Faculty Bibliography

PURPOSE/UNASSIGNED:To assess hip symptomatology during the perioperative and peripregnancy periods and postoperative outcomes among reproductive age females undergoing arthroscopic treatment for femoroacetabular impingement syndrome (FAIS) and pregnancy complications in females after hip arthroscopy. METHODS/UNASSIGNED:Females aged 18-44 years who underwent hip arthroscopy for the treatment of FAIS with a single surgeon were included in the study. Postoperatively, patients were surveyed regarding obstetric history, hip symptomology, and post-surgery pregnancy experiences. Subjects were classified as nulligravid (Group 1), pregnant at least once before hip surgery but never again following surgery (Group 2), or pregnant at least once following hip surgery (Group 3). Hip pain intensity was reported on a 10-point Visual Analog Scale (VAS) and hip function was reported using the modified Harris Hip Score (mHHS). Patients self-reported pregnancy outcomes and complications. RESULTS/UNASSIGNED:85 patients were enrolled with a mean age of 32.3 ± 6.5 years at the time of surgery. Mean follow-up time was 51.9 ± 34.5 months. There were 39 subjects in Group 1 (45.9 %), 20 in Group 2 (23.5 %), and 26 in Group 3 (30.6 %). There were no significant inter-group differences in mHHS preoperatively or at final follow-up (p = 0.95). Group 3 subjects reported that both postoperative and post-pregnancy VAS remained significantly lower than the preoperative baseline (p < 0.001). 69.2 % and 73.1 % report worsened hip pain during the third trimester and postpartum, respectively. 57.9 % reported that their hip pain returned to the pre-pregnancy baseline by time of survey completion. CONCLUSION/UNASSIGNED:Females of reproductive age with FAIS can expect clinical improvements relative to their baseline after hip arthroscopy regardless of pregnancy timing relative to surgical intervention. A majority of patients who become pregnant post-arthroscopy experience a peripartum recurrence of their symptoms. Most but not all of these patients return to the level of maximal improvement they had initially experienced postoperatively.

BACKGROUND:Three-dimensional MR fingerprinting (3D-MRF) has been increasingly used to assess cartilage degeneration, particularly in the knee joint, by looking into multiple relaxation parameters. A comparable 3D-MRF approach can be adapted to assess cartilage degeneration for the hip joint, with changes to accommodate specific challenges of hip joint imaging. PURPOSE/OBJECTIVE:in clinically feasible scan times. STUDY TYPE/METHODS:Prospective. SUBJECTS/METHODS:Eight healthy subjects, three patients with mild osteoarthritis (OA), and one of the OA patients had femoral acetabular impingement (FAI). A National Institute of Standards and Technology/International Society for Magnetic Resonance in Medicine (NIST/ISMRM) system phantom was also used. FIELD STRENGTH/SEQUENCE/UNASSIGNED:mapping. ASSESSMENT/RESULTS:maps of 3D-MRF sequence were evaluated on a NIST/ISMRM phantom and human subjects. Differences in the parametric maps between OA and healthy subjects were assessed. STATISTICAL TESTS/METHODS:Regression, Bland-Altman, Kruskal-Wallis, and Wilcoxon tests were used to assess for accuracy, repeatability, and subregional variation. The P-value <0.05 indicated statistically significant. RESULTS:) in femoral lateral compartment of the hip joint compared to healthy controls. DATA CONCLUSION/CONCLUSIONS:3D-MRF may be a feasible approach for simultaneous, quantitative mapping of bilateral hip joint cartilage in healthy and mild OA patients. EVIDENCE LEVEL/METHODS:1 TECHNICAL EFFICACY: Stage 1.

BACKGROUND:The minimal clinically important difference (MCID), Patient Acceptable Symptom State (PASS), and substantial clinical benefit (SCB) are valuable clinical thresholds used to provide clinical relevance to patient outcome scores. In hip arthroscopy (HA) for femoroacetabular impingement (FAI) syndrome, these values have been defined for the short- and midterm postoperative period, but meaningful long-term thresholds have not been established. PURPOSE/OBJECTIVE:To define the MCID, PASS, and SCB for the modified Harris Hip Score (mHHS) and Nonarthritic Hip Score (NAHS) at a minimum follow-up of 10 years for patients who underwent HA for FAI syndrome. STUDY DESIGN/METHODS:Case series; Level of evidence, 4. METHODS:A retrospective cohort study including all patients who underwent primary HA for FAI with a single surgeon from February 2010 to December 2013 was performed. Patient outcomes were assessed with an anchor question, mHHS, and NAHS at baseline and at 1, 5, and 10 years of follow-up. MCID was calculated using the distribution-based method at all time points, using 0.5 standard deviations as the threshold. The anchor-based MCID, PASS, and SCB were calculated at 10 years using thresholds representing the optimal cutoff on a receiver operating characteristic curve. Correlations between baseline characteristics and achievement of the MCID, PASS, and SCB were assessed with binomial logistic regressions. RESULTS:= .01). CONCLUSION/CONCLUSIONS:The establishment of the MCID, SCB, and PASS for the NAHS and mHHS provides a valuable clinical context for improvements in outcome scores after HA. Anchor-based calculations were consistently higher than distribution-based calculations.

