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Arakawa H, Kobayashi N, Kamono E, Yukizawa Y, Takagawa S, Honda H, Inaba Y. Prior hip arthroscopy increases the risk of dislocation, reoperation, and revision after hip arthroplasty: An updated meta-analysis and systematic review. J Orthop Sci 2024; 29:157-164. [PMID: 36669953 DOI: 10.1016/j.jos.2022.12.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/30/2022] [Revised: 12/13/2022] [Accepted: 12/22/2022] [Indexed: 01/20/2023]
Abstract
BACKGROUND The indications for hip arthroscopy have been increasing, as have been the number of patients undergoing total hip arthroplasty (THA) after hip arthroscopy. Several matched cohort studies have assessed the impact of prior hip arthroscopy on THA, but conflicting results have been observed. The purpose of this study was to evaluate the influence of prior arthroscopy on subsequent THA. METHODS This systematic review and meta-analysis were performed in accordance with the Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) 2020 checklist. PubMed, the Cumulative Index to Nursing and Allied Health Literature (CINAHL), and the Cochrane Library were searched to identify relevant studies. Dichotomous variables were summarized qualitatively as a meta-analysis of pooled odds ratios (ORs) and 95% confidence intervals (CIs), and continuous variables were summarized as standardized mean differences and 95% CIs. P-values <0.05 were considered statistically significant. The risk of bias was evaluated for each study, as was publication bias. RESULTS In patients who underwent hip arthroscopy prior to THA, the ORs for dislocation, reoperation, and revision were 2.02 (P = 0.01), 1.66 (P = 0.01), and 2.15 (P = 0.001), respectively. There were no significant between-group differences in the Harris Hip Score (HHS; P = 0.40), WOMAC (P = 0.069), FJS-12 (P = 0.77), estimated blood loss (P = 0.48), and surgical time (P = 0.16). CONCLUSIONS Prior hip arthroscopy is a risk for postoperative dislocation, reoperation, or revision after conversion THA. However, prior hip arthroscopy has no effect on patient-reported outcomes, or operative factors such as surgical time and blood loss.
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Affiliation(s)
- Hirokazu Arakawa
- Yokohama City University Medical Center, Department of Orthopaedic Surgery, 4-57 Urafune-cho, Minami-ku, Yokohama, Japan
| | - Naomi Kobayashi
- Yokohama City University Medical Center, Department of Orthopaedic Surgery, 4-57 Urafune-cho, Minami-ku, Yokohama, Japan.
| | - Emi Kamono
- Yokohama City University Medical Center, Department of Orthopaedic Surgery, 4-57 Urafune-cho, Minami-ku, Yokohama, Japan
| | - Yohei Yukizawa
- Yokohama City University Medical Center, Department of Orthopaedic Surgery, 4-57 Urafune-cho, Minami-ku, Yokohama, Japan
| | - Shu Takagawa
- Yokohama City University Medical Center, Department of Orthopaedic Surgery, 4-57 Urafune-cho, Minami-ku, Yokohama, Japan
| | - Hideki Honda
- Yokohama City University Medical Center, Department of Orthopaedic Surgery, 4-57 Urafune-cho, Minami-ku, Yokohama, Japan
| | - Yutaka Inaba
- Yokohama City University Medical Center, Department of Orthopaedic Surgery, 4-57 Urafune-cho, Minami-ku, Yokohama, Japan
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Hip Arthroscopy in the Presence of Advanced Osteoarthritis Results in 57% Survivorship, With 78% Survivor Satisfaction, at 10 Years. A Matched-Control Study. Arthroscopy 2023; 39:256-268. [PMID: 35995331 DOI: 10.1016/j.arthro.2022.07.022] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/14/2021] [Revised: 07/27/2022] [Accepted: 07/28/2022] [Indexed: 02/02/2023]
Abstract
