Diabetes Mellitus Is Not a Negative Prognostic Factor for Patients Undergoing Hip Arthroscopy.

Diabetes mellitus (DM) has been associated with inferior clinical outcomes and comorbidities in general. The authors sought to compare the outcomes of hip arthroscopy at minimum 2-year follow-up for patients with DM with those of patients without DM. Data were prospectively collected and retrospectively reviewed for patients who underwent hip arthroscopy between February 2008 and December 2014. The inclusion criteria were patients with DM who underwent hip arthroscopy for the treatment of femoroacetabular impingement and labral tears and had preoperative patient- reported outcomes. The exclusion criteria were preoperative Tönnis grade greater than 1, previous ipsilateral hip surgery, and/or previous conditions. All patients with DM were matched in a 1:2 ratio to control patients without DM. The matching criteria were age at surgery, sex, body mass index, workers' compensation, capsular treatment, and acetabular Outerbridge grade 0 or 1 vs 2, 3, or 4. Of 29 eligible patients with DM, 26 (89.7%) had minimum 2-year follow-up. Twenty-six patients with DM were matched and compared with 52 patients without DM. Acetabuloplasty was performed more frequently in the control group (P=.01). There were no other statistically significant differences detected in terms of demographics, preoperative radiographic imaging, intraoperative findings, procedures, preoperative scores, follow-up scores, revision rates, rates of conversion to total hip arthroplasty, or complication rates. Patients with DM demonstrated favorable improvements at 2 or more years after arthroscopic labral treatment when compared with a matched control group without DM. The DM group demonstrated a non-statistically significant trend toward inferior outcomes in all patient-reported outcomes, visual analog scale score, and satisfaction. [Orthopedics. 2021;44(4):241-248.].

Short-term Clinical Outcomes of Robotic-Arm Assisted Total Hip Arthroplasty: A Pair-Matched Controlled Study.

Advances have made robotic assistance a viable option in total hip arthroplasty (THA). However, the clinical outcomes of this procedure relative to manual THA are limited in the literature. This study compared robotic-arm assisted (RAA) THA and manual THA at minimum 2-year follow-up. Data were collected prospectively on all THAs performed from July 2011 to January 2015. Patients were included if they underwent RAA primary THA for idiopathic osteo-arthritis and had minimum follow-up of 2 years. The following patient-reported outcomes were compared: Harris Hip Score (HHS), Forgotten Joint Score (FJS-12), visual analog scale (VAS) pain score, and satisfaction. Postoperative radio-graphs were analyzed for cup inclination, cup version, leg-length discrepancy, and global offset. Robotic-arm assisted THA patients were matched 1:1 with manual THA patients for age, sex, body mass index, and surgical approach. Each study group included 85 patients. There were no significant differences in the demographic factors between the groups. Both HHS and FJS-12 were significantly higher in the RAA group at minimum 2-year follow-up. The VAS score was lower in the RAA group, but this difference was not statistically significant. A significantly higher proportion of patients were in the Lewinnek and Callanan safe zones for cup orientation. There was no difference between the groups in patient satisfaction. Robotic-arm assisted THA yielded improved short-term patient outcomes compared with manual THA and higher likelihood of cup placement in the safe zones. No differences were found regarding VAS scores, patient satisfaction, complication rates, or subsequent revisions between groups. [Orthopedics. 2021;44(2):e236-e242.].

Hip-Spine Syndrome: The Diagnostic Utility of Guided Intra-articular Hip Injections.

Overlapping symptoms between hip and lumbar spine pathologies complicate diagnoses and treatments. The purpose of this study was to determine the utility of guided intra-articular hip injection in identifying the pain source in hip-spine syndrome. A search of PubMed and Cochrane databases yielded 9 studies. The mean values for sensitivity, specificity, positive predictive value, and negative predictive value of guided intra-articular hip injection were 93.6%, 95.0%, 98.8%, and 86.3%, respectively. Thus, in hip-spine syndrome, when a pain source cannot be elucidated, an ultrasound- or fluoroscopic-guided intra-articular hip injection may be a powerful and reliable diagnostic tool. [Orthopedics. 2020; 43(2):e65-e71.].

