Hip Arthroscopy for Femoroacetabular Impingement in a Military Population

Thomas, Darren D.; Bernhardson, Andrew S.; Bernstein, Ethan; Dewing, Christopher B.

doi:10.1177/0363546517726984

Cited by 38 publications

(52 citation statements)

References 22 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…While the proportion of females is much lower than males in the military, the rate of injuries is much higher in females (Kodesh et al 2015 ; Kucera et al 2016 ; Roy et al 2015 ). A much higher percent of females in the military are undergoing arthroscopic hip surgery and are much less likely to remain in the military after surgery compared to males (Thomas et al 2017 ). In 2015, females made up 16.8% of the military force (Office of the Deputy Assistant Secretary of Defense for Military Community and Family Policy (ODASD (MC&FP)) 2015 ), but they represent 30% or greater of patients in published hip arthroscopy cohorts in the military (Byrd et al 2016 ; Dutton et al 2016 ; Thomas et al 2017 ).…”

Section: Discussionmentioning

confidence: 99%

Predictors of chronic prescription opioid use after orthopedic surgery: derivation of a clinical prediction rule.

et al. 2018

View full text Add to dashboard Cite

BackgroundPrescription opioid use at high doses or over extended periods of time is associated with adverse outcomes, including dependency and abuse. The aim of this study was to identify mediating variables that predict chronic opioid use, defined as three or more prescriptions after orthopedic surgery.MethodsIndividuals were ages between 18 and 50 years and undergoing arthroscopic hip surgery between 2004 and 2013. Two categories of chronic opioid use were calculated based on individuals (1) having three or more unique opioid prescriptions within 2 years and (2) still receiving opioid prescriptions > 1 year after surgery. Univariate elationships were identified for each predictor variable, then significant variables (P > 0.15) were entered into a multivariate logistic regression model to identify the most parsimonious group of predictor variables for each chronic opioid use classification. Likelihood ratios were derived from the most robust groups of variables.ResultsThere were 1642 participants (mean age 32.5 years, SD 8.2, 54.1% male). Nine predictor variables met the criteria after bivariate analysis for potential inclusion in each multivariate model. Eight variables: socioeconomic status (from enlisted rank family), prior use of opioid medication, prior use of non-opioid pain medication, high health-seeking behavior before surgery, a preoperative diagnosis of insomnia, mental health disorder, or substance abuse were all predictive of chronic opioid use in the final model (seven variables for three or more opioid prescriptions; four variables for opioid use still at 1 year; all< 0.05). Post-test probability of having three or more opioid prescriptions was 93.7% if five of seven variables were present, and the probability of still using opioids after 1 year was 69.6% if three of four variables were present.ConclusionA combination of variables significantly predicted chronic opioid use in this cohort. Most of these variables were mediators, indicating that modifying them may be feasible, and the potential focus of interventions to decrease the risk of chronic opioid use, or at minimum better inform opioid prescribing decisions. This clinical prediction rule needs further validation.

show abstract

Section: Discussionmentioning

confidence: 99%

Predictors of chronic prescription opioid use after orthopedic surgery: derivation of a clinical prediction rule.

et al. 2018

View full text Add to dashboard Cite

show abstract

“…We hypothesize that patients with severe impingement at baseline will have the greatest improvement with the osteochondroplasty procedure compared with those with moderate to mild impingement [ 20 – 22 ]. Gender - we hypothesize that the osteochondroplasty procedure will perform better in men [ 23 , 24 ]. Cartilage status (grades 3 and 4 vs 1 and 2) - based on the Tonnis and Heinecke cartilage classification, we hypothesize that osteochondroplasty will perform worse in patients with worse cartilage status (i.e.…”

Section: Discussionmentioning

confidence: 99%

“…Gender - we hypothesize that the osteochondroplasty procedure will perform better in men [ 23 , 24 ].…”

Section: Discussionmentioning

confidence: 99%

Femoroacetabular Impingement Randomised controlled Trial (FIRST) - a multi-centre randomized controlled trial comparing arthroscopic lavage and arthroscopic osteochondroplasty on patient important outcomes and quality of life in the treatment of young adult (18–50 years) femoroacetabular impingement: a statistical analysis plan

