Is hip arthroscopy a hip replacement alternative? One of the patients I saw this week in clinic is in her late 30s and has now had two of these surgeries on one hip. I’ve been seeing her for chronic spine issues for years, but last year she had hip MRIs that showed labral tears and mild arthritis. She is a former physical therapist who wanted to get hip arthroscopy done because she was told she had “FAI” or hip impingement. She had the surgery on her left hip, which failed, so she doubled down for a second. This hip is now a mess. The anchors they put in to hold the labral tissue they tried to tack back to the hip socket caused osteolysis. This means that she had an allergic reaction to the material and the bone in that area died off. What’s left of the labrum is now mush and she has advanced to moderate hip arthritis. What’s worse is that she also has a pelvic fracture that despite being on crutches for three months didn’t heal, which presumably is also from the surgery. What’s next for this poor woman? If she doesn’t have an infection requiring six weeks of IV antibiotics and a surgery, the plan is to remove the anchors in a third surgery which will also remove most of what’s left of the labrum, resulting in a frankly unstable hip joint. My guess is that her fourth surgery will be a hip replacement, which will happen well before she’s in her mid forties.
The upshot? I’ve been very critical that we have sparse high level evidence that operating on the hip labrum in most patients is a good idea. In addition, this is a big surgery with big hip arthroscopy complications that are tough to navigate when things go wrong, just ask this poor woman. My guess is that once we investigate hip arthroscopy results in the same way we’ve studied knee arthroscopy, we’ll find that the results aren’t as good as we think they are.