PURPOSE:To systematically evaluate capsulotomy techniques through patient-reported outcome measures, rates of revision arthroscopy, conversion to total hip arthroplasty, and achievement of clinically meaningful outcomes. METHODS:PubMed, Scopus, and Embase databases were queried in June 2024 for studies that could be used to compare capsular management strategies primarily via patient-reported outcome measures at a minimum 2-year follow-up. Inclusion criteria consisted of patients who underwent primary hip arthroscopy for the treatment of femoroacetabular impingement, minimum 2-year follow-up, and reported capsulotomy type. Based on the capsular management technique performed, groups were defined as interportal capsulotomy with closure, T-capsulotomy with complete closure, periportal capsulotomy, or puncture capsulotomy. Heterogeneity was adjusted for using metaregression models. RESULTS:Of the 1322 unique studies identified in our search, 8 studies (1961 hips) were included. The combined puncture capsulotomy and periportal capsulotomy group (mean difference range, 21.30-32.56) performed similarly to interportal capsulotomy with closure (mean difference range, 18.33-32.00) and T-capsulotomy with complete closure (mean difference range, 20.70-23.30) groups in modified Harris Hip Score (P = .274). This continued when evaluating revision and total hip arthroplasty rates (proportion range, 0.0-0.05 and 0.0-0.01, respectively). Metaregression adjustments found baseline modified Harris Hip Score significantly influences mean differences (adjusted mean difference, -0.53 [-0.83, -0.23], P = .0006). When considering the achievement rates of minimal clinically important difference, all capsulotomy methods were similar for modified Harris Hip Score; however, minimal clinically important difference thresholds had a significant influence of -0.46 (95% confidence interval, [-0.54, -0.39], P < .0001) based on a metaregression model. CONCLUSIONS:Periportal and puncture capsulotomy techniques did not yield statistically different outcomes compared with traditional capsulotomy techniques that use capsular closure at 2-year follow-up. LEVEL OF EVIDENCE:Level IV, systematic review of Level II to IV studies.

Background: Understanding drivers of supply and labor cost variation in orthopaedic surgery is crucial to provide value-based care. Time-driven activity-based costing (TDABC) is a more accurate methodology for capturing costs of care than traditional methods. Anterior cruciate ligament reconstruction (ACLR) is one of the most performed outpatient procedures within orthopaedic surgery. The purpose of this study was to characterize the cost composition of ACLR and identify factors that drive cost variation. Methods: Cost data for supplies and time-based personnel usage were extracted from electronic health records and were used to calculate costs using TDABC. TDABC methodology was applied to calculate the cost of personnel usage by multiplying the duration and associated cost per minute. Descriptive statistics and mixed-effects modeling were used to determine cost drivers. Results: This study included 861 patients who underwent ACLR at 8 hospitals. The mean patient age (and standard deviation) was 31.1 ± 11.6 years. Of the 861 patients, 350 were male and 511 were female; 85.6% of patients were White, 8.1% were Asian, and 3.4% were Black. There was 3.2-fold variation in supply costs ($2,950) and 1.6-fold variation in labor costs ($940) between the 10th and 90th percentiles. Overall, supply costs accounted for 58.2% of total costs, whereas labor costs comprised the remaining 41.8%. The intraoperative phase was the greatest generator of total cost (89.7%). After adjusting for surgeon and hospital variability, variation in total cost was most effectively explained by graft type, primary surgery status, and meniscal repair (conditional R 2 = 0.84; marginal R 2 = 0.27). On subanalysis, patients undergoing allograft ACLR had significantly higher total costs, implant costs, and age compared with those undergoing ACLR with any autograft type (all p < 0.01). Conclusions: The most notable drivers of labor and supply cost variation were graft type, surgeon, surgery center, primary surgery status, and concomitant meniscal repair. Understanding modifiable cost drivers may aid health systems in designing value-based pathways, implant formularies, and surgeon education programs. Future studies may integrate cost with outcome measures for a more holistic view of value. Level of Evidence: Economic and Decision Analysis Level III . See Instructions for Authors for a complete description of levels of evidence.

PURPOSE:To systematically review sex-specific differences in (1) patient-reported outcome measures (PROMs) at a minimum 24-month follow-up, (2) postoperative complication risk, and (3) return-to-sport (RTS) rates after the open Latarjet procedure. METHODS:Searches of PubMed, Cochrane, Embase, and Scopus were performed in September 2024 using the Boolean search: (Male OR Female) AND Latarjet. Articles were included if sex-specific analyses evaluating differences in PROMs, postoperative complication risk, and/or RTS after the open Latarjet procedure were performed. RESULTS:Nine studies met inclusion criteria and included 2576 patients who underwent the open Latarjet procedure for traumatic or atraumatic anterior shoulder instability. Of the patients, 83% were male (vs 17% female), with average age ranging from 26 to 30 years. Three studies, ranging from mean 24- to 50.5-month follow-up, found no significant postoperative differences in PROM scores between male and female patients. One study at a mean 75-month follow-up, female patients had 2.8 greater odds of clinical failure compared with male patients, based on PROM thresholds. Studies reported significantly greater odds of 30-day emergency department visits [odds ratio: 1.79; P = .029] and pulmonary embolism [2.33; P < .01] in female patients compared with male patients. RTS rates ranged from 38% to 67% for female and 50% to 63% for male patients, with no studies finding a significant sex-specific difference in RTS rate. CONCLUSIONS:While sex may not influence functional outcomes at a minimum 24-month follow-up and RTS rate after the open Latarjet procedure, female patients may have significantly greater risk for postoperative complications and emergency department visits. One study found that female patients had significantly greater long-term clinical failure compared with male patients, based on PROM measure thresholds. LEVEL OF EVIDENCE:Level IV, systematic review of Level III and IV studies.

