“You can’t discriminate by age.”—Rodrigo Mardones, MD
“You can’t discriminate by age,” says lead researcher Rodrigo Mardones, MD, an orthopaedic surgeon in Santiago, Chile. “Sixty means a lot of different things in a lot of different patients, so you can’t make hip arthroscopy decisions based on age alone.”New study suggests wider uses for hip arthroscopy
Hip scopes are typically reserved for young and middle aged patients with labral pathology, free bodies, FAI, extraarticular pathology, or chondral defects.
In the new prospective study, 15 patients with FAI with diffuse and focal disease and a mean age of 63.3 were followed for about 28.6 months. Patients had abnormal magnetic resonance imaging (MRI) or X-ray readings and grade I or II tonnis.
Overall, 12 patients did well with hip arthroscopy and 3 patients underwent total hip replacement before 1 year. Those patients who did well showed a mean improvement of 20 points on the Harris Hip Score. Of the 12 patients who improved, all said they would undergo hip scope again. One of the 3 patients who failed also said they would try hip arthroscopy again. Five patients rated the hip scope a 9/10 in terms of their satisfaction and 7 gave it a 10 out of 10.
Pain after the procedure tended to last for 4 to 8 weeks and all patients returned to normal activity by 6 months, the study showed.
“Selection criteria must be very strict, and 20% will fail,” says Dr. Mardones. “The results of hip arthroscopy are worse in patients aged 60 and older, but 80% do well,” he says.
“X-ray or MRI imaging plus assessing the patient’s activity level can help determine if someone aged 60 and older will do well with hip arthroscopy,” he says. “If you can find cartilage defects before with a metabolic MRI, you can select out patients who will fail arthroscopy and improve the success rate.”
Translating research into practice: rule out OA in patients over 60 before hip arthroscopy
“I think the main issue with age and hip arthroscopy is that often these patients have some degenerative changes in their hip joint and as soon as there is cartilage damage in the hip where you see findings on x-ray, then the outcome with hip arthroscopy is not as good,” says Friedrich Boettner, MD, an orthopedic surgeon who is part of the recently created Center for Hip Pain and Preservation at Hospital for Special Surgery in New York City.
“You can treat those older patients with minor cartilage damage, but older patients often have radiographic evidence of arthritis and have narrowing of joint space even if it is not bone on bone,” he explains.
“Once you see any early signs of OA, it becomes unlikely that the patient will benefit from hip arthroscopy,” he tells MSKreport.com.
“The number of patients that we do hip arthroscopy on who are over 60 is relatively small,” he says. “The best outcome is in patients less than 35 and in patients that don’t have evidence of arthritis.”
Older patients with evidence of hip OA may do well with intrarticular injection and activity modification, he says. “If the OA progresses, it will develop into a more significant problem and then one might consider total hip replacement.”
References
1. Mardones R, Nemtala F, Barrientos V. Arthroscopic treatment of femoroacetabular impingement in patients over sixty years old: preliminary report of a pilot study. Presented at: 2009 Annual scientific meeting of the international society for hip arthroscopy. Oct 9-10, 2009. New York, NY.
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