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Segmental and Circumferential Hip Labral Reconstructions Both Show Favorable Outcomes in Primary Hip Arthroscopy: A
Fernando Gómez-Verdejo1,2,3, Juan Bernardo Villarreal-Espinosa1, Tomás F Vega1
1Department of Orthopaedics, Rush University Medical Center, Chicago, Illinois, U.S.A.
Purpose:
To perform a systematic review comparing outcomes of segmental and circumferential hip labral reconstructions for irreparable labral tears.
Methods:
A systematic search was conducted across PubMed, Embase, and CINAHL. The search terms used were "(hip OR hip arthroscopy) AND (labral reconstruction OR labrum reconstruction)." We included clinical studies reporting outcomes after primary segmental or circumferential hip labral reconstruction in nondysplastic hips and a minimum follow-up of 24 months. A qualitative analysis was performed given the encountered heterogeneity between cohorts.
Results:
A total of 9 studies (13 cohorts, 371 hips) were included in the analysis, comprising 192 hips that underwent segmental labral reconstruction and 179 circumferential. Only 1 study reported comparative outcomes of segmental and circumferential reconstructions. At the study level, postoperative modified Harris Hip Score in the segmental and circumferential groups ranged from 75.6 to 89.0 and from 83.6 to 87.8, respectively. International Hip Outcome Tool-12 scores in the segmental and circumferential groups ranged from 63.9 to 76.7 and from 73.6 to 79.5, respectively, across studies. Hip Outcome Score-Activities of Daily Living in the segmental and circumferential groups ranged from 86.7 to 92.6 and averaged 88.4 in the single circumferential cohort reporting this outcome. Revision and total hip arthroplasty rates ranged from 0% to 20% in the segmental cohorts and 0% to 5.4% in the circumferential cohorts. At the study level, for International Hip Outcome Tool-12 and/or modified Harris Hip Score, patient acceptable symptom state achievement ranged from 53.8% to 100% after segmental reconstruction and 58.8% to 80% after circumferential reconstruction, whereas minimal clinically important difference achievement ranged from 55.6% to 100% and 64.7% to 100%, respectively.
Conclusions:
Primary labral reconstructions of the hip using segmental or circumferential techniques are both effective in improving patient-reported outcomes with high rates of clinically significant improvement; however, there is a current paucity of directly comparative outcomes studies between the 2 approaches.
Level Of Evidence:
Level IV, systematic review of Level II to IV studies.