diagnosis of hip dysplasia or hip instability and had minimum 2-year PROMs follow up. Data was collected electronically preoperatively and postoperatively at 6 months, 1year, and 2 years. Outcome measures analyzed were the iHOT -12 and PROMIS computer adaptive tests (CAT): Physical Function (PF), Pain Interference (PI), and Global Physical Health (GPH). MCID and SCB were calculated for these measures. Results106 patients were included in the study with an average age of 23.5 ± 6.6, an average body mass index (BMI) of 24.3, and the majority being female (94%). The values for MCID were calculated to be 40.9, 40.7, 60.2, and 43.5 and the percentage achieving MCID at 2 years was 82.6%, 82.9%, 79.6%, and 80.1% for the iHOT-12, PROMIS-PF, PROMIS-PI, and PROMIS-GPH respectively. The 1 year and 2-year SCB scores for ≥ 80% satisfaction and percent achieving were as follows respectively: iHOT-12 (71.8 (60.3%), 61.9 (65.1%)); PROMIS-PF (47.1 (64.2%), 47.2 (71.7%)); PROMIS-PI (50.6 (48.1%), 52.3 (49.1%)); PROMIS-GPH (49.3 (54.7%), 49.3 (55.7%)). The 1 year and 2 year SCB scores for 100% satisfaction and percent achieving were as follows respectively: iHOT-12 (80.2 (44.3%), 81.3 (47.2%)); PROMIS-PF (50.7 (46.2%), 50.3 (56.6%)); PROMIS-PI (52.4 (34.9%), 52.4 (49.1%)); PROMIS-GPH (52.5 (36.8%), 49.3 (55.7%)). ConclusionThis study reports values for MCID and SCB for PROMIS and iHOT-12 at 2-year follow up in patients undergoing HA+PAO for hip dysplasia or instability. The percentage of patients achieving MCID ranged from 79.6%-82.9% at 2-year follow-up. In addition, the percentage of patients achieving SCB at 2-year follow up for ≥ 80% satisfaction ranged from 49.1%-71.2% and the percentage for 100% satisfaction ranged from 49.1%-56.6%

Moderate burden amongst caregivers posthip arthroscopy linked to younger caregiver age and task load: A cross-sectional survey study.

To evaluate the burden experienced by primary informal caregivers of patients who have undergone hip arthroscopy and to identify factors that predict increased caregiver burden. A cross-sectional study was conducted at a single academic hospital centre, enroling caregivers of patients who underwent hip arthroscopy between November 2018 and November 2023. Caregiver burden was assessed using the Caregiver Burden Inventory (CBI) survey. Multivariable linear regression models were used to identify predictors of caregiver burden, with the global CBI score serving as the primary outcome measure. Secondarily, open-ended survey questions were analyzed qualitatively to elucidate specific challenges and facilitators of caregiving, as reported by the caregivers themselves. The study involved 99 eligible caregivers (mean [standard deviation] age; 47 [11] years), 58% were female, and 85% were relatives of the patient. The median global CBI score was 13.0 (interquartile range: 8.0-22.4), indicating a moderate burden. Regression analyses demonstrated that younger caregiver age and a higher number of caregiving tasks were significant predictors of increased global burden. Additionally, nonweightbearing status of patients, female gender of caregivers and working full-time statistically significantly increased specific dimensions of caregiver burden. This study highlights the meaningful burden faced by caregivers of patients undergoing hip arthroscopy, despite its minimally invasive nature and outpatient setting. Identified risk factors such as younger caregiver age, female gender of the caregiver, nonweight-bearing status and increased caregiving tasks suggest targeted areas for intervention. The qualitative analysis revealed that caregivers struggle with time management and physical and emotional strain, yet better communication and practical support from healthcare teams could help to alleviate these challenges. Level IV, prognostic study.

Effect of the presence of cysts in the hip joint on hip arthroscopy.

