Advertisement

High-Level Athletes With Borderline Hip Dysplasia Achieve Favorable Outcomes and Return to Sport Rates Following Primary Hip Arthroscopy: Minimum 5-Year Outcomes Comparison to a Propensity-Matched Control Group

      Purpose

      (1) To report minimum 5-year patient-reported outcomes (PROs) and return to sport (RTS) rates in high-level athletes with borderline hip dysplasia (BHD) following primary hip arthroscopy for labral pathology and femoroacetabular impingement syndrome and (2) to compare results to a propensity-matched control group of athletes with normal acetabular coverage.

      Methods

      Data were reviewed for surgeries performed between February 2009 and February 2016. Patients were eligible if they underwent primary hip arthroscopy in the setting of BHD (lateral center-edge angle [LCEA] 18-25°) and competed in professional, collegiate, or high school sports. Inclusion criteria were preoperative and minimum 5-year follow-up scores for the modified Harris Hip Score (mHHS), Non-Arthritis Hip Score, Hip Outcome Score–Sport Specific Subscale (HOS-SSS), and visual analog scale for pain. Rates of achieving the minimal clinically importance difference (MCID), patient acceptable symptomatic state (PASS), and maximum outcome improvement satisfaction threshold (MOIST) were recorded in addition to RTS. BHD athletes were matched by age at the time of surgery, sex, body mass index, Tönnis grade, follow-up time, sport type, and competition level to a control group of 58 athletes with normal acetabular coverage (LCEA 25°-40°) for comparison.

      Results

      A total of 34 BHD athletes were included with a mean follow-up of 73.6 ± 10.7 months. BHD athletes showed significant improvements in all PROs, demonstrated high RTS rates (90.0%), and achieved PASS/MCID/MOIST for mHHS (MCID: 80.0%, PASS: 93.3%, MOIST: 80.0%) and HOS-SSS (MCID: 76.7%, PASS: 73.3%) at high rates. When compared to a propensity-matched group with normal acetabular coverage, BHD athletes demonstrated similar postoperative PROs, rates of achieving psychometric thresholds, and RTS rates (P > .05). Additionally, by the latest follow-up, no athlete in either group required conversion to total hip arthroplasty.

      Conclusions

      High-level athletes with BHD undergoing primary hip arthroscopy for labral pathology and femoroacetabular impingement syndrome may expect favorable midterm outcomes and high RTS rates. These results were comparable to a control group of athletes with normal coverage.

      Level of Evidence

      Level III, retrospective cohort 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 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

