For adults 40 years of age and older, hip arthroscopy labral reconstruction offers better results than arthroscopic labral repair, according to a new study.
Labral Reconstruction More Successful in Older Adults
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Secondary#hiparthroscopy#labralreconstruction#labralrepairs
In the study, “Hip Arthroscopy in Patients Ages 40 Years and Older: Greater Success With Labral Reconstruction Compared With Labral Repair,” published in the August 2020 issue of the journal Arthroscopy, there was a lower failure rate with labral reconstruction than with labral repair.
The 312 hip study followed patients for four years after their hip arthroscopy. The labral reconstruction patients had surgery between March 2010 and June 2015 and were between the ages of 30 and 65 years of age. The labral repair patients were treated between June 2009 and June 2015 and were between 40 and 65 years of age.
The researchers measured the modified Harris Hip Score (mHHS), Lower Extremity Function Score, and Visual Analog Scale score for average pain. Failure was defined as the need for revision ipsilateral hip surgery.
Overall, the failure rate was 3.29 times more likely in hips in the repair group than hips in the reconstruction group. In the reconstruction group, there was no difference in the failure rate for patients aged 40 years and older versus those aged 30 to 39 years of age. The rate of conversion to total hip arthroplasty was not meaningfully different between the three groups.
For hips where treatment did not fail, the average improvement in the mHHS measured 35 points. Overall, the labral reconstruction group saw the most significant improvements.
The researchers wrote, “Labral reconstruction led to a lower failure rate, greater average improvement in the mHHS, and equivalent post-operative, patient-reported outcome scores compared with labral repair among patients aged 40 years and older in the study population, and the outcomes of labral reconstruction were similar between patients aged 40 years and older and those aged 30 to 39 years.
They concluded that “…complete labral reconstruction may be particularly advantageous in patients aged 40 years and older.”
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This is a fascinating development. In my practice we've seen similar outcomes with the revised protocol. The key differentiator seems to be patient selection criteria. Has anyone else noticed the correlation with BMI thresholds?
Great point. I'd push back slightly on the conclusion, the sample size in the cited study is too small to draw population-level inferences. That said, the directional signal is compelling and worth a larger RCT.
We implemented a similar approach last year. Early results are promising but we're still gathering 12-month follow-up data. Happy to share our protocol if anyone is interested.
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