ePoster #502 - ISHA Annual Scientific Meeting 2016

Defining Success After Joint Preserving Surgery Of The Hip: A Prospective Database Of Over 1000 Cases

Paul Beaule, MD, FRCSC, Ottawa, Ontario CANADA
Helena Bleeker, MBT, Ottawa, Ontario CANADA
Amardeep Singh, MBBS, MS, Ottawa, Ontario CANADA
Johanna Dobransky, MHK, BSc, Ottawa, Ontario CANADA

The Ottawa Hospital, Ottawa, Ontario, CANADA

FDA Status Not Applicable

Summary: While defining the overall reoperation and complication rates is important to raise awareness in JPSH, the standardization of modes of failure will help identify best practices, which will facilitate better quality of care given to those requiring JPSH.

Abstract:
Introduction: Joint preserving surgery of the hip (JPSH) has evolved tremendously and now includes a variety of procedures, including arthroscopy, surgical dislocation (SD), and peri-acetabular osteotomy (PAO). Because of the variety in diagnoses and procedures performed, factors leading to failure of JPSH can vary. Consequently, it is of interest to assess the various modes of JPSH failure in order to continue to identify best practices and indications for these procedures.
Methods: Using a retrospective observational study design, 1013 JPSH cases from a single surgeon between 2005 and 2015 were reviewed looking at overall failure rates and modes of failure. Of the 1013 JPSH, 783 were arthroscopies, 122 SDs, and 108 PAOs. The mean age was 39, with 504 females and 509 males. Re-operations were categorized into three groups: Mode 1 (Organ Failure) represented total hip arthroplasty (THA) post-JPSH, Mode 2 represented Incorrect Diagnosis/Procedure, and Mode 3 represented Mal/Inadequate Correction.
Results: At a mean follow-up of 2.5 years, there were 104 re-operations with a mean patient age of 35.5 years. There were 64 Mode 1 failures (7% scopes; 7% SD; 1% PAO), with average age of patient being 46.8, 3.2 years post-JPSH. There were 17 Mode 2 failures (2% scopes; 1% SD), with average age of patient being 28.9, 2.2 years post-JPSH. Lastly, there were 23 Mode 3 failures (2% scopes; 2% SD; 5% PAO), with average age of patient being 30.2, 2.0 years post-JPSH. Using the modified Dindo-Clavien classification system, the overall complication rate among JPSHs was 4%.
Conclusion: While defining the overall reoperation and complication rates is important to raise awareness in JPSH, the standardization of modes of failure will help identify best practices, which will facilitate better quality of care given to those requiring JPSH. These results could also be generalizable to other procedures once validated.