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OBJECTIVES: Our unit has pursued Fontan completion in all patients except those with immobility or combined poor ventricular function and high pulmonary artery pressures. We assessed retrospectively whether conventional high-risk criteria would predict patients with a poorer outcome. METHODS: One hundred and thirty-three consecutive children who underwent extracardiac Fontan completion (2004–2012) had their outcomes recorded (mean follow-up of 7 years). Three groups were analysed: those with 1 of 6 historical risk factors (outside 6 commandments), those with 1 of reduced systemic ventricular function or pulmonary artery pressure >15 mmHg (outside 2 commandments) versus those with no contraindications. The Fischer’s exact test examined frequency differences, with the χ2 test to look for outcome associations. RESULTS: There were no differences in postoperative complication rates between the outside 6 commandments (n = 105) or outside 2 commandments (n = 49) versus the low-risk no-contraindication group (n = 28): arrhythmias [18% (P = 0.3) or 18% (P = 0.3) vs 25%], infection [22% (P = 0.6) or 33% (P = 0.2) vs 21%], cerebrovascular accident [6% (P = 0.5) or 10% (P = 0.3) vs 4%], length of stay [20 days (P = 0.4) or 23 days (P = 0.2) vs 21 days] and duration of chest drainage (P = 0.5). There was 1 predischarge mortality in each group. Long term, the majority of patients in each group had suitable haemodynamics for fenestration closure [95% (P = 0.7) or 95% (P = 0.7) vs 92%]. Long term, there was no difference in the rate of arrhythmias [11% (P = 0.5) or 12.5% (P = 0.3) vs 7%], protein-losing enteropathy [1% (P = 0.1) or 2% (P = 0.3) vs 7%] or moderate or more ventricular dysfunction on echocardiography [2% (P = 0.7) or 4% (P = 0.7) vs 4%]. Notably, there was a higher rate of catheter reinterventions in the high-risk groups [22% (P CONCLUSIONS The medium-term benefits of Fontan completion can be achieved for high-risk patients, suggesting that historical selection criteria should be re-examined.

The purpose of this study was to determine if patients undergoing hip arthroscopy for labral pathology with contralateral total hip arthroplasty (THA) have a difference in revision surgeries or patient-reported outcomes (PROs) when compared with those patients undergoing hip arthroscopy for labral pathology with a native contralateral hip. A retrospective review was performed for patients that were undergoing hip arthroscopy between 2008 and 2015. Patients were included in the study group if they met the following inclusion criteria: Tönnis Grade 0 or 1, hip labral pathology, previous contralateral THA, and greater than 2-year follow-up with completion of all PROs or conversion to a THA. Exclusion criteria included the previous surgical history on ipsilateral hip, peritrochanteric or deep gluteal space arthroscopy performed concomitantly, or dysplasia [Lateral Center Edge Angle (LCEA)

Background:The technique of hip arthroscopic surgery is advancing and becoming more commonly performed. However, most current reported results are limited to short-term follow-up, and therefore, the durability of the procedure is largely unknown.Purpose:To perform a multicenter analysis of mid-term clinical outcomes of arthroscopic hip labral repair and determine the risk factors for patient outcomes.Study Design:Cohort study; Level of evidence, 3.Methods:Prospectively collected data of primary hip arthroscopic labral repair performed at 4 high-volume centers between 2008 and 2011 were reviewed retrospectively. Patients were assessed preoperatively and postoperatively with the visual analog scale (VAS), modified Harris Hip Score (mHHS), and Hip Outcome Score–Sports-Specific Subscale (HOS-SSS) at a minimum of 5 years’ follow-up. Factors including age, body mass index (BMI), Tönnis grade, and cartilage grade were analyzed in relation to outcome scores, and revision rates were determined. Failure was defined as subsequent ipsilateral hip surgery, including revision arthroscopic surgery and open hip surgery.Results:A total of 303 patients (101 male, 202 female) with a mean age of 32.0 years (range, 10.7-58.9 years) were followed for a mean of 5.7 years (range, 5.0-7.9 years). Patients achieved mean improvements in VAS of 3.5 points, mHHS of 20.1 points, and HOS-SSS of 29.3 points. Thirty-seven patients (12.2%) underwent revision arthroscopic surgery, and 12 (4.0%) underwent periacetabular osteotomy, resurfacing, or total hip arthroplasty during the study period. Patients with a BMI >30 kg/m2had a mean mHHS score 9.5 points lower and a mean HOS-SSS score 15.9 points lower than those with a BMI ≤30 kg/m2( P < .01). Patients aged >35 years at surgery had a mean mHHS score 4.5 points lower and a HOS-SSS score 6.7 points lower than those aged ≤35 years ( P = .03). Patients with Tönnis grade 2 radiographs demonstrated a 12.5-point worse mHHS score ( P = .02) and a 23.0-point worse HOS-SSS score ( P < .01) when compared with patients with Tönnis grade 0.Conclusion:Patients demonstrated significant improvements in VAS, mHHS, and HOS-SSS scores after arthroscopic labral repair. However, those with Tönnis grade 2 changes preoperatively, BMI >30 kg/m2, and age >35 years at the time of surgery demonstrated significantly decreased mHHS and HOS-SSS scores at final follow-up.

Failure of hip preservation to alleviate symptoms potentially subjects the patient to reoperation or conversion surgery to THA, adding recovery time, risk, and cost. A risk calculator using an algorithm that can predict the likelihood that a patient who undergoes arthroscopic hip surgery will undergo THA within 2 years would be helpful, but to our knowledge, no such tool exists. (1) Are there preoperative and intraoperative variables at the time of hip arthroscopy associated with subsequent conversion to THA? (2) Can these variables be used to develop a predictive tool for conversion to THA? All patients undergoing arthroscopy from January 2009 through December 2011 were registered in our longitudinal database. Inclusion criteria for the study group were patients undergoing hip arthroscopy for a labral tear, who eventually had conversion surgery to THA. Patients were compared with a control group of patients who underwent hip arthroscopy for a labral tear but who did not undergo conversion surgery to THA during the same study period. Of the 893 who underwent surgery during that time, 792 (88.7%) were available for followup at a minimum of 2 years (mean, 31.1 ± 8.1 years) and so were considered in this analysis. Multivariate regression analyses of 41 preoperative and intraoperative variables were performed. Using the results of the multivariate regression, we developed a simplified calculator that may be helpful in counseling a patient regarding the risk of conversion to THA after hip arthroscopy. Variables simultaneously associated with conversion to THA in this model were older age (rate ratio, 1.06; 95% CI, 1.03–1.08; p

In recent years, three-dimensional printing has demonstrated reliable reproducibility of several organs including hearts with complex congenital cardiac anomalies. This represents the next step in advanced image processing and can be used to plan surgical repair. In this study, we describe three children with complex univentricular hearts and abnormal systemic or pulmonary venous drainage, in whom three-dimensional printed models based on CT data assisted with preoperative planning. For two children, after group discussion and examination of the models, a decision was made not to proceed with surgery. We extend the current clinical experience with three-dimensional printed modelling and discuss the benefits of such models in the setting of managing complex surgical problems in children with univentricular circulation and abnormal systemic or pulmonary venous drainage.

Robotic-assisted total hip arthroplasty (THA) is a recent platform introduced to decrease the risk of malpositioned components. The goals of this study were to determine whether intraoperative data on robotic-assisted THA acetabular component position accurately predict postoperative radiographic acetabular component position and to determine whether intraoperative data on robotic-assisted THA leg length and offset accurately predict postoperative radiographic leg length and offset data. In 146 patients, pre- and postoperative radiographs and intraoperative component measurements were reported for acetabular inclination, anteversion, leg length change, and offset change. Component position obtained by the robotic system and radiographic data were compared with subgroup analysis for the posterior and direct anterior approaches. The average difference between groups was 3.3°±3.1° for inclination, 2.9°±2.3° for anteversion, 3.0±2.3 mm for leg length change, and 4.0±3.1 mm for change in global offset. Correlation between the robotic system and postoperative radiographs was within 10° for 95.9% of cases for inclination and 99.3% for anteversion. Posterior approach correlation was within 10° for 97.1% of cases for inclination and 100% for anteversion. Anterior approach correlation was within 10° for 92.7% of cases for inclination and 97.6% for anteversion. Intraoperative data on component position obtained from the robotic system compared well with radiographic data on component position. Surgeons must remain vigilant to ensure outliers related to robotic system malfunction do not occur. [ Orthopedics. 2016; 39(3):193–199.]

