Hip Arthroscopy and Borderline Developmental Dysplasia of the Hip: A Systematic Review

Kuroda, Yasuhiro; Saito, Masayoshi; Kumar, Karadi Hari Sunil; Malviya, Ajay; Khanduja, Vikas

doi:10.1016/j.arthro.2020.05.035

Cited by 43 publications

(74 citation statements)

References 65 publications

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“…The majority of athletes with BD in this study had no femoral head cartilage damage (95.4% with Outerbridge grade 0 changes) at the time of their surgery. In a systematic review evaluating the use of hip arthroscopy in patients with BD, Kuroda et al 45 identified 4 studies that reported an association between BD and articular cartilage damage on the femoral head in the general population. 8,38,39,41 Ishøi et al 39 found that BD was associated with an increased risk of moderate to severe femoral head cartilage injury (International Cartilage Repair Society grade 3 or 4) with an odds ratio of 3.08.…”

Section: Discussionmentioning

confidence: 99%

Achieving Successful Outcomes in High-Level Athletes With Borderline Hip Dysplasia Undergoing Hip Arthroscopy With Capsular Plication and Labral Preservation: A Propensity-Matched Controlled Study

et al. 2021

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Background: Return to sports (RTS) rates and patient-reported outcomes (PROs) after hip arthroscopy in athletes with borderline dysplasia (BD) have not been established. Purpose: (1) To report minimum 2-year PROs and RTS rates in high-level athletes with BD who underwent hip arthroscopy for labral pathology in the setting of microinstability and (2) to compare clinical results with those of a matched control group of athletes with normal acetabular coverage. Study Design: Cohort study; Level of evidence, 3. Methods: Data were reviewed for surgery performed between January 2012 and July 2018. Patients were considered eligible if they received a primary hip arthroscopy in the setting of BD (lateral center-edge angle, 18°-25°) and competed in professional, collegiate, or high school sports. Inclusion criteria included preoperative and minimum 2-year follow-up scores for the modified Harris Hip Score, Non-arthritic Hip Score, Hip Outcome Score–Sport Specific Subscale, and visual analog scale for pain. Athletes with BD were matched to a control group of athletes with normal acetabular coverage (lateral center-edge angle, 25°-40°). Results: A total of 65 patients with BD were included in the study with a mean ± standard deviation follow-up of 47.5 ± 20.4 months. Athletes with BD showed significant improvement in all outcome measures recorded, demonstrated high RTS rates (80.7%), and achieved the minimal clinically important difference (MCID) and Patient Acceptable Symptom State (PASS) for the Hip Outcome Score–Sport Specific Subscale at high rates (MCID, 90.8%; PASS, 75.4%). When compared with a propensity-matched control group with normal acetabular coverage, capsular plication was performed more commonly in the BD group (93.8% vs 82.7%; P = .037). PROs and RTS, PASS, and MCID rates were similar between the BD and control groups ( P > .05). Conclusion: High-level athletes with BD who undergo primary hip arthroscopy for labral pathology in the setting of microinstability may expect favorable PROs and RTS rates at minimum 2-year follow-up. These results were comparable with those of a control group of athletes with normal coverage.

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Section: Discussionmentioning

confidence: 99%

Achieving Successful Outcomes in High-Level Athletes With Borderline Hip Dysplasia Undergoing Hip Arthroscopy With Capsular Plication and Labral Preservation: A Propensity-Matched Controlled Study

et al. 2021

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“…The most lateral point of the acetabulum rather than the sourcil edge is often used, which would cause a typical mistake with a falsely high LCEA value. 35 Besides, the congenital difference in LCEAs between male and female populations must not be neglected, 1,7 which might have resulted in the superior outcomes of the female BDDH patients shown in the current review by Kuroda et al 25 Although an LCEA slightly less than 25 may represent a significant structural abnormality in male patients, it is possibly a normal anatomic variant in female patients. 1,7,25 This difference clearly indicates a need to set different criteria for BDDH based on sex.…”

