Outcomes After Revision Hip Arthroscopic Surgery in Adolescent Patients Compared With a Matched Cohort Undergoing Primary Arthroscopic Surgery

Newman, Justin T.; Briggs, Karen K.; McNamara, Shannen; Philippon, Marc J.

doi:10.1177/0363546516659656

Cited by 25 publications

(42 citation statements)

References 23 publications

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“…Recent studies have reported that patients undergoing revision hip arthroscopy have lower baseline scores and outcomes at 2 years. 5 , 18 Domb et al 5 evaluated 107 cases of revision hip arthroscopy and compared these with a large cohort of patients who underwent primary hip arthroscopy. They determined that patients undergoing revision hip arthroscopy had worse measures of joint pain and function at all time points measured.…”

Section: Discussionmentioning

confidence: 99%

Predictors of Hip Pain and Function in Femoroacetabular Impingement: A Prospective Cohort Analysis

Westermann

Lynch

Jones

et al. 2017

Orthopaedic Journal of Sports Medicine

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Background:Validated patient-reported outcome measures (PROMs) of hip pain and function at the time of arthroscopy could be predictors of the final outcome. Little is known about how patient factors or pathologic intra-articular findings relate to hip pain or function at the time of surgery for those presenting with femoroacetabular impingement (FAI).Purpose:To evaluate all patient and operative factors that contribute to hip pain and dysfunction in patients with FAI.Study Design:Cross-sectional study; Level of evidence, 3.Methods:A prospective cohort of patients undergoing hip arthroscopy for FAI were electronically enrolled between February 2015 and September 2016. Baseline PROMs were collected, including Hip disability and Osteoarthritis Outcome Score (HOOS) for pain, HOOS–Physical Function Shortform (HOOS-PS), Veterans RAND 12-Item Health Survey (VR-12), and University of California–Los Angeles (UCLA) Activity Score. Surgeons documented intra-articular operative findings and treatment. Multivariable linear regression models were created for continuous scores of HOOS pain, HOOS-PS, and VR-12 Physical Component Score as outcome measures. Risk factors included patient characteristics and intraoperative anatomic and pathologic findings.Results:During the study period, 396 patients underwent arthroscopic hip procedures, and 373 (94%) completed preoperative PROMs; 331 patients were undergoing arthroscopic surgery for FAI. The mean patient age was 32.91 ± 12.49 years, mean body mass index was 26.22 ± 4.92 kg/m2, and 71% were female. Multivariate analyses demonstrated female sex, lower education levels, smoking, lower mental health scores, and lower activity-level scores predicted HOOS pain preoperatively. According to multivariate analysis, patient factors associated with worse baseline HOOS-PS include smoking, additional years of education, lower mental health, and activity scores. Lower baseline VR-12 functional scores were predicted by female sex, elevated body mass index, smoking, and lower activity levels. For all baseline PROMs, there was no instance where an arthroscopic variable or pathologic finding proved statistically significant after the important patient covariates were controlled for.Conclusion:Patient factors, including mental health, activity level, sex, and smoking, are more predictive of baseline hip pain (as measured by HOOS) and function than are intra-articular findings (eg, status of the labrum or articular cartilage) during hip arthroscopy for FAI. Future studies evaluating patient outcomes after surgery for FAI should consider adjusting for these identified patient factors to accurately interpret the effect of treatment on patient-reported outcomes after surgery.

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Section: Discussionmentioning

confidence: 99%

Predictors of Hip Pain and Function in Femoroacetabular Impingement: A Prospective Cohort Analysis

Westermann

Lynch

Jones

et al. 2017

Orthopaedic Journal of Sports Medicine

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“…A number of labral tears found in our study may have been present even before surgery; therefore, we decided to call these "residual" labral tears. However, it is known from studies of patients undergoing revision hip arthroscopy that labral repairs and additional labral débridement is often performed during revision surgery (25), so some of the labral tears found are actually clinically relevant labral tears. However, our study design did not allow us to further investigate the relevance of these labral tears.…”

Section: Discussionmentioning

confidence: 99%

“…These adhesions have been suspected as an important cause of softtissue impingement, restricted range of motion, and pain after hip arthroscopy (9,26). In a recent cohort study (25), painful adhesions were seen at revision surgery in nine of 42 patients (21%) who underwent arthroscopic hip surgery. As a consequence, capsular adhesions are a common reason for revision surgery (9,12,13).…”

