Abstract
The aims of this study are (i) to report on the rates of subsequent surgery following hip arthroscopy and (ii) to identify prognostic variables associated with revision surgery, survival rates and complication rates. The Statewide Planning and Research Cooperative System database, a census of hospital admissions and ambulatory surgery in New York State, was used to identify cases of primary hip arthroscopy. Demographic information and rates of subsequent revision hip arthroscopy or arthroplasty were collected. The risks were modeled with use of age, sex, procedure and surgeon volume as risk factors. Survival analyses were also performed, and 30-day complication was recorded. We identified 8267 procedures in 7836 patients from 1998 to 2012. Revision surgery occurred in 1087 cases (13.2%) at a mean of 1.7 ± 1.6 (mean ± SD) years. Revision arthroscopy accounted for 311 cases (3.8%), and arthroplasty for 796 (9.7%) cases. Survival analysis showed a 2-year survival rate of 88.1%, 5-year of 80.7% and 10-year of 74.9%. Regression analysis revealed that age >50 years [hazard ratio (HR) 2.09; confidence interval (CI) 1.82–2.39, P < 0.01] and a diagnosis of osteoarthritis (HR 2.72; CI 2.21–3.34, P < 0.01) were associated with increased risk of re-operation. Labral repair was associated with a lower risk of re-operation (HR 0.71; CI 0.54–0.93, P = 0.01). Finally, higher surgeon volume (>164 cases/year) resulted in a lower risk of re-operation versus lower volume (<102 cases/year) (HR 0.42; CI 0.32–0.54, P < 0.01). The 30-day complication rate was 0.2%. Older age and pre-existing osteoarthritis increased the likelihood of re-operation following hip arthroscopy, whereas performing a labral repair and having the procedure performed by a higher-volume surgeon lowered the risk of re-operation.
Highlights
Hip arthroscopy utilization has significantly increased over the past decade, with annual rates increasing as much as 25-fold over that time period [1,2,3,4]
Revision hip arthroscopy has most commonly been associated with residual impingement, while conversion to hip arthroplasty has been associated with advanced patient age, prolonged pre-operative symptoms, acetabular dysplasia, and osteoarthritis (OA) (Tonnis grade 2 or 3) [9,10,11,12,13,14,15], these results have not all been corroborated in larger sample studies while studies have demonstrated that complication rates are closely associated with surgeon volume [16,17,18,19], the impact of surgeon volume on re-operation rates has not been previously explored
The purpose of this study was 2-fold: (i) to report on population-based rates of subsequent surgery following hip arthroscopy, including revision hip arthroscopy and conversion to arthroplasty and (ii) to identify prognostic variables associated with the need for revision surgery, including the impact of procedural volume, and to identify survival rates and complication rates associated with hip arthroscopy
Summary
Hip arthroscopy utilization has significantly increased over the past decade, with annual rates increasing as much as 25-fold over that time period [1,2,3,4]. Many of the available studies are limited to single-institution designs with limited sample size and follow-up duration. There is limited available information on the long-term need for subsequent surgery from a population standpoint. Revision hip arthroscopy has most commonly been associated with residual impingement, while conversion to hip arthroplasty has been associated with advanced patient age, prolonged pre-operative symptoms, acetabular dysplasia, and osteoarthritis (OA) (Tonnis grade 2 or 3) [9,10,11,12,13,14,15], these results have not all been corroborated in larger sample studies while studies have demonstrated that complication rates are closely associated with surgeon volume [16,17,18,19], the impact of surgeon volume on re-operation rates has not been previously explored
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