A new randomised controlled clinical trial provides new evidence on the effectiveness of hip arthroscopy for labral tears in patients aged > 40 years compared with physiotherapy alone, published in the American journal “The American Journal of Sports Medicine”.
Previous studies have shown unsatisfactory results from arthroscopic surgery for the treatment of acetabular labral tears in patients aged > 40 years. The new study compared hip arthroscopy with conservative treatment in patients with symptoms of an acetabular labral tear, aged > 40 years, who had limited radiographic evidence of osteoarthritis. It is worth noting that the study was Level I in terms of evidence, that is, it was randomised and controlled.
The study data came from a single surgeon, with patients who had a labral tear confirmed on MRI and radiographic evidence of osteoarthritis of Tonnis grade 0 to 2; they were randomised 1:1 against patients who received physiotherapy alone, using an electronic randomisation system. The patients receiving physiotherapy alone followed it for a period of > 14 weeks.
The primary outcomes were obtained using the Hip Outcome Tool, iHOT-33 and Modified Harris Hip Score (MHHS) outcome measures at 12 months after randomisation, while the secondary outcomes included other outcome measures and a visual analogue pain scale. The results were assessed at 3, 6 and 12 months. Ninety patients were included in the study, of whom 81 completed the 12-month follow-up.
The authors concluded that patients aged > 40 years with limited osteoarthritis who underwent arthroscopic repair of an acetabular labral tear and postoperative physiotherapy had better outcomes than those who received physiotherapy alone. The age threshold of 40 years should therefore not be regarded as a contraindication to arthroscopic repair of acetabular labral tears.
Source: “The American Journal of Sports Medicine”, March 2021