To evaluate clinical outcomes, pain, and patient satisfaction following revision hip arthroscopy with a minimum 2-year follow-up.From April 2008 to October 2011, data were prospectively collected on all patients undergoing revision hip arthroscopy. All patients were assessed pre- and postoperatively with 4 patient-reported outcome (PRO) measures: the modified Harris hip score (mHHS), nonarthritic hip score (NAHS), hip outcome score-activities of daily living (HOS-ADL), and hip outcome score-sport-specific subscales (HOS-SSS). Pain was estimated on the visual analog scale (VAS). Patient satisfaction was measured on a scale from 0 to 10. The number of patients who underwent subsequent revision arthroscopy or total hip arthroplasty during the study period is also reported.Eighty-seven patients underwent revision hip arthroscopy during the study period. Seventy (80.5%) patients were included in our study. Average follow-up time was 28 months (range, 20 to 47.4 months). In terms of residual femoroacetabular impingement morphology, 45.7% of patients had preoperative alpha angles ≥ 55°, and 7.14% of patients had a lateral center-edge angle ≥ 40°. The score improvement from preoperative to 2-year follow-up was 57.84 to 73.65 for mHHS, 62.79 to 83.04 for HOS-ADL, 37.33 to 54.93 for HOS-SSS, and 55.65 to 70.79 for NAHS. VAS decreased from 6.72 to 4.08. All scores demonstrated statistically significant improvement (P.001). Overall patient satisfaction was 7.67. Our success rate was 74.58%. Ten (14.29%) patients underwent total hip arthroplasty during the study period. Our hip survivorship was 85.7%. Five (7.14%) patients underwent secondary revision hip arthroscopy during the study period. We found an overall minor complication rate of 10%.Revision hip arthroscopy for all procedures performed on aggregate has improved clinical outcomes for all PROs, high survivorship, and high patient satisfaction scores at short-term follow-up. Patients should be counseled regarding the potential progression of degenerative change leading to arthroplasty and the potential for revision surgery.Level IV retrospective case series.

Patients who have lateral hip pain historically have been diagnosed with trochanteric bursitis and treated with nonsteroidal anti-inflammatory medications, corticosteroid injections, and physical therapy. Although this strategy is effective for most patients, a substantial number of patients continue to have pain and functional limitations. Over the past decade, our understanding of disorders occurring in the peritrochanteric space has increased dramatically. Greater trochanteric pain syndrome encompasses trochanteric bursitis, external coxa saltans (ie, snapping hip), and abductor tendinopathy. A thorough understanding of the anatomy, examination findings, and imaging characteristics aids the clinician in treating these patients. Open and endoscopic treatment options are available for use when nonsurgical treatment is unsuccessful.

The purpose of this multi-surgeon study was to assess and compare the accuracy of acetabular component placement, leg length discrepancy (LLD), and global offset difference (GOD) between six different surgical techniques and modes of guidance in total hip arthroplasty (THA). A total of 1980 THAs met inclusion criteria. Robotic- and navigation-guided techniques were more consistent than other techniques in placing the acetabular cup into Lewinnek's safe zone (P

Obese populations present challenges for acetabular cup placement during total hip arthroplasty (THA). This study examines the accuracy of acetabular cup inclination and version in the obese patient with robotic-assisted computer navigation. A total of 105 patients underwent robotic-assisted computer navigation THA with a posterior approach. Groups were divided on body mass index (BMI, kg/m(2)) of30, 30-35, and35. There was no statistical difference between the BMI30 (n=59), BMI 30-35 (n=34) and BMI35 (n=12) groups for acetabular inclination (P=0.43) or version (P=0.95). Robotic-assisted computer navigation provided accurate and reproducible placement of the acetabular cup within safe zones for inclination and version in the obese patient.

Purpose: To detail our early experience using concomitant hip arthroscopy and periacetabular osteotomy (PAO) for the treatment of acetabular dysplasia. Methods: We prospectively collected and retrospectively reviewed the surgical and outcome data of 17 patients who underwent concomitant hip arthroscopy and PAO between October 2010 and July 2013. Preoperative and postoperative range of motion, outcome and pain scores, and radiographic data were collected. Intraoperative arthroscopic findings and postoperative complications were recorded. Results: The group consisted of 3 male and 14 female patients with a mean follow-up period of 2.4 years. Three patients had undergone previous surgery on the affected hip. Chondrolabral pathology was identified in all 17 patients. Twelve patients underwent labral repair, and five patients underwent partial labral debridement. No patient was converted to total hip arthroplasty or required revision surgery at short-term follow-up. All 4 patient-reported outcome scores showed statistically significant changes from baseline to latest follow-up (P < .001). An excellent outcome was obtained in 82% of patients (13 of 16). The lateral center-edge angle averaged 11 � preoperatively and 29 � postoperatively. The acetabular inclination averaged 18 � preoperatively and 3 � postoperatively. The anterior center-edge angle averaged 7 � preoperatively and 27 � postoperatively. At most recent radiographic follow-up, 1 patient had progression of arthritic changes but remained asymptomatic. No other patient showed any radiographic evidence of progression of arthritis. Complications included 3 superficial wound infections, 1 pulmonary embolism, and 1 temporary sciatic neurapraxia. Conclusions: Our initial experience with concomitant hip arthroscopy and PAO has been favorable. We noted that all our patients have evidence of chondrolabral damage at the time of PAO when the joint is distracted and evaluated. All patients in this series had intra-articular pathology treated arthroscopically and showed satisfactory mean clinical improvement. Hip arthroscopy with PAO did not appear to introduce complications beyond the PAO alone. Level of Evidence: Level IV, therapeutic case series.

Purpose To survey surgeons who perform a high volume of hip arthroscopy procedures regarding their operative technique, type of procedure, and postoperative management. Methods We conducted a cross-sectional survey of 27 high-volume orthopaedic surgeons specializing in hip arthroscopy to report their preferences and practices related to their operative practice and postoperative rehabilitation protocol. All participants completed the survey in person in an anonymous fashion during a meeting of the American Hip Institute. Results All surgeons perform hip arthroscopy with the patient in the supine position, accessing the central compartment of the hip initially, using intraoperative fluoroscopy. All surgeons perform labral repair (100%), with the majority performing labral reconstructions (77.8%) and gluteus medius repairs (81.5%). There is variability in the type of anchors used during labral repair. Most surgeons perform capsular closure in most cases (88.9%), inject either intra-articular cortisone or platelet-rich plasma at the conclusion of the procedure (59%), and prescribe a postoperative hip brace for some or all patients (59%). There is considerable variability in rehabilitation protocols. All surgeons routinely prescribe postoperative heterotopic ossification prophylaxis to their patients, with most surgeons (88.9%) prescribing a nonsteroidal anti-inflammatory medication for 3 weeks. Forty percent of the respondents use the modified Harris Hip Score as the most important outcome measure. Conclusions Consistent practices such as use of intraoperative fluoroscopy, heterotopic ossification prophylaxis, and labral repair skills were identified by surveying 27 hip arthroscopy surgeons at high-volume centers. Most of the surgeons performed routine capsular closure unless underlying conditions precluded capsular release or plication. The survey identified higher variability between surgeons regarding postoperative rehabilitation protocols and use of intra-articular pharmacologic injections at the end of the procedure. These data may provide surgeons with a set of aggregate trends that may help guide training, clinical practice, and research in the evolving field of hip arthroscopy.

