Can hip arthroscopy in the presence of arthritis delay the need for hip arthroplasty?

Viswanath, Aparna; Khanduja, Vikas

doi:10.1093/jhps/hnw050

Cited by 20 publications

(9 citation statements)

References 41 publications

(52 reference statements)

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“…They concluded that there is a correlation between an increased alpha angle >60 in FAI and OA. 16 FAI leads to chondropathies that cause pain and limited functional activities affecting activities of daily living. 17 In due course this ends in osteoarthritis.…”

Section: Fai and Hip Osteoarthritismentioning

confidence: 99%

Hip arthroscopy in osteoarthritis: Is it an option?

Cross

Sobti

Khan

2021

Journal of Clinical Orthopaedics and Trauma

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Arthritis of the hip is a degenerative disease characterised by pain and inflammation. It is common and most often affects middle-aged to older adults, with the definitive management being total hip replacement. Advances in the surgical techniques has brought about the popularity of hip preservation surgery in patients with pre-arthritic hip abnormalities, with a goal to prevent progression to early arthritis and subsequently prolong the need for arthroplasty.There is a large body of evidence correlating femoroacetabular impingement (FAI) and the progression of osteoarthritis. Hip arthroscopy is a successful technique in the management of FAI and labral damage. There is, however, less evidence behind its use in those patients with established arthritic changes.After review of such evidence, we believe hip arthroscopy, and other hip preservation procedures, have a key role, and should be considered in the management of early hip arthritis. However, there is no role for such procedures in end-stage arthritis.

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Section: Fai and Hip Osteoarthritismentioning

confidence: 99%

Hip arthroscopy in osteoarthritis: Is it an option?

Cross

Sobti

Khan

2021

Journal of Clinical Orthopaedics and Trauma

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“…FAI is a recognized risk factor for the early development of hip OA [3,7,13]. However, it is unknown whether surgical intervention with FAO delays or prevents disease progression [3,23]. Although outcomes in young, healthy patients have been encouraging, with most reporting symptom relief, the evidence in older patients, particularly those older than 40 years, is much less encouraging [6,11,14,18,19].…”

Section: Discussionmentioning

confidence: 99%

High Risk of Conversion to THA After Femoroacetabular Osteoplasty for Femoroacetabular Impingement in Patients Older than 40 Years

Yacovelli

Sutton

Vahedi

et al. 2020

Clin Orthop Relat Res

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Background Femoroacetabular impingement (FAI) is a recognized cause of hip pain and decreased quality of life and has been linked to primary idiopathic hip osteoarthritis (OA). Although the operative indications for FAI have expanded to include older patients, we do not know whether there is an increased risk of conversion to THA after femoroacetabular osteoplasty (FAO) via the mini-open approach for FAI in patients older than 40 years compared with younger patients, after controlling for other confounding variables. Questions/purposes (1) After matching for gender, BMI, preoperative symptomatic period, surgeon experience, Tönnis grade, and degree of chondral lesion, are patients older than 40 years who undergo FAO for FAI more likely to be revised to THA at a minimum of 2 years’ follow-up than are patients younger than 40? (2) Is there a difference in delta (postoperative minus preoperative) improvement in functional outcome scores in those patients who did not go on to THA between patients older than and younger than 40 years? Methods Between 2003 and 2017, one surgeon performed 281 FAOs via the mini-open approach in patients older than 40 years and 544 of the same procedure in patients younger than 40 years. During that period, the general indications for FAO were the same in both age groups: (1) history and physical exam consistent with FAI, (2) radiographic evidence of focal impingement (cam, pincer, or both), (3) evidence of labral or chondrolabral tears, and (4) minimal to no arthritic changes (all four criteria required). In general, age was not used as a contraindication for surgery. A total of 86% (241 of 281) of patients older than 40 and 91% (494 of 544) of those younger than 40 were available for minimum of 2 years’ follow-up, had complete datasets (radiographs as well as preoperative and most recent patient-reported outcomes scores) at a minimum of 2 years after surgery, and were considered eligible for the match. Propensity score matching was used to match for BMI, gender, preoperative symptomatic period, surgeon experience, Tönnis grade, and degree of intraoperative chondral lesion. We matched at a 1:2 ratio 130 patients older than age 40 with 260 patients younger than age 40. The mean ± SD follow-up duration for both groups was 5 ± 2 years. The mean age of the cohort of interest was 47 ± 5 years compared with 28 ± 7 years in the control. Fifty-four percent (70 of 130) of patients older than 40 years were women and 46% (60 of 130) were men; for those younger than 40, 51% (133 of 260) of participants were women and 49% (127 of 260) were men. Tönnis grade distribution for patients older than 40 was as follows: 46% (60 of 130) had Grade 0, 42% (55 of 130) had Grade 1, and 12% (15 of 130) had Grade 2. In comparison, Tönnis grade for patients younger than 40 was as follows: 52% (136 of 260) had Grade 0, 38% (100 of 260) had Grade 1, and 9% (24 of 260) had Grade 2 (p = 0.49). Chondral lesion degree was determined intraoperatively as none, a partial-thickness tear, or a full-thickness tear. Tönnis grade was determined based on preoperative plain AP hip radiographs. We then compared the percentage of patients who converted to THA during the surveillance period (our primary study outcome). We also compared the difference in delta (preoperative minus postoperative) improvement in functional outcome scores using the modified Harris Hip Score (mHHS) between the groups, excluding those who had already been converted to THA. Results In patients older than 40 years, 16% (21 of 130) converted to THA at a mean time to conversion of 2 ± 1 years compared with 7% (17 of 260) at a mean time of 2 ± 2 years in patients younger than 40 years (p = 0.01). At a mean of 5 ± 2 years after FAO, among those patients who had not undergone conversion to THA, the mean delta mHHS score for patients older than 40 was 11 ± 17, compared with 20 ± 26 for patients younger than 40 (p = 0.04). Conclusion Since approximately 1 in 6 patients older than 40 years in this series who underwent FAO for FAI opted for early conversion to THA at a mean time of 2 years after the osteoplasty procedure, and the remaining patients who did not undergo THA reported lower improvement in functional outcomes, we recommend surgeons avoid this procedure in patients in this age group until or unless we can better refine our indications. This is especially true because loss to follow-up causes us to believe that, if anything, our estimates of the risk of conversion to THA are conservative. Level of Evidence Level III, therapeutic study.

