Does hip preservation surgery prevent arthroplasty? Quantifying the rate of conversion to arthroplasty following hip preservation surgery

Abstract

Hip arthroscopic surgery for femoroacetabular impingement and periacetabular osteotomy (PAO) for dysplasia is the most commonly used contemporary treatment for these conditions and has been shown to provide pain relief and restore function. What is less understood and perhaps of more interest to health economists, is the role of these procedures in preserving the hip joint and avoiding hip arthroplasty. The aim of this systematic review was to determine whether hip joint preservation surgery, indeed, preserves the hip joint by looking at conversion rates to total hip arthroplasty (THA). Two separate searches were undertaken, using PRISMA guidelines and utilizing PubMed and Open Athens search engines, identifying manuscripts that looked at conversion to THA following either hip arthroscopy (HA) or PAO. When considering HA, we found 64 eligible papers. Out of these studies, there were 59 430 hips with 5627 undergoing conversion to THA (9.47% [95% CI 9.23–9.71%]) with a mean conversion time of 24.42 months. Regarding PAO, there were 46 eligible papers including 4862 patients who underwent PAO with subsequent conversion to THA in 404 patients (8.31% [95% CI 7.54–9.12%]). with a mean conversion time of 70.11 months. Certain features were associated with increased conversion rates, including increasing age, worsening arthritis and joint space <2 mm. This study demonstrates that the mean conversion rates to be <10% for HA and PAO, during the mean follow-up periods of included manuscripts. Joint preserving surgery appears to defer or at least delay the need for THA.

The role of iliocapsularis in hip pathology: a scoping review

“…Determining the size of the iliocapsularis could be of conceivable use in patients with hip symptoms featuring signs of both borderline hip dysplasia and subtle cam-type deformities. In the last 10 years, hip arthroscopy has grown to become an integral part of the treatment of hip pathology [ 22 ]; however, arthroscopic surgery for hip dysplasia remains controversial [ 23 ]. It can be often difficult for the clinician to define the predominant pathophysiological issue in symptomatic hips with features of both borderline dysplasia [defined as a lateral centre-edge angle (LCEA) between 20° and 25°] [ 24 , 25 ] and cam-type femoroacetabular impingement (FAI) [ 22 , 26 ].…”

Pelvic osteotomies for acetabular dysplasia: Are there outcomes, survivorship and complication differences between different osteotomy techniques?

“…In a more recent systematic review, Sohatee et al . [ 33 ] observed a THA conversion rate of 8.3% among 4862 patients, with a mean conversion time of 5.8 years after undergoing PAO. At an average of 11–13 years following RAO, the survival rate with THA as an endpoint has been reported to range between 95% and 100% [ 34 ].…”

Outcomes of Hip Arthroscopy in Patients with Femoroacetabular Impingement and Concomitant Tönnis Grade II Osteoarthritis or Greater: Protocol for a Systematic Review

“…It is hypothesized that femoroacetabular impingement may lead to earlier development of hip osteoarthritis (OA) [ 3 ]. FAI is treated either conservatively with activity-modification and physiotherapy [ 4 ] or with joint-preservation surgery, mainly hip arthroscopy (HA) or in specific cases, periacetabular osteotomies (PAO) or surgical hip dislocations [ 5 ]. The aim of such surgery is to reshape the hip joint to prevent impingement (abnormal mechanical contact) [ 6 ] and normalise stresses in the hip joint [ 7 ] and also address any concomitant extra-articular causes if present [ 8 9 ].…”

“…However, outcomes for FAI and concomitant moderate- to advanced hip osteoarthritis (Tönnis Grade II or greater), for both hip arthroscopy or conservative regimens, is still a matter of intense debate as the best treatment remains controversial [ 13 14 ]. As such, it is still unclear whether patients with FAI and signs of osteoarthritis would benefit from preservation surgery or should with conservative management or a joint replacement [ 5 ]. An important concern in young adults receiving a total hip replacement (THR), is the probability that they will most likely require multiple revisions in their lifetime [ 15 ], leaving the ultimate long-term outcome questionable.…”