Arthroscopic Peripheral Compartment Iliopsoas Release for Iliopsoas Impingement After Primary Total Hip Arthroplasty.

Anterior iliopsoas (IP) impingement after total hip arthroplasty is an underrecognized and continued cause for postoperative pain. There are multiple etiologies for this impingement from cup positioning and sizing to changes in the leg length, and offset must be evaluated to confirm no need for implant revision. Additionally, tension of the IP tendon can be increased in patients with diminished spinal mobility, either from prior fusion or with increasing age. Managing this surgically after failing conservative treatment options is best done arthroscopically to prevent additional large, open procedures that place the arthroplasty at unnecessary risk of infection and potential instability. In this article, we describe an arthroscopic technique using fluoroscopy to guide the release of the iliopsoas tendon from the peripheral compartment.

Anchor Arthropathy Caused by Cartilage Penetration: An Approach to Revision Hip Arthroscopy With Removal of Problematic Anchors.

Hip arthroscopy has been proven to effectively treat labral tears in the setting of femoroacetabular impingement. Anchors used for this treatment have constantly evolved and improved to ensure safety and minimal invasion. However, acetabular drilling and anchor placement are technically challenging due to the concavity of the acetabular articular surface, limited angles for anchor insertion, and finite bone availability in the anterior and posterior column. Inadequate technique can result in protruding anchors, which may lead to full-thickness articular cartilage damage, manifesting in pain, mechanical symptoms, and impaired function. This Technical Note demonstrates arthroscopic removal of protruding anchors and management of the iatrogenic grade IV cartilage damage. In this description, the technical pearls and pitfalls of acetabular anchor placement to treat labral pathology are presented along with the aforementioned technique.

5-Year Arthroscopy-Free Survivorship and Outcomes of Adolescents Undergoing Primary Hip Arthroscopy: A Comparison Between Traumatic and Atraumatic Injuries.

BACKGROUND: There is a paucity of literature evaluating the outcomes of adolescent patients undergoing hip arthroscopy for femoroacetabular impingement syndrome (FAIS) with a discrete traumatic event related to an injury. PURPOSE: (1) To evaluate 5-year outcomes of adolescents undergoing hip arthroscopy for FAIS with traumatic injuries (TIs) and (2) to compare the traumatic group with a propensity-matched control group of patients with atraumatic injuries. STUDY DESIGN: Cohort study; Level of evidence, 3. METHODS: Data were reviewed for all adolescent patients (<18 years) undergoing primary hip arthroscopy for FAIS with a TI between November 2008 and March 2015. Patients were included if they had preoperative and minimum 5-year follow-up outcomes for the modified Harris Hip Score (mHHS), Nonarthritic Hip Score, Hip Outcome Score-Sport Specific Subscale, and visual analog scale for pain. The Patient Acceptable Symptom State (PASS), minimum clinically important difference (MCID), and maximum outcome improvement satisfaction threshold (MOIT) were also calculated for both groups. Adolescents with TI were propensity matched in a 1:2 ratio according to age at surgery, sex, and body mass index (BMI) to a control group of adolescents who reported atraumatic hip symptoms (AHSs). Survivorship was defined as having no secondary surgery on the ipsilateral hip. RESULTS: A total of 31 patients (32 hips) with TI, out of 39 total patients (40 hips) (80%), were included with a mean follow-up time of 72.2 ± 24.1 months and age of 15.8 ± 1.3 years. The TI group demonstrated significant improvement in all patient-reported outcomes (PROs) (P < .001) and demonstrated high rates of MCID (78.3%) and PASS (91.3%) for the mHHS. When compared with a propensity-matched control group of 64 AHS hips (57 patients), the TI group demonstrated similar rates of improvement in all PROs, as well as rates of achieving the MCID, PASS, and MOIT for all PROs; however, the TI group demonstrated significantly higher revision rates compared with controls (28.1% vs 6.3%; P = .008). CONCLUSION: Adolescent patients with TIs undergoing hip arthroscopy demonstrated favorable outcomes for all PROs (P < .001) and achieved high rates of MCID (78.3%) and PASS (91.3%) for the mHHS. When compared with a propensity-matched control group of adolescents with atraumatic injuries undergoing hip arthroscopy, they achieved similar levels of improvement, postoperative scores, and clinical benefit thresholds; however, reoperation rates were higher in the TI group compared with controls.

