News & Announcements

A new study by surgeon-scientists at Hospital for Special Surgery (HSS) found that 25% of patients with femoroacetabular impingement (FAI) who underwent modern arthroscopy for their condition experienced a delay in the natural progression of osteoarthritis (OA) of the hip.

The retrospective study, published by The American Journal of Sports Medicine, is the first to link hip arthroscopy with a reduced risk of developing hip OA over the long term.

RELATED: Register for the International Masters Anterior Course, September 12-14, 2024, in Houston

“I’m very proud of our team for publishing this work, which validates hip arthroscopy as a longer-term joint-preserving procedure in carefully selected patients,” said Bryan T. Kelly, MD, MBA, President and CEO of HSS and a world-renowned pioneer in the field of hip arthroscopy who also served as senior author on the study.

“This paper is a prime example of the benefits of advancing innovations in surgical techniques and analyzing patient data collected over many years so we can understand and share the factors associated with optimal results.”

Study Methods and Results

Prior studies have shown that 85% to 90% of patients with FAI who undergo modern arthroscopy return to their usual activity level. However, until now, little has been known about whether modern arthroscopy can slow the progression of arthritis in these patients.

To explore this connection, investigators examined radiographic images of 200 hips from 100 patients who exhibited signs of FAI in both hips but underwent arthroscopy only for their symptomatic hip between 2010 and 2012. The severity of OA in each hip was assessed retrospectively using radiographic images taken before surgery and at least 10 years later. Notably, the researchers were unaware of which hips had undergone surgical correction during the assessment.

The resulting analysis revealed only 28% of operative hips showed an increase in progression of OA at a minimum of 10 years after surgery in comparison to 48% of non-operative hips. This difference translated to a relative risk reduction of 42% across all patients.

Although there was no difference in the natural development of arthritis between the operative and non-operative hips for 70% of patients, 1 in 4, or 25%, had less OA in their operative hip compared with their non-operative hip 10 years later.

“Previous studies by other centers have reported underwhelming 10-year arthroplasty outcomes for patients with hip impingement. However, those studies reported on older surgical indications and older surgical techniques,” said lead author and former HSS fellow Prem N. Ramkumar, MD, MBA, now an orthopedic surgeon at Long Beach Lakewood Orthopedic Institute, in Long Beach, California.

“By contrast, we studied the effect of modern arthroscopic methods by comparing the degree of arthritis in each patient’s operative hip versus their non-operative hip. Our research design controlled for variables such as age, medical history, lifestyle, and individual mechanics like rotational profile, spinal alignment and gait — leaving history of arthroscopy as the single factor driving any resulting differences in arthritis progression.”

Study Implications

In addition, the investigators identified a small subset of patients whose OA progressed more rapidly in the operative hip compared with the non-operative hip.

Specifically, older age, a higher arthritis grade, an alpha angle greater than 65 degrees and evidence of borderline hip dysplasia before surgery were the primary risk factors associated with the 5% of hip impingement patients whose OA in the operative hip worsened more quickly after surgery.

“We can now identify patients most likely to benefit from arthroscopy for hip impingement and inform patients about their anticipated odds of successful outcomes based on their personal risk factors,” said Danyal H. Nawabi, MD, FRCS, an HSS orthopedic surgeon and an author on the study.

“For ideal candidates, the evidence shows that hip arthroscopy may delay or prevent arthritis for 1 in 4 patients. That’s very powerful information,”

Dr. Nawabi also points to the importance of the modern techniques used to care for patients in the study, all of whom were patients of Dr. Kelly. These methods include labrum repair, removal of bony abnormalities on the ball and socket, and proper closure of the joint capsule enveloping the hip joint.

Source

Ramkumar PN, Olsen RJ, Shaikh HJF, Nawabi DH, Kelly BT. Modern hip arthroscopy for FAIS may delay the natural history of osteoarthritis in 25% of patients: a 12-year follow-up analysis. Am J Sports Med. 2024 Apr;52(5):1137-1143. doi: 10.1177/03635465241232154. Epub 2024 Mar 8.