ePoster #702 - ISHA Annual Scientific Meeting 2016

Survivorship Of Primary Hip Arthroscopy In New York State – A Population-Based Study

Ryan M. Degen, MD, FRCSC, New York, NY UNITED STATES
Ting Jung Pan, MPH, New York, NY UNITED STATES
Brenda Chang, MS, MPH, New York, NY UNITED STATES
Nabil Mehta, BSE, New York, NY UNITED STATES
Peter Chamberlin, BA, New York, NY UNITED STATES
Danyal H. Nawabi, MD, FRCS(Orth), New York, NY UNITED STATES
Bryan Talmadge Kelly, MD, New York, NY UNITED STATES
Stephen Lyman, PhD, New York, NY UNITED STATES

Hospital for Special Surgery, New York, New York, UNITED STATES

FDA Status Not Applicable

Summary: This study reviews the utilization of hip arthroscopy in New York State, as well as the rates of revision hip arthroscopy and conversion to total hip arthroplasty, while also identifying volume-competency thresholds.

Abstract:
Background:
While hip arthroscopy utilization has increased, few studies report on long-term survival. The purpose of this study was to report on the rates of revision hip arthroscopy and conversion to hip arthroplasty (resurfacing or total hip) following hip arthroscopy in the State of New York. Prognostic factors contributing to the need for revision surgery will also be reported.
Methods:
The Statewide Planning and Research Cooperative System (SPARCS) database, a census of all hospital admissions and ambulatory surgery in New York State, was used to identify cases of primary hip arthroscopy. Demographic information was collected, as well as subsequent revision hip arthroscopy or arthroplasty procedures. The risks of these outcomes were modeled with use of age, sex, hospital volume, and surgeon volume as potential risk factors. Patients were also tracked for 30-day and 90-day complications.
Results:
We identified 8,267 procedures in 7,836 patients from 1998-2012. 46.1% of patients were male. Annual hip arthroscopy rates increased 750% over the last 10 years. Revision surgery was required in 1,087 cases (13.2%) at a mean of 1.7±1.6 (mean±SD) years. More specifically, revision hip arthroscopy was required in 311 cases (3.8%) at 1.8±1.6 years, while conversion to arthroplasty was required in 796 (9.7%) cases at 1.7±1.7 years. Kaplan Meier survival analysis showed a 2-year survival rate of 88.1%, 5-year of 80.7% and 10-year of 74.9%. Regression analysis revealed that age >50 years was associated with increased risk of re-operation (Hazard Ratio[HR] 2.09; CI 1.82-2.39, p<0.0001). Similarly, patients with osteoarthritis also carried a higher risk of re-operation than those without (HR 2.72; CI 2.21-3.34). Labral repair was associated with a lower risk of re-operation (HR=0.71; CI 0.54-0.93, p=0.01). Finally, higher annual surgeon volume (>164 cases/yr) resulted in a lower risk of re-operation compared with lower volume (<102 cases/yr) (HR 0.42; CI 0.32-0.54, p<0.0001). The 30-day complication rate was 0.2%, while the 90-day complication rate was 0.3%.
Conclusions:
Hip arthroscopy rates continue to rise, with corresponding increases in rates of revision surgery. Kaplan Meier survival analysis showed a 2-year survival rate of 88.1%, 5-year of 80.7% and 10-year of 74.9%. Age >50, and a diagnosis of OA increased the risk of re-operation; while performing a labral repair and having the procedure performed by a higher volume surgeon lowered the risk of re-operation.