To evaluate post-operative outcomes and pre-operative risk factors for patients with underlying systemic inflammatory disorders (SID) after hip arthroscopy.
A retrospective analysis of patients that had undergone hip arthroscopy, with a history of systemic inflammatory disease. This included patients with a diagnosis of lupus, positive ANA, rheumatoid arthritis, psoriatic arthritis, sarcoidosis, inflammatory bowel disease, Reiter Syndrome, mixed connective tissue disease (MCTD). These cases were 1:2 matched to a control group of patients with no history of systemic inflammatory disease based on age and sex. An a-priori power analysis was conducted and A 1:2 case-control ratio was selected in order to increase study power. Inclusion criteria included all skeletally-mature patients with hip pain refractory to non-operative management who underwent hip arthroscopy for labral tears and femoroacetabular impingement (FAI). Skeletally immature patients, those with Tonnis grades of 2 or more (less than 2mm of joint space), hip dysplasia, patients undergoing revision hip arthroscopy, and patients whose pain failed to improve after intra-articular injection were excluded. The primary outcome was rate of revision hip arthroscopy or total hip arthroplasty 24 months after surgery. Secondary outcomes included two patient-reported outcome (PRO) scores, modified Harris Hip Scores (mHHS) and Non-Arthritic Hip Scores (NAHS).
Twenty patients (21 hip arthroscopy procedures) and 42 controls were included. There was no significant difference in proportion of patients who met failure criteria (28.6% vs 16.7%,p=0.271) or two-year survivorship (76.2% vs 83.3%, p=0.496) between the SID and control groups, respectively. Both groups had a significant improvement in modified Harris Hip Scores (mHHS) and Non-Arthritic Hip Scores (NAHS) at 24-months compared to baseline, however, there was no significant difference in mHHS (p=0.28) or NAHS (p=0.22) at 24-months between the two groups.
Patients with underlying inflammatory conditions have similar 2-year outcomes after hip arthroscopy for intra-articular pathology compared to patients with no history of inflammatory disease.
LEVEL OF EVIDENCE:
This is a retrospective comparative study, Level of Evidence III.