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Editorial Commentary: Do Our Hip Arthroscopy Patients End Up With a Shiny New Hip?

      Abstract

      In a cohort of over 7,000 patients, the rate of conversion to total hip arthroplasty after hip arthroscopy was 12.4%. Increased age, the presence of osteoarthritis, the presence of obesity, and low surgeon volume were all independent risk factors for a higher rate of revision.
      One of the most important objective indicators of success after a surgical procedure is the rate of reoperation or revision. We, as orthopaedic surgeons, are lucky to have large databases such as national joint registries

      New Zealand National Joint Registry. Sixteen year report 2015. Available at http://www.nzoa.org.nz/system/files/Web_DH7657_NZJR2014Report_v4_12Nov15.pdf. Accessed January 3, 2016.

      Australian Orthopaedic Association. National Joint Replacement Registry. Annual report 2015. Available at https://aoanjrr.dmac.adelaide.edu.au/documents/10180/217745/Hip%20and%20Knee%20Arthroplasty. Accessed January 3, 2016.

      Swedish Hip Arthroplasty Register. Annual report 2013. Available at http://www.shpr.se/Libraries/Documents/AnnualReport_2013-04-1_1.sflb.ashx. Accessed January 3, 2016.

      to guide us and enable us to advise our patients, but no such registry exists yet for hip arthroscopy.
      Large, population-based reports are therefore most welcome. In a recent systematic review, Arthroscopy reported on the rate of complications and reoperations in over 6,000 patients.
      • 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.
      We are delighted to present another large case series in which Schairer et al.
      • Schairer W.W.
      • Nwachukwu B.U.
      • McCormick F.
      • Lyman S.
      • Mayman D.
      Use of hip arthroscopy and risk of conversion to total hip arthroplasty: A population-based analysis.
      examine not only conversion rates to total hip arthroplasty (THA) but the influence of age, obesity, and the diagnosis of osteoarthritis (OA) on the rate of conversion.
      Over 7,000 patients identified using Current Procedural Terminology and International Classification of Diseases, Ninth Revision codes from a large database in California and Florida with a minimum follow-up of 2 years were included. Overall, 12.4% of patients underwent THA within 2 years of hip arthroscopy; however, there was a significant increase correlating with age, with an odds ratio of 20.71 for ages 60 to 69 years. The presence of OA and the presence of obesity were also significant risk factors for revision (odds ratios of 3.66 and 2.13, respectively). Interestingly, the rate of conversion decreased over time (from 14.3% in 2005 to 10.3% in 2010) and so did the rate of patients with known OA (from 11.7% to 4.7%). This could indicate that hip arthroscopists are becoming more selective of patients. Not surprisingly, low-volume centers had higher revision rates, indicating either better skilled surgeons in larger centers or stricter patient selection and indications for surgery.
      Claims database–derived studies are not without limitations; most importantly, the accuracy of data capture and the lack of clinical data can be an issue. Such studies, however, are essential to help us appreciate progression to THA after hip arthroscopy and the risk factors for failed hip arthroscopy.

      References

      1. National Joint Registry. 12th annual report 2015. Available at http://www.njrcentre.org.uk/njrcentre/Portals/0/Documents/England/Reports/12th%20annual%20report/NJR%20Online%20Annual%20Report%202015.pdf. Accessed January 3, 2016.

      2. New Zealand National Joint Registry. Sixteen year report 2015. Available at http://www.nzoa.org.nz/system/files/Web_DH7657_NZJR2014Report_v4_12Nov15.pdf. Accessed January 3, 2016.

      3. Australian Orthopaedic Association. National Joint Replacement Registry. Annual report 2015. Available at https://aoanjrr.dmac.adelaide.edu.au/documents/10180/217745/Hip%20and%20Knee%20Arthroplasty. Accessed January 3, 2016.

      4. Swedish Hip Arthroplasty Register. Annual report 2013. Available at http://www.shpr.se/Libraries/Documents/AnnualReport_2013-04-1_1.sflb.ashx. Accessed January 3, 2016.

        • 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
        • Schairer W.W.
        • Nwachukwu B.U.
        • McCormick F.
        • Lyman S.
        • Mayman D.
        Use of hip arthroscopy and risk of conversion to total hip arthroplasty: A population-based analysis.
        Arthroscopy. 2016; 32: 587-593

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