2017 ISAKOS Biennial Congress ePoster #717
Hip Arthroscopy In Patients Over Age 40: A Systematic Review
Nolan Horner, MD, Hamilton, ON CANADA
Seper Ekhtiari, MD, Hamilton, ON CANADA
Nicole Simunovic, MSc, Hamilton, ON CANADA
Marc R. Safran, MD, Prof., Redwood City, CA UNITED STATES
Marc J. Philippon, MD, Vail, CO UNITED STATES
Olufemi R. Ayeni, MD, PhD, MSc, FRCSC, Hamilton, ON CANADA
McMaster University, Hamilton, ON, CANADA
FDA Status Not Applicable
In this systematic review, we found that indications for hip arthroscopy including femoral osteochondroplasty and labral repair resulted in clinically significant improvements in patients over 40 whereas labral debridement did not produce clinically significant improvements post-operatively.
The purpose of this study was to evaluate the existing literature for the indications, outcomes and rates of conversion to total hip arthroplasty (THA) for hip arthroscopy in patients over the age of 40.
The electronic databases MEDLINE, EMBASE, and PubMed were searched for relevant studies and pertinent data was abstracted from eligible studies.
There were 17 studies included in this review comprising 16,327 patients, 9,954 of who were over age 40. All studies reported statistically significant improvement in outcomes after hip arthroscopy for either unspecified indications, femoral osteochondroplasty, or labral repair. However, in patients over 40 receiving labral debridement the improvements in outcomes were not considered to be clinically significant. Obesity predicted poorer outcomes, while osteoarthritic changes were an even better predictor of poor outcomes than age. The rate of conversion to THA was 18.1% for patients >40, 23.1% for patients >50 and 25.2% for patients >60 which were all significantly higher than in patients <40 with an average of 25.0 months to THA. Only one of three studies directly comparing the two groups found that patients >40 had significantly less improvement in a standardized hip outcome score than patients <40 after hip arthroscopy.
Indications for hip arthroscopy including femoral osteochondroplasty and labral repair resulted in clinically significant improvements in patients over 40 whereas labral debridement did not produce clinically significant improvements post-operatively. In this patient population, the rate of conversion to THA is significantly higher than in patients under 40 and increases with each decade of life. The presence of osteoarthritic changes or obesity also acts as a predictor of worse outcomes in these patients. Although hip arthroscopy may be suitable for some patients over 40, patient selection is key and patients should be made aware of the higher risk of conversion to THA.