Hip arthroscopy for athletes in the long term: a 10-year follow up
Arthroscopy is a minimally invasive surgical procedure in which small incisions are made in the skin, through which a tiny camera, fiber optic lighting and miniature tools are inserted and used to repair a joint. Though arthroscopy requires anesthetic and other surgical components, it differs from standard surgery in its quicker recovery time, which is why it is the preferred method of treatment for numerous injuries. One location of the body in which arthroscopy has been consistently used over the years to treat sports-related issues is the hip. Many patients with hip pain unresponsive to non-operative treatment have been referred to arthroscopic procedures instead to treat problem. Even with the frequency of hip arthroscopies, however, few reports have tracked the long-term effects of the procedure on athletes, prompting an investigative study by the Nashville Sports Medicine Foundation.
In order to track the progress and/or further complications of patients with hip arthroscopies, they were each monitored with the Harris hip score prior to their surgery, then for the next ten years at intervals of 1, 3, 12, 24, 60 and 120 months. The Harris hip score takes in factors of mobility level, flexibility and pain to assign a score of the overall health of the hip. Other variables such as age, sex, type of sport in which injury was incurred and details regarding hip symptoms were also recorded for each patient. Out of 52 simple debridement procedures performed on 50 patients who went through the 10-year follow up, 15 developed newer symptoms while performing physical activity, and these 15 became the focal point of the study. For the patients that dropped out of the study due to any open procedure such as a total hip arthroplasty (hip replacement using a prosthetic implant), their scores on the Harris hip score were marked lower than the minimum of those who completed the 10-year follow up. This allowed them to be included in the final data, since if they were removed entirely, data would be deceptively positive. Using the median score made this study as accurate as it could've been.
Results after the 10-year follow-up showed a median overall improvement from 51 points prior to surgery to 96 afterwards, or an impressive 45 points total. Thirteen patients (87%) made a full return to their respective sport at a median of three months after surgery, two of which returned to general sporting activities after the median three months and their primary sport after four years. The most alarming finding, however, was the role of arthritis in the study: all five patients (33%) whose arthroscopy was a result of arthritis ended up having total hip arthroplasty at an average of six years after surgery. This piece of data indicates the inherently dangerous implications of arthritis when regarding hip arthroscopy.
The two major limitations of this study are its timeframe, since it involves procedures used in the past that have been improved upon greatly, and the Harris hip score, which is debatable in its accuracy. Current arthroscopic procedures are more extensive and require longer recoveries than the simple debridement procedures, which may have an impact on an athlete's return to sports. The Harris hip score also has some issues in assessing subjects who score extremely high, and needs to be improved upon. Nonetheless, the study makes no mistake about the negative implications caused by arthritis. The fact that all patients initially affected by an arthritic disorder ended up undergoing a total hip arthroplasty proves that arthritis is a poor prognostic indicator and will likely lead to long-term complications. Therefore, diagnosing arthritis early on is important as further research is conducted to investigate improved procedures that will be effective when simple debridement isn't. While the findings of this study offer no major breakthrough, they do confirm the general effectiveness of hip arthroscopy for athletes and the necessity of continuing research on its connection to arthritis.
-As reported by the Nashville Sports Medicine Foundation in The American Journal of Sports Medicine
-Summarized by Greg Gargiulo
