In the Journals

Hip arthroscopy with labral reconstruction improved outcomes at 5 years

Published results showed significant improvements in patient-reported outcomes at a minimum of 5 years among patients who underwent hip arthroscopy with segmental labral reconstruction. These results were comparable with patients who underwent primary labral repair, except primary labral reconstruction resulted in lower patient satisfaction scores.

“When faced with an irreparable labrum, labral reconstruction can give us an excellent and durable solution once the technical challenges have been overcome by the surgeon,” Benjamin G. Domb, MD, FAOA, co-author of the study and medical director of the American Hip Institute, told Healio.com/Orthopedics. “However, when the labrum is viable and reparable, it is our present practice that it be repaired and preserved, and not replaced with a reconstruction.”

Domb and colleagues identified 28 patients who underwent hip arthroscopy for segmental labral reconstruction in the setting of irreparable labral tear and femoroacetabular impingement and had a minimum 5-year follow-up for modified Harris Hip Score, nonarthritic hip score, hip outcome score–sports specific subscale, patient satisfaction and VAS for pain. Researchers performed a nested matched-pair analysis in which patients undergoing primary labral reconstruction were compared with a control group of patients who underwent primary labral repair based on age, sex and BMI.

Overall, 82.14% of patients who underwent primary labral reconstruction had a minimum 5-year follow-up. From preoperative to latest follow-up, patients experienced a 17.8-point increase in modified Harris Hip Score, a 22-point increase in nonarthritic hip score, a 25.4-point increase in hip outcome score–sports specific subscale and a 2.9-point decrease in VAS pain ratings, all of which were significant improvements. Researchers noted patients had a mean satisfaction score of 7.1 out of 10.

The nested matched-pair analysis showed comparable survivorship and comparable improvements in all patient-reported outcomes among 17 patients who underwent primary labral reconstruction and 51 patients who underwent primary labral repair. However, researchers found patients who underwent primary labral repair had higher patient satisfaction scores compared with patients who underwent primary labral reconstruction.

“I personally was not surprised that patient satisfaction is higher when we are able to preserve the patient’s own labrum, but was encouraged to find that when labral repair is not an option, the other patient-reported outcome scores are equivalent with labral reconstruction,” Domb said. – by Casey Tingle

Disclosures: Domb reports he has had ownership interests in Hinsdale Orthopaedics, the American Hip Institute, SCD#3, North Shore Surgical Suites and Munster Specialty Surgery Center; has received research support from Arthrex, ATI, the Kaufman Foundation, Pacira Pharmaceuticals and Stryker; received consulting fees from Adventist Hinsdale Hospital, Arthrex, Mako Surgical, Medacta, Pacira Pharmaceuticals and Stryker; educational support from Arthrex, Breg and Medwest; royalties from Arthrex, DJO Global, Mako Surgical, Stryker and Orthomerica; and speaking fees from Arthrex and Pacira Pharmaceuticals. Please see the study for a list of all other authors’ relevant financial disclosures.

Published results showed significant improvements in patient-reported outcomes at a minimum of 5 years among patients who underwent hip arthroscopy with segmental labral reconstruction. These results were comparable with patients who underwent primary labral repair, except primary labral reconstruction resulted in lower patient satisfaction scores.

“When faced with an irreparable labrum, labral reconstruction can give us an excellent and durable solution once the technical challenges have been overcome by the surgeon,” Benjamin G. Domb, MD, FAOA, co-author of the study and medical director of the American Hip Institute, told Healio.com/Orthopedics. “However, when the labrum is viable and reparable, it is our present practice that it be repaired and preserved, and not replaced with a reconstruction.”

Domb and colleagues identified 28 patients who underwent hip arthroscopy for segmental labral reconstruction in the setting of irreparable labral tear and femoroacetabular impingement and had a minimum 5-year follow-up for modified Harris Hip Score, nonarthritic hip score, hip outcome score–sports specific subscale, patient satisfaction and VAS for pain. Researchers performed a nested matched-pair analysis in which patients undergoing primary labral reconstruction were compared with a control group of patients who underwent primary labral repair based on age, sex and BMI.

Overall, 82.14% of patients who underwent primary labral reconstruction had a minimum 5-year follow-up. From preoperative to latest follow-up, patients experienced a 17.8-point increase in modified Harris Hip Score, a 22-point increase in nonarthritic hip score, a 25.4-point increase in hip outcome score–sports specific subscale and a 2.9-point decrease in VAS pain ratings, all of which were significant improvements. Researchers noted patients had a mean satisfaction score of 7.1 out of 10.

The nested matched-pair analysis showed comparable survivorship and comparable improvements in all patient-reported outcomes among 17 patients who underwent primary labral reconstruction and 51 patients who underwent primary labral repair. However, researchers found patients who underwent primary labral repair had higher patient satisfaction scores compared with patients who underwent primary labral reconstruction.

“I personally was not surprised that patient satisfaction is higher when we are able to preserve the patient’s own labrum, but was encouraged to find that when labral repair is not an option, the other patient-reported outcome scores are equivalent with labral reconstruction,” Domb said. – by Casey Tingle

Disclosures: Domb reports he has had ownership interests in Hinsdale Orthopaedics, the American Hip Institute, SCD#3, North Shore Surgical Suites and Munster Specialty Surgery Center; has received research support from Arthrex, ATI, the Kaufman Foundation, Pacira Pharmaceuticals and Stryker; received consulting fees from Adventist Hinsdale Hospital, Arthrex, Mako Surgical, Medacta, Pacira Pharmaceuticals and Stryker; educational support from Arthrex, Breg and Medwest; royalties from Arthrex, DJO Global, Mako Surgical, Stryker and Orthomerica; and speaking fees from Arthrex and Pacira Pharmaceuticals. Please see the study for a list of all other authors’ relevant financial disclosures.