Is there an optimal time frame for staged arthroscopies and could a shorter time gap between arthroscopies actually lower risks of revision?
Researchers from the University of Virginia in Charlottesville pulled together statistics on staged arthroscopies in a new study and, in their conclusions, cautioned against a “strict timing guideline” when it comes to bilateral hip arthroscopy.
Their study, “Staging Bilateral Hip Arthroscopies Less than 1 Year Apart may Reduce the Risk of Revision Surgery,” appears in the September 30, 2022, edition of Arthroscopy.
Co-author F. Winston Gwathmey, M.D., associate professor of orthopedic surgery at the University of Virginia Health System explained the genesis of this study to OTW: “Most studies have focused on functional results such as patient-reported outcomes. However, guidance regarding optimal timing is limited. Thus, we sought to identify the influence on timing between staged bilateral hip arthroscopy on medical and surgical complications.”
Using the PearlDiver all-payer claims database, the investigators found patients who had undergone staged bilateral hip arthroscopy, then stratified them into cohorts based on time between procedures.
- ≤ 3 months,
- 3 to ≤ 6 months,
- 6 to ≤ 12 months, and
- > 1 year.
Out of 38,080 patients who underwent primary hip arthroscopy, 998 had staged bilateral hip arthroscopy.
According to the PearlDiver dataset, the two-year revision rate was 7.6% for all patients undergoing bilateral hip arthroscopy, while 1.9% of patients converted to total hip arthroplasty (THA).
Patients who had received arthroscopy procedures staged less than 1 year apart had significantly decreased risk of revision compared to those in the > 1 year cohort.
There were no differences in rates of major medical, minor medical, or remaining surgical complications between the cohorts. Direct comparisons between the cohorts staged ≤ 1 year apart revealed no significant differences in medical or surgical complications.
“Staging hip arthroscopy 1 year apart was associated with a decreased risk of revision when compared to the staged cohort >1 year,” Dr. Gwathmey told OTW. “Among those staged less than 1 year, the timing of staging had no association with rates of medical or surgical complications.”
“We initially hypothesized that patients who had staged procedures less than 3 months apart would be at a higher risk for both medical and surgical complications compared to patients with more than a year between procedures.”
“However, this was not demonstrated in our study. We feel that timing decisions may be patient-specific and rely on the duration of symptoms, severity of pathology, or progression of rehabilitation after the index procedure rather than a strict timing guideline.”
