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McCormick F.,LESS Institute
Arthroscopy - Journal of Arthroscopic and Related Surgery | Year: 2016

Purpose: The purpose of this study was to evaluate how patient satisfaction after surgical femoroacetabular impingement (FAI) treatment is measured and reported in the current evidence base. Methods: A review of the MEDLINE database was performed. Clinical outcome studies of FAI that reported a measure of patient satisfaction were included. Patient demographics, clinical outcome scores, and patient satisfaction measures were extracted. The NewCastle Ottawa Scale (NOS) was used to grade quality. Statistical analysis was primarily descriptive. Results: Twenty-six studies met inclusion criteria; the mean NOS score among included studies was 5.7. Most studies were level 3 or 4 (n = 25, 96.1%). A 0 to 10 numeric scale, described by some studies as a visual analog scale, was the most commonly used method to assess satisfaction (n = 21; 80.8%), and mean reported scores ranged from 6.8 to 9.2 out of 10. Four studies (15.4%) used an ordinal scale, and 1 study (3.8%) used willingness to undergo surgery again as the measure of satisfaction. None of the included studies assessed preoperative satisfaction or patient expectation. Pooled cohort analysis was limited by significant overlapping study populations. Predictors of patients' satisfaction identified in included studies were presence of arthritis and postoperative outcome scores. Conclusions: Patient satisfaction was not uniformly assessed in the literature. Most studies used a 0- to 10-point satisfaction scale, but none distinguished between the process of care and the outcome of care. Although satisfaction scores were generally high, the quality of the methodologies in the studies that reported satisfaction was low, and the studies likely included overlapping patient populations. More work needs to be done to develop standardized ways for assessing patient satisfaction after arthroscopic hip surgery and other procedures in orthopaedic sports medicine. Level of Evidence: Level III, systematic review of Level III studies. © 2016 Arthroscopy Association of North America.


Nwachukwu B.U.,Hospital for Special Surgery | Rebolledo B.J.,Hospital for Special Surgery | McCormick F.,LESS Institute | Rosas S.,LESS Institute | And 3 more authors.
American Journal of Sports Medicine | Year: 2015

Background: Surgical treatment of symptomatic femoroacetabular impingement (FAI) aims to improve symptoms and potentially delay initiation of hip osteoarthritis and prevent progression to end-stage hip osteoarthritis and possible total hip arthroplasty (THA). Hip arthroscopy and open surgical hip dislocations are the 2 most common surgical approaches used for this condition. Purpose: To perform a comparative systematic review to determine whether there is a significant difference in clinical outcomes and progression to THA between hip arthroscopy and open surgical hip dislocation treatment for FAI at minimum medium-term follow-up. Study Design: Systematic review and meta-analysis. Methods: A systematic review of the MEDLINE database by use of the PubMed interface was performed. Minimum mean follow-up for included studies was set at 36 months. English-language studies with a minimum mean medium-term time frame evaluating outcome after arthroscopic or open treatment of FAI were included. Independent t tests, Kaplan-Meier survival analysis, and weighted mean pooled cohort statistics were performed. Results: A total of 16 studies met inclusion criteria. There were 9 open surgical hip dislocation studies and 7 hip arthroscopy studies. Open studies included 600 hips at a mean follow-up of 57.6 months (4.8 years; range, 6-144 months). Arthroscopic studies included 1484 hips at a mean follow-up of 50.8 months (4.2 years; range, 12-97 months). With THA as an outcome endpoint, there was an overall survival rate of 93% for open and 90.5% for arthroscopic procedures (P =.06). Advanced age and preexisting chondral injury were risk factors for progression to THA after both treatments. Direct comparison among disease-specific outcome instruments between the 2 procedures was limited by outcome measure heterogeneity; however, both treatments demonstrated good outcomes in their respective scoring systems. Notably, hip arthroscopy was associated with a higher general health-related quality of life (HRQoL) score on the 12-Item Short-Form Survey physical component score (P <.001). Conclusion: Both hip arthroscopy and open surgical hip dislocation showed excellent and equivalent hip survival rates at medium-term follow-up with hip-specific outcome measures, demonstrating equivalence between groups. However, hip arthroscopy was shown to have superior results regarding general HRQoL in comparison to open treatment. An increased understanding of the natural history of FAI remains warranted, with further studies needed to assess long-term outcomes for patients with FAI. © 2016 The Author(s).


