Outcomes of Hip Arthroscopy in Patients With Previous Lumbar Spine Surgery: A Matched-Pair Controlled Comparative Study With Minimum Two-Year Follow-Up.

PURPOSE: The purpose of this study was to conduct a matched-pair analysis to determine the effect of prior lumbar spine surgery (LSS) on clinical outcomes of hip arthroscopy. METHODS: Data were prospectively collected on all patients undergoing hip arthroscopy during the study period from April 2008 to December 2012. Patients were excluded if they had previous hip conditions or had undergone prior hip surgery. Patients in the LSS group (history of LSS) were matched in a 1:1 ratio to a control group (no history of LSS) according to age ±5 years, gender, body mass index categories, Tönnis grade, and labral treatment. The following outcomes were recorded in each group: modified Harris Hip Score, Non-Arthritic Hip Score (NAHS), Hip Outcome Score-Sports Specific Subscale, Hip Outcome Score-Activities of Daily Living, and visual analogue scale (VAS) score for pain, patient satisfaction, and rates for revision hip arthroscopies and conversion to total hip arthroplasty (THA). RESULTS: During the study period, 1,405 hip arthroscopies were performed with 1,017 eligible for matching. A total of 873 (85.8%) patients had a minimum 2-year follow-up. Fifty-seven patients were matched in each group. Both groups demonstrated significant improvement in patient-reported outcome (PRO) and VAS scores. The LSS group had a lower mean for all preoperative PRO scores. There was no significant difference for the postoperative mean PRO score and change in the PRO score compared with the control group except for NAHS. The mean change in the NAHS demonstrated a greater magnitude of improvement in the LSS group. There was no significant difference between mean VAS scores, patient satisfaction, and rates for revision arthroscopy and conversion to THA between the groups. CONCLUSIONS: Prior LSS does not adversely affect outcomes of hip arthroscopy at a minimum 2-year follow-up. These patients have lower preoperative scores but similar magnitude of improvement and revision/THA rates compared with a matched comparative group of patients without prior LSS. LEVEL OF EVIDENCE: Level II, retrospective analysis of prospectively collected data.

Arthroscopic Reconstruction of the Irreparable Acetabular Labrum: A Match-controlled Study.

PURPOSE: To report clinical outcomes of arthroscopic labral reconstruction in the hip at minimum 2-year follow-up in comparison to a pair-matched labral repair group. METHODS: Patients were included in this study if they underwent labral reconstruction during hip arthroscopy and had minimum 2-year follow-up data available. Exclusion criteria were active workers' compensation claims or previous ipsilateral hip surgery or conditions. Reconstruction patients were matched 1:2 to patients that underwent arthroscopic labral repair but otherwise met all inclusion and exclusion criteria. Matching criteria were age within 5 years, sex, body mass index within 5, same capsular treatment, and whether there was chondral damage of Outerbridge grade II or greater. Three patient-reported outcome (PRO) measures and visual analog scale (VAS) for pain were recorded preoperatively and at a minimum of 2 years postoperatively. International Hip Outcome Tool and patient satisfaction were also collected at latest follow-up. RESULTS: Thirty-four reconstruction patients were matched to 68 repair patients. There were no significant differences in age (P = .941), sex (P > .999), body mass index (P = .935), or any other demographics between groups. A statistically significant increase was seen in PROs for both the reconstruction group (Modified Harris Hip Score, P = .002; Hip Outcome Score - Sports Subscale, P<.001; Non-arthritic Hip Score, P<.001) and the repair group (Modified Harris Hip Score, P<.001; Hip Outcome Score - Sports Subscale, P < .001; Non-arthritic Hip Score, P<.001) at minimum 2-year follow-up. Significant decrease was shown for VAS for both groups (reconstruction VAS, P<.001; repair, P<.001) at minimum 2-year follow-up. There were no significant differences in rates of postoperative complications (P>.999), secondary arthroscopy (P>.999), or conversion to total hip arthroplasty (P = .728) between groups. CONCLUSIONS: Arthroscopic labral reconstruction is associated with significant improvement in PROs and a low incidence of secondary surgery within 2-year follow-up. Improvements in PROs, VAS, patient satisfaction, and incidence of secondary procedures were comparable to a match control treated with labral repair. Although there were no differences shown in the 2 groups with respect to complication rate, secondary arthroscopy, or conversion to total hip arthroplasty, the study was not powered to compare these outcome parameters. Based on this evidence, either labral repair or reconstruction may be selected depending upon the clinical scenario. LEVEL OF EVIDENCE: Level III; retrospective comparative study.

Arthroscopic Technique for Iliopsoas Fractional Lengthening for Symptomatic Internal Snapping of the Hip, Iliopsoas Impingement Lesion, or Both.

