ePoster #737 - ISHA Annual Scientific Meeting 2016

Rate and Predictors of Bilateral Hip Arthroscopy: Which Patients Undergo Bilateral Hip Arthroscopy?

Theodore Wolfson, MD, New York, NY UNITED STATES
Michael K Ryan, MD, New York, NY UNITED STATES
John P Begly, MD, New York, NY UNITED STATES
Christopher A Looze, MD, New York, NY UNITED STATES
Brian Capogna, MD, New York, NY UNITED STATES
Mathew Hamula, MD, New York, NY UNITED STATES
Kristofer Chenard, MD, New York, NY UNITED STATES
Siddharth Mahure, MD, New York, NY UNITED STATES
Thomas Youm, MD, New York, NY UNITED STATES

NYU Hospital for Joint Diseases, New York, NY, UNITED STATES

FDA Status Not Applicable

Summary: Clinical and radiographic evidence of femoroacetabular impingement is frequently present in the asymptomatic or less symptomatic contralateral hip in patients who present with hip pain undergoing hip arthroscopy, and this analysis evaluates the rate and predictive factors of patients undergoing bilateral hip arthroscopy.

Background As the field of hip preservation has grown, hip arthroscopy has emerged as an invaluable tool for the diagnosis and management of a wide spectrum of intraarticular and extraarticular hip pathology. Many of the conditions treated with hip arthroscopy, notably femoracetabular impingement (FAI), commonly affect both hips. Several recent studies have reported high rates of both radiographically- and clinically-evident bilateral pathology in these patients. However, patient risk factors the need for undergoing bilateral hip arthroscopy within this population has not been well defined. Purpose The current study was designed to determine the incidence of staged bilateral hip arthroscopy in a large, consecutive series of patients undergoing hip arthroscopy. In addition, the study set out to identify which patient factors predispose to the need for contralateral hip arthroscopy. We hypothesized that younger patients and patients with more severe disease at the time of the initial arthroscopy would be more likely to undergo a contralateral hip arthroscopy in the future. Materials and Methods A retrospective review of prospectively-collected data of a single surgeon at a single institution between 2010 and 2014 identified patients undergoing non-simultaneous bilateral hip arthroscopy. Patients with at least two years of follow-up without contralateral arthroscopy remained in the unilateral group as controls. Demographic information, preoperative indications, and operative procedures were compared between the unilateral and bilateral groups. Prospective clinical outcomes scores at various time points were compared. A multivariate logistic regression model was used to identify additional risk factors for bilateral hip arthroscopy. Results Between 2010 and 2014, 304 patients (84%) underwent an isolated unilateral hip arthroscopy meeting the above criteria while 57 patients (16%) underwent staged bilateral hip arthroscopies. Factors associated with bilateral hip arthroscopy included younger age at time of initial surgery (mean 34.5 vs. 42.2 years, p < 0.01), subspine impingement (35% vs. 5%, p < 0.01), and loose body (36% vs. 24%, p = 0.02). Patients undergoing bilateral hip arthroscopy were more likely to undergo labral repair (91% vs. 83%, p = 0.05) and subspine resection (34% vs 6%, p < 0.01), and less likely to undergo labral debridement (9% vs. 20%, p = 0.005). There was no significant difference in sex, BMI, laterality, or other surgical interventions between groups. There was no significant difference in mean modified HHS between the unilateral and bilateral groups at baseline (50.0 vs. 50.6), 1 year postoperatively (82.2 vs. 82.6), and 2 years postoperatively (84.4 vs 83.6). The mean time interval between contralateral hip arthroscopies was 13 months (range, 2 – 58 months). Linear regression analysis revealed a weak positive relationship between increasing age and increasing time interval between arthroscopies (r = 0.38). Conclusions In a consecutive series of patients undergoing hip arthroscopy, 16% underwent bilateral procedures. Patients undergoing bilateral hip arthroscopies were more likely to be younger and have subspine impingement and intraarticular loose bodies. Labral repair and subspine resection was more common within this group, while labral debridement was performed less frequently. Severity of ipsilateral symptoms, as defined by clinical outcome scores, either at baseline or follow-up, was not associated with increased rates of contralateral arthroscopy. Contralateral disease is common in patients undergoing hip arthroscopy and often requires intervention. Patients within this population should be closely monitored for contralateral disease and informed that they may eventually be candidates for a contralateral procedure.