Determining Reliability of Arthroscopic Classifications for Hip Labral Tears.

OBJECTIVE: Evaluate interobserver and intraobserver reliability of hip arthroscopic classifications for labral tears. DESIGN: Retrospective diagnostic study of nonconsecutive patients. SETTING: Institutional study. PATIENTS: From a database of 278 hip arthroscopy videos for treatment of femoroacetabular impingement, 70 videos were chosen by simple random sampling. Exclusion criteria included presence of radiological arthrosis (Tonnis > 2), previous hip surgery, inadequate lesion palpation, poor image quality, and refusal to participate in the study. The final sample included 60 videos. INTERVENTIONS: Four hip surgeons evaluated the videos twice at 1-month intervals and classified the lesions according to Lage, Seldes, and Beck classifications for hip labral tears. MAIN OUTCOME MEASURES: Interobserver and intraobserver reliability with the percent of agreement and weighted Cohen kappa values. RESULTS: Patients had a mean age of 33 years (SD, 7; range, 18-47 years), and 32 (53%) were men. Femoroacetabular impingement types included combined (CAM and pincer) in 31 (52%), CAM in 27 (45%), and pincer in 2 (3%). For interobserver reliability, the average weighted kappa values were 0.68, 0.65, and 0.78 for the Lage, Seldes, and Beck classifications, respectively. For intraobserver reliability, the mean weighted kappa values were 0.87, 0.64, and 0.93 for the Lage, Seldes, and Beck classifications, respectively. CONCLUSIONS: Beck classification had the highest average values for interobserver and intraobserver agreements. Lage, Seldes, and Beck scores for acetabular labrum tears showed substantial interobserver agreement. In the intraobserver evaluation, the Seldes system presented substantial agreement, whereas Lage and Beck classifications were considered excellent agreement.

Evaluation of the ischiofemoral space: a case-control study.

OBJECTIVE: To determine the size of the ischiofemoral space (IFS) and quadratus femoris space (QFS) in patients with and without ischiofemoral impingement (IFI). MATERIALS AND METHODS: Case-control study including consecutive patients submitted to magnetic resonance imaging (MRI) of the hip joint during a three-month period. Patients with deep gluteal pain who tested positive for IFI on at least one clinical test and showed signal changes in the quadratus femoris muscle on MRI were categorized as having a confirmed diagnosis of IFI. RESULTS: Final sample comprised 50 patients submitted to unilateral MRI of the hip joint. The mean age was 47.3 ± 14.0 years (range, 22-76 years), and 33 (66%) of the patients were women. A diagnosis of IFI was made in 6 patients (12%), all of whom were female. On average, IFS and QFS were significantly smaller in IFI group than in control group (11.1 ± 2.7 mm versus 27.5 ± 6.5 mm and 5.3 ± 1.8 mm versus 18.8 ± 4.8 mm, respectively; p < 0.001 for both). CONCLUSION: Results of specific clinical tests and MRI findings indicate that the IFS and QFS are significantly reduced in patients with IFI.

OBJETIVO: Avaliar, prospectivamente, os valores médios dos espaços isquiofemoral e quadrado femoral em pacientes com impacto isquiofemoral e em um grupo controle. MATERIAIS E MÉTODOS: Estudo prospectivo incluindo pacientes submetidos a ressonância magnética da articulação do quadril em um intervalo de três meses. Os pacientes com dor glútea profunda, com pelo menos um teste clínico positivo para impacto isquiofemoral e alterações de sinal no músculo quadrado femoral na ressonância magnética, foram diagnosticados com impacto isquiofemoral. RESULTADOS: A amostra final consistiu de 50 pacientes submetidos a ressonância magnética unilateral da articulação do quadril. A idade média foi 47,3 ± 14,0 anos (intervalo de 22 a 76 anos) e 33 (66%) eram mulheres. O diagnóstico de impacto isquiofemoral foi observado em 6 (12%) pacientes, todas mulheres. Os pacientes com impacto isquiofemoral mostraram redução significativa nos espaços isquiofemoral e quadrado femoral quando comparados ao grupo controle: 11,1 ± 2,7 mm versus 27,5 ± 6,5 mm e 5,3 ± 1,8 mm versus 18,8 ± 4,8 mm, respectivamente (p < 0,001 para ambos os grupos). CONCLUSÃO: Os pacientes com diagnóstico de impacto isquiofemoral apresentaram redução significativa dos espaços isquiofemoral e quadrado femoral após análise prospectiva baseada em testes clínicos específicos e ressonância magnética.

