American Hip Institute

In The News

Dr. Domb quoted by Equinox on drugs prescribed to athletes

When you push your body day in and day out, you’re bound to get injured eventually (though hopefully it's short-lived and minor). It happens even to the greatest athletes. While you should never go into your doctor’s office expecting to leave with a certain 'script-after all, they are the expert and know what's best based on your symptoms and history-we talked to a few sports medicine specialists to get an idea of the most common prescriptions they write for exercisers. Anti-inflammatory pills, like ibuprofen to treat minor exercise-related aches, and antifungals to counteract athlete's foot were high up on their most-prescribed lists. But, there were also some more surprising treatments. More interesting still: the vast majority of them really aren’t that scary, and a couple you can pick up at your local drugstore. Here, 6 unexpected remedies docs often prescribe their fit patients.

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Knotless pull-through Technique Creates Efficiency for Labral Hip Reconstruction

The hip labrum is important for joint stability and kinematics and has nerve endings facilitating proprioception and pain. Treating the damaged labrum is essential due to the established correlation between labral damage and the development of osteoarthritis. Labral repair has yielded superior outcomes to debridement, and therefore, it is the first-line approach to repair the labrum.

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Dr. Benjamin Domb calls San Francisco Warriors' 1st round draft pick Damian Jones

Dr. Benjamin Domb calls San Francisco Warriors' 1st round draft pick Damian Jones 'outstanding individual'

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Dr. Benjamin Domb Quoted in TIME Magazine

TIME Magazine's Markham Heid quotes Dr. Benjamin Domb in the 9th March, 2016 article entitled "How Do I Improve My Posture?".

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Bulls: MRI shows Butler has a knee strain, no timetable for return

Jimmy Butler left Friday night's game against the Nuggets with what appeared to be a scary knee injury. He remained down for several minutes, and was taken from the court in a wheelchair as a precaution.

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Broncos' Peyton Manning reveals he'll likely need hip replacement surgery in future

Part of the aging process for Denver Broncos quarterback Peyton Manning includes learning some not-so-great news about his long-term health.

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Splitter to miss second straight game with hip injury

The Hawks will be without Tiago Splitter for Wednesday’s game at the 76ers, the second straight game the reserve center has missed due to a nagging right hip injury. Splitter was listed as out on the Hawks injury report issued Tuesday.

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Carlisle knows Mavs could face trouble without D-Will: 'I'm concerned'

Dallas Mavericks point guard Deron Williams left Monday's game at Atlanta with a hip injury that seemed bad enough for coach Rick Carlisle to say he's "concerned."

Dallas (28-23) has just four games left until the All-Star break, but it is a critical time for the team coming off the blowout loss to the Hawks. They play at home against the Miami Heat on Wednesday, at home against the San Antonio Spurs on Friday and at the Memphis Grizzlies on Saturday. The Mavs wrap up the pre-All-Star portion of the schedule at home against the Utah Jazz on Feb. 9.

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Hip injury forces CSO's Muti to bow out of concerts

CSO Music Director Riccardo Muti is bowing out of concerts in February after a "minor accident" that prompted hip surgery.

Muti, who just wrapped up a trip with the orchestra to Asia, had returned to his home in Italy over the weekend when he suffered the mishap, an orchestra spokeswoman said. She declined to give more details about the nature of the injury.

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Otto Porter Jr. exits Wizards’ win over Bucks with hip injury

The Washington Wizards welcomed Bradley Beal back Wednesday night and his return from a stress reaction in his right fibula went as well as they could’ve hoped in a 106-101 victory. But the evening couldn’t conclude without another injury hitting the Wizards.

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Matt Jones inactive for Redskins’ playoff game against Packers because of injury

LANDOVER — Washington Redskins running back Matt Jones is inactive against the Green Bay Packers on Sunday because of a hip injury that has now kept him out three consecutive games.

Without Jones, the Redskins will go with running backs Alfred Morris, Chris Thompson and Pierre Thomas in the wild-card round game.

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Nuggets Briefs: Jameer Nelson out with injured right hip

Just when the Nuggets got one point guard — Emmanuel Mudiay — back, they lost another.

Jameer Nelson missed Sunday's game with a strained right hip flexor. As was the case when Nelson was in and Mudiay out, Randy Foye was the reserve point guard.

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Mavericks' Chandler Parsons: Leaves Tuesday with a hip injury

Parsons left Tuesday's game against the Kings with a right hip injury, Mavs.com's Earl Sneed reports.

He still managed to play 29 minutes before exiting, contributing 10 points, six rebounds and four assists. His next chance to play would be Wednesday in New Orleans, but considering it is the second game of a back-to-back, it would not be surprising for Parsons to sit that game out, even if the injury ends up being minor. Continue to monitor his status leading up to Wednesday's game.

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How long will hip injury keep Avery Bradley out?