Background: There is a paucity of research on how factors within the social determinants of health (SDOHs), specifically built environment (recreational parks, housing built pre-1980s, and walkability), affect outcomes after hip arthroscopy. Purpose: To evaluate the effect of the built environment on patient-reported outcome measures (PROMs) and rates of achieving minimal clinically important difference (MCID) and patient acceptable symptom state (PASS). Study Design: Cohort study; Level of evidence, 3. Methods: Patients who underwent hip arthroscopy for symptomatic labral tears were enrolled in this study. Study participants prospectively completed PROM surveys preoperatively and at 3, 6, 12, and 24 months after surgery. Patients were excluded if they were <18 years of age, had radiographic evidence of hip dysplasia (lateral center-edge angle <20°), had Tönnis grade >1, or had prior ipsilateral hip surgery. Patients were retrospectively stratified into built environment (BE; BE Good , BE Average , and BE Poor ) cohorts according to the Centers for Disease Control and Prevention's BE percentile. Results: In total, 203 patients (108 male and 95 female) met the inclusion criteria and were stratified into 3 cohorts: BE Good (mean BE: 20.4% ± 9.5%), BE Average (mean BE: 47.8% ± 10.0%), and BE Poor (mean BE: 74.4% ± 6.0%). At baseline, the BE Good reported significantly higher scores in all PROMs compared with the BE Poor cohort (all P < .05). At 2 years, both BE Good and BE Average reported significantly higher PROM scores compared with BE Poor (all P < .05). There were no significant differences between cohorts in achieving MCID values ( P > .05). BE Good reported significantly higher PASS achievement for Hip Outcome Score–Activities of Daily Living ( P = .042), Hip Outcome Score–Sports Specific Subscale ( P = .013), and Non-Arthritic Hip Score ( P = .021) compared with BE Poor . At 24 months, both BE Good and BE Average reported significantly higher rates of achieving PASS for all PROMs (all P < .05), except for the modified Harris Hip Score ( P = .156 and P = .410, respectively), compared with BE Poor . Conclusion: Patients undergoing hip arthroscopy who reside in a poor built environment reported significantly lower preoperative baseline scores, and this disparity continued at the 24-month follow-up, with lower rates of PASS achievement. However, patients across built environment cohorts improved and achieved MCID at similar rates. These findings suggest that a poor built environment may negatively influence preoperative PROMs but that hip arthroscopy is still beneficial for patients regardless of the built environment.

Background: Patients with hip and lumbosacral spinal pathologies may experience exacerbated symptoms as a result of these concomitant conditions. There is a paucity of midterm follow-up on patients who undergo primary hip arthroscopy before spinal surgery. Purpose: To assess patient-reported outcome measures (PROMs) among patients with hip arthroscopy and concomitant symptomatic lumbosacral pathology at 5-year follow-up and to compare revision rates and conversion to total hip arthroplasty between patients in a hip-spine (HS) cohort and patients in a matched control (MC) cohort without lumbosacral pathology. Study Design: Cohort study; Level of evidence, 3. Methods: This retrospective review analyzed prospective data of patients who underwent primary hip arthroscopy for treatment of symptomatic labral tears. The study included patients aged ≥18 years with PROMs at baseline and minimum 60-month follow-up. Patients with HS syndrome were propensity matched to a MC group without any lumbosacral pathologies. Patients in the HS cohort indicated (1) lower back pain/symptoms on preoperative surveys, (2) a pathologic lumbosacral spine diagnosis confirmed by a radiologist, and (3) clinical documentation. PROMs, clinically meaningful outcomes, improvement over time, revision rates, and conversion to total hip arthroplasty were compared. Results: A total of 76 patients were included, with 38 patients each in the HS and MC cohorts. The HS cohort had significantly worse functional outcomes at baseline and 12-, 24-, and 60-month follow-up. However, the HS cohort demonstrated no significant difference in achieving the minimal clinically important difference, Patient Acceptable Symptom State, and substantial clinical benefit but showed a mix of no significant difference or significantly greater mean magnitudes of improvement across various PROMs over time. There were no significant differences in rates of revision or conversion to total hip arthroplasty. Conclusion: Although hip arthroscopy patients with concomitant lumbosacral spinal pathology report lower functional outcomes at 5 years than MCs, they can expect similar, if not higher, magnitudes of improvement, as well as similar rates of achieving clinically meaningful outcomes and no increased risk of secondary surgery. These findings substantiate that HS pathology is not an absolute contraindication for hip arthroscopy.

