2017 ISAKOS Biennial Congress ePoster #702

 

Risk Factors for Revision of Hip Arthorscopy

Ryan M. Degen, MD, FRCSC, London, ON CANADA
Brenda Chang, MPH, New York, NY UNITED STATES
Nabil Mehta, BSE, New York, NY UNITED STATES
Peter Chamberlin, BFA, New York UNITED STATES
Danyal H. Nawabi, MD, FRCS(Orth), New York, NY UNITED STATES
Anil S. Ranawat, MD, New York, NY UNITED STATES
Bryan T. Kelly, MD, New York, NY UNITED STATES
Stephen L. Lyman, PhD, New York, NY UNITED STATES

Hospital for Special Surgery, New York, NY, UNITED STATES

FDA Status Not Applicable

Summary

Hip arthroscopy continues to gain popularity, but revision burden has also increased with risk factors including older age and hip osteoarthritis while labral repair and having the procedure performed by a high volume surgeon decreasing risk of revision.

Abstract

Background

While hip arthroscopy utilization has increased, few studies report on long-term survival. The purpose of this study was to report on the rates of revision hip arthroscopy and conversion to hip arthroplasty following hip arthroscopy in the State of New York (NY). Prognostic factors contributing to the need for revision surgery will also be reported.

Methods

The Statewide Planning and Research Cooperative System (SPARCS) database, a census of all hospital admissions and ambulatory surgery in NY State, was used to identify cases of primary hip arthroscopy. Demographic information was collected, as well as subsequent revision hip arthroscopy or arthroplasty procedures. The risks of these outcomes were modeled with use of age, sex, hospital volume, and surgeon volume as potential risk factors. Patients were also tracked for 30-day and 90-day complications.

Results

We identified 8,267 procedures in 7,836 patients from 1998-2012. 46.1% of patients were male. Annual hip arthroscopy rates increased 750% from 2003 to 2012. Revision surgery was required in 1,087 cases (13.2%) at a mean of 1.7±1.6 (mean±sd) years. More specifically, revision hip arthroscopy was required in 311 cases (3.8%) at 1.8±1.6 years, while conversion to arthroplasty was required in 796 (9.7%) cases at 1.7±1.7 years. Kaplan Meier survival analysis showed a 2-year survival rate of 88.1%, 5-year of 80.7% and 10-year of 74.9%. Regression analysis revealed that age >50 years was associated with increased risk of re-operation (Hazard Ratio[HR] 2.09; 95% CI 1.82-2.39, p<0.01). Similarly, patients with osteoarthritis (OA)also carried a higher risk of re-operation than those without (HR 2.72; CI 2.21-3.34, p<0.01)). Labral repair was associated with a lower risk of re-operation (HR=0.71; CI 0.54-0.93, p=0.01). Finally, higher annual surgeon volume (>164 cases/yr) resulted in a lower risk of re-operation compared with lower volume (<102 cases/yr) (HR 0.42; CI 0.32-0.54, p<0.0001). The 30-day complication rate was 0.2%, while the 90-day complication rate was 0.3%.

Conclusions

Hip arthroscopy rates continue to rise rapidly with corresponding increases in revision surgery. Survival analysis revealed 10 year survival of 75%. Older age and a diagnosis of hip OA at the time of the index procedure increased the likelihood of reoperation while performing a labral repair and having the procedure performed by a higher volume surgeon lowered the risk of reoperation.