Patient-reported Outcomes of Direct Anterior Approach Hip Arthroplasty After Previous Hip Arthroscopy: A Matched Case-control Study With a Minimum 5-year Follow-up
Authors
Quesada-Jimenez R, Kahana-Rojkind AH, Walsh EG, Sikligar D, Domb BG
Background
As hip arthroscopy becomes more common, some patients eventually require conversion to total hip arthroplasty (THA). It is unclear whether prior hip arthroscopy affects outcomes following THA performed using the direct anterior approach (DAA). This study evaluates midterm patient-reported outcomes (PROs) of DAA THA in patients with a history of hip arthroscopy and examines the timing between procedures.
Methods
This retrospective case-control study reviewed patients who underwent DAA THA between 2009 and 2018 with at least 5 years of follow-up. Patients who had a previous hip arthroscopy (THA-PA group) were matched 1:2 to patients undergoing primary THA without prior arthroscopy (THA-N-PA group). Patient-reported outcomes (PROs), complications, revision rates, and satisfaction were analyzed. A secondary analysis compared outcomes based on how soon THA was performed after arthroscopy.
Key Findings
- Both groups demonstrated favorable and statistically similar PROs at minimum 5-year follow-up (p > 0.05).
- The only exception was the Visual Analog Scale (VAS) for pain, which was higher in the THA-PA group (p < 0.05).
- Complication and revision rates were similar between groups.
- Patients who underwent THA within 1 year of prior hip arthroscopy reported significantly lower satisfaction than those who waited longer.
Conclusion
Patients with a history of hip arthroscopy can expect similar long-term results after DAA THA as those without prior surgery. However, undergoing THA within a year of arthroscopy is associated with lower satisfaction. These findings highlight the importance of careful patient selection and appropriate timing of procedures to optimize outcomes.
What Does This Mean For Patients
Having had a previous hip arthroscopy does not negatively impact long-term results of hip replacement through the direct anterior approach. However, if a hip replacement is needed soon after arthroscopy—especially within one year—patients may be less satisfied, suggesting that early conversion may reflect unresolved or misdiagnosed issues at the time of arthroscopy.