Direct anterior total hip arthroplasty after hip arthroscopy: A retrospective review

Matthew Pate; Joshua Gira; Carl Wierks

doi:10.1016/j.jor.2025.01.017

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doi:

10.1016/j.jor.2025.01.017

Direct anterior total hip arthroplasty after hip arthroscopy: A retrospective review

Matthew Pate^a,b,, Joshua Gira^b, Carl Wierks^a,c

a Corewell Health, 100 Michigan St. NE, Grand Rapids, MI, 49503, USA

b Michigan State University College of Human Medicine, 15 Michigan St. NE, Grand Rapids, MI, 49503, USA

c West Michigan Orthopedics (WMO), 2144 E Paris Ave SE Ste 240, Grand Rapids, MI, 49546, USA

⁎Corresponding author: Matthew Pate. mjpate22@gmail.com

Received: 2025-1-6, Accepted: 2025-1-14, Published: 2025-1-29

Disclaimer:
This article was originally published by Reed Elsevier India Pvt. Ltd. and was migrated to Scientific Scholar after the change of Publisher.

Abstract

Limited studies have investigated outcomes of total hip arthroplasty (THA) after ipsilateral hip arthroscopy, with mixed conclusions. There is need to provide clarity on potential risks/complications associated with this sequence of operations.

This is a retrospective single surgeon cohort study, evaluating patients from 01/01/2012–01/01/2020 undergoing direct anterior THA for osteoarthritis, with minimum 90-day follow-up. There were two groups: previous hip arthroscopy plus THA (THA+) and isolated THA (control) without previous hip arthroscopy. All THA + patients had undergone one previous hip arthroscopy prior to THA. Quantitative variables were evaluated using the Mann-Whitney-U test or a two-tailed unpaired t-test. Nominal variables were evaluated using the chi-square or Fisher's Exact test. Significance was assessed at p < 0.05.

Seventy-one patients were included, 38 patients in the THA + group, and 33 patients in the control group. Surgery duration was longer in the THA + group (74 min THA + [SD = 9.5], 60 min control [SD = 11.3], p < 0.0001). The only secondary outcome with significance was average estimated blood loss (400 mL THA+, 275 mL control, p = 0.009). Only one THA + patient required postoperative transfusion (p = 1.0). There were no postoperative deep infections requiring debridement, intra-operative fractures requiring fixation, or postoperative dislocations in either group. The THA group had one post-operative fracture requiring surgery. The THA + group was younger (average) than the control group (52 THA + [SD = 9.9], 58.4 control [SD = 8.8], p = 0.0062).

This study highlights increased operative time and estimated blood loss after previous ipsilateral hip arthroscopy. Surgeons should recognize implications on time management, and assist surgeons when deciding to perform a THA at a surgery center vs hospital. These results contribute to a growing body of literature indicating no increase in major complication rate of THA after ipsilateral hip arthroscopy.

Abstract

Highlights

•Direct anterior total hip arthroplasty after prior ipsilateral hip arthroscopy leads to increased operative time.•Direct anterior total hip arthroplasty after prior ipsilateral hip arthroscopy leads to increased intraoperative blood loss.•There is no increased risk for periprosthetic fracture in patients who undergo total hip arthroplasty after ipsilateral hip arthroscopy.•There is no increased risk for periprosthetic joint infection in patients who undergo total hip arthroplasty after ipsilateral hip arthroscopy.

Keywords

Total hip arthroplasty (THA)

Hip arthroscopy

Femoroacetabular impingement (FAI)

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1 Introduction/Background

Since an arthroscope was first introduced into a cadaveric hip in 1931² it has become the gold standard for treatment of femoral acetabular impingement (FAI) and associated periarticular disorders.⁷^,¹¹^,¹⁸ Over the last two decades hip arthroscopy has grown exponentially as surgical indications and expertise has expanded. Surgical treatment of FAI is inherently biased towards a younger, active patient population. As such, many of these patients will inevitably develop hip arthritis, either as a consequence of the initial FAI conflict or other idiopathic causes.⁴ In addition, iatrogenic injury from hip arthroscopy itself may accelerate degenerative joint disease. Hip arthroscopy has a protracted learning curve, is notoriously technically demanding and likely results in a higher rate of iatrogenic chondral injury than arthroscopic management of other large joints.²⁰ In addition to iatrogenic chondral damage, additional risk factors for need of conversion THA include post-operative tissue scarring, micro- or macro-hip joint instability, or femoral head avascular necrosis.¹²

