Outcomes of arthroscopy of the hip for femoroacetabular impingement based on intraoperative assessment using the Outerbridge classification

Lu, Victor; Andronic, Octavian; Zhang, James Z.; Khanduja, Vikas

doi:10.1302/0301-620x.105b7.bjj-2022-0989.r1

Cited by 11 publications

(1 citation statement)

References 90 publications

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“…Prior studies have demonstrated that increased cartilage wear is associated with inferior outcomes following hip arthroscopy [26]. A recent study reported that an official diagnosis of hip osteoarthritis was associated with prolonged opioid use following hip arthroscopy [2].…”

Section: Discussionmentioning

confidence: 99%

Risk factors for prolonged opioid consumption following hip arthroscopy: A secondary analysis of the Femoroacetabular Impingement RandomiSed controlled Trial and embedded cohort study

Bourgeault‐Gagnon,

Khalik,

Patel

et al. 2024

Knee surg. sports traumatol. arthrosc.

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PurposeThe purpose of the study was to identify prognostic risk factors for prolonged opioid use at 2 and 6 weeks after hip arthroscopy using data from the Femoroacetabular Impingement RandomiSed controlled Trial and its external validation cohort study.MethodsOpioids were prescribed for postoperative pain management at the surgeon's discretion, with a majority being prescribed a combination of oxycodone and paracetamol (5/325 mg). Prolonged opioid use was defined as the ongoing use of any dosage of opioids reported at either 2 or 6 weeks after surgery to treat femoroacetabular impingement, as recorded in the patient's study medication log. Multivariable logistic regressions were performed to evaluate patient and surgical characteristics, such as preoperative opioid use, type of surgical procedure and intraoperative cartilage state that may be associated with prolonged opioid use at either 2 and 6 weeks postoperatively.ResultsA total of 265 and 231 patients were included for analysis at 2 and 6 weeks postoperatively, respectively. The median age of participants was 35 years (interquartile range [IQR]: 27–42) and 33% were female. At 2 weeks postoperatively, female sex (odds ratio [OR]: 2.56; 95% confidence interval: [CI] 1.34–4.98, p = 0.005), higher body mass index (BMI) (OR: 1.10; 95% CI: 1.02–1.18, p = 0.009), active tobacco use (OR: 4.06; 95% CI: 1.90–8.97, p < 0.001), preoperative opioid use (OR: 10.1; 95% CI: 3.25–39.1, p < 0.001) and an Outerbridge classification of ≥3 (OR: 2.33; 95% CI: 1.25–4.43, p = 0.009) were significantly associated with prolonged opioid use. At 6 weeks postoperatively, only preoperative opioid use was significantly associated with prolonged opioid consumption (OR: 10.6; 95% CI: 3.60–32.6, p < 0.001).ConclusionPreoperative opioid use was significantly associated with continued opioid use at 2 and 6 weeks postoperatively. Specific patient factors including female sex, higher BMI, active tobacco use and more severe cartilage damage should be considered in developing targeted strategies to limit opioid use after surgery.Level of EvidenceLevel III.

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Section: Discussionmentioning

confidence: 99%

Risk factors for prolonged opioid consumption following hip arthroscopy: A secondary analysis of the Femoroacetabular Impingement RandomiSed controlled Trial and embedded cohort study

Bourgeault‐Gagnon,

Khalik,

Patel

et al. 2024

Knee surg. sports traumatol. arthrosc.

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Current concepts in the diagnosis and management of Os Acetabuli

Yoshitani,

Schoyer,

Shah

et al. 2024

International Orthopaedics (SICOT)

