Hospital outcomes of scoliosis surgery in children with Prader-Willi Syndrome: comparison with adolescent idiopathic scoliosis.

PURPOSE: The purpose of this study was to evaluate the peri-operative outcomes of patients with Prader-Willi Syndrome (PWS) undergoing spinal deformity correction and compare the outcomes to patients with adolescent idiopathic scoliosis (AIS). METHODS: A retrospective review of the Kid's Inpatient Database was performed from 2000 to 2012 to identify all pediatric patients with scoliosis undergoing spinal fusion. Cohorts were created on the basis of PWS diagnosis and adolescent idiopathic scoliosis. Statistical analysis was performed for differences in post-operative outcomes between these two patient cohorts. RESULTS: Between 2000 and 2012, the number of spinal fusions performed increased by 24.6 and 32.2% in the PWS and adolescent idiopathic scoliosis populations, respectively. There was no difference between the incidence of major complications in PWS patients when compared to AIS (1.7% vs. 1.0% in idiopathic scoliosis; p = 0.362). Although there was no significant difference in the rate of overall minor complications, PWS patients were demonstrated to be more likely to experience post-operative pneumonia (p < 0.0001) and implant complications (p < 0.001). CONCLUSION: Patients with scoliosis associated with PWS do not have any increased risk of major complications following spinal deformity correction when compared to patients with adolescent idiopathic scoliosis. Two important minor complications to keep in mind when surgically treating scoliosis in PWS patients include pulmonary and implant-related complications. LEVEL OF EVIDENCE: Retrospective comparative study, Level III.

When Do Patients Improve After Hip Arthroscopy for Femoroacetabular Impingement? A Prospective Cohort Analysis.

BACKGROUND: Hip arthroscopy for femoroacetabular impingement (FAI) has been shown to improve patient outcomes, especially for returning to sport. Although previous studies often evaluated outcomes 2 years after hip arthroscopy, there has been no analysis of the progression of patient improvement over time or with respect to achieving the minimal clinically important difference (MCID). HYPOTHESIS/PURPOSE: The purpose was to prospectively evaluate changes in patient-reported outcome (PRO) scores during the first 2 years after hip arthroscopy for FAI and to analyze when the MCID is achieved. It was hypothesized that clinically significant changes will be reached by 1 year after surgery. STUDY DESIGN: Case series; Level of evidence, 4. METHODS: Patients undergoing hip arthroscopy for FAI were prospectively enrolled, and they completed the 12-Item Short Form Health survey (SF-12), modified Harris Hip Score, and Hip disability and Osteoarthritis Outcome Score (HOOS) at preoperative baseline and 3 months, 6 months, 1 year, and 2 years after surgery. Mean scores and the percentage of patients reaching the MCID at each time point were analyzed via analysis of variance and Cochrane-Armitage trend tests. RESULTS: A total of 129 hips from 122 patients were evaluated, revealing significant improvements after hip arthroscopy for FAI (PRO scores increased 19 to 45 points) with 95.8%, 93.6%, and 84.8% of patients achieving the MCID for HOOS-Sports, HOOS-Quality of Life (QoL), and HOOS-Pain, respectively, at 2-year follow-up. Analysis of PRO change showed that for all scores, the greatest improvement occurred from presurgery to postoperative 3 months, with lesser improvements at subsequent 6-month, 1-year, and 2-year time points ( P < .001). The SF-12 physical component score, HOOS-Sports, and HOOS-QoL continued to show statistically significant improvements through 2 years, while other scores plateaued after 3 months. The percentage of patients achieving the MCID for HOOS-Sports, HOOS-QoL, and HOOS-Pain continued to increase over 2 years, but the percentage achieving the MCID did not increase after 3 months for all other scores. CONCLUSION: Hip arthroscopy for FAI yields significant improvements in patient outcomes within 2 years of surgery. The majority of improvement occurs within 3 months after surgery, but certain outcomes, such as returning to sport, QoL, and pain, can continue to improve through 2 years.