Hip Arthroscopy Successfully Treats Femoroacetabular Impingement in Adolescent Athletes.

BACKGROUND: There is evidence that femoroacetabular impingement (FAI) is increasingly prevalent among adolescent athletes. Abnormal contact forces across the hip and alterations in bony morphology characteristic of FAI may be especially detrimental in this group, given their young age and active lifestyle. PURPOSE: The purpose of this study was to report the findings, outcomes, and return to sport percentage among adolescent athletes with FAI treated with hip arthroscopy. METHODS: A retrospective review of all patients younger than 18 years who underwent hip arthroscopy for FAI at a single institution was performed. All athletes who were attempting to return to sport and underwent hip arthroscopy were included. Patients with previous hip surgery and/or hip conditions were excluded. Arthroscopic procedures and an assessment of intra-articular findings were recorded. Patient-reported outcome measures were recorded at 3 months, 1 year, and 2 years postoperatively, and included the modified Harris hip score, the nonarthritic hip score, hip outcome score-sports subscale, visual analogue scale for pain, and patient satisfaction. Return to sport percentage and ability levels were also noted. RESULTS: There were 96 eligible cases of adolescent athletes treated with hip arthroscopy; 81 (84.4%) hips in 69 patients had 2-year follow-up. Running/track and field was the most common sport (25), followed by soccer (12), dance (10), baseball/softball (9), and basketball (6). There were 61 females and 20 males, whose average age was 15.9±1.2 y (range: 13.1 to 18.0 y). The most common procedures were labral repair (81.5%), iliopsoas fractional lengthening (72.8%), femoroplasty (69.1%), and acetabuloplasty (66.7%). Capsular repair or plication was performed in most patients (81.5%). Cartilage damage was more common on the acetabulum than the femur, with Outerbridge grade 2 or higher occurring in 23.5% and 4.9% of hips, respectively. Statistically significant improvements were seen in all patient-reported outcomes from preoperative to minimum 2-year follow-up. A total of 84.0% of patients had returned to their sport at latest follow-up. There were 6 (7.4%) patients who underwent revision arthroscopy at a mean of 37.3 months postoperatively. CONCLUSION: Symptomatic FAI in adolescent athletes can be successfully treated with hip arthroscopy, with a higher return to sport rate and low complications and reoperation rate at minimum 2-year follow-up.

Current topics in robotic-assisted total hip arthroplasty: a review.

Total hip arthroplasty (THA) is among the most successful procedures of modern medicine, yet failures and complications continue to occur, leaving room for improvement. Robotics is a cutting-edge technology that tries to improve joint arthroplasty surgery. There is some evidence that shows that robotic-assisted THA improves implant positioning, but less is known about its effect on clinical outcomes or the rate of complications. This article reviews the literature on robotic-assisted THA to elucidate the history, advantages, disadvantages, and current clinical understanding of this procedure.

Return to Basketball After Hip Arthroscopy: Minimum 2-Year Follow-up.