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Purpose The aim of this review is to appraise the current evidence on the epidemiology, pathophysiology, diagnosis and management of os acetabuli. Methods A scoping review was conducted according to the Joanna Briggs Institute guidelines. A systematic search was performed on Medline (PubMed), Embase and Cochrane Library. Inclusion criteria comprised observational and interventional studies and review articles published in the English language that focused on patients with os acetabuli according to the PRISMA extension of scoping reviews checklist using the terms ‘Os Acetabuli’ or ‘os acetabula’ or ‘acetabular ossicles’. A narrative synthesis of results was undertaken, and the included articles were divided into (i) definition, (ii) aetiology, (iii) diagnosis and imaging and (iv) management of os acetabuli. Results 107 articles were screened, with 22 meeting the eligibility criteria. A total of 8836 patients were considered, of which 604 had os acetabuli. The mean age was 32.8 years. The prevalence of os acetabuli ranged from 3.4 to 7.7%, with a higher prevalence in males compared to females. True os acetabuli was defined as an unfused secondary ossification centre along the acetabular rim. The aetiology of os acetabuli is thought to be secondary to acetabular dysplasia and/or femoroacetabular impingement. Standard of care for management of symptomatic os acetabuli is considered to be arthroscopic excision unless the excision results in acetabular undercoverage and/or instability, in which case, fixation is recommended. Conclusions Successful management of os acetabuli depends on understanding the pathology and treating the underlying cause rather than treating the os acetabuli in isolation. Future work needs to focus on establishing clear diagnostic criteria, consensus on definition and an evidence-based treatment algorithm.

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How useful are indirect radiographic measurements of hip instability in borderline hip dysplasia? An MRI-based comparison to a healthy cohort

Andronic,

Germann,

Jud

et al. 2024

International Orthopaedics (SICOT)

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Purpose Symptomatic hips with borderline hip dysplasia (BHD) morphology pose a challenge in differentiating stable from unstable hips. The current study aims to compare indirect radiographic signs of instability in a symptomatic BHD population to those in a healthy cohort. Methods The study group consisted of patients with a lateral centre–edge angle (LCEA) with values 18° ≤ LCEA < 25° who underwent corrective periacetabular osteotomy (PAO) and reported an improvement in patient-reported outcome measures (PROMs). The comparison group consisted of a healthy cohort of athletes who did not complain of any hip-related symptoms and who had normal values of their hip morphological parameters (LCEA, acetabular index (AI°), alpha angle (α°), femoral version, acetabular version). Indirect signs of instability consisting of the femoro-epiphyseal acetabular roof index (FEAR), iliocapsularis-to-rectus-femoris (IC/RF) ratio and labral dimensions (height-to-length ratio) were assessed in both groups. Partial Pearson correlation, logistic multiple regression analysis and Receiver-Operating Characteristic (ROC) curve analysis were performed to determine correlations, as well as the sensitivity and specificity of these signs to differentiate between healthy hips and BHD. Results On binary logistic multiple regression analysis, the FEAR Index was the only independent predictor to differentiate between BHD and healthy hips (p < 0.001). The IC/RF ratio did not achieve significance. The calculated area under the curve (AUC) was 0.93 (0.87 – 0.99, CI 95%, p < 0.001) for the FEAR Index and 0.81 (0.70 – 0.92, CI 95%, p < 0.001) for the height-length ratio. Using the predefined cut-off values (dysplastic—FEAR Index ≥ 5° or labral height-to-length ratio ≤ 0.5), 27% sensitivity/100% specificity and 20% sensitivity/ 100% specificity, were achieved. ROC analysis provided the following new thresholds: FEAR Index ≥ -5° (73% sensitivity/97% specificity); labral height-to-length ratio ≤ 0.8 (70% sensitivity, 79% specificity). Conclusion In our cohort, the FEAR index was an independent parameter that could differentiate between borderline dysplastic and asymptomatic hips. The previously published values for both the FEAR index and labral hypertrophy ratio had a poor sensitivity in differentiating symptomatic unstable BHD from healthy hips. The cut-off values of ≥ -5° (FEAR index) and ≤ 0.8 (labral height-to-length ratio) provided acceptable sensitivity and specificity when comparing to morphological healthy hips.

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Outcomes of arthroscopy of the hip for femoroacetabular impingement based on intraoperative assessment using the Outerbridge classification

Cited by 11 publications

References 90 publications

Risk factors for prolonged opioid consumption following hip arthroscopy: A secondary analysis of the Femoroacetabular Impingement RandomiSed controlled Trial and embedded cohort study

Risk factors for prolonged opioid consumption following hip arthroscopy: A secondary analysis of the Femoroacetabular Impingement RandomiSed controlled Trial and embedded cohort study

Current concepts in the diagnosis and management of Os Acetabuli

How useful are indirect radiographic measurements of hip instability in borderline hip dysplasia? An MRI-based comparison to a healthy cohort

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