Subsequent Hip Arthroplasty Research Articles

Effect of Previous Hip Arthroscopy on Results after Hip Arthroplasty: Systematic Review and Meta-Analysis

Abstract Background Hip arthroplasty is the most frequently performed adult reconstructive hip procedure. Total hip arthroplasty (THA) is one of the most successful procedures performed in modern orthopedics. The primary indication for THA in a patient with endstage arthropathy is pain resulting in significant limitation of physical activity. Important factors to be considered in the decision to recommend or undergo THA are patient age, diagnosis, and medical comorbidities. Aim of the Work This review pursues to systematically review the current evidence in the literature to determine whether previous hip arthroscopy would direct to inferior results in patients undergoing succeeding hip arthroplasty. Patients and Methods The first literature search identified 412 studies in total. After removing duplicates, 307 articles were deemed irrelevant based on their title and Abstractscreening. Eighty- two papers were eliminated from the remaining 105 research based on their title and Abstract. After carefully reviewing the entire text of all remaining publications, 11 studies were eliminated for reasons such as conference Abstracts, reviews, and lack of comparison between intervention and control groups. Additionally, one cohort research that compared THA results in patients who had previously undergone hip salvage surgery to those who had not previously undergone hip salvage surgery was removed. Finally, eleven studies spanning the years 2012 to 2019 were available for meta-analysis. Results Of these citations could result from the studies’ varying designs and sample sizes. Estimated blood loss, on the other hand, was deemed a reasonable indicator of operating time. The consistency in blood loss between the groups may reflect a similar operative time. Conclusion Patients who have previously undergone hip arthroscopy are more likely to experience postoperative complications such as dislocation, revision, and reoperation following subsequent hip arthroplasty. On the other hand, prior hip arthroscopy did not appear to affect functional or intraoperative results.

Poster 216: Comparison of Joint Space Narrowing to the Contralateral Side During Hip Arthroscopy: Predictor of Conversion to THA?

Objectives: Reduced joint space at the time of joint-preserving hip arthroscopy has been shown to be correlated with rates of eventual conversion to total hip arthroplasty (THA). With an increasingly aging population and increased utilization of hip arthroscopy, it is important to identify factors that may predict early failure and the eventual need for arthroplasty. For some patients, hip arthroscopy may provide symptomatic relief for years, while others garner limited benefit and require conversion THA soon after their index surgery. This study sought to determine if quantitative differences in joint space width (JSW) between the operative and non-operative hip predicted the likelihood of conversion to THA at the time of hip arthroscopy. Methods: After obtaining institutional review board approval, a retrospective review identified 105 patients treated for labral tears with arthroscopic hip surgery by a single-surgeon with a minimum of 5- year follow-up. Patients were stratified into cohorts based on whether they received a subsequent THA. Preoperative, anteroposterior pelvic radiographs were obtained for each patient and semi-automated, quantitative JSW measurements were performed at 3 predefined fixed locations per hip (10, 30, and 50 degrees with respect to a polar coordinate system; Figure 1). All measurements were obtained by an independent assessor blinded to other radiographic or clinical information, with high reliability (intra- class correlations > 0.8), as previously described in literature. Differences in JSW at each prefixed angle were calculated by subtracting the width (millimeters) of each patient’s operative hip from the measurements obtained from their non-operative hip. Categorical variables were analyzed using chi- square test or Fisher exact test, as appropriate. After assessing for normality with Shapiro-Wilk tests, continuous variables were compared using Student t-tests or Mann-Whitney U tests to determine baseline differences between patients that converted to THA and those that did not. Logistic regression was run for JSW at each prefixed angle, followed by adjusted, multivariable logistic regression to determine independent predictors of conversion to THA. Results: Mean [standard deviation (SD)] follow-up was 8.81 [2.68] years, identifying 16 (15.2%) patients that converted to THA and 89 (84.8%) that did not. When comparing baseline demographic and intraoperative characteristics between cohorts, THA patients were found to have higher mean [SD] age 41.8 [13.4; p=0.003], BMI 29.3 [4.2; p<0.001], Tönnis grade (p<0.001), Outerbridge grade (p=0.002) and higher percentage of males (p=0.014; Tables 1&2). THA patients were found to have a significantly greater difference in JSW at 30° compared to those that did not require subsequent hip arthroplasty (0.566 ± 0.883mm versus 0.038 ± 0.499mm, p=0.035). Differences in JSW between cohorts were not significant at the 10° (p=0.104) or 50° (p=0.096) locations. When adjusting for significantly different covariates, the difference in JSW at 30° was correlated with an increased likelihood of conversion to THA (Adjusted Odds Ratio [AOR]: 4.00; 95% Confidence Interval [CI]: 1.06 to 15.13; p =0.041). Finally, adjusted analysis controlling for differences in JSW at all predefined angles found that narrowing at 30° was significantly associated with increased odds of conversion ([AOR]: 3.88; [CI]: 1.06 to 14.22; p=0.041), while 10° (p=0.630) and 50° (p=0.995) were not. Conclusions: To best educate patients on the risk of THA following hip arthroscopy, identifying objective predictors of early failure is imperative during preoperative evaluation. This study identified that differences in JSW at 30° between the operative and non-operative hip were significantly associated with increased risk of conversion after controlling for demographic and intraoperative factors. Analysis was limited by predetermined locations for JSW and future studies may identify stronger correlations by incorporating additional measurements within the acetabular sourcil. Quantitative differences in JSW comparing the operative hip to the contralateral side predicts patients progressing to THA at the time of hip arthroscopy. [Table: see text] [Table: see text]

