Perspective

Study finds arthritis strongest predictor of poor outcomes after arthroscopic labral debridement

Morteza Meftah, MD
Morteza Meftah

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.

Coexisting pathologies

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 debridement.”

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

Reference:
  • 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. Glasgow, Scotland.

  • 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: meftahm@hss.edu.

Perspective

Dean K. Matsuda, MD
Dean K. Matsuda

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

References:
  • 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; 25(4);365-368.
  • 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. 2010; 26(10):1370-1383.

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Morteza Meftah, MD
Morteza Meftah

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.

Coexisting pathologies

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 debridement.”

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

Reference:
  • 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. Glasgow, Scotland.

  • 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: meftahm@hss.edu.

Perspective

Dean K. Matsuda, MD
Dean K. Matsuda

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

References:
  • 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; 25(4);365-368.
  • 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. 2010; 26(10):1370-1383.

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