Total knee arthroplasty using a computerized assisted stereotaxic navigation system with bluetooth communication in obese patients - A randomized controlled study.

Correct mechanical alignment (180° hip-knee-angle (HKA)) may be difficult to obtain on a consistent basis in obese patients. This is a randomized controlled study comparing the post-operative coronal alignment in obese patients between two surgical total knee arthroplasty (TKA) techniques - conventional and computer assisted navigation. The primary outcome was the post-operative HKA. A total of 60 patients were assigned to undergo conventional total knee arthroplasty (30 patients) or computerized assisted stereotaxic navigation system with Bluetooth communication surgery (30 patients). One patient from the study group was excluded due to malfunction of the navigation system. Good quality x-rays were available in 57 patients. There was no difference between the groups. Post-operative HKA was 2.8° and 2.9° in the study and control groups, respectively (p = 0.87). In obese patients undergoing TKA, computerized navigation had no impact on post-op HKA. Clincal Trial Registration Number: HMO 0092-13.

The impact of femoral bone quality on cementless total hip pre-operative templating.

INTRODUCTION: Accurate templating is an integral part of pre-operative planning for total hip arthroplasty (THA). Templating of cementless implant accuracy has been average. The aim of this study was to assess the impact of Dorr femoral classification on the accuracy of pre-operative digital templating. PATIENTS AND METHODS: This was a retrospective study of cementless THA pre-operative planning using one implant design. A total of 210 primary THA were reviewed. A total of 102 cementless THAs matched the exclusion and inclusion criteria, using one implant combination, were analyzed by an orthopaedic resident and a fellowship trained arthroplasty surgeon. Each x-ray was evaluated and assigned a femoral Dorr classification. Accuracy of templating was determined by comparing the templated size with the actual implant size both for the femoral and acetabular components. RESULT: Out of the 102 cases, exact templating size was achieved in 35.3% for the acetabulum, 25.5% for the femur, and only in 9.8% for both components. Reasonable templating, ± one of the actual size, was achieved in 78.4% for the acetabulum, 74.5% for the femur, and 60.8% for both components. Use of Dorr femoral type classification did not result in better templating accuracy. CONCLUSION: Pre-operative hip cementless templating using digital x-rays with double marker method do not improve accuracy compared to other methods available for templating. Accounting for bone quality using the Dorr femoral classification did not improve accuracy.

The Hip-Spine Connection: How to Differentiate Hip Conditions From Spine Pathology.

Practitioners treating spine pathology commonly encounter patients with hip pain. These patients frequently manifest groin, buttock, trochanteric, or knee pain. Complex biomechanical interaction between the axial and the appendicular skeleton may result in compensatory adaptation. Cross-innervation of the hip and surrounding tissues may make diagnosis of the primary source difficult, leading to delayed diagnosis. This review elucidates the interaction between the hip and the spine and can assist clinicians in recognizing the hip as a potential source of pain. Diagnostic guidelines enabling a streamlined workup of patients presenting with confusing symptoms related to the hip that masquerade as a spine disorder are presented. [Orthopedics. 2021;44(6):e699-e706.].

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.].

How has arthroscopic management of the iliopsoas evolved, and why? A survey of high-volume arthroscopic hip surgeons.

The rapid growth of hip preservation has left surgeons following trends based on limited, or even anecdotal, evidence in certain circumstances. A consensus as well as high-level research on how best to manage the iliopsoas is lacking. Arthroscopic treatment of the iliopsoas may be an example of how treatment patterns and trends can shift with limited evidence-based medicine. A cross-sectional survey of 16 high-volume hip preservation surgeons was conducted to gather perspectives and opinions on how and why the arthroscopic management of the iliopsoas has evolved. All participants completed the survey in person and anonymously. Of the surveyed surgeons, the mean career hip preservation volume was 1031.25 cases (250 to >3000) with an average annual volume of 162.08 cases (75-400). Of the surveyed surgeons' caseload, 16.1% involved an iliopsoas tenotomy or fractional lengthening mostly commonly (75%) for recalcitrant internal snapping. Labral repair/reconstruction is performed concomitantly 87.5% of the time. Seventy-five percent of surgeons indicated a decrease in frequency of iliopsoas tenotomy over the course of their practice most commonly (56.3%) because of hip flexion weakness; however, 0% of the surgeons could cite literature evidence to support their practices. Perceived poor outcomes in individual practices was the most common (56.3%) source of this complication. Surgeons were less inclined to perform tenotomy on patients with borderline dysplasia (75%) or ligamentous laxity (56.3%).

