Does Conservation of the Labrum Decrease the Chances of Conversion to Total Hip Arthroplasty?

Principal Investigator: Scott D. Martin, MD

Authors: Michael P. Kucharik, BS Paul F. Abraham, MD Mark R. Nazal, MD Nathan H. Varady, MD, MBA Christopher T. Eberlin, BS Wendy M. Meek, BBA Sara A. Naessig, BS Alexander E. Adams, BS Scott D. Martin, MD
Lay Abstract

Introduction: 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 total hip arthroplasty (THA).

 

Methods: This is a retrospective cohort study of patients undergoing hip arthroscopy to treat acetabular labral tears (via labral repair or debridement) between April 2007 and October 2014.

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 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).

 

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.

Scientific Abstract

Introduction: 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 total hip arthroplasty (THA).

 

Methods: This is a retrospective cohort study of patients undergoing hip arthroscopy to treat acetabular labral tears (via labral repair or debridement) between April 2007 and October 2014.

 

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 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).

 

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.

Clinical Implications
This study provides evidence that labral repair is superior to debridement in the treatment of acetabular labral tears and femoroacetabular impingement, as patients who underwent labral repair experienced significantly less risk of THA conversion with long term follow-up.

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