The incidence of total hip arthroplasty (THA) is also increasing, with a projected 572,000 cases to be performed in the United States alone by 2030.¹⁹ Reported conversion rates from hip arthroscopy to THA vary widely from 13 % at 2 years to 34 % at 10 years.⁴^,¹⁸ Although with more careful patient selection hip survival after arthroscopy has been reported at 90 % with over 10 years follow up.⁹ Identified risk factors for conversion include pre-existing degenerative changes (Tonnis >1, advanced age and higher BMI).¹^,¹⁴ Despite these increasing rates of conversion THA's there have been relatively sparse and conflicting reports of the potentially deleterious effect that a prior hip arthroscopy may have on THA. The total knee replacement literature does support potential adverse effect of arthroscopy prior to total knee replacement.¹⁵^,¹⁶ Review of the existing hip literature, however, is conflicting with some studies reporting no difference in the rate of complication or outcomes³^,^5–7^,¹⁷^,²¹ while others report increased risk of complications and less favorable outcomes.⁸^,¹³^,¹⁹ Previously reported complications of prior hip arthroscopy include increased operative times, increased blood loss, and diminished patient reported functional outcomes. Only one other report was identified that specifically evaluated these outcomes following a direct anterior (DA) THA approach alone.²¹ The DA surgical approach is particularly relevant because the surgical plane directly overlaps with that of standard arthroscopic portals potentially obscuring native anatomy. Increased understanding of this topic can help surgeons to properly counsel patients pre-operatively and ideally improve patient outcomes and experience.

2 Materials & methods

After institutional review board approval, a retrospective chart review was completed through a database that was prospectively collected by single surgeon with a practice focused on hip arthroscopy and DA THA. Data was evaluated regarding operative data and 90-day post-op complications of patients that underwent conversion THA following ipsilateral hip arthroscopy at a tertiary hospital center between the dates of 01/01/2012–01/01/2020. Patients were included if they were 18 years or older with a total hip arthroplasty performed via a DA approach due to osteoarthritis or avascular necrosis with femoral head collapse. All patients had a required minimum follow up of 90 days to be included. Patients were excluded if they had previous hip surgery other than hip arthroscopy, any approach besides a DA approach, pathologic lesions leading to total hip arthroplasty, previous fracture of acetabulum or femoral head, rheumatoid arthritis, previous joint infection, pediatric patients, prisoners, or pregnant patients. The control group consisted of matched cohort of patients who underwent primary DA THA due to osteoarthritis between 01/01/2012–01/01/2020 with no prior hip surgeries or joint infection. Controls were matched for age, sex, BMI, and ASA score.

Review of the electronic medical record included patient demographics, comorbidities, estimated blood loss, operative time, duration between hip arthroscopy and hip arthroplasty, and complications. Operative time reflected start of incision to the time patient left the OR. Comorbidities evaluated for included: active smoking status, chronic obstructive pulmonary disease (COPD), diabetes, CHF, cirrhosis, functional dependent health status, previous myocardial infarction, chronic renal failure, previous stroke, or metastatic cancer.

DA THA was performed by the senior author (CHW) using a Hana table (Mizuho, Union City, CA) through a standard linear incision between the sartorious m. and tensor fascia m. The tensor fasciae itself was then incised and the muscle belly retracted laterally along with the gluteus medius m. The sartorius m. and rectus femoris m. were retracted medially. Ascending branches of lateral femoral circumflex vessels were cauterized before incising the capsule. The femoral neck cut was made followed by reaming and inserting the acetabular components. The surgical limb was then positioned to broach the femur. Trial implants were placed, leg length and implant positions were confirmed fluoroscopically before inserting the final implants. Layered closure was performed and sterile dressings applied. All patients received intravenous antibiotic and 1.95 g tranexamic acid (TXA) orally prior to incision. Estimated blood loss (EBL) was calculated using a subtraction method of the total fluid volume collected in the fluid management system, (Neptune, Stryker, Kalamazoo, MI) minus lavage fluid. THA surgical implants consisted of Stryker Trident acetabular cup with highly cross-linked acetabular liners and Biolox delta ceramic femoral heads. Press fit stems used were Stryker Accolade II and cemented stems were Accolade C.

The primary outcome measure was operative time (minutes) between the THA+ and control groups. Secondary outcomes included objective differences and complication rates between groups. Quantitative variables were evaluated using the Mann-Whitney-U test or a two-tailed unpaired t-test, as appropriate. Nominal variables were evaluated using the chi-square or Fisher's Exact test, as appropriate. Significance was assessed at p < 0.05.

