Nho, Shane J.

Abstract Background Some studies have reported more severe chondral pathology and less successful hip arthroscopic outcomes in patients with acetabular subchondral cysts. Purpose The purpose of this study is to report multicenter arthroscopic outcomes of patients with and without acetabular bone cysts. Methods A multicenter matched-pair study was performed with data from a large prospectively collected database. Inclusion criteria were adult patients that had undergone primary unilateral hip arthroscopy for femoroacetabular impingement syndrome (FAIS). The study group was defined by the presence of a superolateral acetabular subchondral cyst on preoperative imaging with > 2mm minimum joint width. 1:1 matching on age, gender, Body Mass Index (BMI), lateral center-edge angle (LCEA), Alpha angle, and rendered arthroscopic treatments of femoroplasty, acetabuloplasty, and labral treatment (i.e., repair, reconstruction, or debridement). Beck chondral grade and minimum 2-year outcomes utilizing VAS for pain, iHOT-12, MCID, SBC, and PASS scores were compared. Results There were 82 patients. The study group had a mean age of 42.16 ± 11.26 years with 48.78% women and a mean BMI of 26.51 ± 4.31 kg/m2. Mean Beck chondral grade was 2.59 ± 1.27 in the study group and 2.70 ± 0.95 in the matched control group (p=0.72). Two-year mean postoperative iHOT-12 scores for the study and control groups were 69.49 ± 24.51 and 73.24 ± 25.16 (p=0.38), while mean postoperative pain VAS were 18.84 ± 18.17 and 20.74 ± 21.39 (p=0.70) The study group reached MCID in 82.93%, SBC in 58.54%, and PASS in 65.85%. The control group reached MCID in 78.05%, SBC in 65.85%, and PASS in 73.17%, with no significant difference between the cohorts (p=0.57, p=0.49, p=0.47, respectively). Discussion/Conclusion Acetabular subchondral cysts are not associated with more chondral pathology than strictly matched controls and may not be a contraindication to hip arthroscopy in patients with FAIS that would otherwise be indicated for this surgery. This finding has pragmatic value in that a significant subset of patients that would otherwise have been denied elective hip arthroscopy may now be potential arthroscopic candidates.

Abstract Background: Prior studies have evaluated the efficacy of subchondroplasty for the management of subchondral cysts of the knee, yet few studies to date evaluate minimum 2-year outcomes following subchondroplasty of the acetabulum. Purpose: The purpose of this study was to evaluate minimum two-year outcomes following arthroscopic subchondroplasty for the treatment of acetabular subchondral cysts and to identify variables associated with total hip arthroplasty (THA) conversion following subchondroplasty. Study Design: Cases Series, Level of Evidence IV. Methods: A retrospective review of prospectively maintained data was performed on patients who underwent primary hip arthroscopy May 2019 to September 2021 by a single surgeon. Consecutive patients who underwent subchondroplasty for acetabular subchondral cysts with minimum two-year follow-up were identified. Demographics, magnetic resonance imaging (MRI), intraoperative findings, and clinical outcomes were evaluated. Cross-sectional area of the subchondral cysts was measured on MRI. Clinical outcomes included Hip Outcome Score–Activities of Daily Living (HOS-ADL), HOS–Sports Subscale (HOS-SS), international Hip Outcome Score-12 (iHOT-12), and visual analog scale for pain (VAS-Pain). Conversion to THA was recorded. The patients who converted to THA were compared to those who did not. Continuous variables associated with THA conversion were analyzed with receiver operating characteristic (ROC) curves to identify thresholds associated with THA conversion. Results: Twenty-nine patients underwent subchondroplasty for acetabular subchondral cysts with minimum two-year follow up (age: 48.2±11.1 years, body mass index: 29.9±6.6kg/m2, 52.0% female). The THA-free survivorship rate was 62.1%. Patients who achieved THA-free survivorship had smaller subchondral cysts (88.5±59.2 mm2 vs. 147.1±54.8, P=0.013) and a lower prevalence of high-grade femoral head chondral defects (16.7% vs. 54.5%, P=0.048) compared to patients who converted to THA. ROC analysis identified patients with a subchondral cyst <133 mm2 were 21.3 times more likely to achieve THA-free survivorship (P=0.001). The THA-free survivors demonstrated significant improvements across all measured PROs (P≤0.015). Conclusions: Subchondroplasty for acetabular subchondral cysts demonstrated a 62.1% THA-free survivorship at minimum 2-year follow-up, with survivors demonstrating significantly improved PROs. Patients with cysts <133 mm2 were 21.3 times more likely to achieve THA-free survivorship than patients with larger cysts. Keywords: Hip, Acetabulum, Subchondral Cysts, Subchondroplasty

