Aims

Metaphyseal tritanium cones can be used to manage the tibial bone loss commonly encountered at revision total knee arthroplasty (rTKA). Tibial stems provide additional fixation and are generally used in combination with cones. The aim of this study was to examine the role of the stems in the overall stability of tibial implants when metaphyseal cones are used for rTKA.

Aims

There are comparatively few randomized studies evaluating knee arthroplasty prostheses, and fewer still that report longer-term functional outcomes. The aim of this study was to evaluate mid-term outcomes of an existing implant trial cohort to document changing patient function over time following total knee arthroplasty using longitudinal analytical techniques and to determine whether implant design chosen at time of surgery influenced these outcomes.

Anterior knee pain (AKP) is the commonest complication of total knee arthroplasty (TKA). This study aims to assess whether sagittal femoral component position is an independent predictor of AKP after cruciate retaining single radius TKA without primary patellofemoral resurfacing.

From a prospective cohort of 297 consecutive TKAs, 73 (25%) patients reported AKP and 89 (30%) reported no pain at 10 years. Patients were assessed pre-operatively and at 1, 5 and 10 years using the short form 12 and Oxford Knee Score (OKS). Variables assessed included demographic data, indication, reoperation, patella resurfacing, and radiographic criteria.

Patients with AKP (mean age 67.0 (38–82), 48 (66%) female) had mean Visual Analogue Scale (VAS) Pain scores of 34.3 (range 5–100). VAS scores were 0 in patients with no pain (mean age 66.5 (41–82), 60 (67%) female). Femoral component flexion (FCF), anterior femoral offset ratio, and medial proximal tibial angle all differed significantly between patients with AKP and no pain (p<0.001), p=0.007, p=0.009, respectively). All PROMs were worse in the AKP group at 10 years (p<0.05). OKSs were worse from 1 year (p<0.05). Multivariate analysis confirmed FCF and Insall ratio <0.8 as independent predictors of AKP (R² = 0.263). Extension of ≥0.5° predicted AKP with 87% sensitivity.

AKP affects 25% of patients following single radius cruciate retaining TKA, resulting in inferior patient-reported outcome measures at 10 years. Sagittal plane positioning and alignment of the femoral component are important determinants of long-term AKP with femoral component extension being a major risk factor.

The primary aim of this study was to compare the knee specific functional outcome of partial compared with total knee replacement (TKR) for the management of patellofemoral osteoarthritis.

Fifty-four consecutive Avon patellofemoral replacements were identified and propensity score matched to a group of 54 patients undergoing a TKR with patella resurfacing for patellofemoral osteoarthritis. The Oxford knee score (OKS), the Short Form (SF-) 12 and patient satisfaction were collected (mean follow up 9.2 years). Survival was defined by revision or intention to revise.

There was no significant difference in the OKS (p>0.60) or SF-12 (p>0.28) between the groups. The TKR group was significantly less likely to be satisfied with their knee (95.1% versus 78.3%, OR 0.18, p=0.03). Length of stay was significantly (p=0.008) shorter for the Avon group (difference 1.8 days, 95% CI 0.4 to 3.2). The 10 year survival for the Avon group was 92.3% (95% CI 87.1 to 97.5) and for the TKR group was 100% (95% CI 93.8 to 100). There was no statistical difference in the survival rate (Log Rank p=0.10).

The Avon patellofemoral replacement have a shorter length of stay with a functional outcome and satisfaction rate that is equal to that of TKR. The benefits of the Avon need to be balanced against the increased rate of revision when compared with TKR.

Instability accounts for approximately 20% of revision total knee arthroplasty (TKA) operations, however, diagnostic tests remain relatively subjective. The aim of this examination was to evaluate the feasibility of using pressure mat analyses during functional tasks to identify abnormal biomechanics associated with TKA instability.

Five patients (M = 4; age = 69.80±7.05 years; weight = 79.73±20.12 kg) with suspected TKA instability were examined compared to 10 healthy controls (M = 4; age = 44.6±7.52 years; weight = 70.80±14.65). Peak pressure and time parameters were measured during normal gait and two-minute bilateral stance. Side-to-side pressure distribution was calculated over 10-second intervals during the second minute. Mann-Whitney tests compared loading parameters between groups and side-to-side differences in TKA patients (significance level = p<0.05).

