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

Published:December 06, 2015DOI:


      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 of Evidence

      Level III, retrospective comparative study.
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        • Bozic K.J.
        • Chan V.
        • Valone III, F.H.
        • Feeley B.T.
        • Vail T.P.
        Trends in hip arthroscopy utilization in the United States.
        J Arthroplasty. 2013; 28: 140-143
        • Montgomery S.R.
        • Ngo S.S.
        • Hobson T.
        • et al.
        Trends and demographics in hip arthroscopy in the United States.
        Arthroscopy. 2013; 29: 661-665
        • Stevens M.S.
        • Legay D.A.
        • Glazebrook M.A.
        • Amirault D.
        The evidence for hip arthroscopy: Grading the current indications.
        Arthroscopy. 2010; 26: 1370-1383
        • Smart L.R.
        • Oetgen M.
        • Noonan B.
        • Medvecky M.
        Beginning hip arthroscopy: Indications, positioning, portals, basic techniques, and complications.
        Arthroscopy. 2007; 23: 1348-1353
        • Ganz R.
        • Gill T.J.
        • Gautier E.
        • Ganz K.
        • Krugel N.
        • Berlemann U.
        Surgical dislocation of the adult hip a technique with full access to the femoral head and acetabulum without the risk of avascular necrosis.
        J Bone Joint Surg Br. 2001; 83: 1119-1124
        • Ganz R.
        • Klaue K.
        • Vinh T.S.
        • Mast J.W.
        A new periacetabular osteotomy for the treatment of hip dysplasias. Technique and preliminary results.
        Clin Orthop Relat Res. 1988; : 26-36
        • Bedi A.
        • Kelly B.T.
        Femoroacetabular impingement.
        J Bone Joint Surg Am. 2013; 95: 82-92
        • Byrd J.W.
        • Jones K.S.
        Arthroscopic management of femoroacetabular impingement.
        Instr Course Lect. 2009; 58: 231-239
        • Ganz R.
        • Parvizi J.
        • Beck M.
        • Leunig M.
        • Notzli H.
        • Siebenrock K.A.
        Femoroacetabular impingement: A cause for osteoarthritis of the hip.
        Clin Orthop Relat Res. 2003; : 112-120
        • Philippon M.J.
        • Schroder e Souza B.G.
        • Briggs K.K.
        Hip arthroscopy for femoroacetabular impingement in patients aged 50 years or older.
        Arthroscopy. 2012; 28: 59-65
        • McCormick F.
        • Nwachukwu B.U.
        • Alpaugh K.
        • Martin S.D.
        Predictors of hip arthroscopy outcomes for labral tears at minimum 2-year follow-up: The influence of age and arthritis.
        Arthroscopy. 2012; 28: 1359-1364
        • Domb B.G.
        • Linder D.
        • Finley Z.
        • et al.
        Outcomes of hip arthroscopy in patients aged 50 years or older compared with a matched-pair control of patients aged 30 years or younger.
        Arthroscopy. 2015; 31: 231-238
        • Healthcare Cost and Utilization Project
        HCUP tools and software—Clinical Classifications Software (CCS) for ICD-9-CM.
        Agency for Healthcare Research and Quality, Rockville, MD2014
        • Bureau of Labor Statistics
        CPI detailed report: data for November 2014.
        Bureau of Labor Statistics, Washington, DC2014
        • Byrd J.W.
        • Jones K.S.
        Arthroscopic management of femoroacetabular impingement: Minimum 2-year follow-up.
        Arthroscopy. 2011; 27: 1379-1388
        • Philippon M.J.
        • Briggs K.K.
        • Yen Y.M.
        • Kuppersmith D.A.
        Outcomes following hip arthroscopy for femoroacetabular impingement with associated chondrolabral dysfunction: Minimum two-year follow-up.
        J Bone Joint Surg Br. 2009; 91: 16-23
        • Philippon M.J.
        • Weiss D.R.
        • Kuppersmith D.A.
        • Briggs K.K.
        • Hay C.J.
        Arthroscopic labral repair and treatment of femoroacetabular impingement in professional hockey players.
        Am J Sports Med. 2010; 38: 99-104
        • Philippon M.
        • Schenker M.
        • Briggs K.
        • Kuppersmith D.
        Femoroacetabular impingement in 45 professional athletes: Associated pathologies and return to sport following arthroscopic decompression.
        Knee Surg Sports Traumatol Arthrosc. 2007; 15: 908-914
        • Byrd J.W.
        • Jones K.S.
        Hip arthroscopy for labral pathology: Prospective analysis with 10-year follow-up.