Background: Acetabular labral tears are a common cause of hip pain. While larger tear size has been linked to worse outcomes after arthroscopic treatment, the influence of labral tear location remains incompletely understood. Purpose: To investigate how labral tear location affects functional outcomes, conversion to total hip arthroplasty (THA), and patient satisfaction after arthroscopy. Study Design: Cohort study; Level of evidence, 3. Methods: Patients who underwent primary hip arthroscopy were retrospectively sent online surveys at a minimum of 8 years after their surgery. Tear location was classified into superior, anterosuperior, and posterosuperior based on intraoperative findings. Outcomes included patient-reported outcome measures, conversion to THA, Patient Acceptable Symptom State improvement, and overall patient satisfaction. Unadjusted and adjusted logistic regression models were performed to identify potential confounding variables. Results: In total, 138 patients were included with a mean ± SD follow-up time of 11.1 ± 2.5 years. There was no significant difference in all postoperative patient-reported outcome measures across tear locations, although posterosuperior tears demonstrated lower mean outcomes as compared with superior and anterosuperior. Labral tear location was also not found to significantly influence rates of Patient Acceptable Symptom State achievement. Satisfaction was similar among superior, anterosuperior, and posterosuperior tear locations. THA conversion occurred in 20.9% of patients and was not independently associated with tear location after adjusting for confounders. Age was the strongest predictor of THA conversion, and tear size was also significant. Conclusion: Acetabular labral tear location was not found to be a significant predictor of functional or clinical outcomes after hip arthroscopy. However, while labral tear location was not predictive of conversion to THA, age and tear size were significant predictors of conversion.

BACKGROUND:Understanding drivers of supply and labor cost variation in orthopaedic surgery is crucial to provide value-based care. Time-driven activity-based costing (TDABC) is a more accurate methodology for capturing costs of care than traditional methods. Anterior cruciate ligament reconstruction (ACLR) is one of the most performed outpatient procedures within orthopaedic surgery. The purpose of this study was to characterize the cost composition of ACLR and identify factors that drive cost variation. METHODS:Cost data for supplies and time-based personnel usage were extracted from electronic health records and were used to calculate costs using TDABC. TDABC methodology was applied to calculate the cost of personnel usage by multiplying the duration and associated cost per minute. Descriptive statistics and mixed-effects modeling were used to determine cost drivers. RESULTS:This study included 861 patients who underwent ACLR at 8 hospitals. The mean patient age (and standard deviation) was 31.1 ± 11.6 years. Of the 861 patients, 350 were male and 511 were female; 85.6% of patients were White, 8.1% were Asian, and 3.4% were Black. There was 3.2-fold variation in supply costs ($2,950) and 1.6-fold variation in labor costs ($940) between the 10th and 90th percentiles. Overall, supply costs accounted for 58.2% of total costs, whereas labor costs comprised the remaining 41.8%. The intraoperative phase was the greatest generator of total cost (89.7%). After adjusting for surgeon and hospital variability, variation in total cost was most effectively explained by graft type, primary surgery status, and meniscal repair (conditional R 2 = 0.84; marginal R 2 = 0.27). On subanalysis, patients undergoing allograft ACLR had significantly higher total costs, implant costs, and age compared with those undergoing ACLR with any autograft type (all p < 0.01). CONCLUSIONS:The most notable drivers of labor and supply cost variation were graft type, surgeon, surgery center, primary surgery status, and concomitant meniscal repair. Understanding modifiable cost drivers may aid health systems in designing value-based pathways, implant formularies, and surgeon education programs. Future studies may integrate cost with outcome measures for a more holistic view of value. LEVEL OF EVIDENCE:Economic and Decision Analysis Level III . See Instructions for Authors for a complete description of levels of evidence.

Background: Social determinants of health (SDoH), including education level, are associated with postoperative outcomes and complication rates after orthopaedic surgery. Purpose: To evaluate the relationship between patient preoperative educational attainment (PEA) and (1) SDoH demographics, (2) long-term patient-reported outcomes (PROs), and (3) rates of revision surgery and conversion to total hip arthroplasty (THA) after primary hip arthroscopy. Study Design: Cohort study; Level of evidence, 3. Methods: A retrospective cohort study was conducted of patients who underwent hip arthroscopy at a single institution. Patients ≥18 years old with minimum 8-year follow-up PROs who underwent primary hip arthroscopy for treatment of symptomatic labral tears were included. Patient demographic, radiographic, and intraoperative variables were collected. Patients were divided into 2 PEA cohorts: (1) college education or less (CL) and (2) graduate or doctorate education (GD). PRO measures (PROMs) utilized in this study included modified Harris Hip Score (mHHS), International Hip Outcome Tool-33 (iHOT-33), and the Non-Arthritic Hip Score (NAHS). PROs, pain scores, satisfaction rates, revision rates, and THA conversion rates were compared. Results: Overall, 164 patients met inclusion criteria. Both the CL and the GD PEA groups consisted of 82 patients, with mean follow-up of 11.2 ± 2.6 years and 11.1 ± 2.4 years, respectively ( P = .34). There were no differences in baseline demographics and radiographic findings between cohorts ( P > .05). CL PEA patients resided in more socioeconomically disadvantaged neighborhoods (mean Area Deprivation Index, 23.1 vs 13.9; P < .001) and lived in neighborhoods with worse community-level health literacy estimates (254.4 vs 257.6; P = .03). At minimum 8-year follow-up, GD PEA patients demonstrated higher mean modified Harris Hip Score (mHHS) (89.5 vs 82.8; P = .003) and International Hip Outcome Tool–33 (iHOT-33) (77.5 vs 69.4; P = .04) scores. By multivariate logistic regression, GD PEA patients had greater odds of achieving 10-year Patient Acceptable Symptom State (PASS) for mHHS and the Non-Arthritic Hip Score) compared with CL PEA patients (odds ratio [OR], 3.0; 95% CI, 1.38-6.51; P = .006; OR, 2.4; 95% CI, 1.14-5.22; P = .02). Revision hip arthroscopy and conversion to THA rates were similar between cohorts. Conclusion: Our study demonstrates that GD PEA patients have significantly higher PROs and greater odds of reaching the PASS at minimum 8-year follow-up compared with CL PEA patients. Furthermore, lower PEA is associated with greater socioeconomic disadvantage. The data suggest that orthopaedic surgeons may use education-level data as an important clinical decision-making tool to assess for long-term functional outcomes and secondary surgery rates after hip arthroscopy.

