Primary Hip Labral Reconstruction Shows Superior Outcomes Compared With Revision Reconstruction After Primary Repair at Minimum 2-Year Follow-Up
Author(s): Kahana-Rojkind AH, Rana K, Kingham YE, Hapa O, Quesada-Jimenez R, Domb BG.
DOI Link: 10.1016/j.arthro.2025.06.022
Background
Labral reconstruction is increasingly used for irreparable or deficient labral tissue, but outcomes may differ when reconstruction is performed as a primary procedure versus as a revision after failed labral repair. This study compared outcomes of revision labral reconstruction to matched primary reconstruction cases.
Methods
This Level 3 retrospective matched cohort study reviewed patients undergoing labral reconstruction from 2008 to 2024. Revision cases (labral reconstruction after failed primary repair) with ≥2-year follow-up were included and matched 1:1 with primary labral reconstruction controls. Outcomes included mHHS, NAHS, HOS-SSS, iHOT-12, VAS pain, patient satisfaction, and achievement of patient acceptable symptom state (PASS). Exclusion criteria included advanced arthritis, dysplasia, microinstability requiring additional procedures, and WC cases.
Key Findings
- 150 hips total (revision: 75; primary: 75)
- Both groups showed significant improvement in all PROs (P < .001)
- Revision reconstruction group demonstrated:
- Inferior postoperative PRO scores across all measures (P < .01)
- Lower rates of PASS achievement compared with primary reconstruction
- Magnitude of improvement was similar between groups
- Primary reconstruction consistently outperformed revision reconstruction in final outcomes
Conclusion
Both primary and revision labral reconstruction provide meaningful clinical improvement; however, primary reconstruction results in superior patient-reported outcomes and higher rates of clinically meaningful threshold achievement compared with revision reconstruction.
What Does This Mean for Providers?
When labral tissue quality is poor or borderline, performing reconstruction at the index procedure may be preferable to repair, as failed repair leading to revision reconstruction is associated with inferior outcomes. Surgical planning should prioritize durable initial management of irreparable labral pathology.