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There Is a Significant Discrepancy Between "Big Data" Database and Original Research Publications on Hip Arthroscopy
Kyle R Sochacki1, Robert A Jack1, Marc R Safran2
1Houston Methodist Orthopedic and Sports Medicine, Houston, Texas, U.S.A.
Insights
Database studies show higher rates of major complications, revisions, and conversions to hip arthroplasty after hip arthroscopy compared to original research. These findings highlight important differences in outcome reporting for hip arthroscopy procedures.
Area of Science:
- Orthopedic Surgery
- Medical Data Analysis
Background:
- Hip arthroscopy is a common procedure for hip joint issues.
- Evaluating the safety and efficacy of hip arthroscopy relies on data from various study types.
- Discrepancies in reported outcomes between different study designs can impact clinical decision-making.
Purpose of the Study:
- To compare major complication, revision, and conversion to arthroplasty rates following hip arthroscopy.
- To differentiate outcomes reported in database studies versus original research peer-reviewed publications.
Main Methods:
- A systematic review adhering to PRISMA guidelines was conducted.
- Searched PubMed, SCOPUS, SportDiscus, and Cochrane Central Register of Controlled Trials for relevant studies.
- Compared complication, revision, and conversion rates between original research and database studies.
Main Results:
- Analyzed 207 studies (201 original research, 6 database studies).
- Database studies reported significantly higher rates of major complications (0.8% vs 0.6%), including femoral neck fracture (RR 8.0) and hip dislocation (RR 2.2).
- Reoperation (11.1% vs 7.3%) and conversion to arthroplasty (8.0% vs 3.7%) rates were also significantly higher in database studies.
Conclusions:
- Database studies indicate significantly higher rates of major complications, revisions, and conversions to hip arthroplasty compared to original research.
- These findings underscore the importance of considering study design when interpreting hip arthroscopy outcomes.
- Further investigation into the reasons for these discrepancies is warranted.
Purpose:
The purpose of this study was to compare (1) major complication, (2) revision, and (3) conversion to arthroplasty rates following hip arthroscopy between database studies and original research peer-reviewed publications.
Methods:
A systematic review was performed using PRISMA guidelines. PubMed, SCOPUS, SportDiscus, and Cochrane Central Register of Controlled Trials were searched for studies that investigated major complication (dislocation, femoral neck fracture, avascular necrosis, fluid extravasation, septic arthritis, death), revision, and hip arthroplasty conversion rates following hip arthroscopy. Major complication, revision, and conversion to hip arthroplasty rates were compared between original research (single- or multicenter therapeutic studies) and database (insurance database using ICD-9/10 and/or current procedural terminology coding terminology) publishing studies.
Results:
Two hundred seven studies (201 original research publications [15,780 subjects; 54% female] and 6 database studies [20,825 subjects; 60% female]) were analyzed (mean age, 38.2 ± 11.6 years old; mean follow-up, 2.7 ± 2.9 years). The database studies had a significantly higher age (40.6 + 2.8 vs 35.4 ± 11.6), body mass index (27.4 ± 5.6 vs 24.9 ± 3.1), percentage of females (60.1% vs 53.8%), and longer follow-up (3.1 ± 1.6 vs 2.7 ± 3.0) compared with original research (P < .0001 for all). Ninety-seven (0.6%) major complications occurred in the individual studies, and 95 (0.8%) major complications occurred in the database studies (P = .029; relative risk [RR], 1.3). There was a significantly higher rate of femoral neck fracture (0.24% vs 0.03%; P < .0001; RR, 8.0), and hip dislocation (0.17% vs 0.06%; P = .023; RR, 2.2) in the database studies. Reoperations occurred at a significantly higher rate in the database studies (11.1% vs 7.3%; P < .001; RR, 1.5). There was a significantly higher rate of conversion to arthroplasty in the database studies (8.0% vs 3.7%; P < .001; RR, 2.2).
Conclusions:
Database studies report significantly increased major complication, revision, and conversion to hip arthroplasty rates compared with original research investigations of hip arthroscopy outcomes.
Level Of Evidence:
Level IV, systematic review of Level I-IV studies.