Pathology of the iliopsoas may cause painful internal snapping of the hip or labral damage from soft impingement. Favorable outcomes have been reported after arthroscopic release or fractional lengthening of the iliopsoas. In patients with risk factors for instability, restoration of other soft-tissue constraints such as the labrum and capsule should be performed if iliopsoas fractional lengthening is undertaken. The purpose of this article is to detail the step-by-step surgical technique of arthroscopic iliopsoas fractional lengthening, in addition to the indications, pearls, and pitfalls of the technique.

Predictors of Clinical Outcomes After Hip Arthroscopy: A Prospective Analysis of 1038 Patients With 2-Year Follow-up.

BACKGROUND: As hip arthroscopy has expanded in popularity and volume, more information is needed about indications for the procedure and the predictive factors of clinical outcomes. PURPOSE: To evaluate clinical outcomes of hip arthroscopy in a prospective study and to analyze the cohort to identify factors that are predictive of improvement. STUDY DESIGN: Case-control study; Level of evidence, 3. METHODS: Data were collected prospectively on all patients undergoing hip arthroscopy between February 2008 and June 2012. We included all patients undergoing hip arthroscopy who agreed to participate and who completed 4 patient-reported outcome (PRO) instruments at a minimum 2-year follow-up: the modified Harris Hip Score (mHHS), Nonarthritic Hip Score (NAHS), Hip Outcome Score-Activities of Daily Living (HOS-ADL), and Hip Outcome Score-Sport-Specific Subscale. The NAHS was selected as our primary outcome instrument. All patients with any previous hip conditions were excluded. We analyzed 34 preoperative and intraoperative variables using bivariate and multivariate analyses compared with NAHS. RESULTS: The cohort consisted of 1038 patients with a mean follow-up of 30.1 months (range, 24.0-61.2 months). Mean age was 36.4 years (range, 13.2-76.4 years). All postoperative PRO scores showed significant improvement ( P < .001) at 2 years compared with preoperative scores. Bivariate analysis identified 15 variables (7 categorical and 8 continuous) and multivariate analysis identified 10 variables that were predictive of 2-year postoperative NAHS. Preoperative NAHS, preoperative HOS-ADL, preoperative mHHS, age, duration of symptoms, body mass index (BMI), and revision hip arthroscopy were identified as predictive factors in both bivariate and multivariate analyses. The predictive value of preoperative NAHS was accentuated for patients with higher BMI. CONCLUSION: This study reports favorable clinical outcomes in the largest cohort of hip arthroscopies with a minimum 2-year follow-up in the literature to date. Factors identified as predictive in both bivariate and multivariate analyses included preoperative NAHS, HOS-ADL, and mHHS; age; duration of symptoms; BMI; and revision hip arthroscopy. These predictive factors may be useful to the clinician in determining prognosis and operative indications for hip arthroscopy.

Central Acetabular Impingement Is Associated With Femoral Head and Ligamentum Teres Damage: A Cross-Sectional Matched-Pair Analysis of Patients Undergoing Hip Arthroscopy for Acetabular Labral Tears.

PURPOSE: The primary purpose of this study was to report the prevalence of femoral head articular damage in patients with a central acetabular osteophyte (CAO) that was identified during hip arthroscopy and compare it with that in a matched control group without a CAO. A secondary purpose was to identify rates of coexisting intra-articular pathology in both patient groups. METHODS: Intraoperative data were collected prospectively on all hip arthroscopy patients at our institution between 2008 and 2015. The inclusion criteria for this study were CAOs identified during hip arthroscopy for a labral tear and/or femoroacetabular impingement. The exclusion criteria were Tönnis grade greater than 0, previous hip conditions, and prior surgical interventions. The matched control group was selected based on sex, age ± 5 years, body mass index, and Workers' Compensation claim at a 3:1 ratio and comprised patients who underwent hip arthroscopy for a labral tear and/or femoroacetabular impingement without a CAO. The size and location of labral tears and chondral lesions were recorded in square millimeters with a 5-mm probe and by the clock-face method. RESULTS: The CAO group consisted of 126 patients, who were matched to 378 patients in the control group. Femoral and acetabular chondral damage grades were significantly different between the 2 groups (P < .001). Of patients with CAOs, 55% had femoral head chondral damage compared with 24% of the control patients. The mean size of femoral chondral damage was 3.2 cm2 in the CAO group and 1.7 cm2 in the control group. The mean size of acetabular chondral damage was 1.7 cm2 in the CAO group and 1.2 cm2 in the control group. Both femoral and acetabular chondral damage sizes were significantly larger in the CAO group (P ≤ .007). The prevalence of ligamentum teres tears was significantly different between the 2 groups (P < .001). There were no statistically significant differences in the types of labral tears between the 2 groups (P = .625). CONCLUSIONS: This study showed that patients with CAOs had a significantly higher prevalence of femoral chondral damage and ligamentum teres tears than matched controls. LEVEL OF EVIDENCE: Level III, comparative study.

