Hip arthroscopy (HA) has become the treatment of choice for femoroacetabular impingement (FAI). However, less favourable outcomes following arthroscopic surgery are expected in patients with severe chondral lesions. The aim of this study was to assess the outcomes of HA in patients with FAI and associated chondral lesions, classified according to the Outerbridge system. A systematic search was performed on four databases. Studies which involved HA as the primary management of FAI and reported on chondral lesions as classified according to the Outerbridge classification were included. The study was registered on PROSPERO. Demographic data, patient-reported outcome measures (PROMs), complications, and rates of conversion to total hip arthroplasty (THA) were collected.Aims
Methods
This study uses prospective registry data to compare early patient outcomes following arthroscopic repair or debridement of the acetabular labrum. Data on adult patients who underwent arthroscopic labral debridement or repair between 1 January 2012 and 31 July 2019 were extracted from the UK Non-Arthroplasty Hip Registry. Patients who underwent microfracture, osteophyte excision, or a concurrent extra-articular procedure were excluded. The EuroQol five-dimension (EQ-5D) and International Hip Outcome Tool 12 (iHOT-12) questionnaires were collected preoperatively and at six and 12 months post-operatively. Due to concerns over differential questionnaire non-response between the two groups, a combination of random sampling, propensity score matching, and pooled multivariable linear regression models were employed to compare iHOT-12 improvement.Aims
Methods
Responsiveness and ceiling effects are key properties of an outcome score. No such data have been reported for the original English version of the International Hip Outcome Tool 12 (iHOT-12) at a follow-up of more than four months. The aim of this study was to identify the responsiveness and ceiling effects of the English version iHOT-12 in a series of patients undergoing hip arthroscopy for intra-articular hip pathology at a minimum of one year postoperatively. A total of 171 consecutive patients undergoing hip arthroscopy with a diagnosis of femoroacetabular impingement (FAI) under the care of a single surgeon between January 2013 and March 2017 were included. iHOT-12 and EuroQol 5D-5L (EQ-5D-5L) scores were available pre- and postoperatively. Effect size and ceiling effects for the iHOT-12 were calculated with subgroup analysis.Aims
Methods
The aim of this study was to use registry data to report and compare early patient outcomes following arthroscopic repair or debridement of the acetabular labrum. Data on adult patients who underwent arthroscopic labral debridement or repair between January 2012 and March 2019 was extracted from the UK Non-Arthroplasty Hip Registry dataset. Patients who underwent microfracture, osteophyte excision or a concurrent extra-articular procedure were excluded. Outcomes comprised EuroQol-5 Dimensions (EQ-5D) index and the International Hip Outcome Tool 12 (iHOT-12), preoperatively and at 6 and 12 months.Objectives
Methods
The study sought to determine the results of labral restoration among patients over age 60 compared to a cohort of younger adults. 21 consecutive patients over age 60 undergoing labral repair with minimum one-year follow-up were compared to a contemporaneous group of 21 patients age 18–55 matched for gender, degree of chondral damage, and associated FAI or dysplasia. Follow-up averaged 18.9 months (12 to 24 months). The study group averaged 63.2 years (61 to 71); with 20 FAI and one dysplasia. 19 had acetabular articular damage (2 grade IV, 11 grade III, 5 grade II, 1 grade I) and 6 had femoral changes (1 grade IV, 5 grade 3). The control group averaged 35.8 years (20 to 54). Average improvement among the study group was 28.1 points modified Harris Hip Score (mHHS) and 37.5 points iHOT; and among the control group, 21.2 points mHHS and 37.1 points iHOT. There was no statistically significant difference between the two groups in the amount of improvement, with statistically and clinically significant improvement noted in both. Two study group patients underwent total hip arthroplasty (THA) at average 10 months with one control group THA at 11 months. All three converted to THA had combined grade IV acetabular and grade III femoral damage. There were no repeat arthroscopies and no complications in either group. We conclude that patients over age 60 can benefit from arthroscopic labral repair with improved outcomes, modest rates of conversion to THA, and small risk of complication. Results are comparable to younger adults. Combined bipolar grade IV or grade III articular damage is a harbinger of conversion to THA, regardless of age.
Arthroscopy of the native hip is an established diagnostic and therapeutic procedure. Its application in the symptomatic replaced hip is still being explored. We describe the use of arthroscopy of the hip in 24 symptomatic patients following total hip replacement, resurfacing arthroplasty of the hip and partial resurfacing (study group), and compared it with arthroscopy of the native hip in 24 patients (control group). A diagnosis was made or confirmed at arthroscopy in 23 of the study group and a therapeutic arthroscopic intervention resulted in relief of symptoms in ten of these. In a further seven patients it led to revision hip replacement. In contrast, arthroscopy in the control group was diagnostic in all 24 patients and the resulting arthroscopic therapeutic intervention provided symptomatic relief in 21. The mean operative time in the study group (59.7 minutes (35 to 93)) was less than in the control group (71 minutes (40 to 100), p = 0.04) but the arthroscopic approach was more difficult in the arthroplasty group. We suggest that arthroscopy has a role in the management of patients with a symptomatic arthroplasty when other investigations have failed to provide a diagnosis.
This review describes the development of arthroscopy of the hip over the past 15 years with reference to patient assessment and selection, the technique, the conditions for which it is likely to prove useful, the contraindications and complications related to the procedure and, finally, to discuss possible developments in the future.
