Arthroscopic Labral Debridement Research Articles

Eighty-One Percent of Unrepaired Interportal Capsulotomies Showed Healed Capsules on Magnetic Resonance Imaging 5 Years After Primary Hip Arthroscopy

PurposeTo evaluate whether un-repaired interportal capsulotomy presents with capsular defect at MR imaging 5 years after primary hip arthroscopy, and to determine its effect on functional results and findings of osteoarthritis on a radiograph or MRI imaging. MethodsPatients with femoro-acetabular impingement (without arthritis, dysplasia) were retrospectively reviewed after arthroscopic labral repair or debridement and femoroplasty through interportal capsulotomy without closure. Patients were assessed preoperatively and a minimum of five years postoperatively using patient-reported outcomes (Hip Outcome Score Activities of Daily Living [HOS-ADL], modified Harris Hip Score [mHHS]), visual analogue scale scores, radiographic measures, and magnetic resonance imaging (MRI) ResultsForty patients (42hips) eligible for the study were evaluated and 81% of the hips had healed capsules, while there were 8 (19%) hips had capsule defects at the latest MR imaging. There were three hips with subchondral oedema in the defect group compared to one in the capsule healed group (p: 0.01) at the latest MRI, which were not present at preoperative MR imaging (still positive at the multivariate analysis when the preoperative alpha angle was also taken into consideration . Functional results did not differ between groups (p>0.05). ConclusionIn this study, 81% of interportal capsulotomies healed without repair at 5 years after primary hip arthroscopy.

Long-Term Outcomes of Arthroscopic Labral Repair Versus Labral Debridement: Which Precludes Patients from Total Hip Arthroplasty Conversion?

Long-Term Outcomes of Arthroscopic Labral Repair Versus Labral Debridement: Which Precludes Patients from Total Hip Arthroplasty Conversion?

EE28 Identifying Factors Underlying Variation in the Cost of Acetabular Labral Repair or Debridement during Hip Arthroscopy: A Time-Driven Activity-Based Costing Analysis

Leveraging time-driven activity-based costing (TDABC), this study aims to (1) quantify the cost of arthroscopic acetabular labral repair or debridement and (2) explore variation in costs based on patient-specific characteristics, operative techniques employed, and surgical settings.

Arthroscopic Acetabular Labral Repair Versus Labral Debridement: Long-term Survivorship and Functional Outcomes.

Background:Arthroscopic treatment for labral tears includes debridement and repair. Long-term studies have failed to demonstrate a difference between these treatments in terms of conversion to total hip arthroplasty (THA).Purpose:To investigate 2 different labral treatments, debridement and repair, using an adjusted analysis to evaluate long-term conversion to THA.Study Design:Cohort study; Level of evidence, 3.Methods:This was a retrospective cohort study of patients who underwent hip arthroscopy by a single surgeon between April 2007 and October 2014. Postoperative follow-up information included conversion to THA, patient satisfaction, and patient-reported outcome measures (modified Harris Hip Score; Hip Outcome Score, Activities of Daily Living and Sports Specific subscales; International Hip Outcome Tool; Nonarthritic Hip Score; and Lower Extremity Functional Scale).Results:Of the 204 hips included in the study, 99 (48.5%) underwent labral repair, and 105 (51.5%) underwent debridement. In total, 28 (13.7%) of the 204 patients underwent conversion to THA within 10 years after hip arthroscopy (labral repair: 5 [5.0%] vs labral debridement: 23 [21.9%]). Labral repair was associated with a significantly lower risk of conversion to THA compared with debridement (hazard ratio [HR] = 0.24; 95% CI, 0.07-0.74; P = .014). Additional factors associated with risk of conversion to THA included older age at the time of arthroscopy (HR = 1.06 per year; 95% CI, 1.02-1.11; P = .002) and Tönnis grade (HR = 2.39; CI, 1.14-5.41; P = .026). Abrasion chondroplasty, acetabuloplasty, body mass index, Outerbridge grade, and radiographic femoroacetabular impingement were not found to be significantly associated with risk of THA. No significant difference in patient satisfaction was found between treatment groups, and for patients who did not convert to THA, there was no difference in mean patient-reported outcome scores at final follow-up.Conclusion:Patients who underwent labral repair were less likely to convert to THA compared with patients who underwent labral debridement, despite adjustment for differences in baseline patient characteristics and preexisting pathology. Additional factors associated with a lower rate of hip survival were older age and osteoarthritis at the time of hip arthroscopy.