PURPOSE: To present minimum 2-year patient-reported outcomes (PROs) and return to sport (RTS) data for a population of basketball players after hip arthroscopy. METHODS: Data were prospectively collected and retrospectively reviewed for all patients who underwent hip arthroscopy between February 2009 and May 2014. Patients with preoperative and minimum 2-year postoperative PROs, visual analog scale score for pain, and satisfaction, who regularly played basketball within 1 year before surgery, and who attempted to RTS met the inclusion criteria. Exclusion criteria were previous ipsilateral hip surgery or conditions such as fracture, dysplasia, or femoral avascular necrosis. Patients were matched 1:1 to a control group composed of those who did not play any sports before surgery, based on the following matching criteria: age ±5 years, sex, and body mass index ±5. Statistical analysis was performed to determine significant differences in PROs. Conversion to total hip arthroplasty (THA) was considered an endpoint. RESULTS: Thirty-one patients (81.6%) met inclusion criteria with follow-up of 46.8 ± 20.6 months. The mean age was 30.0 ± 12.3, and the mean body mass index was 26.3 ± 6.5. Male patients (64.5%) outnumbered female patients (35.5%). A majority of the players (54.8%) identified themselves as recreational athletes; the remainder competed at the high school, collegiate, amateur, or professional level. There was significant (P < .001) improvement in all PRO measures and visual-analog scale scores from baseline to a minimum 2-year follow-up. At the most recent follow-up, mean patient satisfaction was 8.1 ± 2.1. Twenty-two (78.6%), and 23 patients (82.1%) achieved the patient acceptable symptom state on the modified Harris Hip Score and the Hip Outcomes Score-Sports Specific Subscale. Twenty-one (75.0%) and 17 (60.7%) patients had a minimal clinically important difference on the modified Harris Hip Score and the Hip Outcomes Score-Sports Specific Subscale, respectively. Three patients (9.7%) with an average age of 47.5 (P = .023) converted to THA at a mean of 35.9 ± 7.2 (range 29.66-43.75) months after arthroscopy. At the most recent follow-up, the RTS rate was 83.9%. Subjective ability level was the same or higher in 23 patients (74.2%). CONCLUSION: Hip arthroscopy in basketball athletes demonstrates a significant increase in PROs, a high RTS rate, and a low risk of complications. Hip arthroscopy may be considered in basketball players <40 years old for whom nonoperative treatment fails and who have a significantly limited level of play. Careful patient selection and counseling should be used when considering hip arthroscopy in basketball players >40 years old because there may be a high rate of conversion to THA. LEVEL OF EVIDENCE: Level III, retrospective comparative study.

Radiographic and Clinical Outcomes of Adolescents With Acetabular Retroversion Treated Arthroscopically.

BACKGROUND: Retroversion of the acetabulum is a cause of pincer impingement. Symptomatic retroversion has traditionally been treated with anteverting periacetabular osteotomy (PAO). However, arthroscopic rim trimming can also treat pincer impingement associated with acetabular retroversion. The purpose of this study was to report the outcomes and radiographic findings in a series of adolescent patients with symptomatic acetabular retroversion treated arthroscopically. METHODS: Data were prospectively gathered at a single institution using an established hip preservation registry. Patients below 18 years with a retroverted acetabulum that underwent primary hip arthroscopy with 2-year follow-up were included. Acetabular retroversion was defined by 3 radiographic criteria: the presence of crossover, ischial spine sign, and posterior wall sign. Radiographic measurements of the lateral center-edge angle, anterior center-edge angle, alpha angle, and crossover percentage were reported preoperatively and postoperatively. Patient-reported outcome (PROs) measures included the modified Harris Hip Score, the non-Arthritic Hip Score, Hip Outcome Score Sports Subscale, visual analog scale, and patient satisfaction, recorded at 3 months, 1 year, and 2 years, postoperatively. In addition, International Hip Outcome Tool scores were gathered at 2 years. RESULTS: Between April 2008 and July 2014, there were 43 patients (48 hips) treated with hip arthroscopy who met the inclusion criteria. The average age was 16.1 years (range, 13.9 to 17.9 y) and there were 38 females and 10 males. The average follow-up was 50.4 months, with a minimum of 2 years. Statistically significant improvements in all PROs were found at 2 years postoperatively. There were 9 hips with lateral center-edge angle ≤25 degrees; the PROs of this group was not different than patients with normal coverage. Three patients underwent arthroscopic revision. No patient subsequently underwent anteverting PAO during the study period. There were no reported complications. CONCLUSIONS: Femoroacetabular impingement caused by acetabular retroversion treated with hip arthroscopy demonstrates good outcomes at 2 years with a low complication rate. Symptomatic adolescents may be safely and successfully treated arthroscopically, potentially avoiding anteverting PAO. STUDY DESIGN: Level of evidence 4-case series.

