Hip Arthroscopy in Patients Ages 50 Years or Older: Minimum 5-Year Outcomes, Survivorship, and Risk Factors for Conversion to Total Hip Replacement

Perets, Itay; Chaharbakhshi, Edwin O.; Mu, Brian; Ashberg, Lyall; Battaglia, Muriel R.; Yuen, Leslie C.; Domb, Benjamin G.

doi:10.1016/j.arthro.2018.05.034

Cited by 59 publications

(72 citation statements)

References 36 publications

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“…Recently the outcomes in patients older than 50 and 60 have been shown to significantly improve at a mean of 22 and 26 months respectively. Importantly, both studies excluded patients with Tönnis grade ≥ 2 and had 100% and 88% survival rates [32,33].…”

Section: Repairmentioning

confidence: 99%

Surgical Treatment of Labral Tears: Debridement, Repair, Reconstruction

Woyski

Mather

2019

Curr Rev Musculoskelet Med

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Purpose of Review With the rapid growth of hip arthroscopy over the past decade, new treatment paradigms as well as recognition of new disease states have sprung forth. The ability to perform complex arthroscopic procedures of the hip such as labral augmentation and reconstruction is essential for hip arthroscopists in the revision setting, with patient selection and indications for various labral treatments the key driver for improved short-and mid-term clinical outcomes. Recent Findings Current techniques have been developed to address disease states where the labrum is either unstable, torn, deficient, or otherwise incompetent. Many early reports focused on the description of these techniques with new literature reporting short-and mid-term outcomes. A few of these have demonstrated improved outcomes with a contemporary arthroscopy with emphasis on capsule preservation and repair. Summary Studies have demonstrated that labral repair has improved outcomes over labral debridement, with results of labral reconstruction in a revision approaching those of labral repair. In addition, newer reports have shown significantly improved outcomes and survivorship with capsule repair and therefore should be included in every hip arthroscopy.

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Section: Repairmentioning

confidence: 99%

Surgical Treatment of Labral Tears: Debridement, Repair, Reconstruction

Woyski

Mather

2019

Curr Rev Musculoskelet Med

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“…In their systematic review, Levy et al 5 found that a large percentage of patients who undergo hip arthroscopy achieve the MCID with respect to PROs (>90%) but a much smaller percentage achieve the PASS: 88% with respect to the mHHS but far fewer (25%-30%) with respect to the Hip Outcome Score. The results of PROs reported by Perets et al 3 in patients aged 50 years or older were less encouraging: With respect to the mHHS, a smaller percentage of patients achieved the MCID (52.1% vs 97%) and PASS (54.3% vs 88%). In addition, although this study did not specify the percentage of patients who achieved the PASS with respect to the HOS-SSS, the average HOS-SSS reported was lower than the minimum PASS for this outcome measure (73.9 vs 75), suggesting that a minimal number of patients in this population will achieve an acceptable HOS-SSS.…”

Section: See Related Article On Page 3001mentioning

confidence: 81%

Editorial Commentary: Hip Arthroscopy in an Aging Patient Population—Is 50 the New 40?

Shore¹

2018

Arthroscopy: The Journal of Arthroscopic & Related Surgery

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“…9 Another study assessed minimum 5-year outcomes after arthroscopic labral debridement or repair and noted a 27.7% rate of conversion to THA. 23 These findings are concerning because patients with a preserved joint space and no evidence of advanced cartilage pathology may be presented with few treatment options for hip pain for which conservative treatment has failed, when in fact labral preservation procedures may reduce pain and improve function. More rigorous research and evidence are needed to better understand the impact of various treatment options on outcomes among patients with recalcitrant hip pain; however, the results of our study suggest that arthroscopic labral reconstruction can lead to significant improvements in pain and function and a low revision rate among patients aged 40 years and older with labral pathology, a preserved joint space, and minimal or no cartilage pathology.…”

Section: Discussionmentioning

confidence: 99%

Hip Arthroscopy in Patients Aged 40 Years and Older: Greater Success With Labral Reconstruction Compared With Labral Repair

White

Patterson²,

Scoles

et al. 2020

Arthroscopy: The Journal of Arthroscopic & Related Surgery

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To assess the outcomes of complete, primary, arthroscopic hip labral reconstruction among patients aged 40 years and older compared with those who underwent primary labral repair and compared with patients aged 30 to 39 years who underwent complete, primary labral reconstruction. Methods: We recruited all patients who underwent arthroscopic labral reconstruction between March 2010 and June 2015 and were aged 30 to 65 years or who underwent arthroscopic labral repair between June 2009 and June 2015 and were aged 40 to 65 years. The modified Harris Hip Score (mHHS), Lower Extremity Function Score, and visual analog scale score for average pain were collected preoperatively and at minimum 2year follow-up. Failure was defined as the need for revision ipsilateral hip surgery. The rate of conversion to total hip arthroplasty (a subset of failure) was assessed separately. Results: A total of 363 hips in 343 patients met the inclusion criteria. Follow-up was available for 312 hips (86.0%), and the average time to follow-up was 4.2 years (range, 2.0-8.5 years). After adjustment for differences in follow-up time between groups, failure was 3.29 times more likely for hips in the repair group aged 40 years and older than for hips in the reconstruction group aged 40 years and older (relative rate, 3.29; 95% confidence interval, 1.25-8.69; P ¼ .02), and there was no difference in the failure rate for hips in the reconstruction group aged 40 years and older compared with hips in the reconstruction group aged 30 to 39 years (relative rate, 0.58; 95% confidence interval, 0.18-1.89; P ¼ .37). The rate of conversion to total hip arthroplasty was not meaningfully different between the 3 groups. Among hips for which treatment did not fail, average improvement in the mHHS measured 35 points and both labral reconstruction groups saw a greater mHHS improvement than the labral repair group of patients aged 40 years and older (P ¼ .01 and P < .01). Conclusions: Labral reconstruction led to a lower failure rate, greater average improvement in the mHHS, and equivalent postoperative patient-reported outcome scores compared with labral repair among patients aged 40 years and older in this study population, and the outcomes of labral reconstruction were similar between patients aged 40 years and older and those aged 30 to 39 years. Complete labral reconstruction may be particularly advantageous in patients aged 40 years and older. Level of Evidence: Level III, retrospective comparative study.

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Hip Arthroscopy in Patients Ages 50 Years or Older: Minimum 5-Year Outcomes, Survivorship, and Risk Factors for Conversion to Total Hip Replacement

Cited by 59 publications

References 36 publications

Surgical Treatment of Labral Tears: Debridement, Repair, Reconstruction

Surgical Treatment of Labral Tears: Debridement, Repair, Reconstruction

Editorial Commentary: Hip Arthroscopy in an Aging Patient Population—Is 50 the New 40?

Hip Arthroscopy in Patients Aged 40 Years and Older: Greater Success With Labral Reconstruction Compared With Labral Repair

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