Moreover, these researchers stated that care should be taken when treating patients with prior lumbar surgery. All articles were read in full by the authors and selected for inclusion based on relevance to the article. In addition, it has been reported that the time between the onset of symptoms and surgical correction may be 1012months longer for active duty military personnel than for civilians [26, 27]. The term coxa profundarefers to a deep acetabulum with excessive acetabular coverage; also referred to as "deep socket." Haddad B, Konan S, Haddad FS. Hip Int. background-color: #cc0066; Orthop Traumatol Surg Res. Level of Evidence = III. The authors stated that the present cohort study shared the same limits as the previously published literature: retrospective design, small numbers and the lack of direct comparison between different techniques. Become an All-Access Member to access this page, other exclusive content, the ability to our Military Disability Experts, course discounts, and more! Embase, PubMed, and the Cochrane Library were searched in July 2020 for studies reporting the outcomes after primary hip arthroscopic surgery for FAI or labral tears in patients with femoral retroversion (less than 5), femoral anteversion (greater than 20), or normal FV (5 to 20). In anevidence review, Haddad, et al (2014) stated that "It seems logical to repair an unstable tear in a good quality labrum with good potential to heal in order potentially to preserve its physiological function. I have 0% service-connected disability for trochanteris pain syndrome/bursitis, right hip (also claimed as secondary to back condition) and the same for the left hip. Patients who were treated within 1 year of injury had highermodified Harris Hip Scoresthan patients who waited longer than 1 year (93 versus 81, p = 0.03). Eur J Radiol. Reduced pain and improvement in hip function were reported in all studies. Only patients who underwent surgery were included in this study. The above policy is based on the following references: Last Review Subjective data were collected from each patient during their initial visit and at follow-up after surgery. The HOS ADL subscale mean was 57.5 (range of 10.9 to 89.3, SD of 18.8) pre-operatively and 71.6 (range of 14.1 to 100, SD of 26.1) post-operatively (p = 0.005). There was high certainty evidence from 3 RCTs (n = 574 participants) that hip arthroscopic surgery provided superior outcomes compared to non-operative care for hip-specific QOL at 12 months (MD: 11.02 points, 95 % CI: 4.83 to 17.21). Reliability and predictability of the centre-edge angle in the assessment of pincer femoroacetabular impingement. Arthroscopic management of femoroacetabular impingement in athletes. The MHHS is limited because of its ceiling effects, as it was initially designed as a disease specific score for hip osteoarthritis. The independent predictor of patient satisfaction with outcome after labral reconstruction was age. The mean pre-operative MHHS was 55 (range of 33 to 70), HOS ADL was 58 (range of 38 to 75), and HOS sport score was 33 (range of 0 to 78). A total of 11 studies met the inclusion and exclusion criteria; and 373 patients were identified. J Bone Joint Surg Am. Hip arthroscopy for femoroacetabular impingement in a military population. Ferreira GE, O'Keeffe M, Maher CG, et al. They examined the indications for labral reconstruction, surgical technique and graft options, and surgical outcomes that have been described to-date. Again, this was a small (n = 11) study with short-term (minimum of 2 years) results. The incidence of primary hip osteoarthritis in active duty US military servicemembers. The hip labrum reconstruction: Indications and outcomes -- an updated systematic review. In a case-series study, Scanaliato et al (2020) determined the return-to-play rates and hip-specific outcomes in athlete hips with FAI syndrome treated with circumferential labral reconstruction (CLR). The mean time to follow-up was 1.36 years (range of 1 to 2 years). In a systematic review, these investigators compared patient-reported outcomes (PROs) following conservative treatment, IP tenotomy, and revision arthroplasty in patients presenting with IPI following THA. If you believe your affliction is linked to your military service, it's important to learn more about VA disability for bursitis. Matsuda et al (2011) performed a systematic evidence review to analyze the current approaches to the surgical management of symptomatic femoroacetabular impingement (FAI), including open dislocation, mini-open, and arthroscopic surgeries for femoroacetabular impingement. 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. Am J Sports Med. First, radiographic measures of FAI are potentially unreliable between and within individual readers. 2014;10(1):18-24. This work was not supported by any grants. The success of hip arthroscopy in an active duty population. 