Sex-Based Differences in Athletes Undergoing Primary Hip Arthroscopy With Labral Reconstruction: A Propensity-Matched Analysis With Minimum 2-Year Follow-up.

Background: There is a paucity of literature comparing sex-based outcome differences in athletes after primary hip arthroscopy with labral reconstruction for femoroacetabular impingement syndrome (FAIS) and irreparable labral tears. Purpose: To report sex-based differences in clinical characteristics, patient-reported outcome (PRO) scores, and return-to-sports (RTS) rates in athlete who underwent primary hip arthroscopy with labral reconstruction. Study Design: Cohort study; Level of evidence, 3. Methods: Data were reviewed for recreational, organized amateur, high school, collegiate, and professional athletes who underwent primary hip arthroscopy with labral reconstruction for FAIS and irreparable labral tears between July 2014 and May 2019. Inclusion criteria included preoperative and minimum 2-year postoperative PRO scores (modified Harris Hip Score, Non-Arthritic Hip Score, Hip Outcome Score-Sports Specific Subscale, International Hip Outcome Tool [iHOT-12], and visual analog scale [VAS] for pain). Exclusion criteria were Tönnis grade >1, hip dysplasia (lateral center-edge angle, <18°), or prior ipsilateral hip surgery/conditions. Patients were divided into groups by sex and were propensity-matched in a 1:1 ratio by age, body mass index, graft type, labral tear size, and sports level. Results: A total of 101 hips were eligible, and 94 hips (93.1%) had a minimum 2-year follow-up. Twenty-nine female athlete hips were propensity-matched to 29 male athlete hips. Female athletes underwent higher rates of capsular repair (79.3% vs 24.1% for men; P < .001) and lower rates of acetabular microfracture (0.0% vs 20.7% for men; P = .024). Both female and male athletes experienced significant improvement on all PRO scores (P < .001 for all), high RTS rates (women, 84% vs men, 80.8%), and high rates of achieving the minimal clinically important difference for the iHOT-12 and VAS pain (women, 88.5% vs men, 71.4% for both) and achieving the patient acceptable symptom state for the iHOT-12 (women, 88.5% vs men, 71.4%), with no significant difference between the sexes. Conclusion: Despite different clinical characteristics and surgical procedures, both female and male athletes undergoing primary hip arthroscopy with labral reconstruction had significant improvements in all PROs at the minimum 2-year follow-up, high RTS rates, and similar rates of achieving the minimal clinically important difference and patient acceptable symptom state.

Comparison of Outcomes Between Nonsmokers and Patients Who Discontinued Smoking 1 Month Before Primary Hip Arthroscopy: A Propensity-Matched Study With Minimum 2-Year Follow-up.

Background: Cigarette smoking has been shown to negatively affect outcomes after hip arthroscopy for femoroacetabular impingement syndrome (FAIS). The effect of cessation of cigarette smoking before surgery has not been well established. Purposes: (1) To report minimum 2-year patient-reported outcomes (PROs) of former smokers who underwent primary hip arthroscopy for FAIS and (2) to compare these results with those of a propensity-matched control group of nonsmokers. Study Design: Cohort study; Level of evidence, 3. Methods: Data were collected for all patients who underwent primary hip arthroscopy for FAIS between December 2008 and November 2017. Patients were eligible if they indicated that they had previously smoked cigarettes but had quit smoking at least 1 month before surgery and had minimum 2-year postoperative outcomes for the modified Harris Hip Score (mHHS), Nonarthritic Hip Score (NAHS), and visual analog scale (VAS) for pain. The percentage of hips achieving the minimal clinically important difference (MCID) were recorded. The study group was then propensity matched in a 1:1 ratio by age, sex, and body mass index (BMI) to patients who had never smoked. Results: A total of 83 former-smoking patients (84 hips; age, 45.0 ± 13.5 years) were included at a median follow-up of 38.6 months (interquartile range, 27.5-48.2 months); all patients had stopped smoking at a mean ± standard deviation of 14.3 ± 24.5 months preoperatively. Former smokers demonstrated significant improvement from preoperatively to the minimum 2-year follow-up for all recorded PROs (P < .001 for all) and achieved the MCID for the mHHS, NAHS, and VAS at favorable rates (75.0%-81.6%). Logistic regression analysis did not identify a significant relationship between cessation time and rates of achieving MCID for mHHS, NAHS, or VAS. When compared with 84 never-smokers (84 hips), the former smokers demonstrated similar preoperative scores, postoperative scores, and improvement on all recorded PROs (P > .05 for all). Both groups achieved MCID for mHHS, NAHS, and VAS at similar rates and demonstrated similar rates of revision surgery. Conclusion: Former smokers who underwent primary hip arthroscopy for FAIS demonstrated significant improvement in PROs at minimum 2-year follow-up. When compared with a propensity-matched control group of never-smokers, they achieved similar postoperative PROs and rates of achieving psychometric thresholds.

