Faculty Bibliography

INTRODUCTION/BACKGROUND:The purpose of this study was to conduct an analysis of the cross-sectional area (CSA) of hip musculature before and after hip arthroscopy (HA) for femoroacetabular impingement (FAI). The hypothesis was that there will be a significant increase in the CSA of analysed hip muscles that will correlate with increases in PROs following surgery. METHODS:-test. RESULTS: = 0.037) significantly predicted an increase in mHHS at 1 year when controlling for time between surgery and post-op MRI. CONCLUSIONS:Gluteus maximus and minimus muscles demonstrated significantly increased CSA after HA for FAI patients. Change in CSA was positively correlated with PROs for the gluteus maximus at 1-year follow-up. These findings underscore the clinical significance of muscle adaptations following hip arthroscopy for FAI.

Hip arthroscopy has grown exponentially over the past decade, with a parallel rise in revisions, underscoring the importance of refined patient selection and diagnostic accuracy. This review outlines the most common causes of failure after primary hip arthroscopy and provides a framework for evaluation, imaging, and management. Notably, differentiating between impingement and instability is crucial, as misclassification can worsen outcomes. Revision procedures may provide clinically meaningful improvement in patient-reported outcomes and delay total hip arthroplasty in well-selected patients. However, recognizing when to shift from preservation to replacement is key to optimizing outcomes.

PURPOSE/UNASSIGNED:To assess correlation of pre-operative symptoms, labral damage and chondrolabral junction pathology on MRI with intra-operative findings in patients undergoing hip arthroscopy for femoroacetabular impingement (FAI). METHODS/UNASSIGNED:Consecutive patients with FAI treated surgically were included. Data were collected on patient demographics and preoperative clinical outcome measures. Three radiologists performed retrospective independent reviews of pre-operative MRIs in 96 hips. The presence of cartilage fraying, chondrolabral separation, labral tear pattern (intrasubstance, linear, complex), chondral flap, cartilage delamination, and ligamentum teres (LT) pathology (degeneration/partial or complete tear) were recorded on preoperative MRI and intraoperatively during arthroscopy. Inter-reader and inter-method agreement were measured using weighted-Cohen's or Fleiss'-kappa, or Kendall's coefficient. Associations between MRI and arthroscopic findings and preoperative modified-Harris-Hip-Score (mHHS) and Non-Arthritic-Hip-Score (NAHS) were assessed using Mann-Whitney-U or Kruskal-Wallis test. RESULTS/UNASSIGNED:All readers detected lower rates of chondrolabral separation, cartilage delamination, and chondral flap, and higher rates of LT tear on MRI compared to arthroscopy. Linear tears were the most common tear pattern detected by readers on MRI (29%-50%) and arthroscopy (71%). The inter-reader agreement was moderate for LT findings and fair for remaining MRI variables. Between MRI and arthroscopy, there was moderate agreement for labral fraying for one reader (k = 0.303, 95% CI[0.106-0.501], p = 0.004) and fair agreement for labral tear pattern for one reader (k = 0.187, 95% CI[0.037-0.337], p = 0.006). There was poor-to-no agreement between MRI and arthroscopy for the remaining MRI variables for all readers (p = 0.05). Preoperative mHHS and NAHS scores demonstrated no significant association with preoperative MR or intraoperative findings (p > 0.05). CONCLUSION/UNASSIGNED:MRI labral and chondrolabral findings in patients with FAI underestimated the intraoperative pathology identified during hip arthroscopy and were not associated with preoperative patient reported outcome measures. LEVEL OF EVIDENCE/UNASSIGNED:III (retrospective case series).

