2015 ISAKOS Biennial Congress Paper #0

Long-Term Outcomes of Arthroscopic Labral Repair Versus Labral Debridement: Which Precludes Patients from Total Hip Arthroplasty Conversion?

Michael Peter Kucharik, BS, Boston, Massachusetts UNITED STATES
Paul F Abraham, BS, Boston, Massachusetts UNITED STATES
Mark R. Nazal, MPH, Stoneham, MA UNITED STATES
Nathan Varady, MD, MBA, New York, NY UNITED STATES
Christopher T Eberlin, BS, Boston, MA UNITED STATES
Wendy Madeline Meek, BBA, Boston, Massachusetts UNITED STATES
Nathan J Cherian, MD, Somerville, Massachusetts UNITED STATES
Kieran Sinclair Dowley, BA, Boston, Massachusetts UNITED STATES
Stephen M Gillinov, AB, New Haven, CT UNITED STATES
Scott D Martin, MD, Boston, MA UNITED STATES
Department of Orthopaedic Surgery, Massachusetts General Hospital / Harvard Medical School, Boston, MA, UNITED STATES

FDA Status Not Applicable

Summary: Patients who underwent labral repair were less likely to convert to THA when compared to patients who underwent labral debridement despite adjusting for differences in baseline demographics and preexisting pathology.

Abstract:

Background

Arthroscopic treatment for labral tears includes debridement and repair. Currently, long-term studies have failed to demonstrate a difference in conversion to total hip arthroplasty (THA). The purpose of this study was to investigate two different labral treatments, debridement and repair, with an adjusted analysis to evaluate the long-term conversion to THA.

Methods

This is a retrospective cohort study of patients undergoing hip arthroscopy by a single surgeon between April 2007 and October 2014. Postoperative follow-up information included conversion to THA, patient-reported outcome measures and patient satisfaction.

Results

Of the 204 hips included in the study, 99 (48.5%) and 105 (51.5%) underwent labral repair and debridement, respectively. Twenty-eight (13.7%) of the 204 patients underwent conversion to THA within 10 years following hip arthroscopy [labral repair: 5 (5.1%) vs. labral debridement: 23 (21.9%)]. Labral repair remained associated with significantly lower risk of conversion to THA compared to debridement (hazard ratio [HR] = 0.24, 95% CI 0.07-0.74, p = 0.01). Additional factors associated with risk of conversion to THA included increasing age at time of arthroscopy (HR = 1.06 per year, 95% CI 1.02-1.11, p = 0.002) and Tönnis grade (HR = 2.39, CI 1.14-5.41, p = 0.026). Abrasion chondroplasty, acetabuloplasty, BMI, Outerbridge grade, and radiographic FAI were not found to be significantly associated with risk of THA. There was no significant difference between groups for patient satisfaction [87 (87.9%) v 89 (84.8%), p=0.63]. Similarly, for patients who did not convert to THA, there was no difference in mean patient-reported outcome measures at final follow-up for mHHS, HOS-ADL, HOS-Sport, iHOT-33, NAHS, or LEFS.

Conclusion

Patients who underwent labral repair were less likely to convert to THA when compared to patients who underwent labral debridement despite adjusting for differences in baseline demographics and preexisting pathology. Additional factors associated with a lower rate of hip survival were older age and osteoarthritis at the time of hip arthroscopy.

ACKNOWLEDGEMENTS: Conine Family Foundation for Joint Preservation