PURPOSE/OBJECTIVE:To investigate the 10-year outcomes of hip arthroscopy in femoroacetabular impingement syndrome (FAIS), comparing the impact of cam lesion location (superolateral, anterolateral, or anterior) on total hip arthroplasty (THA) conversion rates, revision rates, and patient-reported outcomes (PROs). METHODS:This retrospective cohort study evaluated patients who underwent primary hip arthroscopy for FAIS between 2010 and 2013. Included patients had preoperative radiographic evidence of cam lesions and a minimum of 10-years of follow-up data. Patients were categorized by cam lesion location: superolateral, anterolateral, or anterior. Outcomes included revision rates, conversion to THA, and PROs measured with the modified Harris Hip Score (mHHS) and Non-Arthritic Hip Score (NAHS) at 10 years. Statistical analyses were performed using independent T tests, ANOVA, Fisher's exact tests, and multivariable regression. RESULTS:A total of 157 patients were included, with a mean follow-up of 11.66 ± 1.08 years. The cohort included 93 patients with superolateral cam lesions, 38 with anterolateral lesions, and 26 with anterior lesions. Revision rates were 0% for anterior lesions, 7.89% for anterolateral lesions, and 4.3% for superolateral lesions (P = 0.3806). THA conversion rates were 7.69% (anterior), 2.63% (anterolateral), and 8.6% (superolateral) (P = 0.3558). 10-year mHHS (superolateral: 86.7 ± 18.85; anterolateral: 85.97 ± 18.76; anterior: 90.99 ± 11.61; P = 0.4932) and NAHS (superolateral: 83.92 ± 19.84; anterolateral: 84.73 ± 20.83; anterior: 89.62 ± 13.27; P = 0.4076) were comparable across groups. Achievement of the MCID was high across all groups, with 89.2% (140/157) of patients reaching the mHHS MCID and 91.1% (143/157) reaching the NAHS MCID with no significant differences by cam lesion location for either mHHS (P = 0.526) or NAHS (P = 0.999). Multiple linear regression analysis identified higher BMI (mHHS: P = 0.0005; NAHS: P < 0.0001) and female sex (mHHS: P = 0.0245; NAHS: P = 0.0115) as predictors of worse outcomes. Logistic regression analysis found that female sex (P = 0.0451), elevated Tönnis grade (P = 0.0015), and elevated Outerbridge grade (P = 0.0474) were associated with increased rates of THA conversion and revision. CONCLUSIONS:Cam lesion location does not significantly affect revision rates, THA conversion, or long-term PROs. Factors such as BMI, sex, Outerbridge grade, and Tönnis grade are more influential on long-term outcomes. LEVEL OF EVIDENCE/METHODS:Level III: retrospective diagnostic comparative case series.

Acetabular cartilage delamination (ACD) can result in focal chondral defects, increasing contact stresses and contributing to osteoarthritis. This is commonly associated with femoroacetabular impingement, particularly with cam deformities due to shearing of the cam on the acetabulum. Additionally, ACD associated with labral tears or chondrolabral separation, when untreated, can compromise labral repair outcomes. ACD is often missed on preoperative magnetic resonance imaging and magnetic resonance arthrography, which show a sensitivity of <80%. Thus, given the ubiquity of ACD in patients undergoing femoroacetabular impingement surgery, a single-stage treatment option is essential. Acetabular shape, depth, and constraint, coupled with the thinness of acetabular cartilage, make treatment technically difficult, particularly arthroscopically. Treatment generally falls within 3 categories: repair, repair with augmentation, or cell-based cartilage transplantation. Currently, we most commonly employ primary repair and incorporate the cartilage flap into the labral repair. The chondral nail described by Zhu et al. is an intriguing off-the-shelf, single-stage technique that merits further investigation.

BACKGROUND:While both short- and long-term outcomes after hip arthroscopy for femoroacetabular impingement syndrome (FAIS) have been reported, the predictive relationship between the two has yet to be established. PURPOSE/OBJECTIVE:To determine whether the degree of improvement in patient-reported outcomes observed at 1 year postoperatively predicts long-term outcomes at 10 years after primary hip arthroscopy for FAIS. STUDY DESIGN/METHODS:Cohort study; Level of evidence, 3Methods:Patients who underwent primary hip arthroscopy for FAIS by a single surgeon at a single institution with 10-year follow-up were identified. Outcomes were assessed using the modified Harris Hip Score (mHHS) and Nonarthritic Hip Score (NAHS) at baseline and 1, 2, 5, and 10 years postoperatively. Patients were classified as either high improvement (HI) or low improvement (LI) based on if they achieved the median 1-year change in mHHS from baseline. Chart review was performed to collect surgical details such as operative procedures, complications, and revision surgery. Outcomes were compared between groups over time using repeated-measures analysis of variance. Failure rates were determined using Kaplan-Meier and Mantel-Cox log-rank analyses. RESULTS:= .002). CONCLUSION/CONCLUSIONS:Patients who experienced greater improvement in the first year after hip arthroscopy had superior 10-year outcome scores, fewer complications, and lower rates of reoperation compared with those who experienced minimal improvement in the same period.

