Hip Pelvis.  2020 Mar;32(1):17-25. 10.5371/hp.2020.32.1.17.

Midterm-clinical Outcomes after Hip Arthroscopy in Middle-aged Patients with Early Osteoarthritis

Affiliations
  • 1Department of Orthopaedic Surgery, Chungnam National University School of Medicine, Daejeon, Korea. dshwang@cnu.ac.kr
  • 2Department of Orthopaedic Surgery, Yanbian University Hospital, Yanji, China.

Abstract

PURPOSE
Although the number of hip arthroscopies is rapidly increasing in non-elderly patients, outcomes of this procedure in middle-aged patients are not well documented or clearly understood. The purpose of this study was to evaluate the clinical and radiological outcomes after hip arthroscopy in middle-aged patients with early osteoarthritis.
MATERIALS AND METHODS
This retrospective study analyzed 189 patients with early osteoarthritis of various diagnoses aged 40 years or older who underwent hip arthroscopy between January 2010 and December 2015. Clinical (e.g., modified Harris hip score [mHHS], hip outcome score-activities of daily living [HOS-ADL], visual analogue scale [VAS] for pain, range of motion) and radiological (change of Tönnis grade) outcomes were assessed at a minimum of 3-year follow-up.
RESULTS
The mean preoperative and final mHHS and HOS-ADL improved from 61.2 and 60.6 to 79.5 and 81.8, respectively, while the VAS pain score decreased from 6.3 to 3.2 (P<0.001). Although the mean range of internal rotation and flexion increased from 14.2 and 100.7° preoperatively to 30.4 and 110.6° at 1-year postoperatively, they decreased slightly to 27.4 and 105.4° at the final follow-up, respectively. Eight cases (4.2%) underwent revision arthroscopic surgery and three cases (1.6%) were converted to total hip arthroplasty.
CONCLUSION
Patients with early-stage osteoarthritis of various diagnoses achieved improved clinical outcomes. Therefore, using hip arthroscopy in middle-aged patients with early osteoarthritis, it is possible to achieve good surgical options.

Keyword

Osteoarthritis; Hip arthroscopic surgery; Middle aged; Tönnis grade

MeSH Terms

Arthroplasty, Replacement, Hip
Arthroscopy*
Diagnosis
Follow-Up Studies
Hip*
Humans
Middle Aged
Osteoarthritis*
Retrospective Studies

Figure

  • Fig. 1 A 49-year-old male had a left hip femoroacetabular impingement with acetabular labral tear. He underwent arthroscopic labral repair using two anchors and arthroscopic osteoplasty. (A, B) Preoperative anteroposterior and frog-leg simple radiography. A Tönnis grade I osteoarthritis and decreased offset (asterisk) was observed. (C) Two anchors were used for labral repair. (D) Arthroscopic osteoplasty was performed to an existing femoral neck bump. (E, F) The last 50-month follow-up radiography. A Tönnis grade did not change (grade I), and sufficient osteoplasty was observed (arrow).

  • Fig. 2 Patient-reported outcomes (PROs) collected preoperative and at the midterm last follow-up. There was a significant difference in all PROs between preoperative and midterm last follow-up.mHHS: modified Harris hip score, HOS-ADL: hip outcome score-activities of daily living, VAS: visual analogue scale.* Paired t-test, P<0.001.

  • Fig. 3 The graphs reveal changes in range of motion over time. (A) Significant differences were observed between changes in the mean of internal rotation and flexion over time. (B, C) Repeated measures ANOVA revealed significant differences in the mean range of motion (ROM) (internal rotation, B; flexion, C) changes between the Group 1 and Group 2 divided to determine the effects of osteoplasty on ROM changes.Group 1: patients diagnosed with femoroacetabular impingement, diffuse idiopathic skeletal hyperostosis, ankylosing spondylitis, Group 2: patients diagnosed with the others.* Huynh-Feldt epsilon, P<0.001† Repeated measures ANOVA, P<0.001.

  • Fig. 4 A 64-year-old male received arthroscopic partial removal of chondrocalcinosis and debridement on left hip. Primary diagnosis was chondrocalcinosis and borderline dysplastic hip. (A) This patient had a dysplastic hip on the right side and a borderline dysplastic hip on the left side (lateral center edge angle: 16° on right hip, 21° on left hip), and chondrocalcinosis on both sides. A Tönnis grade of 0 was observed in the preoperative period. (B) Arthroscopic debridement was performed on anterosuperior labrum. Calcific materials were observed. (C) A Tönnis grade III osteoarthritis was noted at the 12-month follow-up and his visual analogue scale for pain was 8. (D) He underwent conversion to total hip arthroplasty.


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