Faculty Bibliography

OBJECTIVES/OBJECTIVE:The purpose of the current study was to determine whether post-operative acetaminophen reduced narcotic consumption following hip arthroscopy for femoroacetabular impingement(FAI). METHODS:This was a single center randomized controlled trial. Opioid-naïve patients undergoing hip arthroscopy for FAI were randomized intotwo groups. The control group received our institution's standard of care for post-operative pain control, 285mg/325mg oxycodone-acetaminophen prescribed as 1-2 tablets every 6 hours as needed for pain; while the treatment group were prescribed 650 mg acetaminophen every 6 hours for pain, with 5mg/325mg oxycodone-acetaminophen prescribed for breakthrough pain. Patients were instructed to be mindful of taking no more than 3gm of acetaminophen in a 24-hour limit. If this limit was reached, oxycodone 5mg would be prescribed.They were contacted daily and asked to report opioid use as well as their level of pain utilizing the VAS pain scale. RESULTS:Our institution enrolled 86 patients, 80 of whom completed the study (40 control, 40 treatment). There were no statistically significant differences with respect to patient demographics and patient-specific factors between groups (age at time of surgery, gender, ASA, or BMI). Additionally, there was no statistically significant difference with respect to Visual Analogue Scale (VAS) pain between groups preoperatively (P=0.64) or at 1-week follow up (P= 0.39).The treatment group did not utilize a statistically significant different number of narcotics than the control group throughout the first post-operative week (6.325 pillstreatmentvs. 5.688pills control, P= 0.237). CONCLUSION/CONCLUSIONS:The findings of this randomized controlled trial suggest that postoperative acetaminophen may have no effect on reducing the number of narcotic pills consumed by opioid naive patients following hip arthroscopy in the setting of reduced opioid-prescribing on the part of orthopedic surgeons.Furthermore, the results of this study suggest surgeons may reduce postoperative narcotic prescribing without reducing patient satisfaction following hip arthroscopy.

Purpose/UNASSIGNED:To identify clinical and radiographic factors associated with failure of revision hip arthroscopy (RHA). Methods/UNASSIGNED:A database was used to identify patients who underwent primary hip arthroscopy and revision hip arthroscopy (RHA) from January 2007 to December 2017 for the indication of femoroacetabular impingement and failure of the index procedure, respectively. The primary outcome was defined as the change, or difference, in the preoperative to postoperative alpha angle between patients with successful RHA and those with failed RHA. Failure was defined as reoperation on the operative hip for any indication or a modified Harris Hip Score (mHHS) of less than 70 at the 1-year postoperative time point. All patients had a minimum of 2 years' follow-up from the date of revision hip surgery. Patients with a history of revision were divided into those with failed revisions and those with successful revisions. The inclusion criteria for failed revision included a history of subsequent revision surgery (or arthroplasty) or an mHHS of less than 70 at final follow-up. Results/UNASSIGNED:The study included 26 patients, comprising 8 (31%) with failed RHA and 18 (69%) with successful revision. The failure group showed a significantly smaller decrease in the alpha angle with surgery, measured on the Dunn view, compared with the success group. When the preoperative alpha angle was held constant, each 1° increase in the difference between the preoperative and postoperative alpha angles achieved during surgery was associated with a 17% decrease in the odds of failure. Patients included in the success group had both a higher preoperative mHHS (44.2 ± 8.6 vs 34.7 ± 9.6) and a higher postoperative mHHS (83.2 ± 8.3 vs 62.3 ± 14.2) than patients with failed RHA. There was a statistically significant difference in the frequency of patients who achieved the patient acceptable symptomatic state of +74.0 between the failure (25%) and success (83%) groups; 88% of patients in the failure group met the minimal clinically important difference, whereas 100% of patients in the success group (n = 18) met it. Conclusions/UNASSIGNED:Complete resection of cam lesions as determined by changes in the alpha angle, anterior offset, and head-neck ratio when measured on the Dunn 45° view correlates with positive clinical outcomes after RHA. Level of Evidence/UNASSIGNED:III, Retrospective Comparative Study.

PURPOSE/OBJECTIVE:To determine the association between labral width as measured on preoperative MRI with hip-specific validated patient self-reported outcomes at a minimum of 2 years follow-up. METHODS:An IRB-approved retrospective review of prospectively gathered hip arthroscopy patients from 2010 to 2017 was performed. Inclusion criteria was defined as patients >18 years old with radiographic evidence of femoroacetabular impingement who underwent a primary labral repair and had a minimum of 2 years clinical follow-up. Exclusion criteria was defined as inadequate preoperative imaging, prior hip surgery, Tonnis grade ≥2 or lateral central edge angle <25 degrees. An a-priori power analysis was performed. MRI measurements of labral width were conducted by two blinded, musculoskeletal fellowship-trained radiologists at standardized "clockface" locations using a previously validated technique. Outcomes were assessed using the Harris Hip Score (HHS), Modified HHS (mHSS), and NonArthritic Hip Score (NAHS). For mHHS, a minimal clinically important difference (MCID) and Patient Acceptable Symptomatic State (PASS) of 8 and 74 were used, respectively. Patients were divided into groups by labral width of < (hypoplastic) and ≥ 1 standard deviation below the mean. Statistical analysis was performed using linear and polynomial regression, Mann-Whitney U, chi-square, Fischer exact, and interclass-correlation coefficients (ICC) testing. RESULTS:=0.26, p<0.001). CONCLUSION/CONCLUSIONS:Hip labral width < 1 standard deviation below the mean measured via preoperative MRI was associated with significantly worse functional outcomes following arthroscopic labral repair and treatment of FAI. The negative relationship between labral width and outcomes may be non-linear.

