Ultrasound versus X-Ray in hip arthroscopy: Safety, accuracy, and clinical outcomes.
ESSKA Academy. Wong I. 05/09/18; 217953; FP08-1787
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Objectives: Hip arthroscopy is accepted as a safe and less invasive technique to treat pathology of the hip. Due to the anatomy of this joint, imaging must be used to safely establish portals. Ultrasound-guided hip arthroscopy, although far less common than X-Ray-guided, eliminates radiation exposure and consists of smaller equipment. Allowing for it to be completed in small operating rooms and those without access to fluoroscopy.

Given no pre-existing literature beyond describing technique, the primary aim of this study is to assess the safety profile of ultrasound-guided hip arthroscopy by determining the rate of iatrogenic injury to the cartilage and labrum, compared to the standard X-Ray-guided technique. Secondary aims include measurement of the accuracy of osteoplasty and comparing the patient-reported outcome scores using the International Hip Outcome Tool-33 (iHOT-33) pre and post-operatively.

We hypothesize that ultrasound-guided hip arthroscopy has a safety profile equal to X-Ray-guided and that the type of imaging used to establish portals will have no effect on patient outcome.

Methods: This retrospective cohort study compares patients who underwent ultrasound-guided hip arthroscopy or X-Ray-guided hip arthroscopy by a single surgeon from January 2014 to August 2017. Ultrasound was used at day surgery centers and X-Ray was used at the hospital. Patients with certain medical comorbidities or high body mass index could only have surgery at the hospital. Otherwise, patients were assigned to a surgical site based on waitlists.
Surgical videos were assessed for iatrogenic labral damage and cartilage injury during portal establishment. The α-angle was measured on pre- and post-operative X-Rays to establish accuracy of femoroplasty. The iHOT-33 was administered pre-operatively and at six months post-operatively.

Results: Three hundred ninety eight cases were identified for inclusion with 51% using ultrasound-guided technique. Patients in the ultrasound-guided cohort were younger (mean age 35.7 years compared to 39.1 years in X-ray-guided) and had a lower BMI (mean of 23.5 compared to 26.5 in X-Ray-guided). There was no significant difference in pre-operative iHOT-33 score (40.1 in ultrasound-guided; 36.1 in X-Ray-guided) or pre-operative α-angle (64.2 degrees in ultrasound-guided; 66.9 degrees in X-Ray-guided).
Video review showed a 1% incidence of femoral head cartilage injury and 1% labrum injury in both techniques. There was no significant difference in post-operative α-angle (56.1 degrees in ultrasound-guided; 57.7 degrees in X-Ray guided). At 6-months post-operatively, both cohorts had significant improvements in iHOT-33 scores (70.4 in ultrasound guided; 54.3 in X-Ray guided).

Conclusions: Although only supported by preliminary data, we find equally low complications with ultrasound- and X-Ray-guided hip arthroscopy. During early follow-up, we found no difference in resection of Cam lesions between the techniques and improved outcome scores post-operatively in both techniques.

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