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      Hip arthroscopy in patients with recurrent pain following Bernese periacetabular osteotomy for acetabular dysplasia: operative findings and clinical outcomes

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          Abstract

          To report the operative findings and outcomes of hip arthroscopy for recurrent pain following periacetabular osteotomy (PAO) for acetabular dysplasia. A departmental database was used to identify patients who underwent hip arthroscopy following PAO between 2000 and 2009. Demographic data, arthroscopic findings, functional outcome scores and patient satisfaction were analysed. Of 556 PAO patients, 17 hips in 16 patients (3.1%) underwent post-PAO hip arthroscopy. Mean age at PAO was 23.8 years, and mean age at arthroscopy was 27.0 years. Common hip arthroscopy findings included labral tears (13 hips, 81.3%), significant (≥grade 2) chondral changes (12 hips, 75%), cam impingement (7 hips, 43.8%) and pincer impingement (6 hips, 37.5%). At mean follow-up 2.8 years after arthroscopy, additional procedures had been performed in six hips (37.5%), including total hip arthroplasty in one hip. Post-PAO arthroscopy questionnaire revealed 85.7% of patients with improved hip pain, 57.1% improved hip stiffness and 57.1% improved hip function. There was no significant difference in functional outcome measures. Common post-PAO hip arthroscopy findings include labral tears, chondral changes and femoroacetabular impingement. Many patients reported subjective hip improvement from post-PAO arthroscopy, but hip outcome scores were unchanged and one-third of patients had further surgery.

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          Most cited references24

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          Acetabular and femoral anteversion: relationship with osteoarthritis of the hip.

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            A new periacetabular osteotomy for the treatment of hip dysplasias. Technique and preliminary results.

            A new periacetabular osteotomy of the pelvis has been used for the treatment of residual hip dysplasias in adolescents and adults. The identification of the joint capsule is performed through a Smith-Petersen approach, which also permits all osteotomies to be performed about the acetabulum. This osteotomy does not change the diameter of the true pelvis, but allows an extensive acetabular reorientation including medial and lateral displacement. Preparations and injections of the vessels of the hip joint on cadavers have shown that the osteotomized fragment perfusion after correction is sufficient. Because the posterior pillar stays mechanically intact the acetabular fragment can be stabilized sufficiently using two screws. This stability allows patients to partially bear weight after osteotomy without immobilization. Since 1984, 75 periacetabular osteotomies of the hip have been performed. The corrections are 31 degrees for the vertical center-edge (VCE) angle of Wiberg and 26 degrees for the corresponding angle of Lequesne and de Seze in the sagittal plane. Complications have included two intraarticular osteotomies, a femoral nerve palsy that resolved, one nonunion, and ectopic bone formation in four patients prior to the prophylactic use of indomethacin. Thirteen patients required screw removal. There was no evidence of vascular impairment of the osteotomized fragment.
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              Assessing activity in joint replacement patients.

              Outcome evaluations of lower extremity joint reconstructions should include an assessment of patient activity. In vivo wear assessments of total joint prostheses should be based on a measure of use, not time in situ or a proxy such as age or gender; however, clinicians lack a simple method to reliably assess the activity of patients with joint replacement. The modern pedometer can be a satisfactory means of quantifying the use of lower extremity joints. The pedometer, however, requires special effort on the part of the physician or evaluator and the patient. Therefore, we compared the quantitative assessment of walking activity of 100 total joint replacement patients, as measured with a pedometer, to the UCLA activity score and a simple visual analog scale that can easily be employed during a routine office evaluation. Both the UCLA activity rating (P = .002) and the visual analog scale rating of the investigator (P = .00001) had a strong correlation with the average steps per day as recorded by the pedometer. There was, however, up to a 15-fold difference in the average steps per day for individual patients with the same UCLA score. The visual analog scale as rated by the patients of their own activity did not have as strong a correlation with the pedometer data (P = .08) as did patient age (P = .049). For practical reasons, the pedometer is probably best reserved for the evaluation of extreme cases of activity (or inactivity). This study indicates that both the UCLA activity rating and the investigator visual analog scale are valid for routine activity assessment in a clinical setting. Adjustments of the UCLA activity score for the frequency and intensity of activity, as can be done with the investigator visual analog scale, increase the accuracy of the activity rating.
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                Author and article information

                Journal
                J Hip Preserv Surg
                J Hip Preserv Surg
                jhps
                jhps
                Journal of Hip Preservation Surgery
                Oxford University Press
                2054-8397
                October 2015
                13 June 2015
                : 2
                : 3
                : 295-302
                Affiliations
                1. Rush University Medical Center, Department of Orthopaedic Surgery, 1611 W. Harrison Street, Suite 201, Chicago, IL 60612, USA and
                2. Children's Hospital Boston, Department of Orthopaedic Surgery, 300 Longwood Avenue, Fegan 2, Boston, MA 02115, USA
                Author notes
                *Correspondence to: G. L. Cvetanovich. Email: Gregory.cvetanovich@ 123456gmail.com
                Article
                hnv037
                10.1093/jhps/hnv037
                4765306
                27011852
                4fe6fe0d-438c-4644-a7d9-16676d2f8c55
                © The Author 2015. Published by Oxford University Press.

                This is an Open Access article distributed under the terms of the Creative Commons Attribution License ( http://creativecommons.org/licenses/by/4.0/), which permits unrestricted reuse, distribution, and reproduction in any medium, provided the original work is properly cited.

                History
                : 11 November 2014
                : 7 April 2015
                : 7 May 2015
                Page count
                Pages: 8
                Categories
                Research Articles

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