Pressure distribution was expressed relative to bodyweight. Notable differences were seen during bilateral stance. Uneven side loading was greater – favouring the non-operated limb – in TKA patients during bilateral stance compared to controls. This was significantly different at 30s (p=0.0336) and 60s (p=0.0336). Gait analyses showed subtle pressure distribution differences in unstable TKA patients. Stance time was indifferent. TKA patients tended to exhibit longer heel contact time (0.76s vs. 0.64s and reduced weight acceptance (50.75% vs. 56.75%) on the operated limb compared to the non-operated limb. Side-to-side differences in peak toe-off forces were significantly more pronounced in TKA patients versus controls (9.25% +/− 1.5% vs. 1.67% +/−5.79%; p=0.0039).

Conclusion: This feasibility work demonstrates subtle differences in limb loading mechanics during simple clinical tests in unstable TKA patients that might be invisible to the naked eye. In the long-term, pressure analyses may be a useful diagnostic tool in identifying patients that would benefit from revision surgery for TKA instability.

Instability accounts for approximately 20% of all revision total knee arthroplasty (TKA), however diagnostic tests remain crude and subjective. The aim of this examination was to evaluate the feasibility of pressure mat (SB Mat, TekScan) analyses of functional tasks to differentiate instability in a clinical setting. Five patients (M = 4; age = 69.80±7.05 years; weight = 79.73±20.12 kg) with suspected TKA instability were examined compared to five healthy controls (M = 1; age = 46.80±7.85 years; weight = 71.54±16.17 kg). Peak pressure and time parameters were measured during normal gait and two-minute bilateral stance. Side-to-side pressure distribution was calculated over 10-second intervals during the second minute. Pressure distributions were expressed relative to bodyweight (%BW). T-tests compared loading parameters between groups (significance level = p<0.05). Analyses showed subtle differences in pressure distribution in unstable TKA patients versus healthy controls. Stance time during gait was indifferent. TKA patients tended to exhibit longer heel contact time (0.76 vs. 0.64 sec) and reduced weight acceptance (50.75% vs. 56.75%) on the operated versus non-operated limb. Side-to-side differences in toe-off forces were significantly more pronounced in TKA patients versus controls (9.25% vs. 3.75%; p=0.0088). Uneven loading was significantly greater – favouring the non-operated limb – in TKA patients during bilateral stance compared to controls (p<0.05). This feasibility work demonstrates subtle differences in limb loading and biomechanics during simple clinical tests in unstable TKA patients that might be undetectable to the naked eye. Pressure analyses may therefore be a useful diagnostic tool. These findings warrant further investigation.

The Low Contact Stress (LCS) mobile-bearing total knee replacement (TKR) was designed to minimize polyethylene wear, aseptic loosening and osteolysis. However, registry data suggests there is a significantly greater revision rate associated with the LCS TKR.

The primary aim of this study was to assess long-term survivorship of the LCS implant. Secondary aims were to assess survival according to mechanism of failure and identify predictors of revision.

We retrospectively identified 1091 LCS TKRs that were performed between 1993 and 2006. There was incomplete data available 33 who were excluded. The mean age of the cohort was 69 (SD 9.2) years and there were 577 TKRs performed in females and 481 in males. Mean follow up was 14 years (SD 4.3).

There were 59 revisions during the study period: 14 for infection, 18 for instability, and 27 for polyethylene wear. 392 patients died during follow up. All cause survival at 10-year was 95% (95%CI 91.7–98.3) and at 15-year was 93% (95%CI 88.6–97.8). Survival at 10-years according to mechanism of failure was: infection 99% (95%CI 94–100%), instability 98% (95%CI 94–100%), and polyethylene wear 98% (95%CI92–100). Of the 27 with polyethylene wear only 19 had associated osteolysis requiring component revision, the other 8 had simple polyethylene exchanges. Cox regression analysis, adjusting for confounding variables, identified younger age was the only predictor of revision (hazard ratio 0.96, 95%CI 0.94–0.99, p=0.003).

The LCS TKR demonstrates excellent long-term survivorship with a low rate of revision for osteolysis, however the risk is increased in younger patients.

Objectives

Preservation of posterior condylar offset (PCO) has been shown to correlate with improved functional results after primary total knee arthroplasty (TKA). Whether this is also the case for revision TKA, remains unknown. The aim of this study was to assess the independent effect of PCO on early functional outcome after revision TKA.

Patient function is poorly characterised following revision TKA. Modern semi-constrained implants are suggested to offer high levels of function, however, data is lacking to justify this claim.

