Faculty Bibliography

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.

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:This report examines 4-year patient reported outcomes and procedural survivorship in patients who underwent microfracture during hip arthroscopy compared to a matched group of non-microfracture patients as well as the risk factors for procedural failure following microfracture of articular lesions in the hip. METHODS:Data for 38 consecutive patients undergoing arthroscopic microfracture was retrospectively analyzed. Propensity score matching identified a matched group of hip arthroscopy patients who had Outerbridge grade 3 or grade 4 chondral lesions but did not undergo microfracture. Preoperative modified Harris Hip Scores (mHHS) and NonArthritic Hip Scores (NAHS) were compared to those at 2- and 4-year follow-up. Postoperative rates of ipsilateral revision arthroscopic surgery or hip arthroplasty were assessed. RESULTS:Thirty-three (86.8%) of the 38 microfracture patients were available for 4-year follow-up. Forty-six patients were matched with the microfracture group. Scores including mHHS and NAHS increased postoperatively for both groups (p < 0.05), though there were no significant differences between groups (p > 0.05). Overall reoperations rates were 24.2% and 21.7% (p = 0.873) for the microfracture and non-microfracture groups, respectively. Hip arthroplasty rates were higher among microfracture patients (18.2% vs. 2.2%, p = 0.038), wherein Tonnis grade ≥ 2, cartilage lesions ≥ 400 mm2 , and femoral-sided lesions were associated with failure. CONCLUSIONS:Patients who underwent microfracture treatment of chondral lesions fared no better than a matched group of patients who did not receive microfracture treatment. Risk of reoperation is high for both groups and microfracture patients are more likely to require conversion to total hip arthroplasty or hip resurfacing.

We present a 24-year-old male who developed an infected hematoma that resulted in sciatic nerve injury after he underwent an endoscopic sciatic nerve decompression. He underwent urgent hematoma evacuation and cultures speciated as Salmonella. At 4 months' follow-up, the patient's nerve had improved motor and sensory function. This case highlights the importance of obtaining appropriate hemostasis at the end of an endoscopic sciatic nerve decompression.