The treatment of labral tears of the hip in the setting of early radiographic degenerative changes is challenging, with multiple studies showing higher failure rates in this group. This study aims to define the clinical effect of intraarticular injection of iliac crest-derived bone marrow aspirate concentrate (BMAC) at the time of labral-preserving hip arthroscopy in patients with symptomatic labral tears and early radiographic degenerative changes.
A retrospective review of a prospectively collected hip registry database was performed. Patients with a symptomatic labral tear, Tönnis grade 1-2 degenerative changes who underwent labral-preserving hip arthroscopy and BMAC were included and were age- and sex-matched to patients without arthritis who underwent hip arthroscopy without BMAC. Demographic information, patient-reported outcomes measures (PROMs), procedures performed, and failure were evaluated. PROMs collected preoperatively and 6-months, 1-year, and 2-years postoperatively included Modified Harris Hip Score (mHHS), Hip Outcomes Score Activities of Daily Living (HOS ADL), Hip Outcomes Score Sport (HOS Sport), International Hip Outcomes Tool 33 (iHOT-33).
35 patients underwent labral-preserving hip arthroscopy with BMAC and were matched with 35 control patients without arthritis. There was no difference in the mean age at time of surgery (p=0.75), gender (p=0.66) or BMI (p=0.10) of the BMAC group (48.5 ± 11.6 years; 68.6% female; 25.3 + 4.1 kg/m2) compared to the control group (47.9 ± 11.4 years; 68.6% female; 23.1 ± 5.3 kg/m2). The BMAC group was comprised of 31 patients (86.6%) Tönnis grade 1 and 4 (11.4%) grade 2, whereas 35 (100.0%) were Tönnis grade 0 in the controls. All outcomes scores were significantly improved for both groups at 2 years; there was no difference in improvement between the study groups. Failure requiring conversion to total hip arthroplasty was 5/35 (14.3%) at mean 1.6 years and 1/35 (5.7%) at mean 7 years postoperative in the biologic and control groups, respectively (p=0.09).
Labral preserving hip arthroscopy with bone marrow aspirate injection results in statistically and clinically significant improvement in patient-reported outcomes scores for patients with symptomatic labral tears and early radiographic degenerative changes at short term follow-up. Although the proportion of failures requiring total hip arthroplasty is comparable in both groups, the time to conversion is earlier in the BMAC group.
Level of Evidence: Level IV