To Scope or Not to Scope in Hip Patients Over 60

Musculoskeletal Report—New York, NY—October 15, 2009

Hip arthroscopy may benefit some patients aged 60 and older with femoroacetabular impingement (FAI) as long as there is proper, stringent selection to weed out patients with evidence of osteoarthritis (OA), according to pilot data presented at the annual meeting of the International Society for Hip Arthroscopy in New York City.

“I think the main issue with age and hip arthroscopy is that often these patients have some degenerative changes in their hip joint and as soon as there is cartilage damage in the hip where you see findings on x-ray, then the outcome with hip arthroscopy is not as good,” says Friedrich Boettner, MD, an orthopedic surgeon who is part of the recently created Center for Hip Preservation at Hospital for Special Surgery in New York City.

“You can treat those older patients with minor cartilage damage, but older patients often have radiographic evidence of arthritis and have narrowing of joint space even if it is not bone on bone,” he explains.

“Once you see any early signs of OA, it becomes unlikely that the patient will benefit from hip arthroscopy,” he tells MSKreport.com.

“The number of patients that we do hip arthroscopy on who are over 60 is relatively small,” he says. “The best outcome is in patients less than 35 and in patients that don’t have evidence of arthritis.”

Older patients with evidence of hip OA may do well with intraarticular injection and activity modification, he says. “If the OA progresses, it will develop into a more significant problem and then one might consider total hip replacement.”