What Are the Results of Surgical Treatment of Hip Dysplasia With Concomitant Cam Deformity?

Goronzy, Jens; Franken, Lea; Hartmann, A.; Thielemann, Falk; Postler, Anne; Paulus, Tobias; Günther, Klaus‐Peter

doi:10.1007/s11999-016-5054-2

Cited by 40 publications

(17 citation statements)

References 43 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…The results presented in this study are very similar to a recent report from Goronzy et al who followed three groups of patients for a mean of 63 months: PAO alone for isolated DDH; PAO and osteochondroplasty via arthrotomy for DDH and cam lesions; PAO and osteochondroplasty and labral repair via HA for DDH with cam lesions and labral tears. They demonstrated no differences in post-operative PROs between all three groups [ 14 ]. This study shares an important limitation with the current work; in both, it remains unclear if the patients with intra-articular pathology would have done worse had their labral tears or cam lesions been ignored.…”

Section: Discussionmentioning

confidence: 99%

Arthroscopy and arthrotomy to address intra-articular pathology during PAO for hip dysplasia demonstrates similar short-term outcomes

Wyles

Hevesi

Bartels

et al. 2018

Journal of Hip Preservation Surgery

View full text Add to dashboard Cite

Periacetabular osteotomy (PAO) remains the gold standard procedure for joint preservation in symptomatic developmental dysplasia of the hip (DDH). Hip arthroscopy (HA) and open arthrotomy have been used to correct intra-articular pathology at the time of PAO, but there is limited data regarding differences in outcomes between these techniques when performed at the time of PAO. The aim of this study was to determine if short-term clinical outcomes differed between patients managed with HA versus arthrotomy to evaluate and treat intra-articular pathology at the time of PAO to discern if one technique is associated with better pain and functional results. Data were retrospectively reviewed from two surgeons at one institution managing DDH patients from September 2013 to December 2015. One surgeon treated patients with PAO and arthrotomy (N = 32), while the other performed PAO and HA (N = 39). There were 87% women, median age was 28 years and mean BMI was 25. Seventy-five percent of all patients received an intra-articular intervention. Patients completed 13 PROs at the pre-operative and 1-year post-operative clinical visits. Pre-operatively, there were no differences in any of the 13 PROs between patients treated with HA versus arthrotomy (P ≥ 0.076). Patients treated with PAO and arthrotomy experienced greater mean improvement in two out of the 13 PROs; the other 11 showed no differences. No treatment effect was observed for any of the 13 PROs using multivariable modelling that accounted for severity of dysplasia and degree of arthritis. Few differences were shown in short-term clinical outcomes between HA and arthrotomy at the time of PAO. This work highlights the need for a high quality randomized clinical trial to provide definitive guidance on whether hip preservation surgeons should address intra-articular pathology at the time of PAO for DDH and which technique best serves this purpose.

show abstract

Section: Discussionmentioning

confidence: 99%

Arthroscopy and arthrotomy to address intra-articular pathology during PAO for hip dysplasia demonstrates similar short-term outcomes

Wyles

Hevesi

Bartels

et al. 2018

Journal of Hip Preservation Surgery

View full text Add to dashboard Cite

show abstract

“…Our results indicate that congruity of the borderline dysplastic hip is impaired but its incongruity is not as severe as the dysplastic hips. As for the borderline dysplasia, it is recognized that instability or concomitant cam deformity may cause labrum tears and cartilage degeneration [11][12][13][14]34,35]. Regarding the concomitant cam deformity, there are several reports that evaluated the 3D morphology in the borderline dysplastic hips [34][35][36][37][38].…”

Section: Plos Onementioning

confidence: 99%

Three-dimensional curvature mismatch of the acetabular radius to the femoral head radius is increased in borderline dysplastic hips

et al. 2020

View full text Add to dashboard Cite

Whether borderline hip dysplasia is pathologic remains unclear. In order to evaluate the three-dimensional joint congruity, this study sought to answer the question: are borderline dysplastic hip curvature mismatch and eccentricity between the acetabulum and the femoral head different from dysplastic or control hips three-dimensionally? The 113 hips, categorized as: dysplastic (LCEA � 20˚), 47 hips; borderline (20˚� LCEA < 25˚), 32 hips; and control (25˚� LCEA < 35˚), 34 hips; were evaluated. Three-dimensional (3D) femoral and coxal bone models were reconstructed from CT images. Using a custom-written Visual C++ routine, the femoral head and acetabular radii of curvature, and the femoral head and the acetabular curvature center were calculated. Then the ratio of the acetabular radius to the femoral head radius (3D curvature mismatch ratio), and the distance between the acetabular curvature center and the femoral head center (3D center discrepancy distance) were calculated. These indices were compared statistically among the three groups using Tukey's post hoc test. The mean 3D curvature mismatch ratio in the borderline (1.13 ± 0.05) was smaller than in the dysplasia (1.23 ± 0.08, p < 0.001), and larger than in the control (1.07 ± 0.02, p < 0.001). The mean 3D center discrepancy distance in the borderline (3.2 ± 1.4 mm) was smaller than in the dysplasia (4.8 ± 2.3, p < 0.001) and larger than in the control (1.6 ± 0.7, p < 0.001). These results demonstrated that three-dimensional congruity of the borderline dysplastic hip is impaired, but its incongruity is not as severe as in dysplastic hips. The 3D curvature mismatch ratio and the 3D center discrepancy distance can be valuable signs of joint congruity in patients with borderline dysplasia. However, future studies are necessary to clarify any associations between curvature mismatch and pathogenesis of osteoarthritis in borderline dysplasia.

