Unicompartmental knee arthroplasty improves mental health in patients with single compartment knee osteoarthritis.

PURPOSE: The purpose of this study was to determine if preoperative mental health status improves following unicompartmental knee arthroplasty (UKA) in patients with single compartment knee osteoarthritis (OA). METHODS: A total of 163 patients underwent UKA [115 (71%) medial, 48 (29%) lateral] (mean age = 65 ± 11) completed preoperative and minimum 2-year postoperative veterans RAND 12 item health survey (VR-12) mental component score (MCS). VR-12 MCS was the primary outcome measure. Secondary measures included VR-12 physical component summary score (PCS), knee osteoarthritis outcome score (KOOS) and KOOS patient acceptable symptom state at the final follow-up. RESULTS: The median VR-12 MCS improved from 50.5 [interquartile range (IQR): 43.7-56.8] to 55.0 [IQR: 52.3-57.0] (p < 0.001) at a mean follow-up of 9.5 ± 4 years (range 2-19 years) following UKA. Preoperative VR-12 MCS was significantly correlated with patients postoperative VR-12 PCS (ρ = 0.294, p < 0.01), KOOS pain (ρ = 0.201, p = 0.012), KOOS ADL (ρ = 0.243, p = 0.002) and KOOS quality of life (ρ = 0.233, p < 0.01). Sixty-three (39%) patients improved from low VR-12 MCS (<50) to normal VR-12 MCS (≥50). One hundred forty-two (87%) achieved a normal VR-12 MCS score (≥50) postoperatively. CONCLUSION: At a mean of 10-year follow-up, patients who underwent UKA for single compartment osteoarthritic knee pain demonstrated significant improvement in mental health scores. UKA resulted in normal mental health in a majority of patients (87%). The resultant improved mental health scores were associated with improved patient pain and activities of daily living. LEVEL OF EVIDENCE: Level III retrospective cohort study.

Arthroscopic Labral Reconstruction With a Modified Inferior Capsular Shift Allows Return to Sport and Excellent Outcomes in Contact and Noncontact Athletes With Anterior Shoulder Instability at Minimum 5-Year Follow-up.

PURPOSE: To compare return to sport, functional outcomes, recurrence of instability, and osteoarthritis (OA) between collision/contact and limited/noncontact athletes following arthroscopic labral reconstruction with a modified inferior capsular shift for anterior shoulder instability. METHODS: Athletes underwent an arthroscopic labral reconstruction with a modified inferior capsular shift by the senior author between 1999 and 2018. Inclusion criteria were labral stripping from 12 (just beyond the biceps anchor) to 6 o'clock, less than 20% glenoid bone loss, active sports participation, and no previous surgery. Athletes were divided into collision/contact and limited/noncontact groups. Outcome measures, physical examination, and radiographic evaluation were collected at a minimum 5-year follow-up. Reoperations or any subjective laxity were considered failures. Radiographs were analyzed for OA using the Samilson-Prieto Radiological Classification. RESULTS: Ninety-two patients underwent arthroscopic labral reconstruction with a modified inferior capsular shift. Sixty-four met the inclusion criteria. Thirty-eight (age = 26.0 ± 8.0 years) participated in at least 1 collision/contact sport, and 26 (age = 38.0 ± 9.0 years) participated in limited/noncontact sports. Two (5%) collision/contact and 3 (12%) limited/noncontact athletes had traumatic reinjury requiring revision surgery. Of the remaining athletes (59/64), minimum 5-year follow-up was obtained on 54 (92%), with a mean follow-up of 12 ± 4 years (range 5-23 years). All athletes returned to their original sport at the same level. There was no significant difference between collision/contact and limited/noncontact athletes in timing of return to sports (5.2 ± 1.9 and 6.0 ± 3.1 months, respectively; P = .389). There were no significant differences between groups on any outcomes scores. CONCLUSIONS: Arthroscopic labral reconstruction with a modified inferior capsular shift addressed anterior instability with return to sport for both collision/contact and limited/noncontact athletes with excellent functional and clinical outcomes, full shoulder range of motion, and a low prevalence of advanced OA at minimum 5-year follow-up. This modified technique resulted in a low failure rate in both limited/noncontact and collision/contact athletes.

Timing From Symptom Onset to Hip Arthroscopy Does Not Affect Patient-Reported Outcome Measures for the Treatment of Femoroacetabular Impingement in Adolescent Patients.

