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.
To read this article in full you will need to make a payment
Purchase one-time access:
Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online accessOne-time access price info
- For academic or personal research use, select 'Academic and Personal'
- For corporate R&D use, select 'Corporate R&D Professionals'
Subscribe:
Subscribe to ArthroscopyAlready a print subscriber? Claim online access
Already an online subscriber? Sign in
Register: Create an account
Institutional Access: Sign in to ScienceDirect
References
- Mild or borderline hip dysplasia: are we characterizing hips with a lateral center-edge angle between 18 degrees and 25 degrees appropriately?.Am J Sports Med. 2019; 47: 112-122
- Rapidly progressive osteoarthritis after arthroscopic labral repair in patients with hip dysplasia.Arthroscopy. 2012; 28: 1738-1743
- Arthroscopy for labral tears in patients with developmental dysplasia of the hip: a cautionary note.J Arthroplasty. 2009; 24: 110-113
- Patient and disease characteristics associated with hip arthroscopy failure in acetabular dysplasia.J Arthroplasty. 2014; 29: 160-163
- Do patients with BHD have inferior outcomes after hip arthroscopic surgery for femoroacetabular impingement compared with patients with normal acetabular coverage?.Am J Sports Med. 2017; 45: 2116-2124
- Hip arthroscopic surgery with labral preservation and capsular plication in patients with borderline hip dysplasia: minimum 5-year patient-reported outcomes.Am J Sports Med. 2018; 46: 305-313
- Hip arthroscopy in the setting of hip dysplasia: a systematic review.Bone Joint Res. 2016; 5: 225-231
- Complications associated with the periacetabular osteotomy: a prospective multicenter study.J Bone Joint Surg Am. 2014; 96: 1967-1974
- Revision hip arthroscopy: a systematic review of diagnoses, operative findings, and outcomes.Arthroscopy. 2015; 31: 1382-1390
- The Warwick Agreement on femoroacetabular impingement syndrome (FAI syndrome): an international consensus statement.Br J Sports Med. 2016; 50: 1169-1176
- Improved outcomes after hip arthroscopic surgery in patients undergoing T-capsulotomy with complete repair versus partial repair for femoroacetabular impingement: a comparative matched-pair analysis.Am J Sports Med. 2014; 42: 2634-2642
- Routine complete capsular closure during hip arthroscopy.Arthrosc Tech. 2013; 2: e89-e94
- The use of double-loaded suture anchors for labral repair and capsular repair during hip arthroscopy.Arthrosc Tech. 2012; 1: e213-e217
- Hip arthroscopy: patient assessment and indications.Instr Course Lect. 2003; 52: 711-719
- Evidence of validity for the hip outcome score in hip arthroscopy.Arthroscopy. 2007; 23: 822-826
- Evidence of reliability and responsiveness for the hip outcome score.Arthroscopy. 2008; 24: 676-682
- Preoperative outcome scores are predictive of achieving the minimal clinically important difference after arthroscopic treatment of femoroacetabular impingement.Am J Sports Med. 2017; 45: 612-619
- The patient acceptable symptomatic state for the modified Harris hip score and hip outcome score among patients undergoing surgical treatment for femoroacetabular impingement.Am J Sports Med. 2015; 43: 1844-1849
- Anteversion of the neck of the femur.Bone Joint J. 1952; 34: 181-186
- Shelf operation in congenital dysplasia of the acetabulum and in subluxation and dislocation of the hip.J Bone Joint Surg Am. 1953; 35: 65-80
- Clinical and radiographic predictors of failed hip arthroscopy in the management of dysplasia: a systematic review and proposal for classification.Knee Surg Sports Traumatol Arthrosc. February 28, 2019; ([Epub ahead of print])
- Trends of hip arthroscopy in the setting of acetabular dysplasia.J Hip Preserv Surg. 2018; 5: 267-273
- The interface between periacetabular osteotomy, hip arthroscopy and total hip arthroplasty in the young adult hip.EFORT Open Rev. 2018; 3: 408-417
- Periacetabular osteotomy after failed hip arthroscopy for labral tears in patients with acetabular dysplasia.J Bone Joint Surg Am. 2011; 93: 57-61
- Early functional outcomes of periacetabular osteotomy after failed hip arthroscopic surgery for symptomatic acetabular dysplasia.Am J Sports Med. 2017; 45: 2460-2467
- Research pearls: the significance of statistics and perils of pooling. part 1: clinical versus statistical significance.Arthroscopy. 2017; 33: 1102-1112
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.
- Full-Text
- Preview
