Thomas Ellis’s research while affiliated with The Ohio State University and other places

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Publications (61)


Podium Presentation Title: Functional Outcomes and Return to Sport for Borderline Dysplasia Patients: Total Hip Arthroscopy vs. Hip Arthroscopy
  • Article

February 2025

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1 Read

Arthroscopy The Journal of Arthroscopic and Related Surgery

Robert C. Kollmorgen

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Thomas Ellis

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Josh Harris

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Figure 1. Patient flow diagram. FAIS, femoroacetabular impingement syndrome; FDO, femoral derotational osteotomy; PAO, periacetabular osteotomy.
Figure 2. ROCs for identifying patients with different degrees of satisfaction at 1-year follow-up after hip arthroscopy for FAIS: (A) 80% satisfied; (B) 90% satisfied; (C) 100% satisfied. iHOT, International Hip Outcome Tool; FAIS, femoroacetabular impingement syndrome; PF, Physical Function; PI, Pain Interference; PROMIS, Patient-Reported Outcomes Measurement Information System; ROC, receiver operating curve.
Patient and Surgery Characteristics a
Preop and Postop iHOT-12, PROMIS-PF, PROMIS-PI, and Postop Satisfaction a
Comparison of the PROMIS and iHOT-12 in Determining Satisfaction Levels After Hip Arthroscopy for FAIS
  • Article
  • Full-text available

May 2023

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62 Reads

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5 Citations

Orthopaedic Journal of Sports Medicine

Background The Patient-Reported Outcomes Measurement Information System (PROMIS) has not been fully evaluated for outcomes assessment after hip arthroscopy to correct femoroacetabular impingement syndrome (FAIS). Purpose/Hypothesis The purpose of this study was to compare the accuracy of the PROMIS Physical Function (PF) and Pain Interference (PI) subscales with the 12-Item International Hip Outcome Tool (iHOT-12) to define patients with 3 unique substantial clinical benefit (SCB) scores—patients who reported ≥80%, ≥90%, and 100% satisfaction at 1 year after hip arthroscopy for FAIS. We hypothesized that the iHOT-12 would be more accurate than the PROMIS-PF and PROMIS-PI subscales in identifying these 3 patient groups. Study Design Cohort study (diagnosis); Level of evidence, 2. Methods We reviewed the records of patients who underwent hip arthroscopy for symptomatic FAIS at 3 centers from January 2019 through June 2021 and had 1-year clinical and radiographic follow-up data. Patients completed the iHOT-12, PROMIS-PF, and PROMIS-PI on initial assessment and at 1 year (±30 days) postoperatively. Postoperative satisfaction was reported on an 11-category scale with anchors defined as “0% satisfied” and “100% satisfied.” Receiver operator characteristic analysis was performed to determine the absolute SCB values for the iHOT-12 and PROMIS subscales that would most accurately identify those patients who reported ≥80%, ≥90%, and 100% satisfaction. Area under the curve (AUC) values and 95% CIs for the 3 instruments were compared. Results Included were 163 patients (111 [68%] women and 52 [32%] men), with a mean age of 26.1 years. Corresponding absolute SCB scores for patients who reported ≥80%, ≥90%, and 100% satisfaction were as follows: iHOT-12, 68.4, 72.1, 74.7; PROMIS-PF, 45, 47.7, 49.9; and PROMIS-PI, 55.9, 52.4, 51.9. The AUC ranged between 0.67 and 0.82, with overlapping 95% CIs indicating a minimal difference in accuracy between the 3 instruments. Sensitivity and specificity values ranged between 0.61 and 0.82. Conclusion The PROMIS-PF and PROMIS-PI subscales were as accurate as the iHOT-12 in defining absolute SCB scores for patients reporting ≥80%, ≥90%, and 100% satisfaction at 1-year follow-up after hip arthroscopy for FAIS.