Boston Celtics guard Avery Bradley injured his hip during Saturday's disappointing loss to the Brooklyn Nets. It didn't look too serious at the time, but he left that game and didn't return. Now, it'll also keep him out of Monday's matchup in Brooklyn.

Bradley didn't travel with the team, per MassLive's Jay King, who has more on the starting shooting guard's health:

Forget about his widely respected on-ball defense, Bradley is one of Boston's better offensive players, and losing him really hurts.

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Texans' Nate Washington: Day-to-Day with hip issue

Coach Bill O'Brien relayed Monday that Washington is "day-to-day" with a hip issue that he sustained in Sunday's win over the Jaguars.

More on that front should be known once the Texans return to practice on Wednesday, but as the team's playoff contest against the Chiefs on Saturday approaches, the status of both Washington and fellow wideout Cecil Shorts (hamstring) merit tracking.

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2014- Domb et al. Clinical Results of Hip Arthroscopy for Labral Tears: A Comparison Between Intra-operative Platelet-Rich Plasma and Bupivacaine Injection. Arthroscopy.

Purpose: The purpose of this prospective comparative study was to evaluate the effect of intraoperative platelet-rich plasma (PRP) injection on the outcomes of patients undergoing hip arthroscopy for labral treatment. Methods: During the period from November 2010 through March 2012, all patients undergoing hip arthroscopy for labral tears were considered for this study. The study group received intra-articular PRP at the end of the operation, and the control group received an intra-articular injection of 0.25% bupivacaine. Selection for the study group was based on the day of the week on which the patient underwent surgery. The protocol included administration of 4 hip-specific patient-reported outcome tools. Patients also reported their pain score on a visual analog scale from 0 to 10. Scores were recorded at the preoperative visit and at 3 months and 2 years postoperatively.

Results: A minimum of 2 years’ follow-up was available for 306 patients. Thirteen patients (4.2%) underwent conversion to total hip arthroplasty and 24 patients (7.8%) underwent revision hip arthroscopy, which left 91 patients in the study group and 180 patients in the control group. The study group had slightly higher pain scores than the control group (3.4 v 2.5) 2 years after surgery (P ¼ .005). No difference in pain scores was identified at 3 months postoperatively. The 2-year modified Harris Hip Score was slightly lower in the study group (78.6) than in the control group (82.6) (P ¼ .049). No significant difference was observed for the Hip Outcome Score Activities of Daily Living, Hip Outcome ScoreeSport-Specific Subscale, or Non-Arthritic Hip Score at any time point. There was no significant difference between groups for conversion to total hip arthroplasty or revision surgery.

Conclusions: On the basis of the results of this study, intraoperative PRP injection does not appear to improve the clinical results of patients undergoing hip arthroscopy for labral treatment

Level of Evidence: Level II, prospective comparative study.

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2014- Domb et al. An Unusual Case of Leg Pain in a Competitive Cyclist: A Case Report and Review of the Literature. Sports Health.

Cycling has become a popular recreational and competitive sport. The number of people participating in the sport is gradually increasing. Despite being a noncontact, low-impact sport, as many as 85% of athletes engage in the sport will suffer from an overuse injury, with the lower limbs comprising the majority of these injuries. Up to 20% of all lower extremity overuse injuries in compitive cyclists are of a vascular source. A 39 yr old competitive cyclist has a 5 year history of thigh pain during cycling, preventing him from competing.

The patient was eventually diagnosed with external iliac artery endofibrosis. After conservative treatment failed, the patient underwent corrective vascular surgery with complete resolution of his symptoms and return to competitive cycling by 1 year. Since its first description in 1985, there have been more than 60 articles addressing external iliac artery endofibrosis pathology

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The effect of liposomal bupivacaine injection during total hip arthroplasty: a controlled cohort study

Multimodal analgesia following total hip arthroplasty (THA) has been shown to improve patient satisfaction, participation with physical therapy, and allow early return to self care [1]. Opioid related side effects are dose dependent, and efforts to minimize opioid consumption through peripheral nerve blockade, epidural anesthesia, local anesthetics, and non-opioid medications have been effective [2-5].

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Patriots’ Amendola, Hightower, Chung sidelined by injuries

Patriots wide receiver Danny Amendola and linebacker Dont’a Hightower both left Sunday’s game against the Tennessee Titans with knee injuries, and safety Patrick Chung suffered a hip injury in the fourth quarter.

All three did not return to the Patriots’ 33-16 victory over the Titans.

Amendola tweaked his knee during a 22-yard punt return with less than 2 minutes left in the first half. Hightower left the game in the third quarter and made his way to the locker room.

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Bucks’ Jason Kidd out indefinitely with hip surgery on Monday

Bucks coach Jason Kidd will be out indefinitely after he undergoes hip surgery on Monday, the team announced Sunday. Charles F. Gardner of the Journal Sentinel was first to report the news.

