Advertisement

Hip Arthroscopy and Borderline Developmental Dysplasia of the Hip: A Systematic Review

      Purpose

      To provide an up-to-date evidence-based review of hip arthroscopy for patients with borderline developmental dysplasia of the hip (BDDH).

      Methods

      Literature describing hip arthroscopy in patients with BDDH was systematically identified from PubMed, EMBASE, and Cochrane Library using the Preferred Reporting Items for Systematic Reviews and Meta-analyses guidelines. All studies that involved BDDH and not just those reporting their clinical outcomes were included. Methodological Index for Non Randomized Studies criteria and Newcastle–Ottawa Scale were used to assess the quality of studies. The definition of BDDH, operative technique, correlation with labrum and/or cartilage lesions, outcome, and factors associated with poor outcome were collected and analyzed.

      Results

      Assessment of the articles yielded 28 studies involving 1502 hips that were included for final analysis. There were no studies with a high risk of bias. BDDH was defined as lateral center-edge angle of 20° to 25° in most studies. Hip arthroscopy for BDDH showed an improvement in the weighted mean postoperative modified Harris Hip Score, from 60.2 to 81.7, a relatively high rate of acquisition of minimal clinically important difference of 79.5% to 87%, and had 1.0% rate of complications. Eleven studies reported on all the patients undergoing a capsular plication. Four studies reported that BDDH was associated with cartilage damage on the femoral head. Age older than 35 or 42 years and ≥20° of femoral anteversion were reported as risk factors for poor outcomes.

      Conclusions

      Hip arthroscopy for BDDH with capsular plication provides improvement in patient-reported outcome measures and a relatively high rate of acquisition of minimal clinically important difference with a low rate of complications in the shorter term. BDDH may be associated with cartilage damage on the femoral head. Female sex is a factor related to good outcomes, whereas older age, excessive femoral anteversion, and anterior undercoverage of acetabulum are risk factors related to poorer outcomes.

      Level of Evidence

      Level IV, systematic review of Level III to IV studies.
      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 access
      One-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 Arthroscopy
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect

      References

        • Bartlett J.D.
        • Lawrence J.E.
        • Khanduja V.
        Virtual reality hip arthroscopy simulator demonstrates sufficient face validity.
        Knee Surg Sports Traumatol Arthrosc. 2019; 27: 3162-3167
        • Nakano N.
        • Gohal C.
        • Duong A.
        • Ayeni O.R.
        • Khanduja V.
        Outcomes of cartilage repair techniques for chondral injury in the hip—a systematic review.
        Int Orthop. 2018; 42: 2309-2322
        • Nakano N.
        • Audenaert E.
        • Ranawat A.
        • Khanduja V.
        Review: Current concepts in computer-assisted hip arthroscopy.
        Int J Med Robot. 2018; 14e1929
        • Khanduja V.
        • Villar R.N.
        The arthroscopic management of femoroacetabular impingement.
        Knee Surg Sports Traumatol Arthrosc. 2007; 15: 1035-1040
        • Nakano N.
        • Lisenda L.
        • Jones T.L.
        • Loveday D.T.
        • Khanduja V.
        Complications following arthroscopic surgery of the hip: A systematic review of 36 761 cases.
        Bone Joint J. 2017; 99-B: 1577-1583
        • Griffin D.R.
        • Dickenson E.J.
        • Wall P.D.H.
        • et al.
        Hip arthroscopy versus best conservative care for the treatment of femoroacetabular impingement syndrome (UK FASHIoN): A multicentre randomised controlled trial.
        Lancet. 2018; 391: 2225-2235
        • Palmer A.J.R.
        • Ayyar Gupta V.
        • Fernquest S.
        • et al.
        Arthroscopic hip surgery compared with physiotherapy and activity modification for the treatment of symptomatic femoroacetabular impingement: Multicentre randomised controlled trial.
        BMJ. 2019; 364: l185
        • Rosinsky P.J.
        • Go C.C.
        • Shapira J.
        • Maldonado D.R.
        • Lall A.C.
        • Domb B.G.
        Validation of a risk calculator for conversion of hip arthroscopy to total hip arthroplasty in a consecutive series of 1400 patients.
        J Arthroplasty. 2019; 34: 1700-1706
        • Nawabi D.H.
        • Degen R.M.
        • Fields K.G.
        • et al.
        Outcomes after arthroscopic treatment of femoroacetabular impingement for patients with borderline hip dysplasia.
        Am J Sports Med. 2016; 44: 1017-1023
        • Domb B.G.
        • Stake C.E.
        • Lindner D.
        • El-Bitar Y.
        • Jackson T.J.
        Arthroscopic capsular plication and labral preservation in borderline hip dysplasia: Two-year clinical outcomes of a surgical approach to a challenging problem.
        Am J Sports Med. 2013; 41: 2591-2598
        • 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
        • Beck E.C.
        • Nwachukwu B.U.
        • Chahla J.
        • et al.
        Patients with borderline hip dysplasia achieve clinically significant outcome after arthroscopic femoroacetabular impingement surgery: A case-control study with minimum 2-year follow-up.
        Am J Sports Med. 2019; 47: 2636-2645
        • Ding Z.
        • Sun Y.
        • Liu S.
        • Chen J.
        Hip arthroscopic surgery in borderline developmental dysplastic hips: A systematic review.
        Am J Sports Med. 2019; 47: 2494-2500
        • Obremskey W.T.
        • Pappas N.
        • Attallah-Wasif E.
        • Tornetta III, P.
        • Bhandari M.
        Level of evidence in orthopaedic journals.
        J Bone Joint Surg Am. 2005; 87: 2632-2638
        • Slim K.
        • Nini E.
        • Forestier D.
        • Kwiatkowski F.
        • Panis Y.
        • Chipponi J.
        Methodological index for non-randomized studies (MINORS): Development and validation of a new instrument.
        ANZ J Surg. 2003; 73: 712-716
        • Stang A.
        Critical evaluation of the Newcastle-Ottawa scale for the assessment of the quality of nonrandomized studies in meta-analyses.
        Eur J Epidemiol. 2010; 25: 603-605
        • Bazerbachi F.
        • Leise M.D.
        • Watt K.D.
        • Murad M.H.
        • Prokop L.J.
        • Haffar S.
        Systematic review of mixed cryoglobulinemia associated with hepatitis E virus infection: association or causation?.