Competitive Athletes Who Underwent Hip Arthroscopy With Capsular Repair Showed Greater Improvement in Patient-Reported Outcome Scores Compared With Those Who Did Not Undergo Repair.

PURPOSE: To compare minimum 2-year postoperative patient-reported outcome (PRO) scores and return to sport between competitive athletes undergoing primary hip arthroscopy for femoroacetabular impingement syndrome with interportal capsulotomy repair and competitive athletes with an unrepaired interportal capsulotomy. METHODS: Data on all consecutive competitive athletes who underwent primary hip arthroscopy for femoroacetabular impingement syndrome between February 2012 and December 2018 were collected. Athletes were divided into 2 groups: those who underwent repair and those without repair. Athletes were considered eligible if they participated in sports within 1 year prior to surgery. Patients were eligible if the return-to-sport status and the following preoperative and minimum 2-year postoperative PROs were available: modified Harris Hip Score, Nonarthritic Hip Score (NAHS), Hip Outcome Score-Sport-Specific Subscale (HOS-SSS), and visual analog scale (VAS) score for pain. Patients were excluded if they underwent prior hip surgery, had Workers' Compensation, were unwilling to consent, had a Tönnis grade greater than 1, or had a previous hip condition. The percentages of patients achieving the minimal clinically important difference (MCID) and maximum outcome improvement satisfaction threshold were recorded. Athletes who underwent interportal capsulotomy repair were propensity score matched in a ratio of 2:1 to athletes without interportal capsulotomy repair according to age, sex, body mass index, sport level, and acetabular labrum articular disruption grade. RESULTS: Forty-nine athletes (53 hips) without repair with an average follow-up time of 36.5 ± 10.2 months and age of 32.1 ± 13.3 years were matched to 79 athletes (84 hips) with repair with an average follow-up time of 41.3 ± 9.4 months and age of 30.1 ± 12.1 years. Athletes in the repaired group showed significantly greater improvements in the NAHS, HOS-SSS, and VAS score and significantly higher rates of achievement of the MCID for the HOS-SSS compared with athletes in the unrepaired group. CONCLUSIONS: Competitive athletes who underwent primary hip arthroscopy with interportal capsulotomy repair showed a significantly greater magnitude of improvement in PRO scores (NAHS, HOS-SSS, and VAS score) and rates of achieving the MCID (HOS-SSS) compared with a propensity score-matched control group of competitive athletes with an unrepaired interportal capsulotomy. LEVEL OF EVIDENCE: Level III, retrospective comparative therapeutic trial.

Revision Hip Arthroscopy With Labral Reconstruction for Irreparable Labral Tears in Athletes: Minimum 2-Year Outcomes With a Benchmark Control Group.

