Background: While the association between spinal disease and hip arthroplasty outcomes has been well studied, there is less known about the effect of spinal pathology in hip arthroscopy (HA) outcomes. Lumbosacral transitional vertebrae (LSTV) are anatomic variations where caudal vertebrae articulate or fuse with the sacrum or ilium. Hypothesis: LSTV can lead to inferior outcomes after HA for treatment of femoroacetabular impingement. Study Design: Cohort study; Level of evidence, 3. Methods: We retrospectively reviewed the prospectively collected Hip Arthroscopy Database at our institution for patients with LSTV who underwent HA between 2010 and 2017. A total of 62 patients with LSTV were identified and then matched to controls. Patient-reported outcome measures (PROMs) were collected, including the modified Harris Hip Score, Hip Outcome Score–Activities of Daily Living, Hip Outcome Score–Sports, and the 33-item International Hip Outcome Tool. They were collected at 4 time points: preoperatively and 5 to 11 months, 12 to 23 months, and 24 to 35 months postoperatively. Longitudinal analysis of the PROMs was done using generalized estimating equation modeling. Additionally, alpha angles were measured from preoperative radiographic data. Results: Preoperatively, there was no significant difference between patients with and without LSTV on 3 of the 4 PROMs; however, patients with LSTV did have significantly lower preoperative scores than controls for the Hip Outcome Score–Activities of Daily Living ( P = .029). Patients with LSTV reported significantly lower scores on all 4 PROMs at each postoperative time point. Radiographic data showed no significant difference in alpha angles across cohorts. When LSTV were compared by Castellvi type, types 3 and 4 tended to have lower scores than types 1 and 2; however, these comparisons were not significant. Conclusion: The data support our hypothesis that HA has less benefit in patients with LSTV as compared with patients without LSTV. In patients with LSTV, careful evaluation of the anomaly is recommended to help guide surgical counseling and manage expectations.

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This study compared patient reported outcomes scores (PROMs) between patients undergoing hip arthroscopy who have and have not had previous lumbar spine surgery. We aimed to determine if prior spine surgery impacts the outcome of hip arthroscopy. Data were prospectively collected and retrospectively reviewed in patients who underwent hip arthroscopy between 2010 and 2017. Twenty cases were identified for analysis and matched to a control group. Four PROMs were collected pre-operatively and between 6 months and 2 years post-operatively (mean 16.2 months): Modified Harris Hip Score (mHHS), Hip Outcome Score-Activities of Daily Living (HOS-ADL), Hip Outcome Score-Sports (HOS-Sports) and the 33-item International Hip Outcome Tool (iHOT-33). Patients with previous spine surgery reported significantly worse (P-value <0.001) post-operative scores on all PROMs and smaller net changes on all PROMs with the difference on the mHHS (P-value 0.007), HOS-Sport (P-value 0.009) and iHOT-33 (P-value 0.007) being significant. Subsequent analyses revealed that the type of spine surgery matters. Patients with a spine fusion reported worse post-operative scores on all PROMs compared with patients with a spine decompression surgery with the difference on the mHHS (P-value 0.001), HOS-ADL (P-value 0.011) and HOS-Sport (P-value 0.035) being significant. Overall, patients with prior decompression surgery experienced considerable improvements from hip arthroscopy whereas patients with a prior spine fusion reported poor post-operative outcomes. Given these results, it is vital that hip preservation surgeons understand the impact of the lumbar spine on the outcome of hip arthroscopy.

Patient-reported outcome measures (PROMs) in patients with and without at least one self-reported allergy undergoing hip arthroscopy were compared. Data on 1434 cases were retrospectively reviewed, and 267 patients were identified with at least one self-reported allergy and randomly matched to a control group on a 1:2 ratio. Four PROMs [Modified Harris Hip Score (mHHS), Hip Outcome Score-Activities of Daily Living (HOS-ADL), Hip Outcome Score-Sports (HOS-Sport) and 33-item International Hip Outcome Tool (iHOT-33)] were collected preoperatively, and at 5–11, 12–23 and 24–35 months postoperatively. Significant PROM differences were found 5–11 months postoperative on mHHS (P &lt; 0.001), HOS-ADL (P = 0.002), HOS-Sport (P &lt; 0.001) and iHOT-33 (P &lt; 0.001). At 12–23 months postoperative, the allergy cohort had significantly worse scores on mHHS (P = 0.002), HOS-ADL (P = 0.001), HOS-Sport (P &lt; 0.001) and iHOT-33 (P &lt; 0.001). They also had significantly worse measures 24–35 months postoperative on mHHS (P = 0.019), HOS-Sport (P = 0.006) and iHOT-33 (P &lt; 0.001). Multivariable logistic regression showed that each additional allergy reported significantly increased the risk of failing to meet the minimal clinically important difference 5–11 months after surgery on mHHS by 1.15 [OR (95% CI): 1.15 (1.03, 1.30), P = 0.014], on HOS-ADL by 1.16 [OR (95% CI): 1.16 (1.02, 1.31), P = 0.021] and on iHOT-33 by 1.20 [OR (95% CI): 1.20 (1.07, 1.36), P = 0.002]. Results suggest self-reported allergies increase the likelihood of a patient-perceived worse outcome after hip arthroscopy. An understanding of this association by the physician is essential during presurgical planning and in the management of postoperative care.

