Patient-reported Outcomes of Direct Anterior Approach Hip Arthroplasty After Previous Hip Arthroscopy: A Matched Case-control Study With a Minimum 5-year Follow-up.

Abstract

Background: The primary aim of this study was to evaluate the impact of prior hip arthroscopy on direct anterior approach (DAA) total hip arthroplasty (THA) midterm outcomes, with a secondary analysis based on time to conversion to THA.

Materials and methods: Data were retrospectively reviewed for all patients who underwent THA by the DAA from 2009 to 2018. Eligible patients completed minimum 5-year follow-up patient-reported outcomes (PROs) questionnaires. Patients with a previous hip arthroscopy (THA-PA) were propensity matched in a 1:2 ratio to a control group of primary arthroplasty patients (THA-N-PA). A secondary analysis based on time to conversion to THA from the previous hip arthroscopy was conducted within the study group.

Results: A total of 402 patients were included. Favorable and comparable (P>0.05) outcomes were observed at minimum 5-year follow-up for all PROs evaluated except Visual Analogue Scale pain scale, where the THA-PA group had significantly higher scores (P<0.05). Importantly, the groups reported similar complications and revision surgery rates. Furthermore, the secondary analysis found patients that converted within one year from the previous hip arthroscopy showed significantly lower patient satisfaction.

Conclusion: Patients with a history of hip arthroscopy who underwent THA using the DAA demonstrated comparable and sustainable outcomes across all PROs, with similar complication and revision rates to the control group at midterm follow-up. However, patients who underwent THA within one year of prior hip arthroscopy reported significantly lower satisfaction levels. Careful patient selection and indication for hip arthroscopy are essential to avoid early conversion to THA. [Orthopedics. 202x;4x(x):xx-xx.].