Outcomes of Gluteus Maximus and Tensor Fascia Lata Transfer for Primary Deficiency of the Abductors of the Hip

2017 ◽  
Vol 27 (6) ◽  
pp. 567-572 ◽  
Author(s):  
Sivashankar Chandrasekaran ◽  
Nader Darwish ◽  
S. Pavan Vemula ◽  
Parth Lodhia ◽  
Carlos Suarez-Ahedo ◽  
...  
Keyword(s):  
Case Series ◽  
Gluteus Maximus ◽  
Fascia Lata ◽  
The Other ◽  
Harris Hip Score ◽  
Tensor Fascia Lata ◽  
Outcome Score ◽  
Small Series ◽  
Patient Reported ◽  
Abductor Strength

Purpose This study aims to present 3 patients’ results after undergoing gluteus maximus and tensor fascia lata (TFL) transfer for chronic abductor tears unable to be repaired primarily. Methods 3 patients were identified intraoperatively as having an abductor tear unable to be repaired primarily. The anterior 1/3 of the gluteus maximus and the posterior 1/3 of the TFL were mobilised and transferred to the greater trochanter in order to reproduce the normal force vector of the gluteus medius and minimus. Data was prospectively collected for changes in gait, abductor strength, and the following patient reported outcomes (PROs): modified Harris Hip Score (mHHS), Nonarthritic Hip Score (NAHS), Hip Outcome Score-Sports Specific Subscale (HOS-SSS), Hip Outcome Score-Activities of Daily Living (HOS-ADL), visual analogue scale (VAS), and satisfaction. Results The patients were female, 63-75 years old, with BMIs of 23-28. All patients had follow-up at mean 2.1 years (1.25-2.5) with positive Trendelenburg signs preoperatively; 2 patients normalised postoperatively. For 2 patients, abductor strength improved by 2 grades postoperatively; the other patient maintained grade four. 2 patients’ PROs all improved; the other patient's PROs all improved except mHHS. Postoperative VAS scores were 0, 0, 1. 2 patients reported maximum satisfaction. Conclusions This case series suggests that gluteus maximus and TFL transfer for irreparable abductor deficiency may be effective for pain relief, improving abductor strength, and reconstructing abductor function. Although this is a small series, it is to our knowledge the first report of clinical outcomes of this procedure.

Defining the Clinically Meaningful Outcomes for Arthroscopic Treatment of Femoroacetabular Impingement Syndrome at Minimum 5-Year Follow-up

2020 ◽  
Vol 48 (4) ◽  
pp. 901-907 ◽  
Author(s):  
Benedict U. Nwachukwu ◽  
Edward C. Beck ◽  
Kyle N. Kunze ◽  
Jorge Chahla ◽  
Jonathan Rasio ◽  
...  
Keyword(s):  
Femoroacetabular Impingement ◽  
Hip Arthroscopy ◽  
Case Series ◽  
Impingement Syndrome ◽  
Arthroscopic Treatment ◽  
Harris Hip Score ◽  
Outcome Score ◽  
Femoroacetabular Impingement Syndrome ◽  
Patient Reported

