Age-related Trends in Hip arthroscopy

Abstract

Objectives:The rate of hip arthroscopy has increased dramatically in the past 5 years but there is a lack of information regarding patient demographics in a large cross-sectional population. The purpose of this study was to evaluate recent trends in hip arthroscopy from a large private payer population in the United States.Methods:We performed a retrospective analysis using the Pearldiver private insurance patient record database from 2007 through 2011. A search was performed for hip arthroscopy procedures including newly introduced codes such as osteochondroplasty of Cam and Pincer lesions and labral repair. Hip arthroscopy incidence, growth over time, and conversion rates to total hip arthroplasty (THA) were stratified by age. Chi-square analysis was used for statistical comparison. Conversion to THA was evaluated using Kaplan-Meier analysis with logrank and Wilcoxon tests.Results:From 2007 through 2011, 15,532,426 outpatient procedure records were analyzed. Hip arthroscopy was performed in 8,237 patients with females comprising 63% of cases. The number of hip arthroscopies increased over 250% from 981 cases in 2007 to 2,507 cases in 2011 (p<0.0001). Patients in age group 40-49 underwent the most number of hip arthroscopies, comprising 28% of cases followed by 30-39 (22%), 50-59 (19%), 20-29 (14%), 10-19 (12%) and 60-69 (5%). Patients under 30 years of age showed the greatest increase in incidence from 2007 to 2011 (335%) but patients over 60 still had over a 200% increase. Chondroplasty/labral debridement was the most common procedure, present in 6,031 cases and approximately 1.6 procedural codes were billed for every case performed. Older patients were more likely to receive labral debridement instead of repair. Within 24 months of hip arthroscopy, 17% of patients older than 50 years old required conversion to THA compared to less than 1% of patients under 30 years old (p<0.0001).Conclusion:Hip arthroscopy procedures are increasing in popularity across all age groups with patients aged 40-49 having the highest incidence in this population. A high rate of conversion to THA within 2 years of hip arthroscopy in patients over 50 suggests a need to better specify appropriate indications.