Hip Arthroscopy Procedures Research Articles

Hip arthroscopy failure rates: a healthcare database analysis in the United States

Abstract With hip arthroscopy cases, there has been a concomitant increase in complications and the need for revision surgery. This study aims to further contribute to the literature regarding hip arthroscopy failure rates and associated patient factors following an index hip arthroscopy procedure. The PearlDiver database was queried for patients who had undergone hip arthroscopy. International Classification of Diseases, 10th Revision, Clinical Modification codes were used to ensure that follow-up was performed on the ipsilateral limb. Hip arthroscopy failure was defined specifically as subsequent ipsilateral total hip arthroplasty (THA) and reoperation, which were examined in all patients that met inclusion criteria. Independent patient variables, including psychiatric comorbidities, preoperative SSRI use, smoking, and obesity, were examined to identify an association with failure rates. A Student t-test, with a significance set at P < 0.05, was used for statistical comparisons of postoperative outcomes. Odds ratios were used to calculate the probability of short-term hip reoperation in patients with the above independent variables. A total of 19 067 hip arthroscopy patients were included in this study. Within 2 years from the index hip arthroscopy, there was an 11.42% failure rate as defined by subsequent reoperation and 7.16% failure rate as defined by revision to THA, with a total revision surgery rate of 18.58%. The most common reoperation procedure was revision femoroplasty (72%). Patients with an active diagnosis of a psychiatric comorbidity in the year leading up to a hip arthroscopy procedure were 1.74 times more likely to require a hip reoperation within 1 year (95% CI, 1.55–1.95).

A Multicenter Analysis of 3 Decades of Hip Arthroscopy: Evolving Techniques and Growing Patient Volumes From 1988 to 2022.

The number of hip arthroscopies performed in the United States has grown significantly over the past several decades, with evolving indications and emerging techniques. To (1) examine the evolution of hip arthroscopy at 3 tertiary referral centers between 1988 and 2022 and (2) quantify trends in patient demographics and procedures performed. Case series; Level of evidence, 4. A retrospective analysis was performed of all patients undergoing hip arthroscopy at 3 academic centers between 1988 and 2022. Demographic data were collected using standardized forms and operative notes, and intraoperative images were manually reviewed for each patient to determine the specific procedures performed at the time of the hip arthroscopy. Surgical procedures were plotted over time to evaluate trends. Patients were divided into 3 time periods for comparison: early hip arthroscopy from 1988 to 2008, 2009 (the time of the first labral repair in our cohort) to 2015, and 2016 to 2022. A total of 3000 patients (age, 35.7 ± 13.8 years; age range, 10-89 years; female sex, 2109 (70.3%); body mass index, 27.4 ± 6.3 kg/m2) underwent arthroscopic hip procedures between 1988 and 2022. The mean number of cases increased from a mean of 3.2 per year in 1988-2008 to 285.9 per year in 2016-2022 (P < .001). Labral treatment at the time of primary hip arthroscopy evolved from 100% debridement and 0% repair in 1988-2008 to 5.0% debridement, 94.0% repair, and 1.0% labral reconstruction in 2016-2022 (P < .001). Cam resection increased from 4.1% in 1988-2008 to 86.9% in 2016-2022 (P < .001). By 2022, 45 out of 325 cases (13.8%) were revisions. The rate of capsular repair at the time of primary hip arthroscopy increased from 0.0% in 1988-2008 up to 81.0% in 2016-2022. There has been a significant growth of hip arthroscopy volumes as well as a significant transition from use as a tool for diagnosis and labral debridement to procedures restoring native anatomy including labral repair, cam resection, capsular repair, periacetabular osteotomy, and gluteal repair.

Revision Hip Arthroscopy: Getting It Right the Second Time

Hip arthroscopy procedures have become increasingly common in the last few decades for treating both intra- and extra-articular hip pathologies. Despite advancements in the field, some patients may not experience improvement and may eventually require revision hip arthroscopy. The multifactorial causes for failure, unknown impacts of the primary procedure and previous iatrogenic considerations can create added complexity for the revision. Given that revision hip arthroscopy has had more variation in patient outcomes and higher rates of subsequent conversion to hip arthroplasty, compared with primary hip arthroscopy, it is imperative to have a good algorithm for patient selection and to understand the various surgical options available to address different pathologies. In this review, we explore the current diagnostic algorithms, etiologies, surgical procedures, outcomes, and provide insights into future directions in the field of revision hip arthroscopy.

Variation in the Cost of Hip Arthroscopy for Labral Pathological Conditions: A Time-Driven Activity-Based Costing Analysis.

