My First 100 Compared to My Last 100 Labral Reconstructions- The Role of Patient Selection in Increasing Survivorship

OBJECTIVES: Hip labral reconstruction has been reported with short-term improvement in patient-reported outcomes and functional scores postoperatively; however, its mid-term outcomes and the risk factors of total hip replacement (THR) conversion are still unclear. The purpose of this study was to evaluate the results of patients who underwent labral reconstruction with iliotibial band autograft comparing our first 100 patients to the last 100 patients. We hypothesized that patient selection had been changed between the 2 cohorts and the last 100 patients achieved better clinical outcomes than the first 100 patients. METHODS: The Skeletally mature patients (>17 years) who underwent hip labral reconstruction with autologous iliotibial band were evaluated preoperatively and postoperatively with a minimum 2 years follow-up. The first consecutive 100 patients (Group 1, between September 2005 and December 2008) and the last 100 patients (Group 2, between August 2011 and October 2014) were retrospectively compared. Radiographic evaluations were performed preoperatively. Conversion ratio to THR, necessity of a revision hip arthroscopy, and 7 kinds of outcome scores were evaluated postoperatively. Student t-test, chi-square test were used to compare 2 groups. Logistic regression analysis and receiver operating characteristic (ROC) curve analysis were performed to detect the risk factors of THR conversion. RESULTS: Overall follow-up rate (> 2 years) was 94% (Group 1 v Group 2, 96% v 91%, P = 0.25). The follow-up period of Group 1 was significantly longer (year, 4.8 v 2.8, P < 0.001). Mean age of Group 1 was significantly higher than that of Group 2 (year, 37.1 v 33.5, P = 0.032). In Group 2, 69 surgeries out of 100 were revision hip arthroscopies, which was significantly higher rate than Group 1 (48%, P = 0.003). Group 1 had significantly higher rate of THR conversion (23% v 5%, P = 0.001). Revision hip arthroscopy was performed 11% of Group 1 and 9% of Group 2 (P = 0.751) (Table). Clinical outcomes of the patients who did not require further surgery were similar between 2 groups (all P > 0.15, Figure). In logistic regression analysis, only higher age was significant risk factor of THR conversion, while grouping, primary surgery were not significant (age: P < 0.001, odds ratio 1.15 [95%, 1.08 -1.22], Group 1: P = 0.09, primary surgery: P = 0.06). Cut off value of age calculated by ROC curve was 45.5 years, and 47% of the overall patients older than 46 years had THR after surgery (5% in the patients younger than 45 years, P < 0.001). The rate of the patients older than 46 years in Group 1 was significantly higher than that in Group 2 (30% v 17%, P = 0.030). CONCLUSION: Patient selection had been changed between the first 100 and the last 100 cohorts. Higher age, especially older 46 year-old, was significantly associated with higher conversion rate to THR. Although autologous labral reconstruction was a promising procedure with success rate of up to 80% in this mid-term investigation, patient selection was considered to be the key to increase the survivorship.