Reliability of the Arthroscopic Classifications of Hip Chondral Lesions.

Objective To evaluate the inter- and intraobserver reliability of the Outerbridge, Beck, and Haddad classifications for acetabular joint cartilage lesions through the arthroscopic procedure. Methods A total of 60 hip arthroscopy videos were evaluated twice by 4 surgeons at 2 different times to assess the inter- and intraobserver reproducibility of the classifications, and the data was analyzed by means of the weighted Cohen Kappa index. Results The mean weighted Kappa values in the interobserver assessment of the Outerbridge, Beck, and Haddad classifications were, respectively, 0.72, 0.78, and 0.68. The three classifications were considered as presenting good interobserver agreement. Regarding the intraobserver assessment of the Outerbridge, Beck, and Haddad classifications, the weighted Kappa values were, respectively, 0.9, 0.9, and 0.93. The three classifications were considered as presenting excellent intraobserver agreement. Conclusion In the present series, the Outerbridge, Beck, and Haddad classifications presented good interobserver reproducibility and excellent intraobserver reproducibility when evaluating acetabular chondral lesions by the arthroscopic approach.

Recovery of the Hip Rotation Center with Tantalum in Revision Arthroplasty.

Objective The objective of the present study is to evaluate the restoration capacity of the hip anatomic rotation center with the use of acetabular tantalum cups, associated or not with addition wedges. Methods Retrospective analysis of patients undergoing hip arthroplasty revision using tantalum between June 2013 and April 2017. The abduction angle of the acetabular component and the horizontal and vertical distances of the component to the center of anatomical rotation of the hip were evaluated. The measurements were made through baseline radiographs performed in the preoperative period and at the last follow-up visit. Results A sample of 21 patients was obtained, 11 (52%) men and 10 (48%) women, with a mean age of 62 ± 13 years old. The mean abduction angle of the acetabular cup decreased from 48.76° ± 13.88 ° in the preoperative period to 38.52° ± 10.08 ° in the postoperative period, and this difference was statistically significant ( p = 0.001). The distances from the center of rotation of the prosthesis relative to the center of anatomical rotation of the hip were also lower after revision surgery with tantalum. The mean horizontal distance of 12.74 ± 10.59 mm was reduced to 7.11 ± 4.84 mm, and the mean vertical distance was reduced from 14.79 ± 10.05 mm to 4.89 ± 6.21 mm, and these reductions were statistically significant ( p < 0.001). Conclusion Hip arthroplasty revision with tantalum cups, associated or not with addition wedges, significantly recovered the anatomical rotation center of the hip.

Evaluation of the ischiofemoral space: a case-control study / Avaliação do espaço isquiofemoral: um estudo caso-controle

Abstract Objective: To determine the size of the ischiofemoral space (IFS) and quadratus femoris space (QFS) in patients with and without ischiofemoral impingement (IFI). Materials and Methods: Case-control study including consecutive patients submitted to magnetic resonance imaging (MRI) of the hip joint during a three-month period. Patients with deep gluteal pain who tested positive for IFI on at least one clinical test and showed signal changes in the quadratus femoris muscle on MRI were categorized as having a confirmed diagnosis of IFI. Results: Final sample comprised 50 patients submitted to unilateral MRI of the hip joint. The mean age was 47.3 ± 14.0 years (range, 22-76 years), and 33 (66%) of the patients were women. A diagnosis of IFI was made in 6 patients (12%), all of whom were female. On average, IFS and QFS were significantly smaller in IFI group than in control group (11.1 ± 2.7 mm versus 27.5 ± 6.5 mm and 5.3 ± 1.8 mm versus 18.8 ± 4.8 mm, respectively; p < 0.001 for both). Conclusion: Results of specific clinical tests and MRI findings indicate that the IFS and QFS are significantly reduced in patients with IFI.

