Patient-Reported Outcomes and Conversion to Total Hip Arthroplasty Rates 10 Years After Hip Arthroscopy in Patients With Severe Chondrolabral Junction Breakdown

Abstract

Background:

The chondrolabral junction (CLJ) plays an important role in maintaining hip dynamics, and there is a paucity in the literature examining the effect of CLJ breakdown on long-term outcomes after hip arthroscopy.

Purpose:

To identify patient-reported outcomes (PROs), achievement of clinically significant outcomes, and reoperation rates at 10-year follow-up in patients with severe CLJ breakdown undergoing hip arthroscopy for femoroacetabular impingement.

Study Design:

Cohort study; Level of evidence, 3.

Methods:

PROs were obtained preoperatively and at 10-year follow-up for patients undergoing surgery between January 2012 and June 2014. PROs included the Hip Outcome Score–Activities of Daily Living, Hip Outcome Score–Sports Subscale, modified Harris Hip Score, international Hip Outcome Tool-12, and visual analog scale for pain. Clinically significant outcomes included the minimal clinically important difference and Patient Acceptable Symptom State. Patients were categorized as having severe CLJ breakdown if their Beck classification was between 3 and 4 and mild if their classification was 1 to 2. Those with severe breakdown were propensity matched 1:1 to patients who had mild breakdown, controlling for age, sex, and body mass index (BMI). Independent t tests and Fisher exact tests were used to compare PROs and rates of hip arthroscopy revision and total hip arthroplasty conversion between groups, respectively.

Results:

In this study, 53 patients with severe CLJ breakdown (25 females; mean ± SD age, 38.6 ± 12.2 years; BMI, 25.9 ± 4.9 kg/m²) were matched successfully 1:1 by age, sex, and BMI to 53 patients with mild CLJ breakdown (27 females; age, 37.8 ± 11.3 years; BMI, 25.9 ± 4.9 kg/m²). Preoperatively, there were no differences in PROs between patients with severe and mild CLJ breakdown. At final 10-year follow-up, PRO scores were also similar between groups. However, at 10 years, patients with severe CLJ breakdown underwent conversion to total hip arthroplasty at significantly higher rates than those with mild breakdown (28.4% vs 5.7%; P = .003).

Conclusion:

Patients with severe CLJ junction breakdown undergoing hip arthroscopy for femoroacetabular impingement achieve similar PROs at long-term follow-up but undergo hip arthroplasty significantly more often when compared with patients with mild breakdown.