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. No complications were reported in either group, and no block group patient demonstrated motor nerve palsy or postoperative fall.
Demographics of cohort
Procedures performed
Addition of Pericapsular Nerve Group and Transversus Abdominis Plane Blocks Significantly Reduces Opioid Use in Patients Undergoing Concomitant Hip Arthroscopy and Periacetabular Osteotomy

January 2023

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34 Reads

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2 Citations

Cureus

Introduction: Previous studies have evaluated the effect of the pericapsular nerve group block for hip arthroscopy and the transverse abdominis plane block for periacetabular osteotomy and have shown decreased narcotic consumption in both groups. No published study has evaluated the effectiveness of combining the blocks when performing hip arthroscopy and periacetabular osteotomy under the same general anesthesia. It was hypothesized that patients treated for hip dysplasia with hip arthroscopy and concomitant periacetabular osteotomy using a pericapsular nerve group block, transverse abdominis plane block, and general anesthesia would have decreased postoperative pain and require less narcotic consumption than those undergoing the procedure with general anesthetic alone. Methods: A single surgeon performed a retrospective analysis of consecutive patients undergoing concomitant hip arthroscopy and periacetabular osteotomy between 11/2020 and 6/2021. Fifteen consecutive patients undergoing the procedure with a general anesthetic alone (no-block group) were compared to 15 patients undergoing the same procedure with a combined pericapsular nerve group block, transverse abdominis plane block, and general anesthetic (block group). Hip arthroscopy was performed utilizing a post-free technique, and a rectus sparing approach was used for the periacetabular osteotomy. The nerve blocks were performed by multiple anesthesiologists using previously published methods. Operating room time, length of stay, visual analog scale pain scores, and total narcotic consumption in morphine milliequivalents were analyzed. Groups were compared using the chi-squared test for non-continuous demographic variables and a two-tailed t-test for continuous variables utilizing Microsoft Excel (Microsoft, Redmond, WA, USA), p-value set at 0.05 for significance. Results: The no-block group consisted of 14 females and one male, while the block group was all females. No significant differences were observed between age, sex, BMI, surgery time, length of stay, or procedures performed, p>0.05. The maximal visual analog scale score in the post-anesthesia care unit was 8 ± 1.3 vs. 7 ± 1.9 in the no-block vs. block groups, respectively, p=0.15. The average hospital floor visual analog scale score was 5.7 ± 1.3 vs. 4.8 ± 1.3 in the no-block vs. block groups, respectively, p=0.07. Total pain medications required were 217.6 ± 54.6 vs. 154 ± 41.9 morphine milliequivalents in the no-block vs. block groups, respectively, p=0.001. No complications were reported in either group, and no patient in the block group demonstrated motor nerve palsy or postoperative fall. Conclusion: This study demonstrated that patients undergoing combined hip arthroscopy and periacetabular osteotomy for symptomatic acetabular dysplasia who had pericapsular nerve group, transverse abdominal plane block, and general anesthesia required fewer narcotics in the first 24 hours after surgery compared to those who had general anesthesia alone.


Females with hip-related pain display altered lower limb mechanics compared to their healthy counterparts in a drop jump task

December 2022

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53 Reads

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4 Citations

Clinical Biomechanics

Background Hip-related pain describes femoroacetabular impingement syndrome, acetabular dysplasia, and other hip pain conditions without clear morphological features. Movement strategies in this population, notably sex-related patterns, are poorly understood and may provide insights into why females report more pain and worse function. This study examined the sex-related differences during a drop vertical jump task between those with hip-related pain and healthy controls. Methods Patients with hip-related pain and healthy controls completed five repetitions of a drop jump while their kinematics and kinetics were recorded using a motion capture system and force plates. Hip, knee, and ankle joint angles and external joint moments during landing were used in general estimating equations for comparison of group by sex by limb interactions. Time series data were further investigated using statistical parametric mapping. Findings: Females with hip-related pain had 9.1° less hip flexion (P = .041) and 9.2° less knee flexion (P = .024) than healthy females, and 8.3° less knee flexion than male counterparts with hip-related pain (P = .039). Males demonstrated 1.4° less hip flexion on the affected side compared to their uninvolved side (P = .004). Statistical parametric mapping results showed significant differences in knee flexion angle for females with hip-related pain compared to healthy females (P = .042). There were no significant differences in hip, knee, or ankle moments. Interpretation Females with hip-related pain showed kinematic patterns distinct from healthy controls. Sex may be an important variable of interest in characterizing movement impairments in this population and movement impairments may be an appropriate target for intervention for these patients.



