Hip arthroscopy is a well-established method for the treatment of many problems of the hip joint, the principal conditions being femoroacetabular impingement and tears of the acetabular labrum. In many scientific circles, however, a scepticism about the effectiveness of hip arthroscopy still prevails, and many clinicians encourage the non-surgical treatment of such problems. Instead, they propose conservative management of the problem with physiotherapy, exercise therapy and intra-articular injections into the joint. Another similar therapeutic approach is modification of the patient's physical activities.
In general, there is a wealth of published articles on the effectiveness of hip arthroscopy in such conditions, in smaller or larger groups of patients. There are not, however, sufficient data comparing patients who underwent hip arthroscopy with patients who followed conservative treatment.
A recent study published in the journal “Journal of Hip Preservation Surgery” set out to compare the clinical outcomes of patients who were obliged to follow conservative treatment because they were on a waiting list for hip arthroscopy with those of patients who had undergone hip arthroscopy.
Patients aged < 60 years were identified from a waiting list for hip arthroscopy at a single hospital in the Australian public health system. Patient-reported outcomes were collected for those on the waiting list. No treatment was offered while they were on the waiting list. This group was compared with a separate group who had undergone hip arthroscopy and who were matched for characteristics such as age, sex, body mass index and patient-reported clinical outcomes.
36 patients in each group were included in the study, with a mean follow-up of 19 months (12 to 36). There were no statistically significant differences in age, sex, body mass index or the patient-reported outcome scores. At final assessment, the results of the hip outcome scores for the patients after hip arthroscopy were significantly higher than those of the patients on the waiting list (82.1 versus 48.9 respectively). The mean Harris hip score after hip arthroscopy was significantly higher than the score in the waiting-list patients, specifically 84.3 versus 48.1 respectively (p < 0.001).
The principal finding of this study was a significant improvement in the group of patients who underwent hip arthroscopy when they were compared with those on conservative treatment because of the waiting list. These findings are strong evidence in favour of the arthroscopic treatment of femoroacetabular impingement, which is also consistent with the small number of publications supporting conservative treatment for femoroacetabular impingement syndrome.
There are now several published studies supporting the surgical treatment of femoroacetabular impingement syndrome and of the coexisting pathology of labral tears or lesions of the acetabular labrum. A recent study showed that patients who underwent hip arthroscopy for femoroacetabular impingement and for a tear of the acetabular labrum had postoperative Harris hip scores of 80.5 and 86.9 respectively.
The main conclusion of this paper was that hip arthroscopy can lead to significant improvements in patient-reported clinical outcomes when these are compared with conservative treatment and activity modification in patients on a waiting list, in cases of intra-articular hip pathology (femoroacetabular impingement, tears of the acetabular labrum, chondral lesions) at a medium-term follow-up of 18 months.
Source: Spencer-Gardner L, Dissanayake R, Kalanie A, Singh P, O''Donnell J. Hip arthroscopy results in improved patient reported outcomes compared to non-operative management of waitlisted patients. J Hip Preserv Surg. 2017 Jan 10;4(1):39-44.