Staging Bilateral Hip Arthroscopies Less Than 1 Year Apart May Reduce the Risk of Revision Surgery

Published:September 30, 2022DOI:


      To identify the influence of timing between staged bilateral hip arthroscopy on 90-day postoperative medical complications and 2-year surgical complications including revision, conversion to total hip arthroplasty (THA), and infection.


      The Mariner data set of the PearlDiver all-payer claims database was queried for patients undergoing staged bilateral hip arthroscopy. Patients were stratified into cohorts based on time between arthroscopies: (1) ≤3 months, (2) 3 to ≤6 months, (3) 6 to ≤12 months, and (4) >1 year. Multivariate logistic regression was utilized to control for any confounding variables.


      In total, 998 patients underwent staged bilateral hip arthroscopy out of 38,080 patients who underwent primary hip arthroscopy. The 2-year revision rate was 7.6% for all patients undergoing bilateral hip arthroscopy, while 1.9% of patients underwent conversion to THA. Patients with arthroscopy procedures staged less than 1 year apart (cohorts 1, 2, and 3) had significantly decreased risk of revision compared to the greater than 1 year cohort (P = .008, .025, and .044, respectively). There were no differences in rates of major medical, minor medical, or remaining surgical complications between the cohorts. Direct comparisons between the cohorts staged ≤1 year apart showed no significant differences in medical or surgical complications (P > .05).


      The revision rate in all patients undergoing staged bilateral hip arthroscopy was 7.6%. Staging hip arthroscopy ≤1 year apart was associated with a decreased risk of revision when compared to the staged cohort >1 year. Among those staged less than 1 year, the timing of staging had no association with rates of medical or surgical complications. Patients who are indicated for bilateral hip arthroscopy may benefit from staging under 1 year apart to reduce the risk of revision surgery. Optimal timing decisions may be patient specific and rely on the duration of symptoms, severity of pathology, or progression of rehabilitation after the index procedure.

