Revision Hip Arthroscopy After Labral Reconstruction Using Iliotibial Band Autograft: Surgical Findings and Comparison of Outcomes With Labral Reconstructions Not Requiring Revision

Locks, Renato; Bolia, Ioanna K; Utsunomiya, Hidetsuna; Philippon, Marc J.

doi:10.1016/j.arthro.2017.10.054

Cited by 33 publications

(33 citation statements)

References 22 publications

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“…Whether this association was related to the low impact of stationary cycling, inhibition of joint adhesions from motion restoration, or other factors requires further study. 9 , 17 , 18 , 35 , 37 …”

Section: Discussionmentioning

confidence: 99%

Pain Scores and Activity Tolerance in the Early Postoperative Period After Hip Arthroscopy

Ramos

Kraeutler

Marty

et al. 2020

Orthopaedic Journal of Sports Medicine

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Background: Despite the rapid growth in the use of hip arthroscopy, standardized data on postoperative pain scores and activity level are lacking. Purpose: To quantify narcotic consumption and use of the stationary bicycle in the early postoperative period after hip arthroscopy. Study Design: Case series; Level of evidence, 4. Methods: In this prospective case series, patients undergoing a primary hip arthroscopy procedure by a single surgeon were asked to fill out a daily survey for 9 days postoperatively. Patients were asked to report their pain level each day on a visual analog scale from 1 to 10, along with the amount of narcotic pain pills they used during those postoperative days (PODs). Narcotic usage was converted to a morphine-equivalent dosage (MED) for each patient. Patients were also instructed to cycle daily starting on the night of surgery for a minimum of 3 minutes twice per day and were asked to rate their pain as a percentage of their preoperative pain level and the number of minutes spent cycling on a stationary bicycle per day. Results: A total of 212 patients were enrolled in this study. Pain levels (POD1, 5.5; POD4, 3.8; POD9, 2.9; P < .0001) and the percentage of preoperative pain (POD1, 51.6%; POD4, 31.8%; POD9, 29.5%; P < .01) significantly decreased over the study period. The amount of narcotics used per day (reported in MED) also significantly decreased (POD1, 27.3; POD4, 22.3; POD9, 8.5; P < .0001). By POD4, 41% of patients had discontinued all narcotics, and by POD9, 65% of patients were completely off narcotic medication. Patients were able to significantly increase the number of minutes spent cycling each day (POD1, 7.6 minutes; POD4, 13.8 minutes; POD9, 19.0 minutes; P < .0001). Patients who received a preoperative narcotic prescription for the affected hip were significantly more likely to require an additional postoperative narcotic prescription ( P < .001). Conclusion: Patients can expect a rapid decrease in narcotic consumption along with a high degree of activity tolerance in the early postoperative period after hip arthroscopy.

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Section: Discussionmentioning

confidence: 99%

Pain Scores and Activity Tolerance in the Early Postoperative Period After Hip Arthroscopy

Ramos

Kraeutler

Marty

et al. 2020

Orthopaedic Journal of Sports Medicine

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“…The clinical outcomes seem poorer after labral resection compared to labral preservation, but no sound evidence is available to date, notably regarding circumferential labral resection [39][40][41]. Labral reconstruction using an autologous tendon graft can be considered to restore fluid sealing, although graft outcomes, particularly in terms of the risk of ossification, remain unclear [42].…”

Section: Open Surgical Treatmentmentioning

confidence: 99%

Limitations of arthroscopy for managing coxa profunda

Flécher¹,

Wettstein²,

May³

2019

Orthopaedics & Traumatology: Surgery & Research

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Coxa profunda is a complex entity that can result in femoro-acetabular impingement (FAI). A meticulous evaluation of the type of acetabular overcoverage is essential to determine which treatment is best suited to each individual patient. Focal overcoverage with no posterior impingement can be treated by arthroscopic recontouring of the disproportionate acetabular wall. Any femoral deformities should be managed during the same procedure. General overcoverage, with predominant postero-inferior impingement, requires open surgery to obtain access to the entire acetabular rim. Rim resection should be sparing, to avoid removing an excessive proportion of the joint surface, yet sufficient to eliminate the impingement. In the event of protrusio acetabuli, which is the extreme form of coxa profunda, reverse peri-acetabular osteotomy should be considered, particularly if the acetabular roof angle is reversed. In some patients, chiefly those with coxa vara, valgus femoral osteotomy should be considered as a means of redirecting the loads towards the acetabular roof, thereby diminishing the forces that tend to drive the femoral head deeper into the socket.

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“…Our patient population differs from several other labral reconstruction study cohorts in that we report a population with high rates of acetabular microfracture (29%), Tönnis grade 1 (22.6%) and high grade (grades 3–4) acetabular cartilage damage (49%) [ 16 , 26 , 36 , 37 ]. This finding suggests patients with irreparable labral damage requiring labrum reconstruction may be more likely to have high grade cartilage damage, but controlled, comparative studies comparing labral reconstruction with debridement/repair are needed to answer this question.…”

Section: Discussionmentioning

confidence: 88%

Arthroscopic labral reconstruction using fascia lata allograft: shuttle technique and minimum two-year results

Carreira

Kruchten²,

Emmons

et al. 2018

Journal of Hip Preservation Surgery

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The purpose of this study was to describe the shuttle technique of acetabular labral reconstruction using allograft fascia lata and report minimum two-year clinical outcomes in a prospective patient cohort. We present a shuttle technique to introduce and fixate the allograft, by which the need to fix the free end of the graft from inside the joint is avoided. Between October 2010 and March 2014, 693 hip arthroscopic surgeries were performed by the senior author. Of these 693 patients, 34 patients underwent a labral reconstruction procedure using allograft fascia lata and the shuttle technique and met inclusion criteria. Outcome measures were collected at minimum two years postoperatively. 91.2% (31) of reconstruction patients were available for follow-up at minimum two years after surgery with 12.9% (4) of these patients converting to total hip arthroplasty at average time 27.9 months post-surgery. For the remaining reconstruction patients, mean mHHS increased from 64.0 preoperatively to 84.6 postoperatively (P = 0.0015), SF-12 Physical from 38.9 to 49.0 (P = 0.0004), SF-12 Mental from 49.5 to 55.6 (P = 0.0095), iHOT-12 from 36.4 to 68.1 (P = 0.0017), HOS-ADL from 62.6 to 81.6 (P = 0.0032) and HOS-SS from 32.9 to 65.7 (P < 0.0001). Arthroscopic acetabular labral reconstruction using fascia lata allograft and a shuttle technique appears to be an effective procedure for the treatment of labral pathology through minimum two-year follow-up. While it is difficult to discern the direct influence of the labral reconstructive procedure given the treatment of often concomitant intra-articular pathology, this patient cohort has fared similarly to other cohorts of labral reconstruction patients. No major adverse events are reported.

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Revision Hip Arthroscopy After Labral Reconstruction Using Iliotibial Band Autograft: Surgical Findings and Comparison of Outcomes With Labral Reconstructions Not Requiring Revision

Cited by 33 publications

References 22 publications

Pain Scores and Activity Tolerance in the Early Postoperative Period After Hip Arthroscopy

Pain Scores and Activity Tolerance in the Early Postoperative Period After Hip Arthroscopy

Limitations of arthroscopy for managing coxa profunda

Arthroscopic labral reconstruction using fascia lata allograft: shuttle technique and minimum two-year results

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