The 'upper deck view' improves visualization during acetabuloplasty without chondro-labral detachment.

The 'upper deck' view is an arthroscopic perspective which visualizes the labral-osseous junction without detachment of the chondro-labral junction. The aim of this study was to evaluate the utility of the 'upper deck' view in preventing incomplete acetabuloplasty. Data were prospectively collected from September 2016 to November 2016 for all hip arthroscopies. We recorded the amount and clock-face of residual pincer-lesion acetabular bone resected using the 'upper deck' view. We noted whether this residual pincer-lesion acetabular bone was visible fluoroscopically, as well as the amount and clock-face of the overall acetabuloplasty. During the study period, 87 hip arthroscopies were performed; 50 met the inclusion criteria. Forty-six (92%) patients had residual pincer-lesion acetabular bone after completion of the acetabuloplasty resected from the bird's eye view. In all such cases the residual pincer-lesion acetabular bone was not visible under fluoroscopy and could only be detected using this specific view. The average maximum resection for the acetabuloplasty was 2.1 ± 0.9 and 1.4 ± 0.5 mm (P = 0.16) for resection of residual pincer-lesion acetabular bone. The 'upper deck' view provides the ability to decrease the risk of incomplete acetabuloplasty, due to the high likelihood (92%) of a residual beak of pincer-lesion acetabular bone when this view is not used during rim trimming.

Hip Arthroscopy: extra-articular Procedures.

Hip preservation is one of the fastest growing fields in orthopaedics and indications of intra-articular procedures are well established. In the last decade, extra-articular procedures have gained momentum and arthroscopic solutions to peri-articular hip pathologies have been offered. It should be noted that many of these pathologies are well-treated conservatively and only those who fail conservative management should be treated operatively. These indications can be divided into 5 categories: greater trochanteric pain syndrome; internal hip snapping; anterior inferior iliac spine/sub-spine impingement; sciatic nerve entrapment; and proximal hamstring injuries. This article reviews the anatomy, patient history and physical examination, imaging, non-operative treatment, endoscopic operative treatment and outcomes of each category. While indications for hip arthroscopy, specifically extra-articular procedures, are rising steadily, there is not enough data to support its superiority over open procedures. Current literature consists of case studies, case reports, and expert opinions and lacks large, randomised control studies.

Midterm Outcomes of Iliopsoas Fractional Lengthening for Internal Snapping as a Part of Hip Arthroscopy for Femoroacetabular Impingement and Labral Tear: A Matched Control Study.

PURPOSE: To report minimum 5-year outcomes and rate of painful snapping resolution for patients who underwent iliopsoas fractional lengthening (IFL) as a part of hip arthroscopy for femoroacetabular impingement (FAI) and labral tear. In addition, to match this group to a group of patients who underwent hip arthroscopy for FAI and labral tear without internal snapping. METHODS: Patients were eligible for inclusion if they underwent hip arthroscopy for treatment of FAI and labral tear with concomitant IFL for painful snapping and had preoperative baseline scores for modified Harris Hip Score, Nonarthritic Hip Score, Hip Outcome Score-Sports Subscale, and visual analog scale for pain. The exclusion criteria for this study were preoperative Tönnis grade >0, active workers' compensation claims, or previous ipsilateral hip conditions. These patients were matched to a control group of patients who did not have snapping or undergo IFL but who otherwise satisfied the same inclusion and exclusion criteria. RESULTS: There were 57 eligible cases (80.3% follow-up). Mean follow-up time was 69.3 months (from 60.0 to 91.9). All patient-reported outcomes measures demonstrated statistically significant improvements between preoperative and latest follow-up scores for the following measures (P < .001): modified Harris Hip Score (from 64.3 to 84.9), Nonarthritic Hip Score (from 61.7 to 85.2), Hip Outcome Score-Sports Subscale (from 47.0 to 75.0), and visual analog scale (from 6.5 to 2.2). Mean satisfaction was 8.1 out of 10. Painful snapping was resolved in 80.7% of cases. Ten hips (17.5%) required secondary arthroscopy at a mean of 30.5 months. Three hips (5.3%) required total hip arthroplasty at a mean of 57.5 months. One case (1.8%) had minor postoperative complications. There were no statistically significant differences between the groups in outcomes, complications, and secondary surgeries. CONCLUSIONS: IFL as part of hip arthroscopy for treatment of FAI and labral tears demonstrated similar favorable improvement, complication rates, and secondary surgeries, when compared with a control group that did not undergo IFL. LEVEL OF EVIDENCE: Level III, retrospective comparative study.