Comparison of early outcomes of arthroscopic labral repair or debridement : a study using the UK Non-Arthroplasty Hip Registry dataset.

AimsThis study uses prospective registry data to compare early patient outcomes following arthroscopic repair or debridement of the acetabular labrum.MethodsData on adult patients who underwent arthroscopic labral debridement or repair between 1 January 2012 and 31 July 2019 were extracted from the UK Non-Arthroplasty Hip Registry. Patients who underwent microfracture, osteophyte excision, or a concurrent extra-articular procedure were excluded. The EuroQol five-dimension (EQ-5D) and International Hip Outcome Tool 12 (iHOT-12) questionnaires were collected preoperatively and at six and 12 months post-operatively. Due to concerns over differential questionnaire non-response between the two groups, a combination of random sampling, propensity score matching, and pooled multivariable linear regression models were employed to compare iHOT-12 improvement.ResultsA total of 2,025 labral debridements (55%) and 1,659 labral repairs (45%) were identified. Both groups saw significant (p < 0.001) EQ-5D and iHOT-12 gain compared to preoperative scores at 12 months (iHOT-12 improvement: labral repair = +28.7 (95% confidence interval (CI) 26.4 to 30.9), labral debridement = +24.7 (95% CI 22.5 to 27.0)), however there was no significant difference between procedures after multivariable modelling. Overall, 66% of cases achieved the minimum clinically important difference (MCID) and 48% achieved substantial clinical benefit at 12 months.ConclusionBoth labral procedures were successful in significantly improving early functional outcome following hip arthroscopy, regardless of age or sex. Labral repair was associated with superior outcomes in univariable analysis, however there was no significant superiority demonstrated in the multivariable model.Level of evidence: IIICite this article: Bone Jt Open 2022;3(4):291–301.

Arthroscopic labral debridement versus labral repair for patients with femoroacetabular impingement: A meta-analysis.

Objective:Femoroacetabular impingement (FAI) is a common cause of hip pain and even tearing of the acetabular labrum in young adults and athletes. Either arthroscopic labral debridement (LD) or labral repair (LR) technique for FAI patients is needed to choose. We conducted this systematic review and meta-analysis to compare the clinical outcomes of arthroscopic LD versus LR intervention.Methods:The five studies were acquired from PubMed, Medline, Embase, and Cochrane Library. The data were extracted by two of the coauthors independently and were analyzed by RevMan5.3. Mean differences (MDs), odds ratios (ORs), and 95% confidence intervals (CIs) were calculated. Cochrane Collaboration's Risk of Bias Tool and Newcastle–Ottawa Scale were used to assess risk of bias.Results:Four observational studies and one prospective randomized study were assessed. The methodological quality of the trials indicated a low to moderate risk of bias. The pooled results of Non-Arthritic Hip Score (NAHS), failure rate of surgeries and complications showed that the differences were not statistically significant between the two interventions. The difference of modified Harris Hip Score (mHHS), the Visual Analogue Scale (VAS) score and satisfaction rate was statistically significant between LD and LR intervention, and LR treatment was more effective. Sensitivity analysis proved the stability of the pooled results and there were too less included articles to verify the publication bias.Conclusions:Hip arthroscopy with either LR or LD is an effective treatment for symptomatic FAI. The difference of mHHS, VAS score, and satisfaction rate was statistically significant between LD and LR intervention, and arthroscopic LR could re-create suction-seal effect, potentially reduce microinstability, which demonstrated a trend toward better clinical efficacy and comparable safety compared with LD. The arthroscopic LR technique is recommended as the optical choice for acetabular labrum tear with FAI.

