Long-term Outcomes After Arthroscopic Treatment of Femoroacetabular Impingement for Patients With Borderline Dysplasia

Abstract

Background: Outcomes after isolated hip arthroscopic surgery for patients with dysplasia have been unfavorable. Results have included iatrogenic instability and conversion to total hip arthroplasty at a young age. However, patients with borderline dysplasia (BD) have shown more favorable results at short- and medium-term follow-up. Purpose: To assess long-term outcomes after hip arthroscopic surgery for femoroacetabular impingement in patients with BD (lateral center-edge angle [LCEA] = 18°-25°) compared with a control group of patients without dysplasia (LCEA = 26°-40°). Study Design: Cohort study; Level of evidence, 3. Methods: We identified a group of 33 patients (38 hips) with BD who were treated for FAI between March 2009 and July 2012. An age- and sex-matched control group of 83 patients (96 hips) was also identified. Patient-reported outcome scores were collected preoperatively and subsequently at a mean of 9.6 years postoperatively. Results: The mean LCEA and Tönnis angle were 22.42°± 2.02° and 6.27°± 3.23° in the BD group, respectively, and 31.71°± 3.52° and 2.42°± 3.02° in the control group, respectively ( P < .001). At a mean follow-up of 9.6 years (range, 8.2-11.6 years), there was a significant improvement in all patient-reported outcome scores in both groups ( P < .001). There were no significant differences between preoperative and postoperative scores or rates of achieving the minimal clinically important difference between the BD and control groups. Bilateral surgery was noted to be a risk factor for any revision during the follow-up period ( P < .001). There were 2 hips (5.3%) that underwent revision surgery in the BD group and 10 hips (10.4%) in the control group; of these, 1 patient in the BD group underwent total hip arthroplasty, and 1 patient who had undergone bilateral surgery in the control group underwent bilateral hip resurfacing. Conclusion: Durable outcomes (>9 years) with low revision rates can be expected after hip arthroscopic surgery with an approach that involves labral preservation where possible and careful attention to capsular closure in patients with BD. The observed outcomes were similar to those of a femoroacetabular impingement group with normal coverage. These results highlight the importance of classifying patients into impingement or instability categories and tailoring treatment appropriately with arthroscopic surgery or periacetabular osteotomy, respectively.

Lateral Center‐edge Angle of 18° (Bone‐Edge): Threshold for Hip Arthroscopy Treatment in Patients with Borderline Developmental Dysplasia of the Hip?

“…Additionally, PAO has shown promise in treating patients with persistent hip instability that does not improve following single or multiple hip arthroscopic procedures 36 . Hip arthroscopy treatment patients with BDDH have durable outcomes (>9 years) and a low revision rate due to minimally invasive surgery and rapid recovery 13 . This study further demonstrated favorable outcomes for arthroscopic surgery in patients with BDDH.…”

“…Traditionally, borderline dysplasia has been defined as an acetabular LCEA between 20° to 25°. Recent studies have defined LCEA 18° to 25° as BDDH and obtained good results by arthroscopic surgery 13,14 . In severe hip dysplasia with LCEA below 18°, there is an acetabular bony structural deficiency that must be addressed, and PAO remains the gold standard to address that matter 32 .…”

“…The primary cause of symptoms in the patients included in the study may be attributed to mechanical impingement rather than joint instability. Additionally, numerous studies have demonstrated the effectiveness of repairing and fixing the injured labrum and capsular suture under arthroscopy 1,13–15 …”

“…Careful patient selection is critical to the success of this procedure. Selley et al 13 . emphasized that the importance of classifying patients into impingement or instability categories and tailoring treatment appropriately with arthroscopic surgery or periacetabular osteotomy, respectively.…”

Hip Arthroscopic Surgery With Chondrolabral Refixation, Osteochondroplasty, and Routine Capsular Closure for Femoroacetabular Impingement Syndrome: Clinical Outcomes at a Minimum 10-Year Follow-up

“…Furthermore, given the relatively low number of patients who underwent revision hip arthroscopic surgery or conversion to THA, it is not yet possible to determine causative differences between patients undergoing revision hip arthroscopic surgery or conversion to THA and those who did not. The study cohort included patients with borderline hip dysplasia (ie, LCEA of 20°-25°); even though these patients have high long-term survivorship, 17,64 they may represent a different abnormality than patients without any dysplasia. Finally, the present study reports data from surgical procedures performed by a single fellowship-trained sports medicine surgeon with advanced training and experience in hip arthroscopic surgery practicing at a high-volume, tertiary referral orthopaedic practice.…”