Background: Minimal clinically important difference (MCID), substantial clinical benefit (SCB), and patient acceptable symptomatic state (PASS) have gained prominence as important variables in the orthopaedic outcomes literature. In hip preservation surgery, much attention has been given to defining early clinically meaningful outcome; however, it is unknown what represents meaningful patient-reported outcome improvement in the medium to long term. Purpose: (1) To define MCID, PASS, and SCB at a minimum 5 years after hip arthroscopy for femoroacetabular impingement syndrome (FAIS) and (2) to evaluate the time-dependent nature of MCID, PASS, and SCB. Study Design: Case series; Level of evidence, 4. Methods: Patients undergoing primary hip arthroscopy for FAIS between January 2012 and March 2014 were included. Clinical and demographic data were collected in an institutional hip preservation registry. MCID, PASS, and SCB were calculated for each outcome score including the Hip Outcome Score–Activities of Daily Living subscale (HOS-ADL), Hip Outcome Score–Sport-Specific subscale (HOS-SS), modified Harris Hip Score (mHHS), and International Hip Outcome Tool (iHOT-12) at 1, 2, and 5 years. MCID was calculated by use of a distribution-based method, whereas PASS and SCB were calculated by use of an anchor method. Results: The study included 283 patients with a mean ± SD age of 34.2 ± 11.9 years. The mean changes in 1-year, 2-year, and 5-year scores, respectively, required to achieve MCID were as follows: HOS-ADL (8.8, 9.7, 10.2); HOS-SS (13.9, 14.3, 15.2); mHHS (6.9, 9.2, 11.4); and iHOT-12 (15.1, 13.9, 15.1). The threshold scores for achieving PASS were as follows: HOS-ADL (89.7, 88.2, 99.2); HOS-SS (72.2, 76.4, 80.9); mHHS (84.8, 83.3, 83.6); and iHOT-12 (69.1, 72.2, 74.3). Last, the threshold scores for achieving SCB scores were as follows: HOS-ADL (89.7, 91.9, 94.6); HOS-SS (78.1, 77.9, 85.8); mHHS (86.9, 85.8, 94.4); and iHOT-12 (72.6, 76.8, 87.5). More patients achieved MCID, SCB, and PASS at 2-year compared with 1-year follow-up; however, by 5 years, fewer patients had achieved clinically meaningful outcome (minimum 1-, 2-, and 5-year follow-up, respectively: MCID, 82.6%, 87.3%, 79.3%; PASS, 67.6%, 74.9%, 67.5%; SCB, 62.3%, 67.2%, 56.6%). Conclusion: The greatest proportion of patients achieved MCID, PASS, and SCB at 2-year follow-up after arthroscopic treatment of FAIS compared with 1- and 5-year time points. Improvements were maintained out to 5-year follow-up, although the proportion of patients achieving clinical significance was slightly decreased.

scholarly journals Clinically Significant Outcome Improvement After Hip Arthroscopy in Patients With Femoroacetabular Impingement Syndrome and Severe Femoral Torsion

2021 ◽  
Vol 9 (10) ◽  
pp. 232596712110345
Author(s):  
Steven F. DeFroda ◽  
Thomas D. Alter ◽  
Blake M. Bodendorfer ◽  
Alexander C. Newhouse ◽  
Felipe S. Bessa ◽  
...  
Keyword(s):  
Femoroacetabular Impingement ◽  
Hip Arthroscopy ◽  
Impingement Syndrome ◽  
Harris Hip Score ◽  
Femoral Torsion ◽  
Outcome Score ◽  
Femoroacetabular Impingement Syndrome ◽  
Patient Reported ◽  
Outcome Improvement ◽  
Clinically Significant

Background: The influence of femoral torsion on clinically significant outcome improvement after hip arthroscopy for femoroacetabular impingement syndrome (FAIS) has not been well-studied. Purpose: To quantify femoral torsion in FAIS patients using magnetic resonance imaging (MRI) and explore the relationship between femoral torsion and clinically significant outcome improvement after hip arthroscopy. Study Design: Cohort study; Level of evidence, 3. Methods: Included were patients who underwent hip arthroscopy for FAIS between January 2012 and August 2018 and had 2-year follow-up and preoperative MRI scans containing transcondylar slices of the knee. Participants were categorized as having severe retrotorsion (SR; <0°), normal torsion (NT; 0°-25°), and severe antetorsion (SA; >25°) as measured on MRI. Patient-reported outcomes (PROs) included the Hip Outcome Score–Activities of Daily Living, Hip Outcome Score–Sports Subscale, modified Harris Hip Score, 12-item International Hip Outcome Tool (iHOT-12), and visual analog scale (VAS) for pain and satisfaction. Achievement of Patient Acceptable Symptom State (PASS) and substantial clinical benefit (SCB) were analyzed among cohorts. Results: Included were 183 patients (SR, n = 13; NT, n = 154; SA, n = 16) with a mean age, body mass index, and femoral torsion of 30.6 ± 12.1 years, 24.0 ± 4.4 kg/m2, and 12.55° ± 9.58°, respectively. The mean torsion was –4.5° ± 2.6° for the SR, 12.1° ± 6.8° for the NT, and 31.0° ± 3.6° for the SA group. There were between-group differences in the proportion of patients who achieved PASS and SCB on the iHOT-12, pain VAS, and any PRO ( P < .05). Post hoc analysis indicated that the SA group achieved lower rates of PASS and SCB on the iHOT-12 and pain VAS, and lower rates of PASS on any PRO versus the SR group ( P < .05); the SR group achieved higher rates of PASS and SCB on pain VAS scores versus the NT group ( P = .003). Conclusion: The orientation and severity of femoral torsion during hip arthroscopy influenced the propensity for clinically significant outcome improvement. Specifically, patients with femoral retrotorsion and femoral antetorsion had higher and lower rates of clinically significant outcome improvement, respectively.

