Malik Azeem T, Jain Nikhil, Scharschmidt Thomas J, Glassman Andrew H, Khan Safdar N
Department of Orthopaedics, Ohio State University, Columbus, OH, USA.
Hip Int. 2022 Mar;32(2):239-245. doi: 10.1177/1120700020951171. Epub 2020 Aug 31.
With limited evidence on national incidences of hip arthroscopy in the elderly population, the current study aims to investigate trends of primary hip arthroscopies being performed in the elderly population, using the US Medicare database, and determine risk factors for conversion to total hip arthroplasty (THA).
Medicare Standard Analytic Files were queried using CPT codes to retrieve records of primary hip arthroscopies done for degenerative pathology during 2005-2014. Overall and age-stratified trends in the incidence of hip arthroscopy over time were analysed. Kaplan Meier survival curves were used to assess the overall 2-year conversion rate to a THA. Cox regression analysis was implemented to study risk factors for conversion.
8100 primary hip arthroscopies for degenerative pathology were performed during 2005-2014. There was a 280% increase in overall incidence of arthroscopy. The most commonly performed arthroscopic procedure was for chondroplasty and/or resection of labrum, with 4712 (58.1%) procedures. Around 18.5% patients underwent arthroplasty within 2 years after primary arthroscopy. Following Cox regression an existing diagnosis of osteoarthritis, ages 65-69, ages 70-74, and arthroscopies done in the West were associated with higher risk of conversion to THA within 2 years. Undergoing a repeat arthroscopy was not significantly associated with a higher risk of conversion.
Despite inconclusive clinical evidence, hip arthroscopies are being increasingly used in patients older than 65 in the Medicare population. We conclude that patients in the age bracket of 65-74 years and with a pre-existing diagnosis of osteoarthritis, arthroscopy should be approached with caution.
鉴于关于老年人群髋关节镜检查全国发病率的证据有限，本研究旨在利用美国医疗保险数据库调查老年人群中初次髋关节镜检查的趋势，并确定转为全髋关节置换术（THA）的风险因素。
使用CPT编码查询医疗保险标准分析文件，以检索2005年至2014年期间因退行性病变进行的初次髋关节镜检查记录。分析了髋关节镜检查发病率随时间的总体和年龄分层趋势。采用Kaplan-Meier生存曲线评估2年总体转为THA的转化率。实施Cox回归分析以研究转化的风险因素。
2005年至2014年期间，共进行了8100例因退行性病变的初次髋关节镜检查。关节镜检查的总体发病率增加了280%。最常进行的关节镜手术是软骨成形术和/或盂唇切除术，共4712例（58.1%）。约18.5%的患者在初次关节镜检查后2年内接受了关节置换术。经过Cox回归分析，现有的骨关节炎诊断、65 - 69岁、70 - 74岁以及在西部进行的关节镜检查与2年内转为THA的较高风险相关。进行重复关节镜检查与较高的转化风险无显著关联。
尽管临床证据尚无定论，但医疗保险人群中65岁以上患者越来越多地使用髋关节镜检查。我们得出结论，对于65 - 74岁且已有骨关节炎诊断的患者，进行关节镜检查时应谨慎。