Influence of less invasive hip preservation surgery on subsequent hip arthroplasty for osteonecrosis of the femoral head.

ABSTRACTThe purpose of this study was to evaluate the outcomes of total hip arthroplasty (THA) following less invasive hip-preserving procedures (LIHPs) and present a critical overview of the literature to aid in better result interpretation. The search time was from the establishment of the database to September 2021, and the outcome indicators were extracted and analyzed by Cochrane Collaboration Review Manager software (RevMan version 5.4). Finally, 10 articles were included in this meta-analysis by searching Chinese databases and English databases. Three of them were published in Chinese, and the remaining studies were published in English. LIHP was further divided into the tantalum rod implantation group and the non-tantalum rod implantation group. The results showed that prior tantalum rod implantation increased the difficulty of conversion to THA, which was reflected mainly in the longer operative time [weighted mean difference (WMD) = 24.50, 95% confidence interval (CI) = 14.09–34.91, P < 0.00001] and greater intraoperative blood loss (WMD = 114.74, 95% CI = 33.52–195.96, P = 0.006), while no significant difference was found between the non-tantalum rod implantation group and the control group. Simultaneously, easier intraoperative fracture [odds ratio (OR) = 5.88, 95% CI = 0.93–37.05, P = 0.06] and stem malalignment (OR = 4.17, 95% CI = 1.18–14.71, P = 0.03) in the LIHP group tended to be observed than in the control THA group. However, there was no significant difference in cup anteversion and inclination angle, ectopic ossification, postoperative Harris Hip Score and survivorship between the LIHP group and the control group. Although LIHP increased the difficulty of the conversion to THA, it does not detrimentally affect the clinical results of subsequent THA in the mid-term follow-up.

Influence of prior hip arthroscopy on outcomes after hip arthroplasty: A meta-analysis of matched control studies.

Background:No meta-analysis exists elucidate the impact of prior hip arthroscopy on the outcomes of subsequent hip arthroplasty. The purpose of this study was to systematically review the current evidence in the literature to ascertain if prior hip arthroscopy leads to inferior outcomes after hip arthroplasty.Methods:PUBMED, Scopus, EMBASE, and Cochrane Library databases were searched on May 20, 2019. Only English publications were included. The primary outcomes were postoperative complication, revision, and reoperation. Secondary outcomes included Harris Hip Score (HHS), Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC), operative time, and estimated blood loss.Results:Eleven studies with a total of 1227 patients were included. The pooled data revealed that patients with prior hip arthroscopy were associated with higher risks for any postoperative complication (P < .00001), dislocation (P = .03), revision (P = .03), and reoperation (P = .02) following subsequent hip arthroplasty. However, there were no significant differences in infection rate (P = .22), HHS (P = .09), WOMAC (P = .19), operative time (P = .52), and estimated blood loss (P = .17) between the groups.Conclusions:Patients with prior hip arthroscopy are at increased risks for any postoperative complication, dislocation, revision, and reoperation following subsequent hip arthroplasty. However, prior hip arthroscopy does not appear to have an impact on the functional outcomes and intraoperative outcomes.

Mid-term Patient-reported Outcomes of Hip Arthroplasty After Previous Hip Arthroscopy: A Matched Case-control Study With a Minimum 5-year Follow-up.

