A Shift in Hip Arthroscopy Use by Patient Age and Surgeon Volume: A New York State–Based Population Analysis 2004 to 2016

Schairer, William W.; Nwachukwu, Benedict U.; Suryavanshi, Joash R; Yen, Yi‐Meng; Kelly, Bryan T.; Fabricant, Peter D.

doi:10.1016/j.arthro.2019.05.008

Cited by 39 publications

(26 citation statements)

References 24 publications

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“…Several population-based studies have identified significant increases in hip arthroscopy annual volumes. 5,9,31,38 Although hip arthroscopy has been shown to be largely successful, demonstrating improvements in patient-reported outcomes at short- to mid-term follow-up, persistent or recurrent symptoms may develop in a subset of patients. 10,12,29,40 Revision arthroscopy rates have been shown to range from as low as 2.6% up to 15.4% depending on surgeon volume.…”

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confidence: 99%

A Biomechanical Comparison of 2 Hip Capsular Reconstruction Techniques: Iliotibial Band Autograft Versus Achilles Tendon Allograft

et al. 2020

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Background: Several techniques for hip capsular reconstruction have been described to address gross instability or microinstability due to capsular deficiency. However, objective biomechanical data to support their use are lacking. Purpose: To compare the kinematic effect of 2 capsular reconstruction techniques (iliotibial band [ITB] graft and Achilles tendon graft). Kinematic effect encompassed rotational range of motion (ROM) as well as joint translation in the coronal, sagittal, and axial planes. Study Design: Controlled laboratory study. Methods: 8 paired, fresh-frozen hemi-pelvises (16 hips) were tested on a custom-designed joint motion simulator in the intact state and after capsulectomy. Pairs were randomly allocated to either ITB or Achilles reconstruction and retested. Testing was performed at 0°, 45°, and 90° of flexion. Internal-external rotation (IR-ER) torques and abduction-adduction torques of 3 N·m were applied to the femur via a load cell at each position, and rotational ROM and joint translation in the coronal, sagittal, and axial planes were recorded. Results: At 45° and 90°, there was a significant effect of the condition of the hip on the total IR-ER ( P = .004, effect size [ES] = 0.305; and P < .001, ES = 0.497; respectively). At 45°, mean ± SD total rotation was significantly greater for the capsulectomy (59.7°± 15.9°) state compared with intact (53.3°± 13.2°; P = .007). At 90°, reconstruction significantly decreased total rotation to 49.0°± 18.9° compared with a mean total rotation of 52.8°± 18.7° after capsulectomy ( P = .02). No difference was seen in the total abduction-adduction of the hip between conditions. Comparisons of the 2 different reconstruction techniques showed no significant differences in total IR-ER or abduction-adduction ROM or joint translation in the coronal, sagittal, or axial planes. For translation, at both 0° and 45° there was a statistically significant effect of the condition on the medial-lateral translation ( P = .033; ES = 0.204). Reconstruction, independent of technique, was successful in significantly decreasing ( P = .030; P = .014) the mean medial-lateral translation at 0° and 45° of hip flexion from 5.2 ± 3.8 mm and 5.6 ± 4.0 mm to 2.8 ± 1.9 mm and 3.9 ± 3.2 mm, respectively. Conclusion: The integrity of the native hip capsule played a significant role in rotational stability, where capsulectomy significantly increased rotational ROM. Both ITB and Achilles reconstruction techniques restored normal rotational ROM of the hip at 90° of flexion as well as coronal plane stability at 0° and 45° of hip flexion. No differences were seen between ITB and Achilles reconstruction techniques. Clinical Relevance: Both capsular reconstruction techniques provide comparable joint kinematics, restoring rotation and translation to normal values with the exception of rotational ROM at 45°, which remained significantly greater than the intact state. The most significant results were the rotational stability at 90° of hip flexion and coronal plane stability at 0° and 45° of hip flexion, which were significantly improved compared with the capsulectomy state.

