Purpose
To compare patient-reported outcomes, progression of osteoarthritis, and conversion
to total hip replacement in a dysplastic population when hip arthroscopy was used
as an isolated treatment or as an adjunct to pelvic reorientation osteotomy.
Methods
An exhaustive search of the existing literature was conducted according to Preferred
Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Three
databases (PubMed, CINAHL [Cumulative Index to Nursing and Allied Health Literature],
Embase) were searched for studies from January 1930 through January 2018 published
in the English language concerning the use of hip arthroscopy with diagnostic and
therapeutic intentions in individuals with acetabular dysplasia. We excluded studies
that presented ambiguous data sets or in which clear identification of the strategy
for arthroscopy was absent.
Results
The selection criteria were defined, and 33 studies (1,368 hip arthroscopies) were
included in the final analysis. Studies that met the inclusion criteria were classified
within 5 different categories: (1) hip arthroscopy for screening, chondral mapping,
and planning (9 studies, 729 hip arthroscopies); (2) isolated arthroscopic treatment
(13 studies, 434 hip arthroscopies); (3) outcomes of hip arthroscopy after previous
reorientation pelvic osteotomy for acetabular dysplasia (4 studies, 52 hip arthroscopies);
(4) arthroscopy followed by unplanned hip-preservation surgery (3 studies, 48 hip
arthroscopies); and (5) combined arthroscopy and periacetabular osteotomy (4 studies,
106 hip arthroscopies). A risk-of-bias analysis showed a moderate to high risk of
bias (level 3 or 4) within and across the included studies.
Conclusions
Although hip arthroscopy can be used to accurately grade the severity of chondral
injuries in the native hip and provide zone-specific geographic mapping that may aid
in subsequent surgical planning, there is insufficient evidence to conclude that arthroscopic
characterization alone has any bearing on the ultimate clinical outcomes after osseous
structural correction. Isolated arthroscopic treatment is not recommended in the setting
of moderate to severe dysplasia, given the inferior clinical outcomes and risk of
iatrogenic instability reported for this group. However, there is limited evidence
to suggest that the isolated use of hip arthroscopy may be considered in cases of
borderline acetabular dysplasia when careful attention is paid to labral and capsular
preservation. Limited evidence supports the conclusion that after prior reorientation
pelvic osteotomy for acetabular dysplasia, hip arthroscopy leads to improved clinical
and functional outcomes and should be considered in this setting. Furthermore, there
is insufficient evidence to conclude that failed hip arthroscopy compromises or challenges
the ultimate clinical outcomes in patients undergoing subsequent reorientation pelvic
osteotomy. Last, there is insufficient evidence to conclude that the adjunctive use
of hip arthroscopy with reorientation pelvic osteotomy produces superior clinical
outcomes compared with pelvic osteotomy alone. In summary, arthroscopic techniques
may provide a useful complement to the correction of acetabular dysplasia and should
be thoughtfully considered on a case-by-case basis when designing a comprehensive
treatment strategy in dysplastic populations.
Level of Evidence
Level IV, systematic review of Level III and IV studies.
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Article info
Publication history
Accepted:
July 31,
2018
Received:
November 8,
2017
Footnotes
See commentary on page 249
The authors report the following potential conflict of interest or source of funding: B.D.G. receives support from Arthrex. Full ICMJE author disclosure forms are available for this article online, as supplementary material.
Identification
Copyright
Published by Elsevier on behalf of the Arthroscopy Association of North America
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- Editorial Commentary: Hip Arthroscopy in Dysplastic Hip Population? A Must, a Maybe, or a No Go?ArthroscopyVol. 35Issue 1
- PreviewTreating symptomatic patients with dysplasia involves a controversy in therapy. The question is whether to obtain osseous correction with the help of pelvic reorientation osteotomy or to address intra-articular pathology with an arthroscopic approach. Neither isolated therapy nor the other method seems to be sufficient, but conducting both treatment options simultaneously has also not proved to be superior and carries the risk of additional complications. Different treatment options have been presented on this topic over the years and should be considered on a case-by-case basis.
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