Section: Discussionmentioning

confidence: 99%

Arthroscopic Hip Surgery: Frequency of Postoperative MR Arthrographic Findings in Asymptomatic and Symptomatic Patients

et al. 2017

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Purpose To determine and compare the frequency of imaging abnormalities in asymptomatic and symptomatic patients after arthroscopic hip surgery. Materials and Methods This study was approved by the institutional review board. Informed consent was obtained from all patients. Thirty-four patients (17 asymptomatic and 17 symptomatic patients) underwent 1.5-T magnetic resonance (MR) arthrography of the hip 1 year after arthroscopic treatment of femoroacetabular impingement. Two readers independently analyzed all MR arthrographic images for the presence of abnormal imaging findings, including capsular adhesions at the femoral neck, obliteration of the paralabral sulcus, labral defects, and defects of the hip capsule in several anatomic positions (anterior to posterior). Postoperative findings were compared with linear and generalized linear mixed-effects regression models. Results Capsular adhesions at the anterior femoral neck were present in 12 of the 34 patients (35%), and there were no differences between the groups or readers (P = .99). The paralabral sulcus was obliterated in at least one anatomic location in 94% (reader 1, 32 of 34 patients) and 100% (reader 2, 34 of 34 patients) of patients (P = .99). Residual labral tears were detected in 35% of asymptomatic patients (six of 17 patients) and 41% of symptomatic patients (seven of 17 patients) by reader 1 and in 53% of asymptomatic and symptomatic patients (nine of 17 patients in each group) by reader 2, without significant differences between the groups (P = .81). Defects of the hip capsule were more common in asymptomatic patients (77% [13 of 17 patients] for reader 1 and 53% [nine of 17 patients] for reader 2) than in symptomatic patients (59% [10 of 17 patients] for reader 1 and 47% [eight of 17 patients] for reader 2), but without significant differences (P = .33). Conclusion Obliteration of the paralabral sulcus was the most frequent finding after arthroscopic hip surgery in both asymptomatic and symptomatic patients, and capsular adhesions at the anterior femoral neck were present in 35% of patients in both groups. RSNA, 2016.

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“…For instance, 9 of 42 patients (21%) in a recent revision hip arthroscopy study were suspected to have painful adhesions preoperatively. 35 Symptomatic intra-articular adhesions can be successfully released by arthroscopic adhesiolysis. 31,32,34,36 In contrast, a recent magnetic resonance arthrography (MRA) study comparing the frequency and size of postoperative intra-articular adhesions in three locations in asymptomatic and symptomatic postoperative FAI patients detected no significant differences of capsular adhesions between the study groups.…”

Section: Adhesionsmentioning

confidence: 99%

“…12,32 Overall, it can be concluded that intra-articular adhesions are common, they occur with the same frequency in asymptomatic and symptomatic patients after FAI surgery, and they are not necessarily linked with symptoms in the postoperative FAI patient. 12,35 At our institution, an injection technique addressing the femoral head instead of the femoral neck for MRA is the most favored injection approach in postoperative patients to avoid contrast injection into the intra-articular adhesions. Hence the femoral head contrast injection technique should reduce the likelihood of an extra-articular contrast material leakage related to the injection path compared with a femoral neck injection technique.…”

Section: Adhesionsmentioning

confidence: 99%

Postoperative Imaging after Impingement Surgery

Dietrich

Grob

Kim

2017

Semin Musculoskelet Radiol

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In addition to the patient's medical history and clinical evaluation, conventional radiographs and magnetic resonance imaging (MRI) are important tools to indicate appropriate conservative treatment or even revision surgery in patients with symptoms after surgical management of femoroacetabular impingement (FAI). We present an overview of current evidence in postoperative imaging after impingement surgery. Undercorrection of the underlying osseous FAI configuration is the most frequent indication for revision surgery within the first 2 years after index FAI surgery. Femoral neck fractures, iatrogenic chondral injuries, early conversion to total hip arthroplasty, loose bodies, and heterotopic ossifications are rare but typical early complications after surgical treatment of FAI. Abnormal MRI findings after FAI surgery such as intra-articular adhesions, labral tears, cartilage defects, and anterior capsular defects are common findings in both asymptomatic and symptomatic postoperative patients. Avascular necrosis of the femoral head is an extremely rare complication after surgical treatment of FAI.

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Outcomes After Revision Hip Arthroscopic Surgery in Adolescent Patients Compared With a Matched Cohort Undergoing Primary Arthroscopic Surgery

Cited by 25 publications

References 23 publications

Predictors of Hip Pain and Function in Femoroacetabular Impingement: A Prospective Cohort Analysis

Predictors of Hip Pain and Function in Femoroacetabular Impingement: A Prospective Cohort Analysis

Arthroscopic Hip Surgery: Frequency of Postoperative MR Arthrographic Findings in Asymptomatic and Symptomatic Patients

Postoperative Imaging after Impingement Surgery

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