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.