Femoracetabular Impingement

ROSEMONT, Ill., Feb. 2, 2024 /PRNewswire/ -- The 2024 Kappa Delta Elizabeth Winston Lanier Award was presented to the Academic Network of Conservative Hip Outcomes Research (ANCHOR) group for 20 years of research to improve the quality of care for adolescent and young adult patients suffering from the three most common pre-arthritic hip conditions: femoroacetabular impingement (FAI), developmental dysplasia of the hip (DDH) and residual Legg-Calve-Perthes Disease (LCPD). Their research helped the orthopaedic community better understand the basic pathophysiology of hip osteoarthritis (OA), disease natural history, diagnosis, surgical treatment and predictors of treatment outcomes for young patients who often live with hip dysfunction for years or even decades with eventual progression to advanced OA. Continue Reading The 2024 Kappa Delta Elizabeth Winston Lanier Award was presented to the Academic Network of Conservative Hip Outcomes Research (ANCHOR) group for 20 years of research to improve the quality of care for adolescent and young adult patients suffering from the three most common pre-arthritic hip conditions. This award recognizes research in musculoskeletal disease or injury with great potential to advance patient care. To read more about the award, please click here. OA is a common condition that affects 27 million Americans with costs that are projected to increase by $185.5 billion per year.i Hip OA is particularly problematic due to the associated disability. Over time, the pre-arthritic conditions of FAI, DDH and LCPD wear down the articular cartilage that covers the hip joint surface and lead to hip OA, which is associated with pain, limited function and reduced quality of life. "In the early 2000s, the orthopaedic community lacked an understanding of pre-arthritic hip disease diagnoses and treatments. Variable patient age at presentation, lack of generalizable surgical treatments and limited clinical outcomes reporting for hip preservation procedures were major challenges," said lead researcher John C. Clohisy, MD, FAAOS, Daniel C. and Betty B. Viehmann Distinguished Professor of Orthopaedic Surgery at Washington University in St. Louis. "Due to a lack of knowledge of pre-arthritic hip disease and a limited number of surgeons to treat these diseases, the average wait time for an accurate pre-arthritic hip diagnosis was three to five years. This was clearly an underserved patient population." Early contributions by Reinhold Ganz, MD, and his colleagues in Switzerland helped transform hip surgery with the introduction of new surgical techniques and refined concepts regarding the causes of hip OA. However, these refined concepts and surgical strategies were initially viewed as untraditional, unproven and technically challenging. "We wanted to understand, investigate and implement Dr. Ganz's concepts to advance the quality of care for these patients, and we established three goals as the basis of our research: improving the individual health care experience of the patient; improving the health of populations; and lowering per capita health care costs for populations," said Dr. Clohisy. The ANCHOR group, coordinated from Washington University, initially enrolled two cohorts (FAI-1 and PAO-1) totaling 3,168 surgical cases to detail population characteristics of FAI and DDH patients, and to investigate the safety and efficacy of surgical treatments. Rigorous, comprehensive data collection of clinical presentation, diagnosis, patient-reported outcome measures (PROMs), radiographic imaging, surgical procedure details and intraoperative disease classification was the foundation for subsequent investigations. This robust dataset enabled the group to study several key performance indicators to provide quantitative measurement of improved patient outcomes. KEY PERFORMANCE INDICATORS AND SUBSEQUENT FINDINGS Timely Diagnosis: Define the patient population and educate orthopaedic surgeons The ANCHOR group performed a series of foundational studies to describe the clinical presentation and epidemiology of patients with FAI, DDH and labral tears. Findings of the studies included: There is a predominance of DDH in young active females, who often present with significant hip dysfunction and symptoms including groin or lateral hip pain. Clinical presentation is accelerated with high activity levels and more severe deformity. Females with FAI have greater symptomatology and milder morphologic abnormalities while males have a higher activity level, larger morphologic abnormalities, and more extensive intra-articular disease. Both groups present with activity-related groin pain, and tend to have restricted hip range of motion and progressive symptoms over time. Patient Satisfaction: