Faculty Bibliography

PURPOSE/OBJECTIVE:The purpose of this study was to assess the prognostic effect of lumbar spinal stenosis on clinical outcomes after hip arthroscopy for femoroacetabular impingement syndrome (FAI). METHODS:Patients undergoing hip arthroscopy between September 2009 to December 2015 for FAI with concomitant lumbar spinal stenosis (central/neuroforaminal) and a 2-year follow-up were identified (hip-spine). A 1:1 case-matching query using pre-operative modified Harris Hip Score (mHHS) within 3 points, body mass index (BMI) within 3 points, age within 5 years, and gender identified a control cohort without spinal pathology. Follow-up patient reported outcomes and clinical failure rates to revision procedure were compared using analysis of variance (ANOVA) and Kaplan-Meier survival analysis. RESULTS:, P=0.61; baseline mHHS: 44.27±2.82, P=0.98). ANOVA analysis demonstrated that all PROs improved from baseline to 2-year outcomes (P<0.001). The hip-spine versus control had lower 1-year (mHHS: 65.97±5.64 versus 85.04±3.09, P=0.006; nonarthritic hip score (NAHS): 70.26±5.71 versus 87.89±2.65, P=0.010) and 2-year (mHHS: 69.72±4.92 versus 84.71±2.56, P=0.007; NAHS: 72.23±5.18 versus 87.14±2.23, P=0.008) outcomes. While there was no difference in Patient Acceptable Symptomatic State (PASS) and Minimal Clinically Important Difference (MCID) rates at 1-year follow-up, the hip-spine group demonstrated lower PASS (42% versus 81%, P =0.004) and MCID (58% versus 88%, P=0.027) rates at 2 years. Although susceptible to type II error, there was no difference in clinical failure rates to revision procedure (P=0.13). CONCLUSION/CONCLUSIONS:While net PROs from baseline improve after hip arthroscopy for FAI, the presence of concomitant lumbar spinal stenosis negatively affects post-operative PROs. FAI patients with spinal stenosis should be counseled accordingly. LEVEL OF EVIDENCE/METHODS:III, case-control study.

Symptomatic femoroacetabular impingement is one of the most common hip pathologies in young athletes. Intraoperative fluoroscopy is commonly used during hip arthroscopy to aid with portal placement and resection of the cam and pincer lesions. However, there are currently no universally agreed-on tools to allow for the assessment of adequacy of femoral and acetabular osteoplasty. Despite the general lack of consensus among hip arthroscopists, the senior author recommends using the femoroacetabular impingement resection arc to guide the adequacy of cam and pincer resection in hip arthroscopy. Using intraoperative fluoroscopy, one should aim to create a continuous "Shenton's line"-type arc along the inferior aspect of the anterior-inferior iliac spine and superolateral femoral neck base by resecting any bone that causes a break in the continuity of this arc.

Purpose/UNASSIGNED:To explore the relationship between generalized joint hypermobility and hip labrum width. Methods/UNASSIGNED:and Fisher exact testing as well as linear regression. Results/UNASSIGNED: = .004). Conclusions/UNASSIGNED:Patients with a BTS ≥4 were found to have significantly thinner labra than those with a BTS of <4. Level of Evidence/UNASSIGNED:III, retrospective comparative trial.

PURPOSE/OBJECTIVE:The purpose of the study is to determine if patients with coexisting lumbar back pain experience back pain improvement after undergoing hip arthroscopy for femoroacetabular impingement (FAI). METHODS:An IRB approved retrospective chart review compared patients undergoing hip arthroscopy for FAI with lumbar spine back pain to patients solely reporting hip pain. The modified Harris Hip Score (MHHS) and Nonarthritic Hip Score (NAHS) were recorded preoperatively and at 1-year follow up . The Oswestry disability score, which quantifies disability from lower back pain, and visual analog scale (VAS) were recorded from the Hip-Spine (HS) cohort alone. Statistical analysis was performed using paired sample t-tests with p≤ 0.05 considered significant. RESULTS:Sixty-eight patients who underwent hip arthroscopy between November 2016 and October 2018 were enrolled. Thirty-four patients with a mean age of 48.2 ± 14.0 years and BMI of 26.6 ± 6.6 had a history of back pain and 34 patients were age- and sex-matched for the Matched-Control (MC) cohort. The MC cohort had lower MHHS and NAHS scores preoperatively. The MC cohort reported a larger increase in the MHHS (p= 0.01) and NAHS scores (p= 0.01) postoperatively. More patients in the MC cohort reached MCID with MMHS (p=0.003) and NAHS (p=0.06). Following surgery, the HS cohort reported a lower Oswestry Disability score, indicating minimal disability (p= 0.01). CONCLUSION/CONCLUSIONS:Surgical intervention for FAI can lead to improvements in hip and back pain in patients with co-existing lumbar pathology.

