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

Abstract

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). 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. 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). 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.