Resumo Objetivo: Avaliar, prospectivamente, os valores médios dos espaços isquiofemoral e quadrado femoral em pacientes com impacto isquiofemoral e em um grupo controle. Materiais e Métodos: Estudo prospectivo incluindo pacientes submetidos a ressonância magnética da articulação do quadril em um intervalo de três meses. Os pacientes com dor glútea profunda, com pelo menos um teste clínico positivo para impacto isquiofemoral e alterações de sinal no músculo quadrado femoral na ressonância magnética, foram diagnosticados com impacto isquiofemoral. Resultados: A amostra final consistiu de 50 pacientes submetidos a ressonância magnética unilateral da articulação do quadril. A idade média foi 47,3 ± 14,0 anos (intervalo de 22 a 76 anos) e 33 (66%) eram mulheres. O diagnóstico de impacto isquiofemoral foi observado em 6 (12%) pacientes, todas mulheres. Os pacientes com impacto isquiofemoral mostraram redução significativa nos espaços isquiofemoral e quadrado femoral quando comparados ao grupo controle: 11,1 ± 2,7 mm versus 27,5 ± 6,5 mm e 5,3 ± 1,8 mm versus 18,8 ± 4,8 mm, respectivamente (p < 0,001 para ambos os grupos). Conclusão: Os pacientes com diagnóstico de impacto isquiofemoral apresentaram redução significativa dos espaços isquiofemoral e quadrado femoral após análise prospectiva baseada em testes clínicos específicos e ressonância magnética.

Reliability of the Arthroscopic Classifications of Hip Chondral Lesions* / Confiabilidade das classificações artroscópicas das lesões condrais do quadril*

Abstract Objective To evaluate the inter- and intraobserver reliability of the Outerbridge, Beck, and Haddad classifications for acetabular joint cartilage lesions through the arthroscopic procedure. Methods A total of 60 hip arthroscopy videos were evaluated twice by 4 surgeons at 2 different times to assess the inter- and intraobserver reproducibility of the classifications, and the data was analyzed by means of the weighted Cohen Kappa index. Results The mean weighted Kappa values in the interobserver assessment of the Outerbridge, Beck, and Haddad classifications were, respectively, 0.72, 0.78, and 0.68. The three classifications were considered as presenting good interobserver agreement. Regarding the intraobserver assessment of the Outerbridge, Beck, and Haddad classifications, the weighted Kappa values were, respectively, 0.9, 0.9, and 0.93. The three classifications were considered as presenting excellent intraobserver agreement. Conclusion In the present series, the Outerbridge, Beck, and Haddad classifications presented good interobserver reproducibility and excellent intraobserver reproducibility when evaluating acetabular chondral lesions by the arthroscopic approach.

Resumo Objetivo Avaliar a confiabilidade inter- e intraobservador das classificações de Outerbridge, Beck e Haddad para lesões da cartilagem articular acetabular com o uso da via artroscópica. Métodos Foram avaliados 60 vídeos de artroscopias do quadril por 4 cirurgiões em 2 momentos para avaliar a reprodutibilidade inter- e intraobservador das classificações. Os dados foram analisados a partir do cálculo do índice Kappa de Cohen ponderado. Resultados Os valores do Kappa ponderado médio na avaliação interobservador das classificações de Outerbridge, Beck e Haddad foram, respectivamente, 0,72, 0,78 e 0,68. As três classificações foram consideradas como de boa concordância interobservador. Comrelação à avaliação intraobservador das classificações de Outerbridge, Beck e Haddad, os valores Kappa foram, respectivamente, 0,9, 0,9 e 0,93. As três classificações foram consideradas excelentes na comparação intraobservador. Conclusão Na presente série, as classificações de Outerbridge, Beck e Haddad apresentaram boa reprodutibilidade interobservador e excelente reprodutibilidade intraobservador ao avaliar lesões condrais acetabulares por via artroscópica.