PURPOSE: To evaluate symptom duration and its relationship to patient-reported outcomes (PROs) and survivorship after hip arthroscopy in adolescents. METHODS: Patients ≤18 at time of primary hip arthroscopy for femoroacetabular impingement (FAI) between January 2011 and September 2018 were included. Exclusion criteria consisted of history of previous ipsilateral hip surgery, presence of osteoarthritis or dysplasia on preoperative radiographs, previous hip fracture, or history of slipped capital femoral epiphysis or Legg-Calve-Perthes disease. Minimum 2-year PROs (modified Harris Hip Score, Hip Outcome Score [HOS]-Activities of Daily Living, HOS-Sport Scale, Short Forms 12 [SF-12]), minimum clinically significant difference (MCID) and patient-acceptable symptom state (PASS) rates, and revision surgery rates were compared based on symptom duration. RESULTS: Two-year minimal follow-up was obtained for 111 patients (134 hips) (80%), including 74 females and 37 males with a mean age of 16.4 ± 1.1 (range 13.0-18.0). The mean symptom duration was 17.2 ± 15.2 months (range 43 days to 6.0 years). Ten patients (11 hips), 6 females (7 hips) and 4 males, required revision surgery at an average of 2.3 ± 1.0 years (range 0.9-4.3 years). At a mean follow-up of 4.8 ± 2.2 years (range 2-10 years), there were statistically significant improvements in all PROs (P < .05 for all). Symptom duration showed no significant correlation to post-operative scores (correlation coefficient range -0.162 to -0.078, P > .05 for all). Symptom duration ≤12 months versus >12 months or as a continuous variable was not a predictor for requiring revision surgery or achieving MCID/PASS (95% confidence interval crosses 1 for all). CONCLUSIONS: In an adolescent cohort of symptomatic FAI patients who underwent hip arthroscopy, there is no difference in PRO measures when analyzing symptom duration by arbitrary time intervals or as a continuous variable. LEVEL OF EVIDENCE: Level IV, case series.

The Role of Severe Lateral Facet Patellar Osteoarthritis in Patient Selection for Success of a Medial Unicompartmental Knee Arthroplasty: Mean Follow-Up of 10 Years.

BACKGROUND: Lateral facet patellar osteoarthritis (LFPOA) has been reported as a contraindication for medial unicompartmental (UKA). The purpose of this paper was to determine if severe LFPOA was related to lower survivorship and patient-reported outcomes following medial UKA. METHODS: A total of 170 medial UKAs were performed. Severe LFPOA was defined as Outerbridge grade 3 to 4 damage on the lateral facet cartilage surfaces of the patella as noted intraoperatively. There were 122 of 170 patients (72%) who had noLFPOA and 48 of 170 patients (28%) who had had severe LFPOA. A routine patelloplasty was performed in all patients. Patients completed the Veterans RAND 12-Item Health Survey (VR-12) Mental Component Score (MCS) and Physical Component Score (PCS), Knee Injury and Osteoarthritis Outcome Score (KOOS), and Knee Society Score. RESULTS: There were 4 patients in the noLFPOA group who required total knee arthroplasty and 2 in the LFPOA group. There was no significant difference in mean survival time: noLFPOA = 17.2 years [95% confidence interval (CI): 17 to 18] and LFPOA = 18.0 years [95% CI: 17 to 19] (P = .94). At mean follow-up of 10 years, there were no significant differences in knee flexion or extension. Patello-femoral crepitus without pain was noted in 7 patients who had LFPOA and 21 patients who had noLFPOA. There were no significant differences in VR-12 MCS, PCS, KOOS subscales, or Knee Society Score between groups. Patient acceptable symptom state (PASS) was achieved in 80% (90 of 112) for KOOS ADL in the noLFPOA group and 82% (36 of 44) in the LFPOA group (P = .68). PASS was achieved in 82% (92 of 112) for KOOS Sport in the noLFPOA group and 82% (36/44) in the LFPOA group (P = .87). CONCLUSION: At a mean of 10 years, patients who had LFPOA had equivalent survivorship and functional outcomes to patients who did not have LFPOA. These long-term results suggest that asymptomatic grade 3 or 4 LFPOA is not a contraindication to medial UKA.

Lower Center Edge Angle and Bioipolar Cartilage Lesions Are Associated With Conversion to Hip Arthroplasty Within 2 Years Following Hip Arthroscopy: A Matched Cohort Analysis.