Relationship Between Age at Onset of Symptoms and Intraoperative Findings in Hip Arthroscopic Surgery.

BACKGROUND: Hip arthroscopic surgery is intended to treat multiple abnormalities in an effort to delay the progression to osteoarthritis, especially in young patients. However, the length of time in which patients experience joint pain before seeking a specialist for a diagnosis can delay hip preservation surgery and influence clinical outcomes. PURPOSE: To investigate the relationship between age at symptom onset and findings during hip arthroscopic surgery as well as outcomes after 2 years of clinical follow-up. STUDY DESIGN: Cohort study; Level of evidence, 3. METHODS: From February 2008 to March 2015, data were prospectively collected on all patients undergoing hip arthroscopic surgery at a single institution. Anatomic and pathological characteristics were recorded intraoperatively. The mean age at onset of symptoms was calculated and correlated with intraoperative findings using Pearson correlation and logistic regression. All patients were assessed preoperatively and postoperatively with 4 patient-reported outcome measures: the modified Harris Hip Score (mHHS), the Non-Arthritic Hip Score (NAHS), the Hip Outcome Score-Activities of Daily Living (HOS-ADL), and the Hip Outcome Score-Sport-Specific Subscale (HOS-SSS). Pain was estimated using a visual analog scale (VAS). Furthermore, patients with an age at onset of symptoms below the mean (34.6 years) were compared with those of an age at onset of symptoms above the mean. The 2 groups were compared using the Student t test and the chi-square test. P values <.05 were considered significant. RESULTS: A total of 1697 patients met the inclusion criteria. Body mass index was weakly correlated with age (r = 0.3). Younger patients had a lower prevalence of combined Seldes type 1 and 2 labral tears; acetabular labrum articular disruption (ALAD) grade 2, 3, and 4 acetabular chondral lesions; and Outerbridge grade 2, 3, and 4 femoral head chondral lesions (P < .05 for all). More advanced age was correlated with wider labral tears and chondral lesions based on a clock face (r ≥ 0.2, P < .05). Patients younger than 34.6 years had a lower prevalence of gluteus medius and ligamentum teres tears (P ≤ .001). The prevalence of synovitis was positively correlated with age, while instability was negatively correlated with age (P = .04). The improvement of scores from preoperatively to 2-year follow-up in the younger patient group was 62.69 to 83.82 for the mHHS, 64.97 to 87.35 for the HOS-ADL, 43.46 to 73.37 for the HOS-SSS, 63.01 to 85.19 for the NAHS, and 5.61 to 2.53 for pain VAS. All score improvements were statistically significant (P < .001). Regarding the older patient group, the improvement of scores from preoperatively to 2-year follow-up was 58.55 to 78.27 for the mHHS, 57.59 to 79.66 for the HOS-ADL, 35.63 to 61.88 for the HOS-SSS, 55.28 to 77.55 for the NAHS, and 5.72 to 3.01 for pain VAS. All score improvements were statistically significant (P < .001). CONCLUSION: Of the multiple intraoperative findings in hip arthroscopic surgery, many are related to age at onset of symptoms. Although we found a statistically significant improvement in clinical outcomes in both groups after 2-year follow-up, apparently the less complex and smaller lesions observed in both the articular cartilage and the labrum of younger patients result in better outcomes compared with older patients.

Correlation Between Changes in Visual Analog Scale and Patient-Reported Outcome Scores and Patient Satisfaction After Hip Arthroscopic Surgery.

BACKGROUND: Improvements in pain, function, and patient satisfaction are used to evaluate the outcomes of hip arthroscopic surgery. PURPOSE: To identify correlations between the visual analog scale (VAS) score for pain and patient satisfaction with 4 commonly used patient-reported outcome (PRO) scores to determine to what extent changes in these 2 parameters are reflected in each of the PRO scores. STUDY DESIGN: Cohort study (diagnosis); Level of evidence, 3. METHODS: Patients undergoing hip arthroscopic surgery between February 2008 and February 2013 were assessed prospectively before surgery, at 3 months, and annually thereafter with the modified Harris Hip Score (mHHS), Nonarthritic Hip Score (NAHS), Hip Outcome Score-sports-specific subscale (HOS-SSS), and Hip Outcome Score-activities of daily living (HOS-ADL). Patients were also assessed using a 10-point VAS for pain and queried for satisfaction at the same time points ("0" indicated no pain, and "10" indicated complete satisfaction with surgery). The VAS score and patient satisfaction were correlated with changes in the 4 PRO scores. RESULTS: During the study period, 1417 patients underwent hip arthroscopic surgery, of whom 1137 patients had 2-year postoperative PRO scores after primary surgery. There was a significant improvement in all PRO scores at 2-year follow-up. The mean improvements in mHHS, NAHS, HOS-ADL, and HOS-SSS scores were 16.7, 21.6, 19.7, and 22.7 points, respectively. The mean improvement in the VAS score was 2.9 points. Mean patient satisfaction at 2-year follow-up was 7.74 (of 10). There was a statistically significant correlation between the VAS and patient satisfaction scores and changes in each of the 4 PRO scores. The strength of the correlation was moderate. CONCLUSION: This study demonstrated a moderate correlation between the VAS and patient satisfaction outcomes and changes in 4 commonly used PRO scores in hip arthroscopic surgery (mHHS, HOS-ADL, HOS-SSS, and NAHS). In addition to several PRO instruments, a VAS for pain and patient satisfaction may add to the overall assessment of the efficacy of hip arthroscopic surgery.

