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Hip arthroscopy a valid treatment option for older patients with hip pain
Among patients ages 50 years and older with a Tönnis arthritic grade of 0 or 1, hip arthroscopy should be considered a valid treatment option for hip pain, with older patients being counseled on the possibility of later conversion to total hip arthroplasty, according to researchers.
The researchers prospectively collected data between September 2008 and March 2010 for patients ages 50 years or older undergoing primary hip arthroscopy. Fifty-two patients meeting inclusion criteria were compared with a matched-pair control group of patients ages 30 years and younger who underwent similar procedures. Mean follow-up period was 32 months.
Results showed score improvement of in the older study group of 61.2 to 82.2 for the modified Harris Hip Score vs. 62.9 to 84.2 in the younger control group. The researchers also observed an increase in Non-Arthritis Hip Score from 59.9 to 80.4 in the older study group vs. 60.5 to 84.2 in the younger control group. Hip Outcome Score – Activities of Daily Living increased from 63.9 to 83 in the older study group and from 63.1 to 86.5 in the younger control group, whereas Hip Outcome Score – Sport-Specific Subscale increased from 41.2 to 64.6 in the older study group and from 42.2 to 72.7 in the younger control group, according to the researchers.
Benjamin G. Domb
At the 2-year postoperative follow-up, the researchers found all improvements were statistically significant in both groups; however, no significant differences between the groups were found for any patient-reported outcome scores at final follow-up.
Results also showed no significant difference between both group when the researchers compared the change in patient-reported outcome scores from preoperatively with those of 2 years postoperatively.
According to study results, the older study group had an overall survivorship rate of 82.7% vs. 98.1% for the younger control group. – by Casey Tingle
Disclosure: Domb received support from Arthrex, MAKO Surgical, Pacira, American Hip Institute, Breg, MedWest, ATI, Orthomerica, DJO Global and Stryker. Please see the full study for a list of all other authors’ relevant financial disclosures.
Perspective
Back to TopIn a study published in Arthroscopy: The Journal of Arthroscopic and Related Surgery in February 2015, Domb et al reported their two-year outcome data on hip arthroscopy in patients over the age of 50 compared to a matched control group of patients under the age of 30.
The authors demonstrated similar improvements in patient reported outcome and patient satisfaction scores between the two groups. However, as with most orthopedic procedures, the authors also note that careful patient selection is paramount.
In this matched study, all patients had minimum two year follow-up, underwent primary hip arthroscopy, and had an osteoarthritic Tonnis grade of 0 or 1. As well, patients were matched by gender, arthritic grade, cross-over percentage, Worker's Compensation claims, and type of labral procedure.
We know from previous reports [Larson, CORR 2011] that patients undergoing hip arthroscopy with Tonnis grades greater or equal to 2 have much higher rates of osteoarthritic progression and convergence to total hip replacement (THR). One of the most interesting findings in this study is that although the patients had no or minimal arthritic changes, (Tonnis grade 0 or 1) 17% of the patients over the age of 50 still went on THR within two years of their index hip arthroscopy procedure.
The strengths of this study include an a priori power analysis and a matching process that controlled for numerous key variables. The main limitation of the study is the heterogeneity of the associated surgical procedures that were performed at the time of hip arthroscopy. For example, almost 50% of the patients in the less than 30 group underwent iliopsoas fractional lengthening compared to only 8% in the older study group. Conversely, approximately 30% of the over 50 group underwent trochanteric bursectomy whereas no patients in the under 30 group had this performed.
In my opinion, the take-home message from this study is that surgeons and patients need to adjust their expectations when considering hip arthroscopy in older patients and inform them that they may need conversion to THR within a short timeframe. Having said that, the vast majority of patients over the age of 50 with minimal arthritic changes can expect satisfactory outcomes from hip arthroscopy.
The authors should be commended for this excellent contribution to the literature as the study was methodologically sound, appropriately powered, and will ultimately help guide surgical decision-making in the future.