Abstract Purpose: 1) To report the clinical outcomes and reoperation rates of arthro- and endo-scopic iliopsoas release at short-term follow-up following ipsilateral total hip arthroplasty from two separate medical institutions, and 2) to evaluate whether demographic and radiographic parameters are associated with postoperative patient reported outcomes. Methods: Patients with iliopsoas tendinitis in the setting of prior THA that underwent arthroscopic iliopsoas fractional lengthening from 1988 – 2023 were reviewed at two academic institutions. Patients were included if they had minimum 12-month follow-up and were evaluated for preoperative anterior acetabular component overhang, surgery satisfaction, postoperative subjective hip flexion strength and anterior groin pain improvement, modified Harris Hip Score (mHHS), Single Assessment Numeric Evaluation (SANE) score, Tegner activity scale, visual analog scale (VAS), and revision hip arthroplasty. Results: Sixty hips in 58 patients (19 males, 39 females) were followed for a mean of 39.3 (12.0-105.9) months postoperatively. 77% of patients reported feeling “much” or “slightly better”, 75% reported improved anterior groin pain, and 60% reported improved subjective hip flexion strength. Surgery satisfaction was 7.2 ± 3.3 (scale of 0 to 10). Mean postoperative mHHS, VAS pain at rest, VAS pain with use, and SANE scores were 73.9 ± 19.4, 1.3 ± 2.4, 3.8 ± 2.9, and 71.9 ± 21.9 respectively. Preoperative anterior acetabular component overhang was 3.3 ± 6.5 mm and didn’t significantly correlate with postoperative PROs (p ≥ 0.45). Tegner score improved to 2.9 ± 1.4 from 2.5 ± 1.7 preoperatively (p = 0.0253). Three patients underwent revision arthroplasty at a mean of 25.3 (11.6 – 40.4) months postoperatively, with an acetabular component revision rate of 3.3%. Conclusions: Satisfactory outcomes and low revision arthroplasty rates were observed in patients undergoing arthroscopic iliopsoas lengthening following THA. There was no statistically significant relationship between anterior acetabular component overhang and final PROs. Level of Evidence: IV; Retrospective Case Series

Abstract As the prevalence of hip arthroscopy increases, hip capsular defects are increasingly recognized as a source of recurrent symptoms in the young athletic hip. The hip capsule is of substantial importance in providing joint stability and normal biomechanics. Several recent studies have demonstrated that capsular closure at the time of primary hip arthroscopy improves both short‐ and long‐term patient‐reported outcomes, revision rates, and conversion to arthroplasty. Similarly, capsular insufficiency has been shown to be a source of recurrent pain and microinstability. Arthroscopic hip capsular management in the setting of chronic defects can be technically challenging, and far medial defects along the iliopsoas bursa are historically difficult to successfully repair because of challenging access and common lack of a proximal cuff of tissue for repair. We present an effective method for arthroscopic management of far medial hip capsular defects that consistently allows for reproducible capsular repair even in the absence of proximal capsular tissue. Technique Video video See video under supplementary data.

Purpose To report the clinical outcomes and reoperation rates of arthroscopic and endoscopic iliopsoas release at short‐term follow‐up after ipsilateral total hip arthroplasty (THA) at 2 separate medical institutions and to evaluate whether demographic and radiographic parameters are associated with postoperative patient‐reported outcomes (PROs). Methods Patients with iliopsoas tendinitis in the setting of prior THA who underwent arthroscopic iliopsoas fractional lengthening from 1988 to 2023 at 2 academic institutions were reviewed. Patients were included if they had 12 months of follow‐up and underwent evaluation of preoperative anterior acetabular component overhang, surgery satisfaction, postoperative subjective hip flexion strength and anterior groin pain improvement, modified Harris Hip Score, Single Assessment Numeric Evaluation score, Tegner activity scale score, visual analog scale (VAS) score, and revision hip arthroplasty. Results Sixty hips in 58 patients (19 male and 39 female patients) were followed up for a mean of 39.3 months (range, 12.0‐105.9 months) postoperatively. Of the patients, 77% reported feeling “much better” or “slightly better,” 75% reported improved anterior groin pain, and 60% reported improved subjective hip flexion strength. The surgery satisfaction rating was 7.2 ± 3.3 (scale of 0 to 10). The mean postoperative modified Harris Hip Score, VAS score for pain at rest, VAS score for pain with use, and Single Assessment Numeric Evaluation score were 73.9 ± 19.4, 1.3 ± 2.4, 3.8 ± 2.9, and 71.9 ± 21.9, respectively. Preoperative anterior acetabular component overhang was 3.3 ± 6.5 mm and did not significantly correlate with postoperative PROs ( P ≥ .45). The Tegner score improved from 2.5 ± 1.7 preoperatively to 2.9 ± 1.4 postoperatively ( P = .0253). Three patients underwent revision arthroplasty at a mean of 25.3 months (range, 11.6‐40.4 months) postoperatively, with an acetabular component revision rate of 3.3%. Conclusions Satisfactory outcomes and low revision arthroplasty rates were observed in patients undergoing arthroscopic iliopsoas lengthening after THA. There was no statistically significant relation between anterior acetabular component overhang and final PROs. Level of Evidence Level IV, therapeutic case series.

