Hip arthroscopy for hip osteoarthritis is associated with increased risk for revision after total hip arthroplasty

Abstract

Background:

It has not been determined yet whether hip arthroscopy (HA) leads to adverse outcomes after total hip arthroplasty (THA). The purpose of this study was to (1) determine 2-year conversion rate of HA done for osteoarthritis (OA) to THA and (2) explore the relationship between HA performed in patients with hip osteoarthritis and the risk of revision THA within 2 years of index arthroplasty.

Methods:

Data was collected from the Medicare Standardized Analytic Files insurance database using the PearlDiver Patient Records Database from 2005–2016. Patients were stratified into 2 groups based upon a history of hip arthroscopy prior to THA.

Results:

The 2-year conversion to THA rate for hip arthroscopy in patients with OA was 68.4% (95% CI, 66.2–70.6%). Multivariate analysis demonstrated that OA patients who underwent HA prior to THA were at an increased risk of revision surgery (OR 3.72; 95% CI, 3.15–4.57; p = 0.012), periprosthetic joint infection (OR 1.86; 95% CI, 1.26–2.77, p = 0.010) and aseptic loosening (OR 2.81; 95% CI, 1.66–4.76; p < 0.001) within 2 years of THA.

Conclusions:

Analysis of a large insurance database found the conversion rate from HA performed in Medicare OA patients to THA within 2 years is unacceptably high. Hip arthroscopy prior to THA also significantly increased the risk of THA revision within 2 years after index THA. These results suggest that arthroscopic hip surgery should not be performed in patients with a diagnosis of OA as conversion rates are high and revision rates post THA are significantly increased.

Keywords

Hip arthroscopy hip osteoarthritis large insurance database propensity score matched analysis risk factors total hip arthroplasty

Get full access to this article

View all access options for this article.

References

Zhang

Feeley

BT.

Editorial commentary: the rise of hip arthroscopy: temporary trend or here to stay?

Arthroscopy 2018; 34: 1831–1832.

Bozic

Chan

Valone

III , et al. Trends in hip arthroscopy utilization in the United States. J Arthroplasty 2013; 28(Suppl. 8): 140–143.

Fayad

Khan

Haddad

FS.

Femoroacetabular impingement: an arthroscopic solution. Bone Joint J 2013; 95–B(Suppl. A): 26–30.

Fukui

Trindade

Briggs

, et al. Arthroscopy of the hip for patients with mild to moderate developmental dysplasia of the hip and femoroacetabular impingement: outcomes following hip arthroscopy for treatment of chondrolabral damage. Bone Joint J 2015; 97–B: 1316–1321.

Parvizi

Bican

Bender

, et al. Arthroscopy for labral tears in patients with developmental dysplasia of the hip: a cautionary note. J Arthroplasty 2009; 24: 110–113.

Piuzzi

Slullitel

Bertona

, et al. Hip arthroscopy in osteoarthritis: a systematic review of the literature. Hip Int 2016; 26: 8–14.

Schairer

Nwachukwu

McCormick

, et al. Use of hip arthroscopy and risk of conversion to total hip arthroplasty: a population-based analysis. Arthroscopy 2016; 32: 587–593.

Haviv

O’Donnell

The incidence of total hip arthroplasty after hip arthroscopy in osteoarthritic patients. Sports Med Arthrosc Rehabil Ther Technol 2010; 2: 18.

McCarthy

. Hip arthroscopy: when it is and when it is not indicated. Instr Course Lect 2004; 53: 615–621.

10.

Konopka

Buly

Kelly

, et al. The effect of prior hip arthroscopy on patient-reported outcomes after total hip arthroplasty: an institutional registry-based, matched cohort study. J Arthroplasty 2018; 33: 1806–1812.

11.

Perets

Mansor

, et al. Prior arthroscopy leads to inferior outcomes in total hip arthroplasty: a match-controlled study. J Arthroplasty 2017; 32: 3665–3668.

12.

Piedade

Pinaroli

Servien

, et al. Is previous knee arthroscopy related to worse results in primary total knee arthroplasty? Knee Surg Sports Traumatol Arthrosc 2009; 17: 328–333.

