Decreased Hip Labral Width Measured on Preoperative Magnetic Resonance Imaging Is Associated With Greater Revision Rate After Primary Arthroscopic Labral Repair for Femoroacetabular Impingement Syndrome at 5-Year Follow-Up

Zachary I Li; Dhruv S Shankar; Kinjal D Vasavada; Berkcan Akpinar; Lawrence J Lin; Mohammad M Samim; Christopher J Burke; Thomas Youm

doi:10.1016/j.arthro.2023.11.030

Decreased Hip Labral Width Measured on Preoperative Magnetic Resonance Imaging Is Associated With Greater Revision Rate After Primary Arthroscopic Labral Repair for Femoroacetabular Impingement Syndrome at 5-Year Follow-Up

Arthroscopy. 2023 Dec 5:S0749-8063(23)00959-3. doi: 10.1016/j.arthro.2023.11.030. Online ahead of print.

Authors

Zachary I Li¹, Dhruv S Shankar¹, Kinjal D Vasavada¹, Berkcan Akpinar¹, Lawrence J Lin¹, Mohammad M Samim², Christopher J Burke², Thomas Youm³

Affiliations

¹ Department of Orthopedic Surgery, New York University Langone Health, New York, New York, U.S.A.
² Department of Radiology, New York University Langone Health, New York, New York, U.S.A.
³ Department of Orthopedic Surgery, New York University Langone Health, New York, New York, U.S.A.. Electronic address: Thomas.youm@nyulangone.org.

PMID: 38061686
DOI: 10.1016/j.arthro.2023.11.030

Abstract

Purpose: To examine the associations between hip labral width and patient-reported outcomes, clinical threshold achievement rates, and rate of reoperation among patients with femoroacetabular impingement syndrome (FAIS) who underwent hip arthroscopy and labral repair at minimum 5-year follow-up.

Methods: Patients were identified from a prospective database who underwent primary hip arthroscopy for treatment of labral tears and FAIS. Modified Harris Hip Score (mHHS) and Nonarthritic Hip Score (NAHS) were recorded preoperatively and at 5-year follow-up. Achievement of the minimal clinically important difference (MCID), substantial clinical benefit (SCB), and patient-acceptable symptom state (PASS) was determined using previously established values. Labral width magnetic resonance imaging measurements were performed by 2 independent readers at standardized "clockface" locations. Patients were stratified into 3 groups at each position: lower-width (<½ SD below mean), middle-width (within ½ SD of mean), and upper-width (>½ SD above mean). Multivariable regression was used to evaluate associations of labral width with patient-reported outcomes and reoperation rate.

Results: Seventy-three patients (age: 41.0 ± 12.0 years; 68.5% female) were included. Inter-rater reliability for labral width measurements was high at all positions (intraclass correlation coefficient 0.94-0.96). There were no significant intergroup differences in mHHS/NAHS improvement (P > .05) or in achievement rates of MCID/SCB/PASS at each clockface position (P > .05). Eleven patients (15.1%) underwent arthroscopic revision and 4 patients (5.5%) converted to total hip arthroplasty. Multivariable analysis found lower-width groups at 11:30 (odds ratio 1.75, P = .02) and 3:00 (odds ratio 1.59, P = .04) positions to have increased odds of revision within 5 years; however, labral width was not associated with 5-year improvement in mHHS/NAHS, achievement of MCID/PASS/SCB, or conversion to total hip arthroplasty (P > .05).

Conclusions: Hip labral width <½ SD below the mean measured on preoperative magnetic resonance imaging at 11:30- and 3:00-clockface positions was associated with increased odds of reoperation after arthroscopic labral repair and treatment of FAIS. Labral width was not associated with 5-year improvement of mHHS, NAHS, achievement of clinical thresholds, or conversion to arthroplasty.

Level of evidence: Level IV, case series.