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Dean MC, Cherian NJ, LaPorte ZL, Eberlin CT, Wang C, Torabian KA, Dowley KS, Kucharik MP, Abraham PF, Nazal MR, Martin SD. Association Between Chondrolabral Junction Breakdown and Conversion to Total Hip Arthroplasty After Hip Arthroscopy for Symptomatic Labral Tears: Minimum 8-Year Follow-up. Am J Sports Med 2024; 52:1153-1164. [PMID: 38476016 PMCID: PMC10986152 DOI: 10.1177/03635465241234258] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/30/2023] [Accepted: 12/20/2023] [Indexed: 03/14/2024]
Abstract
BACKGROUND Arthroscopic treatment of femoroacetabular impingement (FAI) and symptomatic labral tears confers short- to midterm benefits, yet further long-term evidence is needed. Moreover, despite the physiological and biomechanical significance of the chondrolabral junction (CLJ), the clinical implications of damage to this transition zone remain understudied. PURPOSE To (1) report minimum 8-year survivorship and patient-reported outcome measures after hip arthroscopy for FAI and (2) characterize associations between outcomes and patient characteristics (age, body mass index, sex), pathological parameters (Tönnis angle, alpha angle, type of FAI, CLJ breakdown), and procedures performed (labral management, FAI treatment, microfracture). STUDY DESIGN Cohort study; Level of evidence, 3. METHODS This retrospective cohort study included patients who underwent primary hip arthroscopy for symptomatic labral tears secondary to FAI by a single surgeon between 2002 and 2013. All patients were ≥18 years of age with minimum 8-year follow-up and available preoperative radiographs. The primary outcome was conversion to total hip arthroplasty (THA), and secondary outcomes included revision arthroscopy, patient-reported outcome measures, and patient satisfaction. CLJ breakdown was assessed using the Beck classification. Kaplan-Meier estimates and weighted Cox regression were used to estimate 10-year survivorship (no conversion to THA) and identify risk factors associated with THA conversion. RESULTS In this study of 174 hips (50.6% female; mean age, 37.8 ± 11.2 years) with mean follow-up of 11.1 ± 2.5 years, the 10-year survivorship rate was 81.6% (95% CI, 75.9%-87.7%). Conversion to THA occurred at a mean 4.7 ± 3.8 years postoperatively. Unadjusted analyses revealed several variables significantly associated with THA conversion, including older age; higher body mass index; higher Tönnis grade; labral debridement; and advanced breakdown of the CLJ, labrum, or articular cartilage. Survivorship at 10 years was inferior in patients exhibiting severe (43.6%; 95% CI, 31.9%-59.7%) versus mild (97.9%; 95% CI, 95.1%-100%) breakdown of the CLJ (P < .001). Multivariable analysis identified worsening CLJ breakdown (weighted hazard ratio per 1-unit increase, 6.41; 95% CI, 3.11-13.24), older age (1.09; 95% CI, 1.04-1.14), and higher Tönnis grade (4.59; 95% CI, 2.13-9.90) as independent negative prognosticators (P < .001 for all). CONCLUSION Although most patients achieved favorable minimum 8-year outcomes, several pre- and intraoperative factors were associated with THA conversion; of these, worse CLJ breakdown, higher Tönnis grade, and older age were the strongest predictors.
