Purpose
This study analyzed minimum 2-year hip arthroscopy outcomes in rheumatoid arthritis
(RA) patients and non-RA control patients. It also examined whether disease-modifying
antirheumatic drugs (DMARDs) affected RA patient outcomes. We hypothesized that patients
with RA undergoing hip arthroscopy would have lower reported outcome scores.
Methods
Data were prospectively collected on all hip arthroscopies performed from 2009-2013.
The indications for surgery were patients with hip pain and with physical examination
and imaging studies confirming intra-articular pathology in whom conservative management
had failed. The exclusion criteria were previous ipsilateral hip conditions and Tönnis
grade greater than 1. Patients with at least 2 years of follow-up and preoperative
RA diagnoses were matched (1:2 ratio) to controls without RA (based on age ± 5 years,
body mass index ± 5, and lateral center-edge angle [18°-25°, 26°-39°, or >39°]). RA
cases were further analyzed based on DMARD use. Patient-reported outcome (PRO) scores
were collected preoperatively and postoperatively at 3 months, as well as annually
thereafter. The outcomes collected included the modified Harris Hip Score, Non-Arthritic
Hip Score, Hip Outcome Score–Sports Specific Subscale, visual analog scale (VAS) score
for pain, satisfaction rating, future procedures, and complications.
Results
We matched 26 hips in 20 RA patients to a control group of 52 hips in 52 patients.
At a minimum of 2 years of follow-up, RA patients reported no significant improvements
except in the Non-Arthritic Hip Score, whereas the control group significantly improved
in all PRO and VAS scores. Preoperative PRO and VAS scores between the RA and control
groups were not significantly different, but postoperatively, all scores were lower
in RA patients at a minimum of 2 years, whether they were taking DMARDs or not. Patients
taking DMARDs showed slightly more improvement in PRO and VAS scores. There was a
greater trend toward more secondary arthroscopy procedures for RA patients (19.2%
vs 7.7%, P = .47), but total hip arthroplasty rates were similar. Complication rates were low
in both groups.
Conclusions
Patients undergoing hip arthroscopy who have a diagnosis of RA had less improvement
in PRO and VAS scores and were less satisfied than a matched control group of patients
without RA at a minimum 2-year follow-up. Patients who were taking DMARDs had slightly
better improvement in their PRO and VAS scores than nonmedicated patients. With this
early follow-up, we could not show a difference in the rate of conversion to total
hip arthroplasty, although RA patients required more revision arthroscopies than controls.
Patients with a diagnosis of RA who undergo hip arthroscopy should be counseled about
the potential for lesser degrees of postoperative improvement and should have their
expectations managed accordingly.
Level of Evidence
Level III, comparative trial.
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References
- Perioperative treatment of patients with rheumatoid arthritis.J Am Acad Orthop Surg. 2015; 23: e38-e48
- Perioperative outcomes in patients with rheumatoid versus osteoarthritis for total hip arthroplasty: A population-based study.Clin Exp Rheumatol. 2013; 31: 889-895
- Increased risk of complications following total joint arthroplasty in patients with rheumatoid arthritis.Arthritis Rheumatol. 2013; 66: 254-263
- Perioperative complications in patients with inflammatory arthropathy undergoing total hip arthroplasty.J Arthroplasty. 2016; 31: 2286-2290
- Co-morbidities in established rheumatoid arthritis.Best Pract Res Clin Rheumatol. 2011; 25: 469-483
- Rheumatoid arthritis.Best Pract Res Clin Rheumatol. 2010; 24: 733-745
- Lower extremity arthroplasty in patients with inflammatory arthritis: Preoperative and perioperative management.J Am Acad Orthop Surg. 2013; 21: 355-363
- The impact of rheumatoid arthritis on rehabilitation outcomes after lower extremity arthroplasty.J Clin Rheumatol. 2007; 13: 247-250
- Perioperative drug safety in patients with rheumatoid arthritis.Rheum Dis Clin. 2012; 38: 747-759
- The role of hip arthroscopy in the treatment of synovial disorders and loose bodies.Clin Orthop Relat Res. 2003; 406: 48-59
- Anatomy, histologic features, and vascularity of the adult acetabular labrum.Clin Orthop Relat Res. 2001; 382: 232-240
- The adult hip.Lippincott Williams & Wilkins, Philadelphia2007
- The etiology of chondromalacia patellae.J Bone Joint Surg Br. 1961; 43: 752-757
- The ligamentum teres of the hip: An arthroscopic classification of its pathology.Arthroscopy. 1997; 13: 575-578
- Risk factors for ligamentum teres tears.Arthroscopy. 2013; 29: 64-73
- The patient acceptable symptomatic state for the modified Harris Hip Score and Hip Outcome Score among patients undergoing surgical treatment for femoroacetabular impingement.Am J Sports Med. 2015; 43: 1844-1849
- Hip arthroscopy outcomes with respect to patient acceptable symptomatic state and minimal clinically important difference.Arthroscopy. 2016; 32: 1877-1886
- Is the incidence of rheumatoid arthritis rising?: Results from Olmsted County, Minnesota, 1955-2007.Arthritis Rheum. 2010; 62: 1576-1582
- Age-related trends in hip arthroscopy: A large cross-sectional analysis.Arthroscopy. 2015; 31: 2307-2313.e2
- Utilization of orthopedic surgery among patients with rheumatoid arthritis 1980-2007: A population based study focused on rates of surgery, patient gender and mortality.J Rheumatol. 2012; 39: 481-485
- Changes in the rates of joint surgery among patients with rheumatoid arthritis in California, 1983-2007.Ann Rheum Dis. 2010; 69: 868-871
- Patient-reported outcome instruments for femoroacetabular impingement and hip labral pathology: A systematic review of the clinimetric evidence.Arthroscopy. 2011; 27: 279-286
Article Info
Publication History
Published online: January 04, 2019
Accepted:
August 24,
2018
Received:
February 19,
2018
Footnotes
The authors report the following potential conflicts of interest or sources of funding: L.A. reports grant support from Arthrex; and has received food and beverage and travel and lodging support from Arthrex, outside the submitted work. B.G.D. is a board member for American Orthopedic Foundation, American Hip Foundation, AANA Learning Center Committee, Hinsdale Hospital Foundation, and Arthroscopy Journal; has received consulting fees from Adventist Hinsdale Hospital, Amplitude, Arthrex, MAKO, Medacta, Pacira Pharmaceuticals, and Stryker; educational funding from Arthrex, Breg, and Medwest; food and beverage from Arthrex, Ceterix Orthopaedics, DePuy Syntheses Sales, DJO Global, FUJIFILM SonoSite, Linvatec, MAKO Surgical Corporation, Medacta, Pacira Pharmaceuticals, Stryker, and Zimmer Biomet Holdings; has ownership interests in Hinsdale Orthopedic Associates, American Hip Institute, SCD#3, North Shore Surgical Suites, Munster Specialty Surgery Center; has received research support from Arthrex, ATI, Kaufman Foundation, Medacta, Pacira Pharmaceuticals, and Stryker; royalties from Arthrex, DJO Global, MAKO Surgical Corporation, Stryker, and Orthomerica; speaking fees from Arthrex and Pacira Pharmaceuticals; and travel and lodging from Arthrex, Medacta, and Stryker. Full ICMJE author disclosure forms are available for this article online, as supplementary material.
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© 2018 by the Arthroscopy Association of North America