Recovery of the Hip Rotation Center with Tantalum in Revision Arthroplasty / Recuperação do centro de rotação do quadril com tântalo em artroplastias de revisão

Abstract Objective The objective of the present study is to evaluate the restoration capacity of the hip anatomic rotation center with the use of acetabular tantalum cups, associated or not with addition wedges. Methods Retrospective analysis of patients undergoing hip arthroplasty revision using tantalum between June 2013 and April 2017. The abduction angle of the acetabular component and the horizontal and vertical distances of the component to the center of anatomical rotation of the hipwere evaluated. The measurements were made through baseline radiographs performed in the preoperative period and at the last follow-up visit. Results A sample of 21 patients was obtained, 11 (52%) men and 10 (48%) women, with amean age of 62 ± 13 years old. The mean abduction angle of the acetabular cup decreased from 48.76° ± 13.88 ° in the preoperative period to 38.52° ± 10.08 ° in the postoperative period, and this difference was statistically significant (p = 0.001). The distances from the center of rotation of the prosthesis relative to the center of anatomical rotation of the hip were also lower after revision surgery with tantalum. The mean horizontal distance of 12.74 ± 10.59 mm was reduced to 7.11 ± 4.84 mm, and the mean vertical distance was reduced from 14.79 ± 10.05 mm to 4.89 ± 6.21 mm, and these reductions were statistically significant (p < 0.001). Conclusion Hip arthroplasty revision with tantalum cups, associated or not with addition wedges, significantly recovered the anatomical rotation center of the hip.

Resumo Objetivo O objetivo do presente estudo é avaliar a capacidade de restauração do centro de rotação anatômico do quadril com uso de copas acetabulares de tântalo associado ou não a cunhas de adição. Métodos Análise retrospectiva dos pacientes submetidos a revisão de artroplastia do quadril comuso de tântalo entre o período de junho de 2013 e abril de 2017. Foramavaliados o ângulo de abdução do componente acetabular e as distâncias horizontal e vertical do componenteao centro de rotação anatômicodoquadril.Asmedidas foramrealizadas através de radiografias da bacia realizadas no pré-operatório e na última visita de seguimento. Resultados Obteve-se uma amostra de 21 pacientes, 11 (52%) homens e 10 (48%) mulheres, com média de idade de 62 ± 13 anos. O ângulo médio de abdução da copa acetabular reduziu de 48,76° ± 13,88° no pré-operatório para 38,52° ± 10,08° no pósoperatório, sendo esta diferença estatisticamente significativa (p = 0,001). As distâncias do centro de rotação da prótese em relação ao centro de rotação anatômico do quadril também foram menores após a cirurgia de revisão com o tântalo. A distância média horizontal de 12,74 ± 10,59 mm foi reduzida para 7,11 ± 4,84 mm, e a distância média vertical foi reduzida de 14,79 ± 10,05 mm para 4,89 ± 6,21 mm, sendo essas reduções estatisticamente significativas (p < 0,001). Conclusão As revisões de artroplastia do quadril comcopas de tântalo, associadas ou não a cunhas de adição, recuperaram de forma significativa o centro de rotação anatômico do quadril.

Clinical outcomes of arthroscopic repair of acetabular labral tears.

PURPOSE: To evaluate the primary clinical outcomes of arthroscopic labral repair. METHODS: All patients who underwent arthroscopic repair of the acetabular labrum performed by a senior surgeon between October 2010 and December 2013 were invited to participate in this prospective study. Patients included were those who had a preoperative diagnosis of labral tears, a lateral centre edge greater than 25° and a labral tear believed to be suturable during the intraoperative evaluation. Patients with Tönnis grade 2 or grade 3 hip osteoarthritis and those who had undergone a previous hip surgery were excluded. All patients were evaluated using the modified Harris Hip Score (mHHS) during the final appointment before surgery, 4 months after surgery and at the final evaluation. Interviews were conducted by the senior surgeon. RESULTS: Eighty-four patients (90 hips) underwent arthroscopic repair. The mean age was 44.2 years and the mean follow-up period was 43.0 months (minimum of 25 months and maximum of 59 months). The mean mHHS was 80.4 preoperatively, 95.0 at 4 months postoperatively and 96.6 at final evaluation. A statistically significant difference existed among these scores (p<0.001). CONCLUSION: Arthroscopic labral repair was associated with a clinically significant improvement in mHHS after short-term (4 months) and medium-term (43 months) follow-up. LEVEL OF EVIDENCE: Level IV, therapeutic case series.

