Hip Arthroscopy Survivorship: A Population-based Study

OBJECTIVES: Recently, hip arthroscopy has been increasingly utilized to address pathology such as femoracetabular impingement and symptomatic labral tears. However, its role in advanced age and degenerative changes has not been clearly defined. The aim of this study was to examine survivorship following hip arthroscopy and identify risk factors for failure. METHODS: Data from the California Office of Statewide Health Planning and Development, a mandatory statewide discharge database, was utilized to identify patients who underwent hip arthroscopy from 2000 to 2014. Exclusions included lower extremity trauma, infection, congenital deformities, malignancy, and concurrent arthroplasty. Demographic information was assessed and failure defined as conversion to total hip arthroplasty (THA). Statistically significant differences between patients requiring THA and those who did not were identified by univariate analysis. Multivariate analysis was performed to account for identified differences, and a Kaplan-Meier curve constructed to estimate 5 and 10-year survivorship. RESULTS: After exclusions, 10,061 patients were identified with an average follow-up of 2.7 years. Five and 10-year survivorship were 90.9% and 77.9%, respectively. Patients converted to THA were older (53.1 years versus 40.1 years, p<0.001) and had more comorbidities (27.5% versus 20.1% having at least one comorbidity, p<0.001). THA patients had a higher prevalence of osteoarthritis (41.5% versus 13.24%, p<0.001) and osteochondral defects (44.0% versus 38.9%, p=0.001). On multivariate analysis, each 1-year increase in age presented a 7% increase in failure risk (OR 1.07, p<0.001). Obese patients were more likely to fail (OR 2.19, p=0.049), as were patients with osteoarthritis and osteochondral defects (OR 2.98, p<0.001 and OR 1.13, p=0.081). Patients whose surgery included removal of loose bodies or debridement were also at increased risk of failure (OR 1.58, p<0.001 and OR 1.62, p=0.001). CONCLUSION: Older age, obesity, and diagnoses of osteoarthritis or osteochondral defects at the time of surgery are risk factors for conversion to arthroplasty following hip arthroscopy.