Christopher A. Colasanti

Purpose This study compares PROMs between patients who underwent hip arthroscopy prior to hip resurfacing arthroplasty (HRA) to a matched cohort of HRA patients without prior arthroscopy. Methods A retrospective cohort study was performed of patients who underwent a HRA from 2016 to 2021 with minimum 2-year follow-up. Patients with prior arthroscopy were matched 1:3 with controls on age, sex, BMI, and ASA classification. Subjects completed HOOS JR, FJS, SANE, and PROMIS for physical function, pain intensity, and pain interference. The Mann-Whitney U test was used for intergroup mean comparisons and Fisher’s exact test for categorical variables. Results 20 patients with prior hip arthroscopy were matched to 60 controls (mean age: 47.1 ± 7.2 years; BMI: 29.5 ± 4.2, 96% male). Patients who underwent hip arthroscopy prior to HRA reported significantly greater pain (33.8 vs. 13.2, p = 0.011), poorer FJS (46.6 vs. 70.5, p = 0.030), physical function (43.7 vs. 50.9, p = 0.018), SANE rating (59.9 vs. 82.6, p = 0.005), and satisfaction (66.1 vs. 88.1, p = 0.006) after HRA. 11 patients (55.0%) stated that their hip resurfacing procedure met their expectations compared to 52 patients (86.7%) in the control group. Conclusions Patients who underwent hip arthroscopy prior to HRA have an association with significantly worse patient-reported outcome metrics, poor postoperative satisfaction, and higher postoperative pain.

The landscape of total shoulder arthroplasty (TSA) is rapidly evolving, with a significant shift toward outpatient procedures. This transition has been supported by enhanced recovery protocols and shorter hospital stays. Key factors for successful outpatient TSA include careful patient selection, focusing on individuals with minimal comorbidities, and preoperative optimization, such as patient education and mental health assessments. Intraoperative considerations like blood loss management, pain control, and surgical efficiency play a crucial role in ensuring positive outcomes. Although challenges remain, including patient selection bias and the need for standardized protocols, ongoing research, innovation in surgical practices, and integration of technology can further enhance the safety and effectiveness of outpatient TSA. Ultimately, with appropriate patient selection and optimization strategies, outpatient TSA can provide comparable outcomes to inpatient procedures, benefiting both patients and health care systems.

Background/Objectives: Hip–knee coupling is a well-documented phenomenon, and interventions to one joint can alter biomechanics at the other. The purpose of this study was to investigate if knee surgery is associated with later onset of femoroacetabular impingement syndrome (FAIS). Methods: A retrospective chart review was conducted regarding patients at a single academic institution who underwent hip arthroscopy for FAIS between January 2011–October 2021. Patient charts were queried for past surgical history of knee arthroscopy before hip arthroscopy. Patients who previously underwent hip arthroscopy with no history of knee arthroscopy served as controls. Details about demographics and the onset of hip symptoms were abstracted from patient charts. Statistical analysis was conducted using Mann–Whitney testing and binary logistic regression. Results: Of the 1569 patients identified, 127 had a history of knee arthroscopy and reported no hip symptoms at or prior to the time of surgery. Patients who had undergone prior knee arthroscopy were significantly older at onset of initial hip symptoms (42.15 ± 11.80 years versus 34.62 ± 12.49 years, p < 0.001) and at the time of hip arthroscopy (44.12 ± 11.85 years versus 36.90 ± 12.14 years, p < 0.001) when controlling for age, sex, and BMI. These patients first developed hip symptoms at a mean of 8.57 ± 8.53 years following knee arthroscopy (median 6.10 years) and underwent operative treatment 1.76 ± 1.96 years later. Conclusions: Patients with a history of prior knee arthroscopy are older at the time of hip symptom onset and subsequent hip arthroscopy for the treatment of FAIS.

