Chondral degeneration and therapeutic hip arthroscopy

Abstract

Therapeutic hip arthroscopy for the treatment of chondral degeneration remains controversial. A retrospective cohort study examined 70 patients of mean age 47 (range 22-87) years who had undergone hip arthroscopy and assessed them for evidence of chondral degeneration using radiological and arthroscopic means. Clinical outcome was assessed using a modified Farjo and Glick classification. Thirty-nine patients had evidence of chondral degeneration on arthroscopy with or without radiological diagnosis, and 31 had alternative pathology. If patients were found to have chondral degeneration at arthroscopy, they were significantly more likely to have a poor clinical result than if an alternative diagnosis such as a loose body or labral tear was made (p<0.0001). Patients with evidence of degenerative changes on plain hip radiographs were significantly more likely to have a poor clinical result following hip arthroscopy than patients with unremarkable hip radiographs (p<0.0001). Therapeutic hip arthroscopy for osteoarthritis should be used with caution, as a poor clinical result is significantly more likely compared to other pathologies such as a labral tear or loose body.Résumé L'arthroscopie thérapeutique de la Hanche pour le traitement des chondropathies reste controversé. Une étude rétrospective d'une cohorte de 70 malades d'âge moyen 47 ans (22-87) qui avait subi arthroscopie de la hanche a été faite avec étude de la chondropathie à partir des données radiologiques et arthroscopiques. Le résultat clinique a été noté en utilisant une classification modifié de Farjo et Glick. Thirty-nine malades avaient une chondropathie arthroscopique, avec ou sans diagnostic radiologique, et 31 avaient une pathologie alternative. Si les malades avaient une chondropathie, ils avaient significativement un plus mauvais résultat clinique que s'ils avaient une autre pathologie, comme un corps étranger ou une déchirure du labrum (p<0.0001). Les patients avec des signes radiologiques dégénératifs avaient un plus mauvais résultat clinique que ceux avec une radiographie normale (p<0.0001). Les arthroscopies thérapeutiques pour arthrose devraient être utilisées avec prudence car le résultat cinique est moins bon que dans les autres pathologies comme les corps étrangers ou les déchirures du labrum.

Does Arthroscopic FAI Correction Improve Function with Radiographic Arthritis?

“…Similar to our study, Horisberger et al reported a 60% (12 patients) failure rate using non-arthritic hip score (NAHS) in 20 patients with radiographic OA (Tonnis Grades 1-3) at a mean last followup of 3 years [14]. Most studies evaluating hip arthroscopy in the setting of OA predate FAI bony resections [4,8,13,17,18,23,27,35] ( Table 6). Margheritini and Villar [23] evaluated 133 patients with hip OA who underwent hip arthroscopy and reported a 39% failure rate at a mean followup of 18 months using the HHS.…”

“…In addition, we found that a greater duration of symptoms preoperatively was an independent predictor of poorer scores and higher failure rates, and increasing MRI chondral grade was an independent predictor of poorer scores (Tables 3-5). Two prior studies report increased failure rates with greater degrees of intraoperative chondral disorders in the presence of preoperative radiographic OA [8,35]. In addition, Margheritini and Villar [23] found that greater age was predictive of a poorer HHS for HHS = Harris hip score; NAHS = non-arthritic hip score; JOA = Japanese orthopaedic association pain score; A = longer duration of symptoms; B = greater preoperative joint space narrowing/OA grade; C = greater intraoperative chondral damage; D = greater age; NA = not available.…”

“…Studies show that the presence of OA negatively impacts outcomes after hip arthroscopy and nonarthroplasty open hip surgery [2,4,8,13,14,17,18,23,25,27,[29][30][31][32]35]. However, most studies predate FAI correction, are limited to small numbers, or lack well-defined independent predictors of improved function or failure rates after managing FAI in the presence of OA.…”

“…Margheritini and Villar [23] evaluated 133 patients with hip OA who underwent hip arthroscopy and reported a 39% failure rate at a mean followup of 18 months using the HHS. Walton et al [35] reported 72% poor results at a minimum 4 months followup using the classification of Farjo et al [8] in a cohort of 39 patients with OA who underwent hip arthroscopy. Byrd and Jones [4] evaluated 50 patients with a minimum of 10 years followup; 14 of these patients had preoperative radiographic OA.…”

“…This disorder can result in labral-chondral injury and eventual osteoarthritic changes in the hip [2,7,10,25,29]. Numerous studies show the presence of OA negatively impacts improvements in pain and function after hip arthroscopy and nonarthroplasty open hip surgery [2,4,8,13,14,17,18,23,25,27,[29][30][31][32]35]. However, the majority of these studies predate resection of FAI impingement lesions [4,8,13,17,18,23,27,35], or are limited to small numbers [2,14,25,32].…”