Minimum 5-Year Outcomes of Robotic-assisted Primary Total Hip Arthroplasty With a Nested Comparison Against Manual Primary Total Hip Arthroplasty: A Propensity Score-Matched Study.

BACKGROUND: Robotic-assisted technology has been a reliable tool in enhancing precision and accuracy of cup placement in total hip arthroplasty (THA). Still, questions remain on the clinical benefit of this technology. METHODS: The purposes of the ongoing study were (1) to report on minimum 5-year outcomes in patients who underwent robotic-assisted primary THA (rTHA), (2) to compare those outcomes to a propensity score-matched manual primary THA (mTHA) control group, and (3) to compare radiographic measures between the groups regarding acetabular cup placement. Prospectively collected patient data were retrospectively reviewed for primary THA recipients during June 2008 to July 2013. Patients with minimum 5-year follow-up for Harris Hip Score, Forgotten Joint Score-12, Veterans RAND-12 Mental, Veterans RAND-12 Physical, 12-Item Short Form Survey Mental, 12-Item Short Form Survey Physical, visual analog scale, and satisfaction were included. Patient-reported outcomes, cup placement, and revision rate of the rTHA group were compared with those of a propensity score-matched mTHA control group. RESULTS: Sixty-six rTHAs were matched to 66 mTHAs. The rTHA group reported significantly higher Harris Hip Score, Forgotten Joint Score-12, Veterans RAND-12 Physical, and 12-Item Short Form Survey Physical (P < 0.001, P = 0.002, P = 0.002, P = 0.001). The acetabular implant placement by rTHA had a 9 and 4.7-fold reduced risk of placement outside the Lewinnek and Callanan safe zones, respectively (relative risk, 0.11 [95% confidence interval, 0.03 to 0.46]; P = 0.002; relative risk, 0.21 [95% confidence interval, 0.01 to 0.47]; P = 0.001). In addition, rTHA recipients had lesser absolute values of leg length discrepancy and global offset (P = 0.091, P = 0.001). CONCLUSIONS: Patients who received rTHA reported favorable outcomes at minimum 5-year follow-up. Furthermore, in comparison to a propensity score pair-matched mTHA group, rTHAs reported higher patient-reported outcome scores and had 89% reduced risk of acetabular implant placement beyond the Lewinnek safe zone and 79% reduced risk of placement beyond the Callanan safe zone. LEVEL OF EVIDENCE: Level III.

Effect of alcohol consumption on patient-reported outcomes in hip arthroscopy: a matched controlled study with minimum 2-year follow-up.

