Purpose
To compare outcomes of borderline hip dysplasia (BHD) patients undergoing revision
hip arthroscopy with 1) patients with BHD undergoing primary hip arthroscopy for femoroacetabular
impingement syndrome (FAIS) and 2) patients without BHD undergoing revision hip arthroscopy
for FAIS.
Methods
A retrospective cohort study was performed to identify patients who underwent arthroscopy
from January 2012 to January 2016 by a single fellowship-trained surgeon, including
a 2-year follow-up. Patient demographics, comorbid medical conditions, and preoperative
outcome scores were compared between patients with BHD (lateral center-edge angle
18° to 25°) who had revision hip arthroscopy to patients with BHD undergoing primary
arthroscopy and patients without BHD (lateral center-edge angle >25°) undergoing revision
arthroscopy. Cohorts were matched 2:1 by age and body mass index. Multivariate regressions
were used to compare Hip Outcome Score, Activities of Daily Living subscale (HOS-ADL)
and Sports subscale (HOS-SS) scores and modified Harris Hip Score (mHHS) between the
cohorts at 2-year follow-up. Binomial regression analysis was used to determine predictors
of achieving minimal clinically important difference (MCID) and patient-acceptable
symptom state (PASS).
Results
There was no statistical difference in age and BMI between the BHD revision (29.1
± 8.8 years; 25.5 ± 3.58 kg/m2), BHD nonrevision (28.9 ± 8.5 years; 24.6 ± 3.1 kg/m2), and non-BHD revision (29.15 ± 8.6 years; 25.01 ± 3.2 kg/m2) cohorts. There were no statistically significant differences in 2-year clinical
outcomes between BHD revision patients and either BHD primary or non-BHD revision
patient groups, but BHD revision patients were significantly less likely to achieve
PASS for HOS-SS compared with BHD primary and non-BHD revision groups (P = .047 and P = .031, respectively).
Conclusion
Surgeons should exercise caution when indicating patients for revision hip arthroscopy
with BHD. Although the current study lacks statistical power, the available data suggest
that patients undergoing revision surgery with BHD may still experience clinical improvement
but be less likely to achieve PASS metrics for several patient-reported outcomes at
2-year follow up.
Level of Evidence
III, case-control study.
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Article Info
Publication History
Accepted:
June 13,
2019
Received:
January 20,
2019
Footnotes
See commentary on page 3248
The authors report the following potential conflicts of interest or sources of funding: S.J.N. reports nonfinancial support from Allosource, Arthrex, Inc., Athletico, DJ Orthopaedics, Linvatec, Miomed, Smith & Nephew, Stryker; other from American Journal of Orthopedics , American Orthopaedic Society for Sports Medicine , Arthroscopy Association of North America ; personal fees from Ossur; personal fees and nonfinancial support form Springer. Full ICMJE author disclosure forms are available for this article online, as supplementary material.
Identification
Copyright
© 2019 by the Arthroscopy Association of North America
ScienceDirect
Access this article on ScienceDirectLinked Article
- Editorial Commentary: Revision Arthroscopy for Borderline Dysplastic Hips: A Borderline Surgical IndicationArthroscopyVol. 35Issue 12
- PreviewPatients with mild or borderline acetabular dysplasia who present with refractory hip pain are challenging patients. Recommending open versus arthroscopic surgery for these patients is a difficult decision, in part because there are conflicting data regarding the outcomes of these procedures. Equally challenging is deciding on a treatment course in a borderline dysplastic patient who has not responded to a previous arthroscopic surgery. Surgeons must give great consideration before recommending revision arthroscopy in this setting.
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