Simunovic

Heels‐Ansdell

Thabane

et al. 2018

Trials

View full text Add to dashboard Cite

BackgroundThe research objectives of the Femoroacetabular Impingement Randomised controlled Trial (FIRST) are to assess whether surgical correction of the hip impingement morphology (arthroscopic osteochondroplasty) with or without labral repair, in adults aged 18–50 years diagnosed with non-arthritic femoroacetabular impingement (FAI), provides decreased pain and improved health-related quality of life at 12 months compared to arthroscopic lavage of the hip joint. This article describes the statistical analysis plan for the FIRST trial.Methods/designFIRST is an ongoing multi-centre, blinded randomised controlled trial of 220 patients who have been diagnosed with FAI and are optimized for surgical intervention. This article describes the overall analysis principles, including how participants will be included in each analysis, the presentation of the results, adjustments for covariates, the primary and secondary outcomes and their respective analyses. In addition, we will present the planned sensitivity and subgroup analyses.DiscussionOur rationale for FIRST is based upon (1) an epidemic of FAI surgery with resultant increased healthcare costs over that last decade, (2) worldwide disparity in perceptions about its utility, and (3) consensus that definitive evidence for or against surgical approaches is lacking.Trial registrationClinicalTrials.gov, NCT01623843. Registered on 20 June 2012.

show abstract

“…4,[11][12][13] The majority of studies that have examined gait mechanics of individuals with FAIS included primarily male participants, 5 despite epidemiological reports that indicate females represent over half of the FAIS population. 14 Sex-specific differences for patient-reported outcomes have been identified, [15][16][17] but the effect of sex on movement impairments has only recently been examined. While sex differences are apparent in gait mechanics of healthy populations, [18][19][20][21] these may be exacerbated in patients with FAIS.…”

Section: Introductionmentioning

confidence: 99%

“…6 In another cross-sectional study specific to competitive soccer players with FAIS, males demonstrated less hip flexion, adduction, and internal rotation during the stance phase of gait than females. 8 Considering the evidence that gait mechanics in FAIS may be sex-specific and that females may be more susceptible to inferior treatment outcomes, [15][16][17] an understanding of sex-specific mechanics following hip arthroscopy could enhance current perioperative rehabilitation. [11][12][13] The purpose of this study was to compare sex-specific gait kinematics between persons after hip arthroscopy for FAIS and HCs.…”

Section: Introductionmentioning

confidence: 99%

Sex‐specific sagittal and frontal plane gait mechanics in persons post‐hip arthroscopy for femoroacetabular impingement syndrome

Brown‐Taylor

Schroeder

Lewis

et al. 2020

Journal Orthopaedic Research

View full text Add to dashboard Cite

Postoperative gait mechanics in persons with femoroacetabular impingement syndrome (FAIS) remain understudied as a treatment outcome despite observed, yet inconclusive, preoperative gait abnormalities. Females with FAIS demonstrate worse preoperative patient-reported hip function and altered hip mechanics when compared with males; it is unknown whether these sex differences persist postarthroscopy. The purpose of this study was to compare sex-specific gait kinematics between persons at least 1 year postarthroscopy for FAIS and healthy comparisons. General linear models with estimating equations were used to evaluate the effect of (a) limb and sex within each group, and (b) limb and group within each sex for peak sagittal and frontal plane trunk, pelvis, and hip kinematics during stance phase of gait. Analyses were covaried by gait speed. Seventeen females and eight males an average 2.5 years postarthroscopy (1.1-7.2 year) for FAIS were compared with healthy females (n = 7) and males (n = 5). Females in the FAIS group presented with an average of 4.6°more anterior pelvic tilt, and 4.8°less hip extension compared with healthy females (P ≤ .03) and 8.6°less trunk flexion, 4.8°more anterior pelvic tilt, 3.1°more pelvic drop, and 7.5°more hip flexion than males with FAIS (P ≤ .03). Males in the FAIS group presented with 2.9°less pelvic drop, and 3.2°less hip adduction than healthy males. Preoperative gait mechanics were not collected and thus changes in mechanics could not be evaluated. This study is significant to clinicians who treat patients postarthroscopy to consider sex-specific gait impairments.

show abstract

Hip Arthroscopy for Femoroacetabular Impingement in a Military Population

Cited by 38 publications

References 22 publications

Predictors of chronic prescription opioid use after orthopedic surgery: derivation of a clinical prediction rule.

Predictors of chronic prescription opioid use after orthopedic surgery: derivation of a clinical prediction rule.

Sex‐specific sagittal and frontal plane gait mechanics in persons post‐hip arthroscopy for femoroacetabular impingement syndrome

Contact Info

Product

Resources

About