PURPOSE/OBJECTIVE:To compare 10-year outcomes of hip arthroscopy in patients with Tönnis grade 1 versus grade 0 osteoarthritis, with specific focus on patient-reported outcomes, rates of minimal clinically important difference, Patient Acceptable Symptom State, Substantial Clinical Benefit, and arthroscopic revision and total hip arthroplasty (THA) conversion rates. METHODS:Patients undergoing hip arthroscopy for femoroacetabular impingement syndrome (FAIS) were prospectively enrolled. A 1:1 propensity score match based on age, sex, body mass index, smoking status, labral treatment, capsular management, lateral center edge angle, and preoperative alpha angle matched Tönnis grade 1 patients to Tönnis grade 0 patients. Inclusion criteria were symptomatic FAIS with radiographic deformity, failure of nonoperative treatment, and ≥10-year follow-up. Patients were excluded for prior ipsilateral hip arthroscopy, Tönnis grade >1, incomplete data, dysplasia (lateral center edge angle < 18°), developmental hip disorders, or concomitant procedures. Modified Harris hip score (mHHS), Non-Arthritic Hip Score (NAHS), minimal clinically important difference, Patient Acceptable Symptom State, Substantial Clinical Benefit, and failure (revision arthroscopy or THA conversion) rates at 10 years were assessed. RESULTS:Out of a total database of 152 patients, the study matched 32 Tönnis grade 1 patients (mean age 40.79 ± 10.1 years; body mass index 25.13 ± 3.73; follow-up 12.16 ± .96 years [range, 10.08-13.59]) to 32 Tönnis grade 0 patients (mean age 41.82 ± 11.66; body mass index 25.63 ± 3.53; follow-up 11.42 ± 1.23 years [range: 10.02-13.58]) for a total of 64 included patients within this study. Baseline characteristics were well matched with the only significantly different variable being follow-up time (P = .009), though all patients reached a minimum follow-up of 10-years. Both cohorts showed significant improvements in mHHS and NAHS at 10 years (P < .0001), with no significant differences between groups at 10-years (mHHS P = .509; NAHS P = .339) or any other time point. MCID achievement rates were high for both mHHS (Tönnis 0: 87.5%; Tönnis 1: 90.6%; P = .689) and NAHS (Tönnis 0: 87.5%; Tönnis 1: 93.8%; P = .391). Tönnis grade 1 patients showed higher failure (THA/revision) rates compared to Tönnis grade 0 patients (31.25% vs 3.13%; P = .006). Analyzed separately, Tönnis grade 1 patients had 5 cases (15.63%) of THA conversion compared to 0 cases in the Tönnis grade 0 cohort (P = .05), while revision rates were similarly elevated in the Tönnis grade 1 group (5/32; 15.63%) compared to Tönnis grade 0 patients (1/32; 3.13%) (P = .196). CONCLUSIONS:Hip arthroscopy yields significant long-term improvements for FAIS patients with Tönnis grade 1 and 0 osteoarthritis. However, increased failure rates in Tönnis grade 1 patients suggests that preoperative osteoarthritis may predispose patients to greater rates of subsequent THA conversion or revision. LEVEL OF EVIDENCE/METHODS:Level III, retrospective comparative matched case series.

BACKGROUND:Hip arthroscopy has demonstrated favorable short- and mid-term outcomes for femoroacetabular impingement syndrome (FAIS) in patients with borderline hip dysplasia (BHD). However, long-term outcomes in patients with FAIS and BHD treated with hip arthroscopy remain understudied. PURPOSE/OBJECTIVE:To evaluate hip survivorship and patient-reported outcomes (PROs) in patients with FAIS and BHD compared with those without BHD at a minimum 10-year follow-up. STUDY DESIGN/METHODS:Cohort Study; Level of evidence, 4. METHODS:A retrospective matched-cohort study was conducted on patients undergoing primary hip arthroscopy for FAIS by a single surgeon (2012-2024). BHD was defined as a lateral center-edge angle (LCEA) of 20° to 25°. Patients with BHD were matched 1 to 2 to controls without BHD based on age, sex, body mass index, and preoperative modified Harris Hip Score (mHHS). Radiographic parameters (eg, alpha angle, LCEA) were assessed pre- and postoperatively. PROs-including mHHS, Non-Arthritic Hip Score (NAHS), and hip survivorship (revision arthroscopy, conversion to total hip arthroplasty [THA])-were compared. RESULTS:= .01). CONCLUSION/CONCLUSIONS:At a minimum 10-year follow-up, patients with BHD who underwent hip arthroscopy for FAIS achieved comparable PROs and hip survivorship to those without BHD. These findings support the use of hip arthroscopy as a durable and effective treatment for FAIS in this population.

