Hip Arthroscopy for Osteoarthritis Associated With Unacceptably High Conversion to Total Hip Replacement

May 20, 2020

The percentage of patients with hip osteoarthritis who had a hip replacement within 2 years of hip arthroscopy was unacceptably high at 68%, according to a study of more than 2,600 patients published in HIP International.

Within 2 years of having had arthroscopy, about two-thirds of patients with hip osteoarthritis had undergone a total hip replacement. The study also found that prior hip arthroscopy was associated with significantly higher risks of revision hip replacement surgery, joint implant loosening, and joint infection after hip replacement.

“Our study is the first to quantify the clinical outcomes and risks of complications from having hip arthroscopy before total hip replacement in patients with osteoarthritis,” said senior author Alexander S. McLawhorn, MD, Hospital for Special Surgery, New York, New York. “Our results suggest that arthroscopy should be avoided in patients with hip arthritis, especially in those over the age of 65 years.”

For their study, the investigators examined Medicare data from a large national insurance database called the PearlDiver Patient Records Database. They identified more than 5,200 patients with hip osteoarthritis who had undergone a total hip replacement procedure between 2005 and 2016, and grouped them according to whether they had received hip arthroscopy before hip replacement. After matching to ensure there were no differences between groups in age, sex, smoking status, obesity or other health conditions, each group contained data for 2,600 patients. The majority (82%) of patients were aged older than 65 years.

Overall, a total of 1,790 (68%) patients who had received hip arthroscopy to treat osteoarthritis had undergone a total hip replacement procedure within 2 years. Patients who had a prior hip arthroscopy had 3.7 times greater risk of needing revision hip replacement surgery, 2.8 times greater risk of implant loosening, and 1.9 times higher risk of joint infection after hip replacement, compared with patients who had not had hip arthroscopy prior to their hip replacement.

Within 2 years of total hip replacement, 3.4% of patients in the arthroscopy group required revision surgery compared with 2.1% in the non-arthroscopy group. In the same period, rates of complications were higher for the arthroscopy group compared with the non-arthroscopy group, including dislocation (3.2% vs 2.3%), joint infections (2.9% vs 1.6%), and joint loosening (2.3% vs 1.0%).

“These risk percentages may seem small, but they are critically important,” said Dr. McLawhorn. “The goal is to drive complications down to as close to zero as possible. No patient should undergo an unnecessary procedure, even if the downstream risk of a complication is small. A joint replacement infection, for example, is a life-altering event.”

Reference: https://journals.sagepub.com/doi/full/10.1177/1120700020911043

SOURCE: Hospital for Special Surgery