PURPOSE/OBJECTIVE:Previous research has demonstrated that there is a statistically significant relationship between hip arthroscopy outcomes and age. The purpose of this research was to investigate the link, if any, between hip arthroscopy outcomes and intraoperative pathology as well as with both patient age and sex. METHODS:All male patients 14 years of age or older who underwent primary hip arthroscopy for femoroacetabular impingement (FAI) and who had a 2-year patient-reported outcome scores were analyzed. These patients were separated into three age-based cohorts (< 30 years old, 30 to 45 years old, and > 45 years old). These cohorts were then analyzed and compared with respect to patient demographic information, intraoperative pathology, and functional outcome scores for statistical significance, set at p < 0.05. RESULTS:At 2-year follow-up, there was a significant difference seen between the modified Harris Hip scores (mHHS) of the < 30 years old and > 45 years old cohorts with a mean difference of 10.2 (92.05 ± 10.3 and 81.89 ± 16.7, p = 0.044). The results of an ANOVA comparing 2-year non-arthritic hip scores (NAHS) were not statistically significant (p = 0.196). At 2-year follow up, the NAHS scores were 92.18 ± 10.3, 87.76 ± 15.6, and 84.63 ± 15.9 for the < 30 years old, 30 to 45 years old, and > 45 years old cohorts, respectively. When analyzing cohorts for rates of achieving a minimal clinically important difference (MCID) and patient acceptable symptomatic state (PASS), however, there were no statistically significant differences between groups. CONCLUSIONS:The results of this study suggest that males of all ages have generally good and similar outcomes following hip arthroscopy for FAI as determined by their similar rates of achieving both MCID and PASS.

BACKGROUND/UNASSIGNED:Limited evidence exists concerning the effect of age on hip arthroscopy outcomes for femoroacetabular impingement (FAI). PURPOSE/HYPOTHESIS/UNASSIGNED:The purpose was to investigate patient-reported outcomes (PROs) and clinical failure rates across various age groups in patients undergoing hip arthroscopy for FAI. We hypothesized that older patients would experience lower improvements in PROs and higher clinical failure rates. STUDY DESIGN/UNASSIGNED:Cohort study; Level of evidence, 3. METHODS/UNASSIGNED:A total of 109 of 130 eligible consecutive patients underwent hip arthroscopy for FAI with a minimum 5-year follow-up. Patients were stratified into 3 groups for comparison (ages 15-34, 35-50, and 51-75 years). Clinical survival rates to revision surgery or total hip arthroplasty (THA) were determined by Kaplan-Meier analysis, and PROs were assessed using analysis of variance. Regression analysis was used to determine factors associated with clinical failure and ΔPROs from baseline to 5 years. RESULTS/UNASSIGNED:= .030) groups from 6-month to 5-year outcomes. CONCLUSION/UNASSIGNED:Although hip arthroscopy for FAI yielded improvements in PROs regardless of age, middle-aged and older patients experienced greater declines in clinical outcomes over time than younger patients. Older patients remain good candidates for arthroscopy despite a greater risk for conversion to THA.

BACKGROUND/UNASSIGNED:Limited evidence exists comparing short- and long-term patient-reported outcomes (PROs) and overall survival rates after hip arthroscopy for femoroacetabular impingement syndrome (FAIS). HYPOTHESIS/UNASSIGNED:Patients with high improvement (HI) versus low improvement (LI) at 1 year postoperatively would achieve higher PROs and better index procedure survival rates at 5-year follow-up. STUDY DESIGN/UNASSIGNED:Cohort study; Level of evidence, 3. METHODS/UNASSIGNED:Patients who underwent primary hip arthroscopy for FAIS between September 2012 and March 2014 with minimum 5-year outcome data were identified. Using the median 1-year change in modified Harris Hip Score (mHHS) as a threshold, HI and LI subcohorts were determined. Analysis of variance was used to compare PROs. Failure rates were determined using Kaplan-Meier and Cox proportional hazards model analyses. Regression analysis was used to identify factors associated with increasing 5-year change in mHHS and Nonarthritic Hip Score (NAHS). RESULTS/UNASSIGNED:= .023) were associated with higher 5-year ΔPROs. CONCLUSION/UNASSIGNED:Patients with FAIS and significant improvement in the first year after hip arthroscopy had superior 5-year outcomes versus patients with persistent symptom severity. Survival rates and PROs were significantly better in patients who achieved high early outcomes at the 1-year mark.

