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The HAR-index: a reliable method for evaluating the risk of total hip arthroplasty conversion after hip arthroscopy for femoroacetabular impingement

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Knee Surgery, Sports Traumatology, Arthroscopy Aims and scope

Abstract

Purpose

Hip arthroscopy is a growing technique in the treatment of femoroacetabular impingement (FAI), but can sometimes lead to unsatisfactory results such as the early conversion to total hip arthroplasty (THA). The purpose of this study is to describe a new tool for assessing the preoperative risk of THA conversion after hip arthroscopy in patients with FAI.

Methods

This study is a retrospective analysis of a prospective cohort of 584 patients with FAI who underwent hip arthroscopy at a single centre with a minimum 2 years follow-up. The preoperative variables of these patients were analysed to calculate the risk of each variable for THA. By selecting variables with an area under the receiver operating characteristic (ROC) curve greater than 0.7, a calculator was created to provide a risk index for each patient.

Results

Four variables (age, body mass index, Tönnis score and ALAD) were associated with an increased risk of THA conversion. The optimal cut-off points for each variable were determined, and a risk index was created. The Hip-Arthroplasty-Risk Index (HAR-Index) is a 0–4 points scale obtained from four binary scores of 0 or 1 depending on whether the cut-off point for each variable was reached or not. The increased risk of THA for each HAR-Index value was 1.1%, 6.2%, 17.9%, 55.1% and 79.3% respectively. The HAR-Index showed a very good predictive capacity with an area under the ROC curve of 0.89.

Conclusion

The HAR-Index is a simple and practical tool for practitioners to make more informed decisions about performing hip arthroscopy in patients with FAI. With a very good predictive capacity, the HAR-Index can help to reduce the rate of conversion to THA.

Level of evidence

Level III.

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Data availability

Data is available upon reasonable request. Additional requested analysis may be available for future review studies.

Abbreviations

FAI:

Femoroacetabular impingement

THA:

Total hip arthroplasty

MRI:

Magnetic resonance imaging

BMI:

Body mass index

VAS:

Visual analogue scale

ALAD:

Acetabular labrum articular disruption

mHHS:

Modified harris hip score

HOS-ADL:

Hip outcome score-activities of daily living

HOS-SS:

Hip outcome score-sport scale

WOMAC:

Western Ontario and McMaster Index

OR:

Odds ratio

ORa:

Odds ratio adjusted

ROC curve:

Receiver operating characteristic curve

AUC:

Area under the curve

HAR-Index:

Hip arthroplasty risk index

SD:

Standard deviation

CT:

Computed tomography

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Acknowledgements

The authors would like to acknowledge Ms. Esther Molins for its administrative help in the development of the research.

Funding

The authors did not receive any financial support from any organization for the submitted work.

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Authors and Affiliations

  1. Instituto Cugat, Hospital Quironsalud Barcelona, Plaça d’Alfonso Comín 5-7, Barcelona, Spain

    Roberto Seijas, Patricia Laiz, Alfred Ferré-Aniorte, David Barastegui & Ramón Cugat

  2. Fundación García Cugat, Barcelona, Spain

    Roberto Seijas, Patricia Laiz, Alfred Ferré-Aniorte, David Barastegui & Ramón Cugat

  3. Faculty of Medicine and Health Sciences, International University of Catalunya, Sant Cugat del Vallés, Spain

    Martín Eusebio Barra-López & Carlos López-de-Celis

  4. Mutualidad de Futbolistas Españoles-Delegació Catalana, Barcelona, Spain

    David Barastegui & Ramón Cugat

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Contributions

The author RS was involved in the design, data acquisition and writing of the first draft of this manuscript. Both MEB and CL performed the data analysis and wrote the first draft of the manuscript. PL and AF were involved in the study design as well as the correction and writing of the final manuscript version. DB collaborated with the study design and data collection. Finally, RC oversaw the coordination and the study design. All authors approved the final draft of this manuscript.

Corresponding author

Correspondence to Roberto Seijas.

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Ethical approval

The study was approved by the institutional research ethics board (Hospital Quironsalud Barcelona, Approval Number HIPARTH-2017).

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Informed consent was obtained from all individual participants included in the study.

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Seijas, R., Barra-López, M.E., López-de-Celis, C. et al. The HAR-index: a reliable method for evaluating the risk of total hip arthroplasty conversion after hip arthroscopy for femoroacetabular impingement. Knee Surg Sports Traumatol Arthrosc 31, 2730–2738 (2023). https://doi.org/10.1007/s00167-023-07368-1

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