Thomas J. W., Kay S Jones, Nicole Dwyer, Amy M McManus, Ellen B Byrd, Wallace L Freeman
The purpose of this study is to compare general anesthesia (GA) to spinal anesthesia (SA) for hip arthroscopy, based on measurable perioperative parameters. The pandemic signaled a change from GA to SA, and thus a retrospective review was performed of the first 120 consecutive SA cases compared to the last 120 GA cases prior to the pandemic. Demographic data included age, sex, BMI, preop narcotic usage and procedure performed. The groups were compared for post-anesthesia care unit length of stay, entry and discharge visual analog scale (VAS) scores, morphine mg equivalent usage, need for regional blocks and untoward events. Additionally, the length of time from entry to the operating room until completion of induction anesthesia was compared. Demographically, the groups were virtually identical. SA used significantly less morphine mg equivalent (6.0 versus 8.1; P = 0.005), had more needing no narcotics (17 versus 7; P = 0.031), fewer requiring blocks (1 versus 14; P = 0.001) and lower entry VAS scores (5.2 versus 6.2; P = 0.003). Five early SA patients required catheterization for urinary retention, and this was avoided later in the study by having patient void on call to operating room and avoiding anticholinergic agents. Completion of induction anesthesia was 0.8 min longer for SA. Hip arthroscopy can be effectively performed with either GA or SA. SA results in statistically significant better post-anesthesia care unit pain control, reflected by lower entry VAS, less need for narcotics and fewer requiring regional blocks compared to GA. Urinary retention, a potential problem of SA, is minimized with routine precautions.
本研究的目的是根据围手术期的可测量参数，比较髋关节镜手术中的全身麻醉（GA）和脊髓麻醉（SA）。大流行标志着从GA到SA的转变，因此我们对前120例连续SA病例与大流行前最后120例GA病例进行了回顾性回顾。人口统计学数据包括年龄、性别、体重指数、术前麻醉剂使用情况和所实施的手术。比较了两组患者在麻醉后护理病房的住院时间、入院和出院时的视觉模拟量表（VAS）评分、吗啡毫克当量用量、区域阻滞需求和意外事件。此外，还比较了从进入手术室到完成诱导麻醉的时间长度。从人口统计学角度来看，两组患者几乎完全相同。SA 组使用的吗啡毫克当量（6.0 对 8.1；P = 0.005）明显较少，不需要麻醉药的人数较多（17 对 7；P = 0.031），需要阻滞的人数较少（1 对 14；P = 0.001），入院时的 VAS 评分较低（5.2 对 6.2；P = 0.003）。五名早期 SA 患者因尿潴留需要导尿，通过让患者在手术室呼叫时排尿并避免使用抗胆碱能药物，在研究后期避免了这一情况的发生。SA患者完成诱导麻醉的时间延长了0.8分钟。使用 GA 或 SA 均可有效地进行髋关节镜手术。与GA相比，SA对麻醉后护理单元疼痛的控制在统计学上有明显的改善，这体现在较低的入室VAS、较少的麻醉药需求和较少的区域阻滞需求。尿潴留是 SA 的一个潜在问题，通过常规预防措施可将其降到最低。
{"title":"Spinal versus general anesthesia for hip arthroscopy—a pandemic (COVID) and epidemic (opioid) driven study","authors":"Thomas J. W., Kay S Jones, Nicole Dwyer, Amy M McManus, Ellen B Byrd, Wallace L Freeman","doi":"10.1093/jhps/hnae009","DOIUrl":"https://doi.org/10.1093/jhps/hnae009","url":null,"abstract":"The purpose of this study is to compare general anesthesia (GA) to spinal anesthesia (SA) for hip arthroscopy, based on measurable perioperative parameters. The pandemic signaled a change from GA to SA, and thus a retrospective review was performed of the first 120 consecutive SA cases compared to the last 120 GA cases prior to the pandemic. Demographic data included age, sex, BMI, preop narcotic usage and procedure performed. The groups were compared for post-anesthesia care unit length of stay, entry and discharge visual analog scale (VAS) scores, morphine mg equivalent usage, need for regional blocks and untoward events. Additionally, the length of time from entry to the operating room until completion of induction anesthesia was compared. Demographically, the groups were virtually identical. SA used significantly less morphine mg equivalent (6.0 versus 8.1; P = 0.005), had more needing no narcotics (17 versus 7; P = 0.031), fewer requiring blocks (1 versus 14; P = 0.001) and lower entry VAS scores (5.2 versus 6.2; P = 0.003). Five early SA patients required catheterization for urinary retention, and this was avoided later in the study by having patient void on call to operating room and avoiding anticholinergic agents. Completion of induction anesthesia was 0.8 min longer for SA. Hip arthroscopy can be effectively performed with either GA or SA. SA results in statistically significant better post-anesthesia care unit pain control, reflected by lower entry VAS, less need for narcotics and fewer requiring regional blocks compared to GA. Urinary retention, a potential problem of SA, is minimized with routine precautions.","PeriodicalId":48583,"journal":{"name":"Journal of Hip Preservation Surgery","volume":"33 1","pages":""},"PeriodicalIF":1.5,"publicationDate":"2024-03-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140311306","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Hip dysplasia in young adults is underdiagnosed and can cause pain and discomfort. Progression to osteoarthritis (OA) is common, necessitating total hip arthroplasty at an early age. When discovered early, symptomatic patients can be offered physiotherapy and/or hip-preserving surgery to alleviate pain and decrease the risk of early OA. A pilot project to screen radiograms for hip dysplasia was started across the Swedish region of Örebro Län in January 2019, comparing the incidence of dysplasia before and after initiation of the screening program. All elective conventional radiograms of the hip (age 12–44 years), requested by primary care physicians, were analyzed by consultant radiologists according to a pre-established algorithm to identify hip abnormalities. If the hip radiograms showed dysplastic changes, or other pathological signs, the radiologist advised referral to a specialized Youth Hip Clinic for further work-up and treatment. A total of 1056 radiograms were requested by clinicians during the study periods (601 and 455 during 2018 and 2020, respectively). A total of 457 trauma-related cases were excluded, resulting in 599 available for analysis (348 and 251 during 2018 and 2020, respectively). During 2018, 17 patients (4.9%) received the radiologic diagnosis of dysplasia, compared with 44 patients (17.5%) during 2020 (P < 0. 001). A three-fold increase of patients diagnosed with hip dysplasia was detected as a result of the implementation of the screening program. The advantage of screening is early referral to an orthopedic department for evaluation and consideration for physiotherapy and/or surgical intervention.
