Scientists at the Hospital for Special Surgery (HSS) recently discovered that a quarter of patients with hip impingement who underwent modern arthroscopy for their condition dealt with a delay in the progression of osteoarthritis. The study, which was posted in The American Journal of Sports Medicine, is the first to connect hip arthroscopy to a decrease in the risk of developing hip arthritis over a long time.
Hip impingement is one of the main causes of hip pain for patients with a typical age range of teenagers to middle-aged. It is proven to be the underlying cause of hip pain for roughly 40% of the patients within that age range. When bones of the hip joint are not properly shaped, they can rub up against one another, leading to increased pain and stiffness and, ultimately, arthritis.
“I’m very proud of our team for publishing this work, which validates hip arthroscopy as a longer-term joint-preserving procedure in carefully selected patients,” says Bryan T. Kelly, MD, MBA, President and CEO of HSS and a world-renowned pioneer in the field of hip arthroscopy who also served as senior author on the study. “At HSS, we focus on providing excellence in clinical care through innovation and evidence-based research. This paper is a prime example of the benefits of advancing innovations in surgical techniques and analyzing patient data collected over many years so we can understand and share the factors associated with optimal results.”
In previous studies, it has been found that 85-90% of patients with hip impingement who undergo modern arthroscopy return to their typical physical workload. However, it has remained unknown whether or not modern arthroscopy could delay the rate at which arthritis develops in these patients, until now.
Researchers were able to build this connection by analyzing X-ray images from 100 patients who showed signs of hip impingement and went for an arthroscopy between 2010 and 2012. The X-ray images from over a decade ago were compared with more up-to-date ones, which showed little to no signs of hip correction.
Through the analysis, it was found that just 28% of operative hips showed an increase in arthritis progression compared to 48% of nonoperative hips. While many patients found no change in their natural progression of arthritis, about 25% of patients had less arthritis in their operative hip when compared to their nonoperative hip a decade later.
“Previous studies by other centers have reported underwhelming 10-year arthroplasty outcomes for patients with hip impingement. However, those studies reported on older surgical indications and older surgical techniques,” explains lead author and former HSS fellow Prem N. Ramkumar, MD, MBA, now an orthopedic surgeon at Long Beach Lakewood Orthopedic Institute, in Long Beach, California. “By contrast, we studied the effect of modern arthroscopic methods by comparing the degree of arthritis in each patient’s operative hip versus their nonoperative hip. Our research design controlled for variables such as age, medical history, lifestyle, and individual mechanics like rotational profile, spinal alignment and gait—leaving history of arthroscopy as the single factor driving any resulting differences in arthritis progression.”
Some patients, however, did have their arthritis worsened over the past decade, though it was far less common. The main risk factors among these patients were old age, a high arthritis grade, an alpha angle greater than 65 degrees and evidence of possible hip dysplasia before surgery.
The paper documenting this new procedure and its effectiveness has already earned two awards: the 2024 American Orthopedic Society for Sports Medicine Fellow Research Award for Clinical Science and the Philip D. Wilson, MD, Award.