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Editorial Commentary: Shall We Just Get It All Done With? Simultaneous Versus Staged Bilateral Hip Arthroscopy
Editorial Commentary: Shall We Just Get It All Done With? Simultaneous Versus Staged Bilateral Hip Arthroscopy
Abstract: Simultaneous bilateral hip arthroscopies have comparable patient-reported outcomes and little risk of complications when compared with staged bilateral hip arthroscopies in the treatment of femoroacetabular impingement. There will always be a selection bias, however: rehabilitation requiring 4-point gait will be more difficult, and some would consider that a simultaneous bilateral operation is more suited for the young, motivated, physically fit patient.
See related article on page 1300
A
ll too often, our patients come to us with more than one joint problem and want them sorted out as soon as possible. Simultaneous operations have fascinated us orthopaedic surgeons. The safety and efficacy of various procedures have been investigated; knee replacements have received possibly the most attention. Simultaneous operations are generally regarded safe, but one would have to consider the higher risk of cardiovascular and pulmonary complications and the higher risk of mortality.1 A relative paucity exists in the literature to help us guide decision making in bilateral hip arthroscopy. In a previous study, Mei-Dan et al.2 compared the outcomes of simultaneous and staged bilateral hip arthroscopies in the treatment of femoroacetabular impingement (FAI). They found no differences between groups in the Nonarthritic Hip Score and WOMAC scores at 6 and 12 months, although there was a significant difference in early postoperative mobilization. In addition, patients who needed microfractures could only undergo staged procedures. In our current issue, Degen et al.,3 from the Hospital for Special Surgery in New York, present their results. They examined 3 groups of patients: 12 patients with bilateral simultaneous hip arthroscopy for FAI; a group of 24 matched for age, sex, and alpha angle; and the rest of 81 patients undergoing bilateral operations. Interestingly, average age was significantly younger than the age of patients in the study by Mei-Dan et al.,2 and microfractures were not performed in any of the cases. Also, the simultaneous group was younger than the unmatched group, but there was no difference in treated pathology and
procedures. Patient-reported outcomes measured with the Hip Outcome ScoreeActivities of Daily Living (HOS-ADL), Hip Outcome ScoreeSport-Specific Subscale (HOS-SSS), and Modified Harris Hip Score showed significant improvement in all groups but no difference between groups apart from lower final HOS-ADL and HOS-SSS for the unmatched group. Just as important is the lack of procedural and rehabilitation complications in all groups. These results should be reassuring: patients having bilateral simultaneous operations may have one operation that lasts twice as long but it does not double the risks. There will always be a selection bias, however: rehabilitation requiring 4-point gait will be more difficult, and some would consider that a simultaneous bilateral operation is more suited for the young, motivated, physically fit patient. Arpad Konyves, M.D., F.R.C.S.(Edin) Associate Editor
References 1. Restrepo C, Parvizi J, Dietrich T, Einhorn TA. Safety of simultaneous bilateral total knee arthroplasty: a metaanalysis. J Bone Joint Surg Am 2007;89:1220-1226. 2. Mei-Dan O, McConkey MO, Knudsen JS, Brick MJ. Bilateral hip arthroscopy under the same anesthetic for patients with symptomatic bilateral femoroacetabular impingement: 1-year outcomes. Arthroscopy 2014;30:47-54. 3. Degen RM, Nawabi DH, Fields KG, Wentzel S, Kelly BT, Coleman ST. Simultaneous versus staged bilateral hip arthroscopy in the treatment of femoroacetabular impingement. Arthroscopy 2016;32:1300-1307.
Ó 2016 by the Arthroscopy Association of North America 0749-8063/16405/$36.00 http://dx.doi.org/10.1016/j.arthro.2016.05.011
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Arthroscopy: The Journal of Arthroscopic and Related Surgery, Vol 32, No 7 (July), 2016: p 1308
Abstract: Simultaneous bilateral hip arthroscopies have comparable patient-reported outcomes and little risk of complications when compared with staged bilateral hip arthroscopies in the treatment of femoroacetabular impingement. There will always be a selection bias, however: rehabilitation requiring 4-point gait will be more difficult, and some would consider that a simultaneous bilateral operation is more suited for the young, motivated, physically fit patient.
See related article on page 1300
A
ll too often, our patients come to us with more than one joint problem and want them sorted out as soon as possible. Simultaneous operations have fascinated us orthopaedic surgeons. The safety and efficacy of various procedures have been investigated; knee replacements have received possibly the most attention. Simultaneous operations are generally regarded safe, but one would have to consider the higher risk of cardiovascular and pulmonary complications and the higher risk of mortality.1 A relative paucity exists in the literature to help us guide decision making in bilateral hip arthroscopy. In a previous study, Mei-Dan et al.2 compared the outcomes of simultaneous and staged bilateral hip arthroscopies in the treatment of femoroacetabular impingement (FAI). They found no differences between groups in the Nonarthritic Hip Score and WOMAC scores at 6 and 12 months, although there was a significant difference in early postoperative mobilization. In addition, patients who needed microfractures could only undergo staged procedures. In our current issue, Degen et al.,3 from the Hospital for Special Surgery in New York, present their results. They examined 3 groups of patients: 12 patients with bilateral simultaneous hip arthroscopy for FAI; a group of 24 matched for age, sex, and alpha angle; and the rest of 81 patients undergoing bilateral operations. Interestingly, average age was significantly younger than the age of patients in the study by Mei-Dan et al.,2 and microfractures were not performed in any of the cases. Also, the simultaneous group was younger than the unmatched group, but there was no difference in treated pathology and
procedures. Patient-reported outcomes measured with the Hip Outcome ScoreeActivities of Daily Living (HOS-ADL), Hip Outcome ScoreeSport-Specific Subscale (HOS-SSS), and Modified Harris Hip Score showed significant improvement in all groups but no difference between groups apart from lower final HOS-ADL and HOS-SSS for the unmatched group. Just as important is the lack of procedural and rehabilitation complications in all groups. These results should be reassuring: patients having bilateral simultaneous operations may have one operation that lasts twice as long but it does not double the risks. There will always be a selection bias, however: rehabilitation requiring 4-point gait will be more difficult, and some would consider that a simultaneous bilateral operation is more suited for the young, motivated, physically fit patient. Arpad Konyves, M.D., F.R.C.S.(Edin) Associate Editor
References 1. Restrepo C, Parvizi J, Dietrich T, Einhorn TA. Safety of simultaneous bilateral total knee arthroplasty: a metaanalysis. J Bone Joint Surg Am 2007;89:1220-1226. 2. Mei-Dan O, McConkey MO, Knudsen JS, Brick MJ. Bilateral hip arthroscopy under the same anesthetic for patients with symptomatic bilateral femoroacetabular impingement: 1-year outcomes. Arthroscopy 2014;30:47-54. 3. Degen RM, Nawabi DH, Fields KG, Wentzel S, Kelly BT, Coleman ST. Simultaneous versus staged bilateral hip arthroscopy in the treatment of femoroacetabular impingement. Arthroscopy 2016;32:1300-1307.
Ó 2016 by the Arthroscopy Association of North America 0749-8063/16405/$36.00 http://dx.doi.org/10.1016/j.arthro.2016.05.011
1308
Arthroscopy: The Journal of Arthroscopic and Related Surgery, Vol 32, No 7 (July), 2016: p 1308