Posterolateral Acetabuloplasty and Distal Femoral Neckplasty, Labral Repair, and Capsular Plication for Hip Reverse Contre-Coupe Lesion.

This article describes the arthroscopic approach and management of a "reverse contre-coup" injury to the hip labrum. The injury occurs in the setting of posterolateral acetabular rim over-coverage impinging on the distal femoral neck in extension causing the femoral head to lever out anteriorly against the labrum. Ligamentous laxity and associated loss of anterior capsular restraint allow increased femoral head translation, adding further insult to the anterior labrum. The arthroscopic approach entails not only a labral repair with correction of the osseous conflict but also restoration of soft-tissue stability to minimize anterior femoral translation.

Outcomes of gluteus maximus and tensor fascia lata transfer for primary deficiency of the abductors of the hip.

PURPOSE: This study aims to present 3 patients' results after undergoing gluteus maximus and tensor fascia lata (TFL) transfer for chronic abductor tears unable to be repaired primarily. METHODS: 3 patients were identified intraoperatively as having an abductor tear unable to be repaired primarily. The anterior 1/3 of the gluteus maximus and the posterior 1/3 of the TFL were mobilised and transferred to the greater trochanter in order to reproduce the normal force vector of the gluteus medius and minimus. Data was prospectively collected for changes in gait, abductor strength, and the following patient reported outcomes (PROs): modified Harris Hip Score (mHHS), Nonarthritic Hip Score (NAHS), Hip Outcome Score-Sports Specific Subscale (HOS-SSS), Hip Outcome Score-Activities of Daily Living (HOS-ADL), visual analogue scale (VAS), and satisfaction. RESULTS: The patients were female, 63-75 years old, with BMIs of 23-28. All patients had follow-up at mean 2.1 years (1.25-2.5) with positive Trendelenburg signs preoperatively; 2 patients normalised postoperatively. For 2 patients, abductor strength improved by 2 grades postoperatively; the other patient maintained grade four. 2 patients' PROs all improved; the other patient's PROs all improved except mHHS. Postoperative VAS scores were 0, 0, 1. 2 patients reported maximum satisfaction. CONCLUSIONS: This case series suggests that gluteus maximus and TFL transfer for irreparable abductor deficiency may be effective for pain relief, improving abductor strength, and reconstructing abductor function. Although this is a small series, it is to our knowledge the first report of clinical outcomes of this procedure.

Minimum 2-Year Outcomes of Hip Arthroscopic Surgery in Patients With Acetabular Overcoverage and Profunda Acetabulae Compared With Matched Controls With Normal Acetabular Coverage.