13.

Piedade

Pinaroli

Servien

, et al. TKA outcomes after prior bone and soft tissue knee surgery. Knee Surg Sports Traumatol Arthrosc 2013; 21: 2737–2743.

14.

Liu

Yang

al-Shaikh

, et al. Collagen in tendon, ligament, and bone healing. A current review. Clin Orthop Relat Res 1995; 318: 265–278.

15.

Chaudhry

Salem

Hammoud

, et al. Does prior hip arthroscopy affect outcomes of subsequent hip arthroplasty? A systematic review. Arthroscopy 2019; 35: 631–643.

16.

Zingg

Schallberger

Rüdiger

, et al. Does previous hip arthroscopy negatively influence the short term clinical result of total hip replacement? Arch Orthop Trauma Surg 2012; 132: 299–303.

17.

Elixhauser

Steiner

Harris

, et al. Comorbidity measures for use with administrative data. Med Care 1998; 36: 8–27.

18.

Colvin

Harrast

Harner

Trends in hip arthroscopy. J Bone Joint Surg Am 2012; 94: e23.

19.

Charles

LaTulip

Goulet

, et al. Previous arthroscopic repair of femoro-acetabular impingement does not affect outcomes of total hip arthroplasty. Int Orthop 2017; 41: 1125–1129.

20.

Myers

Lertwanich

, et al. Role of the acetabular labrum and the iliofemoral ligament in hip stability: an in vitro biplane fluoroscopy study. Am J Sports Med 2011; 39: 85S–91S.

21.

Abrams

Hart

Takami

, et al. Biomechanical evaluation of capsulotomy, capsulectomy, and capsular repair on hip rotation. Arthroscopy 2015; 31: 1511–1517.

22.

Sansone

Ahldén

Jónasson

, et al. Total dislocation of the hip joint after arthroscopy and ileopsoas tenotomy. Knee Surg Sports Traumatol Arthrosc 2013; 21: 420–423.

23.

Ortiz-Declet

Chen

, et al. Should the capsule be repaired or plicated after hip arthroscopy for labral tears associated with femoroacetabular impingement or instability? A systematic review. Arthroscopy 2018; 34: 303–318.

24.

Bayne

Stanley

Simon

, et al. Effect of capsulotomy on hip stability-a consideration during hip arthroscopy. Am J Orthop (Belle Mead NJ) 2014; 43: 160–165.

25.

Jain

Kumar

Shaw

, et al. Functional outcome of total hip arthroplasty after a previous hip arthroscopy: a retrospective comparative cohort study. Hip Int 2019; 29: 363–367.

26.

Haughom

Plummer

Hellman

, et al. Does hip arthroscopy affect the outcomes of a subsequent total hip arthroplasty? J Arthroplasty 2016; 31: 1516–1518.

27.

Spencer-Gardner

Camp

Martin

, et al. Does prior surgery for femoroacetabular impingement compromise hip arthroplasty outcomes? J Arthroplasty 2016; 31: 1899–1903.

28.

Forsythe

Agarwalla

Puzzitiello

, et al. The timing of injections prior to arthroscopic rotator cuff repair impacts the risk of surgical site infection. J Bone Joint Surg Am 2019; 101: 682–687.

29.

Barnds

Morris

Mullen

, et al. Increased rates of knee arthroplasty and cost of patients with meniscal tears treated with arthroscopic partial meniscectomy versus non-operative management. Knee Surg Sports Traumatol Arthrosc 2019; 27: 2316–2321.

30.

Abbott

Hedlund

Tyni-Lenné

Patients’ experience post-lumbar fusion regarding back problems, recovery and expectations in terms of the international classification of functioning, disability and health. Disabil Rehabil 2011; 33: 1399–1408.

31.

Kester

Capogna

Mahure

, et al. independent risk factors for revision surgery or conversion to total hip arthroplasty after hip arthroscopy: a review of a large statewide database from 2011 to 2012. Arthroscopy 2018; 34: 464–470.