{"title":"A pilot screening project for the detection of hip dysplasia in young patients","authors":"Frederik Berstad Møse, Shahin Mohseni, Tomas Borg","doi":"10.1093/jhps/hnae010","DOIUrl":"https://doi.org/10.1093/jhps/hnae010","url":null,"abstract":"Hip dysplasia in young adults is underdiagnosed and can cause pain and discomfort. Progression to osteoarthritis (OA) is common, necessitating total hip arthroplasty at an early age. When discovered early, symptomatic patients can be offered physiotherapy and/or hip-preserving surgery to alleviate pain and decrease the risk of early OA. A pilot project to screen radiograms for hip dysplasia was started across the Swedish region of Örebro Län in January 2019, comparing the incidence of dysplasia before and after initiation of the screening program. All elective conventional radiograms of the hip (age 12–44 years), requested by primary care physicians, were analyzed by consultant radiologists according to a pre-established algorithm to identify hip abnormalities. If the hip radiograms showed dysplastic changes, or other pathological signs, the radiologist advised referral to a specialized Youth Hip Clinic for further work-up and treatment. A total of 1056 radiograms were requested by clinicians during the study periods (601 and 455 during 2018 and 2020, respectively). A total of 457 trauma-related cases were excluded, resulting in 599 available for analysis (348 and 251 during 2018 and 2020, respectively). During 2018, 17 patients (4.9%) received the radiologic diagnosis of dysplasia, compared with 44 patients (17.5%) during 2020 (P &lt; 0. 001). A three-fold increase of patients diagnosed with hip dysplasia was detected as a result of the implementation of the screening program. The advantage of screening is early referral to an orthopedic department for evaluation and consideration for physiotherapy and/or surgical intervention.","PeriodicalId":48583,"journal":{"name":"Journal of Hip Preservation Surgery","volume":"2 1","pages":""},"PeriodicalIF":1.5,"publicationDate":"2024-03-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140097330","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Lei Zhao, Molly Uchtman, Alexander Aretakis, Courtney Selberg, James J McCarthy, Patrick W Whitlock
Stainless-steel screws are commonly used for fragment fixation during periacetabular osteotomy (PAO) at our institutions. Titanium is reserved for patients with documented nickel allergies. Titanium screws possess a significantly lower Young’s modulus than stainless steel and, therefore, potentially less resistance to physiologic loading. Thus, we hypothesized that the use of titanium screws might be associated with changes in acetabular correction prior to healing. The aim of this study was to compare the maintenance of acetabular correction following PAO using stainless-steel or titanium screws. A documented nickel allergy was confirmed with an allergy specialist. Patients’ age at surgery, gender and BMI were collected. The lateral center–edge angle of Wiberg (LCEA), medial center–edge angle (MCEA), anterior wall index (AWI), posterior wall index (PWI) and Tönnis angle were measured. The delta value for radiographic parameters was calculated as the difference between values immediately post-operation and at 6 months post-operation. Only age at surgery (P < 0.001) and the pre-operative LCEA (P = 0.013) were significantly different between groups (Tables I and II). The remaining pre- and post-operative radiological measurements were similar (Table II). Comparison of delta values at 6 months follow-up indicated no significant differences between screw types (Table III). No patients in the titanium group had a trans-iliac retrograde screw included in their construct (P = 0.003). All patients healed from their osteotomies. The use of titanium screws in patients with an allergy to nickel was not associated with differences in acetabular correction or the rate of osseous union rates despite its lower inherent mechanical properties.