The aim of this study was to investigate whether the presence and size of fibrous cysts affected postoperative results in patients undergoing hip arthroscopy. Between January 2010 and December 2019, a total of 261 patients (138 males, 123 females; mean age: 39.5±11.9 years; range, 18 to 66 years) who underwent hip arthroscopy with the diagnosis of cam-pincer-mixed-type femoroacetabular impingement (FAI) and labral pathologies were retrospectively analyzed. The study groups (impingements and labral pathologies) and the presence of cyst (or cyst size: <5 mm, 5-8 mm, >8 mm) were used as the fixed effects, and the analysis was adjusted for baseline age, sex, and preoperative scores. Pre- and postoperative modified Harris Hip Score (mHHS) and Visual Analog Scale (VAS) scores that were applied to all patients were used as an indication of clinical results. The mean preoperative mHHS score of the patients with a cyst was significantly lower compared to the patients without a cyst (56.8±12.3 vs. 60.3±12.7, p=0.026). The mean change in the mHHS score and the mean percentage change in VAS score were significantly higher in the patients with a cyst compared to the patients without a cyst (mHHS score: 28.1±14.0 vs. 22.5±14.1, p=0.002; VAS score: 61.9±30.2 vs. 52.6±47.4, p=0.038). The increase in mHHS score over time for patients with a cyst was significantly higher than the patients without cysts in the pincer group (38.1±11.1 vs. 19.3±13.5, p<0.001). The patients with a cyst size of >8 mm had a significantly higher increase in the mHHS scores compared to the patients with a cyst size of <5 mm (29.5±12.9 vs. 23.5±13.8, p=0.043). Subchondral cysts in the femoral head and neck junction accompanied cam-type and mixed-type FAI, while subchondral cysts in the acetabulum accompanied pincer-type impingement. In all groups, the mean increase in mHHS scores and the mean decrease in VAS scores were higher in patients with subchondral cysts than in patients without cysts. In patients with subchondral cysts, if the lesion causing FAI is treated arthroscopically, it can positively affect the functional results.

The Impact of Preoperative Intra-articular Injections on Postoperative Outcomes in Hip Arthroscopy

Introduction: Hip arthroscopy is a minimally invasive procedure commonly performed to treat various hip conditions. Preoperative intra-articular injections, such as local anesthetics and corticosteroids, are frequently used to alleviate pain and as a diagnostic tool before hip arthroscopy. However, studies have shown conflicting information; some demonstrate better patient outcomes, while others have found an increased risk of complications and negative effects on postoperative recovery. This retrospective study evaluated the association between preoperative injections and postoperative outcomes in hip arthroscopy patients. Materials and Methods: A retrospective review of 1400 patients who underwent hip arthroscopy between 2014 and 2021 at our institution was performed. The patients were allocated into two cohorts based on whether they received a cortisone injection with local anesthetic within 1 year before the surgery. Outcomes during the study follow-up period (average: 437 days, max: 3018 days) were compared. Further analysis looked at subgroups at 30-day increments. Results: The results showed that 35.5% of the patients had received a preoperative injection. Although patients who received injections were more likely to be female (68.3% injected vs. 60.8% not injected, P = 0.019) and have asthma (12.5% injected vs. 7.3% not injected, P = 0.008), there were no significant differences in 90-day complications, 90-day emergency department visits, 90-day readmissions, any complications (wound infection, re-injury, recurrent pain or weakness, deep vein thrombosis, or pulmonary embolism), prolonged pain or recovery, reoperation, total hip arthroplasty, 6-month Patient-Reported Outcomes Measurement Information System Physical Function, 6-month Hip Dysfunction and Osteoarthritis Outcome Score Joint Replacement, or follow-up time between the injection and noninjection groups. There were no other differences in demographics, comorbidities, or physical function between the groups. Conclusion: Our study suggests that preoperative corticosteroid injections with local anesthetics do not significantly affect postoperative outcomes in hip arthroscopy patients or increase the risk of adverse effects. Careful evaluation of these risks and benefits is crucial to minimize potential adverse effects and maximize patient outcomes.

Radiological predictors of outcomes in hip arthroscopy for femoroacetabular impingement.