Background:Mechanical symptoms, such as catching, locking, and giving out, are common concerns for patients with acetabular labral tears prior to hip arthroscopy. Yet the rate at which they resolve following hip arthroscopy remains poorly understood. Purpose:To use the Nonarthritic Hip Score (NAHS) to evaluate the rate at which mechanical symptoms resolve after primary hip arthroscopy for patients with symptomatic labral tears. Study Design:Case series; Level of evidence, 4. Methods:This was a retrospective review of prospective data for patients who underwent primary hip arthroscopy from May 2014 to March 2023. Mechanical symptoms were assessed using 3 NAHS items: catching or locking, giving out, and stiffness, each rated on a Likert scale (0-4). Patients who reported preoperative scores of ≤3 were classified as symptomatic, while patients with a 4 were classified as asymptomatic. Symptom resolution was defined as improvement to a score of 4 after surgery at 24 months postoperatively. Univariate analyses identified factors associated with symptom resolution, and a multivariate logistic regression was used to determine independent predictors. Functional outcomes were compared between groups with resolved and persistent symptoms using NAHS subscales. Results:Among 228 patients (age range, 18-64 years), stiffness was the most common preoperative symptom (85.5%), followed by catching/locking (65.8%), and giving out (36.4%). At 24 months, resolution rates were 80.7% for giving out, 59.3% for catching/locking, and 29.7% for stiffness. For patients who were asymptomatic at baseline, very few patients developed symptoms of catching/locking or giving way (14.1% and 4.1%, respectively); however, 45.5% of patients who reported no stiffness at baseline reported some at 24 months. Multivariable analysis identified lower Tönnis angle and higher center-edge angle as independent predictors for resolution of giving out. Patients with resolved mechanical symptoms demonstrated significantly higher NAHS subscores for the majority of items at 2 years compared to those with persistent symptoms (P < .05). Conclusion:Hip arthroscopy efficiently resolves mechanical symptoms such as catching/locking or giving out while significantly improving functional outcomes. However, persistent stiffness was a common postoperative issue. Patients should be informed preoperatively that residual stiffness may improve with surgery but not be completely alleviated.

Background:There is a paucity of literature on the effects of labral tear size on long-term patient-reported outcomes (PROs) and conversion to total hip arthroplasty (THA) after hip arthroscopy. Purpose:To understand the differences in hip arthroscopy survivorship and outcomes between patients with large labral tears (LLTs) and small labral tears (SLTs). Study Design:Cohort study; Level of evidence, 3. Methods:This retrospective cohort study included patients who underwent primary hip arthroscopy for symptomatic labral tears secondary to femoroacetabular impingement by a single surgeon from 2001 to 2013; they completed surveys for such PRO measures (PROMs) as the modified Harris Hip Score (mHHS), Hip Outcome Score-Activities of Daily Living (HOS-ADL), Hip Outcome Score-Sports Specific, 33-item International Hip Outcome Tool (iHOT-33), and pain relief. Patients ≤18 years of age, hip dysplasia LCEA <20°, and Tönnis grade ≥2 were excluded. Included patients were stratified into 2 cohorts: SLT (≤60°) and LLT (>60°). Results:In this study of 154 patients (48.7% female; mean ± SD age, 38 ± 10.8), there was a mean ± SD follow-up of 11.0 ± 2.4 years and body mass index of 26.1 ± 4.3 kg/m2. Women experienced a higher frequency of SLT than men (59.8% vs 40.2%; P = .003). Student t tests demonstrated that the SLT cohort experienced significantly better outcomes than the LLT cohort for mHHS, HOS-ADL, and iHOT-33. Multivariate linear regression analyses adjusting for demographic, radiographic, and intraoperative findings indicated that LLT size can predict worse long-term outcomes after hip arthroscopy for mHHS and HOS-ADL (P < .05). Kaplan-Meier estimates and weighted Cox regression demonstrated that the conversion rate to THA for LLT was significantly greater than that for SLT (hazard ratio, 7.92; 95% CI, 2.96-21.2; P < .0001). Conclusion:Those in the LLT cohort experienced a significantly greater conversion rate to THA than did the SLT cohort. Also, SLT size can independently predict better long-term outcomes on certain PROMs after primary hip arthroscopy.