3 Results

There was a total of 71 total patients included in this study. 38 patients were included in the study group (THA+), while 31 patients were included in the control group. In the THA + group, there were 14 males and 21 females. Average age was 52.1 years ( ± 9.9), average BMI was 28.7 ( ± 4.7), and three patients had at least one comorbidity [Table 1]. Of the comorbidities, two patients had a diagnosis of diabetes, and one patient was a current smoker with a diagnosis of COPD. In the control group, one patient had a diagnosis of diabetes and chronic renal failure, one patient had diabetes, and one was an active smoker. Overall consistency of the control group did not show any significant differences in the parameters previously decided upon when matching (age, sex, BMI, or number of comorbidities). All patients received their THA via a DA surgical approach by the senior author (CHW), and all patients in each group had a press-fit stem.

Table 1 Demographic data.

Variable	Control (n = 33)	Scope (n = 38)	p-value
Age	58.4 ± 8.8	52.1 ± 9.9	0.0062
BMI	29.7 ± 5.3	28.7 ± 4.7	0.4083
Length of stay (Days)	1.0 [1.0, 1.0]	0.0 [0.0, 1.0]	<0.0001
ASA Score		n = 37
I	5 (15.1)	6 (16.2)	0.7108
II	24 (72.7)	24 (64.9)
III	4 (12.1)	7 (18.9)
Sex
Male	10 (30.3)	14 (36.8)	0.5613
Comorbidities
At least 1	13 (39.4)	3 (7.9)	0.0015
Surgery Approach
Anterior	33 (100.0)	38 (100.0)	n/a

Regarding the primary outcome, surgery duration was significantly longer in the THA+ (73.5 min [68–79 min; SD = 9.5]), compared to the control group (60 min [56–67 min; SD = 11.3]). Additionally, average estimated blood loss (EBL) was significantly higher in the THA + group (400 cc[250–550cc]) compared to the control group (275 cc[250–325cc]) (p = 0.0088). No patients in either group experienced an intraoperative fracture requiring fixation. No patients in the THA + group had a postoperative fracture, while three patients in the THA group experienced a postoperative fracture, though comparison between these group was not significant (p = 0.0955). One patient sustained a nondisplaced medial acetabular wall fracture that was treated nonoperatively, one patient sustained a greater trochanter fracture that was treated nonoperatively, and one patient sustained a periprosthetic femur fracture 19 days after the primary THA, requiring revision. Two patients in the THA + group experienced a superficial wound infection requiring oral antibiotic therapy compared to zero patients in the control group (p = 0.4954). No patients in either group had a deep infection requiring irrigation and debridement, and no patient in either group experienced a postoperative dislocation [Table 2]. One patient in both the control and THA + group required revision THA due to osteolysis.

Table 2 Outcome measures.

Variable	Control (n = 33)	Scope (n = 38)	p-value
Surgery Duration (min.)	60.0 [56.0, 67.0]	73.5 [68.0, 79.0]	<0.0001
EBL (cc)	275.0 [250.0, 325.0]	400.0 [250.0, 550.0]	0.0088
Intra Op Fx
Yes	0 (0.0)	0 (0.0)	n/a
Postop Fx
Yes	3 (9.1)	0 (0.0)	0.0955∗
Transfusion
Yes	0 (0.0)	1 (2.6)	1.0000∗
Readmission
ED	1 (3.0)	1 (2.6)	0.7947∗
Admission	2 (6.1)	1 (2.6)
No	30 (90.9)	36 (94.7)
Superficial Infection
Yes	0 (0.0)	2 (5.3)	0.4954∗
Infection Req I&D
Yes	0 (0.0)	0 (0.0)	n/a
Wound Healing Compl.
Yes	0 (0.0)	0 (0.0)	n/a
Heterotopic Ossification
Yes	0 (0.0)	1 (2.6)	1.0000∗
No	33 (100.0)	36 (94.7)
Present prior	0 (0.0)	1 (2.6)
Postop Dislocation		N = 37
Yes	0 (0.0)	0 (0.0)	n/a
Other Complications		N = 37
Yes	13 (39.4)	7 (18.9)	0.0584
Total Complications	0.0 [0.0,1.0]	0.0 [0.0,1.0]	0.1516
Revisions	2 (6.1)	1 (2.6)	0.5941∗

4 Discussion

To our knowledge, this is only the second study to evaluate outcomes of patients who solely underwent DA THA after previous ipsilateral hip arthroscopy. The DA THA surgical approach is of particular interest in this scenario since it overlaps the surgical plane of standard arthroscopic portals. This means that post-surgical scarring of native tissue planes or retained implants can potentially complicate future THA surgery. Our study reported increased surgical time and increased blood loss in patients undergoing DA THA after previous hip arthroscopy. Surgeons should be aware of these implications to be able to appropriately educate patients on risks as well as plan their surgical procedure.

