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Background: Compromise of the acetabular labrum can lead to pain and loss of critical intra-articular fluid pressure. Revision labral preservation poses unique challenges due to adhesions and compromised tissue quality. Purpose/Hypothesis: The purpose of the study was to evaluate patient-reported outcome (PRO) measures (PROMs) in patients undergoing revision hip arthroscopy with either labral reconstruction or labral repair after primary hip arthroscopy for labral tear. It was hypothesized that both procedures would lead to improved PROs. Study Design: Systematic review; Level of evidence, 4. Methods: A systematic review of the literature was conducted with the following keywords: (revision) AND (hip OR femoroacetabular impingement) AND (arthroscop*) AND (reconstruction OR repair) in PubMed, Cochrane, and Scopus in August 2023 using the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) criteria, yielding 2002 initial records. Only studies comparing PROMs between revision labral reconstruction or revision labral repair after primary hip arthroscopy for labral tear were included. Background article information was recorded, including article title, author, study design, level of evidence, patient demographics, radiographic information, intraoperative data, PROMs, psychometric thresholds, and secondary surgeries. Secondary surgery in our study was defined as any open or arthroscopic hip surgery secondary to the initial revision surgery. Forest plots were created for pre- and postoperative outcomes present in ≥3 studies. Heterogeneity was calculated using I 2 values. Results: Four studies, including 215 revision labral reconstructions and 115 revision labral repairs of the hips, were included in this systematic review. All studies were level 3 evidence, and study periods ranged between 2009 and 2019. Mean follow-up for the reconstruction and repair groups ranged from 26.3 to 36.6 months and 30.7 to 56.4 months, respectively. The mean age for the reconstruction and repair groups varied between 27 to 34.6 years and 27.5 to 30 years, respectively. Mean postoperative modified Harris Hip Scores for the reconstruction and repair cohorts ranged from 72.0 to 81.2 and 70.8 to 84.1, respectively (I 2 = 0%). Mean visual analog scale for pain scores for the reconstruction and repair cohorts ranged from 3 to 3.5 and 2.3 to 3.9 (I 2 = 33%). Overall secondary surgery rates ranged from 10.0% to 26.7% in the labral reconstruction cohort, compared with 10.0% to 50.0% in the labral repair cohort. One study reported superior outcomes in the revision labral repair group, with 3 studies finding no statistically significant difference in outcomes between the groups. Conclusion: Our systematic review showed that patients undergoing revision hip arthroscopy with labral reconstruction demonstrated significant improvement in postoperative outcome measures. Postoperative outcomes were similar to those of a benchmark control group of patients undergoing revision hip arthroscopy and labral repair. Labral reconstruction in the revision setting appears to be an effective treatment in clinically indicated patients.
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PURPOSE: To systematically investigate the outcomes of patients who underwent autologous matrix-induced chondrogenesis (AMIC) during hip arthroscopy for the treatment of acetabular chondral lesions due to femoroacetabular impingement syndrome. METHODS: PubMed and Cochrane were queried in June 2022 to conduct this systematic review using the following keywords: "femoroacetabular impingement," "arthroscopy," "microfracture," and "autologous matrix-induced chondrogenesis." Articles were included if they reported on patient-reported outcomes of AMIC during hip arthroscopy to treat chondral lesions of the hip. The review adhered to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses criteria. Each study was queried for demographics, lesion classification, surgical treatment, patient-reported outcome scores, revision arthroscopy, and conversion to total hip arthroplasty (THA). A qualitative subanalysis was performed to compare patients undergoing AMIC to patients undergoing microfracture alone if included studies also assessed results of microfracture alone. RESULTS: Four studies met inclusion criteria and assessed 209 hips undergoing AMIC. The included studies consisted of 99 male and 110 female patients. Mean postoperative follow-up ranged from 1 to 8 years, and mean patient age ranged from 34.3 to 45 years. Three of the 4 included studies reported the modified Harris Hip Score, and all 3 of these studies reported statistically significant improvement in the modified Harris Hip Score at final follow-up (P < .001) with mean preoperative values ranging from 44.5 to 62.8 and mean postoperative values ranging from 78.8 to 95.8. Two of the 4 studies compared patients treated with AMIC to microfracture alone. In these 2 studies, the AMIC groups reported 0 patients converting to THA while the microfracture-alone groups reported a highly variable rate of conversion to THA (2%-32.6%). CONCLUSIONS: Patients who underwent hip arthroscopy and AMIC for the treatment of femoroacetabular impingement syndrome and acetabular chondral lesions demonstrated improved patient-reported outcomes and low rates of secondary surgeries at short-term follow-up. STUDY DESIGN: Level IV, systematic review of Level III and IV studies.
