Thousand Oaks High School AP Research STEM
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1 Investigating open surgical and arthroscopic surgical treatments and non-surgical alternatives for femoral acetabular impingement and torn acetabular labrum Thousand Oaks High School AP Research STEM
2 2 Acetabular Labrum Cartilage that lines the rim of the acetabulum Prevents bones from rubbing against each other Provides for proper joint lubrication Pressure distribution Increases stability of joint
3 3 Acetabular Labral Tear Diagnosed with increased frequency Result of a fall, accident, or sport that requires regular rotation of hip Tears develop gradually May be asymptomatic Severe groin pain
4 4 Comparison between a torn and a repaired labrum.
5 5 Acetabular labral tear MRI Image of labral tear
6 6 Femoral Acetabular Impingement (FAI) Found in the hip joint where the femur meets the pelvis Cam Impingement: Deformity of the femoral head Pincer Impingement: Deformity of the socket
7 7 Comparison between a normal hip and a hip with FAI.
8 8 Treatment Non-surgical Open Surgery Arthroscopic Surgery
9 9 Treatment: Non-surgical Physical Therapy Activity Modification Medication Anti-inflammatory Narcotics Steroid Injections
10 10 Treatment: Open Surgery Dislocating the ball and socket 7 to 10 inch incision Complete visualization Inpatient surgery
11 11 Treatment: Arthroscopic ¼ inch incisions 2 to 5 Minimal invasion Outpatient surgery
12 Question 1 What is the best treatment for torn acetabular labrum and femoral acetabular impingement given varying needs of the patient? 12
13 13 Hypothesis 1: Treatments vary in their desirability depending on varying patient needs (e.g., post-treatment activity levels). Arthroscopic surgery is most desirable for athletes. Non-surgical treatment is an option for patients with low anticipated levels of post-treatment activity.
14 Question 2 What is the process by which physicians help their patients choose among treatment options? 14
15 15 Hypothesis 2: Decisions are informed by a number of things including: existing literature prior experience surgical expertise opinions of other medical specialists needs and desires of the patient
16 16 Participants: Orthopedic Surgeon 24 Orthopedic Surgeons were contacted Thousand Oaks and Westlake Village 1 Male Participant Responded 10 years in practice 41 years old
17 17 Participants: Physical Therapists 75 Physical Therapists were contacted Thousand Oaks and Westlake Village 6 Females, 5 Males, and 1 Prefered not to state his/her sex Average age was 45 (Mean = 45.16, SD = 13.19) Average of 18 years in practice (Mean = 18.21, SD = 10.97)
18 18 Procedure: Orthopedic Surgeon Interview conducted with orthopedic surgeon Consisted of the following questions: i. How many patients have you seen with labral tear and FAI within the last year? ii. What is your preferred course of treatment? iii. Are you usually the person with the final say about whether surgery is necessary? Clarification and follow-up questions as necessary
19 19 Procedure: Physical Therapists Survey consisted of nine questions that asked things such as: i. History of work with patients with labral tear and FAI ii. Frequency of different treatments iii. Predictions regarding recovery time iv. Benefits and drawbacks of each treatment
20 20 Results: Orthopedic Surgeon Interview Sees several hundred of patients per year Patients respond well to non-surgical treatment Operates on a small percentage It depends on the patient's activity level and how much change in the femoral head--the ball and socket or the socket side--they have.
21 21 Results: Orthopedic Surgeon Interview Prefered Course of Treatment: 1. Modify training 2. Physical therapy 3. Anti-inflammatory medication 4. Confirm labral tear and FAI 5. Injection: a. Anesthetic b. Steroid c. Blood based cell therapy 6. Surgery
22 22 Results: Orthopedic Surgeon Interview Guidance from other medical professionals Second opinions from other surgeons Physical therapists MRI and X-Ray technician Surgeons have the final say
23 23 Number of patients seen by Physical Therapists. Number of PTs 0 8+ Number of Patients Treated
24 24 Most common form of treatment. Number of PTs Most Frequent Type of Treatment
25 25 Anticipated recovery times for each treatment. Number of PTs Anticipated Recovery Time, By Treatment
26 26 Results: Physical Therapists Surveys Non Surgical Treatment Benefits Continue activities No postoperative healing Less invasive Eliminate risk of complications and infections Drawbacks Continued pain Problems with functionality Risk of developing osteoarthritis Potential need for future surgery
27 27 Results: Physical Therapists Surveys Open Surgery Benefits Complete visualization Drawbacks Long recovery High risk of surgical complications an infection Invasive Pain with larger incision Fixing an anatomical structure isn't necessarily going to change someone's pain.
28 28 Results: Physical Therapists Surveys Arthroscopic Surgery Benefits Quick recovery Addresses the pain Minimal soft tissue damage Less risk of infection Less likely to develop osteoarthritis Drawbacks Post operative recovery time Risk of damaging hip nerves or musculature Risk of infection Doesn t have full visualization Non-weight bearing for several weeks
29 29 Discussion & Conclusion Sample representing Thousand Oaks and Westlake Village Medical Professionals have different opinions on: Benefits Drawbacks Expected Recovery Time Further Work More Orthopedic Surgeons interviewed Interview with X-Ray and MRI Technicians
30 Investigating open surgical and arthroscopic surgical treatments and non-surgical alternatives for femoral acetabular impingement and torn acetabular labrum Thousand Oaks High School AP Research STEM
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