52 consecutive aseptic revision TKA procedures performed at a single centre were prospectively evaluated; all were revision of a primary implant to a Triathlon total stabiliser prosthesis. Patients were assessed pre-operatively and at 6, 26, 52 and 104 weeks post-op. Outcome assessments were the Oxford Knee Score (OKS), range of motion, pain rating scale and timed functional assessment battery. Analysis was by repeated measures ANOVA with post-hoc Tukey HSD 95% simultaneous confidence intervals as pairwise comparison. Secondary analysis compared the results of this revision cohort to previously reported primary TKA data, performed by the same surgeons, with identical outcome assessments at equivalent time points.

Mean age was 73.23 (SD 10.41) years, 57% were male. Mean time since index surgery was 9.03 (SD 5.6) years. 3 patients were lost to follow-up. All outcome parameters improved significantly over time (p <0.001). Post-hoc analysis demonstrated that all outcomes changed between pre-op, 6 week and 26 weeks post-op assessments.

No difference was seen between primary and revision cohorts in OKS (p = 0.2) or pain scores (p=0.19). Range of motion and functional performance was different between groups over the 2 year period (p=0.03), however this was due to differing pre-operative scores, post-hoc analysis showed no difference between groups at any post-operative time point.

Patients undergoing aseptic revision TKA with semi-constrained implants made substantial improvements in OKS, pain scores, knee flexion, and timed functional performance, with the outcomes achieved comparable to those of primary TKA. High levels of function can be achieved following revision knee arthroplasty, which may be important considering the changing need for, and demographics of, revision surgery.

This study assessed whether patient satisfaction with their hospital stay influences the early outcome of total knee replacement (TKR).

During a five year period patients undergoing primary TKR at the study centre had prospectively outcome data recorded (n=2264). Patients with depression (p=0.04) and worse mental wellbeing (p<0.001), according to the short form (SF)-12, were more likely to be dissatisfied with their hospital stay. Decreasing level of satisfaction with their hospital stay was associated with a significantly worse post-operative OKS (p<0.001) and SF-12 score (p<0.001). Multivariable regression analysis confirmed that the patients perceived level of satisfaction with their hospital stay was an independent predictor of change in the OKS (p<0.001) and SF-12 score (p<0.001) after adjusting for confounding variables. Patient satisfaction with their TKR was significantly influenced by their hospital experience, decreasing from 96% in those with an excellent experience to 42% in those with a poor experience. Food, staff/care, and the hospital environment were the most frequent reasons of why patients rated their hospital experience as fair or poor.

A patient's perception of their inpatient hospital experience after surgery is an important modifiable predictor of early functional outcome and satisfaction with TKR.

Total knee arthroplasty (TKA) is an established and successful procedure. However, the design of prostheses continues to be modified in an attempt to optimise the functional outcome of the patient.

The aim of this study was to determine if patient outcome after TKA was influenced by the design of the prosthesis used.

A total of 212 patients (mean age 69; 43 to 92; 131 female (62%), 81 male (32%)) were enrolled in a single centre double-blind trial and randomised to receive either a Kinemax (group 1) or a Triathlon (group 2) TKA.

Patients were assessed pre-operatively, at six weeks, six months, one year and three years after surgery. The outcome assessments used were the Oxford Knee Score; range of movement; pain numerical rating scales; lower limb power output; timed functional assessment battery and a satisfaction survey. Data were assessed incorporating change over all assessment time points, using repeated measures analysis of variance longitudinal mixed models. Implant group 2 showed a significantly greater range of movement (p = 0.009), greater lower limb power output (p = 0.026) and reduced report of ‘worst daily pain’ (p = 0.003) over the three years of follow-up. Differences in Oxford Knee Score (p = 0.09), report of ‘average daily pain’ (p = 0.57) and timed functional performance tasks (p = 0.23) did not reach statistical significance. Satisfaction with outcome was significantly better in group 2 (p = 0.001).

These results suggest that patient outcome after TKA can be influenced by the prosthesis used.

Cite this article: Bone Joint J 2015;97-B:64–70.

Instability is the reason for revision of a primary total knee replacement (TKR) in 20% of patients. To date, the diagnosis of instability has been based on the patient’s symptoms and a subjective clinical assessment. We assessed whether a measured standardised forced leg extension could be used to quantify instability.

