Arthroscopic Management of Dysplastic Hip Deformities

Abstract

Arthroscopic management of mild to moderate acetabular dysplasia had inferior good/excellent results and higher failure rates when compared with an FAI cohort; therefore, isolated arthroscopic procedures in this population should be cautiously considered. These results were independent of patient sex. Labral repair and capsular plication resulted in better clinical outcomes in this mildly dysplastic cohort.

The interface between periacetabular osteotomy, hip arthroscopy and total hip arthroplasty in the young adult hip

“…Hip arthroscopy in patients with mild to moderate acetabular dysplasia, defined by a CE-angle of 19° to 25°, recently demonstrated short-term improvements in post-operative outcome comparable with those with an CE-angle > 25° in a study by Nawabi et al 70 In a similar study, Larsen et al 53 concluded that isolated arthroscopic procedures in patients with dysplasia (average CE-angle 20.8°) leads to improvements in patient outcome, though it was inferior when compared with a FAI cohort. Hence, an improved functional outcome but a high risk of repeated surgery and subsequent THA can be expected.…”

“…If these patients are considered for treatment arthroscopically following PAO, it is recommended to inform the patient thoroughly as some studies indicate that hip arthroscopy in this group of patients leads to inferior outcome compared with non-dysplastic FAI patients. 53 …”

“…Ehlers-Danlos syndrome, previous PAO surgery), the overall opinion is to perform a capsular plication procedure to prevent further instability after hip arthroscopy, which was associated with a better clinical outcome in a mildly dysplastic cohort. 53 …”

Editorial Commentary: Hip Arthroscopy in Hip Dysplasia: Just Because You Are Doing It, Should You?

“…There remains controversy in the literature around this topic; while some studies have shown worse postoperative outcomes and high failure rates with hip arthroscopy in patients with hip dysplasia, others have shown equivalent outcomes in patients with mild or borderline hip dysplasia compared with femoroacetabular impingement cohorts. [3][4][5][6][7] Even the lead author has a precautionary paper in this journal about rapid development of osteoarthritis after hip arthroscopy in patients with hip dysplasia. 8 Just because we are doing it, does it mean we should?…”

Femoral Derotation Osteotomy Technique for Excessive Femoral Anteversion

“…Hip arthroscopy has shown positive results in patients with symptomatic femoroacetabular impingement with labral tear. 1 , 2 , 3 There are other structural abnormalities of the hip joint that can make arthroscopic treatment alone less likely to be successful including acetabular dysplasia 4 and femoral version extremes. 5 , 6 , 7 Hip arthroscopy cannot address these morphologic abnormalities, and open surgery is often necessitated to change the underlying cause of the hip pain.…”