ePoster #501 - ISHA Annual Scientific Meeting 2016
Does Previous Hip Arthroscopy Impact the Clinical Outcomes of Total Hip Arthroplasty?
Jacob Haynes, MD, St. Louis, MO UNITED STATES
Geneva Baca, BA, St. Louis, MO UNITED STATES
Tonya An, BS, St. Louis, MO UNITED STATES
Ryan M. Nunley, MD, St. Louis, MO UNITED STATES
John Clohisy, MD, St. Louis, MO UNITED STATES
Washington University School of Medicine, Saint Louis, MO, UNITED STATES
FDA Status Not Applicable
Summary: Prior ipsilateral arthroscopic hip surgery did not adversely affect the clinical outcome of primary total hip arthroplasty, or increase the risk for major postoperative complications, in a study group of 58 patients.
Introduction: Hip arthroscopy is a well-accepted practice for the treatment of nonstructural hip problems such as labral tears, as well as structural pathology; predominantly femoroacetabular impingement (FAI). In spite of early arthroscopic intervention, osteoarthritis can develop and progress to eventually require total hip arthroplasty (THA). The incidence of THA for osteoarthritis following arthroscopy has been reported to be as high as 16%. The primary objective of this study was to compare the clinical outcomes of primary THA in patients with and without prior ipsilateral arthroscopic hip surgery. Our secondary aim was to evaluate the occurrence of surgical complications and revision rates between the two groups.
Methods: Using our institution’s joint arthroplasty registry, all patients undergoing primary THA following prior ipsilateral hip arthroscopy from December 2000 to September 2013 were identified. Patients were excluded for prior ipsilateral hip fracture or trauma, hip disease secondary to infectious or rheumatologic conditions, or history of any prior ipsilateral hip surgery in addition to arthroscopy. To generate a control group, the study group subjects were matched in a 1:2 manner with patients from the same arthroplasty registry who had no ipsilateral hip surgery prior to primary THA. Matching was performed based on BMI, age at time of THA, race, sex, and surgeon. Preoperative and 1 year postoperative outcomes measures, including the Modified Harris Hip Score, UCLA Activity Score, and WOMAC Pain, Stiffness and Physical Function Score, were obtained. All complications, including revision THA, were recorded for each group.
Results: Fifty-eight patients who had an ipsilateral arthroscopic hip surgery prior to primary THA were identified. Mean follow up was 3.2 years (range 1-10) following primary THA. The average age at the time of primary THA was 48 and 49 years for the study and control groups, respectively. The average time between arthroscopic hip surgery and primary THA was 28 months (range 1-102 months). There were no significant differences between the study and control group in any of the preoperative or postoperative outcomes measures. Additionally, there was no significant difference in the absolute change (delta) in outcomes scores between the study and control groups. There were four total complications in the study group (6.9%). Two patients developed deep vein thromboses that were treated on an outpatient basis. Two patients experienced hip dislocation, managed by closed reduction and abduction bracing. There was one postoperative complication in the control group (0.9%) of a deep infection of the THA requiring explant with antibiotic spacer placement, IV antibiotic therapy and staged replantation of all components.
Conclusions: Our results show that at midterm follow up, prior arthroscopic hip surgery did not negatively impact the clinical outcome of a patient undergoing subsequent, ipsilateral THA. There were more complications in the study group; however, they were minor and did not require additional hospitalization or operative treatment. This study illustrates that prior ipsilateral arthroscopic hip surgery does not adversely affect the clinical outcome of primary total hip arthroplasty or increase the risk for major postoperative complications.