First Study to Demonstrate Longer-Term Benefits of Modern
Hip Arthroscopy Techniques
NEW
YORK, April 18, 2024 /PRNewswire/ -- A new study
by surgeon-scientists at Hospital for Special Surgery (HSS) found
that 25% of patients with hip impingement who underwent modern
arthroscopy for their condition experienced a delay in the natural
progression of osteoarthritis. The retrospective study, published
online on March 8, 2024, in The
American Journal of Sports Medicine, is the first to link hip
arthroscopy with a reduced risk of developing hip arthritis over
the long term.
"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."
Hip impingement, also called femoroacetabular impingement (FAI),
is a condition that typically arises between the teenage years and
middle age, and is the underlying cause of hip pain in about 40% of
patients in this age range. Hip impingement occurs when the bones
of the hip joint are not shaped properly, causing them to rub
against one another. Over time, the persistent friction can lead to
pain and stiffness, eventually progressing to advanced
arthritis.
Prior studies have shown that 85-90% of patients with hip
impingement who undergo modern arthroscopy return to their usual
activity level. However, until now, little has been known about
whether modern arthroscopy can slow the progression of arthritis in
these patients. To explore this connection, investigators examined
X-ray images of 200 hips from 100 patients who exhibited signs of
impingement in both hips but only underwent arthroscopy for their
symptomatic hip between 2010 and 2012. The severity of arthritis in
each hip was assessed retrospectively using X-ray images taken
before surgery and at least 10 years later. Notably, the
researchers were unaware of which hips had undergone surgical
correction during the assessment.
The resulting analysis revealed only 28% of operative hips
showed an increase in arthritis progression at a minimum of 10
years after surgery in comparison to 48% of nonoperative hips. This
difference translated to a relative risk reduction of 42% across
all patients.
While there was no difference in the natural development of
arthritis between the operative and nonoperative hips for 70% of
patients, one in four, or 25%, had less arthritis in their
operative hip compared to their nonoperative hip 10 years
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."
In addition, the investigators identified a small subset of
patients whose arthritis progressed more rapidly in the operative
hip as compared to the nonoperative hip. Specifically, older age, a
higher arthritis grade, an alpha angle greater than 65 degrees and
evidence of borderline hip dysplasia before surgery were the
primary risk factors associated with the 5% of hip impingement
patients whose arthritis in the operative hip worsened more quickly
after surgery.
"We can now identify patients most likely to benefit from
arthroscopy for hip impingement and inform patients about their
anticipated odds of successful outcomes based on their personal
risk factors. For ideal candidates, the evidence shows that hip
arthroscopy may delay or prevent arthritis for one in four
patients. That's very powerful information," says Danyal W. Nawabi, MD, FRCS, an HSS orthopedic
surgeon and an author on the study.
Dr. Nawabi also points to the importance of the modern
techniques used to care for patients in the study, all of whom were
patients of Dr. Kelly. These methods include labrum repair, removal
of bony abnormalities on the ball and socket, and proper closure of
the joint capsule enveloping the hip joint. "This study is a
testament to the fact that where you go for orthopedic care truly
matters," he adds.
Thus far, the paper has garnered two awards: the 2024 American
Orthopedic Society for Sports Medicine Fellow Research Award for
Clinical Science, which will be presented at the AOSSM Annual
Meeting in July, as well as the Philip D.
Wilson, MD, Award, presented by HSS in honor of the
hospital's fifth Surgeon-in-Chief to a fellow who has demonstrated
excellence in orthopedic surgery research.
About HSS
HSS is the world's leading academic medical center focused on
musculoskeletal health. At its core is Hospital for Special
Surgery, nationally ranked No. 1 in orthopedics (for the 14th
consecutive year), No. 2 in rheumatology by U.S. News & World
Report (2023-2024), and the best pediatric orthopedic hospital in
NY, NJ and CT by U.S. News & World Report "Best Children's
Hospitals" list (2023-2024). In a survey of medical professionals
in more than 20 countries by Newsweek, HSS is ranked
world #1 in orthopedics for a fourth consecutive year
(2023). Founded in 1863, the Hospital has the lowest readmission
rates in the nation for orthopedics, and among the lowest infection
and complication rates. HSS was the first in New York State to receive Magnet Recognition
for Excellence in Nursing Service from the American Nurses
Credentialing Center five consecutive times. An affiliate of Weill
Cornell Medical College, HSS has a main campus in New York City and facilities in New Jersey, Connecticut and in the Long Island and Westchester County regions of New York State, as well as in Florida. In addition to patient care, HSS
leads the field in research, innovation and education. The HSS
Research Institute comprises 20 laboratories and 300 staff members
focused on leading the advancement of musculoskeletal health
through prevention of degeneration, tissue repair and tissue
regeneration. In addition, more than 200 HSS clinical investigators
are working to improve patient outcomes through better ways to
prevent, diagnose, and treat orthopedic, rheumatic and
musculoskeletal diseases. The HSS Innovation Institute works to
realize the potential of new drugs, therapeutics and devices. The
HSS Education Institute is a trusted leader in advancing
musculoskeletal knowledge and research for physicians, nurses,
allied health professionals, academic trainees, and consumers in
more than 165 countries. The institution is collaborating with
medical centers and other organizations to advance the quality and
value of musculoskeletal care and to make world-class HSS care more
widely accessible nationally and
internationally. www.hss.edu.
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SOURCE Hospital for Special Surgery