PURPOSE: The fulfillment of patients’ expectations is an essential factor in their satisfaction with outcomes of their surgery. It is therefore necessary to assess whether patients have realistic expectations of the likely effects of the prospective surgery on their symptoms and function. Comparison of the clinical outcomes anticipated by the patients and their surgeons provides important initial information in studying the formation of patients’ expectations. This study examined the level of agreement in the preoperative expectations of patients with DDH and their surgeons of the PAO surgery. METHODS: Two surgeons and their combined 72 patients preoperatively completed 4-point Likert-scales rating their realistic expectations of improvement (“not improved at all” to “greatly improved”) in six domains representing different hip symptoms after surgery. Domains included pain, stiffness, locking, stability, walking ability and athletic ability. Concordance between patient and surgeon expectation was evaluated by the percent of exact and partial (within one rating) agreement as well as Kappa coefficients. RESULTS: Exact agreement between patients and surgeons ranged from 17.4% (Stiffness) to 54.2% (Pain). Partial agreement between patients and surgeons ranged from 46.4% (Stiffness) to 100% (Pain). Agreement was consistently lowest regarding expected hip stiffness and highest regarding expected pain following surgery. Weighted Kappa estimates were low ranging from 0.07 to 0.45. In instances of disagreement, patients consistently had higher expectations than the surgeon especially with respect to stiffness, walking ability and locking/catching of the hip. CONCLUSIONS: There was discrepancy between patients and surgeons in their preoperative expectations of outcomes of the PAO, with most patients being more optimistic than their surgeons in every domain. In the domains of hip stiffness, locking, and walking ability, there was frequent discrepancy between patient and surgeon expectations. But for the pain domain, patients and surgeons were close in their expectations. Our findings highlight differences in perspectives between patients and surgeons regarding the effectiveness of the PAO in improving various hip symptoms and function.

BACKGROUND: Hip preservations surgeries are a type of surgical intervention used to often delay or prevent arthritis in patients before damage has occurred. A hip arthroscopy, a type of hip preservation surgery, allows for a minimally invasive method by using an arthroscope, a small fiber-optic tube with a camera attached, and surgical tools to perform the surgery. Hip preservation surgeries are often linked with moderate to severe postoperative pain, often leading to the use of substantial anesthesia. Nerve blocks have become increasingly popular for certain procedures as there may be advantages with postoperative pain and other same-day recovery advantages. Nerve blocks continue to be investigated in their role in lowering postoperative pain, postoperative opioid consumption, length of stay/time in postoperative anesthesia care unit, and patient satisfaction of pain control. OBJECTIVE: The objective of this systematic review was to determine the efficacy of nerve blocks for postoperative pain management in hip arthroscopies. METHODS: Two reviewers (J.A., E.B.) independently conducted a literature search in January 2022 with adjudication by a third reviewer using the databases Pubmed, EMBASE, and Medline. The included studies were systematically screened and reviewed, and data was analyzed. RESULTS: With a quadratus lumborum block, a study showed a significant difference in postoperative VAS pain scores in the study group with a block compared to the control from admission into the PACU through 24 hours after the operation (P<.001). In postoperative opioid consumption, another significant difference was reported in the group with a lumbar plexus block compared to control from the PACU all the way to 24 hours post operation (P<.001). When comparing a fascia iliaca block versus a local infiltration analgesia, a study found that 1 hour post operation the patients reported a significantly lower mean pain level. However, it was found that a fascia iliaca block may be less effective in reducing the number of opioids consumed in the PACU compared to a lumbar plexus block (P=.020). With a femoral nerve block, reports show a significant reduction in postoperative pain using VAS at 30 minutes (P=.009), 1 hour (P=.004), 2 hours(P=.003), 4 hours(P=.006) and 6 hours (P=.0002). Patients who receive a femoral nerve block consumed a mean amount of 47.6 milligrams of morphine equivalents compared to 59.2 milligrams of morphine equivalents in the control group which is significantly less (P=.006). Patients with a lumbar plexus block reported a lower mean pain score compared to a combined spinal epidural (P=.048) at 48 hours (YaDeau et al., 2012). There was no difference observed in pain scores when a lumbar plexus block was compared to a pericapsular injection. The lumbar plexus block had no differences in opioid consumption when compared to both combined spinal epidural and pericapsular injection. CONCLUSION: The use of nerve blocks provides sufficient pain management in hip arthroscopies. The effectiveness of these blocks may be more than other types of analgesic methods in lowering postoperative pain and postoperative opioid consumption.