Periacetabular osteotomy with or without arthroscopic management in patients with hip dysplasia: study protocol for a multicenter randomized controlled trial

Wilkin, Geoffrey; Poitras, Stéphane; Clohisy, John C.; Belzile, Étienne L.; Zaltz, Ira; Grammatopoulos, George; Melkus, Gerd; Rakhra, Kawan; Ramsay, Tim; Thavorn, Kednapa; Beaulé, Paul E.

doi:10.1186/s13063-020-04592-9

Cited by 16 publications

(9 citation statements)

References 72 publications

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“…The ANCHOR study group is currently randomizing patients for PAO alone or with the addition of hip arthroscopy, without any consideration of MRI or physical examination findings. 22 For these reasons, we do believe that the comparison between the groups in this study is still meaningful.…”

Section: Discussionmentioning

confidence: 86%

“…The randomized controlled trial currently underway by members of the ANCHOR group, for which this center is currently enrolling patients, will ideally provide further guidance in this direction. 22 The ANCHOR study randomizes patients between hip arthroscopy and no hip arthroscopy at the time of their PAO but leaves the need for labral repair at the discretion of the operating surgeon.…”

Section: Discussionmentioning

confidence: 99%

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The Effects of Arthroscopic Labral Repair on Patient-Reported Outcomes in the Setting of Periacetabular Osteotomy

et al. 2023

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Background: It is currently unknown whether the addition of arthroscopic labral repair in the setting of periacetabular osteotomy (PAO) provides any clinical benefit. Purpose/Hypothesis: The purpose of this study was to compare outcomes of patients who underwent arthroscopic labral repair concomitantly with PAO versus patients who underwent PAO alone. We hypothesized that there would be no difference in patient-reported outcome measures (PROMs) between the cohorts. Study Design: Cohort study; Level of evidence, 3. Methods: Patients undergoing PAO from a single-center prospective hip preservation registry were eligible for this study if they completed pre- and postoperative PROMs (minimum, 1 year). PROMs were collected at 1 year, 2 years, and latest follow-up at 6.05 years for PAO group and 4.2 years for scope/PAO group. The study group consisted of 53 patients who underwent arthroscopic labral repair at the time of their PAO, and the comparison group consisted of 170 patients who underwent PAO alone. A subset of the PAO group who had radiologic evidence of a detached labral tear (n = 33) was also compared with the rest of the PAO-alone group. PROMs were compared at every time point for both groups as well as the subset of patients who underwent PAO alone despite a labral tear. Results: The mean follow-up of all patients was 2 years (range, 1-6 years). Overall, 85.2% of the PAO group and 85.7% of the scope/PAO group met the minimal clinically important difference for either the modified Harris Hip Score (mHHS) or the International Hip Outcome Tool (iHOT-33) at the most recent follow-up. There was no difference in improvement between groups (mHHS, P = .670; iHOT-33, P = .944). Patients who had a radiologically diagnosed detached labral tear and underwent PAO alone had no difference in outcomes when compared with the rest of the PAO cohort (mHHS, P = .981; iHOT-33, P = .909). Conclusion: There was no significant benefit measured by PROMs at follow-up for concomitant arthroscopic labral repair in the setting of PAO.

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Section: Discussionmentioning

confidence: 86%

Section: Discussionmentioning

confidence: 99%

The Effects of Arthroscopic Labral Repair on Patient-Reported Outcomes in the Setting of Periacetabular Osteotomy

et al. 2023

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“…Similarly, although PAO remains highly successful for the treatment of acetabular dysplasia, debate remains regarding whether concomitant procedures, such as hip arthroscopy, should be part of standard perioperative care [15]. Thus, as surgical techniques adapt and surgeons become more familiar with the procedure, prospective, RCTs may become more feasible [16].…”

Section: Discussionmentioning

confidence: 99%

Top 100 cited studies in periacetabular osteotomy for acetabular dysplasia: do lower levels of evidence guide clinical practice?