{"title":"Maintenance of acetabular correction following PAO: a multicenter study comparing stainless-steel and titanium screws","authors":"Lei Zhao, Molly Uchtman, Alexander Aretakis, Courtney Selberg, James J McCarthy, Patrick W Whitlock","doi":"10.1093/jhps/hnae008","DOIUrl":"https://doi.org/10.1093/jhps/hnae008","url":null,"abstract":"Stainless-steel screws are commonly used for fragment fixation during periacetabular osteotomy (PAO) at our institutions. Titanium is reserved for patients with documented nickel allergies. Titanium screws possess a significantly lower Young’s modulus than stainless steel and, therefore, potentially less resistance to physiologic loading. Thus, we hypothesized that the use of titanium screws might be associated with changes in acetabular correction prior to healing. The aim of this study was to compare the maintenance of acetabular correction following PAO using stainless-steel or titanium screws. A documented nickel allergy was confirmed with an allergy specialist. Patients’ age at surgery, gender and BMI were collected. The lateral center–edge angle of Wiberg (LCEA), medial center–edge angle (MCEA), anterior wall index (AWI), posterior wall index (PWI) and Tönnis angle were measured. The delta value for radiographic parameters was calculated as the difference between values immediately post-operation and at 6 months post-operation. Only age at surgery (P &lt; 0.001) and the pre-operative LCEA (P = 0.013) were significantly different between groups (Tables I and II). The remaining pre- and post-operative radiological measurements were similar (Table II). Comparison of delta values at 6 months follow-up indicated no significant differences between screw types (Table III). No patients in the titanium group had a trans-iliac retrograde screw included in their construct (P = 0.003). All patients healed from their osteotomies. The use of titanium screws in patients with an allergy to nickel was not associated with differences in acetabular correction or the rate of osseous union rates despite its lower inherent mechanical properties.","PeriodicalId":48583,"journal":{"name":"Journal of Hip Preservation Surgery","volume":"26 1","pages":""},"PeriodicalIF":1.5,"publicationDate":"2024-02-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140003424","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Ali Parsa, Omkar N Prabhavalkar, Sheema Saeed, Julio Nerys-Figueroa, Andrew Carbone, Benjamin G Domb
Patient education is important as it gives patients a better understanding of the risks and benefits of medical and surgical interventions. Developing communication technologies have completely changed and enhanced patient access to medical information. The aim of this study was to evaluate available patient education materials (PEMs) regarding hip surgery on the websites of major hip societies and centers. The PEM from 11 selected leading hip centers and societies were evaluated with the following assessment tools: Flesch–Kincaid (FK) readability test, Flesch Reading Ease formula, Literature-Intelligence-Data-Analysis (LIDA) instrument and Discernibility Interpretability Sources Comprehensive Evidence Relevance Noticeable (DISCERN) tool. Videos were assessed using Patient Educational Video Assessment Tool (PEVAT). A total of 69 educational items, including 52 text articles (75.4%) and 17 videos (24.6%) were retrieved and evaluated. The median Interquartile Range (IQR) FK level of 52 text articles was 10.8 (2.2). The median (IQR) LIDA score of text articles by center was 45. According to the LIDA score, 60% of all website articles demonstrated high accessibility (LIDA score > 44). The median DISCERN score of text articles by center was 69. Overall, 52 (100%) of the text articles were deemed to be at ‘good’ quality rating or higher, and 23.2% (16 out of 69) of the articles had excellent quality. The mean PEVAT score for the 17 videos was 25 ± 1.9. Analysis of text and video articles from the 11 leading orthopedic surgery centers and societies demonstrated that by selecting a reliable source of information from main scientific societies and major centers in hip surgery, patients can find more accurate information regarding their hip conditions.
{"title":"Best practices on patient education materials in hip surgery based on learnings from major hip centers and societies","authors":"Ali Parsa, Omkar N Prabhavalkar, Sheema Saeed, Julio Nerys-Figueroa, Andrew Carbone, Benjamin G Domb","doi":"10.1093/jhps/hnae011","DOIUrl":"https://doi.org/10.1093/jhps/hnae011","url":null,"abstract":"Patient education is important as it gives patients a better understanding of the risks and benefits of medical and surgical interventions. Developing communication technologies have completely changed and enhanced patient access to medical information. The aim of this study was to evaluate available patient education materials (PEMs) regarding hip surgery on the websites of major hip societies and centers. The PEM from 11 selected leading hip centers and societies were evaluated with the following assessment tools: Flesch–Kincaid (FK) readability test, Flesch Reading Ease formula, Literature-Intelligence-Data-Analysis (LIDA) instrument and Discernibility Interpretability Sources Comprehensive Evidence Relevance Noticeable (DISCERN) tool. Videos were assessed using Patient Educational Video Assessment Tool (PEVAT). A total of 69 educational items, including 52 text articles (75.4%) and 17 videos (24.6%) were retrieved and evaluated. The median Interquartile Range (IQR) FK level of 52 text articles was 10.8 (2.2). The median (IQR) LIDA score of text articles by center was 45. According to the LIDA score, 60% of all website articles demonstrated high accessibility (LIDA score &gt; 44). The median DISCERN score of text articles by center was 69. Overall, 52 (100%) of the text articles were deemed to be at ‘good’ quality rating or higher, and 23.2% (16 out of 69) of the articles had excellent quality. The mean PEVAT score for the 17 videos was 25 ± 1.9. Analysis of text and video articles from the 11 leading orthopedic surgery centers and societies demonstrated that by selecting a reliable source of information from main scientific societies and major centers in hip surgery, patients can find more accurate information regarding their hip conditions.","PeriodicalId":48583,"journal":{"name":"Journal of Hip Preservation Surgery","volume":"48 1","pages":""},"PeriodicalIF":1.5,"publicationDate":"2024-02-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140003696","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Michael D Harris, Brecca M.M Gaffney, John C Clohisy, Cecilia Pascual-Garrido