Arthroscopic Labral Treatment in Adolescents: Clinical Outcomes With Minimum 5-Year Follow-up

Background: The success of hip arthroscopy has led to increased application in younger populations. However, hip arthroscopy remains a challenging procedure, and its safety and efficacy in the adolescent population have been controversial. Most existing literature on outcomes in such patients contains only short-term follow-up, and a paucity of evidence is available regarding long-term outcomes in adolescents. Purpose: To report on clinical outcomes at a minimum 5-year follow-up in patients younger than 18 years who underwent arthroscopic treatment of labral tears. Study Design: Case series; Level of evidence, 4. Methods: Data were prospectively collected and retrospectively reviewed on all patients younger than 18 years who underwent hip arthroscopy in a tertiary hip preservation setting at a single institution. Patients were excluded if they had previous ipsilateral hip conditions or surgery. All patients underwent either labral repair or debridement for treatment of a labral tear. Patient-reported outcome measures were recorded at 3 months and at 1, 2, or a minimum of 5 years. These included the modified Harris Hip Score (mHHS), Nonarthritic Hip Score, Hip Outcome Score–Sports Specific Subscale (HOS-SSS), visual analog scale, and patient satisfaction. Additionally, the abbreviated International Hip Outcome Tool and Short Form Health Survey were collected at latest follow-up. Results: The study included 44 hips in 32 patients that underwent arthroscopic labral repair (86.4%) or labral debridement (13.6%) between April 2008 and April 2011, with latest follow-up at a mean of 69.2 months (range, 60.0-89.9 months) postoperatively. The average age at surgery was 16.3 years (range, 14.2-17.9 years), and 39 hips from female patients. Statistically significant improvements were seen in all patient-reported outcome measures from preoperative to minimum 5-year follow-up. Improvements were noted at 1-year follow-up and maintained at minimum 5-year follow-up. At the latest follow-up, the Patient Acceptable Symptomatic State was achieved in 95.5% of patients for the mHHS and 72.7% for the HOS-SSS. Two patients subsequently underwent secondary arthroscopy on the ipsilateral hip; however, the survivorship of all hips was 100%. Conclusion: Hip arthroscopy for the treatment of labral tears in adolescents remains a technically challenging procedure that should be approached with appropriate caution. The results of the present study on a population treated in a specialized hip preservation center demonstrate that hip arthroscopy is a safe procedure with stable improvement in patient-reported outcome measures at 5 years.

A Technique for Arthroscopic-Assisted Ligamentum Teres Augmentation Using a Suture Tape Augmentation

Ligamentum teres (LT) tears are a pathologic condition being identified at increasing frequency because of growing use of hip arthroscopy. The exact role of the LT is not well understood, but it has been shown in recent biomechanical studies to contribute to hip stability. Patients with hip pain, instability, and/or mechanical symptoms with advanced imaging findings showing LT pathology may benefit from an LT augmentation. We present an arthroscopic-assisted LT augmentation technique, which can be performed as an isolated procedure or in conjunction with an arthroscopic labral repair and/or debridement, chondroplasty, and femoroplasty.

Selective Debridement With Labral Preservation Using Narrow Indications in the Hip: Minimum 5-Year Outcomes With a Matched-Pair Labral Repair Control Group