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. London, UK: NICE;September 28, 2011. Ilizalitturi et al (2008)reported on short-term follow-up of an uncontrolled cohort of 19 patients with cam femoroacetabular impingement. In order to ensure the groups were suitably matched for comparison of treatment effects, patients with advanced degenerative changes (Tnnis gradegreater than2, lateral sourcil heightless than2 mm and Outerbridge grade 4 changes in the weight-bearing area of the femoral head) were excluded, leaving 96 patients (101 hips) in the study. Compared to revision arthroplasty, IP tenotomy resulted in a lower overall rate of complications with less severe complication types; thus, IP tenotomy should be considered as a 2nd line of treatment for patients who failed conservative measures. From the same incision,the surgeoncan also access the hip joint to debride extra bone from the head/neck as needed. These investigators reported that peri-acetabular osteotomy produced a good or excellent result in 26/29 (90 %)of hips. Unresolved issues include the indications for acetabular rim trimming with labral refixation in the presence of acetabular retroversion and/or delaminated acetabular cartilage. Ayeni OR, Alradwan H, de Sa D, Philippon MJ. The authors concluded that hypermobility and secondary dislocation of the hip joint is a common problem in patients with Down syndrome, which often requires surgical intervention at an early stage. This included 13 osteotomies according to Chiari, 11 triple osteotomies according to Tonnis, 10 corrections by femoral varus derotation osteotomy, 8 pelvic osteotomies according to Pemberton, 5 pelvic osteotomies according to Salter and 2 open reductions of the hip. Procedures performed, complications, failures, and functional outcome measures were included in this analysis. The guidance stated that, while this was considered adequate for the present recommendation, further studies would be useful. No EDS patients were lost to follow-up or excluded from analysis. Most studies noted strength recovery. Washington State Health Care Authority, Health Technology Clinical Committee. Both groups demonstrated significant improvements in the HOS-ADL (PR: 64.6 17.0 to 90.7 8.4 [p < 0.0001]; CR: 66.1 15.7 to 92.1 7.9 [p < 0.0001]) and HOS-SS (PR: 39.4 23.9 to 83.6 9.6 [p < 0.0001]; CR: 39.1 24.2 to 87.3 8.3 [p < 0.0001]) at final follow-up. The mean mHHS, SF-12 score, and VAS score were 45.6 points, 62.4 points, and 6.5 points, respectively, pre-operatively compared with 88.5 points, 79.3 points, and 1.6 points, respectively, at a mean follow-up of 45 months. 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). 12009101120. They stated that AIIS decompression for FAI correction improved post-operative PRO scores without altering the muscle strength of hip flexor and knee extensor. Patients with severe pre-existing osteoarthritis or acetabular dysplasia were excluded. 2010;468(2):555-564. 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. Armed Forces Health Surveillance Center (AFHSC). There were many cases in which rehabilitation follow-up was limited in the authors hospital because many surgery cases have come over from all over the country. Clin Orthop Relat Res. Based on 6 studies, the mHHS improved by a mean 29.0 points after labral reconstruction (p < 0.0001). Capsular reconstruction may play an important role in restoring stability in these difficult cases. The authors concluded that arthroscopic hip labral reconstruction resulted in clinically significant improvements in PROs. } Frank RM, Lee S, Bush-Joseph CA, et al. Failures were defined as the need for revision ipsilateral hip surgery. Of 6,264 initial studies, 3 met the full-text inclusion criteria. At1 and2 years post-operatively, the Merle d'Aubign clinical score and the Tnnis arthrosis classification system were used to compare the two groups. Note:CPT Code 29862 -- Debridement during hip arthroscopy is considered integral to the FAI surgery codes 29914/5/6 and would therefore not be covered. Following the Shapiro-Wilks test for normality, independent t-tests were used to compare alpha angles and LCEAs between groups. In 24 hips that underwent cam decompression, the mean alpha-angle improved from 64 16 to 40 5.3 post-operatively. Philippon MJ, Ejnisman L, Ellis HB, Briggs KK. The findings of this analysis indicated that there are no significant differences in outcomes based on graft type alone. Third, specific radiographical assessment of the degree of acetabular prominence was not carried out. Salem, OR: HERC; August 9, 2012. Anterior acetabular component prominence was measured on a true lateral hip radiograph. 