Background: There is a paucity of literature investigating the impact of cannabis usage on functional outcomes after primary hip arthroscopy surgery to treat symptomatic labral tears. Purpose: To compare patient-reported outcome measures (PROM) for hip arthroscopy patients who did and did not self-report cannabis use, understand how frequency of cannabis use correlates to PROMs, and compare rates of achieving clinically meaningful outcomes for both cohorts. Study Design: Cohort study; Level of evidence, 3. Methods: This was a matched-control cohort study of patients who underwent primary hip arthroscopy for symptomatic labral tears. Included patients were ≥18 years old and completed baseline and 2-year postoperative outcomes surveys. Excluded patients had missing follow-up data, previous ipsilateral hip surgery or revision surgery, and/or hip dysplasia (lateral center-edge angle ≤20°). Patients were retrospectively divided into 2 groups based on whether they were cannabis naive (CN) or cannabis users by reviewing their social history. The 2 groups were then propensity-matched 1:1 by age, sex, body mass index, and Tönnis grade. PROMs were collected prospectively at baseline and 2 years postoperatively. These included the modified Harris Hip Score, Nonarthritic Hip Score, Hip Outcome Score–Activities of Daily Living, Hip Outcome Score–Sports Specific Subscale, 33-item International Hip Outcome Tool, Lower Extremity Functional Score, and RAND-36 pain subscale (Pain). Results: In total, 68 patients were included (aged 31.4 ± 9.67 years). Of these, 34 patients had self-reported cannabis use, and 34 did not report use. All PROM scales were similar at baseline ( P > .05). Cannabis use was not a predictor of functional outcomes at any time point, including the 2-year follow-up for all PROM scales ( P > .05); however, the improvement in Pain scores was significantly better in the CN cohort from baseline to the 2-year follow-up (27.3 ± 28.8 vs 11.6 ± 19.0, P = .012). A linear regression model adjusting for cannabis use frequency found pain scores worsened with increased usage (adjusted mean difference, –2.68; 95% CI, –5.12 to −0.25; P = .031). Further analysis showed no differences in achieving minimal clinically important difference, patient acceptable symptom state, or substantial clinical benefit ( P > .05). Conclusion: Self-reported cannabis usage has no impact on raw functional outcomes after hip arthroscopy, but increased usage correlates with worse pain symptoms.

Background: Despite the growing volume of neighborhood-level health disparity research, there remains a paucity of prospective studies investigating the relationship between Area of Deprivation Index (ADI) and functional outcomes for patients undergoing hip arthroscopy. The purpose of the present study is to investigate the influence of neighborhood-level socioeconomic status (SES) on functional outcomes following hip arthroscopy. Methods: This retrospective analysis of prospectively collected data queried patients aged ≥18 years with minimum 1-year follow-up who underwent hip arthroscopy for the treatment of symptomatic labral tears secondary to FAI. The study population was divided into ADILow and ADIHigh cohorts according to ADI score, a validated measurement of neighborhood-level SES standardized to yield a score between 1 and 100. Collected patient-reported outcomes measures (PROMs) included the modified Harris Hip Score (mHHS), Nonarthritic Hip Score (NAHS), Hip Outcome Score (HOS)–Activities of Daily Living (HOS-ADL), HOS–Sports Specific Subscale (HOS-SSS), 33-item International Hip Outcome Tool (iHOT-33), VAS pain score, and patient satisfaction. Results: 228 patients met inclusion criteria and were included in the final analysis. After stratifying patients by ADI score, the ADILow (n = 113; mean ADI: 5.8 ± 3.0; range: 1 to 12) and ADIHigh (n=115; mean ADI: 28.0 ± 14.5; range: 13 to 97) cohorts had no differences in baseline patient demographics. ADIHigh patients reported significantly worse pre-operative baseline scores for all 5 PROMs; however, these differences were not present by 1-year follow-up. Furthermore, patients in both cohorts achieved similar rates of MCID for all 5 PROMs and PASS for 4 PROMs. When controlling for patient demographics, patients with higher ADI scores had greater odds of achieving MCID for all PROMs except for iHOT-33. Conclusions: Although hip arthroscopy patients experiencing greater neighborhood-level socioeconomic disadvantage exhibited significantly lower preoperative baseline scores, this disparity resolved at 1-year follow-up. In fact, when adjusting for patient characteristics including ADI score, more disadvantaged patients achieved greater odds of achieving MCID. The present study is merely a first step towards understanding health inequities among patients seeking orthopaedic care. Further development of clinical guidelines and health policy research are necessary to advance care for patients from disadvantaged communities.

Introduction: While the impact of social determinants of health (SDOH) has become increasingly emphasized across orthopaedic surgery, to date, there exists limited research assessing the role of SDOH in hip arthroscopy. The purpose of this study was to investigate the impact of SDOH on 30-day emergency department (ED) visits, 90-day postoperative complications, and 5-year revision rates after primary hip arthroscopy using a large national database. Methods: A national administrative claims database was used to identify patients who underwent primary hip arthroscopy between 2015 and 2022. Patients were queried for whether they experienced any SDOH, including economic, educational, environmental, or social disparities; those experiencing SDOH within 1 year prior to primary hip arthroscopy were matched 1:1 by age, sex, Elixhauser Comorbidity Index score, diabetes, obesity, and tobacco use to patients not experiencing any lifetime SDOH. Rates of 90-day complications and 30-day ED visits were compared using multivariable logistic regression. Rates of revision hip arthroscopy within five years were compared by Kaplan-Meier analysis. Results: A total of 3,383 primary hip arthroscopy patients who experienced SDOH were matched 1:1 to a control cohort of 3,383 patients who had not experienced SDOH. Rates of adverse events following arthroscopy were low and not significantly different between cohorts (SDOH: 1.51%, vs. No SDOH: 1.57%). Additionally, there was no significant difference in rates of 30-day ED visits (SDOH: 5.65%, vs. No SDOH: 4.79%). The rate of 5-year revision hip arthroscopy was significantly greater among patients experiencing SDOH (5.4% vs. 4.1%). Conclusions: Patients experiencing SDOH within one year prior to primary hip arthroscopy had similar rates of postoperative complications and ED visits but greater odds of 5-year revision hip arthroscopy compared to a matched-control cohort of patients not experiencing SDOH. These data highlight the significant impact of SDOH on long-term postoperative outcomes and bring to light the growing importance of multidisciplinary, culturally-competent orthopaedic care that equitably improves the health of all patients.