INTRODUCTION: There is a paucity of literature examining the effects of alcohol consumption on patient-reported outcomes (PROs) after hip arthroscopy. The purpose of this study was to report 2-year outcomes of hip arthroscopy in patients who consume alcohol compared to patients who abstain. METHODS: Registry data were prospectively collected and retrospectively reviewed to identify heavy drinkers at the time of primary hip arthroscopy. Patients were matched 1:1 (heavy drinkers:non-drinkers) based on age, sex, BMI, acetabular Outerbridge grade, and capsular treatment. All patients were assessed with 4 validated PROs: mHHS, NAHS, HOS-SSS, and iHOT-12. Pain was estimated with VAS. RESULTS: 42 patients were pair matched in each group (heavy drinkers:non-drinkers). Both groups demonstrated significant improvement for all PROs and VAS. Heavy drinkers reported lesser improvement in HOS-SSS (p = 0.0169), smaller decrease in VAS (p = 0.0157), and lower final scores on iHOT-12 (p = 0.0302), SF-12 mental (p = 0.0086), and VR-12 mental (p = 0.0151). Significantly fewer patients in the heavy-drinking group reached PASS for mHHS (p = 0.0464). Odds of achieving PASS for mHHS was 2.5 times higher for patients who abstain from alcohol. The rates of revision hip arthroscopy and conversion to total hip arthroplasty were not statistically different between groups. CONCLUSION: While hip arthroscopy may still yield clinical benefit in drinkers, patients who consume heavy amounts of alcohol may ultimately achieve an inferior functional status and should be counselled on drinking cessation to optimise their results.

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.

Acetabular Morphologic Characteristics Predict Early Conversion to Arthroplasty After Isolated Hip Arthroscopy for Femoroacetabular Impingement.

BACKGROUND: Hip arthroscopy in the setting of dysplasia and borderline dysplasia is controversial. Dysplasia severity is most often defined by the lateral center edge angle (LCEA) but can also be evaluated radiographically by the acetabular inclination (AI). PURPOSE/HYPOTHESIS: The purpose was to determine the effect of AI on outcomes after isolated hip arthroscopy for femoroacetabular impingement (FAI). We hypothesized that patients with dysplasia would have higher rates of arthroplasty as well as inferior clinical and functional outcomes compared with patients who did not have dysplasia. STUDY DESIGN: Cohort study; Level of evidence, 3. METHODS: A hip arthroscopy registry was reviewed for participants undergoing arthroscopic correction of FAI from February 28, 2008, to June 10, 2013. Participants required a clinical diagnosis and isolated arthroscopic correction of FAI with preoperative imaging and intraoperative cartilage status recorded. AI dysplasia was defined as an AI greater than 10°, LCEA dysplasia as LCEA less than 18°, and borderline LCEA dysplasia as LCEA 18° to 25°. Patients without an acetabular deformity (LCEA 25°-40°; AI <10°) served as a control population. Postoperative variables included patient-reported outcome surveys with conversion to arthroplasty as the primary endpoint. Minimum 5-year outcome scores were obtained for 337 of 419 patients (80.4%) with an average follow-up of 75.2 ± 12.7 months. RESULTS: This study included 419 patients: 9 (2%) with LCEA dysplasia, 42 (10%) with AI dysplasia, and 51 (12%) with borderline dysplasia. The AI but not LCEA was significantly correlated with lower outcome scores on the modified Harris Hip Score (r = 0.13; P = .01), Non-Arthritic Hip Score (r = 0.10; P = .04), and Hip Outcome Score-Sports Subscale (r = 0.11; P = .04). A total of 58 patients (14%) underwent arthroplasty at 31 ± 20 months postoperatively. Patients with LCEA dysplasia had an arthroplasty rate of 56% (odds ratio, 8.4), whereas patients with AI dysplasia had an arthroplasty rate of 31% (odds ratio, 3.3), which was significantly greater than the rate for the nondysplastic cohort (13.5%; P < .0001). Patients with borderline LCEA dysplasia did not have increased rates of arthroplasty. A multivariate analysis found increasing age, increasing AI, Tönnis grade higher than 1, and femoral Outerbridge grade higher than 2 to be most predictive of conversion to arthroplasty. CONCLUSION: We found that an elevated AI, along with increasing age, Tönnis grade, and femoral Outerbridge grade significantly predict early conversion to arthroplasty after isolated hip arthroscopy. We recommend using the AI, in addition to the LCEA, in evaluating hip dysplasia before hip arthroscopy.

Return to Play in Amateur Soccer Players Undergoing Hip Arthroscopy: Short- to Mid-Term Follow-Up.