PURPOSE: The purpose of this study was to determine whether radiographic parameters, intraoperative findings, patient-reported outcome measures, or intraoperative interventions that were performed differentiate those patients with >2 mm of joint space who convert under two years to total hip arthroplasty (THA) after undergoing hip arthroscopy for femoroacetabular impingement (FAI) when compared to those converting after 2 years. METHODS: Included in this study were patients who underwent conversion to THA within 2 years of primary hip arthroscopy from a prospectively collected patient registry from 2007 to 2017. Patients who underwent early conversions to arthroplasty were matched 1:1 with patients who converted after 2 years, based upon age and gender. Preoperative outcome scores were collected, including Short Form-12, modified Harris Hip Score, and Hip Outcome Score. Additionally, variables from the preoperative radiographic evaluation, surgical findings, and procedures performed were also compared. RESULTS: Forty-nine patients were included in the early conversion group and were matched with 49 patients in the later conversion group. Patients with lateral center edge angles of less than 25° were more likely to be in the early failure group [OR: 3.9; 95% CI: 1.01 to 15]. Patients with unipolar chondral defects on either the femoral (P = .128) or acetabular side (P = .656) were not at increased odds for early conversion compared to later conversion; however, those with bipolar chondral lesions at the time of surgery had increased odds of early conversions [OR: 3.3; 95% CI: 1.4 to 8] (P = .01). Neither surgical treatment nor preoperative patient-reported outcome measures were associated with early conversion. CONCLUSIONS: In patient with >2 mm of joint space, lateral center edge angles of less than 25° and those with bipolar articular cartilage lesions seen at the time of hip arthroscopy are at increased risk for conversion to total hip arthroplasty within two years. LEVEL OF EVIDENCE: Level III, retrospective comparison study.

Arthroscopic Hip Capsular Reconstruction Using Iliotibial Band Allograft as a Salvage Option for Unrepairable Capsular Defects Demonstrates Good Survivorship and Improved Patient-Reported Outcomes.

PURPOSE: To describe patient outcomes 3 to 5 years after arthroscopic hip capsule reconstruction. METHODS: Between January 2007 and December 2016, patients aged 18 to 50 years who underwent arthroscopic hip capsular reconstruction using an Iliotibial band allograft by the senior author and had minimum of 3-year follow-up were identified. Patients were excluded if they had previous open hip surgery, advanced osteoarthritis (Tönnis grade >2), significant acetabular dysplasia (lateral center edge angle <20°), avascular necrosis, or Legg-Calve-Perthes disease. Outcome scores including the Hip Outcome Score (HOS)-Activities of Daily Living scale, modified Harris Hip Score, HOS-Sports scale, SF-12, and Western Ontario & McMaster Universities Osteoarthritis Index were compared in addition to failure rate, revision rate, and patient satisfaction rate with the outcome (range, 1-10). All patients were assessed by the senior author pre- and postoperatively. RESULTS: Thirty-nine patients met the inclusion criteria. The mean age of the cohort was 32 ± 10 years, with 6 male and 33 female patients. The average number of previous hip arthroscopy surgeries was 2 ± 1. Six patients (15%) converted to total hip arthroplasty at an average of 2.1 years (range 7 months to 6 years) following capsular reconstruction. Four patients required revision hip arthroscopy after the arthroscopic capsular reconstruction. All arthroscopic revisions occurred in female patients with the primary intraoperative finding of capsulolabral adhesions at the time of revision. At mean follow-up of 4.3 years (range 3-6.8 years), the 29 patients who did not require subsequent surgery had significant improvements from preoperatively to postoperatively in HOS-Activities of Daily Living and HOS-Sport with 90% reaching minimal clinically important difference. All other scores showed significant improvement. Survival for patients not requiring total hip arthroplasty was 86% at 3 years, with a mean survival of 5.7 years (95% confidence interval 4.97-6.4). CONCLUSIONS: Arthroscopic hip capsular reconstruction with iliotibial band allograft is a successful treatment option for patients with symptomatic capsular defects, demonstrating improved patient-reported outcomes maintained at mean follow-up time of 4 years. This technique offers restoration of the anatomic structure and function of the capsular ligaments to improve pain and instability. LEVEL OF EVIDENCE: IV, case series.

Reliability and Validity of the Knee Injury and Osteoarthritis Outcome Score in Patients Undergoing Unicompartmental Knee Arthroplasty.

