Literature review indicates low complication rates for hip arthroscopy

The researchers said the learning curve of the procedure influenced the complication rates.

A systematic review of studies with short-term follow-up shows that hip arthroscopy has a 0.58% rate of major complications and a low rate of conversion to total hip arthroplasty.

“There was a low rate of complications,” Joshua D. Harris, MD, told Orthopedics Today. “We found the reoperation rate was what we expected, and the conversion rate to total hip replacement was low.”

Systematic review

The study authors noted an increase in the use of hip arthroscopy as a treatment for patients with labral tears and femoroacetabular impingement. To determine the morbidity associated with this procedure, they began a systematic review of studies on these patients using PubMed, SCOPUS, Sport Discus and the Cochrane Register. Harris said they included studies listing the reoperation or complication rates for hip arthroscopy and excluded any open surgeries such as total hip replacements (THRs), hip resurfacings or mini-open procedures to avoid any confounders.

They narrowed down their search to 92 studies that included a total of 6,134 patients. Most of the studies the researchers examined had a mean follow-up of 2 years and 88% had level 4 evidence, Harris said. The patients in the study had an average age of 34 years, and more than half were women.

Results and study limitations

The investigators found a major complication rate of 0.58% and a minor complication rate of 7.5%, according to the study abstract. The most common complications were iatrogenic chondrolabral injury and temporary neuropraxia “related to the pudendal and lateral cutaneous nerves,” Harris said. The overall reoperation rate was 6.3%. The most common reoperation was for THR, and the conversion rate THR was 2.9%.

Although the nature of the systematic review made the study prone to selection, answer and performance biases, Harris said the research offers surgeons vital information for patients.

“This gives surgeons that perform hip arthroscopy data to discuss with their patients regarding the expected outcomes, complications and reoperations if their patients decide to undergo a hip scope,” Harris said. “The rate of complications is related to the learning curve of hip arthroscopy and, as our indications evolve, we should limit the number of cases that are being converted to total hip — those are any patients with advanced degenerative arthritis of the hip.”

Next, the researchers plan to examine how to prevent hip arthroscopy complications in a multicenter collaborative project, Harris said. – by Renee Blisard Buddle

Reference:
Harris JD. Arthroscopy. 2013;doi:10.1016/j.arthro.2012.11.003.
For more information:
Joshua D. Harris, MD, can be reached at Midwest Orthopaedics at Rush, Rush University Medical Center, 1611 West Harrison St., Suite 300, Chicago, IL 60612; email: joshuaharrismd@gmail.com.
Disclosure: Harris has no relevant financial disclosures.

A systematic review of studies with short-term follow-up shows that hip arthroscopy has a 0.58% rate of major complications and a low rate of conversion to total hip arthroplasty.

“There was a low rate of complications,” Joshua D. Harris, MD, told Orthopedics Today. “We found the reoperation rate was what we expected, and the conversion rate to total hip replacement was low.”

Systematic review

The study authors noted an increase in the use of hip arthroscopy as a treatment for patients with labral tears and femoroacetabular impingement. To determine the morbidity associated with this procedure, they began a systematic review of studies on these patients using PubMed, SCOPUS, Sport Discus and the Cochrane Register. Harris said they included studies listing the reoperation or complication rates for hip arthroscopy and excluded any open surgeries such as total hip replacements (THRs), hip resurfacings or mini-open procedures to avoid any confounders.

They narrowed down their search to 92 studies that included a total of 6,134 patients. Most of the studies the researchers examined had a mean follow-up of 2 years and 88% had level 4 evidence, Harris said. The patients in the study had an average age of 34 years, and more than half were women.

Results and study limitations

The investigators found a major complication rate of 0.58% and a minor complication rate of 7.5%, according to the study abstract. The most common complications were iatrogenic chondrolabral injury and temporary neuropraxia “related to the pudendal and lateral cutaneous nerves,” Harris said. The overall reoperation rate was 6.3%. The most common reoperation was for THR, and the conversion rate THR was 2.9%.

Although the nature of the systematic review made the study prone to selection, answer and performance biases, Harris said the research offers surgeons vital information for patients.

“This gives surgeons that perform hip arthroscopy data to discuss with their patients regarding the expected outcomes, complications and reoperations if their patients decide to undergo a hip scope,” Harris said. “The rate of complications is related to the learning curve of hip arthroscopy and, as our indications evolve, we should limit the number of cases that are being converted to total hip — those are any patients with advanced degenerative arthritis of the hip.”

Next, the researchers plan to examine how to prevent hip arthroscopy complications in a multicenter collaborative project, Harris said. – by Renee Blisard Buddle

Reference:
Harris JD. Arthroscopy. 2013;doi:10.1016/j.arthro.2012.11.003.
For more information:
Joshua D. Harris, MD, can be reached at Midwest Orthopaedics at Rush, Rush University Medical Center, 1611 West Harrison St., Suite 300, Chicago, IL 60612; email: joshuaharrismd@gmail.com.
Disclosure: Harris has no relevant financial disclosures.