PURPOSE: To describe patient-reported outcomes (PROs) and return to play at any level in amateur soccer players undergoing hip arthroscopy for femoroacetabular impingement syndrome at short- to mid-term follow-up. METHODS: Data were prospectively collected and retrospectively reviewed for patients who underwent hip arthroscopy between March 2009 and June 2014. Patients who participated in amateur soccer within 1 year prior to surgery and intended to return to their sport after hip arthroscopy for femoroacetabular impingement syndrome were considered for inclusion in our study. Patients were excluded if they had a preoperative Tönnis osteoarthritis grade of 2 or greater, previous ipsilateral hip conditions or hip surgical procedures, or Workers' Compensation status. The patients from the initial group who had preoperative and minimum 2-year postoperative measures for the modified Harris Hip Score, Non-Arthritic Hip Score, Hip Outcome Score-Sports Specific Subscale, and visual analog scale for pain were included in our final group. In addition to PROs, data regarding the patients' return to soccer, surgical complications, and secondary surgical procedures were collected. RESULTS: A total of 41 patients were eligible for inclusion in our study, of whom 34 (82.9%) had a mean follow-up period of 47.4 months. Five patients were not eligible because they did not intend to return to soccer. There were 15 male hips (44.1%) and 19 female hips (55.9%). The mean age at surgery was 20.8 ± 7.4 years. All PROs and the visual analog scale score improved significantly from preoperatively to latest follow-up. Of the 34 patients, 27 (79.4%) returned to soccer. Of the patients who returned to soccer, 19 (70.4%) were competing at the same level or a higher level compared with their highest level within 1 year of surgery. Regardless of competitive level, 21 patients (77.8%) reported that their athletic ability was the same as or higher than it was within 1 year of surgery. CONCLUSIONS: Hip arthroscopy was associated with significant improvements in PROs for amateur soccer players. There was a high level of return to soccer and a high proportion of patients whose competitive level was similar or improved. As such, hip arthroscopy is a good option for soccer players, in the absence of underlying osteoarthritis, presenting with hip pathology. LEVEL OF EVIDENCE: Level IV, case series.

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.

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.

Does Femoral Retroversion Adversely Affect Outcomes After Hip Arthroscopy for Femoroacetabular Impingement Syndrome? A Midterm Analysis.

PURPOSE: To report 5-year outcomes of arthroscopic treatment of femoroacetabular impingement syndrome in patients with femoral retroversion compared with a control group of patients with normal femoral anteversion. METHODS: Data were prospectively collected and retrospectively reviewed for all patients who underwent hip arthroscopy between August 2008 and April 2013. Patients were included in analysis if they underwent hip arthroscopy during this period and had femoral version ≤0° calculated using magnetic resonance imaging. Exclusion criteria included prior ipsilateral hip conditions/surgeries or Tönnis grade >1. These patients were pair matched with patients having femoral anteversion between 10° and 20° based on gender, body mass index ± 10, and age ± 10 years. Patient-reported outcomes (PROs) were collected at 3 months and 1 year postoperatively and annually thereafter. An a priori power analysis was performed. RESULTS: A total of 59 patients were identified as the experimental group out of 69 eligible for inclusion (86%). All 59 patients were matched, with a mean age of 37.4 years and mean body mass index of 26.9. Twenty patients were female, and 39 were male. These patients demonstrated significant improvement from their preoperative state in all patient-reported outcomes and visual analog score scores (P < .001). Thirty-eight patients met the threshold for minimal clinically important difference, and 35 achieved patient acceptable symptomatic state for the modified Harris Hip Score questionnaire. Seven patients converted to total hip replacement. No differences were noted between retroverted and control patients in any of the outcome measures collected, in pain or satisfaction ratings, in the frequency of or duration to secondary surgeries or in complication rate (P > .05). CONCLUSIONS: Patients with femoral retroversion demonstrated significantly higher outcomes at minimum 5-year follow-up after undergoing arthroscopic hip surgery. These outcomes were not different from those of patients with normal femoral version. While femoral retroversion should not be considered a contraindication to hip arthroscopy, it should be carefully considered as a factor in patient selection and surgical planning. LEVEL OF EVIDENCE: Level III, retrospective comparative study.

