Prior hip arthroscopy impacts long-term outcomes of total hip arthroplasty : a propensity-matched study with a minimum ten-year follow-up.

Abstract

Aims: The objective of this study was to perform a long-term comparative analysis of patients who underwent total hip arthroplasty (THA) with a history of previous ipsilateral hip arthroscopy (PA) to a propensity-score matched control group of primary THA with no prior hip arthroscopy (NPA).

Methods: Data were analyzed from patients who underwent primary THA for symptomatic hip osteoarthritis between November 2010 and November 2013. Patients included had completed a minimum of ten years of patient-reported outcome measure questionnaires. The PA group was propensity-score matched 1:1 based on age at THA, BMI, sex, robotic assistance, approach, and laterality to the NPA group. Clinical hip arthroplasty outcome thresholds, complications, and revision surgery rates were compared between cohorts. A Kaplan-Meier analysis was performed to assess survivorship.

Results: A total of 108 patients were included, 54 in each group. The groups displayed comparable outcomes at minimum ten-year follow-up, for modified Harris Hip Score (mHHS) (p = 0.370), Harris Hip Score (HHS) (p = 0.370), Hip dysfunction and Osteoarthritis Outcome Score for Joint Replacement (HOOS-JR) (p = 0.380), Forgotten Joint Score (FJS) (p = 0.250), visual analogue scale (VAS; p = 0.150), and patient satisfaction (p = 0.310). The two groups reached Patient Acceptable Symptom State (PASS) for FJS, HHS, and HOOS-JR at similar rates (p > 0.05). The PA group exhibited a significantly higher complication rate, with 11 major complications compared to two in the NPA group, translating to a relative risk of 2.8 (p < 0.033). Among the major complications in the PA group, nine required revision surgery, resulting in a relative risk of 4.5 (p < 0.047).

Conclusion: Patients undergoing primary THA with a history of prior hip arthroscopy achieve similar long-term functional outcomes compared to a propensity-matched control group. However, they face a 2.8-fold increased risk of complications and a 4.5-fold higher risk of major complications requiring revision THA.