A total of 25 patients (11 male/14 female, mean age 70 years; 49 to 85) who were to undergo a revision TKR for instability of a primary implant were assessed with a Nottingham rig pre-operatively and then at six and 26 weeks post-operatively. Output was quantified (in revolutions per minute (rpm)) by accelerating a stationary flywheel. A control group of 183 patients (71 male/112 female, mean age 69 years) who had undergone primary TKR were evaluated for comparison.

Pre-operatively, all 25 patients with instability exhibited a distinctive pattern of reduction in ‘mid-push’ speed. The mean reduction was 55 rpm (sd 33.2). Post-operatively, no patient exhibited this pattern and the reduction in ‘mid-push’ speed was 0 rpm. The change between pre- and post-operative assessment was significant (p < 0.001). No patients in the control group exhibited this pattern at any of the intervals assessed. The between-groups difference was also significant (p < 0.001). This suggests that a quantitative diagnostic test to assess the unstable primary TKR could be developed.

Cite this article: Bone Joint J 2014;96-B:1339–43.

Summary Statement

Using current analysis/methodology, new implant technology is unlikely to demonstrate a large enough change in patient function to impact on the cost-effectiveness of the procedure.

There is conflicting data from small retrospective studies as to whether pre-operative mental health influences the outcome of total knee replacement (TKR).

We assessed the effect of mental disability upon the outcome of TKR and whether mental health improves post-operatively. During a three year period patients undergoing TKR for primary osteoarthritis at the study centre had prospectively outcome data recorded (n=962). Pre-operative and one year short-form (SF) 12 scores and Oxford knee scores (OKS) were obtained. The mental component of the SF-12 was stratified into four groups according to level of mental disability (none ≥50, mild 40to49, moderate 30to39, severe <30). Ethical approval was obtained (11/AL/0079).

Patients with any degree of mental disability had a significantly greater subjective physical disability according to the SF-12 (p=0.06) and OKS (p<0.001). Although the improvement in the disease specific score (OKS) was not affected by a patients mental health (p=0.33). In contrast the improvement of the global physical health (SF-12) for patients with a mental disability did not improve to the same magnitude (p<0.001). However, patients with mental disability, of any degree, had a significant improvement in their mental health post-operatively (p<0.0001). Despite the similar improvement in the disease specific scores and improvement in their mental health, patients with mental disability were significantly more likely to be dissatisfied with their TKR at one year (p=0.001).

TKR for patients with poor mental health benefit from improvement in their mental health and in their knee function, but do have a higher rate of dissatisfaction.

Introduction

Many prosthetic design changes have been introduced in attempt to improve outcomes following TKA; however there is no consensus as to whether these changes confer benefits to patients. This study aimed to assess whether patients treated with a modern implant design had an enhanced patient outcome compared to a traditional model in a double blind randomised controlled trial.

Isolated liner exchange in revision total hip arthroplasty for the treatment of polyethylene wear is an increasingly common surgical procedure. Twenty-four hips underwent this procedure via the direct lateral approach and were prospectively followed clinically and radiographically. Accessible osteolytic lesions were curetted and bone grafted. At a mean follow-up of forty months, a significant clinical improvement was observed. One cup collapsed into an osteolytic lesion postoperatively; all other lesions regressed. No dislocations have occurred. Isolated liner exchange via the direct lateral approach may reduce dislocation rates while avoiding the morbidity associated with the removal of well-fixed components.

The purpose of this study was to evaluate the clinical and radiographic results of isolated liner exchange in revision total hip arthroplasty (THA) for osteolysis and polyethylene wear via the direct lateral surgical approach.

Retention of well-fixed implants avoids unnecessary bone loss at revision surgery. Previous studies report a significant dislocation rate with isolated liner exchange. Revision via the direct lateral surgical approach may reduce the dislocation rate in surgery for acetabular osteolysis.

Twenty-four hips that underwent an isolated liner exchange revision procedure via the direct lateral approach were prospectively followed. Accessible osteolytic lesions were curetted and bone grafted. Harris Hip Score, WOMAC Index, and radiographic analysis were recorded. The area of osteolytic lesions was calculated using a computer imaging technique.

At mean follow-up of forty months, all except one of the osteolytic lesions had regressed in size. Mean Harris Hip scores improved from sixty-nine to eighty-three and WOMAC indices improved from thirty-seven to twenty-four. No dislocations have occurred. One cup collapsed into an osteolytic lesion postoperatively, requiring an acetabular revision procedure.

Isolated liner exchange is a promising technique that avoids the removal of well-fixed acetabular implants. The increased dislocation rate associated with revision THA may be reduced and osteolytic lesions may be debrided and bone grafted through the direct lateral approach.

