Cost-Effectiveness Analysis of Hip Arthroscopic Surgery and Structured Rehabilitation Alone in Individuals With Hip Labral Tears: Response
Authors: Lodhia P, Gui C, Chandrasekaran S, Suarez-Ahedo C, Dirschl DR, Domb BG
Journal: Am J Sports Med. 2017 Mar;45(3):NP2–NP4
Purpose
To address critiques and clarify findings of a cost-effectiveness analysis comparing hip arthroscopy to structured rehabilitation in patients with labral tears and no osteoarthritis.
Methods
Markov decision model using published data on outcomes, costs, OA progression, and conversion to THA. Sensitivity analyses tested model robustness across patient ages (20–70).
Key Findings
- Hip arthroscopy is more cost-effective than rehab alone in patients without OA.
- Lower rates of symptomatic OA and THA seen with surgical management.
- Rehab remains essential prior to surgery; cost-effectiveness assumes failed nonoperative care.
Conclusions
In appropriately selected patients, arthroscopic surgery offers a cost-effective, long-term benefit over rehabilitation alone, especially in minimizing OA progression.
What Does This Mean for Providers?
- Hip arthroscopy is a viable and cost-effective intervention after failed conservative treatment.
- Rehabilitation remains essential as a first-line approach.
- Use shared decision-making tools to align treatment with patient age, OA risk, and response to nonoperative care.