PURPOSE/OBJECTIVE:To determine if any association exists between physical examination and/or imaging findings [ultrasound (US) and magnetic resonance imaging (MRI)] and IPT in order to characterize the reliability of these diagnostic modalities. METHODS:Patients who had undergone US-guided iliopsoas tendon sheath injection (of lidocaine and a corticosteroid agent) as well as MRI performed within one year of injection between 2014-2019 were retrospectively reviewed. Demographic data, response to physical exam maneuvers, and response to injection were queried from patient records. US and MRIs were reviewed by 2 independent musculoskeletal-trained radiologists. Response to injection was considered positive if the patient improved by >2 points on a 0-10 VAS score. Chi-square and Fischer exact testing was utilized to assess for any associations. Sensitivities, specificities, positive predictive values, and negative predictive values were calculated. RESULTS:Sixty-three patients, with mean age 52.3 years +/- 17.3, with average BMI 27.4 +/- 4.3, and average follow-up was 33.6 months +/- 20.6 met inclusion criteria. No physical exam maneuvers, sonographic features, or MRI findings were significantly associated with response to iliopsoas tendon injection (p>0.05). Groin pain had a sensitivity of 100%, though a specificity of 7%. Snapping hip had a specificity of 82%, though a sensitivity of 24%. Pain with resisted SLR (sensitivity 62%, specificity 25%), and weakness with resisted SLR (sensitivity 15%, specificity 71%) both were non-reliable. Sonographic bursal distension and tendinosis had low sensitivities (67% and 63%, respectively) and specificities (35% and 32%, respectively). Bursal distension on MRI had sensitivity and specificity of 64% and 45% respectively. Tendon thickening had sensitivity and specificity of 55% and 60%, respectively, while heterogeneity had sensitivity and specificity of 52% and 65%, respectively. CONCLUSION/CONCLUSIONS:Neither physical examination, nor US, nor MRI findings were associated with a positive response to peritendinous iliopsoas corticosteroid injections in patients with suspected IPT.

Purpose/UNASSIGNED:To correlate patient-reported outcomes (PROs) and minimal clinically important difference (MCID) achievement rates after hip arthroscopy for femoroacetabular impingement syndrome (FAI). Methods/UNASSIGNED:linically diagnosed FAI who underwent primary hip arthroscopy from September 2012 to March 2014 with a minimum of 5-year outcomes were identified. Patients undergoing labral debridement, microfracture, bilateral procedures, with evidence of dysplasia, Tönnis grade >1, and joint space <2 mm were excluded. Analysis of variance was used to compare PROs. Survival rates were determined using Kaplan-Meier analysis. Regression analysis identified associations with modified Harris Hip Scores (mHHS), minimal clinically important difference (MCID) rates, and Nonarthritic Hip Scores (NAHS). Results/UNASSIGNED: = .010) with 5-year outcomes. Conclusions/UNASSIGNED:There is a decline in MCID at 5-year follow-up after hip arthroscopy for FAI. Lower BMI, younger age, and cam resection are associated with positive outcomes. There is excellent index procedure survivability and excellent total hip arthroplasty prevention rate. Level of Evidence/UNASSIGNED:Level IV.

Purpose/UNASSIGNED:To investigate what effect decreased opioid prescribing following hip arthroscopy had on Press-Ganey satisfaction survey scores. Methods/UNASSIGNED:A retrospective review of prospectively collected data was conducted on patients who underwent primary hip arthroscopy for femoroacetabular impingement between October 2014 and October 2019. Inclusion criteria consisted of complete Press-Ganey survey information, no history of trauma, fracture, connective tissue disease, developmental hip dysplasia, autoimmune disease, or previous hip arthroscopy. Groups were separated based on date of surgery relative to implementation of an institutional opioid reduction policy that occurred in October 2018. Prescriptions were converted to milligram morphine equivalents (MME) for direct comparison between different opioids. Results/UNASSIGNED:> .05). Conclusions/UNASSIGNED:A reduction in opioids prescribed after a hip arthroscopy is not associated with any statistically significant difference in patient satisfaction with pain management, as measured by the Press-Ganey survey. Level of Evidence/UNASSIGNED:Level III, retrospective comparative study.

Intraarticular corticosteroid injections are commonly administered by physicians to provide analgesia for acute athletic injuries, though there is an increasing body of literature that has illuminated substantial risks to the soft tissues. A review of Clinical Key, MEDLINE, and PubMed databases from 2012 to 2020 was performed using search terms, including corticosteroid, shoulder arthroscopy, knee arthroscopy, hip arthroscopy, intraarticular, and injections. The references of pertinent articles were reviewed for other relevant sources. Corticosteroid injections can provide reliable pain control in athletes for various pathologies affecting the shoulder, knee, and hip. The use of these medications has demonstrated efficacy in some disorders, whereas the clinical benefit for others remains questionable. Intraarticular injections to the shoulder, knee, and hip are all associated with increased risks to the soft tissues, which must be considered and weighed heavily, especially in an athlete. Perioperative corticosteroids confer an increased risk of surgical site infection after knee, shoulder, and shoulder arthroscopy. Subacromial injections confer an increased risk for revision rotator cuff repair if given within 6 months of surgery, but are safe if given at least 1 month postoperatively. Hip injections for chondral pathology perform significantly better than those for labral injuries.
Copyright

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.