Fig 1. (A) Patient is in the supine position undergoing left PENG block. The ultrasound probe is over the anterior superior iliac spine and turned 45 to be in line with the iliopectineal eminence (IPE). (B) Needle is inserted in plane between the IPE and psoas tendon. Green arrow shows the IPE; star shows the psoas tendon. (PENG, pericapsular nerve group.)
Preoperative Pericapsular Nerve Group Block Results in Less Pain, Decreased Narcotic Use, and Quicker Discharge Time Than No Block in Patients Who Were Surgically Treated for Femoroacetabular Impingement Syndrome

August 2022

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94 Reads

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10 Citations

Arthroscopy Sports Medicine and Rehabilitation

Purpose To determine the effectiveness of pericapsular nerve group (PENG) block for patients surgically treated for femoroacetabular impingement syndrome (FAIS). Methods Consecutive patients who underwent surgical treatment of FAIS either with or without preoperative PENG block by a single surgeon were retrospectively identified. Twenty-five patients who received PENG block were matched 1:1 by age, sex, body mass index, and procedure to 25 patients who received no block (NB). A retrospective review of the medical records of consecutive patients undergoing the PENG block was performed. Outcome measures of postanesthesia care unit visual analog scale initial (PACU VAS-initial), maximum (PACU VAS-max), discharge (PACU VAS-discharge), intraoperative fentanyl, pain medications in morphine equivalents (ME), and PACU to discharge times were recorded. Results Twenty-five patients undergoing a PENG block and 25 patients who did not undergo a block (NB) were identified. No significant differences observed between age, sex, body mass index, surgery time, or procedures performed between the PENG and NB groups, P > .05. Significantly less VAS-initial was observed in the PENG group 3.7 ± 3.2, versus 5.5 ± 2.9 in the NB group, P = .04. Fentanyl usage intraoperatively was 137.3 ± 53.3 μg versus 108.5 ± 39.6 μg in NB versus PENG group respectively, P = .04. Narcotic use was 50.29 ± 11.2 ME versus 34.3 ± 12.1 ME in NB versus PENG group respectively, P = .001. PACU to discharge time was 95.8 ± 31 minutes versus 81.5 ± 19 minutes in NB versus PENG group, respectively, P = .05. No patient in the PENG group demonstrated a motor nerve palsy. Conclusions For patients undergoing hip arthroscopy for FAIS, the addition of a preoperative PENG block showed a significant decrease in initial PACU pain, PACU narcotic consumption, intraoperative fentanyl usage, and quicker time to discharge without complications when compared to a no block, post-free control group. Level of Evidence III, retrospective cohort study.


Rehabilitation protocols for femoroacetabular impingement(FAI) hip arthroscopy and periacetabular osteotomy(PAO)
A comparison of 6-month outcomes between periacetabular osteotomy with concomitant hip arthroscopy to isolated hip arthroscopy for femoroacetabular impingement

March 2022

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165 Reads

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5 Citations

Archives of Orthopaedic and Trauma Surgery

Purpose To compare early outcomes of periacetabular osteotomy (PAO) with concomitant hip arthroscopy to isolated hip arthroscopy for femoroacetabular impingement (FAI) and chondrolabral pathology using patient-reported outcomes measurement information system (PROMIS). Materials and methods Consecutive patients scheduled for PAO with concomitant hip arthroscopy (PAO + HA) or isolated hip arthroscopy (HA) between the ages of 15 and 30 years old were prospectively included in the study. Based on power analysis, subjects were recruited until there were 22 subjects in the PAO + HA group. These subjects were then gender matched to the HA group. The PROMIS, with six subscales and two global health measures, were completed during preoperative and 6-month follow-up visits. One-way ANOVA was performed to compare intake information of age, symptom duration, body mass index, and Beighton scores as well as preoperative and 6-month postoperative PROMIS scores between the PAO + HA and HA. Results 22 consecutive subjects undergoing PAO + HA were all females (average age 20.0 years) and matched to 22 consecutive females (average age 22.6) in the HA group. ANOVA did not find a significant difference between the two groups when comparing intact information, with exception of age (p = 0.04). A significant difference was also not identified (p ≥ 0.05) between the two groups on preoperative or 6-month postoperative PROMIS scores. The largest difference in 6-month postoperative scores between the two groups was 4.4 points on physical function subscale. Conclusion Outcomes at 6 months were not significantly different when comparing PAO + HA to HA for FAI and chondrolabral pathology in females under 30 years of age. The more extensive surgery with a prolonged protective period associated with PAO do not seem to negatively impact outcomes at 6 months when compared to HA. These finding support the use of PAO + HA, particularly if the patient and/or surgeon were concerned about prolonged disability, metal health issues, and/or higher pain levels that might be associated with the PAO procedure.



