New Study: Too Much Hip Arthroscopy Variability

In a recent Houston Methodist Orthopedics & Sports Medicine study titled ” Arthroscopic hip preservation surgery practice patterns: an international survey” published in the December issue of the Journal of Hip Preservation Surgery, researchers found that worldwide hip arthroscopy practices lack consistency.
“Arthroscopic hip preservation surgery is a rapidly growing specialty, with an evolving and improving base of literature. In comparison to other specialties in orthopedic surgery, hip arthroscopy is relatively new, with a tremendous increase in utilization over the past 10 to 15 years,” Joshua D. Harris, M.D., one of the lead researchers and a Houston Methodist orthopedic surgeon told OTW.

“Currently, expert opinion and small retrospective investigations comprise the vast majority of the literature across the world. Thus, the purpose of this study was to assimilate international expert opinions on pre-, intra-, and post-operative management of patients undergoing hip arthroscopy.”

Harris and his colleagues designed a 21 question international survey to assess treatment practices of hip arthroscopists from around the world. Seventy-five of the 151 hip arthroscopists who received the survey completed it. They were from the following eight countries: the United States, Japan, Switzerland, United Kingdom, Scotland, Canada, Brazil and Australia.

The researchers found a lack of consensus on several areas of patient management, and emphasized the need for more high-level evidence. The most common radiographs used were standing antero-posterior pelvis, false profile and Dunn 45. CT scans were used by 54% of the surgeons and an arthogram with MRI was only recommended by 56%. Arthroscopy was very rarely performed on patients with Tönnis grade-2 or grade-3 osteoarthritis (Never 40%, Infrequently 58%) or on patients with dysplasia (Never 51%, Infrequently 44%). And only 25% of the surgeons performed a routine ‘T’ capsulotomy. After the operation, slightly more than half of the surgeons didn’t use a brace and 39% never used continuous passive motion.

Some of the most important findings of the survey, according to Harris, were that “clinical evaluation supersedes that of radiographs and MRI; hip arthroscopy should not be performed in patients with advanced arthritis or moderate to severe dysplasia; and capsular closure is a controversial technique, in which surgeons are more frequently limiting capsulotomy size and more frequently performing repair.”