Thank you for having me, I'm David Maldonado from UT Houston, former fellow of the American Hip Institute in Chicago. So previous, in previous, this is my disclosure, so previous data has suggested that we can get better results with premium liver reconstruction in patients over 40 years, specifically with lower secondary surgery rates. So the purpose of this study were to report minimum two years outcomes in secondary surgeries in patients over 40 years who underwent primary hip liver reconstruction in the setting of irreparable labral tears and to compare this group to a propensity match primary repair group. So our hypothesis were that comparable outcomes and clinical benefit will be obtained for both groups, but the rate of secondary surgeries will be lower for the primary liver reconstruction group. So on the methods, we collect data from 2014 to 2018. We include patients who underwent primary liver reconstruction and repair, who were over 40 years old with minimum, with baseline and minimum two years follow-up for all the scores that we can see here. And we exclude patients with arthritis, previous hip condition, dysplasia, or work comp status. So this is the algorithm of treatment that we use for all the repairable tears. We repair those tears. In the setting of irreparable liver, we try to customize the procedure to the intra-op findings. So for a segmental defect, if we can preserve the condoliberal junction, we are going to do augmentation. If the condoliberal junction is compromised, we can do a segmental reconstruction. And if we have a complete defect, we can do a circumferential reconstruction. So we match reconstruction for every two repairs, and we base this match in age, sex, and BMI. We did a priority power analysis and that report that we needed 45 primary liver reconstruction and 82 repairs. So on the results, we were able to identify 53 liver reconstruction that we were able to match to 106 liver repair. As you can see, there were not significant difference. The groups were similar in terms of demographic, with a main age of 48. And the surgical procedures were similar in terms of capsule treatment and femoral plasty and acetabular microfracture. But they were different in terms of traction and surgical time. So in terms of outcomes, both groups reached significant improvement for all the outcomes that we collect. And the improvement were similar between the groups as well. In terms of the clinical benefits, both groups reached high rates of achievement of the PASS MCNZ MOI. And these rates were similar between the groups. And also, the secondary surgical procedures were also similar between the groups. So the discussion on this patient population, primary liver reconstruction, and primary liver repair show similar outcomes and clinical benefits and also comparable rates of secondary surgeries. We have some previous data that suggests that patients over 45 years, even age, can be used as a predictor for primary liver reconstruction. And as I mentioned before, some authors have advocated for a systematic primary liver reconstruction in this group, regardless of the need of labral tissue. So the strengths and limitations, this is a match study design, multiple PROs, and we try to provide data for clinical benefits. Obviously on the limitations, this is a non-randomized study, retrospective design, single center, single surgeon. And I think one of the more important limitations is that we are not having an apple to apple comparison as the initial label state was not the same. So in conclusion, patients over 40 years with primary liver reconstruction and primary liver repair can achieve similar outcomes and clinical benefits and also similar rates for secondary surgeries. And in the present of the take-home messages, and in the present of valuable liver, we still consider liver repair as the preferred option for liver function restoration, even in this group population. Thank you.

Dr. David Maldonado

UT Houston

hip labral reconstruction

hip labral repair

patients over 40 years old