show abstract

“…Borderline dysplasia is commonly defined as lateral center‐edge angle (LCEA) 20° to 25°. As for borderline dysplasia, it is recognized that instability or concomitant cam deformity cause labrum tears and cartilage damages 4–9 . An unstable hip would logically benefit from acetabular reorientation osteotomy 9–11 .…”

Section: Introductionmentioning

confidence: 99%

“…As for borderline dysplasia, it is recognized that instability or concomitant cam deformity cause labrum tears and cartilage damages 4–9 . An unstable hip would logically benefit from acetabular reorientation osteotomy 9–11 . On the other hand, concomitant cam deformity can be treated with arthroscopic procedures 6,10,12,13 .…”

Section: Introductionmentioning

confidence: 99%

“…However, it is difficult to characterize the pathological mechanism as impingement (stable) or dysplasia (unstable) by two‐dimensional radiographic measurements alone 10 although the recently introduced Femoro‐epiphyseal Acetabular Roof (FEAR) index seems to have a high association with instability 14,15 . As for the femoral side, there are several reports that evaluated the three‐dimensional morphology in the borderline dysplastic hips with concomitant cam deformity 4,9,16–18 . However, there is scarce information on the three‐dimensional acetabular morphology in borderline dysplasia although the acetabular morphology affects joint incongruity and instability.…”

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

Three‐dimensional hip joint congruity evaluation of the borderline dysplasia: Zonal‐acetabular radius of curvature

Irie

Orías

Nho

et al. 2020

Journal Orthopaedic Research

View full text Add to dashboard Cite

In theory, a hemispherical acetabulum provides the ideal hip congruity in any hip position. However, it remains unknown how the three‐dimensional acetabular morphology of borderline dysplastic and frank dysplastic hips compare to normal hips. This study inquires if borderline dysplastic zonal‐acetabular curvatures in the anterior, superior, and posterior zones are different from normal or dysplastic hips three‐dimensionally. One‐hundred and fifteen hips, grouped as control (25°≤ LCEA <40°), 36 hips; borderline (20°≤ LCEA <25°), 32 hips; dysplasia (LCEA ≤20°), 47 hips were analyzed. The radii of acetabular curvature for the anterior, superior, and posterior zones were calculated as the zonal‐acetabular radius of curvature (ZARC). The mean acetabular roof obliquity of the borderline (10.6 ± 4.3 [SD]°) was significantly larger than the control (3.0° ± 5.4°; P < .001) and smaller than the dysplasia (19.3° ± 5.7°; P < .001). Although the mean acetabular anteversion angle of the borderline (21.3° ± 3.7°) was significantly larger than control (17.9 ± 3.5°; P = .001), that of the borderline was not different from the dysplasia (23.3° ± 4.0°; P = .053). The mean anterior ZARC in the borderline (29.8 ± 2.6 mm) was significantly larger than the control (28.0 ± 2.2 mm; P = .011) and smaller than the dysplasia (31.5 ± 2.7 mm; P = .009). The mean superior ZARC in the borderline (25.7 ± 3.0 mm) was not different from the control (25.9 ± 2.2 mm; P = .934) or the dysplasia (25.8 ± 2.5 mm; P = .991). Although the mean posterior ZARC in the borderline (27.2 ± 2.5 mm) was not different from the control (26.4 ± 1.9 mm; P = .455), that of the borderline group was significantly smaller than the dysplasia (30.4 ± 3.3 mm; P < .001); that is, the severity of lateral under‐coverage affects the anterior and/or posterior zonal‐acetabular curvature.

show abstract

What Are the Results of Surgical Treatment of Hip Dysplasia With Concomitant Cam Deformity?

Abstract: Level III, therapeutic study.

Cited by 40 publications

References 43 publications

Arthroscopy and arthrotomy to address intra-articular pathology during PAO for hip dysplasia demonstrates similar short-term outcomes

Arthroscopy and arthrotomy to address intra-articular pathology during PAO for hip dysplasia demonstrates similar short-term outcomes

Three-dimensional curvature mismatch of the acetabular radius to the femoral head radius is increased in borderline dysplastic hips

Three‐dimensional hip joint congruity evaluation of the borderline dysplasia: Zonal‐acetabular radius of curvature

Contact Info

Product

Resources

About