ePoster #1212 - ISHA Annual Scientific Meeting 2016

Time to Presentation: The Impact of Duration of Symptoms on Hip Arthroscopy

Alejandro Marquez-Lara, MD, Winston Salem, NC UNITED STATES
T. David Luo, MD, Winston-Salem, NC UNITED STATES
Austin Stone, MD, Winston Salem, NC UNITED STATES
Sandeep Mannava, MD, PhD, Winston Salem, NC UNITED STATES
Elizabeth A. Howse, MD, Walnut Creek, CA UNITED STATES
Thomas J. Kelsey, MA, 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 longer duration of symptoms was associated with more severe chondral defects and more often underwent arthroscopic microfracture. In contrast, patients who presented early more often experienced anterior hip pain and underwent acetabuloplasty and iliopsoas release.

Abstract:
Introduction: Hip pathology in young and active individuals can be associated with a wide spectrum of symptoms and functional limitations. Although the time from injury to seeking medical care can be variable, recent studies have highlighted that longer duration of hip pain prior to surgery is associated with more severe chondral defects. The purpose of this study is to further characterize the impact of duration of symptoms on hip pathology in patients undergoing hip arthroscopy. Methods: A database of 791 consecutive patients who underwent hip arthroscopy by a single surgeon between 2008 and 2015 was queried. Patients were selected and stratified based on the duration of hip pain (in months) into three groups: less than12 (early), 12-24 (median), and greater than 24 (late). Location of hip pain, pain with activity, non-operative interventions, diagnostic imaging findings, and intraoperative arthroscopic procedures were assessed. Chondromalacia severity index (CMI) was reported as a product of the Outerbridge chondromalacia grade and effected surface area (mm2*severity). Statistical analysis was performed using chi-square and one-way ANOVA with post-hoc (Bonferroni) for categorical and continuous data respectively. Regression analysis was utilized to asses the association between duration of symptoms and hip pathology. Results: A total of 564 were included in the analysis. The majority of patients in this cohort (n=215, 38.2%) presented early at an average of 8.1±2.8 months, followed by those who presented late (n=204, 36.1%) at an average of 50.4±23.2 months. Those in the median group (n=145, 25.7%) presented at an average 18.1±3.7 months. Patients who presented early were younger and more often complained of anterior pain compared to those with a longer duration of symptoms (early: 94.4%, median: 86.1%, late: 84.8%). Longer duration of symptoms was associated with more severe acetabular chondral defects (CMI: early: 337.9±324.9; median group: 320.6±359.2 and late group: 438.8±414.4). Regression analysis confirmed that duration of symptoms was a significant predictor of chondral lesion severity (Standardized ß:0.17, R2:0.196, 95% CI:1.3-3.9, p-value:<0.001). In addition, those who presented demonstrated an increased probability of undergoin microfracture (OR:1.6, 95%CI 1.1-3.4, p=0.039). Hip pain duration of less than 12 months was a signficant predictor for acetabular chondroplasty (OR:1.8, 95%CI:1.1-3.0, p=0.032) and iliopsoas release (OR:1.6, 95%CI:1.0-2.7, p=0.045). Conclusion: This study highlights the differences in clinical presentation and hip pathology based on the duration of symptoms. As expected, longer duration of symptoms was associated with more severe chondral defects and more often underwent arthroscopic microfracture. In contrast, patients who presented early more often underwent acetabuloplasty and iliopsoas release. The higher rate of anterior hip pain on early presenters may be associated with superior-anterior labral tears that can be caused by iliopsoas impingement, a condition that is often treated with iliopsoas release. Understanding the pathologies associated with the duration of hip pain is likely to help develop hip specific algorithms for the diagnosis and management of patients undergoing hip arthroscopy.