Are Results of Arthroscopic Labral Repair Durable in Dysplasia at Midterm Follow-up? A 2-Center Matched Cohort Analysis

Mario Hevesi, David E. Hartigan, Isabella T. Wu, Bruce A Levy, Benjamin G. Domb, Aaron Krych

Research output: Contribution to journalArticle

3 Citations (Scopus)

Abstract

Background: Studies assessing dysplasia’s effect on hip arthroscopy are often limited to the short term and unable to account for demographic factors that may vary between dysplastic and nondysplastic populations. Purpose: To determine the midterm failure rate and patient-reported outcomes of arthroscopic labral repair in the setting of dysplasia and make subsequent failure and outcome comparisons with a rigorously matched nondysplastic control group. Study Design: Cohort study; Level of evidence, 3. Methods: Primary arthroscopic labral repair cases at 2 centers from 2008 to 2011 were reviewed. Patients with lateral center edge angle (LCEA) <25° were matched to nondysplastic controls by age, sex, laterality, body mass index (BMI), Tönnis grade, and capsular repair per a 1:2 matching algorithm. Groups were compared with a visual analog scale (VAS) for pain, modified Harris Hip Score (mHHS), and Hip Outcome Score–Sports Specific Subscale (HOS-SSS) to determine predictors of outcome and failure. Results: Forty-eight patients with dysplasia (mean LCEA, 21.6°; range, 13.0°-24.9°; n = 25 with capsular repair) were matched to 96 controls (mean LCEA, 32.1°; range, 25°-52°; n = 50 with capsular repair) and followed for a mean of 5.7 years (range, 5.0-7.7 years). Patients achieved mean VAS improvements of 3.3 points, mHHS of 19.5, and HOS-SSS of 29.0 points (P <.01) with no significant differences between the dysplasia and control populations (P >.05). Five-year failure-free survival was 83.3% for patients with dysplasia and 78.1% for controls (P =.53). No survival or outcomes difference was observed between patients with dysplasia who did or did not have capsular repair (P ≥.45) or when comparing LCEA <20° and LCEA 20° to 25° (P ≥.60). BMI ≤30 was associated with increased revision surgery risk (P <.01). Age >35 years (P <.05) and Tönnis grade 0 radiographs (P <.01) predicted failure to reach minimal clinically important differences. Conclusion: With careful selection and modern techniques, patients with dysplasia can benefit significantly and durably from arthroscopic labral repair. The dysplastic cohort had outcomes and failure rates similar to those of rigorously matched controls at midterm follow-up. Subanalyses comparing LCEA <20° and LCEA 20° to 25° are presented for completeness; however, this study was not designed to detect differences in dysplastic subpopulations. BMI ≤30 was associated with increased revision risk. Age >35 years and Tönnis grade 0 radiographs predicted failure to achieve minimal clinically important differences.

Original languageEnglish (US)
JournalAmerican Journal of Sports Medicine
DOIs
StateAccepted/In press - May 1 2018

Fingerprint

Cohort Studies
Survival
Arthroscopy
Hip
Demography
Control Groups
Population
Minimal Clinically Important Difference
Patient Reported Outcome Measures

Keywords

  • dysplasia
  • hip arthroscopy
  • HOS-SSS
  • labral repair
  • MCID
  • mHHS
  • midterm
  • VAS

ASJC Scopus subject areas

  • Orthopedics and Sports Medicine
  • Physical Therapy, Sports Therapy and Rehabilitation

Cite this

Are Results of Arthroscopic Labral Repair Durable in Dysplasia at Midterm Follow-up? A 2-Center Matched Cohort Analysis. / Hevesi, Mario; Hartigan, David E.; Wu, Isabella T.; Levy, Bruce A; Domb, Benjamin G.; Krych, Aaron.

In: American Journal of Sports Medicine, 01.05.2018.