Background Ehlers-Danlos syndrome (EDS) is a genetic disorder that affects the structural integrity of collagen within the body. This presents clinically as a connective tissue disorder with increased elasticity of joints, muscles, and ligaments. Multiple joints are affected by hypermobility and joint injury is common in these patients. It is estimated that EDS occurs once in every 5,000 births worldwide. Case review This article focuses on reconstruction of the ligamentum teres (LT) of the hip using a tibialis anterior allograft to treat severe instability and pain in a 43 year-old female with EDS. The LT reconstruction was accompanied by labral repair and capsular plication. The patient was assessed pre- and postoperatively using modified Harris Hip Score (mHHS), Hip Outcome Score Activities of Daily Living (HOS-ADLS), Hip Outcome Score Sports Specific Subscale (HOS-SSS), Non Arthritic Hip Score (NAHS), Visual Analog Scale (VAS), and satisfaction. One year following surgery the patient has reported positive outcomes in terms of pain and instability. Literature review Ligament reconstruction has been reported in patients with Ehlers-Danlos syndrome for shoulders and knees with positive results and restoration of stability. Currently there is a paucity of literature regarding patients with EDS undergoing hip procedures. In addition, reconstruction of the ligamentum teres for hip instability and pain has rarely been reported in a normal patient cohort. Clinical relevance This is the first study to report ligamentum teres reconstruction of the hip in a patient with Ehlers-Danlos syndrome and hip instability. The patient demonstrated satisfactory results 1 year from surgery.

This study compared 2-year clinical outcomes in hip arthroscopy patients treated with microfracture to a matched control group without full-thickness chondral damage.During the study period between June 2008 and July 2011, data were collected on all patients treated with hip arthroscopy who underwent microfracture. All patients were assessed pre- and postoperatively with 4 patient-reported outcome (PRO) measures. Pain was estimated on the visual analog scale (VAS), and satisfaction was measured on a scale from 0 to 10. A matched-pair group of patients who did not undergo microfracture was selected in a 1:2 ratio. Matching criteria were age within 5 years, sex, surgical procedures, and radiographic findings.Average follow-up for the study was 26.66 months (17.29 to 48.89 months). Forty-nine hips were included in the microfracture group and 98 hips were in entered in the nonmicrofracture group, with no significant difference in PRO scores preoperatively between the groups. Both groups had statistically significant postoperative improvement in all scores, and the average amount of change from preoperative to postoperative scores between the 2 groups was not statistically significantly different for any of the PRO scores. Most importantly, there was no statistically significant difference in postoperative PRO scores between the microfracture and control groups. Patient satisfaction was 6.9 for the microfracture group and 7.84 for the nonmicrofracture group, which was statistically significant (P.05). When comparing patients who received acetabular microfracture to those who received femoral microfracture, both groups had similar preoperative and postoperative PRO scores, with no significant difference in the magnitude of change (delta) at final follow-up.Our study found that patients undergoing microfracture during hip arthroscopy did not show a statistically significant difference in PRO scores when compared with a matched-pair control group at an average of 2 years of follow-up. Both groups showed significant improvement in all PRO scores.Level III, matched case-control study.

Purpose The purpose of this prospective comparative study was to evaluate the effect of intraoperative platelet-rich plasma (PRP) injection on the outcomes of patients undergoing hip arthroscopy for labral treatment. Methods During the period from November 2010 through March 2012, all patients undergoing hip arthroscopy for labral tears were considered for this study. The study group received intra-articular PRP at the end of the operation, and the control group received an intra-articular injection of 0.25% bupivacaine. Selection for the study group was based on the day of the week on which the patient underwent surgery. The protocol included administration of 4 hip-specific patient-reported outcome tools. Patients also reported their pain score on a visual analog scale from 0 to 10. Scores were recorded at the preoperative visit and at 3 months and 2 years postoperatively. Results A minimum of 2 years' follow-up was available for 306 patients. Thirteen patients (4.2%) underwent conversion to total hip arthroplasty and 24 patients (7.8%) underwent revision hip arthroscopy, which left 91 patients in the study group and 180 patients in the control group. The study group had slightly higher pain scores than the control group (3.4 v 2.5) 2 years after surgery ( P = .005). No difference in pain scores was identified at 3 months postoperatively. The 2-year modified Harris Hip Score was slightly lower in the study group (78.6) than in the control group (82.6) ( P = .049). No significant difference was observed for the Hip Outcome Score–Activities of Daily Living, Hip Outcome Score–Sport-Specific Subscale, or Non-Arthritic Hip Score at any time point. There was no significant difference between groups for conversion to total hip arthroplasty or revision surgery. Conclusions On the basis of the results of this study, intraoperative PRP injection does not appear to improve the clinical results of patients undergoing hip arthroscopy for labral treatment. Level of Evidence Level II, prospective comparative study.

Lateral hip pain along with tenderness of the greater trochanter has been associated with greater trochanteric pain syndrome. Radiographically, this has been associated with gluteus medius pathology on magnetic resonance imaging. This has led some surgeons to conclude that abductor pathology is a primary cause of lateral hip pain. Failure of conservative treatment in the setting of gluteus medius pathology may lead to surgical intervention. In some patients a focal tear of the gluteus medius cannot be visualized and likely represents more diffuse tendinopathy. In these patients we propose micropuncture of the greater trochanter. Similar procedures have shown effectiveness in the elbow and shoulder by eliciting a healing response. Our experience suggests that trochanteric micropuncture at the insertion of the gluteus medius tendon can be effectively performed endoscopically for gluteus medius tendinopathy.

Background: Obesity presents a challenging problem in surgical treatment and has led to poorer postoperative outcomes. The purpose of this study was to evaluate whether hip arthroscopy in the obese patient influences postoperative clinical and patient-reported outcome scores. Methods: From February 2008 to February 2012, data were collected prospectively on all patients undergoing primary hip arthroscopy. A total of 680 patients were included. All patients were assessed preoperatively and postoperatively with four patient-reported outcome measures. Pain was estimated on the visual analog scale. The patient satisfaction score was measured. Three groups were stratified by body mass index. The non-obese group, those with a body mass index of

There are no reports examining the learning curve during the adoption of robotic assisted THA. The purpose of this study was to examine the learning curve of robotic assisted THA as measured by component position, operative time, and complications. The first 105 robotic-assisted THAs performed by a single surgeon were divided into three groups based on the order of surgery. Component position, operative time, intra-operative technical problems, and intra-operative complications were recorded. There was a decreased risk of acetabular component malpositioning with experience (P

Educational Objectives As a result of reading this article, physicians should be able to: 1. Discuss the kinematic relationship between the hip and lumbar spine. 2. Explain the innervation of the hip and lumbar spine and how they relate to one another. 3. Recognize the effect of hip disease on the lumbar spine in an athletic population, prior to the onset of degenerative changes. 4. Describe an algorithm for diagnosis and treatment of patients who present with concomitant hip and lumbar spine pain. The hip and lumbar spine are closely related and can create similar patterns of pain and dysfunction. Diagnosis and treatment of hip and spine–related conditions can be challenging due to symptom overlap. Successful evaluation and treatment of hip and lumbar spine conditions requires a thorough understanding the hip-spine connection. Historically the hip-spine connection has been considered in the context of arthrosis; however, the hip-spine connection also needs to be considered in a younger athletic population. The purpose of this review is to describe the hip-spine connection, discuss the clinical implications of this connection, and offer an approach to diagnosis and treatment. [ Orthopedics. 2015; 38(1):49–55.]