Despite growing interest in delivering high-value orthopaedic care, the costs associated with hip arthroscopy remain poorly understood. By employing time-driven activity-based costing (TDABC), we aimed to characterize the cost composition of hip arthroscopy for labral pathological conditions and to identify factors that drive variation in cost. Using TDABC, we measured the costs of 890 outpatient hip arthroscopy procedures for labral pathological conditions across 5 surgeons at 4 surgery centers from 2015 to 2022. All patients were ≥18 years old and were treated by surgeons who each performed ≥20 surgeries during the study period. Costs were normalized to protect the confidentiality of internal hospital cost data. Descriptive analyses and multivariable linear regression were performed to identify factors underlying cost variation. The study sample consisted of 515 women (57.9%) and 375 men (42.1%), with a mean age (and standard deviation) of 37.1 ± 12.7 years. Most of the procedures were performed in patients who were White (90.6%) or not Hispanic (93.4%). The normalized total cost of hip arthroscopy per procedure ranged from 43.4 to 203.7 (mean, 100 ± 24.2). Of the 3 phases of the care cycle, the intraoperative phase was identified as the largest generator of cost (>90%). On average, supply costs accounted for 48.8% of total costs, whereas labor costs accounted for 51.2%. A 2.5-fold variation between the 10th and 90th percentiles for total cost was attributed to supplies, which was greater than the 1.8-fold variation attributed to labor. Variation in total costs was most effectively explained by the labral management method (partial R2 = 0.332), operating surgeon (partial R2 = 0.326), osteoplasty type (partial R2 = 0.087), and surgery center (partial R2 = 0.086). Male gender (p < 0.001) and younger age (p = 0.032) were also associated with significantly increased costs. Finally, data trends revealed a shift toward labral preservation techniques over debridement during the study period (with the rate of such techniques increasing from 77.8% to 93.2%; Ptrend = 0.0039) and a strong correlation between later operative year and increased supply costs, labor costs, and operative time (p < 0.001 for each). By applying TDABC to outpatient hip arthroscopy, we identified wide patient-to-patient cost variation that was most effectively explained by the method of labral management, the operating surgeon, the osteoplasty type, and the surgery center. Given current procedural coding trends, declining reimbursements, and rising health-care costs, these insights may enable stakeholders to design bundled payment structures that better align reimbursements with costs. Economic and Decision Analysis Level IV. See Instructions for Authors for a complete description of levels of evidence.

Extended Interportal Capsulotomy for Hip Arthroscopy, a Single-Center Clinical Experience.

Background and Objectives: The number of hip arthroscopy procedures is on the rise worldwide, and awareness regarding proper management of the hip capsule has increased. No capsulotomy shape is agreed upon as a standard approach, with literature supporting both isolated interportal and T-shaped capsulotomies. The aim of this retrospective cohort study is to report the clinical results of a standardized extended interportal capsulotomy (EIPC) during hip arthroscopy. Materials and Methods: Patients operated on between 2017 and 2020 with a hip arthroscopy were eligible. The inclusion criteria were ages 18-60 years, failed non-operative treatment, and at least a 2-year follow-up. Exclusion criteria were bilateral femoroacetabular impingement syndrome (FAS) cases or labral lesions, ipsilateral knee injury, history of ipsilateral hip surgery, and significant spine lesions. Data regarding demographic characteristics such as age, gender, operation date, BMI, but also Beighton score, presence of postoperative pudendal nerve damage, and revision for any reason were gathered from patients' records. All patients were evaluated preoperatively with a visual analog scale (VAS), the Hip Disability and Osteoarthritis Outcome Score (HOOS), and the modified Harris Hip Score (mHHS). Results: Of the 97 patients operated on with a hip arthroscopy between the defined dates, only 90 patients were included. The mean age was 37.9 ± 9.8, and 58.9% of patients were male. The most frequent surgical indication was an isolated FAS lesion (73.3%), followed by FAS associated with a labral tear (12.2%), an isolated labrum tear (10.0%), synovitis (3.3%), and a loose body (1.1%). The mean follow-up for the study cohort was 39.3 months. The majority of the patients had uneventful surgeries (76.7%), while there were three cases of sciatic nerve neuropraxia and 12 cases of pudendal nerve neuropraxia. Two patients underwent revision surgery during the study period. Comparison between preoperative and postoperative clinical scores showed a significant improvement with a final mHHS mean value of 67.7 ± 18.2, an HOOS value of 74.1 ± 13.2, and a low VAS score of 1.3 ± 1.2. Conclusions: A hip arthroscopy procedure with a standardized and unrepaired, extended interportal capsulotomy is a safe procedure with satisfactory mid-term results and high overall patient satisfaction. At a minimum of 2 years and a mean of 39.2 months, patients showed improved clinical scores and a low revision rate.

Declining Inflation-Adjusted Medicare Physician Fees: An Unsustainable Trend in Hip Arthroscopy.

