Original Research

Does a Prior Hip Arthroscopy Affect Clinical Outcomes in Metal-on-Metal Hip Resurfacing Arthroplasty?

Am J Orthop. 2014 November;43(11):E255-E260

References

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Radiographic assessment consisted of a low anteroposterior (AP) pelvic radiograph (with the radiographic beam centered on the pubic symphysis) and a cross-table lateral radiograph obtained at the most recent follow-up visit. Both the acetabular component abduction relative to the inter-teardrop line, and the angle between the femoral stem and the anatomic axis of the femoral shaft (stem-shaft angle) were measured on AP radiographs.^19,20 Acetabular component anteversion was measured on the cross-table lateral radiographs as the angle between the projected long axis of the acetabular opening and a line drawn perpendicular to the long axis plane of the body (Figures A, B).²¹

The same registry database was used to identify patients who received an HRA without a prior history of arthroscopy or hip surgery. A 1:2 matching analysis for those patients with a prior hip arthroscopy to those without a prior hip arthroscopy was performed to formulate a control group (control cohort) of 86 patients. Each patient in the arthroscopy cohort was matched with 2 patients in the control cohort based on the following parameters: age (± 6 years), sex (same), BMI (± 4 kg/m²), femoral head size (± 4 mm), and preoperative HHS and WOMAC scores (± 7 points). In the event an arthroscopy patient matched to 2 or more control patients, the patients who minimized the least squared error among the matching variables were selected.

Statistical Analysis

All data were collected and analyzed using Microsoft Excel software (Microsoft Corporation, Redmond, Washington). Statistical comparisons between the 2 cohorts regarding demographic variables, clinical outcomes, and radiographic alignment were performed using an unpaired, Student 2-tailed t test, with statistical significance set at P ≤ .05.

Results

A comparison of the results of the 1:2 matching analysis between the arthroscopy and control cohorts is presented in Table 2. There was no significant difference in the preoperative age, BMI, femoral head size, HHS, or WOMAC score between the 2 cohorts. However, the control cohort did show a more severe, preoperative flexion contracture (as expressed by a decreased amount of extension) and a decreased amount of preoperative abduction (Table 3). The preoperative UCLA activity score was also decreased in the control cohort, but this was not statistically significant.

The mean (SD) follow-up was 2.0 (1.0) years in the arthroscopy cohort and 2.1 (1.1) years in the control cohort. There was no significant difference in radiographic alignment between the 2 cohorts. The stem-shaft angle was 139.3° (SD, 5.4°) in the arthroscopy cohort (vs 138.3° [SD, 5.5°] in the control cohort; P = .3), the acetabular abduction was 43.9° (SD, 5.8°) in the arthroscopy cohort (vs 42.9° [SD, 6.1°] in the control cohort; P = .4), and the acetabular anteversion was 21.1° (SD, 7.5°) in the arthroscopy cohort (vs 20.8° [SD, 7.1°] in the control cohort; P = .8).

At 6-week follow-up, the arthroscopy cohort showed a significantly decreased WOMAC score compared with the control cohort (72.9 [SD, 15.5] vs 80.5 [SD, 11.8], respectively; P = .05). In addition, there was a trend towards a decreased SF-12 mental component score in the arthroscopy cohort (52.2 [SD, 9.3] vs 56.5 [SD, 7.8] in the control cohort; P = .06). However, none of the remaining clinical indices showed a significant difference between the 2 cohorts, and there was no difference in range of motion between the 2 cohorts at the 6-week follow-up visit (Table 4).

In addition, at 3-month follow-up, no statistically significant differences were seen between the 2 cohorts for any of the clinical indices or range of motion values. Both groups continued to improve rapidly, with HHS of 96.9 (SD, 3.5) in the arthroscopy cohort and 95.5 (SD, 6.6) in the control cohort, and WOMAC scores of 88.7 (SD, 10.2) and 89.5 (SD, 9.8), respectively (Table 5). Similarly, at the 6-month and 1-year follow-up intervals, the 2 cohorts showed continued improvement in their clinical measures, with no statistically significant differences between the 2 cohorts (Tables 6, 7).

At the most recent follow-up visit, more than 1 year after surgery, the HHS was 99.5 (SD, 1.3) in the arthroscopy cohort and 99.2 (SD, 9.7) in the control cohort (P = .9), and the WOMAC score was 93.5 (SD, 11.3) and 92.4 (SD, 12.2), respectively (P = .8). No significant perioperative complications were seen in the arthroscopy cohort. In the arthroscopy cohort, 1 patient was diagnosed with a deep venous thrombosis 2 weeks after the procedure and was placed on low-molecular-weight heparin and coumadin for treatment. A second patient in the arthroscopy cohort had continued serosanguinous drainage for 4 days postoperatively, which resolved with continued compressive dressings. To date, no patients in the arthroscopy or control cohorts have required a second operation or revision of their components.