        Gastroenterol Rep. 2017; 5: 178-184
        • Haffar S.
        • Bazerbachi F.
        • Prokop L.
        • Watt K.D.
        • Murad M.H.
        • Chari S.T.
        Frequency and prognosis of acute pancreatitis associated with fulminant or non-fulminant acute hepatitis A: A systematic review.
        Pancreatology. 2017; 17: 166-175
        • Ashwell Z.R.
        • Flug J.
        • Chadayammuri V.
        • Pascual-Garrido C.
        • Garabekyan T.
        • Mei-Dan O.
        Lateral acetabular coverage as a predictor of femoroacetabular cartilage thickness.
        J Hip Preserv Surg. 2016; 3: 262-269
        • Bolia I.K.
        • Briggs K.K.
        • Locks R.
        • Chahla J.
        • Utsunomiya H.
        • Philippon M.J.
        Prevalence of high-grade cartilage defects in patients with borderline dysplasia with femoroacetabular impingement: A comparative cohort study.
        Arthroscopy. 2018; 34: 2347-2352
        • Byrd J.T.
        • Jones K.S.
        Hip arthroscopy in the presence of dysplasia.
        Arthroscopy. 2003; 19: 1055-1060
        • Chaharbakhshi E.O.
        • Hartigan D.E.
        • Perets I.
        • Domb B.G.
        Is hip arthroscopy effective in patients with combined excessive femoral anteversion and borderline dysplasia? A match-controlled study.
        Am J Sports Med. 2019; 47: 123-130
        • Chaharbakhshi E.O.
        • Perets I.
        • Ashberg L.
        • Mu B.
        • Lenkeit C.
        • Domb B.G.
        Do ligamentum teres tears portend inferior outcomes in patients with borderline dysplasia undergoing hip arthroscopic surgery? A match-controlled study with a minimum 2-year follow-up.
        Am J Sports Med. 2017; 45: 2507-2516
        • Chandrasekaran S.
        • Darwish N.
        • Martin T.J.
        • Suarez-Ahedo C.
        • Lodhia P.
        • Domb B.G.
        Arthroscopic capsular plication and labral seal restoration in borderline hip dysplasia: 2-year clinical outcomes in 55 cases.
        Arthroscopy. 2017; 33: 1332-1340
        • Christensen J.C.
        • Marland J.D.
        • Miller C.J.
        • Horton B.S.
        • Whiting D.R.
        • West H.S.
        Trajectory of clinical outcomes following hip arthroscopy in female subgroup populations.
        J Hip Preserv Surg. 2019; 6: 25-32
        • Cvetanovich G.L.
        • Levy D.M.
        • Weber A.E.
        • et al.
        Do patients with borderline dysplasia 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
        • Evans P.T.
        • Redmond J.M.
        • Hammarstedt J.E.
        • Liu Y.
        • Chaharbakhshi E.O.
        • Domb B.G.
        Arthroscopic treatment of hip pain in adolescent patients with borderline dysplasia of the hip: Minimum 2-year follow-up.
        Arthroscopy. 2017; 33: 1530-1536
        • Fukui K.
        • Briggs K.K.
        • Trindade C.A.
        • Philippon M.J.
        Outcomes after labral repair in patients with femoroacetabular impingement and borderline dysplasia.
        Arthroscopy. 2015; 31: 2371-2379
        • Garabekyan T.
        • Ashwell Z.
        • Chadayammuri V.
        • et al.
        Lateral acetabular coverage predicts the size of the hip labrum.
        Am J Sports Med. 2016; 44: 1582-1589
        • Hatakeyama A.
        • Utsunomiya H.
        • Nishikino S.
        • et al.
        Predictors of poor clinical outcome after arthroscopic labral preservation, capsular plication, and cam osteoplasty in the setting of borderline hip dysplasia.
        Am J Sports Med. 2018; 46: 135-143
        • Ishøi L.
        • Thorborg K.
        • Kraemer O.
        • Lund B.
        • Mygind-Klavsen B.
        • Hölmich P.
        Demographic and radiographic factors associated with intra-articular hip cartilage injury: A cross-sectional study of 1511 hip arthroscopy procedures.
        Am J Sports Med. 2019; 47: 2617-2625
        • Kalisvaart M.M.
        • Safran M.R.
        Hip instability treated with arthroscopic capsular plication.
        Knee Surg Sports Traumatol Arthrosc. 2017; 25: 24-30
        • Kalore N.V.