BACKGROUND: Advancements in instrumentation and techniques have extended the scope of hip arthroscopic surgery to treat complex osseous deformities that were previously best addressed with an open approach. Global pincer-type femoroacetabular impingement is an example of an abnormality requiring osseous correction with a technically challenging access point. PURPOSE: To report on the patterns of clinical presentation and intra-articular derangements, radiological associations, and minimum 2-year outcomes after hip arthroscopic surgery in patients with a lateral center edge angle (LCEA) >40° and profunda acetabulae in comparison with matched controls with normal acetabular coverage. STUDY DESIGN: Cohort study; Level of evidence, 3. METHODS: Data were collected on all patients undergoing hip arthroscopic surgery during the study period from April 2008 to April 2013. All patients who had undergone hip arthroscopic surgery for symptomatic labral tears not responsive to a minimum of 3 months of physical therapy with both an LCEA >40° and profunda acetabulae, as defined by the ilioischial line lateral to the medial border of the teardrop, and without a history of hip surgery or hip conditions were included. This group was matched in a 1-to-1 ratio with a control group that had also undergone the arthroscopic management of symptomatic labral tears refractory to a minimum of 3 months of physical therapy with an LCEA between 25° and 40° according to age within 3 years, sex, body mass index category, Tönnis grade, labral treatment, and capsular treatment. Range of motion, impingement signs, and radiographic indices of coverage and version were recorded for each group. Four patient-reported outcome (PRO) scores, the visual analog scale (VAS) for pain, patient satisfaction, revision hip arthroscopic surgery, and conversion to total hip arthroplasty (THA) were also recorded. RESULTS: Thirty-nine patients met the inclusion criteria for the study (overcoverage) group, of which 36 (92.3%) patients had a minimum 2-year follow-up; 215 patients satisfied the inclusion criteria for the control (normal coverage) group, of which 183 (85.1%) had a minimum 2-year follow-up. Thirty-six patients were matched in each group using the above criteria. There was no difference with respect to range of motion and impingement signs between the groups. The study group had significantly higher radiological markers of overcoverage but not retroversion compared with the control group. The study group had a significantly higher incidence of Seldes type 2 tears compared with the control group: 50.0% versus 19.4%, respectively ( P = .013). Both groups demonstrated significant improvements in the mean scores of all PROs, but the study group had a lower magnitude of improvement for all the PROs compared with the control group, with the modified Harris Hip Score (mHHS) achieving statistical significance: 13.5 versus 21.7 points, respectively ( P = .032). The study group had a significantly lower mean patient satisfaction score compared with the control group: 6.61 versus 7.91, respectively ( P = .019). The study group also had a significantly higher incidence of conversion to THA compared with the control group: 4 versus 0, respectively ( P = .040). CONCLUSION: Hip arthroscopic surgery for the management of symptomatic labral tears in patients with combined overcoverage and coxa profunda is associated with improvements in patient outcomes and pain at a minimum 2-year follow-up. However, the degree of improvement is of lower magnitude compared with a matched cohort with normal coverage undergoing the arthroscopic management of symptomatic labral tears. While hips with lateral overcoverage combined with coxa profunda may have a smaller potential for improvement compared with hips with normal coverage, this type of osseous morphology is still repairable with arthroscopic treatment.

Arthroscopic Reconstruction of Segmental Defects of the Hip Labrum: Results in 22 Patients With Mean 2-Year Follow-Up.

PURPOSE: To report mean 2-year patient-reported outcomes (PROs) and the incidence of revision hip arthroscopy or conversion to total hip arthroplasty (THA) in patients who had undergone arthroscopic reconstruction of the hip labrum for segmental defects. METHODS: Data were prospectively collected and retrospectively reviewed on all patients who had undergone hip arthroscopy from April 2008 to April 2013. All patients who underwent arthroscopic labral reconstruction with either a semitendinosus allograft or a gracilis autograft with mean 2-year follow-up were part of the inclusion criteria. The following outcomes were recorded: modified Harris hip score, nonarthritic athletic hip score, hip outcome score-sports-specific subscale, hip outcome score-activities of daily living subscale, visual analog scale, for pain, patient satisfaction, revision hip arthroscopies, and conversion to THA. A 2-tailed Student's t-test was used to assess for statistically significant differences between the mean of preoperative and postoperative PROs. P values less than .05 were considered statistically significant. RESULTS: A total of 22 patients (14 females, 8 males) met the inclusion criteria. There was 100% follow-up. The mean age of the study population was 32.2 years. Twelve patients had reconstruction as part of a revision procedure and 10 patients had a reconstruction at the time of primary arthroscopy. Concomitant arthroscopic procedures included acetabuloplasty and femoroplasty. There was statistically significant improvement in all PROs (P = .013 to < .001). The mean changes for the modified Harris hip score, nonarthritic athletic hip score, hip outcome score-sports-specific subscale, and hip outcome score-activities of daily living subscale were 11.0 ± 19.5, 22.2 ± 15.0, 23.1 ± 30.9, and 19.1 ± 17.5 points, respectively. The mean improvement in the visual analog scale was 3.33 ± 2.92 points (P < .001), and the mean patient satisfaction was 6.73 out of 10 points. One patient required conversion to THA for presumed progression of osteoarthritis and 2 patients required a revision procedure for adhesions. CONCLUSIONS: This arthroscopic technique for labral reconstruction was associated with a significant improvement in PROs and function. Conversion to THA with the procedure was 4.5%. LEVEL OF EVIDENCE: Level IV, therapeutic case series.

Acetabular Chondral Lesions in Hip Arthroscopy: Relationships Between Grade, Topography, and Demographics.