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A Biomechanical Comparison of 2 Hip Capsular Reconstruction Techniques: Iliotibial Band Autograft Versus Achilles Tendon Allograft

et al. 2020

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“…In this older patient subset (which is small), by decreasing 1 (cam) bump, I am increasing another at the far right of the age distribution. Another interesting finding from the study by Schairer et al 1 is that of 128 total surgeons performing hip arthroscopy, 119 were low-volume surgeons, performing a mean 12.3 cases per annum. With any technically challenging procedure, (case) volume matters.…”

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confidence: 97%

“…In a New York Stateebased longitudinal epidemiologic study, Schairer et al 1 report a significant increase in hip arthroscopic procedures performed in the 10-to 19-year-old age group, with patients of higher-volume surgeons tending to be younger than those of lowervolume surgeons. The younger bump of my bimodal practice is fully consistent with this finding and makes sense.…”

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confidence: 99%

Editorial Commentary: Hip Arthroscopy—Bimodal Bump and Volume Matters

Matsuda

2019

Arthroscopy: The Journal of Arthroscopic & Related Surgery

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“…15 Currently, more females undergo hip arthroscopy in the United States than males. 2,16 Nepple et al 17 found that females presented with significantly greater disability than males, as quantified by patient-reported outcome measures. Females tend to have smaller alpha angles and greater femoral and acetabular anteversion 18 and have lower center edge angles than males, 19 consistent with female sex being a known risk factor for hip dysplasia.…”

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confidence: 99%

Editorial Commentary: Hip Arthroscopy Evolution and Causes of Failure

Spiker

2021

Arthroscopy: The Journal of Arthroscopic & Related Surgery

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Hip arthroscopy use has grown as a result of expanding indications; improved imaging including higher resolution magnetic resonance imaging with stronger magnetic fields and the advent of 3-dimensional computed tomography revealing the nuances of hip joint morphology; increased specialized training; improvements in instruments and implants; a record of successful outcomes; and increased understanding of microinstability, focal acetabular undercoverage or occult dysplasia, indications for labral reconstruction and capsular plication, and, most of all, femoroacetabular impingement syndrome, the leading diagnosis for which hip arthroscopy is performed, in the orthopaedic community as well as the general medical and athletic communities. We now know that labral repair results in better outcomes than labral debridement, and evidence suggests that capsule closure leads to better long-term success. Osteoarthritis and its correlate, advanced age, result in inferior survivorship after hip arthroscopy, which is unsurprising; hip preservation surgery is not designed to treat irreparable cartilage damage. Association of female sex with hip arthroscopy failure requires additional investigation. More females undergo hip arthroscopy than males, and females initially present with greater disability. Females tend to have smaller alpha angles, greater femoral and acetabular anteversion, and lower center edge angles than males, consistent with increased prevalence of hip dysplasia. Thus surgeons indicating females for hip arthroscopy should be aware of atypical locations of cam lesions, borderline dysplasia, or ligamentous laxity, all of which must be appropriately respected at the time of surgery. With all of the improvements we have made in techniques, patient diagnosis and surgical indications, and our overall understanding of complex anatomy and a technically challenging surgery, we can speculate that our long-term survivorship will only improve. I await with interest the long-term outcomes we will see 10 years from today, with the addition of insight from patient-reported outcome measures to answer these questions with greater certainty. University of WisconsineMadisonThe author reports that she has no conflicts of interest in the authorship and publication of this article. Full ICMJE author disclosure forms are available for this article online, as supplementary material.

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A Shift in Hip Arthroscopy Use by Patient Age and Surgeon Volume: A New York State–Based Population Analysis 2004 to 2016

Cited by 39 publications

References 24 publications

A Biomechanical Comparison of 2 Hip Capsular Reconstruction Techniques: Iliotibial Band Autograft Versus Achilles Tendon Allograft

A Biomechanical Comparison of 2 Hip Capsular Reconstruction Techniques: Iliotibial Band Autograft Versus Achilles Tendon Allograft

Editorial Commentary: Hip Arthroscopy—Bimodal Bump and Volume Matters

Editorial Commentary: Hip Arthroscopy Evolution and Causes of Failure

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