        • Beck E.C.
        • Drager J.
        • Nwachukwu B.U.
        • et al.
        Patients with borderline hip dysplasia achieve clinically significant improvement after arthroscopic femoroacetabular impingement surgery: A case-control study with a minimum 5-year follow-up.
        Am J Sports Med. 2020; 48: 1616-1624https://doi.org/10.1177/0363546520916473
        • 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
        • 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: 2591-2598https://doi.org/10.1177/0363546513499154
        • Dwyer M.K.
        • Lee J.A.
        • McCarthy J.C.
        Cartilage status at time of arthroscopy predicts failure in patients with hip dysplasia.
        J Arthroplasty. 2015; 30: 121-124https://doi.org/10.1016/j.arth.2014.12.034
        • Kalore N.V.
        • Jiranek W.A.
        Save the torn labrum in hips with borderline acetabular coverage.
        Clin Orthop Relat Res. 2012; 470: 3406-3413https://doi.org/10.1007/s11999-012-2499-9
        • McCarthy J.C.
        • Lee J.A.
        Acetabular dysplasia: A paradigm of arthroscopic examination of chondral injuries.
        Clin Orthop Relat Res. 2002; 405: 122-128
        • Domb B.G.
        • LaReau J.M.
        • Hammarstedt J.E.
        • Gupta A.
        • Stake C.E.
        • Redmond J.M.
        Concomitant hip arthroscopy and periacetabular osteotomy.
        Arthroscopy. 2015; 31: 2199-2206https://doi.org/10.1016/j.arthro.2015.06.002
        • Kim K.I.
        • Cho Y.J.
        • Ramteke A.A.
        • Yoo M.C.
        Peri-acetabular rotational osteotomy with concomitant hip arthroscopy for treatment of hip dysplasia.
        J Bone Joint Surg Br. 2011; 93: 732-737https://doi.org/10.1302/0301-620X.93B6.25809
        • Mei-Dan O.
        • McConkey M.O.
        • Brick M.
        Catastrophic failure of hip arthroscopy due to iatrogenic instability: Can partial division of the ligamentum teres and iliofemoral ligament cause subluxation?.
        Arthroscopy. 2012; 28: 440-445
        • 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: 110-113https://doi.org/10.1016/j.arth.2009.05.021
        • Ashberg L.
        • Charharbakhshi E.O.
        • Perets I.
        • Yuen L.C.
        • Walsh J.P.
        • Domb B.G.
        Hip arthroscopic surgery with labral preservation and capsular plication in patients with borderline hip dysplasia: Minimum 5-year patient-reported outcomes: Response.
        Am J Sports Med. 2019; 47: NP32-NP33https://doi.org/10.1177/0363546519825641
        • Kraeutler M.J.
        • Safran M.R.
        • Scillia A.J.
        • Ayeni O.R.
        • Garabekyan T.
        • Mei-Dan O.
        A contemporary look at the evaluation and treatment of adult borderline and frank hip dysplasia.
        Am J Sports Med. 2020; 48: 2314-2323https://doi.org/10.1177/0363546519881411
        • Jimenez A.E.
        • Monahan P.F.
        • Miecznikowski K.B.
        • et al.
        Achieving successful outcomes in high-level athletes with borderline hip dysplasia undergoing hip arthroscopy with capsular plication and labral preservation: A propensity-matched controlled study.
        Am J Sports Med. 2021; 49: 2447-2456https://doi.org/10.1177/03635465211021001
        • Aprato A.
        • Jayasekera N.
        • Villar R.N.
        Does the modified Harris Hip Score reflect patient satisfaction after hip arthroscopy?.
        Am J Sports Med. 2012; 40: 2557-2560https://doi.org/10.1177/0363546512460650
        • Christensen C.P.
        • Althausen P.L.
        • Mittleman M.A.
        • Lee J ann
        • McCarthy J.C.
        The nonarthritic hip score: Reliable and validated.
        Clin Orthop Relat Res. 2003; : 75-83https://doi.org/10.1097/01.blo.0000043047.84315.4b
        • Martin R.L.
        • Philippon M.J.
        Evidence of reliability and responsiveness for the hip outcome score.
        Arthroscopy. 2008; 24: 676-682https://doi.org/10.1016/j.arthro.2007.12.011
        • Chandrasekaran S.
        • Gui C.
        • Walsh J.P.
        • Lodhia P.
        • Suarez-Ahedo C.
        • Domb B.G.
        Correlation between changes in visual analog scale and patient-reported outcome scores and patient satisfaction after hip arthroscopic surgery.
