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Research identifies predictors of success in professional dancers who undergo hip arthroscopy
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SAN DIEGO — Ballet dancers are less likely to return to work after undergoing hip arthroscopy, according to a study presented here.
Sommer Hammoud, MD, shared her team’s findings at the 2011 Annual Meeting of the American Academy of Orthopaedic Surgeons.
The study also found that older dancers or those who present with higher grades of chondromalacia are less likely to return to professional dance after hip arthroscopy.
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“Annual professional dance company injury rates vary from 67 to 95%, with 20% of these localized to the hip joint,” Hammoud said. “The literature is sparse regarding the role of arthroscopy of the hip in the professional dancer.”
Study methods and findings
Hammoud’s group performed a retrospective review of 41 hips in 40 professional dancers who were treated by a single surgeon and had a minimum 1-year follow-up. The investigators reviewed preoperative MRI and radiographs for bony and soft tissue pathology. They used return to professional dance for at least 3 months as the primary outcome and Harris Hip score, WOMAC and SF-12 questionnaires as secondary measures.
“In terms of dysplasia, 22 hips were diagnosed with dysplasia — all of these were female patients,” Hammoud reported. “Ten patients had a diagnosis of cam impingement — nine of these were male. No patients had any pincer impingement. Normal radiographs were identified in nine hips, and all of those were female.”
All patients in the study had labral debridement with anterior capsular thermal shrinkage. Hammoud noted that three patients with cam impingement also had an osteochondroplasty. At a mean of 7.4 months, 29 of the patients (73%) returned to work. These patients were typically younger and displayed lower chondromalacia grades. Patients with normal radiographs (89%) and cam impingement (70%) had a higher rate of return to work than those with dysplasia (64%).
“Ballet dancers were least successful,” Hammoud said. “They were 60% successful in returning to dance. Musical theatre was 79% and modern dance saw 73% success.”
Predictors of success or failure
“As far as predictors of success and failure, older patients definitely did worse,” Hammoud said. “Patients with grade III or IV chondromalacia did poorly as well, and the style of dance had no significant influence on the outcome.”
Ballet dancers have a more difficult path of recovery because their style of dance requires a greater range of motion and holding the leg in more extreme positions, the study authors noted.
“While hip arthroscopy is successful in the majority of professional dancers, the older dancer and the dancer with moderate chondral damage should be cautioned and counseled appropriately as to the role and the outcomes of arthroscopy,” Hammoud concluded. — by Robert Press
Reference:
- Hammoud S, et al. Hip arthroscopy in the professional dancer. Paper 642. Presented at the 2011 Annual Meeting of the American Academy of Orthopaedic Surgeons. Feb. 14-19, 2011. San Diego.
Disclosure: Hammoud has no relevant financial disclosures.
Doing hip arthroscopy for dysplasia is something you should think once, twice and three times about — particularly in a dancer. I do not think we can afford as hip arthroscopists to have the operation done on the wrong patient. I appreciate everything you said … but it really is key. The anatomy of dysplasia is such that you could do the patients a major disfavor. You have to have a very good reason to arthroscope.
– Fares Sami Haddad, FRCS
Princess Grace Hospital
United Kingdom
Disclosure: He receives royalties and research or institutional support from Smith & Nephew, is on the speakers bureau or performs paid presentations for Pfizer, and is a paid consultant for DePuy, Smith & Nephew and Stryker.
This is a group that was looked at by one of the senior authors at our institution. It is a long series, as he takes care of a lot of the dancers. It was simply looking at the results of simple labral debridements. I think the comments made so far are completely accurate, and the general consensus is we do not do hip arthroscopy in dysplastic patients. If we are going to do it as a staged procedure, frequently we do them at the same time as a PAO, but making sure we understand the mechanics that led to labral pathology first and correcting those mechanics is the primary way of addressing these problems at this point.
– Bryan T. Kelly, MD
Assistant professor of orthopedic surgery
Weill Medical College
Cornell University
Disclosure: He is an unpaid consultant for and holds stock or stock options in Pivot Medical and A-2 Surgical, and receives research or institutional support from Pivot Medical.
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