Although hip arthroscopy continues to be one of the most used arthroscopic procedures, no focused, comprehensive evaluation of reimbursement trends has been conducted. The purpose of this study was to analyze the temporal Medicare reimbursement trends for hip arthroscopy procedures. From 2011 to 2021, the Medicare Physician Fee Schedule Look-Up Tool was queried for Current Procedural Terminology (CPT) codes related to hip arthroscopy (29860 to 29863, 29914 to 29916). All monetary data were adjusted to 2021 US dollars. The compound annual growth rate and total percentage change were calculated. Mann-Kendall trend tests were used to evaluate the reimbursement trends. Based on the unadjusted values, a significant increase in physician fee was observed from 2011 to 2021 for CPT codes 29861 (removal of loose or foreign bodies; % change: 3.49, P = 0.03) and 29862 (chondroplasty, abrasion arthroplasty, labral resection; % change: 3.19, P = 0.03). The remaining CPT codes experienced no notable changes in reimbursement based on the unadjusted values. After adjusting for inflation, all seven of the hip arthroscopy CPT codes were observed to experience a notable decline in Medicare reimbursement. Hip arthroscopy with acetabuloplasty (CPT: 29915) and labral repair (CPT: 29916) exhibited the greatest reduction in reimbursement with a decrease in physician fee of 24.69% ( P < 0.001) and 24.64% ( P < 0.001), respectively, over the study period. Medicare reimbursement for all seven of the commonly used hip arthroscopy services did not keep up with inflation, demonstrating marked reductions from 2011 to 2021. Specifically, the inflation-adjusted reimbursements decreased between 19.23% and 24.69% between 2011 and 2021.

Clinical outcomes after hip arthroscopy in acetabular dysplastic patients, previously treated with periacetabular osteotomy: a minimum of two-year follow-up data from the Danish Hip Arthroscopy Registry

ABSTRACT Periacetabular osteotomy (PAO) is the treatment of choice in dysplastic acetabulum. Due to continued symptoms, 2–11% of these patients require an additional hip arthroscopy. The purpose of this study was to report clinical outcome after a minimum of 2-year follow-up of additional hip arthroscopy after PAO with data from Danish Hip Arthroscopy Registry. Inclusion criteria in the study cohort were PAO surgery resulting in an additional hip arthroscopy procedure. The cohort was evaluated according to the surgical findings and patient-related outcome measures (PROMs) pre-operatively and at 2-year follow-up. A total of 287 patients were included in the study cohort. PROMs improved significantly in all subscales from pre-operatively to 2-year follow-up in the study cohort. According to PROM subscales, 47.8–57.6% and 25.2–38.2% achieved Minimal Clinical Important Difference and Patient Acceptable Symptom State, respectively. This study demonstrates, in PAO-treated patients, significant PROM improvements after additional hip arthroscopy. Unfortunately, only ∼50% and 30% achieved Minimal Clinical Important Difference and Patient Acceptable Symptom State, respectively.

Return to Golf After Hip Arthroscopy: A Systematic Review of the Literature.

Patients experiencing pain from femoral acetabular impingement and considering hip arthroscopy may be concerned about their timeline to resume activities they enjoy, such as golf. The purpose of this study was to review current literature on return-to-play data after hip arthroscopy and to provide clinicians with data to set proper expectations with patients. The following terms were used to search PubMed and Embase electronic databases on October 18, 2023: hip, arthroscopy, arthroscopic, golf. Studies were included if they were in the English language, of Level 1 to 4 evidence, and contained data specific to golfers undergoing hip arthroscopy. Studies were excluded if they did not designate participants as golfers or did not specify return-to-play data. Editorials, case reports, and review articles were excluded. Screening was completed by 2 authors in a blind and duplicate manner. Systematic review. Level II. The following datapoints were extracted from each study: hip pathology and arthroscopic procedure data; number of players returning to golf and time from surgery to return; outcome score(s); and rehabilitation details. Descriptive statistics were calculated using Comprehensive Meta-Analysis software. The search returned 400 studies, of which 4 were included for analysis. Of these 4 studies, 2 specified return-to-play time. Of 95 golfers, 90 (94.7%) returned to golf successfully after arthroscopic hip surgery. Subjective and objective outcome scores improved postoperatively, including an increased average drive distance. Return to golf after hip arthroscopy is highly probable, with approximately 95% of patients throughout literature returning to play. A mean return time of 4.7 months for professional golfers and 7.2 months for amateurs, alongside improved subjective outcomes and performance metrics postsurgery, suggest patients can expect a relatively quick return to the course with similar or improved performance.

Relationship Between Hip Capsular Thickness and Instability After Previous Hip Arthroscopic Surgery: A Matched-Cohort Analysis.