Research output: Contribution to journalArticle

@article{90d86467402e4cdf9f0425a4b83e2936,
title = "Are Results of Arthroscopic Labral Repair Durable in Dysplasia at Midterm Follow-up? A 2-Center Matched Cohort Analysis",
abstract = "Background: Studies assessing dysplasia’s effect on hip arthroscopy are often limited to the short term and unable to account for demographic factors that may vary between dysplastic and nondysplastic populations. Purpose: To determine the midterm failure rate and patient-reported outcomes of arthroscopic labral repair in the setting of dysplasia and make subsequent failure and outcome comparisons with a rigorously matched nondysplastic control group. Study Design: Cohort study; Level of evidence, 3. Methods: Primary arthroscopic labral repair cases at 2 centers from 2008 to 2011 were reviewed. Patients with lateral center edge angle (LCEA) <25° were matched to nondysplastic controls by age, sex, laterality, body mass index (BMI), T{\"o}nnis grade, and capsular repair per a 1:2 matching algorithm. Groups were compared with a visual analog scale (VAS) for pain, modified Harris Hip Score (mHHS), and Hip Outcome Score–Sports Specific Subscale (HOS-SSS) to determine predictors of outcome and failure. Results: Forty-eight patients with dysplasia (mean LCEA, 21.6°; range, 13.0°-24.9°; n = 25 with capsular repair) were matched to 96 controls (mean LCEA, 32.1°; range, 25°-52°; n = 50 with capsular repair) and followed for a mean of 5.7 years (range, 5.0-7.7 years). Patients achieved mean VAS improvements of 3.3 points, mHHS of 19.5, and HOS-SSS of 29.0 points (P <.01) with no significant differences between the dysplasia and control populations (P >.05). Five-year failure-free survival was 83.3{\%} for patients with dysplasia and 78.1{\%} for controls (P =.53). No survival or outcomes difference was observed between patients with dysplasia who did or did not have capsular repair (P ≥.45) or when comparing LCEA <20° and LCEA 20° to 25° (P ≥.60). BMI ≤30 was associated with increased revision surgery risk (P <.01). Age >35 years (P <.05) and T{\"o}nnis grade 0 radiographs (P <.01) predicted failure to reach minimal clinically important differences. Conclusion: With careful selection and modern techniques, patients with dysplasia can benefit significantly and durably from arthroscopic labral repair. The dysplastic cohort had outcomes and failure rates similar to those of rigorously matched controls at midterm follow-up. Subanalyses comparing LCEA <20° and LCEA 20° to 25° are presented for completeness; however, this study was not designed to detect differences in dysplastic subpopulations. BMI ≤30 was associated with increased revision risk. Age >35 years and T{\"o}nnis grade 0 radiographs predicted failure to achieve minimal clinically important differences.",
keywords = "dysplasia, hip arthroscopy, HOS-SSS, labral repair, MCID, mHHS, midterm, VAS",
author = "Mario Hevesi and Hartigan, {David E.} and Wu, {Isabella T.} and Levy, {Bruce A} and Domb, {Benjamin G.} and Aaron Krych",
year = "2018",
month = "5",
day = "1",
doi = "10.1177/0363546518767399",
language = "English (US)",
journal = "American Journal of Sports Medicine",
issn = "0363-5465",
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T1 - Are Results of Arthroscopic Labral Repair Durable in Dysplasia at Midterm Follow-up? A 2-Center Matched Cohort Analysis

AU - Hevesi, Mario

AU - Hartigan, David E.

AU - Wu, Isabella T.

AU - Levy, Bruce A

AU - Domb, Benjamin G.