scholarly journals Tensor fascia lata flap is a workhorse for defects after inguinal lymph node block dissection

2016 ◽  
Vol 144 (5-6) ◽  
pp. 288-292
Author(s):  
Asen Velickov ◽  
Predrag Kovacevic ◽  
Aleksandra Velickov
Keyword(s):  
Lymph Node ◽  
Complication Rate ◽  
Inguinal Lymph Node ◽  
Donor Site ◽  
Case Series ◽  
Fascia Lata ◽  
Tumor Type ◽  
Tensor Fascia Lata ◽  
Immediate Reconstruction ◽  
Tfl Flap

Introduction. Enlarged inguinal lymph nodes very often present a site of metastatic disease. Inguinal lymph node block dissection is a demanding procedure, which usually requires at least one of reconstructive modalities. Among different reconstruction options we selected the tensor fascia lata (TFL) musculocutaneous flap. Objective. The paper aims at presenting a series of inguinal block dissections, followed by immediate reconstruction, using the TFL flap, and evaluation of tumor type, flap dimension, complication rate and the duration of hospital stay. Methods. We present a consecutive case series of 25 conducted block dissections. The defects were reconstructed using TFL flap, because of the extent and site of the tissue defects, reliability of the flap, and potentially primarily infected exulcerated tumors. Results. The reconstruction was successful in all cases, the incidence of surgical complications was 16%, no further complications, such as lymphedema or gait disturbances, were noted. Primary skin tumors were predominant (13 cases), followed by genitalia tumors (four cases). The male sex was more frequently affected (14 vs. 11 cases). Conclusion. Having in mind that TFL presents as a flap of adjustable size, length, shape, and volume, with negligible donor site morbidity, and after comparing of our results to those of other authors, we advise broader use of TFL flap. As a reliable flap, not too difficult to harvest, with a low complication rate, it must be taken into consideration regarding the benefits for the patient, and, on the other hand, the surgery cost and duration.

scholarly journals Prospective Randomized Comparison of Capsule Management Techniques During Hip Arthroscopy

2019 ◽  
Vol 7 (3_suppl2) ◽  
pp. 2325967119S0020 ◽  
Author(s):  
Kostas John Economopoulos ◽  
Christopher Y. Kweon
Keyword(s):  
Activities Of Daily Living ◽  
Hip Arthroscopy ◽  
Daily Living ◽  
Alpha Angle ◽  
Labral Repair ◽  
Harris Hip Score ◽  
Outcome Score ◽  
Patient Reported ◽  
Management Techniques

