Association Between Chondrolabral Junction Breakdown and Conversion to Total Hip Arthroplasty After Hip Arthroscopy for Symptomatic Labral Tears: Minimum 8-Year Follow-up.

Autor:	Dean MC; Department of Orthopaedic Surgery, Massachusetts General Hospital, Boston, Massachusetts, USA., Cherian NJ; Department of Orthopaedic Surgery, Massachusetts General Hospital, Boston, Massachusetts, USA.; Department of Orthopaedic Surgery, University of Nebraska, Omaha, Nebraska, USA., LaPorte ZL; Department of Orthopaedic Surgery, Massachusetts General Hospital, Boston, Massachusetts, USA., Eberlin CT; Department of Orthopaedic Surgery, Massachusetts General Hospital, Boston, Massachusetts, USA.; Department of Orthopaedic Surgery, University of Iowa, Iowa City, Iowa, USA., Wang C; Department of Orthopaedic Surgery, Massachusetts General Hospital, Boston, Massachusetts, USA., Torabian KA; Department of Orthopaedic Surgery, Massachusetts General Hospital, Boston, Massachusetts, USA., Dowley KS; Department of Orthopaedic Surgery, Massachusetts General Hospital, Boston, Massachusetts, USA., Kucharik MP; Department of Orthopaedic Surgery, Massachusetts General Hospital, Boston, Massachusetts, USA.; Department of Orthopaedic Surgery, University of South Florida, Tampa, Florida, USA., Abraham PF; Department of Orthopaedic Surgery, Massachusetts General Hospital, Boston, Massachusetts, USA.; Department of Orthopaedic Surgery, University of Southern California, Los Angeles, California, USA., Nazal MR; Department of Orthopaedic Surgery, Massachusetts General Hospital, Boston, Massachusetts, USA.; Department of Orthopaedic Surgery, University of Kentucky, Lexington, Kentucky, USA., Martin SD; Department of Orthopaedic Surgery, Massachusetts General Hospital, Boston, Massachusetts, USA.
Jazyk:	angličtina
Zdroj:	The American journal of sports medicine [Am J Sports Med] 2024 Apr; Vol. 52 (5), pp. 1153-1164. Date of Electronic Publication: 2024 Mar 12.
DOI:	10.1177/03635465241234258
Abstrakt:	Background: Arthroscopic treatment of femoroacetabular impingement (FAI) and symptomatic labral tears confers short- to midterm benefits, yet further long-term evidence is needed. Moreover, despite the physiological and biomechanical significance of the chondrolabral junction (CLJ), the clinical implications of damage to this transition zone remain understudied. Purpose: To (1) report minimum 8-year survivorship and patient-reported outcome measures after hip arthroscopy for FAI and (2) characterize associations between outcomes and patient characteristics (age, body mass index, sex), pathological parameters (Tönnis angle, alpha angle, type of FAI, CLJ breakdown), and procedures performed (labral management, FAI treatment, microfracture). Study Design: Cohort study; Level of evidence, 3. Methods: This retrospective cohort study included patients who underwent primary hip arthroscopy for symptomatic labral tears secondary to FAI by a single surgeon between 2002 and 2013. All patients were ≥18 years of age with minimum 8-year follow-up and available preoperative radiographs. The primary outcome was conversion to total hip arthroplasty (THA), and secondary outcomes included revision arthroscopy, patient-reported outcome measures, and patient satisfaction. CLJ breakdown was assessed using the Beck classification. Kaplan-Meier estimates and weighted Cox regression were used to estimate 10-year survivorship (no conversion to THA) and identify risk factors associated with THA conversion. Results: In this study of 174 hips (50.6% female; mean age, 37.8 ± 11.2 years) with mean follow-up of 11.1 ± 2.5 years, the 10-year survivorship rate was 81.6% (95% CI, 75.9%-87.7%). Conversion to THA occurred at a mean 4.7 ± 3.8 years postoperatively. Unadjusted analyses revealed several variables significantly associated with THA conversion, including older age; higher body mass index; higher Tönnis grade; labral debridement; and advanced breakdown of the CLJ, labrum, or articular cartilage. Survivorship at 10 years was inferior in patients exhibiting severe (43.6%; 95% CI, 31.9%-59.7%) versus mild (97.9%; 95% CI, 95.1%-100%) breakdown of the CLJ ( P < .001). Multivariable analysis identified worsening CLJ breakdown (weighted hazard ratio per 1-unit increase, 6.41; 95% CI, 3.11-13.24), older age (1.09; 95% CI, 1.04-1.14), and higher Tönnis grade (4.59; 95% CI, 2.13-9.90) as independent negative prognosticators ( P < .001 for all). Conclusion: Although most patients achieved favorable minimum 8-year outcomes, several pre- and intraoperative factors were associated with THA conversion; of these, worse CLJ breakdown, higher Tönnis grade, and older age were the strongest predictors. Competing Interests: One or more of the authors has declared the following potential conflict of interest or source of funding: This study was supported by the Conine Family Fund for Joint Preservation. C.W. has received support for education from Smith & Nephew and hospitality payments from Exactech. S.D.M. has received support for education from Kairos Surgical and a gift from Allergan. AOSSM checks author disclosures against the Open Payments Database (OPD). AOSSM has not conducted an independent investigation on the OPD and disclaims any liability or responsibility relating thereto.
Databáze:	MEDLINE
Externí odkaz:	Zobrazit plný text záznamu