Advanced cartilage damage and radiographic osteoarthritis are associated with inferior outcomes and higher rates of conversion to total hip arthroplasty after hip labral reconstructions: A systematic review

Abstract

Purpose Hip labral reconstruction survival refers to the durability of the reconstructed labrum, typically measured by the rate of freedom from revision surgery or conversion to total hip arthroplasty (THA) over time. This systematic review aimed to identify and combine prognostic factors, particularly those related to cartilage status, graft characteristics, and osteoarthritis, that are associated with functional outcomes and long-term survivorship after hip labral reconstruction.Methods Clinical studies reporting prognostic/exposure factors (e.g., cartilage status, osteoarthritis severity and graft/technique variables) and postoperative outcomes in adult patients undergoing hip labrum reconstruction were searched in PubMed and Scopus databases up to December, 2025. Two reviewers performed the search, data extraction, and risk of bias assessment using ROBINS-I. Random-effects meta-analyses and meta-regressions were performed when >= 2 studies provided comparable data.Results Thirty-two studies (2252 hips) were included. Patient-reported outcomes showed significant improvement across cohorts after reconstruction, but survival not requiring arthroplasty varied depending on joint status and technique. In a random-effects meta-analysis, the pooled THA conversion rate was 8.8% (95% CI: 6.7%-11.5%). In meta-regression, a higher prevalence of high-grade acetabular cartilage damage was associated with increased THA conversion (univariate p = 0.035; beta = 0.0269, p = 0.0165 after adjusting for follow-up time), and longer follow-up time independently increased the risk of conversion (beta = 0.0300/month, p = 0.0082). In exploratory subgroup analyses, circumferential reconstruction was associated with greater PROM recovery and a lower pooled THA conversion rate than segmental techniques, and allografts were associated with a lower pooled THA conversion rate than autografts; these comparisons are confounded by surgeon experience, institutional volume, and indication, and should be regarded as hypothesis-generating only.Conclusion Outcomes after hip labral reconstruction appear to be associated with preoperative joint status, particularly cartilage damage and radiographic osteoarthritis. These findings are derived from study-level analyses and should not be interpreted as evidence of independent or causal effects. Apparent differences between graft types and reconstruction configurations are exploratory and likely reflect underlying confounding rather than true treatment effects. Capsular management and concomitant cartilage procedures were not consistently associated with differences in clinical outcomes or THA conversion.Level of evidence Level IV, systematic review and meta-analysis of Level IV-III studies.