Thank you and good morning. I'd like to congratulate Rick Wright and Kurt Spindler for a great meeting, and thanks for including me in this session. I'd like to acknowledge my co-authors, Jeff Kneppel, Paul Bollet, and the anchor group investigators. These are my disclosures. The first two are related and help support the work I'll present. This is our funding for the anchor work that I'll present over the past several years. So anchor is a little different than these other groups in that the field was very young and not established. So the understanding and treatment of pre-arthritic hip disease has evolved markedly over the past 20 years. In the early 2000s, these were new disease concepts and new treatments. We have to acknowledge Ryan Holgans for his incredible contributions. At that point, we were starting to have a paradigm shift in the treatment of hip disease, focusing on early diagnosis and preservation treatments. In North America, these concepts were formally introduced between 2001-2005. Early acceptance was slow, it was cautious, and there was skepticism about these disease concepts and about the surgical treatments. There was a lack of understanding of these disease concepts, and there was concern regarding these novel surgeries, especially the open procedures. So this is the context when we started anchor, so a very early time in the discipline. So a little bit about anchor. It's a multicenter research group based at Wash U. We started in 2007. Our continued goal is improving patient quality of care through research, education, and mentorship. We have grown to 39 surgeons at 24 sites. Our investigators represent different aspects of orthopedic subspecialty care and cover the full spectrum of hip procedures. We've had multiple funding sources and multiple publications. These are our focus areas. So two prospective longitudinal cohorts, FAI-1 and PAO-1. We have reported on average four-year follow-up for these cohorts, and we're looking at long-term follow-up. They have a complete and extensive data set. More recent studies are a more contemporary FAI-2 cohort, borderline acetaldehyde dysplasia, and now a randomized controlled trial looking at the PAO plus or minus hip arthroscopy. These are our research teams. This is the anchor team, outstanding group of investigators in the Wash U hip research team that help support anchor. So what have we learned from anchor? This is a model of quality of care and how we improve quality of care. There are six dimensions of quality of care, and I will comment on four of these and how anchor has contributed to the field. So in terms of accessibility, when we started, as I mentioned, this was early in the introduction of these diseases. We did multiple clinical presentation and epidemiology studies, and most importantly, the mean time to a definitive diagnosis for patients was from approximately two years to five years. They saw three to four healthcare providers prior to a diagnosis, and most notable, 13 to 21% of these patients had surgery at the wrong anatomic site prior to the diagnosis of their hip problem. And then epidemiology here, very young group of patients, active, healthy, athletic, but their hip scores are like those of a total hip arthroplasty patient, so very much impacted by these diseases. What about appropriateness? This was a challenge in the beginning. Hip arthroscopy was effective for some patients, but not all. So we thought we'd look at causes of failure to help refine our surgical indications. This is a series of our papers looking at the causes of failure for hip arthroscopy and joint preservation surgery. Basically, three main causes. They continue to be the causes today. Persistent FAI that's not corrected at the primary surgery, acetabular dysplasia or instability that's not corrected at the primary surgery, and established secondary osteoarthritis in the joint. So these three areas helped us refine our surgical indications. What about safety? We had major concern about these procedures, especially the open procedures in the orthopedic community. There was no consistent reporting, and there was lack of a standardized methodology for reporting complications. We modified the dendroclavian complication grading scheme from the general surgery literature. We validated it, and we looked at it in relatively large cohorts of hip preservation procedures. Surgical dislocation, PAO, and arthroscopy. Most importantly, on your far right, long-term morbidity associated with the procedure is really quite uncommon, even in the large open procedure like PAO is about 1%. So demonstrating in general these procedures are safe in the hands of experienced surgeons. Effectiveness. We have to look at PROMs to validate our new concepts and treatments. These are the four-year average follow-up data of the FAI-1 and PAO-1 cohorts. You can just see they're highlighted in the middle. Marked improvements. Clinically important improvements in pain, function, return to sport, and recreation. So lessons learned. Start simple and small and evolve to more sophisticated, larger studies. Regular conference calls. Meeting biostats. Objective accomplishments are important. Should be celebrated and motivate the group. It takes time and patience. Challenges, as we all know, funding. IRBs at different institutions. Patient follow-up compliance is our biggest challenge. Data reporting. We have a wealth of data, but manuscript submission, completion and submission is a challenge. The COVID pandemic slowed us down, and it was very difficult for a few sites to continue their program. So in conclusion, we started in 2007. Our focus on improving patient quality of care through research, education, and mentorship. Our studies have evolved from small retrospective studies to targeted, randomized controlled trials. We've made major contributions in terms of defining these patient presentation characteristics, the epidemiology of these diseases, surgical indications, clinical outcomes, and complication risk. Our future work will focus on the long-term legacy cohorts that I mentioned, both now approaching 10-year follow-up. Our more contemporary cohorts, which are important because our procedures have evolved over time, and then selective randomized controlled trials. Thanks for your attention. Thank you.

pre-arthritic hip disease

Anchor research group

hip surgeries

patient follow-up

randomized controlled trials