• High hip survival rate seen after hip arthroscopy in patients with dysplastic hips

    Source: Healio

    Seventy percent of patients with hip dysplasia who underwent hip arthroscopy did not require total hip arthroplasty at 5 years and demonstrated improved outcome scores, quality of life and patient satisfaction, according to data presented at the American Academy of Orthopaedic Surgeons Annual Meeting.

    “In the difficult patient population of those with dysplastic hips, arthroscopy has had a controversial role,” said Marc J. Philippon, MD,managing partner of the Steadman Clinic and co-chair and board member of the Steadman Philippon Research Institute. “There is not much evidence to support treatment by arthroscopy in this group. But, a correlation has been shown between hip dysplasia and early-onset osteoarthritis, tears of the labrum and joint failure in the young patient.”

    Philippon and his colleagues evaluated data from a prospective data registry to determine survivorship, defined as not requiring total hip replacement, at 3 years to 8 years after hip arthroscopy in patients with dysplastic hips. A single surgeon performed all consecutive hip arthroscopies in the data registry from 2005 to 2011.

    Inclusion criteria were primary hip arthroscopy for labral pathology and femoroacetabular impingement with no previous total hip replacement or resurfacing and a center edge angle of 20° or less. Patients were excluded if they were professional athletes or had hip fracture, hips with bone grafting, bone plugs, hemicap implant performed during arthroscopy, underlying hip disease such as Legg-Calve-Perthes, pigmented villonodular synovitis, synovial chondromatosis or labral reconstruction during arthroscopy.

    Researchers identified 11 hips that met the inclusion criteria. Patients were an average age of 39 years and the study included six women and five men. Their average centeredge angle was 16°, and their average alpha angle was 69°. All hips had a labral repair, 10 had a femoral neck osteoplasty, and five had a minimal acetabular rim trimming.

    Three patients required total hip arthroplasty: a 50-year-old patient at 12 months after the index hip arthroscopy, a 42-year-old patient at 15 months and a 58-year-old patient at 25 months. Two of these patients had a joint space of less than 2 mm.

    For those patients who did not require total hip replacement, preoperative modified Harris hip scores improved from 55 points to 74 points postoperatively. The postoperative SF-12 physical component score was 53.2 points and the mean SF-12 mental component score was 53 points. Patients rated their satisfaction at a median of nine out of 10.

    “Patients requiring total hip replacement were older and two of the three had limited joint space,” Philippon said during his presentation. “Hip arthroscopy was successful in the younger dysplastic adult with adequate joint space. Patients improved in function and symptoms. They had good general physical and mental health, and high patient satisfaction was reported. We use hip arthroscopy as a first stage in treatment, often to assess the cartilage and the status of the labrum, and we coordinate further treatment in the patient when indicated.” – by Tina DiMarcantonio

    References:Philippon MJ. Paper #411. Presented at: American Academy of Orthopaedic Surgeons Annual Meeting; March 11-15, 2014; New Orleans.

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  • Revision preservation with hip arthroscopy successful after failed primary

    Source: Healio

    After failed primary hip preservation surgery, revision with hip arthroscopy achieved moderately successful outcomes on the basis of multiple patient-reported outcome scores, according to study results.

    All patients who underwent revision hip preservation with arthroscopy from April 2008 to December 2010, including patients who had previous open surgery and underwent revision with arthroscopy, were included. The researchers obtained patient-reported outcome (PRO) scores preoperatively and at 3-month, 1-year, 2-year and 3-year follow-up time points. Using a multiple regression analysis, the researchers looked for positive and negative predictive factors for improvement in PROs after revision hip arthroscopy.

    Overall, 47 hips in 43 patients had completed 2 years' follow-up or needed total hip arthroplasty. Sixty-six percent of the hips had either unaddressed or incompletely treated femoroacetabular impingement.

    At a mean 29 months after revision, the researchers found a significant improvement in all PRO scores, as well as improvement in VAS scores. The Non-Arthritic Hip Score showed improvements of at least 10 points in 65% of hips and of at least 20 points in 44% of hips. According to study results, four hips in three patients required conversion to total hip arthroplasty.

    The researchers found previous open surgery, pincer impingement, cam impingement, symptomatic heterotopic ossification and segmental labral defects treated with labral reconstruction to be positive predictive factors for PRO improvement.

