The Utility of Hip Arthroscopy in the Setting of Acetabular Dysplasia: A Systematic Review

Adler, Kelly L.; Giordano, Brian D.

doi:10.1016/j.arthro.2018.07.048

Cited by 32 publications

(29 citation statements)

References 54 publications

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“…50 Multiple systematic reviews have examined outcomes of patients with dysplasia/BHD undergoing hip arthroscopy. 1,13,24,34,49,58 Three reviews 1,24,49 recommended against an arthroscopic-only approach in patients with moderate to severe dysplasia. In particular, Shah et al 49 noted the following risk factors for failure with an arthroscopic-only approach: LCEA <15°, severe cartilage lesions, Tönnis angle >20°, broken Shenton line, and joint space ≤2 mm.…”

Section: Hip Arthroscopy Outcomesmentioning

confidence: 99%

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A Contemporary Look at the Evaluation and Treatment of Adult Borderline and Frank Hip Dysplasia

et al. 2019

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Background: Adult hip dysplasia is often diagnosed according to the lateral center-edge angle (LCEA). Patients with frank hip dysplasia (LCEA <20°) traditionally require treatment with bony realignment through a periacetabular osteotomy (PAO) and/or derotational femoral osteotomy, while patients with borderline hip dysplasia (BHD) present a challenging treatment dilemma, as it remains unknown when they should be treated with hip arthroscopy and/or a PAO. Purpose: To perform a narrative review to report the differences in hip morphology and clinical outcomes between adult patients with frank hip dysplasia and BHD. Study Design: Narrative review. Methods: A systematic search of the literature was conducted through the Medline, EMBASE, and Cochrane databases with the search phrase borderline hip dysplasia. Results: The search identified 305 articles, of which 48 were considered relevant to this study after screening of titles and abstracts. Four articles discussed new radiographic means of evaluating adult hip dysplasia, 16 articles analyzed morphology of dysplastic hips, and 28 articles described the clinical outcomes of patients with frank hip dysplasia or BHD treated with hip arthroscopy and/or PAO. Because the level of evidence obtained from this search was not adequate for systematic review or meta-analysis, a current concepts review on the diagnosis, hip morphology, and clinical outcomes of patients with frank hip dysplasia or BHD is presented. Conclusion: Adult hip dysplasia is most commonly diagnosed based on the LCEA; however, the LCEA is an unreliable sole marker for dysplasia, and additional radiographic parameters should be utilized. Furthermore, specific pathology identified on imaging and/or during hip arthroscopy can provide clues to a surgeon when the diagnosis is inconclusive according to history and physical examination alone. While the data support that patients with frank dysplasia are best treated with PAO, there is no such preferred treatment for patients with BHD, who have a wide spectrum of instability. Selective use of arthroscopic labral and capsular treatment alone may provide good results in carefully chosen patients with BHD, while some may end up requiring a bony realignment procedure.

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Section: Hip Arthroscopy Outcomesmentioning

confidence: 99%

“…However, the isolated use of hip arthroscopy in patients with BHD may portend good short-term outcomes when attention is paid to labral and capsular preservation. 1…”

Section: Hip Arthroscopy Outcomesmentioning

confidence: 99%

A Contemporary Look at the Evaluation and Treatment of Adult Borderline and Frank Hip Dysplasia

et al. 2019

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“…[2][3][4][5][6][7][8] Items 1 through 6 are negative predictive factors that have been identified in the current manuscript by Stone et al1 1. Presence of femoral chondral damage 2.…”

mentioning

confidence: 72%

Editorial Commentary: Patient Profiling: Identifying Risk Factors That Help Predict Outcomes of Hip Arthroscopy Candidates

Aoki

2019

Arthroscopy: The Journal of Arthroscopic & Related Surgery

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Hip pain in the young athletic population is often caused by femoroacetabular impingement morphology. If a patient fails conservative management, hip arthroscopy becomes a potential treatment option. Our ability to maximize patient outcomes after hip arthroscopy is directly related to preoperative patient selection, intraoperative technical ability, and attention to detail in the postoperative period. When considering surgery as a therapeutic option, we want to first identify that the pain is truly stemming from the hip. Once the hip is identified as the culprit, then we proceed with the responsibility of discussing pros and cons and risks and benefits to each patient to critically evaluate whether surgical treatment is a viable option. With the explosion of literature in the field of hip preservation, we have recognized certain modifiable and nonmodifiable risk factors that aid us in identifying patients who may have difficulty in achieving their functional athletic expectations after surgery.