AU - Krych, Aaron

PY - 2018/5/1

Y1 - 2018/5/1

N2 - Background: Studies assessing dysplasia’s effect on hip arthroscopy are often limited to the short term and unable to account for demographic factors that may vary between dysplastic and nondysplastic populations. Purpose: To determine the midterm failure rate and patient-reported outcomes of arthroscopic labral repair in the setting of dysplasia and make subsequent failure and outcome comparisons with a rigorously matched nondysplastic control group. Study Design: Cohort study; Level of evidence, 3. Methods: Primary arthroscopic labral repair cases at 2 centers from 2008 to 2011 were reviewed. Patients with lateral center edge angle (LCEA) <25° were matched to nondysplastic controls by age, sex, laterality, body mass index (BMI), Tönnis grade, and capsular repair per a 1:2 matching algorithm. Groups were compared with a visual analog scale (VAS) for pain, modified Harris Hip Score (mHHS), and Hip Outcome Score–Sports Specific Subscale (HOS-SSS) to determine predictors of outcome and failure. Results: Forty-eight patients with dysplasia (mean LCEA, 21.6°; range, 13.0°-24.9°; n = 25 with capsular repair) were matched to 96 controls (mean LCEA, 32.1°; range, 25°-52°; n = 50 with capsular repair) and followed for a mean of 5.7 years (range, 5.0-7.7 years). Patients achieved mean VAS improvements of 3.3 points, mHHS of 19.5, and HOS-SSS of 29.0 points (P <.01) with no significant differences between the dysplasia and control populations (P >.05). Five-year failure-free survival was 83.3% for patients with dysplasia and 78.1% for controls (P =.53). No survival or outcomes difference was observed between patients with dysplasia who did or did not have capsular repair (P ≥.45) or when comparing LCEA <20° and LCEA 20° to 25° (P ≥.60). BMI ≤30 was associated with increased revision surgery risk (P <.01). Age >35 years (P <.05) and Tönnis grade 0 radiographs (P <.01) predicted failure to reach minimal clinically important differences. Conclusion: With careful selection and modern techniques, patients with dysplasia can benefit significantly and durably from arthroscopic labral repair. The dysplastic cohort had outcomes and failure rates similar to those of rigorously matched controls at midterm follow-up. Subanalyses comparing LCEA <20° and LCEA 20° to 25° are presented for completeness; however, this study was not designed to detect differences in dysplastic subpopulations. BMI ≤30 was associated with increased revision risk. Age >35 years and Tönnis grade 0 radiographs predicted failure to achieve minimal clinically important differences.

AB - Background: Studies assessing dysplasia’s effect on hip arthroscopy are often limited to the short term and unable to account for demographic factors that may vary between dysplastic and nondysplastic populations. Purpose: To determine the midterm failure rate and patient-reported outcomes of arthroscopic labral repair in the setting of dysplasia and make subsequent failure and outcome comparisons with a rigorously matched nondysplastic control group. Study Design: Cohort study; Level of evidence, 3. Methods: Primary arthroscopic labral repair cases at 2 centers from 2008 to 2011 were reviewed. Patients with lateral center edge angle (LCEA) <25° were matched to nondysplastic controls by age, sex, laterality, body mass index (BMI), Tönnis grade, and capsular repair per a 1:2 matching algorithm. Groups were compared with a visual analog scale (VAS) for pain, modified Harris Hip Score (mHHS), and Hip Outcome Score–Sports Specific Subscale (HOS-SSS) to determine predictors of outcome and failure. Results: Forty-eight patients with dysplasia (mean LCEA, 21.6°; range, 13.0°-24.9°; n = 25 with capsular repair) were matched to 96 controls (mean LCEA, 32.1°; range, 25°-52°; n = 50 with capsular repair) and followed for a mean of 5.7 years (range, 5.0-7.7 years). Patients achieved mean VAS improvements of 3.3 points, mHHS of 19.5, and HOS-SSS of 29.0 points (P <.01) with no significant differences between the dysplasia and control populations (P >.05). Five-year failure-free survival was 83.3% for patients with dysplasia and 78.1% for controls (P =.53). No survival or outcomes difference was observed between patients with dysplasia who did or did not have capsular repair (P ≥.45) or when comparing LCEA <20° and LCEA 20° to 25° (P ≥.60). BMI ≤30 was associated with increased revision surgery risk (P <.01). Age >35 years (P <.05) and Tönnis grade 0 radiographs (P <.01) predicted failure to reach minimal clinically important differences. Conclusion: With careful selection and modern techniques, patients with dysplasia can benefit significantly and durably from arthroscopic labral repair. The dysplastic cohort had outcomes and failure rates similar to those of rigorously matched controls at midterm follow-up. Subanalyses comparing LCEA <20° and LCEA 20° to 25° are presented for completeness; however, this study was not designed to detect differences in dysplastic subpopulations. BMI ≤30 was associated with increased revision risk. Age >35 years and Tönnis grade 0 radiographs predicted failure to achieve minimal clinically important differences.

KW - dysplasia

KW - hip arthroscopy

KW - HOS-SSS

KW - labral repair

KW - MCID

KW - mHHS

KW - midterm

KW - VAS

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