Femoral deformities are common in developmental dysplasia of the hip (DDH), but decisions about how to treat them are not standardized. Of interest are deformities that may be akin to cam femoroacetabular impingement (FAI). We used three-dimensional and two-dimensional measures to clarify the similarities and differences in proximal femur shape variation among female patients with DDH (n = 68) or cam FAI (n = 60). Three-dimensional measures included femoral head asphericity, as well as shape variation using statistical shape modeling and principal component analysis (PCA). Two-dimensional measures included the α-angle, head–neck offset (HNO) and the neck–shaft angle (NSA). Significant shape variations were captured in the first five PCA modes, with the greatest shared variation between groups being the length from the lesser trochanter to the femoral head and greater trochanter height. Variations unique to DDH were irregularities at different areas of the femoral head, but not at the lateral femoral head–neck junction where variation was strong in FAI. The FAI group also had unique variations in greater trochanter shape. DDH femoral heads were less spherical, as indicated by larger sphere-fitting errors (P < 0.001). Radiographically, the DDH group had significantly smaller α-angles (P < 0.001), larger head–neck offsets (P = 0.02) and larger NSAs (P < 0.001). Both the articular and extra-articular regions of the proximal femur have distinct shape features in DDH and cam FAI that can uniquely affect the biomechanics of each disorder. Accordingly, approaches to addressing each disorder should be unique.
{"title":"Femurs in patients with hip dysplasia have fundamental shape differences compared with cam femoroacetabular impingement","authors":"Michael D Harris, Brecca M.M Gaffney, John C Clohisy, Cecilia Pascual-Garrido","doi":"10.1093/jhps/hnae004","DOIUrl":"https://doi.org/10.1093/jhps/hnae004","url":null,"abstract":"Femoral deformities are common in developmental dysplasia of the hip (DDH), but decisions about how to treat them are not standardized. Of interest are deformities that may be akin to cam femoroacetabular impingement (FAI). We used three-dimensional and two-dimensional measures to clarify the similarities and differences in proximal femur shape variation among female patients with DDH (n = 68) or cam FAI (n = 60). Three-dimensional measures included femoral head asphericity, as well as shape variation using statistical shape modeling and principal component analysis (PCA). Two-dimensional measures included the α-angle, head–neck offset (HNO) and the neck–shaft angle (NSA). Significant shape variations were captured in the first five PCA modes, with the greatest shared variation between groups being the length from the lesser trochanter to the femoral head and greater trochanter height. Variations unique to DDH were irregularities at different areas of the femoral head, but not at the lateral femoral head–neck junction where variation was strong in FAI. The FAI group also had unique variations in greater trochanter shape. DDH femoral heads were less spherical, as indicated by larger sphere-fitting errors (P &lt; 0.001). Radiographically, the DDH group had significantly smaller α-angles (P &lt; 0.001), larger head–neck offsets (P = 0.02) and larger NSAs (P &lt; 0.001). Both the articular and extra-articular regions of the proximal femur have distinct shape features in DDH and cam FAI that can uniquely affect the biomechanics of each disorder. Accordingly, approaches to addressing each disorder should be unique.","PeriodicalId":48583,"journal":{"name":"Journal of Hip Preservation Surgery","volume":"16 1","pages":""},"PeriodicalIF":1.5,"publicationDate":"2024-02-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139750577","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Grant H Cabell, Nicholas F Kwon, Christopher Shultz, Carolyn A Hutyra, Brian D Lewis, Steven A Olson, Michael J Salata, Shane J Nho, Richard C Mather III
Decision-making regarding surgical treatment of patients showing radiographic evidence of femoroacetabular impingement syndrome (FAIS) in the setting of borderline hip dysplasia (BHD) remains a challenge as there is no consensus on treatment in current literature. When medical evidence is unclear, understanding patient preferences becomes particularly important in deciding the optimal treatment for each patient. The purpose of this study was to measure the patient-determined importance of factors surrounding surgical treatment of FAIS in BHD. Patients aged 18–65 with hip pain and BHD (defined as lateral center edge angle 18–25 or Tonnis angle 10–15) morphology were given a discrete-choice experiment (DCE) focusing on attributes that differ between treatment options: Length of Hospital Stay, Major Complication Rate, Chance of Needing Reoperation within 2 Years and Time to Return to Regular Exercise. This DCE was used to calculate treatment preferences, relative attribute importance and preference weights. A total of 101 patients fully completed the DCE. The most important attribute (average importance weight, 95% CI) was Chance of Reoperation (60.16, 56.99–63.34), while the least important was Hospital Stay (6.57, 5.73–7.41). Only 6 Months to Resume Regular Exercise and 2% Chance of Reoperation (P < 0.05) significantly impacted treatment choice. When presented with fixed choice parameters, 50.5% of subjects preferred PAO and arthroscopy while 49.5% opted for arthroscopy alone. When no clear surgical treatment is indicated, patient preferences have an amplified role in patient decision-making. Our results confirm variation in attribute importance within treatments as well as treatment choice, highlighting the importance in understanding patient preferences in decision-making for FAIS in BHD. More patient-specific generalizable outcomes of surgical treatment options are needed in the literature.
