Minimum Five-Year Outcomes of Hip Arthroscopy for the Treatment of Femoroacetabular Impingement and Labral Tears in Patients with Obesity

Perets, Itay; Rybalko, Danil; Chaharbakhshi, Edwin O.; Mu, Brian; Chen, Austin W.; Domb, Benjamin G.

doi:10.2106/jbjs.17.00892

Cited by 45 publications

(52 citation statements)

References 28 publications

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“…Although obese patients demonstrate improvement after arthroscopy, studies indicate that the obese population is more likely to require a subsequent revision arthroscopy or THA. 21,36 In a matched controlled study, Gupta et al 21 noted that obese patients, defined as having a BMI >30, demonstrated significantly lower patient-reported outcomes at 2 years postoperatively and were twice as likely to convert to a revision hip arthroscopy or THA when compared with nonobese patients. Furthermore, our results indicating that patients with a greater BMI are more likely to convert to THA are consistent with existing literature.…”

Section: Discussionmentioning

confidence: 99%

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Predictors of Clinical Outcomes After Hip Arthroscopy: 5-Year Follow-up Analysis of 1038 Patients

Domb

Chen

et al. 2020

Am J Sports Med

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Background: Although hip arthroscopy has been shown to have favorable results, there is a paucity of literature describing predictive factors of 5-year clinical outcomes. Purpose: To identify predictive factors of midterm outcomes after hip arthroscopy in a cohort of 1038 patients whose outcomes at minimum 2-year follow-up were previously reported. In addition, to provide a comparison of short- and midterm predictive factors in outcome measures after hip arthroscopy. Study Design: Case-control study; Level of evidence, 3. Methods: Data were prospectively collected and retrospectively reviewed on all patients undergoing hip arthroscopy between February 2008 and June 2012. Patients were included if they had minimum 5-year follow-up on 2 patient-reported outcomes: Nonarthritic Hip Score (NAHS) and modified Harris Hip Score. Patients were excluded if they had any previous ipsilateral hip conditions. Using bivariate and multivariate analyses, we analyzed the effect of 36 pre- and intraoperative variables on the NAHS, modified Harris Hip Score, and conversion to total hip arthroplasty. Results: A total of 1038 patients met the inclusion criteria for the 2-year study, and 860 met our listed inclusion criteria for the 5-year study. The mean follow-up time was 62.0 months (range, 60.0-120.0 months). The bivariate analysis identified 10 variables (4 categorical and 6 continuous) that were predictive of 5-year postoperative NAHS. For the multivariate analysis, 7 variables were identified as being significant: preoperative NAHS, body mass index (BMI), age, lateral joint space, alpha angle, revision hip arthroscopy, and acetabular microfracture. These 7 variables were also predictive in the bivariate analysis. Age, BMI, revision hip arthroscopy, Tönnis grade, sex, trochanteric bursectomy, femoral head cartilage damage, and acetabular inclination were significant predictors of conversion to total hip arthroplasty. Conclusion: This study reports favorable midterm clinical outcomes in the largest cohort of hip arthroscopies with minimum 5-year follow-up in the literature to date. Seven variables were identified as being significant predictors of postoperative NAHS in the bivariate and multivariate analyses: preoperative NAHS, BMI, age, lateral joint space, alpha angle, revision hip arthroscopy, and acetabular microfracture. Of these, preoperative NAHS, BMI, age, and revision hip arthroscopy were predictive of 2- and 5-year postoperative NAHS. These predictive factors may prove useful to clinicians in determining indications for hip arthroscopy and counseling patients on its expected outcomes.

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Section: Discussionmentioning

confidence: 99%

“…Furthermore, our results indicating that patients with a greater BMI are more likely to convert to THA are consistent with existing literature. 36…”

Section: Discussionmentioning

confidence: 99%

Predictors of Clinical Outcomes After Hip Arthroscopy: 5-Year Follow-up Analysis of 1038 Patients

Domb

Chen

et al. 2020

Am J Sports Med

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“…[1][2][3][4][5][6][7][8][9] Yet, as with all orthopaedic procedures, rate of recovery and outcomes are highly influenced by patient-specific factors, including age, sex, body habitus, and arthritic changes. 10,11 Increasing evidence has demonstrated that outcomes of orthopaedic procedures also depend on patient psychological traits, which can affect compliance, rehabilitation effort, and pain perception. 12,13 It recently has been shown that psychological factors such as depression and distress are predictors of lower preoperative patient-reported outcome scores, chronic postoperative pain, and poor outcomes following hip arthroscopy.…”

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confidence: 99%

What is the Role of Kinesiophobia and Pain Catastrophizing in Outcomes After Hip Arthroscopy for Femoroacetabular Impingement Syndrome?