Thinner anterior hip capsules are associated with hip laxity, but there is little known about the impact of capsular thickness on the development of instability after primary hip arthroscopic surgery. To investigate the relationship between hip capsular thickness as measured on preoperative magnetic resonance imaging (MRI) and the development of hip instability after hip arthroscopic surgery for femoroacetabular impingement. Case-control study; Level of evidence, 3. We reviewed revision hip arthroscopic procedures performed between January 1, 2019, and May 1, 2021, at a single institution. Inclusion criteria were preoperative MRI/magnetic resonance arthrography, completion of the study traction protocol, and asymmetric distraction between the hips of ≥3 mm on examination under anesthesia. A comparison group of patients treated for femoroacetabular impingement with primary hip arthroscopic surgery who did not develop capsular instability were matched 1:1 to the patients with instability. Superolateral hip capsular thickness was measured on MRI before index surgery. Analysis was conducted using independent-samples t tests and multivariable linear regression. A total of 44 patients were included, with 22 patients each in the instability and no-instability groups. The mean capsular thickness was lower in the patients with hip instability than in those without (1.9 ± 0.6 vs 3.4 ± 1.1 mm, respectively; P < .001). Decreased capsular thickness was significantly associated with hips with instability versus no-instability (β = -1.468 [95% CI, -2.049 to -0.887]; P < .001). Thinner preoperative hip capsules in the region of the iliofemoral ligament were seen in patients who subsequently underwent revision arthroscopic surgery for hip instability compared to patients who underwent primary hip arthroscopic surgery without subsequent revision. Patients at a higher risk for the development of postoperative hip instability had a superolateral hip capsular thickness of <2 mm.

Capsular Repair, Labral Repair, and Femoroplasty are Increasingly Performed for the Arthroscopic Treatment of Femoroacetabular Impingement Syndrome

PurposeThe purpose of our study was to provide an updated assessment of hip arthroscopy utilization using an institutional database that is specific to the treatment of femoroacetabular impingement syndrome (FAIS). MethodsAll patients undergoing hip arthroscopy for the treatment of FAIS were retrospectively identified between the years 2014 and 2022 via Current Procedural Terminology (CPT) coding in a multi-institutional, single health-system database. A longitudinal analysis was performed to identify trends in the utilization of arthroscopic techniques including capsular and labral treatment, osteoplasty, and traction set-up. ResultsDuring the study, a total of 789 arthroscopic hip procedures in 733 patients were analyzed (56 staged bilateral). Between 2016 and 2022, the number of hip arthroscopies performed each year increased by 1490% (R2 =0.87, p=0.001). Capsular repair (R2=0.92, p<0.001), labral repair (R2=0.75, p=0.002), and femoroplasty (R2=0.70, p=0.004) were performed in an increasing proportion of cases over our study period while labral debridement (R2=-0.84, p<0.001) became less utilized. Postless traction systems were employed in 84% (663/789) of hip arthroscopies overall, were used in at least 70% of hip arthroscopies each year, and did not undergo any significant changes in utilization (R2=0.02, p=0.73). ConclusionCapsular repair, labral repair, and femoroplasty were increasingly performed for the arthroscopic treatment of FAIS while the use of labral debridement decreased significantly over our study period. Postless traction systems were utilized in the majority of cases each year. Clinical RelevanceAs comparative literature continues to define the safety and efficacy of hip arthroscopy, understanding how novel techniques or procedures are incorporated in clinical practice is important.

Social Determinants of Health in Maryland Hip Arthroscopy Patients.

Background Prior studies have demonstrated racial and socioeconomic disparities in patient-reported outcome measure(PROM) completion rates, and improvement exists across multiple orthopedic conditions. The purpose of this study was to assess whether these disparities are present in patients undergoing hip arthroscopy (HA) procedures. Methods A retrospective study of 306 patients undergoing HA from 2021 to 2023 was performed. Social determinants of health (SDOH) were compared between HA patients and the general Maryland population. Patients were then classified by whether they completed baseline and six-month PROMs (Patient-Reported Outcomes Measurement Information System Physical Function (PROMIS-PF) instrument). Patients who completed PROMIS-PF were classified by whether or not they achieved minimal clinically important difference (MCID) at six months. Demographics and SDOH were compared using univariate analyses between patients who did and did not complete PROMs and between those who did and did not achieve MCID. SDOH were evaluated at the zip-code level using regional health information exchange measures. Results Compared to the Maryland population, HA patients resided in areas of lower social vulnerability. Preoperative and six-month PROMs were completed by 102 (33%) patients. No significant differences in demographics or any SDOH were found between patients who did and did not complete PROMs. Six-month MCID was achieved in 75 of 102 (74%) patients with complete PROMs; no significant differences in demographics or SDOH were observed between patients who did and did not achieve MCID. Conclusions For patients undergoing HA, disparities in patient-reported outcome completion rates and postoperative functional improvement do not appear to be present across demographics and SDOH, indicating equitable care is being delivered.

