Hip arthroscopy may not be best option for older people with arthritis, says study

A new study has found that arthroscopic surgery, a less invasive procedure than total hip replacement, may not be the best option for people over 60 who have arthritis.

Researchers at Hospital for Special Surgery (HSS) in Manhattan, New York, analysed patient databases from California and Flora, to see how many patients ended up needing a hip replacement within two years of arthroscopic hip surgery.

Hip arthroscopy wasn’t a particularly common procedure ten years ago. Often performed on younger patients, the procedure treats hip impingement, labral tears and loose cartilage in the hip joint causing symptoms. It is hoped that by relieving symptoms, it will lower the risk of developing future hip arthritis.

The study, published in Arthroscopy: The Journal of Arthroscopic and Related Surgery, found that one-third of patients aged between 60 – 69 went on to have a hip replacement within two years of their arthroscopy.

“We launched the study because the use of arthroscopic hip surgery has grown tremendously in the last decade,” says Dr William Schairer, lead author. “Between 2006 and 2010 alone, the number of hip arthroscopies performed in the United States increased more than 600 percent.”

Dr David Mayman, is an orthopedic surgeon at HSS and senior study author. “Over the last decade, the technology has improved and a lot more orthopedic surgeons have been trained to do it. More patients are also asking if they are candidates,” Dr. Mayman says. “One of the goals of our study was to determine the proper indications for arthroscopy. We found that a lot of arthroscopy was being done in people in whom the indications were not sound.”

For this study, 7,351 patients from the databases were divided into groups based on age: younger than 40; 40 – 49; 50 – 59; 60 – 69; and 70 or older. Researchers also identified those who had received diagnosis of hip arthritis before arthroscopic surgery and identified those who were obese.

Only 3% of patients younger than 40 went on to have a hip replacement, compared to 35% of patients who were 60 to 69, the age group more likely to have arthritis. In addition to arthritis, obesity was found to be a major risk factor for needing a hip replacement within two years.

“There is growing concern regarding the efficacy of hip arthroscopy in patients with pre-existing hip arthritis,” Dr. Schairer says. “Previous smaller studies have also noted a worse prognosis in these patients, with most advising against hip arthroscopy in patients with more than mild arthritis. This is important information for patients and surgeons so they can have a real discussion about what types of treatments would be most beneficial in the long run based on a patient’s individual circumstances.”

“Hip arthroscopy is a very good procedure in the right patient. It’s a major advance in treating certain hip conditions, but not hip arthritis,” Dr. Mayman says.

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