Does Joint-preservation Surgery Change the Natural History of the Hip?
At the ICJR East meeting, Rafael J. Sierra, MD, from Mayo Clinic in Rochester, Minnesota, was charged with discussing arthroscopic joint-preservation surgery and its effect on the natural history of the hip.
His conclusion: We don’t yet know the effect of this surgery because we don’t yet have enough long-term data.
Dr. Sierra believes that even in the absence of these data, orthopaedic surgeons should be performing joint-preservation surgery. The reason: Despite optimism about the benefits of alternative bearing surfaces, he believes total hip arthroplasty should be discouraged in younger patients.
So what is known about young patients with dysplasia and FAI and the role of joint-preservation surgery? Dr. Sierra made these observations:
- Up to 90% of young patients who require a THA have an underlying structural problem.
- Damage from femoral or acetabular structural issues becomes irreversible in many patients. Once that occurs, hip replacement is the only option.
Patients with structural abnormalities will not necessarily be symptomatic. Dr. Sierra said that based on research from Mayo Clinic, patients with decreased range of motion and asymptomatic structural issues bear watching – many already have hip joint damage
Not all patients with structural abnormalities will go on to develop arthritis. Hartofilakidis et al followed patients with structural abnormalities who had a THA for an average of 18.5 years. Only 18% of patients had a hip replacement on the contralateral hip.
The aim of treatment is to restore the anatomy as close to normal as possible. In patients with hip dysplasia, that means reorienting the socket via a PAO. In patients with FAI, that means improving the femoral or acetabular deformity.
Surgery can change the natural history in a negative way. Understanding patient selection criteria is essential: Some patients will do better without surgical intervention.
Joint-preservation surgery is safe and improves hip pain and function. For example, PAO will improve symptoms in many patients by correcting the dysplasia. Again, patient selection criteria are important: The worse the patient’s arthritis, the less chance the patient will do well after surgery.
Dr. Sierra’s presentation can be found here.