Hip arthroscopy results in improved patient reported outcomes compared to non-operative management of waitlisted patients

Abstract

Hip arthroscopy (HA) is an established treatment option to address intra-articular pathology of the hip. However, some clinicians encourage non-operative management (NOM). Non-operative management may include active measures such as physiotherapy and intra-articular steroid injections, or NOM may involve so called watchful waiting with no active intervention. These approaches, along with surgery have been detailed recently in the Warwick Agreement, a Consensus Statement regarding diagnosis and treatment of Femoroacetabular Impingement Syndrome The aim of this study is to compare the change in clinical outcome scores of waitlisted patients with intra-articular hip pathology who receive no active treatment with matched controls that have undergone HA. Patients less than 60 years of age were identified from a HA waiting list in a single hospital in the Australian public hospital system. Patient reported outcomes (PRO) were collected whilst patients waited for surgery. During this waiting period no specific treatment was offered. A separate group of patients who had previously undergone HA were matched based on age, sex, body mass index and baseline non-arthritic hip scores (NAHS). The groups were compared using the NAHS as the primary outcome measures. Modified Harris Hip Scores were also collected and compared. Thirty-six patients were included in each group, with a mean follow up of 19 months (12–36). There were no significant differences in age, sex, BMI and NAHS between groups at baseline. At final follow up, mean NAHS scores after HA were significantly higher than scores after NOM, 82.1 (36.4–100.0) versus 48.9 (11.3–78.8), respectively (P < 0.001) with a large effect size for mean change in scores between groups (d = 1.77, 95% CI 1.21–2.30). Mean mHHS after HA were significantly higher than scores after NOM, 84.3 (15.4–100.0) versus 48.1 (21.0–66.0) respectively (P < 0.001), with a large effect size for mean change in scores between groups (d = 1.92, 95% CI 1.34–2.46). HA may lead to significant improvements in PRO when compared to non-operative management of waitlisted patients with intra-articular pathology of the hip at 18 months follow-up.

Immediate Versus Delayed Hip Arthroscopy for Femoroacetabular Impingement: An Expected Value Decision Analysis

“…In a study of patients in a national health care system, patients who were waitlisted for surgery had notably lower PRO scores than patients who were able to schedule surgery quickly. 12 In a system with private payers, Dierckman et al 24 likewise determined that increased symptom times were correlated with lower PRO scores on a logarithmic scale. Aprato et al found that patients who had delayed arthroscopy with preoperative symptoms lasting greater than three years had notably worse outcomes than those with shorter symptom durations.…”

“…In addition, a comparison of arthroscopic treatment with nonoperative management for FAI has demonstrated clinically meaningful improvements in patient-reported hip function and quality of life in the arthroscopic population. 12 …”

Hip arthroscopy for femoroacetabular impingement

“… 29 A recent study showed significantly improved patient-reported outcomes in patients aged < 60 years who underwent hip arthroscopy for FAI when compared with a cohort that was waitlisted. 30 Both groups had undergone three months of conservative treatment including community physiotherapy before either having the arthroscopy or being waitlisted. In another study evaluating high-level athletes, return to their high-level sport after hip arthroscopy was measured as 3/4 by one year post-operatively.…”

Analysis of the referral pattern and wait time for hip arthroscopy in a single payer publicly funded health care system

“…The length of the waiting period for consultation and/or surgery can potentially have an impact on the patient's quality of life or an athletes' performance, as well as financial impacts in terms of cost related to time loss from work, physiotherapy treatments, and pain management . While this has been extensively investigated for hip and knee arthroplasty, there is no published data that analyse the wait time and the referral processes for patients needing hip arthroscopy.…”