Predictors of Poor Clinical Outcome After Arthroscopic Labral Preservation, Capsular Plication, and Cam Osteoplasty in the Setting of Borderline Hip Dysplasia

• Published in: The American journal of sports medicine 2018-01, Vol.46 (1), p.135-143
• Main Authors: Hatakeyama, Akihisa, Utsunomiya, Hajime, Nishikino, Shoichi, Kanezaki, Shiho, Matsuda, Dean K., Sakai, Akinori, Uchida, Soshi
• Format: Article
• Language: English
• Subjects: Acetabulum - pathology; Adolescent; Adult; Age; Aged; Arthritis; Arthroplasty, Replacement, Hip; Arthroscopy; Arthroscopy - methods; Case-Control Studies; Child; Clinical outcomes; Female; Femoracetabular Impingement - surgery; Femur Head - surgery; Hip dislocation; Hip Dislocation, Congenital - surgery; Hip joint; Hip Joint - surgery; Humans; Joint surgery; Male; Middle Aged; Osteoarthritis - diagnosis; Osteoarthritis - pathology; Postoperative Period; Proportional Hazards Models; Radiography; Reoperation; Sports medicine; Success; Surgery; Treatment Outcome; Young Adult
• ISSN: 0363-5465; 1552-3365
• DOI: 10.1177/0363546517730583

Background: Borderline developmental dysplasia of the hip (BDDH) is frequently diagnosed concurrently with cam impingement. While hip arthroscopy has advanced the treatment of hip joint pathology, including femoroacetabular impingement (FAI), arthroscopic treatment for FAI in the setting of BDDH remains a challenge amid a subset of patients. The risk factors of poor clinical results after hip arthroscopic labral preservation and FAI corrections in the setting of BDDH patients have not been well established. Hypothesis: Pre- and intraoperative findings can predict the poor clinical outcomes after hip arthroscopic surgery for FAI in the setting of BDDH. Study Design: Case control study; Level of evidence, 3. Methods: Of patients with BDDH (defined as lateral center edge [LCE] angle between 20° and 25°) who underwent arthroscopic procedures for FAI between 2009 and 2014, 45 met inclusion criteria (45 hips: 15 males and 30 females). Their mean age was 31.4 years (range, 12-65 years), and the mean LCE angle was 23.2°. Clinical and radiographic follow-up evaluations up to a minimum of 2 years after surgery were performed for all patients. Failure of the procedure was defined as conversion to subsequent surgery or having a Tönnis osteoarthritis grade of 2, and success was defined as patients who did not need subsequent surgery. Univariate analysis and Cox hazard proportional analysis were performed for both cohorts. Results: Of 45 patients, 11 (24%) had revision surgery (endoscopic shelf acetabuloplasty for 5 patients, total hip arthroplasty for 2, and revision hip arthroscopy for 2) or advanced to Tönnis grade ≥2 osteoarthritis and thus constituted the failure group. In the success group, modified Harris Hip Score (median, pre- vs postoperative: 72.1 vs 100, P< .001, Wilcoxon signed-rank test) and nonarthritic hip score (58.8 vs 98.8, P< .001) were significantly improved at the minimum 2-year follow-up. The median age of the failure group was significantly higher than that of the success group (47.0 vs 20.0, P< .001, Mann-Whitney Utest). Risk factors of poor clinical outcomes were identified as follows: age ≥42 years (hazard ratio [HR], 11.6; 95% CI, 2.5-53.9; P= .002, Cox hazard model), broken Shenton line (HR, 6.4; 95% CI, 1.9-22.3; P= .003), Tönnis angle ≥15° (HR, 3.9; 95% CI, 1.2-12.9; P= .03), vertical center anterior (VCA) angle ≤17° (HR, 5.0; 95% CI, 1.5-17.1; P= .01), Tönnis grade 1 at preoperative radiograph (HR, 3.6; 95% CI, 1.1-11.7; P= .04), severe c