Isolated liner exchange via the direct lateral approach reduces the dislocation rate in THA. Retention of wellfixed implants and bone grafting is a procedure that preserves bone stock and addresses osteolytic lesions at revision surgery.

The results of a randomized controlled clinical trial of ninety patients comparing resurfacing to non-resurfacing of the patella in total knee arthroplasty (TKA) are reported with a minimum of ten-years of follow-up. Using a cruciate retaining hybrid TKA, the outcome measures included Knee Society Clinical Rating scores, functional testing (stair climb and flexion extension torques), patient satisfaction, anterior knee pain, and a patellofemoral specific questionnaire. The results indicated no difference between the groups in all categories. Results at two and ten years postoperatively are compared. This study represents the longest follow-up to date comparing resurfacing to nonresurfacing of the patella.

Patellar resurfacing in TKA remains controversial.

Purpose: To evaluate the results of resurfacing/non-resurfacing of the patella in a randomized controlled clinical trial at a minimum of ten-years of follow-up.

One hundred knees (ninety patients) with osteoarthritis were enrolled in a prospective randomized controlled double-blinded trial using the same posterior cruciate retaining total knee replacement. Patients were randomized to resurfacing or nonresurfacing of the patella. Evaluations were performed preoperatively and yearly to a minimum ten years (range, 10.1–11.5 years) postoperatively. Disease specific (Knee Society Clinical Rating System), functional (stair climbing, knee flex-ion/extension torques, patellar examination) outcomes were measured. Patient satisfaction, anterior knee pain, and patellofemoral questionnaires were completed. Intraoperative grading of the articular cartilage was performed.

No patients were lost to follow-up; forty-six knees remained alive. Nine revisions (9/90-ten percent) were performed – 7/48 (fifteen percent) in the nonresurfaced and 2/42 (five percent) in the resurfaced group. Three knees in the nonresurfaced group were revised to a resurfaced patella for anterior knee pain. One resurfaced patella was complicated by AVN and fracture, requiring revision. No significant difference was found between the groups regarding revision rates, KSCR score, functional, satisfaction, anterior knee pain, patellofemoral, and radiographic outcomes. Intraoperative cartilage quality was not a predictor of outcome.

This study represents the longest follow up to date of a randomized controlled clinical trial to examine patellar resurfacing in TKA. The results showed no significant difference between the groups for all outcome measures at a minimum of ten-years.

Purpose: Problem : Infection in TKA is a devastating yet common complication. 2-stage reimplant procedures are performed in the treatment of this condition. Purpose:To evaluate the clinical, radiographic, complications, and patient satisfaction results of 2nd stage reimplantation revision TKA with the use of a TTO. Technical aspects of TTO length, fixation, bypass, and complications are reported.

Methods: From 1996–2004 our database identified 25 revision TKA (12% of 206 revision TKA) performed using a TTO. In 20/25 cases the procedure was a 2nd stage reimplant. Demographics, infecting organism, Gustillo grade, clinical, radiographic, AORI defects, complications, patient satisfaction were evaluated prospectively. All patients were followed until radiographic union of the TTO.

Results: At a mean follow up of 22 mo(range,6–84) no patients were lost to follow-up. 24 (96%)TTO’s healed - 1 requiring revision ORIF. Prior to reimplantation, patients had undergone a mean of 3.3 prior knee surgeries(range,2–8). Prior extensor mechanism procedures had been performed in 43% of knees. Methicillin resistant staphylococcus was the infecting organism in > 50% of knees. 19 knees had a static cement spacer removed at revision. Time to 2nd stage reimplant was 39 weeks(range,15–68). Poor preop range of motion and stiffness (mean arc 430 , range 10–950) improved significantly postop (mean flexion 880 p< .05). 13 (56%) knees required an adjunctive extensor procedure at the time of TTO. TTO length averaged 8.8cm(range,8–10). Screws(15 knees), 2mm cables(6), wires(4) were used for TTO fixation. Mean stem bypass of the TTO was 63mm (−20 to 100). 21 (84%) patients were satisfied with the procedure, despite 8 knees(32%) requiring further surgery. 6 (24%) TTO complications occurred; 1 escape requiring fixation. All TTO’s had healed at recent follow up.