Focus on responsiveness to patients' needs The ANCHOR group measured patient-reported satisfaction with standardized methodology to provide feedback on the patient experience associated with surgery for FAI. The findings included: FAI patients self-reported high overall satisfaction rates (>91%) and low rates of dissatisfaction (>9%). Longer-term mean 10-year follow up of the FAI-1 cohort was recently completed (unpublished data) and demonstrated maintenance of these high satisfaction rates (91%). Most patients studied who underwent PAO surgery demonstrated marked clinical improvement and returned to their sport, and only a small percentage had activity limitations from surgical hip symptoms (<11%). Overall patient satisfaction in PAO patients was also consistently over 90%. Treatment Indication: Causes of hip preservation failure and innovations in surgical techniques These studies aimed to identify appropriateness in patient selection and precise surgical technique. The findings included: Hip arthroscopy procedures are best utilized in the treatment of FAI with accessible FAI morphology. Alternatively, outcomes of isolated hip arthroscopy in the setting of acetabular dysplasia or advanced articular disease are not favorable. Complication Risk: Ensuring safety for high-quality care The initial literature on surgical procedures in the young population was not standardized and lacked risk and complication reporting. The group analyzed the safety of PAO, hip arthroscopy and surgical hip dislocation. The findings included: The complication risk is very acceptable and ranges from 1 to 5%, depending on the procedure. Permanent disability related to any of these procedures is less than 1%. Effectiveness: Using PROMs to compare preoperative and follow-up outcomes Early skepticism among the orthopaedic community related to the diagnosis of FAI, its association with hip OA, indications for surgery and efficacy of surgery required critical investigation of these new concepts. The findings included: Preoperative PROM score was a strong, highly significant predictor of all outcomes. More recent analyses have determined that competitive athletes have superior outcomes and lower failure rates compared to non-athletes (after controlling for important covariates). For FAI surgery, a lower risk of clinical failure was associated with participation in competitive athletics (p=0.01) and male gender (p<0.001). Longer chronicity of preoperative symptoms, patients over 40 years old requiring acetabular microfracture, and revision surgery are all independently associated with inferior clinical outcomes. Subgroup analysis of adolescent patients identifies females, mild cam FAI deformities and lack of sports participation to be associated with higher rates of treatment failure. Diagnosis and Length of Stay: Timeliness, accurate evaluation/diagnosis and cost The ANCHOR group developed a consensus document to standardize radiograph evaluation of the young adult hip and more recently have emphasized the important role of 3D imaging. This work included: A comprehensive review of radiographic technique and image interpretation that has served as a cornerstone contribution for surgeons, radiologists, radiology technicians and orthopaedic/radiology trainees. Three-dimensional imaging plays a fundamental role in the evaluation of young adult hip disorders. Low-dose computed tomography (CT) scanning is an excellent tool to precisely determine acetabular and femoral morphology as well as femoral version. "Over the past 20 years, access to quality care for young patients with pre-arthritic hip disease has markedly improved" said Dr. Clohisy. "We now have surgeons and health care teams who can deliver a comprehensive approach to manage the full spectrum of pre-arthritic hip disease. While we've made great strides, we're continuing to improve by better defining and diagnosing the conditions, determining the best indications for surgery and optimizing our surgical techniques." About the Kappa Delta Awards In 1947, at its golden anniversary, the Kappa Delta Sorority established the Kappa Delta Research Fellowship in Orthopaedics, the first award ever created to honor achievements in the field of orthopaedic research. The first annual award, a single stipend of $1,000, was made available to the AAOS in 1949 and presented at the AAOS meeting in 1950. The Kappa Delta Awards have been presented by the AAOS to persons who have performed research in orthopaedic surgery that is of high significance and impact. The sorority has since added two more awards and increased the award amounts to $20,000 each. Two awards are named for the sorority national past presidents who were instrumental in the creation of the awards: Elizabeth Winston Lanier and