Purpose: The purpose of this study was to investigate the influence of multiple demographic and radiographic findings on the size of labral tears identified at the time of hip arthroscopy. Methods: Data were prospectively collected for patients treated with arthroscopic labral repair or debridement from February 2008 to August 2011. Preoperative radiographic and demographic data were collected for 392 patients during the study period. Exclusion criteria included revision surgery and previous hip conditions. An anteroposterior pelvic view, 45 � Dunn view, and false-profile view were used to measure Tonnis grade, neck-shaft angle, alpha angle, lateral center edge angle (LCEA), anterior center edge angle (ACEA), acetabular inclination, and the extent of crossover sign when present. At the time of surgery, labral tear size and location were documented for all patients, using traditional acetabular clock face nomenclature for sizing. A multiple linear regression analysis was then performed to assess the correlation of radiographic and demographic findings with the size of the labral tear. Results: Regression analysis displayed statistical significance for sex (P < .0001), age (P < .0001), and alpha angle (P ¼ .005) with labral tear size. For female patients, Tonnis grade (P ¼ .0004) and neck-shaft angle (P ¼ .004) correlatedwithlabraltearsize.Thismodelaccountedforonly26%ofvariationinlabraltearsize.Conclusions: Preoperative risk factorsfortheextentoflabraltearsizearemalesex, increasingage, and increasingalphaangle.Labraltearswerelargerin female patients with higher Tonnis grades and lower neck-shaft angles. Measurements of acetabular coverage and version showed no correlation with labral tear size. The majority of labral tear size variation was not accounted for in this model. Level of Evidence: Level IV, therapeutic case series.

Background: Arthroscopic acetabuloplasty was initially described with detachment of the labrum to access the acetabular rim for resection, followed by labral refixation. Recent technical improvements have made it possible to perform acetabuloplasty and labral refixation without labral detachment when the chondrolabral junction is intact. Purpose: To compare outcomes for patients undergoing arthroscopic acetabuloplasty and labral refixation without labral detachment (study group), as well as compare this with a group of patients who underwent acetabuloplasty with labral refixation and labral detachment (control group) with a minimum 2-year follow-up. Study Design: Cohort study; Level of evidence, 3. Methods: During the study period, data were prospectively collected on all patients treated with hip arthroscopy. Inclusion criteria for the study group were acetabuloplasty and labral refixation without detachment, performed in cases with an intact chondrolabral junction. Patients were then compared with a control group of patients who had acetabuloplasty with labral detachment and refixation. All patients were assessed pre- and postoperatively using 4 patient-reported outcome (PRO) measures and a visual analog scale (VAS) for pain, as well as monitored for revision surgery. Results: In the study group, the preoperative to postoperative score changed from 64.2 to 86.6 for modified Harris Hip Score (mHHS), 60.5 to 83.8 for Nonarthritic Hip Score (NAHS), 65.3 to 87.3 for Hip Outcome Score–Activity of Daily Living (HOS-ADL), 45 to 75.1 for Hip Outcome Score–Sport-Specific Subscale (HOS-SSS), and 5.7 to 2.6 for VAS. In the control group, the preoperative to postoperative score changed from 61.2 to 84.4 for mHHS, 59 to 84 for NAHS, 62.7 to 86.2 for HOS-ADL, 40.1 to 74.1 for HOS-SSS, and 6.3 to 2.8 for VAS. There was no difference between preoperative and postoperative PRO scores. The preoperative VAS score was lower in the study group than in the control group ( P = .04). The control group demonstrated larger mean preoperative anterior center edge angles (ACEA) (33.8° vs 29.5°) and mean alpha angles (60.5° vs 53.5°) than the study group ( P < .05). There was no statistically significant difference in the change in PRO or VAS scores between groups. Both groups demonstrated significant improvement from preoperative to 2-year follow-up for all 4 PRO scores ( P < .05) and decrease in VAS ( P < .05). One patient in the study group converted to total hip arthroplasty. Seven patients underwent revision hip arthroscopy in the study group, and 8 patients in the control group underwent revision hip arthroscopy. There was no difference in revision rates between groups. Conclusion: Treatment of pincer- and combined-type impingement with arthroscopic acetabuloplasty and labral refixation without detachment, when possible, resulted in similar patient outcomes compared with acetabuloplasty with labral detachment. We may conclude that in cases where the chondrolabral junction remains intact, acetabuloplasty and labral refixation without detachment is a viable option.

Purpose The purpose of this systematic review was to evaluate the literature to determine complications of hip arthroscopy, with a secondary focus on how to minimize complications and risks. Methods Two independent reviewers performed a search of PubMed for articles that contained at least 1 of the following terms: complications and hip arthroscopy, hip impingement, femoral acetabular impingement and complications, or femoroacetabular impingement (FAI) and complications. The search was limited to articles published between 1999 and June 2013. An additional search was performed for articles evaluating techniques on how to minimize complications. Results We identified 81 studies (5,535 patients; 6,277 hips). The mean age was 35.48 years, and the mean body mass index was 25.20 kg/m 2 . Of the participants, 52% were male and 48% were female. The majority of studies were Level IV Evidence (63%). A total of 285 complications were reported, for an overall rate of 4.5%. There were 26 major complications (0.41%) and a 4.1% minor complication rate. The overall reoperation rate was 4.03%. A total of 94 hips underwent revision arthroscopy. Regarding open procedures, 150 patients (93%) underwent either total hip arthroplasty or a hip resurfacing procedure. The conversion rate to total hip arthroplasty or a resurfacing procedure was 2.4%. Conclusions Overall, primary hip arthroscopy is a successful procedure with low rates of major (0.41%) and minor (4.1%) complications. The reoperation rate was 4.03% in our review. There is admittedly a learning curve to performing hip arthroscopy, and we present a systematic review of the complications and how to minimize these complications with careful technique and planning. Level of Evidence Level IV, systematic review of Level II to V studies.

Background:There are currently no studies that have examined the recurrence of the cam lesion after femoral neck osteoplasty for femoroacetabular impingement. Although patient-reported outcome (PRO) scores at midterm follow-up have shown continued success, the maintenance of a normalized alpha angle has not been shown radiographically.Purpose:To assess the radiographic recurrence of cam deformity at 2-year follow-up after adequate decompression during the index hip arthroscopic procedure and correlate the findings with PRO scores. The hypothesis was that there would be no recurrence or regrowth of the cam deformity at the 2-year postoperative time point after adequate cam decompression during hip arthroscopic surgery.Study Design:Case series; Level of evidence, 4.Methods:Between March 2009 and January 2011, data were prospectively collected on all patients undergoing hip arthroscopic surgery with femoral neck osteoplasty. Minimum follow-up was 2 years, with radiographic images for review.Results:A total of 47 patients met the inclusion criteria. The mean age of the participants at the start of the study was 37.18 years (range, 31.70-47.43 years). There were 28 men (59.57%) and 19 women (40.43%). The mean follow-up duration was 28.32 months (range, 24-41 months). The mean preoperative alpha angle (Dunn view) was 70° (range, 60°-97°), compared with 42.79° (range, 32°-50°) at 2 weeks postoperatively ( P < .0001). The mean 2-year alpha angle was 42.72° (range, 32°-54°), which was not significantly different compared with the mean 2-week alpha angle ( P = .93). Additionally, the mean femoral offset measurement was 3.7 mm (range, 0-9.9 mm) preoperatively and 7.8 mm (range, 0.3-13.9 mm) 2 weeks postoperatively ( P < .0001). The mean 2-year postoperative femoral offset measurement was 8.0 mm (range, 2.4-12.8 mm), which was not significantly different compared with the mean 2-week femoral offset measurement ( P = .63). All PRO scores were significantly improved at 3 months compared with preoperative scores and, except for visual analog scale score, continued to show improvement at 2-year follow-up.Conclusion:There was no recurrence of cam deformity at 2 years after femoral neck osteoplasty for femoroacetabular impingement. PRO scores were improved at the 3-month and 2-year postoperative time points.

