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Iatrogenic labral punctures during hip arthroscopy have no major effect at 1-year
Clinical outcomes between patients with and without punctures displayed similar findings.
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Iatrogenic labral punctures sustained during hip arthroscopy do not affect the 1-year outcomes of patients, according to a recently presented study.
The findings were presented by John S. Badylak, MD, at the American Orthopaedic Society for Sports Medicine annual meeting.
According to Badylak, although there was a slight difference in findings between a group of patients that sustained injuries and a group that did not, that difference was not significant and did not grow greater over the course of a year during several follow-ups.
No difference
“This study demonstrates that the clinical outcomes of the punctures are no different than the patients that did not have punctures at 1-year follow-up,” he said.
Although iatrogenic labral punctures have been estimated to occur in 18% of hip arthroscopies, the consequences of those punctures had not previously been documented. Badylak’s study aimed to examine the problem by comparing the results of 50 patients who had iatrogenic labral punctures (ILP) with those of a demographically matched group of 50 patients who did not have labral punctures (NLP) during their hip arthroscopy.
Fifty patients with ILPs were identified from a database of 250, and those ILPs were recorded. The results of their hip arthroscopies were compared with those of 50 demographically matched NLP patients with similar arthroscopic procedures selected from the remaining 200 in the database. Byrd’s 100-point modified Harris hip scoring system was used to assess the hips before arthroscopy, as well as at 1.5, 3, 6 and 12 months afterward.
Study findings
Badylak reported average preoperative scores of 36 points, with an average joint distraction of 13 mm and 15 mm in the ILP and NLP patients, respectively. Byrd’s sign — the lack of movement in the initial guide needle after the injection of fluid – was seen in both ILP (85%) and NLP (42%) patients.
“When measuring the joint distraction, the puncture group had a distraction of 13 mm on average, but the patients with no puncture had a distraction of 15 mm, and this was a significant difference,” Badylak said.
After surgery, the two groups had improvement of their hip pain and 6-week scores that averaged 74 and 76 points in ILP and NLP patients, respectively. Badylak reported no significant differences between the scores of the two groups at any particular follow-up.
Injuries occurred despite similar joint distraction in both ILP and NLP patients.
“These punctures did occur despite what was previously thought to be acceptable joint distraction,” Badylak said. “Also, Byrd’s sign was fairly sensitive – it showed up in 85% of the patients with punctures, but it carried a false positive in the 42% without punctures.
“We recognize that this is a short, 1-year follow-up, and a larger follow-up would be nice to see in the future,” he added.
For more information:John S. Badylak, MD, is a resident with the Department of Orthopedic Surgery at the University of Wisconsin-Madison. He can be reached at Department of Orthopedic Surgery, University of Wisconsin-Madison, 600 Highland Ave., Madison, WI 53792-3236; e-mail: js.babylak@hosp.wisc.edu. He has no direct or financial interest in any company or product mentioned in this article.
- Reference:
Badylak JS, Keene JS. Results of hip arthroscopy in patients that sustain iatrogenic punctures of the labrum. Presented at the American Orthopaedic Society for Sports Medicine. July 9-12, 2009. Keystone, CO.