BACKGROUND: The Knee Injury and Osteoarthritis Outcome Score (KOOS) was developed to document outcomes from knee injury, including the impact of osteoarthritis on knee function. The purpose of this study is to determine the reliability and validity of the KOOS subscales for evaluating outcomes following unicompartmental knee arthroplasty (UKA). METHODS: KOOS Pain, Activities of Daily Living (ADL), Sport, Symptoms, and Quality of Life (QoL) scores collected from 172 patients who underwent UKA were used in the analysis. KOOS subscales were tested for reliability and validity of scores through a Rasch model analysis. RESULTS: KOOS Sport, KOOS ADL, and KOOS QoL had good evidence of reliability with acceptable person reliability, person separation, and item reliability. For overall scale functioning, KOOS Pain, Symptoms, and ADL all had 1 question that did not have an acceptable value for infit or outfit mean square value. Questions in KOOS Sport and QoL all had acceptable values. There was a positive, linear relationship between the Short-Form 12 Physical Component Summary and the KOOS subscales which indicated good evidence of convergent validity. These associations were also seen when the cohort was separated in medial and lateral UKA. CONCLUSION: Two of the 5 KOOS subscales (KOOS Sport and KOOS QoL) were considered adequate in measuring outcomes, as well as reliability. The KOOS ADL had borderline values; however, it had adequate infit and outfit values. The KOOS Pain and Symptom score performed poorly in this analysis. For documenting outcomes following UKA, this study supports the use of KOOS ADL, Sport, and QoL.

The Lawrence D. Dorr Surgical Techniques & Technologies Award: Patient Acceptable Symptom State (PASS) in Medial and Lateral Unicompartmental Knee Arthroplasty: Does the Status of the ACL Impact Outcomes?

BACKGROUND: The aim of this study is to determine if there is a difference in the percentage of patients who reach Patient Acceptable Symptom State (PASS) when comparing anterior cruciate ligament (ACL)-deficient and ACL-intact knees following fixed-bearing medial and lateral unicompartmental knee arthroplasty (UKA). METHODS: A consecutive series of 215 knees that underwent UKA (medial = 158, lateral = 57) were included in the study. The Knee Osteoarthritis Outcome Score functional score [KOOS activities of daily living (ADL)] and KOOS Sport were used as the primary outcome variables. A KOOS ADL PASS of 87.5 and KOOS Sport PASS of 43.8 were previously described for total knee arthroplasty (TKA). Failure was defined as conversion to TKA. RESULTS: There were 157 in the ACL-intact group and 58 in the ACL-deficient group. Conversion to TKA was 3.7%. The failure rate in the ACL-deficient group was 5% (3/58) and 3% (5/157) in the ACL-intact group (P = .447). The mean survival for the entire group was 18.1 years (95% confidence interval 17.6-18.6). At 10 years, the survival was 94.3% (standard error = 0.028) in the ACL-deficient group and 97.6% (standard error = 0.014) in the ACL-intact group. At a mean 10 ± 3.5 years, with 93% follow-up, 83% in the ACL-deficient group and 80% in the ACL-intact group reached PASS for KOOS ADL (P = .218). For KOOS Sport, 85% of the ACL-deficient group compared to 81% in the ACL-intact group (P = .374) reached PASS. CONCLUSION: The ACL-deficient cohort results were not significantly different compared to ACL-intact knees in both medial and lateral compartment UKA. Fixed-bearing medial and lateral UKA resulted in low failure rate and excellent long-term outcomes.

An algorithm for successfully managing anterior shoulder instability.

ABSTRACT: The most common form of shoulder instability involves the anterior glenohumeral joint. Often it is associated with labral and bony injuries with subsequent recurrent instability. To determine optimal management, clinicians should perform a detailed history and physical examination, including appropriate diagnostic imaging to assess for concomitant humeral and glenoid bony deficiencies and other soft-tissue pathologies. Early surgical intervention may reduce risk of recurrence, particularly in young, active athletes. This article highlights the relevant anatomy, pathoanatomy, diagnostic examination including radiologic imaging, management, and prevention of complications for anterior shoulder instability. Minimizing recurrence is key to restoring function for patients to safely return to recreational and sporting activities, and to perform activities of daily living.

Salvage Revision Hip Arthroscopy Including Remplissage Improves Patient-Reported Outcomes After Cam Over-Resection.

