Short-term Complications and Survival Analyses of Hip Arthroscopies Performed in the English National Health Service - A Review of 6,395 Cases

Abstract

The role of hip arthroscopic intervention for dealing with young adult hip problems is well established. While hip arthroscopies are becoming common, it is not known if it delays the need to have hip replacement in these patients. No guidance exists as to the use of thromboprophylaxis for these patients where surgery can occasionally take a long time. We extracted records for patients undergoing hip arthroscopy from the administrative hospital admissions database (hospital episode statistics) covering all admissions to the NHS hospitals in England using ICD-10 and OPCS-4 codes. A total of 6395 hip arthroscopies were performed in the English NHS from 1st April 2005 to 31st January 2013. Data were obtained on the co-morbidities, Charlson score, 30-day readmission rate, reoperation rate, 90-day deep vein thrombosis (DVT), pulmonary embolism (PE) and mortality rate, and conversion to total hip replacement (THR) at any stage of followup. The mean age of the patients was 38 years with majority being females (M:F=2381:4014). The 30-day readmission rate was 0.5% and 30-day reoperation rate was 1%. The 90-day DVT rate was 0.08% and PE rate was 0.08%. The 90-day mortality rate was 0.02%. 680 patients (10.6%) underwent total hip replacement at a mean of 1.4 years after the index operation. The mean age (48 years) of the patients undergoing THR was significantly (p<0.001) higher than the group who did not undergo THR (36.7 years). Females were more likely to need hip replacement than males (F=12.4%; M=7.3%; p<0.001). Kaplan Meier survival analysis revealed an eight-year survival of 82% while Cox proportional hazard analysis adjusting for age, gender, and Charlson comorbidity score revealed an eight-year survival of 86%. In a large series of hip arthroscopies performed under the NHS in England we have demonstrated that the survival of hip arthroscopy at eight years with joint replacement as the point of failure is 82%. Age and gender are significant predictors of failure. The risk of thromboembolism and mortality rate at 90 days is low, therefore we do not recommend routine use of thromboprophylaxis for these patients.