High revision, conversion rates found among young and old patients after hip arthroscopy
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Despite a plateau in the rate of hip arthroscopy procedures, published results showed patients younger than 30 years had a higher revision rate and patients older than 50 years had a higher conversion rate to total hip arthroplasty.
Alan L. Zhang, MD, and colleagues identified 53,103 patients in the Mariner PearlDiver dataset who underwent hip arthroscopy from 2010 to 2017. Researchers recorded patient demographics and tracked subsequent hip arthroscopy procedures and THA conversion within 2 years after surgery using ICD-10 codes to accurately identify laterality. Researchers also queried ED and hospital admission within 30 days after surgery.
Results showed a twofold increase in hip arthroscopy case volume from 2010 to 2014. However, the case volume remained relatively unchanged from 2014 to 2017. Researchers found patients 40 to 49 years old were the most common age group undergoing surgery, while female patients represented 70% of cases. Researchers noted a 2-year subsequent surgery rate of 19%, with 15.1% of patients undergoing revision arthroscopy and 3.9% of patients converting to THA. Femoroplasty, labral repair and acetabuloplasty were the most common revision arthroscopy procedures, according to results. Researchers found younger patients were more likely to undergo revision arthroscopy, while older patients had a significant risk for conversion to THA within 2 years. Researchers also found a slightly higher rate of conversion to THA among female patients compared with male patients. The highest risk of ED admission and hospital admission within 30 days of surgery was among patients 20 to 29 years old, according to results.
“The main results of this study showed that the previously reported rising rate of hip arthroscopy surgery in the United States may be starting to plateau in this large cross-sectional population. This administrative dataset also revealed a higher-than-expected rate of revision hip arthroscopy within 2 years of the index surgery in young patients, with the most common revision procedures being arthroscopic femoroplasty and labral repair. In older patients, their rate of conversion to hip arthroplasty within 2 years of hip arthroscopy was very high,” Zhang told Healio Orthopedics. “These results may further caution hip arthroscopy surgery for patients [older than] 50 [years] but also demonstrate the need for a thorough femoroplasty and robust labral repair at the index surgery in young patients, as revision hip arthroscopy to address these areas may be more common than previously reported.”
Perspective
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Alexander S. McLawhorn, MD, MBA
The overall reoperation rate within 2 years of the index hip arthroscopy procedure was 19%, which I think most surgeons would consider to be high. Most of these reoperations were repeat hip arthroscopies, and 4% were THA. It is interesting to note that women and patients aged 40 to 49 years were the most common groups of patients to receive hip arthroscopy in this study. In fact, 70% of patients were female and more than 50% were aged 40 years or older. Not surprisingly, older patients and female patients were at greater risk for conversion to THA after arthroscopy, with THA being the most frequent reoperation in patients 40 years of age and older in this study.
Although the subgroup analyses exploring underlying diagnoses were not reported in this study, it is my opinion that hip arthroscopy should not be performed if there is underlying hip osteoarthritis. Approximately two-thirds of Medicare-aged patients with hip arthritis undergoing hip arthroscopy will require conversion to THA within 2 years of the arthroscopy, and the risk of THA failure is nearly four times that of patients without having prior arthroscopy.
Despite the limitations of an observational study using an insurance claims database, I think this study underscores the importance of a careful preoperative assessment to identify accurately the pain generator within and around the hip joint, with scrutiny of the hip joint for underlying arthritic change, particularly in patients older than 40 years of age.
Reference:
Malahias MA, et al. Hip Int. 2020;doi:10.1177/1120700020911043.
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