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The HAR-index: a reliable method for evaluating the risk of total hip arthroplasty conversion after hip arthroscopy for femoroacetabular impingement. Knee Surg Sports Traumatol Arthrosc 2023:10.1007/s00167-023-07368-1. [PMID: 36884127 DOI: 10.1007/s00167-023-07368-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/08/2022] [Accepted: 02/24/2023] [Indexed: 03/09/2023]
Abstract
PURPOSE Hip arthroscopy is a growing technique in the treatment of femoroacetabular impingement (FAI), but can sometimes lead to unsatisfactory results such as the early conversion to total hip arthroplasty (THA). The purpose of this study is to describe a new tool for assessing the preoperative risk of THA conversion after hip arthroscopy in patients with FAI. METHODS This study is a retrospective analysis of a prospective cohort of 584 patients with FAI who underwent hip arthroscopy at a single centre with a minimum 2 years follow-up. The preoperative variables of these patients were analysed to calculate the risk of each variable for THA. By selecting variables with an area under the receiver operating characteristic (ROC) curve greater than 0.7, a calculator was created to provide a risk index for each patient. RESULTS Four variables (age, body mass index, Tönnis score and ALAD) were associated with an increased risk of THA conversion. The optimal cut-off points for each variable were determined, and a risk index was created. The Hip-Arthroplasty-Risk Index (HAR-Index) is a 0-4 points scale obtained from four binary scores of 0 or 1 depending on whether the cut-off point for each variable was reached or not. The increased risk of THA for each HAR-Index value was 1.1%, 6.2%, 17.9%, 55.1% and 79.3% respectively. The HAR-Index showed a very good predictive capacity with an area under the ROC curve of 0.89. CONCLUSION The HAR-Index is a simple and practical tool for practitioners to make more informed decisions about performing hip arthroscopy in patients with FAI. With a very good predictive capacity, the HAR-Index can help to reduce the rate of conversion to THA. LEVEL OF EVIDENCE Level III.
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Conversion to Total Hip Arthroplasty After Hip Arthroscopy: A Cohort-Based Survivorship Study With a Minimum of 2-Year Follow-up. J Am Acad Orthop Surg 2021; 29:885-893. [PMID: 33201044 DOI: 10.5435/jaaos-d-20-00748] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/30/2020] [Accepted: 09/20/2020] [Indexed: 02/01/2023] Open
Abstract
INTRODUCTION The purpose of this study was to determine which patient, provider, and surgical factors influence progression to total hip arthroplasty (THA) after hip arthroscopy (HA) through a large cohort-based registry. METHODS All patients ≥18 years who underwent unilateral HA in Ontario, Canada, between October 1, 2010, and December 31, 2016, were identified with a minimum of 2-year follow-up. The rate of THA after HA was reported using Kaplan-Meier survivorship analyses. A Cox proportional hazard model was used to assess which factors independently influenced survivorship. RESULTS A total of 2,545 patients (53.2% female, mean age 37.4 ± 11.8 years) were identified. A total of 237 patients (9.3%) were identified to have undergone THA at a median time of 2 years after HA, with an additional 6.3% requiring a revision arthroplasty at a median time of 1.1 years. Patients who underwent isolated labral resection (hazard ratio [HR]: 2.55, 95% confidence interval [CI]: 1.51 to 4.60) or in combination with osteochondroplasty (OCP) [HR: 2.11, 95% CI: 1.22 to 3.88] were more likely to undergo THA versus patients who underwent isolated labral repair or in combination with an OCP, respectively. Older age increased the risk for THA (HR: 14.0, 95% CI: 5.76 to 39.1), and treatment by the highest-volume HA surgeons was found to be protective (HR: 0.55, 95% CI: 0.33 to 0.89). DISCUSSION Using our methods, the rate of THA after HA was 9.3% at 2 years. The rate of revision arthroplasty was 6.3% at 1 year. Patients who underwent labral resection, isolated OCP, and/or were of increased age were at increased independent risk of conversion to THA. Those treated by the highest-volume HA surgeons were found to be at reduced risk of conversion to THA.