PURPOSE: To evaluate outcomes of arthroscopic hip remplissage with folded iliotibial band allograft to treat cam over-resection. METHODS: Patients who underwent arthroscopic iliotibial band hip remplissage from May 2013 to April 2018 were prospectively evaluated. Pre- and postoperative patient-reported outcome scores were compared and included the 12-Item Short Form Survey (SF12) Physical Health Composite Score (PCS), SF12 Mental Health Composite Score (MCS), Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC), modified Harris Hip Score (mHHS), and Hip Outcome Score (HOS) (Activities of Daily Living [ADL] and Sport). Postoperative Tegner Activity Scale and patient satisfaction (1-10) were also evaluated. RESULTS: Thirteen patients (2 men, 11 women) with an average age of 39.8 ± 9 years underwent arthroscopic hip remplissage with minimum 2-year and mean 3.1-year follow-up (range, 2.1-4.1 years). One hundred percent follow-up was achieved. The average number of previous surgeries was 1.38 (range, 1-3). One patient underwent total hip arthroplasty 2 years after remplissage. All 12 patients who did not undergo total hip arthroplasty had improved patient-reported outcomes after remplissage (mean scores: SF12 PCS 36 vs 42, P = .02; SF12 MCS 45 vs 51, P = .14; mHHS 45 vs 66, P < .001; minimal clinically important difference [MCID] 83%; WOMAC 42 vs 28, P < .001; HOS ADL 52 vs 69, P = .003; MCID, 67%; HOS Sport 27 vs 46, P = .015; MCID, 67%). All improvements met statistical significance, besides the SF12 MCS. Median postoperative Tegner score was 2.9. Median postoperative patient satisfaction was 7 out of 10 (range, 5-10). CONCLUSIONS: Arthroscopic hip remplissage is a successful salvage treatment option for hip instability caused by previous cam over-resection. Care must be taken during primary surgery not to over-resect the cam as patient-reported outcomes after remplissage are inferior to those undergoing primary hip arthroscopy. LEVEL OF EVIDENCE: Level IV, case series.

Relevance of the Tibial Slope on Functional Outcomes in ACL-Deficient and ACL Intact Fixed-Bearing Medial Unicompartmental Knee Arthroplasty.

BACKGROUND: Excessive posterior tibial slope in medial unicompartmental knee arthroplasty (UKA) has been implicated in early failure. The purpose of this study was to evaluate the relationship between preoperative posterior tibial slope and postoperative slope of the implant (PSI) on outcomes in patients with anterior cruciate ligament (ACL) intact and ACL-deficient knees after fixed-bearing medial UKA. METHODS: Patients who underwent a medial UKA between 2002 and 2017 with a minimum 3-year follow-up were included. Preoperative posterior tibial slope and postoperative PSI were measured. Outcomes measures included Knee Injury and Osteoarthritis Outcomes Score (KOOS) subscales, Lysholm, and VR-12. Failure was defined as conversion to total knee arthroplasty. RESULTS: Of 241 knees undergoing UKA, 131 patients (70 women, 61 men; average age of 65 ± 10 years (average BMI of 27.9 ± 4) were included. For all patients, survivorship was 98% at 5 years and 96% at 10 years with a mean survival time for UKA was 15.2 years [95% CI: 14.6-15.7]. No failure had a PSI >7°. There were no superficial or deep infections. There were no significant differences in outcome scores between the ACL intact and the ACL-deficient group; therefore, the data were combined for analysis. At mean 8-year follow-up, KOOS pain scores were better in patients with PSI ≤7° (87 ± 16) than those with PSI >7° (81 ± 15). 76% of patients with PSI ≤7° reached the Patient Acceptable Symptom State for KOOS pain; whereas, 59% of patients with PSI >7° reached PASS for KOOS pain (P = .015). CONCLUSION: Patients with postoperative posterior slope of the tibial implant >7° had significantly worse postoperative pain, without conversion to TKA, and with maintenance of high function. In ACL deficient and intact knees, nonrobotically-assisted, fixed-bearing medial UKA had a 96% survivorship at 10 years.

Unmet needs in sexual health in bladder cancer patients: a systematic review of the evidence.

BACKGROUND: Bladder cancer (BC) treatment can have a detrimental effect on the sexual organs of patients and yet assessment of sexual health needs has been greatly overlooked for these patients compared to those who have undergone other cancer therapies. METHODS: This review was conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) guidelines in July 2019. Studies were identified by conducting searches for Medline (using the PubMed interface), the Cochrane Central Register of Controlled Trials (CENTRAL) and Ovid Gateway (Embase and Ovid) using a list of defined search terms. RESULTS: 15 out of 37 studies included men only, 10 studies women only and 11 both sexes. Most participants were aged 50 to 65 years. Most studies (n = 34) focused on muscle invasive BC and only three on non-muscle invasive BC. Measurements of sexual dysfunction, including erection, ejaculation, firmness and desire, were the most commonly used measurements to report sexual health in men. In women, lubrification/dryness, desire, orgasm and dyspareunia were the most commonly reported. Twenty-one studies evaluated sexual dysfunction based on validated questionnaires, two with a non-validated questionnaire and through interviewing participants. CONCLUSION: While recognition of the importance of the inclusion of psychometric measurements to assess sexual health is growing, there is a lack of consistent measures to assess sexual health in BC. With the focus on QoL arising in cancer survivorship, further studies are needed to develop, standardize and implement use of sexual health questionnaires with appropriate psychometrics and social measures to evaluate QoL in BC patients. TRIAL REGISTRATION: "PROSPERO does not currently accept registrations for scoping reviews, literature reviews or mapping reviews. PROSPERO is therefore unable to accept your application or provide a registration number. This decision should not stop you from submitting your project for publication to a journal."