BACKGROUND: Hip pain remains a challenge given the multiple factors that can cause damage to the articular cartilage, such as traumatic injury, metabolic damage, and morphologic variations such as femoroacetabular impingement (FAI) and that can contribute to progression of osteoarthritis. However, a direct relationship between patient characteristics, the extent of acetabular chondral damage, and topologic characteristics of chondral lesions has not been established. PURPOSE: To compare the grade of acetabular chondral damage, measured in terms of acetabular labrum articular disruption (ALAD) classification, to the size and position of the chondral lesions, matching patients' demographic factors such as age and body mass index (BMI). STUDY DESIGN: Cross-sectional study; Level of evidence, 3. METHODS: This study included all hip arthroscopies performed by the corresponding author from August 7, 2008, to November 19, 2014, in which acetabular chondral lesions were intraoperatively identified and measured in terms of ALAD grade, clockface location, and size. Bivariate analyses and multiple logistic regression were used to identify the demographic factors, characteristics of the acetabular chondral lesion, and other anatomic characteristics that were related to the ALAD grade of the acetabular chondral lesion. RESULTS: Acetabular chondral lesions were measured in 1502 patients during the study period. Multivariate analysis showed that higher ALAD grade of acetabular chondral damage was significantly related to male sex, more advanced age, the area of the acetabular chondral lesion, anterior extension of the acetabular chondral lesion within the anterosuperior quadrant, labral detachment from the acetabular cartilage, and posterior extension of the labral tear. CONCLUSION: Higher grades of acetabular chondral damage were related to male sex, increased age, height, weight, BMI, and the size of the lesion. Chondral lesions were generally found in the anterosuperior region of the acetabulum, consistent with labral lesions and the weightbearing area of the acetabulum.

Robotic-arm assisted total hip arthroplasty results in smaller acetabular cup size in relation to the femoral head size: a matched-pair controlled study.

PURPOSE: To compare the acetabular component size relative to the patient's native femoral head size between conventional THA (CTHA) approach and robotic-arm assisted THA (RTHA) to infer which of these techniques preserved more acetabular bone. METHODS: Patients were included if they had primary osteoarthritis (OA) and underwent total hip replacement between June 2008 and March 2014. Patients were excluded if they had missing or rotated postoperative anteroposterior radiographs. RTHA patients were matched to a control group of CTHA patients, in terms of preoperative native femoral head size, age, gender, body mass index (BMI) and approach. Acetabular cup size relative to femoral head size was used as a surrogate for amount of bone resected. We compared the groups according to 2 measures describing acetabular cup diameter (c) in relation to femoral head diameter (f): (i) c-f, the difference between cup diameter and femoral head diameter and (ii) (c-f)/f, the same difference as a fraction of femoral head diameter. RESULTS: 57 matched pairs were included in each group. There were no significant differences between groups for demographic measures, femoral head diameter, or acetabular cup diameter (p>0.05). However, measures (i) and (ii) did differ significantly between the groups, with lower values in the RTHA group (p<0.02). CONCLUSIONS: Using acetabular cup size relative to femoral head size as an approximate surrogate measure of acetabular bone resection may suggest greater preservation of bone stock using RTHA compared to CTHA. Further studies are needed to validate the relationship between acetabular cup size and bone loss in THA.

Arthroscopic Capsular Plication and Labral Seal Restoration in Borderline Hip Dysplasia: 2-Year Clinical Outcomes in 55 Cases.

PURPOSE: To report clinical outcomes in patients with borderline dysplasia undergoing an arthroscopic technique of labral seal restoration with minimal acetabular rim resection and capsular plication. METHODS: Patients younger than 40 years with a lateral center-edge angle of 18° greater and 25° or less and 2-year follow-up after undergoing an arthroscopic technique of labral seal restoration with minimal rim resection (≤2 mm) and capsular plication (3-5 sutures placed in an oblique orientation to create an imbrication and inferior shift) were included. Patients underwent arthroscopy for symptoms that had marginal improvement with a minimum 6-week structured physical therapy program. Patients with a Tönnis grade of 1 or greater, a center-edge angle of 17° or less, and Legg-Calvé-Perthes disease were excluded. The following patient-reported outcomes (PROs) were recorded prospectively but retrospectively reviewed: modified Harris Hip Score, Non-Arthritic Hip Score, Hip Outcome Score-Sports-Specific Subscale, and Hip Outcome Score-Activities of Daily Living. The visual analog scale score, patient satisfaction score, complications, and revision procedures were also recorded. A 2-tailed paired t test was used to analyze change in preoperative to postoperative PRO scores. Significance was defined as P < .05. RESULTS: During the study period, 232 hip arthroscopies were performed in patients with a lateral center-edge angle between 18° and 25°. The inclusion criteria were met by 59 procedures. Of these procedures, 55 (93.2%) were available for follow-up. The labrum was repaired, debrided, and reconstructed in 37 procedures, 17 procedures, and 1 procedure, respectively. The iliopsoas was released in 34 procedures, the ligamentum teres was debrided in 29, and femoral osteoplasty was performed in 32. At 2-year follow-up, there was significant improvement in the mean scores of all PROs compared with baseline. Mean improvements for the modified Harris Hip Score, Hip Outcome Score-Activities of Daily Living, Hip Outcome Score-Sports-Specific Subscale, and Non-Arthritic Hip Score were 20.7, 17.5, 27.6, and 20.0, respectively. There was significant improvement in the visual analog scale score at 2 years, decreasing by 3.16 compared with baseline, and the mean patient satisfaction score was 8.09, with 83.6% of patients achieving a good to excellent result (patient satisfaction score ≥7). No complications were related to the procedure, and 6 patients (11%) required revision procedures (4 for labral retear, 1 for painful iliopsoas internal snapping, and 1 for removal of a symptomatic loose body). CONCLUSIONS: Arthroscopic intervention that encompasses minimal rim resection, restoration of labral function, and capsular plication significantly improves outcomes in patients with borderline dysplasia who do not warrant a periacetabular osteotomy. LEVEL OF EVIDENCE: Level IV, therapeutic case series.