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“…18–20 However, the massive increase in utilisation in arthroscopic procedures in patients >65 years is surprising given the inconclusive evidence of its role in the elderly. 2,21 1 possible reason for this finding could be due to broadening surgical indications. A recent trends analysis using the same database as ours concluded that an increase in the complexity and diversity of procedures could be responsible for the upward trend in annual arthroscopies being performed.…”

Section: Discussionmentioning

confidence: 99%

Primary hip arthroscopy and conversion to total hip arthroplasty: trends and survival analysis in the Medicare population

Malik¹,

Jain²,

Glassman³

et al. 2020

HIP International

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Introduction: With limited evidence on national incidences of hip arthroscopy in the elderly population, the current study aims to investigate trends of primary hip arthroscopies being performed in the elderly population, using the US Medicare database, and determine risk factors for conversion to total hip arthroplasty (THA). Methods: Medicare Standard Analytic Files were queried using CPT codes to retrieve records of primary hip arthroscopies done for degenerative pathology during 2005–2014. Overall and age-stratified trends in the incidence of hip arthroscopy over time were analysed. Kaplan Meier survival curves were used to assess the overall 2-year conversion rate to a THA. Cox regression analysis was implemented to study risk factors for conversion. Results: 8100 primary hip arthroscopies for degenerative pathology were performed during 2005–2014. There was a 280% increase in overall incidence of arthroscopy. The most commonly performed arthroscopic procedure was for chondroplasty and/or resection of labrum, with 4712 (58.1%) procedures. Around 18.5% patients underwent arthroplasty within 2 years after primary arthroscopy. Following Cox regression an existing diagnosis of osteoarthritis, ages 65–69, ages 70–74, and arthroscopies done in the West were associated with higher risk of conversion to THA within 2 years. Undergoing a repeat arthroscopy was not significantly associated with a higher risk of conversion. Conclusions: Despite inconclusive clinical evidence, hip arthroscopies are being increasingly used in patients older than 65 in the Medicare population. We conclude that patients in the age bracket of 65–74 years and with a pre-existing diagnosis of osteoarthritis, arthroscopy should be approached with caution.

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Can hip arthroscopy in the presence of arthritis delay the need for hip arthroplasty?

Cited by 20 publications

References 41 publications

Hip arthroscopy in osteoarthritis: Is it an option?

Hip arthroscopy in osteoarthritis: Is it an option?

High Risk of Conversion to THA After Femoroacetabular Osteoplasty for Femoroacetabular Impingement in Patients Older than 40 Years

Primary hip arthroscopy and conversion to total hip arthroplasty: trends and survival analysis in the Medicare population

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