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Minimally Invasive Hip Surgery Isn't Always the Right Choice

FRIDAY, June 3, 2016 -- Minimally invasive hip surgery may not always be the best option to relieve serious, ongoing hip pain, a new study suggests.

Researchers found that more than one-third of people in their 60s who had the minimally invasive procedure -- known as hip arthroscopy -- ended up needing a hip replacement within two years.

Hip arthroscopy relies on small incisions around the hip to allow for the insertion of a tiny camera, as well as surgical tools, according to the American Academy of Orthopaedic Surgeons (AAOS).

Hip arthroscopy can be used to treat a number of painful conditions, the AAOS says.

For example, the procedure can be used to repair torn cartilage or remove extra bone that occurs in the very earliest stages of osteoarthritis, explained Dr. Stuart Weinstein.

"Hip arthroscopy has been an amazing development and has helped many patients with hip disorders," said Weinstein, chair and professor of orthopaedic surgery at the University of Iowa Carver College of Medicine. He wasn't part of the current study team.

The use of hip arthroscopy has skyrocketed. Between 2006 and 2010, the estimated use of this surgical procedure increased by 600 percent, the study authors said.

For the study, Dr. William Schairer, who's with the Hospital for Special Surgery in New York City, and colleagues reviewed information from two surgical databases. One was in California, the other was in Florida. The investigators found more than 7,300 patients who'd had hip arthroscopy and had at least two years of medical follow-up.

The mean age of the patients was 44. And about 60 percent of the group was female, according to the report.

Overall, 12 percent had hip replacement surgery within two years of having a hip arthroscopy, the findings showed.

People who had hip arthroscopy in hospitals that performed a high volume of those procedures were less likely to need a hip replacement within two years, the study authors said.

The researchers also found other risk factors that increased the odds of needing a hip replacement. These included older age (over 60), obesity, or arthritis related to wear and tear of the joint (osteoarthritis). Rates of hip replacement were lowest in people under 40, the study found.

Because hip arthroscopy is a relatively new procedure, Dr. Shane Nho said it wasn't surprising that the study found some risk factors.

"Sometimes, we don't know who the best people are to operate on until we've (done procedures) for a decade or two," said Nho, an orthopedic surgeon at Rush University Medical Center in Chicago. He wasn't involved in the current research.

In his experience, Nho said hip arthroscopy for a labral tear in the right patient is an "excellent" surgery. It helps accommodate the ability of patients to keep their own joints and maintain a healthy, active lifestyle, he said. The labrum is cartilage that acts like a seal to help keep the top of your thighbone in your hip socket.

Hip arthroscopy has been highly effective among those younger than or around ages 40 to 50, Nho added. For example, he performs about 10 to 15 hip arthroscopies a week -- mostly on those in their 40s, high school or college athletes, and serious runners.

Nho said he sometimes advises patients not to have the procedure but, ultimately, it's their call.

"Sometimes, if someone just wants to eliminate the pain, they might make a separate decision. Certainly, that's up to them. After all, no one knows their threshold for discomfort better than they do," Nho said.

Weinstein said people should discuss their condition with a hip expert to learn about all of their options.

The study was published recently in Arthroscopy: The Journal of Arthroscopic and Related Surgery.

More information

To find out more about hip arthroscopy, visit the American Academy of Orthopaedic Surgeons.

Posted: June 2016


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