        Orthop J Sports Med. 2017; 52325967117724772https://doi.org/10.1177/2325967117724772
        • Chahla J.
        • Beck E.C.
        • Okoroha K.
        • Cancienne J.M.
        • Kunze K.N.
        • Nho S.J.
        Prevalence and clinical implications of chondral injuries after hip arthroscopic surgery for femoroacetabular impingement syndrome.
        Am J Sports Med. 2019; 47: 2626-2635https://doi.org/10.1177/0363546519865912
        • Hanson J.A.
        • Kapron A.L.
        • Swenson K.M.
        • Maak T.G.
        • Peters C.L.
        • Aoki S.K.
        Discrepancies in measuring acetabular coverage: Revisiting the anterior and lateral center edge angles.
        J Hip Preserv Surg. 2015; 2: 280-286https://doi.org/10.1093/jhps/hnv041
        • Braly B.A.
        • Beall D.P.
        • Martin H.D.
        Clinical examination of the athletic hip.
        Clin Sports Med. 2006; 25 (vii. doi:10.1016/j.csm.2005.12.001): 199-210
        • Domb B.G.
        • Brooks A.G.
        • Byrd J.W.
        Clinical examination of the hip joint in athletes.
        J Sport Rehabil. 2009; 18: 3-23
        • Martin H.D.
        • Kelly B.T.
        • Leunig M.
        • et al.
        The pattern and technique in the clinical evaluation of the adult hip: The common physical examination tests of hip specialists.
        Arthroscopy. 2010; 26: 161-172https://doi.org/10.1016/j.arthro.2009.07.015
        • Clohisy J.C.
        • Carlisle J.C.
        • Beaulé P.E.
        • et al.
        A systematic approach to the plain radiographic evaluation of the young adult hip.
        J Bone Joint Surg Am. 2008; 90: 47-66https://doi.org/10.2106/JBJS.H.00756
        • Domb B.G.
        • Chaharbakhshi E.O.
        • Rybalko D.
        • Close M.R.
        • Litrenta J.
        • Perets I.
        Outcomes of hip arthroscopic surgery in patients with Tönnis grade 1 osteoarthritis at a minimum 5-year follow-up: A matched-pair comparison with a Tönnis grade 0 control group.
        Am J Sports Med. 2017; 45: 2294-2302https://doi.org/10.1177/0363546517706957
        • 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
        • Ogata S.
        • Moriya H.
        • Tsuchiya K.
        • Akita T.
        • Kamegaya M.
        • Someya M.
        Acetabular cover in congenital dislocation of the hip.
        Joint Surg Br. 1990; 72: 190-196
        • Domb B.G.
        • Chen S.L.
        • Go C.C.
        • et al.
        Predictors of clinical outcomes after hip arthroscopy: 5-year follow-up analysis of 1038 patients.
        Am J Sports Med. 2021; 49: 112-120https://doi.org/10.1177/0363546520968896
        • Maldonado D.R.
        • Chen J.W.
        • Walker-Santiago R.
        • et al.
        Radiographic and demographic factors can predict the need for primary labral reconstruction in hip arthroscopic surgery: A predictive model using 1398 hips.
        Am J Sports Med. 2020; 48: 173-180https://doi.org/10.1177/0363546519887749
        • Chahal J.
        • Leiter J.
        • McKee M.D.
        • Whelan D.B.
        Generalized ligamentous laxity as a predisposing factor for primary traumatic anterior shoulder dislocation.
        J Shoulder Elbow Surg. 2010; 19: 1238-1242https://doi.org/10.1016/j.jse.2010.02.005
        • 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: 2225-2235https://doi.org/10.1016/S0140-6736(18)31202-9
        • Lall A.C.
        • Saadat A.A.
        • Battaglia M.R.
        • Maldonado D.R.
        • Perets I.
        • Domb B.G.
        Perineal pressure during hip arthroscopy is reduced by use of Trendelenburg: A prospective study with randomized order of positioning.
        Clin Orthop Relat Res. 2019; 477: 1851-1857https://doi.org/10.1097/CORR.0000000000000804
        • Maldonado D.R.
        • Rosinsky P.J.
        • Shapira J.
        • Domb B.G.
        Stepwise safe access in hip arthroscopy in the supine position: Tips and pearls from A to Z.
        J Am Acad Orthop Surg. 2020; 28: 651-659https://doi.org/10.5435/JAAOS-D-19-00856
        • Seldes R.M.
        • Tan V.
        • Hunt J.
        • Katz M.
        • Winiarsky R.
        • Fitzgerald R.H.
        Anatomy, histologic features, and vascularity of the adult acetabular labrum.
        Clin Orthop Relat Res. 2001; : 232-240
