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International trends in arthroscopic hip preservation surgery-are we treating the same patient?

ABSTRACT: The goal of this study was to perform a systematic review and meta-analysis of the entire arthroscopic hip preservation literature to answer the question, 'Across the world, are we treating the same patient?' There are significant differences in arthroscopic hip preservation publications, subjects and techniques based on both continent and country published. A systematic review was registered with PROSPERO and performed with PRISMA guidelines using three publicly available databases. Therapeutic clinical outcome investigations reporting arthroscopic hip preservation were eligible for inclusion. All study, subject and surgical technique demographics were analyzed and compared between continents and countries. Statistics were calculated using Student's t-tests, one-way analysis of variance, chi-squared and two-proportion Z-tests. There were 134 studies included in the analysis (10?752 subjects; 11?007 hips; 51% female; mean 37.6 years of age; mean 27.2 months length of follow-up), which had a low Modified Coleman Methodology Score (mean 32.4; poor). North America published the largest number of studies (58%) and the most subjects (55%) and hips (56%). Australia (22%) and Europe (18%) operated on subjects with some amount of osteoarthritis most commonly. North America (2.7%) and Europe (2.0%) operated on subjects with dysplasia or borderline dysplasia most commonly. The Modified Harris Hip Score was the most frequently utilized outcome score (24% of studies). The quantity and quality of arthroscopic hip preservation literature is significantly increasing with time. Several significant differences in study, subject and surgical technique demographics between continents and countries were identified. Deficiencies in use of clinical outcome scores and definitions of treated pathologies preclude complete subject comparisons and serve as an impetus for future study quality improvements.

SUBMITTER: Erickson BJ

PROVIDER: S-EPMC4718469 | biostudies-literature | 2015 Jan

REPOSITORIES: biostudies-literature

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International trends in arthroscopic hip preservation surgery-are we treating the same patient?

Erickson Brandon J BJ Cvetanovich Gregory L GL Frank Rachel M RM Bhatia Sanjeev S Bush-Joseph Charles A CA Nho Shane J SJ Harris Joshua D JD

Journal of hip preservation surgery 20150101 1

The goal of this study was to perform a systematic review and meta-analysis of the entire arthroscopic hip preservation literature to answer the question, 'Across the world, are we treating the same patient?' There are significant differences in arthroscopic hip preservation publications, subjects and techniques based on both continent and country published. A systematic review was registered with PROSPERO and performed with PRISMA guidelines using three publicly available databases. Therapeutic ...[more]

PMID: 27011812

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Project description:PurposeTo identify and evaluate techniques used for postless hip arthroscopy.MethodsA narrative review was performed using Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines to identify surgical technique articles or clinical studies describing techniques for the use of postless hip arthroscopy. Specific items sought for analysis included hip arthroscopy for femoroacetabular impingement including cam or pincer-type lesions, surgical time, traction time, traction force, bed Trendelenburg angle, intraoperative techniques, and postoperative outcomes, including complications. Exclusion criteria included any postless techniques used for open hip surgeries such as periacetabular osteotomy, sports hernia, peritrochanteric work, gluteus medius repair, ischiofemoral impingement, hamstring repair, or need for intraoperative conversion from postless to posted technique.ResultsTen studies (1 Level III, 3 Level IV, 6 Level V), published from 2007 to 2021, were analyzed (1,341 hips, 51.5% male, mean age ranged from 16.0 to 66.0 years). In 4 studies, Trendelenburg position with a foam pad (The Pink Pad; Xodus Medical, Inc.) was used at 5 to 20°. Six of 10 studies contained no clinical results. The average traction force and time ranged from 65.0 to 88 pounds and 31.0 to 73.5 minutes, respectively. The remaining studies used the yoga mat technique, the Tutankhamun technique, the beanbag technique, and the Hip Arthroscopy Post-less Procedure Impingement technique. There was only one incident of pudendal neurapraxia, which resolved spontaneously at 6 weeks without complication. Sufficient distraction was able to be obtained using postless traction in all cases.ConclusionsPostless hip arthroscopy may adequately be performed with a variety of techniques. Obtaining adequate traction and countertraction may be achieved through these postless methods.Clinical relevanceGiven the potential serious complications that may result from use of a perineal post, it is important for surgeons to be aware of postless techniques that may be used effectively for hip arthroscopy.

Project description:PurposeTo identify postoperative complications and risk factors associated with hip fracture and dislocation following primary arthroscopic surgical management of femoroacetabular impingement (FAI) syndrome.MethodsMarketScan was queried to identify patients who underwent FAI surgery from 2007 to 2016. Patients were stratified into 2 groups: acetabuloplasty only or femoroplasty only. A subanalysis of combined acetabuloplasty and femoroplasty also was undertaken. Surgical outcomes were followed postoperatively for 180 days. Multivariate logistic regression was used to control for with an alpha value of 0.05 set as significant.ResultsThis study identified 13,809 patients (mean age, 36.3 years) who underwent primary acetabuloplasty or femoroplasty. We also identified 10,026 patients who underwent both procedures. Postoperative complication rates were similar between the cohorts (acetabuloplasty 17.1%, femoroplasty 19.9%, P = .0622). Rates of hip fracture (femoroplasty: 2.4% vs acetabuloplasty: 2.0%, P = .0302) and heterotopic ossification (femoroplasty: 11.3% vs acetabuloplasty: 8.8%, P < .0001) were greater in the femoroplasty-only cohort. Combined acetabuloplasty and femoroplasty was associated with the greatest complication burden of 21.6% (P < .0001). After multivariate regression, differences in age, sex, comorbid status, or procedure type did not influence odds in risk for postoperative hip dislocation. Adjusted data showed that neither femoroplasty nor acetabuloplasty influenced odds of hip fracture (P > .05). Patients who were aged younger than 20 years old were significantly less likely to fracture their hips postoperatively than patients aged 60+ years (odds ratio 0.3, 95% confidence interval 0.1-0.8). Hypertension was independently associated with increased odds of hip fracture (odds ratio 1.7, 95% confidence interval 1.2-3.5).ConclusionsOlder age, male sex, and hypertension all carry increased risk for a hip fracture following acetabuloplasty or femoroplasty. Patient- and procedure-specific factors that could be assessed with this database did not influence risk for hip dislocation.Level of evidenceLevel III; retrospective comparative observation trial.

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International trends in arthroscopic hip preservation surgery-are we treating the same patient?

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International trends in arthroscopic hip preservation surgery-are we treating the same patient?

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