Hip Arthroscopy is Associated with Increased Risk of Total Hip Arthroplasty Failure and Increased Resource Allocation in Middle-Aged Total Hip Arthroplasty Patients.

BACKGROUND: Hip arthroscopy (HA) rates continue to increase. While efficacious in hip preservation outcomes, many patients will develop osteoarthritis necessitating total hip arthroplasty (THA). Presently, there is limited, conflicting literature on the correlation between preceding HA and subsequent THA outcomes. The purpose of this study was to evaluate the risk of prior HA on subsequent THA revision rates in middle-aged THA patients (40 to 65 years old). Resource allocation before and after THA was additionally explored.

METHODS: Administrative data was used to perform a retrospective population-based study of Ontario residents who underwent primary THA for osteoarthritis (2002 to 2023). Exposure was prior ipsilateral HA, subcategorized as recent (≤ five years pre-THA) or remote (greater than five years). Outcomes included 5-year THA revision, 30-day emergency department (ED) visit, readmission, major surgical complication, hospital lengths of stay (LOS), 1-year costs, outpatient orthopaedic visits, mortality, and chronic opioid use. Multivariable logistic regressions were used to evaluate the influence of prior HA on outcomes. Of 85,814 primary THA identified, 5,642 (6.6%) underwent prior HA. There were 1,215 patients who received HA less than five years before index THA.

RESULTS: Prior HA was associated with statistically higher revision risk (4.9 versus 3.3%; hazard ratio (HR) = 1.49; absolute risk difference = 1.7%). The 30-day ED visits, readmissions, and major complications were similar. Prior HA patients had greater pre-THA resource utilization and associated costs, 1-year post-THA costs (median $14,148 versus $13,740; P < 0.001), and number of outpatient visits. Chronic opioid use was associated with prior HA and increased odds of ED visit (OR [odds ratio] 1.37), readmission (OR 1.61), major complication (OR 1.40), postoperative visits (OR 1.12), and 1-year costs (OR 1.47) post-THA (all P < 0.001).

DISCUSSION: In adults 40 to 65 years, prior HA was associated with increased risk of all-cause revision after THA, increased healthcare utilization and costs, and equivalent short-term complication and readmission rates. The benefits of HA should be carefully considered in this population, along with the risks elucidated in the present study. Patient counseling and education is essential given improvements in modern THA implant survivorship.