2015- Domb et al. Arthroscopic Treatment of Labral Tears in Patients Aged 60 Years or Older. Arthroscopy
John M. Redmond, M.D., Asheesh Gupta, M.D., M.P.H., William M. Cregar, B.S.,Jon E. Hammarstedt, B.S., Chengcheng Gui, B.S.E., and Benjamin G. Domb, M.D.
Purpose:The purpose of this study was to (1) evaluate the clinical outcomes of a series of patients aged 60 years or older who underwent hip arthroscopy for labral tears with minimum 2-year follow-up and (2) identify risk factors for conversion to total hip arthroplasty (THA).
Methods:Outcome data were prospectively collected and retrospectively reviewed in patients aged 60 years or older who underwent hip arthroscopy between April 2008 and May 2012. Four patient-reported outcome (PRO) scores, pain scores, and satisfaction ratings were collected. Conversion to THA and revision surgery rates were recorded. A subgroup analysis compared survivors with patients requiring THA.
Results: Minimum 2-year follow-up was available for 30 patients with a mean age of 63.9 years. The 2-year survivorship rate was 70%, with 9 patients undergoing conversion to THA at a mean of 1.1 years after hip arthroscopy. Two patients required additional surgery during the study period, for a reoperation rate of 37% (11 of 30 patients). The remaining cohort showed mean improvements in all PRO scores. All scores, except the sports-related PRO (P ¼ .12), improved significantly from the preoperative baseline scores. Visual analog scale scores for pain decreased from a mean of 5.0 preoperatively to 2.7 postoperatively (P ¼ .003). Patients who required conversion to THA had lower preoperative modified Harris Hip Scores (P ¼ .015), lower preoperative Hip Outcome ScoreeActivity of Daily Living values (P ¼ .01), higher pain scores (P ¼ .05), greater acetabular inclination (P ¼ .023), and more severe chondral damage (P ¼ .033).
Conclusions: Arthroscopic treatment of labral tears in patients aged 60 years or older should be approached with caution. Patients in this age group had an overall 2-year survivorship rate of 70% and should be counseled before surgery on the possibility of subsequent conversion to THA. Patients aged 60 years or older with poor preoperative PRO scores, high pain scores, radiographic evidence of borderline dysplasia, and severe chondral damage may be poor candidates for hip arthroscopy.
Level of Evidence: Level IV, therapeutic case series.