PMID- 29226162
OWN - NLM
STAT- PubMed-not-MEDLINE
LR  - 20220311
IS  - 2325-9671 (Print)
IS  - 2325-9671 (Electronic)
IS  - 2325-9671 (Linking)
VI  - 5
IP  - 11
DP  - 2017 Nov
TI  - Relationship Between Age at Onset of Symptoms and Intraoperative Findings in Hip 
      Arthroscopic Surgery.
PG  - 2325967117737480
LID - 10.1177/2325967117737480 [doi]
LID - 2325967117737480
AB  - BACKGROUND: Hip arthroscopic surgery is intended to treat multiple abnormalities 
      in an effort to delay the progression to osteoarthritis, especially in young 
      patients. However, the length of time in which patients experience joint pain 
      before seeking a specialist for a diagnosis can delay hip preservation surgery 
      and influence clinical outcomes. PURPOSE: To investigate the relationship between 
      age at symptom onset and findings during hip arthroscopic surgery as well as 
      outcomes after 2 years of clinical follow-up. STUDY DESIGN: Cohort study; Level 
      of evidence, 3. METHODS: From February 2008 to March 2015, data were 
      prospectively collected on all patients undergoing hip arthroscopic surgery at a 
      single institution. Anatomic and pathological characteristics were recorded 
      intraoperatively. The mean age at onset of symptoms was calculated and correlated 
      with intraoperative findings using Pearson correlation and logistic regression. 
      All patients were assessed preoperatively and postoperatively with 4 
      patient-reported outcome measures: the modified Harris Hip Score (mHHS), the 
      Non-Arthritic Hip Score (NAHS), the Hip Outcome Score-Activities of Daily Living 
      (HOS-ADL), and the Hip Outcome Score-Sport-Specific Subscale (HOS-SSS). Pain was 
      estimated using a visual analog scale (VAS). Furthermore, patients with an age at 
      onset of symptoms below the mean (34.6 years) were compared with those of an age 
      at onset of symptoms above the mean. The 2 groups were compared using the Student 
      t test and the chi-square test. P values <.05 were considered significant. 
      RESULTS: A total of 1697 patients met the inclusion criteria. Body mass index was 
      weakly correlated with age (r = 0.3). Younger patients had a lower prevalence of 
      combined Seldes type 1 and 2 labral tears; acetabular labrum articular disruption 
      (ALAD) grade 2, 3, and 4 acetabular chondral lesions; and Outerbridge grade 2, 3, 
      and 4 femoral head chondral lesions (P < .05 for all). More advanced age was 
      correlated with wider labral tears and chondral lesions based on a clock face (r 
      >/= 0.2, P < .05). Patients younger than 34.6 years had a lower prevalence of 
      gluteus medius and ligamentum teres tears (P </= .001). The prevalence of synovitis 
      was positively correlated with age, while instability was negatively correlated 
      with age (P = .04). The improvement of scores from preoperatively to 2-year 
      follow-up in the younger patient group was 62.69 to 83.82 for the mHHS, 64.97 to 
      87.35 for the HOS-ADL, 43.46 to 73.37 for the HOS-SSS, 63.01 to 85.19 for the 
      NAHS, and 5.61 to 2.53 for pain VAS. All score improvements were statistically 
      significant (P < .001). Regarding the older patient group, the improvement of 
      scores from preoperatively to 2-year follow-up was 58.55 to 78.27 for the mHHS, 
      57.59 to 79.66 for the HOS-ADL, 35.63 to 61.88 for the HOS-SSS, 55.28 to 77.55 
      for the NAHS, and 5.72 to 3.01 for pain VAS. All score improvements were 
      statistically significant (P < .001). CONCLUSION: Of the multiple intraoperative 
      findings in hip arthroscopic surgery, many are related to age at onset of 
      symptoms. Although we found a statistically significant improvement in clinical 
      outcomes in both groups after 2-year follow-up, apparently the less complex and 
      smaller lesions observed in both the articular cartilage and the labrum of 
      younger patients result in better outcomes compared with older patients.
FAU - Suarez-Ahedo, Carlos
AU  - Suarez-Ahedo C
AD  - American Hip Institute, Westmont, Illinois, USA.
FAU - Gui, Chengcheng
AU  - Gui C
AD  - American Hip Institute, Westmont, Illinois, USA.
FAU - Rabe, Stephanie M
AU  - Rabe SM
AD  - American Hip Institute, Westmont, Illinois, USA.
FAU - Walsh, John P
AU  - Walsh JP
AD  - American Hip Institute, Westmont, Illinois, USA.
FAU - Chandrasekaran, Sivashankar
AU  - Chandrasekaran S
AD  - American Hip Institute, Westmont, Illinois, USA.
FAU - Domb, Benjamin G
AU  - Domb BG
AD  - American Hip Institute, Westmont, Illinois, USA.
AD  - Hinsdale Orthopaedics, Hinsdale, Illinois, USA.
LA  - eng
PT  - Journal Article
DEP - 20171129
PL  - United States
TA  - Orthop J Sports Med
JT  - Orthopaedic journal of sports medicine
JID - 101620522
PMC - PMC5714088
OTO - NOTNLM
OT  - age
OT  - cartilage
OT  - hip arthroscopic surgery
OT  - labrum
COIS- One or more of the authors has declared the following potential conflict of 
      interest or source of funding: B.G.D. is a consultant for Arthrex, Pacira, 
      Amplitude, Medacta, and Stryker and receives royalties from Arthrex, Orthomerica, 
      and DJO Global. The American Hip Institute receives research support from 
      Arthrex, Breg, ATI, Pacira, Stryker, Medacta, and Adventist Hinsdale Hospital.
EDAT- 2017/12/12 06:00
MHDA- 2017/12/12 06:01
PMCR- 2017/11/29
CRDT- 2017/12/12 06:00
PHST- 2017/12/12 06:00 [entrez]
PHST- 2017/12/12 06:00 [pubmed]
PHST- 2017/12/12 06:01 [medline]
PHST- 2017/11/29 00:00 [pmc-release]
AID - 10.1177_2325967117737480 [pii]
AID - 10.1177/2325967117737480 [doi]
PST - epublish
SO  - Orthop J Sports Med. 2017 Nov 29;5(11):2325967117737480. doi: 
      10.1177/2325967117737480. eCollection 2017 Nov.