Hip arthroscopy is the method of choice for patients with a painful non-arthritic hip. It has traditionally been held that hip arthroscopy is applicable to younger patients, while older ones are more often candidates for total hip arthroplasty, that is, complete replacement of the joint. There are, however, not a few patients over the age of 50 in whom osteoarthritis has not become formally established, and in whom the surgeon and the patient have to choose between replacing the joint and a joint-preserving operation, that is, arthroscopy. In cases of severe, established osteoarthritis the operation of choice is total arthroplasty, but there is a large number of patients who fall into a grey area.
In order to answer this question a study was carried out to analyse the desired outcomes of patients followed up for at least five years after hip arthroscopy, in which the results and the predisposing factors for conversion of the procedure to total arthroplasty were analysed in patients over the age of 50 who had a tear of the labrum of the acetabulum and femoroacetabular impingement.
Data were collected prospectively on patients who underwent hip arthroscopy for the treatment of a labral tear and femoroacetabular impingement between February 2008 and January 2012. The inclusion criteria were age ≥ 50 years at the time of surgery, arthroscopic treatment for a tear of the acetabular labrum, and femoroacetabular impingement. The rating scales used were Modified Harris Hip Score, Non Arthritic Hip Score, Hip Outcome Score-Sports Specific Subscale and Visual Analog Scale. The exclusion criteria from the study were osteoarthritis of a grade greater than 1 on the Tönnis classification and previous pathological conditions or operations on the hip. Of the 103 cases, 94 hips had a minimum follow-up of five years. In every case the assessment of the rating scales showed significant improvement at the latest review. The results also showed that the improvement was maintained from two years after surgery through to the last assessment. Four cases (4.3%) required a second arthroscopy. The group of patients in whom total hip arthroplasty proved necessary had a higher body mass index, larger alpha angles and smaller centre-edge angles, and had more chondral lesions both in the articular cartilage of the femoral head and in that of the acetabulum.
The authors concluded that hip arthroscopy for the treatment of a tear of the acetabular labrum and femoroacetabular impingement in patients over the age of 50 shows statistically significant improvement for a minimum period of five years after surgery. However, because of the potential impending need for total arthroplasty in a part of this population, surgeons should apply strict selection criteria and counsel patients accordingly.
Source: “Arthroscopy, The Journal of Arthroscopic and Related Surgery”, October 2018