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). VA Disability Rating for Hip Pain Explained | CCK Law Our study has some limitations. A hierarchical cluster analysis was performed to identify hip morphologic subtypes according to radiographic parameters, including the LCEA, femoro-epiphyseal acetabular roof (FEAR) index, anterior and posterior wall indices (AWI and PWI), Tonnis angle, alpha angle, and femoral neck-shaft angle. Hip arthroscopy in patients over 40: Greater success with labral reconstruction compared to labral repair. This was a small (n = 20 for patients with a hypertrophic labrum who underwent arthroscopic hip surgery) with early/mid-term follow-up (2 years). Muscle force was recovered at a mean 3.25 months (0.5 to 6); 8 patients were very satisfied, 1 satisfied and 1 moderately satisfied. Patients were excluded if they underwent any previous ipsilateral hip surgery, had dysplasia, or had prior hip conditions. Substantial variability in surgical technique, graft choice, and concurrent pathology was found. They stated that labral repair may result in improvements over labral debridement. We performed an Institutional Review Board (IRB)-approved, retrospective review of all patients undergoing a primary total hip arthroplasty (THA) for symptomatic hip osteoarthritis at a single Veterans Affairs Hospital between January 1, 2015 and December 31, 2015. } All authors read and approved the final manuscript. The assessment identifiedseveral case series that reported improvement in pain, patient reported and clinician reported hip outcome scores, patient satisfaction and return to normal activities following FAI surgery. display: none; li.bullet { The following databases were searched on September 14, 2020: Medline, Embase, CENTRAL, Web of Science, and PEDro. PubMed and Embase databases were searched for studies regarding IPI following THA. Capsular defects after hip arthroscopy may suggest an alteration of the biomechanical properties of the ilio-femoral ligament and lead to iatrogenically induced hip instability. The individual geometry of the proximal femur and acetabulum partly influences this phenomenon. Following the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-analyses) method, the PubMed and Medline databases were searched in March 2019 for studies that reported on surgical outcomes in hips with concomitant mid acetabular dysplasia and FAI. Arthrosc Tech. Arthroscopy. The authors concluded that surgery should be tailored to treat individual patient's abnormal hip morphology and should address the major underlying impinging deformities. Patients were included if they identified as an athlete (high school, college, recreational, or amateur); had follow-up on the following PROs: mHHS, NAHS, HOS-SS, and VAS; and completed a return-to-sport survey at 1 year post-operatively. One potential cause for continued pain is the prevalence of hip OA. Correlation between radiologic findings and clinical outcomes. 2012;28(8):1170-1179. Complete follow-up outcome data were available on 323 patients, none of whom had THA, with a mean follow-up of 73 months. Included in this review were 5 studies with 822 patients who underwent hip arthroscopic surgery for FAI or labral tears; there were 166 patients with retroversion, 512 patients with normal version, and 144 patients with anteversion. Br Med Bull. Arthroscopy. Data were prospectively collected and retrospectively analyzed for patients who underwent an arthroscopic labral reconstruction between August 2012 and December 2017. Am J Sports Med. VA Disability Benefits for Hip Pain Secondary to Knee Pain Arthroscopic femoro-acetabular surgery for hip impingement. background: url('https://www.aetna.com/cpb/medical/data/assets/images/purplearrow.jpg') no-repeat; 4.19 - 4.21 - Age in Service-Connected Claims/Analogous Ratings/Application of Rating Schedule. Fourth, although these investigators included 3 studies regarding outcomes on patients who underwent conservative management, it was likely that outcomes following conservative management were under-reported in the literature. Capsular plication is an arthroscopic procedure that involves suturing the ligaments around the joint for greater hip stability. This study provided Level 3 evidence. The mean MHHS improved from 58 to 84 (mean difference = 24 (95 % CI 19 to 28)) and the median patient satisfaction was 9 (1 to 10). Centre for Reviews and Dissemination (CRD). padding: 15px; There was a 13 % revision rate in the PR group, but no patients in the CR group required revision surgery. Search terms included femoro-acetabular impingement, arthroscopic treatment, open treatment, etiology, pathophysiology. Conversion to THA and re-operation rates ranged from 0 to 13.2 % and 0 to 11 %, respectively . The authors concluded that arthroscopic management of patients with FAI results in significant improvement in outcomes measures, with good to excellent results being observed in 75% of hips at a minimum 1-year follow-up. 2014;42(11):2634-2642. Figure3 contains side-by-side anteroposterior radiographs used in this analysis: one of a normal LCEA (<40) and the other of a pincer deformity (LCEA 40). Cochrane Collaboration's Risk of Bias Tool and Newcastle-Ottawa