Previous hip arthroscopy may affect the outcomes of subsequent hip arthroplasty. The purpose is to compare mid-term patient-reported outcomes (PROs) and complication rates in patients who had previous ipsilateral hip arthroscopy (PA) with those without a previous surgery. A minimum 5-year PROs, complications, and revision surgery rates were compared between total hip arthroplasty (THA) recipients who received PA and those without. Available intraoperative findings, procedures, and conversion time of arthroscopies were reported. The relative risk (RR) of complications and revision THAs were reported. A Kaplan-Meier analysis assessed survivorship of revision THA. There were 34 cases (33 patients) of PA that were matched to 89 control cases (87 patients). Both cohorts reported similar scores for Harris hip score, Forgotten Joint Score, pain, and patient satisfaction. No differences in the outcomes were found based on the arthroplasty approach. A higher postoperative complication rate {RR, 2.617 (95% confidence interval [CI], 0.808 to 8.476)} and revision THA rate (RR, 13.088 [95% CI, 1.59 to 107.99]) were found in the PA group. Patients with PA demonstrated similar levels of PROs as those without previous ipsilateral hip arthroscopy. There may, however, be a higher rate of complications and revision surgery in the PA group. III.

Likelihood of hip arthroplasty within 15 years is tripled after sports-related hip or thigh injury

Purpose: Sports-related knee joint injury is strongly associated with subsequent knee arthroplasty surgery; however, the link between sports injury and hip arthroplasty is less clear. Systematic reviews of hip osteoarthritis outcomes have focused on elite-level sport and may not be generalisable to the broader community where recreational or amateur sport participation is more common. To better understand the downstream consequences of sports injury, a population-based approach is required. This study aimed to quantify the likelihood of hip arthroplasty at a population level up to 15 years after sports injury. Methods: A population-level cohort was established for the state of Victoria, Australia (population size 6.4 million) through linkage of two key administrative datasets: the Victorian Admitted Episodes dataset (capturing all hospital admissions) and the Victorian Emergency Minimum Dataset (capturing all emergency department (ED) presentations). Sports injury presentations from 2000-2005 and hip arthroplasty admissions from 2000-2015 were identified using ICD-10-AM codes. Cox proportional hazards models were used to estimate the likelihood of hip arthroplasty using time to surgery data, with adjustment for potential confounders. Results: Over the 15-year study period there were 64,750 sports injuries (including 815 hip or thigh injuries) resulting in ED presentation or hospitalisation, and 368 hip arthroplasty procedures. Having a hip or thigh injury tripled the rate of subsequent hip arthroplasty (hazard ratio 3.07, 95%CI 2.00 to 4.72), compared to all other sports-related injuries. Of the main injury types, femoral fractures (hazard ratio 3.08, 95%CI 1.77 to 5.36) and hip dislocations (hazard ratio 5.64, 95%CI 2.34 to 13.58) were significantly associated with hip arthroplasty. For those with a hip or thigh injury, the median time from sports injury to hip arthroplasty was 5.3 years (range 0.3 to 14.0 years). Conclusions: Sports-related hip or thigh injury is associated with a significantly higher likelihood of hip arthroplasty within 15 years. Effective injury prevention programs and appropriate post-injury management are needed to curtail this burden. For people who sustained a sports-related hip or thigh injury and progressed to arthroplasty, the duration from injury to surgery was relatively short. This could reflect pre-existing hip osteoarthritis that was exacerbated by injury. Continued surveillance of population-level hip arthroplasty data will assist with evaluating the impacts of sports injury prevention initiatives over time.

Defining the Learning Curve for Hip Arthroscopy: A Threshold Analysis of the Volume-Outcomes Relationship

