Allografts and Autografts in Primary Hip Labral Reconstruction Result in Improved Postoperative Outcomes, With Autografts Showing Lower Revision and Complication Rates: A Systematic Review.

Abstract

To compare patient-reported outcomes, complications, and revision rates after the use of autograft versus allograft for primary arthroscopic hip labral reconstruction. The PubMed, Scopus, and Embase databases were queried following the 2020 Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines to identify human clinical studies reporting outcomes following primary arthroscopic hip labral reconstruction with a minimum follow-up of 2 years. Studies that did not report graft type or outcomes were excluded. Studies were separated into 2 cohorts on the basis of graft type, allograft or autograft. The mean delta (change from preoperative to postoperative values) was calculated for each patient-reported outcome score and compared between cohorts. The methodological index for non-randomized studies criteria were used to evaluate bias. Seventeen studies (allograft = 9 studies, autograft = 11 studies) of 756 patients were included. Mean follow-up for the allograft cohort was 37 months (mean range, 25.5-66.1) compared with 38.3 months (mean range, 25.4-80.8) for the autograft cohort. At final follow-up, delta values for modified Harris Hip Score ranged from 18.2-34 (allograft) versus 9.4-31.7 (autograft), HOS-Sports scale ranged from 24.2-39.7 (allograft) versus 21.4-41.3 (autograft), visual analog pain scale ranged from -5.7 to -1.7 (allograft) versus -5.7 to -2.4 (autograft), and delta values for the Non-Arthritic Hip score ranged from 19.7-31.3 (allograft) versus 16.6-35.4 (autograft). Postoperative complication rates ranged from 0.0% to 17.6% (allograft) versus 0.0% to 9.1% (autograft). The most common complication for the allograft cohort was numbness (n = 2) versus heterotopic ossification (n = 6) in the autograft cohort. Rates of arthroscopic revision surgery were 0.0% to 5.9% (allograft) versus 0.0% to 9.1% (autograft), whereas conversion to total hip arthroplasty ranged from 0.0% to 17.6% (allograft) versus 0.0% to 8.3% (autograft). The use of allografts and autografts in primary hip labral reconstruction results in improved postoperative outcomes. However, allografts were associated with greater rates of complications with worse graft survivorship. Level IV, systematic review of Level of Evidence III-IV studies.