ePoster #1208 - ISHA Annual Scientific Meeting 2016
Clinical Impact of Motor Vehicle Collision on Hip Pain: A Review of Hip Arthroscopy Patients
Alejandro Marquez-Lara, MD, Winston Salem, NC UNITED STATES
Elizabeth A. Howse, MD, Walnut Creek, CA UNITED STATES
Sandeep Mannava, MD, PhD, Winston Salem, NC UNITED STATES
Austin Stone, MD, Winston Salem, NC UNITED STATES
T. David Luo, MD, Winston-Salem, NC UNITED STATES
Andre Antunes, HSDG, Winston Salem, NC UNITED STATES
Allston J. Stubbs, MD, MBA, Winston Salem, NC UNITED STATES
Wake Forest University Baptist Hospital, Winston-Salem, North Carolina, UNITED STATES
FDA Status Not Applicable
Summary: Retrospective review of single surgeon practice demonstrated that a history of a motor vehicle collision (MVC) in an operative hip arthroscopy cohort is associated with more severe pain symptoms and greater narcotic consumption. This highlights a potential barrier to successful perioperative management of pain and functional symptoms in patients with a history of significant trauma.
Introduction: The association between trauma and medical liability is well documented, and understanding the social and economic challenges that these patients phase is paramount to harness a positive patient-physician relationship and improve the patient’s quality of life. Despite this awareness, little is known about the effects of trauma secondary to motor vehicle collisions (MVC) on hip pathology. Although direct joint trauma is a risk factor for degenerative joint disease, less is known about the potential deleterious effects that major blunt trauma (i.e MVC) has on patients undergoing hip arthroscopy. We hypothesize that patients with a history of MVC will present with more severe hip pathology based on functional capacity, pain relief, diagnostic imaging compared to those without a history of MVC.
Methods: Following institutional review board approval, a database of 791 consecutive hip arthroscopies from a single surgeon practice performed between March 2008 and October 2015 was queried. Patients with a history of MVC were identified and compared to a control cohort of hip arthroscopy patients without a history of MVC trauma. Those with joint space <2mm, previous hip surgery, history of trauma from any other causes, and <3 months of hip symptoms were excluded. Patient demographics, body mass index (BMI), clinical presentation, radiographic findings, narcotic consumption, and intraoperative arthroscopic procedures were assessed. Chi-square and Students T test analysis was utilized to compare categorical and continuous variables respectively. A p-value <0.05 denoted statistical significance.
Results: A total of 563 patients met inclusion criteria,19 (3.4%) of which had a history of a MVC. The study groups did not differ with respect to age (35.6±11.0 vs 32.1±11.4 years, p=0.187), gender (78.9% vs. 69.9% female, p=0.394), or BMI (26.7±7.9 vs. 25.4±5.4 kg/m2, p=0.330). Patients with a history of MVC more often complained of chronic lower back pain (73.7% vs. 48.2%, p=0.029), hip pain with low impact activity (80.0% vs. 33.9%, p=0.033), and more often required narcotics for pain relief (75% vs. 43.2%, p=0.029) compared to patients with no history of trauma. There were no differences in the presence of mechanical symptoms, duration of symptoms, and preoperative physical and radiographic examinations. While patients without a history of trauma more often underwent femoroplasty (97.1% vs. 63.2%, p<0.001), MVC patients more often required an iliopsoas release (57.9% vs. 28.9%, p=0.007) during hip arthroscopy.
Conclusions: Our results support the hypothesis that a history of a MVC in an operative hip arthroscopy cohort is associated with more severe pain symptoms and greater narcotic consumption than patients who present with hip pathology without a history of MVC. This highlights a potential barrier to successful perioperative management of pain and functional symptoms in patients with a history of significant trauma. In addition, these findings provide a foundation for further investigation into the effects of increased narcotic consumption on the short- and long-term outcomes following hip arthroscopy.