Increasing Hip Arthroscopy Case Volume Is Associated With Increased Risk for Revision Surgery but Not Conversion to Total Hip Arthroplasty or 90-Day Hospitalizations: A Cross-Sectional Analysis of 468 Surgeons

To analyze the effects of surgeon-specific factors, including case volume, career duration, fellowship training, practice type, and region of practice, on rates of 2-year revision surgery, conversion to total hip arthroplasty (THA), and 90-day hospitalizations following hip arthroscopy. The PearlDiver Mariner Database was used to query patients undergoing hip arthroscopy between 2015 and 2018. Surgeons performing these procedures were identified, and surgeon-specific demographics and variables were collected from publicly available data. Patients were followed for 2 years to assess for reoperations, including revision hip arthroscopy and conversion to THA, as well as 90-day hospitalizations, including emergency department visits and hospital readmissions. International Classification of Diseases, Tenth Revision codes were used to track the laterality of revision hip procedures. Associations between surgeon-specific factors and postoperative outcomes were assessed through univariate and multivariate analyses. In total, 20,834 patients underwent hip arthroscopy procedures by 468 surgeons. Multivariate analysis with logistic regression adjusted for patient-related factors (age, sex, obesity, Charlson Comorbidity Index, and smoking status) identified increasing surgeon case volume to be associated with increased risk for 2-year revision hip arthroscopy (P < .001), but not 2-year conversion to THA or 90-day hospitalizations. Nonsports medicine fellowship-trained surgeons were associated with greater risk for 2-year THA conversion (P < .001) and 90-day hospital readmissions (P < .01). Surgeons practicing in an academic setting demonstrated greater risk for 90-day hospital readmissions (P < .001). Surgeons practicing in the West region of the United States were more likely to incur 2-year revision hip arthroscopy procedures compared to surgeons in the South, Midwest or Northeast (P < .001). Increasing surgeon hip arthroscopy case volume is associated with an increased risk for 2-year revision hip arthroscopy but not conversion to THA or 90-day hospitalizations. Further, non-sports medicine fellowship-trained surgeons were associated with higher risk for 2-year THA conversion after hip arthroscopy. Level III, retrospective cohort analysis.

The revision hip arthroscopy complex: capsular deficiency, labral deficiency, femoral over-resection andadhesions can result ingood survivorship with revision hip arthroscopy.

To evaluate the patient-reported outcomes (PROs) and survivorship of combined arthroscopic hip labral reconstruction/augmentation, capsular reconstruction, femoral neck remplissage and lysis of adhesions. Patients ≥18 years old who underwent this combination of procedures during revision hip arthroscopy and were eligible for minimum 2-year follow-up were identified. PRO scores including Hip Outcome Score (HOS)-Activities of Daily Living scale, HOS-Sports scale, modified Harris Hip Score, Short Form 12, and Western Ontario & McMaster Universities Osteoarthritis Index, patient satisfaction and failure rates were analyzed. Seven patients (5 females and 2 males) with average age of 45.0 ± 5.2 (range: 40-54 years) met inclusion criteria. Patients had a median of 1 (range: 1-3) prior hip surgery at an outside institution. All patients had previously undergone femoral osteoplasty, and 85% (6/7) of patients had a labral repair performed. Four patients had no capsule closure performed in their prior procedures. Six patients were available for minimum 2-year follow-up. Two patients converted to total hip arthroplasty: one patient with four prior hip arthroscopies and the other had advanced osteoarthritis with outerbridge grade 3/4 defects requiring microfracture. Mean patient satisfaction was 7 (range: 2-9). At mean follow-up of 3 years, most patients who underwent the combination of labral reconstruction, capsular reconstruction, femoral neck remplissage and lysis of adhesions during revision hip arthroscopy demonstrated improved PROs. This salvage procedure has the potential to restore hip function in patients who have failed an initial hip arthroscopy procedure. In patients with these pathologies present and concomitant joint space narrowing, a total hip arthroplasty may be a more appropriate salvage option.

Validation of the French version of the Non-Arthritic Hip Score (NAHS) in 113 hip arthroscopy procedures

BackgroundThe Non-Arthritic Hip Score (NAHS) used to evaluate the hip in younger patients is a self-administered questionnaire with 20 items in four sections: pain, symptoms, function, and activities. Although used in France, no transcultural version had been validated. The objective of this study was to translate the NAHS into French then assess the validity, reliability, and sensitivity to change of the French-language version (NAHS-Fr) in younger patients with hip conditions other than osteoarthritis. HypothesisThe NAHS-Fr demonstrates good validity and reliability when used in younger French-speaking patients with hip pain. Material and methodsWe conducted a prospective observational study in 105 patients (62 males and 43 females) scheduled for surgery on one or both hips (113 hips in total) to treat cam-type femoro-acetabular impingement or labral lesions. Before and 6 months after surgery, each patient completed the NAHS-Fr and Western Ontario and McMaster Osteoarthritis Index (WOMAC). Statistical tests were done to evaluate validity, reliability, and sensitivity to change, as recommended by the Consensus-based Standards for the selection of health Measurement Instruments (COSMIN). ResultsThe response rate was 100%, confirming that the NAHS-Fr was easy to use. The NAHS-Fr was both valid and reliable. No ceiling or floor effect was detected for the total NAHS-Fr score. All items had Cronbach alpha coefficients greater than 0.8, indicating good internal consistency. External consistency between the NAHS-Fr and WOMAC was negative (–0.676) due to inversely proportional score indexing. Before surgery, the NAHS-Fr and WOMAC scores were strongly and significantly correlated (p<0.0001). The effect size was greater than 0.8, indicating good sensitivity to the change induced by surgery. DiscussionThese results confirm the study hypothesis: the NAHS-Fr has the same good psychometric characteristics as does the original version and versions in other languages. The NAHS-Fr is useful for evaluating younger patients with non-osteoarthritic hip pain and can be used by French-speaking surgeons in everyday clinical practice. Level of evidenceIV, prospective observational non-comparative cohort study.

