Hip arthroscopy in patients aged 40 and older remains a topic of debate, particularly due to concerns about functional outcomes and the risk of progression to total hip arthroplasty (THA). This study, a randomized controlled trial with 97 participants, evaluates the effectiveness of hip arthroscopy followed by postoperative physical therapy (SPT) compared to nonoperative physical therapy alone (PTA) in treating symptomatic acetabular labral tears. The trial focused on patients over 40 years old with limited radiographic osteoarthritis (Tönnis grades 0-2). After 24 months, results showed that the SPT group had superior patient-reported outcomes and lower pain scores across nearly all measures compared to the PTA group. Interestingly, patients who failed to improve with PTA and crossed over to surgery also experienced favorable outcomes. The study concludes that age over 40 should not be an independent contraindication for arthroscopic labral repair when surgery is indicated.
Study Highlights:
Patient Demographics: The study included 97 patients aged 40 or older with symptomatic acetabular labral tears and limited osteoarthritis (Tönnis grade 0-2). Patients were randomized to either hip arthroscopy with postoperative physical therapy (SPT) or physical therapy alone (PTA). The cohort was 51.5% female, 48.5% male, with balanced baseline characteristics.
Follow-ups: Patients were assessed at baseline and followed up at 6, 12, and 24 months post-intervention
Positive Outcomes: Patients in the hip arthroscopy with postoperative physical therapy (SPT) group showed significantly better outcomes at 24 months, with higher International Hip Outcome Tool-33 (iHOT-33) and modified Harris Hip Score (mHHS) scores and lower visual analog scale (VAS) pain scores compared to the physical therapy alone (PTA) group.
Conclusion
In conclusion, this randomized controlled trial demonstrates that hip arthroscopy with postoperative physical therapy (SPT) significantly improves outcomes for patients aged 40 and older with symptomatic acetabular labral tears and limited radiographic osteoarthritis. The SPT group exhibited higher scores on the International Hip Outcome Tool-33 (iHOT-33) and modified Harris Hip Score (mHHS) at the 24-month follow-up, along with reduced pain levels compared to those receiving physical therapy alone (PTA). Importantly, patients who initially opted for PTA but later crossed over to SPT also achieved notable improvements, highlighting the potential benefits of surgical intervention when nonoperative management is insufficient. These findings suggest that age should not be a sole contraindication for arthroscopic acetabular labral repair. Clinicians should consider hip arthroscopy as a viable treatment option for older patients, fostering better functional outcomes and enhancing quality of life in this demographic. Further research may elucidate long-term effects and optimal patient selection criteria.
At Mayo Clinic, located in Minneapolis, Minnesota, we are committed to providing personalized care and innovative treatments to help athletes reach their full potential. To learn more about hip impingement, FAI, hip labral tears, CAM and Pincer lesions, schedule a consultation with Dr. Okoroha today. Seeing patients from Minneapolis, St. Paul, Plymouth, Edina, Minnetonka, Rochester, and Minnesota ensures that athletes receive specialized care aimed at maximizing their athletic performance and long-term hip health.