Arthroscopic Labral Treatment in Adolescents: Clinical Outcomes With Minimum 5-Year Follow-up.

BACKGROUND: The success of hip arthroscopy has led to increased application in younger populations. However, hip arthroscopy remains a challenging procedure, and its safety and efficacy in the adolescent population have been controversial. Most existing literature on outcomes in such patients contains only short-term follow-up, and a paucity of evidence is available regarding long-term outcomes in adolescents. PURPOSE: To report on clinical outcomes at a minimum 5-year follow-up in patients younger than 18 years who underwent arthroscopic treatment of labral tears. STUDY DESIGN: Case series; Level of evidence, 4. METHODS: Data were prospectively collected and retrospectively reviewed on all patients younger than 18 years who underwent hip arthroscopy in a tertiary hip preservation setting at a single institution. Patients were excluded if they had previous ipsilateral hip conditions or surgery. All patients underwent either labral repair or debridement for treatment of a labral tear. Patient-reported outcome measures were recorded at 3 months and at 1, 2, or a minimum of 5 years. These included the modified Harris Hip Score (mHHS), Nonarthritic Hip Score, Hip Outcome Score-Sports Specific Subscale (HOS-SSS), visual analog scale, and patient satisfaction. Additionally, the abbreviated International Hip Outcome Tool and Short Form Health Survey were collected at latest follow-up. RESULTS: The study included 44 hips in 32 patients that underwent arthroscopic labral repair (86.4%) or labral debridement (13.6%) between April 2008 and April 2011, with latest follow-up at a mean of 69.2 months (range, 60.0-89.9 months) postoperatively. The average age at surgery was 16.3 years (range, 14.2-17.9 years), and 39 hips from female patients. Statistically significant improvements were seen in all patient-reported outcome measures from preoperative to minimum 5-year follow-up. Improvements were noted at 1-year follow-up and maintained at minimum 5-year follow-up. At the latest follow-up, the Patient Acceptable Symptomatic State was achieved in 95.5% of patients for the mHHS and 72.7% for the HOS-SSS. Two patients subsequently underwent secondary arthroscopy on the ipsilateral hip; however, the survivorship of all hips was 100%. CONCLUSION: Hip arthroscopy for the treatment of labral tears in adolescents remains a technically challenging procedure that should be approached with appropriate caution. The results of the present study on a population treated in a specialized hip preservation center demonstrate that hip arthroscopy is a safe procedure with stable improvement in patient-reported outcome measures at 5 years.

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.

Diagnostic accuracy of a new clinical test (resisted internal rotation) for detection of gluteus medius tears.

