The two-year incidence of hip osteoarthritis after arthroscopic hip surgery for femoroacetabular impingement syndrome

Abstract

Background One of the reported goals of hip preservation surgery is to prevent or delay the onset of osteoarthritis. This includes arthroscopic surgery to manage Femoroacetabular Impingement (FAI) Syndrome. The purpose of this study was to describe the prevalence of clinically-diagnosed hip OA within 2 years after hip arthroscopy for FAI syndrome, and 2) determine which variables predict a clinical diagnosis of OA after arthroscopy. Methods Observational analysis of patients undergoing hip arthroscopy between 2004 and 2013, utilizing the Military Health System Data Repository. Individuals with prior cases of osteoarthritis were excluded. Presence of osteoarthritis was based on diagnostic codes rendered by a medical provider in patient medical records. Adjusted odds ratios (95% CI) for an osteoarthritis diagnosis were reported for relevant clinical and demographic variables. Results Of 1870 participants in this young cohort (mean age 32.2 years), 21.9% ( N = 409) had a postoperative clinical diagnosis of hip osteoarthritis within 2 years. The 3 significant predictors in the final model were older age (OR = 1.04; 95%CI = 1.02, 1.05), male sex (OR = 1.31; 95%CI = 1.04, 1.65), and having undergone an additional hip surgery (OR = 2.33; 95% CI = 1.72, 3.16). Military status and post-surgical complications were not risk factors. Conclusion A clinical diagnosis of hip osteoarthritis was found in approximately 22% of young patients undergoing hip arthroscopy in as little as 2 years. These rates may differ when using alternate criteria to define OA, such as radiographs, and likely underestimate the prevalence. A more comprehensive approach, considering various criteria to detect OA will likely be necessary to accurately identify the true rates. Females were at lower risk, while increasing age and multiple surgeries increased the risk for an OA diagnosis. OA onset still occurs after “hip preservation” surgery in a substantial number of individuals within 2 years. This should be considered when estimating rates of disease prevention after surgery. Prospective trials with sound methodology are needed to determine accurate rates and robust predictors of osteoarthritis onset after hip preservation surgery.

Risk Factors for Conversion of Hip Arthroscopy to Total Hip Arthroplasty: A Large Closed-Cohort Study

“…The present study did not find BMI, sex, or race to be predictive of conversion to THA within 2 years. Other studies have also shown that prior hip arthroscopy or surgeries have been associated with predictors of clinical outcomes, 14 , 31 whereas the present study did not note prior hip arthroscopy as a significant predictor of conversion, despite it being statistically significant. Additional factors previously associated with conversion have been worsening preoperative evidence of arthritic changes or chondral damage 20 , 22 , 23 , 25 , 26 , 28 , 33 , 34 , 35 or acetabular morphology.…”

“…It is important to consider that prior studies have not used a consistent definition of osteoarthritis or “failure” of hip arthroscopy. The manner in which studies evaluate progression of disease and outcomes have included clinical diagnoses and electronic medical record coding, 14 patient-reported outcome measures, 6 , 12 , 13 , 24 imaging changes, 7 , 15 and subsequent hip arthroscopy or THA. 2 , 4 , 13 , 18 , 19 , 25 Because of the variability in defining outcomes, it is important to evaluate each study’s outcome measures carefully.…”

“…Sex has been identified as a risk factor for poor outcomes in several studies, though they are inconsistent as to male or female. 12 , 14 , 16 , 18 , 26 A recent systematic review correlated female sex with negative outcomes. 27 On the other hand, some studies report no difference based on sex 28 , 29 or suggest that there may be variable impact of sex based on age.…”

“… 11 , 12 Several studies have evaluated correlates of hip arthroscopy with subsequent hip arthroscopy, imaging-determined degenerative changes, or conversion to THA. 4 , 7 , 13 , 14 , 15 Factors associated with failure of hip arthroscopy to manage symptoms have varied among studies but have included body mass index (BMI), sex, age, preoperative patient-reported outcome measures, workers’ compensation, preoperative radiographic arthritis scoring, and prior hip surgery. 4 , 6 , 12 , 13 , 14 , 16 Given the increasing use of hip arthroscopy, it is of interest to evaluate current risks of failure in large patient populations with adequate follow-up; there have been limited data on hip arthroscopy in closed patient cohorts.…”

Achieving a Perfectly Spherical Femoroplasty: Pearls, Pitfalls, and Optimal Surgical Technique

“…Instead, many studies have focused on results of hip arthroscopy overall, including patient indications and complications. 32,33 Operative hip is in 0o flexion, 0o rotation (neutral position); (B) The C-arm is set to 0 tilt, À10 cantilever. Note: the patient is intentionally placed in Trendelenburg to minimize perineal pressure.…”