The overall revision rate was 6.25 %; all patients (n = 4) who required revision arthroscopic surgery were in the PR group (13 % of 32 patients), while no patients in the CR group required revision surgery. The authors stated that this study had several drawbacks. As posttraumatic OA now represents the most common cause of military disability [11], the findings of this study support that there may be value for earlier, more aggressive interventions for military members with symptomatic FAI to help prevent or halt the progression of OA. 2007;74(5):354-358. Future studies are necessary to determine whether earlier diagnosis and surgical correction of FAI may prevent or delay the progression of OA in physically active patients. Substantial variability in surgical technique, graft choice, and concurrent pathology was found. Indications were painful anterior hip impingement and decreased hip flexion following a hypertrophic osseous sub-spinal deformation. and a 2.9-point decrease in VAS pain ratings (p < 0.001). Espinosa N, Beck M, Rothenfluh DA, et al. First, radiation exposure by CT is considerable, although CT evaluation may be needed for a diagnosis of FAI morphology in detail regardless of computer-assisted techniques application. Commonly reported radiographic indicators for arthroscopic FAI management included the following: results from a computed tomography scan or magnetic resonance imaging, cam or pincer lesions evident on anteroposterior and/or lateral radiographs, loss of sphericity of the femoral neck, acetabular retroversion, magnetic resonance arthrography, reduction in head-neck offset, an alpha angle greater than 50, and coxa profunda. Shapira et al (2019) stated that non-operative and operative management of iliopsoas impingement (IPI) is commonly performed following THA. There were 2 revisions in this group of patients, both for lysis of capsulo-labral adhesions in which the graft was found to be well integrated at the time of surgery. The datasets used during the current study are available from the corresponding author upon reasonable request. Since 1993, the authors assessed all patients undergoing hip arthroscopy prospectively with a modified Harris hip score pre-operatively and then post-operatively at 3, 12, 24, 60, and 120 months. Clinical Policy Bulletins are developed by Aetna to assist in administering plan benefits and constitute neither offers of coverage nor medical advice. Wilcoxon signed-rank tests were used to compare pre- and post-tenotomy scores, and intra-class correlation coefficients (ICCs) to evaluate inter-method agreement. Hip arthroscopy in patients over 40: Greater success with labral reconstruction compared to labral repair. The most common cause of arthroscopic surgery in the study group was an isolated acetabular labral tear without any bony structural abnormalities (68.2 %, 15 of 22 hips). Peterlein CD, Schiel M, Timmesfeld N, et al. 2014;42(11):2634-2642. Surgical treatments for treating FAI include arthroscopic or open surgery and hip replacement. Regression analyses revealed no associations between clinical scores and overhang/anteversion. 2019;34(7):1498-1501. The authors concluded that management of IPI following THA included non-operative measures, IP tenotomy, or acetabular component revision. In a systematic review, Trivedi and colleagues (2019) examined the evidence for the current indications and outcomes of arthroscopic labral reconstruction of the hip; the secondary objective was to assess the role of arthroscopic labral reconstruction in the management of reparable labral tears. Orthopedics. Surgical criteria for femoroacetabular impingement syndrome: A scoping review. The adult hip: hip preservation surgery. Arthroscopy 2016;32:190-200. Arthroscopy. The mean modified Harris hip score in the labral repair group was 7.3 points greater than in the resection group (p = 0.036, 95 % confidence interval [CI]:0.51 to 14.09). The United Kingdom Feasibility study of a trial of ArthroscopicSurgery for Hip Impingement compared with Non-operative care (UK FASHIoN) is a large-scale multicenter pilot project funded by the Health Technology Assessment Programme, a division of the National Institute for Health Research (NIHR) of the National Health Service in the United Kingdom. Autograft options include ITB, semitendinosus, and indirect head of the rectus femoris tendon, while allografts have included fascia lata and gracilis tendon allografts. Treatment can be non-operative, endoscopic or arthroscopic, or by open revision of the acetabular component. Complication rates were similar for hip arthroscopy but remained low in all series. However, they stated that virtually all the literature on arthroscopy outcomes comes from small uncontrolled studies. Beaule PE, Allen DJ, Clohisy JC, et al. The PROs included the International Hip Outcome Tool short version (iHOT-12), the Copenhagen Hip and Groin Outcome Score (HAGOS), the European QOL-5 Dimensions Questionnaire (EQ-5D), the Hip Sports Activity Scale (HSAS) for physical activity level, the VAS for overall hip function and a single question regarding overall satisfaction with the surgery. Arthroscopic anterior inferior iliac spine decompression does not alter postoperative muscle strength. Arthroscopy. 