Higher grades of acetabular chondral damage were related to male sex, increased age, height, weight, BMI, and the size of the lesion. Chondral lesions were generally found in the anterosuperior region of the acetabulum, consistent with labral lesions and the weightbearing area of the acetabulum.
Introduction: Workers’ compensation (WC) claims have been associated with poor short-term outcomes after hip arthroscopy. We aim to report mid-term outcomes and return to work (RTW) among patients with WC claims. Methods: Data were prospectively collected and retrospectively reviewed for patients undergoing hip arthroscopy between September 2008 and July 2011. Inclusion criteria were an active WC claim at time of surgery with preoperatively-documented patient-reported outcomes (PROs). Exclusion criteria were a previous hip condition and preoperative Tönnis grade >1. Patient-reported WC cases were pair-matched to non-WC cases based on body mass index (BMI) ± 5, age ± 5 years, gender, preoperative LCEA, labral treatment, and capsular treatment. Results: 52 patients had minimum 5-year outcomes. Mean age was 40.6 (±10.6) years and a mean BMI of 27.5 (±5.3). 9 (16.7%) hips underwent secondary arthroscopies. 5 hips (9.3%) were converted to THA. There were 5 (9.3%) reports of numbness, all of which resolved spontaneously. Work status details were available for 49 patients and 47 patients (95.9%) returned to work. 42 WC hips were matched to 42 control hips. At ⩾5-year follow-up, patient-reported outcomes, visual analogue scale (VAS) and satisfaction were not different between the groups. All magnitudes in improvement were significantly higher in the WC group ( p = < 0.001) except for VAS. No significant differences were found in rates of secondary arthroscopies, conversions to THA, or complications between the groups. Conclusions: WC patients have equal favourable mid-term outcomes as non-WC patients after hip arthroscopy for the treatment of femoroacetabular impingement and labral pathology.
Background:Hip arthroscopic surgery is intended to treat multiple abnormalities in an effort to delay the progression to osteoarthritis, especially in young patients. However, the length of time in which patients experience joint pain before seeking a specialist for a diagnosis can delay hip preservation surgery and influence clinical outcomes.Purpose:To investigate the relationship between age at symptom onset and findings during hip arthroscopic surgery as well as outcomes after 2 years of clinical follow-up.Study Design:Cohort study; Level of evidence, 3.Methods:From February 2008 to March 2015, data were prospectively collected on all patients undergoing hip arthroscopic surgery at a single institution. Anatomic and pathological characteristics were recorded intraoperatively. The mean age at onset of symptoms was calculated and correlated with intraoperative findings using Pearson correlation and logistic regression. All patients were assessed preoperatively and postoperatively with 4 patient-reported outcome measures: the modified Harris Hip Score (mHHS), the Non-Arthritic Hip Score (NAHS), the Hip Outcome Score–Activities of Daily Living (HOS-ADL), and the Hip Outcome Score–Sport-Specific Subscale (HOS-SSS). Pain was estimated using a visual analog scale (VAS). Furthermore, patients with an age at onset of symptoms below the mean (34.6 years) were compared with those of an age at onset of symptoms above the mean. The 2 groups were compared using the Student t test and the chi-square test. P values <.05 were considered significant.Results:A total of 1697 patients met the inclusion criteria. Body mass index was weakly correlated with age (r = 0.3). Younger patients had a lower prevalence of combined Seldes type 1 and 2 labral tears; acetabular labrum articular disruption (ALAD) grade 2, 3, and 4 acetabular chondral lesions; and Outerbridge grade 2, 3, and 4 femoral head chondral lesions (P < .05 for all). More advanced age was correlated with wider labral tears and chondral lesions based on a clock face (r ≥ 0.2, P < .05). Patients younger than 34.6 years had a lower prevalence of gluteus medius and ligamentum teres tears (P ≤ .001). The prevalence of synovitis was positively correlated with age, while instability was negatively correlated with age (P = .04). The improvement of scores from preoperatively to 2-year follow-up in the younger patient group was 62.69 to 83.82 for the mHHS, 64.97 to 87.35 for the HOS-ADL, 43.46 to 73.37 for the HOS-SSS, 63.01 to 85.19 for the NAHS, and 5.61 to 2.53 for pain VAS. All score improvements were statistically significant (P < .001). Regarding the older patient group, the improvement of scores from preoperatively to 2-year follow-up was 58.55 to 78.27 for the mHHS, 57.59 to 79.66 for the HOS-ADL, 35.63 to 61.88 for the HOS-SSS, 55.28 to 77.55 for the NAHS, and 5.72 to 3.01 for pain VAS. All score improvements were statistically significant (P < .001).Conclusion:Of the multiple intraoperative findings in hip arthroscopic surgery, many are related to age at onset of symptom...
Clostridium difficile infection is an increasingly common clinical challenge in hospitals and healthcare facilities. The infection often results in severe complications for the infected individual including relentless diarrhea, abdominal pain, dehydration, and mortality. Currently, there is a significant gap between research and practice in the management of recurrent Clostridium difficile infection, and treatment guidelines are limited. Numerous attempts at treating this infection have been made including the practice of fecal transplantation. A comprehensive literature search was conducted and 6 studies were reviewed to evaluate the safety and effectiveness of fecal transplantation as a modality in treating recurrent Clostridium difficile infection refractory to other treatment methodologies. The implementation of fecal transplantation is suggested to restore normal bowel flora in individuals with Clostridium difficile and rid patients of the infection. Additional studies have since revealed perceived barriers toward the implementation of this treatment modality, although it has shown promising results with success rates of 83%-100%. Further efficacy testing validation is needed in larger, prospective controlled trials to guide healthcare providers in the direction of a reliable, standardized treatment protocol for recurrent Clostridium difficile infection.
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