Schairer W.W.,Hospital for Special Surgery | Nwachukwu B.U.,Hospital for Special Surgery | McCormick F.,LESS Institute | Lyman S.,Hospital for Special Surgery | Mayman D.,Hospital for Special Surgery
Arthroscopy - Journal of Arthroscopic and Related Surgery | Year: 2016

Purpose To use population-level data to (1) evaluate the conversion rate of total hip arthroplasty (THA) within 2 years of hip arthroscopy and (2) assess the influence of age, arthritis, and obesity on the rate of conversion to THA. Methods We used the State Ambulatory Surgery Databases and State Inpatient Databases for California and Florida from 2005 through 2012, which contain 100% of patient visits. Hip arthroscopy patients were tracked for subsequent primary THA within 2 years. Out-of-state patients and patients with less than 2 years follow-up were excluded. Multivariate analysis identified risks for subsequent hip arthroplasty after arthroscopy. Results We identified 7,351 patients who underwent hip arthroscopy with 2 years follow-up. The mean age was 43.9 ± 13.7 years, and 58.8% were female patients. Overall, 11.7% of patients underwent THA conversion within 2 years. The conversion rate was lowest in patients aged younger than 40 years (3.0%) and highest in the 60- to 69-year-old group (35.0%) (P <.001). We found an increased risk of THA conversion in older patients and in patients with osteoarthritis or obesity at the time of hip arthroscopy. Patients treated at high-volume hip arthroscopy centers had a lower THA conversion rate than those treated at low-volume centers (15.1% v 9.7%, P <.001). Conclusions Hip arthroscopy is performed in patients of various ages, including middle-aged and elderly patients. Older patients have a higher rate of conversion to THA, as do patients with osteoarthritis or obesity. Level of Evidence Level III, retrospective comparative study. © 2016 Arthroscopy Association of North America.


McCormick F.,LESS Institute | Wilcox R.B.,Brigham and Women's Hospital | Alqueza A.,Brigham and Women's Hospital
Operative Techniques in Orthopaedics | Year: 2015

Selection and management of a postoperative rotator cuff repair rehabilitation protocol is a vital component in achieving pain control in patients, a reliable return to activities and preinjury level, retear risk management, and overall surgical outcome. Optimal treatment approaches require a team effort; open communication between the surgeon, the therapist, and the patient; continual reassessment; and a stepwise staged protocol progression. Much work has been done to identify high-level evidence-based rotator cuff rehabilitation protocols and identify risk factors for complications and tendon failure. The orthopedic surgeon is best positioned to identify predictive factors at the time of treatment that influence overall outcome and may direct and customize early rehabilitation based on these assessments. In addition, the surgeon is overall responsible for much of the postoperative decision making: ensuring an optimal environment for tendon healing, avoidance of postoperative stiffness, return to work or activity pressures, postoperative pain management, cost constraints of therapy, avoidance of revision surgery, and optimization of long-term outcome. Thus, a comprehensive understanding of the rotator cuff repair rehabilitation protocol is requisite. This article aims to review patient and surgical factors to consider in customizing the postoperative rehabilitation protocol, present postoperative assessments to guide surgical recovery and rehabilitation, and provide our current evidence-based rehabilitation protocol. © 2015 Elsevier Inc.


McCormick F.,LESS Institute | Alpaugh K.,Harvard University | Haughom B.,Rush University Medical Center | Nho S.,Rush University Medical Center
Orthopedics | Year: 2015

Pigmented villonodular synovitis (PVNS) is a benign synovial tumor of unknown etiology with a predilection for the large joints of the appendicular skeleton. The poor prognosis for patients with hip disease is partially imparted by current surgical techniques. Recent advances in hip arthroscopy technique and instrumentation may enable arthroscopic treatment for PVNS in the hip. The authors report the first case where hip arthroscopy was used to surgically excise a biopsyconfirmed local PVNS lesion in the hip. Using selected capsular releases and accessory portals, the authors achieved adequate visualization and instrument mobilization to successfully excise the entire PVNS tumor with no identifiable complications. Copyright © SLACK Incorporated.