Post-Related Complications in Hip Arthroscopy Are Reported Significantly Greater in Prospective Versus Retrospective Literature: A Systematic Review

December 2021

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93 Reads

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23 Citations

Arthroscopy The Journal of Arthroscopic and Related Surgery

PURPOSE To determine if there are differences in: 1) the incidence of post-related complications following hip arthroscopy between prospective and retrospective publications; and 2) between post-assisted and postless techniques. METHODS A systematic review was performed using PRISMA guidelines to characterize post-related complications following hip arthroscopy for central or peripheral compartment hip pathology, including FAI ( Femoroacetabular Impingement) Syndrome and chondrolabral injury. Inclusion criteria were prospective and retrospective, level I-IV evidence investigations that reported results of hip arthroscopy performed in the supine position. Exclusion criteria included open or extra-articular endoscopic hip surgery. Post-related complications included pudendal nerve injury (sexual dysfunction, dyspareunia, perineal pain or numbness) or perineum/external genitalia soft tissue injury. RESULTS Ninety- four studies (12,212 hips; 49% male, 51% female; 52% level IV evidence) were analyzed. Prospective studies (3,032 hips) report a higher incidence of post-related complications compared to retrospective (8,116 hips) studies (7.1% versus 1.4%, p<0.001). Three studies (1,064 hips) utilized a postless technique and all reported a 0% incidence of pudendal neurapraxia or perineal soft tissue injury. Most pudendal nerve complications were transient, resolving by 3 months, but permanent nerve injury was reported in 4 cases. Only 19%, 22%, 7%, and 4% of studies reported a total surgery time, traction time, traction force, and bed Trendelenburg angle for their study samples, respectively. CONCLUSIONS The incidence of post-related complications is five times greater in prospective (versus retrospective) hip arthroscopy literature. Postless distraction result ed in a 0% incidence of post-related injuries.


Citations (35)


... However, there is psychometric evidence to support that PROMIS measures are accurate and responsive in assessing outcomes after hip arthroscopy, and correlate well with legacy hip-specific measures. 7,20,23,26 Additionally, this study showed that 34 showed that 70% of patients reported being CB at 2 years after anterior cruciate ligament reconstruction, which serves as a good point of reference for a widely successful surgery. Our finding that SSQ-8 at 2 years postoperative and change in PROMIS-PF over 2 years were independently predictive of CB status suggests that surgical satisfaction and improvement in PF may be the most important metrics to patients when undergoing hip arthroscopy. ...

Reference:

Patient-Reported Outcomes Associated With “Completely Better” Status at 2 Years After Hip Arthroscopy
Comparison of the PROMIS and iHOT-12 in Determining Satisfaction Levels After Hip Arthroscopy for FAIS

Orthopaedic Journal of Sports Medicine

... Furthermore, one study examined overground running [165], while another explored stair ambulation before and after hip osteochondroplasty and labral-chondral debridement [166]. In addition, two studies assessed jumping/landing activities [160,167], and two additional studies evaluated the biomechanics of squatting. One of these studies was observational [168], while the other assessed the effects of a targeted exercise program (Table 5) [163]. ...

Females with hip-related pain display altered lower limb mechanics compared to their healthy counterparts in a drop jump task
  • Citing Article
  • December 2022

Clinical Biomechanics

... Regional techniques that have shown to be beneficial for analgesia after hip arthroscopy include lumbar plexus, 7,8 femoral nerve, 9,10 fascia iliaca, 11,12 quadratus lumborum (QL), [13][14][15][16] and pericapsular nerve group (PENG) blocks. [17][18][19][20] There is a risk of quadriceps weakness and the potential for postoperative falls after regional techniques such as lumbar plexus, femoral, and fascia iliaca blocks. 7,10,15 Concern for postoperative fall risk has led to a focus on regional nerve blocks that target the sensory innervation of the hip capsule while preserving motor function. ...

Preoperative Pericapsular Nerve Group Block Results in Less Pain, Decreased Narcotic Use, and Quicker Discharge Time Than No Block in Patients Who Were Surgically Treated for Femoroacetabular Impingement Syndrome

Arthroscopy Sports Medicine and Rehabilitation

... 14 Previous studies have shown that pudendal nerve complications may cause sexual dysfunction and prevent patients from achieving higher scores on the IIEF-5 or FSFI. [19][20][21] Overall, these results indicate that while patients can expect some benefit from hip arthroscopy, there may still be residual pain after hip arthroscopy. Therefore, surgeons should counsel patients that sexual intercourse may not be pain-free after hip arthroscopy. ...

