Hip Arthroscopy for Labral Tears

Abstract

BackgroundArthroscopy of the hip joint is a relatively new diagnostic and therapeutic option for labral tears.PurposeMore data are needed to characterize the utility and effectiveness of hip arthroscopy and identify patient-related factors that might predict functional outcome.Study DesignCase series; Level of evidence, 4.MethodsThis retrospective study with prospective follow-up examined the clinical outcomes of 52 consecutive patients undergoing hip arthroscopy for labral tears. Outcomes measures included clinical outcome and the modified Harris hip score. Any complications associated with the procedure were recorded. Exclusion criteria included age younger than 18 years or prior ipsilateral hip surgery.ResultsMean patient age was 42 years. Mean follow-up was 4.8 years. Twenty-one patients (40.4%) had a traumatic cause of the labral tears. Eight patients (15.4%) had possible secondary gain issues. Four (7.7%) patients suffered transient nerve palsies; in 1 case, the guide wire broke during initial cannulation. Three patients (5.8%) went on to total hip arthroplasty after hip arthroscopy. On multivariate analysis, left-sided surgery, a higher preoperative activity level, and duration of symptoms greater than 18 months were found to be positive predictors of good or excellent outcomes. Smoking and secondary gain issues were significant negative predictors of good or excellent outcomes. Only prior level of activity was a significant positive predictor of return to activity after surgery. A traumatic cause of the labral tear was a significant negative predictor of return to activity. Chondromalacia and osteoarthritis were not significant predictors of negative outcome. Postoperative modified Harris hip score improved 40% from 56.8 preoperatively to 80.4 (P < .001). No cases of patients with secondary gain issues achieved good or excellent outcomes. Overall percentage of good or excellent outcomes was 56%, or 66% when those with secondary gain issues were excluded; 84% of patients were able to return to sports or equivalent level of preoperative recreational activity. Neither preoperative radiographic osteoarthritis nor grade of intraoperative chondromalacia predicted postoperative outcome.ConclusionThis series supports the hypothesis that hip arthroscopy provides safe and reliable improvement of labral symptoms in the majority of patients.