A study of 50 patients who had MRI-documented labral tears who failed
conservative management but subsequently underwent
hip arthroscopy for labral debridement, found that
preoperative arthritis is the greatest prognostic factor for poor outcomes.
Before undertaking the study, lead author Morteza Meftah, MD, a clinical
research fellow at the Hospital for Special Surgery in New York City, and
coauthor Jose Rodriquez, MD, chief of Adult Reconstruction at Lenox Hill
Hospital in New York City, discovered there was limited published literature
about the long-term results of
arthroscopic labral debridement.
Recent reports focus on short- to mid-term comparison of labral fixation
to debridement, and most do not assess coexisting pathologies as confounding
factors. “Biomechanical functions of the labrum, such as enhancing and
preserving joint stability and congruity through sealing mechanism with
negative pressure, is fascinating” Meftah said.
Patients in the current study had a mean age of 40 years, and underwent
hip arthroscopy for labral debridement between 1996 and 2003. The mean
follow-up was of 8.3 years. The study investigated the effect of coexisting
pathologies, including arthritis,
femoroacetabular impingement (FAI) and dysplasia on outcomes
using the Harris Hip Score (HHS) and a patient-satisfaction survey.
Study results, which were presented at the
2010 Meeting of the Combined Meeting of the Orthopaedic
Associations in Glasgow, Scotland, indicate that low postoperative HHS has
a strong correlation with coexisting pathology, especially arthritis.
“Although patients with arthritis did not do as well overall as
patients without arthritis, 92% of patients achieved good or excellent results,
which was a bit surprising,” Meftah told Orthopedics Today. “This may
be due to the fact that HHS is not the optimum tool for clinical analysis for
this study and may have a ceiling effect, but for the sake of comparison to
preoperative data, we chose to use this tool. Several reports of short- to
mid-term follow-up of labral fixation show better results than just labral
Correlation to arthritis
Of the 50 patients, 22 were noted to have arthritis preoperatively or
intraoperatively, of which about two-thirds did not fare as well as those
patients without arthritis. In addition, two of the 11 patients who had FAI but
were not treated at the time of index surgery also resulted in inferior
results, leading to a second operation for decompression of cam lesion.
“Therefore, FAI should be addressed at the time of surgical intervention
for treatment of labral tears for better outcomes,” Meftah said.
The satisfaction survey revealed that 84% of patients were satisfied
with pain relief and functional recovery after surgery. Two patients with
arthritis had subsequent total hip replacement.
“It is interesting that all eight dissatisfied patients had
arthritis, and satisfaction had a strong correlation with absence of
arthritis,” Meftah said. “This finding is similar to other published
reports that indicate arthritis is a poor prognostic indicator.”
Indications for labral debridement are dependent on the type of tear and
location. Although selective debridement of symptomatic labral tears can result
in favorable outcomes, in nondegenerative tears that are repairable, one should
repair the labrum and address coexisting pathologies such as FAI, according to
Meftah. “Prospective randomized studies with longer follow-ups and larger
numbers of patients comparing labral debridement to labral fixation are also
needed for more accurate results.” – by Bob Kronemyer
- Meftah M, Rodriguez J, Alexiades M. Long-term results of hip
arthroscopy for labral tears: predictors of outcomes. Presented at the 12th
Meeting of the Combined Meeting of the Orthopaedic Associations. Sept. 12-17.
- Morteza Meftah, MD, can be reached at Hospital for Special Surgery,
535 E. 70th St., 6th Floor, New York, New York, 10021; 646-797-8716; e-mail:
We are beginning to see long-term outcome studies of arthroscopic hip
surgeries. I believe most hip arthroscopic surgeons already recognize advanced
arthritis as a relative if not absolute contraindication. Perhaps more
surprising, this study as well as recent ones by Byrd and McCarthy with minimum
10-year follow-up show relatively durable improvements are possible following
even arthroscopic partial labral debridements in patients without advanced
arthritis or chondral damage. Keep in mind that the aforementioned longer-term
studies are reporting outcomes of the then-current procedures (eg,
intra-articular or central compartment hip arthroscopies with selective labral
debridements) for then-current diagnoses (eg, labral tears). Hip arthroscopy
has since evolved with the addition of conditions such as femoroacetabular
impingement and procedures including peripheral compartment arthroscopies,
acetabulo- and femoroplasties, and labral repairs/reconstructions. Although
more demanding, these procedures have the potential to also be more definitive.
Despite conflicting evidence both for and against the efficacy of hip
arthroscopy in milder degrees of coxarthrosis, as noted by Stevens, studies
such as this one showing poorer outcomes with more advanced arthritis and/or
more severe chondral damage help refine the indications for hip arthroscopy
while supporting the rationale for early detection, preventative measures and
treatment of labrochondral pathology.
– Dean K. Matsuda, MD
Los Angeles, CA
- Byrd JWT, Jones KS: Prospective analysis of hip arthroscopy with
10-year follow-up. Clin Orthop Relat Res. 2010;468(3):741.
- Byrd JWT, Jones KS: Hip arthroscopy for labral pathology:
Prospective analysis with 10-year follow-up. Arthroscopy. 2009;
- Byrd JWT, Jones KS: Hip arthroscopy in athletes: 10-year follow-up.
Am J Sports Med. 2009;37:2140-2143.
- McCarthy JC, Jarrett BT, Ojeifo O, Lee JA, Bragdon CR. What Factors
Influence Long-term Survivorship After Hip Arthroscopy? Clin Orthop Relat
Res. 2010; 25(9). [Epub ahead of print]
- Stevens MS, Legay DA, Glazebrook MA, Amirault D. The evidence for
hip arthroscopy: grading the current indications. Arthroscopy.
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