Paper #61 - ISHA Annual Scientific Meeting 2016

Age is Associated with Greater Chondromalacia Severity in Hip Arthroscopy

T. David Luo, MD, Winston-Salem, NC UNITED STATES
Alejandro Marquez-Lara, MD, Winston Salem, NC UNITED STATES
Sandeep Mannava, MD, PhD, Winston Salem, NC UNITED STATES
Austin Stone, MD, Winston Salem, NC UNITED STATES
Elizabeth A. Howse, MD, Walnut Creek, CA UNITED STATES
Allston J. Stubbs, MD, MBA, Winston Salem, NC UNITED STATES

Wake Forest Baptist Medical Center, Winston-Salem, NC, UNITED STATES

FDA Status Not Applicable

Summary: The size and severity of chondromalacia increased with age and is a significant portion of hip pathology in older patients. As the number of hip arthroscopies continues to increase especially in patients over the age of 45, these findings will help the surgeon counsel patients on the etiology of their hip pain and expected surgical procedures.

Abstract:
Introduction
There is limited data comparing the clinical presentation of hip pain and the intraoperative findings of hip arthroscopies across different patient age groups. We hypothesize that advanced age is associated with more severe femoral head and acetabular chondral lesions, which may have implications in guiding treatment based on patient age.
Methods
In our institutional review board-approved study, we reviewed prospectively collected data from 791 consecutive hip arthroscopies from a single surgeon practice between 2008 and 2015. Patients <18 years old, who had previous hip surgery and body mass index (BMI) >50 kg/m2 were excluded. The cohort was stratified intro four age groups: 18-25 (age group I), 26-35 (II), 36-45 (III), and over 45 (IV). Clinical symptoms, radiographic assessments, and intraoperative findings were reviewed. Chondromalacia severity index (CMI) was calculated as a product of the Outerbridge chondromalacia grade and affected surface area (mm2*severity) based on intraoperative evaluation. Chi-square and one-way ANOVA was utilized to compare groups. Logistic regression analysis was performed to assess the association between age on hip pathology and treatment. Data are presented as percentages and odds ratios (OR). Statistical significance was set at p<0.05.
Results
A total of 571 patients met inclusion criteria, which comprised 163 patients (28.5%) in age group I, 140 (24.5%) in group II, 167 (29.2%) in group III, and 101 (17.7%) in group IV. The groups were well-matched with respect to sex and BMI. Group I was more likely to experience pain with high impact activity (running, sports) than group IV (p=0.002, OR 3.9). The rate of acetabular and femoral head chondromalacia on MRI did not differ between groups (p=0.085, p=0.284, respectively). However, the acetabular and femoral head CMI was significantly greater with increased age (p<0.001 for both) on intraoperative assessment. Labral repair was performed more often in group I (95.1%) than group IV (77.2%, OR 5.1). Conversely, group IV was more likely to undergo labral debridement (21.8%) and microfracture (32.7%) compared to group I (3.7%, OR 10.0; 8.5%, OR 10.0, respectively).
Discussion and Conclusion
Our data supports that the size and severity of chondromalacia increased with age and is a significant portion of hip pathology in older patients. Treatment approaches during hip arthroscopy must be modified accordingly for different age groups. As the number of hip arthroscopies continues to increase especially in patients over the age of 45, these findings will help the surgeon counsel patients on the etiology of their hip pain and expected surgical procedures. Our MRI findings did not correlate with intraoperative assessment of cartilage in the hip joint. Routine MRI imaging with or without contrast of the hip may not be a reliable diagnostic tool for this specific pathology. Other MRI sequences may be necessary to detect chondral injuries with greater accuracy, but may not be available to all surgeons. To improve diagnostic sensitivity and specificity, we recommend standardization of MRI protocols with routine cartilage sequencing for at-risk hips.