Background: Arthroscopic labral debridement in the hip can be an effective treatment for labral tears but has demonstrated inferior outcomes compared with labral repair. Thus, the role for labral debridement has become unclear. Hypothesis/Purpose: The purpose was to evaluate the outcomes of a selective debridement with labral preservation (SDLP) group with a minimum 5-year follow-up. It was hypothesized that, with narrow indications, SDLP would produce statistically improved patient-reported outcome (PRO) scores, comparable with those of a matched-pair labral repair control group. Study Design: Cohort study; Level of evidence, 3. Methods: Data were collected on all patients undergoing primary hip arthroscopic surgery between February 2008 and September 2011. Exclusion criteria were acetabular or femoral head Outerbridge grade 4 chondral damage, preoperative Tnnis grade ≥2, workers’ compensation claims, previous hip conditions, severe dysplasia (lateral center-edge angle <18°), or previous ipsilateral hip surgery. Patients who underwent arthroscopic labral debridement and had preoperative and minimum 5-year PRO scores, including the modified Harris Hip Score (mHHS), Non-Arthritic Hip Score (NAHS), and Hip Outcome Score–Sports-Specific Subscale (HOS-SSS) as well as the visual analog scale (VAS) for pain, were included. In a nested matched-pair comparison, the SDLP group was matched 1:1 to an arthroscopic labral repair control group based on age ±5 years, body mass index ±5 kg/m2, sex, and Seldes tear type. Results: One hundred twenty-five hips were eligible for inclusion, of which 101 (80.8%) hips had a minimum 5-year follow-up. All PRO scores were significantly improved (P < .001) at latest follow-up (mHHS, 63.4 to 82.4; NAHS, 57.4 to 83.6; HOS-SSS, 44.2 to 74.5). The mean VAS score decreased from 5.8 to 2.3 (P < .001). The mean patient satisfaction score was 8.1. Four (4.0%) patients underwent second-look arthroscopic surgery (mean, 18.5 months), and 14 (13.9%) patients converted to total hip arthroplasty (mean, 46.9 months). In the matched-pair comparison, 69 in the SDLP group were matched 1:1 with those undergoing labral repair. Outcomes at latest follow-up of the SDLP group were comparable with those of the control group, respectively: mHHS, 83.0 vs 86.1 (P = .084); NAHS, 85.0 vs 85.4 (P = .415); HOS-SSS, 74.8 vs 76.8 (P = .219); VAS, 2.3 vs 2.0 (P = .277); international Hip Outcome Tool–12 (iHOT-12), 73.8 vs 76.4 (P = .136); Short Form Health Survey–12 (SF-12) mental, 57.4 vs 55.1 (P = .031); SF-12 physical, 48.7 vs 48.9 (P = .357); Veterans RAND Health Survey–12 (VR-12) mental, 61.6 vs 59.8 (P = .160); VR-12 physical, 50.1 vs 50.2 (P = .340); and patient satisfaction, 8.0 vs 8.3 (P = .211). Conclusion: In select cases of stable labral tears, SDLP may allow the preservation of a functional labrum. At a minimum 5-year follow-up, SDLP using narrow indications produced favorable outcomes comparable with a matched-pair labral repair group.

Effect of centre-edge angle on clinical and quality of life outcomes after arthroscopic acetabular labral debridement.

The aim of this study was to compare clinical and quality of life outcomes following arthroscopic acetabular labral debridement between patients with different centre-edge (CE) angle. A total of 79 patients who underwent hip labral debridement were enrolled in this study. Radiographic measurements of CE angle were collected, and patients were assigned into a normal group (25° < CE angle <40°, n = 68) and dysplasia group (CE angle <20°, n = 11). Clinical outcomes were evaluated by modified Harris Hip Score (mHHS), Hip Outcome Score (HOS) for activities of daily living (ADL) and sports and Short Form 12 (SF-12). At the final follow-up, the normal group showed significant improvements in mHHS, HOS (ADL and sports) and SF-12 (P < 0.05). However, the dysplasia group revealed significant improvements in mHHS, HOS (ADL) and SF-12 physical component summary (PCS) (P < 0.05) and no significant changes in HOS sports and SF-12 mental component summary (MCS) (P > 0.05). Additionally, there was a greater improvement in clinical scores post-operatively in the normal group compared with the dysplasia group (P < 0.05). Arthroscopic acetabular labral debridement resulted in significantly greater clinical and quality of life outcomes in patients with CE angle >25° compared with patients with CE angle < 20°.