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PURPOSE: The internet provides access to a myriad of educational health-related resources which are an invaluable source of information for patients. Lower back pain is a common complaint that is discussed extensively online. In this article, we aim to determine if the most commonly accessed articles about lower back pain imaging use language that can be understood by most patients. According to the American Medical Association (AMA) and National Institute of Health (NIH), this corresponds to a sixth-grade reading level. METHODS: Online searches were conducted from the most commonly used search engine, Google, to assess the present state of readability on radiograph imaging for LBP. Then the top 20 populated URL links from each search were utilized based on "health & fitness" search trends and click-through rates (CTRs). The readability of various websites was evaluated with WebFX online software that analyzed the unique websites' text when put into reader view on Firefox web browser version 116.0.3 (64-bit). Evaluation occurred via five common readability indices: the Automated Readability Index (ARI), the Coleman Liau Index (CLI), the SMOG index, the Gunning Fog Score Index (GFSI), and the Flesch Kincaid Grade Level Index (FKGLI). In addition, the Flesch Kincaid Reading Ease Index (FKREI) was also used but was excluded from the calculation due to its measuring scale outside of US grade levels. The number of samples was analyzed via health and fitness-specific CTR from an open-access database from July 2022 to July 2023. This was used to calculate the number of persons clicking and visiting positional URLs (first URL to the 20th URL) from each unique keyword search and the rational criteria for selecting the first 20 websites for each query. RESULTS: Online material that included LBP imaging information was calculated to have an overall readability score of 10.745 out of the 23 websites obtained from unique searches. The range was a mean readability score of 8 to 14. Notably, 17 websites were excluded from a total of 40 websites due to duplication of the same data (URLs that resulted from both unique searches) and accessibility requiring payment (specifically, an UpToDate link). A readability score of 10.745 refers to an 11th-grade reading level. That is to say, the most commonly visited sites on Google that contain information about lower back pain imaging are, on average, five grade levels higher than the sixth-grade reading level recommended by the AMA and the NIH. CONCLUSIONS: Most internet content regarding lower back pain imaging is written at a reading level that is above the recommended limit defined by the AMA and NIH. To improve education about lower back pain imaging and the patient-physician relationship, we recommend guiding patients to online material that contains a reading level at the sixth-grade level as suggested by the AMA and NIH.
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Levothyroxine (LT) is the synthetic form of thyroxine (T4), a thyroid hormone analog used to treat hypothyroidism. LT overdose rarely results in severely poor outcomes. General guidelines for treating exogenous thyrotoxicosis depend on the severity of symptoms. There is no standardized protocol; however, drug discontinuation, beta-blockers (specifically propranolol), and cholestyramine effectively manage overdose when needed, with most cases resolving independently without medical intervention. Here, we present the case of a 26-year-old female with a history of supraventricular tachycardia, anxiety, depression, and Hashimoto thyroiditis who was accidentally overprescribed LT (300 mcg for one and a half months) that resulted in symptoms of lethargy, tremors, body temperature dysregulation, orthostatic hypotension, and diarrhea. This case, with limited evidence, suggests that excessive LT exacerbated the patient's underlying psychiatric symptoms, encouraging suicidal ideation.