Trends inhip preservation surgery inJapan from 2014 to 2019 with a focus onhip arthroscopic surgery.

Secondary hip osteoarthritis due to hip dysplasia is common among Japanese populations. This study aimed to investigate the number of hip preservation surgeries performed in Japan and assess trends, by age and sex, from 2014 to 2019, focusing on hip arthroscopic surgery, based on the National Database of Health Insurance Claims and Specific Health Checkups of Japan (NDB). We downloaded the files 'Number of calculations by division, sex, and age group' under 'operation (code K)' from 2014 to 2019 from the NDB Open Data Japan database. Data on hip preservation surgeries were extracted, including the number for each surgical procedure and its incidence per year, calculated as the number of surgeries performed for each 10-year age group and by sex, regarding hip arthroscopic surgery. Overall, 14 891 hip preservation surgeries were performed in Japan over the study period, with pelvic osteotomy being the most common procedure. Although the incidence of hip preservation surgeries decreased from 2014 to 2019, there was a specific 1.54-fold higher incidence in hip arthroscopic procedures in 2019 compared to 2014. Hip arthroscopic labral repair was performed more frequently than synovectomy. The highest incidence of hip arthroscopic surgery was in the 40- to 49-years age group, with no difference in incidence between sexes (P = 0.951). In Japan, pelvic osteotomy was performed more often as a hip preservation surgery than hip arthroscopic surgery. Although hip arthroscopic surgery was developed in Japan, its use has not increased from 2017 to 2019.

Poster 362: Identifying Racial Disparity in Utilization and Outcomes of Hip Arthroscopy using Machine Learning

Objectives: Background: Arthroscopic diagnosis and treatment of femoroacetabular pathology has been increasingly used in the past thirty years with interventions resulting in improved hip function and ultimate delay of hip arthroplasty in a minimally invasive manner. Unfortunately, previous investigations have observed decreased rates of access, utilization of, and outcomes following orthopedic interventions such as hip arthroplasty in underrepresented patients. The purpose of this study is to examine racial differences in procedural rates, outcomes, and complications in patients undergoing hip arthroscopy. Methods: The State Ambulatory Surgery and Services Database (SASD) and State Emergency Department Database (SEDD) of New York were queried for patients undergoing hip arthroscopy from 2011 to 2017. The primary outcomes investigated were utilization over time, total charges billed per encounter, 90-day emergency department visits, and revision hip arthroscopy. Patients were stratified into White and non-White race, and intergroup differences were evaluated with descriptive statistics. Subgroup analysis was performed with linear mixed-effects models to identify significant interactions between race and individual variables that contributed to any differences in the outcomes of interest. Temporal trends in utilization of hip arthroscopy and concomitant procedures between the two groups were analyzed with Poisson regression modeling. Finally, targeted maximum likelihood estimation (TMLE) was performed to provide nonparametric estimates of the specific differences in the outcomes studied using machine learning ensembles while controlling for patient risk factors. Results: A total of 9,745 patients underwent hip arthroscopy during the study period, with 1,081 patients of non-White race (11.9%). Results of Poisson regression demonstrated an annual increase of 1.11 in the incidence rate of hip arthroscopy among White patients, compared to 1.03 for non-White patients (p&lt;0.001), with this disparity projected to increase by 2040. Based on TMLE utilizing an ensemble of machine learning models, non-White patients were significantly more likely to incur higher costs (OR: 1.30, 95% CI: 1.24-1.37, p&lt;0.001) and visit the emergency department within 90-days (OR: 1.09, 95% CI: 1.01, 1.18, p=0.05), but had negligible differences in reoperation rates at 90 days to 2 years (OR: 1.13, 95% CI: 0.78-1.63, p=0.53). Subgroup analysis identified higher likelihood for 90-day emergency department admissions among non-White patients compared to White patients, which were significantly compounded by Medicare insurance (OR: 2.95, 95% CI 1.46-5.95, p=0.002), median income in the lowest quartile (OR: 1.84, 95% CI: 1.2-2.61, p=0.012), and residence in low-income neighborhoods (OR: 2.05, 95% CI: 1.31-3.2, p=0.006). Subgroup analysis for charges billed and reoperation did not identify significant findings. Conclusions: Hip arthroscopy remains an increasingly utilized surgical technique for the treatment of a myriad of hip disorders. Unfortunately, racial disparities exist and are worsening over time. Irrespective of insurance status, non-white patients undergo hip arthroscopy at a lower rate, incur higher costs, and more frequently experience unexpected returns to the emergency department. Improved initiatives to improve the disparity in access to and outcomes following hip arthroscopy must be addressed to further its utility for all patients.

