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Hip arthroscopy linked with improved clinical outcomes in patients with Tönnis grade 1
Patients with Tönnis grade 1 who underwent arthroscopic treatment of femoroacetabular impingement and labral tears experienced similar, durable improvements compared with patients with Tönnis grade 0, according to results.
“There is a paucity of literature regarding midterm outcomes of hip arthroscopy for the treatment of [femoroacetabular impingement] FAI and labral tear in patients with mild [osteoarthritis] OA,” Benjamin G. Domb, MD, told Healio.com/Orthopedics. “This study demonstrates the outcomes of this group of patients and shows the outcomes compared to a matched non-arthritic control group.”
Domb and his colleagues prospectively collected data on 292 hips that underwent arthroscopic surgery for femoroacetabular impingement and labral tears and had either Tönnis grade 1 (n=85) or Tönnis grade 0 (n=207). Researchers also collected preoperative patient-reported outcome scores, including the modified Harris Hip score, non-arthritic hip score, hip outcome score–sport-specific subscale and VAS for pain. In a further analysis, researchers compared 62 hips with Tönnis grade 1 with 62 hips with Tönnis grade 0 that were matched for age, BMI, sex, labral treatment and capsular treatment.
Results showed significant improvements in all patient-reported outcomes and VAS scores for patients with Tönnis grade 1 at 5-year follow-up. Researchers noted an overall satisfaction score of 8.2. According to results, survivorship rate at 5 years with respect to conversion to total hip arthroplasty was 69.4% and 88.4% in the Tönnis grade 1 group and Tönnis grade 0 group, respectively.
When comparing the two groups, researchers found improvements in all patient-reported outcome and VAS scores from preoperatively to postoperatively in both groups, as well as no significant differences between preoperative or postoperative scores or survivorship. – by Casey Tingle
Disclosures: Domb reports he receives personal fees and other support from Arthrex, Pacira and Stryker; receives other support from Breg and ATI; and receives personal fees from Orthomerica, DJO Global, Amplitude and Medacta. Please see the full study for a list of all other authors’ relevant financial disclosures.
Perspective
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Hip arthroscopy is a beneficial surgical tool in the treatment of FAI and chondrolabral pathology. Prior evidence has suggested arthroscopic hip surgery may have limited benefit in patients with hip OA.
Domb and colleagues sought to evaluate outcomes for arthroscopic treatment of FAI and labral tears in patients with mild preoperative OA (Tönnis grade 1) at a minimum 5-year follow-up. They also performed a matched-pair comparison to a control group with Tönnis grade 0 OA. The authors included 85 hips with Tönnis grade 1 OA status. Among these patients, there was significant improvement in patient reported outcomes measures, as well as a high rate of patient satisfaction. When looking at survivorship with conversion to total hip arthroplasty (THA) as an endpoint, survivorship at 5 years was 69.4% in the Tönnis grade 1 group and 88.4% in the Tönnis grade 0 group. However, after controlling for other variables using a matched-pair comparison, patients with Tönnis grade 1 had similar survivorship to patients with Tönnis grade 0. It should be noted though that the matching process in this study led to a control group that was older and had a higher BMI (all known risk factors for conversion to THA).
There is a paucity of studies demonstrating durability and good outcome after arthroscopic treatment of FAI in patients with mild hip OA. A few prior studies have demonstrated acceptable outcome of hip arthroscopy in patients with mild hip OA; however, these studies were limited by short-term follow-up. Domb and colleagues included patients with a minimum 5-year follow-up and, as such, were able to demonstrate durable outcome in these patients for the medium to long term. Given the lack of longer term outcome reporting, the current study is an important addition to the literature.
Despite the positive outcomes demonstrated in this study, indications for arthroscopic treatment of FAI in patients with mild arthritis should be carefully considered. Prior to matching, survivorship in the Tönnis grade 1 group was 69.4%. Patients with mild hip OA should still be carefully counseled about their expected outcome and survivorship.