Hip Arthroscopy in Patients Ages 50 Years or Older: Minimum 5-Year Outcomes, Survivorship, and Risk Factors for Conversion to Total Hip Replacement

Arthroscopy. 2018 Nov;34(11):3001-3009. doi: 10.1016/j.arthro.2018.05.034. Epub 2018 Oct 6.

Abstract

Purpose: To report minimum 5-year outcomes and risk factors for conversion to total hip arthroplasty (THA) in patients ≥50 years old undergoing hip arthroscopy to treat labral tears and femoroacetabular impingement (FAI).

Methods: Data were prospectively collected on patients who underwent hip arthroscopy to treat labral tears and FAI between February 2008 and January 2012. The inclusion criteria were ≥50 years old at surgery, arthroscopic treatment for both labral tears and FAI, and preoperative patient-reported outcome (PRO) scores for modified Harris Hip Score (mHHS), Nonarthritic Hip Score (NAHS), Hip Outcome Score-Sports Specific Subscale (HOS-SSS), and Visual Analog Scale (VAS). The exclusion criteria were Tönnis grade > 1 and previous hip conditions or surgeries.

Results: Of 103 eligible cases, 94 hips (91.3%) had minimum 5-year follow-up at a mean of 70.1 months (range, 60.0-95.1 months). All PROs and VASs demonstrated significant improvement at latest follow-up (P = .0001). Mean patient satisfaction was 8.4. All mean scores demonstrated durability from 2 years to latest follow-up, and NAHS (P = .009), HOS-SSS (P = .02), and VAS (P = .04) continued to significantly improve. Fifty-one (54.3%) of cases reached patient acceptable symptomatic state for mHHS, and 49 cases (52.1%) achieved minimal clinically important difference for this outcome measure. Four cases (4.3%) required secondary arthroscopy, and survivorship was 72.3%. Compared with survivors, the subgroup requiring THA demonstrated higher body mass indexes (P = .01), had larger alpha angles (P = .0200) and smaller lateral center-edge angles (P = .0200), and had higher proportions of Tönnis grade 1 (P = .0012), acetabular Outerbridge grade ≥ 2 (P = .0500), and femoral head Outerbridge grade ≥2 (P = .0001).

Conclusions: Hip arthroscopy for the treatment of labral tears and FAI in patients ≥50 years old demonstrates statistically significant PRO improvements at minimum 5-year follow-up. However, due to potential for subsequent need for THA in a subset of this population, surgeons should use rigorous selection criteria and counsel patients appropriately.

Level of evidence: Level IV, case series.

MeSH terms

  • Acetabulum / diagnostic imaging
  • Acetabulum / injuries
  • Acetabulum / surgery*
  • Aged
  • Arthroplasty, Replacement, Hip / methods*
  • Arthroscopy / methods*
  • Female
  • Femoracetabular Impingement / diagnosis
  • Femoracetabular Impingement / etiology
  • Femoracetabular Impingement / surgery*
  • Follow-Up Studies
  • Hip Fractures / complications
  • Hip Fractures / diagnosis
  • Hip Fractures / surgery*
  • Hip Joint / diagnostic imaging
  • Hip Joint / surgery*
  • Humans
  • Male
  • Middle Aged
  • Patient Reported Outcome Measures
  • Patient Satisfaction
  • Radiography
  • Risk Factors
  • Time Factors
  • Treatment Outcome