Risk Factors for Adhesions Following Hip Arthroscopy (SS-39)

Abstract

Introduction Intra-articular adhesions have been reported both after open and arthroscopic approaches to the hip. However the factors which may lead to an increased rate of adhesions have not been identified. The purpose of this study was to evaluate the possible risk factors for adhesions after hip arthroscopy. Methods Between 2005 and 2009, data from arthroscopic hip surgeries were analyzed. The study included only those primary hip arthroscopies. For all cases, it was determined if hips had been revised due to adhesions. This was determined by patients returning to surgeon or by patient report. Patients were excluded if no contact could be made to determine if a revision had occurred. Data included age, gender, labral treatment, microfracture of chondral surfaces, and rehabilitation protocol. The study was IRB approved. Results Between 2005 and 2009, 1,402 hip in patients over the age of 18 years had primary hip arthroscopy. 1,358 of the 1,402 (96%) were contacted. 65 hips required revision hip arthroscopy (4.8%). 153 of the hips had labral debridement, and 1,196 had labral repair. 6/153 debridements had adhesions and 57/1,196 of the repair had adhesions (p=0.641). There is no difference in the prevalence of adhesions between debridement and repairs. 5% of patients who did not undergo microfracture had adhesions and 3% of hips that did undergo microfracture had adhesions. In November of 2008, the hip rehabilitation program was changed to include hip circumduction. 1,067 hips did not do circumduction, and 291 did do circumduction. 4/291 had adhesions with circumduction, while 61/1,108 had adhesions without circumduction (p=0.001). Patients without circumduction were 4.4 [95 CI 1.6 to 11.6] times more likely to have adhesions. Conclusion Adhesions following hip arthroscopy were reduced with changes to the rehabilitation protocol. Other factors such as demographics and surgical treatment were not associated with risk of adhesions. Intra-articular adhesions have been reported both after open and arthroscopic approaches to the hip. However the factors which may lead to an increased rate of adhesions have not been identified. The purpose of this study was to evaluate the possible risk factors for adhesions after hip arthroscopy. Between 2005 and 2009, data from arthroscopic hip surgeries were analyzed. The study included only those primary hip arthroscopies. For all cases, it was determined if hips had been revised due to adhesions. This was determined by patients returning to surgeon or by patient report. Patients were excluded if no contact could be made to determine if a revision had occurred. Data included age, gender, labral treatment, microfracture of chondral surfaces, and rehabilitation protocol. The study was IRB approved. Between 2005 and 2009, 1,402 hip in patients over the age of 18 years had primary hip arthroscopy. 1,358 of the 1,402 (96%) were contacted. 65 hips required revision hip arthroscopy (4.8%). 153 of the hips had labral debridement, and 1,196 had labral repair. 6/153 debridements had adhesions and 57/1,196 of the repair had adhesions (p=0.641). There is no difference in the prevalence of adhesions between debridement and repairs. 5% of patients who did not undergo microfracture had adhesions and 3% of hips that did undergo microfracture had adhesions. In November of 2008, the hip rehabilitation program was changed to include hip circumduction. 1,067 hips did not do circumduction, and 291 did do circumduction. 4/291 had adhesions with circumduction, while 61/1,108 had adhesions without circumduction (p=0.001). Patients without circumduction were 4.4 [95 CI 1.6 to 11.6] times more likely to have adhesions. Adhesions following hip arthroscopy were reduced with changes to the rehabilitation protocol. Other factors such as demographics and surgical treatment were not associated with risk of adhesions.