Original Articles
The relationship between diagnosis and outcome in arthroscopy of the hip

https://doi.org/10.1053/jars.2001.21481Get rights and content

Abstract

Purpose: The purpose of this study was to compare the results of arthroscopy of the hip for osteonecrosis (ON) with those obtained for other diagnoses by presenting a cohort of patients with diagnosis and symptoms as dependant variables in a consecutive series of 86 cases of hip arthroscopy. Type of Study: Retrospective review of outcomes. Methods: There were 83 patients (86 hips) who underwent arthroscopy. Indications included ON (43%), labral injuries (20%), osteoarthritis (degenerative joint disease, DJD) (10%), Legg-Calvé-Perthes (LCP) disease (10%), and loose bodies (10%). All but 2 patients had had symptoms for at least 6 months. Symptoms were pain (100%), mechanical problems (78%), and loss of motion (56%). Arthroscopy was performed in the supine position, using a standard traction table, 30° and/or 70°arthroscopes, and the anterior and peritrochanteric portals. Data were collected longitudinally, retrospectively reviewed, and statistically analyzed. Results: No complications were seen; 60% of the patients had significant improvement over an average follow-up of 30 months. Better results were with labral tears (91%, P <.003) or LCP disease (89%, P <.05). ON and DJD did worse with only 40% and 44% improvement, respectively. After free-vascularized fibular graft (FVFG), 34% of patients showed improvement at follow-up (P =.003). Eighteen patients (21%) underwent total hip arthroplasty at an average of 8.4 months after arthroscopy. Mechanical symptoms were a significant favorable prognostic factor (P =.0019), with 85% having a good result. Patients with ON and mechanical symptoms had a significantly lower conversion rate to total hip arthroplasty than those with only pain or pain and decreased range of motion (P =.0043). Conclusions: Arthroscopy of the hip is useful for diagnosis and therapy of loose bodies, labral injuries, focal chondral lesions, or the late sequellae of LCP disease. We conclude that the presence of mechanical symptoms is a favorable prognostic factor for any diagnosis except degenerative arthritis. Furthermore, the identification of mechanical symptoms is a specific indication for arthroscopy in ON before or after FVFG.

Arthroscopy: The Journal of Arthroscopic and Related Surgery, Vol 17, No 2 (February), 2001: pp 181–188

Section snippets

Methods

From January 1995 to February 1998, 84 patients with refractory hip pain in 86 hips were treated at our institution with arthroscopy of the hip performed by a single surgeon (T.P.V.). The majority (37 hips) of these cases were performed for a diagnosis of ON either before or following free-vascularized fibular grafting. The remainder of the cases (49 hips) are discussed in detail to provide a cohort of patients and diagnoses with which to compare the outcome of diagnostic and therapeutic

Results

The average age of the patients was 33.6 years, with a range of 11 to 65 years. There were 53 male (63%), and 31 female (37%) patients. In only 2 cases was clicking or popping elicited during physical examination (Table 1).The clinical indications for this procedure included ON (without FVFG), 5 patients (5.8%); ON (after FVFG), 32 patients (37.2%); labral injuries, 22 patients (25.6%); degenerative arthritis, 9 patients (10.5%); the late sequelae of LCP disease, 9 patients (10.5%); and loose

Discussion

The purpose of this study was to compare the results of arthroscopy in the treatment of ON in patients without prior surgical intervention and in those with unsatisfactory results following FVFG with the results obtained in the treatment of other diagnoses. Additionally, we sought to further define the clinical indications for hip arthroscopy, document the resultant outcome of the procedure, identify any significant prognostic factors, and report any associated complications. This study

Conclusions

The authors’ experience with arthroscopy of the hip demonstrates the application of the procedure in a diverse patient population with a variety of clinical indications and the subsequent outcome of each group. Further, this patient population identifies patients with ON following FVFG and unequivocal mechanical symptoms as potential beneficiaries of arthroscopic treatment. Regardless of preoperative diagnosis, the presence of definite mechanical symptoms was an important prognostic indicator

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    Address correspondence and reprint requests to Thomas Parker Vail, M.D., Department of Surgery, Division of Orthopaedic Surgery, Duke University Medical Center, DUMC Box 3332, Durham, NC 27710, U.S.A.

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