PURPOSE To (1) determine the 10-year survivorship (avoidance of total hip arthroplasty, THA) for patients with advanced osteoarthritis (OA) undergoing hip arthroscopy for femoroacetabular impingement, and (2) compare survivorship and patient-reported outcomes (PROs) with a matched-control group without OA. METHODS Advanced OA hips (Tönnis ≥2) were matched in a 1:1 ratio (age ± 5 years, sex) to hips with preoperative Tönnis grade ≤1. Exclusion criteria was dysplasia, age <18 years, previous hip conditions/surgeries, and bilaterally operated patients with OA on one side only. Survival was estimated by Kaplan-Meier analysis for levels of sex, age groups and Tönnis. Cox proportional hazards model estimated hazard ratios (HR) of undergoing THA conversion. Where THA was avoided, outcomes and proportion of cases achieving patient acceptable symptomatic state was determined RESULTS: 53 OA hips were matched with 53 control hips. Survival distributions were significantly different for: (1) Group: OA 57.1%, control 87.0% (P = .001); (2) Tönnis grade: Tönnis 0, 89.2%; Tönnis 1, 77.8%; Tönnis 2, 67.6%; Tönnis 3, 25.0% (P < .001); and (3) age: (OA: 75.0% vs 44.8%, control: 100%, vs 75.0%, for <35 and >35 years respectively) (P = .002). Conversion to THA was greater for increasing Tönnis: HR 1.9 (P = .450), 3.5 (P = .032), and 11.0 (P < .001) for Tönnis 1, 2, and 3 respectively, relative to no OA (Tönnis 0) and >35 years: HR 4.3 (95% confidence interval 1.6-11.3, P = .003). Patient acceptable symptomatic state achievement was similar for both groups (78% OA vs 91% control, P = .167). modified Harris Hip Score and Short Form-36 significantly improved within both groups from baseline to 10 years CONCLUSIONS: Arthroscopic correction of femoroacetabular impingement, in the presence of advanced OA results in 57% survivorship at 10 years (68% Tönnis 2, 25% Tönnis 3). Where THA was avoided, 78% considered their 10-year post-HA state to be satisfactory, with patient-reported outcomes similar to a matched non-OA cohort. Tönnis 2 in particular should be considered for arthroscopic hip preservation to avoid the need to prematurely replace the hip joint. LEVEL OF EVIDENCE IV, case series.
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Ross BJ, Wortman RJ, Lee OC, Mansour AA, Cole WW, Sherman WF. Is Prior Hip Arthroscopy Associated With Higher Complication Rates or Prolonged Opioid Claims After Total Hip Arthroplasty? A Matched Cohort Study. Orthop J Sports Med 2022; 10:23259671221126508. [PMID: 36199826 PMCID: PMC9528006 DOI: 10.1177/23259671221126508] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/30/2022] [Accepted: 07/27/2022] [Indexed: 12/03/2022] Open
Abstract
Background: Hip arthroscopy (HA) procedures have increased exponentially in recent years. Their effect on outcomes after subsequent total hip arthroplasty (THA) remains unclear. Purpose: To compare rates of complications and opioid claims after elective THA among patients with prior HA versus controls. Study Design: Cohort study; Level of evidence, 3. Methods: Patients who underwent THA were identified in the PearlDiver database. Arthroplasty performed for hip fractures and hip avascular necrosis were excluded. Within this population, patients with HA before arthroplasty (n = 3156) were propensity score matched 1:1 with controls on age, sex, US region, and several comorbidities. Rates of medical complications within 90 days and prosthesis-related complications within 2 years were queried. The number of patients with an opioid claim within 0 to 30 days and subsequent opioid claim(s) during the 90-day global period were obtained to assess rates of prolonged opioid use after arthroplasty. Rates of postoperative complications and opioid claims were compared using logistic regression. Results: Patients with prior HA exhibited significantly lower rates of readmission (5.6% vs 7.3%; odds ratio [OR], 0.72), pulmonary embolism (0.2% vs 0.6%; OR, 0.45), urinary tract infection (3.1% vs 4.0%; OR, 0.75), and blood transfusion (3.6% vs 6.1%; OR, 0.55). The prior HA cohort also exhibited a significantly lower rate of prosthetic joint infection at 1 year postoperatively (0.6% vs 1.3%; OR, 0.50). Rates of dislocation, periprosthetic fracture, mechanical complications, and aseptic revision arthroplasty were statistically comparable between the cohorts within 2 years. The prior HA cohort was significantly less likely to file persistent opioid claims after 30 days postoperatively, including between 31 and 60 days (27.2% vs 33.1%; OR, 0.74) and 61 to 90 days (16.2% vs 20.9%; OR, 0.71). Conclusion: After elective THA, patients with prior HA exhibited significantly lower rates of medical complications and prolonged opioid claims within 90 days and prosthetic joint infection at 1 year. Rates of all other prosthesis-related complications within 2 years were statistically comparable.
