The Success of Hip Arthroscopy in an Active Duty Population

Dutton, Jason R.; Kusnezov, Nicholas; Lanzi, Joseph T.; Garcia, E’Stephan J.; Pallis, Mark

doi:10.1016/j.arthro.2016.05.042

Cited by 27 publications

(34 citation statements)

References 24 publications

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“…FAI syndrome is a musculoskeletal disorder of the hip more common in younger adults and often treated with surgical correction of joint morphology (Amanatullah et al 2015 ; Fayad et al 2013 ). In fact, it is the most common reason for arthroscopic hip surgery in younger, active adults in civilian as well as military populations (Dutton et al 2016 ), with a fivefold increase in the US between 2005 and 2013 (Kremers et al 2017 ) Therefore, subjects under 18 or over 50 years of age were excluded, leaving those that best represents the age range for symptomatic FAI syndrome (Clohisy et al 2013 ). Because FAI syndrome does not have a diagnosis code established by the International Classification of Diseases (ICD-9), we identified surgical procedures used to treat this condition, in order to make the cohort more homogenous.…”

Section: Methodsmentioning

confidence: 99%

Predictors of chronic prescription opioid use after orthopedic surgery: derivation of a clinical prediction rule.

et al. 2018

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BackgroundPrescription opioid use at high doses or over extended periods of time is associated with adverse outcomes, including dependency and abuse. The aim of this study was to identify mediating variables that predict chronic opioid use, defined as three or more prescriptions after orthopedic surgery.MethodsIndividuals were ages between 18 and 50 years and undergoing arthroscopic hip surgery between 2004 and 2013. Two categories of chronic opioid use were calculated based on individuals (1) having three or more unique opioid prescriptions within 2 years and (2) still receiving opioid prescriptions > 1 year after surgery. Univariate elationships were identified for each predictor variable, then significant variables (P > 0.15) were entered into a multivariate logistic regression model to identify the most parsimonious group of predictor variables for each chronic opioid use classification. Likelihood ratios were derived from the most robust groups of variables.ResultsThere were 1642 participants (mean age 32.5 years, SD 8.2, 54.1% male). Nine predictor variables met the criteria after bivariate analysis for potential inclusion in each multivariate model. Eight variables: socioeconomic status (from enlisted rank family), prior use of opioid medication, prior use of non-opioid pain medication, high health-seeking behavior before surgery, a preoperative diagnosis of insomnia, mental health disorder, or substance abuse were all predictive of chronic opioid use in the final model (seven variables for three or more opioid prescriptions; four variables for opioid use still at 1 year; all< 0.05). Post-test probability of having three or more opioid prescriptions was 93.7% if five of seven variables were present, and the probability of still using opioids after 1 year was 69.6% if three of four variables were present.ConclusionA combination of variables significantly predicted chronic opioid use in this cohort. Most of these variables were mediators, indicating that modifying them may be feasible, and the potential focus of interventions to decrease the risk of chronic opioid use, or at minimum better inform opioid prescribing decisions. This clinical prediction rule needs further validation.

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Section: Methodsmentioning

confidence: 99%

Predictors of chronic prescription opioid use after orthopedic surgery: derivation of a clinical prediction rule.

et al. 2018

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“…Following current reports, the treatment outcomes are very good for patients without degenerative changes in the articular cartilage, while for patients with advanced degenerative disease, the outcomes are rather poor [6,7]. Several recent studies show that patients are able to return to work without restrictions after reaching maximal medical improvement at a minimum of 1-year following hip arthroscopy [8,9]. The primary endpoints of the study were to assess the effectiveness of hip joint arthroscopy in the treatment of femoroacetabular impingement in patients with joint gap stenosis exceeding the assumed, hypothetical limit point of 3 mm, and to determine how quickly post-operative patients were able to return to work and to physical activity.…”