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Seijas R, Barastegui D, Montaña F, Rius M, Cuscó X, Cugat R. Prognostic Factors for Conversion to Arthroplasty after Hip Arthroscopy. Review of the Literature. Surg J (N Y) 2021; 7:e374-e380. [PMID: 34984235 PMCID: PMC8718264 DOI: 10.1055/s-0041-1741512] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2020] [Accepted: 01/13/2021] [Indexed: 11/21/2022] Open
Abstract
Arthroscopic techniques in the treatment of femoroacetabular impingement have experienced an exponential increase over recent years for both diagnosis and treatment. The main risks with treatment are poor clinical outcomes and the conversion to prosthesis. Better knowledge and understanding of the various risk factors leading to prosthesis will improve patient selection for arthroscopic treatments rendering better results. The published papers that have been selected are related to series of hip arthroscopies with risk factors that lead to total hip arthroplasty (THA), in the PubMed database, without a time limit, number of patients, or follow-up time. We selected over 302 papers, 19 papers that show risk factors for conversion to THA. The main risk factors found were femoral chondropathy grade III/IV (relative risk 58.1-12 times increased), acetabular (20-2.96 times), an articular space <2 mm (39-4.26 times), age (14.6-1.06 times), Tönnis 2 in radiographic studies (7.73-3.1 times), obesity (5.6-2.3 times), and osteoarthritis (4.6-2.4 times). There are several risk factors which in an isolated way, highly increase the risk of THA. Some of them have a clear relationship (chondropathy, reduced joint space, Tönnis 2, and osteoarthritis). Based on the review we observed that the elements that are most associated with a conversion to THA after a hip arthroscopy are a high degree of femoral and acetabular chondropathy, a reduced joint space below 2 mm, older age, Tönnis 2, obesity, and hip osteoarthritis.
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Affiliation(s)
- Roberto Seijas
- Instituto Cugat Hospital Fundació García Cugat Quiron, Barcelona, Spain
- Fundació García Cugat, Garcia, Cugat
- Medicine Department, Universitat Internacional de Catalunya, Barcelona, Spain
| | - David Barastegui
- Instituto Cugat Hospital Fundació García Cugat Quiron, Barcelona, Spain
- Fundació García Cugat, Garcia, Cugat
- Medicine Department, Universitat Internacional de Catalunya, Barcelona, Spain
- Mutualitat Catalana de Futbolistas (FCF)—Real Federación Española de Futbol, Madrid, Spain
| | - Ferran Montaña
- Instituto Cugat Hospital Fundació García Cugat Quiron, Barcelona, Spain
- Medicine Department, Universitat Internacional de Catalunya, Barcelona, Spain
| | - Marta Rius
- Instituto Cugat Hospital Fundació García Cugat Quiron, Barcelona, Spain
- Fundació García Cugat, Garcia, Cugat
- Mutualitat Catalana de Futbolistas (FCF)—Real Federación Española de Futbol, Madrid, Spain
| | - Xavier Cuscó
- Instituto Cugat Hospital Fundació García Cugat Quiron, Barcelona, Spain
- Fundació García Cugat, Garcia, Cugat
| | - Ramón Cugat
- Instituto Cugat Hospital Fundació García Cugat Quiron, Barcelona, Spain
- Fundació García Cugat, Garcia, Cugat
- Mutualitat Catalana de Futbolistas (FCF)—Real Federación Española de Futbol, Madrid, Spain
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Seijas R, Barastegui D, López-de-Celis C, Montaña F, Cuscó X, Alentorn-Geli E, Samitier-Solis G, Cugat R. Preoperative risk factors in hip arthroscopy. Knee Surg Sports Traumatol Arthrosc 2021; 29:1502-1509. [PMID: 33555385 DOI: 10.1007/s00167-021-06484-0] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/16/2020] [Accepted: 01/28/2021] [Indexed: 01/02/2023]
Abstract
PURPOSE Arthroscopic surgery is a usual technique to repair hip femoroacetabular impingement. Correlation exists among surgical indication, postoperative evolution, the final result, and the necessity of prosthesis in the near future. The assessment of specific parameters allowing us to evaluate the prognosis becomes vital to improve the results. The objective of this study is to check the variables found in patients with femoroacetabular impingement (FAI) treated with hip arthroscopy, and determine which of these variables would serve as key indicators in predicting the need for subsequent arthroplasty. METHODS Data from FAI surgical indications (age, weight, height, BMI, gender, side, radiographic Tönnis degree, cartilage lesion degree by Acetabular Labrum Articular Disruption (ALAD) degree, VAS value, HOS, mHHS and WOMAC) were collected from cases which should have had a minimum monitoring period of 2 years from 2007 to 2017. The results of the group which needed prosthesis were compared to the results of the ones who did not. RESULTS Among 452 patients who were monitored for an average of 5.8 years, 82 (18.1%) required conversion to prosthesis. The variables that indicated relatively high risk were fourth-degree acetabular labrum articular disruption (ALAD) chondral injury, preoperative radiographic Grade 2 Tönnis classification, age of over 55 years, WOMAC over 45 points, and HOS-ADL under 50 points. There were no significant differences between side, gender, VAS level, nor HOS. CONCLUSIONS The presence of chondral injuries such as acetabular labrum articular disruption (ALAD) 4, radiographic Grade 2 Tönnis classification, higher age, higher BMI, and worse WOMAC, along with mHHS and HOS-ADL preoperative results, are factors which lead to a poor prognosis following FAI hip arthroscopic surgery, increasing the risk of prosthetic conversion in the short or medium term. LEVEL OF EVIDENCE Level IV.