Use of Intraoperative Technology to Perform a Cam Resection During Hip Arthroscopy for Femoroacetabular Impingement Syndrome

Background: The learning curve for the surgical treatment of cam deformities in femoroacetabular impingement syndrome (FAIS) presents a challenge for young or inexperienced surgeons, with the leading cause of failed hip arthroscopy being incomplete resection. Historically, alpha angle measurements are typically used perioperatively to both diagnose cam deformity and evaluate the adequacy of cam resection. The computer-assisted Styker HipCheck system offers the surgeon real-time alpha angle measurements, assisting with the execution of cam resection. Indications: The indication for use is any hip arthroscopic procedure for femoroacetabular impingement requiring osteochondroplasty of cam deformity. Advantages of the HipCheck system include shortened operative time; reduced risk of inadequate or over-resection; accelerated learning curve; no requirement of preoperative computed tomographic imaging or pre-planning; being noninvasive, portable, and not requiring additional instruments; increased patient and surgeon satisfaction; and allowance of repeated quantitative and visual assessment, which is particularly beneficial for more difficult regions, such as posteromedial and posterolateral, to view the femoral head/neck. Technique Description: Briefly, after intra-articular procedures are complete, the peripheral compartment is accessed. We prefer a T-type capsulotomy. Next, the cam deformity is registered on Stryker HipCheck software, automatically calculating alpha angles as the hip is dynamically moved through 6 registered positions. A standard cam resection is then performed. Once complete, the hip is dynamically assessed and again registered with the HipCheck system in the same 6 positions to ensure adequate resection has been performed. Results: When comparing patients with FAIS undergoing computer-guided resection or standard resection, both surgical interventions demonstrated successful reduction in alpha angle and no difference in degree of resection. In addition, the various computer-guided views exhibited good correlations to clinical radiographs. Discussion: The HipCheck intraoperative system allows the surgeon to evaluate the adequacy of cam resection through the use of automated alpha angles. Furthermore, the system offers instantaneous feedback of cam resection at any desired position of the hip. This intraoperative technology may offer less experienced surgeons an aid when performing hip arthroscopy for cam resection in the setting of femoroacetabular impingement. Patient Consent Disclosure Statement: The author(s) attests that consent has been obtained from any patient(s) appearing in this publication. If the individual may be identifiable, the author(s) has included a statement of release or other written form of approval from the patient(s) with this submission for publication.

Poster 227: The Impact of Hip Arthroscopy on Pregnancy-Related Decision-Making and Outcomes among Female Patients: A Single Surgeon’s Experience

Objectives: Women of reproductive age are among the most frequent recipients of hip arthroscopic procedures in the U.S., and anecdotal evidence suggests that some female patients consider pregnancy a factor in their decision to undergo, delay, or avoid such surgeries. In addition, anatomical changes during pregnancy may exacerbate existing hip pathologies such as femoroacetabular impingement (FAI) and labral tears, potentially leading to greater pain and risk of complications during gestation, labor, and delivery. However, the impact of hip pain and arthroscopy on pregnancy-related decision-making and outcomes is poorly understood. The aims of this study were to determine (1) how pregnancy planning affected patients’ decisions to pursue hip arthroscopy, (2) whether undergoing hip arthroscopy affected hip pain before and after pregnancy, and (3) whether hip arthroscopy was associated with any pregnancy-related complications. Methods: We retrospectively studied female patients aged 18-45 years who underwent hip arthroscopy for the treatment of FAI and/or labral tears at our center from 2010-2021. Subjects were identified using a prospectively-collected single-surgeon database. Eligible subjects were administered an electronic survey that assessed obstetrical history, concerns about how their hip pain and/or the process of undergoing hip arthroscopy could affect future pregnancies, location and intensity of hip pain at various time points (before surgery, after surgery, during pregnancy), and complications experienced during pregnancy. Hip pain intensity was reported on a 10-point Visual Analog Scale (VAS). Subjects also completed the modified Harris Hip Score (mHHS). Continuous variables were compared within groups with Wilcoxon signed rank test and between groups with Kruskal-Wallis test. Fisher’s exact test was used to compare categorical variables between groups. P-values &lt; 0.05 were considered significant. Results: A total of 86 patients completed the survey. Mean age at time of surgery was 32.3 ± 6.4 years (range 18 - 45), mean BMI was 24.5 ± 4.7 (range 18.7 – 39.8), and mean follow-up time was 52.0 ± 34.3 months (range 6 – 146). 47 patients (54.7%) had been pregnant at least once. Half of the cohort reported moderate or high concern that their hip pain would worsen during a future pregnancy, while a slight majority felt that hip surgery would not raise their risk of complications during pregnancy (56.0%) or impair hip function after pregnancy (51.2%). 27 patients (31.4%) had become pregnant after hip surgery at an average of 6.3 ± 1.4 months (range 2 – 8) postoperative, of whom 13 (48.2%) cited hip pain as a factor in getting surgery before pregnancy and 9 (33.3%) reported delaying a planned pregnancy to undergo surgery. Patients who became pregnant after surgery experienced a significant increase in VAS hip pain during pregnancy (p = 0.02), most commonly during the third trimester, though pain resolved after pregnancy in most (19 of 27, 70.4%). Five patients (5 of 27, 18.5%) experienced a miscarriage and the most common complication reported was vaginal/perineal tear (13 of 27, 48.1%). Of the 39 nulligravid patients, 28 (71.2%) were considering a future pregnancy and 32 (84.2%) did not consider hip pain to be a factor in their nulligravid status. There was no significant difference in mHHS at latest follow-up between nulligravid patients, patients who had not been pregnant since hip surgery, and patients who got pregnant after hip surgery (mean 79.6 vs 80.0 vs 79.6, p = 0.94). Conclusions: Most female hip arthroscopy patients were not concerned that their surgery would have a negative impact on their pregnancy outcomes or hip function after pregnancy. Within the hip arthroscopy population, although hip pain was exacerbated during pregnancy, most patients experienced a resolution of pain following delivery. Pregnancy-related complications did not occur more frequently in the hip arthroscopy cohort compared to the wider U.S. population. Patient-reported hip outcomes were comparable between nulligravid women and those who had only been pregnant prior to surgery.