Section: Methodsmentioning

confidence: 92%

Hip joint arthroscopy in professionally active patients with osteoarthritis

Drobniewski

Synder

Skrzypek

et al. 2018

Int J Occup Med Environ Health

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Objectives:The primary endpoints of the study were to assess the effectiveness of hip joint arthroscopy in the treatment of femoroacetabular impingement (FAI) in patients with joint gap stenosis and to determine if and how quickly patients were able to return to work and physical activity. Material and Methods: The prospective study of patients undergoing hip joint arthroscopy due to pain in FAI has been conducted. They were divided into 2 groups depending on the degree of the radiological examination. The criterion was the width of the joint gap. The study group involved 47 patients with hip joint gap of 2-3 mm, identified by means of the standardized X-ray examination. The control group consisted of 45 patients with hip joint gap > 3 mm. The post-operative follow-up period of the patients lasted at least 2 years. In addition, the Western Ontario McMaster Universities Osteoarthritis Index (WOMAC) questionnaire together with Harris Hip Score (HHS) were applied. The patients were also evaluated for the post-operative time period enabling return to work. Results: All the patients after hip joint arthroscopy returned to normal physical activity within 12 weeks after operation, enabling their return to work. However, it should be noted that during the post-operative follow-up, pain sensations either recurred or did not regress in 37 patients in the study group and 12 patients in the control group after treatment. The nearly equal results of the WOMAC questionnaire and HHS before operation significantly vary between both groups in the last follow up. In the study group they did not change expressively. Conclusions: Despite the little invasiveness, hip joint arthroscopy in patients with joint gap stenosis brings about the far from satisfactory results. This procedure is not worth considering. Despite unsatisfactory pain relief, patients decided to returned to work, due to their occupational position and for fear of losing the job due to long absenteeism. Int J Occup Med Environ Health. 2019;32(1):115 -20

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“…Neither the Army physical profile or the APFT have been validated as outcomes measures but have been used in numerous previous studies as an adjunct for functional outcomes. 2,[21][22][23] Deployment standards are also variable according to job description within the military. Additionally, no subject included in this study underwent a capsular closure.…”

Section: Discussionmentioning

confidence: 99%

“…Numerous authors have demonstrated that hip arthroscopy is a successful treatment modality with high rates of return to sport, as well as significant improvements in clinical and functional outcomes. [1][2][3][4][5][6] Additionally, it has been found to be a safe procedure with a low rate of major and minor complications, estimated at 0.58% and 7.5% respectively. 1 Rehabilitation following hip arthroscopy is integral to the clinical outcome.…”

Section: Introductionmentioning

confidence: 99%

Functional Outcomes of Hip Arthroscopy in an Active Duty Military Population Utilizing a Criterion-Based Early Weight Bearing Progression

Shaw

Jacobs

Evanson

et al. 2017

Intl J Sports Phys Ther

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Introduction: Hip arthroscopy allows surgeons to address intra-articular pathology of the hip while avoiding more invasive open surgical dislocation. However the post-operative rehabilitation protocols have varied greatly in the literature, with many having prolonged periods of limited motion and weight bearing. Purpose: The purpose of this study was to describe a criterion-based early weight bearing protocol following hip arthroscopy and investigate functional outcomes in the subjects who were active duty military. Methods: Active duty personnel undergoing hip arthroscopy for symptomatic femoroacetabular impingement were prospectively assessed in a controlled environment for the ability to incorporate early postoperative weight-bearing with the following criteria: no increased pain complaint with weight bearing and normalized gait pattern. Modified Harris Hip (HHS) and Hip Outcome score (HOS) were performed preoperatively and at six months post-op. Participants were progressed with a standard hip arthroscopy protocol. Hip flexion was limited to not exceed 90 degrees for the first three weeks post-op, with progression back to running beginning at three months. Final discharge was dependent upon the ability to run two miles at military specified pace and do a single leg broad jump within six inches of the contralateral leg without an increase in pain. Results: Eleven participants met inclusion criteria over the study period. Crutch use was discontinued at an average of five days following surgery based on established weight bearing criteria. Only one participant required continued crutch use at 15 days. Participants' functional outcome was improved postoperatively, as demonstrated by significant increases in HOS and HHS. At the six month follow up, eight of 11 participants were able to take and complete a full Army Physical Fitness Test. Conclusions: Following completion of the early weight bearing rehabilitation protocol, 81% of participants were able to progress to full weight bearing by four days post-operative, with normalized pain-free gait patterns. Active duty personnel utilizing an early weight bearing protocol following hip arthroscopy demonstrated significant functional improvement at six months.

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The Success of Hip Arthroscopy in an Active Duty Population

Cited by 27 publications

References 24 publications

Predictors of chronic prescription opioid use after orthopedic surgery: derivation of a clinical prediction rule.

Predictors of chronic prescription opioid use after orthopedic surgery: derivation of a clinical prediction rule.

Hip joint arthroscopy in professionally active patients with osteoarthritis

Functional Outcomes of Hip Arthroscopy in an Active Duty Military Population Utilizing a Criterion-Based Early Weight Bearing Progression

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