Purpose: Many patients presenting with hip disease also have coexisting lumbar spine disease (LSD). At present there is a paucity of literature examining the effect of arthroscopic hip surgery in patients with coexisting LSD. The purpose of this systematic review was to examine the relationship between the hip and lumbar spine to determine whether low back pain impacts the indications and outcomes for surgical intervention of the hip. Methods: A systematic review of the literature was performed by a search of PubMed using the following search terms: (1) hip, back, and motion; (2) hip, back, and pain; and (3) hip, lumbar spine, and pain. Two reviewers searched for relevant articles that met established inclusion criteria. We excluded review articles, technique articles, articles reporting on the same patient population, and articles without reported patient data. Kinematic data pertaining to the hip for patients with low back pain was collected. Preoperative and postoperative data were collected for patients treated for hip disease in the setting of LSD. Results: After examining 2,020 references and abstracts, 15 articles were selected for this review. Patients with low back pain consistently demonstrated decreased hip range of motion compared with controls. Patients undergoing hip surgery with coexisting LSD showed improvement in the modified Harris Hip Score (mHHS), Harris Hip Score (HHS), Visual Analog Scale (VAS), SF-36 scores, and the Owestry Disability Index. Conclusions: Patients with low back pain frequently have limited or altered hip range of motion, and these patients routinely improve after surgical intervention for hip disease. Surgical intervention for hip disease should be considered in the context of low back pain and LSD. Level of Evidence: Level IV, systematic review of Level III and IV studies.

Periacetabular osteotomy (PAO) has become an accepted treatment option for patients with severe hip dysplasia. In addition to correcting acetabular architecture, consideration has been given to concomitant joint evaluation and treatment of coexisting intra-articular pathologic conditions, which can be identified with hip arthroscopy or through an open arthrotomy. The purpose of this systematic review was to evaluate the prevalence of intra-articular pathologic conditions identified arthroscopically compared with that of those identified with open arthrotomy.A systematic review of the literature was performed by a search of PubMed using the words "periacetabular osteotomy," "Bernese osteotomy," and "Ganz osteotomy." Two reviewers searched for relevant articles that met established inclusion criteria, which follow: (1) they were in the English language, (2) they contained data on patients who underwent periacetabular osteotomy, (3) the study patients underwent concomitant arthroscopy or arthrotomy, and (4) the studies contained data on the intra-articular findings at the time of osteotomy. Exclusion criteria included review articles, technique articles, articles reporting on the same patient population, and articles without reported patient data.After review of 361 references and abstracts, 8 articles met the inclusion criteria. A total of 775 patients who had undergone PAO were included in the 8 articles. Three articles inspected all joints at the time of PAO and accounted for 345 PAOs. Arthrotomy was used to evaluate 151 hips, and 31 (21%) labral tears were identified. Arthroscopy was used to evaluate 194 hips, and 162 (84%) labral tears were identified. The difference in prevalence is statistically significant (P.05). Two of the 3 articles reported chondral injury: 141 (73%) acetabular chondral injuries and 52 (27%) femoral chondral injuries were noted in 194 hips.The prevalence of intra-articular damage, including labral injuries and pathologic conditions of cartilage, at the time of PAO is substantial. Labral tears and chondral injury appear to be better recognized with concomitant arthroscopy when compared with arthrotomy at the time of PAO. Further study is needed to determine whether the treatment of chondrolabral injuries can improve patient outcome and reduce reoperations.Level IV, systematic review of Level IV studies.

Background: Complete atrioventricular septal defect (CAVSD) in association with tetralogy of Fallot is a rare and complex disease that makes its repair more difficult than repair of either lesion alone. We reviewed retrospectively our experience in managing this lesion. Patients and Methods: Between February 2006 and May 2017, 16 patients who underwent repair of CAVSD/tetralogy of Fallot (TOF) were reviewed retrospectively. Fifteen patients had trisomy 21. Five patients underwent primary repair while eleven patients went for staged repair in the form of right ventricular outflow tract (RVOT) stenting (n = 9) or systemic to pulmonary (S-P) surgical shunt (n = 2). RVOT stenting has replaced surgical shunt since 2012 in our center. Early presentation with cyanosis was the main determinant factor for staged versus primary repair. Results: The median age at first palliation was 46 days (range 15–99 days). The median age at total repair for both groups was 6 months (range 3–18 months); the median age for the palliated patients was 6.5 months (range 5–18 months) while the median age for primary repaired patients was 5 months (range 3–11 months). The median weight at final repair was 6.9 kg (3.7–8.2 kg). The pulmonary valve was preserved in five patients (31%), four of them had no prior palliation. Chylothorax occurred in 50% of the patients. One late mortality occurred after final repair due to sepsis. Conclusion: CAVSD/TOF can be repaired with low mortality and morbidity. The use of RVOT stent has replaced the surgical (S-P) shunt with acceptable results in our center.

This study reviewed pain and outcome scores of patients undergoing revision surgery with heterotopic ossification (HO) excision following previous hip arthroscopy. The aim was to determine if performing the excision arthroscopically improved clinical outcomes. Data were prospectively collected and retrospectively reviewed in patients who had HO removed arthroscopically between February 2008 and 2014. Four patient-reported outcome (PRO) measures were collected: Modified Harris Hip Score (mHHS), Non-Arthritis Hip Score (NAHS), Hip Outcome Score-Activity of Daily Living (HOS-ADL) and Sport-Specific (HOS-SS) subscales. Minimum 1.5 year follow-up from index procedure was available for 23 patients (mean age = 38.6 years). Of the 23 patients who had revision surgery and HO removal, 19 (83%) were available for follow-up. Prior to revision, the average mHHS was 53.4, HOS-ADL 51.4, HOS-SS 24.5, NAHS 50.3 and VAS 6.7. Following revision with HO excision, each score had improved with an average mHHS of 73.62, HOS-ADL of 68.88, HOS SS of 58.51, NAHS of 70.83 and VAS of 4.33. Overall, mHHS increased by 20.26 points (P < 0.001), HOS-ADL increased by 17.48 points (P = 0.023), HOS-SS increased by 34.03 points (P < 0.001), NAHS increased by 20.55 points (P = 0.001) and VAS decreased by 2.38 points (P < 0.001). Patients undergoing revision hip surgery with HO excision demonstrated improved outcome scores and pain resolution; however, few patients achieved a good or excellent result. Revision hip surgery with HO excision should be approached cautiously because of the modest results in this patient group.

The treatment of chondral hip injuries is challenging. However, for young patients with hip disorders, orthopedic surgeons now have the opportunity to intervene early in the development of debilitating joint disease. As understanding of the hip joint continues to evolve, more effective treatment strategies are emerging. There are several reportedly successful options for surgical treatment. This article reviews the clinical presentation of chondral injuries and the surgical modalities, arthroscopic and open, available to treat them.

To examine arthroscopic treatment of hip pain in patients with borderline hip dysplasia (lateral center edge angle [LCEA] between 20° and 25°).From 2008 to 2013, patients below 18 years of age who underwent arthroscopic hip surgery with an LCEA between 20° and 25° were retrospectively matched 1:1 to a control group without dysplasia (LCEA ≥25°) based on age, gender, femoroplasty, labral treatment, and capsular plication. Indications for surgery included failure to improve with nonoperative treatments and anti-inflammatory medications after 3 months. Patient-reported outcome data were collected using modified Harris hip score, hip outcome score-activities of daily living subscale, hip outcome score-sports-specific subscale, nonarthritic athletic hip score, and visual analog scale.From 2008 to 2013, 168 patients below the age of 18 underwent arthroscopic hip surgery. Twenty-one patients met inclusion criteria and were matched 1:1 to a control group. Follow-up was achieved for 17 patients in both groups (81%). Mean follow-up time, age, and LCEA were 2.19 years, 15.5 years, and 22.3° for the dysplastic group and 2.16 years, 16.0 years, and 31.2° for the control group, respectively. Preoperative patient-reported outcomes between groups were not statistically different. At the latest follow-up, both groups showed statistically significant improvement over baseline in modified Harris hip score, hip outcome score-activities of daily living subscale, hip outcome score-sports-specific subscale, nonarthritic athletic hip score, and visual analog scale (P.001). Latest follow-up scores were not statistically different between groups.This study shows favorable 2-year outcomes in adolescent patients with borderline dysplasia undergoing labral treatment and capsular plication. Outcomes in the borderline dysplastic patients were as good as those of a control group. Although adolescents with borderline dysplasia have traditionally been a challenging group of patients to treat, these results suggest that an arthroscopic approach that addresses both labral pathology and instability may be beneficial.Level IV, therapeutic case series.