Conclusions: TTO is a useful procedure for exposure in 2nd stage revision TKA. TTO union is predictable(96%), despite technical complications. Recurrence of infection requiring further surgery did not compromise TTO results. Prior/concurrent extensor mechanism procedures were noted frequently.

Funding : Other Education Grant

Funding Parties : Wright Medical Technologies

The results of a randomized controlled clinical trial of ninety patients comparing resurfacing to non-resurfacing of the patella in total knee arthroplasty (TKA) are reported with a minimum of ten-years of follow-up. Using a cruciate retaining hybrid TKA, the outcome measures included Knee Society Clinical Rating scores, functional testing (stair climb and flexion extension torques), patient satisfaction, anterior knee pain, and a patellofemoral specific questionnaire. The results indicated no difference between the groups in all categories. Results at two and ten years postoperatively are compared. This study represents the longest follow-up to date comparing resurfacing to nonresurfacing of the patella.

Patellar resurfacing in TKA remains controversial. Purpose: To evaluate the results of resurfacing/non-resurfacing of the patella in a randomized controlled clinical trial at a minimum of ten-years of follow-up.

One hundred knees (ninety patients) with osteoarthritis were enrolled in a prospective randomized controlled double-blinded trial using the same posterior cruciate retaining total knee replacement. Patients were randomized to resurfacing or nonresurfacing of the patella. Evaluations were performed preoperatively and yearly to a minimum ten years (range, 10.1–11.5 years) postoperatively. Disease specific (Knee Society Clinical Rating System), functional (stair climbing, knee flexion/extension torques, patellar examination) outcomes were measured. Patient satisfaction, anterior knee pain, and patellofemoral questionnaires were completed. Intraoperative grading of the articular cartilage was performed.

No patients were lost to follow-up; forty-six knees remained alive. Nine revisions (9/90-ten percent) were performed – 7/48 (fifteen percent) in the nonresurfaced and 2/42 (five percent) in the resurfaced group. Three knees in the nonresurfaced group were revised to a resurfaced patella for anterior knee pain. One resurfaced patella was complicated by AVN and fracture, requiring revision. No significant difference was found between the groups regarding revision rates, KSCR score, functional, satisfaction, anterior knee pain, patellofemoral, and radiographic outcomes. Intraoperative cartilage quality was not a predictor of outcome.

This study represents the longest follow up to date of a randomized controlled clinical trial to examine patellar resurfacing in TKA. The results showed no significant difference between the groups for all outcome measures at a minimum of ten-years.

Purpose: A prospective investigation to define the syndrome associated with symptomatic labral tears definitively diagnosed at hip arthroscopy.

Methods: 66 consecutive patients that had an arthroscopically documented labral tear were evaluated. Demographics, symptomatology, examination, previous treatments, functional limitations, were assessed prospectively. Onset/duration of symptoms to diagnosis of tears, other diagnoses offered by healthcare providers, and non-labral procedures that patients had undergone for the symptoms were analyzed. Radiographic abnormalities and MR arthrography findings were recorded.

Results: There were 47 female and 19 male patients with a mean age of 38 years. Initial presentation: insidious in 61%, acute injury in 30%, and trauma in 9% hips. Moderate to severe pain occurred in 86% of patients, with groin pain predominating (92%). Fifty three percent had true mechanical symptoms - catching/locking. Walking, pivoting, impact activity aggravated patient symptoms (p< 0.05). Pain was characterized as a combination of dull aching pain with intermittent episodes of sharp pain in 70%(p=0.001). Pain was frequently activity related (p< 0.05) and night pain occurred in 71% of patients (p=0.0006). The majority of patients (98%) with a labral tear reported being active/athletic. On examination 39% patients had a limp, 38% a positive Trendelenburg sign, and 95% a positive impingement sign. The mean time to diagnosis of labral tear from the onset of symptoms was 21 months. A mean of 3.3 healthcare providers were seen prior to a definitive diagnosis. Surgery on another anatomic site was recommended in 11 patients and 4 of these underwent an unsuccessful surgery prior to diagnosis of the labral tear. Radiographic data indicated that 38% of hips had an underlying structural abnormality consistent with mild development dysplasia or anterior femoroacetabular impingement. Preoperative MRA detected 73% of the labral tears.

Conclusions: The clinical presentation of a labral tear may vary, with duration of symptoms often greater than 12 months prior to diagnosis. In young, active patients with a predominant complaint of groin pain with or without a history of trauma, the diagnosis of a labral tear should be suspected, and investigated, as radiographs and history may be nonspecific for this diagnosis.