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2023 AOSSM Annual Meeting Recordings with CME
Q & A: Management of the Athlete's Hip
Q & A: Management of the Athlete's Hip
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Video Transcription
Thanks to all our speakers. Any questions from the audience for our speakers? Okay, Aaron, a question for you on your study. When you were defining the elite athletes, there's a lot of crossover between the different groups that you had. So, like the contact had wrestling, and then I think the rotation was like, or hyper-mobility was like martial arts. Can you kind of discern how you guys made those decisions? Sure. Obviously, there's a lot of crossover based on the sport and the athlete. So and also position, you know, you can't just say all baseball positions are the same either. So instead of sort of limiting it, you know, any classification system, you're limited a little bit by putting people into buckets. So instead of sort of limiting it, we allowed more than one classification system per sport because, like I said, it depends on the athlete and the position that they play. And so we sort of sat down, and there were three of us that, three positions that sat down and said, what hip problematic positions or at-risk motions do these go into? And we tried to be as inclusive as possible. And you could argue that if you put too many classifications on it, then it sort of loses its significance. But, you know, we wanted to be as inclusive as possible. Yeah. Okay. Thanks. Thanks. Charles, you, in your data, and this, again, this might be a little bit different than what you presented, but this is based off your manuscript. You had 21% tonus II, and 30% of the hips had severe breakdown during the study period, which was early in kind of the hip arthroscopy world. You had 10-year survivorship of 81.6%. And in the severe degenerative change patients, it was 43% in the manuscript. But your patient satisfaction was 87% who were satisfied with the treatment, 82% said that they would choose the same treatment. When you hear this data, would you recommend doing a hip arthroscopy in someone who is degenerative? Yeah. So I think definitely, I think even patients with greater wear could do all the hip arthroscopy. Our group actually did publish in the last five years a study in JBJS utilizing BMAC in more degenerated hips. And they actually did have good outcomes with it. So I do think that patients with higher grades of wear could do well and have high satisfaction rates with a hip arthroscopy. So do you have a cutoff? Like, is there something that you would look at and say, okay, that's too much for me? I think generally around like tonus grade threes. Okay. Yeah. All right. Great. Joe, you know, in your study, you had the lower traction forces noted on the post-free cases, but you also had smaller distraction distances in the post-free cases. And you have a normalized distraction distance that is in your manuscript. Do you have any idea of how much distraction, a 2-3% difference in the normalized distraction amounts to in millimeters? Yeah, absolutely. So it's 2-3% of the femoral head diameter. And if you think about an average femoral head size of around 50 millimeters or so, you know, 2% would be a one millimeter difference, you know, so it's on the order of magnitude of slightly over a millimeter. Okay. Great. And since switching to post-free, have there been any issues of being unable to gain safe access that you know of? Yeah. Another good question. I might defer that one to the senior author a little bit. I have not seen it happen in my five years of working with our hip arthroscopy faculty. I haven't seen a case of it, but there could have been one. Okay. Trav. This is working. Yeah, great. So we haven't had any increased incidents in iatrogenic injury. We were just chatting. We had to convert three patients to a post in the entire cohort over the last five years, and they were all the same. They were thin, male, big cam. So we weren't able to distract them with the postless aperture. But other than that, no other issues. And that was a distraction issue, not an access to the far anteromedial for a recon or anything like that? Correct. Okay. You couldn't pull them out because they were too light and too tight. And finally, thanks, Travis. And finally, Dylan, if you're looking at your manuscript from a brace or non-brace standpoint, after the results of your study, are there any patients that your group tends to still brace? And if so, why? Yeah. That's a big reason that we just tried to maintain the study as routine arthroscopy of RAI because we do have patients that we do brace for more advanced arthroscopy procedures. Once again, I think I would like to kind of defer this to my more senior author and elaborate more on patients specifically that we would brace. Okay. Gotcha. Yeah. We were actually... Scott Holden's the other surgeon here. We were just talking about that on the way over. They're really... I mean, outside of full fitness glute tears that we repair, there really isn't anybody we brace anymore. And some of the numbers were a little bit screwy here because it was through COVID. And so in our second branch, in our non-braced branch, our collection took a while to get those numbers up there. So we haven't seen as many through two years. But it's still trending very low, lower reoperation rate than when we were using them. So more and more, we're getting away from braces completely. Great. Thanks, everyone. Thanks for your presentations.
Video Summary
The video features a Q&A session with multiple speakers discussing various topics related to sports injuries and treatments. Aaron explains the decision-making process for classifying elite athletes based on their sport and position, aiming to be inclusive rather than limiting. Charles discusses the data on hip arthroscopy, indicating that even patients with degenerative conditions can have good outcomes and high satisfaction rates. Joe provides information on traction forces and distraction distances in post-free cases. Travis mentions minimal incidents of iatrogenic injury and rare cases where postless aperture couldn't be used. Finally, Dylan mentions that bracing after arthroscopy is becoming less common except for specific cases. Overall, the speakers provide insights and recommendations based on their expertise. No specific credits were mentioned.
Asset Caption
Aaron Casp, MD; Charles Wang, MD; Joseph Featherall, MD; Dylan Wentzel, BS
Keywords
sports injuries
elite athletes
hip arthroscopy
iatrogenic injury
bracing after arthroscopy
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