2025 ISAKOS Congress in Munich, Germany

2025 ISAKOS Biennial Congress Paper


Long Term Outcomes and Survivorship of Acetabular Labral Reconstruction With Iliotibial Band Autograft: A Minimum 15 Year Follow up Study

Bradley M. Kruckeberg, MD, Madison Lake, Colorado UNITED STATES
Nicholas A Felan, BA, highland village, texas UNITED STATES
Grant J Dornan, MS, Vail, CO UNITED STATES
Alyson Speshock, MPH, Vail, CO UNITED STATES
Mark Cinque, MD, MS, La Jolla, CA UNITED STATES
Eddie Afetse, BA, BS, Vail, CO UNITED STATES
Marc J. Philippon, MD, Vail, CO UNITED STATES

Steadman Philippon Research Institute, Vail, Colorado, UNITED STATES

FDA Status Not Applicable

Summary

Labral reconstruction using an iliotibial band autograft is a viable treatment option for labral deficiency, with patients free of conversion to THA or revision reporting significant improvement in outcomes at 15-years post-operatively.

Abstract

Introduction

Hip labral reconstruction has demonstrated good survivorship and improved patient reported outcomes (PROs) at 10-year follow-up in patients with labral deficiency. However, patient outcomes and survivorship at a minimum 15-year follow-up remain unknown. The purpose of the present study was to evaluate outcomes and survivorship in patients who underwent acetabular labral reconstruction with iliotibial band autograft at a minimum 15-year follow-up.

Methods

A retrospective review of hip labral reconstructions performed by the senior author between 1/1/2005 and 1/1/2009 was conducted. Patients were excluded if they had borderline or severe acetabular dysplasia (LCEA<25), a prior hip dislocation, were under 18 at the time of surgery, deceased, had previously refused to participate in research, had insufficient contact information, or had a history of avascular necrosis of the femoral head. Patient demographics, radiographic parameters, subsequent surgery information, and patient reported outcomes (PROs)—including modified Harris Hip Score (mHHS), Hip Outcome Score – Activities of Daily Living (HOS-ADL), and Hip Outcome Score – Sport (HOS-Sport)—were collected pre- and minimum 15 years postoperatively. Survivorship was evaluated using a cox proportional-hazards model with total hip arthroplasty (THA) as the end point.

Results

A total of 79 hips (76 patients) meeting inclusion criteria were identified, and the 15-year endpoint (either PROs or known subsequent surgery) was obtained for 66 (84%) at a median of 15.8 years (Range: 14.9–17.8) following labral reconstruction. The median age at the time of surgery was 42 years (Range: 18–66), and most hips were male (n=39, 59%). Thirty (46%) of the hips had prior surgery. Additionally, 44 (68%) of hips were found to have an Outerbridge Grade 3 or 4 defect, and 14 (22%) of hips underwent a microfracture procedure at the time of surgery. Of the patients who completed follow-up, 30 (46%) converted to THA, and 9 (14%, not mutually exclusive from THA) underwent a revision procedure. Notably, patient survival at 5, 10, and 15 years was 68% (95%CI: 58%-80%), 62% (95%CI: 52%-74%), and 61% (95%CI: 50%-73%), respectively. Additionally, age greater than 45 was significantly associated with conversion to THA (Hazard Ratio: 6.9; 95%CI: 3.2-15.0; p<0.001). Patients who did not undergo subsequent surgery demonstrated a statistically significant improvement in mHHS, HOS-ADL, and HOS-Sport at 15-year follow-up. Among surviving hips, 61%, 55%, and 61 % of patients exceeded the patient acceptable symptom state (PASS) for HOS-ADL, HOS-Sport, and mHHS, respectively.

Conclusion

The present study is the first to report on the 15-year outcomes of patients following hip labral reconstruction. Our findings suggest labral reconstruction is a viable procedure for treatment of labral deficiency, with patients reporting significant improvement in PROs and over 60% of patients not requiring an additional procedure at 15-years postoperatively. Additionally, our results suggest patients older than 45 at the time of labral reconstruction are almost 7 times more likely to undergo THA. Clinicians can utilize these findings to better guide clinical decision making in this population as well as manage patient expectations prior to surgery.