Outcomes in patients undergoing primary total hip arthroplasty with history of prior hip arthroscopy

Abstract

Introduction:

As the number of total hip arthroscopies performed rises, further research is needed on the impact hip arthroscopy (HA) may have on total hip arthroplasty (THA). This study aimed to compare clinical and patient-reported outcomes of THA in patients with and without a history of HA.

Methods:

We retrospectively reviewed 167 patients who underwent unilateral, primary THA following ipsilateral HA from 2012 to 2024 (HA, n = 167). Patients were propensity matched 3:1 to THA patients without history of ipsilateral HA (NHA, n = 448) based on age, sex, race, smoking status, American Society of Anesthesiologists score, body mass index, and Charlson Comorbidity Index. Perioperative data, rates of complications and reoperation/revisions, Hip disability and Osteoarthritis Outcome Score, Joint Replacement (HOOS, JR), and Patient-Reported Outcomes Measurement Information System (PROMIS) scores were collected. Logistic regression was used to assess if the likelihood of reoperation was related to prior HA and surgical approach.

Results:

Patients with history of HA had longer mean follow-up duration (4.2 vs. 2.2 years, p < 0.001), lengths of stay (p = 0.013) and shorter operative times (p < 0.001). HA patients had higher dislocation and post-THA arthroscopy rates (p = 0.006; p = 0.020). Time to return to operation room was longer in the HA group compared to NHA cohort (334.1 vs. 104.4 days, p = 0.019). HA was associated with increased rates of reoperation due to dislocation (adjusted odds ratio 7.89, 95% CI, 1.68–36.9, p = 0.009). Surgical approach for THA was not associated with postoperative dislocation rate. Patient-reported outcomes were not different among the 2 cohorts.

Conclusions:

In our study, THA patients with history of HA experienced increased rates of dislocation and return to operation room. These findings highlight a need for increased clinical awareness. These findings may inform intraoperative and postoperative modifications to increase prosthetic hip stability. Additionally, this knowledge can have implications for insurance billing and payments, as these cases are coded as primary THA but may present with more complexity or worse outcomes.

Keywords

Arthroscopy conversion dislocation revision THA total hip arthroplasty

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References

Kyin

Maldonado

, et al. Mid- to long-term outcomes of hip arthroscopy: a systematic review. Arthroscopy 2021; 37: 1011–1025.

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.

Redmond

Gupta

Dunne

, et al. What factors predict conversion to THA after arthroscopy? Clin Orthop Relat Res 2017; 475: 2538–2545.

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.

Shanmugaraj

Kumar

Al Naji

, et al. Hip arthroscopy improves outcomes with moderate conversion to total hip arthroplasty rates in patients aged 50 years or older: a systematic review. Arthroscopy 2023; 39: 1539–1551.e1.

Lemme

Veeramani

Yang

, et al. Total hip arthroplasty after hip arthroscopy has increased complications and revision risk. J Arthroplasty 2021; 36: 3922–3927.

Vovos

Lazarides

Ryan

, et al. Prior hip arthroscopy increases risk for perioperative total hip arthroplasty complications: a matched-controlled study. J Arthroplasty 2019; 34: 1707–1710.

Haughom

Plummer

Hellman

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

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.

10.

Nairn

Gyemi

Gouveia

, et al. The learning curve for the direct anterior total hip arthroplasty: a systematic review. Int Orthop 2021; 45: 1971–1982.

11.

Schwartz

Grant

Bhadra

. The learning curve for robotic-assisted total hip arthroplasty in low, medium, and high-volume surgeons. J Orthop 2024; 55: 163–168.

12.

Arakawa

Kobayashi

Kamono

, et al. Prior hip arthroscopy increases the risk of dislocation, reoperation, and revision after hip arthroplasty: an updated meta-analysis and systematic review. J Orthop Sci 2024; 29: 157–164.

13.

Salimy

Paschalidis

Dunahoe

, et al. Patient-reported outcomes following revision total hip arthroplasty demonstrate less improvement and significantly higher rates of worsening compared to primaries. J Arthroplasty 2023; 38: 2410–2414.

14.

Mortensen

Metz

Froerer

, et al. Hip capsular deficiency-a cause of post-surgical instability in the revision setting following hip arthroscopy for femoroacetabular impingement. Curr Rev Musculoskelet Med 2021; 14: 351–360.

15.

Schwartz

Goel

Sweeney

, et al. Capsular management in direct anterior total hip arthroplasty: a randomized, single-blind, controlled trial. J Arthroplasty 2021; 36: 2836–2842.

16.

Sun

Zhu

Zeng

, et al. The effect of posterior capsule repair in total hip arthroplasty: a systematic review and meta-analysis. BMC Musculoskelet Disord 2020; 21: 263.

17.

Duplantier

McCulloch

Nho

, et al. Hip dislocation or subluxation after hip arthroscopy: a systematic review. Arthroscopy 2016; 32: 1428–1434.

18.

Sinkler

Magister

, et al. Femoral version may impact hip arthroscopy outcomes in select patient populations: a systematic review. Arthroscopy 2023; 39: 114–127.

19.

Nathani

Safran

. Hip arthroscopy - state of the art in 2018. Sports Med Arthrosc Rev 2018; 26: 185–189.

20.

Colvin

Harrast

Harner

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

21.

Domb

Chen

Shapira

, et al. The evolution of hip arthroscopy: what has changed since 2008—a single surgeon’s experience. Arthroscopy 2020; 36: 761–772.

22.

Domb

Gui

Lodhia

. How much arthritis is too much for hip arthroscopy: a systematic review. Arthroscopy 2015; 31: 520–529.

23.

Betensky

. Measures of follow-up in time-to-event studies: why provide them and what should they be? Clin Trials 2015; 12: 403–408.

24.

Kunutsor

Barrett

Beswick

, et al. Risk factors for dislocation after primary total hip replacement: meta-analysis of 125 studies involving approximately five million hip replacements. Lancet Rheumatol 2019; 1: e111–e121.

25.

Hermansen

Viberg

Hansen

, et al. “True” cumulative incidence of and risk factors for hip dislocation within 2 years after primary total hip arthroplasty due to osteoarthritis: a nationwide population-based study from the Danish Hip Arthroplasty Register. J Bone Joint Surg Am 2021; 103: 295–302.

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