        • Jiranek W.A.
        Save the torn labrum in hips with borderline acetabular coverage.
        Clin Orthop Relat Res. 2012; 470: 3406-3413
        • Kaya M.
        • Suzuki T.
        • Emori M.
        • Yamashita T.
        Hip morphology influences the pattern of articular cartilage damage.
        Knee Surg Sports Traumatol Arthrosc. 2016; 24: 2016-2023
        • Kobayashi N.
        • Inaba Y.
        • Kubota S.
        • et al.
        The distribution of impingement region in cam-type femoroacetabular impingement and borderline dysplasia of the hip with or without cam deformity: A computer simulation study.
        Arthroscopy. 2017; 33: 329-334
        • Kraeutler M.J.
        • Goodrich J.A.
        • Ashwell Z.R.
        • Garabekyan T.
        • Jesse M.K.
        • Mei-Dan O.
        Combined lateral osseolabral coverage is normal in hips with acetabular dysplasia.
        Arthroscopy. 2019; 35: 800-806
        • Maldonado D.R.
        • Perets I.
        • Mu B.H.
        • et al.
        Arthroscopic capsular plication in patients with labral tears and borderline dysplasia of the hip: Analysis of risk factors for failure.
        Am J Sports Med. 2018; 46: 3446-3453
        • Matsuda D.K.
        • Kivlan B.R.
        • Nho S.J.
        • et al.
        Arthroscopic outcomes as a function of acetabular coverage from a large hip arthroscopy study group.
        Arthroscopy. 2019; 35: 2338-2345
        • 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° and 25° appropriately?.
        Am J Sports Med. 2019; 47: 112-122
        • Ohnishi Y.
        • Suzuki H.
        • Nakashima H.
        • et al.
        Radiologic correlation between the ischiofemoral space and morphologic characteristics of the hip in hips with symptoms of dysplasia.
        AJR Am J Roentgenol. 2018; 210: 608-614
        • Wyatt M.
        • Weidner J.
        • Pfluger D.
        • Beck M.
        The Femoro-Epiphyseal Acetabular Roof (FEAR) index: A new measurement associated with instability in borderline hip dysplasia?.
        Clin Orthop Relat Res. 2017; 475: 861-869
        • Yoon S.J.
        • Lee S.H.
        • Jang S.W.
        • Jo S.
        Hip arthroscopy of a painful hip with borderline dysplasia.
        Hip Pelvis. 2019; 31: 102-109
        • Wiberg G.
        The anatomy and roentgenographic appearance of a normal hip joint.
        Acta Chir Scand. 1939; 83: 7-38
        • Lequesne M.
        False profile of the pelvis. A new radiographic incidence for the study of the hip. Its use in dysplasias and different coxopathies.
        Rev Rhum Mal Osteoartic. 1961; 28: 643-652
        • Sharp I.K.
        Acetabular dysplasia: The acetabular angle.
        J Bone Joint Surg Br. 1961; 43: 268-272
        • Siebenrock K.A.
        • Kistler L.
        • Schwab J.M.
        • Büchler L.
        • Tannast M.
        The acetabular wall index for assessing anteroposterior femoral head coverage in symptomatic patients.
        Clin Orthop Relat Res. 2012; 470: 3355-3360
        • Domb B.G.
        • Philippon M.J.
        • Giordano B.D.
        Arthroscopic capsulotomy, capsular repair, and capsular plication of the hip: Relation to atraumatic instability.
        Arthroscopy. 2013; 29: 162-173
        • Chandrasekaran S.
        • Vemula S.P.
        • Martin T.J.
        • Suarez-Ahedo C.
        • Lodhia P.
        • Domb B.G.
        Arthroscopic technique of capsular plication for the treatment of hip instability.
        Arthrosc Tech. 2015; 4: e163-e167
        • Jackson T.J.
        • Peterson A.B.
        • Akeda M.
        • et al.
        Biomechanical effects of capsular shift in the treatment of hip microinstability: Creation and testing of a novel hip instability model.
        Am J Sports Med. 2016; 44: 689-695
        • Seldes R.M.
        • Tan V.
        • Hunt J.
        • Katz M.
        • Winiarsky R.
        • Fitzgerald Jr., R.H.
        Anatomy, histologic features, and vascularity of the adult acetabular labrum.
        Clin Orthop Relat Res. 2001; 382: 232-240
        • Brittberg M.
        • Winalski C.S.
