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Tomasz Poboży

Hip labral treatment in femoroacetabular impingement: repair or debridement?

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Tomasz Poboży

Polish version: Obrąbek biodra w FAI — naprawa czy częściowe usunięcie?

Hip preservation surgery generally favours retaining a functional labrum when tissue quality allows reliable repair. A meta-analysis published on 11 August 2026 in The American Journal of Sports Medicine supports this approach. In arthroscopic treatment of femoroacetabular impingement (FAI), repair was associated with fewer subsequent total hip arthroplasties (THAs) and better long-term pain outcomes than debridement with partial removal.

Why this study matters

The labrum contributes to the joint seal, stability and synovial fluid distribution. However, much earlier evidence was observational: patients selected for repair may differ from those selected for debridement in tissue quality, degeneration and baseline prognosis. This review analysed randomized and cohort evidence separately.

Review methods

The systematic review and meta-analysis followed a prospectively registered PROSPERO protocol and searched PubMed, Embase and Cochrane CENTRAL. Studies compared arthroscopic labral repair with debridement in FAI. Open procedures and labral reconstruction were excluded to reduce clinical heterogeneity.

Ten studies included 2,730 hips: 1,580 repairs and 1,150 debridements. Outcomes were patient-reported function, pain and conversion to THA, with analyses by study design and follow-up duration.

Main results

Pooled modified Harris Hip Score did not differ significantly: mean difference 1.92 points (95% CI −2.33 to 6.16). Observational studies showed no HOS-ADL or HOS-SSS difference, whereas the randomized trial favoured repair by 10.3 points for HOS-ADL and 12.4 for HOS-SSS.

Short-term pain was similar. At follow-up of at least 5 years, VAS pain favoured repair by a mean of −1.37 points. Conversion to THA occurred in 3.5% of repaired hips versus 7.4% after debridement: pooled RR 0.56 (95% CI 0.37–0.84; P = 0.006). The difference was mainly driven by longer-term results.

Clinical interpretation for an orthopaedic surgeon

The results support preserving a functional, repairable labrum, with long-term pain and THA conversion providing the most compelling signals. They do not support repair irrespective of tissue quality. Repairable and irreparable tissue differ, as may patient age, cartilage condition, joint-space width and degeneration. Some apparent benefit may reflect better baseline prognosis in patients selected for repair.

Limitations

  • The review combined randomized and observational evidence and was rated Level 3 overall.
  • Most evidence came from cohorts susceptible to treatment-selection bias.
  • Arthroscopic techniques, FAI correction and repairability criteria varied.
  • Lower THA conversion does not prove that repair itself prevents osteoarthritis.
  • Findings should not be extrapolated to irreparable labra, reconstruction or advanced hip degeneration.

Implications for practice

Reliable repair of a functional labrum remains a preferred strategy when feasible. The long-term direction of results is more persuasive than small differences in general functional scores. The study does not imply that every debridement is an error or that repair is beneficial regardless of cartilage and tissue quality. It also does not determine when reconstruction is preferable to either treatment.

References

  • Konarski W, Poboży T. Removal of a Periarticular Cyst of the Hip Joint Using an Ultrasoundbased Minimally Invasive Technique – A Case Report. Current Medical Imaging. 2022;18(11):1226–1230. DOI: 10.2174/1573405618666220415125416. This report concerned peri-articular hip pathology associated with an acetabular labral lesion and arthroscopic treatment.
  • Bohn DS, Bigarella LG, Gusmão PDF, Fritsch CG, Lima DJL. Arthroscopic Labral Repair Versus Debridement for Femoroacetabular Impingement: A Systematic Review and Meta-analysis of 2730 Hips. Am J Sports Med. Published online 11 August 2026. DOI: 10.1177/03635465261465092. PubMed PMID 42578456.

This summary is based on the publicly available abstract and publication metadata.

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Content prepared by: Tomasz Poboży - orthopaedic surgeon.

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