“It’s been chronic for the last three to four years, since I was [playing] in Dallas the last time,” Kidd told Gardner. “The pain has been to the point where I can’t function.”

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Arthroscopic Decompression of Central Acetabular Impingement With Notchplasty

Acetabular notch osteophytes are often encountered during routine diagnostic arthroscopy of the hip. It has been our observation that when notch osteophytes are present, there is often corresponding chondral damage to the anterosuperior femoral head and ligamentum teres degeneration.

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A promising future for patients undergoing primary, revision hip arthroscopies: The American Hip Institute conducts groundbreaking study

Chicago orthopedic surgeon, Benjamin Domb, MD, founder of the American Hip Institute, conducted a survival analysis of patients following hip arthroscopy procedures. From February 2008 to June 2012, Dr. Domb and his colleagues collected data from all patients undergoing primary or revision hip arthroscopy procedures. Researchers collected data from over 1,000 patients over a four year period. American Hip Institute researchers are still collecting research on the ongoing study.

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Return to Sport After Hip Arthroscopy: Aggregate Recommendations From High-volume Hip Arthroscopy Centers

Hip arthroscopy is a minimally invasive surgical technique often performed in athletes who want an expeditious return to sport. To the authors’ knowledge, no studies in the literature provide a time frame or criteria for return to sport after hip arthroscopy.

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Arthroscopic hip surgery with a microfracture procedure of the hip: clinical outcomes with two-year follow-up

Articular cartilage damage is challenging for orthopedists to address because of its limited healing capacity (1). Advances in the field of hip arthroscopy, such as the use of microfracture in the hip, have broadened the spectrum of surgical interventions available for management of intra-articular pathology

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Report: Splitter to miss time with hip injury; Bazemore remains out

The Atlanta Hawks were hoping for the best when Tiago Splitter left Saturday’s loss to the Cleveland Cavaliers with an apparent hip injury. But late on Monday, the team announced that Splitter would miss Tuesday’s game against the Boston Celtics.

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Endoscopic Transtendinous Repair for Partial-Thickness Proximal Hamstring Tendon Tears

Partial tears of the proximal hamstring tendon can successfully be managed with tendon repair in cases of failed conservative management. As in partial-thickness gluteus medius repair, a transtendinous technique can be used to repair partial-thickness undersurface tears of the hamstring origin. This report details an endoscopic transtendinous approach for the treatment of partial-thickness hamstring tendon tears.

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Dr. Domb, head team physician of the WNBA Chicago Sky, proud of Elena Delle Donne’s star performance!

When the NBA season kicks off this week, the best free-throw shooter in professional basketball will be at home in Delaware preparing to run a camp for young girls.

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Dr. Domb interviewed on ABC7 Windy City Live about football injuries, from NFL to high school

On October 18th MSU hero Jalen Watt-Jackson reportedly sustained season ending hip injury

Sophomore MSU defensive back Jalen Watts-Jackson was the hero of MSU’s miraculous 27-23 victory against in-state rival Michigan Saturday night. Watts-Jackson scooped up a muffed punt and returned it all the way to the house for a game-winning 38-yard score.

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Dr. Benjamin Domb interviewed on WGN radio about football injuries, from NFL to high school

It’s Friday folks! Sit back, relax, and enjoy this packed episode of The Wintrust Business Lunch. John Carpenter joins Amy Guth to begin today’s show with a look at Dolly – a platform that connects people who need things moved with the people who are willing to help them move (think Uber for movers). Then, Steve checks in to discuss the legal aspects of religion and business with local lawyer Eugene Hollander. Next, Tim Swindle of Point Drive joins Amy to talk about the best ways to deliver sales content. Dr. Benjamin Domb – an orthopedic sports surgeon who’s worked with some of the biggest names in the NFL – joins Amy to wrap up the show.

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2014- Domb et al. Arthroscopic Labral Reconstruction of the Hip Using Local Capsular Autograft. Arthroscopy Techniques.

Abstract: Labral reconstruction is becoming an important treatment modality for hips with nonsalvageable labra. Nonsalvageable labra can be present in cases of intrasubstance damage, revision surgery after debridement, labral calcification, and hypoplasia. Previous methods of reconstruction have been performed in an open manner and arthroscopically using ligamentum teres, iliotibial band, and gracilis autograft. We present an alternate method of arthroscopic labral reconstruction using capsular autograft. The technique uses readily available capsular tissue during arthroscopy with no donor-site morbidity. This technique may be valuable in appropriately selected patients with labral deficiency.