Ann Doner Vaughn. The third is known as the Young Investigator Award. For more information about the manuscript submission process, please visit aaos.org/kappadelta. Learn more about the Kappa Delta Foundation, here. About the AAOS With more than 39,000 members, the American Academy of Orthopaedic Surgeons is the world's largest medical association of musculoskeletal specialists. The AAOS is the trusted leader in advancing musculoskeletal health. It provides the highest quality, most comprehensive education to help orthopaedic surgeons and allied health professionals at every career level to best treat patients in their daily practices. The AAOS is the source for information on bone and joint conditions, treatments and related musculoskeletal health care issues; and it leads the health care discussion on advancing quality. Follow the AAOS on Facebook, X, LinkedIn and Instagram. Disclosure Funding and Conflicts of Interest 1R13AR061918-01: 2012 AAOS Femoroacetabular Impingement Research Symposium Femoroacetabular impingement (FAI) is at the forefront as a potential precursor to hip osteoarthritis. The symposium emphasized a multidisciplinary, focused approach to summarize current knowledge, develop consensus and identify research strategies for several key issues related to FAI. Focus topics included: The etiology, epidemiology and societal impact of hip OA The role of FAI in hip OA pathophysiology The basic science of FAI FAI disease screening, diagnostics, and disease staging The relative effectiveness and outcomes of different treatment modalities and optimal clinical science methodologies Strategies for future basic and clinical investigations The current ANCHOR study (FAI-1, FAI-2) is funded by the following federal agency: Department of Defense: Contract # W81XWH1920042 (PI: John C. Clohisy, MD) The ongoing RCT (PAO +/- Arthroscopy) is funded by the following agency: Canadian Institute of Health Research: Funding Reference # PJT-178351 (PI: Paul Beaulé, MD) The ANCHOR Study Group has also been supported through the years by the following non-federal entities: Barnes-Jewish Hospital Foundation National Football League Washington Institute of Clinical and Translational Sciences Program North American Hip Society Industry grant programs (Smith and Nephew; Zimmer Biomet; Stryker; Pivot Medical) International Hip Dysplasia Institute NIH/AAOS/OREF/ORS R13 FAI consensus conference grant and proceedings Disclosures: Hip Society: Board or committee member International Hip Society: Board or committee member International Society for Hip Arthroscopy: Board or committee member Microport: IP royalties Microport Orthopedics, Inc.: Paid consultant Wolters Kluwer Health - Lippincott Williams & Wilkins: Publishing royalties, financial or material support 2018: Dr. Paul Beaulé (primary author) in year he won the Kappa Delta Award 1993, 2007: Dr. Young-Jo Kim (co-author) in years of Kappa Delta Award i Kotlarz, H., Gunnarsson, C. L., Fang, H. and Rizzo, J. A. 2009. Insurer and out-of-pocket costs of osteoarthritis in the US: evidence from national survey data. Arthritis Rheum. 60 (12): 3546-3553. SOURCE American Academy of Orthopaedic Surgeons

ROSEMONT, Ill., Feb. 10, 2023 /PRNewswire/ -- Marc J. Philippon, MD, FAAOS, was honored with the 2023 Orthopaedic Research and Education Foundation (OREF) Clinical Research Award, which recognizes outstanding clinical research related to musculoskeletal disease or injury. Continue Reading Marc J. Philippon, MD, FAAOS, was honored with the 2023 Orthopaedic Research and Education Foundation (OREF) Clinical Research Award, which recognizes outstanding clinical research related to musculoskeletal disease or injury. As managing partner of the Steadman Clinic and chair of Steadman Philippon Research Institute (SPRI) in Vail, Colorado, Dr. Philippon built and leads a research team and laboratory facilities to support a long-standing, multifaceted approach to research in the field of hip disorders, sports medicine and hip arthroscopy. For over 25 years, Dr. Philippon and his team of investigators have validated and advanced hip arthroscopy and developed techniques, such as labral repair and reconstruction, and orthobiologic approaches to attain the best possible outcomes. As a result, he has helped treat painful joint injuries in countless patients, including nearly 1,000 professional and Olympic athletes, many of whom have gone on to achieve significant accomplishments in their sport following treatment. To read more about the award, please click here. Entitled "Hip Chondrolabral Dysfunction: The Road from Excision to Repair, Replace, and Regeneration," the award-winning research explores the impact of Dr. Philippon's career in hip arthroscopy. Hip arthroscopy was first introduced