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Scientific Articles   |    
Arthroscopic Acetabular Labral Debridement in Patients Forty-five Years of Age or Older Has Minimal Benefit for Pain and Function
Geoffrey Wilkin, MD1; Gerard March, MD, FRCSC1; Paul E. Beaulé, MD, FRCSC1
1 Division of Orthopaedic Surgery, The Ottawa Hospital, 501 Smyth Road, Ottawa, ON K1H 8L6, Canada. E-mail address for P.E. Beaulé: pbeaule@ottawahospital.on.ca
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A commentary by Fred R.T. Nelson, MD, is linked to the online version of this article at jbjs.org.

Investigation performed at the Division of Orthopaedic Surgery, The Ottawa Hospital, Ottawa, Ontario, Canada



Disclosure: None of the authors received payments or services, either directly or indirectly (i.e., via his or her institution), from a third party in support of any aspect of this work. One or more of the authors, or his or her institution, has had a financial relationship, in the thirty-six months prior to submission of this work, with an entity in the biomedical arena that could be perceived to influence or have the potential to influence what is written in this work. No author has had any other relationships, or has engaged in any other activities, that could be perceived to influence or have the potential to influence what is written in this work. The complete Disclosures of Potential Conflicts of Interest submitted by authors are always provided with the online version of the article.

Copyright © 2014 by The Journal of Bone and Joint Surgery, Inc.
J Bone Joint Surg Am, 2014 Jan 15;96(2):113-118. doi: 10.2106/JBJS.L.01710
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Abstract

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.

Level of Evidence: 

Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence.

Peer Review 

This article was reviewed by the Editor-in-Chief and one Deputy Editor, and it underwent blinded review by two or more outside experts. It was also reviewed by an expert in methodology and statistics. The Deputy Editor reviewed each revision of the article, and it underwent a final review by the Editor-in-Chief prior to publication. Final corrections and clarifications occurred during one or more exchanges between the author(s) and copyeditors.

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    References

    Accreditation Statement
    These activities have been planned and implemented in accordance with the Essential Areas and policies of the Accreditation Council for Continuing Medical Education (ACCME) through the joint sponsorship of the American Academy of Orthopaedic Surgeons and The Journal of Bone and Joint Surgery, Inc. The American Academy of Orthopaedic Surgeons is accredited by the ACCME to provide continuing medical education for physicians.
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