Thanks, I'd just like to acknowledge and thank my co-authors who helped with the study. So surgical factors that lead to failure of arthroscopic hip conditions have been well described. Larson taught us that OA was a risk factor for failure back in 2011. Also unaddressed cam deformity, the anchor group has highlighted that as being a cause for failure. Infection experience more recently and over a section in certain cases has also been implicated to be associated with failure of hip arthroscopy. But in the setting of well done surgery, we don't know much about opioid use, smoking obesity and psychiatric comorbidity in terms of risk factors for failure of surgery. So the purpose was to evaluate predictive factors associated with hip arthroscopy failure and we thought that preoperative opioid use and presence of osteoarthritis would predict failure. We used a large insurance claims database that covers 16 million lives, access using Pearl Diver research technologies, performed a power analysis, looked at hip arthroscopy cases performed between 07 and 15. We defined failure as any subsequent ipsilateral hip surgery and subsequent ipsilateral total hip replacement and patients had to have one year of follow up with the same insurance type to be included in the analysis. We then used linear regression to look at multiple patient factors and we controlled for the use of opioids preoperatively, psychiatric diagnoses, presence of OA, age, gender, obesity and smoking and then we looked at independent predictors of revision scope and total hip using multivariate analysis. So in total we had 785 patients that had one year follow up, 64% were female and the mean age was 40 which is quite old. The overall failure rate was 18% at minimum one year follow up, that's 8% receiving revision hip scope and 10% receiving a total hip. Psychiatric comorbidities were the only factors that predicted both revision hip scope and total hip. Independent predictors of revision scope were younger age and psychiatric diagnoses and independent predictors of total hip only were older age and presence of arthritis which intuitively do make sense. Finally what factors did not predict failure? Preoperative opioid use, so patients on opioids prior to surgery, obese patients, smokers and female gender were not predictive of revision hip arthroscopy or conversion to total hip. So for discussion this 18% is alarmingly high, it's much higher than other previously cited series. BIRD had previously reported a .5% conversion to total hip at two years. The highest one is probably at Dome had a 9.2% conversion to total hip rate and some tonus grade ones. Harris' largest systematic review showed that there's a 6.3% reoperation rate so really we're about triple the revision rates as previously cited. OA has been well described as a predictor of failure both by BIRD and Lars up here but psychological factors have not been demonstrated as a predictor of failure. We know they negatively impact WHO scores. Further opioid use also has been shown to negatively impact hip outcome scores but we found this not to be a predictor of conversion to total hip or revision hip scope. Mental health is also important to help predict hip pain in patients with FAI and the VR-12 mental component score actually can influence your WHO score by up to 20 points depending on what patient's mental health status is like at the time of surgery. This does have some limitations. We're unable to control for surgical quality so we're not sure if we're comparing camera sections that were done like this to ones that were done properly. There's no patient reported outcomes. The database limits our ability to control for all confounders and ICD-10 codes for arthritis do not necessarily equal radiographic assessment. But in conclusion, this 18% failure rate is much higher than the previous series would suggest. Arthroscopy should have a limited role in the setting of OA and patients that screen in for depression, anxiety, we should look at other avenues in terms of how to best treat them maybe with multidisciplinary collaborations. We're piloting some cognitive behavioral therapy applications in this cohort of patients at our institution and hopefully we'll give you some updates on that next year. Thanks. APPLAUSE

arthroscopic hip conditions

failure factors

risk factors

osteoarthritis

cam deformity