PURPOSE/OBJECTIVE:The primary outcome is to compare post-operative outcomes between opioid naïve patients and patients with a history of pre-operative opioid usage undergoing hip arthroscopy. The secondary outcome is to determine if pre-operative opioid users consumed more oral morphine milligram equivalents than opioid naïve patients following surgery. METHODS:This is a single-center, retrospective analysis comparing outcomes and postoperative opioid usage between patients with and without a history of pre-operative opioid use. Inclusion criteria included patients ≥ 18 years, Tonnis grade 0 or 1, imaging consistent with FAI or labral pathology, and a diagnosis of symptomatic FAI requiring hip arthroscopy. Patient outcomes were compared throughout a 2-year follow up using the modified Harris Hip Score (mHHS), Nonarthritic Hip Score (NAHS) and Visual Analog Scale (VAS). RESULTS:17 patients were evaluated in each cohort. The mean age of the study cohort and control cohort were 52.0 ± 9.4 years and 51.2 ± 12.2 years, respectively. Females were 58.8% (n=10) of both cohorts. Non-naïve patients had a lower pre-operative NAHS score (p= 0.05) and a higher VAS at their 6-month and 1-year (p <0.001) postoperative visits. Naïve patients reported higher mHHS scores 2 years postoperatively (p <0.001). The study cohort was prescribed higher levels of oral morphine equivalents (OME) at the postoperative 1-year visit (p=0.05). Opioid naïve patients were more likely to reach MCID and PASS of VAS at a faster rate. At the 2-year follow-up, 11.8% of opioid naïve patients continued to take opioids compared to 58.8% from the non-naïve group for persistent hip pain (p <0.001). CONCLUSION/CONCLUSIONS:We have determined that preoperative opioid usage in patients undergoing hip arthroscopy is associated with inferior outcomes compared to opioid naïve patients. Additionally, pre-operative opioid users are likely to continue the use of opioid medications postoperatively and at higher doses than opioid naïve patients.

PURPOSE/OBJECTIVE/OBJECTIVE:To evaluate clinical outcomes in patients who underwent endoscopic gluteus medius repair with at least two-year follow-up. METHODS:This was a single-center, single-surgeon retrospective study of 19 patients (20 hips) who underwent endoscopic knotless gluteus medius repair between August 2010-August 2016 with at least 2 years of follow-up. Preoperative magnetic resonance imaging (MRI) was reviewed and graded according to the Goutallier/Fuchs classification; preoperative X-rays were reviewed and graded according to the Tonnis classification. Baseline and two-year postoperative Modified Harris Hip Score (mHHS) and Non-arthritic Hip Score (NAHS) were prospectively collected. The number of patients reaching the minimal clinically important difference (MCID) and patient acceptable symptomatic rate (PASS) was determined. RESULTS:20 hips from 19 patients met the inclusion criteria and separated based on tear type. The study population comprised of 15 (79%) females and 4 (21%) males presenting with a mean age of 51.3±11.9 years and an average BMI of 25.3±3.9. Patients with partial tears reported an average preoperative mHHS and NAHS of 33.6±11.3 and 40.4±14.9, respectively; at two-year follow-up, an average mHHS and NAHS of 72.9±22.9 and 77.2±19.7 was reported, respectively. Patients with full thickness tears reported an average preoperative mHHS and NAHS of 43.8±14.7 and 46.4±8.3, respectively; at two-year follow-up, an average mHHS and NAHS of 80.1±8.5 and 79.5±10.1 was reported, respectively. There was significant clinical improvement at two-year follow-up, relating to both outcome measures in each subject group (p<0.001). At 2 years, 90% of hips surpassed the MCID and 63% of hips achieved the PASS. CONCLUSION/CONCLUSIONS:Endoscopic repair for gluteus medius tears results in improved mHHS and NAHS at two-years of follow-up compared to baseline. Most patients reach critical thresholds of minimal and satisfactory clinical improvement.

BACKGROUND/UNASSIGNED:Previous research has demonstrated a statistically significant relationship between hip arthroscopy outcomes and age. PURPOSE/UNASSIGNED:To investigate the link, if any, between hip arthroscopy outcomes and intraoperative pathology as well as with patient age and sex. STUDY DESIGN/UNASSIGNED:Cohort study; Level of evidence, 3. METHODS/UNASSIGNED:< .05. RESULTS/UNASSIGNED:< .0004). CONCLUSION/UNASSIGNED:Surgical treatment of femoroacetabular impingement in females led to improved functional outcomes at 2 years of follow-up, although older female patients did worse after hip arthroscopy as compared with their younger counterparts. There may be an age-dependent decrease in incidence of cam-type lesions in female patients.