Pregnancy-Related Decision-Making and Perceptions of Risk among Reproductive-Age Females Undergoing Hip Arthroscopy for Femoroacetabular Impingement Syndrome: A Single-Surgeon Cross-Sectional Study

Round 1

Reviewer 1 Report

Comments and Suggestions for Authors

This manuscript aimed to assess perceived risks to pregnancy from hip pain and/or hip arthroscopy among reproductive age females who underwent arthroscopic treatment of  femoroacetabular impingement syndrome (FAIS). A cross-sectional study was conducted involving 12 females aged 18-44 years who underwent hip arthroscopy for the treatment of FAIS with a single 13 surgeon were included in the study. Subjects completed a survey that assessed obstetric and gyne- 14 cologic history, decision-making regarding the planning and timing of hip surgery and pregnancy, 15 and perceived risks to pregnancy from hip pain and/or hip surgery. Subjects were classified as nul- 16 ligravid (Group 1), pregnant at least once before hip surgery but never again following hip surgery 17 (Group 2), or pregnant at least once following hip surgery (Group 3).

 

I read the article with interest, the title is well thought out and faithfully reflects the content of the study.

 

The abstract is poorly developed, and it is not very useful to frame the characteristics and purpose of the study.

 

In the introduction, the characteristics of hip arthroscopy have been poorly described. In the materials and methods participants, interventions, outcome measures and statistical analysis have been adequately development. The discussion is sufficiently described.

 

Nevertheless, some minor changes are needed to be considered suitable for publication.

 

Comment 1: In the abstract: it would be appropriate to insert a brief introduction

Comment 2: In the introduction: “By extension, females of reproductive age 33 make up one of the largest demographics of the hip arthroscopy population. As with other 34 elective surgical populations, there are a variety of non-clinical factors such as finances, 35 personal time commitments, employment status, and expectations of therapeutic benefit 36 that influence patients’ decisions to undergo or defer elective hip arthroscopy, and among 37 reproductive-age females, planning for a future pregnancy may be one such factor.” please adding appropriate bibliographical references.

Comment 3: In the introduction: some information about the outcomes of arthroscopic hip treatment should be specified, especially in in the sports population: (Loppini M et al (2022) “Sport Activity and Clinical Outcomes after Hip Arthroscopy with Acetabular Microfractures at a Minimum 2-Year Follow-Up: A Matched-Pair Controlled Study.”)

Comment 4: In the materials and methods: what kind of rehabilitation therapy did they perform?

Comment 5: Finally, additional English editing is needed. The Non-Native Speakers of English Editing Certificate was not signed.This manuscript aimed to assess perceived risks to pregnancy from hip pain and/or hip arthroscopy among reproductive age females who underwent arthroscopic treatment of  femoroacetabular impingement syndrome (FAIS). A cross-sectional study was conducted involving 12 females aged 18-44 years who underwent hip arthroscopy for the treatment of FAIS with a single 13 surgeon were included in the study. Subjects completed a survey that assessed obstetric and gyne- 14 cologic history, decision-making regarding the planning and timing of hip surgery and pregnancy, 15 and perceived risks to pregnancy from hip pain and/or hip surgery. Subjects were classified as nul- 16 ligravid (Group 1), pregnant at least once before hip surgery but never again following hip surgery 17 (Group 2), or pregnant at least once following hip surgery (Group 3).

 

I read the article with interest, the title is well thought out and faithfully reflects the content of the study.

 

The abstract is poorly developed, and it is not very useful to frame the characteristics and purpose of the study.

 

In the introduction, the characteristics of hip arthroscopy have been poorly described. In the materials and methods participants, interventions, outcome measures and statistical analysis have been adequately development. The discussion is sufficiently described.

 

Nevertheless, some minor changes are needed to be considered suitable for publication.

 

Comment 1: In the abstract: it would be appropriate to insert a brief introduction

Comment 2: In the introduction: “By extension, females of reproductive age 33 make up one of the largest demographics of the hip arthroscopy population. As with other 34 elective surgical populations, there are a variety of non-clinical factors such as finances, 35 personal time commitments, employment status, and expectations of therapeutic benefit 36 that influence patients’ decisions to undergo or defer elective hip arthroscopy, and among 37 reproductive-age females, planning for a future pregnancy may be one such factor.” please adding appropriate bibliographical references.

Comment 3: In the introduction: some information about the outcomes of arthroscopic hip treatment should be specified, especially in in the sports population: (Loppini M et al (2022) “Sport Activity and Clinical Outcomes after Hip Arthroscopy with Acetabular Microfractures at a Minimum 2-Year Follow-Up: A Matched-Pair Controlled Study.”)