Perineal Pressure During Hip Arthroscopy Is Reduced by Use of Trendelenburg: A Prospective Study With Randomized Order of Positioning.

BACKGROUND: The use of traction during hip arthroscopy is commonly used to provide safe joint access and to improve visualization. However, traction during hip arthroscopy has been associated with complications ranging from transient neuropraxias to devastating soft-tissue necrosis. Trendelenburg positioning may be helpful, but the degree to which this is true is not well understood. QUESTIONS/PURPOSES: To determine whether there would be a reduction in perineal pressure at 5°, 10°, and 15° of Trendelenburg compared with baseline (0° of Trendelenburg) while in the modified supine position during hip arthroscopy. METHODS: A consecutive cohort of 50 patients treated with hip arthroscopy by a single, high-volume orthopaedic surgeon was analyzed. There were 30 females and 20 males in this study, with a mean age of 36 ± 16 years (range, 14 to 66 years); mean BMI was 26 kg/m. In the operating room, patients were placed in the modified supine position on a traction extension table with a well-padded perineal post. A standard blood pressure cuff was secured to the post to measure pressure exerted on the perineum as traction was applied to distract the hip. For each patient, pressure against the perineum was measured at four different positions using a digital level: 0°, 5°, 10°, and 15° of Trendelenburg. These positions were tested in a random order for each patient. Mean pressure was compared within patients under the four-period crossover design using a repeated-measure (mixed) ANOVA model. Examination of the residual error quantile plot showed that the pressure data followed a normal distribution, making the use of a parametric model appropriate. Tests were made for period and order effects. RESULTS: Compared with baseline (0° or no Trendelenburg) there was a reduction in pressure of 4.4 (15.5%) at 5° of Trendelenburg (p = 0.203), 8 (28%) at 10° of Trendelenburg (p = 0.022) and 13.1 (46%) at 15° (p = 0.006). These results were maintained regardless of the sequence of positions used in each patient (0°, 5°, 10°, 15°). CONCLUSIONS: Trendelenburg positioning of 10° and 15° during hip arthroscopy resulted in decreased perineal pressure compared with the neutral (0°) position. This technique is intended to harness gravity to exert the majority of countertraction while retaining the perineal post as a backup patient stabilizer. Routine introduction of Trendelenburg during hip arthroscopy reduces perineal pressure against the post, which may decrease complications related to traction and perineal pressure. Future studies should assess whether the observed differences in perineal pressure will reduce the frequency of post-related complications after hip arthroscopy. LEVEL OF EVIDENCE: Level II, therapeutic study.

Minimum 5-Year Outcomes of Arthroscopic Hip Labral Reconstruction With Nested Matched-Pair Benchmarking Against a Labral Repair Control Group.

