Inconclusive and Contradictory Evidence for Outcomes After Hip Arthroscopy in Patients With Femoroacetabular Impingement and Osteoarthritis of Tönnis Grade 2 or Greater: A Systematic Review

Andronic, Octavian; Claydon, Leica S.; Cubberley, Rachael; Karczewski, Daniel; Kumar, Karadi Hari Sunil; Khanduja, Vikas

doi:10.1016/j.arthro.2022.01.024

Cited by 15 publications

(10 citation statements)

References 40 publications

(97 reference statements)

Supporting

Mentioning

Contrasting

Order By: Relevance

“…While there is some evidence that focal chondral defects do not necessary preclude good results after PAO, 51 bilateral lesions (femoral and acetabular) may have a clinical impact. 52 Similar to HA, 53 the Tönnis grading system is mostly used as a first step in the patient selection process to exclude patients with advanced hip OA. Although the cut-off value remains debatable for HA undertaken for FAI, 53 long-term outcomes after PAO for dysplasia demonstrated poor outcomes in the presence of preoperative Tönnis grade II or greater OA.…”

Section: Discussionmentioning

confidence: 99%

“…52 Similar to HA, 53 the Tönnis grading system is mostly used as a first step in the patient selection process to exclude patients with advanced hip OA. Although the cut-off value remains debatable for HA undertaken for FAI, 53 long-term outcomes after PAO for dysplasia demonstrated poor outcomes in the presence of preoperative Tönnis grade II or greater OA. 54 Our hypothesis related to previous clinical judgements that a labral reconstruction is not necessary, and that excellent results are obtained with PAO without labral repair.…”

Section: Discussionmentioning

confidence: 99%

See 1 more Smart Citation

Factors influencing patient-reported outcomes following periacetabular osteotomy and open osteochondroplasty in the setting of borderline hip dysplasia

et al. 2023

View full text Add to dashboard Cite

AimsThis study reports mid-term outcomes after periacetabular osteotomy (PAO) exclusively in a borderline hip dysplasia (BHD) population to provide a contrast to published outcomes for arthroscopic surgery of the hip in BHD.MethodsWe identified 42 hips in 40 patients treated between January 2009 and January 2016 with BHD defined as a lateral centre-edge angle (LCEA) of ≥ 18° but < 25°. A minimum five-year follow-up was available. Patient-reported outcomes (PROMs) including Tegner score, subjective hip value (SHV), modified Harris Hip Score (mHHS), and Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) were assessed. The following morphological parameters were evaluated: LCEA, acetabular index (AI), α angle, Tönnis staging, acetabular retroversion, femoral version, femoroepiphyseal acetabular roof index (FEAR), iliocapsularis to rectus femoris ratio (IC/RF), and labral and ligamentum teres (LT) pathology.ResultsThe mean follow-up was 96 months (67 to 139). The SHV, mHHS, WOMAC, and Tegner scores significantly improved (p < 0.001) at last follow-up. According to SHV and mHHS, there were three hips (7%) with poor results (SHV < 70), three (7%) with a fair score (70 to 79), eight (19%) with good results (80 to 89), and 28 (67%) who scored excellent (> 90) at the last follow-up. There were 11 subsequent operations: nine implant removals due to local irritation, one resection of postoperative heterotopic ossification, and one hip arthroscopy for intra-articular adhesions. No hips were converted to total hip arthroplasty at last follow-up. The presence of preoperative labral lesions or LT lesions did not influence any PROMs at last follow-up. From the three hips that had poor PROMs, two have developed severe osteoarthritis (> Tönnis II), presumably due to surgical overcorrection (postoperative AI < -10°).ConclusionPAO is reliable in treating BHD with favourable mid-term outcomes. Concomitant LT and labral lesions did not negatively influence outcomes in our cohort. Technical accuracy with avoidance of overcorrection is essential in achieving successful outcomes.Cite this article: Bone Joint J 2023;105-B(7):735–742.

show abstract

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Factors influencing patient-reported outcomes following periacetabular osteotomy and open osteochondroplasty in the setting of borderline hip dysplasia

et al. 2023

View full text Add to dashboard Cite

show abstract

“…Although arthroscopic lavage, debridement, and resection of torn meniscus have been reported to be no more effective that sham surgery in knee OA [19], they may still have a role in carefully selected patients, for example, those with a loose body (typically a cartilaginous or osteocartilaginous fragment) causing knee locking or parameniscal cysts. There is no evidence of any benefit of arthroscopic procedures for OA of the hip [81].…”

