Does hip arthroscopy lead to hip replacement?

In patients without arthritis, hip arthroscopy may offer relief from hip pain with a minimally invasive surgical treatment option that can also improve function and movement. For those who have more extensive injury and a diagnosis of arthritis, total hip replacement is the preferred surgical approach.

Table of Contents Show

The MASH Study Group
Osteoarthritis
Total Hip Replacement
Does labral tear lead to hip replacement?
Is hip arthroscopy a hip replacement?
What is the success rate of hip arthroscopy?
What conditions lead to hip replacement?

Hip arthroscopy is a minimally invasive surgery in which only two or three small incisions are utilized to insert a small camera and miniature surgical instruments into the hip joint to repair damaged cartilage and bone malformations. The operation typically takes about 2 hours and patients go home the same day. Patients can begin weight bearing 2 days to 8 weeks after surgery.

FAI is one of the most common problems treated by hip arthroscopy. FAI (Femoroacetabular Impingement) is when there is abnormal contact between the hip joint socket and the femur (thigh bone) and is treated by reshaping the bone to remove the abnormal contact. This abnormal contact can cause cartilage damage in the joint and damage to the labrum. The labrum is a ring of cartilage that sits on the edge of the hip socket and forms a seal on the head of the femur. Torn labrums are treated by fixating it back to the rim of the hip socket, removing it completely, or by reconstructing it with new tissue. Cartilage damage is treated by removing the damaged cartilage, allowing new healthy cartilage to grow. These procedures have been shown to greatly reduce pain and increase function in the hip.

The MASH Study Group

Arthroscopy is a relatively new and growing field in surgery. Dominic Carreira currently leads a research group of expert hip arthroscopists looking for ways to provide quality improvements in hip arthroscopy. Visit MASHstudy.com to learn more about the exciting research conducted by Dr. Carreira.

Osteoarthritis

Osteoarthritis is a painful wear and tear condition that destroys joint cartilage. It can be caused by trauma, repetitive movement, or even for no apparent reason. Hip arthroscopy is a preservation method for pre-osteoarthritic hips. It does not cure osteoarthritis; however, it may help prevent its progression. If hip osteoarthritis has advanced into later stages, hip arthroscopy is not indicated and may actually make matters worse. Under these circumstances total hip replacement is the best option.

Total Hip Replacement

Hip replacement is an invasive procedure that involves large incisions, removal of the head of the femur as well as damaged bone and cartilage from the hip socket and replacement with prosthesis. The operation typically takes about 2 hours and patients are hospitalized for 1 to 3 days after surgery. After surgery most patients use a walker or cane for about 2 to 4 weeks.

The results of total hip replacement vary depending on the individual’s age, weight, activity level, lifestyle, and medical conditions. Typically a hip replacement results in less pain and better hip function. The implants used in hip replacement do have a limited life expectancy. A joint implant’s longevity will vary in every patient, but they typically last about 20 years.

Joint replacement technology continues to advance rapidly. Prostheses are being developed through new means such as 3D printing, so we can expect the hip replacement surgery to keep getting better.

New York, NY—May 12, 2016

For patients with serious, ongoing hip pain, sometimes surgery is their best bet for relief. Given the choice between minimally invasive hip surgery and total hip replacement, most patients would choose the less invasive procedure, often done on an outpatient basis. But a study by researchers at Hospital for Special Surgery (HSS) in Manhattan finds that arthroscopic surgery may not be the best option, especially if a patient is over 60 or has arthritis.

Analyzing patient databases from California and Florida, researchers looked at how many patients ended up needing a hip replacement within two years of arthroscopic hip surgery. The study, published in Arthroscopy: The Journal of Arthroscopic and Related Surgery, found that more than one-third of the patients ages 60 to 69 went on to have a hip replacement. Hip arthritis and obesity were also major risk factors, with a significantly higher number of these patients needing a hip replacement within two years.

"We launched the study because the use of arthroscopic hip surgery has grown tremendously in the last decade," said William Schairer, MD, lead author. "Between 2006 and 2010 alone, the number of hip arthroscopies performed in the United States increased more than 600 percent."

Hip arthroscopy was not a very common procedure 10 years ago. It is a difficult procedure technically to perform, according to David J. Mayman, MD, an orthopedic surgeon at HSS and senior study author. "Over the last decade, the technology has improved and a lot more orthopedic surgeons have been trained to do it. More patients are also asking if they are candidates," Dr. Mayman said. "One of the goals of our study was to determine the proper indications for arthroscopy. We found that a lot of arthroscopy was being done in people in whom the indications were not sound."

Hip arthroscopy by an experienced orthopedic surgeon is an excellent procedure to treat hip impingement, labral tears and loose cartilage in the hip joint causing symptoms, according to the researchers. It is often performed in younger patients with the hope of relieving their symptoms and lowering their risk of future hip arthritis. Most studies to date have looked at arthroscopic hip surgery in this patient population, finding good results overall.

For the current study, HSS researchers identified 7,351 patients in the California and Florida databases who had arthroscopic hip surgery with a two-year follow-up from 2005 through 2012. Patients were divided into groups based on their age: those younger than 40; those ages 40 to 49; ages 50 to 59; 60 to 69; and 70 or older. Researchers also determined which patients had received a diagnosis of hip arthritis before arthroscopic surgery and identified those who were obese.

Only 3% of patients younger than 40 went on to have a hip replacement, compared to 35% of patients who were 60 to 69, the age group more likely to have arthritis. In addition to arthritis, obesity was found to be a major risk factor for needing a hip replacement within two years.

"There is growing concern regarding the efficacy of hip arthroscopy in patients with pre-existing hip arthritis," Dr. Schairer said. "Previous smaller studies have also noted a worse prognosis in these patients, with most advising against hip arthroscopy in patients with more than mild arthritis. This is important information for patients and surgeons so they can have a real discussion about what types of treatments would be most beneficial in the long run based on a patient's individual circumstances."

"Hip arthroscopy is a very good procedure in the right patient. It's a major advance in treating certain hip conditions, but not hip arthritis," Dr. Mayman said.

Does labral tear lead to hip replacement?

Studies suggest that when older people undergo hip surgery to repair a torn labrum the likelihood of needing a hip replacement increases. In these cases, a labral tear repair should be approached with caution,² and hip replacement may be considered.

Is hip arthroscopy a hip replacement?

Hip arthroscopy is generally recommended for younger patients with hip pain who do not require a hip replacement. The cause of their pain is usually related to sports injuries to the hip, overuse injuries or abnormalities in the shape of the bones that make up the hip joint.

What is the success rate of hip arthroscopy?

The arthroscopic hip surgery success rate is around 85 to 90 percent. The operation is performed to help restore your hip's function, but it's most successful at easing pain.