Are Short-term Outcomes of Hip Arthroscopy in Patients 55 Years and Older Inferior to Those in Younger Patients?

Bryan, Andrew J.; Krych, Aaron J.; Pareek, Ayoosh; Reardon, Patrick J.; Berardelli, Rebecca L.; Levy, Bruce A.

doi:10.1177/0363546516652114

Cited by 32 publications

(19 citation statements)

References 24 publications

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“…Up to a half of patients may not achieve a clinically important improvement after surgery; hence accurate patient selection is critical to optimising treatment outcomes. Increasing patient age, higher preoperative patient reported scores, and the presence of osteoarthritis have been identified as having a negative impact on outcome in cohort studies of arthroscopic hip surgery 3334 35 36…”

Section: Discussionmentioning

confidence: 99%

Arthroscopic hip surgery compared with physiotherapy and activity modification for the treatment of symptomatic femoroacetabular impingement: multicentre randomised controlled trial

Palmer

Gupta

Fernquest

et al. 2019

BMJ

210

310

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Objective To compare arthroscopic hip surgery with physiotherapy and activity modification for improving patient reported outcome measures in patients with symptomatic femoroacetabular impingement (FAI). Design Two group parallel, assessor blinded, pragmatic randomised controlled trial. Setting Secondary and tertiary care centres across seven NHS England sites. Participants 222 participants aged 18 to 60 years with symptomatic FAI confirmed clinically and with imaging (radiography or magnetic resonance imaging) were randomised (1:1) to receive arthroscopic hip surgery (n=112) or a programme of physiotherapy and activity modification (n=110). Exclusion criteria included previous surgery, completion of a physiotherapy programme targeting FAI within the preceding 12 months, established osteoarthritis (Kellgren-Lawrence grade ≥2), and hip dysplasia (centre-edge angle <20 degrees). Interventions Participants in the physiotherapy group received a goal based programme tailored to individual patient needs, with emphasis on improving core stability and movement control. A maximum of eight physiotherapy sessions were delivered over five months. Participants in the arthroscopic surgery group received surgery to excise the bone that impinged during hip movements, followed by routine postoperative care. Main outcome measures The primary outcome measure was the hip outcome score activities of daily living subscale (HOS ADL) at eight months post-randomisation, with a minimum clinically important difference between groups of 9 points. Secondary outcome measures included additional patient reported outcome measures and clinical assessment. Results At eight months post-randomisation, data were available for 100 patients in the arthroscopic hip surgery group (89%) and 88 patients in the physiotherapy programme group (80%). Mean HOS ADL was 78.4 (95% confidence interval 74.4 to 82.3) for patients randomised to arthroscopic hip surgery and 69.2 (65.2 to 73.3) for patients randomised to the physiotherapy programme. After adjusting for baseline HOS ADL, age, sex, and study site, the mean HOS ADL was 10.0 points higher (6.4 to 13.6) in the arthroscopic hip surgery group compared with the physiotherapy programme group (P<0.001)). No serious adverse events were reported in either group. Conclusions Patients with symptomatic FAI referred to secondary or tertiary care achieve superior outcomes with arthroscopic hip surgery than with physiotherapy and activity modification. Trial registration ClinicalTrials.gov NCT01893034 .

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Section: Discussionmentioning

confidence: 99%

Arthroscopic hip surgery compared with physiotherapy and activity modification for the treatment of symptomatic femoroacetabular impingement: multicentre randomised controlled trial

Palmer

Gupta

Fernquest

et al. 2019

BMJ

210

310

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“…An association between advanced degenerative arthritis and inferior outcomes after hip arthroscopy is well documented [ 4 , 57 , 58 ]. A large meta-analysis of over 6000 hip arthroscopy patients by Harris et al [ 6 ] found that conversion to THA was the most common reason for revision surgery.…”

Section: Inappropriate Indications: Arthritis and Hip Dysplasiamentioning

confidence: 99%

“…Hip arthroscopy has been used successfully as a treatment for both intra-articular [femoroacetabular impingement (FAI), labral tears, chondral lesions, loose bodies, synovial abnormalities, instability, septic arthritis] and extra-articular (snapping iliopsoas tendon/iliotibial band, gluteus tendon tears) conditions. Most published results of hip arthroscopy have reported favorable short and mid-term clinical and radiographic outcomes [ 3 , 4 ]. However, with expanding indications for arthroscopic surgery and the subsequent increasing number of procedures being performed, the burden of refractory pain following hip arthroscopy will likely increase.…”

