Hip Arthroscopy Over 70: Post-operative Patient Reported Outcomes at Minimum 1 Year Follow-Up

Abstract

To report the indications, intra-operative diagnostics, surgical management options and minimum 1-year outcomes in patients ≥70 years old undergoing hip arthroscopy. Data were prospectively collected on patients who underwent hip arthroscopy to treat central (chondrolabral, iliopsoas), peripheral (Cam-type FAI), and peritrochanteric (GT bursitis, gluteus medius/minimus) compartment pathology along with any subsequent revision hip arthroscopies and/or conversion to total hip arthroplasty (THA), between February 2009 and April 2018. The inclusion criteria were ≥70 years old at surgery and minimum 1-year follow-up on the following patient-reported outcomes (PROs): modified Harris Hip Score (mHHS), Nonarthritic Hip Score (NAHS), Hip Outcome Score- Sport Specific Subscale (HOS-SSS), and a visual analog scale (VAS) for pain. In addition, the International Hip Outcome Tool (iHOT-12) and the physical and mental portions of the Veterans RAND 12-Item Health Survey (VR-12M and VR-12P) and Short Form 12 (SF-12M and SF-12P) questionnaires were also included. The proportion of patients who achieved the minimal clinically important difference (MCID) and patient acceptable symptomatic state (PASS) for mHHS was also reported. Of the 59 eligible cases, 48 (81.4%) had minimum 1-year follow-up at a mean of 36.8 months (range, 12.0-116.4 months). Of note, the most common indication was a gluteus medius tear for which 42 of 48 (87.5%) patients underwent peritrochanteric endoscopic gluteus medius repair. Five (10.4%) cases underwent a subsequent surgery, with 3 (6.3%) converting to total hip arthroplasty (THA). Postoperative mHHS scores were significantly increased (72.8 ± 20.8) at latest follow-up. Furthermore, there were 26 (54.2%) patients who demonstrated improvement that surpassed the literature values for the minimal clinically important difference and patient acceptable symptomatic state for mHHS. Regarding NAHS, HOS-SSS, iHOT-12, SF-12P, and VR-12P, patients demonstrated significant improvement following surgery (P < 0.05). In addition, pain on the visual analog scale (out of 10) decreased from 6.1 to 2.2 (P < 0.001). The mean satisfaction with surgery was 7.2 out of 10 at latest follow-up. Hip arthroscopy in patients ≥70 years old demonstrates statistically significant PRO improvements at minimum 1-year follow-up. Most notably, 87.5% of patients underwent peritrochanteric endoscopic gluteus medius repair, which highlights a significant indication for surgical management in this population. The low rate of conversion to THA and high rate of patient satisfaction underscores the potential to help an older patient cohort in need of minimally invasive arthroscopic procedures to relieve hip pain. Surgeons, therefore, should have a high index of suspicion for abductor tendon pathology, in addition to intraarticular sources of pain, when managing this population, and expectations of outcomes should be discussed accordingly.