The purpose of this study was to perform an initial, prospective evaluation of imaging findings and outcomes after open surgical repair of gluteus medius tendon tears with bioinductive collagen patch augmentation. A prospective study was performed of patients with clinical and magnetic resonance imaging (MRI) evidence of symptomatic gluteus medius tears who underwent open, double-row suture anchor repair with bioinductive bovine collagen patch augmentation. Preoperative and 6-month postoperative MRIs were reviewed by a fellowship-trained musculoskeletal radiologist, and outcome scores were recorded preoperatively and 6 months postoperatively [Hip Outcome Score (HOS) Sport; HOS Activities of Daily Living (HOS ADL); Modified Harris Hip Score (mHHS) and International Hip Outcomes Tool (iHOT-33)]. Nine patients, four high-grade tears (≥50% tendon thickness) and five low-grade tears (&lt;50% thickness) underwent surgical repair. At 6 months, 7/9 (77.8%) of tendons were qualitatively classified as completely healed on MRI, with no complications. Mean tendon thickness increased significantly: mediolateral dimension by 5.8 mm (P &lt; 0.001), anteroposterior dimension by 4.1 mm (P = 0.02) and cross-sectional area (CSA) by 48.4 mm2 (P = 0.001). Gluteus medius and minimus CSA did not change significantly (P &gt; 0.05). Patients demonstrated improvements in mean scores for HOS ADL, mHHS and iHOT that met defined minimum clinically important differences (P &lt; 0.05). Open surgical repair of gluteus medius tendon tears with bioinductive collagen patch augmentation is safe and associated with increased tendon thickness on postoperative MRI. Early outcome scores are encouraging and should be evaluated after patients have completed postoperative rehabilitation to measure the whole effect of treatment.

Background: Research has identified factors that influence achievement rates of threshold scores on patient-reported outcome measures (PROMs) after hip arthroscopy. However, little data exist on whether failure to achieve a threshold score (minimal clinically important difference [MCID] or substantial clinical benefit [SCB]) in the short term after hip arthroscopy predicts the risk of future hip surgery. Purpose/Hypothesis: The purpose of this study was to determine if failure to achieve the MCID or SCB on PROMs within 1 year of hip arthroscopy can be considered a risk factor for repeat surgery within 5 years of primary hip arthroscopy. It was hypothesized that failure to achieve threshold scores would increase the risk of subsequent hip surgery. Study Design: Case-control study; Level of evidence, 3. Methods: A retrospective review of prospectively collected data was completed. Four PROMs were collected preoperatively and within 1 year of hip arthroscopy: modified Harris Hip Score, Hip Outcome Score–Activities of Daily Living, Hip Outcome Score–Sports, and the 33-Item International Hip Outcome Tool. Results: Two cohorts were formed: (1) a study cohort (n = 88) composed of patients who underwent repeat hip surgery within 5 years of hip arthroscopy and (2) a control cohort (n = 288) composed of patients who did not require repeat hip surgery. The study cohort had significantly ( P < .001) lower scores on all postoperative PROMs, and a significantly ( P < .001) smaller percentage of the study cohort met the MCID and SCB. Multivariable regression analysis demonstrated that not achieving the MCID or SCB on each of the PROMs is an independent risk factor for repeat hip surgery. For every PROM in which a patient failed to achieve the MCID, the odds of subsequent surgery increased by 1.68 (95% CI, 1.42-1.98; P < .001). For every PROM in which a patient failed to achieve the SCB, the odds of subsequent surgery increased by 1.63 (95% CI, 1.35-1.97; P < .001). Conclusion: Failure to meet threshold scores on PROMs after hip arthroscopy was an independent risk factor for subsequent hip surgery. This study establishes a novel utility of PROMs and confirms the importance of these metrics in the orthopaedic literature.

A simple in vitro setup was developed to measure the permeabilities of coil masses based on traditional permeametry. Coil permeability should be considered when evaluating the hemodynamic efficacy of coiling instead of just packing density. Coils made of thicker wires may be more permeable, and thus less effective, than coils made from thinner wires. Whether aneurysm recurrence is affected by coil wire diameter or permeability needs to be confirmed with clinical trials.