Efficacy evaluation of a protocol for safe hip surgery (total hip arthroplasty).

OBJECTIVE: To propose a multidisciplinary protocol to standardize the care of patients undergoing total hip arthroplasty (THA) and evaluate it effectiveness after implementation. METHODS: Retrospective evaluation of 95 consecutive patients undergoing THA divided into two groups, one group of 47 patients operated before the protocol implementation and 48 after. RESULTS: Assessing the re-admission rate, among 47 patients evaluated prior to implementation of the protocol, seven (14.9%) were re-admitted, and when observing the 48 patients evaluated after implementation, one (2.1%) was re-admitted, showing statistical significance (p < 0.05). The chance of re-admission before the protocol was eight times the chance of hospitalization after implementation (95% CI: 1.01 to 377.7). By comparing the clinical complications among the groups, it was observed that there was a lower rate of complications following implementation of the protocol (p = 0.006). CONCLUSION: The introduction of a multidisciplinary protocol to standardize the management of patients undergoing THA decreased the rates of rehospitalization and clinical complications after the procedure.

OBJETIVO: Propor um protocolo multidisciplinar para padronização do cuidado dos pacientes que serão submetidos a artroplastia total do quadril (ATQ) e avaliar sua eficácia após a implantação. MÉTODOS: Avaliação retrospectiva dos resultados de 95 pacientes consecutivos submetidos a ATQ divididos em dois grupos, um com 47 operados antes da implantação do protocolo e 48 após. RESULTADOS: Na avaliação da taxa de reinternação, tem-se que entre os 47 pacientes avaliados antes da implantação do protocolo, sete (14,9%) foram reinternados e dos 48 avaliados depois da implantação, um (2,1%) foi reinternado, mostrou-se significância estatística (p < 0,05). A chance de reinternação antes da implantação foi oito vezes maior do que a chance de internação após a implantação (IC 95%: 1,01 a 377,7). Ao comparar as complicações clínicas entre os grupos observou-se que houve menor taxa de complicações após a implantação do protocolo (p = 0,006). CONCLUSÃO: A introdução de um protocolo multidisciplinar para padronização do manejo do paciente submetido a ATQ diminuiu as taxas de reinternação e de complicações clínicas após o procedimento.

Efficacy evaluation of a protocol for safe hip surgery (total hip arthroplasty) / Avaliação da eficácia do protocolo para cirurgia segura do quadril (artroplastia total)

Abstract Objective To propose a multidisciplinary protocol to standardize the care of patients undergoing total hip arthroplasty (THA) and evaluate it effectiveness after implementation. Methods Retrospective evaluation of 95 consecutive patients undergoing THA divided into two groups, one group of 47 patients operated before the protocol implementation and 48 after. Results Assessing the re-admission rate, among 47 patients evaluated prior to implementation of the protocol, seven (14.9%) were re-admitted, and when observing the 48 patients evaluated after implementation, one (2.1%) was re-admitted, showing statistical significance (p < 0.05). The chance of re-admission before the protocol was eight times the chance of hospitalization after implementation (95% CI: 1.01 to 377.7). By comparing the clinical complications among the groups, it was observed that there was a lower rate of complications following implementation of the protocol (p = 0.006). Conclusion The introduction of a multidisciplinary protocol to standardize the management of patients undergoing THA decreased the rates of rehospitalization and clinical complications after the procedure.

