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Purpose: The "Purse-String Technique" (PST) is an arthroscopic horizontal mattress suture technique for recurrent anterior shoulder instability that uses a single double-loaded suture anchor at the 4-o' clock position, achieving a Bankart labral repair and an infero-superior capsular shift. In this study, we describe the long-term results of the PST. Methods: The study included 69 individuals (70 shoulders), with a mean age of 30 years, who had recurrent post-traumatic anteroinferior instability. A purse-string suture anchor at the 4-o'clock position was used to address the Bankart lesion and capsular laxity, recreating the anterior glenoid bumper. All patients were assessed via telephone interview at a mean of 116 months after surgery (7–13-year follow-up). Results: Postoperatively, the mean Constant score was 94, mean Rowe score was 93 and mean Walch–Duplay score was 89. 89% of patients resumed their preinjury sport activities, with 61% of patients achieving preinjury levels and most professional athletes returning to full activity. Seven patients had recurrent dislocation postoperatively (10% failure rate). Of these patients, three had revision arthroscopic stabilization, one patient had revision arthroscopic stabilization with remplissage, two had a Latarjet procedure, whereas one patient decided to seek no further treatment. Conclusion: The long-term results of PST are promising, with a low failure rate, high patient satisfaction and a high rate of return to sport. Level of evidence: Level IV; Case series; Treatment study. [ABSTRACT FROM AUTHOR]

Background: Humeral avulsion of the glenohumeral ligament (HAGL) is an uncommon condition but a major contributor to shoulder instability and functional decline. Purpose: To describe the pre- and postoperative HAGL lesion presentations of instability, pain, and functionality and the return-to-sports activities in patients managed arthroscopically for anterior and posterior HAGL lesions. Study Design: Case series; Level of evidence, 4. Methods: Data on patients with HAGL lesions treated with arthroscopic repair between 2009 and 2018 were retrospectively retrieved from medical charts, and the patients were interviewed to assess their level of postoperative functionality. The Rowe; Constant; University of California, Los Angeles; Oxford; and pain visual analog scale (VAS) scores were obtained for both pre- and postoperative status. Return-to-sports activities and level of activities after surgery were compared with the preinjury state, and complications, reoperations, and recurrent instability were recorded and evaluated. Results: There were 23 study patients (12 females and 11 males; mean age, 24 years). The mean follow-up duration was 24.4 months (range, 7-99 months; median, 17 months). In 7 (30.4%) of the patients, HAGL lesions were diagnosed only intraoperatively. A significant improvement was seen in all examined postoperative functional scores and VAS. At the last follow-up visit, 2 patients (8.7%) reported residual instability with no improvement in pain levels and declined any further treatment, and 3 others (13.0%) required revision surgeries for additional shoulder pathologies (reoperations were performed 18-36 months after the index procedure). The remaining 18 patients (78.3%) were free of pain and symptoms. There was a mean of 0.65 coexisting pathologies per patient, mostly superior labral anterior-posterior, Bankart, and rotator cuff lesions. Conclusion: HAGL lesions are often missed during routine workup in patients with symptoms of instability, and a high level of suspicion is essential during history acquisition, clinical examination, magnetic resonance imaging arthrogram interpretation, and arthroscopic evaluation. Arthroscopic repair yields good pain and stability results; however, some high-level athletes may not return to their preinjury level of activity. [ABSTRACT FROM AUTHOR]