        • Outerbridge R.E.
        The etiology of chondromalacia patellae.
        J Bone Joint Surg Br. 1961; 43: 752-757
        • Maldonado D.R.
        • Chen S.L.
        • Walker-Santiago R.
        • et al.
        An intact ligamentum teres predicts a superior prognosis in patients with borderline dysplasia: A matched-pair controlled study with minimum 5-year outcomes after hip arthroscopic surgery.
        Am J Sports Med. 2020; 48: 673-681https://doi.org/10.1177/0363546519898716
        • Lall A.C.
        • Annin S.
        • Chen J.W.
        • et al.
        Achieving a perfectly spherical femoroplasty: Pearls, pitfalls, and optimal surgical technique.
        Arthrosc Tech. 2020; 9: e303-e313https://doi.org/10.1016/j.eats.2019.10.011
        • Domb B.G.
        • Hartigan D.E.
        • Perets I.
        Decision making for labral treatment in the hip: repair versus débridement versus reconstruction.
        J Am Acad Orthop Surg. 2017; 25: e53-e62https://doi.org/10.5435/JAAOS-D-16-00144
        • Maldonado D.R.
        • Lall A.C.
        • Walker-Santiago R.
        • et al.
        Hip labral reconstruction: Consensus study on indications, graft type and technique among high-volume surgeons.
        J Hip Preserv Surg. 2019; 6: 41-49https://doi.org/10.1093/jhps/hnz008
        • Sabetian P.W.
        • Owens J.S.
        • Maldonado D.R.
        • et al.
        Circumferential and segmental arthroscopic labral reconstruction of the hip utilizing the knotless pull-through technique with all-suture anchors.
        Arthrosc Tech. 2021;Sep 8; 10: e2245-e2251https://doi.org/10.1016/j.eats.2021.05.029
        • 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-e167https://doi.org/10.1016/j.eats.2015.01.004
        • 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: 162-173https://doi.org/10.1016/j.arthro.2012.04.057
        • Norman G.R.
        • Sloan J.A.
        • Wyrwich K.W.
        Interpretation of changes in health-related quality of life: the remarkable universality of half a standard deviation.
        Med Care. 2003; 41: 582-592https://doi.org/10.1097/01.MLR.0000062554.74615.4C
        • Beck E.C.
        • Nwachukwu B.U.
        • Kunze K.N.
        • Chahla J.
        • Nho S.J.
        How can we define clinically important improvement in pain scores after hip arthroscopy for femoroacetabular impingement syndrome? Minimum 2-year follow-up study.
        Am J Sports Med. 2019; 47: 3133-3140https://doi.org/10.1177/0363546519877861
        • Chahal J.
        • Thiel G.S.V.
        • Mather R.C.
        • Lee S.
        • Salata M.J.
        • Nho S.J.
        The minimal clinical important difference (MCID) and patient acceptable symptomatic state (PASS) for the modified Harris Hip Score and hip outcome score among patients undergoing surgical treatment for femoroacetabular impingement.
        Orthop J Sports Med. 2014; 22325967114S00105https://doi.org/10.1177/2325967114S00105
        • Rosinsky P.J.
        • Kyin C.
        • Maldonado D.R.
        • et al.
        Determining clinically meaningful thresholds for the nonarthritic hip score in patients undergoing arthroscopy for femoroacetabular impingement syndrome.
        Arthroscopy. 2021; 37: 3113-3121https://doi.org/10.1016/j.arthro.2021.03.059
        • Beck E.C.
        • Gowd A.K.
        • Liu J.N.
        • et al.
        How is maximum outcome improvement defined in patients undergoing shoulder arthroscopy for rotator cuff repair? A 1-year follow-up study.
        Arthroscopy. 2020; 36: 1805-1810https://doi.org/10.1016/j.arthro.2020.02.047
        • Maldonado D.R.
        • Kyin C.
        • Shapira J.
        • et al.
        Defining the maximum outcome improvement of the modified Harris Hip Score, the Nonarthritic Hip Score, the visual analog scale for pain, and the International Hip Outcome Tool-12 in the arthroscopic management for femoroacetabular impingement syndrome and labral tear.
        Arthroscopy. 2021; 37: 1477-1485https://doi.org/10.1016/j.arthro.2021.01.002
        • Ali M.S.
        • Prieto-Alhambra D.
        • Lopes L.C.
        • et al.
        Propensity score methods in health technology assessment: Principles, extended applications, and recent advances.
