Hip Arthroscopy Volume and Reoperations in a Large Cross-sectional Population: High Rate of Subsequent Revision Hip Arthroscopy in Young Patients and Total Hip Arthroplasty in Older Patients

Purpose: To report contemporary trends in hip arthroscopy case volume in the United States using a large cross-sectional cohort with accurate laterality tracking for assessment of revision surgery and rates of conversion to total hip arthroplasty (THA).

Methods: The Mariner PearlDiver dataset was used to query patients who underwent hip arthroscopy from 2010 to 2017 using CPT codes. Patient demographics were recorded and subsequent hip arthroscopy procedures and THA conversion within 2 years after surgery were tracked using ICD-10 codes to accurately identify laterality. Emergency department (ED) and hospital admission within 30-days after surgery were queried.

Results: Of the 53,103 patients undergoing hip arthroscopy procedures, hip arthroscopy case volume increased two-fold from 2010 to 2014 but remained relatively unchanged from 2014 to 2017. The most common age group undergoing surgery was 40 to 49 years and female patients represented 70% of cases. Two-year subsequent surgery rate was 19% with 15.1% undergoing a revision arthroscopy and 3.9% converting to THA. The most common revision arthroscopy procedures were femoroplasty (9.5%), labral repair (8.5%) and acetabuloplasty (4.3%). Younger patients were more likely to undergo revision arthroscopy (18% age 10-19; 15% age 20-29). Older patients had a significant risk for conversion to THA within 2 years (36% age 60 to 69; 28% age 50-59). Female patients also demonstrated a slightly higher rate of conversion to THA (4.1% female, 3.5% male, P <.0001). Patients 20 to 29 years had the highest risk of ED admission (5.4%) and hospital admission (0.8%) within 30 days of surgery.

Conclusions: The rise in hip arthroscopy procedures may be starting to plateau in the United States. Cross-sectional data also indicate that there is a higher than previously reported rate of revision hip arthroscopy in patients under age 30 and conversion to THA in patients over age 50.

Keywords: femoroacetabular impingement; hip arthroscopy; reoperation; total hip arthroplasty; trends.