Abstract
Background
Hip arthroscopy is a rapidly growing, evolving area within arthroscopic Orthopaedic Surgery, with annual rates increasing as much as 25-fold each year. Despite improvements in equipment and training, it remains a challenging procedure. Rates of revision surgery have been reported as 6.3% to 16.9%.
Objectives
The primary objective was to determine the success of joint preservation after hip arthroscopy. The secondary objective was to determine whether patient characteristics or PROM functional score trends could predict revision hip arthroscopy or Total Hip Arthroplasty (THA).
Study Design & Methods
We reviewed 1363 hip arthroscopies performed from January 2010 to December 2016 by a single high-volume surgeon at a single institution. Data was prospectively collected and retrospectively reviewed with a minimum 2-year follow-up. Functional outcomes were assessed with the International Hip Outcome Tool (IHOT-33). Hip arthroscopy failures were defined as Total Hip Arthroplasty or revision hip arthroscopy after index hip arthroscopy.
Results
There were751 females and 612 males with an average age of 34.63 years (19 – 58 years). There were 199 cases (14.6%) of labrum repairs only, 286 (20.9%) cam and labrum repairs, 319 (23.4%) cam and pincer surgeries and 193 (14.1%) cam only surgeries. All pre-operative IHOT-33 patient-reported outcomes scores (27.42 ± 6.2) improved significantly at the 6 week-, 3 month- and 6-month follow-up visits (p<0.05). The best improvements were seen in symptoms and functional improvements (IHOT-SFL) (p<0.05) while the poorest amelioration of job-related concerns (IHOT-JRC) existed at all time points (p<0.05). There were 223 failures, 131 patients (9.61%) underwent revision hip arthroscopy and 92 required THA (6.75%) at 18.45 months ± 7.34 months. The 2-year survival rate was 89.2%. The THA conversion rate was 8.4% for patients > 50 years old and 3.72% for patients < 50 years old. Age (>50 years) and female sex were associated with increased risk of conversion to THA (p<0.05) while young (<25 years old) and female patients were most likely to undergo hip revision arthroscopy. Surgery involving repair of the labrum only are more likely to result in revision arthroscopy surgery and THA (70.7% at 10.6 years). CAM & pincer surgery have best longevity (90.9% at 10.6 years)
Conclusions
Joint preservation and no subsequent surgery at 10.6 years is 83.64%
This study showed that predictors of revision hip arthroscopy or THA included poor pre-morbid functional score, female gender, age > 45, sudden functional score decrease at 3 months follow-up and cases in which only the labrum is surgically repaired.
