Patient-reported Outcomes of Direct Anterior Approach Hip Arthroplasty After Previous Hip Arthroscopy: A Matched Case-control Study With a Minimum 5-year Follow-up
Authors: Quesada-Jimenez R, Kahana-Rojkind AH, Walsh EG, Sikligar D, Domb BG
DOI: 10.3928/01477447-20250409-02
Background
With increasing hip arthroscopy procedures, more patients require total hip arthroplasty (THA) subsequently. The impact of prior hip arthroscopy on outcomes after direct anterior approach (DAA) THA remains unclear. This study examines midterm patient-reported outcomes (PROs), complications, and satisfaction in patients with and without prior hip arthroscopy.
Methods
A retrospective case-control study including patients undergoing DAA THA from 2009 to 2018 with ≥5 years follow-up. Patients with previous hip arthroscopy (THA-PA) were matched 1:2 to those without prior arthroscopy (THA-N-PA). Outcomes assessed included PROs, complications, revision rates, and satisfaction. Secondary analysis compared outcomes based on interval between arthroscopy and THA.
Key Findings
- Both groups demonstrated similar favorable PROs at minimum 5 years, except:
- THA-PA group reported higher pain scores (VAS) (p < 0.05).
- No significant differences in complications or revision rates.
- Patients undergoing THA within 1 year of arthroscopy had significantly lower satisfaction than those with longer intervals between surgeries.
Conclusion
Prior hip arthroscopy does not negatively affect midterm outcomes after DAA THA. However, early conversion to THA (within 1 year) is associated with lower patient satisfaction, indicating the need for careful timing and patient selection when considering hip replacement after arthroscopy.
What Does This Mean for Providers?
- Prior hip arthroscopy should not deter surgeons from recommending or performing DAA THA, as long-term outcomes and complication rates are comparable.
- Special attention is warranted for patients considering THA soon after arthroscopy (<1 year), as they may report lower satisfaction and potentially unresolved underlying issues.
- Providers should emphasize appropriate timing and thorough evaluation before proceeding to THA following arthroscopy to optimize patient satisfaction.
- This evidence supports counseling patients realistically regarding expectations for pain relief and satisfaction, especially if early conversion is planned.
- These findings highlight the importance of comprehensive pre-THA assessment, possibly including revisiting arthroscopy indications and outcomes.