The Academic Network of Conservative Hip Outcomes Research (ANCHOR) group has been honored with the 2024 Kappa Delta Elizabeth Winston Lanier Award, a recognition of their 20 years of research to improve the quality of care for adolescent and young adult patients suffering from the three most common pre-arthritic hip conditions: femoroacetabular impingement, developmental dysplasia of the hip, and residual Legg-Calve-Perthes Disease.
“In the early 2000s, the orthopedic community lacked an understanding of pre-arthritic hip disease diagnoses and treatments. Variable patient age at presentation, lack of generalizable surgical treatments and limited clinical outcomes reporting for hip preservation procedures were major challenges,” said lead researcher John C. Clohisy, M.D., Daniel C. and Betty B. Viehmann Distinguished Professor of Orthopaedic Surgery at Washington University in St. Louis.
“Due to a lack of knowledge of pre-arthritic hip disease and a limited number of surgeons to treat these diseases, the average wait time for an accurate pre-arthritic hip diagnosis was three to five years. This was clearly an underserved patient population.”
The researchers credit early contributions from Reinhold Ganz, M.D. and his colleagues in Switzerland who introduced new surgical techniques and refined concepts regarding the causes of hip osteoarthritis (OA).
Dr. Clohisy explained, “Prior to the work of Ganz and colleagues, orthopedic treatment of the adult hip primarily focused on total hip replacement for end stage joint disease. These refined concepts and new surgical strategies represented a paradigm shift in our thinking about hip disease.”
“Specifically, better understanding of the mechanical etiology of hip disease and introduction of new surgical treatments initiated a transition in thought towards early diagnosis and hip preservation treatments. The periacetabular osteotomy and safe surgical dislocation procedures were major open techniques that were new and understandably were adopted with caution.”
The ANCHOR group, coordinated from Washington University, initially enrolled two cohorts (3,168 surgical cases) to assess population characteristics of femoroacetabular impingement and developmental dysplasia of the hip patients, and to investigate the safety and efficacy of surgical treatments.
One of their findings was that “Females with femoroacetabular impingement have greater symptomatology and milder morphologic abnormalities while males have a higher activity level, larger morphologic abnormalities, and more extensive intra-articular disease. Both groups present with activity-related groin pain and tend to have restricted hip range of motion and progressive symptoms over time.”
Elaborating, Dr. Clohisy said, “This is a very interesting question. We definitely have noted and published sex-dependent differences in pre-arthritic hip disease (femoroacetabular impingement and developmental dysplasia of the hip) and outcomes. There are several factors that contribute to hip symptomatology and response to surgery. These factors definitely vary when comparing females and males. For example, hip joint stability, femoral head shape, soft tissue laxity, femoral alignment/version, and extent of intra-articular disease all contribute to symptoms and outcomes. Future studies will be performed to tease out these more subtle disease characteristics and enable a more patient-specific approach to hip preservation treatments.”
Regarding patient-reported satisfaction, the findings included:
- “Femoroacetabular impingement patients self-reported high overall satisfaction rates (>91%) and low rates of dissatisfaction (>9%)
- Overall patient satisfaction in periacetabular osteotomy patients was also consistently over 90%.”
In addition, the ANCHOR group developed a consensus document in an effort to standardize radiograph evaluation of the young adult hip; more recently they have emphasized the important role of 3D imaging.
OTW asked Dr. Clohisy what might get in the way of a timely diagnosis. Dr. Clohisy commented, “Delay in evaluation, inadequate evaluation and misdiagnoses are the main challenges to a timely diagnosis. The most important aspect of timely diagnosis is an early clinical and imaging evaluation by a healthcare provider skilled in the assessment of adolescent and young adult hip disease. In general, 6-8 weeks of persistent symptoms (hip/groin pain) that do not respond to routine symptomatic care (rest, non-steroidal anti-inflammatory drugs, physical therapy) should be investigated by a qualified hip care specialist.”
“The award represents the culmination of remarkable, collaborative work between the ANCHOR and Washington University research teams. Most exciting is the exceptional progress we have made in the hip preservation field over the past 20 years. Continued investigation and innovation will move the field forward and will optimize patient-specific care for this historically underserviced population.”