Section: Surgical Treatmentsmentioning

confidence: 99%

Osteoarthritis, part of life or a curable disease? A bird's‐eye view

Englund

2023

J Intern Med

View full text Add to dashboard Cite

Osteoarthritis (OA) is a chronic joint disease caused by disruption of joint homeostasis by a variety of systemic and biomechanical factors. The disease is characterized by degradation of cartilage and other joint tissues, and low‐grade inflammation which may result in pain, reduced function, and disability. The disease appears to have ancient origins, with findings of OA recognized in fossilized bones from birdlike dinosaurs living some 130 million years ago. Today, the burden of OA in the world's population is steadily increasing due to aging and often rising rates of obesity. Structural findings, indicative of the disease, are also frequent in asymptomatic persons, which make the distinction between disease and normal aging sometimes challenging. OA is frequently associated with comorbidity in the form of obesity, cardiovascular disease, and depressive symptoms. The current management and treatments largely rely on contextual factors, and the actual effects of the intended therapeutic element of today's interventions are minor. The different mechanistic pathways (endotypes) and clinical characteristics (phenotypes) of OA make the development of disease‐modifying treatments challenging. Current development of drug candidates, aimed to restore joint homeostasis, is mainly targeting either inhibition of catabolic factors or stimulation of anabolic factors. However, there is yet no breakthrough in stage III clinical trials. Earlier diagnosis, better knowledge of endotypes—for example, by new insights into soluble biomarkers, and compositional imaging—and more careful selection of patients into clinical trials are possible tools to aid development of future therapies.

show abstract

“…13 However, there is contradictory evidence on the outcomes of HA in patients with moderate-to-severe OA. 14 It is also not clear how the location and degree of chondral damage affects the outcome. 15 In a cohort that included patients with Tönnis grade 16 II OA on preoperative assessment, up to 44% were found to have Outerbridge grade 17 IV changes intraoperatively.…”

Section: Introductionmentioning

confidence: 99%

“…In this context of contradictory and insufficient evidence, 14 the aim of this systematic review and meta-analysis was to analyze the outcomes of HA in patients with FAI and chondral lesions, classified using the Outerbridge classification. 25 Secondary aims were to analyze the influence of the selection of patients, the location of articular cartilage damage, cartilage repair techniques, and augmentation on the outcomes.…”

Section: Introductionmentioning

confidence: 99%

Outcomes of arthroscopy of the hip for femoroacetabular impingement based on intraoperative assessment using the Outerbridge classification

Andronic

Zhang

et al. 2023

Bone Joint J

View full text Add to dashboard Cite

AimsHip arthroscopy (HA) has become the treatment of choice for femoroacetabular impingement (FAI). However, less favourable outcomes following arthroscopic surgery are expected in patients with severe chondral lesions. The aim of this study was to assess the outcomes of HA in patients with FAI and associated chondral lesions, classified according to the Outerbridge system.MethodsA systematic search was performed on four databases. Studies which involved HA as the primary management of FAI and reported on chondral lesions as classified according to the Outerbridge classification were included. The study was registered on PROSPERO. Demographic data, patient-reported outcome measures (PROMs), complications, and rates of conversion to total hip arthroplasty (THA) were collected.ResultsA total of 24 studies were included with a total of 3,198 patients (3,233 hips). Patients had significantly less improvement in PROMs if they had Outerbridge grade III and IV lesions (p = 0.012). Compared with microfracture, autologous matrix-induced chondrogenesis (AMIC) resulted in significantly reduced rates of conversion to THA (p = 0.042) and of revision arthroscopy (p = 0.038). Chondral repair procedures in these patients also did not significantly reduce the rates of conversion to THA (p = 0.931), or of revision arthroscopy (p = 0.218). However, compared with microfracture, AMIC significantly reduced the rates of conversion to THA (p = 0.001) and of revision arthroscopy (p = 0.011) in these patients. Those with Outerbridge grade III and IV lesions also had significantly increased rates of conversion to THA (p = 0.029) and of revision arthroscopy (p = 0.023) if they had associated lesions of the acetabulum and femoral head. Those who underwent labral debridement had a significantly increased rate of conversion to THA compared with those who underwent labral repair (p = 0.015).ConclusionThere is universal improvement in PROMs following HA in patients with FAI and associated chondral lesions. However, those with Outerbridge grade III and IV lesions had significantly less improvement in PROMs and a significantly increased rate of conversion to THA than those with Outerbridge grade I and II. This suggests that the outcome of HA in patients with FAI and severe articular cartilage damage may not be favourable.Cite this article: Bone Joint J 2023;105-B(7):751–759.

show abstract

Inconclusive and Contradictory Evidence for Outcomes After Hip Arthroscopy in Patients With Femoroacetabular Impingement and Osteoarthritis of Tönnis Grade 2 or Greater: A Systematic Review

Cited by 15 publications

References 40 publications

Factors influencing patient-reported outcomes following periacetabular osteotomy and open osteochondroplasty in the setting of borderline hip dysplasia

Factors influencing patient-reported outcomes following periacetabular osteotomy and open osteochondroplasty in the setting of borderline hip dysplasia

Osteoarthritis, part of life or a curable disease? A bird's‐eye view

Outcomes of arthroscopy of the hip for femoroacetabular impingement based on intraoperative assessment using the Outerbridge classification

Contact Info

Product

Resources

About