Clinical outcomes analysis of conservative and surgical treatment of patients with clinical indications of prearthritic, intra-articular hip disorders.
ABSTRACT To describe outcomes of the conservative treatment of patients who had the clinical presentation of a prearthritic, intra-articular hip disorder, including acetabular labral tears, developmental hip dysplasia, and femoroacetabular impingement.
Prospective observational clinical outcomes study.
Outpatient orthopedic clinic at a tertiary university hospital.
Patients presenting with prearthritic, intra-articular hip disorders were recruited. Fifty-eight consecutive patients were enrolled; 6 were lost to follow-up, and 52 subjects completed the study.
Patients were recruited on the basis of symptoms, distribution of pain, and the findings of a physical examination. Radiographic measurements of the hip were obtained for all subjects to describe the presence or absence and extent of deformity and/or osteoarthritis. All subjects completed a directed course of conservative treatment. After 3 months of conservative care, subjects with continued limitations, reduction of symptoms with a diagnostic intra-articular hip injection, and a surgically amenable lesion found on a magnetic resonance arthrogram proceeded to surgery.
Numeric Pain Score (0-10), Short Form-12, Modified Harris Hip Score, Western Ontario and McMaster Universities Osteoarthritis Index, Nonarthritic Hip Score, Baecke Questionnaire of Habitual Activity, and patient choice to have surgery.
Fifty-eight patients (9 men and 49 women) with a mean age of 35 ± 11 years (range, 18-50 years) enrolled in the study. Fifty-two subjects completed the study. Twenty-three subjects (44%) reported satisfaction with conservative care. Twenty-nine subjects (56%) chose to have surgery. Both groups demonstrated equally significant improvement (P value ranges: P = .03 to P = .0001) in all outcome measures from baseline to 1-year follow-up. Subjects who chose surgery had higher baseline activity scores compared with the conservative treatment group (P = .02).
All subjects with signs and symptoms of prearthritic, intra-articular hip disorders who were treated with conservative treatment alone and with conservative treatment followed by surgery demonstrated significant improvement in pain and functioning from baseline to 1 year. Forty-four percent of patients improved with conservative care alone, and 56% chose to have surgery after receiving conservative care. Persons with more active lifestyles were more likely to choose surgery. These data suggest that a trial of conservative management for persons with prearthritic, intra-articular hip disorders should be considered before engaging in surgical intervention.
Article: Atypical hip impingement.[show abstract] [hide abstract]
ABSTRACT: OBJECTIVE. This article summarizes how atypical forms of hip impingement can be assessed with radiographs, CT, and MRI. CONCLUSION. Subspine impingement, ischiofemoral impingement, and iliopsoas impingement are atypical forms of hip impingement and are less common than classic femoroacetabular impingement. Additional forms of atypical impingement, such as abnormal femoral antetorsion, abnormal pelvic and acetabular tilt, and extreme hip motion, can occur combined with classic femoroacetabular impingement or as separate entities.American Journal of Roentgenology 09/2013; 201(3):W437-42. · 2.90 Impact Factor
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ABSTRACT: BACKGROUND: Currently, three surgical approaches are available for the treatment of cam femoroacetabular impingement (FAI), namely surgical hip dislocation (SHD), hip arthroscopy (HA), and the miniopen anterior approach of the hip (MO). Although previous systematic reviews have compared these different approaches, an overall assessment of their performance is not available. QUESTIONS/PURPOSES: We therefore executed a multidimensional structured comparison considering the benefits, opportunities, costs, and risk (BOCR) of the different approaches using multicriteria decision analysis (MCDA). METHODS: A MCDA using analytic hierarchical process (AHP) was conducted to compare SHD, HA, and MO in terms of BOCR on the basis of available evidence, institutional experience, costs, and our understanding of pathophysiology of FAI. A preclinical decision-making model was created for cam FAI to establish the surgical approach that better accomplishes our objectives regarding the surgical treatment. A total score of an alternative's utility and sensitivity analysis was established using commercially available AHP software. RESULTS: The AHP model based on BOCR showed that MO is the best surgical approach for cam FAI (normalized score: 0.38) followed by HA (normalized score: 0.36) and SHD (normalized score: 0.25). The sensitivity analysis showed that HA would turn into the best alternative if the variable risks account for more than 61.8% of the priority during decision-making. In any other decision-making scenario, MO remains as the best alternative. CONCLUSIONS: Using a recognized method for decision-making, this study provides supportive data for the use of MO approach as our preferred surgical approach for cam FAI. The latter is predominantly derived from the lower cost of this approach. Our data may be considered a proxy performance measurement for surgical approaches in cam FAI. LEVEL OF EVIDENCE: Level II, economic and decision analyses. See the Guidelines for Authors for a complete description of levels of evidence.Clinical Orthopaedics and Related Research 03/2013; · 2.79 Impact Factor
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ABSTRACT: The concept of femoroacetabular impingement (FAI) emerged following the observation that FAI can be precipitated by acetabular reorientation and can produce new labral damage. Interest in the association between chondrolabral damage and variations in femoral and acetabular anatomy has established a causal relationship between mechanical aberration in the function of the hip joint and the development of labral and cartilage damage. The accepted definition of FAI is that it is characterized by abnormal mechanical contact between the rim of the acetabulum and the upper femur. Combinations of certain morphologies and movements may lead to FAI.Orthopedic Clinics of North America 10/2013; 44(4):575-589. · 1.25 Impact Factor