{"title":"Decision-making in borderline hip dysplasia and concomitant femoracetabular impingement syndrome: using a discrete choice experiment to explore patient preferences","authors":"Grant H Cabell, Nicholas F Kwon, Christopher Shultz, Carolyn A Hutyra, Brian D Lewis, Steven A Olson, Michael J Salata, Shane J Nho, Richard C Mather III","doi":"10.1093/jhps/hnae002","DOIUrl":"https://doi.org/10.1093/jhps/hnae002","url":null,"abstract":"Decision-making regarding surgical treatment of patients showing radiographic evidence of femoroacetabular impingement syndrome (FAIS) in the setting of borderline hip dysplasia (BHD) remains a challenge as there is no consensus on treatment in current literature. When medical evidence is unclear, understanding patient preferences becomes particularly important in deciding the optimal treatment for each patient. The purpose of this study was to measure the patient-determined importance of factors surrounding surgical treatment of FAIS in BHD. Patients aged 18–65 with hip pain and BHD (defined as lateral center edge angle 18–25 or Tonnis angle 10–15) morphology were given a discrete-choice experiment (DCE) focusing on attributes that differ between treatment options: Length of Hospital Stay, Major Complication Rate, Chance of Needing Reoperation within 2 Years and Time to Return to Regular Exercise. This DCE was used to calculate treatment preferences, relative attribute importance and preference weights. A total of 101 patients fully completed the DCE. The most important attribute (average importance weight, 95% CI) was Chance of Reoperation (60.16, 56.99–63.34), while the least important was Hospital Stay (6.57, 5.73–7.41). Only 6 Months to Resume Regular Exercise and 2% Chance of Reoperation (P &lt; 0.05) significantly impacted treatment choice. When presented with fixed choice parameters, 50.5% of subjects preferred PAO and arthroscopy while 49.5% opted for arthroscopy alone. When no clear surgical treatment is indicated, patient preferences have an amplified role in patient decision-making. Our results confirm variation in attribute importance within treatments as well as treatment choice, highlighting the importance in understanding patient preferences in decision-making for FAIS in BHD. More patient-specific generalizable outcomes of surgical treatment options are needed in the literature.","PeriodicalId":48583,"journal":{"name":"Journal of Hip Preservation Surgery","volume":"245 1","pages":""},"PeriodicalIF":1.5,"publicationDate":"2024-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139677724","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
It is well known that increased posterior tilt of the pelvis is an effective strategy for avoiding impingement of the femur with the pelvis during movement. Daily repetitive collisions become mechanical loads, and the more frequently they occur, the more tissue damage and pain they cause. Therefore, reducing the rate of occurrence of impingement is important to avoid aggravation of symptoms. This study aimed to evaluate the effects of changes in posterior pelvic tilt on the risk of impingement between the femur and the anterior inferior iliac spine (AIIS)/subspine in various functional postures. Patients with femoroacetabular impingement syndrome (FAIS) who were candidates for hip arthroscopic osteochondroplasty between October 2013 and June 2020 were included. A three-dimensional reconstructed model was used to simulate the incidence of impingement at 12 hip positions required for activities of daily living. We predicted value of the spatial incidence of impingement assumed that hip motion should exceed 130/30 degrees without impingement. Impingement was measured at three pelvic positions: an anterior tilt of 10°, in the functional pelvic plane and a posterior tilt of 10°. Multivariate linear-mixed models were used to assess the effect of covariate-adjusted posterior pelvic tilt on the impingement incidence in the AIIS region. AIIS type, center-edge angle, acetabular version and femoral version were used as covariates. The impingement rates and locations of the three pelvic tilt postures were assessed. Seventy-eight patients (60 males and 18 females; average age, 46 ± 15.1 years) with FAIS were analyzed. A multivariate linear-mixed model revealed a coefficient of -0.8% (95% confidence interval -0.9 to -0.7%; P < 0.001) for posterior pelvic tilt. Thus, posterior pelvic tilt affects AIIS impingement incidence. After adjusting for anatomical effects, the posterior pelvic tilt should be addressed to avoid impingement.