in 1931 by Michael Burman, MD, but did not fully emerge as a modern treatment until the 1990's, moving beyond an experimental procedure to one that could treat specific pathologies. In these early days of hip arthroscopy treatment, much of the labrum was removed. Through Dr. Philippon's work, now the labrum is repaired or reconstructed instead of removal, allowing for the successful treatment of disorders like femoroacetabular impingement (FAI). FAI is a condition that occurs when the hip bones do not form normally during adolescence, or through repetitive motion in sports like ice hockey, ballet, tennis and others. "Hip disorders and injuries, especially in young patients, has always been one of the last frontiers in sports medicine," said Dr. Philippon. "The hip can be more difficult to scope than a knee, shoulder or ankle since it's a deeper joint. The technical challenges inherent to hip arthroscopy created a barrier to widespread adoption, delaying its acceptance as a mainstream procedure." While attending McMaster University Medical School in Hamilton, Ontario, Canada, Dr. Philippon was trained in evidence-based medicine by Dr. Dave Sackett which required a critical look at techniques to optimize results for patients. "Validating hip arthroscopy and making it a standard procedure to safely treat hip injuries, prevent further hip degeneration and osteoarthritis has always been one of my goals," added Dr. Philippon. "In doing so, our team provided extensive evidence-based support for hip arthroscopic procedures that led to positive long-term outcomes based on four pillars: large clinical outcomes studies; biomechanics; biomotion/imaging; and therapies for regenerative and personalized medicine." One of the main areas of Dr. Philippon's research has focused on better understanding the role of the labrum for hip preservation. The labrum is an important fibrocartilage structure of the hip that lines the acetabular rim of the hip joint and contains nerve fibers that help mediate pain and provide a person's sense of position in space (proprioceptors). Factors such as wear and tear from repetitive motion or extreme ranges of motion in athletes, a hip injury or FAI can all lead to a torn labrum, causing subsequent hip pain and debilitation. "Based on previous research demonstrating the importance of the labrum for maintaining hip biomechanics and tissue health, I was convinced we needed to preserve tissue and repair the labrum; however, at the time, many surgeons and scientists questioned if the labrum would even heal with labral repair and felt it was easier to just remove the torn tissue," said Dr. Philippon. "In collaboration with Steven Arnoczky, PhD, we first demonstrated that the labrum did heal following repair, and we then performed biomechanical studies to evaluate techniques for repairing and preserving the labrum and hip cartilage." Over the years, Dr. Philippon and his team have made contributions in different areas of research including anatomy, labral debridement, labral repair, labral reconstruction and augmentation, novel orthobiologics and identifying factors that lead to optimal patient outcomes. Since 1990 SPRI has published the most papers in arthroscopy.i Highlights of the team's work include: Publishing the "Most Influential Paper in Hip Arthroscopy," (Barbera et al.; Arthroscopy 2020) which provided evidence for the now commonly followed rule of ≤2mm of joint space as a contraindication for hip preservation surgery, as these patients were 39 times more likely to eventually need total hip arthroplasty (THA). Developing tools to accurately measure and validate outcomes following labral repair and FAI, which included Hip Outcome Score for Activities of Daily Living (HOS-ADL) and for Sports (HOS-Sport). This score continues to be used today. Determining that with labral repair, proper reattachment of the labrum to the acetabular rim can reestablish the appropriate seal for the hip joint, restoring proper tracking of the labrum on the femoral head cartilage and increasing the surface area for pressure distribution within the hip joint. Failure in any of these areas will cause subsequent pain, potential instability, and further degeneration of the cartilage. Additional clinical studies demonstrated improved outcomes in patients over 10 years. Identifying novel biologic and pharmaceutical approaches—including Losartan (an FDA-approved drug)—reduced the formation of adhesions/scar tissue to improve tissue healing. This work, which is being done in conjunction with Johnny Huard, PhD, chief scientific officer and director of the Linda and Mitch Hart Center for Regenerative and Personalized Medicine at SPRI, is helping to induce the regeneration of cartilage within the joint, thus directly