David bloom california sports medicine4/28/2024 ![]() 10, 11 The exclusion criteria consisted of patients who did not have 2 years of follow-up after RHA and those with a history of hip dysplasia or borderline hip dysplasia, a connective tissue disorder or autoimmune disease, or pediatric hip pathology such as slipped capital femoral epiphysis. Patients were included in the study if they underwent RHA, had a complete set of preoperative and intraoperative radiographs, had completed preoperative and postoperative PRO questionnaires (i.e., modified Harris Hip Score and Non-arthritic Hip Score ), and had at least 2 years of follow-up. Patients in this database were prospectively enrolled and underwent procedures relating to hip arthroscopy from January 2007 to December 2017. This single-site, institutional review board–approved study was a retrospective comparative study conducted using data obtained from a single surgeon’s (T.Y.) operative database. Our hypothesis was that individuals with a failed RHA would be more likely to display a smaller change in the alpha angle from preoperatively to postoperatively on radiographic imaging and to have worse preoperative patient-reported outcome (PRO) scores. The purpose of this study, therefore, was to identify clinical and radiographic factors associated with failure of RHA. 9 Although there is a growing body of literature examining outcomes associated with RHA, there is a general paucity of studies attempting to associate radiographic findings with outcomes after RHA. The investigation of predictive factors associated with RHA is of substantial clinical value because arthroscopy is a less invasive intervention that may be used to delay hip arthroplasty. ![]() This same systematic review showed that male sex, lower BMI (<24.5), younger age, and Tönnis grade of 0, as well as preoperative pain relief from clinically diagnostic intra-articular injections about the hip, predicted positive outcomes. 8 of 9,272 hips determined that the following factors were associated with poor outcomes of primary hip arthroscopy: female sex, increased lateral center-edge angle, treatment with labral debridement alone, increased Kellgren-Lawrence grade (>3), decreased joint space (≤2 mm), chondral defects, increased Tönnis grade (≥1), elevated body mass index (BMI), increased duration of preoperative symptoms (>8 months), and increased age. 7Ī recent systematic review by Sogbein et al. RHA is currently indicated for patients who require improvements in residual pain and/or functional outcomes after primary hip arthroscopy. As this small but significant cohort of patients has increased in size, so too has the popularity and academic study of RHA. 6 reported a reoperation rate of 6.8% after primary hip arthroscopy, with approximately 2.9% being converted to total hip arthroplasty. There is sparse literature describing the rate of revision hip arthroscopy (RHA) in the general population, although a recent meta-analysis by Harris et al. 4 Despite these largely positive outcomes, a notable subset of patients experience persistent or recurrent pain after primary hip arthroscopy. 2, 3 Typical indications for hip arthroscopy include chondral lesions, labral tears, and loose bodies in the setting of femoroacetabular impingement (FAI). 1 This procedure’s popularity is owed to the evidence that shows that patients achieve substantial clinical improvement with relatively few complications. The utilization of hip arthroscopy in the United States has grown substantially over the past decade, with a 180% increase in surgical volume in the United States from 2008 to 2013. There was a statistically significant difference in the frequency of patients who achieved the patient acceptable symptomatic state of +74.0 between the failure (25%) and success (83%) groups 88% of patients in the failure group met the minimal clinically important difference, whereas 100% of patients in the success group (n = 18) met it. Patients included in the success group had both a higher preoperative mHHS (44.2 ± 8.6 vs 34.7 ± 9.6) and a higher postoperative mHHS (83.2 ± 8.3 vs 62.3 ± 14.2) than patients with failed RHA. When the preoperative alpha angle was held constant, each 1° increase in the difference between the preoperative and postoperative alpha angles achieved during surgery was associated with a 17% decrease in the odds of failure. The failure group showed a significantly smaller decrease in the alpha angle with surgery, measured on the Dunn view, compared with the success group. The study included 26 patients, comprising 8 (31%) with failed RHA and 18 (69%) with successful revision.
0 Comments
Leave a Reply.AuthorWrite something about yourself. No need to be fancy, just an overview. ArchivesCategories |