Hip arthroscopy results in improved patient reported outcomes compared to non-operative management of waitlisted patients

Luke Spencer-Gardner; Ruch Dissanayake; Amir Kalanie; Parminder Singh; John O'Donnell

doi:10.1093/jhps/hnw051

Hip arthroscopy results in improved patient reported outcomes compared to non-operative management of waitlisted patients

J Hip Preserv Surg. 2017 Jan 10;4(1):39-44. doi: 10.1093/jhps/hnw051. eCollection 2017 Jan.

Authors

Luke Spencer-Gardner¹, Ruch Dissanayake², Amir Kalanie³, Parminder Singh⁴, John O'Donnell⁴

Affiliations

¹ The Hip Preservation Center, Baylor University Medical Center, 3900 Junius Street, #705, Dallas, TX 75246, USA.
² Eastern Health 8 Arnold St, Box Hill, VIC 3128, Australia.
³ St. Vincent's Private Hospital, Suite 901A St Vincent's Clinic 438 Victoria Street, Darlinghurst, NSW 2010, Australia.
⁴ Hip Arthroscopy Australia, 21 Erin Street, Richmond, VIC 3121, Australia.

Abstract

Hip arthroscopy (HA) is an established treatment option to address intra-articular pathology of the hip. However, some clinicians encourage non-operative management (NOM). Non-operative management may include active measures such as physiotherapy and intra-articular steroid injections, or NOM may involve so called watchful waiting with no active intervention. These approaches, along with surgery have been detailed recently in the Warwick Agreement, a Consensus Statement regarding diagnosis and treatment of Femoroacetabular Impingement Syndrome The aim of this study is to compare the change in clinical outcome scores of waitlisted patients with intra-articular hip pathology who receive no active treatment with matched controls that have undergone HA. Patients less than 60 years of age were identified from a HA waiting list in a single hospital in the Australian public hospital system. Patient reported outcomes (PRO) were collected whilst patients waited for surgery. During this waiting period no specific treatment was offered. A separate group of patients who had previously undergone HA were matched based on age, sex, body mass index and baseline non-arthritic hip scores (NAHS). The groups were compared using the NAHS as the primary outcome measures. Modified Harris Hip Scores were also collected and compared. Thirty-six patients were included in each group, with a mean follow up of 19 months (12-36). There were no significant differences in age, sex, BMI and NAHS between groups at baseline. At final follow up, mean NAHS scores after HA were significantly higher than scores after NOM, 82.1 (36.4-100.0) versus 48.9 (11.3-78.8), respectively (P < 0.001) with a large effect size for mean change in scores between groups (d = 1.77, 95% CI 1.21-2.30). Mean mHHS after HA were significantly higher than scores after NOM, 84.3 (15.4-100.0) versus 48.1 (21.0-66.0) respectively (P < 0.001), with a large effect size for mean change in scores between groups (d = 1.92, 95% CI 1.34-2.46). HA may lead to significant improvements in PRO when compared to non-operative management of waitlisted patients with intra-articular pathology of the hip at 18 months follow-up.