Dornan Grant J, Ruzbarsky Joseph J, Comfort Spencer M, Ernat Justin J, Martin Maitland D, Briggs Karen K, Philippon Marc J
Steadman Philippon Research Institute, Vail, Colorado.
The Steadman Clinic, Vail, Colorado.
J Bone Joint Surg Am. 2024 Oct 2;106(19):1757-1766. doi: 10.2106/JBJS.23.00966. Epub 2024 Aug 26.
Labral repair has become the preferred method for the arthroscopic treatment of acetabular labral tears that are associated with femoroacetabular impingement (FAI) resulting in pain and dysfunction. Labral reconstruction is performed mainly in revision hip arthroscopy but can be utilized in the primary setting for absent or calcified labra. The purpose of this study was to compare the minimum 2-year patient-reported outcomes (PROs) and risk of revision or conversion to arthroplasty between primary labral reconstruction and primary labral repair.
Patients with FAI who underwent primary hip arthroscopy with labral repair or reconstruction performed by the senior author between 2006 and 2018 were identified from a prospectively enrolled patient outcome registry. Exclusion criteria included confounding injuries, dysplasia, prior ipsilateral hip surgery, or a joint space of <2 mm. Patients who were 18 to 80 years old were eligible for inclusion. Multiple regression with inverse propensity score weighting was conducted to estimate the average treatment effect in the treated (ATT) for labral reconstruction versus labral repair with respect to postoperative PROs and the likelihood of subsequent surgery (revision hip arthroscopy or conversion to arthroplasty). PRO end points included the Hip Outcome Score Activities of Daily Living subscale (HOS-ADL), modified Harris hip score, Western Ontario and McMaster Universities Osteoarthritis Index total score (WOMAC), 12-Item Short Form Health Survey Physical Component Summary score (SF-12 PCS), and patient satisfaction.
A total of 150 hips undergoing primary labral reconstruction and 998 hips undergoing primary labral repair were included. The median follow-up time was 5.3 years in the reconstruction group and 5.8 years in the repair group. Compared with labral repair, labral reconstruction was associated with a higher risk of conversion to total hip arthroplasty (THA) (20% versus 7%; adjusted odds ratio, 3.2; 95% confidence interval [CI], 1.2 to 8.8; p = 0.024). Inverse propensity score-weighted multiple regression estimated a significant negative effect of labral reconstruction, relative to labral repair, on the postoperative values for the HOS-ADL (ATT, -3.3; 95% CI, -5.8 to -0.7; p = 0.012) and WOMAC (ATT, 2.6; 95% CI, 0.1 to 5.2; p = 0.044).
Compared with primary labral reconstruction, primary labral repair resulted in better postoperative HOS-ADL and WOMAC values and decreased conversion to THA. These findings were demonstrated in both the unadjusted group comparisons and multivariable modeling. These data support the use of labral repair in the primary setting of labral tears and the reservation of labral reconstruction for more advanced labral pathology or for revision cases.
Therapeutic Level III . See Instructions for Authors for a complete description of levels of evidence.
盂唇修复已成为关节镜治疗与股骨髋臼撞击症（FAI）相关的髋臼盂唇撕裂导致疼痛和功能障碍的首选方法。盂唇重建主要用于翻修髋关节镜手术，但也可用于初次手术中盂唇缺失或钙化的情况。本研究的目的是比较初次盂唇重建和初次盂唇修复术后至少2年的患者报告结局（PROs）以及翻修或转换为关节成形术的风险。
从一个前瞻性登记的患者结局数据库中识别出2006年至2018年间由资深作者进行初次髋关节镜下盂唇修复或重建的FAI患者。排除标准包括合并伤、发育不良、同侧髋关节既往手术史或关节间隙<2mm。年龄在18至80岁之间的患者符合纳入标准。采用逆倾向评分加权的多元回归分析，以估计盂唇重建与盂唇修复在术后PROs以及后续手术（翻修髋关节镜手术或转换为关节成形术）可能性方面的平均治疗效果（ATT）。PRO终点包括髋关节结局评分日常生活活动子量表（HOS-ADL）、改良Harris髋关节评分、西安大略和麦克马斯特大学骨关节炎指数总分（WOMAC）、12项简短健康调查问卷身体成分汇总评分（SF-12 PCS）以及患者满意度。
共纳入150例接受初次盂唇重建的髋关节和998例接受初次盂唇修复的髋关节。重建组的中位随访时间为5.3年，修复组为5.8年。与盂唇修复相比，盂唇重建转换为全髋关节置换术（THA）的风险更高（20%对7%；调整后的优势比，3.2；95%置信区间[CI]，1.2至8.8；p = 0.024）。逆倾向评分加权的多元回归分析估计，相对于盂唇修复，盂唇重建对HOS-ADL术后值（ATT，-3.3；95% CI，-5.8至-0.7；p = 0.012）和WOMAC（ATT，2.6；95% CI，0.1至5.2；p = 0.044）有显著负面影响。
与初次盂唇重建相比，初次盂唇修复术后的HOS-ADL和WOMAC值更好，且转换为THA的比例降低。这些发现不仅在未调整的组间比较中得到证实，在多变量模型中也得到了验证。这些数据支持在初次盂唇撕裂的情况下使用盂唇修复，并将盂唇重建保留用于更严重的盂唇病变或翻修病例。
治疗性III级。有关证据水平的完整描述，请参阅作者指南。