Objectives: Capsular management during hip arthroscopy remains controversial. Studies evaluating this topic consist mostly of retrospective comparative reviews of prospectively gathered data on a large series of patients. The purpose of this study was to perform a prospective randomized trial to comparatively assess three commonly performed capsule management techniques. It was hypothesized that capsular closure during hip arthroscopy would result in superior outcomes compared to non-closing capsulotomy management techniques. Methods: Patients undergoing hip arthroscopy were randomly assigned into three groups at the time of surgery: 1) T-capsulotomy without closure (TC), 2) interportal capsulotomy without closure (IC), and 3) interportal capsulotomy with closure (CC). Inclusion criteria included patients with labral tear on advanced imaging, cam lesion with alpha angle greater than 55 degrees, center-edge angle less than 40 degrees, and Tönnis grade 0 or 1. Patients younger than 18, older than 55, or those with signs of clinical hip hypermobility or radiographic dysplasia were excluded from the trial. All patients underwent labral repair and femoral osteoplasty. Modified Harris Hip Score (mHHS), Hip Outcome Score-Activities of Daily Living (HOS-ADL), and Hip Outcome Score-Sports Specific Subscale (HOS-SSS) was obtained preoperatively and at intervals up to 2 years. Other outcomes obtained included need for future hip surgery. Results: 50 patients were randomly allocated into each group. Patient demographics, preoperative patient-reported outcomes (PROs) and radiographic measures of impingement were similar between all three groups. Revision hip arthroscopy was performed in 5 TC patients, 2 IC patients and 0 CC patients (p=0.17). Conversion to hip arthroplasty occurred in 4 patients in the TC group, none in the IC or CC groups (p=0.48). All three groups showed increased PRO scores postoperatively compared to preoperative values (p<0.01). The CC group when compared to the TC group demonstrated superior mHHS (86.2 vs 76), HOS-ADL (85.6 vs 76.8), and HOS-SSS (74.4 vs 65.3) at the final 2 year follow up (p<0.001). The IC group demonstrated more modest improvements in outcomes compared to the TC group. The CC group showed greater improvement in HOS-SSS compared to the IC group at early follow up (65.6 vs 55.1, p>.001) that was not maintained at 2 years (74.4 vs 71.4, p=.28). Conclusion: Patients undergoing capsular closure during hip arthroscopy showed improved patient-reported and surgical outcomes compared to those with unrepaired T-capsulotomy or interportal capsulotomy. These results suggest that repair after capsulotomy may be a favorable arthroscopic capsule management technique, especially in respect to optimizing postoperative activities of daily living.

Defining Minimal Clinically Important Difference and Patient Acceptable Symptom State After Isolated Endoscopic Gluteus Medius Repair

2019 ◽  
Vol 47 (13) ◽  
pp. 3141-3147 ◽  
Author(s):  
Kelechi R. Okoroha ◽  
Edward C. Beck ◽  
Benedict U. Nwachukwu ◽  
Kyle N. Kunze ◽  
Shane J. Nho
Keyword(s):  
Clinical Outcomes ◽  
Minimal Clinically Important Difference ◽  
Case Series ◽  
Gluteus Medius ◽  
Patient Characteristics ◽  
Harris Hip Score ◽  
Level Of Evidence ◽  
Common Procedure ◽  
Clinically Important Difference ◽  
Patient Reported

Background: Endoscopic surgical repair has become a common procedure for treating patients with gluteus medius tears. However, meaningful clinical outcomes after the procedure have not been defined. Purpose: To (1) define the minimal clinically important difference (MCID) and patient acceptable symptomatic state (PASS) in patients undergoing endoscopic gluteus medius repair and (2) determine correlations between preoperative patient characteristics and achievement of MCID/PASS. Study Design: Case series; Level of evidence, 4. Methods: A retrospective review was performed of prospectively collected data from all patients undergoing primary endoscopic repair of gluteus medius tears between January 2012 and February 2017 with a minimum 2-year follow-up. Patient data collected included patient characteristics, radiographic parameters, preoperative clinical function scores, and postoperative patient-reported outcomes (PROs). Paired t tests were used to compare the differences in 2-year PROs. The MCID and PASS for each PRO were calculated and Spearman coefficient analysis was used to identify correlations between MCID, PASS, and preoperative variables. Results: A total of 60 patients were included in the study. A majority of patients were female (91.7%), with an average age and body mass index of 57.9 ± 9.91 years and 27.6 ± 6.1, respectively. The MCIDs of the Activities of Daily Living (ADL) and Sport-Specific (SS) subscales of the Hip Outcome Score (HOS) and the modified Harris Hip Score (mHHS) were calculated to be 15.02, 14.53, and 14.13, respectively. The PASS scores of HOS-ADL, HOS-SS, and mHHS were calculated to be 81.32, 67.71, and 77.5, respectively. In addition, 76.7% of patients achieved either MCID or PASS postoperatively, with 77.8% and 69.0% reaching at least 1 threshold score for achieving MCID and PASS, respectively, and 48.3% achieving both MCID and PASS. Smoking had a negative and weak association with achieving PASS ( r = −0.271; P = .039). No other patient characteristic variables were found to correlate with achieving MCID or PASS. Conclusion: In patients undergoing endoscopic gluteus medius repair, our study defined MCID and PASS for HOS-ADL, HOS-SS, and mHHS outcome scores. A large percentage of patients (76.7%) achieved meaningful clinical outcomes at 2 years after surgery.

