No abstract

Context:Successful treatment of nonarthritic hip pain in young athletic individuals remains a challenge. A growing fund of clinical knowledge has paralleled technical innovations that have enabled hip preservation surgeons to address a multitude of structural variations of the proximal femur and acetabulum and concomitant intra-articular joint pathology. Often, a combination of open and arthroscopic techniques are necessary to treat more complex pathomorphologies. Peri- and postoperative recovery after such procedures can pose a substantial challenge to the patient, and a dedicated, thoughtful approach may reduce setbacks, limit morbidity, and help optimize functional outcomes.Evidence Acquisition:PubMed and CINAHL databases were searched to identify relevant scientific and review articles through December 2014 using the search terms hip preservation, labrum, surgical dislocation, femoroacetabular impingement, postoperative rehabilitation, peri-acetabular osteotomy, and rotational osteotomy. Reference lists of included articles were reviewed to locate additional references of interest.Study Design:Clinical review.Level of Evidence:Level 4.Results:Hip preservation procedures and appropriate rehabilitation have allowed individuals to return to a physically active lifestyle.Conclusion:Effective postoperative rehabilitation must consider modifications and precautions specific to the particular surgical techniques used. Proper postoperative rehabilitation after hip preservation surgery may help optimize functional recovery and maximize clinical success and patient satisfaction.

Objectives:Patient reported outcomes (PRO) following surgery is vital to determining treatment efficacy and is valuable for executing comparative trials. Traditional legacy measures used to assess outcomes of patients undergoing arthroscopic hip surgery have included the modified Harris Hip Score (mHHS), the Non-arthritic Hip Score (NAHS) and the Hip Outcome Score (HOS), among others. Each of these PROs have been touted for specific advantages and criticized for certain limitations. In addition, clinical results documented for each of these PROs cannot be easily compared with those from other measures employed in patients undergoing different procedures in varying anatomic locations. The Patient Reported Outcomes Measurement Information System (PROMIS) tool was developed by the National Institute of Health to provide efficient, precise and valid patient-reported outcome data. While PROMIS has been broadly utilized due to its efficiency and generalizability, it has not yet been validated among patients undergoing hip arthroscopy. The purpose of this study was to determine whether the PORMIS Computer Adaptive Testing (CAT) tool demonstrates validity against commonly used legacy PRO measures among a population of patients undergoing arthroscopic hip surgery.Methods:A consecutive series of patients undergoing elective arthroscopic hip surgery at a single academic medical center from 4/22/15 to 3/11/16 were prospectively enrolled into an IRB approved. Patients who were under the age of 18 or who had undergone previous open or arthroscopic hip surgery were excluded. Eligible patients completed a series of outcome questionnaires including the visual analog pain scale (VAS), a hip outcome score (HOS; ADL and Sports Subscales), modified harris hip (mHHS), and non-arthritic hip score (NAHS) as well as the PROMIS CAT for pain, physical function and emotional distress (depression). Patients completed all questionnaires at their preoperative evaluation and at regular postoperative intervals (1 week, 6 weeks, 3 months). Outcome measure scores compared via the Pearson product correlation coefficient.Results:A total of 77 patents elected to be included in this study, 28 (36.8%) were male and 49 (64.5%) were female. The average age of study participants was found to be 38 years (range 18-69). With regards to questionnaire completion, data from all patient reported outcome measures were gathered from 77 patients at their preoperative clinical visit, 71 during their first postoperative follow up, 69 at 6 weeks and 58 at 3 months postoperatively. Pearson correlations between PROMIS Physical Function T scores and the HOS ADL, HOS Sports, NAHS and mHHS were found to be 0.858, 0.799, 0.773 and 0.830 respectively. With regards to pain, the Pearson correlation between the PROMIS Pain T score and the VAS for pain was found to be 0.599.Conclusion:The PROMIS tool was found to correlate well with current standards for patient reported outcome measures for individuals undergoing arthroscopic hip surgery. PROMIS Physical Function demonstrated ...

Injury to the rectus femoris (RF) myotendinous complex is the most common location of quadriceps injury, due to combined loads of stretch and eccentric muscular activation. To our knowledge, open proximal RF repair has been reported, but a thorough description of postoperative rehabilitation and functional progression of athletic activity has not been described. This case report outlines the rehabilitation of a 30-year-old female following open proximal RF repair after 15 months of failed conservative treatment. Six months postoperatively she returned to competitive recreational soccer with no complaints.

Introduction: The purpose of this study is to report the results of labral restoration among patients over age 60 compared to a cohort of younger adults. Methods: 23 consecutive patients over age 60 undergoing labral repair with minimum one-year follow-up were compared (modified Harris hip Score) to a contemporaneous group of 23 patients age 18-55 matched for gender, degree of chondral damage, and associated FAI or dysplasia. Results: Follow-up averaged 17.5 months (12-24 months). The study group consisted of 13 males and 10 females, average age 63 years (61-71); with 21 FAI and one dysplasia. 20 had acetabular articular damage (2 grade IV, 12 grade III, 5 grade II, 1 grade I) and 7 had femoral changes (1 grade IV, 6 grade 3). The exactly matched control group averaged 36 years (20-54). Study group improvement averaged 21 points (-19-46 points) with 20 (87%) improved. The average improvement in the control group was 19 points (-9-34) with 20 (87%) improved. There was no statistically significant difference between the two groups and the amount of improvement with statistically (p<0.01) and clinically (>5 points) significant in both. Two study group patients underwent THA at average 10 months with one control group THA at 11 months. All three converted to THA had combined grade IV acetabular and grade III femoral damage. There were no repeat arthroscopies and no complications in either group. Conclusion: Patients over age 60 can benefit from arthroscopic labral repair with improved outcomes, modest rates of conversion to THA, and small risk of complication. Results are comparable to younger adults. Combined bipolar grade IV and grade III articular damage is a harbinger of conversion to THA, regardless of age.