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Microfracture in the Hip: Results of a Matched-Cohort Controlled Study With 2-Year Follow-up
Benjamin G Domb1, Asheesh Gupta2, Kevin F Dunne2
1American Hip Institute, Westmont, Illinois, USA Hinsdale Orthopaedics, Westmont, Illinois, USA DrDomb@americanhipinstitute.org.
Background:
Microfracture in hip preservation surgery has demonstrated favorable outcomes, but studies with a higher level of evidence assessing microfracture are warranted.
Purpose:
To assess 2-year outcomes of patients who underwent hip arthroscopy with full-thickness chondral damage treated with microfracture and compare these outcomes with those of a control group from a similar cohort of patients who did not have full-thickness chondral damage and who were not treated with microfracture.
Study Design:
Cohort study; Level of evidence, 3.
Methods:
Between February 2008 and May 2012, prospectively gathered data for patients undergoing microfracture during hip arthroscopy with a 2-year follow-up were reviewed. All patients were assessed pre- and postoperatively at 3 months, 1 year, and 2 years with 4 patient-reported outcome (PRO) instruments. A matched cohort of patients who did not have full-thickness chondral damage and hence did not receive microfracture was selected on a 1:2 ratio. Matching criteria were sex, age within 6 years, workers' compensation status, concomitant labral treatment, and radiographic parameters. Statistical analyses were performed to compare the change in PROs in both groups.
Results:
A total of 79 hips were included in the microfracture group and 158 in the control group. There was no significant difference in PRO scores preoperatively between the groups. Both groups demonstrated significant improvement in all postoperative PRO scores at all time points. There was no statistically significant difference in postoperative PRO scores between the microfracture and control groups, except for the visual analog scale (VAS) score at 2 years, which was higher (P = .02) in the microfracture group (mean ± SD, 3.63 ± 2.50) than in the control group (2.82 ± 2.76). Patient satisfaction was 7.2 for the microfracture group and 8.04 for the control group, which was statistically different (P < .05). The mean change in all PRO scores was similar between groups at 3 months and 1 year postoperatively but significantly lower in the microfracture group at 2 years postoperatively. The greatest improvement in both groups was noted at 3 months postoperatively.
Conclusion:
This study showed that patients undergoing microfracture during hip arthroscopy had equivalent PRO scores compared with the control group at 2 years postoperatively. The change in PRO scores from preoperatively to 2 years postoperatively was significantly lower in the microfracture group compared with the control group. The VAS scores and satisfaction were inferior by 0.81 and 0.84 units, respectively, in the microfracture group compared with the control group, likely due to lack of full-thickness chondral defects in the latter. However, both groups showed significant improvement in all PRO scores after surgery, with no significant difference in final PRO scores.
Insights
Microfracture during hip arthroscopy showed similar final patient-reported outcomes (PROs) compared to a control group. However, the change in PROs over two years was less favorable in the microfracture group, indicating potential long-term differences.
Area of Science:
- Orthopedic Surgery
- Hip Arthroscopy
- Regenerative Medicine
Background:
- Microfracture is a surgical technique used in hip preservation surgery.
- While microfracture has shown promise, higher-evidence studies are needed.
- This study addresses the need for more robust evidence on microfracture outcomes.
Purpose of the Study:
- To evaluate 2-year outcomes of hip arthroscopy with microfracture for full-thickness chondral damage.
- To compare these outcomes with a matched control group without full-thickness chondral damage.
- To assess the efficacy of microfracture in hip preservation.
Main Methods:
- A prospective cohort study (Level of evidence, 3) was conducted.
- 79 patients undergoing microfracture were compared to 158 matched controls.
- Patient-reported outcomes (PROs) were assessed pre- and postoperatively using 4 instruments over 2 years.
Main Results:
- Both groups showed significant postoperative improvement in PROs.
- No significant difference in final PRO scores between groups at 2 years.
- Microfracture group had a higher visual analog scale (VAS) score and lower patient satisfaction at 2 years.
Conclusions:
- Microfracture in hip arthroscopy yields comparable final PROs to non-microfracture treatment at 2 years.
- The overall improvement in PROs was less pronounced in the microfracture group.
- While final outcomes are similar, microfracture may lead to slightly inferior patient-reported pain and satisfaction.
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