Background: Global acetabular retroversion has been associated with an increased risk of hip osteoarthritis, femoroacetabular impingement, and intra-articular soft tissue abnormalities. However, the role of global acetabular retroversion on total hip arthroplasty (THA)–free survivorship has not been explored. Purpose: To compare long-term THA-free survivorship after primary hip arthroscopic surgery between patients with global acetabular retroversion and a propensity score–matched control group without global acetabular retroversion. Study Design: Cohort study; Level of evidence, 3. Methods: This retrospective study examined patients aged ≥18 years with a minimum 8-year follow-up who underwent primary hip arthroscopic surgery by a single surgeon between May 2001 and September 2013 for the treatment of symptomatic labral tears secondary to femoroacetabular impingement. Patients with global acetabular retroversion, indicated by the combined presence of a crossover sign, ischial spine sign, and posterior wall sign on preoperative supine pelvic radiographs, were 1:1 propensity score matched by age, sex, body mass index, and labral treatment (repair vs debridement) to controls without global acetabular retroversion. Patient, radiographic, and intraoperative variables were compared between groups. Cox multivariate regression, controlling for global acetabular retroversion and Tönnis grade, was used to assess conversion to THA. Patient-reported outcome measure (PROM) scores were also compared between groups. Results: Overall, 49 patients (49 hips) with global acetabular retroversion were 1:1 matched to 49 controls, with a mean follow-up of 10.7 ± 2.1 and 11.1 ± 2.8 years, respectively ( P = .524). There were no significant differences in patient characteristics and radiographic findings between groups. Patients with global acetabular retroversion had significantly greater rates of severe chondrolabral junction breakdown ( P = .010). Unadjusted Kaplan-Meier survival curves analyzed by the log-rank test demonstrated significantly decreased survivorship among patients with global acetabular retroversion (68.6%) compared with matched controls (83.9%) at final follow-up ( P = .036). Cox multivariate regression demonstrated that patients with global acetabular retroversion had a significantly greater risk of conversion to THA (hazard ratio, 3.94; P = .039). There were no statistically significant differences in any PROM scores at final follow-up. Conclusion: Patients with global acetabular retroversion had significantly inferior THA-free survivorship at a minimum 8-year follow-up after hip arthroscopic surgery relative to matched controls as well as greater rates of severe chondrolabral junction breakdown, despite no statistically significant differences in PROM scores at final follow-up among patients not converting to THA. These findings suggest that global acetabular retroversion on preoperative radiographic assessments may be a valuable predictor of long-term failure after hip arthroscopic surgery.

BACKGROUND:Physical therapy is routinely recommended for knee pain attributed to a degenerative meniscal tear, but its efficacy has not been established. METHODS:We randomly assigned participants 45 to 85 years of age with knee pain, osteoarthritis, and meniscal tear to one of four groups: home exercise (3-month home-exercise program), home exercise plus text messages to encourage exercise adherence, home exercise plus text messages plus sham physical therapy (in-clinic sham manual therapy and sham ultrasound therapy), and home exercise plus text messages plus standard physical therapy (supervised strengthening, functional, and stretching exercises and manual therapy). The primary outcome was the change in the Knee Injury and Osteoarthritis Outcome Score (KOOS) pain subscore (range, 0 to 100, with higher scores indicating more pain) between baseline and 3 months, with adjustment for trial site, baseline KOOS pain subscore, and radiographic grade. RESULTS:A total of 879 participants underwent randomization (mean [±SD] age, 59.2±7.8 years). The difference in the 3-month change in the KOOS pain subscore between home exercise and home exercise plus text messages was -0.1 points (98.3% confidence interval [CI], -3.8 to 3.7) and between home exercise and home exercise plus text messages plus standard physical therapy was 2.5 points (98.3% CI, -1.3 to 6.2); the difference between home exercise plus text messages and home exercise plus text messages plus standard physical therapy was 2.5 points (98.3% CI, -1.4 to 6.5). Adverse events were generally nonserious and evenly distributed overall across groups. CONCLUSIONS:For patients with degenerative meniscal tear and knee pain, the addition of physical therapy or text messages to encourage adherence to home exercises was not superior in reducing pain to a home-exercise program alone. (Funded by the National Institute of Arthritis and Musculoskeletal and Skin Diseases and others; TeMPO ClinicalTrials.gov number, NCT03059004.).

