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Conversion to Total Hip Arthroplasty After Hip Arthroscopy: A Cohort-Based Survivorship Study With a Minimum of
Graeme Hoit1, Daniel B Whelan, Patrick Ly
1From the Division of Orthopaedic Surgery, Department of Surgery, University of Toronto (Hoit, Whelan, Atrey, and Khoshbin), the Department of Orthopaedic Surgery, St. Michael's Hospital (Whelan, Ly, Atrey, and Khoshbin), and the Institute for Clinical Evaluative Sciences, University of Toronto (Saskin), Toronto, ON, Canada .
Introduction:
The purpose of this study was to determine which patient, provider, and surgical factors influence progression to total hip arthroplasty (THA) after hip arthroscopy (HA) through a large cohort-based registry.
Methods:
All patients ≥18 years who underwent unilateral HA in Ontario, Canada, between October 1, 2010, and December 31, 2016, were identified with a minimum of 2-year follow-up. The rate of THA after HA was reported using Kaplan-Meier survivorship analyses. A Cox proportional hazard model was used to assess which factors independently influenced survivorship.
Results:
A total of 2,545 patients (53.2% female, mean age 37.4 ± 11.8 years) were identified. A total of 237 patients (9.3%) were identified to have undergone THA at a median time of 2 years after HA, with an additional 6.3% requiring a revision arthroplasty at a median time of 1.1 years. Patients who underwent isolated labral resection (hazard ratio [HR]: 2.55, 95% confidence interval [CI]: 1.51 to 4.60) or in combination with osteochondroplasty (OCP) [HR: 2.11, 95% CI: 1.22 to 3.88] were more likely to undergo THA versus patients who underwent isolated labral repair or in combination with an OCP, respectively. Older age increased the risk for THA (HR: 14.0, 95% CI: 5.76 to 39.1), and treatment by the highest-volume HA surgeons was found to be protective (HR: 0.55, 95% CI: 0.33 to 0.89).
Discussion:
Using our methods, the rate of THA after HA was 9.3% at 2 years. The rate of revision arthroplasty was 6.3% at 1 year. Patients who underwent labral resection, isolated OCP, and/or were of increased age were at increased independent risk of conversion to THA. Those treated by the highest-volume HA surgeons were found to be at reduced risk of conversion to THA.