Background: Femoral torsion measurements and outcomes are variable throughout the literature and have focused on short-term follow-up. However, there is a paucity of literature investigating clinically meaningful outcomes at midterm follow-up after hip arthroscopy for femoroacetabular impingement syndrome (FAIS). Purpose: To quantify femoral version using computed tomography imaging in patients with FAIS and to explore the relationship between version abnormalities and 5-year outcomes after hip arthroscopy. Study Design: Cohort study; Level of evidence, 3. Methods: Patients who underwent primary hip arthroscopy for FAIS between January 2012 and November 2017 were identified. Patients were included if they had 5-year follow-up with completion of ≥1 patient-reported outcome (PRO) scores and excluded if they had Tönnis grade >1, revision hip surgery, a concomitant hip procedure, a developmental disorder, or a lateral center-edge angle <20°. Torsion groups were defined as severe retrotorsion (<0°), moderate retrotorsion (0.1°-5°), normal torsion (5.1°-20°), moderate antetorsion (20.1°-25°), and severe antetorsion (>25.1°) based on computed tomography measurements. Patient characteristics were analyzed among the torsion cohorts, as were preoperative and 5-year PROs: Hip Outcome Score–Activities of Daily Living, Hip Outcome Score–Sports Subscale, modified Harris Hip Score, international Hip Outcome Tool, visual analog scale for pain, and visual analog scale for satisfaction. Achievement rates of cohort-specific thresholds for the minimal clinically important difference and Patient Acceptable Symptom State were calculated and compared among cohorts. Results: A total of 362 patients (244 female, 118 male; mean ± SD age, 33.1 ± 11.5 years; body mass index, 26.9 ± 17.8) met inclusion/exclusion criteria and were analyzed at a final mean follow-up of 64.3 ± 9.4 months (range, 53.5-115.5 months). Mean femoral torsion was 12.8°± 9.2°. The number of patients within each group was 20 for severe retrotorsion (torsion, −6.3°± 4.9°), 45 for moderate retrotorsion (2.7°± 1.3°), 219 for normal torsion (12.2°± 4.1°), 39 for moderate antetorsion (21.9°± 1.3°), and 39 for severe antetorsion (29.0°± 4.2°). No significant differences in age, body mass index, sex, smoking status, workers’ compensation, psychiatric history, back pain, or physical activity were found among the torsional groups. All groups demonstrated significant improvements at 5 years postoperatively ( P < .01 for all). All torsion subgroups demonstrated similar pre- to postoperative changes in PROs ( P≥ .515) and PRO values at 5-year follow-up ( P≥ .098). There were no significant differences in the achievement of the minimal clinically important difference ( P≥ .422) or Patient Acceptable Symptom State ( P≥ .161) for any of the PROs among the torsion groups. Conclusion: The orientation and severity of femoral torsion at the time of hip arthroscopy for FAIS in this study’s cohort did not affect the propensity for clinically meaningful outcome improvement at midterm follow-up.