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Affiliation(s)
- Bailey J. Ross
- Department of Orthopaedic Surgery, Emory University School of Medicine, Atlanta, Georgia, USA
- Department of Orthopaedic Surgery, Tulane University School of Medicine, New Orleans, Louisiana, USA
| | - Ryan J. Wortman
- Department of Orthopaedic Surgery, Tulane University School of Medicine, New Orleans, Louisiana, USA
- Department of Orthopaedic Surgery, Albany Medical Center, Albany, New York, USA
| | - Olivia C. Lee
- Department of Orthopaedic Surgery, Tulane University School of Medicine, New Orleans, Louisiana, USA
- Department of Orthopaedic Surgery, LSUHSC School of Medicine, New Orleans, Louisiana, USA
| | - Alfred A. Mansour
- Department of Orthopaedic Surgery, University of Texas, McGovern School of Medicine at UTHealth, Houston, Texas, USA
| | - Wendell W. Cole
- Department of Orthopaedic Surgery, Tulane University School of Medicine, New Orleans, Louisiana, USA
| | - William F. Sherman
- Department of Orthopaedic Surgery, Tulane University School of Medicine, New Orleans, Louisiana, USA
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Liu Q, Tian Z, Pian K, Duan H, Wang Q, Zhang H, Shi L, Song D, Wang Y. The influence of prior arthroscopy on outcomes of primary total lower extremity arthroplasty: A systematic review and meta-analysis. Int J Surg 2022; 98:106218. [PMID: 34995806 DOI: 10.1016/j.ijsu.2021.106218] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2021] [Revised: 11/25/2021] [Accepted: 12/31/2021] [Indexed: 12/18/2022]
Abstract
PURPOSE The primary purpose of this systematic review and meta-analysis was to investigate the impact of prior arthroscopy on postoperative revisions, complications, and other clinical outcomes after conversion total lower extremity arthroplasty. METHODS Two individual researchers conducted the platform searches on the Embase, PubMed, Cochrane Central, and Google Scholar electronic databases from inception to June 02, 2021. We identified cohort trials that compared the outcomes of patients who underwent primary THA or TKA in the prior arthroscopy or control groups. The primary outcome was revision, and secondary outcomes included reoperation, patient-reported outcomes, and postoperative complications. A modified version of the Downs and Black tool was used to assess the methodological quality of the non-randomized cohort studies. RESULTS Of the 23 included studies with 319946 cases, 18 were matched retrospectively and five were non-matched retrospectively. Methodological quality was high in ten studies and moderate in thirteen studies. Our analysis demonstrated that TKA or THA patients with prior arthroscopy were associated with an increased risk of revision, reoperation, infection, and aseptic loosening. THA patients with prior arthroscopy were also associated with an increased risk of dislocation. Furthermore, there were no significant intergroup differences in periprosthetic fracture, range of motion, Harris Hip Score, or Knee Society Score. CONCLUSION Arthroscopy performed before total lower extremity arthroplasty substantially increased the revision, reoperation, infection, and aseptic loosening rates. THA patients with prior arthroscopy were also associated with an increased risk of dislocation. Patients should be counseled on the potential increased risks associated with conversion total lower extremity arthroplasty after prior arthroscopy. Further research is needed to better characterize these findings.
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Affiliation(s)
- Qiuliang Liu
- Department of Pediatric Surgery, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, 450052, PR China Department of Orthopedics, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, 450052, PR China
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Lemme NJ, Veeramani A, Yang DS, Tabaddor RR, Daniels AH, Cohen EM. Total Hip Arthroplasty After Hip Arthroscopy Has Increased Complications and Revision Risk. J Arthroplasty 2021; 36:3922-3927.e2. [PMID: 34456089 DOI: 10.1016/j.arth.2021.07.020] [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: 02/10/2021] [Revised: 06/25/2021] [Accepted: 07/27/2021] [Indexed: 02/02/2023] Open
Abstract
BACKGROUND There has been an increase in hip arthroscopy (HA) over the last decade. After HA, some patients may ultimately require a total hip arthroplasty (THA). However, there is a scarcity of research investigating the outcomes in patients undergoing THA with a history of ipsilateral HA. METHODS The PearlDiver research program (www.pearldiverinc.com) was queried to capture all patients undergoing THA between 2015 and 2020. Propensity matching was performed to match patients undergoing THA with and without a history of ipsilateral THA. Rates of 30-day medical complications, 1-year surgical complications, and THA revision were compared using multivariate logistic regression. Kaplan-Meier analysis was conducted to estimate survival probabilities of each of the groups with patients undergoing THA . RESULTS After propensity matching, cohorts of 1940 patients undergoing THA without prior HA and 1940 patients undergoing a THA with prior HA were isolated for analysis. The mean time from HA to THA was 1127 days (standard deviation 858). Patients with a history of ipsilateral HA had an increased risk for dislocation (odds ratio [OR] 1.56, P = .03) and overall decreased implant survival within 4 years of undergoing THA (OR 1.53; P = .05). Furthermore, our data demonstrate the timing of previous HA to be associated with the risk of complications, as illustrated by the increased risk for dislocation (OR 1.75, P = .03), aseptic loosening (OR 2.18, P = .03), and revision surgery at 2 (OR 1.92, P = .02) and 4 years (OR 2.05, P = .01) in patients undergoing THA within 1 year of HA compared twitho patients undergoing THA more than 1 year after HA or with no previous history of HA. CONCLUSION Patients undergoing THA after HA are at an increased risk for surgical complications, as well as the need for revision surgery.