Hip arthroscopy has gained prominence as a primary surgical intervention for symptomatic femoroacetabular impingement (FAI). This study aimed to identify radiological features, and their combinations, that predict the outcome of hip arthroscopy for FAI. A prognostic cross-sectional cohort study was conducted involving patients from a single centre who underwent hip arthroscopy between January 2013 and April 2021. Radiological metrics measured on conventional radiographs and magnetic resonance arthrography were systematically assessed. The study analyzed the relationship between these metrics and complication rates, revision rates, and patient-reported outcomes. Out of 810 identified hip arthroscopies, 359 hips were included in the study. Radiological risk factors associated with unsatisfactory outcomes after cam resection included a dysplastic posterior wall, Tönnis grade 2 or higher, and over-correction of the α angle. The presence of acetabular retroversion and dysplasia were also significant predictors for worse surgical outcomes. Notably, over-correction of both cam and pincer deformities resulted in poorer outcomes than under-correction. We recommend caution in performing hip arthroscopy in patients who have three positive acetabular retroversion signs. Acetabular dysplasia with a lateral centre-edge angle of less than 20° should not be treated with isolated hip arthroscopy. Acetabular rim-trimming should be avoided in patients with borderline dysplasia, and care should be taken to avoid over-correction of a cam deformity and/or pincer deformity.

Patients With a History of Lumbar Fusion Have a Greater Risk of Revision Arthroscopy and Conversion to Total Hip Arthroplasty After Primary Hip Arthroscopy

PurposeTo characterize the risk of revision hip arthroscopy or conversion to total hip arthroplasty (THA) among patients with a history of lumbar fusion undergoing primary hip arthroscopy. MethodsWe used the Statewide Planning and Research Cooperative System, an administrative database including all ambulatory and inpatient surgery encounters in New York (NY), to identify all patients who underwent hip arthroscopy for FAI between 2010–2020. Patients with prior lumbar fusion were identified using CPT and ICD 9th/10th Revision coding definitions. Patients with and without prior fusion were matched in a 1:5 ratio according to age and comorbidity burden. The number of levels fused was defined in the following fashion: i) no fusion, ii) 1-2 levels, or iii) ≥3 levels. Patients were followed for two years to evaluate the rate of revision hip arthroscopy or conversion to THA. Multivariable logistic regression models were used to measure the association between number of levels fused and revision hip arthroscopy or conversion to THA. ResultsBetween 2010–2020, there were 23,277 patients that underwent primary hip arthroscopy in NY state. Of these, 348 (1.4%) had a prior lumbar fusion. After matching for age and comorbidities, the composite rate of revision hip arthroscopy or conversion to THA was higher in patients with prior lumbar fusion compared to patients without (16.5% vs. 8.5%; P < 0.001). This risk increased with the number of levels fused (1-2 levels: 15.1%; aOR, 1.8; 95% CI, 1.3–2.6; vs. ≥3 levels: 26.3%; aOR, 3.4; 95% CI, 1.7–7.0). ConclusionPatients with a history of lumbar fusion had significantly higher rates of revision hip arthroscopy and conversion to THA compared to patients without prior fusion. The risk of revision hip arthroscopy or conversion to THA was increased approximately 2-fold in patients with 1-2 levels fused and 3-fold in patients with 3 or more levels fused. Level of EvidenceLevel III, prognostic retrospective matched comparative case series.

Preoperative Hip Injection Response Does Not Reliably Predict 2-Year Postoperative Outcomes After Hip Arthroscopy for Femoroacetabular Impingement