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“…Over the past 3 years, there have been three systematic reviews looking at the clinical impact of arthroscopy for hip dysplasia, with all concluding potential benefits of the procedure from pre-experimental studies, but highlighting the absence of randomized controlled trials limiting the utility of the results [ 37 – 39 ]. Furthermore, there have been two systematic reviews looking at the contribution of arthroscopy, PAO, or a combination of both procedures in patients with hip dysplasia, both concluding the lack of robust studies concerning the combination of the two procedures [ 40 , 41 ].…”

Section: Methodsmentioning

confidence: 99%

“…It is anticipated the loss of follow-up will be around 15%, with around 20% for imaging at 2 years. This is based on loss to follow-up rates seen in similar trials with similar follow-up periods [41,70]. Randomized controlled trials accomplished at our site have also typically seen 15% loss to follow-up rates.…”

Section: Anticipated Loss To Follow-up Ratementioning

confidence: 97%

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

Wilkin

Poitras

Clohisy

et al. 2020

Trials

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Background: Hip dysplasia is one of the most common causes of hip arthritis. Its incidence is estimated to be between 3.6 and 12.8% (Canadian Institute for Health Information, Hip and knee replacements in Canada, 2017-2018: Canadian joint replacement registry annual report, 2019; Jacobsen and Sonne-Holm, Rheumatology 44:211-8, 2004). The Periacetabular Osteotomy (PAO) has been used successfully for over 30 years (Gosvig et al., J Bone Joint Surg Am 92:1162-9, 2010), but some patients continue to exhibit symptoms post-surgery (Wyles et al., Clin Orthop Relat Res 475:336-50, 2017). A hip arthroscopy, performed using a small camera, allows surgeons to address torn cartilage inside the hip joint. Although both procedures are considered standard of care treatment options, it is unknown whether the addition of hip arthroscopy improves patient outcomes compared to a PAO alone. To delay or prevent future joint replacement surgeries, joint preservation surgery is recommended for eligible patients. While previous studies found an added cost to perform hip arthroscopies, the cost-effectiveness to Canadian Health care system is not known. Methods: Patients randomized to the experimental group will undergo central compartment hip arthroscopy prior to completion of the PAO. Patients randomized to the control group will undergo isolated PAO. Patient-reported quality of life will be the primary outcome used for comparison between the two treatment groups as measured by The International Hip Outcome Tool (iHOT-33) (Saberi Hosnijeh et al., Arthritis Rheum 69:86-93, 2017). Secondary outcomes will include the four-square step test and sit-to-stand (validated in patients with pre-arthritic hip pain) and hip-specific symptoms and impairment using the HOOS; global health assessment will be compared using the PROMIS Global 10 Score; health status will be assessed using the EQ-5D-5L and EQ VAS questionnaires (Ganz et al., Clin Orthop Relat Res 466:264-72, 2008) pre-and post-operatively. In addition, operative time, hospital length of stay, adverse events, and health services utilization will be collected. A subgroup of patients (26 in each group) will receive a T1rho MRI before and after surgery to study changes in cartilage quality over time. A cost-utility analysis will be performed to compare costs and quality-adjusted life years (QALYs) associated with the intervention.

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The Utility of Hip Arthroscopy in the Setting of Acetabular Dysplasia: A Systematic Review

Cited by 32 publications

References 54 publications

A Contemporary Look at the Evaluation and Treatment of Adult Borderline and Frank Hip Dysplasia

A Contemporary Look at the Evaluation and Treatment of Adult Borderline and Frank Hip Dysplasia

Editorial Commentary: Patient Profiling: Identifying Risk Factors That Help Predict Outcomes of Hip Arthroscopy Candidates

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

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