Minimum 2-Year Outcomes of Arthroscopic Management of Symptomatic Hip Labrum Tears in Patients With Global Acetabular Overcoverage.

PURPOSE: To report minimum 2-year patient-reported outcomes (PROs) after hip arthroscopy (HA) for symptomatic labral tears in patients with global acetabular overcoverage. METHODS: This study was a retrospective case series of patients who underwent HA from April 2008 to April 2013. The inclusion criteria were patients with global acetabular overcoverage, defined as a lateral center-edge angle greater than 40°, and with coxa profunda, defined radiologically by the ilioischial line lateral to the acetabular floor. Only patients with minimum 2-year follow-up and no history of hip conditions or surgery were included. We recorded demographic, examination, radiologic, and intraoperative findings; intraoperative procedures performed; and the following PROs: modified Harris Hip Score (mHHS), Non-Arthritic Hip Score, Hip Outcome Score-Activities of Daily Living (HOS-ADL), Hip Outcome Score-Sports-Specific Subscale (HOS-SSS), visual analog scale, and patient satisfaction. RESULTS: The inclusion criteria were met by 39 patients, of whom 35 (89.7%) had 2-year follow-up. There was no distinct pattern of examination findings. The study population had a mean acetabular inclination of -1.19° and an anterior center-edge angle of 35°. There was no association with measures of acetabular retroversion. Intrasubstance tearing of the labrum occurred in 75% of patients (mean tear size, 2.68 hours on acetabular clock face; mean location, 11.5 to 3 on acetabular clock face). There were significant improvements in the mean scores for all PROs: mHHS, 13.5 ± 17.7 points (P < .01); Non-Arthritic Hip Score, 14.3 ± 21.3 (P < .001); HOS-ADL, 11.6 ± 19.7 (P < .001); HOS-SSS, 17.1 ± 35.1 (P < .001); and visual analog scale, -2.77 ± 2.58 (P < .001). The mean patient satisfaction rating was 6.61. The improvements in mHHS, HOS-ADL, and HOS-SSS did not reach the minimal clinically important difference. The incidence of secondary procedures was 17% (4 patients underwent conversion to total hip arthroplasty and 2 required revision HA). CONCLUSIONS: HA in patients with global acetabular overcoverage was associated with improvements in PROs and pain at minimum 2-year follow-up. However, these improvements did not reach the minimal clinically important difference for the mHHS, HOS-ADL, and HOS-SSS. The incidence of secondary procedures was 17%. The pattern of labral injury is predominantly intrasubstance labral damage with a narrow rim of adjacent chondral injury. LEVEL OF EVIDENCE: Level IV, therapeutic case series.

Arthroscopic Treatment of Labral Tears of the Hip in Adolescents: Patterns of Clinical Presentation, Intra-articular Derangements, Radiological Associations and Minimum 2-Year Outcomes.

