Hip arthroscopy versus total hip arthroplasty—A study on patients with obesity above 40 years of age

Abstract

SummaryPatients older than 40 years with a body‐mass‐index (BMI) >30 kg/m2, a femoroacetabular‐impingement (FAI) and little cartilage damage are a challenge for hip surgeons. Hip‐arthroscopy (HAS) or conservative therapy until a total hip arthroplasty (THA) is needed are possible treatments. Our research purpose was to compare the clinical results and complication/reoperation rate after HAS and THA in patients with obesity over 40 years. This retrospective study includes a consecutive series of patients with obesity (BMI >30 kg/m2) who underwent HAS (19 hips) and THA (37 hips) over 40 years of age between 2007 and 2013 at our institution with a minimum of 12‐months follow‐up. Outcome measures were WOMAC (Western Ontario und McMaster Universities Arthritis Index), subjective‐hip‐value (SHV), residual complaints and the reoperation rate. Patient data and scores were collected pre‐operative, 12 months post‐operatively and at the last follow‐up. Both groups showed a comparable age (mean 48 years). Regarding SHV‐Scores the THA‐group shows continuous significant improvements. Reaching 87% (range 50%–100%), the HAS‐group showed in case of the SHV no significant change after 1 year and an improvement from preoperative to the last follow‐up reaching 72% (range 30%–100%) at the last follow‐up. Residual groin pain was significant higher in the HAS‐group. Two deep infections (5.4%) requiring reoperations were reported in the THA‐group. The conversion rate to THA after a mean time of 60 months was 26% (5 of 19). Patients with obesity over 40 years demonstrated inferior SHV, more often residual pain and revision surgery after HAS, when compared to THA at short‐term, with conversions rate of one fourth. However, THA in this patient group showed high infection rate of 5%. This information is relevant for counselling above‐mentioned patients.