Arthroscopic hip surgery is less invasive than total hip replacement, but may not always be the best choice. That´s according to a study by researchers at the Hospital for Special Surgery (HSS) in Manhattan, which found that older patients and those with arthritis or obesity are significantly more likely to need a hip replacement within two years.
Hip arthroscopy by an experienced orthopaedic surgeon is an excellent procedure to treat hip impingement, labral tears and loose cartilage in the hip joint causing symptoms, the researchers stressed. It is often performed in younger patients with the hope of relieving their symptoms and lowering their risk of future hip arthritis. Most studies to date have looked at arthroscopic hip surgery in this patient population, finding good results overall.
For the latest study, the researchers analysed the records of 7,351 patients in California and Florida who had arthroscopic hip surgery with a two-year follow-up between 2005 and 2012.
Patients were divided into groups based on their age: under 40; 40 to 49; 50 to 59; 60 to 69; and 70 or older. Researchers also determined which patients had received a diagnosis of hip arthritis before arthroscopic surgery and identified those who were obese.
The findings, published in Arthroscopy: The Journal of Arthroscopic and Related Surgery, show that more than one-third of the patients aged 60 to 69 went on to have a hip replacement. Other major risk factors were osteoarthritis of the hip and obesity, with many of these patients needing a hip replacement within two years.
Overall, 11.7% of patients underwent a hip replacement within two years. Only 3% of patients younger than 40 went on to have a hip replacement, compared to 35% of patients aged 60 to 69, the age group more likely to have arthritis.
Dr William Schairer, lead author of the study, noted that the use of arthroscopic hip surgery has increased considerably in the last decade but there is growing concern over the efficacy of the procedure in patients with pre-existing hip arthritis.
“Previous smaller studies have also noted a worse prognosis in these patients, with most advising against hip arthroscopy in patients with more than mild arthritis. This is important information for patients and surgeons so they can have a real discussion about what types of treatments would be most beneficial in the long run based on a patient´s individual circumstances,” Dr Schairer said.
“Hip arthroscopy is a very good procedure in the right patient. It´s a major advance in treating certain hip conditions, but not hip arthritis,” added Dr David J. Mayman, senior author of the study.