Microbial Colonization of Capsular Traction Sutures in Hip Arthroscopic Surgery.

A common practice in hip arthroscopic surgery is the utilization of capsular traction sutures that can be incorporated into the capsular repair site at the end of the procedure, potentially seeding the hip joint with colonized suture material. To investigate the rate of the microbial colonization of capsular traction sutures used during hip arthroscopic surgery and to identify patient-associated risk factors for this microbial colonization. Cross-sectional study; Level of evidence, 3. A total of 50 consecutive patients who underwent hip arthroscopic surgery with a single surgeon were enrolled. There were 4 braided nonabsorbable sutures utilized for capsular traction during each hip arthroscopic procedure. These 4 traction sutures and 1 control suture were submitted for aerobic and nonaerobic cultures. Cultures were held for 21 days. Demographic information was collected, such as age, sex, and body mass index. All variables underwent bivariate analysis, and variables with a P value <.1 underwent further analysis in a multivariate logistic regression model. One of 200 experimental traction sutures and 1 of 50 control sutures had a positive culture. Proteus mirabilis and Citrobacter koseri were isolated in both these positive experimental and control cultures from the same patient. Age and traction time were not significantly associated with positive cultures. The rate of microbial colonization was 0.5%. The rate of the microbial colonization of capsular traction sutures used in hip arthroscopic surgery was low, and no patient-associated risk factors were identified for microbial colonization. Capsular traction sutures used in hip arthroscopic surgery were not a significant potential source of microbial contamination. Based on these results, capsular traction sutures can be incorporated in capsular closure with a low risk of seeding the hip joint with microbial contaminants.

Increased 90-Day Readmissions and Complications Following Hip Arthroscopy in Centers With Low Surgical Volume in New York State

The aims of the study were to (1) classify surgical centers in New York State by volume of hip arthroscopies performed, (2) calculate rates of readmissions and complications by center volume, and (3) identify socioeconomic predictive factors for readmissions and complications following hip arthroscopy. Patients who underwent hip arthroscopy at New York State health care facilities from 2010 to 2020 were retrospectively identified using the New York Statewide Planning and Research Cooperative System (SPARCS) database. Hip arthroscopic procedures were identified using the following Current Procedural Terminology codes. Surgical center volumes were classified into 3 categories: low (<85th percentile), medium (85th-95th percentile), and high (>95th percentile). Incidence of readmissions and complications within 90 days was abstracted from SPARCS. Neighborhood socioeconomic status was quantified using the U.S. Area Deprivation Index. Multivariable logistic regression was used to determine whether center volume and other socioeconomic variables were independent predictors of outcomes. In total, 50,252 patients who underwent hip arthroscopy were identified in SPARCS from 2010 to 2020. Of these patients, 13,861 (27.6%) underwent surgery at low-volume centers, 11,757 (23.4%) at medium-volume centers, and 24,634 (49.0%) at high-volume centers. Minorities, publicly insured patients, and patients from lower socioeconomic status neighborhoods made up a larger proportion of cases seen by low-volume centers versus high-volume centers (P < .001). Patients in the low-volume group experienced significantly greater 90-day rates of readmissions (P < .001) and all-cause complications (P < .001) than the other groups. Furthermore, high-volume centers were independently associated with lower odds of readmission (odds ratio 0.57, P < .001) and all-cause complications (odds ratio 0.73, P < .001) versus low-volume centers. Low-volume surgical centers are associated with increased readmission and complication rates following hip arthroscopy, independent of other socioeconomic factors such as age, sex, race, insurance status, and neighborhood socioeconomic status. III, retrospective comparative prognostic trial.