Jeong

Samuel

et al. 2022

Journal of Pediatric Orthopaedics B

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As no prior study has examined the citations profile of key articles related to periacetabular osteotomy (PAO), our analysis utilized the Web of Science database to (1) identify the most-cited clinical studies relating to PAO in the management of acetabular dysplasia and (2) assess any trends over time with respect to the quality of literature. The top 100 highest-cited studies related to PAO had a mean of 49 citations (range, 6–666 per study). With respect to the level of evidence, most studies had level IV evidence (58%); 1% level I, 16% level II, 28% level III and 2% level V. Most studies were retrospective (n = 86); there were 14 prospective studies (including one randomized study). The most common study designs were case series (n = 58) and cohort (n = 16), followed by matched-cohort (n = 13) and case–control (n = 6). The mean ± SD Newcastle-Ottawa Scale score was 6.48 ± 1.31. A total of 59 and 41 of the included articles were classified as high risk and high quality, respectively. No studies were classified as very high risk. As a whole, our analysis demonstrated that currently available PAO literature is still of low quality and of low level of evidence. While PAO has been well-documented as a durable procedure for addressing acetabular dysplasia, future research must focus on higher quality, randomized and prospective data to answer key clinical or technique-related topics.

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“…Indeed, 60% to 85% of patients with dysplasia have concomitant intra-articular abnormalities, the most common being labral tears and chondral defects. 10,23,25,33 While some early studies have reported favorable outcomes after arthroscopic surgery in patients with dysplasia, 3,18 the general body of evidence supports dysplasia as a relative contraindication for isolated arthroscopic surgery. 1,11,32 The International Hip Dysplasia Institute recommends against arthroscopic surgery alone, opting for skeletal realignment surgery for the treatment of hip dysplasia.…”

Section: Discussionmentioning

confidence: 99%

Use of Anatomic Radiographic Horizons for the Lateral Center-Edge Angle in the Classification of Hip Dysplasia

et al. 2022

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Background: The lateral center-edge angle of Wiberg (LCEA) and Tönnis angle (TA) rely on a “horizon” that functions as a reference point for measurements of hip dysplasia on weightbearing anteroposterior pelvis radiographs. There are 3 different horizons that are currently utilized depending on surgeon preference: (1) a line parallel to the radiographic floor (F), (2) a line that connects the inferior portions of the acetabular teardrops (ATs), or (3) a line that connects the ischial tuberosities (ITs). It is imperative to accurately assess the degree of hip dysplasia on initial workup to select the appropriate surgical intervention. Purpose: To assess how the choice of a radiographic horizon affects the measurements of the LCEA and TA. The secondary purpose was to assess how the horizon affected the classification of hips as either normal, borderline dysplastic, or dysplastic. Study Design: Cohort study (diagnosis); Level of evidence, 3. Methods: The LCEA and TA were measured on all preoperative weightbearing anteroposterior pelvis radiographs for 186 consecutive patients who underwent hip preservation surgery between February 2016 and November 2020 (140 hip arthroscopic procedures, 46 combined hip arthroscopic procedures with periacetabular osteotomy), 3 times per hip, each time using an F, AT, and IT horizon. The Student t test was used to analyze the differences in the measurements of the LCEA and TA, and discordance rates in the dysplasia classification between horizons were quantified. Results: For the entire study population, the mean LCEAF (23.4°± 7.4°) was significantly greater than the mean LCEAIT (23.1°± 7.2°) (95% CI, −0.634 to −0.003; P = .047) and mean LCEAAT (23.0°± 7.1°) (95% CI, −0.723 to −0.139; P = .004). There was no difference between the LCEAIT and LCEAAT (95% CI, −0.305 to 0.080; P = .251). When stratified by hip arthroscopic surgery, the mean LCEAF (26.3°± 5.6°) was significantly greater than the mean LCEAAT (25.8°± 5.3°) (95% CI, −0.845 to −0.162; P = .004). Overall, there was a 17.7% and 18.3% discordance rate in the dysplasia classification using the LCEAIT and LCEAAT compared with the LCEAF, respectively. There were no statistically significant differences between the mean TAIT, TAAT, and TAF for the entire study population, the arthroscopic surgery group, and the combined arthroscopic surgery and periacetabular osteotomy group. Conclusion: There was no statistical difference between the AT and IT horizons for LCEA measurements. The dysplasia classification was in better agreement between the 2 anatomic horizons compared with the F horizon. The TA was not affected by changes in the horizon.

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Periacetabular osteotomy with or without arthroscopic management in patients with hip dysplasia: study protocol for a multicenter randomized controlled trial

Cited by 16 publications

References 72 publications

The Effects of Arthroscopic Labral Repair on Patient-Reported Outcomes in the Setting of Periacetabular Osteotomy

The Effects of Arthroscopic Labral Repair on Patient-Reported Outcomes in the Setting of Periacetabular Osteotomy

Top 100 cited studies in periacetabular osteotomy for acetabular dysplasia: do lower levels of evidence guide clinical practice?

Use of Anatomic Radiographic Horizons for the Lateral Center-Edge Angle in the Classification of Hip Dysplasia

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