Introduction: Hip arthroscopy (HA) is an effective treatment for various young adult hip pathology but has a steep learning curve and its effect on long-term joint preservation is unclear. This study uses population-level data to assess (1) the 90-day complication rate, and (2) the frequency and timing of revision HA (rHA), conversion to total hip replacement (cTHR), and pelvic osteotomy (cPO) following primary HA.

Methods: We performed a retrospective observational study analysing national data from the National Hospital Episode Statistics (HES) database. We examined all patients who underwent primary hip arthroscopy in NHS hospitals in England from 2010 to 2023, using relevant OPCS-4 codes. We evaluated patient demographics, 90-day readmission rate for complications, and long-term reoperation rates for rHA, cTHR, and cPO. Descriptive statistical analyses were performed to calculate frequencies and mean time to reoperations. The lifetime risk of revision surgery was calculated using a life table approach and cumulative probability method.

Results: A total of 22,401 HA procedures were identified from the HES database. The mean LOS was 0.82±2.04 days. The 90-day readmission rate was 0.17% at a mean of 54.4±8.1 days. The most common reasons for readmission were reoperation (0.071%), followed by infection (0.031%), pulmonary embolism (0.027%), pain (0.022%), bleeding (0.018%), and deep vein thrombosis (0.004%). One patient died within 90 days. Overall, 4942 patients (22.1%) required further surgery at a mean of 2.71±2.27 years. The rates of rHA, cTHR, and cPO were 6.94%, 14.6%, and 0.50% at a mean of 2.39±1.79, 2.87±2.46, and 2.26±1.80 years respectively. Female patients had higher reoperation rates than males for all indications: cTHR (16.46% vs 11.78%), rHA (8.10% vs 5.14%), and cPO (0.71% vs. 0.16%). The cumulative survival with THR as the endpoint was 84.9% over the 13-year study period.

Conclusions: This study demonstrates a low short-term complication rate following HA, yet a relatively high readmission rate for revision and conversion to THR, particularly in females. These findings highlight the need for careful patient selection and pre-operative counselling, as well as further research investigating long-term prognostic factors that contribute to reoperations and conversion to THR, thereby aiding in improved patient-specific clinical decision-making.