If you are over 40 years old you should know that there are a number of studies that have been published on hip arthroscopy with labral repair that have shown higher failure rate in your age range relative to younger patients. These have documented failure rates with the need for another surgery and often total hip replacement in 25-35% of patients. I have always been critical of these studies as they are small with less than 50 patients and have had potential for insurance companies to use them as support to limit access in patients over 40 to hip arthroscopy. I have not seen these problems or failures in this age range with labral reconstruction, and so I decided to perform this study to answer the question of which labral surgery: Repair or Reconstruction is better in patients over 40 years old.
In contrast to the previous studies, which again were quite small, our study included 312 patients from my surgical database and eliminated all possible variables to cleanly compare the 2 labral surgeries: Labral Repair, where simple sutures are placed around the torn labral tissue and Labral Reconstruction, where the torn, damaged labral tissue is removed and a graft is used to make a new labrum. We designed the study with 3 groups: Labral Repair in patients over 40 (93 patients), Labral Reconstruction in patients over 40 (158 patients) and Labral Reconstructions in patients in their 30’s as a control (112 patients).
We found no difference between Labral Reconstructions in patients in their 30’s and those above 40. The results were the same in both groups and the failure rate was 7.4%, so over 92% successful. In contrast, the Labral Repairs failed in 20.7% of patients, and this high failure rate with labral repair, is similar to what was seen in those other studies. We concluded that Labral Repair was 3.29 times more likely to fail than Labral Reconstruction.
Clearly, age is not the reason for this unacceptably higher failure rate. Rather, I believe that there is a correlation between the health of the labral tissue and age. As FAI or an imperfect shape for the ball and the cup is chronic, then the damage to the labrum occurs over a lifetime of use. The labrum in patients over 40 is simply too damaged to be effectively repaired. Often it does not heal and continues to be painful. Labral Reconstruction in contrast offers the ability to remove this poor quality, chronically damaged tissue, and make a new labrum that is critical for a hip joint to function properly.
If you are over 40 years old, the decision is simple. Labral reconstruction with my team offers you the best possible outcome. If you would like to read this study, it is attached for your convenience.
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