addressing the monumental problem of early post-traumatic osteoarthritis and therefore preventing or postponing THA. Developing a new technique for replacing the severely damaged labrum: the labral reconstruction. This technique is now used all over the world, and SPRI's research has shown positive patient outcomes with a median satisfaction score of 10 out of 10 at the 10-year follow-up. "Our team, which includes Dr. Huard, Karen K. Briggs, MPH, Grant J. Dornan, MS, and countless others, is humbled to receive this award from our peers, the OREF and the American Academy of Orthopaedic Surgeons," said Dr. Philippon. "It is rewarding to receive recognition of our work and shows that well-directed innovation can lead to validated treatment through evidence-based medicine, which can help our patients have a better quality of life." About the OREF Clinical Research Award The OREF Clinical Research Award was established in 1995 to recognize outstanding clinical research related directly to musculoskeletal disease or injury. All submitted manuscripts are reviewed, graded, and selected by the AAOS Research Development Committee. The award provides $20,000 to recipients. For more information about the manuscript submission process, please visit aaos.org/kappadelta. About the OREF The Orthopaedic Research and Education Foundation (OREF) is an independent, 501(c)3 non-profit organization that raises funds to support research on diseases and injuries of bones, nerves and muscles and to enhance clinical care leading to improved health, increased activity and a better quality of life for patients. To further its mission, OREF is committed to exploring ways to partner with others to move the field of musculoskeletal research forward. For more information, visit and follow us on Twitter. About the AAOS With more than 39,000 members, the American Academy of Orthopaedic Surgeons is the world's largest medical association of musculoskeletal specialists. The AAOS is the trusted leader in advancing musculoskeletal health. It provides the highest quality, most comprehensive education to help orthopaedic surgeons and allied health professionals at every career level to best treat patients in their daily practices. The AAOS is the source for information on bone and joint conditions, treatments and related musculoskeletal health care issues and it leads the health care discussion on advancing quality. Follow the AAOS on Facebook, Twitter, LinkedIn and Instagram. Disclosure Funding and Conflicts of Interest Marc J. Philippon, MD potential conflict of interest: Smith and Nephew Endoscopy: Research Support, Paid Consultant, Royalties; Arthrosurface: Shareholder, Royalties; MJP Innovations: LLC Ownership, Shareholder; MIS: Shareholder, Consultant; Ossur: Research Support; Arthrex: Research Support; Siemens: Research Support, EffRx: Shareholder; Bledsoe: Royalties; ConMed Linvatec: Royalties; DonJoy: Royalties; SLACK Inc: Royalties; Elsevier: Royalties; Vail Health Services: Board Member; Vail Valley Surgery Center: General Council Member, Shareholder; Steadman Philippon Research Institute Co-Chairman; Vail MSO Holdings LLC: Shareholder; ISHA (International Society of Hip Arthroscopy): Board Member. Some research described in this manuscript was supported by research grants from National Institutes of Health, United States Department of Defense, The State of Colorado, and Smith and Nephew Endoscopy. Current active funding: National Institute of Health (NIH)Regenerative Medicine Innovation Project: (Philippon Co-PI) Funded April 2020; 1 UG3 AR077748-01 RMIP-NIH. The use of senolytic and anti- fibrotic agents to improve the beneficial effect of Bone Marrow Stem Cells for Osteoarthritis. (4/01/20-3/30/24) Department of Defense (DOD) # N00014-18-RFI-0014: (Philippon Co-PI) 10/01/19-9/30/22. Office of Naval Research Request for Information (RFI) # N00014-18-RFI-0014. Response to the Treatment of Poly-Traumatic Injuries Using Platelet-Rich Plasma and Bone Marrow. Department of Defense (DOD) # N00014-21-1-2716 (Philippon Co-PI) 2021/08/20- 2024/08/19; Office of Naval Research. The Use of a Senolytic Agent to Improve the Benefit of Platelet-Rich Plasma and Losartan for Treatment of Femoroacetabular Impingement and Labral Tear: A Pilot Study State of Colorado Collaborative Infrastructure award through the Advanced Industries Accelerator Program (Philippon Co-PI) 2022/06/15-2025/05/31. Development of Approaches to Optimize Stem Cell Banking. i Tang N, Zhang W, George DM, Wei C, Su Y, Huang T, The Top 100 Most Cited Articles on Arthroscopy: Most Popular Topic is Rotator Cuff Rather Than Cartilage in the Recent 5 Years, Arthroscopy: The Journal of Arthroscopic and Related Surgery (2021), doi: . SOURCE American Academy of Orthopaedic Surgeons