Arthroscopic acetabular labral debridement in patients forty-five years of age or older has minimal benefit for pain and function

Geoffrey Wilkin, Gerard March, Paul E Beaulé
Journal of Bone and Joint Surgery. American Volume 2014 January 15, 96 (2): 113-8

BACKGROUND: Hip arthroscopy is being performed with expanding indications, commonly including symptomatic labral tears. The effects of various patient factors, including patient age, on clinical outcomes are not well understood. The purpose of the present study was to quantify the postoperative functional and quality-of-life outcomes after arthroscopic debridement of symptomatic labral tears in patients forty-five years of age or older.

METHODS: Forty-one patients who were at least forty-five years of age (mean age, 52.7 years [range, 45.5 to 67.0 years]; mean body mass index, 26.1 kg/m² [range, 18.4 to 33.2 kg/m²]; 75.6% female) and who underwent labral debridement at the time of hip arthroscopy were included. Disease-specific clinical outcome measures (Western Ontario and McMaster Universities Osteoarthritis Index [WOMAC] and modified Harris hip score [mHHS]) and general health-related measures (12-Item Short Form Health Survey [SF-12]) were collected preoperatively and postoperatively.

RESULTS: The reoperation rate was 17% (seven of forty-one) at a mean of 21.3 months, and six of the seven reoperations involved conversion to hip arthroplasty or resurfacing. The overall hip arthroscopy cohort had postoperative improvements in the mean WOMAC pain score (from 54.0 [range, 20 to 90] to 69.4 [range, 0 to 100], p < 0.001), WOMAC function score (from 60.4 [range, 16.2 to 95.6] to 69.1 [range, 10.3 to 100], p = 0.004), SF-12 physical component summary score (from 33.2 to 39.3, p < 0.001), and mHHS (from 56.6 [range, 9.9 to 84.6] to 63.9 [range, 29.7 to 100], p = 0.022). The changes in the WOMAC stiffness score (from 54.6 ± 20.8 to 60.1 ± 28.1, p = 0.157) and SF-12 mental component summary score (from 51.3 ± 11.4 to 51.6 ± 12.2, p = 0.870) were not significant. Thirteen patients (32%) had a good or excellent outcome as indicated by the postoperative mHHS.

CONCLUSIONS: Arthroscopic labral debridement in patients forty-five years of age or older was associated with a relatively high reoperation rate and minimal overall improvement in joint-specific and quality-of-life outcome measures. Although differences in some outcome measures were statistically significant, most did not reach the level of the minimum clinically important difference. Arthroscopic debridement of labral tears in this patient population must be approached with caution as the overall clinical benefit was small.

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