Hip arthroscopy for hip osteoarthritis is associated with increased risk for revision after total hip arthroplasty

Hip Int. 2021 Sep;31(5):656-662. doi: 10.1177/1120700020911043. Epub 2020 Mar 3.

Abstract

Background: It has not been determined yet whether hip arthroscopy (HA) leads to adverse outcomes after total hip arthroplasty (THA). The purpose of this study was to (1) determine 2-year conversion rate of HA done for osteoarthritis (OA) to THA and (2) explore the relationship between HA performed in patients with hip osteoarthritis and the risk of revision THA within 2 years of index arthroplasty.

Methods: Data was collected from the Medicare Standardized Analytic Files insurance database using the PearlDiver Patient Records Database from 2005-2016. Patients were stratified into 2 groups based upon a history of hip arthroscopy prior to THA.

Results: The 2-year conversion to THA rate for hip arthroscopy in patients with OA was 68.4% (95% CI, 66.2-70.6%). Multivariate analysis demonstrated that OA patients who underwent HA prior to THA were at an increased risk of revision surgery (OR 3.72; 95% CI, 3.15-4.57; p = 0.012), periprosthetic joint infection (OR 1.86; 95% CI, 1.26-2.77, p = 0.010) and aseptic loosening (OR 2.81; 95% CI, 1.66-4.76; p < 0.001) within 2 years of THA.

Conclusions: Analysis of a large insurance database found the conversion rate from HA performed in Medicare OA patients to THA within 2 years is unacceptably high. Hip arthroscopy prior to THA also significantly increased the risk of THA revision within 2 years after index THA. These results suggest that arthroscopic hip surgery should not be performed in patients with a diagnosis of OA as conversion rates are high and revision rates post THA are significantly increased.

Keywords: Hip arthroscopy; hip osteoarthritis; large insurance database; propensity score matched analysis; risk factors; total hip arthroplasty.

MeSH terms

  • Aged
  • Arthroplasty, Replacement, Hip* / adverse effects
  • Arthroscopy / adverse effects
  • Hip Joint / surgery
  • Humans
  • Medicare
  • Osteoarthritis, Hip* / diagnosis
  • Osteoarthritis, Hip* / epidemiology
  • Osteoarthritis, Hip* / surgery
  • Reoperation
  • Treatment Outcome
  • United States / epidemiology