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

Abstract

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.

Risk factors for conversion to arthroplasty after hip arthroscopy for femoroacetabular impingement

“…Several studies note a particularly increased association of age >40 years with conversion to arthroplasty, however in the present study the patient´s age was not a predictive factor. 3,7,10,13,15,22 These findings may indicate that hip arthroscopy treatment can lead to a good clinical result, regardless of age.…”

“…The most commonly reported reoperation after hip arthroscopy is THA. [10][11][12][13][14][15][16] The patient should be informed about the risk of failure, therefore, risk factors that predicts THA after hip arthroscopy should be identified.…”

A lower extremity rehabilitation system for ground training at 16 weeks after total hip arthroplasty: a randomized controlled trial

“…With the increasing incidence of femoral neck fractures and femoral head necrosis, total hip arthroplasty is currently the most effective and ideal treatment method due to its advantages of minimal injury, quick recovery and short bed rest time [1][2] . Total hip arthroplasty can effectively relieve patients' pain, improve joint function, enhance quality of life and reduce family burden [3][4][5] , and has satisfactory medium and long-term treatment results [6] . Factors affecting the patient's ability to start walking and weight-bearing exercises after surgery include the type of hip prosthesis, the surgical approach and the recovery of the patient's muscle strength and balance [7] .…”

Patient Outcomes Are Not Improved by Platelet-Rich Plasma Injection Onto the Capsule at the Time of Closure During Hip Arthroscopy for Femoroacetabular Impingement Syndrome

“… 2 Multiple studies have demonstrated the increasing use of hip arthroscopy over time, 3 , 4 with increased incidence seen in all age groups from adolescents (10-18 years old), 5 to adults (18-64 years old), 6 to the elderly population (65-74 years old). 7 …”