To quantify the prevalence of Generalized Joint Hypermobility (GJH), aka Hypermobility Spectrum Disorder, in adult patients presenting with hip pain to a sub-specialty hip practice, this 4-year, prospective, observational study evaluated correlations with clinical, demographic, and baseline outcomes. 1,004 consecutive new hip patients (390 males, 614 females) were evaluated for GJH using the Beighton 9-point physical exam criteria and the Hakim-Grahame 5-item history questionnaire. Diagnosis, age, sex and race were tested as predictors of GJH. Patient reported outcomes from iHOT-12 and a modified Harris Hip Score (mHHS) were also assessed. There were 333 patients presenting with hip dysplasia over this period. Hip dysplasia (DDH) patients without osteoarthritis (OA) had a significantly elevated prevalence of GJH (77.9%) compared to non-dysplastic hip patients (32.8%, p<0.0001) or to patients with DDH+OA (35.7%, p<0.0001). The prevalence of GJH was significantly higher in females (OR=4.2, 95% CI: 3.2 to 5.5, p<0.0001) and inversely proportional to age. Hispanic patients presented with significantly lower prevalence of GJH compared with other races (p<0.05). GJH was not a predictor of patient-reported outcomes scores (p=0.51 for iHOT-12 and p=0.44 for mHHS). During the course of this study, we successfully performed our first PAO procedure on an outpatient basis (February 2019). That is currently our standard practice. With a strong correlation observed between hypermobility and developmental dysplasia of the hip (DDH), further research is warranted to explore the genetic basis and significance of this association.
Periacetabular osteotomy (PAO) is a demanding procedure that puts patients at risk for potentially significant blood loss, and blood transfusions. Avoidance of transfusions in otherwise healthy young patients is important. This project was designed to study the effectiveness of our blood conservation efforts. 178 consecutive PAOs performed in one hospital by one surgeon (RFS) from 2008 to 2016 were reviewed retrospectively. PAO's were performed in other hospitals, too, but a majority were from the study group hospital. Data were collected from digitalized patient office charts and hospital electronic medical records. Collected data were analyzed for categorical associations between blood loss, demographic data, and transfusion risks. Over the past 27 months, the transfusion rate in 63 consecutive patients has been reduced to Zero. Discontinuation of drains, use of TXA, spinal anesthesia, reducing trigger for transfusion to Hgb of <7, cell saver use in all cases, and careful intraop coagulation, among others, have been incrementally incorporated. The overall transfusion rate was 10.7% for all patients. In the early years of this study, prior to adoption of all of these blood conservation measures, the transfusion rate was 12.5%. Over the past four years the transfusion rate was 1.5%. Over the last two years it has been zero. There is little data specifically regarding transfusion rates in PAOs but this study establishes that an aggressive approach to blood saving techniques and limitation of bleeding can reduce the risk of transfusion to virtually zero in this population of mostly young patients.
