Arthroscopic Treatment of Femoroacetabular Impingement in Patients With and Without Borderline Developmental Dysplasia of the Hip: A Systematic Review and Meta-analysis

Abstract

Background: Based on previous studies, it is difficult to discern whether patients who have femoroacetabular impingement (FAI) with borderline developmental dysplasia of the hip (BDDH) would benefit from arthroscopy when compared with patients without BDDH. Purpose: To evaluate the existing comparative literature on arthroscopic findings, procedures, patient-reported outcomes (PROs), and failures in patients who have FAI with BDDH compared with those without BDDH. Study Design: Systematic review; Level of evidence, 3. Methods: The PubMed, Embase, and Ovid databases were searched for studies published up to August 31, 2019, that reported outcomes after arthroscopy to treat patients who had FAI with BDDH. Included studies were required to have patients diagnosed with FAI and BDDH who were treated arthroscopically and compared with control patients (FAI without BDDH). Arthroscopic findings, PROs, and revision or total hip arthroplasty (THA) conversion rates were compared between groups. Results: Included in the review were 4 articles (933 patients). Patients who had FAI with BDDH were defined as having a lateral center-edge angle (LCEA) of either 18° to 25° or 20° to 25°; for control patients, the maximum LCEA was 40°. Across the studies, there were 224 patients who had FAI with BDDH compared with 709 control patients; the mean follow-up time ranged from 21.6 to 31.3 months among the groups. Improvements were shown across all PROs in each study. Random-effects meta-analysis indicated no statistically significant differences in postoperative PROs, the risk for revision surgery, or conversion to THA between the patients who had FAI with versus without BDDH. Conclusion: The results of the current review indicated that hip arthroscopy produced similar short-term outcomes between patients who had FAI with versus without BDDH.

Borderline Dysplastic Hips Undergoing Hip Arthroscopy Achieve Equivalent Patient Reported Outcomes When Compared With Hips With Normal Acetabular Coverage: A Systematic Review and Meta-Analysis

“…In our meta-analysis, all six identified studies used LCEA as the radiographic marker for BDH, with 25° being the cutoff point for BDH. This is in line with the results of Murata et al 6 where all studies included had the same cutoff point. By contrast, the cutoff point between BDH and frank dysplasia were more unclear, with some studies using a cutoff of less than 18° 20–22 while other studies used a cutoff point of less than 20°.…”

“…17,18 Future investigations should explicitly define upper and lower bounds when defining borderline dysplastic and normal coverage populations, given the existence of more extreme populations such as frank dysplasia or pincer deformity. Although this meta-analysis highlights that the LCEA is currently the benchmark for radiographically identifying BDH, 5,6 some have suggested alternate radiographic measurements, such as the Femoro-Epiphyseal Acetabular Roof Index, as either an alternative or adjunctive measure for assessing BDH. 34 The present review passively identified only two studies relating Femoro-Epiphyseal Acetabular Roof Index to PROs.…”

“…However, these results did not meet statistical significance, and the investigation demonstrated methodological shortcomings such as overlapping cohorts. 6 Thus, a need for a quantitatively summative investigation of the current literature comparing patients with borderline dysplastic hips (BDHs) with patients with normal coverage exists. Further investigation may help determine how variable coverage affects postoperative outcomes after hip arthroscopy and aid in preoperative planning with the patient.…”

Chinese expert consensus on the diagnosis and treatment of borderline developmental dysplasia of the hip (2022 Edition)

“…From 2019 to 2021, after eliminating duplicate literature, 29 studies were selected from four systematic reviews of BDDH. [3][4][5][6] Of these, LCEA was used to define BDDH in 28 studies, and one used LCEA combined with Sharp angle and ACEA; 14 studies reported the LCEA range of 20°to 25°, 10 reported 18°to 25°, and four reported <25°. Additionally, 18% of hip dysplasias showed a change in pelvic tilt of >10°on radiographs from supine to standing.…”

“…Studies have shown that the average difference between Wiberg's and Ogata's methods for measuring LCEA is about 4°. From 2019 to 2021, after eliminating duplicate literature, 29 studies were selected from four systematic reviews of BDDH [3–6] . Of these, LCEA was used to define BDDH in 28 studies, and one used LCEA combined with Sharp angle and ACEA; 14 studies reported the LCEA range of 20° to 25°, 10 reported 18° to 25°, and four reported <25°.…”