Post-Related Complications in Hip Arthroscopy Are Reported Significantly Greater in Prospective Versus Retrospective Literature: A Systematic Review
  • Citing Article
  • December 2021

Arthroscopy The Journal of Arthroscopic and Related Surgery

... Continuous passive motion was at first suggested in postoperative recovery after wound or joint operation, since an animal experiment demonstrated that it counteracted the pathologic phases of joint stiffness [49]. However, recent studies did not reveal the efficacy of CPM in enhancing body function [50], which was a similar result as the RCTs, and it led to conflicting results. We found very low-certainty evidence that CPM showed better pain reduction and quality of life. ...

Use of continuous passive motion device after arthroscopic hip surgery decreases post-operative pain: A randomized controlled trial
  • Citing Article
  • October 2021

Journal of Clinical Orthopaedics and Trauma

... 10,11 As bovine knee has been validated to be used to improve surgical skills, 12 bovine labrum has been reported to have similar biomechanical properties compared with its human counterpart, [13][14][15] and bovine proximal femur has natural cam morphology (Fig 1), the present study aimed to clarify young bovine hip as an effective education tool, especially for key parts such as labrum repair and cam excision in arthroscopic impingement treatment. 16 Surgical Technique (With Video Illustration) ...

The Key Parts of Hip Arthroscopy for Femoroacetabular Impingement Syndrome: Implications for the Learning Curve

Orthopaedic Journal of Sports Medicine

... There is a paucity of research supporting post-operative PAO rehabilitation guidelines. Ellis et al. 75 published a rehabilitation protocol for use after concomitant PAO and hip arthroscopy, however, this Delphi study was focused on an isolated PAO. Therefore, initial study questions were generated by expert opinion which could result in bias. ...

A comparison of 6-month outcomes between periacetabular osteotomy with concomitant hip arthroscopy to isolated hip arthroscopy for femoroacetabular impingement

Archives of Orthopaedic and Trauma Surgery

... Fast-track models have been implemented and studied as one type of model that is proposed to allow an earlier recovery [12]. The ongoing uncertainty in the literature due to various self-developed surgical protocols and precautions contributes to the clinical question of the effectiveness of rehabilitation programs for individuals after DAA THA [13]. Important factors that have been proposed for selecting postoperative physiotherapy management rather than relying on self-guidance include initial pain levels and prior reported level of function [13][14][15]. ...

Worse Preoperative Pain and Higher Activity Levels Predict Patient Choice of Formal Physical Therapy After Primary Anterior Total Hip Arthroplasty
  • Citing Article
  • March 2021

The Journal of Arthroplasty

... While patients who undergo iliopsoas tenotomy have been reported to have lower patient-reported outcomes compared with patients without tenotomy, iliopsoas fractional lengthening preserves a portion of the iliopsoas muscle-tendon complex and has been shown to improve symptomatic iliopsoas impingement. 9,22 Psoas fractional lengthening may also be an option for patients with painful snapping or impingement following THA. In our study, 460 arthroscopic iliopsoas fractional lengthenings were performed, with 67 (14.6%) occurring in the setting of a prosthetic hip. ...

Tenotomy for Iliopsoas Pathology is Infrequently Performed and Associated with Poorer Outcomes in Hips Undergoing Arthroscopy for Femoroacetabular Impingement
  • Citing Article
  • February 2021

Arthroscopy The Journal of Arthroscopic and Related Surgery

... Potential strategies to leverage this insight include redirecting patients to high-volume, fellowship-trained surgeons and equipping physicians with actionable, individualized performance data 72,73 . Regarding the variation in supply costs due to the use of suture anchors, prior literature has suggested that cost savings may be achieved either by establishing joint administrator-physician committees to negotiate lower prices from vendors or by aligning allocation practices with clinical outcomes 40,74,75 . Furthermore, we identified significant cost variation between surgery centers in the present study, possibly owing to differences in facility culture, caseload mix, staffing incentive structures, personnel turnover, supply-chain management, and/or anesthesia protocols [76][77][78] . ...

Allocation of Anchors During Labral Repair A Multicenter Cohort Analysis of Labral Treatment in Hip Arthroscopy

Orthopaedic Journal of Sports Medicine