Likelihood of hip arthroplasty within 15 years is tripled after sports-related hip or thigh injury

Abstract

Purpose: Sports-related knee joint injury is strongly associated with subsequent knee arthroplasty surgery; however, the link between sports injury and hip arthroplasty is less clear. Systematic reviews of hip osteoarthritis outcomes have focused on elite-level sport and may not be generalisable to the broader community where recreational or amateur sport participation is more common. To better understand the downstream consequences of sports injury, a population-based approach is required. This study aimed to quantify the likelihood of hip arthroplasty at a population level up to 15 years after sports injury. Methods: A population-level cohort was established for the state of Victoria, Australia (population size 6.4 million) through linkage of two key administrative datasets: the Victorian Admitted Episodes dataset (capturing all hospital admissions) and the Victorian Emergency Minimum Dataset (capturing all emergency department (ED) presentations). Sports injury presentations from 2000-2005 and hip arthroplasty admissions from 2000-2015 were identified using ICD-10-AM codes. Cox proportional hazards models were used to estimate the likelihood of hip arthroplasty using time to surgery data, with adjustment for potential confounders. Results: Over the 15-year study period there were 64,750 sports injuries (including 815 hip or thigh injuries) resulting in ED presentation or hospitalisation, and 368 hip arthroplasty procedures. Having a hip or thigh injury tripled the rate of subsequent hip arthroplasty (hazard ratio 3.07, 95%CI 2.00 to 4.72), compared to all other sports-related injuries. Of the main injury types, femoral fractures (hazard ratio 3.08, 95%CI 1.77 to 5.36) and hip dislocations (hazard ratio 5.64, 95%CI 2.34 to 13.58) were significantly associated with hip arthroplasty. For those with a hip or thigh injury, the median time from sports injury to hip arthroplasty was 5.3 years (range 0.3 to 14.0 years). Conclusions: Sports-related hip or thigh injury is associated with a significantly higher likelihood of hip arthroplasty within 15 years. Effective injury prevention programs and appropriate post-injury management are needed to curtail this burden. For people who sustained a sports-related hip or thigh injury and progressed to arthroplasty, the duration from injury to surgery was relatively short. This could reflect pre-existing hip osteoarthritis that was exacerbated by injury. Continued surveillance of population-level hip arthroplasty data will assist with evaluating the impacts of sports injury prevention initiatives over time.