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Outcomes in patients undergoing primary total hip arthroplasty with history of prior hip arthroscopy
Zoe Alpert1, Farouk Khury1,2, Mark Kurapatti1
1Department of Orthopaedic Surgery, NYU Langone Health, New York, NY, USA.
Introduction:
As the number of total hip arthroscopies performed rises, further research is needed on the impact hip arthroscopy (HA) may have on total hip arthroplasty (THA). This study aimed to compare clinical and patient-reported outcomes of THA in patients with and without a history of HA.
Methods:
We retrospectively reviewed 167 patients who underwent unilateral, primary THA following ipsilateral HA from 2012 to 2024 (HA, n = 167). Patients were propensity matched 3:1 to THA patients without history of ipsilateral HA (NHA, n = 448) based on age, sex, race, smoking status, American Society of Anesthesiologists score, body mass index, and Charlson Comorbidity Index. Perioperative data, rates of complications and reoperation/revisions, Hip disability and Osteoarthritis Outcome Score, Joint Replacement (HOOS, JR), and Patient-Reported Outcomes Measurement Information System (PROMIS) scores were collected. Logistic regression was used to assess if the likelihood of reoperation was related to prior HA and surgical approach.
Results:
Patients with history of HA had longer mean follow-up duration (4.2 vs. 2.2 years, p < 0.001), lengths of stay (p = 0.013) and shorter operative times (p < 0.001). HA patients had higher dislocation and post-THA arthroscopy rates (p = 0.006; p = 0.020). Time to return to operation room was longer in the HA group compared to NHA cohort (334.1 vs. 104.4 days, p = 0.019). HA was associated with increased rates of reoperation due to dislocation (adjusted odds ratio 7.89, 95% CI, 1.68-36.9, p = 0.009). Surgical approach for THA was not associated with postoperative dislocation rate. Patient-reported outcomes were not different among the 2 cohorts.
Conclusions:
In our study, THA patients with history of HA experienced increased rates of dislocation and return to operation room. These findings highlight a need for increased clinical awareness. These findings may inform intraoperative and postoperative modifications to increase prosthetic hip stability. Additionally, this knowledge can have implications for insurance billing and payments, as these cases are coded as primary THA but may present with more complexity or worse outcomes.