by Elizabeth Hofheinz, M.P.H., M.Ed.
A team of researchers from Hospital for Special Surgery (HSS) studying 2,600 patients has found that the percentage of patients with hip osteoarthritis (OA) who had a hip replacement within two years of hip arthroscopy was a whopping 68%. In addition, having undergone prior hip arthroscopy was associated with significantly worse outcomes after hip replacement.
Their study, “Hip arthroscopy for hip osteoarthritis is associated with increased risk for revision after total hip arthroplasty,” appeared in the March 3, 2020 online edition of Hip International.
Alexander McLawhorn, M.D., M.B.A., a hip and knee surgeon at HSS, told OSN, “We had observed suboptimal outcomes and more complications after total knee replacement in patients with prior knee arthroscopy compared to patients who had never had a knee arthroscopy. Also, we had observed that patient reported outcomes – patients’ subjective assessment of their outcomes – after total hip replacement were lower in patients who had prior hip arthroscopy versus those who did not.”
The study, the first to quantify the clinical outcomes and risks of complications of hip arthroscopy before total hip replacement in OA patients, is available online as part of the AAOS 2020 Virtual Education Experience and is currently published online on HIP International.
Using Medicare data from a large national insurance database (PearlDiver Patient Records Database), the team identified more than 5,200 patients with hip arthritis who had undergone a total hip replacement procedure between 2005 and 2016. Patients were categorized as to whether they had received hip arthroscopy before hip replacement; there were 2,600 patients in each group.
Dr. McLawhorn commented to OSN, “First, there was a very high rate of conversion to total hip replacement within two years of hip arthroscopy, when arthroscopy was performed in the setting of hip arthritis. Second, there was a significantly higher odds of serious complications, including reoperation, infection, implant loosening and dislocation, after hip replacement in patients with a history of prior hip arthroscopy.”
Indeed, 1,790 (68%) of patients who had received hip arthroscopy for OA had undergone a total hip replacement procedure within two years. According to the study, “Patients who had a prior hip arthroscopy had 3.7 times greater risk of needing revision hip replacement surgery, 2.8 times greater risk of implant loosening and 1.9 times higher risk of joint infection after hip replacement, compared to patients who had not had hip arthroscopy prior to their hip replacement.”
“Within two years of total hip replacement, 3.4% of patients in the arthroscopy group required revision surgery compared to 2.1% in the non-arthroscopy group. In the same period, rates of complications were higher for the arthroscopy group compared to the non-arthroscopy group as follows: dislocation 3.2% versus 2.3%; joint infections 2.9% versus 1.6%; and joint loosening 2.3% versus 1.0%, respectively.”
Dr. McLawhorn told OSN, “In the majority of patients with hip arthritis, hip arthroscopy is probably a low value procedure to be avoided or approached with extreme caution. Surgeons often focus on potential benefits of interventions without appropriate acknowledgement of potential risks. In this case, if hip arthroscopy is offered to patients with underlying hip arthritis, the real risk of conversion to total hip replacement should be discussed along with the potential negative effects of arthroscopy on the subsequent replacement.”
“I think it should be noted that there may be a subset of patients with hip arthritis who benefit from hip arthroscopy (with or without concomitant interventions), as one third of patients did not undergo immediate conversion to total hip replacement. This population deserves closer study in order to refine the indications, if any, for hip arthroscopy in the arthritic hip.”