Early outcome of hip arthroscopy for the treatment of pincer femoroacetabular impingement

Background Femoroacetabular impingement (FAI) is recognized as a cause of hip pain in young adults and as a precursor to osteoarthritis. Labral tears have been described in association with FAI. It is not clear as to whether arthroscopic labral debridement can improve patient symptoms. Patients and methods Eleven patients with FAI pincer-type lesion were treated with arthroscopic labral debridement. The presence of FAI was confirmed preoperatively on plain radiograph and MRI. The clinical (Merle d'Aubigne) score was used preoperatively and at 1 year postoperatively. Results The mean Merle d'Aubigne score improved from 10 points (range = 7-11 points) preoperatively to 17 points (range = 14-18 points) at 1 year postoperatively. Conclusion Arthroscopic labral debridement for pincer type of FAI significantly improves patient symptoms and gives rapid functional recovery

Labral Injury: Radiographic Predictors at the Time of Hip Arthroscopy

The purpose of this study was to investigate the influence of multiple demographic and radiographic findings on the size of labral tears identified at the time of hip arthroscopy. Data were prospectively collected for patients treated with arthroscopic labral repair or debridement from February 2008 to August 2011. Preoperative radiographic and demographic data were collected for 392 patients during the study period. Exclusion criteria included revision surgery and previous hip conditions. An anteroposterior pelvic view, 45° Dunn view, and false-profile view were used to measure Tönnis grade, neck-shaft angle, alpha angle, lateral center edge angle (LCEA), anterior center edge angle (ACEA), acetabular inclination, and the extent of crossover sign when present. At the time of surgery, labral tear size and location were documented for all patients, using traditional acetabular clock face nomenclature for sizing. A multiple linear regression analysis was then performed to assess the correlation of radiographic and demographic findings with the size of the labral tear. Regression analysis displayed statistical significance for sex (P < .0001), age (P < .0001), and alpha angle (P = .005) with labral tear size. For female patients, Tönnis grade (P = .0004) and neck-shaft angle (P = .004) correlated with labral tear size. This model accounted for only 26% of variation in labral tear size. Preoperative risk factors for the extent of labral tear size are male sex, increasing age, and increasing alpha angle. Labral tears were larger in female patients with higher Tönnis grades and lower neck-shaft angles. Measurements of acetabular coverage and version showed no correlation with labral tear size. The majority of labral tear size variation was not accounted for in this model. Level IV, therapeutic case series.

Modest mid-term outcomes after isolated arthroscopic debridement of acetabular labral tears

Currently, there is a paucity of literature regarding outcomes after isolated labral debridement. The purpose of this study was to (1) report the reoperation rate following isolated labral debridement, (2) report clinical and functional outcomes after labral debridement with a minimum 2-year follow-up and (3) identify risk factors for worse clinical and functional outcomes. It was hypothesized that inferior outcomes are associated with an increasing Tönnis grade and those with untreated femoral acetabular impingement (FAI). The records of patients undergoing hip arthroscopy between 1998 and 2005 were reviewed. Patients with labral tears who underwent isolated arthroscopic labral debridement were identified. Kaplan-Meier estimate of failure (defined as subsequent surgery) was performed for all patients. Patients with minimum 2-year follow-up were assessed with Modified Harris Hip Score (MHHS) and Hip Outcome Score (HOS). Univariate analysis was then performed to assess which factors were associated with worse clinical and functional outcomes. Fifty-nine hips in 57 patients met our inclusion criteria (39 females, 18 males) with a mean age of 46 ± 14 years and mean follow-up of 5 (range 2-14) years. Overall, 45 % of the hips failed for repeat surgery (20 %) or rating for hip function as abnormal or severely abnormal (25 %). Twelve hips (20 %) required subsequent surgical intervention at a mean 23 (range 6-60) months (7 total hip arthroplasties, 2 open revisions, 3 arthroscopic revisions). Of the remaining hips, mean MHHS was 83.4 ± 19.7, mean HOS ADL score was 83.8 ± 21.3 and mean HOS sport score was 70.6 ± 32.9, with 33 of 41 (75 %) reporting normal or nearly normal current level of function. Univariate analysis revealed that hips with untreated bony impingement (p = 0.01) or requiring concomitant chondroplasty (p = 0.03) had inferior clinical outcome scores. Isolated arthroscopic labral debridement for hip labral tears had 45 % combined poor results when strictly defining failure as repeat surgery or abnormal hip rating. Untreated FAI and concomitant chondroplasty were risk factors for inferior outcome. We recommend concomitant treatment for bony impingement lesions and preservation of the labrum whenever possible.

