Usefulness of hip arthroscopy

AUGUSTOVSKI, F.; PICHON RIVIERE, A.; ALCARAZ, A.; BARDACH, A.; FERRANTE, D.; GARCIA MARTI, S.; GLUJOVSKY, D.; LOPEZ, A.; REGUEIRO, A.

Documentos de Evaluación de Tecnologías Sanitarias

IECS

Año: 2005 p. 1 - 30

1668-2793

This study aims to assess the usefulness of arthroscopy in hip pathologies.A bibliographic search was carried out on the main data bases (MEDLINE, Cochrane, DARE, LILACS, NHS NICE, EMBASE, Centre for Reviews and Dissemination York University), in general Internet search engines, in sanitary technology evaluation agencies and health suppliers using a search strategy. Priority was given to the inclusion of systematic revisions; controlled, randomized clinical trials, observational studies, assessment of sanitary technologies and economic evaluations; clinical practice guidelines and coverage policies of other health systems. Information from local sources on the use (Orthopedics Argentine Society and others) was searched for.For this report narrative revisions and case series were used. No other observational designs or randomized controlled clinical trials were detected, neither documents that set position on the topic, published by the main national or international orthopedic associations. Two case series of 40 and 102 patients compare hip arthroscopy (HA) with other diagnostic alternatives such as Magnetic Resonance arthrography (MRA), magnetic resonance imaging (MRI) with contrast and anesthetic injection within the coxofemoral joint. In both series the other methods validity was calculated against HA, which was used as reference test for the possibility it offers to directly explore the joint. The case series generally report therapeutic indications. One common application is the resection of labrum flaps. Approximately two thirds of the patients in most revised series report a symptomatic improvement after surgery. Foreign or loose body removal is another recognized application, since it decreases the risk of avascular necrosis. Debridement for septic arthritis in children and adults, using this technique has clear advantages over open surgery. With respect to its usefulness as diagnostic test, it was reported that patients with chronic pain (6 months or more) with negative radiologic studies would benefit from HA, since in half of the cases treatable pathologies were found. It is also useful to make a differential diagnosis between arthrosis and inflammatory disease, chondrocalcinosis, villonodular synovitis, and chondromatosis.With respect to the regulatory framework: The Programa Medico Obligatorio (PMO) (Obligatory Medical Program), in its resolution 201/2002, Appendix 2 considers coverage of shoulder arthoscopy (Code 122001), and knee arthroscopy (code 122002), but not HA. No national or international coverage policies were found on this topic.