PurposeTo determine whether response to preoperative local anesthetic or corticosteroid intra-articular injections can predict 2-year postoperative outcomes in patients undergoing hip arthroscopy for femoroacetabular impingement syndrome (FAIS). MethodsThis was a retrospective analysis of patients undergoing hip arthroscopy for FAIS at a single institution from 2014-2020. Patients who underwent preoperative intra-articular hip injection were classified based on injection type (local anesthetic, corticosteroid) and whether they experienced pain relief following injection (responders, non-responders). Responders were matched 2:1 by age, BMI, and sex with non-responders. Patient reported outcomes (PROs) including Hip Disability and Osteoarthritis Outcome Score (HOOS), 12-item Short-Form Survey mental (SF-12-MCS) and physical component summary (SF-12-PCS) and visual analogue scale (VAS) pain were collected preoperatively and 2-years postoperatively. Mean score change and Minimal Clinically Important Difference (MCID) achievement were calculated and compared between groups. ResultsThe matched cohort included 126 total patients (42 non-responders, 84 responders; 74.6% female; mean ± SD age: 30.9 ± 9.9 years; BMI: 24.7 ± 3.7 kg/m2) with no differences in demographic or radiographic hip variables. Both groups demonstrated significant 2-year postoperative score improvements across all PROs, except SF-12-MCS, which remained unchanged. There was no difference in mean score change or MCID achievement across all PROs between corticosteroid injection responder and non-responder groups. In the local anesthetic group, MCID achievement was similar across all PROs, except VAS pain which showed greater percentage of MCID achievement among local anesthetic non-responders relative responders (Responders: 55.0%, Non-responders: 89.5%; p = 0.03). Significant ceiling effects were most readily apparent among the injection responders group with greater percentages of patients achieving maximal 2-year postoperative survey scores (36.9% HOOS-ADL, 19.0% HOOS-Pain, 15.5% HOOS-QoL, 32.1% HOOS-Sport). ConclusionsResponse to preoperative injection with either corticosteroid or local anesthetic did not predict 2-year outcomes after hip arthroscopy in patients with FAIS. Level of EvidenceLevel III, retrospective matched cohort study.

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.

Synovium-Derived and Bone-Derived Mesenchymal Stem/Stromal Cells from Early OA Patients Show Comparable In Vitro Properties to Those of Non-OA Patients.

Degenerative disorders like osteoarthritis (OA) might impair the ability of tissue-resident mesenchymal stem/stromal cells (MSCs) for tissue regeneration. As primary cells with MSC-like properties are exploited for patient-derived stem cell therapies, a detailed evaluation of their in vitro properties is needed. Here, we aimed to compare synovium-derived and bone-derived MSCs in early hip OA with those of patients without OA (non-OA). Tissues from three synovial sites of the hip (paralabral synovium, cotyloid fossa, inner surface of peripheral capsule) were collected along with peripheral trabecular bone from 16 patients undergoing hip arthroscopy (8 early OA and 8 non-OA patients). Primary cells isolated from tissues were compared using detailed in vitro analyses. Gene expression profiling was performed for the skeletal stem cell markers podoplanin (PDPN), CD73, CD164 and CD146 as well as for immune-related molecules to assess their immunomodulatory potential. Synovium-derived and bone-derived MSCs from early OA patients showed comparable clonogenicity, cumulative population doublings, osteogenic, adipogenic and chondrogenic potential, and immunophenotype to those of non-OA patients. High PDPN/low CD146 profile (reminiscent of skeletal stem cells) was identified mainly for non-OA MSCs, while low PDPN/high CD146 mainly defined early OA MSCs. These data suggest that MSCs from early OA patients are not affected by degenerative changes in the hip. Moreover, the synovium represents an alternative source of MSCs for patient-derived stem cell therapies, which is comparable to bone. The expression profile reminiscent of skeletal stem cells suggests the combination of low PDPN and high CD146 as potential biomarkers in early OA.

Effect of Previous Hip Arthroscopy on Results after Hip Arthroplasty: Systematic Review and Meta-Analysis

Abstract Background Hip arthroplasty is the most frequently performed adult reconstructive hip procedure. Total hip arthroplasty (THA) is one of the most successful procedures performed in modern orthopedics. The primary indication for THA in a patient with endstage arthropathy is pain resulting in significant limitation of physical activity. Important factors to be considered in the decision to recommend or undergo THA are patient age, diagnosis, and medical comorbidities. Aim of the Work This review pursues to systematically review the current evidence in the literature to determine whether previous hip arthroscopy would direct to inferior results in patients undergoing succeeding hip arthroplasty. Patients and Methods The first literature search identified 412 studies in total. After removing duplicates, 307 articles were deemed irrelevant based on their title and Abstractscreening. Eighty- two papers were eliminated from the remaining 105 research based on their title and Abstract. After carefully reviewing the entire text of all remaining publications, 11 studies were eliminated for reasons such as conference Abstracts, reviews, and lack of comparison between intervention and control groups. Additionally, one cohort research that compared THA results in patients who had previously undergone hip salvage surgery to those who had not previously undergone hip salvage surgery was removed. Finally, eleven studies spanning the years 2012 to 2019 were available for meta-analysis. Results Of these citations could result from the studies’ varying designs and sample sizes. Estimated blood loss, on the other hand, was deemed a reasonable indicator of operating time. The consistency in blood loss between the groups may reflect a similar operative time. Conclusion Patients who have previously undergone hip arthroscopy are more likely to experience postoperative complications such as dislocation, revision, and reoperation following subsequent hip arthroplasty. On the other hand, prior hip arthroscopy did not appear to affect functional or intraoperative results.