The objective of this study was to evaluate the diagnostic accuracy of a new dynamic clinical examination for detection of gluteus medius (GM) tears. A case group of 50 patients undergoing arthroscopy with GM repair was compared with a control group of 50 patients undergoing arthroscopy who had no peritrochanteric symptoms. Both groups were examined clinically, had magnetic resonance imaging studies performed and underwent arthroscopic surgery. Recorded clinical examinations included abnormal gait (Trendelenburg), tenderness to palpation of the greater trochanter, resisted abduction and the test being studied, resisted internal rotation. For all clinical tests, the sensitivity, specificity, positive predictive value, negative predictive value and diagnostic accuracy rates were calculated and compared with the arthroscopic and MRI data for the case group, and the MRI data for the control group. The resisted internal rotation test had a sensitivity of 92%, specificity of 85% and diagnostic accuracy of 88% in the detection of GM tears, with a low rate of false-positive and false-negative recordings. Other traditional clinical examination tests, with the exception of Trendelenburg gait, showed inferior rates. Trendelenburg gait had a higher specificity, but much lower sensitivity. The resisted internal rotation test aides in the detection of GM pathology. Due to the good results of the resisted internal rotation test in all the diagnostic parameters, we recommend incorporating it on the physical exam of patients with hip pain.

Hip Arthroscopy for Femoroacetabular Impingement and Labral Tears in Patients Younger than 50 Years: Minimum Five-year Outcomes, Survivorship, and Risk Factors for Reoperations.

INTRODUCTION: There is a paucity of literature on mid-term outcomes for hip arthroscopy for femoroacetabular impingement and labral tears. METHODS: Inclusion criteria were age at surgery <50 years and documented preoperative patient-reported outcomes. Patients with a Tönnis grade >0 or previous ipsilateral hip conditions were excluded. RESULTS: Of 407 eligible cases, 327 hips (295 patients) had minimum 5-year follow-up. Mean age was 32.4 years. All mean patient-reported outcomes and visual analog scale improved at follow-up (P < 0.001). Mean satisfaction was 7.9. Thirty-eight hips (11.6%) required secondary arthroscopy at a mean of 25.1 months. Survivorship at minimum 5 years was 92.4%. The complication rate was 7.0%. CONCLUSIONS: Hip arthroscopy for management of femoroacetabular impingement and labral tears in patients aged <50 demonstrates favorable and safe mid-term outcomes. Several risk factors for conversion to total hip arthroplasty in this age group warrant cautious patient selection for arthroscopy.

In Revision Hip Arthroscopy, Labral Reconstruction Can Address a Deficient Labrum, but Labral Repair Retains Its Role for the Reparable Labrum: A Matched Control Study.

BACKGROUND: Revision hip arthroscopy is increasingly common and often addresses acetabular labrum pathology. There is a lack of consensus on indications or outcomes of revision labral repair versus reconstruction. PURPOSE: To report clinical outcomes of labral reconstruction during revision hip arthroscopy at minimum 2-year follow-up as compared with pair-matched labral repair during revision hip arthroscopy (control group) and to suggest a decision-making algorithm for labral treatment in revision hip arthroscopy. STUDY DESIGN: Cohort study; Level of evidence, 3. METHODS: Patients who underwent revision hip arthroscopy with labral reconstruction were matched 1:2 with patients who underwent revision arthroscopic labral repair. Patients were matched according to age, sex, and body mass index. Outcome scores, including the modified Harris Hip Score (mHHS), Non-Arthritic Hip Score, Hip Outcome Score-Sport-Specific Subscale, and a visual analog scale for pain, were collected preoperatively and at minimum 2-year follow-up. At latest follow-up, patient satisfaction on a 0-10 scale and the abbreviated International Hip Outcome Tool (iHOT-12) were collected. Complications, subsequent arthroscopies, and conversion to total hip arthroplasty were collected as well. RESULTS: A total of 15 revision labral reconstructions were pair matched to 30 revision labral repairs. The reconstructions had fewer isolated Seldes type I detachments ( P = .008) and lower postoperative lateral center-edge angle, but there were otherwise no significant differences in demographics, radiographics, intraoperative findings, or procedures. Both groups demonstrated significant improvements in all outcomes and visual analog scale at minimum 2-year follow-up. The revision repairs trended toward better preoperative scores: mHHS (mean ± SD: 59.3 ± 16.5 vs 54.2 ± 16.0), Non-Arthritic Hip Score (61.0 ± 16.7 vs 51.2 ± 17.6), Hip Outcome Score-Sport-Specific Subscale (39.6 ± 25.1 vs 30.5 ± 22.1), and visual analog scale (5.8 ± 1.8 vs 6.2 ± 2.2). At follow-up, the revision repair group had significantly higher mHHS (84.1 ± 14.8 vs 72.0 ± 18.3, P = .043) and iHOT-12 (72.2 ± 23.3 vs 49.0 ± 27.6, P = .023) scores than the reconstruction group. The magnitudes of pre- to postoperative improvement between the groups were comparable. The groups also had comparable rates of complications: 1 case of numbness in each group ( P > .999), subsequent arthroscopies (repair: n = 2, 6.5%; revision: n = 3, 20%; P = .150), and conversion to total hip arthroplasty (1 patient in each group, P > .999). CONCLUSION: Labral reconstruction safely and effectively treats irreparable labra in revision hip arthroscopy. However, labral repair is another treatment option for reparable labra, yielding similar magnitude of improvement. A proposed algorithm may assist in surgical decision making to achieve optimal outcomes based on the condition and history of each patient's acetabular labrum.

