Prior hip arthroscopy does not affect 1-year patient-reported outcomes following total hip arthroplasty: a register-based matched case-control study of 675 patients

Prior hip arthroscopy increases the risk of dislocation, reoperation, and revision after hip arthroplasty: An updated meta-analysis and systematic review

BACKGROUND

The indications for hip arthroscopy have been increasing, as have been the number of patients undergoing total hip arthroplasty (THA) after hip arthroscopy. Several matched cohort studies have assessed the impact of prior hip arthroscopy on THA, but conflicting results have been observed. The purpose of this study was to evaluate the influence of prior arthroscopy on subsequent THA.

METHODS

This systematic review and meta-analysis were performed in accordance with the Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) 2020 checklist. PubMed, the Cumulative Index to Nursing and Allied Health Literature (CINAHL), and the Cochrane Library were searched to identify relevant studies. Dichotomous variables were summarized qualitatively as a meta-analysis of pooled odds ratios (ORs) and 95% confidence intervals (CIs), and continuous variables were summarized as standardized mean differences and 95% CIs. P-values <0.05 were considered statistically significant. The risk of bias was evaluated for each study, as was publication bias.

RESULTS

In patients who underwent hip arthroscopy prior to THA, the ORs for dislocation, reoperation, and revision were 2.02 (P = 0.01), 1.66 (P = 0.01), and 2.15 (P = 0.001), respectively. There were no significant between-group differences in the Harris Hip Score (HHS; P = 0.40), WOMAC (P = 0.069), FJS-12 (P = 0.77), estimated blood loss (P = 0.48), and surgical time (P = 0.16).

CONCLUSIONS

Prior hip arthroscopy is a risk for postoperative dislocation, reoperation, or revision after conversion THA. However, prior hip arthroscopy has no effect on patient-reported outcomes, or operative factors such as surgical time and blood loss.

A Matched Comparison of the Rates of Achieving the Minimal Clinically Important Difference Following Conversion and Primary Total Hip Arthroplasty

BACKGROUND

Patient-reported outcome measures (PROMs) are often lower following conversion total hip arthroplasty (cTHA) compared to matched primary total hip arthroplasty (THA) controls. However, the minimal clinically important differences (MCIDs) for any PROMs are yet to be analyzed for cTHA. This study aimed to (1) determine if patients undergoing cTHA achieve primary THA-specific 1-year PROM MCIDs at comparable rates to matched controls undergoing primary THA and (2) establish 1-year MCID values for specific PROMs following cTHA.

METHODS

A retrospective case-control study was conducted using 148 cases of cTHA which were matched 1:2 to 296 primary THA patients. Previously defined anchor values for 2 PROM measures in primary THA were used to compare cTHA to primary THA, while novel cTHA-specific MCID values for 2 PROMs were calculated through a distribution method. Predictors of achieving the MCID of PROMs were analyzed through multivariate logistic regressions.

RESULTS

Conversion THA was associated with decreased odds of achieving the primary THA-specific 1-year Hip dysfunction and Osteoarthritis Outcome Score for Joint Replacement PROM (Odds Ratio: 0.319, 95% Confidence Interval: 0.182-0.560, P < .001) and Patient Reported Outcomes Measurement Information System Physical Function Short-Form-10a PROM (Odds Ratio: 0.531, 95% Confidence Interval: 0.313-0.900, P = .019) MCIDs in reference to matched primary THA patients. Less than 60% of cTHA patients achieved an MCID. The 1-year MCID of the Hip dysfunction and Osteoarthritis Outcome Score for Joint Replacement and Patient Reported Outcomes Measurement Information System Physical Function Short-Form-10a specific to cTHA were +10.71 and +4.68, respectively.

CONCLUSION

While cTHA is within the same diagnosis-related group as primary THA, patients undergoing cTHA have decreased odds of achieving 1-year MCIDs of primary THA-specific PROMs.

LEVEL OF EVIDENCE

Level III, retrospective comparative study.

Hip Arthroscopy in the Presence of Advanced Osteoarthritis Results in 57% Survivorship, With 78% Survivor Satisfaction, at 10 Years. A Matched-Control Study

PURPOSE

To (1) determine the 10-year survivorship (avoidance of total hip arthroplasty, THA) for patients with advanced osteoarthritis (OA) undergoing hip arthroscopy for femoroacetabular impingement, and (2) compare survivorship and patient-reported outcomes (PROs) with a matched-control group without OA.

METHODS

Advanced OA hips (Tönnis ≥2) were matched in a 1:1 ratio (age ± 5 years, sex) to hips with preoperative Tönnis grade ≤1. Exclusion criteria was dysplasia, age <18 years, previous hip conditions/surgeries, and bilaterally operated patients with OA on one side only. Survival was estimated by Kaplan-Meier analysis for levels of sex, age groups and Tönnis. Cox proportional hazards model estimated hazard ratios (HR) of undergoing THA conversion. Where THA was avoided, outcomes and proportion of cases achieving patient acceptable symptomatic state was determined RESULTS: 53 OA hips were matched with 53 control hips. Survival distributions were significantly different for: (1) Group: OA 57.1%, control 87.0% (P = .001); (2) Tönnis grade: Tönnis 0, 89.2%; Tönnis 1, 77.8%; Tönnis 2, 67.6%; Tönnis 3, 25.0% (P < .001); and (3) age: (OA: 75.0% vs 44.8%, control: 100%, vs 75.0%, for <35 and >35 years respectively) (P = .002). Conversion to THA was greater for increasing Tönnis: HR 1.9 (P = .450), 3.5 (P = .032), and 11.0 (P < .001) for Tönnis 1, 2, and 3 respectively, relative to no OA (Tönnis 0) and >35 years: HR 4.3 (95% confidence interval 1.6-11.3, P = .003). Patient acceptable symptomatic state achievement was similar for both groups (78% OA vs 91% control, P = .167). modified Harris Hip Score and Short Form-36 significantly improved within both groups from baseline to 10 years CONCLUSIONS: Arthroscopic correction of femoroacetabular impingement, in the presence of advanced OA results in 57% survivorship at 10 years (68% Tönnis 2, 25% Tönnis 3). Where THA was avoided, 78% considered their 10-year post-HA state to be satisfactory, with patient-reported outcomes similar to a matched non-OA cohort. Tönnis 2 in particular should be considered for arthroscopic hip preservation to avoid the need to prematurely replace the hip joint.

LEVEL OF EVIDENCE

IV, case series.