Faculty Bibliography

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.

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/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.

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.

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.

OBJECTIVE:There is a high prevalence of femoroacetabular impingement (FAI) amongst elite men's ice hockey players, yet little is known about the hips of players in the National Women's Hockey League (NWHL). The primary purpose of this study was to determine the prevalence of radiographic cam-type FAI in women's professional ice hockey players. The secondary purpose was to analyze the relationship between the cam deformity and both menarchal age and hip range-of-motion (ROM). METHODS:Data were collected for NWHL players during pre-participation physicals. Alpha angles were measured on 45° Dunn radiographs, with alpha angles >55° defined as cam-positive. Pearson correlation coefficients (ρ) were performed to analyze the relationship between alpha angle and both ROM measurements and menarchal age, with statistical significance set at p<0.05. RESULTS:Twenty-six athletes were included. Twenty-four (92%) had alpha angles >55°; 20 players (77%) had bilateral cam deformity. Average menarchal age was 13.8 ±1.7 years. There was a significant association between age of menarche and alpha angle (ρ=0.36, p<0.02). There was no significant association between alpha angle and hip ROM, (p>0.05). CONCLUSION/CONCLUSIONS:Elite women's ice hockey players have a higher prevalence of cam-type morphology than the general population. The positive association between alpha angle and menarchal age lends additional support to the etiological hypothesis of the cam lesion resulting from activity-related stress at the proximal femoral physis during skeletal development. Professional women's ice hockey players have a high risk of developing cam-type morphology, although each player's menarchal age may mediate her individual risk for cam development.

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:The practice of hip arthroscopy is increasing in popularity, which has highlighted the importance of identifying risk factors that predict hip arthroscopy outcomes. The literature suggests that lumbar spine disease is an independent risk factor for poorer outcomes following total hip arthroplasty; however, the effect of lumbar spine disease on hip arthroscopy outcomes has not been fully investigated. At present, there is a paucity of literature investigating the effect of coexisting hip and lumbar spine disease on outcomes after hip arthroscopy. PURPOSE/UNASSIGNED:To evaluate the outcomes of hip arthroscopy in patients with concomitant lumbar spine disease compared with those without a history of lumbar spine disease. STUDY DESIGN/UNASSIGNED:Cohort study; Level of evidence, 3. METHODS/UNASSIGNED:test. RESULTS/UNASSIGNED:= .44). CONCLUSION/UNASSIGNED:Patients with known lumbar spine disease who underwent hip arthroscopy had a significantly greater percentage improvement at 24-month follow-up compared with those without a history of lumbar spine disease, and outcomes were ultimately not significantly different. No increased risk of reoperation was noted in patients with concomitant lumbar spine disease.