Background: Hip dysplasia has been shown to be a cause of early arthritis. The decrease in bony coverage has shown increased stress on the acetabular labrum as it shares an increased load. Purpose/Hypothesis: The purpose of this study was to divide a cohort of patients by radiographic measures of dysplastic and nondysplastic hips for comparison with regard to labral size at 4 anatomic locations. The hypothesis was that dysplastic hips will have significantly larger labral size compared with nondysplastic hips. Study Design: Cross-sectional study; Level of evidence, 3. Methods: A prospective study was conducted at a single institution. A total of 130 patients underwent hip arthroscopy during the study period from September 2011 to February 2012. Intraoperatively, arthroscopic measurements were taken at 4 quadrants on the acetabular clockface: anterosuperior (12-3 o’clock), anteroinferior (3-6 o’clock), posterosuperior (9-12 o’clock), and posteroinferior (6-9 o’clock). Three radiographic parameters for dysplasia were used to substratify the study population base: lateral center-edge angle (LCEA) ≤25° and LCEA >25°, acetabular inclination (AI) ≤10° and AI >10°, and anterior center-edge angle (ACEA) ≤20° and ACEA >20°. Results: For the LCEA ≤25° group, there were 28 hips with mean LCEA of 20.96° ± 3.40°. Patients with LCEA ≤25° had larger labral width in all 4 quadrants ( P < .05). For AI >10°, there were 12 hips with the mean AI 12.92° ± 2.50°. Patients with AI >10° had larger labral size in the posteroinferior quadrant only ( P < .05). For ACEA ≤20°, there were 4 hips with a mean ACEA of 11.25° ± 5.19°. The anteroinferior and posteroinferior quadrants had a significant increase in labral size when substratified by ACEA ≤20° ( P < .05). Conclusion: Labral size was significantly larger in dysplastic hips compared with nondysplastic hips. The posteroinferior quadrant labrum was larger in size in dysplastic hips, as measured by any of the 3 radiographic measurements of dysplasia. Hips with LCEA ≤25° had larger labra in all 4 quadrants.

The labrum of the hip is recognized as being important to the stability of the hip and a major cause of hip pain. Damage to the labrum may result in increased joint stress and articular damage. Labral damage is often treated through various methods, among them simple stitch repair, base refixation, and debridement. Labral reconstruction becomes necessary when the labrum is too damaged to salvage, which renders labral repair improbable and labral debridement ineffective. In contrast to other methods that have been described for this treatment, our technique uses a semitendinosus allograft as a graft source, allowing for arthroscopic hip labral reconstruction. This technique has many advantages and is easily reproducible. It has shown promising results in patients with labral damage. The purpose of this article is to detail the step-by-step surgical technique of labral reconstruction using a semitendinosus allograft, in addition to the indications, pearls, and pitfalls of the technique.

Objectives: The purpose of this study was to evaluate clinical outcomes, pain, and patient satisfaction following revision hip arthroscopy at a high volume referral center with a minimum 2-year follow-up. Methods: During the study period, April 2008 to October 2011, data was prospectively collected on all patients undergoing revision hip arthroscopy. All patients were assessed pre- and post-operatively with 4 patient-reported outcome (PRO) measures: the modified Harris Hip Score (mHHS), Non-Arthritic Hip Score (NAHS), Hip Outcome Score-Activities of Daily Living (HOS-ADL), and Hip Outcome Score-Sport Specific Subscales (HOS-SSS). Pain was estimated on the visual analog scale (VAS). Patient satisfaction was measured on a scale from 0 to 10. Results: Eighty-seven patients underwent revision hip arthroscopy during the study period. Seventy (80.5%) patients were included in our study. In terms of residual FAI morphology, 45.7% of patients had preoperative alpha angles ≥55 degrees and 7.14% of patients had a LCEA ≥40 degrees. The score improvement from preoperative to 2-year follow-up was 57.84 to 73.65 for mHHS, 62.79 to 83.04 for HOS-ADL, 37.33 to 54.93 for HOS-SSS, 55.65 to 70.79 for NAHS. VAS decreased from 6.72 preoperatively to 4.08 postoperatively. All scores demonstrated statistically significant improvement (PConclusion: Revision hip arthroscopy for all procedures performed on aggregate has excellent clinical outcomes for all PROs and patient satisfaction scores at short-term follow-up. Patients should be counseled regarding the potential progression of degenerative change leading to arthroplasty, and the potential for revision surgery.

Objectives: The most common reason for reoperation following arthroscopic hip surgery is conversion to total hip arthroplasty (THA). The purpose of this study was to identify clinical and radiographic risk factors for early conversion to THA. Methods: Data were prospectively collected on all hip arthroscopy patients from January 2009 through December 2011. Inclusion criteria for the study group were patients undergoing hip arthroscopy for a labral tear who eventually converted to THA. Patients were then compared to a control group of patients who underwent hip arthroscopy for a labral tear and did not convert to THA during the same period. Exclusion criteria were patients with previous hip conditions such as Legg-Calves-Perthes, slipped capital femoral epiphysis, pigmented villonodular synovitis, and avascular necrosis. A bivariate analysis of 41 preoperative and intraoperative variables was performed. Results: A total of 792 patients met inclusion and exclusion criteria. A total of 72 (9%) converted to THA. The control group consisted of 720 patients who did not convert to THA. Bivariate analysis demonstrated that the study group had significantly higher means or frequencies than the control group for the following variables: male gender, age at time of surgery, BMI, back pain, previous back surgery, Tönnis grade above 0, acetabular inclination angle, alpha angle, Seldes combined-type labral tear, labral tear size, chondral injury, traction time, labral debridement (versus repair), number of anchors used repair or reconstruction, and capsular release (versus repair). The study group had significantly lower means or frequencies than the control group for the following variables: preoperative patient reported outcome scores, crossover sign, lateral center edge angle, and psoas release. A statistically significant difference in average joint space was not observed. Conclusion: Multiple risk factors are possible preoperative and intraoperative risk factors for conversion to THA following hip arthroscopy. The clinician and patient should be aware of these variables.

Patient-reported outcome (PRO) scores are used to evaluate treatment modalities in orthopaedic surgery. The method of PRO collection may introduce bias to reported surgical outcomes due to the presence of an interviewer. This study evaluates post-operative PROs for variation of outcomes between survey methods—in-person, online, or telephone. From 2008 to 2011, 456 patients underwent arthroscopic surgical treatment for acetabular labral tears. All pre-operative surveys were completed in the clinic during pre-operative visit. Two-year follow-up questionnaires were completed by 385 (84 %) patients. The PRO data were prospectively collected pre- and post-operatively using five tools: modified Harris Hip Score (mHHS), Hip Outcome Score Activities of Daily Living (HOS-ADLS), Hip Outcome Score Sports-Specific Subscale (HOS-SSS), Non-Arthritic Hip Score (NAHS), and visual analog scale. Patients were grouped according to method of 2-year follow-up: in-person during follow-up visit (102 patients, 26 %), online by email prompt (138 patients, 36 %), or telephone with an interviewer (145 patients, 38 %). Pre-operative baseline PRO scores demonstrated no statistically significant difference between groups for mHHS, HOS-ADLS, HOS-SSS, and NAHS. Two-year post-operative PRO scores obtained by telephone were statistically greater than scores obtained in-person or online for mHHS (p