Purpose and Hypothesis: The aim of this study was to evaluate outcomes after acetabular labral reconstruction using the indirect head of the rectus femoris tendon. The study hypothesis stated that arthroscopic acetabular labral reconstruction may improve patient reported outcomes in patients with labral tears that were not amenable to repair.Methods: Between 2009 and 2015, the senior author performed 31 acetabular labral reconstructions using the indirect head of the rectus femoris tendon. The graft is harvested through the same arthroscopic portals established for the procedure. The graft was gradually secured to the acetabular rim starting at its origin to the myotendinous junction, reestablishing the suction seal of the joint. Medical records and surgical reports were reviewed for demographic data, and outcome measures were assessed with pre- and postoperative modified Harris Hip Scores (mHHS).Results: Twenty-two patients with follow-up of more than 2 years were evaluated. Fourteen procedures were revision hip arthroscopy and 8 were primary labral reconstruction in 13 males and 9 females. The median age was 43 (range 22-68 years old). The median follow-up time was 36.2 months with a range from 24 to 72 months. The median preoperative mHHS was 67.1. Postoperatively, patients improved to a median mHHS of 97.8 (range 73.7-100) (p < 0.0001).Conclusion: Acetabular labral reconstruction using the indirect head of the rectus femoris tendon is a minimally invasive surgical procedure. The technique was applicable in all patients in this study with good outcomes. This procedure is clinically relevant for patients with large labral tears not amendable to labral repair as it offers good results using a local allograft. The local allograft is clinically advantageous as there is no additional donor-site morbidity and no risk of disease transmission.Level Of Evidence: IV. [ABSTRACT FROM AUTHOR]

The Mayo metaphysical conservative femoral stem (Zimmer, Warsaw, Indiana) is a wedge-shaped implant designed to transfer loads proximally, reduce femoral destruction, and enable the preservation of bone stock in the proximal femur. Thus, it is a potentially preferred prosthesis for active, non-elderly patients who may require additional future surgeries. This retrospective case study analyzed the outcomes of consecutive patients who underwent total hip replacements with this stem between May 2001 and February 2013. All patients underwent clinical assessment, radiological evaluation for the presence and development of radiolucent lines, and functional assessment (numerical analog scale, Harris hip score, and Short Form-12 questionnaire). Ninety-five hips (79 patients) were available for analysis. The patients' mean age was 43 years (range, 18-64 years), and the mean follow-up was 97 months (range, 26.9-166 months). The postoperative clinical assessments and functional assessments revealed significant improvements. Sixteen patients (20.3%) had 18 orthopedic complications, the most common of which were an intraoperative femoral fracture and implant dislocation requiring revision surgeries in 10 hips (10.5%). Radiological analysis revealed evidence of femoral remodeling in 64 (67.4%) implants, spot welds (neocortex) in 35 (36.8%), and osteolysis in 3 (3.2%). These results suggest that the conservative hip femoral implant has an unacceptable complication rate for non-elderly patients. [Orthopedics. 2018; 41(4):e516-e522.]. [ABSTRACT FROM AUTHOR]

BACKGROUND: In recent years, hip arthroscopy has rapidly evolved, offering patients evidence-based interventions with the merits of minimally invasive surgery and a relatively short rehabilitation period. Although considered a safe procedure, hip arthroscopy has associated complications that may be underreported depending on how patients are asked about their complications. PURPOSE: The aim of this study was to evaluate hip arthroscopy complications from the patient's perspective. METHODS: Between February 2006 and April 2010, a total of 78 consecutive patients underwent arthroscopy of the hip by a single surgeon. A questionnaire was created that included questions regarding demographic data, functional data, and the patient's opinion as to the operation's indications, subjective evaluation of the success of the procedure, and the presence of specific complications. Patients were asked about the presence of specific complications rather than being asked about the presence of any complication in general. RESULTS: Sixty-two patients participated. The mean time postsurgery was 27.9 months (range = 5-55 months). Main indications for surgery were correction of femoroacetabular impingement in 31 (50%) patients. Mean surgery time was 1.2 hours (range = 0.5-2.43 hours), mean postoperative modified Harris hip score (MHHS) was 76.2 (range = 15-100), and mean postoperative pain score was 4 (range = 2-10). Fifteen (24%) patients reported complications after surgery, with 20 complications reported overall (32%). Eight (12.9%) patients reported transient neuropraxias. No significant differences were found between patients reporting complications and patients not reporting complications in terms of age, gender distribution, surgery time, visual analog scale score, MHHS, and time from surgery. CONCLUSIONS: When patients are asked a general question, whether they suffer from any complications, they tend to underreport the presence of such complications. Complete and comprehensive interviews of the patient may give us a better understanding of the true incidence of complications. [ABSTRACT FROM AUTHOR]

