Abstract
Hip arthroscopy has continued to expand its horizons in treating many conditions other than femoroacetabular impingement (FAI). However, the results of hip arthroscopy are known to be poor if the degree of articular cartilage damage is significant. We wanted to assess, whether the procedure might have a role in the management of young and active patients with advanced osteoarthritis (OA) and whether it should be offered as a treatment modality. 77 consecutive patients with Tönnis grade 2 and 3 osteoarthritis of the hip who had undergone hip arthroscopy were included in the study. Patients' medical notes, plain radiographs and outcome scores (modified Harris hip score (mHHS), non-arthritic hip score (NAHS)) preoperatively and postoperatively at six weeks, six months, one year and annually thereafter, were analysed. 77 patients consisted of 63 men and 14 women with mean follow-up of 2.8 years (2.2 to 4.2) and mean age at surgery of 43 years (19 to 64). The mean preoperative mHHS and NAHS scores were 58 (28 to 87) and 64 (27 to 93) respectively. The mean improvements in both the mHHS and NAHS scores were significant (p = 0.003 and p = 0.0001 for mHHS at one and two years, p = 0.002 and p = 0.0003 for NAHS at one and two years, respectively). There were 34 patients (44%) who required a total hip replacement at mean of 18 months (6 to 48) after hip arthroscopy. We conclude that hip arthroscopy improves outcome scores in 56% of patients with severe OA of the hip (Tönnis grade 2 and 3) for at least two years after surgery. We thus consider the procedure to be a reasonable option for patients with hip OA, although success of the procedure will be less than if undertaken for certain other conditions.
Highlights
Hip arthroscopy is presently experiencing a large expansion in its use as a conservative surgical procedure
We compared the incidence of total hip replacement (THR) in patients aged < 50 years (n = 60) compared with those aged 50 years (n = 17) but found no significant difference between the two groups (p = 0.79)
Patients with OA of the hip to present to our specialist practice seeking a possible arthroscopic solution to their problem. Such patients are frequently athletically inclined and wish to conserve their hip joint for as long as possible, even if they are made aware that conversion to an arthroplasty may one day be required [19, 20]
Summary
Hip arthroscopy is presently experiencing a large expansion in its use as a conservative surgical procedure. A major indication for its application is in the management of femoroacetabular impingement (FAI), this has begun to change in recent years as other pathologies have been recognised as suitable for the operation[1, 2]. Its role in the management of osteoarthritis (OA) of the hip remains controversial [3,4,5,6]. Arthroscopy for OA in other joints such as the knee has been shown to help patients who have mechanical symptoms [7]. OA of the hip may present clinically with evidence of impingement, pain, and PLOS ONE | DOI:10.1371/journal.pone.0113970. OA of the hip may present clinically with evidence of impingement, pain, and PLOS ONE | DOI:10.1371/journal.pone.0113970 January 30, 2015
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