Ross Bailey J, Wortman Ryan J, Lee Olivia C, Mansour Alfred A, Cole Wendell W, Sherman William F
Department of Orthopaedic Surgery, Emory University School of Medicine, Atlanta, Georgia, USA.
Department of Orthopaedic Surgery, Tulane University School of Medicine, New Orleans, Louisiana, USA.
Orthop J Sports Med. 2022 Sep 30;10(9):23259671221126508. doi: 10.1177/23259671221126508. eCollection 2022 Sep.
Hip arthroscopy (HA) procedures have increased exponentially in recent years. Their effect on outcomes after subsequent total hip arthroplasty (THA) remains unclear.
To compare rates of complications and opioid claims after elective THA among patients with prior HA versus controls.
Cohort study; Level of evidence, 3.
Patients who underwent THA were identified in the PearlDiver database. Arthroplasty performed for hip fractures and hip avascular necrosis were excluded. Within this population, patients with HA before arthroplasty (n = 3156) were propensity score matched 1:1 with controls on age, sex, US region, and several comorbidities. Rates of medical complications within 90 days and prosthesis-related complications within 2 years were queried. The number of patients with an opioid claim within 0 to 30 days and subsequent opioid claim(s) during the 90-day global period were obtained to assess rates of prolonged opioid use after arthroplasty. Rates of postoperative complications and opioid claims were compared using logistic regression.
Patients with prior HA exhibited significantly lower rates of readmission (5.6% vs 7.3%; odds ratio [OR], 0.72), pulmonary embolism (0.2% vs 0.6%; OR, 0.45), urinary tract infection (3.1% vs 4.0%; OR, 0.75), and blood transfusion (3.6% vs 6.1%; OR, 0.55). The prior HA cohort also exhibited a significantly lower rate of prosthetic joint infection at 1 year postoperatively (0.6% vs 1.3%; OR, 0.50). Rates of dislocation, periprosthetic fracture, mechanical complications, and aseptic revision arthroplasty were statistically comparable between the cohorts within 2 years. The prior HA cohort was significantly less likely to file persistent opioid claims after 30 days postoperatively, including between 31 and 60 days (27.2% vs 33.1%; OR, 0.74) and 61 to 90 days (16.2% vs 20.9%; OR, 0.71).
After elective THA, patients with prior HA exhibited significantly lower rates of medical complications and prolonged opioid claims within 90 days and prosthetic joint infection at 1 year. Rates of all other prosthesis-related complications within 2 years were statistically comparable.
近年来，髋关节镜检查（HA）手术数量呈指数级增长。其对后续全髋关节置换术（THA）术后结果的影响仍不明确。
比较既往接受过HA手术的患者与对照组在择期THA术后的并发症发生率和阿片类药物索赔率。
队列研究；证据等级为3级。
在PearlDiver数据库中识别接受THA手术的患者。排除因髋部骨折和髋部缺血性坏死而进行的关节置换术。在该人群中，将关节置换术前接受过HA手术的患者（n = 3156）按年龄、性别、美国地区和几种合并症进行倾向评分匹配，1:1与对照组进行匹配。查询90天内的医疗并发症发生率和2年内的假体相关并发症发生率。获取术后0至30天内有阿片类药物索赔的患者数量以及90天全球观察期内随后的阿片类药物索赔情况，以评估关节置换术后长期使用阿片类药物的发生率。使用逻辑回归比较术后并发症发生率和阿片类药物索赔率。
既往接受过HA手术的患者再次入院率（5.6%对7.3%；比值比[OR]，0.72）、肺栓塞发生率（0.2%对0.6%；OR，0.45）、尿路感染发生率（3.1%对4.0%；OR，0.75）和输血率（3.6%对6.1%；OR，0.55）显著较低。既往接受过HA手术的队列在术后1年时假体关节感染率也显著较低（0.6%对1.3%；OR，0.50）。两组在2年内的脱位、假体周围骨折、机械并发症和无菌性翻修关节置换术发生率在统计学上相当。既往接受过HA手术的队列在术后30天后提出持续性阿片类药物索赔的可能性显著较低，包括术后31至60天（27.2%对33.1%；OR，0.74）和61至90天（16.2%对20.9%；OR，0.71）。
在择期THA术后，既往接受过HA手术的患者在90天内的医疗并发症发生率和长期阿片类药物索赔率以及术后1年的假体关节感染率显著较低。两组在2年内所有其他假体相关并发症发生率在统计学上相当。
