Long-term Outcomes and Conversion to Total Hip Arthroplasty Based on Acetabular Labral Tear Size: Minimum 8-Year Follow-up

Background: There is a paucity of literature on the effects of labral tear size on long-term patient-reported outcomes (PROs) and conversion to total hip arthroplasty (THA) after hip arthroscopy. Purpose: To understand the differences in hip arthroscopy survivorship and outcomes between patients with large labral tears (LLTs) and small labral tears (SLTs). 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 femoroacetabular impingement by a single surgeon from 2001 to 2013; they completed surveys for such PRO measures (PROMs) as the modified Harris Hip Score (mHHS), Hip Outcome Score–Activities of Daily Living (HOS-ADL), Hip Outcome Score–Sports Specific, 33-item International Hip Outcome Tool (iHOT-33), and pain relief. Patients ≤18 years of age, hip dysplasia LCEA <20°, and Tönnis grade ≥2 were excluded. Included patients were stratified into 2 cohorts: SLT (≤60°) and LLT (>60°). Results: In this study of 154 patients (48.7% female; mean ± SD age, 38 ± 10.8), there was a mean ± SD follow-up of 11.0 ± 2.4 years and body mass index of 26.1 ± 4.3 kg/m2. Women experienced a higher frequency of SLT than men (59.8% vs 40.2%; P = .003). Student t tests demonstrated that the SLT cohort experienced significantly better outcomes than the LLT cohort for mHHS, HOS-ADL, and iHOT-33. Multivariate linear regression analyses adjusting for demographic, radiographic, and intraoperative findings indicated that LLT size can predict worse long-term outcomes after hip arthroscopy for mHHS and HOS-ADL (P < .05). Kaplan-Meier estimates and weighted Cox regression demonstrated that the conversion rate to THA for LLT was significantly greater than that for SLT (hazard ratio, 7.92; 95% CI, 2.96-21.2; P < .0001). Conclusion: Those in the LLT cohort experienced a significantly greater conversion rate to THA than did the SLT cohort. Also, SLT size can independently predict better long-term outcomes on certain PROMs after primary hip arthroscopy.