The acetabular labrum deepens the hip socket and provides a suction seal to the femoral head. Anatomic restoration of the suction seal is the goal of hip labral repair. Labral debridement outcomes are inferior to labral repair because this suction seal is disrupted. Labral height, surface area, and volume contribute to the suction seal and are important to consider in order to restore hip stability. Labral height should be measured on MRI prior to arthroscopy. If the labrum is insufficient, surgeons should plan labral augmentation and reconstruction using a graft. Labral reconstruction can lead to successful outcomes in cases of short labral height or hypoplastic labrum by restoring the suction seal.

OBJECTIVE:To assess the correlation of pre-operative symptoms, pre-operative diagnostic imaging for cartilage loss, and intra-operative cartilage findings in patients undergoing hip arthroscopy for femoroacetabular impingement syndrome. MATERIALS AND METHODS/METHODS:Three radiologists performed retrospective independent reviews of pre-operative MRIs in 96 hips for acetabular/femoral cartilage loss utilizing a simplified "high-low" classification and the International Cartilage Repair Society grading system. Severity of supra-foveal central femoral head cartilage loss was separately noted. Pre-operative radiographs were graded using the Tonnis and Kellgren-Lawrence systems and for central joint space narrowing. Pre-operative patient symptoms were prospectively gathered utilizing the Nonarthritic Hip Score and the modified Harris Hip Score. Intra-operatively, cartilage loss was recorded using the Outerbridge system. RESULTS: CONCLUSION/CONCLUSIONS:Despite MRI underestimation of cartilage loss, the very weak-to-weak correlation of clinical symptoms with pre-operative imaging and intra-operative findings emphasizes the importance of MRI in pre-operative evaluation.

INTRODUCTION/BACKGROUND:Bone Marrow Lesions (BMLs) have a strong correlation to patient reported pain, functional limitations, joint deterioration, and rapid progression to total knee arthroplasty. The Subchondroplasty® (SCP) Procedure uses AccuFill®, a calcium phosphate bone substitute material (BSM), to treat bone defects such as microtrabecular fractures and BML. METHODS:This observational, prospective, multicenter, cohort study evaluated the effect of the SCP Procedure at two-year follow-up for 70 patients with knee BML. Under arthroscopic and fluoroscopic guidance, the BML was injected with AccuFill®. Patient reported outcomes, including Visual Analog Scale (VAS) pain, Knee Injury and Osteoarthritis Outcome Score (KOOS), International Knee Documentation Committee (IKDC), and modified Knee Society Score (mKSS) were collected through 24 months postoperatively. Radiographs and magnetic resonance images (MRI) were performed at baseline and up to 24 months post-operatively. Patient selection was not limited based on degree of osteoarthritis (OA) as determined radiologically by Kellgren-Lawrence (K-L) grade. For a subset of subjects, patient reported outcomes were collected up to five years including pain evaluation, patient knee global assessment, and satisfaction with the procedure. RESULTS:Pre-operative radiographs indicated moderate to severe osteoarthritis (K-L grades 2-4) in 65 subjects (92.8%). Significant improvements (p<0.0001) in mean VAS Pain, IKDC, mKSS and KOOS scores were observed compared with baseline. Kaplan-Meier survivorship free from conversion to knee arthroplasty was 76.2% at two years. The subset of subjects followed for five years demonstrated low pain scores and high procedure satisfaction. CONCLUSION/CONCLUSIONS:This study presents statistically significant and clinically meaningful evidence of improvement in clinical outcomes following SCP for BMLs of the knee after two years. The survivorship rate from arthroplasty at two years was 76.2%. SCP for BMLs can relieve pain with a minimally invasive procedure and may delay the need for knee arthroplasty.

Traditionally, acetabular global overcoverage had been treated by open surgical dislocation of the hip and was a relative contraindication for hip arthroscopy. With advancing arthroscopic techniques, hip arthroscopy can successfully treat acetabular global overcoverage with less morbidity for the patient than an open hip procedure. Successful arthroscopic treatment of this condition is not for the beginner hip arthroscopist. Pitfalls of an arthroscopic technique include difficult entry into the joint and labral insufficiency with the inability to perform a repair and these difficulties should be understood ahead of the procedure. However, with careful, thoughtful technique, arthroscopic treatment of acetabular global overcoverage has successful outcomes and now should be considered the preferred option instead of open surgical dislocation of the hip.