Section: Introductionmentioning

confidence: 99%

“…The mean time to reoperation was 16.4 months with a conversion rate of 2.9% to total hip arthroplasty (THA). A more recent article analyzing indications and outcomes of only revision hip arthroscopy reported that the most common indications for revision hip arthroscopy were unaddressed or inadequately addressed FAI, labral tears and chondral lesions at the time of index surgery [ 4 ]. Additionally, the review reported that patients who most commonly underwent revision hip arthroscopy were female, younger (mean age of 33.4 years) and had a mean interval between index and revision hip arthroscopy of 25.6 months.…”

Section: Introductionmentioning

confidence: 99%

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Refractory pain following hip arthroscopy: evaluation and management

Shin

Burnham

et al. 2018

Journal of Hip Preservation Surgery

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With increased knowledge and understanding of hip pathology, hip arthroscopy is rapidly becoming a popular treatment option for young patients with hip pain. Despite improved clinical and radiographic outcomes with arthroscopic treatment, some patients may have ongoing pain and less than satisfactory outcomes. While the reasons leading to failed hip arthroscopy are multifactorial, patient selection, surgical technique and rehabilitation all play a role. Patients with failed hip arthroscopy should undergo a thorough history and physical examination, as well as indicated imaging. A treatment plan should then be developed based on pertinent findings from the workup and in conjunction with the patient. Depending on the etiology of failed hip arthroscopy, management may be nonsurgical or surgical, which may include revision arthroscopic or open surgery, periacetabular osteotomy or joint arthroplasty. Revision surgery may be appropriate in settings including, but not limited to, incompletely treated femoroacetabular impingement, postoperative adhesions, heterotopic ossification, instability, hip dysplasia or advanced degeneration.

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“…One of the most common indications for hip arthroscopy is a labral tear with femoroacetabular impingement. Previous studies have noted a conversion to THA following hip arthroscopy between 4 and 25% [19, 24, 25]. Risk factors for failure of hip arthroscopy include obesity, decreased joint space (<2 mm), significant chondromalacia, Tönnis Grade 2 osteoarthritis and remaining unaddressed FAI [24, 26].…”

Section: Introductionmentioning

confidence: 99%

Hip arthroscopy following contralateral total hip arthroplasty: a multicenter matched-pair study

Patel¹,

Domb

Krych³

et al. 2018

Journal of Hip Preservation Surgery

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The purpose of this study was to determine if patients undergoing hip arthroscopy for labral pathology with contralateral total hip arthroplasty (THA) have a difference in revision surgeries or patient-reported outcomes (PROs) when compared with those patients undergoing hip arthroscopy for labral pathology with a native contralateral hip. A retrospective review was performed for patients that were undergoing hip arthroscopy between 2008 and 2015. Patients were included in the study group if they met the following inclusion criteria: Tönnis Grade 0 or 1, hip labral pathology, previous contralateral THA, and greater than 2-year follow-up with completion of all PROs or conversion to a THA. Exclusion criteria included the previous surgical history on ipsilateral hip, peritrochanteric or deep gluteal space arthroscopy performed concomitantly, or dysplasia [Lateral Center Edge Angle (LCEA) < 20°]. A 3:1 matched-pair study was conducted. Multiple PRO scores were recorded for both groups. There was no statistically significant difference in the modified Harris hip score, non-arthritic hip score, hip outcome score-sports specific sub-scale, visual analog pain score and patient satisfaction scores between both groups. However, the study group was noted to have six patients converted to THA (67%) at an average of 30 months post-operatively, compared with only four patients (15%) in the control group (P = 0.006). Hip arthroscopy cannot be currently recommended in patients who have undergone contralateral THA due to the high conversion to THA (67%).

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Are Short-term Outcomes of Hip Arthroscopy in Patients 55 Years and Older Inferior to Those in Younger Patients?

Cited by 32 publications

References 24 publications

Arthroscopic hip surgery compared with physiotherapy and activity modification for the treatment of symptomatic femoroacetabular impingement: multicentre randomised controlled trial

Arthroscopic hip surgery compared with physiotherapy and activity modification for the treatment of symptomatic femoroacetabular impingement: multicentre randomised controlled trial

Refractory pain following hip arthroscopy: evaluation and management

Hip arthroscopy following contralateral total hip arthroplasty: a multicenter matched-pair study

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