Background: Hip arthroscopy has emerged as a successful option for the treatment of femoroacetabular impingement and related hip disorders, but the procedure is technically challenging. Purpose: To define the learning curve through which surgeons become proficient at hip arthroscopy. Study Design: Cohort study; level of evidence, 3. Methods: The authors identified hip arthroscopy procedures performed by surgeons through a New York State database (Statewide Planning and Research Cooperative System) and followed those cases for additional hip surgery (total hip arthroplasty, hip resurfacing, or ipsilateral hip arthroscopy) within 5 years of the original procedure. Career volume for each case was calculated as the number of hip arthroscopy procedures that the surgeon had performed. Volume strata were identified via the stratum-specific likelihood ratio method. A Cox proportional hazards model was used to measure the effect of surgeon career volume on risk of additional hip surgery, adjusting for the following patient characteristics: age, sex, race/ethnicity, insurance type, and concurrent diagnosis of hip osteoarthritis. Results: Among 8041 hip arthroscopies performed by 251 surgeons, 989 (12.3%) cases underwent additional hip surgery within 5 years. Four strata of surgeon career volume associated with distinct frequencies of reoperation were identified: cases in the lowest stratum (0-97) had the highest frequency of additional surgery (15.4%). Frequencies declined for cases in the medium (98-388), high (389-518), and highest (≥519) strata (13.8%, 10.1%, and 2.6%, respectively). There was an increased risk of subsequent surgery in each stratum when compared with the highest stratum (hazard ratio [95% CI]: low volume, 3.22 [2.29-4.54]; medium, 3.40 [2.41-4.82]; high, 2.81 [1.86-4.25]; P < .0001 for all). Patients with a diagnosis of hip osteoarthritis had increased risk of subsequent hip arthroplasty or resurfacing (2.46 [2.09-2.89], P < .0001) . Risk also increased with age: 30 to 39 vs ≤29 years (5.12 [3.29-8.00], P < .0001), 40 to 49 vs ≤29 years (11.30 [7.43-17.190], P < .0001), ≥50 vs ≤29 years (18.39 [12.10-27.96], P < .0001). Increased age and osteoarthritis were not risk factors for revision hip arthroscopy. Conclusion: The learning curve for hip arthroscopy was unexpectedly demanding. Cases performed by surgeons with career volumes ≥519 had significantly lower risk of subsequent hip surgery than those performed by lower-volume surgeons.

Orthopaedic Surgeon

Objectives:Results of revision labral repair and labral debridement of irreparable issue have been poor. A circumferential labral reconstruction (CLR) with ITB allograft between the transverse acetabular ligament antero-inferiorly to the 7-8 o’clock position postero-inferiorly eliminates any tissue damaged beyond repair, restores stability and eliminates any high stress junction points. This study seeks to compare outcomes with this technique relative to our patients with hip problems that are reliably fixed with simple labral repair.Methods:We retrospectively examined 34 consecutive patients undergoing arthroscopic surgery of the hip with CLR with a fascia lata allograft and compared them with 49 consecutive patients undergoing simple labral repair during the same 4 month period. Pre- and post-op surveys included Visual Analog Pain Score (VAS), International Hip Outcome Tool (IHOT-12), modified Harris Hip Score (mHHS), 12-item Short Form Health Survey (SF-12) and Hip Outcome Score (HOS-ADL and HOS-SSS). Pre-op Tonnis grade was recorded. Severity of labral damage was evaluated in separate sidearm study of 20 patient videos not involved in current study to assess intra-observer reliability for grading of severity of labral damage.Results:The mean age of the reconstruction patients was 43.0 vs. 29.1 for the repair patients (p<0.001). The repair group had 45% mild and 55% moderate tears; the CLR group had 80% severe tears or segmental defects and 20% moderate tears. 3.9% of the repair group were revision procedures, while 35% of the CLR group were revision procedures. Pre-op Tonnis grade in the CLR group was 0.44 vs. 0.11 (P<0.001). Follow-up rate was 82% with a minimum follow-up of 23 months (range: 23-28 months). In the CLR group, 5 patients failed; 1 for core muscle repair procedure, 2 went on to subsequent hip arthroplasty, 2 in need of hip arthroplasty. All 4 conversions to arthroplasty had pre-op tonnis grade of 2. 3 procedures failed in the repair group with one subsequent core muscle repair and 2 revisions to labral reconstruction. In the reconstruction group, the mean Pain VAS score decreased from 4.78 preoperatively to 1.9 postoperatively (P<0.001), IHOT-12 scores increased from 32.38 to 68.9 (P<0.001), and mHHS increased from 48.67 to 74.63 (P<0.001). The SF-12 survey exhibited an increase from 36.29 to 43.15 (P=0.028), HOS-ADL scores increased from 56.28 to 87.47 (P<0.001), and HOS-SSS scores increased from 32.40 to 68.55 (P=0.0028). These improvements were not statistically different from those observed in the repair group (Pain VAS: P=0.361; HOS-ADL: P=0.314; HOS-SSS: P=0.288; mHHS: P=0.996; IHOT: P=0.192; SF: P=0.642). Intra-observer reliability of sidearm video study Kappa = 0.66 indicating moderately good reliability in the grading of severity of labral damage.Conclusion:This study shows that patients undergoing circumferential labral reconstruction with ITB allograft exhibit favorable outcome at 2 years postoperatively with respect to pain and activities of daily living—comparable to the results achieved in patients undergoing repairs of labra with lower severity of damage in a more challenging patient population (14 yrs older with far worse labral damage, a higher Tonnis grade, and far higher percentage of revisions). These data suggest that circumferential arthroscopic labral reconstruction is a viable option for patients with missing or severely compromised labral tissue.