Abstract Background: The purpose of this study was to investigate the effects of neighborhood-level socioeconomic disadvantage on healthcare accessibility and long-term functional outcomes for patients undergoing hip arthroscopy. Methods: This retrospective analysis queried patients ≥18 years old with minimum 8-year follow-up who underwent hip arthroscopy for the treatment of symptomatic labral tears. Utilizing the ADI score as a validated measurement of neighborhood-level socioeconomic disadvantage, the study population was divided into quartiles. Patients in the least and most disadvantaged quartiles represented the ADILow and ADIHigh cohorts, respectively. Healthcare accessibility and socioeconomic disadvantage were compared between ADI cohorts using rural classification, health professional shortage area designation (HPSA), medically underserved area/population (MUA/P) designation, insurance status, level of education, and household income. Collected PROMs included mHHS, HOS-ADL, HOS-SSS, NAHS, iHOT-33, pain levels, patient satisfaction, and rates of conversion to THA. Results: 86 patients were stratified to the ADILow (n=43; ADI score: 4.0±2.1) and ADIHigh (n=43; 37.7±12.1) cohorts. When comparing healthcare accessibility, a greater proportion of ADIHigh patients resided in rural communities, primary care HPSAs, and MUA/Ps. At a patient level, the ADIHigh cohort had lower levels of insurance coverage, education, and household income. Finally, ADIHigh patients achieved worse functional outcome scores for mHHS (79.3±14.6 vs. 90.1±13.9; P=.008), NAHS (80.7±14.9 vs. 87.5±15.3; P=.043), HOS-ADL (84.7±14.8 vs. 91.6±11.8; P=.020), and iHOT-33 (66.8±26.0 vs. 78.2±24.2; P=.0041). By multivariate logistic regression, ADIHigh patients were approximately 5 and 10 times less likely to achieve 10-year clinically meaningful thresholds for HOS-ADL (OR: 0.22; P=.031) and mHHS (OR: 0.10; P=.002), respectively. Despite having significantly worse PROMs, ADIHigh patients converted to THA at a statistically similar rate (ADIHigh: 11.6% vs. ADILow: 20.9%; P=.243). Discussion and Conclusions: Hip arthroscopy patients from neighborhoods with greater ADI scores experience worse healthcare accessibility and inferior long-term functional outcomes at minimum 8-year follow-up.

BACKGROUND:Amid mounting pressure to reduce health care spending, strategies for identifying and eliminating unwarranted variation in costs have garnered significant attention. Previous studies have characterized intersurgeon variation in costs for common orthopaedic procedures, but such variation remains unexplored in the context of hip arthroscopic surgery. PURPOSE:To (1) characterize variation in the cost of hip arthroscopic surgery between surgeons using time-driven activity-based costing (TDABC) and (2) identify patient characteristics, intraoperative findings, and operative procedures underlying such intersurgeon variation in costs. STUDY DESIGN:Cohort study; Level of evidence, 3. METHODS:Employing TDABC, the authors determined the intraoperative cost of 890 outpatient hip arthroscopic surgery cases performed by 5 surgeons at 4 surgery centers from 2015 to 2022. All costs were calculated in United States dollars. Costs were normalized to protect the confidentiality of internal hospital cost data. Surgeon-specific mean costs were calculated with and without adjustment for patient characteristics, surgical personnel, operative factors, and surgery center. Finally, to elucidate the sources of surgeon-driven cost variation, the authors estimated the proportion of variation attributable to different cost subcategories, including labor, implant/allograft, and other supply costs. RESULTS:The intraoperative cost per patient ranged from 38.2 to 212.8 normalized cost units (mean, 100.0 ± 26.5), with a 1.6-fold variation in the mean cost between the highest and lowest cost surgeons. Operating surgeon alone explained 53.4% of the observed variation in costs. Controlling for case-specific features significantly improved the explanatory power to 91.8% (P < .001), but the adjusted variation in costs between surgeons remained essentially unchanged (decreased by <3%). Each of the 5 surgeons generated costs that deviated significantly from those predicted based on case-specific factors, with mean surgeon deviations ranging from -5.0% to 21.8% (P < .001 for all). Drivers of cost variation differed substantially between surgeons but generally stemmed from labor or other supply costs rather than implant/allograft costs. CONCLUSION:The cost of outpatient hip arthroscopic surgery varied widely between surgeons; the cause of this deviation was multifactorial and surgeon specific. While within-surgeon cost variation was effectively explained by patient and operative characteristics, most between-surgeon variability remained unexplained by observable factors. These insights may support individual surgeons in cost reduction efforts and, more importantly, may enable the alignment of reimbursement rates with costs.

Introduction: Global acetabular retroversion has been associated with increased risk of hip osteoarthritis, femoroacetabular impingement (FAI), and intraarticular soft tissue pathology. However, to date, the role of global retroversion on total hip arthroplasty (THA)-free survivorship has not been explored. The purpose of the present study was to compare long-term survivorship following primary hip arthroscopy between patients with global acetabular retroversion and a propensity-matched control group. Methods: This retrospective study queried patients >18 years, with preoperative hip and pelvic radiographs, and minimum 8-year follow-up that underwent hip arthroscopy by a single surgeon for the treatment of symptomatic labral tears secondary to FAI. Patients with global acetabular retroversion, as indicated by the presence of a crossover sign, ischial spine sign, and posterior wall sign on preoperative pelvic radiographs, were propensity-score matched 1:1 by age, sex, body mass index (BMI), and labral treatment (repair versus debridement) to controls. Baseline demographic, radiographic, and intraoperative variables were compared between cohorts. Cox multivariate regression controlling for global retroversion and Tönnis grade was used to assess conversion to THA. Patient-reported outcome measures (PROMs) were compared between cohorts. Results: Overall, 49 patients with global retroversion were 1:1 matched to 49 controls, with mean follow-up of 10.7 ± 2.1 years and 11.1 ± 2.8 years, respectively. There were no significant differences in baseline demographics, radiographic findings, or intraoperative findings between cohorts (P>0.05 for all). Unadjusted Kaplan-Meier survival curves analyzed by log-rank test demonstrated a significantly decreased survivorship among patients with global retroversion (68.6%) compared to controls (83.9%) at final follow-up (P=0.036). Cox multivariable regression controlling for Tönnis grade demonstrated that patients with global retroversion had a significant greater risk of THA conversion (hazard ratio, 3.94; p=0.038). There were no differences in PROMs at final follow-up between cohorts (P>0.05 for all). Conclusion: Patients with global acetabular retroversion had significantly inferior THA-free survivorship at minimum 8-year follow-up relative to matched controls, despite no differences in PROMs at final follow-up for patients who did not undergo THA. These findings suggest that global retroversion by preoperative radiographic assessment may be a useful predictor of long-term failure and that patients should be counseled accordingly.