Biomechanical and clinical studies continue to document the importance of the hip labrum. Ferguson et al. 1,2 have shown the importance of the labrum in providing a fluid seal and assisting in contact force transmission. Clinically, the results of labral repair appear to be better than those of labral resection. 3,4 Ideally, when one is treating patients with labral tears, the labrum can be preserved because labral damage has been associated with degenerative changes in the hip joint. 5

At the time of surgery, many patients have labral tissue that cannot be salvaged. This may be because of significant tearing, degenerative tissue, or hypoplasia. Patients also present after labral debridement with persistent postoperative pain. Many of these patients have undergone
significant labral resection. When the labrum is nonsalvageable or nonexistent, labral reconstruction is a viable treatment option. To our knowledge, three types of labral reconstruction have been described. Philippon et al. 6

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2014- Domb et al. Arthroscopic Iliopsoas Fractional Lengthening for Internal Snapping of the Hip: Clinical Outcomes with a Minimum Two-Year Follow-up. American Journal of Sports Medicine.

Background: Internal snapping of the hip is caused by the iliopsoas (IP) tendon sliding over the iliopectineal eminence or the femoral head. In many cases that require hip arthroscopic surgery, there is coexistent painful internal snapping. In such cases, fractional lengthening of the IP tendon has been suggested as an adjunctive procedure.

Purpose: To examine the outcomes and effectiveness of arthroscopic IP tendon fractional lengthening as a solution to coexistent internal hip snapping in patients undergoing hip arthroscopic surgery for a labral tear and/or femoroacetabular impingement.

Study Design: Case series; Level of evidence, 4.

Methods: Between June 2010 and June 2011, data were prospectively collected for all patients with internal snapping of the hip who underwent primary arthroscopic IP tendon fractional lengthening, with a minimum 2-year follow-up. All patients were interviewed by telephone with specific questions regarding the resolution or persistence of snapping. Patients were assessed preoperatively and postoperatively using the following patient-reported outcome (PRO) measures: Non-Arthritic Hip Score (NAHS), Hip Outcome Score–Activity of Daily Living (HOS-ADL) and Sport-Specific Subscale (HOS-SSS), and modified Harris Hip Score (mHHS). Pain was recorded on a visual analog scale (VAS), and satisfaction was measured on a scale from 0 to 10.

Results: A total of 55 patients were included, with all PROs showing statistically significant improvement postoperatively (NAHS: 57.6 6 20.6 preoperatively vs 80.2 6 19.2 at 2 years; HOS-ADL: 60.9 6 21.4 preoperatively vs 81.8 6 20.6 at 2 years; HOS-SSS: 43.4 6 24.6 preoperatively vs 70.0 6 26.7 at 2 years; and mHHS: 62.3 6 16.4 preoperatively vs 80.5 6 18.3 at 2 years) (P.001 for all). Forty-five patients (81.8%) reported good/excellent satisfaction (7). Overall, 45 patients (81.8%) reported resolution of painful snapping. Patients who had resolution of snapping had statistically significant superior outcomes compared with those with persistent snapping using the change in the NAHS value (25.8 6 16.1 vs 8.0 6 22.5, respectively; P = .005), change in the HOS-ADL value (23.6 6 18.0 vs 8.5 6 15.2, respectively; P = .017), change in the HOS-SSS value (30.7 6 26.9 vs 8.7 6 23.6, respectively; P = .021), and change in the mHHS value (23.3 6 20.1 vs 4.4 6 9.9, respectively; P = .005).

Conclusion: A majority of patients reported resolution of painful snapping and improvement in symptoms. Nonetheless, the rate of persistence of internal snapping at a minimum 2 years postoperatively was higher than that reported in previous studies.

Keywords: iliopsoas; hip arthroscopic surgery; internal hip snapping; impingement; FAI; labrum; labral tear

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2014- Domb et al. Saftey Measures in Hip Arthroscopy and Their Efficacy in Minimizing Complications: A Systematic Review of the Evidence. Arthroscopy. – American Hip Institute.

Purpose: The purpose of this systematic review was to evaluate the literature to determine complications of hip arthroscopy, with a secondary focus on how to minimize complications and risks.

Methods: Two independent reviewers performed a search of PubMed for articles that contained at least 1 of the following terms: complications and hip arthroscopy, hip impingement, femoral acetabular impingement and complications, or femoroacetabular impingement
(FAI) and complications. The search was limited to articles published between 1999 and June 2013. An additional search was performed for articles evaluating techniques on how to minimize complications.

Results: We identified 81 studies (5,535 patients; 6,277 hips). The mean age was 35.48 years, and the mean body mass index was 25.20 kg/m2. Of the participants, 52% were male and 48% were female. The majority of studies were Level IV Evidence (63%). A total of 285
complications were reported, for an overall rate of 4.5%. There were 26 major complications (0.41%) and a 4.1% minor complication rate. The overall reoperation rate was 4.03%. A total of 94 hips underwent revision arthroscopy. Regarding open procedures, 150 patients (93%) underwent either total hip arthroplasty or a hip resurfacing procedure. The conversion rate to total hip arthroplasty or a resurfacing procedure was 2.4%.