BACKGROUND: The incidence of revision hip arthroscopy with labral reconstruction in athletes is increasing. However, the outcomes of revision hip arthroscopy with labral reconstruction in athletes have not been well established. PURPOSES: (1) To report minimum 2-year patient-reported outcome (PRO) scores and return to sports (RTS) characteristics for high-level athletes undergoing revision hip arthroscopy with labral reconstruction and (2) to compare clinical results with those of a propensity-matched control group of high-level athletes undergoing revision hip arthroscopy with labral repair. STUDY DESIGN: Cohort study; Level of evidence, 3. METHODS: Data were prospectively collected and retrospectively reviewed for athletes at any level who underwent a revision hip arthroscopy and a labral reconstruction between April 2010 and March 2019. Minimum 2-year PROs were reported for the modified Harris Hip Score (mHHS), the Nonarthritic Hip Score (NAHS), the Hip Outcome Score-Sport Specific Subscale (HOS-SSS), the visual analog scale (VAS) for pain, and RTS. The percentages of athletes achieving the minimal clinically important difference (MCID) and the maximum outcome improvement satisfaction threshold (MOIST) were also recorded. These patients were propensity matched in a 1: 1 ratio to athletes undergoing revision hip arthroscopy with labral repair for comparison. RESULTS: A total of 46 athletes (N = 47 hips) were reported from 50 (n = 51 hips) athletes who underwent revision with labral reconstruction. A subanalysis of 30 propensity-matched athletes undergoing revision labral reconstruction was performed, with a mean follow-up time of 26.3 ± 2.4 months and an age of 28.5 ± 10.1 years, and compared with a revision labral repair group. Significant improvements were obtained for the mHHS, the NAHS, the HOS-SSS, and the VAS from preoperative to the latest follow-up (P < .001), with an achievement MCID rate of 61.5%, 72%, 62.5%, and 76.9% for the mHHS, the NAHS, the HOS-SSS, and the VAS, respectively. The rate for re-revision surgery (2 tertiary arthroscopy and 1 conversion to total hip arthroplasty) was 10%, and 14 patients (63.6%) were able to RTS. Improvements in PROs, rates of achieving MCID/MOIST, rate of re-revision surgery (re-revision hip arthroscopy, P = .671; conversion to total hip arthroplasty, P > .999), and RTS rate (P = .337) were similar when compared with those of the propensity-matched control labral repair group (P > .05). CONCLUSION: Revision hip arthroscopy with labral reconstruction, in the context of an irreparable labral tear, seems to be a valid treatment option in the athletic population, demonstrating significant improvements in all PROs and low rates of undergoing revision surgery. Athletes experienced a similar magnitude of improvement in PROs, RTS rate, and revision surgery rate to that of a propensity-matched control group of athletes undergoing revision hip arthroscopy with labral repair.

Competitive Athletes with Femoroacetabular Impingement and Painful Internal Snapping Treated Arthroscopically with Intrabursal Iliopsoas Fractional Lengthening: High Rate of Return to Sport and Favorable Midterm Functional Outcomes.

BACKGROUND: Athletes with femoroacetabular impingement syndrome (FAIS) who undergo hip arthroscopy with iliopsoas fractional lengthening (IFL) in the context of painful internal snapping have demonstrated favorable patient-reported outcomes (PROs), return to sport (RTS), and resolution of internal snapping symptoms at short term follow-up. Midterm outcomes have not been established. PURPOSES: (1) To report minimum 5-year PROs and RTS rate in competitive athletes who underwent primary hip arthroscopy for FAIS and intra-bursal IFL for painful internal snapping and (2) to compare these clinical results with those of a propensity score-matched control group of competitive athletes who underwent primary hip arthroscopy without painful internal snapping and IFL. STUDY DESIGN: Cohort study; Level of evidence, 3. METHODS: Data were reviewed for consecutive surgeries performed by a single surgeon between February 2010 and December 2013. Patients were considered eligible if they were professional, collegiate, or high school athletes and received a primary hip arthroscopy for FAIS and intra-bursal IFL without extended capsulotomy for painful internal snapping. Indications for IFL were painful internal snapping on preoperative physical examination. Inclusion criteria were preoperative and minimum 5-year follow-up scores for the modified Harris Hip Score, Nonarthritic Hip Score, Hip Outcome Score-Sport Specific Subscale, and visual analog scale for pain. Rates of achieving the minimal clinically important difference were also reported. For comparison, athletes in the IFL group were propensity matched by age, sex, body mass index, lateral and anterior center-edge angles, and sports level to a control group of athletes without internal snapping who underwent primary hip arthroscopy for FAIS without IFL. RESULTS: A total of 105 competitive athletes in the IFL group were included in the study with a follow-up of 66.8 ± 6.9 months (mean ± SD). The IFL cohort showed significant improvement in all recorded PROs at minimum 5-year follow-up (P < .001). Furthermore, they demonstrated favorable rates of achieving the minimal clinically important difference for the modified Harris Hip Score (82.0%), Nonarthritic Hip Score (85.4%), and Hip Outcome Score-Sport Specific Subscale (82.8%). Further, 89.5% of athletes in the IFL cohort successfully returned to sport. A total of 42 athletes in the IFL group were propensity matched to 54 control athletes. When groups were compared, they demonstrated similar improvement in PROs and rates of RTS, revision arthroscopy, and achieving psychometric thresholds. CONCLUSION: Competitive athletes undergoing primary hip arthroscopy and intra-bursal IFL in the context of FAIS and painful internal snapping demonstrated favorable PROs and RTS rate at minimum 5-year follow-up. These results were comparable with those of a control group of athletes not requiring IFL.