ePoster #1207 - ISHA Annual Scientific Meeting 2016

Complication Rates for Hip Arthroscopy are Underestimated: A Population-Based Study

Jeremy Truntzer, MD, Redwood City, CA UNITED STATES
Daniel Hoppe, MD, Redwood City, CA UNITED STATES
Lauren M. Shaprio , MD, Redwood City, CA UNITED STATES
Geoff D. Abrams, MD, Redwood, CA UNITED STATES
Marc R. Safran, MD, Redwood City, CA UNITED STATES

Stanford University, Redwood City, CA, UNITED STATES

FDA Status Not Applicable

Summary: Hip Arthroscopy Complications Using a National Database

Abstract:
Background: The incidence of hip arthroscopy continues to increase as the understanding of hip pathology and technical advances improve. Recent studies have investigated outcomes and complications associated with hip arthroscopy primarily through the use of small-scale, observational trials, particularly from high volume accomplished surgeons and/or centers. The purpose of this study was to investigate complication trends associated with hip arthroscopy across 1-year and 5-year periods using a payer-based national database. We hypothesized that complication rates would be higher when queried from a payer-based database when compared with series from experienced surgeons. Methods: Patients who underwent hip arthroscopy were identified from a publicly available database of over 18 million patients with both private insurance and Medicare Advantage charge data. Patients having undergone hip arthroscopy were searched for Current Procedural Terminology (CPT) and International Classification of Diseases, Ninth Revision (ICD-9) codes associated with significant complications including conversion to total hip arthroscopy (THA). Incidence rates for the general database population to be used as a control were also determined for a subset of complications including proximal femur fractures, conversion to THA, and hip dislocations. Statistical significance was set at alpha less than 0.05. Results: The rates of major and minor complications within a 1-year post-operative period were 1.74% and 4.22%, respectively. Heterotopic ossification (2.85%) was the most common complication followed by bursitis (1.23%), proximal femur fracture (1.08%), hip dislocation (0.77%), and DVT (0.46%). The percentage rate of conversion to THA within 1 year was 2.85% and 4.74% after 5 years. When compared to the rates in the general population, the relative risk of requiring a THA (RR 57.66 < 50 years, p<.001; RR 22.05 > 50 years, p< .001) or sustaining a proximal femur fracture (RR 18.02 < 50 years, p<.001; RR 2.23 > 50 years, p<.001) following hip arthroscopy at 1 year was significantly higher at all age groups. Conclusions: This study reports overall higher complications rates using a payer-based database following hip arthroscopy as compared to traditional observational trials. Additionally, hip arthroscopy is shown to be associated with significantly higher rates of hip dislocations, conversion to THA, as well as an increased incidence of proximal femur fractures, especially in patients younger than 50 years. The high incidence of hip fractures found in our study is concerning given the possible underreporting in other studies. As there were only 2,581 hip arthroscopies performed over the 8-year period of this database, it would suggest most of these hip arthroscopies were performed by surgeons that do not perform a high volume of hip arthroscopies. Future large, prospective studies are required to assess more specific attributes of hip arthroscopy techniques in order to help reduce complications and improve patient selection in order to optimize outcomes. Additionally, studies should be completed to compare complication rates and outcomes following hip arthroscopy performed by high volume surgeons and lower volume surgeons.