Arthroscopic Capsular Plication in Patients With Labral Tears and Borderline Dysplasia of the Hip: Analysis of Risk Factors for Failure.

BACKGROUND: Hip arthroscopy for the treatment of instability in the setting of borderline dysplasia is controversial. Capsular management in such cases is an important consideration, and plication has been described as a reliable technique, with good midterm outcomes reported when indications are appropriate. HYPOTHESIS: Patients with borderline dysplasia who have a lower lateral center-edge angle (LCEA) and greater age will be at a higher risk of failure after arthroscopic capsular plication. STUDY DESIGN: Case-control study; Level of evidence, 3. METHODS: Data were retrospectively reviewed for all patients between 15 and 40 years of age who underwent hip arthroscopy from November 2008 to January 2015. Inclusion criteria were an LCEA between 18° and 25°, Tönnis grade ≤1, primary case with capsular plication, and minimum 2-year follow-up. Patients were excluded if they had any history of ipsilateral hip procedure or conditions such as Legg-Calve-Perthes disease, slipped capital femoral epiphysis, rheumatologic disease, and Tönnis grade ≥2. Age, sex, and body mass index data were retrieved for each patient. Patient-reported outcomes (PROs)-including modified Harris Hip Score (mHHS), Non-Arthritic Hip Score (NAHS), Hip Outcome Score-Sports Specific Subscale, and a visual analog scale (VAS) for pain (0-10)-were obtained preoperatively and at a minimum of 2 years postoperatively, in addition to the postoperative International Hip Outcome Tool-12. The "success" group consisted of all patients who achieved the patient acceptable symptomatic state of mHHS ≥74 and had no ipsilateral hip surgery subsequent to their index arthroscopy. The "failure" group was composed of patients who were below the patient acceptable symptomatic state at latest follow-up or required secondary arthroscopy or conversion to total hip arthroplasty. Patient satisfaction and minimal clinically important difference were also calculated. Mean age for the failure group was applied as a cutoff age for subanalysis, and relative risk for failure was determined. RESULTS: Ninety patients (97 hips; 79.5%) met criteria for the success group, and 25 patients (25 hips) met criteria for the failure group. No significant differences in preoperative baseline scores or VAS were found. However, there did appear to be a trend that the failure group had lower mean preoperative scores for all PRO measures and a higher VAS score. The differences in preoperative mHHS and NAHS closely approached significance ( P = .053). Postoperative PRO, VAS, and patient satisfaction scores of the success group were significantly higher than the failure group. The failure group was significantly older than the success group (28.5 ± 7.8 vs 23.5 ± 7.5 years, P = .005). Patients >35 years old were 2.25 times more likely to fail according to relative risk (95% CI, 1.10-4.60; P = .0266). LCEA did not differ between the groups, and no other risk factors for failure were identified. CONCLUSION: Stringent criteria for patient selection and meticulous repair or augmentation of the static stabilizers of the hip yielded favorable clinical outcomes in this study cohort with borderline dysplasia. Within this carefully selected group, the analysis revealed that increased age was the main risk factor for failure in the management of borderline hip dysplasia via isolated primary arthroscopic hip surgery with capsular plication.

