Patients 65 years of age and older with intra-articular hip pain who failed nonoperative treatment experienced a modest improvement in function, high-patient satisfaction and high survivorship following hip arthroscopy, according to study results.
"The bottom line is hip arthroscopy should be approached with caution in patients over 65 years old, and this population represents a small fraction of hip arthroscopies at both institutions," Benjamin G. Domb, MD, medical director of the American Hip Institute, told Orthopedics Today. "However, in well-selected patients who have failed conservative treatment and do not have any significant arthritis, hip arthroscopy demonstrated favorable outcomes at minimum 2-year follow-up with approximately 90% survivorship during that time period.
In a collaboration between the American Hip Institute and the Mayo Clinic, Domb and his colleagues prospectively collected and retrospectively reviewed outcome data of 19 patients 65 years of age and older with intra-articular hip pain who underwent hip arthroscopy after failing nonoperative treatment. At a minimum 2-year follow-up, researchers analyzed outcomes using prospectively collected Hip Outcome score (HOS) and modified Harris Hip score (HHS).
According to Domb, a 10% conversion to total hip replacement yielded a 90% patient survivorship during the study period. Results showed a mean modified HHS of 72.2, HOS-activities of daily living of 77 and HOS-sports specific subscale of 62.8 at a minimum of 2-year follow-up. Researchers found a mean improvement of 10 in modified HHS, 15 in HOS-activities of daily living and 22 in HOS-sports specific subscale. On a scale of 10, patients had an average patient satisfaction of 8.3, according to results.
"There was a modest decrease in the visual analogue pain score and modest increase in HHS and hip outcomes scores sports-specific subscales," Domb said.
Domb said he was pleased with the modest improvement in patients' functional outcomes, and the high survivorship rate was surprising, as it was similar to survivorship found in many studies of patients of younger age groups.
"We should approach hip arthroscopy in patients over 65 with caution, with very stringent patient selection criteria and surgical indications, but in this age group, when patients have failed conservative treatment and are not good candidates for hip arthroplasty, then hip arthroscopy may have a positive role," Domb said.
He added although it is rare for patients 65 years of age and older to undergo hip arthroscopy, it is important that future research continues to refine the surgical technique and identify risk factors in this group of patients.
"As we have done with other patient populations, the initial step is refining our technique, the next step is demonstrating our outcomes and then further research continues to refine our surgical indications and identify risk factors for failure that we can recommend surgeries to patients who will benefit from those surgeries," Domb said. - by Casey Tingle