Labral degeneration prior to hip arthroscopy yielded worse functional outcomes
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Patients with greater than 50% labral degeneration prior to hip arthroscopy had worse hip specific functional outcomes at a minimum 2-year follow-up, according to results.
In this multicenter study, Dominic S. Carreira, MD, and colleagues categorized 613 patients into groups based on whether they had less than 50% labral degeneration (n=473; control group) or greater than 50% labral degeneration (labral degeneration group; n=140) prior to arthroscopic hip surgery. At a minimum 2-year follow-up, researchers collected International Hip Outcome Tool-12 (iHOT-12) scores, as well as minimal clinically important difference, substantial clinical benefit and patient-acceptable symptom state (PASS).
In his presentation at the Arthroscopy Association of North America and American Orthopaedic Society for Sports Medicine Specialty Day, Carreira noted patients with labral degeneration had worse baseline scores, with a preoperative iHOT-12 score of 33 vs. 37 in the control group. The groups also had significant differences in 2-year iHOT-12 outcome scores, as well as significant differences in minimal clinically important difference of 10%, PASS of 16% and substantial clinical benefit of 16%, according to Carreira.
When acetabular cartilage damage was reviewed as a possible confounder, Carreira said investigators found some degree of acetabular cartilage damage documented in about half of the study group for both patients in the degenerated and control group.
“In looking at our results, we also did a logistic regression model controlling for baseline iHOT-12, age, BMI and gender, and labral degeneration was found to be an independent negative predictor of achieving all clinical significant thresholds as a difference,” Carreira said in his presentation. “This is noted with odds ratios in minimal clinical important difference, PASS and, again, substantial clinical benefit.”
Perspective
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I enjoyed the Arthroscopy Association of North America and American Orthopaedic Society for Sports Medicine Specialty Day presentation “Labral degeneration prior to hip arthroscopy yielded worse functional outcomes” by Dominic S. Carreira, MD, and colleagues. I commend the authors on their multicenter study design and thoughtful question.
Several questions arise as I took in the results. The most predictable hip to manage arthroscopically is possibly the normal volume hip with a labral tear and anteriorly based cam deformity. Labral degeneration might indicate a more challenging anatomy (Pincer-type deformities or Osseous instability/dysplasia) or patient population (hypermobility/soft tissue instability). Management of global acetabular and posterior over-coverage can be challenging arthroscopically. Patients with soft tissue instability or dysplasia are also more challenging to manage arthroscopically and, in some cases, require open corrective osteotomies. A detailed evaluation of preoperative and postoperative radiographic parameters might be critical to determine future directions regarding this topic. Is the labral degeneration the primary reason for inferior outcomes with future consideration of labral reconstruction based on degree of degeneration? Or, alternatively, might the femoral and acetabular anatomy be the primary reason for labral degeneration with the need to improve our arthroscopic techniques or even consider open corrective procedures for this subset of challenging patients?
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Carreira DS, et al. Paper 16. Presented at: Arthroscopy Association of North America and American Orthopaedic Society for Sports Medicine Specialty Day; March 17 and 18, 2021 (virtual meeting).
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