Background: Heterotopic ossification (HO) after hip arthroscopic surgery is a common complication and may be associated with clinical sequelae such as pain, impingement, and decreased range of motion. Nonsteroidal anti-inflammatory drugs (NSAIDs) are commonly used medications for reducing or preventing HO. Hypothesis/Purpose: The purpose of this study was to evaluate the effectiveness of short-term selective cyclooxygenase-2 (COX-2) inhibitors used for HO prophylaxis after hip arthroscopic surgery. The hypothesis was that postoperative HO prophylaxis with 600 mg etodolac once daily for 2 weeks would significantly reduce the incidence of HO after hip arthroscopic surgery when compared with no prophylaxis. Study Design: Cohort study; Level of evidence, 3. Methods: Between July 2010 and April 2014, a total of 263 consecutive patients underwent hip arthroscopic surgery, performed by a single surgeon, for various pathological abnormalities at 1 medical center. The initial 163 patients received no postoperative NSAID prophylaxis for HO, and the subsequent 100 patients received 600 mg etodolac once daily for 2 weeks postoperatively. Prophylaxis compliance data, gastrointestinal side effects, and postoperative radiographs for HO were monitored. Results: A total of 100 control patients and 63 study patients met the inclusion criteria. The mean follow-up period was 12.88 months. No significant differences were observed in terms of age, sex, follow-up, or procedures performed. No gastrointestinal bleeding was observed. Radiographic findings of HO were present in 36 of 100 control patients with 17, 15, and 4 classified as having Brooker grades 1, 2, and 3, respectively. No patients in the study group presented with HO, and a significant difference in the HO rate between groups was observed (P < .0001). Conclusion: HO after hip arthroscopic surgery is a relatively common complication, with a rate of 19% for Brooker grade ≥2 in the patients who did not receive NSAID prophylaxis. No HO was found in the patients who received short-term COX-2 inhibitor prophylaxis. The short-term administration of 600 mg etodolac once daily for 2 weeks was found to be safe and effective in preventing HO in patients undergoing hip arthroscopic surgery. HO prophylaxis protocols based on short-term etodolac treatment may be considered after hip arthroscopic surgery. [ABSTRACT FROM AUTHOR]

Purpose: Hip osteoarthritis (OA) is a slowly progressive destructive disease that results in alterations in joint loads and biomechanics to which patients adapt compensatory alterations and abnormal gait patterns. This prospective cross-sectional, case-controlled study examined these alterations in gait metrics and evaluated gender differences in gait spatiotemporal parameters. Correlations between function and gait metrics were also investigated. Basic Procedures: Hip OA patients (138 females and 122 males) and healthy controls (14 females and 26 males) matched for age and gender underwent the same investigative protocol consisting of a spatiotemporal gait analysis followed by functional evaluations using the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) and the SF-36 Health Survey (SF-36). Main Findings: Differences between the patient and the control groups were significant in all the spatiotemporal parameters. There were significant gender differences within the hip OA group in all parameters except for cadence and single limb support percentage. WOMAC and SF-36 scores revealed significant differences between the study and control groups in most components. Significantly higher scores in the three components of the WOMAC as well as in six SF-36 score components were found among males compared to females in the patient group. Principal Conclusions: Gait, WOMAC and SF-36 were effective objective and subjective tools for evaluating a large cohort of patients with hip OA, and can be highly useful for supplementing the assessment of hip OA severity and enhancing treatment efficacy during the course of the disease. [ABSTRACT FROM AUTHOR]