Clapp

Nwachukwu

Beck

et al. 2020

Arthroscopy, Sports Medicine, and Rehabilitation

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Purpose: To (1) investigate trends in kinesiophobia and pain catastrophizing after hip arthroscopy for femoroacetabular impingement syndrome (FAIS), and (2) determine whether kinesiophobia and pain catastrophizing scores are associated with achieving minimal clinically important difference (MCID) for any of the hip-specific patient-reported outcome questionnaires. Methods: Patients undergoing primary hip arthroscopy for treatment of FAIS between December 2016 and March 2017 were prospectively enrolled. Patients received the Tampa Scale of Kinesiophoibia-11 (TSK-11) and Pain Catastrophizing Scale (PCS) questionnaires preoperatively, 6 months, and 1 year postoperatively. They also received the hip-specific patient-reported outcome questionnaires (Hip Outcome Score Activities of Daily Living and Sport-Specific subscales, modified Harris Hip Score, and International Hip Outcome Tool-12), as well as visual analog scale for satisfaction and pain preoperatively and 1-year postoperatively. The threshold for achieving MCID was determined for each hip outcome tool, and patients achieving MCID were compared with those who did not. Results: A total of 85 (80.2%) patients (mean age: 33.7 AE 12.4 years; female: 75.3%) were included in the final analysis. At 1-year follow-up, there was a significant reduction in TSK-11 scores (26.22 AE 5.99 to 18.70 AE 6.49; P < .001) and PCS scores (17.81 AE 10.13 to 4.77 AE 7.57; P < .001) when compared with preoperative scores. 1-year PCS scores were significantly lower in patients achieving MCID compared with patients failing to achieve MCID (3.2 AE 4.4 vs 10.8 AE 15.2; P ¼ .006). There were no significant differences in TSK-11 scores between those achieving and not achieving MCID. Conclusions: Patient kinesiophobia and pain catastrophizing both show significant improvements 1 year after undergoing hip arthroscopy for FAIS. However, pain catastrophizing scores at 1 year are significantly greater in patients not achieving MCID, whereas no association was identified between kinesiophobia and likelihood for MCID achievement. This suggests PCS may be a more useful tool than TSK-11 during postoperative rehabilitation for identifying patients at risk for not achieving MCID.

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“…The anterolateral (AL) portal is usually the very first access portal created when performing hip arthroscopy. Anatomically, it has been standardized relative to the location of the greater trochanter (GT) 1, 2, 3, 4…”

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Forget the Greater Trochanter! Hip Joint Access With the 12 O’clock Portal in Hip Arthroscopy

Maldonado

Chen

Walker-Santiago

et al. 2019

Arthroscopy Techniques

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Most surgeons rely on the greater trochanter as the reference point to establish the anterolateral portal. Nevertheless, we believe that the anterosuperior iliac spine is a more reliable landmark. Unlike the greater trochanter, it is unaffected by leg rotation and is more easily identified by palpation. Abiding by the central tenet of medicine to “do no harm,” the technique described herein presents in detail the concept of the 12 o’clock portal placement, a hip joint access method based on identifying specific anatomic points under fluoroscopy and by palpation. To accomplish this goal, this Technical Note presents a step-by-step approach, including tips and pearls for patient positioning and fluoroscopic guidance. We believe this method ensures a reproducible and safe way to start hip arthroscopy in the supine position.

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Minimum Five-Year Outcomes of Hip Arthroscopy for the Treatment of Femoroacetabular Impingement and Labral Tears in Patients with Obesity

Abstract: Prognostic Level III. See Instructions for Authors for a complete description of levels of evidence.

Cited by 45 publications

References 28 publications

Predictors of Clinical Outcomes After Hip Arthroscopy: 5-Year Follow-up Analysis of 1038 Patients

Predictors of Clinical Outcomes After Hip Arthroscopy: 5-Year Follow-up Analysis of 1038 Patients

What is the Role of Kinesiophobia and Pain Catastrophizing in Outcomes After Hip Arthroscopy for Femoroacetabular Impingement Syndrome?

Forget the Greater Trochanter! Hip Joint Access With the 12 O’clock Portal in Hip Arthroscopy

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