NEW YORK, New York—Earlier intervention is better when it comes to joint-sparing hip operations, according to new research presented at the annual meeting of the International Society for Hip Arthroscopy in New York City.¹

“The recurring theme is that the earlier we can get to the problem and correct it, the better the results,” says Robert L. Buly, MD, an associate attending orthopaedic surgeon at the Hospital for Special Surgery and an associate professor of clinical orthopedic surgery at Weill Cornell Medical College, both in New York City.

In a retrospective study of 96 hips in 79 patients who underwent arthroscopy with femoral neck osteochondroplasty of a “cam” impingement lesion, 16 hips needed subsequent surgery (including 8 total hip replacements). Fully 80% of patients felt they had improved after the surgery and 71% said their pain relief was excellent or good.

Patients with Grade 4 cartilage loss reported less pain relief than counterparts who had lower levels of cartilage loss. In fact, “the presence of a Grade 4 defect was associated with a retroverted acetabulum, a higher alpha angle, Tönnis grade 2 or 3, and older age,” the researchers report. “With the arthroscopic treatment of femoro-acetabular impingement, the presence of a grade 4 articular cartilage lesion is the most significant predictor of pain relief and clinical success,” they conclude.

Translating research into practice: early scoping may stave off THR

Patient selection is key, Dr. Buly adds. “If they have lost cartilage or arthritic changes, the results may be less predictable. In the study, all failures had arthritis and grade 4 cartilage loss.

“The longer you live with the problem, the more damage there is to the labrum and cartilage and it is harder to get that back and have an operation that is as successful,” he says.

Dr. Bully says if there was such a thing as a crystal ball, it could make sense to perform such joint preserving procedures prophylactically before there is pain or any other symptom. “It would be ideal if we could intervene before problems start,” he tells MSKreport.com.

This is the opposite of what total hip replacement patients are told. “If you are facing a hip replacement, you are told to wait as long as you can because you are young and the implants don’t last forever, so you are told to wait until you can’t stand it or are too restricted,” he says.

By contrast, “with a hip preserving operation, the earlier you do it, the better the results,” he says.

Hopefully, such early intervention will prevent the need for future hip arthroplasty, but longer follow-up is needed to make that call.

Reference

1. Buly RL, Henn RF, Moya R, et al. The Arthroscopic Treatment of Cam Type Femoroacetabular Impingement: Minimum Two-Year Follow-up. Presented at: 2009 annual scientific meeting of the International Society for Hip Arthroscopy. Oct 9-10, 2009. New York, NY.