PURPOSE/OBJECTIVE:This study compares PROMs between patients who underwent hip arthroscopy prior to hip resurfacing arthroplasty (HRA) to a matched cohort of HRA patients without prior arthroscopy. METHODS:A retrospective cohort study was performed of patients who underwent a HRA from 2016 to 2021 with minimum 2-year follow-up. Patients with prior arthroscopy were matched 1:3 with controls on age, sex, BMI, and ASA classification. Subjects completed HOOS JR, FJS, SANE, and PROMIS for physical function, pain intensity, and pain interference. The Mann-Whitney U test was used for intergroup mean comparisons and Fisher's exact test for categorical variables. RESULTS:20 patients with prior hip arthroscopy were matched to 60 controls (mean age: 47.1 ± 7.2 years; BMI: 29.5 ± 4.2, 96% male). Patients who underwent hip arthroscopy prior to HRA reported significantly greater pain (33.8 vs. 13.2, p = 0.011), poorer FJS (46.6 vs. 70.5, p = 0.030), physical function (43.7 vs. 50.9, p = 0.018), SANE rating (59.9 vs. 82.6, p = 0.005), and satisfaction (66.1 vs. 88.1, p = 0.006) after HRA. 11 patients (55.0%) stated that their hip resurfacing procedure met their expectations compared to 52 patients (86.7%) in the control group. CONCLUSIONS:Patients who underwent hip arthroscopy prior to HRA have an association with significantly worse patient-reported outcome metrics, poor postoperative satisfaction, and higher postoperative pain.

Purpose: Though Femoroacetabular impingement (FAI) is thought of as primarily a hip condition an increasing body of evidence has demonstrated the existence of a relationship between the hip joint and lumbopelvic spine, termed the hip-spine syndrome (HSS). This review will provide an overview of the relevant pelvic parameters, proper HSS patient evaluation, describe how lumbar pathology may mechanistically affect the hip, provide a literature review of biomechanic and outcome papers exploring the subject, and finally investigate potential interventions that can be considered in these challenging patients. Recent Findings: Deviations from normal ranges in pelvic parameters have been shown in biomechanical studies to worsen FAI by decreasing the range of impingement free motion. The clinical relevance of this is still being determined. Patients with concomitant lumbar spine pathology may significantly improve after hip arthroscopy, though they may have a lower ceiling than comparable patients without lumbar spine pathology. Summary: Surgeons and patients should be aware of the HSS. Alterations in pelvic parameters may affect outcomes, though this still has to be determined. Patients with lumbar spine pathology and FAI can still be treated successfully with hip arthroscopy, though should be counseled appropriately.

PURPOSE/UNASSIGNED:To evaluate short-term clinical and patient reported outcomes after gluteus maximus/tensor fascia lata (GM/TFL) transfer for abductor insufficiency. METHODS/UNASSIGNED:This was a retrospective case series. Inclusion criteria were patients who underwent GM/TFL for chronic abductor insufficiency from 2017 to 2024 at a single institution with a minimum follow-up of 6 months and at least 1 recorded postoperative visit. Demographic, clinical, and outcome data were collected, including hip range of motion, abduction strength, presence of Trendelenburg gait, postoperative rehabilitation details, complications, and patient-reported outcomes. Statistical comparisons of pre- and postoperative objective measures were performed using the Wilcoxon signed-rank test. RESULTS/UNASSIGNED:> .05), and Trendelenburg gait persisted in 80% of patients. However, patient-reported outcome scores were strong, with a mean postoperative modified Harris Hip Score of 76.5 ± 22.4 and Non-Arthritic Hip Score of 74.1 ± 21.7. Patient satisfaction was high, with 100% of patients indicating they would undergo the procedure again. Three patients experienced complications (30%), including 2 patients who had persistent pain and seroma formation, and a patient who had a recurrent hematoma. CONCLUSIONS/UNASSIGNED:GM/TFL transfer does not consistently improve hip strength or gait mechanics; however, it provides pain relief and improved quality of life, as evidenced by high patient satisfaction and favorable modified Harris Hip Score outcomes. Three patients experienced complications (30%), including two patients who had persistent pain and seroma formation, and a patient who had a recurrent hematoma. LEVEL OF EVIDENCE/UNASSIGNED:Level IV, retrospective therapeutic case series.