2006;20(10):73944. Arthroscopically, the joint may distract easily, and there may be associated ligamentum teres tears and laxity of the capsule on manual probing. Am J Sports Med. 2015;31(12):2287-2294. Furthermore, these researchers examined the various ways that arthroscopic hip surgeons address the capsule intra-operatively: Language services can be provided by calling the number on your member ID card. Oxford score, patient satisfaction, anterior pain and iliopsoas strength were assessed at last follow-up. 2014;30(3):305-310. Between 2006 and 2008, prospectively collected data were retrieved fromthe authorsdatabase on 153 patients aged 50 years or older undergoing hip arthroscopy for FAI. Rev Esp Cir Ortop Traumatol. Radiographs were reviewed by a musculoskeletal radiologist to evaluate component positioning and to compare with a control cohort. Byrd JW, Jones KS. Cochrane Collaboration's Risk of Bias Tool and Newcastle-Ottawa Scale were used to assess risk of bias. Arthroscopic femoro-acetabular surgery for hip impingement. Over time, the repetitive contact can cause damage to the articular or labral cartilage, which may lead to degenerative joint disease. 2015;4(6):e625-e630. The most common indication for labral reconstruction was an irreparable labrum. Pincer Impingementis atype of impingement in which extra bone extends out over the normal rim of the acetabulum (ie, acetabular cause). transitioned to CR, which may suggest an improvement in the overall surgical technique. Javed A, O'Donnell JM. This condition can be treated with corticosteroids, nonsteroidal anti-inflammatory drugs (NSAIDs), physical therapy, rest and surgery. The outcomes pain, disability, and adverse effects were extracted. 2013;151(6):585-595. 2006;88(8):1735-1741. The authors stated that this systematic review had several drawbacks. During my first VA exam I guess I move it enough to get a rating of ZERO, but still SC. There were 32 (14 females) athletes who underwent primary arthroscopic labral reconstruction during the study period. Femoroacetabular impingement: a cause for osteoarthritis of the hip. Phillipon et al (2012) reported on a case series of patients age 50 years and older who underwent hip arthroscopy for femoracetabular impingement. Unresolved issues include the indications for acetabular rim trimming with labral refixation in the presence of acetabular retroversion and/or delaminated acetabular cartilage. list-style-type: decimal; Second, it was possible that the 51 hips where follow-up was unavailable had different outcomes than the group for which post-operative outcomes were assessed. Am J Sports Med. MR imaging of femoroacetabular impingement. A logistic regression model was constructed to predict the influence of these two variables in the development of osteoarthritis. Risk factors include female sex, ligamentous laxity, and borderline dysplasia. Exclusion criteria were Tonnis OA grade of greater than 1, prior hip conditions, or workers' compensation claims. The authors concluded that arthroscopic autograft reconstruction of the acetabular labrum resulted in significant improvement in the short- and mid-term patient reported outcomes, for properly selected patients presenting with pain and functional limitation in the hip due to an irreparable labral injury. One complication was reported, a post-operative hematoma managed conservatively. background-color: #cc0066; Functional outcomes and 8-year survival after hip arthroscopy in patients with degenerative hip disease. The mean VAS pain score improved by 3 points at rest (p < 0.0001), 4 points with average pain with daily activities (p < 0.0001), and 5 points with sport (p < 0.0001). In a third case-series study,Murphy et al (2004)evaluated a group of 23 hips in 23 patients treated by surgical debridement for impingement: 22 patients were treated by full surgical dislocation and1 patient was treated by relief of impingement without dislocation. Patients reported an overall satisfaction of 9 (range of 1 to 10). (Im Air National Guard & I have not yet made a claim. Longo UG, Franceschetti E, Maffulli N, Denaro V. Hip arthroscopy: State of the art. Patients with no co-existing pathology had significantly higher satisfaction and Harris Hip Scores. Endoscopic