Abstract
BackgroundOne of the reported goals of hip preservation surgery is to prevent or delay the onset of osteoarthritis. This includes arthroscopic surgery to manage Femoroacetabular Impingement (FAI) Syndrome. The purpose of this study was to describe the prevalence of clinically-diagnosed hip OA within 2 years after hip arthroscopy for FAI syndrome, and 2) determine which variables predict a clinical diagnosis of OA after arthroscopy.MethodsObservational analysis of patients undergoing hip arthroscopy between 2004 and 2013, utilizing the Military Health System Data Repository. Individuals with prior cases of osteoarthritis were excluded. Presence of osteoarthritis was based on diagnostic codes rendered by a medical provider in patient medical records. Adjusted odds ratios (95% CI) for an osteoarthritis diagnosis were reported for relevant clinical and demographic variables.ResultsOf 1870 participants in this young cohort (mean age 32.2 years), 21.9% (N = 409) had a postoperative clinical diagnosis of hip osteoarthritis within 2 years. The 3 significant predictors in the final model were older age (OR = 1.04; 95%CI = 1.02, 1.05), male sex (OR = 1.31; 95%CI = 1.04, 1.65), and having undergone an additional hip surgery (OR = 2.33; 95% CI = 1.72, 3.16). Military status and post-surgical complications were not risk factors.ConclusionA clinical diagnosis of hip osteoarthritis was found in approximately 22% of young patients undergoing hip arthroscopy in as little as 2 years. These rates may differ when using alternate criteria to define OA, such as radiographs, and likely underestimate the prevalence. A more comprehensive approach, considering various criteria to detect OA will likely be necessary to accurately identify the true rates. Females were at lower risk, while increasing age and multiple surgeries increased the risk for an OA diagnosis. OA onset still occurs after “hip preservation” surgery in a substantial number of individuals within 2 years. This should be considered when estimating rates of disease prevention after surgery. Prospective trials with sound methodology are needed to determine accurate rates and robust predictors of osteoarthritis onset after hip preservation surgery.
Highlights
Osteoarthritis (OA) of the knee and hip is a leading cause of disability worldwide, [1] and a primary cause of medical separation from the military [2]
Several crosssectional and longitudinal studies suggest that femoroacetabular impingement (FAI) syndrome is a precursor to future radiographic OA of the hip [3,4,5,6]
The aim of delaying the onset and progression of hip OA has in part contributed to an exponential rise in the rate of arthroscopic surgery for FAI Syndrome, [16, 17] despite the lack of long-term outcomes, and inconclusive determination regarding whether surgical intervention can influence the natural history and progression of hip OA [13, 14]
Summary
Osteoarthritis (OA) of the knee and hip is a leading cause of disability worldwide, [1] and a primary cause of medical separation from the military [2]. Rhon et al BMC Musculoskeletal Disorders (2019) 20:266 the progression of OA in the femoroacetabular joint [13, 14]. It is unknown if this intervention alters the onset of OA beyond morphologically-normal controls [15]. One of the reported goals of hip preservation surgery is to prevent or delay the onset of osteoarthritis. This includes arthroscopic surgery to manage Femoroacetabular Impingement (FAI) Syndrome. The purpose of this study was to describe the prevalence of clinically-diagnosed hip OA within 2 years after hip arthroscopy for FAI syndrome, and 2) determine which variables predict a clinical diagnosis of OA after arthroscopy
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