Comment 4: In the materials and methods: what kind of rehabilitation therapy did they perform?

Comment 5: Finally, additional English editing is needed. 

Comments on the Quality of English Language

This manuscript aimed to assess perceived risks to pregnancy from hip pain and/or hip arthroscopy among reproductive age females who underwent arthroscopic treatment of  femoroacetabular impingement syndrome (FAIS). A cross-sectional study was conducted involving 12 females aged 18-44 years who underwent hip arthroscopy for the treatment of FAIS with a single 13 surgeon were included in the study. Subjects completed a survey that assessed obstetric and gyne- 14 cologic history, decision-making regarding the planning and timing of hip surgery and pregnancy, 15 and perceived risks to pregnancy from hip pain and/or hip surgery. Subjects were classified as nul- 16 ligravid (Group 1), pregnant at least once before hip surgery but never again following hip surgery 17 (Group 2), or pregnant at least once following hip surgery (Group 3).

 

I read the article with interest, the title is well thought out and faithfully reflects the content of the study.

 

The abstract is poorly developed, and it is not very useful to frame the characteristics and purpose of the study.

 

In the introduction, the characteristics of hip arthroscopy have been poorly described. In the materials and methods participants, interventions, outcome measures and statistical analysis have been adequately development. The discussion is sufficiently described.

 

Nevertheless, some minor changes are needed to be considered suitable for publication.

 

Comment 1: In the abstract: it would be appropriate to insert a brief introduction

Comment 2: In the introduction: “By extension, females of reproductive age 33 make up one of the largest demographics of the hip arthroscopy population. As with other 34 elective surgical populations, there are a variety of non-clinical factors such as finances, 35 personal time commitments, employment status, and expectations of therapeutic benefit 36 that influence patients’ decisions to undergo or defer elective hip arthroscopy, and among 37 reproductive-age females, planning for a future pregnancy may be one such factor.” please adding appropriate bibliographical references.

Comment 3: In the introduction: some information about the outcomes of arthroscopic hip treatment should be specified, especially in in the sports population: (Loppini M et al (2022) “Sport Activity and Clinical Outcomes after Hip Arthroscopy with Acetabular Microfractures at a Minimum 2-Year Follow-Up: A Matched-Pair Controlled Study.”)

Comment 4: In the materials and methods: what kind of rehabilitation therapy did they perform?

Comment 5: Finally, additional English editing is needed. 

Author Response

This manuscript aimed to assess perceived risks to pregnancy from hip pain and/or hip arthroscopy among reproductive age females who underwent arthroscopic treatment of  femoroacetabular impingement syndrome (FAIS). A cross-sectional study was conducted involving 12 females aged 18-44 years who underwent hip arthroscopy for the treatment of FAIS with a single 13 surgeon were included in the study. Subjects completed a survey that assessed obstetric and gyne- 14 cologic history, decision-making regarding the planning and timing of hip surgery and pregnancy, 15 and perceived risks to pregnancy from hip pain and/or hip surgery. Subjects were classified as nul- 16 ligravid (Group 1), pregnant at least once before hip surgery but never again following hip surgery 17 (Group 2), or pregnant at least once following hip surgery (Group 3).

 

Author’s Response: The reviewers’ description of our study is accurate.

 

I read the article with interest, the title is well thought out and faithfully reflects the content of the study.

 

Author’s Response: Thank you. 

 

The abstract is poorly developed, and it is not very useful to frame the characteristics and purpose of the study.

 

Author’s Response: We appreciate the critique, and have revised the abstract accordingly using your comments below (Lines 10-27). 

 

In the introduction, the characteristics of hip arthroscopy have been poorly described. In the materials and methods participants, interventions, outcome measures and statistical analysis have been adequately development. The discussion is sufficiently described.

 

Author’s Response: We appreciate the critique, and have revised the Introduction accordingly using your comments below (Lines 31-59). 

 

Nevertheless, some minor changes are needed to be considered suitable for publication.

 

Author’s Response: We have made the requested changes that you listed below. 

 

Comment 1: In the abstract: it would be appropriate to insert a brief introduction

 

Author’s Response: We have added a brief introduction to the abstract (Lines 10-12).

 

Comment 2: In the introduction: “By extension, females of reproductive age 33 make up one of the largest demographics of the hip arthroscopy population. As with other 34 elective surgical populations, there are a variety of non-clinical factors such as finances, 35 personal time commitments, employment status, and expectations of therapeutic benefit 36 that influence patients’ decisions to undergo or defer elective hip arthroscopy, and among 37 reproductive-age females, planning for a future pregnancy may be one such factor.” please adding appropriate bibliographical references.

