Changing Demographics and Outcomes of Hip Arthroscopy: Who Is at Risk for Conversion to Total Hip Arthroplasty?

Background: Prior studies examining trends in hip arthroscopy (HA) are limited, with data extending only to 2014.Additionally, there remains concern regarding rates of conversion to total hip arthroplasty (THA) in patients who undergo HA.This study sought to examine trends in HA utilization, including 2-and 5-year conversion rates and risk factors associated with conversion from 2010 to 2022.Methods: Patients who underwent HA between 2010 and 2022 were identified in a large national database.Trends in the utilization of HA and the 2-and 5-year rate of conversion to THA were observed using the compounded annual growth rate (CAGR) and Kaplan-Meier survival analyses, respectively.Multivariate logistic regression was performed to identify risk factors associated with conversion to THA, with Elixhauser comorbidities included as independent variables.Results: From 2010 to 2022, the overall incidence of HA decreased significantly (CAGR: -4.91%, p < 0.001).There were significant increases in the proportion of HAs performed for those aged 20-29 (CAGR: 5.78%, p < 0.001) and 30-39 (CAGR: 2.33%, p < 0.001) and decreases for those aged 40-49 (CAGR: -0.61%, p = 0.02), 50-59 (CAGR: -1.89%, p < 0.001), 60-69 (CAGR: -1.62%, p < 0.001), and 70-100 (CAGR: -0.78%, p = 0.04).The highest 2-and 5-year conversion rates to THA were seen in those aged 50-59 years at 3.5 and 5.4%, respectively.Risk factors associated with conversion included increasing age, female gender, and osteoarthritis.Conclusion: Overall utilization of HA has decreased over the past decade.While overall rates of conversion to THA were low, older patients, female patients, and those with osteoarthritis should be carefully evaluated prior to HA.