Summary

Patients with large labral tears (>60°) have significantly worse outcomes and a significantly greater conversion rate to THA than those with small labral tears (≤60°) but experiences no significant difference in pain relief

Abstract

Introduction

There is a paucity of literature on the effects of labral tear size on long-term patient-reported outcomes (PROMs), conversion to total hip arthroplasty (THA) after hip arthroscopy, and pain relief. So, this study aims to contribute to the knowledge about the relative influences of factors affecting the outcomes of hip arthroscopy for symptomatic labral tears secondary to femoroacetabular impingement, specifically in the long-term.

Methods

This retrospective cohort study included patients who underwent primary hip arthroscopy for symptomatic labral tears secondary to femoroacetabular impingement by a single surgeon from 2002 to 2013; they completed surveys for modified Harris Hip Score (mHHS), Hip Outcome Score–Activities of Daily Living (HOS-ADL), Lower Extremity Functional Scale (LEFS), and pain relief. Patients ≤18 years of age, Tönnis grade ≥2, and no labral tears were excluded. Included patients were stratified into two cohorts: small labral tear (SLT), ≤60°, and large labral tear (LLT), >60°. Student’s t-tests and multivariate linear regression were used to compare outcomes between cohorts, and Kaplan-Meier estimates and weighted Cox regression were used to compare survivorship and conversion rate to THA. This study was approved by the IRB.

Results

In this study of 154 patients (48.7% female; mean age±SD: 37.7±11.03), there was a mean±SD follow-up of 11.0±0.38 years and body mass index (BMI) of 26.1±0.71 kg/m^2. Females experienced a higher frequency of SLT than males (62.1% vs 37.9%, p<0.001). Student’s t-tests demonstrated that the SLT cohort experienced significantly better outcomes than the LLT cohort for mHHS(88.6±12.4 vs 83.4±14.8, P=0.0398), HOS-ADL(92.0±10.4 vs 87.2±14.5, P=0.0252), and LEFS(71.2±10.45 vs 63.6±16.23, P=0.0019). Multivariate linear regression analyses adjusting for demographic, radiographic, and intraoperative findings indicated that labral tear size can independently predict long-term outcomes for hip arthroscopy (p<0.05). Kaplan-Meier estimates and weighted Cox regression demonstrated that the conversion rate to THA for LLT is significantly greater than that of SLT (hazard ratio, 7.92; 95% CI, 2.96-21.2; p<0.001). There was no significant difference in pain relief between cohorts.

Conclusion

Labral tear size can independently predict long-term PROMs after primary hip arthroscopy. The LLT cohort has significantly worse outcomes and a significantly greater conversion rate to THA than the SLT cohort but experiences no significant difference in pain relief. These findings solidify labral tear size as an effective prognosticator of long-term outcomes after hip arthroscopy for symptomatic labral tears secondary to femoroacetabular impingement. As novel therapies to augment labral tears become more prevalent, evaluating labral tear size can factor into identifying candidates who could most benefit.