Decision Making with Osteoarthritis

Abstract

Arthroscopic treatment of hip arthritis is both undefined and controversial. The treatment of advanced hip arthritis is universally accepted to be a total joint replacement (THR). Non-arthroplasty methods to preserve the hip joint, such as open arthrotomy with debridement, osteotomy, and denervation procedures, were historically used with less than ideal results.

Hip arthroscopy has been utilized as a palliative procedure to bridge the gap for providing pain relief in those too young or with little damage from hip arthritis to justify THR.

Very little has been written on the arthroscopic treatment for hip arthritis in the past 30 years, and what has been published has described it as either not useful or having long-term benefits. To date, there cannot be any credible claims that arthroscopic hip surgery will prevent nor cure arthritis and thus eliminate the need for THR. The problem lies in the decision process as to who is an appropriate candidate for arthroscopic treatment of osteoarthritis of the hip and to what can be accomplished.

Choosing the right candidate with a correctable level of damage, and having an agreement between the surgeon and patient as to what is an acceptable outcome, is the key to success.

The objectives of good decision making in correcting osteoarthritis of the hip are in the recognition of all the pathologic anatomy in the central and peripheral compartments as well as contributing abnormal morphology of the head-neck junction of the femur and acetabulum.

The specific methods on how to expose the damage and morphology through a capsulotomy are explained.

One thousand thirty-four hips were studied to March 1, 2011 (110 months) with an average of 67 months. We identified 464 hips with osteoarthritis in which 64% were female and 36% male, and all hips had concurrent FAI mostly consisting of mixed CAM and pincer lesions. Two hundred and sixty-eight patients were below the age of 55 years old and 196 patients were above the age of 55 years old. Fifty-three (11.4%) of the patients went one onto THR.

In general, we will attempt to arthroscopically treat osteoarthritis in most any young individual as a palliative procedure. We define young as under the age of 45 years old. We will be skeptical in recommending the procedure on any female over the age of 50 years old and a male over 55 years old.

We also recommend treating hips that exhibit greater than 50% rotational range of motion compared to their opposite “normal” hip and have greater than 50% joint space on the affected hip’s X-ray compared to their opposite side.

We would not recommend arthroscopic treating hip joints with X-rays that show less than 2 mm of joint space unless they are a young male athletic individual who was involved previously in some form of aggressive sports. The expectation should be that arthroscopy is only a palliative procedure and to expect a THR future.