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Affiliation(s)
- Michael C. Dean
- Department of Orthopaedic Surgery, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Nathan J. Cherian
- Department of Orthopaedic Surgery, Massachusetts General Hospital, Boston, Massachusetts, USA
- Department of Orthopaedic Surgery, University of Nebraska, Omaha, Nebraska, USA
| | - Zachary L. LaPorte
- Department of Orthopaedic Surgery, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Christopher T. Eberlin
- Department of Orthopaedic Surgery, Massachusetts General Hospital, Boston, Massachusetts, USA
- Department of Orthopaedic Surgery, University of Iowa, Iowa City, Iowa, USA
| | - Charles Wang
- Department of Orthopaedic Surgery, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Kaveh A. Torabian
- Department of Orthopaedic Surgery, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Kieran S. Dowley
- Department of Orthopaedic Surgery, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Michael P. Kucharik
- Department of Orthopaedic Surgery, Massachusetts General Hospital, Boston, Massachusetts, USA
- Department of Orthopaedic Surgery, University of South Florida, Tampa, Florida, USA
| | - Paul F. Abraham
- Department of Orthopaedic Surgery, Massachusetts General Hospital, Boston, Massachusetts, USA
- Department of Orthopaedic Surgery, University of Southern California, Los Angeles, California, USA
| | - Mark R. Nazal
- Department of Orthopaedic Surgery, Massachusetts General Hospital, Boston, Massachusetts, USA
- Department of Orthopaedic Surgery, University of Kentucky, Lexington, Kentucky, USA
| | - Scott D. Martin
- Department of Orthopaedic Surgery, Massachusetts General Hospital, Boston, Massachusetts, USA
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Melugin HP, Comfort SM, Shelton TS, Day HK, Ruzbarsky JJ, Dornan GJ, Philippon MJ. The revision hip arthroscopy complex: capsular deficiency, labral deficiency, femoral over-resection and adhesions can result in good survivorship with revision hip arthroscopy. J Hip Preserv Surg 2023; 10:197-203. [PMID: 38162272 PMCID: PMC10757422 DOI: 10.1093/jhps/hnad026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/17/2022] [Revised: 06/18/2023] [Accepted: 08/16/2023] [Indexed: 01/03/2024] Open
Abstract
To evaluate the patient-reported outcomes (PROs) and survivorship of combined arthroscopic hip labral reconstruction/augmentation, capsular reconstruction, femoral neck remplissage and lysis of adhesions. Patients ≥18 years old who underwent this combination of procedures during revision hip arthroscopy and were eligible for minimum 2-year follow-up were identified. PRO scores including Hip Outcome Score (HOS)-Activities of Daily Living scale, HOS-Sports scale, modified Harris Hip Score, Short Form 12, and Western Ontario & McMaster Universities Osteoarthritis Index, patient satisfaction and failure rates were analyzed. Seven patients (5 females and 2 males) with average age of 45.0 ± 5.2 (range: 40-54 years) met inclusion criteria. Patients had a median of 1 (range: 1-3) prior hip surgery at an outside institution. All patients had previously undergone femoral osteoplasty, and 85% (6/7) of patients had a labral repair performed. Four patients had no capsule closure performed in their prior procedures. Six patients were available for minimum 2-year follow-up. Two patients converted to total hip arthroplasty: one patient with four prior hip arthroscopies and the other had advanced osteoarthritis with outerbridge grade 3/4 defects requiring microfracture. Mean patient satisfaction was 7 (range: 2-9). At mean follow-up of 3 years, most patients who underwent the combination of labral reconstruction, capsular reconstruction, femoral neck remplissage and lysis of adhesions during revision hip arthroscopy demonstrated improved PROs. This salvage procedure has the potential to restore hip function in patients who have failed an initial hip arthroscopy procedure. In patients with these pathologies present and concomitant joint space narrowing, a total hip arthroplasty may be a more appropriate salvage option.
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Affiliation(s)
- Heath P Melugin
- Center for Outcomes-Based Orthopaedic Research, Steadman Philippon Research Institute, 181 W Meadow Dr, Ste 1000, Vail, CO 81657, USA
- Steadman Clinic and United States Coalition for the Prevention of Illness and Injury in Sport, 181 W Meadow Dr, Ste 400, Vail, CO 81657, USA
| | - Spencer M Comfort
- Center for Outcomes-Based Orthopaedic Research, Steadman Philippon Research Institute, 181 W Meadow Dr, Ste 1000, Vail, CO 81657, USA
| | - Trevor S Shelton
- Steadman Clinic and United States Coalition for the Prevention of Illness and Injury in Sport, 181 W Meadow Dr, Ste 400, Vail, CO 81657, USA
| | - Hannah K Day
- Center for Outcomes-Based Orthopaedic Research, Steadman Philippon Research Institute, 181 W Meadow Dr, Ste 1000, Vail, CO 81657, USA
| | - Joseph J Ruzbarsky
- Center for Outcomes-Based Orthopaedic Research, Steadman Philippon Research Institute, 181 W Meadow Dr, Ste 1000, Vail, CO 81657, USA
- Steadman Clinic and United States Coalition for the Prevention of Illness and Injury in Sport, 181 W Meadow Dr, Ste 400, Vail, CO 81657, USA
| | - Grant J Dornan
- Center for Outcomes-Based Orthopaedic Research, Steadman Philippon Research Institute, 181 W Meadow Dr, Ste 1000, Vail, CO 81657, USA
| | - Marc J Philippon
- Center for Outcomes-Based Orthopaedic Research, Steadman Philippon Research Institute, 181 W Meadow Dr, Ste 1000, Vail, CO 81657, USA
- Steadman Clinic and United States Coalition for the Prevention of Illness and Injury in Sport, 181 W Meadow Dr, Ste 400, Vail, CO 81657, USA
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