Arthroscopic Capsular Plication in Patients With Labral Tears and Borderline Dysplasia of the Hip: Analysis of Risk Factors for Failure

Abstract

Background: Hip arthroscopy for the treatment of instability in the setting of borderline dysplasia is controversial. Capsular management in such cases is an important consideration, and plication has been described as a reliable technique, with good midterm outcomes reported when indications are appropriate. Hypothesis: Patients with borderline dysplasia who have a lower lateral center-edge angle (LCEA) and greater age will be at a higher risk of failure after arthroscopic capsular plication. Study Design: Case-control study; Level of evidence, 3. Methods: Data were retrospectively reviewed for all patients between 15 and 40 years of age who underwent hip arthroscopy from November 2008 to January 2015. Inclusion criteria were an LCEA between 18° and 25°, Tönnis grade ≤1, primary case with capsular plication, and minimum 2-year follow-up. Patients were excluded if they had any history of ipsilateral hip procedure or conditions such as Legg-Calve-Perthes disease, slipped capital femoral epiphysis, rheumatologic disease, and Tönnis grade ≥2. Age, sex, and body mass index data were retrieved for each patient. Patient-reported outcomes (PROs)—including modified Harris Hip Score (mHHS), Non-Arthritic Hip Score (NAHS), Hip Outcome Score–Sports Specific Subscale, and a visual analog scale (VAS) for pain (0-10)—were obtained preoperatively and at a minimum of 2 years postoperatively, in addition to the postoperative International Hip Outcome Tool–12. The “success” group consisted of all patients who achieved the patient acceptable symptomatic state of mHHS ≥74 and had no ipsilateral hip surgery subsequent to their index arthroscopy. The “failure” group was composed of patients who were below the patient acceptable symptomatic state at latest follow-up or required secondary arthroscopy or conversion to total hip arthroplasty. Patient satisfaction and minimal clinically important difference were also calculated. Mean age for the failure group was applied as a cutoff age for subanalysis, and relative risk for failure was determined. Results: Ninety patients (97 hips; 79.5%) met criteria for the success group, and 25 patients (25 hips) met criteria for the failure group. No significant differences in preoperative baseline scores or VAS were found. However, there did appear to be a trend that the failure group had lower mean preoperative scores for all PRO measures and a higher VAS score. The differences in preoperative mHHS and NAHS closely approached significance ( P = .053). Postoperative PRO, VAS, and patient satisfaction scores of the success group were significantly higher than the failure group. The failure group was significantly older than the success group (28.5 ± 7.8 vs 23.5 ± 7.5 years, P = .005). Patients >35 years old were 2.25 times more likely to fail according to relative risk (95% CI, 1.10-4.60; P = .0266). LCEA did not differ between the groups, and no other risk factors for failure were identified. Conclusion: Stringent criteria for patient selection and meticulous repair or augmentation of the static stabilizers of the hip yielded favorable clinical outcomes in this study cohort with borderline dysplasia. Within this carefully selected group, the analysis revealed that increased age was the main risk factor for failure in the management of borderline hip dysplasia via isolated primary arthroscopic hip surgery with capsular plication.

Return to Play After Hip Arthroscopy Among Tennis Players: Outcomes with Minimum Five-Year Follow-up

“…In addition, all procedures were performed by a single surgeon, which may limit the generalizability of the results. Furthermore, capsular and labral management has evolved in the recent years and in consequence, patients who underwent labral debridement and capsular release in the ongoing study would currently be treated with labral restoration technique such labral reconstruction or labral augmentation, and capsular plication (23,24,(44)(45)(46). ConclusionRegardless of the level of participation, tennis players who underwent hip arthroscopic surgery reported statistically significant PRO improvements.…”

“…(23) The decision to release, repair, or plicate the capsule was dictated by the patient's Beightons score and acetabular coverage. (24,25) Rehabilitation Using a fitted X-Act ROM brace (DJO Global Vista, CA) and crutches, patients were instructed to use toe-touch weight bearing for two weeks. To restore strength and range of motion, physical therapy was initiated one day after surgery.…”

Achieving a Perfectly Spherical Femoroplasty: Pearls, Pitfalls, and Optimal Surgical Technique

“…If there is joint instability present as indicated by preoperative and intraoperative criteria 28,29 capsular plication is performed. If no joint instability is present, capsulorrhaphy is performed.…”

Editorial Commentary: Quantifying Anterior and Lateral Acetabular Coverage in Hip Dysplasia: What About Posterior Coverage?

“…This is especially relevant to hips with so-called "borderline dysplasia," in which hip arthroscopy is being reported as an effective treatment solution. 6 But what qualifies as borderline dysplasia on plain radiographs? A recent systematic review by Yeung et al 7 showed that there is a wide range in LCEA when defining borderline dysplasia ranging from 18 to 25 with overlap, with moderate dysplasia ranging from 16 to 24 .…”