Arthroscopic Labral Base Repair in the Hip: 5-Year Minimum Clinical Outcomes

Hip Arthroscopy for Femoroacetabular Impingement and Labral Tears in Patients Younger than 50 Years: Minimum Five-year Outcomes, Survivorship, and Risk Factors for Reoperations

INTRODUCTION

There is a paucity of literature on mid-term outcomes for hip arthroscopy for femoroacetabular impingement and labral tears.

METHODS

Inclusion criteria were age at surgery <50 years and documented preoperative patient-reported outcomes. Patients with a Tönnis grade >0 or previous ipsilateral hip conditions were excluded.

RESULTS

Of 407 eligible cases, 327 hips (295 patients) had minimum 5-year follow-up. Mean age was 32.4 years. All mean patient-reported outcomes and visual analog scale improved at follow-up (P < 0.001). Mean satisfaction was 7.9. Thirty-eight hips (11.6%) required secondary arthroscopy at a mean of 25.1 months. Survivorship at minimum 5 years was 92.4%. The complication rate was 7.0%.

CONCLUSIONS

Hip arthroscopy for management of femoroacetabular impingement and labral tears in patients aged <50 demonstrates favorable and safe mid-term outcomes. Several risk factors for conversion to total hip arthroplasty in this age group warrant cautious patient selection for arthroscopy.

Labral Repair of the Acetabulum Using a Toggle Suture Technique

Acetabular labral repair requires positioning the labrum on the edge of the acetabulum with appropriate tension and rotation to recreate the suction seal with the femoral head. Considering that the labrum is a triangular shape in cross-section, rotation of the articular face of the labrum relative to the femoral head also affects the suction seal. The purpose of the toggle suture technique described herein is to control the rotation of the labrum to allow the articular face to directly contact the femoral head and optimize the suction seal. The technique is performed by passing the midaspect of a suture around the labrum at the chondrolabral junction. The loop is retrieved and delivered outside the same portal. One of the 2 free suture tails is then passed through the loop, which is then manually tensioned. This creates a single loop around the labrum with a suture tail on either side that allows for rolling, or "toggling," of the labrum to place the articular face in line with the femoral head.

[Application of arthroscopic surgery combined with direct anterior approach in hip diseases]

Objective

To evaluate the short-term effectiveness of arthroscopic surgery combined with direct anterior approach for hip diseases.

Methods

A retrospective study was performed on 23 cases with hip diseases (23 hips), who were treated with the arthroscopic surgery combined with direct anterior approach, between January 2015 and December 2016. There were 9 males and 14 females, aged from 27 to 49 years (mean, 38.6 years). There were 11 cases of posterior dislocation of the hip associated with femoral head fracture (Pipkin typeⅠ) and 7 cases of femoral neck fracture (Garden type Ⅳ). And the interval between injury and operation was 2-8 days (mean, 4.3 days). Five cases were osteonecrosis of femoral head at precollapse stage which were rated as stageⅡA according to Association Research Circulation Osseous (ARCO) classification system. The disease duration was 3-8 months (mean, 5.9 months). The preoperative Harris hip score, Oxford Hip Score (OHS), Postel score, and visual analogue scale (VAS) were 57.3±8.2, 11.2±3.6, 3.2±1.5, and 7.2±1.3, respectively.

Results

All the wounds healed primarily. Lateral femoral nerve injury occurred in 3 cases. All patients were followed up 8-19 months (mean, 15.6 months). Bone union achieved in all patients after 14-19 weeks (mean, 15.8 weeks) and no secondary osteoarthritis or heterotopic ossification occurred. At last follow-up, the Harris hip score (92.5±5.3), OHS (36.5±5.9), and Postel score (14.2±2.6) were significantly higher than preoperative scores ( t=45.274, P=0.000; t=36.586, P=0.000; t=32.486, P=0.000), and VAS score (1.8±0.9) was significantly lower than preoperative score ( t=21.314, P=0.000).

Conclusion

Arthroscopic surgery combined with direct anterior approach for hip diseases can effectively relieve pain, improve hip function, and obtain the satisfactory short-term effectiveness.

Fresh Osteochondral Allograft Transplantation for Treatment of Large Cartilage Defects of the Femoral Head: A Minimum Two-Year Follow-Up Study of Twenty-Two Patients

BACKGROUND

Controversy remains over the surgical management of large osteochondral lesions of the femoral head in young, active patients. The purpose of this study is to assess midterm clinical and radiographic outcomes after fresh osteochondral allograft transplantation (OAT) for large femoral head lesions at minimum 2-year follow-up.

METHODS

A retrospective review of prospectively collected data was performed for 22 patients under the age of 50 years with defined femoral head osteochondral lesions who underwent fresh OAT between 2008 and 2015. Patients were assessed clinically using the modified Harris Hip Score (mHHS) preoperatively and at each follow-up visit. Postoperative radiographs were evaluated for graft integrity and Kellgren & Lawrence Grade for osteoarthritis severity. Complications and reoperation were assessed by chart review. Kaplan-Meier survivorship analyses with 95% confidence intervals were performed for the end point of conversion to total hip arthroplasty.

RESULTS

At a mean follow-up of 68.8 months (26-113), the mean mHHS improved significantly (P < .001) from 48.9 (19-84) to 77.4 (35-98). Sixteen of 22 patients (72.7%) had an mHHS ≥70 at the latest follow-up. Arthritic progression, as indicated by an increase in the Kellgren & Lawrence Grade, occurred in 4 of 22 hips (18.2%). Five patients (22.7%) underwent conversion to total hip arthroplasty. Graft survivorship was 86.4 ± 7.3% at 2 years, 78.5 ± 10.0% at 5 years, and 67.3 ± 13.5% at 9 years.

CONCLUSION

Fresh OAT may be a viable treatment option for osteochondral defects of the femoral head in young, active patients with minimal preexisting joint deformity.