Previous studies assessed elite athletes' return to sport (RTS) after hip arthroscopy, but few investigated a cohort including athletes from all levels of sport. This study compared athletes who returned to sport to those who did not, based on four patient-reported outcome (PRO) scores, including the Hip Outcome Score-Sports Specific Subscale (HOS-SSS). Between September 2008 and April 2012, hip arthroscopies were performed on 157 patients (168 hips) who reported playing a sport preoperatively and indicated their level of sports activity post-operatively. Two-year follow-up was available for 148 (94%) amateur and professional athletes with a total of 158 hips. Of these 60 cases (65 hips) did not return to sports (NRTS) and were in the NRTS group. The remaining 88 cases (93 hips) constituted the RTS group. The modified Harris Hip Score, Non-Arthric Hip Score, Hip Outcome-Activities of Daily Living (HOS-ADL), and HOS-SSS were used to assess outcomes. The HOS-SSS was used to assess specific sport-related movement. Both groups demonstrated significant improvement at 2 years post-operatively in visual analog score and four PRO scores (P

Background: Hip arthroscopy has gained increasing popularity over the past decade. The need to develop metrics to evaluate success and complications in primary hip arthroscopy is an important goal. Purpose: To evaluate 2-year patient-related outcome (PRO) scores and patient satisfaction scores for a single surgeon at a high-volume referral center for all primary hip arthroscopy procedures performed. Study Design: Case series; Level of evidence, 4. Methods: During the study period between April 2008 and October 2011, data were collected on all patients who underwent primary hip arthroscopy. All patients were assessed pre- and postoperatively with 4 PRO measures: the modified Harris Hip Score (mHHS), Non-Arthritic Hip Score (NAHS), Hip Outcome Score–Activities of Daily Living (HOS-ADL), and Hip Outcome Score–Sport-Specific Subscale (HOS-SSS). Pain was estimated on the visual analog scale (VAS), and satisfaction was measured on a scale from 0 to 10. The number of patients who underwent revision arthroscopy, total hip arthroplasty (THA), or a resurfacing procedure during the study period was also reported. Results: A total of 595 patients were included in the study. The score improvement from preoperative to 2-year follow-up was 61.29 to 82.02 for mHHS, 62.79 to 83.05 for HOS-ADL, 40.96 to 70.07 for HOS-SSS, 57.97 to 80.41 for NAHS, and 5.86 to 2.97 for VAS. All scores were statistically significantly different ( P < .0001). Overall patient satisfaction was 7.86 ± 2.3 (range, 1-10). Forty-seven (7.7%) patients underwent revision hip arthroscopy, and 54 (9.1%) patients underwent either THA or the hip resurfacing procedure during the study period. The multivariate regression analysis showed that increased age at time of surgery was a significant risk factor for conversion to THA, revision arthroscopy, and change in NAHS Conclusion: Primary hip arthroscopy for all procedures performed in aggregate had excellent clinical outcomes and patient satisfaction scores at short-term follow-up in this study. More studies must be conducted to determine the definition of a successful outcome. There was a 6.1% minor complication rate, which was consistent with previous studies. Patients should be counseled regarding the potential progression of degenerative change leading to arthroplasty as well as the potential for revision surgery.

Background: Hip arthroscopy has gained popularity over the past decade, and its indications have broadened as newer techniques have been developed. However, there has been a paucity of literature evaluating the outcomes of hip arthroscopy in obese patients. Purpose: To compare 2-year clinical outcomes of obese patients undergoing primary hip arthroscopy with matched nonobese controls. Study Design: Cohort study; Level of evidence, 3. Methods: From February 2008 to February 2012, data were collected prospectively on all obese patients undergoing primary hip arthroscopy. A matched-pair nonobese control group was selected at a 1:2 ratio. All patients were assessed pre- and postoperatively with 4 patient-reported outcome (PRO) measures: the modified Harris Hip Score, Non-Arthritic Hip Score, Hip Outcome Score–Activities of Daily Living, and Hip Outcome Score–Sport Specific Subscale. Pain was estimated on the visual analog scale, and satisfaction was measured on a scale from 0 to 10. Results: Sixty-two hips (62 patients) were included in the obese group and 124 hips (124 patients) in the control group. At preoperative baseline, the obese group had significantly lower PRO scores when compared with the control group. Both groups demonstrated statistically significant postoperative improvement in all scores ( P < .05). Absolute scores were significantly lower in the obese group for all PRO measures, pre- and postoperatively. However, the improvement (delta) in PRO scores from pre- to postoperative time was not significantly different between groups. The rate of conversion to total hip arthroplasty, the rate of revision, and the complication rate were not significantly different between the 2 groups; however, rates of conversion to total hip arthroplasty and revision tended to be twice as high in the obese patients, but the study was not powered for these 2 outcomes. Conclusion: Overall, obese patients had lower absolute PRO scores preoperatively and at 2-year follow-up. Both obese and nonobese patients demonstrated significant improvement in all PRO scores, and the change in scores were similar between groups. These results indicate that while obese patients may not have similar absolute scores after hip arthroscopy, they may show similar gains in improvement when compared with baseline. Hip arthroscopy appears to be a viable treatment option in the obese patient as long as expectations are adjusted accordingly.

Purpose The purpose of this study was to (1) evaluate the clinical outcomes of a series of patients aged 60 years or older who underwent hip arthroscopy for labral tears with minimum 2-year follow-up and (2) identify risk factors for conversion to total hip arthroplasty (THA). Methods Outcome data were prospectively collected and retrospectively reviewed in patients aged 60 years or older who underwent hip arthroscopy between April 2008 and May 2012. Four patient-reported outcome (PRO) scores, pain scores, and satisfaction ratings were collected. Conversion to THA and revision surgery rates were recorded. A subgroup analysis compared survivors with patients requiring THA. Results Minimum 2-year follow-up was available for 30 patients with a mean age of 63.9 years. The 2-year survivorship rate was 70%, with 9 patients undergoing conversion to THA at a mean of 1.1 years after hip arthroscopy. Two patients required additional surgery during the study period, for a reoperation rate of 37% (11 of 30 patients). The remaining cohort showed mean improvements in all PRO scores. All scores, except the sports-related PRO ( P = .12), improved significantly from the preoperative baseline scores. Visual analog scale scores for pain decreased from a mean of 5.0 preoperatively to 2.7 postoperatively ( P = .003). Patients who required conversion to THA had lower preoperative modified Harris Hip Scores ( P = .015), lower preoperative Hip Outcome Score–Activity of Daily Living values ( P = .01), higher pain scores ( P = .05), greater acetabular inclination ( P = .023), and more severe chondral damage ( P = .033). Conclusions Arthroscopic treatment of labral tears in patients aged 60 years or older should be approached with caution. Patients in this age group had an overall 2-year survivorship rate of 70% and should be counseled before surgery on the possibility of subsequent conversion to THA. Patients aged 60 years or older with poor preoperative PRO scores, high pain scores, radiographic evidence of borderline dysplasia, and severe chondral damage may be poor candidates for hip arthroscopy. Level of Evidence Level IV, therapeutic case series.

Acetabular notch osteophytes are often encountered during routine diagnostic arthroscopy of the hip. It has been our observation that when notch osteophytes are present, there is often corresponding chondral damage to the anterosuperior femoral head and ligamentum teres degeneration. We propose that removal of the notch osteophyte and decompression of the articulating surface offer an effective method of delaying the progression of arthritis. This article describes in detail the technique used to perform arthroscopic acetabular notchplasty, and a companion video, demonstrating the procedure, is included. Our experience suggests that decompression of the acetabular notch can remove offending structural abnormalities that can potentially cause further chondral damage and may hasten the progression of arthritis.