Poster 203: Staged Hip Arthroscopy and Periacetabular Osteotomy Versus Hip Arthroscopy Alone in Patients with Borderline Hip Dysplasia: A Propensity-Matched Study

Objectives: The management of borderline hip dysplasia (BHD) remains an area of interest in the field of hip preservation. The purpose of this study was to (1) evaluate mean 2-year outcomes for patients with BHD treated with staged hip arthroscopy and periacetabular osteotomy (PAO) to those who underwent hip arthroscopy alone, and (2) evaluate rates of complications, hardware removal, reoperations, conversions to total hip arthroplasty (THA), along with conversions to PAO. Methods: Hips with a lateral center-edge angle (LCEA) values 18° ≤ LCEA &lt; 25° that underwent a hip arthroscopy for femoroacetabular impingement syndrome (FAIS) between January 2018 and June 2022 were reviewed. Patients who underwent staged periacetabular osteotomy and hip arthroscopy were identified. Staged hips were propensity-matched 1:4 to other borderline dysplastic hips that underwent hip arthroscopy alone. Matching was performed based on age, sex, and body-mass index (BMI). Patient-reported outcomes (PROs) were collected, including Hip Outcome Score – Activities of Daily Living (HOS-ADL), HOS-Sports Specific (HOS-SS) subscale, 12-item International Hip Outcome Tool (iHOT-12) questionnaire, Patient-Reported Outcomes Measurement Information System-Pain Interference (PROMIS-PI) subscale, and PROMIS-Physical Function (PROMIS-PF) subscale. Cohort-specific minimal clinically important difference (MCID) and Patient Acceptable Symptom State (PASS) thresholds were calculated. Postoperative PROs, rates of MCID/PASS achievement, and rates of reoperation and conversion to THA were compared. Results: Twenty-four patients who underwent staged hip arthroscopy and PAO were successfully matched to 96 patients who underwent hip arthroscopy alone. Both groups were similar in terms of age, sex, and BMI. The patients who underwent a PAO had smaller LCEAs and larger Tönnis angles (21.0° vs. 23° and 11.6° vs. 9.1°, respectively). Both groups demonstrated significant improvement in PROs at minimum 1-year postoperatively (p &lt; 0.001, for all). There were no significant differences in postoperative PRO scores between the groups (p ≥ 0.223, for all). There were no significant differences in MCID/PASS achievement (p ≥ 0.224. for all). There were no reoperations or conversion to THA in the staged hip arthroscopy and PAO group. In the hip arthroscopy alone cohort, reoperation rates were 5.2% and conversion to THA occurred in 1% of the patients. There were no significant differences in secondary surgery rates between the groups (p = 1.000). Three patients in the hip arthroscopy alone group ultimately underwent PAO, 1 underwent a proximal femoral osteotomy (PFO), and one underwent a revision hip arthroscopy. These female patients were young and athletic with an LCEA &lt; 20°. Conclusions: Patients undergoing staged PAO and hip arthroplasty and isolated hip arthroplasty for treatment of BHD demonstrate similar clinical improvement. Rates of revision surgery and conversion to THA were similarly low. A small subset of patients who were initially treated arthroscopically ultimately received a PAO. This group was entirely made up of young, athletic female patients. This is encouraging early data and more long-term data is needed to evaluate the differences in survivorship. [Figure: see text]