Baron JE, Westermann RW, Bedard NA, Willey MC, Lynch TS, Duchman KR. Is the Actual Failure Rate of Hip Arthroscopy Higher Than Most Published Series? An Analysis of a Private Insurance Database.
Iowa Orthop J 2020;
40:135-142. [PMID:
32742221 PMCID:
PMC7368532]
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Abstract
BACKGROUND
The use of hip arthroscopy (HA) for the management of intra-articular hip pathology has increased greatly, with a 600% increase in utilization from 2006-2010. Studies have demonstrated good to excellent outcomes in patients undergoing hip arthroscopy for treatment of femoroacetabular impingement (FAI) syndrome. However, some patients undergoing primary hip arthroscopy will require revision hip arthroscopy (revision HA) or conversion to total hip arthroplasty (THA). The purpose of the present study was to evaluate the association between hip arthroscopy failure and (1) osteoarthritis, (2) age > 40 years, and (3) psychiatric comorbidities.
METHODS
The Humana Inc. insurance claims database was used to identify patients undergoing hip arthroscopy between 2007 and 2015, with query by CPT (current procedural terminology code) of more than 25 million deidentified insurance and Medicare beneficiary claims. Following primary hip arthroscopy, patients were longitudinally tracked for subsequent ipsilateral hip arthroscopy (revision HA) or total hip arthroplasty (THA) with a minimum of 1-year clinical follow-up from the primary HA procedure. Hip arthroscopy failure (HA failure) was defined specifically as patients who underwent a revision HA or THA with a minimum of 1-year of clinical follow-up from the primary HA procedure. Variables assessed included presence of pre-existing osteoarthritis, age < 40 years or age > 40 years, and presence of preoperatively diagnosed psychiatric comorbidities including depression or anxiety. The relationships between revision HA, THA, or HA failure and these variables were assessed utilizing univariate and multiple logistic regression analysis. Independent predictors of revision ipsilateral hip arthroscopy and subsequent hip arthroplasty were identified using multiple logistic regression.
RESULTS
In total, 785 patients (64.1% female) underwent primary hip arthroscopy. The overall failure rate with a minimum of 1-year clinical follow-up from the index HA procedure was 18%[140/785; 8% (63/785) revision hip arthroscopy, 10% (82/785) THA]. Multivariable logistic regression analysis identified psychiatric comorbidities (Odds Ratio [OR] 2.8, 95% Confidence Interval [CI] 1.2-6.2, p<0.01) as the only independent predictor of hip arthroscopy failure (revision HA or THA). Independent predictors of revision HA included both psychiatric comorbidity (OR 2.8, 95% CI 1.2-6.2, p<0.01) and age < 40 years (OR 2.6, 95% CI 1.4-5.0, p<0.01), while age > 40 years (OR 3.09, 1.47-7.25, p<0.005), smoking (OR 2.05, 95% CI, 1.68-1.88, p=0.02), and osteoarthritis (OR 3.24, 95% CI 1.98-5.43, p<0.001) predicted conversion to THA.
CONCLUSION
The hip arthroscopy failure rate of 18% in the present study is alarmingly high, a figure much higher than reported in previously published series. Patient factors associated with conversion to THA included age > 40 years, smoking, and preexisting osteoarthritis. The presence of psychiatric comorbidities, specifically depression and anxiety, was independently associated with revision HA and overall HA failure.Level of Evidence: III.
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