Author’s Response: We feel that references are not warranted as this statement reflects common-sense knowledge regarding factors that influence patients’ decisions to undergo or defer elective surgery. Most if not all surgeons performing elective procedures would understand that factors such as money, time, employment status (with associated health insurance benefits), and expectations of benefits can influence a patient’s decision-making. We have, however, rephrased the sentence to make it clear that we are stating this about elective surgeries in general, and not specifically hip arthroscopy (Lines 40-44)..

 

Comment 3: In the introduction: some information about the outcomes of arthroscopic hip treatment should be specified, especially in in the sports population: (Loppini M et al (2022) “Sport Activity and Clinical Outcomes after Hip Arthroscopy with Acetabular Microfractures at a Minimum 2-Year Follow-Up: A Matched-Pair Controlled Study.

 

Author’s Response: We appreciate the suggestion and have cited two of the most recent systematic reviews of outcomes following hip arthroscopy for the treatment of FAIS (Lines 34-37).

 

Comment 4: In the materials and methods: what kind of rehabilitation therapy did they perform?

 

Author’s Response: We have added a brief description of the physical rehab protocol (Lines 106-112).

 

Comment 5: Finally, additional English editing is needed. The Non-Native Speakers of English Editing Certificate was not signed.

 

Author’s Response: All the authors on this manuscript are native English-language speakers. We have reviewed the manuscript and corrected any grammar and usage errors that were present. Changes are highlighted in the edited manuscript.

Reviewer 2 Report

Comments and Suggestions for Authors

Dear authors, the subject is interesting because the hormonal, metabolic and morphological changes of pregnancy can exacerbate hip pain in FAIS and the use of arthroscopy can be a valuable therapeutic tool to improve the period of gestation.

 

As regards the introduction, the M&M and the results, the sections are well described.

Very useful the subdivision into sub-paragraphs in the M&M section. A mode of visual representation encourages the reader to dwell on the section.

As regards the introduction, I suggest to specify the types of FAIS and to discute the conservative treatment options before surgical treatment, with reference to both rehabilitation exercises protocols and use of shock waves, which are increasingly applied in the orthopedic field, see for example the following scientific works:

-        Journal of Biological Regulators and Homeostatic Agents, Volume 32, Issue 2, Pages 385 – 389,1 March 2018

Extracorporeal shockwave therapy versus exercise program in patients with low back pain: Short-term results of a randomised controlled trial

Notarnicola A et al

-        Journal of Personalized Medicine, Volume 13, Issue 6, June 2023 Article number 976

DOI 10.3390/jpm13060976

Shock Waves and Therapeutic Exercise in Greater Trochanteric Pain Syndrome: A Prospective Randomized Clinical Trial with Cross-Over

Notarnicola A

 

As regards the discussion and conclusion, are balanced and well supported by analysis.

Author Response

Dear authors, the subject is interesting because the hormonal, metabolic and morphological changes of pregnancy can exacerbate hip pain in FAIS and the use of arthroscopy can be a valuable therapeutic tool to improve the period of gestation.

 

Author’s Response: Thank you.

 

As regards the introduction, the M&M and the results, the sections are well described.

 

Author’s Response: Thank you.

 

Very useful the subdivision into sub-paragraphs in the M&M section. A mode of visual representation encourages the reader to dwell on the section.

 

Author’s Response: Thank you.

 

As regards the introduction, I suggest to specify the types of FAIS and to discute the conservative treatment options before surgical treatment, with reference to both rehabilitation exercises protocols and use of shock waves, which are increasingly applied in the orthopedic field, see for example the following scientific works:

 

-        Journal of Biological Regulators and Homeostatic Agents, Volume 32, Issue 2, Pages 385 – 389,1 March 2018

 

Extracorporeal shockwave therapy versus exercise program in patients with low back pain: Short-term results of a randomised controlled trial

 

Notarnicola A et al

 

-        Journal of Personalized Medicine, Volume 13, Issue 6, June 2023 Article number 976

 

DOI 10.3390/jpm13060976

 

Shock Waves and Therapeutic Exercise in Greater Trochanteric Pain Syndrome: A Prospective Randomized Clinical Trial with Cross-Over

 

Notarnicola A

 

Author’s Response: We appreciate the reviewer’s suggestion, however the focus of the study is on patients who meet indications for operative management of FAIS. We feel that adding information about nonoperative management of FAIS to the introduction would detract from this focus and only serve to confuse the reader.

 

As regards the discussion and conclusion, are balanced and well supported by analysis.

 

Author’s Response: Thank you.