Survey results from an international hip course: comparison between experts and non-experts on hip arthroscopy clinical practice and post-operative rehabilitation.

PURPOSE: The purpose of this study was to compare the clinical practices between expert and non-expert arthroscopy hip surgeons. METHODS: Registered orthopedic surgeons completed anonymous surveys during a hip arthroscopy meeting. The survey included 60 questions on physician's level of expertise, surgical anesthesia, procedures performed, hospital stay, pain control, rehabilitation and socioeconomic parameters, and the results are presented. Comparisons were made between hip arthroscopy experts (> 500 cases performed) and non-experts (≤ 500 cases performed) on aspects of patient care. RESULTS: Forty-eight (74%) surgeons responded. Forty-four questionnaires were filled out completely. There were no significant differences in recommendations between 15 (34%) hip arthroscopy experts and 29 (66%) non-experts on hip capsular management and cartilage repair techniques, use of antithrombotic prophylaxis and opioid analgesics, time of rehabilitation initiation and patient compliance factors, use of hip brace and CPM, and patient evaluation to return to sports following surgery. Surgical expertise was significantly associated with the performance of hip labral reconstruction (p = 0.016), subspine decompression (p = 0.039) and recommendation of a longer period of restricted weight bearing following the performance of microfractures (p = 0.011). There were no significant differences in clinical practice between surgeons who performed hip arthroscopy exclusively versus those who did not. CONCLUSIONS: Hip arthroscopy is a relatively new field, and clinical practice may vary among physicians based on the surgical expertise. In this study, hip arthroscopy experts agree with non-experts on most aspects of patient care. Surgical expertise was associated with performance of advanced techniques and recommendation of longer period of restricted weight bearing following performance of microfractures. This study highlights different care patterns that need to be investigated to determine which treatment results in improved patient care. LEVEL OF EVIDENCE: V.

First 100 segmental labral reconstructions compared to the most recent 100: the role of surgeon experience in decreasing conversion to total hip arthroplasty.

PURPOSE: The purpose of this study was to determine if conversion to total hip arthroplasty and patient-reported outcomes were similar in the first 100 patients who underwent segmental labral reconstruction with iliotibial band autograft compared to the most recent 100 patients. METHODS: Patients who underwent hip segmental labral reconstruction with autologous iliotibial band were evaluated preoperatively and postoperatively with a minimum 2-year follow-up. The first consecutive 100 patients (Group 1) and the most recent 100 patients (Group 2) were retrospectively compared. Conversion to total hip arthroplasty, necessity of a revision hip arthroscopy, and patient-reported outcome scores were compared. RESULTS: Overall follow-up rate (> 2 years) was 94% (Group 1 vs. Group 2, 91% vs. 96%, n.s.). Mean age of Group 1 (37 ± 12) was significantly higher than that of Group 2 (34 ± 12) (p = 0.03). In Group 2, 69 surgeries out of 100 were revision hip arthroscopies, which was significantly higher rate than Group 1 (48/100) (p = 0.003). Group 1 had significantly higher rate of conversion to THA [23% (23/100) vs. 5% (5/100), p = 0.001]. Revision hip arthroscopy was performed in 11/76 (15%) in Group 1 and in 8/95 (9%) in Group 2 (n.s.). Patient-reported outcomes scores were similar between two groups (all n.s.). Higher age and joint space ≤ 2 mm were significant risk factors of total hip arthroplasty conversion. CONCLUSION: This study showed that, with experience, fewer conversions to total hip arthroplasty were seen; however, revision rate and outcomes were similar. LEVEL OF EVIDENCE: IV.

The global prevalence of erectile dysfunction: a review.