iliopsoas tenotomy for recurrence was performed in dorsal decubitus on an ordinary table, under fluoroscopy, using 2 approaches (inferior for the endoscope, superior for the instruments) converging on the lesser trochanter. The authors concluded that patients treated with labral re-fixation recovered earlier and had superior clinical and radiographical outcomes when compared with patients who had undergone resection of a torn labrum. There were 21 tenotomies at the lesser trochanter. VA Disability Hip Pain Secondary to Knee Pain - VA Claims Insider Complete labral reconstruction may be particularly advantageous in patients aged 40+ years. Clin J Sport Med. Larson et al (2014) reported that capsular plication was a predictor of improved outcomes with revision arthroscopic surgery for residual FAI. Uchida et al (2014) noted that in addition to the underlying shallow acetabular deformity, a patient with hip dysplasia has a greater risk of development of a labral tear, a cam lesion, and capsular laxity. J Am Acad Orthop Surg. There were 47 patients (32 men, 15 women, mean age 37 years (range of18 to 55 years))who had undergone surgery at a minimum of 1 year previously and met the inclusion criteria. Gedouin JE, May O, Bonin N, et al. What Is The Va Disability Rating For A Hip Replacement Specifically, the most interesting comparisons would be hamstring and ITB grafts with grafts such as the indirect head of rectus femoris tendon that may be harvested without causing donor-site complications. Observational studies have demonstrated substantial improvements in symptoms with femoroacetabular surgery; however, observational studies may overestimate the actual degree of improvement from surgery. The authors found that greater joint space narrowing, advanced MRI chondral grade, and longer duration of pre-operative symptoms predicted lower scores. Lubowitz JH. The Hip and Thigh - Military Disability Made Easy A tenotomyis the total or partial severing of a tendon to allow lengthening. Hip arthroscopy for femoroacetabular impingement in a military population. Become an All-Access Member to access this page, other exclusive content, the ability to our Military Disability Experts, course discounts, and more! Skendzel JG, Philippon MJ, Briggs KK, Goljan P. The effect of joint space on midterm outcomes after arthroscopic hip surgery for femoroacetabular impingement. PLRECON reached comparable functional outcomes when compared with a benchmark PLREPAIR control group but demonstrated lower patient satisfaction at latest follow-up. Only patients who underwent surgery were included in this study. The incidence of primary hip osteoarthritis in active duty US military servicemembers. Last Review04/07/2023. After adjusting for differences in follow-up time between groups, hips in the 40+ repair group were 3.29 times more likely to fail than hips in the 40+ reconstruction group (relative risk [RR] = 3.29, 95 % CI: 1.25 to 8.69, p = 0.02), and there was no difference in failure rate for hips in the 40+ reconstruction group compared to the 30 to 39 reconstruction group (RR = 0.58, 95 % CI: 0.18 to 1.89, p = 0.37). No EDS patients were lost to follow-up or excluded from analysis. The minimum follow-up was 1 year (average of1.5 years; range of1 to 2.5 years). The mean anterior prominence was 7.25 mm (range of 3 to 12 mm). This Clinical Policy Bulletin addresses femoro-acetabular surgery for hip impingement syndrome. Post-operative inflammation of the origin of the direct head of the rectus femoris may theoretically exist and affect patient function as well. In the autograft cohort, failures included 0 % to 13.2 % conversion to THA and 0 % to 11.0 % revision hip arthroscopy. The complications rate was 3.2 %, with complete resolution. Patient acceptable symptom state was achieved in 23 patients (57.5 %) for mHHS, 22 patients (55 %) for HOS-ADL and 25 patients for HOS-SS scores; no major complication was observed. Statistical analyses were performed to compare the change in PROs in both groups. #backTop { The management of labral tears and femoroacetabular impingement of the hip in the young, active patient. Level of Evidence = III. Furthermore, they stated that long-term follow-up will beneeded to evaluate if use of this technique results in improved functional outcomes and a reduction in the prevalence of symptomatic osteoarthritis in affected patients. Hartigan DE, Perets I, Walsh JP, et al. White BJ, Herzog MM. Trivedi NN, Sivasundaram L, Su CA, et al. Overall, 18 hips (13.7 %) required revision procedures at a mean of 17 months (range of 1 to 37) after the labral reconstruction. In symptomatic patients with AIIS extension to or below the acetabular rim, AIIS decompression is considered part of an FAI corrective procedure.