{"title":"Multivariate linear-mixed analysis of changes in anterior inferior iliac spine impingement incidence with posterior pelvic tilt: a computer simulation study.","authors":"Emi Kamono, Naomi Kobayashi, Yuya Yamamoto, Yohei Yukizawa, Hideki Honda, Hyonmin Choe, Hiroyuki Ike, Ken Kumagai, Yutaka Inaba","doi":"10.1093/jhps/hnae003","DOIUrl":"10.1093/jhps/hnae003","url":null,"abstract":"<p><p>It is well known that increased posterior tilt of the pelvis is an effective strategy for avoiding impingement of the femur with the pelvis during movement. Daily repetitive collisions become mechanical loads, and the more frequently they occur, the more tissue damage and pain they cause. Therefore, reducing the rate of occurrence of impingement is important to avoid aggravation of symptoms. This study aimed to evaluate the effects of changes in posterior pelvic tilt on the risk of impingement between the femur and the anterior inferior iliac spine (AIIS)/subspine in various functional postures. Patients with femoroacetabular impingement syndrome (FAIS) who were candidates for hip arthroscopic osteochondroplasty between October 2013 and June 2020 were included. A three-dimensional reconstructed model was used to simulate the incidence of impingement at 12 hip positions required for activities of daily living. We predicted value of the spatial incidence of impingement assumed that hip motion should exceed 130/30 degrees without impingement. Impingement was measured at three pelvic positions: an anterior tilt of 10°, in the functional pelvic plane and a posterior tilt of 10°. Multivariate linear-mixed models were used to assess the effect of covariate-adjusted posterior pelvic tilt on the impingement incidence in the AIIS region. AIIS type, center-edge angle, acetabular version and femoral version were used as covariates. The impingement rates and locations of the three pelvic tilt postures were assessed. Seventy-eight patients (60 males and 18 females; average age, 46 ± 15.1 years) with FAIS were analyzed. A multivariate linear-mixed model revealed a coefficient of -0.8% (95% confidence interval -0.9 to -0.7%; <i>P</i> < 0.001) for posterior pelvic tilt. Thus, posterior pelvic tilt affects AIIS impingement incidence. After adjusting for anatomical effects, the posterior pelvic tilt should be addressed to avoid impingement.</p>","PeriodicalId":48583,"journal":{"name":"Journal of Hip Preservation Surgery","volume":"11 2","pages":"125-131"},"PeriodicalIF":1.4,"publicationDate":"2024-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11272635/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141789556","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Stephen D Bigach, Akshar P Thakkar, Lucas T Buchler, Michael B Ellman, Sanjeev Bhatia, Michael D Stover
This study aims to examine the trends and demographics of periacetabular osteotomy (PAO) in the United States from 2016 to 2020 using a large healthcare database analysis. The PearlDiver database was queried for patients who underwent a PAO procedure starting with current procedural terminology (CPT) codes 27299, S2115 and 27146. Subsequently, the population was filtered for patients being ages 12–50, having an inpatient charge-type and those having a length of stay of at least 1 day. Patients with total hip arthroplasty were filtered out, and the resulting population was filtered by ICD-10 diagnosis codes. The providers of each patient were also examined to ensure their history of treating hip dysplasia. Student t and multiple regression analysis tests were used for statistical comparisons and trends analysis (P < 0.05 reported as significant). A total of 535 consecutive patients were analyzed over the study period. There was a higher incidence of PAO in females compared with males (P < 0.001) and a higher incidence of PAO in patients aged 15–19 years compared with older age groups (P = 0.017). Within the first year after the index PAO, 171 of the 535 patients, almost one-third (32%), received a reoperation. Of the 171 reoperations, 115 were deep removal of implant, 55 were a hip arthroscopy and 1 patient had a bone excision for heterotopic ossification. Similar studies should be carried out using other large health databases to confirm the external validity of these trends and rates across the United States.
本研究旨在通过大型医疗保健数据库分析，研究 2016 年至 2020 年美国髋臼周围截骨术（PAO）的发展趋势和人口统计数据。研究人员从 PearlDiver 数据库中查询了接受 PAO 手术的患者，这些患者的当前手术术语（CPT）代码为 27299、S2115 和 27146。随后，筛选出年龄在 12-50 岁、住院费用类型和住院时间至少为 1 天的患者。过滤掉了全髋关节置换术患者，并根据 ICD-10 诊断代码过滤出了患者群体。此外，还对每位患者的医疗服务提供者进行了调查，以确保他们有治疗髋关节发育不良的历史。统计比较和趋势分析采用了学生 t 检验和多元回归分析检验（P < 0.05 为显著）。在研究期间，共对 535 名连续患者进行了分析。女性 PAO 发病率高于男性（P < 0.001），15-19 岁患者 PAO 发病率高于老年患者（P = 0.017）。在指数 PAO 后的第一年内，535 名患者中有 171 人（近三分之一（32%））接受了再次手术。在这 171 例再次手术中，115 例是深部移除植入物，55 例是髋关节镜手术，1 例患者因异位骨化进行了骨切除术。应利用其他大型健康数据库开展类似研究，以确认全美这些趋势和比率的外部有效性。