scholarly journals Endoscopic Transfer of Gluteus Maximus and Tensor Fascia Lata for Primary Hip Abductor Deficiency

2020 ◽  
Vol 9 (9) ◽  
pp. e1235-e1239
Author(s):  
Mathieu Thaunat ◽  
Timothy Roberts ◽  
Aliou Bah ◽  
Thais Dutra Vieira ◽  
Ibrahim Haidar ◽  
...  
Keyword(s):  
Gluteus Maximus ◽  
Fascia Lata ◽  
Tensor Fascia Lata ◽  
Hip Abductor

scholarly journals Bilateral versus unilateral hip arthroscopy for femoroacetabular impingement: a systematic review

2020 ◽  
Vol 7 (2) ◽  
pp. 225-232
Author(s):  
Claire E Fernandez ◽  
Allison M Morgan ◽  
Ujash Sheth ◽  
Vehniah K Tjong ◽  
Michael A Terry
Keyword(s):  
Systematic Review ◽  
Femoroacetabular Impingement ◽  
Hip Arthroscopy ◽  
Case Reports ◽  
Case Series ◽  
Return To Sport ◽  
Harris Hip Score ◽  
Study Patient ◽  
Significant Difference ◽  
Patient Reported

Abstract One in four patients presenting with femoroacetabular impingement (FAI) has bilateral symptoms, and despite excellent outcomes reported after arthroscopic treatment of FAI, there remains a paucity of data on the outcomes following bilateral hip arthroscopy. This systematic review aims to examine the outcomes following bilateral (either ‘simultaneous’ or ‘staged’) versus unilateral hip arthroscopy for FAI. A systematic review of multiple electronic databases was conducted using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines and checklist. All studies comparing simultaneous, staged and/or unilateral hip arthroscopy for FAI were eligible for inclusion. Case series, case reports and reviews were excluded. All study, patient and hip-specific data were extracted and analyzed. The Newcastle–Ottawa Scale was used to assess study quality. A meta-analysis was not performed due to heterogeneity among outcome measures. A total of six studies, including 722 patients (42.8% male) and 933 hips were eligible for inclusion. The mean age across patients was 35.5. The average time between staged procedures was 7.7 months. Four of the six studies were retrospective cohort studies, while the remaining two were prospective in nature. The overall quality of the eligible studies was found to be good. No significant difference was noted among patient-reported outcomes (modified Harris hip score, hip outcome score and non-arthritic hip score), visual analog scale, return to sport, traction time and complications between those undergoing bilateral (simultaneous or staged) versus unilateral hip arthroscopy. Based on the current available evidence, bilateral hip arthroscopy (whether simultaneous or staged) exhibits similar efficacy and safety when compared with unilateral hip arthroscopy. However, further prospective study is required to confirm this finding.

scholarly journals The effect of platelet-rich plasma in patients with early hip osteoarthritis: a pilot study

2020 ◽  
Author(s):  
Victor Ortiz-Declet ◽  
David A Iacobelli ◽  
Muriel R Battaglia ◽  
Cammille C Go ◽  
David R Maldonado ◽  
...  
Keyword(s):  
Platelet Rich Plasma ◽  
Hip Osteoarthritis ◽  
Degenerative Joint Disease ◽  
Joint Disease ◽  
Harris Hip Score ◽  
Post Injection ◽  
Mri Findings ◽  
Outcome Score ◽  
Patient Reported