As orthopedic surgeons navigate the complexities of selecting their first positions, or established surgeons seek changes in employment, understanding the evolving financial and structural landscape of surgical practices is crucial. The rising influence of private equity (PE) in health care has added another dimension to this decision, as investment firms increasingly acquire stakes in practices to drive consolidation and profitability. Between 2015 and 2022, PE transactions in health care surged dramatically, reflecting the growing trend of practice consolidation in response to declining reimbursements, rising operational costs, and regulatory burdens. PE firms use leveraged buyouts to acquire and restructure practices, often forming management services organizations to streamline operations. Although PE partnerships offer benefits, including access to capital and corporate expertise, they also raise concerns about reduced autonomy, increased procedural volumes, and potential impacts on care quality and costs. This article provides an overview of PE's role in orthopedic practices, including its history, investment strategies, and the anatomy of typical deals. It explores the implications of PE partnerships on financial and clinical outcomes and highlights the importance of physicians staying informed about these developments. By understanding the benefits and risks, orthopedic surgeons can make more informed decisions in the context of a rapidly changing health care environment.

BACKGROUND:The purpose of our study was to compare patient-reported outcomes at 6-month follow-up between primary hip arthroscopy patients who were partial weight bearing on crutches for 4 weeks vs. 1 week postoperatively. METHODS:We conducted a pseudorandomized clinical trial involving patients who underwent arthroscopic treatment of femoroacetabular imipingement at a single center from September 2020 to April 2021. Subjects aged 18-65 years old were alternately assigned to one of the 2 rehabilitation regimens involving either 4-week or 1-week partial weight bearing on crutches. Subjects completed the modified Harris Hip Score (mHHS) and Nonarthritic Hip Score (NAHS) surveys before surgery and at 6-month follow-up. Achievement of the minimum clinically important difference (MCID), substantial clinical benefit (SCB), and patient acceptable symptom state (PASS) was assessed using published mHHS cutoff values. Outcomes were compared between groups with the Mann-Whitney U test and analysis of covariance, while MCID, SCB, and PASS rates were compared with the Fisher exact test. P-values < .05 were considered significant. RESULTS:Fifty patients were included in the study of whom 28 (56.0%) were assigned to 4-week crutch use and 22 (44.0%) to 1-week crutch use. The 4-week crutch use group was significantly older on average (38.4 vs. 32.1 years, P = .03) and had significantly higher mean body mass index (27.6 vs. 24.5, P = .01), but there were no significant baseline differences between the 2 groups (P > .05). After adjusting for age and body mass index, there was no significant difference in preoperative to postoperative improvement in mHHS (P = .43) or NAHS (P = .46) between the 2 groups at 6-month follow-up. Furthermore, there were no significant differences in achievement rates for MCID (P = .50), SCB (P = .51), or PASS (P = .77) between the 2 groups. CONCLUSION/CONCLUSIONS:We identified no significant differences in improvement of mHHS and NAHS or achievement of the MCID, SCB, or PASS at 6-month follow-up between patients on crutches for 4 weeks vs. 1 week postoperatively. LEVEL OF EVIDENCE/METHODS:II, Pseudorandomized clinical trial.