Is Hip Arthroscopy Cost-effective for Femoroacetabular Impingement?

Background  

The impact of hip arthroscopy on health-related quality of life (HRQoL) among younger patients with symptomatic femoroacetabular impingement (FAI) is unknown, but with increasing recognition of the condition there is likely to be increasing demand for arthroscopy.     

Editorial Commentary: Predicting Satisfaction After Hip Arthroscopy Using Machine Learning: What Do Treadmills and Black Boxes Have to Do With Arthroscopy?

The use of advanced statistical methods and artificial intelligence including machine learning enables researchers to identify preoperative characteristics predictive of patients achieving minimal clinically important differences in health outcomes after interventions including surgery. Machine learning uses algorithms to recognize patterns in data sets to predict outcomes. The advantages are the ability, using “big data” registries, to infer relations that otherwise would not be readily understood and the ability to continuously improve the model as new data are added. However, machine learning has limitations. Models are only as good as the data incorporated, and data may be misapplied owing to huge data sets and strong computing capabilities, in which spurious correlations may be suggested based on significant P values. Hence, common sense must be applied. The future of outcome prediction studies will most definitely rely on machine learning and artificial intelligence methods.     

What Factors Influence Long-term Survivorship After Hip Arthroscopy?

Background  

Hip arthroscopy is an evolving procedure. One small study suggested that a low modified Harris hip score and arthritis at the time of surgery were predictors of poor prognosis.     

Editorial Commentary: Spine Pathology May Compromise the Results of Hip Arthroscopy: Will Hip Arthroscopy Improve Low Back Pain?

Pathology of the lumbar spine and hip commonly occur concurrently. The hip–spine connection has been well documented in the hip arthroplasty literature but until recently has been largely ignored in the setting of hip arthroscopy. Physical examination and diagnostic workup of the lumbosacral junction are warranted to further our understanding of the effects of lumbosacral motion and pathology in patients with concomitant femoroacetabular impingement syndrome. An understanding of this relationship will better allow surgeons to counsel and preoperatively optimize patients undergoing evaluation and treatment of femoroacetabular impingement syndrome. Several studies have reported that patients with a previous lumbar arthrodesis undergoing hip arthroplasty have lower patient-reported outcomes and greater revision rates compared with patients without previous lumbar surgery, and similar to its effect on outcomes after hip arthroplasty, lumbar spine disease can compromise outcomes after hip arthroscopy. On the other side of the coin, hip arthroplasty has been shown to improve low back pain in patients with concomitant hip osteoarthritis. Can the arthroscopic treatment of nonarthritic hip pathology offer a similar result? We won't know unless we look.     

Editorial Commentary: Most Patients With Borderline Hip Dysplasia Do Well After Hip Arthroscopy: Could Instability Be the Problem for Those Who Do Poorly?

Borderline hip dysplasia (BHD) is often defined based on the lateral center edge angle. While patients with frank hip dysplasia often require bony realignment with periacetabular osteotomy and/or derotational femoral osteotomy, patients with BHD represent an “in-between” group of patients. While many, perhaps even most, patients with BHD will have successful outcomes after hip arthroscopy alone, some will be unresponsive to an arthroscopic-only approach and require the same surgical treatments as those with frank dysplasia. A variety of radiographic and arthroscopic parameters can be used to assess the degree of instability in patients with BHD. It may be that patients with “borderline” hip dysplasia combined with hip instability are more likely to fail an arthroscopic-only approach but to date we still do not have a great algorithm for determining which patients with BHD should undergo bony treatment with periacetabular osteotomy. It is important for future studies to continue to seek out characteristics of BHD patients that predict failure of an arthroscopic-only approach. This will not only allow for optimal initial surgical treatment in “at-risk” patients with BHD but will also improve success rates in BHD patients selected for hip arthroscopy as initial surgical treatment.     

Why Do Patients Stay Longer Than Three Nights Following Hip and Knee Arthroplasty?

BackgroundProlonged length of stay (PLOS) is frequently cited by secondary data studies as an adverse outcome following hip and knee arthroplasty. Although perhaps indisputable that PLOS increases the cost of hospitalization, it is unknown whether it is an appropriate measure of the quality of an arthroplasty procedure.MethodsWe searched our institution’s database for all hip and knee arthroplasty procedures over a 5-year period using MS-DRG (Medicare Severity-Diagnosis Related Group) 469 and 470. Cases with greater than 3 night stays were identified. Charts were manually reviewed by 2 independent reviewers to identify the primary reason for PLOS, and the need for 30-day readmission or reoperation.ResultsOf a total 4347 hip and knee arthroplasty cases, 218 (5.0%) were identified with LOS greater than 3 nights. The majority of prolonged stays were due to exclusively medical reasons (81 cases: 37.2%; 95% confidence interval [CI] 31.0-43.7). The second most common cause was inpatient days prior to the arthroplasty procedure (45 cases: 20.6%; 95% CI 15.8-26.5). Orthopedic reasons for PLOS were significantly less common than medical reasons (36 cases: 16.5%; 95% CI 12.2-22.0, P < .0001), most often due to failure to meet therapy goals. Neither readmission (31 cases: 14.2%) nor reoperation (10 cases: 4.6%) was associated with an underlying reason for PLOS.ConclusionWhen evaluating LOS as a measure of quality of an arthroplasty procedure, readers of secondary “big data” studies should be aware that there are significant limitations to its utility. Even after controlling for potential confounders, we found that PLOS does not necessarily reflect an adverse outcome.     

Editorial Commentary: Safe Innovation? Arthroscopy After Traumatic Hip Dislocation

Hip arthroscopy can be helpful relative to conventional imaging when diagnosing (and treating) intra-articular injuries after a hip dislocation, but more evidence is required before adopting this approach diagnostic and therapeutic strategy.     

Editorial Commentary: How Do We Measure Return-to-Sport “Success” After Hip Arthroscopy for Femoroacetabular Impingement?

Hip arthroscopy for femoroacetabular impingement has generally been considered to enjoy a high rate of success. These patients tend to be young and active. One measure of “success” has been return to sport. However, much of the literature has used subjective return criteria and reported on diverse groups in terms of skill levels, sports, and sexes, as well as small numbers, thus limiting specific recommendations.