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Affiliation(s)
- Roberto Seijas
- Instituto Cugat, Hospital Quiron Barcelona Floor -1, Pza., Alfonso Comín 5, 08023, Barcelona, Spain.
- Basic Sciences Department, Faculty of Medicine and Health Sciences, Universitat International de Catalunya, Barcelona, Spain.
- Foundation Garcia Cugat, Barcelona, Spain.
| | - David Barastegui
- Instituto Cugat, Hospital Quiron Barcelona Floor -1, Pza., Alfonso Comín 5, 08023, Barcelona, Spain
- Basic Sciences Department, Faculty of Medicine and Health Sciences, Universitat International de Catalunya, Barcelona, Spain
- Foundation Garcia Cugat, Barcelona, Spain
- Mutualidad Catalana de Futbolistas, Federación Española de Fútbol, Ronda Sant Pere 19-21, 08010, Barcelona, Spain
| | - Carlos López-de-Celis
- Basic Sciences Department, Faculty of Medicine and Health Sciences, Universitat International de Catalunya, Barcelona, Spain
| | - Ferran Montaña
- Instituto Cugat, Hospital Quiron Barcelona Floor -1, Pza., Alfonso Comín 5, 08023, Barcelona, Spain
- Basic Sciences Department, Faculty of Medicine and Health Sciences, Universitat International de Catalunya, Barcelona, Spain
| | - Xavier Cuscó
- Instituto Cugat, Hospital Quiron Barcelona Floor -1, Pza., Alfonso Comín 5, 08023, Barcelona, Spain
- Foundation Garcia Cugat, Barcelona, Spain
| | - Eduard Alentorn-Geli
- Instituto Cugat, Hospital Quiron Barcelona Floor -1, Pza., Alfonso Comín 5, 08023, Barcelona, Spain
- Foundation Garcia Cugat, Barcelona, Spain
- Mutualidad Catalana de Futbolistas, Federación Española de Fútbol, Ronda Sant Pere 19-21, 08010, Barcelona, Spain
| | - Gonzalo Samitier-Solis
- Instituto Cugat, Hospital Quiron Barcelona Floor -1, Pza., Alfonso Comín 5, 08023, Barcelona, Spain
- Foundation Garcia Cugat, Barcelona, Spain
| | - Ramón Cugat
- Instituto Cugat, Hospital Quiron Barcelona Floor -1, Pza., Alfonso Comín 5, 08023, Barcelona, Spain
- Foundation Garcia Cugat, Barcelona, Spain
- Mutualidad Catalana de Futbolistas, Federación Española de Fútbol, Ronda Sant Pere 19-21, 08010, Barcelona, Spain
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Vesey RM, Bacon CJ, Brick MJ. Pre-existing osteoarthritis remains a key feature of arthroscopy patients who convert to total hip arthroplasty. J ISAKOS 2020; 6:199-203. [PMID: 34272295 DOI: 10.1136/jisakos-2020-000492] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/26/2020] [Indexed: 11/04/2022]
Abstract
OBJECTIVES To determine the rate of conversion to total hip arthroplasty following ipsilateral hip arthroscopy by a single surgeon in New Zealand and to describe patient-related and surgical characteristics of patients who converted. METHODS A retrospective cohort analysis of hip arthroscopy patients with 2 years of minimum follow-up identified the total hip arthroplasty conversion rate using the New Zealand National Joint Registry. Prospective data collected from patients who subsequently converted to hip arthroplasty included: sex, age at arthroscopy, body mass index, side of hip arthroscopy and arthroplasty, duration of symptoms and patient-reported outcome measures. Imaging (Tönnis grade and lateral centre-edge angle) and surgical findings (labral, ligamentum teres and osteochondral pathology) along with the arthroscopic procedures performed were also documented. RESULTS Sixty-six out of 1856 (3.56%) primary hip arthroscopies were followed by an ipsilateral hip arthroplasty during the follow-up period (mean 87 ± 29 months). Most patients had pre-existing osteoarthritis and/or chondral lesions (n=51). Dysplasia and over-resection of the acetabulum were also identified as contributing factors. CONCLUSION Conversion rate by a high-volume surgeon in New Zealand was relatively low. Most patients had pre-existing osteoarthritis and/or chondral lesions that became apparent at arthroscopy. Dysplasia is also a factor to be cautious of when selecting patients for arthroscopy. Acetabular resection must be approached cautiously. LEVEL OF EVIDENCE Level IV.