Abstract We investigate whether platelet-rich plasma (PRP) injections can improve symptoms and function in patients with mild to moderate osteoarthritis (OA). Data were prospectively collected and retrospectively reviewed for all patients receiving PRP intra-articular hip injections between February 2017 and June 2017. The inclusion criteria were patients with a well-preserved joint space (Tönnis 0 or 1) whose magnetic resonance imaging (MRI) findings demonstrated degenerative joint disease or a Tönnis grade of 2. The patient-reported outcomes (PROs) used were the modified Harris Hip Score (mHHS), Hip Outcome Score-Activities of Daily Living Subscale (HOS-ADL), Hip Outcome Score-Sports Specific Subscale (HOS-SSS), International Hip Outcome TOOL (iHOT-12), Single Assessment Numeric Evaluation (SANE) and Mental and Physical aspects of the Veteran RAND 12 Item Health Survey (VR-12M and VR-12P). The visual analog scale (VAS) was utilized to indicate pain. Nine patients (11 hips) were eligible for inclusion. All PROs and VAS improved from pre- to post-injection. These improvements were present at the 3-month follow-up visit and stable until the 12-month follow-up. There was statistically significant improvement for mHHS (P &lt; 0.001), HOS-ADL (P = 0.006), iHOT-12 (P = 0.003) and VR-12M (P = 0.005) at 12 months post-injection. Similarly, VAS improved from 4.1 to 2.3, although the change was not statistically significant. PRP injections significantly improved PROs in all measured scales at time points up to a year after intervention, except for VR-12P and HOS-SSS. In conclusion, patients with early OA of the hip had significant improvement of patient-reported functional outcomes up to 12 months after PRP intra-articular injections.

Predictors of Clinical Outcomes After Hip Arthroscopy: A Prospective Analysis of 1038 Patients With 2-Year Follow-up

2018 ◽  
Vol 46 (6) ◽  
pp. 1324-1330 ◽  
Author(s):  
Benjamin G. Domb ◽  
Timothy J. Martin ◽  
Chengcheng Gui ◽  
Sivashankar Chandrasekaran ◽  
Carlos Suarez-Ahedo ◽  
...  
Keyword(s):  
Clinical Outcomes ◽  
Predictive Factors ◽  
Hip Arthroscopy ◽  
Multivariate Analyses ◽  
Harris Hip Score ◽  
Duration Of Symptoms ◽  
Outcome Instrument ◽  
Outcome Score ◽  
Patient Reported

Background: As hip arthroscopy has expanded in popularity and volume, more information is needed about indications for the procedure and the predictive factors of clinical outcomes. Purpose: To evaluate clinical outcomes of hip arthroscopy in a prospective study and to analyze the cohort to identify factors that are predictive of improvement. Study Design: Case-control study; Level of evidence, 3. Methods: Data were collected prospectively on all patients undergoing hip arthroscopy between February 2008 and June 2012. We included all patients undergoing hip arthroscopy who agreed to participate and who completed 4 patient-reported outcome (PRO) instruments at a minimum 2-year follow-up: the modified Harris Hip Score (mHHS), Nonarthritic Hip Score (NAHS), Hip Outcome Score–Activities of Daily Living (HOS-ADL), and Hip Outcome Score–Sport-Specific Subscale. The NAHS was selected as our primary outcome instrument. All patients with any previous hip conditions were excluded. We analyzed 34 preoperative and intraoperative variables using bivariate and multivariate analyses compared with NAHS. Results: The cohort consisted of 1038 patients with a mean follow-up of 30.1 months (range, 24.0-61.2 months). Mean age was 36.4 years (range, 13.2-76.4 years). All postoperative PRO scores showed significant improvement ( P < .001) at 2 years compared with preoperative scores. Bivariate analysis identified 15 variables (7 categorical and 8 continuous) and multivariate analysis identified 10 variables that were predictive of 2-year postoperative NAHS. Preoperative NAHS, preoperative HOS-ADL, preoperative mHHS, age, duration of symptoms, body mass index (BMI), and revision hip arthroscopy were identified as predictive factors in both bivariate and multivariate analyses. The predictive value of preoperative NAHS was accentuated for patients with higher BMI. Conclusion: This study reports favorable clinical outcomes in the largest cohort of hip arthroscopies with a minimum 2-year follow-up in the literature to date. Factors identified as predictive in both bivariate and multivariate analyses included preoperative NAHS, HOS-ADL, and mHHS; age; duration of symptoms; BMI; and revision hip arthroscopy. These predictive factors may be useful to the clinician in determining prognosis and operative indications for hip arthroscopy.

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