Conclusions: Overall, primary hip arthroscopy is a successful procedure with low rates of major (0.41%) and minor (4.1%) complications. The reoperation rate was 4.03% in our review. There is admittedly a learning curve to performing hip arthroscopy, and we present a
systematic review of the complications and how to minimize these complications with careful technique and planning.

Level of Evidence: Level IV, systematic review of Level II to V studies.

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2014- Variability in Locations of Hip Neurovascular Structures and Their Proximity to Hip Arthroscopic Portals.

Purpose: To measure the distances of pertinent neurovascular structures from bony landmarks used during hip arthroscopy and compare them among different demographic groups.

Methods: The distances from neurovascular structures to bony landmarks often used during hip arthroscopy were measured on magnetic resonance images of the hip in 100 patients. The structures studied include the lateral femoral cutaneous nerve (LFCN), sciatic nerve, femoral nerve, and femoral artery. These distances were then compared across different demographic groups, and statistical analysis was performed

Results: The mean anteroposterior (AP) distance from the tip of the greater trochanter to the sciatic nerve was 10.32 mm (range, 0 to 23.8 mm). At the level of the superior tip of the greater trochanter, the mean distances from the anterior superior iliac spine reference line to the LFCN, femoral nerve, and femoral artery were 6.37 mm (range, 9.8 to 35.9 mm) for medial-lateral, 23.24 mm (range, 3.4 to 67.0 mm) for AP, and 26.34 mm (range, 7.3 to 65.5 mm) for AP, respectively. We found significant differences in distances for the LFCN, femoral nerve, and femoral artery for weight (P¼.003,P¼.041, and P ¼ .004, respectively) and body mass index (P¼.003,P¼.010, and P¼.003, respectively), as

well as for the LFCN between whites and Hispanics (P¼.032). There were also significant differences for the femoralnerve vector between African Americans and whites (P¼.04), as well as between African Americans and Hispanics (P¼.04).

Conclusions: We found the LFCN to be the most at-risk neurovascular structure with hip arthroscopy portal placement. This study also showed that there is wide variability in the locations of pertinent neurovascular structures across different demographic groups, including weight, body mass index, and race or ethnicity.

Clinical Relevance: Portal placement during hip arthroscopy carries a risk of neurovascular injury, particularly to the LFCN. The clinician should be aware of the variability in structure location with different patient demographic characteristics.

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2014- The Prevalence of Hip Labral and Chondral Lesions Identified by Method of Detection During Periacetabular Osteotomy: Arthroscopy Versus Arthrotomy.

Purpose: Periacetabular osteotomy (PAO) has become an accepted treatment option for patients with severe hip dysplasia. In addition to correcting acetabular architecture, consideration has been given to concomitant joint evaluation and treatment of coexisting intra-articular pathologic conditions, which can be identified with hip arthroscopy or through an open arthrotomy. The purpose of this systematic review was to evaluate the prevalence of intra-articular pathologic conditions identified arthroscopically compared with that of those identified with open arthrotomy.

Methods: A systematic review of the literature was performed by a search of PubMed using the words “periacetabular osteotomy, ” “ Berneseosteotomy, ”and “ Ganzosteotomy.” Two reviewers searched for relevant articles that met established inclusion criteria, which follow: (1) they were in the English language, (2) they contained data on patients who underwent peri-acetabular osteotomy, (3) the study patients underwent concomitant arthroscopy or arthrotomy, and (4) the studies contained data on the intra-articularfindings at the time of osteotomy. Exclusion criteria included review articles, technique articles, articles reporting on the same patient population, and articles without reported patient data.

Results: After review of 361 references and abstracts, 8 articles met the inclusion criteria. A total of 775 patients who had undergone PAO were included in the 8 articles. Three articles inspected all joints at the time of PAO and accounted for 345 PAOs. Arthrotomy was used to evaluate 151 hips, and 31 (21%) labral tears were identified. Arthroscopy was used to evaluate 194 hips, and 162 (84%) labral tears were identified. The difference in prevalence is statistically significant (P<.05).Two of the 3 articles reported chondral injury: 141 (73%) acetabular chondral injuries and 52 (27%) femoral chondral injuries were noted in 194 hips.

Conclusions: The prevalence of intra-articular damage, including labral injuries and pathologic conditions of cartilage, at the time of PAO is substantial. Labral tears and chondral injury appear to be better recognized with concomitant arthroscopy when compared with arthrotomy at the time of PAO. Further study is needed to determine whether the treatment of chondrolabral injuries can improve patient outcome and reduce reop-erations.

Level of Evidence: Level IV, systematic review of Level IV studies.

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2014- Domb et al. Arthroscopic Labral Base Repair in the Hip: Clinical Results of a Described Technique.