OBJECTIVE: The purpose of this study was to perform a network meta-analysis of level I and II evidence comparing different management techniques to define the optimum treatment method for humeral shaft fractures (HSFs). METHODS: Data Sources: A systematic review of the literature using Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines of MEDLINE, Embase, and Cochrane Library was screened from 2010 to 2023. Study Selection: Inclusion criteria were evidence level I or II studies comparing nonoperative and/or operative repair techniques including open reduction internal fixation plate osteosynthesis (ORIF-Plate), minimally invasive percutaneous plating (MIPO), and intramedullary nail (IMN) fixation for the management of HSFs (OTA/AO 12A, B, C). Data Extraction: The risk of bias and methodologic quality of evidence were assessed according to the guidelines designed by the Cochrane Statistical Methods Group and Cochrane Methods Bias Group. Data Synthesis: Network meta-analysis was conducted with a frequentist approach with a random-effects model using the netmeta package version 0.9-6 in R. RESULTS: A total of 25 studies (1908 patients) were included. MIPO resulted in the lowest complication rate (2.1%) when compared with ORIF-Plate (16.1%) [odds ratio (OR), 0.13; 95% confidence interval (CI), 0.04–0.49]. MIPO resulted in the lowest nonunion rate (0.65%) compared with all management techniques (OR, 0.28; 95% CI, 0.08–0.98), whereas Non-Op resulted in the highest (15.87%) (OR, 3.48; 95% CI, 1.98–6.11). MIPO demonstrated the lowest rate of postoperative radial nerve palsy overall (2.2%) and demonstrated a significantly lower rate compared with ORIF-Plate (OR, 0.22; 95% CI, 0.07–0.71, P = 0.02). IMN resulted in the lowest rate of deep infection (1.1%) when compared with ORIF-Plate (8.6%; P = 0.013). MIPO resulted in a significantly lower Disabilities of the Arm, Shoulder, and Hand score (3.86 ± 5.2) and higher American Shoulder and Elbow Surgeons score (98.2 ± 1.4) than ORIF-Plate (19.5 ± 9.0 and 60.0 ± 5.4, P < 0.05). CONCLUSION: The results from this study support that surgical management results in better postoperative functional outcomes, leads to higher union rates, reduces fracture healing time, reduces revision rate, and decreases malunion rates in patients with HSFs. In addition, MIPO resulted in statistically higher union rates, lowest complication rate, lowest rate of postoperative radial nerve palsy, and lower intraoperative time while resulting in better postoperative Disabilities of the Arm, Shoulder, and Hand and American Shoulder and Elbow Surgeons scores when compared with nonoperative and operative (ORIF and IMN) treatment modalities. LEVEL OF EVIDENCE: Therapeutic Level II. See Instructions for Authors for a complete description of levels of evidence.

Background: Spinopelvic parameters, including pelvic tilt (PT), sacral slope (SS), and pelvic incidence, have been developed to characterize the relationship between lumbar spine and hip motion, but a paucity of literature is available characterizing differences in spinopelvic parameters among patients with femoroacetabular impingement syndrome (FAIS) versus patients without FAIS, as well as the effect of these parameters on outcomes of arthroscopic treatment of FAIS. Purpose: To (1) identify differences in spinopelvic parameters between patients with FAIS versus controls without FAIS; (2) identify associations between spinopelvic parameters and preoperative patient-reported outcomes (PROs); and (3) identify differences in PROs between patients with stiff spines (standing-sitting ΔSS ≤10°) versus those without. Study Design: Cohort study; Level of evidence, 2. Methods: The study enrolled patients ≥18 years of age who underwent primary hip arthroscopy for treatment of FAIS with cam, pincer, or mixed (cam and pincer) morphology. Participants underwent preoperative standing-sitting imaging with a low-dose 3-dimensional radiography system and were matched on age and body mass index (BMI) to controls without FAIS who also underwent EOS imaging. Spinopelvic parameters measured on EOS films were compared between the FAIS and control groups. Patients with FAIS completed the modified Harris Hip Score (mHHS) and Non-Arthritic Hip Score (NAHS) before surgery and at 1-year follow-up. Outcome scores were compared between patients with stiff spines versus those without. Associations between spinopelvic parameters and baseline outcome scores were assessed with Pearson correlations. Continuous variables were compared with Student t test and/or Mann-Whitney U test, and categorical variables were compared with Fisher exact test. Results: A total of 50 patients with FAIS (26 men; 24 women; mean age, 36.1 ± 10.7 years; mean BMI, 25.6 ± 4.2) were matched to 30 controls without FAIS (13 men; 17 women; mean age, 36.6 ± 9.5 years; mean BMI, 26.7 ± 3.6). Age, sex, and BMI were not significantly different between the FAIS and control groups ( P > .05). Standing PT was not significantly different between stiff and non-stiff cohorts ( P = .73), but sitting PT in the FAIS group was more than double that of the control group (36.5° vs 15.0°; P < .001). Incidence of stiff spine was significantly higher in the FAIS group (62.0% vs 3.3%; P < .001). Among FAIS patients, those with stiff spines had a significantly higher prevalence of cam impingement, whereas those with non–stiff spines had a higher prevalence of mixed impingement ( P = .04). No significant differences were seen in preoperative mHHS or NAHS scores or pre- to postoperative improvement in scores between FAIS patients with stiff spines versus those without ( P > .05), but a greater sitting SS was found to be positively correlated with a higher baseline mHHS ( r = 0.36; P = .02). Conclusion: Patients with FAIS were more likely to have a stiff spine (standing-sitting ΔSS ≤10°) compared with control participants without FAIS. FAIS patients with stiff spines were more likely to have isolated cam morphology than patient without stiff spines. Although sitting SS was positively correlated with baseline mHHS, no significant differences were seen in 1-year postoperative outcomes between FAIS patients with versus without stiff spine.