Objectives: Full thickness chondral defects have been suggested to portend poor prognosis in hip arthroscopy. Although there is a small amount of data suggesting favorable outcomes with microfracture for such cases, no comparative studies have been performed to assess outcomes of full thickness chondral defects treated with microfracture. The purpose of this study is to compare two-year clinical outcomes of patients treated with microfracture to a matched control group that did not have full thickness chondral damage. Methods: During the study period, between June 2008 and July 2011, data were collected on all patients treated with hip arthroscopy who underwent microfracture. A matched-pair control group of patients who did not undergo a microfracture procedure was selected in a 1:2 ratio. Matching criteria were age within 5 years, sex, surgical procedures, and radiographic findings. All patients were assessed pre- and post-operatively with 4 patient-reported outcome (PRO) measures: the modified Harris Hip Score (mHHS), Non-Arthritic Hip Score (NAHS), Hip Outcome Score-Activities of Daily Living (HOS-ADL), and Hip Outcome Score-Sport Specific Subscales (HOS-SSS). Pain was estimated on the visual analog scale (VAS), and satisfaction was measured on a scale from 0 to 10. Results: Forty-nine hips were included in the microfracture group and 98 in the control group. There was no significant difference in pre-operative PRO scores between the groups. For the microfracture group, the score improvement from preoperative to 2-year follow-up was 57.5 to 75.4 for mHHS, 53.6 to 71.8 for NAHS, 59.5 to 79.1 for HOS-ADL, and 35.5 to 55.5 for HOS-SSS. For the control group, the score improvement from preoperative to 2-year follow-up was 59.2 to 79.5 for mHHS, 54.4 to 76.2 for NAHS, 60.6 to 80.4 for HOS-ADL, and 38.6 to 64.2 for HOS-SSS. Both groups demonstrated statistically significant postoperative improvement in all scores (p Conclusion: Our study demonstrated that patients receiving microfracture during hip arthroscopy did not show a statistically significant difference in PRO scores when compared to a matched-pair control group at two year follow-up. Both groups demonstrated significant improvement in all PRO scores. These results show that microfracture appears to be a viable treatment option for grade IV cartilage damage identified at the time of hip arthroscopy. Furthermore, full thickness chondral defects may not necessarily portend an inferior functional prognosis when treated with microfracture

Recalcitrant osteitis pubis presents a challenging problem for orthopaedic surgeons. Various surgical interventions have been described for treatment, including opening-wedge resection, symphysiodesis, and curettage. We propose that endoscopic pubic symphysectomy offers an effective method of treating such a challenging problem. This article describes in detail the technique used to perform endoscopic pubic symphysectomy, and a companion video demonstrating the procedure is included. Our experience suggests that removal of the interpubic fibrocartilaginous lamina and resection of approximately 1 cm of bone can successfully eliminate all sources of pain and dysfunction caused by the recalcitrant osteitis pubis.

Evaluation and treatment of concomitant intra-articular pathology may be beneficial before periacetabular osteotomy (PAO) is performed. Hip arthroscopy before PAO allows the surgeon to perform full inspection of the hip joint and can be used to treat hip pathology before osteotomy. The indications for hip arthroscopy before PAO are presented in this article. The combined surgical procedure is described, along with potential complications. The advantages and disadvantages of this technique are outlined.

Labral reconstruction is becoming an important treatment modality for hips with nonsalvageable labra. Nonsalvageable labra can be present in cases of intrasubstance damage, revision surgery after debridement, labral calcification, and hypoplasia. Previous methods of reconstruction have been performed in an open manner and arthroscopically using ligamentum teres, iliotibial band, and gracilis autograft. We present an alternate method of arthroscopic labral reconstruction using capsular autograft. The technique uses readily available capsular tissue during arthroscopy with no donor-site morbidity. This technique may be valuable in appropriately selected patients with labral deficiency.

ARF proteins regulate the formation of transport vesicles at many steps of the secretory and endocytic pathways. A recently identified family of ARF effectors, named GGAs, appears to regulate membrane traffic exiting the trans-Golgi network in mammalian cells (Boman et al., 2000). We have identified two GGA homologues in the yeast S. cerevisiae. These previously uncharacterized open reading frames, YDR358w and YHR108w, have been named GGA1 and GGA2, respectively. Using the two-hybrid assay and GST-affinity chromatography, we show that Gga1p and Gga2p interact with Arf1p and Arf2p in a GTP-dependent manner, suggesting that both are functional homologues of the human GGA proteins. The Arf-binding domain resides in the amino-terminal half of Gga1p (amino acids 170–330), and the carboxy-terminal 100 amino acids resemble the γ-adaptin ‘ear domain’. Gene deletion experiments indicate that GGA1 and GGA2 are not essential genes, as single and double knockouts are viable at both 30°C and 37°C. However, cells lacking GGA1 and GGA2 exhibit defects in invertase processing and CPY sorting, but not endocytosis. We conclude that yeast Gga proteins are effectors of Arf in yeast that facilitate traffic through the late Golgi. Copyright © 2000 John Wiley & Sons, Ltd.

Growth of vascular anastomoses is desirable in pediatric vascular surgery, especially in pediatric organ transplantation. Although absorbable suture has been shown to be superior to nonabsorbable suture in permitting growth of arterial anastomoses, the optimal suture material for venous anastomoses has not been established. To examine this in a porcine model, we performed bilateral primary end-to-end anastomoses of transected external jugular veins in 10, 4-week-old piglets. In each piglet one anastomosis was constructed with continuous absorbable 8-0 polyglyconate suture, whereas the contralateral anastomosis was constructed with continuous nonabsorbable 8-0 polypropylene suture. After 6 months the veins were excised, pressure fixed at 15 mm Hg for 2 hours, and examined grossly and histologically. Vein diameter was measured by contrast radiography at the anastomosis and 1 cm proximal and distal to the anastomosis. Vein cross-sectional area 1 cm from the anastomosis was similar in the two groups: polyglyconate 95.7 ±12.3 mm 2 versus polypropylene 95.3 ± 9.7 mm 2 . However, polyglyconate anastomoses had greater cross-sectional area (polyglyconate 72.8 ± 7.9 mm 2 vs polypropylene 51.8 ± 6.0 mm 2 ; p p 2 ) from control pigs at 4 weeks of age. On histologic examination, polyglyconate had dissolved entirely in six cases and was present but in varying degrees of dissolution in the other four; in contrast, polypropylene was identifiable at all anastomoses. These results suggest that absorbable suture is superior to nonabsorbable suture for construction of venous anastomoses when anastomotic growth is important. (J Vasc Surg 1992;769–73.)

As a screening tool, CT angiography has excellent sensitivity and specificity combined with fewer complications compared to conventional arteriography.

Objectives: It is unknown whether pateints undergoing tenotomy for painful internal snapping at the time of hip arthroscopy can expect equivalent functional outcome to patients undergoing hip arthroscopy without tenotomy. The contribution of the psoas tendon and hip capsule to hip stability is also currently debated. The purpose of this matched study is to (1) compare two-year outcome scores in a study group who underwent psoas tenotomy to a matched control group who did not have a psoas tenotomy, and (2) perform a subgroup analysis of the study group comparing capsular repair to capsular release. Methods: Between April of 2008 and December of 2012, we prospectively collected data and reviewed 694 hip arthroscopies with a minimum 2 year follow up. A total of 243 patients had undergone psoas tenotomy and comprised the study group available for matching. After a power analysis was performed we matched 50 patients in the control group to 50 patients in the study group. A subgroup analysis of the study group was then performed based on the capsular treatment performed. Twenty five patients who underwent capsular release were compared to 25 patients who underwent capsular repair. The protocol included pre- and post-operative administration of four hip-specific patient-reported outcome (PRO) tools, the visual analog scale (VAS), and patient satisfaction scores. Results: Both the study group (n=50) and control group (n=50) demonstrated a statistically significant improvement in patient-reported outcome (PRO) scores and pain scores at 2-year follow up (pConclusion: In patients with painful internal snapping and psoas impingement lesions arthroscopic psoas tenotomy appears to result in similar two-year outcomes to patients not undergoing psoas tenotomy at the time of labral treatment. We were unable to detect a significant role for capsular closure at the time of psoas tenotomy; however, this requires further study.