Objectives: The purpose of the present study is to investigate the influence of neighborhood-level socioeconomic status (SES) on functional outcomes following hip arthroscopy. Methods: This retrospective analysis of prospectively collected data queried patients aged ≥18 years with minimum 1-year follow-up who underwent hip arthroscopy for the treatment of symptomatic labral tears secondary to FAI. The study population was divided into ADI Low and ADI High cohorts according to ADI score, a validated measurement of neighborhood-level SES standardized to yield a score between 1 and 100. Collected patient-reported outcomes measures (PROMs) included the modified Harris Hip Score (mHHS), Nonarthritic Hip Score (NAHS), Hip Outcome Score (HOS)–Activities of Daily Living (HOS-ADL), HOS–Sports Specific Subscale (HOS-SSS), 33-item International Hip Outcome Tool (iHOT-33), VAS pain score, and patient satisfaction. Results: 228 patients met inclusion criteria and were included in the final analysis. After stratifying patients by ADI score, the ADI Low (n = 113; mean ADI: 5.8 ± 3.0; range: 1 to 12) and ADI High (n=115; mean ADI: 28.0 ± 14.5; range: 13 to 97) cohorts had no differences in baseline patient demographics. ADI High patients reported significantly worse pre-operative baseline scores for all 5 PROMs; however, these differences were not present by 1-year follow-up. Furthermore, patients in both cohorts achieved similar rates of MCID for all 5 PROMs and PASS for 4 PROMs. When controlling for patient demographics, patients with higher ADI scores had greater odds of achieving MCID for all PROMs except for iHOT-33. Conclusions: Although hip arthroscopy patients experiencing greater neighborhood-level socioeconomic disadvantage exhibited significantly lower preoperative baseline scores, this disparity resolved at 1-year follow-up. In fact, when adjusting for patient characteristics including ADI score, more disadvantaged patients achieved greater odds of achieving MCID. The present study is merely a first step towards understanding health inequities among patients seeking orthopaedic care. Further development of clinical guidelines and health policy research are necessary to advance care for patients from disadvantaged communities.

Background:Despite the increasing utilization of hip arthroscopy and identification of predictors of poor outcomes, the effect of short-term improvement on long-term functional outcomes has been understudied. Purpose:To determine whether improvements in patient-reported outcomes (PROs) 6 months after hip arthroscopy predict 5-year outcomes. Study Design:Case-control study. Methods:A retrospective review of prospectively collected data identified patients ≥18 years who underwent primary hip arthroscopy by a single surgeon for the treatment of symptomatic labral tears. Included patients had a Tönnis grade <2 and completed PROs at baseline, 6-month, and minimum 2-year follow-up, and annually thereafter. The minimal clinically important difference (MCID) for the modified Harris Hip Score (mHHS), 8 points, was used to stratify patients into cohorts based on high improvement (HI) versus low improvement (LI) at 6 months. PROs were compared at 1, 2, 3, 4, and 5 years postoperatively by rates of MCID achievement and linear mixed-effects modeling. Subsequent surgery rates were compared by chi-square or Fisher exact tests, as appropriate. Results:Overall, 175 patients (age, 37.2 ± 11.4 years; 52.0% female) met inclusion criteria. Of these, 131 HI patients were compared with 44 LI patients. At 5 years, 88.3% of HI patients reached MCID, versus 42.1% of LI patients (P < .001). By multivariable logistic regression, achievement of 6-month MCID (adjusted odds ratio [AOR], 17.43; P < .001) and labral management (augmentation, relative to debridement: AOR, 14.5; P = .01) predicted achievement of 5-year MCID. mHHS scores were greater for HI versus LI patients through 3-year follow-up (P < .05) but were not significantly different at 4 and 5 years. Subsequent surgery rates were 9.9% and 11.4% in HI versus LI patients, respectively (P > .05). Conclusion:The study demonstrates that early functional improvements after hip arthroscopy, assessed by 6-month MCID, predicted clinically meaningful outcomes at 5-year follow-up, underscoring the importance of early cautious recovery to prioritize labral healing while also meeting appropriate, stepwise rehabilitation milestones to advance functionally during these 6 months. Despite this, LI patients continued improving for 5 years, demonstrating that late functional improvements are still possible for certain patients in the event of a poor 6-month rehabilitation period.