Purpose: The purpose of this study was to evaluate the clinical outcomes of a cohort of patients who underwent labral repair by use of a previously published labral base repair suture technique for the treatment of acetabular labral tears and pincer-type femoroacetabular impingement (FAI)

Methods: Patients who received hip arthroscopy for symptomatic intra-articular hip disorders and underwent the previously described labral base repair technique were included in the study group. Patients who had Tönnis arthritis grade 2 or greater, had Legg-Calves-Perthes disease, or underwent simple looped stitch repair were excluded. The patient-reported outcome scores included the modified Harris Hip Score, the Non-Arthritic Hip Score, the Hip Outcome Score eActivities of Daily Living, and the Hip Outcome Score eSport-Specific Sub-scale obtained preoperatively and at 2 years ’and 3 years’follow-up. Any complications, revision surgeries, and conversions to total hip arthroplasty were noted.

Results: Of the patients, 54 (82%) were available for follow-up. The mean length of follow-up for this cohort was 2.4 years (range, 1.7 to 4.1 years). At final follow-up, there was significant improvement in all 4 patient-reported outcome scores (modified Harris Hip Score, 63.7 to 89.9; Non-Arthritic Hip Score, 60.9 to 87.9; Hip Outcome Score eActivities of Daily Living, 66.9 to 91.0; and Hip Outcome Score eSport-Specific Subscale, 46.5 to 79.2) (P< .0001). A good or excellent result was achieved in 46 patients (85.2%). There was significant improvement in pain as measured by the change in visual analog scale score from 6.5 to 2.3 (P<.0001), and the patient satisfaction rating was 8.56 2.01. There were no perioperative complications. Revision surgery was required in 3 patients (5.6%), and 2 patients (3.7%) required conversion to total hip arthroplasty.

Conclusions: The clinical results of this labral base repair technique showed favorable clinical improvements based on 4 patient-reported outcome questionnaires, visual analog scale, and patient satisfaction. More clinical, biomechanical, and histologic studies are needed to determine the optimal repair technique.

Level of Evidence: Level IV, therapeutic case series.

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2013- Domb et al. Comparison of Robotic Assisted and Conventional Acetabular Cup Placement in THA: A Matched-Pair Controlled Study. Clinical Orthopedics and Related Research.

Background Improper acetabular component orientation in THA has been associated with increased dislocation rates, component impingement, bearing surface wear, and a greater likelihood of revision. Therefore, any reasonable steps to improve acetabular component orientation should be considered and explored.

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2013- Domb et al. Arthroscopic Capsular Plication and Labral Preservation in Borderline Hip Dysplasia: Two-Year Clinical Outcomes of a Surgical Approach to a Challenge Problem. American Journal of Sports Medicine

Background: The role of hip arthroscopy in the treatment of patients with dysplasia is unclear because of the spectrum of dysplasia that exists. Patients with borderline dysplasia are generally not candidates for periacetabular osteotomy because of the invasive nature of the procedure. However, arthroscopy in dysplasia has had mixed results and has the potential to exacerbate instability.

Hypothesis: Patients with borderline dysplasia will demonstrate postoperative improvement, high satisfaction rates, and low reoperation rates after a surgical approach that includes arthroscopic labral repair augmented by capsular plication with inferior shift.

Study Design: Case series; Level of evidence, 4.

Methods: Between April 2008 and November 2010, patients less than 40 years old who underwent hip arthroscopy for symptomatic intra-articular hip disorders, with a lateral center-edge (CE) angle 18 and 25, were included in this study. Patients withTo¨ nnis grade 2 or greater, severe hip dysplasia (CE 17), and Legg-Calve-Perthes disease were excluded. Patient-reported outcome scores, including the modified Harris Hip Score (mHHS), Non-Arthritic Hip Score (NAHS), Hip Outcome Score–Sport-Specific Subscale (HOS-SSS), Hip Outcome Score–Activity of Daily Living (HOS-ADL), and visual analog scale (VAS) for pain were obtained in all patients preoperatively and at 1, 2, and 3 years postoperatively. Revision surgery and complications were recorded for each group.

Results: A total of 26 patients met the criteria to be included in the study. Of these, 22 (85%) patients were available for follow-up. The mean (6 standard deviation) length of follow-up for this cohort was 27.5 6 5.5 months (range, 17-39 months) and the average age was 20 years (range, 14-39 years). The mean lateral CE angle was 22.2 (range, 18-25) and the mean To¨ nnis angle was 5.8 (range, 0-17). There was significant improvement in all patient-reported outcome scores (mHHS, NAHS, HOS-SSS, and HOS-ADL) (P\.0001). There was a significant improvement in VAS scores from 5.8 to 2.9 (P\.0001). Overall patient satisfaction was 8.4 out of 10. Seventeen patients had good/excellent results (77%). Two patients required revision arthroscopy.

Conclusion: Patients with borderline dysplasia have often fallen into a gray area between arthroscopy and periacetabular osteotomy, and viable treatment options have remained scarce. The current study demonstrates favorable results at 2-year follow-up

for an arthroscopic approach that includes labral repair augmented by capsular plication with inferior shift.

