2015 - Domb et al. Does Primary Hip Arthroscopy Result in Improved Clinical Outcomes?:2-year Follow-up on a Mixed Group of 738 Consecutive Primary Hip Arthroscopies Performed at a High Volume Referral Center
Does Primary Hip Arthroscopy Result in Improved Clinical Outcomes?
2-Year Clinical Follow-up on a Mixed Group of 738 Consecutive Primary Hip Arthroscopies Performed at a High-Volume Referral Center
Asheesh Gupta,* MD, John M. Redmond,* MD, Christine E. Stake,* DHA,
Kevin F. Dunne,* BS, and Benjamin G. Domb,*yz§ MD
Investigation performed at the American Hip Institute, Westmont, Illinois, USA
Background: Hip arthroscopy has gained increasing popularity over the past decade. The need to develop metrics to evaluate success and complications in primary hip arthroscopy is an important goal.
Purpose: To evaluate 2-year patient-related outcome (PRO) scores and patient satisfaction scores for a single surgeon at a high-volume referral center for all primary hip arthroscopy procedures performed.
Study Design: Case series; Level of evidence, 4.
Methods: During the study period between April 2008 and October 2011, data were collected on all patients who underwent primary hip arthroscopy. All patients were assessed pre- and postoperatively with 4 PRO measures: the modified Harris Hip Score (mHHS), Non-Arthritic Hip Score (NAHS), Hip Outcome Score–Activities of Daily Living (HOS-ADL), and Hip Outcome Score– Sport-Specific Subscale (HOS-SSS). Pain was estimated on the visual analog scale (VAS), and satisfaction was measured on a scale from 0 to 10. The number of patients who underwent revision arthroscopy, total hip arthroplasty (THA), or a resurfacing procedure during the study period was also reported.
Results: A total of 595 patients were included in the study. The score improvement from preoperative to 2-year follow-up was 61.29 to 82.02 for mHHS, 62.79 to 83.05 for HOS-ADL, 40.96 to 70.07 for HOS-SSS, 57.97 to 80.41 for NAHS, and 5.86 to 2.97 for VAS. All scores were statistically significantly different (P \ .0001). Overall patient satisfaction was 7.86 6 2.3 (range, 1-10). Forty-seven (7.7%) patients underwent revision hip arthroscopy, and 54 (9.2%) patients underwent either THA or the hip resurfacing procedure during the study period. The multivariate regression analysis showed that increased age at time of surgery was a significant risk factor for conversion to THA, revision arthroscopy, and change in NAHS\10 points. Acute injury, acetabuloplasty, iliopsoas release, and patient sex were significant for 2 of the 3 types of failure. In addition, the success rate, defined as change in NAHS .10 with no revision arthroscopy or conversion to THA during the study period, was 59.8%.
Conclusion: Primary hip arthroscopy for all procedures performed in aggregate had excellent clinical outcomes and patient satisfaction scores at short-term follow-up in this study. While the chance for a successful outcome was 59.8%, more studies must be conducted to determine the definition of a successful outcome. There was a 6.1% minor complication rate, which was consistent with previous studies. Patients should be counseled regarding the potential progression of degenerative change leading to arthroplasty as well as the potential for revision surgery.
Keywords: hip arthroscopy; outcomes; high-volume referral center; labral tears; FAI