4.1

4.1 Increased length of surgery

Our data demonstrate an average of 13.5 min increase in operative time in the THA + group. The additional surgery time is likely the result of superficial and deep adhesions from previous hip arthroscopy. Hip arthroscopy relies on at least two surgical portals which are typically an anterolateral (AL) and mid-anterior portal (MA). The MA portal shares a surgical plan with the DA THA approach. Superficially, it passes between the sartorius and tensor fascia muscles, and in the deep plane passes through the rectus femoris before entering the hip capsule. Despite this being a “minimally invasive” technique, there is subsequent scar tissue that forms in these tissue planes that results in adhesions and blurring of the native surgical planes. For instance, in the THA + group the tensor fascia was often scarred to the overlying fascia layer requiring additional time for sharp surgical dissection as opposed to using a quicker blunt dissection method in the primary setting. Similarly, deep surgical exposure between the rectus femoris and gluteus medius has adhesions between the muscles as well as to the underlying hip capsule. Further, arthroscopic femoroplasty can cause the hip capsule to scar down to the femoral neck, also requiring additional time spent releasing the capsule before the femoral neck cut is made.

Retained implants also contribute to increased surgical time in the THA + group. Arthroscopic labral repair is typically performed using non-absorbable anchors. During each THA, labral tissue was routinely sharply excised. Additional time, however, was required in the revision setting to remove the high strength suture material from previous labral repair. The suture themselves pose another threat. While it is necessary to remove underlying anchors so they do not interfere with the acetabular component, it is often not practical to remove all the anchor material as they are embedded deep into the acetabular rim. Complete removal could result in deficient acetabular coverage and compromise cup stability. As such, most labral repair anchors remain in the acetabulum even after THA. It remains unknown if these retained implants could result in increased risk of postoperative infection or implant loosening.

Our findings of increased surgical time corroborate those of Vovos et al. They reported on a group of 95 matched patients who underwent THA via various surgical approaches in patients with previous hip arthroscopy. They found longer OR times in the hip scope group of 122 min vs 103 min in the non-hip scope group.¹⁹ Other studies, however, have reported no difference in surgical times.³^,⁶^,⁷ Interestingly, in an early study similar to ours, Zingg et al. reported short-term results of DA THA on a series of 18 patients who underwent prior hip arthroscopy.²¹ In contrast to our study, they found decreased surgical time in the group with previous hip arthroscopy. The authors acknowledged the unexpected finding and attributed the result to relatively small sample size or less time spent teaching residents in the revision surgical setting. Given the fact that every patient received a press-fit stem in our study, there was no confounding in either group to account for cement hardening.

4.2

4.2 Increased blood loss

Our study found an increased average blood loss of 400 mL in the THA + group compared to that of 275 mL in the THA group. This represents an increase of 45 %. Despite this seemingly large increase, the total blood loss in the THA + group still falls within reported range of expected blood loss during THA.¹⁰ Tranexamic acid has been proven safe and effective in the setting of THA, reducing blood loss by 400 mL compared to controls and was given to all patients preoperatively, which likely contributed to the overall relatively low EBL's.¹⁰ Our finding of increased blood loss could be due to the longer operative time discussed above, as additional bleeding occurs during longer procedures. The magnitude of increased blood loss, however represents a 45 % increased average versus only a 22.5 % increased operative time. This disproportionate increase could be due to abnormally high blood loss occurring during cauterizing the lateral femoral circumflex vessels. It is not uncommon in the THA + group for the vessels to be encapsulated in post-operative adhesions making clean electrocauterization challenging, resulting in additional blood loss. While the overall transfusion rate was low for both groups, it follows that the only patient who a required a post-op transfusion was in the THA + group. This isolated event did not reach statistical significance.