Keywords: hip; arthroscopy; dysplasia; capsular plication

Level of Evidence: Level IV, therapeutic case series.

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2013- Domb et al. Joint-preserving Surgical Options for Management of Chondral Injuries of the Hip

Management of injuries to the articular cartilage is complex and challenging; it becomes especially problematic in weight-bearing joints such as the hip. Several causes of articular cartilage damage have been described, including trauma, labral tears, and femoroacetabular impingement, among others. Because articular cartilage has little capacity for healing, nonsurgical management options are limited. Surgical options include total hip arthroplasty, microfracture, articular cartilage repair, autologous chondrocyte implantation, mosaicplasty, and osteochondral allograft transplantation. Advances in hip arthroscopy have broadened the spectrum of tools available for diagnosis and management of chondral damage. However, the literature is still not sufficiently robust to draw firm conclusions regarding best practices for chondral defects. Additional research is needed to expand our knowledge of and develop guidelines for management of chondral injuries of the hip.

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Largest-ever Hip Arthroscopy Study Data may surprise // HSS scores #1 for 6th year in a row // and more!

One surgeon…1,155 arthroscopies. Benjamin Domb, M.D., founder of the American Hip Institute, recently presented his clinical outcomes study at the American Orthopedic Society for Sports Medicine (AOSSM). This study represents the largest series of patients undergoing hip arthroscopy by a single surgeon. Dr. Domb tells OTW, “Hip arthroscopy is a relatively new field and is still finding its place in the world.

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Dr. Benjamin Domb presented “Basics of Hip Arthroscopy: What you need to know to get started” on behalf of the American Hip Institute during American Orthopaedic Society for Sports Medicine Conference held in Orlando, Florida July 9-12.

Dr. Benjamin Domb presented “Outcomes of 1,038 Hip Arthroscopies: A 2 year follow-up study” on behalf of the American Hip Institute during American Orthopaedic Society for Sports Medicine Conference held in Orlando, Florida July 9-12.

Dr. Benjamin Domb presented “Revision Hip Arthroscopy 2 Year” on behalf of the American Hip Institute during American Orthopaedic Society for Sports Medicine Conference held in Orlando, Florida July 9-12.

Dr. Benjamin Domb presented “Psoas Tenotomy” on behalf of the American Hip Institute during American Orthopaedic Society for Sports Medicine Conference held in Orlando, Florida July 9-12.

Dr. Benjamin Domb presented “Risk Factors for Early Conversion for THA following hip Arthroscopy ” on behalf of the American Hip Institute during Association of Bone and Joint Surgeons Annual Meeting July 8-12

Dr. Benjamin Domb presented “Return to Sports After Hip Arthroscopy with a Minimum Two-Year Follow-Up” on behalf of the American Hip Institute during American Orthopaedic Society for Sports Medicine Conference held in Orlando, Florida July 9-12.

5+ surgeons share opinions on innovations and advancements in outpatient joint replacement

While many advancements in outpatient total hip and knee replacement have been implemented in surgery centers across the country, physicians have differing opinions on the effectiveness and practicality of such methods.

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Speaker: Hip arthroscopy has a role in the management of FAI in adolescents

Source: Healio

Hip arthroscopy can be used in the management of adolescents with symptomatic femoroacetabular impingement, according to data presented at the American Orthopaedic Society for Sports Medicine Annual Meeting, here.

“This study reports favorable outcomes of arthroscopic management of [femoroacetabular impingement] FAI in adolescents with results at least comparable to an adult population. Concomitant procedures and revision surgery are both more common among adolescents and there is certainly a propensity for athletes in both groups,” J.W. Thomas Byrd, MD, said.

Byrd and colleagues at the Nashville Sports Medicine Center prospectively assessed 122 consecutive hips among 108 adolescent patients who had arthroscopic surgery for symptomatic FAI. The adolescent group was 55% female with an average age of 16 years. The matched control group was 122 patients with an average of 36 years and was 58% male. Minimum follow-up was 1 year with an average follow-up of 30 months. Overall, 96% of the adolescents participated in athletics compared with 61% of the adults in the control group.

The average improvement in the modified Harris Hip Score was 23 points for the adolescent group and 21 points for the adult group. For the adolescent group, FAI correction was performed for 36 cam and 17 pincer lesions and for 69 combined lesions. There were 111 labral tears that required 85 refixations and 26 debridements. There were 101 acetabular chondral lesions with four microfractures. There were three femoral chondral lesions. The researchers removed seven loose bodies and debrided 19 lesions of the ligamentum teres. Concomitant extraarticular procedures included 13 iliopsoas tendon releases and two iliotibial band tendinoplasties.