Section: See Related Article On Page 2550mentioning

confidence: 84%

“…Our previous study concluded that overall satisfactory improvement regarding patientreported outcomes was achieved after isolated hip arthroscopy for BDDH, 24 and the conclusion is corroborated in the current systematic review entitled "Arthroscopy and Borderline Developmental Dysplasia of the Hip: A Systematic Review" by Kuroda, Saito, Kumar, Malviya, and Khanduja. 25 However, it still remains controversial whether hip arthroscopy is a better option than periacetabular osteotomy (PAO) for BDDH. 2,24,26 Surgeons opposing arthroscopy for BDDH have argued that it only addresses the soft tissues, that is, the secondary stabilizers of the hip, not solving the biomechanical problems associated with the abnormal osseous geometry.…”

Section: See Related Article On Page 2550mentioning

confidence: 99%

Editorial Commentary: Arthroscopy for Borderline Developmental Dysplasia of the Hip: Selection Determines the Outcomes

Ding

Chen

2020

Arthroscopy: The Journal of Arthroscopic & Related Surgery

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Although the literature has presented results that favored arthroscopic procedures in treating borderline developmental dysplasia of the hip (BDDH), it remains controversial whether arthroscopic surgery would be better than periacetabular osteotomy for BDDH. Instead of a debate on the application of arthroscopy, the issue worthy of discussion should be distinguishing suitable BDDH candidates for hip arthroscopy. First, identification of patients with real BDDH is critical for making management choices. Second, it should be distinguished whether the major symptoms result from mechanical lesions or functional hip instability. Third, once hip arthroscopy is suggested for BDDH patients, relative contraindications such as advanced age and osteoarthritis should be taken into consideration, in addition to labral repair and capsular closure or plication intraoperatively. In conclusion, more long-term and high-grade evidence is still demanded to end the debate, but we believe that an individualized management strategy based on an accurate diagnosis and comprehensive assessment will bring optimal outcomes for BDDH patients.

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“…For symptomatic DDH in young adults, joint-preserving surgeries such as hip arthroscopy, periacetabular osteotomy (PAO), femoral head-neck junction osteochondroplasty combined with PAO, intertrochanteric osteotomy, or capsular arthroplasty are recommended to patients with minimal articular cartilage degeneration, as they could reduce or delay the degeneration of the hip joint [4]. A recent systematic review revealed that hip arthroscopy for borderline DDH with capsular plication improved short-term patient-reported outcome measures [5].…”

Section: Discussionmentioning

confidence: 99%

Total hip arthroplasty for Crowe type IV developmental dysplasia of the hip combined with intertrochanteric fracture: a case report and literature review

Chen¹,

Ma²,

Ma³

et al. 2020

BMC Surg

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Background Total hip arthroplasty for Crowe type IV developmental dysplasia of the hip (DDH) is a complex procedure. Crowe type IV DDH combined with intertrochanteric frature is very rare. Case presentation A 75-year-old patient suffering from left hip pain after a fall was sent to our hospital. Plain radiographs and computed tomography scans were used to diagnose this patient with DDH combined with an intertrochanteric fracture. We conducted a total hip arthroplasty using an S-rom prosthesis following subtrochanteric shortening osteotomy in this patient, after which steel wires were used to fix the intertrochanteric fracture. The patient did not suffer any significant intraoperative or postoperative complications, and treatment was sufficient to overcome lower leg abnormalities. The patient was encouraged to resume walking with support at 3 days post-surgery, and at 6-month postoperatively he had regained the majority of his original range of motion. At 10-month postoperatively, the intertrochanteric fracture and subtrochanteric osteotomy of left femur had healed effectively,and the patient’s VAS and mHSS scores had improved significantly. Conclusions Total hip arthroplasty is an effective approach to treat patients suffering from Crowe type IV DDH combined with an intertrochanteric fracture, and can achieve satisfactory clinical outcomes.

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Hip Arthroscopy and Borderline Developmental Dysplasia of the Hip: A Systematic Review

Cited by 43 publications

References 65 publications

Achieving Successful Outcomes in High-Level Athletes With Borderline Hip Dysplasia Undergoing Hip Arthroscopy With Capsular Plication and Labral Preservation: A Propensity-Matched Controlled Study

Achieving Successful Outcomes in High-Level Athletes With Borderline Hip Dysplasia Undergoing Hip Arthroscopy With Capsular Plication and Labral Preservation: A Propensity-Matched Controlled Study

Editorial Commentary: Arthroscopy for Borderline Developmental Dysplasia of the Hip: Selection Determines the Outcomes

Total hip arthroplasty for Crowe type IV developmental dysplasia of the hip combined with intertrochanteric fracture: a case report and literature review

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