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Affiliation(s)
- Nicholas J Lemme
- Department of Orthopaedics Warren Alpert Medical School of Brown University, Providence, RI
| | - Ashwin Veeramani
- Department of Orthopaedics Warren Alpert Medical School of Brown University, Providence, RI
| | - Daniel S Yang
- Department of Orthopaedics Warren Alpert Medical School of Brown University, Providence, RI
| | - Ramin R Tabaddor
- Department of Orthopaedics Warren Alpert Medical School of Brown University, Providence, RI
| | - Alan H Daniels
- Department of Orthopaedics Warren Alpert Medical School of Brown University, Providence, RI
| | - Eric M Cohen
- Department of Orthopaedics Warren Alpert Medical School of Brown University, Providence, RI
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Rhon DI, Greenlee TA, Dickens JF, Wright AA. Are We Able to Determine Differences in Outcomes Between Male and Female Servicemembers Undergoing Hip Arthroscopy? A Systematic Review. Orthop J Sports Med 2021; 9:23259671211053034. [PMID: 34805422 PMCID: PMC8600561 DOI: 10.1177/23259671211053034] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/06/2021] [Accepted: 08/04/2021] [Indexed: 11/16/2022] Open
Abstract
Background: Female servicemembers sustain higher rates of lower extremity injuries as
compared with their male counterparts. This can include intra-articular
pathology in the hip. Female patients are considered to have worse outcomes
after hip arthroscopy for femoroacetabular impingement and for hip labral
repair. Purpose: To (1) compare published rates of hip arthroscopy between male and female
military servicemembers and (2) determine if there are any sex-based
differences in outcomes after hip arthroscopy in the military. Study Design: Systematic review; Level of evidence, 3. Methods: We reviewed the literature published from January 1, 2000, through December
31, 2020, to identify studies in which hip arthroscopy was performed in
military personnel. Clinical trials and cohort studies were included. The
proportion of women within each cohort was identified, and results of any
between-sex analyses were reported. Results: Identified were 11 studies that met established criteria. Studies included
2481 patients, 970 (39.1%) of whom were women. Surgery occurred between
January 1998 and March 2018. Despite women accounting for approximately 15%
of the active-duty military force, they represented 39.1% (range,
25.7%-57.6%) of patients undergoing hip arthroscopy. In most cases, there
were no differences in self-reported outcomes (pain, disability, and
physical function), return to duty, or medical disability status based on
sex. Conclusion: Women account for approximately 15% of the military, but they made up 40% of
patients undergoing hip arthroscopy. Outcomes were not different between the
sexes; however, definitive conclusions were limited by the heterogeneity of
outcomes, missing data, lack of sex-specific subgroup analyses, and zero
studies with sex differences as the primary outcome. A proper understanding
of sex-specific outcomes after hip arthroscopy will require a paradigm shift
in the design and reporting of trials in the military health system.