{"title":"Trends, demographics and reoperation rates of periacetabular osteotomy: an analysis from the PearlDiver database","authors":"Stephen D Bigach, Akshar P Thakkar, Lucas T Buchler, Michael B Ellman, Sanjeev Bhatia, Michael D Stover","doi":"10.1093/jhps/hnad040","DOIUrl":"https://doi.org/10.1093/jhps/hnad040","url":null,"abstract":"This study aims to examine the trends and demographics of periacetabular osteotomy (PAO) in the United States from 2016 to 2020 using a large healthcare database analysis. The PearlDiver database was queried for patients who underwent a PAO procedure starting with current procedural terminology (CPT) codes 27299, S2115 and 27146. Subsequently, the population was filtered for patients being ages 12–50, having an inpatient charge-type and those having a length of stay of at least 1 day. Patients with total hip arthroplasty were filtered out, and the resulting population was filtered by ICD-10 diagnosis codes. The providers of each patient were also examined to ensure their history of treating hip dysplasia. Student t and multiple regression analysis tests were used for statistical comparisons and trends analysis (P &lt; 0.05 reported as significant). A total of 535 consecutive patients were analyzed over the study period. There was a higher incidence of PAO in females compared with males (P &lt; 0.001) and a higher incidence of PAO in patients aged 15–19 years compared with older age groups (P = 0.017). Within the first year after the index PAO, 171 of the 535 patients, almost one-third (32%), received a reoperation. Of the 171 reoperations, 115 were deep removal of implant, 55 were a hip arthroscopy and 1 patient had a bone excision for heterotopic ossification. Similar studies should be carried out using other large health databases to confirm the external validity of these trends and rates across the United States.","PeriodicalId":48583,"journal":{"name":"Journal of Hip Preservation Surgery","volume":"23 1","pages":""},"PeriodicalIF":1.5,"publicationDate":"2024-01-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139556830","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Lissa Pacheco-Brousseau, Stéphane Poitras, Marc-Antoine Ricard, Koorosh Kashanian, Sasha Carsen, Geoffrey Wilkin, George Grammatopoulos, Paul E Beaulé
The association between preoperative pain catastrophizing and postoperative patient-reported outcome measures of patients with pre-arthritic hip disease was evaluated. All patients scheduled for joint-preserving surgeries of the hip (JPSH) at our institution were approached. Patient demographics (age, sex, body mass index (BMI)), pain intensity (Numeric Pain Scale (NPS)) and pain catastrophizing (Pain Catastrophizing Scale (PCS)) were collected preoperatively. Patient function (12-Item International Hip Outcome Tool (iHot-12)) and physical and mental health (Patient-Reported Outcomes Measurement Information System (PROMIS-10) mental/physical) were collected preoperatively, three-month and one-year postoperatively. The analysis consisted of multivariate linear regression models fitted for continuous scores of outcome measures at three-month and one-year. Correlation between preoperative PCS and iHot-12 was assessed using the Pearson correlation coefficient. A total of 274 patients completed the PCS and were included in the multivariate linear regression models. Most patients were females (66.8%), mean age was 33 (SD 9), mean BMI was 26.5 (SD 5.8) and most were diagnosed with femoro-acetabular impingement (46.0%) and underwent arthroscopy (77.0%). There were statistically significant correlations between PCS and iHot-12 (preoperatively −0.615, P < 0.001; three-month −0.242, P = 0.002). Statistically significant associations were found for function (three-month PCS P = 0.046, age P = 0.014, NPS P = 0.043; one-year BMI P = 0.005, NPS P = 0.014), physical health (three-month BMI, P = 0.002, NPS P = 0.008; one-year BMI P = 0.002, NPS P = 0.013) and mental health (three-month BMI P = 0.047; one-year BMI P = 0.030). There is an association between function and preoperative pain catastrophizing in patients with pre-arthritic hip disease undergoing JPSH. When considering confounding variables, preoperative pain catastrophizing is associated with short-term recovery.
本研究评估了关节炎前髋关节疾病患者术前疼痛灾难化与术后患者报告结果之间的关联。研究对象是本院所有计划接受髋关节保留手术（JPSH）的患者。术前收集了患者的人口统计学资料（年龄、性别、体重指数（BMI））、疼痛强度（数值疼痛量表（NPS））和疼痛灾难化（疼痛灾难化量表（PCS））。术前、术后三个月和一年的患者功能（12项国际髋关节结果工具（iHot-12））和身心健康（患者报告结果测量信息系统（PROMIS-10）心理/生理）数据均已收集。分析包括针对术后三个月和一年的结果测量连续得分的多变量线性回归模型。使用皮尔逊相关系数评估了术前 PCS 与 iHot-12 之间的相关性。共有 274 名患者完成了 PCS，并被纳入多元线性回归模型。大多数患者为女性（66.8%），平均年龄为 33 岁（SD 9），平均体重指数为 26.5（SD 5.8），大多数患者被诊断为股骨髋臼撞击症（46.0%），并接受了关节镜手术（77.0%）。PCS与iHot-12之间存在统计学意义上的显著相关性（术前-0.615，P < 0.001；三个月-0.242，P = 0.002）。在功能（三个月 PCS P = 0.046，年龄 P = 0.014，NPS P = 0.043；一年 BMI P = 0.005，NPS P = 0.014）、身体健康（三个月 BMI，P = 0.002，NPS P = 0.008；一年 BMI P = 0.002，NPS P = 0.013）和心理健康（三个月 BMI P = 0.047；一年 BMI P = 0.030）方面发现了具有统计学意义的关联。接受髋关节置换术前关节炎患者的功能与术前疼痛灾难化之间存在关联。考虑到混杂变量，术前疼痛灾难化与短期康复有关。