PURPOSE: To report on patterns of clinical presentation, intra-articular derangements, radiological associations, and minimum 2-year outcomes after hip arthroscopy (HA) in patients 18 years or younger. METHODS: This study was a retrospective case series on patients 18 years or younger who had undergone HA for labral tears that had failed nonoperative management from April 2008 to April 2013 with a minimum 2-year follow-up. Exclusion criteria were previous hip conditions or surgery. The following were recorded: demographic, examination, radiological and intraoperative findings, intraoperative procedures performed, patient-reported outcomes (PROs), and patient satisfaction. The PROs reported included the modified Harris Hip Score, Non-Arthritic Hip Score, Hip Outcome Score-Sport-Specific Subscale, Hip Outcome Score-Activities of Daily Living, and Visual Analogue Score for pain. RESULTS: One hundred and two patients satisfied the inclusion criteria, of whom 90 (88.2%, 77 females and 13 males) had minimum 2-year follow-up. Females had increased external rotation in flexion (58.9° vs 50.0°, P = .041). Sixty-eight females had a Beighton's score of >4 compared to 6 males (P < .001). There was no distinct pattern within the group or between genders for radiological markers of acetabular coverage, depth, or version and femoral cam size. Mean femoral anteversion for females was 15.7° and for males 11.3°. Females had significantly smaller labral tears (1.73 hours vs 2.34 hours on the acetabular clock face, P = .028). Females were more likely to require a capsular plication and iliopsoas fractional lengthening (88.3% vs 46.2%, and 77.9% vs 38.5%, respectively). There was a significant improvement in all PRO measures in both males and females (P < .01), but females had lower preoperative and postoperative scores. Mean preoperative and postoperative PROs for males and females were as follows: modified Harris Hip Score 71.0/94.3 and 63.4/88.8, Hip Outcome Score-Activities of Daily Living 78.1/93.4 and 64.0/91.8, Hip Outcome Score-Sport-Specific Subscale 51.7/91.0 and 45.7/78.6, Non-Arthritic Hip Score 78.1/94.5 and 63.1/89.2, and visual analog score 4.77/1.85 and 6.29/2.21. The mean patient satisfaction score was 8.29 out of 10. Five patients (5.56%) required a revision procedure. CONCLUSIONS: HA is associated with improved outcomes and pain and high satisfaction scores at minimum 2-year follow-up in adolescent population. The pattern of labral injury is different in males and females and dictates the arthroscopic approach. Females are likely to require a capsular plication and iliopsoas release to address soft-tissue laxity and impingement. LEVEL OF EVIDENCE: Level IV, therapeutic case series.

Can Stem Version Consistently Correct Native Femoral Version Using Robotic Guidance in Total Hip Arthroplasty?

The purpose of this study is to investigate whether robotic guidance in total hip arthroplasty (THA) can consistently correct native femoral version. One hundred seventy-five consecutive patients who underwent MAKO® (Stryker, Kalamazoo, Michigan) robotic-guidance THA were included in the study. The study population had a mean age of 57.9 years and a mean body mass index (BMI) of 30.41. Forty-eight percent of the population was male and 74% of the procedures were performed through an anterior approach. Robotic guidance in THA was effective in correcting native femoral version toward a target of 15°. This can be achieved using both the anterior and posterior approach; it is not affected by BMI.

Anatomic Labral Repair in the Hip Using a Knotless Tensionable Suture Anchor.

To perform a proper labral repair, most surgeons use anchors to secure the labrum to the acetabular bone. We aim to describe a technique for labral repair with a knotless tensionable suture anchor. This technique uses a looped suture configuration, allowing selective tensioning of the repair to maintain the anatomic suction seal of the hip. The use of this technique is easily reproducible and reduces the surgical time compared with previous techniques.

Arthroscopic Central Acetabular Decompression: Clinical Outcomes at Minimum 2-Year Follow-up Using a Matched-Pair Analysis.

PURPOSE: To assess 2-year clinical outcomes of patients who underwent hip arthroscopy for central acetabular osteophytes (CAO) treated with central acetabular decompression (CAD), and to compare these outcomes with those of a matched control group. METHODS: Data were prospectively gathered for patients undergoing CAD during hip arthroscopy from February 2008 to July 2012. All patients were assessed pre- and postoperatively at 3 months, 1 year, and 2 years with modified Harris Hip Score, Non-Arthritic Hip Score, Hip Outcome Score-Activities of Daily Living, Hip Outcome Score-Sport-Specific Subscale, and visual analog scale (VAS) for pain. Patient satisfaction (0 to 10) was collected. A matched control group of patients without CAOs who did not undergo CAD was selected on a 1:3 ratio. RESULTS: Forty-nine hips were included in the CAD group and 147 in the control group. The mean change in patient-reported outcome (PRO) scores at 2-year follow-up in the CAD group for modified Harris Hip Score, Hip Outcome Score-Activities of Daily Living, Hip Outcome Score-Sport-Specific Subscale, Non-Arthritic Hip Score, and VAS was 11.0, 19.6, 15.2, 21.4, and -2, respectively. The mean change in PRO scores at 2-year follow-up in the control group was 17.0, 19.8, 24.0, 20.9, and -2.75, respectively. All improvements in PRO scores for both groups were statistically significant compared with the data collected preoperatively (P < .001). There was no statistically significant difference in postoperative PRO scores and VAS between the groups. Postoperative patient satisfaction at the latest follow-up was 7.14 and 7.60 for CAD and control groups, respectively. CONCLUSIONS: This study showed that patients with a CAO treated with CAD during hip arthroscopy had favorable outcomes at minimum 2 years postoperatively. Furthermore, the study group showed similar PRO scores and VAS to the control group. We conclude that CAD is a viable treatment option for CAO, yielding clinical improvement at short-term follow-up. LEVEL OF EVIDENCE: Level III, prospective comparative study.