ePoster #1504 - ISHA Annual Scientific Meeting 2016
Assessment of Gender-Related Variation in Adolescent Hip Arthroscopy Patients
Michael S. Schallmo, BS, Winston Salem, North Carolina UNITED STATES
Alejandro Marquez-Lara, MD, Winston Salem, NC UNITED STATES
T. David Luo, MD, Winston-Salem, NC UNITED STATES
Elizabeth A. Howse, MD, Walnut Creek, CA UNITED STATES
Austin Stone, MD, Winston Salem, NC UNITED STATES
Sandeep Mannava, MD, PhD, Winston Salem, NC UNITED STATES
Allston J. Stubbs, MD, MBA, Winston Salem, NC UNITED STATES
Wake Forest School of Medicine, Winston Salem, North Carolina, UNITED STATES
FDA Status Not Applicable
Summary: The purpose of this study was to determine if gender is predictive of adolescent symptoms and pathology at the time of hip arthroscopy, and identified differences in the management of hip pathology between male and female adolescent patients, as well as highlighted possible differences in management between adolescent and adult patients.
Introduction: Previous studies have reported differences in outcomes following hip arthroscopy between genders, as well as greater utilization of hip arthroscopy in the adolescent population. The purpose of this study was to determine if gender is predictive of adolescent symptoms and pathology at the time of hip arthroscopy to better identify factors that influence reported differences in outcomes and utilization.
Methods: A retrospective review of a database of 791 consecutive hip arthroscopies performed by a single surgeon between 2008 and 2015 was conducted. Inclusion criteria for this study were adolescent males and females 18 years of age or younger at the time of surgery who were symptomatic for 3-120 months prior to surgery. Patients who previously underwent hip surgery or had a history of hip dysplasia were excluded. We assessed patient symptoms and physical exam, diagnostic imaging findings, and intraoperative pathology and procedures. Chondromalacia severity index (CMI) was defined as the product of outerbridge chondromalacia grade (I to IV) and effected surface area (severity ? mm2). Groups were compared using chi-squared and Student’s t-test for categorical and continuous variables, respectively. Odds ratios (OR) were determined using regression analysis to assess the impact of gender on hip pathology.
Results: 24 male and 64 female adolescent patients met the inclusion criteria for this study. The average ages of male and female patients in this cohort were 16.8±1.2 years old and 16.5±1.2 years old, respectively. Gender was found to be a significant predictor of hip mobility, CMI, and selection of intraoperative procedures. Female patients had significantly higher internal rotation than males on both the operative (13.8±11.8 degrees vs. 3.7±9.9 degrees; p<0.001) and non-operative side (27.2±17.6 degrees vs. 13.6±10.5 degrees; p=0.001). Compared with females, male gender was associated with a higher acetabular (372.0±350.4 vs. 211.9±308.4, p<0.001) and femoral head (124.5±70.1 vs. 82.0±139.7, p=0.016) CMI. Male patients showed an increased probability of undergoing chondroplasty of the femoral head (OR=5.2, 95% CI [1.5-17.5]; p=0.009). However, gender was not significantly associated with an increased probability of undergoing other arthroscopic procedures.
Conclusion: Understanding the differences in hip pathology between male and female adolescent patients may help guide treatment option for those undergoing hip arthroscopy. This study identified that the probability of undergoing arthroscopic chondroplasty was greater in male patients, which is likely associated with the severity of chondral lesions in males. Interestingly, microfracture was rarely performed, highlighting potential differences in the management of chondral defects between adolescent and adult patients. The relationship between chondral lesion severity and limited range of motion in male patients compared to females warrants further investigation to continue efforts in creating focused strategies for improving outcomes in this population.