{"title":"The relationship of pain catastrophizing with postoperative patient-reported outcome measures in adults with pre-arthritic hip disease","authors":"Lissa Pacheco-Brousseau, Stéphane Poitras, Marc-Antoine Ricard, Koorosh Kashanian, Sasha Carsen, Geoffrey Wilkin, George Grammatopoulos, Paul E Beaulé","doi":"10.1093/jhps/hnad049","DOIUrl":"https://doi.org/10.1093/jhps/hnad049","url":null,"abstract":"The association between preoperative pain catastrophizing and postoperative patient-reported outcome measures of patients with pre-arthritic hip disease was evaluated. All patients scheduled for joint-preserving surgeries of the hip (JPSH) at our institution were approached. Patient demographics (age, sex, body mass index (BMI)), pain intensity (Numeric Pain Scale (NPS)) and pain catastrophizing (Pain Catastrophizing Scale (PCS)) were collected preoperatively. Patient function (12-Item International Hip Outcome Tool (iHot-12)) and physical and mental health (Patient-Reported Outcomes Measurement Information System (PROMIS-10) mental/physical) were collected preoperatively, three-month and one-year postoperatively. The analysis consisted of multivariate linear regression models fitted for continuous scores of outcome measures at three-month and one-year. Correlation between preoperative PCS and iHot-12 was assessed using the Pearson correlation coefficient. A total of 274 patients completed the PCS and were included in the multivariate linear regression models. Most patients were females (66.8%), mean age was 33 (SD 9), mean BMI was 26.5 (SD 5.8) and most were diagnosed with femoro-acetabular impingement (46.0%) and underwent arthroscopy (77.0%). There were statistically significant correlations between PCS and iHot-12 (preoperatively −0.615, P &lt; 0.001; three-month −0.242, P = 0.002). Statistically significant associations were found for function (three-month PCS P = 0.046, age P = 0.014, NPS P = 0.043; one-year BMI P = 0.005, NPS P = 0.014), physical health (three-month BMI, P = 0.002, NPS P = 0.008; one-year BMI P = 0.002, NPS P = 0.013) and mental health (three-month BMI P = 0.047; one-year BMI P = 0.030). There is an association between function and preoperative pain catastrophizing in patients with pre-arthritic hip disease undergoing JPSH. When considering confounding variables, preoperative pain catastrophizing is associated with short-term recovery.","PeriodicalId":48583,"journal":{"name":"Journal of Hip Preservation Surgery","volume":"23 1","pages":""},"PeriodicalIF":1.5,"publicationDate":"2024-01-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139509440","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Ricardo Ramón, Esteban Holguín, Manuel Ribas, Nihad Al Hussin, Marco Ezechieli
The coronavirus disease 2019 pandemic has significantly affected people worldwide. Herein, we present a case of massive heterotopic ossification (HO) of the right hip following severe SARS-CoV-2 infection. The exact origin of HO development is still unknown, but a critical illness, chronic immobilization and hypoxia are important risk factors. Considering the location and size of the HOs in this case, modified Ludloff’s medial approach of the hip was used. This approach allows for good exposure and access to the medial and inferior part of the hip joint and the successful extirpation of the pathologic tissue.
冠状病毒疾病 2019 年的大流行给全世界人民带来了重大影响。在此，我们介绍一例严重感染 SARS-CoV-2 后右侧髋关节大量异位骨化（HO）的病例。HO发生的确切原因尚不清楚，但危重疾病、长期固定和缺氧是重要的风险因素。考虑到该病例中 HO 的位置和大小，采用了改良的 Ludloff 髋关节内侧入路。这种方法可以很好地暴露和进入髋关节的内侧和下部，并成功地切除病变组织。
{"title":"Modified Ludloff’s medial approach for resection of heterotopic ossification of the hip following severe SARS-CoV-2 infection: a case report","authors":"Ricardo Ramón, Esteban Holguín, Manuel Ribas, Nihad Al Hussin, Marco Ezechieli","doi":"10.1093/jhps/hnad048","DOIUrl":"https://doi.org/10.1093/jhps/hnad048","url":null,"abstract":"The coronavirus disease 2019 pandemic has significantly affected people worldwide. Herein, we present a case of massive heterotopic ossification (HO) of the right hip following severe SARS-CoV-2 infection. The exact origin of HO development is still unknown, but a critical illness, chronic immobilization and hypoxia are important risk factors. Considering the location and size of the HOs in this case, modified Ludloff’s medial approach of the hip was used. This approach allows for good exposure and access to the medial and inferior part of the hip joint and the successful extirpation of the pathologic tissue.","PeriodicalId":48583,"journal":{"name":"Journal of Hip Preservation Surgery","volume":"12 1","pages":""},"PeriodicalIF":1.5,"publicationDate":"2024-01-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139373662","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
京公网安备 11010802042870号
京ICP备2023020795号-1
扫码关注我们
求助内容：
应助结果提醒方式：