OBJECTIVE: To evaluate the global prevalence of erectile dysfunction (ED); as well as its association with physiological and pathological ageing by examining the relationship between ED and cardiovascular disease (CVD), benign prostatic hyperplasia (BPH), and dementia. We also aimed to characterise discrepancies caused by the use of different ED screening tools. METHODS: The Excerpta Medica dataBASE (EMBASE) and Medical Literature Analysis and Retrieval System Online (MEDLINE) were searched to find population-based studies investigating the prevalence of ED and the association between ED and CVD, BPH, and dementia in the general population. RESULTS: The global prevalence of ED was 3-76.5%. ED was associated with increasing age. Use of the International Index of Erectile Function (IIEF) and Massachusetts Male Aging Study (MMAS)-derived questionnaire identified a high prevalence of ED in young men. ED was positively associated with CVD. Men with ED have an increased risk of all-cause mortality odds ratio (OR) 1.26 (95% confidence interval [CI] 1.01-1.57), as well as CVD mortality OR 1.43 (95% CI 1.00-2.05). Men with ED are 1.33-6.24-times more likely to have BPH then men without ED, and 1.68-times more likely to develop dementia than men without ED. CONCLUSION: ED screening tools in population-based studies are a major source of discrepancy. Non-validated questionnaires may be less sensitive than the IIEF and MMAS-derived questionnaire. ED constitutes a large burden on society given its high prevalence and impact on quality of life, and is also a risk factor for CVD, dementia, and all-cause mortality.

Editorial Commentary: Outcomes After Hip Arthroscopy-Am I Better, Improved, or Who Knows?

Patient-reported outcomes are critical in the evaluation of the success of hip arthroscopy. Many different outcome scores are currently being used; however, that is a totally different subject. Most scores range from 0 to 100 or use some type of scale. The question becomes, Is a good outcome a score of 70 or 90? In many cases, it depends on the patient and his or her personal experiences. One way we gauge whether the patient is better is to use summary scores, which provide us with general goals for improvement. These include the minimal clinically important difference and substantial clinical benefit. While these are being defined, they can be used to help gauge patients' progress and provide improved treatment of patients.

Midterm Outcomes Following Repair of Capsulotomy Versus Nonrepair in Patients Undergoing Hip Arthroscopy for Femoroacetabular Impingement With Labral Repair.

PURPOSE: The purpose of this study was to compare the midterm outcomes and conversion to total hip arthroplasty (THA) rate in patients who had repair of the capsulotomy versus nonrepair following arthroscopic hip labral repair and correction of femoroacetabular impingement (FAI). METHODS: All patients undergoing primary arthroscopic hip labral repair and correction of FAI between 2005 and 2012 were eligible for this study. Exclusion criteria were age < 18 years, lateral center-edge angle < 25°, previous hip procedures, femoral avascular necrosis, radiographic joint space ≤ 2 mm, or microfracture at arthroscopy. Patients who did not have the capsulotomy repaired were matched 1:2 with patients who had the capsulotomy repaired. Patients were matched by age, gender, and intraoperative procedures. The primary outcome score was the Hip Outcome Score Daily Living (HOS-ADL). RESULTS: Forty-two patients (18 female patients, 24 male patients) without repair of the capsulotomy were matched with 84 patients with repaired capsulotomy. The average age for both groups was 38 ± 15 years. Patients in the nonrepair group were 6.8 (95% confidence interval, 1.2-52) times more likely to undergo THA compared with the repair group. There was no difference in revision rate between the 2 groups. The mean follow-up time was 7.3 ± 2.7 years and 6.4 ± 2.3 years for the nonrepair and repair group, respectively (P = .107). Patients in the repair group had significantly higher HOS-ADL (P = .01) and modified Harris hip score (mHHS; P = .007). The percentage of patients who reached minimum clinically important difference was significantly higher in the repair group for HOS-ADL (P = .002) and HOS-Sport (P = .036) compared with the nonrepair group. However, there was no difference in the percentage of patients who reached minimal important change for the mHHS (P = .060). Following hip arthroscopy, the average alpha angle was 41.6° ± 6° in the nonrepair group and 40.8° ± 3° in the repair group. CONCLUSIONS: Patients who undergo arthroscopic FAI correction and hip labral repair with repair of the capsulotomy had higher HOS-ADL and mHHS scores at midterm follow-up compared with patients with nonrepair, and the percentage of patients who reached the minimum clinically important difference was significantly higher in the repair group for HOS-ADL and HOS-Sport compared with the nonrepair group. In addition, a lower rate of conversion to THA was seen in the repair group. LEVEL OF EVIDENCE: Level III, retrospective comparative study.

Early Outcomes After Arthroscopic Hip Capsular Reconstruction Using Iliotibial Band Allograft Versus Dermal Allograft.

