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AOSSM 2022 Annual Meeting Recordings - no CME
Q & A: Hip I (FAI)
Q & A: Hip I (FAI)
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Video Transcription
Question for Dr. Knapp about the Rush paper. You said in your retroversion cohort, when there was anterior overcoverage, was there any attempts to correct that anterior overcoverage arthroscopically with an anterior acetabuloplasty, and was that measured with like an anterior wall index as something that could correlate with outcomes? Yeah, so we didn't report that, but we did look at, I mean, we did look at Tonus Angle, we looked at our lateral femoral Weinberg Angle, we did look at all those and none of those were correlated with our version measurements between groups, but when we did identify, we did correct it. Was the excess anterior rim taken down during the FAI surgeries, or was it just fixed in site too? That's kind of the question. I don't know if Shane's here. Yeah, again, not being on there, I'm not quite sure about that, but that's a great question for Dr. Knapp that I can ask him. A quick question for Prem too. Prem, about once a year I get a 32-year-old male with FAI, we get an MRI and he has some AVN in his hip. Probably about once a year I see that, and I've seen one stress fracture that really surprised me too on an MRI. So when you guys wrote this up, do you look at the cost of a missed stress fracture or cost of missed AVN? I'm not like a bio, whatever, like a business calculator guy, but is there a way to calculate what it would cost to miss a significant finding like that? The short answer is no, we did not do that. There weren't any missed diagnoses, but that paper was the most painstakingly written paper to make sure that physicians were not disempowered from that and to specifically say if there is any suspicion or to make sure that if an insurer were to look at that paper, that there wasn't reason to all of a sudden start denying necessary MRIs. But that's a good question, so no, I didn't answer that. I have a question for Dr. Nepple. So that was a fascinating paper looking at the long-term outcomes of those two cohorts, and actually I was surprised that the osteoplasty group did so well despite not having a labral repair. Has that reframed your decision making on that procedure or what its efficacy is? Yeah, I think it's, I don't think we expected them to be doing quite that well. You have 20% with a total hip, but the other group is still doing very well with Harris hips, very similar to the two and five year studies we just saw. I think we get better and better about some of the technical things that the differences may not be as dramatic as we think. We probably repair some labrums that maybe don't need it, but hopefully, I mean, 10 years down the road we're showing maybe even better results with our modern treatments. Any other questions from the audience? You can use the app to forward them up. Another question for Dr. Nepple. With acetabular retroversion, should we be considering an anteverting PAO based on your data? That's from the audience. Yeah, yeah. I think that's one limitation is, you know, none of the patients underwent a PAO. But all patients we did have a discussion with about that as a possibility, and all patients understood the risk of not undergoing that procedure. Dr. Larson and I presented an abstract last year at this meeting showing that females with retroversion had worse outcomes with arthroscopic treatment. Did you find any sex differences or gender differences in your study, or was that looked at? Yeah, no gender differences that we appreciated between males and females. Question for Dr. Padilla. On the return to sport rates, was there any subgroup analysis on the type of sports? I was surprised to see the 30% unable to return due to continued hip pain. No, we did not do a sub-analysis, but that's a good subsequent study we could do in regards to that. All right, thanks guys. I'd like to have the first group of authors step down. Thank you.
Video Summary
In the video, Dr. Knapp is asked if there were any attempts to correct anterior overcoverage arthroscopically in his retroversion cohort. He responds that they didn't report that, but they did look at various measurements, such as the Tonus Angle and lateral femoral Weinberg Angle, but none of them correlated with their version measurements. However, they did correct any identified issues. It is then asked if the excess anterior rim was taken down during the FAI surgeries, but Dr. Knapp is unsure about this and suggests asking Dr. Shane. Another question is directed to Prem, asking if the cost of missed stress fractures or AVN was considered in the research. Prem explains that they did not look into this, but the paper was carefully written to prevent physicians from being disempowered and to ensure that insurers would not deny necessary MRIs. Dr. Nepple is then asked about the outcomes of the osteoplasty group, and he admits that they did not expect them to do as well, but suggests that technical improvements may have played a role. Another question is asked about considering anteverting PAO for acetabular retroversion, to which Dr. Nepple responds that although none of the patients underwent a PAO, they did have discussions about it as a possibility. Regarding gender differences, Dr. Nepple states that they didn't find any in their study. Finally, Dr. Padilla is asked if there was a subgroup analysis on the type of sports for return rates, but he explains that they did not do it in this study.
Asset Caption
Jeffrey Nepple, MD, MS; Prem Ramkumar, MD MBA; Paulo Padilla, MD; Derrick Knapik, MD; Andrew Jimenez, MD
Keywords
anterior overcoverage arthroscopically
Tonus Angle
lateral femoral Weinberg Angle
excess anterior rim
missed stress fractures or AVN
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