Abstract
Objective
To assess the incidence of total hip arthroplasty (THA) in osteoarthritic patients who were treated by arthroscopic debridement and to evaluate factors that might influence the time interval from the first hip arthroscopy to THA.
Design
Retrospective clinical series
Methods
Follow-up data and surgical reports were retrieved from 564 records of osteoarthritic patients that have had hip arthroscopy between the years 2002 to 2009 with a mean follow-up time of 3.2 years (range, 1-6.4 years). The time interval between the first hip arthroscopy to THA was modelled as a function of patient age; level of cartilage damage; procedures performed and repeated arthroscopies with the use of multivariate regression analysis.
Results
Ninety (16%) of all participants eventually required THA. The awaiting time from the first arthroscopy to a hip replacement was found to be longer in patients younger than 55 years and in a milder osteoarthritic stage. Patients that experienced repeated hip scopes had a longer time to THA than those with only a single procedure. Procedures performed concomitant with debridement and lavage did not affect the time interval to THA.
Conclusions
In our series of arthroscopic treatment of hip osteoarthritis, 16% required THA over a period of 7 years. Factors that influence the time to arthroplasty were age, degree of osteoarthritis and recurrent procedures.
Background
Currently there are various options to treat osteoarthritis (OA) and certain evidence based recommendations have been developed1,2. According to these propositions in young adults with symptomatic OA one should consider a joint preserving surgical procedure while replacement is usually reserved for older patients. With the evolution of hip arthroscopy, it has been used as joint preserving surgery for OA among various other indications, yet there are only a few reports on its efficacy in treating OA3-8. In a controlled trial involving patients with osteoarthritis of the knee9, the outcomes after arthroscopic lavage or arthroscopic debridement were no better than those after a placebo procedure. There are, however, times when arthroscopic treatment of the osteoarthritic joint can be of benefit, particularly in that patient who has relatively mild to moderate osteoarthritis and a mechanically significant derangement10. Several studies do support the use of hip arthroscopy in mild to moderate OA while others consider severe OA as a contraindication for hip arthroscopy11,12. This study reviews a cohort of patients that required a total hip arthroplasty (THA) after a trial of arthroscopic surgery for hip degeneration. The aim of the study was to assess the incidence of THA in that subgroup of patients and to evaluate several factors that might influence the time interval from the first hip arthroscopy to THA. Our hypothesis is that in selected patients hip arthroscopy can temporarily delay the need for replacement.
Methods
The inclusion criteria for the study were patients who have had hip replacement following a trial of arthroscopic surgery for idiopathic osteoarthritis (i.e. not secondary to infection, trauma or avascular necrosis). The indication for the first hip arthroscopy was hip pain with limitation of internal rotation and confirmative findings on radiography (i.e. T
