Differences and Similarities between Hip and Knee Indications for - - PowerPoint PPT Presentation

Aman Sharma1, Alejandro Marquez-Lara1, T. David Luo1, Sandeep Mannava1, Austin V. Stone1, Elizabeth A. Howse2, Allston J. Stubbs1

Differences and Similarities between Hip and Knee Indications for the Arthroscopic Management of Chondral Defects

• 1. Wake Forest School of Medicine, Winston-Salem, NC, USA
• 2. Kaiser Permanente Walnut Creek Medical Center, Walnut Creek, California, U.S.A.

Disclosures

• Allston J. Stubbs MD, MBA

– Consultant: Smith & Nephew – Stock: Johnson & Johnson – Research Support: Bauerfeind – Department Support: Smith & Nephew Endoscopy, Depuy, Mitek – Boards/Committees: AOSSM, ISHA, AANA

• Austin V. Stone MD, PhD

– Research Support: Smith & Nephew

• Sandeep Mannava MD, PhD

– US patent: Mannava et al. Tissues tensioning and related methods awarded January 2015 – Grant funding: American Board of Medical Specialties and the American Board of Orthopaedic Surgery – Boards/Committees: Arthroscopy Association of North America

• Drs. Marquez-Lara, Howse, Luo., and Mr. Sharma

– Nothing to disclose.

Introduction

• Hip-specific indications for arthroscopic management of chondral

defects are poorly defined in the literature.

• The principles for treating these defects in the knee are currently

applied in hip arthroscopy.

• Fundamental differences in hip anatomy and biomechanics limit the

applicability of cartilage preservation techniques used in the knee.

• The purpose of the present study is to review the indications for

current cartilage preservation techniques in the hip and the knee to better define efficacious strategies for cartilage preservation.

Methods

Systematic Review of hip and knee arthroscopy 2004 and 2016 (n=8,154) Excluded cases* (n=6,805) Study sample (n=1,349)

Knee Microfractures (MF; n=476)

Hip Autologous Chondrocyte Transfer (ACT; n=37)

• Case Reports
• Literature reviews
• Open procedures
• Osteonecrosis

*

Knee Autologous Chondrocyte Transfer (ACT; n=557)

Hip Microfracture (MF; n=279)

Methods

• Sample size, patient demographics, BMI, defect location, Outerbridge severity

grades, lesion size, and surgical technique were assessed.

• Duration of symptoms, associated injuries, follow-up time, and outcome

measures were also recorded.

• Cohorts were grouped by surgical technique [MF vs. ACT and joint (hip vs.

knee)].

• Statistical analysis was performed using Students t-test to compare means.
• Regression analysis was utilized to assess the impact of patient- and lesion-

specific characteristics.

n = 476 n = 557 n = 279 n = 37 100 200 300 400 500 600 Knee MF Knee ACT Hip MF Hip ACT Number of patients

Results - Frequency

Results – Arthroscopic MF

• Significant differences were identified in gender, BMI, lesion size

and mean follow-up time between hip and knee cohorts.

Comparative measurements Hip Knee P-Value Number of studies Number of patients Mean age % male patients Duration of Symptoms (weeks)

9 31.0±19.4 35.1±7.0 77.0±20.4 99.6±75.9 10 39.7±25.3 36.1±3.8 56.5±13.3 154.4±50.1 0.416 0.722 0.017 0.297

Body mass index (Kg/m2) Lesion size (mm2) Follow up time (months)

24.0±0.0 149.5±20.7 22.2±3.9 25.6±0.49 279.3±87.2 48.2±34.2 0.008 0.015 0.039

Results – Arthroscopic ACT

• There were no differences identified in hip and knee patient

parameters and chondral defects treated with ACT.

Comparative measurements Hip Knee P-Value Number of studies Number of patients Mean age % male patients Duration of Symptoms (weeks)

3

12.3±5.5 35.2±4.8 70.3±26.3

• 7

53.6±40.8 33.6±2.8 60.4±10.1 181.9±36.1 0.130 0.537 0.586

• Body mass index (Kg/m2)*

Lesion size (mm2) Follow up time (months)

26 357.3±96.0 33.1±33.8 26.3±2.6 425.4±58.1 38.7±15.3

• 0.194

0.832 * Only one hip ACT study reported BMI and none reported duration of symptoms

Results – Arthroscopy

Arthroscopy Procedure Odds Ratio 95% CI P-value Microfracture

• Lesion size

0.15 0.03-0.72 0.018 ACT

• Lesion size

6.6 1.4-31.2 0.018

• Regression analysis demonstrated that lesion size was a significant predictor

for MF and ACT.

• Patients with larger chondral lesions were more likley to undergo ACT while

those with smaller lesions were more likely to undergo MF.

Discussion

• Significant differences exist in patient- and lesion- specific characteristics

between hip and knee chondral defects treated with MF. – Patients who underwent MF for hip chondral defects demonstrated smaller lesion size, lower BMI and a greater proportion of males compared to those treated with MF for knee defects.

• No significant differences were identified in hip and knee patient parameters and

chondral defects treated with ACT.

• Regression analysis demonstrated that lesion size was a significant predictor for

arthroscopic technique. – While the odds of undergoing MF decreased with increasing lesion size, the

• dds of undergoing ACT increased with greater lesion size.

Conclusions

• In the hip, gender and lesion size may play a role in developing

hip-specific indications for arthroscopic microfractures.

• Ultimately, understanding the differences and similarities between

joint-specific algorithms for the management of chondral defects will optimize hip preservation strategies.

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Thank You

Winston-Salem, NC