Rapid decline of yearly number of hip arthroscopies in Sweden: a retrospective time series of 6,105 hip arthroscopies based on a national patient data register

Abstract

Background and purpose — Hip arthroscopies (HAs) have increased exponentially worldwide and are expected to continue rising. We describe time trends in HA procedures in Sweden (10 million inhabitants) between 2006 and 2018 with a focus on procedure rates, surgical procedures, and patient demographics such as age and sex distribution.

Patients and methods — We retrospectively collected data from the Swedish National Patient Register (NPR) for all surgeries including surgical treatment codes considered relevant for HA from 2006 to 2018. Surgical codes were validated through a multiple-step procedure and classified into femoroacetabular impingement syndrome (FAIS) related or non-FAIS related procedure. Frequencies, sex differences, and time trends of surgical procedures and patient demographics are presented.

Results — After validation of HA codes, 6,105 individual procedures, performed in 4,924 patients (mean age 34 years [SD 12]) were confirmed HAs and included in the analysis. Yearly HA procedure rates increased from 15 in 2006 to 884 in 2014, after which a steady decline was observed with 469 procedures in 2018. The majority (65%) of HAs was performed in males. Male patients were younger, and surgeries on males more frequently included an FAIS-related procedure.

Interpretation — Similar to previous studies in other parts of the world, we found dramatic increases in HA procedures in Sweden between 2006 and 2014. Contrary to existing predictions, HA rates declined steadily after 2014, which may be explained by more restrictive patient selection based on refined surgical indications, increasing evidence, and clinical experience with the procedure.

All authors contributed to the planning of the study. TW, JKS, and AS prepared and placed the order of data from the NPR. FE performed data management and analysis. AS and MS were responsible for communication with clinics regarding validating surgical codes and surgery rates. TW drafted the manuscript, which was critically appraised and revised by all co-authors.

Acta thanks Enrico De Visser and Bent Lund for help with peer review of this study.