Resumo Objetivo Propor um protocolo multidisciplinar para padronização do cuidado dos pacientes que serão submetidos a artroplastia total do quadril (ATQ) e avaliar sua eficácia após a implantação. Métodos Avaliação retrospectiva dos resultados de 95 pacientes consecutivos submetidos a ATQ divididos em dois grupos, um com 47 operados antes da implantação do protocolo e 48 após. Resultados Na avaliação da taxa de reinternação, tem-se que entre os 47 pacientes avaliados antes da implantação do protocolo, sete (14,9%) foram reinternados e dos 48 avaliados depois da implantação, um (2,1%) foi reinternado, mostrou-se significância estatística (p < 0,05). A chance de reinternação antes da implantação foi oito vezes maior do que a chance de internação após a implantação (IC 95%: 1,01 a 377,7). Ao comparar as complicações clínicas entre os grupos observou-se que houve menor taxa de complicações após a implantação do protocolo (p = 0,006). Conclusão A introdução de um protocolo multidisciplinar para padronização do manejo do paciente submetido a ATQ diminuiu as taxas de reinternação e de complicações clínicas após o procedimento.

A New Technique for Surgical Treatment of Proximal Hamstring Tendinopathy in a Triathlon Athlete.

INTRODUCTION: Proximal hamstring tendinopathy (PHT) is the result of chronic overload caused by repetitive eccentric contraction. Surgical treatment becomes an option for patients with chronic symptoms that do not respond to conservative treatment. CASE REPORT: This report describes a case of a 48-year-old man, an amateur triathlete, with deep gluteal pain in the left hip for 12 months, leading to a decline in sports performance. Magnetic resonance imaging revealed abnormalities that suggested a PHT. Surgery was indicated following the failure of conservative treatments. Debridement of the conjoint tendon and its reinsertion associated with semimembranosus tenotomy showed good results and is thus an option for the treatment of this pathology after 12 months of follow-up. CONCLUSION: This article provides surgeons with a new surgical option for this debilitating condition with clinical and functional improvement after 12 months of follow-up.

Avaliação da velocidade de hemossedimentação e da proteína C-reativa em pacientes submetidos à artroplastia total do quadril / Evaluation of erythrocyte sedimentation rate and C-reactive protein in patients submitted to total hip arthroplasty

Foi realizado estudo prospectivo em pacientes submetidos à artroplastia total do quadril primária, isentos de complicações, avaliando os resultados da proteína C-reativa (PCR) e da velocidade de hemossedimentação (VHS). As avaliações ocorreram no pré-operatório, 24 horas, 72 horas, uma semana, 30, 60 e 90 dias pós-cirurgia. Objetivou-se a avaliação da variação normal dos valores desses exames em uma situação pós-artroplastia do quadril. Como metodologia estatística foram utilizados o teste não- paramétrico de Kruskal-Wallis e o aplicativo Epitable do Epi Info. Concluindo, observou-se normalização dos valores da PCR nos primeiros 30 dias pós-operatórios. A VHS também assumiu valores considerados normais entre 30 e 60 dias depois da cirurgia

Artroscopia cirúrgica em pacientes acima de 40 anos / Surgical arthroscopy in patients over 40 years of age

Os autores avaliaram 71 pacientes acima de 40 anos, submetidos a cirurgia artroscópica para tratamento de uma lesao meniscal. Os pacientes foram divididos em grupos, segundo a faixa etária: grupo I - 40 a 50 anos; grupo II - de 51 a 60 anos; grupo III - de 61 a 70 anos; e grupo IV - de 71 a 80 anos. Procurou-se demonstrar a relaçao dos resultados, analisados segundo o método de Yang & Nisonson, com os grupos estudados, com o alinhamento do membro e com a época da cirurgia e o início dos sintomas. Foram observados 81,9 por cento de excelentes e bons resultados no grupo I, 54,6 por cento no grupo II, 45,6 por cento no grupo III e 20,0 por cento no grupo IV. Nos pacientes com alinhamento normal dos membros houve 72,5 por cento de resultados excelentes e bons, contra 57,9 por cento naqueles com deformidade em varo e 50,0 por cento na deformidade em valgo. Os autores concluem que os melhores resultados ocorreram nas faixas etárias mais jovens. E que o alinhamento normal do membro leva aos melhores resultados. O tempo decorrido entre o início dos sintomas e o procedimento cirúrgico nao pareceu influenciar nos resultados.