Surgical Trends in Arthroscopic Hip Surgery using a Large National Database

OBJECTIVES: Hip arthroscopy has seen dramatic growth over the past several years. As technology improves, indications continue to evolve. Our purpose was to evaluate the most recent trends in various arthroscopic hip procedures using a national database significantly larger than those previously utilized and which obviates many of the concerns seen with previously used databases. Our secondary purpose was to assess the incidence and specific details regarding secondary procedures, including total hip arthroplasty, for patients during the study period. METHODS: The MarketScan Commercial Claims and Encounters Database was searched using ICD-9 and CPT codes to identify patients who underwent any arthroscopic hip procedure from 2008-2013 including soft tissue procedures such as labral debridement or labral repair as well as bony procedures such as femoroplasty or actetabuloplasty. Patients identified were characterized by gender, age group and year of the initial procedure. Data for procedures was also divided between index procedures and revision procedures. Regression analysis was used to evaluate differences in surgical trends between individual patient groups delineated by age and gender. The Cochran-Armitage trend test was used to identify significant differences in surgical trends seen yearly. RESULTS: A total of 55,477 patients underwent a total of 62,782 arthroscopic hip procedures from 2008 through 2013. The number of cases per number of patients in the database increased every year with 15,031 total procedures in 2013 versus 3763 total procedures in 2008. Prior to changes in CPT coding, labral and/or chondral debridement represented the most commonly performed procedure. However, femoroplasty became the most common procedure in 2012 at 25% of all cases and increased to 28% of all cases by 2013. Labral repair and acetabuloplasty showed similar increases from 2011 to 2013, becoming the second and third most common procedures during that time at 21% and 17% of all procedures. Females underwent more procedures during the study period (35,088 to 20,389 for males). Patients age 40-49 were most likely to undergo any procedure, undergoing 16,373 (26%) procedures with labral or chondral debridement being the most common procedure performed (32%) followed by femoroplasty (18%). A total of 2,754 patients (10%) underwent a second arthroscopic procedure during the study period with labral or chondral debridement representing the most common secondary procedure (54%). A total of 29892 patients (5%) underwent a total hip arthroplasty following an arthroscopic procedure during the study period. Patients undergoing arthroscopic loose body removal had the highest percentage of patients eventually undergoing total hip arthroplasty (11%). CONCLUSION: Arthroscopic hip procedures continue to increase in incidence. Femoroplasty has become the most common procedure performed since specific coding began though labral or chondral debridement was the most common secondary procedure. Patients age 40-49 underwent the most arthroscopic hip procedures. Despite smaller studies that have shown that lack of addressing osseous lesions may lead to a higher risk of failure, this large database did not support this. A significant percentage (5%) of patients undergoes hip arthroplasty within 4 years of having hip arthroscopy done.