A Traffic Light Grading System of Hip Dysplasia to Predict the Success of Arthroscopic Hip Surgery

Grammatopoulos, George; Davies, Owain; El‐Bakoury, Ahmed; Gill, Harinderjit; Pollard, T. C. B.; Andrade, A. J.

doi:10.1177/0363546517713176

Cited by 22 publications

(29 citation statements)

References 45 publications

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“…Grammatopoulos et al 21 performed a retrospective case-control study of 111 hips with an acetabular index >10° and/or LCEA <25° that underwent hip arthroscopy. The authors identified 33 hips with failed arthroscopic treatment, requiring hip arthroplasty at a mean 4.5-year follow-up.…”

Section: Defining Frank Hip Dysplasia and Bhd With Radiographic Parammentioning

confidence: 99%

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: Defining Frank Hip Dysplasia and Bhd With Radiographic Parammentioning

confidence: 99%

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

et al. 2019

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“…Grammatopoulos et al 20 conducted a study to identify radiographic and intraoperative features that could predict the success of hip preservation with arthroscopic surgery. Using a mean follow-up of 4.5 years, they concluded that arthroscopic hip surgery can be associated with an excellent chance of hip preservation with a Tönnis angle <15° and an LCEA >25° in the absence of hip instability.…”

Section: Discussionmentioning

confidence: 99%

A Multicenter Study of Radiographic Measures Predicting Failure of Arthroscopy in Borderline Hip Dysplasia: Beware of the Tönnis Angle

et al. 2020

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Background: Hip arthroscopy has been previously demonstrated to be an effective treatment for adult mild hip dysplasia. There are many radiographic parameters used to classify hip dysplasia, but to date few studies have demonstrated which parameters are of most importance for predicting surgical outcomes. Purpose: To identify preoperative radiographic parameters that are associated with poor outcomes in the arthroscopic treatment of adult mild hip dysplasia. Study Design: Case-control study; Level of evidence, 3. Methods: Radiographic analysis was performed in patients with mild hip dysplasia who underwent arthroscopic surgery between 2009 and 2015. Preoperative radiographic measurements included lateral center edge angle, Tönnis angle, neck shaft angle, anterior center edge angle, alpha angle, femoral head extrusion index, and acetabular depth-to-width ratio. Failure was defined as failure to achieve the minimal clinically important difference (MCID) utilizing the modified Harris Hip Score or as the need for secondary operation. The equal variance t test was used to analyze radiographic parameters. Statistical significance was determined using a P value of .05. Results: A total of 373 hips underwent analysis with an average follow-up of 41 months (range, 24-102 months). Of these, 46 hips (12%) required secondary operation, and 95 (25%) failed to meet the MCID. The overall failure rate was 32.4%. There was no single measurement or combination thereof associated with failure to reach the MCID. Higher preoperative Tönnis angles were associated with secondary operation, with a mean of 6.7° (95% CI, 5.3°-8.1°) in the secondary operation group versus 4.8° (95% CI, 4.4°-5.3°) in the nonsecondary operation group ( P = .006). The odds ratio was 1.12 (95% CI, 1.0-1.2; P = .05) per degree increase in Tönnis angle for secondary operation. In patients with a Tönnis angle >10°, 84% required secondary operation. Conclusion: Higher Tönnis angles portend a higher risk for revision surgery. The probability of secondary operation was increased by a magnitude of 1.12 with each degree increase in the Tönnis angle. In patients with a Tönnis angle >10°, 84% required a secondary operation.

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“…Features of dysplasia on pre-operative radiographs seem to suggest limited success for hip arthroscopy; Larson et al [ 20 ] showed that the more severe the dysplasia, the less the likelihood that arthroscopy can be effective as hip preserving surgery. This, however, appears to represent a point on a spectrum and we feel that hip arthroscopy still has a role in the management of patients with mild dysplasia although this needs further exploration [ 21 ].…”

Section: Discussionmentioning

confidence: 99%

Factors increasing risk of failure following hip arthroscopy: a case control study

Davies

Grammatopoulos

Pollard

et al. 2018

Journal of Hip Preservation Surgery

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We aimed to identify factors such as pre-arthroscopy and intra-operative variables that were associated with failure of hip arthroscopy as a joint preserving operation. We performed a retrospective analysis of a database containing 344 consecutive hip arthroscopies performed at our institution. Forty-four hips were identified that underwent a subsequent arthroplasty procedure following their hip arthroscopy (cases). Sixty-six control hips (hip arthroscopy with no subsequent arthroplasty) were randomly selected from the same database. Cases and controls were matched for age, sex and follow-up (P = 0.59, 0.48, 0.10, respectively). Pre-operative radiographs/MRI scans plus intra-operative findings were analysed to identify factors associated with failure. Both a lower centre edge angle and higher acetabular index on pre-operative radiographs were associated with higher rates of failure (P < 0.001). The presence of any acetabular wear at operation was also associated with failure (P < 0.001). Highest rates of failure were seen in hips with both features of dysplasia on pre-operative radiographs and any intra-operative acetabular wear (relative risk: 5, odds ratio: 9.13, P < 0.001). Dysplastic features on pre-operative radiographs and the finding of acetabular wear at hip arthroscopy increase the risk of subsequent arthroplasty. Identification of these features pre-operatively with evolving imaging techniques would improve the results of hip arthroscopy as joint preserving surgery.

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A Traffic Light Grading System of Hip Dysplasia to Predict the Success of Arthroscopic Hip Surgery

Cited by 22 publications

References 45 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

A Multicenter Study of Radiographic Measures Predicting Failure of Arthroscopy in Borderline Hip Dysplasia: Beware of the Tönnis Angle

Factors increasing risk of failure following hip arthroscopy: a case control study

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