P198 - The Evolution of Hip Arthroscopy: What Has Changed Between 2008 and 2018 - A Single Surgeon’s Experience
Abstract
Purpose
To compare a single surgeon’s first 200 cases of hip arthroscopy to the last 200 cases with regard to patient demographics, indications for surgeries, intraoperative findings, procedures performed, and patient reported outcomes (PROs).
Methods and Materials
Data were prospectively collected and retrospectively reviewed between February 2008 and February 2018 for all patients undergoing primary hip arthroscopy by a single surgeon. Of over 4000 patients, the first 200 (Group A) and last 200 (Group B) eligible for minimum two-year follow up were included in our analysis. Patient demographics, preoperative imaging, intraoperative procedures, PROs, and complications were collected and compared.
Results
Follow-up was available for 192 (96.0%) and 189 (94.5%) patients in groups A and B, respectively. The groups were similar in age, sex, and body mass index. In Group A, there were significantly more patients with Tönnis Grade 1 and preoperative chondral damage (38% vs 30%; 30.5% vs. 7.0%, respectively). Group B consisted of significantly more labral reconstructions (9.5% vs 0%), capsular closures (71.5% vs 31%), gluteus medius repairs (17.5% vs 3%), and iliopsoas fractional lengthening procedures (45% vs 29.5%). Femoroplasty was performed for smaller cam lesions, and resulted in smaller postoperative alpha angles (45.9°±8.2° vs 42.4°±6.3°, P<0.001). With regard to PROs, Group B exhibited significantly higher mHHS, NAHS, HOS-SSS scores at latest follow up.
Conclusion
This study demonstrates the significant evolution in patient management and procedures that has occurred in hip arthroscopy over the past decade. Stringent patient selection has resulted in fewer hip arthroscopies in arthritic patients. Intraoperatively, the transition from labral debridement to repair and reconstruction reflects a greater biomechanical understanding of the hip and the novel procedures that have emerged. Growing awareness of hip microinstability has led to increased appreciation for the importance of restoring capsular anatomy. These changes have resulted in superior PROs and lower rates of revision and conversion to THA.
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