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Affiliation(s)
- Daniel I Rhon
- Department of Rehabilitation Medicine, Brooke Army Medical Center, Joint Base San Antonio-Fort Sam Houston, Texas, USA.,Uniformed Services University of Health Sciences, Bethesda, Maryland, USA
| | - Tina A Greenlee
- Department of Rehabilitation Medicine, Brooke Army Medical Center, Joint Base San Antonio-Fort Sam Houston, Texas, USA
| | - Jonathan F Dickens
- Uniformed Services University of Health Sciences, Bethesda, Maryland, USA.,Department of Sports Medicine, Walter Reed National Military Medical Center, Bethesda, Maryland, USA.,John A. Feagin Jr Sports Medicine Fellowship, Keller Army Community Hospital, West Point, New York, USA
| | - Alexis A Wright
- School of Medicine, Tufts University, Boston, Massachusetts, USA
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Guo J, Dou D. Influence of prior hip arthroscopy on outcomes after hip arthroplasty: A meta-analysis of matched control studies. Medicine (Baltimore) 2020; 99:e21246. [PMID: 32702905 PMCID: PMC7373566 DOI: 10.1097/md.0000000000021246] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/26/2022] Open
Abstract
BACKGROUND No meta-analysis exists elucidate the impact of prior hip arthroscopy on the outcomes of subsequent hip arthroplasty. The purpose of this study was to systematically review the current evidence in the literature to ascertain if prior hip arthroscopy leads to inferior outcomes after hip arthroplasty. METHODS PUBMED, Scopus, EMBASE, and Cochrane Library databases were searched on May 20, 2019. Only English publications were included. The primary outcomes were postoperative complication, revision, and reoperation. Secondary outcomes included Harris Hip Score (HHS), Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC), operative time, and estimated blood loss. RESULTS Eleven studies with a total of 1227 patients were included. The pooled data revealed that patients with prior hip arthroscopy were associated with higher risks for any postoperative complication (P < .00001), dislocation (P = .03), revision (P = .03), and reoperation (P = .02) following subsequent hip arthroplasty. However, there were no significant differences in infection rate (P = .22), HHS (P = .09), WOMAC (P = .19), operative time (P = .52), and estimated blood loss (P = .17) between the groups. CONCLUSIONS Patients with prior hip arthroscopy are at increased risks for any postoperative complication, dislocation, revision, and reoperation following subsequent hip arthroplasty. However, prior hip arthroscopy does not appear to have an impact on the functional outcomes and intraoperative outcomes.
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Affiliation(s)
- Jiankuo Guo
- Department of Orthopedics, Huaihe Hospital, Henan University
| | - Dongmei Dou
- Institute of Chronic Disease Risks Assessment, Henan University, Henan, China
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Ruzbarsky JJ, Soares R, Johannsen A, Philippon MJ. Survivorship Following Hip Arthroscopy: Lessons Learned from a Comprehensive Database. Curr Rev Musculoskelet Med 2020; 13:220-232. [PMID: 32377960 PMCID: PMC7251001 DOI: 10.1007/s12178-020-09622-2] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
PURPOSE OF REVIEW Hip arthroscopy and its indications continue to expand. Understanding the durability of hip arthroscopic procedures remains important not only for counseling patients, but also for determining the success of certain procedures or in certain populations. Survivorship is defined as the proportion of hip arthroscopy patients who have not yet gone on to periacetabular osteotomy (PAO), total hip arthroplasty (THA), and/or revision surgery. The purpose of this review is to summarize the recent literature pertaining to survivorship after certain hip arthroscopic procedures and certain special populations. RECENT FINDINGS There is yet to be level 1 evidence published with relation to survivorship following hip arthroscopy. The best evidence in the recent literature is contained in just rew long-term prospective studies demonstrating good to excellent survivorship following hip arthroscopy for femoroacetabular impingement (FAI). Unfortunately, the follow-up for other conditions treated by hip arthroscopy is more limited. In summary, hip arthroscopy indications continue to expand. The most common indication for surgery is FAI, and its recently published long-term survivorship demonstrates excellent durability. Other hip arthroscopic procedures, including labral reconstruction, adjunctive procedures such as capsular closure, and special populations such as athletes, also demonstrate excellent survivorship in shorter term follow-up. Further prospective research is needed to further define survivorship of various hip conditions, associated procedures, and special populations commonly treated with hip arthroscopy.
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Affiliation(s)
- Joseph J Ruzbarsky
- The Steadman Clinic and United States Coalition for the Prevention of Illness and Injury in Sport, Vail, CO, USA
| | - Rui Soares
- Steadman Philippon Research Institute, 181 W Meadow Dr, Ste 400, Vail, CO, 81657, USA
| | - Adam Johannsen
- The Steadman Clinic and United States Coalition for the Prevention of Illness and Injury in Sport, Vail, CO, USA
| | - Marc J Philippon
- The Steadman Clinic and United States Coalition for the Prevention of Illness and Injury in Sport, Vail, CO, USA.
- Steadman Philippon Research Institute, 181 W Meadow Dr, Ste 400, Vail, CO, 81657, USA.
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