The purpose of this study was to determine if conversion to total hip arthroplasty and patient-reported outcomes were similar in the first 100 patients who underwent segmental labral reconstruction with iliotibial band autograft compared to the most recent 100 patients.
Patients who underwent hip segmental labral reconstruction with autologous iliotibial band were evaluated preoperatively and postoperatively with a minimum 2-year follow-up. The first consecutive 100 patients (Group 1) and the most recent 100 patients (Group 2) were retrospectively compared. Conversion to total hip arthroplasty, necessity of a revision hip arthroscopy, and patient-reported outcome scores were compared.
Overall follow-up rate (> 2 years) was 94% (Group 1 vs. Group 2, 91% vs. 96%, n.s.). Mean age of Group 1 (37 ± 12) was significantly higher than that of Group 2 (34 ± 12) (p = 0.03). In Group 2, 69 surgeries out of 100 were revision hip arthroscopies, which was significantly higher rate than Group 1 (48/100) (p = 0.003). Group 1 had significantly higher rate of conversion to THA [23% (23/100) vs. 5% (5/100), p = 0.001]. Revision hip arthroscopy was performed in 11/76 (15%) in Group 1 and in 8/95 (9%) in Group 2 (n.s.). Patient-reported outcomes scores were similar between two groups (all n.s.). Higher age and joint space ≤ 2 mm were significant risk factors of total hip arthroplasty conversion.
This study showed that, with experience, fewer conversions to total hip arthroplasty were seen; however, revision rate and outcomes were similar.
Level of evidence
This is a preview of subscription content, log in to check access.
Buy single article
Instant access to the full article PDF.
Price includes VAT for USA
Subscribe to journal
Immediate online access to all issues from 2019. Subscription will auto renew annually.
This is the net price. Taxes to be calculated in checkout.
Ayeni OR, Alradwan H, de Sa D, Philippon MJ (2014) The hip labrum reconstruction: indications and outcomes–a systematic review. Knee Surg Sports Traumatol Arthrosc 22(4):737–743
Boykin RE, Patterson D, Briggs KK, Dee A, Philippon MJ (2013) Results of arthroscopic labral reconstruction of the hip in elite athletes. Am J Sports Med 41(10):2296–2301
Cadet ER, Chan AK, Vorys GC, Gardner T, Yin B (2012) Investigation of the preservation of the fluid seal effect in the repaired, partially resected, and reconstructed acetabular labrum in a cadaveric hip model. Am J Sports Med 40(10):2218–2223
Chahla J, Soares E, Bhatia S, Mitchell JJ, Philippon MJ (2016) Arthroscopic technique for acetabular labral reconstruction using iliotibial band autograft. Arthrosc Tech 5(3):e671–677
Chandrasekaran S, Gui C, Darwish N, Lodhia P, Suarez-Ahedo C, Domb BG (2016) Outcomes of hip arthroscopic surgery in patients with Tonnis Grade 1 osteoarthritis with a minimum 2-year follow-up: evaluation using a matched-pair analysis with a control group with Tonnis Grade 0. Am J Sports Med 44(7):1781–1788
Dietrich F, Ries C, Eiermann C, Miehlke W, Sobau C (2014) Complications in hip arthroscopy: necessity of supervision during the learning curve. Knee Surg Sports Traumatol Arthrosc 22(4):953–958
Domb BG, El Bitar YF, Stake CE, Trenga AP, Jackson TJ, Lindner D (2014) Arthroscopic labral reconstruction is superior to segmental resection for irreparable labral tears in the hip: a matched-pair controlled study with minimum 2-year follow-up. Am J Sports Med 42(1):122–130
Ferguson SJ, Bryant JT, Ganz R, Ito K (2003) An in vitro investigation of the acetabular labral seal in hip joint mechanics. J Biomech 36(2):171–178
Geyer MR, Philippon MJ, Fagrelius TS, Briggs KK (2013) Acetabular labral reconstruction with an iliotibial band autograft: outcome and survivorship analysis at minimum 3-year follow-up. Am J Sports Med 41(8):1750–1756
Harris JD, Brand JC, Cote MP, Dhawan A (2017) Research pearls: the significance of statistics and perils of pooling. Part 1: clinical versus statistical significance. Arthroscopy 33(8):1594–1602
Hoppe DJ, de Sa D, Simunovic N, Bhandari M, Safran MR, Larson CM, Ayeni OR (2014) The learning curve for hip arthroscopy: a systematic review. Arthroscopy 30(3):389–397
Horner NS, Ekhtiari S, Simunovic N, Safran MR, Philippon MJ, Ayeni OR (2017) Hip arthroscopy in patients age 40 or older: a systematic review. Arthroscopy 33(2):464–475
Konan S, Rhee SJ, Haddad FS (2011) Hip arthroscopy: analysis of a single surgeon's learning experience. J Bone Joint Surg Am 93(Suppl 2):52–56
Kautzner J, Zeman P, Stančák A, Havlas V (2018) Hip arthroscopy learning curve: a prospective single-surgeon study. Int Orthop 42(4):777–782
Krych AJ, Thompson M, Knutson Z, Scoon J, Coleman SH (2013) Arthroscopic labral repair versus selective labral debridement in female patients with femoroacetabular impingement: a prospective randomized study. Arthroscopy 29(1):46–53