BACKGROUND: Labral reconstruction has demonstrated short-term benefit for the treatment of irreparable labral tears. Nonetheless, there is a scarcity of evidence for midterm outcomes of this treatment. HYPOTHESES: Arthroscopic segmental reconstruction in the setting of irreparable labral tears would show improvement in patient-reported outcomes (PROs) and high patient satisfaction at minimum 5-year follow-up. Second, primary labral reconstruction (PLRECON) would result in similar improvement in PROs at minimum 5-year follow-up when compared with a matched-pair primary labral repair (PLREPAIR) control group. STUDY DESIGN: Cohort study; Level of evidence, 3. METHODS: Data from February 2008 to April 2013 were retrospectively reviewed. Patients were included if they underwent hip arthroscopy for segmental labral reconstruction in the setting of irreparable labral tear and femoroacetabular impingement, with minimum 5-year follow-up for modified Harris Hip Score, Nonarthritic Hip Score, Hip Outcome Score-Sports Specific Subscale, patient satisfaction, and visual analog scale for pain. Exclusion criteria were Tönnis osteoarthritis grade >1, prior hip conditions, or workers' compensation claims. PLRECON cases were matched in a 1:3 ratio to a PLREPAIR control group based on age ±5 years, sex, and body mass index ±5 kg/m2. RESULTS: Twenty-eight patients were eligible for the study, of which 23 (82.14%) had minimum 5-year follow-up. The authors found significant improvement from preoperative to latest follow-up in all outcome measures recorded: 17.8-point increase in modified Harris Hip Score (P = .002), 22-point increase in Nonarthritic Hip Score (P < .001), 25.4-point increase in Hip Outcome Score-Sports Specific Subscale (P = .003), and a 2.9-point decrease in visual analog scale pain ratings (P < .001). Mean patient satisfaction was 7.1 out of 10. In the nested matched-pair analysis, 17 patients who underwent PLRECON were matched to a control group of 51 patients who underwent PLREPAIR. PLRECON demonstrated comparable survivorship and comparable improvements in all PROs with the exception of patient satisfaction (6.7 vs 8.5, P = .04). CONCLUSION: Hip arthroscopy with segmental labral reconstruction resulted in significant improvement in PROs at minimum 5-year follow-up. PLRECON reached comparable functional outcomes when compared with a benchmark PLREPAIR control group but demonstrated lower patient satisfaction at latest follow-up.

Do Larger Acetabular Chondral Defects Portend Inferior Outcomes in Patients Undergoing Arthroscopic Acetabular Microfracture? A Matched-Controlled Study.

PURPOSE: To elucidate the effect, if any, of acetabular chondral defect size on surgical outcomes after arthroscopic microfracture was performed with concomitant treatment for labral tears and femoroacetabular impingement (FAI) syndrome. METHODS: The study period was between February 2008 and November 2014. Data were collected on patients who underwent hip arthroscopy. The inclusion criteria were acetabular microfracture; concomitant treatment for labral tears and FAI syndrome; and preoperative modified Harris Hip Score, Nonarthritic Hip Score, Hip Outcome Score-Sports Specific Subscale, and visual analog scale. Exclusion criteria were Workers' Compensation, preoperative Tönnis grade >1, or previous ipsilateral hip surgeries or conditions. Patients were grouped based on smaller chondral defects (SCDs) or larger chondral defects (LCDs), then matched 1:1 by age at surgery ±10 years, sex, body mass index ±5, labral treatment, capsular treatment, acetabuloplasty, and femoroplasty. Outcomes, secondary arthroscopies, and conversions to total hip arthroplasty (THA) were documented. RESULTS: Of 131 eligible cases, 107 (81.7%) had minimum 2-year follow-up. Before matching, the conversion rate to THA was higher for LCDs (24.6%) than for SCDs (12.0%). Thirty-five patients were matched for each group. Mean follow-up time was 47.9 months (range, 24.0, 84.1) for the matched LCD group and 46.1 months (range, 24.0, 88.1) for the matched SCD group. Ligamentum teres debridement (P = .03) was performed more frequently in the LCD group. No other differences were found regarding demographics, intraoperative findings, procedures, traction time, preoperative scores, or follow-up scores. Both groups demonstrated significant improvements in all scores. Rates of revision or conversion to THA were similar between groups. The relative risk for conversion to THA was 2.33 for patients with defects ≥300 mm2 compared with patients with defects ≤250 mm2 (P = .13). Deep vein thrombosis occurred in 3 (5.3%) patients with LCDs. CONCLUSIONS: Matched patients with either SCDs or LCDs undergoing arthroscopic acetabular microfracture with concomitant treatment for labral tears and FAI syndrome demonstrated similar improvements at minimum 2-year follow-up. Patients with chondral defects approaching 300 mm2 or greater may have a higher propensity toward conversion to THA. LEVEL OF EVIDENCE: Level III, retrospective comparative therapeutic trial.