        Arthroscopy. 2009; 25: 365-368
        • Harris J.D.
        • McCormick F.M.
        • Abrams G.D.
        • et al.
        Complications and reoperations during and after hip arthroscopy: A systematic review of 92 studies and more than 6,000 patients.
        Arthroscopy. 2013; 29: 589-595
        • Malviya A.
        • Raza A.
        • Jameson S.
        • James P.
        • Reed M.R.
        • Partington P.F.
        Complications and survival analyses of hip arthroscopies performed in the national health service in England: A review of 6,395 cases.
        Arthroscopy. 2015; 31: 836-842
        • Horisberger M.
        • Brunner A.
        • Herzog R.F.
        Arthroscopic treatment of femoral acetabular impingement in patients with preoperative generalized degenerative changes.
        Arthroscopy. 2010; 26: 623-629
        • Larson C.M.
        • Giveans M.R.
        • Taylor M.
        Does arthroscopic FAI correction improve function with radiographic arthritis?.
        Clin Orthop Relat Res. 2011; 469: 1667-1676
        • Domb B.G.
        • Gui C.
        • Lodhia P.
        How much arthritis is too much for hip arthroscopy: A systematic review.
        Arthroscopy. 2015; 31: 520-529
        • Gupta A.
        • Redmond J.M.
        • Hammarstedt J.E.
        • Lindner D.
        • Stake C.E.
        • Domb B.G.
        Does obesity affect outcomes after hip arthroscopy? A cohort analysis.
        J Bone Joint Surg Am. 2015; 97: 16-23
        • Collins J.A.
        • Beutel B.G.
        • Garofolo G.
        • Youm T.
        Correlation of obesity with patient-reported outcomes and complications after hip arthroscopy.
        Arthroscopy. 2015; 31: 57-62
        • Losina E.
        • Barrett J.
        • Mahomed N.N.
        • Baron J.A.
        • Katz J.N.
        Early failures of total hip replacement: Effect of surgeon volume.
        Arthritis Rheum. 2004; 50: 1338-1343
        • Katz J.N.
        • Barrett J.
        • Mahomed N.N.
        • Baron J.A.
        • Wright R.J.
        • Losina E.
        Association between hospital and surgeon procedure volume and the outcomes of total knee replacement.
        J Bone Joint Surg Am. 2004; 86: 1909-1916
        • Jain N.
        • Pietrobon R.
        • Hocker S.
        • Guller U.
        • Shankar A.
        • Higgins L.D.
        The relationship between surgeon and hospital volume and outcomes for shoulder arthroplasty.
        J Bone Joint Surg Am. 2004; 86: 496-505
        • Fehring T.K.
        • Odum S.M.
        • Troyer J.L.
        • Iorio R.
        • Kurtz S.M.
        • Lau E.C.
        Joint replacement access in 2016: A supply side crisis.
        J Arthroplasty. 2010; 25: 1175-1181

      Linked Article

      • Regarding “Use of Hip Arthroscopy and Risk of Conversion to Total Hip Arthroplasty: A Population-Based Analysis”
        ArthroscopyVol. 32Issue 8
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          We read with interest the article by Schairer et al.1 that strives to further define which subset of patients who have undergone hip arthroscopy are at higher risk of a subsequent primary hip arthroplasty (total hip arthroplasty [THA]) within 2 years of the index procedure. This type of study is useful to help identify risk factors over a large group of patients. Reporting on over 7,000 cases provides results that are more applicable to the general population. The results of this study reinforce the concept that older patients with signs of joint degeneration and patients with a higher body mass index have an increased risk of a subsequent joint replacement.
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      • Authors' Reply
        ArthroscopyVol. 32Issue 8
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          We would like to thank Philippon and Briggs for their comments on our article titled “Use of Hip Arthroscopy and Risk of Conversion to Total Hip Arthroplasty: A Population-Based Analysis.” The authors raise an important point about sources of data used in clinical studies. Large clinical cohort studies such as those by the MOON (Multicenter Orthopaedic Outcomes Network) and MARS (Multicenter ACL Revision Study) groups provide detailed clinical information and patient-reported outcomes but can be expensive to maintain.
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