      Level of Evidence

      III, retrospective comparative study.
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        • Ganz R.
        • Parvizi J.
        • Beck M.
        • Leunig M.
        • Nötzli H.
        • Siebenrock K.A.
        Femoroacetabular impingement: A cause for osteoarthritis of the hip.
        Clin Orthop Relat Res. 2003; 417: 112-120
        • Kuhns B.D.
        • Hannon C.P.
        • Makhni E.C.
        • et al.
        A comparison of clinical outcomes after unilateral or bilateral hip arthroscopic surgery: Age- and sex-matched cohort study.
        Am J Sports Med. 2017; 45: 3044-3051
        • Essilfie A.A.
        • Bloom D.A.
        • Zusmanovich M.
        • Kester B.
        • Wolfson T.
        • Youm T.
        Staged Bilateral hip arthroscopy compared with a matched unilateral hip arthroscopy group: Minimum 2-year follow-up.
        Arthroscopy. 2020; 36: 1856-1861
        • Fernandez C.E.
        • Morgan A.M.
        • Sheth U.
        • Tjong V.K.
        • Terry M.A.
        Bilateral versus unilateral hip arthroscopy for femoroacetabular impingement: A systematic review.
        J Hip Preserv Surg. 2020; 7: 225-232
        • Cvetanovich G.L.
        • Chalmers P.N.
        • Levy D.M.
        • et al.
        Hip arthroscopy surgical volume trends and 30-day postoperative complications.
        Arthroscopy. 2016; 32: 1286-1292
        • Frank R.M.
        • Lee S.
        • Bush-Joseph C.A.
        • Salata M.J.
        • Mather R.C.
        • Nho S.J.
        Outcomes for hip arthroscopy according to sex and age: A comparative matched-group analysis.
        J Bone Jt Surg Am. 2016; 98: 797-804
        • Khan M.
        • Habib A.
        • de SA D.
        • et al.
        Arthroscopy up to date: Hip femoroacetabular impingement.
        Arthroscopy. 2016; 32: 177-189
        • Allen D.
        • Beaulé P.E.
        • Ramadan O.
        • Doucette S.
        Prevalence of associated deformities and hip pain in patients with cam-type femoroacetabular impingement.
        J Bone Jt Surg Ser B. 2009; 91: 589-594
        • Nawabi D.H.
        • Bedi A.
        • Tibor L.M.
        • Magennis E.
        • Kelly B.T.
        The demographic characteristics of high-level and recreational athletes undergoing hip arthroscopy for femoroacetabular impingement: A sports-specific analysis.
        Arthroscopy. 2014; 30: 398-405
        • Nogier A.
        • Bonin N.
        • May O.
        • et al.
        Descriptive epidemiology of mechanical hip pathology in adults under 50 years of age. Prospective series of 292 cases: Clinical and radiological aspects and physiopathological review.
        Orthop Traumatol Surg Res. 2010; 96: S53-S58
        • Matsuda D.K.
        • Ching K.
        • Matsuda N.A.
        Simultaneous bilateral hip arthroscopy.
        Arthrosc Tech. 2017; 6: e913-e919
        • McConkey M.O.
        • Chadayammuri V.
        • Garabekyan T.
        • Mayer S.W.
        • Kraeutler M.J.
        • Mei-Dan O.
        Simultaneous bilateral hip arthroscopy in adolescent athletes with symptomatic femoroacetabular impingement.
        J Pediatr Orthop. 2019; 39: 193-197
        • Mei-Dan O.
        • McConkey M.O.
        • Knudsen J.S.
        • Brick M.J.
        Bilateral hip arthroscopy under the same anesthetic for patients with symptomatic bilateral femoroacetabular impingement: 1-year outcomes.
        Arthroscopy. 2014; 30: 47-54
        • Cevallos N.
        • Soriano K.K.J.
        • Flores S.E.
        • Wong S.E.
        • Lansdown D.A.
        • Zhang A.L.
        Hip arthroscopy volume and reoperations in a large cross-sectional population: High rate of subsequent revision hip arthroscopy in young patients and total hip arthroplasty in older patients.
        Arthroscopy. 2021; 37 (3445-3454.e1. doi:10.1016/j.arthro.2021.04.017)
        • Rosinsky P.J.
        • Kyin C.
        • Lall A.C.
        • Shapira J.
        • Maldonado D.R.
        • Domb B.G.
        Rate of return to sport and functional outcomes after bilateral hip arthroscopy in high-level athletes.
        Am J Sports Med. 2019; 47: 3444-3454
        • Kumar M.V.
        • Shanmugaraj A.
        • Kay J.
        • et al.
        Bilateral hip arthroscopy for treating femoroacetabular impingement: A systematic review.
        Knee Surg Sport Traumatol Arthrosc. 2022; 30: 1095-1108
        • Haviv B.
        • O’Donnell J.
        Arthroscopic treatment for symptomatic bilateral cam-type femoroacetabular impingement.
        Orthopedics. 2010; 33
        • Hassebrock J.D.
        • Krych A.J.
        • Domb B.G.
        • Levy B.A.
        • Neville M.R.
        • Hartigan D.E.
        Bilateral hip arthroscopy: Can results from initial arthroscopy for femoroacetabular impingement predict future contralateral results?.
        Arthroscopy. 2019; 35: 1837-1844
        • Hassebrock J.D.
        • Chhabra A.
        • Makovicka J.L.
        • Economopoulos K.J.
        Bilateral hip arthroscopy in high-level athletes: Results of a shorter interval between staged bilateral hip arthroscopies.
        Am J Sports Med. 2020; 48: 654-660
        • Basques B.A.
        • Waterman B.R.
        • Ukwuani G.
        • et al.
        Preoperative symptom duration is associated with outcomes after hip arthroscopy.
        Am J Sports Med. 2019; 47: 131-137
        • Domb B.G.
        • Gui C.
        • Hutchinson M.R.
        • Nho S.J.
        • Terry M.A.
        • Lodhia P.
        Clinical outcomes of hip arthroscopic surgery: A prospective survival analysis of primary and revision surgeries in a large mixed cohort.
        Am J Sports Med. 2016; 44: 2505-2517
        • Degen R.M.
        • Nawabi D.H.
        • Fields K.G.
        • Wentzel C.S.
        • Kelly B.T.
        • Coleman S.H.
        Simultaneous versus staged bilateral hip arthroscopy in the treatment of femoroacetabular impingement.
        Arthroscopy. 2016; 32: 1300-1307
        • Cancienne J.M.
        • Denard P.J.
        • Garrigues G.E.
        • Werner B.C.
        The relationship of staged, bilateral arthroscopic primary rotator cuff repair timing and postoperative complications.
        Am J Sports Med. 2021; 49: 2027-2034