In contrast to our findings of increased blood loss, other similar studies have reported no significant difference in blood loss between the THA groups with and without prior hip arthroscopy.³^,¹⁷^,¹⁹^,²¹ This contrast could be due to the fact that our study included only DA THA patients that are particularly prone to increased blood loss due to scarring in the surgical plane including around the circumflex vessels.

4.3

4.3 Complications

While there was no statistically significant difference in the number of intra-operative or post-operative complications it is worth noting that two THA + patients did receive oral antibiotic treatment for apparent superficial wound infections compared to zero patient in the THA group. This issue was also discussed by¹³ who reported 2 out of 35 prior hip arthroscopy patients required antibiotics for superficial infection. The overlapping surgical site could be susceptible to infection or appear infected due to a delayed histamine response in the setting of second exposure to suture material.

A single postoperative fracture was only reported in the THA group which is likely an incidental finding, although the THA group did have more medical comorbidities than the THA + group, potentially making the group more vulnerable to diminished bone mineral density. While underpowered to make definitive conclusions regarding major complications like postoperative fracture, dislocation and deep surgical site infection, the lack of such complications in the THA + group within 90 day follow up could be interpretted that there is not an alarming increased risk of major complications in this group. This is supported by other similar studies demonstrating lack of major complication rates as well.³^,^5–7^,¹⁷^,²¹ Similarly, 90-day ER and admission rates were not different between the two study groups.

5 Strengths/Limitations

Strengths of this study include a single surgeon treating all study patients using a single surgical approach and uniform implant company. This limits heterogeneity of surgical techniques, surgical approaches and implant specific variables. In addition, it is a matched study which controls for differences in important variables.

This study does, however, have multiple limitations. Notably, it is a retrospective report inherently prone to selection bias. It also has a relatively small sample size making it underpowered to detect differences in uncommon events like infection and fracture rates. Further, patient reported outcome scores were not collected so we are unable to comment on any functional impact prior hip arthroscopy may convey. Larger prospective or registry-based studies would be extremely valuable in clarifying risks of converting a hip arthroscopy to a total hip replacement.

6 Conclusion

These changes are important for surgeons to recognize as it may have implications in time management of an operative day. Additionally, these results will assist surgeons in risk stratifying patients when deciding to perform a THA at a surgery center vs hospital if they had a previous ipsilateral hip arthroscopy. However, these results also contribute to a growing body of literature that shows there is no increase in major complication rate of a THA after a patient has had an ipsilateral hip arthroscopy, specifically regarding fracture, instability, and infection rates. Given that surgeons often place suture anchors when performing a labral repair during hip arthroscopy, there may be concern for increased infection risk with subsequent THA. However, there were no increased infection rates in these patients compared to controls, giving surgeons confidence that subsequent THA can be safely performed with no obvious increased infection risk. Furthermore, there is a theoretical risk of capsular attrition in patients undergoing subsequent THA after a previous ipsilateral hip arthroscopy. No patients in the study group sustained a postoperative dislocation, suggesting no overt risk of capsular attrition leading to instability.

CRediT authorship contribution statement

Matthew Pate: Conceptualization, Methodology, Investigation, Writing – original draft, Visualization. Joshua Gira: Investigation, Writing – original draft, Visualization. Carl Wierks: Conceptualization, Methodology, Validation, Resources, Data curation, Writing – review & editing, Supervision, Project administration.

Disclosures

•The authors of this study have no conflicts of interest to disclose that are relevant to this study.•This research did not receive any specific grant from funding agencies in the public, commercial or not-for-profit sectors•Ethical review committee approval was attained for this study, and all data collection and evaluation were performed in accordance with that which was approved by the ethical review committee.•All work for this project was performed at the offices of West Michigan Orthopedics

Funding statement

This research did not receive any specific grant from funding agencies in the public, commercial or not-for-profit sectors.

Ethical statement

Ethical review committee approval was attained for this study, and all data collection and evaluation were performed in accordance with that which was approved by the ethical review committee.

Patient Consent

Consent was not necessary for this study.

