Hip Arthroscopic Surgery With Labral Preservation and Capsular Plication in Patients With Borderline Hip Dysplasia: Minimum 5-Year Patient-Reported Outcomes

Domb, Benjamin G.; Chaharbakhshi, Edwin O.; Perets, Itay; Yuen, Leslie C.; Walsh, John P.; Ashberg, Lyall

doi:10.1177/0363546517743720

Cited by 113 publications

(141 citation statements)

References 45 publications

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“…E ven as experience with hip-preservation surgery has increased exponentially over the past decade, patients with mild or borderline dysplasia have remained a challenging group. Well-designed recent studies have demonstrated excellent results after arthroscopic surgery in these patients, 1,2 whereas others have demonstrated failure rates more than 30%. 3 Whether it is due to reports of good clinical outcomes, improved arthroscopic technologies, the technically demanding nature and increased morbidity of periacetabular osteotomy (PAO), or the high prevalence of concomitant cam deformity in dysplastic hips, 4 the use of hip arthroscopy in dysplastic patients has been increasing over recent years.…”

Section: See Related Article On Page 3240mentioning

confidence: 96%

Editorial Commentary: Revision Arthroscopy for Borderline Dysplastic Hips: A Borderline Surgical Indication

Blackman¹

2019

Arthroscopy: The Journal of Arthroscopic & Related Surgery

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Patients with mild or borderline acetabular dysplasia who present with refractory hip pain are challenging patients. Recommending open versus arthroscopic surgery for these patients is a difficult decision, in part because there are conflicting data regarding the outcomes of these procedures. Equally challenging is deciding on a treatment course in a borderline dysplastic patient who has not responded to a previous arthroscopic surgery. Surgeons must give great consideration before recommending revision arthroscopy in this setting.

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Section: See Related Article On Page 3240mentioning

confidence: 96%

Editorial Commentary: Revision Arthroscopy for Borderline Dysplastic Hips: A Borderline Surgical Indication

Blackman¹

2019

Arthroscopy: The Journal of Arthroscopic & Related Surgery

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“…54 In this case, labral repair and capsular plication should be performed when possible. 53,55 Given the varied clinical outcomes, hip arthroscopy should therefore be used with caution in the setting of dysplasia. Strong consideration should be given to PAO in the setting of DDH.…”

Section: Hip Arthroscopymentioning

confidence: 99%

Treatment of Early-Onset Hip Osteoarthritis in Young Patients

et al. 2018

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Pain and debilitating symptoms due to hip osteoarthritis (OA) can significantly compromise quality of life in young, active patients. The management of the young adult with hip OA presents a unique set of challenges, with symptoms that originate from a variety of underlying hip pathologies, and patient age spanning from youth through middle age. Early options for hip OA include nonoperative treatment with anti-inflammatory medications, physical therapy, and injections. For patients with structural hip abnormalities (femoroacetabular impingement or dysplasia), arthroscopy or reconstructive osteotomy are acceptable treatment options. In advanced disease, joint-preserving techniques are often ineffective, and patients may require joint resurfacing or replacement. The treatment strategies for early hip OA continues to evolve with the development of new and refined surgical techniques, especially in the setting of underlying hip pathology, and a growing popularity of utilizing biologic agents. The purpose of this manuscript is to review current conservative and surgical management and to describe an algorithm for treatment of early-onset hip OA.

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“…Surgical management of borderline hip dysplasia is an area of multiple recent clinical investigations. 7,10,11,36,37 There is consensus that symptomatic mild and moderate/severe dysplasia is best treated with PAO with good clinical results. [12][13][14] Recent retrospective studies have evaluated clinical outcomes of hip arthroscopy in patients with borderline hip dysplasia.…”

Section: Operative Treatment Of Borderline Hip Dysplasiamentioning

confidence: 99%

“…8 The radiographic criteria for borderline hip dysplasia are variably defined in the literature. 4,6,[9][10][11] While there is general consensus that mild and moderate/severe hip dysplasia is best treated with PAO, [12][13][14] the efficacy and longevity of arthroscopic procedures for the treatment of borderline hip dysplasia are controversial. 15,16 In contrast, acetabular retroversion is characterized by excess anterior coverage of the femoral head by the acetabulum resulting in femoroacetabular impingement (FAI) and subsequent joint damage.…”

mentioning

confidence: 99%

Diagnosis and Management of Borderline Hip Dysplasia and Acetabular Retroversion

et al. 2018

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Borderline hip dysplasia and acetabular retroversion are common radiographic findings in young individuals with and without hip pain. Orthopaedic surgeons should be knowledgeable about the radiographic findings, diagnosis, and appropriate nonsurgical and surgical treatment of these conditions. Borderline hip dysplasia is generally defined by a lateral center edge angle of Wiberg from 20 to 25° (some define as 18–25°) and is a cause of joint microinstability. The degree of soft tissue laxity can have significant implications for joint stability in patients with borderline hip dysplasia. The most common presenting symptoms are groin pain and lateral hip pain. Acetabular retroversion is defined by radiographic findings of crossover sign, ischial spine sign, and posterior wall sign. Individuals with symptomatic retroversion have a clinical presentation consistent with impingement, groin pain with flexion activities, and less commonly lateral hip pain. Physical therapy has been shown to improve symptoms in a subset of individuals with these conditions. There are multiple recent publications about arthroscopic treatment of patients with borderline hip dysplasia. These reports generally find that good short-term outcomes can be expected when using arthroscopic techniques that include labral preservation/repair and capsular plication. There are limited reports of periacetabular osteotomy as a treatment for borderline hip dysplasia. Publications focusing specifically on surgical treatment of acetabular retroversion are also infrequent. Periacetabular osteotomy has been shown to have superior long-term clinical outcomes to surgical hip dislocation with anterior rim trimming in patients with all three radiographic findings of retroversion. Arthroscopic treatment has been shown to have good short-term outcomes. Future work in the areas of borderline hip dysplasia and acetabular retroversion should focus on reporting long-term clinical follow-up of these surgical treatments and using computation techniques as a tool to determine appropriate surgical and nonsurgical treatment for each individual patient.

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Hip Arthroscopic Surgery With Labral Preservation and Capsular Plication in Patients With Borderline Hip Dysplasia: Minimum 5-Year Patient-Reported Outcomes

Cited by 113 publications

References 45 publications

Editorial Commentary: Revision Arthroscopy for Borderline Dysplastic Hips: A Borderline Surgical Indication

Editorial Commentary: Revision Arthroscopy for Borderline Dysplastic Hips: A Borderline Surgical Indication

Treatment of Early-Onset Hip Osteoarthritis in Young Patients

Diagnosis and Management of Borderline Hip Dysplasia and Acetabular Retroversion

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