Arthroscopic Acetabular Labral Debridement in Patients Forty-five Years of Age or Older Has Minimal Benefit for Pain and Function

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. 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. 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. 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.

Hip Arthroscopy for Femoroacetabular Impingement: Results of 118 Consecutive Cases in a District General Hospital

Femoroacetabular impingement (FAI) is an increasingly recognised cause of hip symptoms in the young active adult and can lead to labral tears and chondral damage. FAI can be treated with open surgery or arthroscopically: aiming to stabilise labral tears and remove bony impingement. We report the results of a single surgeon series of arthroscopic labral debridement and cam resection in 118 consecutive cases during a two-year period, with a minimum follow-up of one year. Quantitative assessment was undertaken using the Non-Arthritic Hip Score (NAHS) calculated preoperatively and at two, four and 12 months postoperatively. Mean NAHS in all patient groups at two and four months, and at one year showed improvement (p<0.05). These results compare favourably with previous patients treated with open osteochondroplasty by the same surgeon, as well as with the published results from other larger centres. The faster improvement and the shorter hospital stay and lower morbidity make arthroscopic surgery for FAI a favourable option, and a feasible treatment modality in the non-specialist setting.

Retrospective Evaluation of Femoral Osteoplasty And Labral Debridement in Cam-Type Femoroacetabular Impingement Patients—An Average Followup of 5 Years (SS-38)

Femoroacetabular impingement (FAI) has been increasingly recognized as a source of primary hip pathology and has been associated with early onset degenerative hip disease. Cam-type impingement can create shear stress at the acetabular rim, causing chondral delamination and articular-sided labral degeneration. The purpose of this study is to evaluate the clinical outcomes of arthroscopic treatment of cam-type femoroacetabular impingement. Ninety-four consecutive patients (100 hips) with cam impingement underwent arthroscopic femoral neck osteoplasty and labral debridement. Eighty-two hips (82%) were contacted and available for followup at a mean of 60 months (range, 40-74). Patients were assessed with preoperative and postoperative physical examination, nonarthritic hip score (NAHS), Western Ontario and McMasters Universities (WOMAC) score, and radiographs to assess the Tonnis Grade for osteoarthritis and alpha-angle. Postoperative evaluation included pain score assessment with a visual analog scale and satisfaction assessment. Eighty-two hips were contacted for followup evaluation. There were 54 patients who had not undergone additional surgeries. Six patients required revision hip arthroscopies. Twenty-two patients underwent hip arthroplasty, summing up to an overall revision rate of 28%. Of the patients who had not undergone revision surgeries, the mean NAHS rose from 48.9 to 78 and the WOMAC increased from 66.8 to 77. Patient satisfaction was 70 percent. Twenty-five of the 54 hips were available for clinical evaluation. Presence of internal rotation impingement sign decreased from 92.6 to 37.5 percent. Repeat radiograph showed improved alpha angles from 76.8 to 61.6 degrees. Of the patients with pre-existing osteoarthritis (Tonnis Grade 2-3), 84.6% went on to require hip arthroplasty. Of the patients with minimal to no pre-existing osteoarthritis (Tonnis Grade 0-1), 16.4% went on to require hip arthroplasty. Arthroscopic femoral neck resection in patients with cam-type FAI results in improved clinical outcomes, decreased physical symptoms, and a high patient satisfaction at a mean followup of 5 years. In the subset of patients with pre-existing osteoarthritis, there is high risk of needing an arthroplasty procedure within 5 years.

