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Functional and Clinical Outcomes of Patients Undergoing Revision Hip Arthroscopy With Borderline Hip Dysplasia at 2-Year Follow-up

      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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      References

        • McClincy M.P.
        • Wylie J.D.
        • Yen Y.M.
        • Novais E.N.
        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
        • Matsuda D.K.
        • Khatod M.
        Rapidly progressive osteoarthritis after arthroscopic labral repair in patients with hip dysplasia.
        Arthroscopy. 2012; 28: 1738-1743
        • Parvizi J.
        • Bican O.
        • Bender B.
        • et al.
        Arthroscopy for labral tears in patients with developmental dysplasia of the hip: a cautionary note.
        J Arthroplasty. 2009; 24: 110-113
        • Ross J.R.
        • Clohisy J.C.
        • Baca G.
        • Sink E.
        • Investigators A.
        Patient and disease characteristics associated with hip arthroscopy failure in acetabular dysplasia.
        J Arthroplasty. 2014; 29: 160-163
        • Cvetanovich G.L.
        • Levy D.M.
        • Weber A.E.
        • et al.
        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
        • Domb B.G.
        • Chaharbakhshi E.O.
        • Perets I.
        • Yuen L.C.
        • Walsh J.P.
        • Ashberg L.
        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
        • Yeung M.
        • Kowalczuk M.
        • Simunovic N.
        • Ayeni O.R.
        Hip arthroscopy in the setting of hip dysplasia: a systematic review.
        Bone Joint Res. 2016; 5: 225-231
        • Zaltz I.
        • Baca G.
        • Kim Y.J.
        • et al.
        Complications associated with the periacetabular osteotomy: a prospective multicenter study.
        J Bone Joint Surg Am. 2014; 96: 1967-1974
        • Cvetanovich G.L.
        • Harris J.D.
        • Erickson B.J.
        • Bach Jr., B.R.
        • Bush-Joseph C.A.
        • Nho S.J.
        Revision hip arthroscopy: a systematic review of diagnoses, operative findings, and outcomes.
        Arthroscopy. 2015; 31: 1382-1390
        • Griffin D.R.
        • Dickenson E.J.
        • O’Donnell J.
        • et al.
        The Warwick Agreement on femoroacetabular impingement syndrome (FAI syndrome): an international consensus statement.
        Br J Sports Med. 2016; 50: 1169-1176
        • Frank R.M.
        • Lee S.
        • Bush-Joseph C.A.
        • Kelly B.T.
        • Salata M.J.
        • Nho S.J.
        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
        • Harris J.D.
        • Slikker 3rd, W.
        • Gupta A.K.
        • McCormick F.M.
        • Nho S.J.
        Routine complete capsular closure during hip arthroscopy.
        Arthrosc Tech. 2013; 2: e89-e94
        • Slikker 3rd, W.
        • Van Thiel G.S.
        • Chahal J.
        • Nho S.J.
        The use of double-loaded suture anchors for labral repair and capsular repair during hip arthroscopy.
        Arthrosc Tech. 2012; 1: e213-e217
        • Byrd J.W.
        Hip arthroscopy: patient assessment and indications.
        Instr Course Lect. 2003; 52: 711-719
        • Martin R.L.
        • Philippon M.J.
        Evidence of validity for the hip outcome score in hip arthroscopy.
        Arthroscopy. 2007; 23: 822-826
        • Martin R.L.
        • Philippon M.J.
        Evidence of reliability and responsiveness for the hip outcome score.
        Arthroscopy. 2008; 24: 676-682
        • Nwachukwu B.U.
        • Fields K.
        • Chang B.
        • Nawabi D.H.
        • Kelly B.T.
        • Ranawat A.S.
        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
        • Chahal J.
        • Van Thiel G.S.
        • Mather 3rd, R.C.
        • et al.
        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
        • Dunn D.
        • Notley B.
        Anteversion of the neck of the femur.
        Bone Joint J. 1952; 34: 181-186
        • Wiberg G.
        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
        • Shah A.
        • Kay J.
        • Memon M.
        • et al.
        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])
        • Haynes J.A.
        • Pascual-Garrido C.
        • An T.W.
        • Nepple J.J.
        • Group A.
        • Clohisy J.C.
        Trends of hip arthroscopy in the setting of acetabular dysplasia.
        J Hip Preserv Surg. 2018; 5: 267-273
        • Jakobsen S.S.
        • Overgaard S.
        • Soballe K.
        • et al.
        The interface between periacetabular osteotomy, hip arthroscopy and total hip arthroplasty in the young adult hip.
        EFORT Open Rev. 2018; 3: 408-417
        • Kain M.S.
        • Novais E.N.
        • Vallim C.
        • Millis M.B.
        • Kim Y.J.
        Periacetabular osteotomy after failed hip arthroscopy for labral tears in patients with acetabular dysplasia.
        J Bone Joint Surg Am. 2011; 93: 57-61
        • Ricciardi B.F.
        • Fields K.G.
        • Wentzel C.
        • Kelly B.T.
        • Sink E.L.
        Early functional outcomes of periacetabular osteotomy after failed hip arthroscopic surgery for symptomatic acetabular dysplasia.
        Am J Sports Med. 2017; 45: 2460-2467
        • Harris J.D.
        • Brand J.C.
        • Cote M.P.
        • Faucett S.C.
        • Dhawan A.
        Research pearls: the significance of statistics and perils of pooling. part 1: clinical versus statistical significance.
        Arthroscopy. 2017; 33: 1102-1112

      Linked Article

      • Editorial Commentary: Revision Arthroscopy for Borderline Dysplastic Hips: A Borderline Surgical Indication
        ArthroscopyVol. 35Issue 12
        • Preview
          Patients 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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