PubMed | LESS Institute, Houston Methodist Orthopaedics and Sports Medicine and Hospital for Special Surgery
Type: Journal Article | Journal: The American journal of sports medicine | Year: 2016

Surgical treatment of symptomatic femoroacetabular impingement (FAI) aims to improve symptoms and potentially delay initiation of hip osteoarthritis and prevent progression to end-stage hip osteoarthritis and possible total hip arthroplasty (THA). Hip arthroscopy and open surgical hip dislocations are the 2 most common surgical approaches used for this condition.To perform a comparative systematic review to determine whether there is a significant difference in clinical outcomes and progression to THA between hip arthroscopy and open surgical hip dislocation treatment for FAI at minimum medium-term follow-up.Systematic review and meta-analysis.A systematic review of the MEDLINE database by use of the PubMed interface was performed. Minimum mean follow-up for included studies was set at 36 months. English-language studies with a minimum mean medium-term time frame evaluating outcome after arthroscopic or open treatment of FAI were included. Independent t tests, Kaplan-Meier survival analysis, and weighted mean pooled cohort statistics were performed.A total of 16 studies met inclusion criteria. There were 9 open surgical hip dislocation studies and 7 hip arthroscopy studies. Open studies included 600 hips at a mean follow-up of 57.6 months (4.8 years; range, 6-144 months). Arthroscopic studies included 1484 hips at a mean follow-up of 50.8 months (4.2 years; range, 12-97 months). With THA as an outcome endpoint, there was an overall survival rate of 93% for open and 90.5% for arthroscopic procedures (P = .06). Advanced age and preexisting chondral injury were risk factors for progression to THA after both treatments. Direct comparison among disease-specific outcome instruments between the 2 procedures was limited by outcome measure heterogeneity; however, both treatments demonstrated good outcomes in their respective scoring systems. Notably, hip arthroscopy was associated with a higher general health-related quality of life (HRQoL) score on the 12-Item Short-Form Survey physical component score (P < .001).Both hip arthroscopy and open surgical hip dislocation showed excellent and equivalent hip survival rates at medium-term follow-up with hip-specific outcome measures, demonstrating equivalence between groups. However, hip arthroscopy was shown to have superior results regarding general HRQoL in comparison to open treatment. An increased understanding of the natural history of FAI remains warranted, with further studies needed to assess long-term outcomes for patients with FAI.


PubMed | LESS Institute and Hospital for Special Surgery
Type: Journal Article | Journal: Arthroscopy : the journal of arthroscopic & related surgery : official publication of the Arthroscopy Association of North America and the International Arthroscopy Association | Year: 2016

The purpose of this study was to evaluate how patient satisfaction after surgical femoroacetabular impingement (FAI) treatment is measured and reported in the current evidence base.A review of the MEDLINE database was performed. Clinical outcome studies of FAI that reported a measure of patient satisfaction were included. Patient demographics, clinical outcome scores, and patient satisfaction measures were extracted. The NewCastle Ottawa Scale (NOS) was used to grade quality. Statistical analysis was primarily descriptive.Twenty-six studies met inclusion criteria; the mean NOS score among included studies was 5.7. Most studies were level 3 or 4 (n= 25, 96.1%). A 0 to 10 numeric scale, described by some studies as a visual analog scale, was the most commonly used method to assess satisfaction (n= 21; 80.8%), and mean reported scores ranged from 6.8 to 9.2 out of 10. Four studies (15.4%) used an ordinal scale, and 1 study (3.8%) used willingness to undergo surgery again as the measure of satisfaction. None of the included studies assessed preoperative satisfaction or patient expectation. Pooled cohort analysis was limited by significant overlapping study populations. Predictors of patients satisfaction identified in included studies were presence of arthritis and postoperative outcome scores.Patient satisfaction was not uniformly assessed in the literature. Most studies used a 0- to 10-point satisfaction scale, but none distinguished between the process of care and the outcome of care. Although satisfaction scores were generally high, the quality of the methodologies in the studies that reported satisfaction was low, and the studies likely included overlapping patient populations. More work needs to be done to develop standardized ways for assessing patient satisfaction after arthroscopic hip surgery and other procedures in orthopaedic sports medicine.Level III, systematic review of Level III studies.

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