        Front Pharmacol. 2019; 10: 973https://doi.org/10.3389/fphar.2019.00973
        • Austin P.C.
        Optimal caliper widths for propensity-score matching when estimating differences in means and differences in proportions in observational studies.
        Pharm Stat. 2011; 10: 150-161https://doi.org/10.1002/pst.433
        • Austin P.C.
        Some methods of propensity-score matching had superior performance to others: Results of an empirical investigation and Monte Carlo simulations.
        Biometrical J. 2009; 51: 171-184https://doi.org/10.1002/bimj.200810488
        • Perets I.
        • Rybalko D.
        • Mu B.H.
        • et al.
        In revision hip arthroscopy, labral reconstruction can address a deficient labrum, but labral repair retains its role for the reparable labrum: A matched control study.
        Am J Sports Med. 2018; 46: 3437-3445https://doi.org/10.1177/0363546518809063
        • Matsuda D.
        • Kivlan B.R.
        • Nho S.J.
        • et al.
        Arthroscopic treatment and outcomes of borderline dysplasia with acetabular retroversion: A matched-control study from the MASH Study Group.
        Am J Sports Med. 2021; 49: 2102-2109https://doi.org/10.1177/03635465211011753
        • Kuroda Y.
        • Saito M.
        • Sunil Kumar K.H.
        • Malviya A.
        • Khanduja V.
        Hip arthroscopy and borderline developmental dysplasia of the hip: A systematic review.
        Arthroscopy. 2020; 36: 2550-2567.e1https://doi.org/10.1016/j.arthro.2020.05.035
        • 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: 2347-2352https://doi.org/10.1016/j.arthro.2018.03.012
        • 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. 2017; 46: 135-143https://doi.org/10.1177/0363546517730583
        • 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: 2617-2625https://doi.org/10.1177/0363546519861088
        • Kaya M.
        • Suzuki T.
        • Emori M.
        • Yamashita T.
        Hip morphology influences the pattern of articular cartilage damage.
        Knee Surg Sports Traumatol Arthrosc. 2016; 24: 2016-2023https://doi.org/10.1007/s00167-014-3297-6
        • 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: 1102-1112https://doi.org/10.1016/j.arthro.2017.01.053
        • Chandrasekaran S.
        • Darwish N.
        • Mu B.H.
        • et al.
        Arthroscopic reconstruction of the irreparable acetabular labrum: A match-controlled study.
        Arthroscopy. 2019; 35: 480-488https://doi.org/10.1016/j.arthro.2018.09.024
        • Jimenez A.E.
        • Owens J.S.
        • Shapira J.
        • et al.
        Hip capsular management in patients with femoroacetabular impingement or microinstability: A systematic review of biomechanical studies.
        Arthroscopy. 2021; 37: 2642-2654https://doi.org/10.1016/j.arthro.2021.04.004
        • Owens J.S.
        • Jimenez A.E.
        • Shapira J.
        • et al.
        Capsular repair may improve outcomes in patients undergoing hip arthroscopy for femoroacetabular impingement: A systematic review of comparative outcome studies.
        Arthroscopy. 2021; 37: 2975-2990https://doi.org/10.1016/j.arthro.2021.03.063
        • Riff A.J.
        • Kunze K.N.
        • Movassaghi K.
        • et al.
        Systematic review of hip arthroscopy for femoroacetabular impingement: The importance of labral repair and capsular closure.
        Arthroscopy. 2019; 35: 646-656.e3https://doi.org/10.1016/j.arthro.2018.09.005
        • 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: 112-122https://doi.org/10.1177/0363546518810731
        • Irie T.
        • Espinoza Orías A.A.
        • Irie T.Y.
        • et al.
        Computed tomography-based three-dimensional analyses show similarities in anterosuperior acetabular coverage between acetabular dysplasia and borderline dysplasia.
        Arthroscopy. 2020; 36: 2623-2632https://doi.org/10.1016/j.arthro.2020.05.049
        • Larson C.M.
        Editorial commentary: “The earth is not flat”: Progressing from plain radiographs to three-dimensional imaging when evaluating hip disorders.
        Arthroscopy. 2020; 36: 2633-2634https://doi.org/10.1016/j.arthro.2020.07.031
        • 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: 861-869https://doi.org/10.1007/s11999-016-5137-0