PURPOSE: To compare the clinical outcomes between 2 groups of patients who underwent arthroscopic hip capsular reconstruction with the same surgical technique with an iliotibial band (ITB) allograft versus dermal allograft tissue. METHODS: From March 2013 to October 2015, patients who were 18 years of age or older and who underwent revision arthroscopic hip surgery with capsular reconstruction by the senior author were identified. Patients who were younger than 18 years old, had a lateral center-edge angle <20° or Tonnis osteoarthritis grade 2 or 3, or refused to participate were excluded. Patients were assigned to 2 groups based on whether an ITB (ITB group) or a dermal allograft (dermal group) was used to reconstruct the capsule. The ITB graft was used initially, then the dermal graft was used when it was available. The dimensions were based on the intraoperative measurement of the capsular defect, and the thickness was 3 mm. Other treatments included labral debridement, repair, or reconstruction; treatment of residual femoroacetabular impingement; and treatment of cartilage damage. Clinical outcome scores including the Hip Outcome Score (HOS)-Activity of Daily Living scale (primary outcome measure), modified Harris Hip Score, HOS-Sports scale, SF-12, and Western Ontario & McMaster Universities Osteoarthritis Index were compared between the groups in addition to the failure rate (conversion to total hip arthroplasty, revision hip arthroscopy) and patient satisfaction rate with the outcome (range, 1-10). RESULTS: Thirty-six patients (9 men and 27 women) met the inclusion criteria. Each group consisted of 18 patients (18 hips) with a mean age of 30.9 ± 9.4 years in the ITB group and a mean age of 29.8 ± 9.4 years in the dermal group (P = .718). There were no differences in patient demographics, physical examination findings, or imaging characteristics. The procedure failed for 8 patients (4 in the ITB group and 4 in the dermal group), and another surgery was required (P = 1.0). Additional surgeries included 3 total hip arthroplasties, 1 periarticular osteotomy, and 4 revision arthroscopies. The mean follow-up time was 25 months (range, 18-38 months) in both groups (P = .881). At follow-up, the HOS-Activity of Daily Living scale, SF-12, modified Harris Hip Score, and HOS-Sports scale measures were significantly higher in the ITB group than in the dermal group (P < .05). A greater percentage of patients reached minimum clinically important difference in the ITB group for Western Ontario & McMaster Universities Osteoarthritis Index and HOS scales with the minimum clinically important difference for HOS-Sports scale being significantly higher in the ITB group (P = .04). Patient satisfaction scores were 8 and 6 in the ITB and dermal groups, respectively. CONCLUSIONS: At a mean follow-up time of 25 months, hip capsular reconstruction with an ITB allograft results in improved clinical outcomes compared with the dermal allograft. A similar failure rate was noted in both groups, but a greater percentage of patients in the ITB group achieved clinical improvement.

Predicting Severe Cartilage Damage in the Hip: A Model Using Patient-Specific Data From 2,396 Hip Arthroscopies.

PURPOSE: To determine patient-specific factors that can be used to predict the presence of severe articular cartilage damage in the hip in patients without osteoarthritis. METHODS: The prevalence of severe (Outerbridge grade III or IV) cartilage damage to the acetabulum and femoral head was prospectively recorded at hip arthroscopy. Patients who underwent primary hip arthroscopic surgery between 2006 and 2016 performed by a single surgeon were included. Patients were excluded if they underwent previous hip surgery, had poor-quality radiographs, were younger than 16 years at the time of surgery, or had a minimal joint space of 2 mm or less. The relation between severe cartilage damage and preoperative patient characteristics was examined using multivariable logistic regression analysis with restricted cubic splines. RESULTS: Of the 2,396 hips presenting for hip arthroscopy, 995 (41%) had severe cartilage damage to the acetabulum and 257 (11%) had severe cartilage damage to the femoral head. Older age was a significant risk factor for severe cartilage damage both to the acetabulum (χ2 = 69.5, P < .001) and to the femoral head (χ2 = 53.9, P < .001). An age of 45 years was associated with a 1.96 (95% confidence interval, 1.54-2.49) increase in the odds of severe acetabular cartilage damage and a 3.94 (95% confidence interval, 2.61-5.94) increase in the odds of severe femoral head cartilage damage relative to an age of 20 years. Male sex was associated with severe cartilage damage to the acetabulum (χ2 = 66.7, P < .001), and a lower center-edge angle was a significant risk factor for severe cartilage damage to the femoral head (χ2 = 78.5, P < .001). Predictive nomograms were established for severe cartilage lesions. CONCLUSIONS: The primary risk factors for severe hip cartilage damage were older age for both the femoral head and acetabulum; a lower center-edge angle and larger Tönnis angle for the femoral head; and male sex, body mass index, alpha angle, and joint space for the acetabulum. The likelihood of cartilage damage to the hip can be estimated clinically using a prediction nomogram. LEVEL OF EVIDENCE: Level III, cross-sectional study.