Purpose To determine whether (1) patient‐reported outcome (PRO) scores after index hip arthroscopy correlate with PRO scores for the contralateral hip in patients undergoing staged bilateral hip arthroscopy and (2) patients who achieved minimal clinically important difference (MCID) or patient‐acceptable symptom state (PASS) for the index hip were more likely to achieve MCID or PASS for the contralateral hip. Methods Patients who underwent staged bilateral hip arthroscopy for femoroacetabular impingement syndrome were retrospectively reviewed. PRO scores were prospectively collected at preoperative and 1‐ and 2‐year timepoints. Odds ratios for achievement of MCID and PASS for the contralateral hip given achievement for the index hip were calculated. Improvements from before surgery to 2 years after surgery were correlated between both hips. Results A total of 143 patients (286 hips) were included in the final analysis. Average time between surgeries was 8.5 months (range, 0.7‐57.2). Both hips demonstrated significant improvement ( P < .05 for all) in all PROs at 2 years. Achievement of MCID in Hip Outcome Score Activities of Daily Living (HOS‐ADL) at the 1‐year timepoint for the index hip was predictive of achievement of MCID in HOS‐ADL at 2 years for the contralateral hip. Achievement of PASS in all PROs at the 1‐year timepoint for the index hip were predictive of achievement of PASS in the equivalent outcome score at the 2‐year mark for the contralateral hip. Achievement of MCID or PASS at the 2‐year timepoint for the index hip was predictive of achievement of the equivalent outcome at the 2‐year timepoint for the contralateral hip. The strongest correlation between improvement in PRO scores for the index and contralateral hips was noted in patients who underwent staged hip arthroscopy within less than 3 months. Conclusion Patients experience significant clinical benefit in both hips after staged bilateral hip arthroscopy. Results from the initial hip arthroscopy at either 1‐ or 2‐year follow‐up can be used to predict outcomes on the contralateral side; however, there is a higher degree of predictive value using 2‐year results. Average correlations between 2‐year PROs on the index and contralateral hips were moderate to strong, regardless of the time between surgeries. Level of Evidence Level III, retrospective cohort study.

Background: Increased attention has been directed toward the acetabular morphology in the management of patients with femoroacetabular impingement syndrome (FAIS). Whether acetabular version influences patient-reported outcomes remains poorly understood. Purpose: To use computed tomography (CT)–based 3-dimensional (3D) bone models to (1) quantify acetabular version in patients with FAIS, (2) compare acetabular version on 3D bone models with current plain radiographic parameters, and (3) explore the relationship between the magnitude of acetabular version and minimum 2-year clinical outcomes after hip arthroscopy. Study Design: Cohort study; Level of evidence, 3. Methods: Three-dimensional models of the pelvis and femur were generated by semiautomated segmentation and aligned to a standard coordinate system. Acetabular version was quantified at the 3-o’clock position, and 3 groups were identified: acetabular retroversion (AR; <15°), normal acetabular version (NV; 15°-25°), and acetabular anteversion (AA; >25°). Patient demographic characteristics, plain radiographic parameters, and clinical outcomes were analyzed, including the Hip Outcome Score–Activities of Daily Living, Hip Outcome Score–Sports Subscale, modified Harris Hip Score (mHHS), International Hip Outcome Tool (iHOT-12), and visual analog scale (VAS) for pain and satisfaction. Results: Preoperative CT scans were acquired in 105 consecutive patients before hip arthroscopy for FAIS, of which 84 (80.0%) completed minimum 2-year patient-reported outcomes. The mean ± SD age and body mass index of patients were 33.9 ± 12.6 years and 26.0 ± 5.4, respectively; 70.2% were female. The number of patients and the mean central acetabular version within each group were as follows: AR (n = 12; 11.3°± 2.7°), NV (n = 56; 20.7°± 2.9°), and AA (n = 16; 28.5°± 2.7°). Posterior wall sign was the only plain radiographic parameter that was significantly more observed in the AR group than in the other 2 groups. At minimum 2-year follow-up, significant between-group differences in the mHHS, iHOT-12, and VAS for pain and satisfaction ( P < .05) were appreciated, while post hoc analysis with Bonferroni correction ( P < .0167) found lower scores on the mHHS, iHOT-12, and VAS for pain and satisfaction in patients with AR as compared with NV. Lower scores on the VAS for satisfaction were reported in patients with AR when compared with AA ( P = .006) but not on the mHHS ( P = .023), iHOT-12 ( P = .032), or VAS for pain ( P = .072). Conclusion: Traditional plain radiographic indices to describe AR, including crossover sign and ischial spine sign, were not reliable in defining AR according to 3D models derived from CT scans. Only the posterior wall sign was observed in a higher proportion in the AR group. Patients with AR demonstrated inferior outcomes when compared with patients with NV and AA after hip arthroscopy for FAIS.