Heterotopic ossification in portal sites following hip arthroscopy

Heterotopic ossification (HO) is a well-known condition that usually occurs after head trauma, burns and open surgical procedures, most commonly around the hip and elbow joints. It is a well-documented complication occurring after open hip surgery; however, there exists limited information regarding its prevalence and clinical importance following hip arthroscopy. We report a case of symptomatic HO formation in portal sites following arthroscopic rim decompression, femoroplasty and labral debridement that was successfully treated with arthroscopic removal.

Arthroscopic Labral Repair Versus Selective Labral Debridement in Female Patients With Femoroacetabular Impingement: A Prospective Randomized Study

The purpose of this prospective randomized study was to compare the outcomes of arthroscopic labral repair and selective labral debridement in female patients undergoing arthroscopy for the treatment of pincer-type or combined pincer- and cam-type femoroacetabular impingement. Between June 2007 and June 2009, 36 female patients undergoing arthroscopic hip treatment for pincer- or combined-type femoroacetabular impingement were randomized to 2 treatment groups at the time of surgery: labral repair or labral debridement. The repair group comprised 18 patients with a mean age of 38; the debridement group comprised 18 patients with a mean age of 39. All patients underwent the same rehabilitation protocol postoperatively. At a minimum of 1 year, all patients were assessed using a validated Hip Outcome Score (HOS) to determine hip function, and also completed a simple subjective outcome measure. All 36 patients were available for follow-up at an average time of 32 months (range, 12 to 48). In both groups, HOSs for activities of daily living (ADL) and sports improved significantly from before surgery to the final follow-up (P < .05). The postoperative ADL HOS was significantly better in the repair group (91.2; range, 73 to 100) compared with the debridement group (80.9; range, 42.6 to 100; P < .05). Similarly, the postoperative sports HOS was significantly greater in the repair group (88.7; range, 28.6 to 100) than in the debridement group (76.3; range, 28.6 to 100; P < .05). Additionally, patient subjective outcome was significantly better in the labral repair group (P = .046). Arthroscopic treatment of femoroacetabular impingement with labral repair in female patients resulted in superior improvement in hip functional outcomes compared with labral debridement. In addition, a greater number of patients in the repair group subjectively rated their hip function as normal or nearly normal after surgery compared with the labral debridement group. Level I, prospective randomized study.

Intraoperative Neurophysiological Monitoring of Somatosensory Evoked Potentials during Hip Arthroscopy Surgery

ABSTRACT.Arthroscopic hip surgery is used to treat many of the causes of hip pain, hip instability, and hip disorders. Hip pain and instability are often caused by injuries to the acetabular labrum. Repairing labral tears, suturing, and debridement involve stabilizing the hip and placing the operative side leg in traction (Phillipon 2006, Phillipon and Schenker 2006) to allow for instrument clearance and to avoid iatrogenic injury to the chondral surfaces. This places the sciatic nerve in a stretched position and may cause temporary or permanent nerve injury. Transient neuropraxia is the most common injury occurring in 5% of the patients undergoing arthroscopic hip surgery (McCarthy and Lee 2006).35 patients; 24 women and 11 men, (a total of 36 surgeries) were monitored with intraoperative neurophysiological monitoring using somatosensory evoked potentials (SSEPs) during hip arthroscopy for labral repair and femoral head osteoplasty. They ranged in age from 15 to 59 years; mean age: 39.81 years. During surgery 19 (54%) patients experienced significant SSEP waveform changes. Time from placement of traction to loss of signals in those patients experiencing SSEP changes ranged from 7 minutes to 46 minutes. Recovery of SSEP signals ranged from 2 minutes to over 15 minutes when the traction of the leg was released. Surgeries ranged from 2 to 4 hours; mean: 2.78 hours.These findings show that neuromonitoring during hip arthroscopic labral repair and debridement procedures might be useful to prevent temporary and permanent neural tissue injuries.

Paper 4: Arthroscopic Treatment Cam-Type Hip Impingement Lesions with 32.8-Month Mean Follow-Up

Paper 4: Arthroscopic Treatment Cam-Type Hip Impingement Lesions with 32.8-Month Mean Follow-Up