Among the adult cohort, the researchers performed FAI correction for 53 cam and 5 pincer lesions and for 64 combined lesions. There were 103 labral tears that required 52 refixations and 50 debridements. There were 112 acetabular chondral lesions with 20 microfractures and 17 femoral chondral lesions. The researchers removed 17 loose bodies and debrided 21 lesions of the ligamentum teres in the adult group. Concomitant extraarticular procedures included four iliopsoas tendon releases and one abductor repair.

Four adolescents needed repeat arthroscopic surgery and one patient underwent a periacetabular osteotomy. One adult patient had repeat arthroscopic surgery. – by Kristine Houck, MA, ELS

Reference:Byrd JWT. Paper #32.Presented at: American Orthopaedic Society for Sports Medicine Annual Meeting; July 10-13, 2014; Seattle.

Disclosure: Byrd is a consultant to and receives research support from Smith & Nephew Endoscopy and is a consultant to and has stock in A3 Surgical.

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Dr. Frank Jobe, a true game-changer, should be in Hall of Fame

Frank Jobe batted third at Cooperstown last summer, in the annual awards ceremony on the Saturday before the induction ceremony.Paul Hagen led off, a distinguished baseball writer from Philadelphia. Shirley Cheek followed, the widow of the late Tom Cheek, a beloved broadcaster for the Toronto Blue Jays.

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3/6/14-Someone Historical–Photo Tribute to Dr. Frank Jobe by Jon SooHoo/LA Dodgers

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Frank Jobe, Surgeon Who Saved Pitchers’ Careers, Dies at 88

On a July night in 1974, Dr. Frank Jobe, the orthopedist for the Los Angeles Dodgers, was sitting in the stands at Dodger Stadium watching the ace left-hander Tommy John face the Montreal Expos.In the third inning, John threw a pair of wild pitches and heard the sound of a “collision,” as he put it, coming from his arm. He had torn an elbow ligament, which almost certainly meant the end of a pitcher’s career.

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Dodgers announce passing of Dr. Frank Jobe at age 88

On Thursday, the Dodgers announced the passing of Dr. Frank Jobe at the age of 88. Jobe was a true pioneer in the field of sports medicine and served as the Dodgers’ team physician for many years. Jobe is of course most famous for in 1974 performing the first Tommy John surgery — on, of course, Tommy John — and in doing so changing the course of pitching history in very real way …

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A true pioneer: Put Dr. Jobe in Cooperstown

The Hall of Fame elected Tom Yawkey, the longtime owner of the Red Sox who presided over a franchise that didn’t integrate until 12 years after Jackie Robinson debuted with the Dodgers and didn’t win a World Series in his 44 years of ownership.

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Gary Nolan one of many careers saved by Dr. Frank Jobe

By now, most baseball fans know the story of Tommy John surgery. In 1974, John — a solid pitcher for a decade — blew out his elbow while pitching for Los Angeles against the Montreal Expos. “Blew out his elbow” is not a medical term, of course, but there was no need for medical terms when it came to pitchers in 1974. Once a pitcher tore the ulnar collateral ligament in his pitching arm, he was finished. That was exactly what Tommy John had done.

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Chicago Doct & Rabbi Aid Israeli Victem of Terror

Ten years after being injured in a bus bombing in Israel , Chana Nathanson was in Chicago this week undergoing a procedure to make walking easier and to ease her discomfort. Thanks to a Chicago-area doctor and a Rabbi, Chana and her husband, Matanya continue to receive excellent medical care a decade after their ordeal in which their three year- old daughter was killed. Two other daughters were also wounded in the attack.

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The American Hip Institute Presents at ISHA in Munich, Germany

International Society for Hip Arthroscopy

Dr Benjamin Domb presented on behalf of the American Hip Institute on:

  • Influence of Capsular Repair vs Unrepaired Capsulotomy on Two-year Clinical Outcomes Following Arthroscopic Hip Preservation Surgery
  • Does Labral take down affect results of arthroscopic acetabuloplasty and labral repair?
  • Arthroscopic Acetabular Labral Reconstruction in FAI; A Matched Compare Control Study with Minimum 2 Year Follow Up (Top 10 Poster Finalist)

Dr Timothy Jackson presented on behalf of the American Hip Institute on:

  • Arthroscopic Microfracture of the Hip: Prospective Clinical Outcomes with Minimum Two-Year Follow-Up

Dr Dror Lindner presented on behalf of the American Hip Institute on:

  • Outcomes of Endoscopic Treatment for Greater Trochanteric Pain Syndrome; Minimum of Two-Year Follow Up (Top 10 Poster Finalist)

Dr Brian Giordano presented on behalf of the American Hip Institute on:

  • Outcomes of Endoscopic Gluteus Medius Repair with Minimum Two Year Follow Up

The American Hip Institute Presents at ISHA 2013

Click on the Thumbnails of enlarged image

Agreement Back-Pain Borderline-Hip-Dysplasia
Calcific-Labritis Gender Greater-Trochanteric-Pain-Syndrome
Labral-Reconstruction Ligamentum-Ters PRP
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