Faculty Bibliography

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.

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/OBJECTIVE:To determine the clinical outcomes of hip arthroscopy for anterior inferior iliac spine subspine impingement (SSI). LEVEL OF EVIDENCE/METHODS:Case Series; level IV. METHODS:Patients who underwent unilateral, primary hip arthroscopy for SSI from February 2015 to December 2017 with minimum 3-year follow-up data were identified (SSI). Analysis of variance, Kaplan-Meier analysis, and regression modeling were used to analyze outcomes. RESULTS:Of 23 eligible, 19 (83% inclusion) patients (mean [standard error of the mean]: age: 45.9 [3.1]; body mass index, 26.3 [0.9]; 79% female, 53% right side) had a minimum of 3-year follow-up (48.3 [2.2] months). The estimated mean survival time of index procedure across the whole cohort was 64.9 ± 3.1 months. One patient underwent total hip arthroplasty. Patients improved from baseline modified Harris Hip Score (62.7 [5.1]) to follow-up (75.1 [4.3]; P = .014). Twelve patients (63%) met minimal clinically importance difference criteria while 7 (37%) met patient acceptable symptomatic state criteria. Linear regression modeling demonstrated lower postoperative lateral center edge angle (beta = -2.1, 95% confidence interval: -0.5 to -2.9, P = .035) and presence of labral repairs (beta = 46.1, 95% confidence interval: 24.8-67.4, P = .003) were associated with higher follow-up modified Harris Hip Score. CONCLUSION/CONCLUSIONS:In conclusion, patients undergoing anterior inferior iliac spine decompression during hip arthroscopy for SSI in the setting of femoroacetabular impingement syndrome have acceptable, improved clinical outcomes at minimum 3-year follow-up. Labral repair and decreasing postoperative lateral center edge angle were predictive of improved patient-reported outcomes. Hip arthroscopy remains a viable successful treatment options in the treatment of concomitant SSI during femoroacetabular impingement syndrome surgery.

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.

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.

PURPOSE/UNASSIGNED:To assess hip symptomatology during the perioperative and peripregnancy periods and postoperative outcomes among reproductive age females undergoing arthroscopic treatment for femoroacetabular impingement syndrome (FAIS) and pregnancy complications in females after hip arthroscopy. METHODS/UNASSIGNED:Females aged 18-44 years who underwent hip arthroscopy for the treatment of FAIS with a single surgeon were included in the study. Postoperatively, patients were surveyed regarding obstetric history, hip symptomology, and post-surgery pregnancy experiences. Subjects were classified as nulligravid (Group 1), pregnant at least once before hip surgery but never again following surgery (Group 2), or pregnant at least once following hip surgery (Group 3). Hip pain intensity was reported on a 10-point Visual Analog Scale (VAS) and hip function was reported using the modified Harris Hip Score (mHHS). Patients self-reported pregnancy outcomes and complications. RESULTS/UNASSIGNED:85 patients were enrolled with a mean age of 32.3 ± 6.5 years at the time of surgery. Mean follow-up time was 51.9 ± 34.5 months. There were 39 subjects in Group 1 (45.9 %), 20 in Group 2 (23.5 %), and 26 in Group 3 (30.6 %). There were no significant inter-group differences in mHHS preoperatively or at final follow-up (p = 0.95). Group 3 subjects reported that both postoperative and post-pregnancy VAS remained significantly lower than the preoperative baseline (p < 0.001). 69.2 % and 73.1 % report worsened hip pain during the third trimester and postpartum, respectively. 57.9 % reported that their hip pain returned to the pre-pregnancy baseline by time of survey completion. CONCLUSION/UNASSIGNED:Females of reproductive age with FAIS can expect clinical improvements relative to their baseline after hip arthroscopy regardless of pregnancy timing relative to surgical intervention. A majority of patients who become pregnant post-arthroscopy experience a peripartum recurrence of their symptoms. Most but not all of these patients return to the level of maximal improvement they had initially experienced postoperatively.

BACKGROUND:Previous studies on the outcomes of hip arthroscopy in patients with global acetabular overcoverage and focal lateral acetabular overcoverage have been limited by short- and intermediate-term follow-up periods and inconsistent radiographic criteria in defining these specific subpopulations with femoroacetabular impingement syndrome (FAIS). PURPOSE/OBJECTIVE:To evaluate the long-term outcomes of hip arthroscopy in patients with FAIS and global acetabular overcoverage, lateral acetabular overcoverage, or normal acetabular coverage over a 10-year period. STUDY DESIGN/METHODS:Retrospective cohort study; Level of evidence, 3. METHODS:< .05. RESULTS:≤ .05). CONCLUSION/CONCLUSIONS:At a minimum of 10 years postoperatively, there was no significant difference in reoperation or THA rates between groups. However, patients with global overcoverage demonstrated worse functional outcomes compared with those with lateral or no overcoverage.

BACKGROUND:Patients with femoroacetabular impingement syndrome (FAIS) due to pincer impingement may have global retroversion. Previously treated with periacetabular osteotomy, this condition has been increasingly treated arthroscopically; however, no evidence is available regarding long-term outcomes of these patients. PURPOSE/OBJECTIVE:To compare hip survivorship and patient-reported outcome measures (PROMs) after primary hip arthroscopy with a minimum of 10-year follow-up between patients who had FAIS with and without radiographic signs of global acetabular retroversion. STUDY DESIGN/METHODS:Cohort study; Level of evidence, 3. METHODS:value <.05 was considered statistically significant. RESULTS:= .003, respectively). Increased BMI was correlated with worse PROMs in both groups. CONCLUSION/CONCLUSIONS:Patients with global retroversion undergoing hip arthroscopy for FAIS did not have increased failure rates compared with patients without global retroversion and demonstrated significant improvement in outcome scores at 10 years.