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Affiliation(s)
- Renuka M Vesey
- Faculty of Medical and Health Sciences, The University of Auckland, Auckland, New Zealand .,Orthosports North Harbour Ltd., Millennium Institute of Sport and Health, Auckland, New Zealand
| | - Catherine J Bacon
- Faculty of Medical and Health Sciences, The University of Auckland, Auckland, New Zealand.,Orthosports North Harbour Ltd., Millennium Institute of Sport and Health, Auckland, New Zealand
| | - Matthew J Brick
- Orthosports North Harbour Ltd., Millennium Institute of Sport and Health, Auckland, New Zealand
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Sohatee MA, Ali M, Khanduja V, Malviya A. Does hip preservation surgery prevent arthroplasty? Quantifying the rate of conversion to arthroplasty following hip preservation surgery. J Hip Preserv Surg 2020; 7:168-182. [PMID: 33163202 PMCID: PMC7605779 DOI: 10.1093/jhps/hnaa022] [Citation(s) in RCA: 26] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/22/2019] [Revised: 03/12/2020] [Accepted: 04/18/2020] [Indexed: 12/15/2022] Open
Abstract
Hip arthroscopic surgery for femoroacetabular impingement and periacetabular osteotomy (PAO) for dysplasia is the most commonly used contemporary treatment for these conditions and has been shown to provide pain relief and restore function. What is less understood and perhaps of more interest to health economists, is the role of these procedures in preserving the hip joint and avoiding hip arthroplasty. The aim of this systematic review was to determine whether hip joint preservation surgery, indeed, preserves the hip joint by looking at conversion rates to total hip arthroplasty (THA). Two separate searches were undertaken, using PRISMA guidelines and utilizing PubMed and Open Athens search engines, identifying manuscripts that looked at conversion to THA following either hip arthroscopy (HA) or PAO. When considering HA, we found 64 eligible papers. Out of these studies, there were 59 430 hips with 5627 undergoing conversion to THA (9.47% [95% CI 9.23–9.71%]) with a mean conversion time of 24.42 months. Regarding PAO, there were 46 eligible papers including 4862 patients who underwent PAO with subsequent conversion to THA in 404 patients (8.31% [95% CI 7.54–9.12%]). with a mean conversion time of 70.11 months. Certain features were associated with increased conversion rates, including increasing age, worsening arthritis and joint space <2 mm. This study demonstrates that the mean conversion rates to be <10% for HA and PAO, during the mean follow-up periods of included manuscripts. Joint preserving surgery appears to defer or at least delay the need for THA.
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Affiliation(s)
- Mark Andrew Sohatee
- Health Education North East, Waterfront 4, Goldcrest Way, Newcastle upon Tyne, NE15 8NY, UK
| | - Mohammed Ali
- Department of Trauma and Orthopaedics, South Tyneside and Sunderland NHS Foundation Trust, Harton Ln, South Shields NE34 OPL, UK
| | - Vikas Khanduja
- Department of Trauma and Orthopaedics, Cambridge University Hospitals NHS Foundation Trust, Hills Road, Cambridge CB2 0QQ, UK
| | - Ajay Malviya
- Department of Trauma and Orthopaedics, Northumbria NHS Foundation Trust, Unit 7-8 Silver Fox Way Cobalt Business Park, Silver Fox Way, Newcastle upon Tyne NE27 0QJ, UK
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Walter SS, Wintermeyer E, Klinger C, Lorbeer R, Rathmann W, Peters A, Schlett CL, Thorand B, Gatidis S, Nikolaou K, Bamberg F, Notohamiprodjo M. Association between metabolic syndrome and hip osteoarthritis in middle-aged men and women from the general population. PLoS One 2020; 15:e0230185. [PMID: 32155212 PMCID: PMC7064195 DOI: 10.1371/journal.pone.0230185] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2019] [Accepted: 02/24/2020] [Indexed: 12/15/2022] Open
Abstract