    Disclosures: Jackson, Domb, Stake, Lindner and El-Bitar received support from the American Hip Institute. Domb also received support from MAKO Surgical and Arthrex.

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  • Primary hip arthroscopy showed favorable outcomes for torn acetabular labrum

    Source: Healio

    Primary arthroscopy of the torn acetabular labrum had favorable outcomes and evidence of good healing, according to study results.

    Researchers assessed patients undergoing hip arthroscopy with the modified Harris Hip Score; 37 patients underwent primary repair of a torn acetabular labrum and had reached 2 years' follow-up over a 4-year period. The researchers also evaluated the ratio of labral refixations after pincer femoroacetabular impingement correction to primary repairs for perspective on the frequency of this procedure.

    Modified Harris Hip Score showed a mean improvement of 18.9 points, with 92% of hips showing improvement, including good and excellent results. Articular damage was seen in 21 hips, ligamentum teres in 14 hips, cam femoroacetabular impingement in 11 hips, borderline dysplasia in three hips, dysplasia in two hips and iliopsoas in two hips.

    At a mean 10 months postoperatively, four patients underwent repeat arthroscopy, and the labral repair site was fully healed in each of these cases. Overall, the researchers did not observe any complications.

    Disclosures: Byrd received support from Smith & Nephew, A3 Surgical and Springer Medical Publishing. Jones also received support from Smith & Nephew.

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  • Speaker: Hip arthroscopy has a role in the management of FAI in adolescents

    Source: Healio

    Hip arthroscopy can be used in the management of adolescents with symptomatic femoroacetabular impingement, according to data presented at the American Orthopaedic Society for Sports Medicine Annual Meeting, here.

    “This study reports favorable outcomes of arthroscopic management of [femoroacetabular impingement] FAI in adolescents with results at least comparable to an adult population. Concomitant procedures and revision surgery are both more common among adolescents and there is certainly a propensity for athletes in both groups,” J.W. Thomas Byrd, MD, said.

    Byrd and colleagues at the Nashville Sports Medicine Center prospectively assessed 122 consecutive hips among 108 adolescent patients who had arthroscopic surgery for symptomatic FAI. The adolescent group was 55% female with an average age of 16 years. The matched control group was 122 patients with an average of 36 years and was 58% male. Minimum follow-up was 1 year with an average follow-up of 30 months. Overall, 96% of the adolescents participated in athletics compared with 61% of the adults in the control group.

    The average improvement in the modified Harris Hip Score was 23 points for the adolescent group and 21 points for the adult group. For the adolescent group, FAI correction was performed for 36 cam and 17 pincer lesions and for 69 combined lesions. There were 111 labral tears that required 85 refixations and 26 debridements. There were 101 acetabular chondral lesions with four microfractures. There were three femoral chondral lesions. The researchers removed seven loose bodies and debrided 19 lesions of the ligamentum teres. Concomitant extraarticular procedures included 13 iliopsoas tendon releases and two iliotibial band tendinoplasties.

    Among the adult cohort, the researchers performed FAI correction for 53 cam and 5 pincer lesions and for 64 combined lesions. There were 103 labral tears that required 52 refixations and 50 debridements. There were 112 acetabular chondral lesions with 20 microfractures and 17 femoral chondral lesions. The researchers removed 17 loose bodies and debrided 21 lesions of the ligamentum teres in the adult group. Concomitant extraarticular procedures included four iliopsoas tendon releases and one abductor repair.

    Four adolescents needed repeat arthroscopic surgery and one patient underwent a periacetabular osteotomy. One adult patient had repeat arthroscopic surgery. – by Kristine Houck, MA, ELS

    Reference:Byrd JWT. Paper #32.Presented at: American Orthopaedic Society for Sports Medicine Annual Meeting; July 10-13, 2014; Seattle.

    Disclosure: Byrd is a consultant to and receives research support from Smith & Nephew Endoscopy and is a consultant to and has stock in A3 Surgical.

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  • Predictors of successful ACL reconstruction identified

    Source: Medical News Today

    Researchers have found that a patient's age and the type of tissue graft have a direct impact on ACL reconstructive surgery (ACLR) outcomes, according to an exhibit presented at the 2014 American Academy of Orthopaedic Surgeons (AAOS) annual meeting in New Orleans.

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