Outcomes of Hip Arthroplasty After Failed Hip Arthroscopy: A Case-Control Study

BackgroundHip arthroscopy is increasingly being used in joint preservation surgery with clear benefits in the treatment of prearthritic conditions. A number of patients, however, will still go on to require subsequent hip arthroplasty, and at present, little evidence exists determining the impact that prior hip arthroscopy may have on the outcomes of a subsequent arthroplasty. MethodsUsing prospectively collated data, we identified 35 patients who had a hip arthroplasty (22 total hip arthroplasties and 13 hip resurfacing arthroplasties) after prior ipsilateral hip arthroscopy (cases). Cases were matched for age, gender, and prosthesis type with 70 controls (patients who received a primary arthroplasty over the same period, without prior arthroscopy). Outcome measures included range of movement, implant survival, complications, and functional outcome (Oxford Hip Score and Harris Hip Score). ResultsThere was no demonstrable difference in improved range of motion after hip arthroplasty between the 2 groups, across any axis of movement (flexion, extension, internal/external rotation, abduction, and adduction; P = .07-.78). There was no significant difference in complication rate (P = .72). Overall 7-year implant survival was 85.9% (95% confidence interval [CI], 75-95.8). There was no difference in survival between cases (87.6%; 95% CI, 73.5-100) and controls (86.3%; 95% CI, 74.6%-98.0%; P = .2). Ten of the 11 revision arthroplasties performed were due to adverse reactions to metal debris in metal-on-metal hip resurfacing arthroplasty cases (P = .01). There was no difference in improvement of functional outcome postarthroplasty between groups (P = .48-.76). ConclusionThis study demonstrates that hip arthroscopy does not adversely influence outcome of a subsequent hip arthroplasty.

Use of Hip Arthroscopy and Risk of Conversion to Total Hip Arthroplasty: A Population-Based Analysis

To use population-level data to (1) evaluate the conversion rate of total hip arthroplasty (THA) within 2 years of hip arthroscopy and (2) assess the influence of age, arthritis, and obesity on the rate of conversion to THA. We used the State Ambulatory Surgery Databases and State Inpatient Databases for California and Florida from 2005 through 2012, which contain 100% of patient visits. Hip arthroscopy patients were tracked for subsequent primary THA within 2 years. Out-of-state patients and patients with less than 2 years follow-up were excluded. Multivariate analysis identified risks for subsequent hip arthroplasty after arthroscopy. We identified 7,351 patients who underwent hip arthroscopy with 2 years follow-up. The mean age was 43.9 ± 13.7 years, and 58.8% were female patients. Overall, 11.7% of patients underwent THA conversion within 2 years. The conversion rate was lowest in patients aged younger than 40 years (3.0%) and highest in the 60- to 69-year-old group (35.0%) (P < .001). We found an increased risk of THA conversion in older patients and in patients with osteoarthritis or obesity at the time of hip arthroscopy. Patients treated at high-volume hip arthroscopy centers had a lower THA conversion rate than those treated at low-volume centers (15.1% v 9.7%, P < .001). Hip arthroscopy is performed in patients of various ages, including middle-aged and elderly patients. Older patients have a higher rate of conversion to THA, as do patients with osteoarthritis or obesity. Level III, retrospective comparative study.

Cemented total hip arthroplasty following previous femoral osteotomy: An average 16-year follow-up study

The indications for proximal femoral osteotomy would be substantially limited if it significantly compromised the outcome of a subsequent hip arthroplasty. Previous reports have followed only early cementing techniques over intermediate duration. This study comprised 22 primary cemented total hip arthroplasties performed by a single surgeon following failed proximal femoral osteotomies at an average follow-up period of 15.8 years. Three patients who died prior to the 11-year minimum follow-up period are not included, leaving 19 hips for long-term review. All stems were cemented with second-generation techniques. Stem placement and collar-calcar contact, however, were substantially worse compared with historical control subjects. Eight reconstructions required custom miniature or calcar replacement components, and in 6 hips, the stems were inserted only in the diaphysis. Two of 19 femoral components (10.5%) were revised for aseptic loosening and 2 additional femoral components were loose. The average Harris hip score of those not revised was 80.4. Five acetabular components (26.3%) required revision. Four additional cups were loose, yielding a total acetabular loosening rate of 47.4% at 15.5 years. Intertrochanteric osteotomy in general did not affect the expected excellent results of the femoral component using modern cementing techniques. Severe deformity following subtrochanteric osteotomy, however, did adversely affect the outcome.