Larson CM, Giveans MR, Stone RM (2012) Arthroscopic debridement versus refixation of the acetabular labrum associated with femoroacetabular impingement: mean 3.5-year follow-up. Am J Sports Med 40(5):1015–1021
Lebus GF, Briggs KK, Dornan GJ, McNamara S, Philippon MJ (2018) Acetabular labral reconstruction: development of a tool to predict outcomes. Am J Sports Med 46(13):3119–3126
Lee S, Wuerz TH, Shewman E, McCormick FM, Salata MJ, Philippon MJ, Nho SJ (2015) Labral reconstruction with iliotibial band autografts and semitendinosus allografts improves hip joint contact area and contact pressure: an in vitro analysis. Am J Sports Med 43(1):98–104
Matsuda DK, Burchette RJ (2013) Arthroscopic hip labral reconstruction with a gracilis autograft versus labral refixation: 2-year minimum outcomes. Am J Sports Med 41(5):980–987
Menge TJ, Briggs KK, Dornan GJ, McNamara SC, Philippon MJ (2017) Survivorship and outcomes 10 years following hip arthroscopy for femoroacetabular impingement: labral debridement compared with labral repair. J Bone Joint Surg Am 99(12):997–1004
Mehta N, Chamberlin P, Marx RG, Hidaka C, Ge Y, Nawabi DH, Lyman S (2018) Defining the learning curve for hip arthroscopy: a threshold analysis of the volume-outcomes relationship. Am J Sports Med 46(6):1284–1293
Mook WR, Briggs KK, Philippon MJ (2015) Evidence and approach for management of labral deficiency: the role for labral reconstruction. Sports Med Arthrosc 23(4):205–212
Myers CA, Register BC, Lertwanich P, Ejnisman L, Pennington WW, Giphart JE, LaPrade RF, Philippon MJ (2011) Role of the acetabular labrum and the iliofemoral ligament in hip stability: an in vitro biplane fluoroscopy study. Am J Sports Med 39(Suppl):85s–91s
Nepple JJ, Philippon MJ, Campbell KJ, Dornan GJ, Jansson KS, LaPrade RF, Wijdicks CA (2014) The hip fluid seal–Part II: the effect of an acetabular labral tear, repair, resection, and reconstruction on hip stability to distraction. Knee Surg Sports Traumatol Arthrosc 22(4):730–736
Philippon MJ, Briggs KK, Hay CJ, Kuppersmith DA, Dewing CB, Huang MJ (2010) Arthroscopic labral reconstruction in the hip using iliotibial band autograft: technique and early outcomes. Arthroscopy 26(6):750–756
Philippon MJ, Briggs KK, Yen YM, Kuppersmith DA (2009) Outcomes following hip arthroscopy for femoroacetabular impingement with associated chondrolabral dysfunction: minimum two-year follow-up. J Bone Joint Surg Br 91(1):16–23
Philippon MJ, Nepple JJ, Campbell KJ, Dornan GJ, Jansson KS, LaPrade RF, Wijdicks CA (2014) The hip fluid seal–Part I: the effect of an acetabular labral tear, repair, resection, and reconstruction on hip fluid pressurization. Knee Surg Sports Traumatol Arthrosc 22(4):722–729
Pollard TC, Khan T, Price AJ, Gill HS, Glyn-Jones S, Rees JL (2012) Simulated hip arthroscopy skills: learning curves with the lateral and supine patient positions: a randomized trial. J Bone Joint Surg Am 94(10):e68
Schüttler KF, Schramm R, El-Zayat BF, Schofer MD, Efe T, Heyse TJ (2018) The effect of surgeon's learning curve: complications and outcome after hip arthroscopy. Arch Orthop Trauma Surg 138(10):1415–1421
Shi YY, Chen LX, Xu Y, Hu XQ, Ao YF, Wang JQ (2016) Acetabular labral reconstruction with autologous tendon tissue in a porcine model: in vivo histological assessment and gene expression analysis of the healing tissue. Am J Sports Med 44(4):1031–1039
Sing DC, Feeley BT, Tay B, Vail TP, Zhang AL (2015) Age-related trends in hip arthroscopy: a large cross-sectional analysis. Arthroscopy 31(12):2307–2313
Skendzel JG, Philippon MJ, Briggs KK, Goljan P (2014) The effect of joint space on midterm outcomes after arthroscopic hip surgery for femoroacetabular impingement. Am J Sports Med 42(5):1127–1133
Trivedi NN, Sivasundaram L, Su CA, Knapik D, Nho SJ, Mather RC 3rd, Salata MJ (2019) Indications and outcomes of arthroscopic labral reconstruction of the hip: a systematic review. Arthroscopy 35(7):2175–2186
Weber AE, Harris JD, Nho SJ (2015) Complications in hip arthroscopy: a systematic review and strategies for prevention. Sports Med Arthrosc Rev 23(4):187–193
White BJ, Stapleford AB, Hawkes TK, Finger MJ, Herzog MM (2016) Allograft use in arthroscopic labral reconstruction of the hip with front-to-back fixation technique: minimum 2-year follow-up. Arthroscopy 32(1):26–32
Conflict of interest
The author declares that they have no competing interests.
No outside funding was provided for this study.
This study was approved by Vail Valley Medical Center IRB.
Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.
About this article
Cite this article
Philippon, M.J., Utsunomiya, H., Locks, R. et al. First 100 segmental labral reconstructions compared to the most recent 100: the role of surgeon experience in decreasing conversion to total hip arthroplasty. Knee Surg Sports Traumatol Arthrosc 28, 2295–2301 (2020). https://doi.org/10.1007/s00167-019-05692-z
- Hip labral reconstruction
- Hip arthroscopy
- Surgeon experience