        Evaluation of cartilage injuries and repair.
        J Bone Joint Surg Am. 2003; 85: 58-69
        • Bhatia S.
        • Nowak D.D.
        • Briggs K.K.
        • Patterson D.C.
        • Philippon M.J.
        Outerbridge grade IV cartilage lesions in the hip identified at arthroscopy.
        Arthroscopy. 2016; 32: 814-819
        • Kemp J.L.
        • Collins N.J.
        • Roos E.M.
        • Crossley K.M.
        Psychometric properties of patient-reported outcome measures for hip arthroscopic surgery.
        Am J Sports Med. 2013; 41: 2065-2073
        • Chahal J.
        • Van Thiel G.S.
        • Mather III, 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
        • Philippon M.J.
        • Wolff A.B.
        • Briggs K.K.
        • Zehms C.T.
        • Kuppersmith D.A.
        Acetabular rim reduction for the treatment of femoroacetabular impingement correlates with preoperative and postoperative center-edge angle.
        Arthroscopy. 2010; 26: 757-761
        • Landa J.
        • Benke M.
        • Feldman D.S.
        The limbus and the neolimbus in developmental dysplasia of the hip.
        Clin Orthop Relat Res. 2008; 466: 776-781
        • Dwyer M.K.
        • Tumpowsky C.
        • Boone A.
        • Lee J.
        • McCarthy J.C.
        What is the association between articular cartilage damage and subsequent THA 20 years after hip arthroscopy for labral tears?.
        Clin Orthop Relat Res. 2019; 477: 1211-1220
        • Levy D.M.
        • Kuhns B.D.
        • Chahal J.
        • Philippon M.J.
        • Kelly B.T.
        • Nho S.J.
        Hip arthroscopy outcomes with respect to patient acceptable symptomatic state and minimal clinically important difference.
        Arthroscopy. 2016; 32: 1877-1886
        • Katz N.P.
        • Paillard F.C.
        • Ekman E.
        Determining the clinical importance of treatment benefits for interventions for painful orthopedic conditions.
        J Orthop Surg Res. 2015; 10: 24
        • 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
        • Clapp I.M.
        • Nwachukwu B.U.
        • Beck E.C.
        • Jan K.
        • Gowd A.K.
        • Nho S.J.
        Comparing outcomes of competitive athletes versus nonathletes undergoing hip arthroscopy for treatment of femoroacetabular impingement syndrome.
        Am J Sports Med. 2020; 48: 159-166
        • Cvetanovich G.L.
        • Weber A.E.
        • Kuhns B.D.
        • et al.
        Hip arthroscopic surgery for femoroacetabular impingement with capsular management: Factors associated with achieving clinically significant outcomes.
        Am J Sports Med. 2018; 46: 288-296
        • Basques B.A.
        • Waterman B.R.
        • Ukwuani G.
        • et al.
        Preoperative symptom duration is associated with outcomes after hip arthroscopy.
        Am J Sports Med. 2019; 47: 131-137
        • Fukui K.
        • Trindade C.
        • Briggs K.
        • Philippon M.
        Arthroscopy of the hip for patients with mild to moderate developmental dysplasia of the hip and femoroacetabular impingement: Outcomes following hip arthroscopy for treatment of chondrolabral damage.
        Bone Joint J. 2015; 97: 1316-1321
        • Malviya A.
        • Raza A.
        • Jameson S.
        • James P.
        • Reed M.R.
        • Partington P.F.
        Complications and survival analyses of hip arthroscopies performed in the national health service in England: A review of 6,395 cases.
        Arthroscopy. 2015; 31: 836-842
        • Philippon M.J.
        • Ejnisman L.
        • Ellis H.B.
        • Briggs K.K.
        Outcomes 2 to 5 years following hip arthroscopy for femoroacetabular impingement in the patient aged 11 to 16 years.
        Arthroscopy. 2012; 28: 1255-1261
        • McClincy M.P.
        • Wylie J.D.
        • Kim Y.-J.
        • Millis M.B.
        • Novais E.N.
        Periacetabular osteotomy improves pain and function in patients with lateral center-edge angle between 18° and 25°, but are these hips really borderline dysplastic?.
        Clin Orthop Relat Res. 2019; 477: 1145-1153