Summary

In this large national study of primary hip arthroscopy, 90-day adverse events were low at 1.28%, and the five-year secondary surgery rate was 4.9%; age less than 20 years, female sex, and obesity were risk factors for secondary surgery, suggesting the need for increased surveillance in these patient groups.

Abstract

Background

Hip arthroscopy is frequently used to treat femoroacetabular impingement (FAI) and labral tears. However, large cross-sectional studies documenting rates and predictors of revision surgery at midterm follow-up after primary hip arthroscopy are lacking.

Purpose

To evaluate 90-day complications, five-year secondary surgery rates, and risk factors for secondary surgery following primary hip arthroscopy performed for FAI and/or labral tears using a large national dataset.

Methods

A retrospective analysis was conducted using the PearlDiver Mariner151 database. Patients with International Classification of Diseases (ICD)-10 diagnosis codes for FAI and/or labral tear undergoing primary hip arthroscopy with femoroplasty, acetabuloplasty, and/or labral repair between 2015 and 2021 were identified. Those with concomitant ICD-10 codes for infection, neoplasm, or fracture were excluded, as were patients with a history of prior hip arthroscopy or total hip arthroplasty (THA), or age >70 years. Rates of complications within 90 days of surgery were assessed. Five-year rates of secondary surgery—revision hip arthroscopy or conversion to THA—were determined by Kaplan-Meier analysis, and risk factors for secondary surgery were identified by multivariate logistic regression.

Results

A total of 31,623 patients underwent primary hip arthroscopy from October 2015-April 2021, with annual volumes ranging from 5,340 to 6,343 surgeries per year. Femoroplasty was the most frequent surgical procedure (performed in 81.1% of surgical encounters), followed by labral repair (72.6%) and acetabuloplasty (33.0%). Ninety-day postoperative complication rates were low, with 1.28% of patients experiencing any complication. The five-year secondary surgery rate was 4.9% (N=915 patients). Multivariate logistic regression identified age<20 years (OR, 1.50; P<0.001), female sex (OR, 1.33; P<0.001), class I obesity (BMI 30-34.9 kg/m2: OR, 1.30; P=0.04), and class II/III obesity (BMI>35.0 kg/m2: OR, 1.29; P=0.02) as independent predictors of secondary surgery.

Conclusion

In this study of primary hip arthroscopy, 90-day adverse events were low at 1.28%, and the five-year secondary surgery rate was 4.9%. Age less than 20 years, female sex, and obesity were risk factors for secondary surgery, suggesting the need for increased surveillance in these patient groups.