OBJECTIVE To investigate the impact of metabolic syndrome and its components on osteoarthritis of the hip joints compared to a healthy cohort in the KORA MRI-study. METHODS Randomly selected men and women from the general population were classified as having metabolic syndrome, defined as presence of central obesity plus two of the following four components: elevated blood pressure (BP), elevated fasting glucose, elevated triglycerides (TG) and low HDL-cholesterol (HDL-c), or as controls without metabolic syndrome. Therefore, each subject underwent detailed assessment of waist circumference as well as fasting glucose, systolic and diastolic BP, TG, and HDL-c concentrations as well as a full-body MR scan. MR measurements were performed on a 3 Tesla scanner (Magnetom Skyra, Siemens) including a dual-echo Dixon and a T2 SS-FSE sequence for anatomical structures. In order to quantify osteoarthritis of the hip, assessment was performed by two independent, experienced radiologists for joint gap narrowing, osteophytic lipping and subchondral changes (e.g. sclerosis, pseudocysts). Associations between metabolic syndrome components and hip degeneration were estimated by logistic regression models providing odds ratios. RESULTS Among 354 included participants (mean age: 56.1 ± 9.2 years; 55.4% male), 119 (34%) had metabolic syndrome, while 235 (66%) were part of the control group. Except for elevated blood glucose (p = 0.02), none of the metabolic syndromes' component was independently associated with osteoarthritis. Multivariable adjusted ORs for osteoarthritis of the right hip were 1.00 (95% CI 0.98;1.03), 1.00 (95% CI 0.99;1.00), 1.01 (95% CI 0.99;1.03), 1.00 (95% CI 0.97;1.04) and 1.01 (95% CI 0.96;1.06), and for the left hip 1.00 (95% CI 0.98;1.03), 1.00 (95% CI 1.00;1.01), 1.01 (95% CI 0.99;1.03), 0.99 (95% CI 0.96;1.02) and 1.04 (95% CI 0.99;1.09) for waist circumference, triglyceride, HDL-c and systolic and diastolic BP, respectively. Blood glucose was a borderline non-dependent factor for osteoarthritis of the right hip (OR: 1.02 (95% CI 1.0;1.04); p = 0.05). Furthermore, the compound metabolic syndrome was not significantly associated (OR left hip: 1.53 (95% CI 0.8;2.92), p = 0.20; OR right hip: 1.33 (95% CI 0.72;2.45), p = 0.37) with osteoarthritis of the hip joint. Age as well as gender (left hip) were the only parameters in univariate and multivariate analysis to be significantly associated with osteoarthritis of the hip joint. CONCLUSION The compound metabolic syndrome showed no association with osteoarthritis of the hip joint. Age was the only parameter to be dependently and independently associated to osteoarthritis of both hip joints, while elevated blood glucose was independently associated with degeneration of the right hip joint.
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Affiliation(s)
- Sven S. Walter
- Department for Diagnostic and Interventional Radiology, Eberhard Karls University Tuebingen, University Hospital Tuebingen, Tübingen, Germany
| | - Elke Wintermeyer
- Department for Trauma and Reconstructive Surgery, BG Trauma Center Tuebingen, Eberhars Karls University Tuebingen, Tuebingen, Germany
| | - Christian Klinger
- Department for Diagnostic and Interventional Radiology, Eberhard Karls University Tuebingen, University Hospital Tuebingen, Tübingen, Germany
| | - Roberto Lorbeer
- Department of Radiology, Ludwig-Maximilian-University Hospital Marchioninistraße, Munich, Germany
- German Center for Cardiovascular Disease Research, Munich, Germany
| | - Wolfgang Rathmann
- Department of Biometry and Epidemiology, German Diabetes Center, Düsseldorf, Germany
| | - Annette Peters
- German Center for Cardiovascular Disease Research, Munich, Germany
- Institute of Epidemiology, Helmholtz Zentrum München, German Research Center for Environmental Health, Neuherberg, Germany
- Institute for Cardiovascular Prevention, Ludwig-Maximilian-University Hospital, Munich, Germany
| | - Christopher L. Schlett
- Department of Diagnostic and Interventional Radiology, Medical Center ‐ University of Freiburg, Freiburg, Germany
| | - Barbara Thorand
- Institute of Epidemiology, Helmholtz Zentrum München, German Research Center for Environmental Health, Neuherberg, Germany
| | - Sergios Gatidis
- Department for Diagnostic and Interventional Radiology, Eberhard Karls University Tuebingen, University Hospital Tuebingen, Tübingen, Germany
| | - Konstantin Nikolaou
- Department for Diagnostic and Interventional Radiology, Eberhard Karls University Tuebingen, University Hospital Tuebingen, Tübingen, Germany
| | - Fabian Bamberg
- Department of Diagnostic and Interventional Radiology, Medical Center ‐ University of Freiburg, Freiburg, Germany
| | - Mike Notohamiprodjo
- Department for Diagnostic and Interventional Radiology, Eberhard Karls University Tuebingen, University Hospital Tuebingen, Tübingen, Germany
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