References

Bedard N.A., Pugely A.J., Duchman K.R., Westermann R.W., Gao Y., Callaghan J.J., . When hip scopes fail, they do so quickly. J Arthroplasty. 2016;31(6)
[Google Scholar]
Burman M.S., . Arthroscopy or the direct visualization of joints: an experimental cadaver study. 1931. Clin Orthop Relat Res. 2001;390
[Google Scholar]
Charles R., LaTulip S., Goulet J.A., Pour A.E., . Previous arthroscopic repair of femoro-acetabular impingement does not affect outcomes of total hip arthroplasty. Int Orthop. 2017;41(6)
[Google Scholar]
Ganz R., Parvizi J., Beck M., Leunig M., Nötzli H., Siebenrock K.A., . Femoroacetabular impingement: a cause for osteoarthritis of the hip. Clin Orthop Relat Res 2003
[Google Scholar]
Haughom B.D., Plummer D.R., Hellman M.D., Nho S.J., Rosenberg A.G., Della Valle C.J., . Does hip arthroscopy affect the outcomes of a subsequent total hip arthroplasty? J Arthroplasty. 2016;31(7)
[Google Scholar]
Haynes J.A., Xiong A., Nepple J.J., An T., Nunley R.M., Clohisy J.C., . Does previous hip arthroscopy affect the clinical outcomes of total hip arthroplasty? Orthop J Sports Med. 2019;7(3)
[Google Scholar]
Hoeltzermann M., Sobau C., Miehlke W., Zimmerer A., . Prior arthroscopic treatment for femoro-acetabular impingement does not compromise hip arthroplasty outcomes: a matched-controlled study with minimum two-year follow-up. Int Orthop. 2019;43(7)
[Google Scholar]
Konopka J.F., Buly R.L., Kelly B.T., Su E.P., McLawhorn A.S., . The effect of prior hip arthroscopy on patient-reported outcomes after total hip arthroplasty: an institutional registry–based, matched cohort study. J Arthroplasty. 2018;33(6)
[Google Scholar]
Lee M.S., et al . “Patients undergoing primary hip arthroscopy report favorable outcomes at minimum 10 Year follow-up. Syst Rev 2023
[Google Scholar]
Magill P., Cunningham E.L., Hill J.C., Beverland D.E., . Identifying the period of greatest blood loss after lower limb arthroplasty. Arthroplast Today. 2018;4(4)
[Google Scholar]
Magrill A.C.L., Nakano N., Khanduja V., . Historical Review of Arthroscopic Surgery of the Hip. 2017
[Google Scholar]
Nakano N., Khanduja V., . Complications in hip arthroscopy. Muscles Ligaments Tendons J. 2016;6(3)
[Google Scholar]
Perets I., Mansor Y., Mu B.H., Walsh J.P., Ortiz-Declet V., Domb B.G., . Prior arthroscopy leads to inferior outcomes in total hip arthroplasty: a match-controlled study. J Arthroplasty. 2017;32(12)
[Google Scholar]
Philippon M.J., Schroder E Souza B.G., Briggs K.K., . Hip arthroscopy for femoroacetabular impingement in patients aged 50 years or older. Arthrosc J Arthrosc Relat Surg. 2012;28(1)
[Google Scholar]
Piedade S.R., Pinaroli A., Servien E., Neyret P., . TKA outcomes after prior bone and soft tissue knee surgery. Knee Surg Sports Traumatol Arthrosc. 2013;21(12)
[Google Scholar]
Piedade S.R., Pinaroli A., Servien E., Neyret P., . Is previous knee arthroscopy related to worse results in primary total knee arthroplasty? Knee Surg Sports Traumatol Arthrosc. 2009;17(4)
[Google Scholar]
Spencer-Gardner L.S., Camp C.L., Martin J.R., Sierra R.J., Trousdale R.T., Krych A.J., . Does prior surgery for femoroacetabular impingement compromise hip arthroplasty outcomes? J Arthroplasty. 2016;31(9)
[Google Scholar]
Sing D.C., Feeley B.T., Tay B., Vail T.P., Zhang A.L., . Age-related trends in hip arthroscopy: a large cross-sectional analysis. Arthrosc J Arthrosc Relat Surg. 2015;31(12)
[Google Scholar]
Vovos T.J., Lazarides A.L., Ryan S.P., Kildow B.J., Wellman S.S., Seyler T.M., . Prior hip arthroscopy increases risk for perioperative total hip arthroplasty complications: a matched-controlled study. J Arthroplasty. 2019;34(8)
[Google Scholar]
Weber A.E., Harris J.D., Nho S.J., . Complications in Hip Arthroscopy: A Systematic Review and Strategies for Prevention. 2015
[Google Scholar]
Zingg P.O., Schallberger A., Rüdiger H.A., Poutawera V., Dora C., . Does previous hip arthroscopy negatively influence the short term clinical result of total hip replacement? Arch Orthop Trauma Surg. 2012;132(3)
[Google Scholar]