Scale were used to assess risk of bias. Grade 0: No signs of OAGrade 1: Increased sclerosis, slight joint space narrowing, no or slight loss of head sphericityGrade 2: Small cysts, moderate joint space narrowing, moderate loss of head sphericityGrade 3: Large cysts, severe joint space narrowing, severe deformity of the head, Grade 0: normal cartilageGrade I: cartilage with softening and swellingGrade II: a partial-thickness defect with fissures on the surface that do not reach subchondral bone or exceed 1.5 cm in diameterGrade III: fissuring to the level of subchondral bone in an area with a diameter more than 1.5 cmGrade IV: exposed subchondral bone. The meta-analyses found no difference in disability between surgical versus conservative treatment, with a MD between groups of 3.91 points (95 % CI: -2.19 to 10.01) at 6 months, MD of 5.53 points (95 % CI: -3.11 to 14.16) at 12 months and 3.8 points (95 % CI: -6.0 to 13.6) at 24 months. 2016;32(1):177-189. .newText { Posterior dislocation of the hip following arthroscopy - a case report and discussion. Subjective data included the modified Harris Hip score (MHHS), patient satisfaction, and hip outcome score (HOS) activities of daily living (ADL), and sports subscales. Google Scholar. Rahl and associates (2020) stated that the acetabular labrum is critical to maintenance of hip stability and has been found to play a key role in preservation of the hip fluid seal. Haviv B, O'Donnell J. Arthroscopic treatment for acetabular labral tears of the hip without bony dysmorphism. Follow-up ranged from 6 months to 2 years, with 650 participants in total. # font-weight: bold; A total of 158 patients (163 hips) underwent correction of cam impingement (femoroplasty) alone while 42 patients (44 hips) underwent concomitant correction of pincer impingement. Pre-operative MHHS ranged from 56 to 67.3 and improved post-operatively to a range of 81.4 to 97.8. The Hip and Thigh - Military Disability Made Easy You may experience: hip pain or groin pain that . width: 100%; The revision surgery rate for the AIIS group was significantly lower compared with that in the FAI group (p<0.05). Peters CL, Erickson JA. Median patient satisfaction was 9. 4.22 - 4.23 - Rating of Disabilities Aggravated by Active Service/Attitude of Rating Officers. In total, 4 sex-independent clusters with different morphologic patterns of the hip were identified: cluster 1, unstable anterolateral deficiency (FEAR index greater than 2, AWI less than 0.35); cluster 2, stable antero-lateral deficiency (FEAR index less than 2, AWI less than 0.35); cluster 3, stable lateral deficiency (FEAR index greater than 2, normal AWI and PWI); and cluster 4, stable postero-lateral deficiency (FEAR index less than 2, PWI less than 0.85). Subsequent total hip arthroplasty was performed in 4 patients (9 %). Among hips that did not fail treatment, average mHHS improvement was 35 points and both labral reconstruction groups saw a greater mHHS improvement than 40+ labral repairs (p = 0.01 and p < 0.01). Macfarlane RJ, Haddad FS. color:#eee; The authors concluded that the findings of this systematic review showed that improved PROs can be obtained with hip arthroscopy in the treatment of concomitant mild acetabular dysplasia and FAI at a minimum 2-year follow-up. It is important to note that labral reconstruction, in particular, is technically demanding and requires proficiency in hip arthroscopy techniques; thus, results may not be generalizable to other patients or other surgeons. All arthroscopic labral reconstruction patients between March 2010 and June 2015 who were 30 to 65 years old or arthroscopic LR patients between June 2009 and June 2015 who were 40 to 65 years old were recruited; mHHS, LEFS, and VAS for average pain were collected pre-operatively and at minimum 2-year follow-up. Although several studies reported post-operative osteoarthritis findings, the authors found thatit is too soon to predict whether progression of osteoarthritis is delayed or halted. There were 5 patients who did not have a pre-operative iliopsoas injection to confirm diagnosis; however, similar results were observed when those 5 patients were excluded from analysis. Hip surgery for femoroacetabular impingement syndrome (FAI). There were 5 eligible studies (3 case series, 1 prospective cohort, and 1 retrospective chart review) with a total of 128 patients, and an average 11/16 quality on the MINORS score included in this review. Peri-acetabular osteotomy entails an incision over the front of the hip. Aetna Inc. and its subsidiary companies are not responsible or liable for the content, accuracy, or privacy practices of linked sites, or for products or services described on these sites. Two independent reviewers performed a systematic review of the literature using PubMed and the reference lists of related articles by means of defined search terms.
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