Hip Arthroscopy in Patients Ages 50 Years or Older: Minimum 5-Year Outcomes, Survivorship, and Risk Factors for Conversion to Total Hip Replacement.

PURPOSE: To report minimum 5-year outcomes and risk factors for conversion to total hip arthroplasty (THA) in patients ≥50 years old undergoing hip arthroscopy to treat labral tears and femoroacetabular impingement (FAI). METHODS: Data were prospectively collected on patients who underwent hip arthroscopy to treat labral tears and FAI between February 2008 and January 2012. The inclusion criteria were ≥50 years old at surgery, arthroscopic treatment for both labral tears and FAI, and preoperative patient-reported outcome (PRO) scores for modified Harris Hip Score (mHHS), Nonarthritic Hip Score (NAHS), Hip Outcome Score-Sports Specific Subscale (HOS-SSS), and Visual Analog Scale (VAS). The exclusion criteria were Tönnis grade > 1 and previous hip conditions or surgeries. RESULTS: Of 103 eligible cases, 94 hips (91.3%) had minimum 5-year follow-up at a mean of 70.1 months (range, 60.0-95.1 months). All PROs and VASs demonstrated significant improvement at latest follow-up (P = .0001). Mean patient satisfaction was 8.4. All mean scores demonstrated durability from 2 years to latest follow-up, and NAHS (P = .009), HOS-SSS (P = .02), and VAS (P = .04) continued to significantly improve. Fifty-one (54.3%) of cases reached patient acceptable symptomatic state for mHHS, and 49 cases (52.1%) achieved minimal clinically important difference for this outcome measure. Four cases (4.3%) required secondary arthroscopy, and survivorship was 72.3%. Compared with survivors, the subgroup requiring THA demonstrated higher body mass indexes (P = .01), had larger alpha angles (P = .0200) and smaller lateral center-edge angles (P = .0200), and had higher proportions of Tönnis grade 1 (P = .0012), acetabular Outerbridge grade ≥ 2 (P = .0500), and femoral head Outerbridge grade ≥2 (P = .0001). CONCLUSIONS: Hip arthroscopy for the treatment of labral tears and FAI in patients ≥50 years old demonstrates statistically significant PRO improvements at minimum 5-year follow-up. However, due to potential for subsequent need for THA in a subset of this population, surgeons should use rigorous selection criteria and counsel patients appropriately. LEVEL OF EVIDENCE: Level IV, case series.

Fresh Femoral Head Osteochondral Allograft Transplantation for Treating Osteochondritis Dissecans of the Femoral Head.

Treatment options for the management of osteochondritis dissecans (OCD) lesions of the femoral head are limited. Although arthroscopic surgery of the hip can treat a variety of intra- and extra-articular pathologies, an OCD lesion located at the superior and medial zone of the femoral head is often difficult to access and cannot be adequately treated arthroscopically. The use of fresh-stored osteochondral allograft allows surgeons to both avoid donor-site morbidity and treat lesions of a larger surface area. We present our technique for surgical treatment of a femoral head OCD lesion with open surgical dislocation of the hip through stepped trochanteric osteotomy and osteochondral transplantation of fresh-stored femoral head allograft.