Factors increasing risk of failure following hip arthroscopy: a case control study

Abstract

We aimed to identify factors such as pre-arthroscopy and intra-operative variables that were associated with failure of hip arthroscopy as a joint preserving operation. We performed a retrospective analysis of a database containing 344 consecutive hip arthroscopies performed at our institution. Forty-four hips were identified that underwent a subsequent arthroplasty procedure following their hip arthroscopy (cases). Sixty-six control hips (hip arthroscopy with no subsequent arthroplasty) were randomly selected from the same database. Cases and controls were matched for age, sex and follow-up (P = 0.59, 0.48, 0.10, respectively). Pre-operative radiographs/MRI scans plus intra-operative findings were analysed to identify factors associated with failure. Both a lower centre edge angle and higher acetabular index on pre-operative radiographs were associated with higher rates of failure (P < 0.001). The presence of any acetabular wear at operation was also associated with failure (P < 0.001). Highest rates of failure were seen in hips with both features of dysplasia on pre-operative radiographs and any intra-operative acetabular wear (relative risk: 5, odds ratio: 9.13, P < 0.001). Dysplastic features on pre-operative radiographs and the finding of acetabular wear at hip arthroscopy increase the risk of subsequent arthroplasty. Identification of these features pre-operatively with evolving imaging techniques would improve the results of hip arthroscopy as joint preserving surgery.

Acetabular Morphologic Characteristics Predict Early Conversion to Arthroplasty After Isolated Hip Arthroscopy for Femoroacetabular Impingement

“…The AI has also previously been evaluated as a prognostic factor for arthroplasty, with Uchida et al 45 demonstrating elevated AI in their cohort experiencing failure (15° vs 11°), although this did not reach significance ( P = .44). In a more recent matched case-control study by Davies et al, 9 the AI and LCEA as well as cartilage wear were directly evaluated as prognostic markers for future conversion to hip arthroplasty. In a group of 44 participants requiring arthroplasty, the investigators reported an average LCEA of 19° and AI of 10.2°, which were both significantly higher than values in the control population that did not require arthroplasty.…”

“…Reports on the use of arthroscopic techniques for dysplastic hips range from cautionary to favorable, with predictors of failure including age, severity of dysplasia, and cartilage status at the time of surgery. 9-11,23,27,33,40,45 In contrast, arthroscopic techniques used to address conditions such as FAI labral-chondral abnormalities or synovial abnormalities have a high rate of good to excellent results, durable therapeutic gain, and a high rate of return to sport. 13,24,34…”

“…Reports on the use of arthroscopic techniques for dysplastic hips range from cautionary to favorable, with predictors of failure including age, severity of dysplasia, and cartilage status at the time of surgery. [9][10][11]23,27,33,40,45 In contrast, arthroscopic techniques used to address conditions such as FAI labral-chondral abnormalities or synovial abnormalities have a high rate of good to excellent results, durable therapeutic gain, and a high rate of return to sport. 13,24,34 Although arthroscopy is well-suited to address intraand/or extra-articular abnormalities that frequently accompany hip dysplasia, specific concerns have been raised by reports of rapidly progressive joint deterioration after arthroscopy on dysplastic hips.…”

Demographic and Radiographic Factors Associated With Intra-articular Hip Cartilage Injury: A Cross-sectional Study of 1511 Hip Arthroscopy Procedures

“…17 Furthermore, a high prevalence (>70%) of cartilage injury exists in patients undergoing hip arthroscopy for FAIS, 23,36 with the severity affecting the postoperative outcome. 9,12,30,37 Few studies have investigated the association between hip bony morphology and demographic factors with cartilage injury in FAIS 21,22,31,39 and between cam deformity and end-stage hip osteoarthritis. 1 However, lack of consistency in the definition of bony deformity characterizing FAIS and in the classification of cartilage severity makes interpretation of existing literature difficult.…”

Impact, impact, impact

“…Each submission seems almost better than the last. Again, being unable to pick a favourite as I simply cannot decide, I was especially interested in the paper by Davies et al , who help identify factors increasing the risk of failure after hip arthroscopy [ 10 ]. What an excellent contribution.…”