Arthroscopy may favorably alter natural history of OA in patients with hip impingement
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Key takeaways:
- Arthroscopy for hip impingement may reduce the risk of osteoarthritis progression vs. nonoperative treatment.
- Worse preoperative Tönnis grades may be a risk factor for progression of arthritis.
Published results showed arthroscopic correction was associated with favorable outcomes for patients with femoroacetabular impingement despite a similar progression of osteoarthritis vs. patients who received nonoperative treatment.
Researchers at Hospital for Special Surgery analyzed data from 100 patients (200 hips) who received primary unilateral hip arthroscopy (100 hips) or nonoperative treatment (100 hips) for femoroacetabular impingement (FAI) between 2010 and 2012. Outcome measures included radiographic progression of OA and Tönnis classification. Researchers noted 98% of operative hips and 99% of nonoperative hips were Tönnis grade 0 or grade 1 preoperatively.
At a mean follow-up of 12 years, researchers found 70% of patients who underwent either operative or nonoperative treatment showed no differences in Tönnis grades. Operative hips had better Tönnis grades in 25% of patients, while nonoperative hips had better Tönnis grades in 5% of patients. Overall, 28% of operative hips and 48% of nonoperative hips advanced to a worse Tönnis grade at final follow-up.
After subgroup analysis, researchers found arthroscopy was associated with a 42% relative risk reduction in progression of OA vs. nonoperative treatment. They noted older patient age, impingement with dysplasia, a worse preoperative Tönnis grade and an alpha angle greater than 65° were risk factors for OA progression.
“Although the majority of patients undergoing hip arthroscopy for FAI did not experience differences between operative and nonoperative hips in terms of the radiographic progression of OA, the natural history may be favorably altered for 25% of patients whose Tönnis grade was better after undergoing arthroscopic correction,” the researchers wrote in the study.
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