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

• Published in: The American journal of sports medicine Vol. 45; no. 12; pp. 2882 - 2890
• Main Authors: Domb, Benjamin G., Yuen, Leslie C., Ortiz-Declet, Victor, Litrenta, Jody, Perets, Itay, Chen, Austin W.
• Format: Journal Article
• Language: English
• Published: Los Angeles, CA SAGE Publications 01-10-2017; Sage Publications Ltd
• Subjects: Aged; Aged, 80 and over; Arthroscopy; Arthroscopy - methods; Clinical outcomes; Cohort Studies; Female; Femur Head - surgery; Follow-Up Studies; Hip - diagnostic imaging; Hip - surgery; Hip Injuries - diagnostic imaging; Hip Injuries - surgery; Hip joint; Humans; Joint surgery; Knee; Male; Middle Aged; Pain Measurement; Patient Reported Outcome Measures; Patient Satisfaction; Radiography; Retrospective Studies; Sports medicine; Surgery; Treatment Outcome; Visual Analog Scale; labral repair technique; labral tear; hip arthroscopic surgery; midterm outcomes; labral base repair
• ISSN: 0363-5465; 1552-3365
• DOI: 10.1177/0363546517713731

Background:
Arthroscopic labral base repair (LBR) in the hip is a previously described technique designed to restore the native functional anatomy of the labrum by reproducing its seal against the femoral head. LBR has been shown to have good short-term outcomes.
Hypothesis/Purpose:
The purpose was to evaluate clinical outcomes of an LBR cohort with a minimum 5-year follow-up. It was hypothesized that patients who underwent LBR would continue to have significant improvement from their preoperative scores and maintain scores similar to their 2-year outcomes.
Study Design:
Case series; Level of evidence, 4.
Methods:
Data for patients undergoing primary hip arthroscopic surgery with LBR from February 2008 to May 2011 with a minimum 5-year follow-up were prospectively collected and retrospectively reviewed. Patients with preoperative Tonnis osteoarthritis grade ≥2, previous hip conditions (slipped capital femoral epiphysis, avascular necrosis, Legg-Calv-Perthes disease), severe dysplasia (lateral center-edge angle <18°), or previous ipsilateral hip surgery were excluded. Statistical equivalence tests evaluated patient-reported outcomes (PROs) including the modified Harris Hip Score (mHHS), Non-Arthritic Hip Score (NAHS), Hip Outcome Score–Sport-Specific Subscale (HOS-SSS), visual analog scale (VAS) for pain, and patient satisfaction (0-10 scale; 10 = very satisfied).
Results:
Of the 70 patients (74 hips) who met inclusion and exclusion criteria, 60 (85.7%) patients (64 hips) were available at a minimum 5-year follow-up. All PRO scores significantly improved from preoperative values with a mean follow-up of 67.8 ± 7.4 months (range, 60.0-89.7 months). The mean mHHS increased from 64.4 ±13.8 to 85.3 ± 17.7 (P < .001), the mean NAHS from 63.7 ± 17.0 to 87.0 ± 14.7 (P < .001), and the mean HOS-SSS from 47.1 ± 23.2 to 76.5 ± 25.9 (P < .001). The mean VAS score decreased from 5.9 ± 2.4 to 2.0 ± 2.1 (P < .001). The mean patient satisfaction score was 8.1 ± 2.0. The improvement in PRO scores was sustained from 2- to 5-year follow-up. At 2 and 5 years, survivorship rates were 96.9% and 90.6%, respectively, and the respective secondary arthroscopic surgery rates were 10.9% (7/64) and 17.2% (11/64).
Conclusion:
At a minimum 5-year follow-up, arthroscopic LBR continued to be a successful procedure and valid technique based on 3 PROs, the VAS, patient satisfaction, and survivorship. Significantly improved outcome scores were maintained compared with preoperative values and showed no signs of deterioration from the 2-year scores. The long-term survivorship of hip arthroscopic surgery has yet to be determined; however, these midterm results demonstrate the rates of additional procedures (both secondary arthroscopic surgery and conversion to total hip arthroplasty), that may be necessary after 2 years.