A retrospective review of our hip arthroscopy database was performed. There were 2541 patients included in the database from hip arthroscopies performed by two surgeons between September 2012 and September 2015. Of these patients 459 had labral repairs. Patients were excluded if they were younger than 18 years, had less than one-year follow-up, had prior ipsilateral hip surgery and had radiological or arthroscopic evidence of femoroacetabular impingement (FAI), hip dysplasia or other bony dysmorphism.
After exclusion criteria was applied there were 71 procedures in 69 patients who received primary repair of a torn acetabular labrum. Of these there were 26 patients failed to respond postoperatively via email or post. Thus the final sample size was 43 patients undergoing 45 procedures.
Indication for surgery in all patients was recalcitrant hip pain and associated mechanical symptoms that were not responsive to conservative treatment for at least 6 months. On clinical examination, all patients had positive pain provocation tests (flexion, adduction and internal rotation) and were investigated using plain radiographs (AP pelvis, lateral, Dunn view), magnetic resonance imaging scans (MRI) and CT scans to exclude osseous abnormality including femoroacetabular impingement and hip dysplasia.
Hip arthroscopy was performed under general anaesthesia in the lateral decubitus position using a McCarthy Hip Distractor (Innomed, Inc., Savannah, GA, USA). With the use of an image intensifier two portals were established; a viewing portal above the apex of the greater trochanter and an instrumentation portal 3-4 cm anterior to the anterior margin of the greater trochanter. An arthroscopic pump was used throughout to maintain constant distension of the joint with Ringer solution, at a pressure of 40 mmHg. A 70° arthroscope was used throughout the procedure in both the central and peripheral compartments.
Classification of an acetabular labral tear was described intraoperativley based on location of the lesion on the labral circumference using a clock-face nomenclature where 6 o’clock was the transverse ligament and 3 o’clock was anterior [8, 9]. The Labrum was then treated with circumferential suture anchor refixation using the Stryker Nano Tack Flex (Kalamazoo, MI, USA).
Upon visualization of the central compartment, articular cartilage pathology was classified according to the Outerbridge classification and The international cartilage research society (ICRS) grading system, [10, 11]. Microfracture was undertaken in patients with full-thickness cartilage loss (Outerbridge grade 4) at the chondrolabral junction in lesions up to 3 cm2.
During the arthroscopy procedure a dynamic inspection of the LT using both internal and external rotation was performed. Ligamentum teres (LT) tears were described using the Salas and O’Donnell classification system . LT tears were debrided with a radiofrequency probe (Vulcan Eflex Ablator Probe, Smith & Nephew, And over, MA, USA). Local anaesthetic (100 mg ropivicaine) was injected via portals into the hip joint and the wounds were closed with interrupted Nylon sutures 2.0.
Surgical findings were recorded at the time of surgery. All patients underwent formal rehabilitation post-operatively using a standard protocol . Post-operatively all patients were discharged with crutches, full weight bear status and instructed to take oral meloxicam for 30 days.
Each patient was asked to complete the iHOT-33 questionnaire prior to surgery on consultation. Post operatively patients completed the i-HOT33 via email or post. The iHOT-33 is a self-administered tool containing 33 questions distributed within four domains; symptoms and functional limitations, sports and recreational activities, job-related concerns and social, emotional and lifestyle concerns. Each question is answered on a visual analogue scale format ranging from 0 to 100, where a higher score represents a higher quality of life.7 The total score is the mean score for each item. Questions included may not be applicable to all patients and have the option to not to be answered. These optional questions relate to cutting/changing direction during sports activities, job related concerns, sexual activities and carrying children. If these questions are omitted or unable to be answered then the overall score is still taken as the average out of 100 from all the questions answered.
Multivariate model with repeated measures was used to explore differences between the iHOT-33 pre-surgery and post-surgery total scores. LT-tear (yes or no) and chondroplasty (yes or no) were used as the between-subject effects to determine if they had effect on the outcome. We correlated patients with ligamentum teres tear or chondroplasty using Bonferroni tests. The iHOT-33 total score was the within-subjects effects (repeated effects). Repeated measures were also performed on the 4 iHOT-33 domains; symptoms, sport, job, and social. All statistical tests were run using SPSS version 24 (IBM® SPSS Statistics) with α set at 0.05, p < 0.05, as the level of significance.