Patient and Disease Characteristics Associated with Hip Arthroscopy Failure in Acetabular Dysplasia

Ross, James R.; Clohisy, John C.; Baca, Geneva; Sink, Ernest L.

doi:10.1016/j.arth.2014.03.054

Cited by 89 publications

(88 citation statements)

References 24 publications

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“…The hip joint biomechanics are altered as a result, which places additional stress on the labrum, anterior capsule, and dynamic stabilizers. 14,33 Consequently, there is an overreliance on the hip soft tissue stabilizers (cartilage, labrum, capsule, and LT) for stability of the hip through the full range of motion in patients with dysplasia and borderline dyplasia. In this study, patients with borderline dysplasia had a significantly thinner hip capsule.…”

Section: Discussionmentioning

confidence: 99%

Generalized Joint Hypermobility Is Predictive of Hip Capsular Thickness

Devitt

Smith

Stapf

et al. 2017

Orthopaedic Journal of Sports Medicine

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Background:The pathomechanics of hip microinstability are not clearly defined but are thought to involve anatomical abnormalities, repetitive forces across the hip, and ligamentous laxity.Purpose/Hypothesis:The purpose of this study was to explore the relationship between generalized joint hypermobility (GJH) and hip capsular thickness. The hypothesis was that GJH would be predictive of a thin hip capsule.Study Design:Cross-sectional study; Level of evidence, 3.Methods:A prospective study was performed on 100 consecutive patients undergoing primary hip arthroscopy for the treatment of hip pain. A Beighton test score (BTS) was obtained prior to each procedure. The maximum score was 9, and a score of ≥4 was defined as hypermobile. Capsular thickness at the level of the anterior portal, corresponding to the location of the iliofemoral ligament, was measured arthroscopically using a calibrated probe. The presence of ligamentum teres (LT) pathology was also recorded.Results:Fifty-five women and 45 men were included in the study. The mean age was 32 years (range, 18-45 years). The median hip capsule thickness was statistically greater in men than women (12.5 and 7.5 mm, respectively). The median BTS for men was 1 compared with 4 for women (P < .001). A statistically significant association was found between BTS and capsular thickness; a BTS of <4 is strongly predictive of having a capsular thickness of ≥10 mm, while a BTS ≥4 correlates with a capsular thickness of <10 mm. There was a statistically greater incidence of LT tears in patients with a capsular thickness of ≤7.5 mm and a BTS of ≥4 (P < .001).Conclusion:Measurement of the GJH is highly predictive of hip capsular thickness. A BTS of <4 correlates significantly with a capsular thickness of ≥10 mm, while a BTS ≥4 correlates significantly with a thickness of <10 mm.

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Section: Discussionmentioning

confidence: 99%

Generalized Joint Hypermobility Is Predictive of Hip Capsular Thickness

Devitt

Smith

Stapf

et al. 2017

Orthopaedic Journal of Sports Medicine

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“…Two studies from one institution were included for review of arthroscopic findings as there was no overlap of the patient cohorts [12, 24]. Another institution first reported the arthroscopic findings and outcome [21] and later reported only the arthroscopic finding with a larger cohort [25] which overlap the patient with the previous study.…”

Section: Resultsmentioning

confidence: 99%

“…The study from Ross et al . [24] indicates, failure to correct the pathoanatomy may result in suboptimal patient outcome.…”

Section: Discussionmentioning

confidence: 99%

The role of arthroscopy in the dysplastic hip—a systematic review of the intra-articular findings, and the outcomes utilizing hip arthroscopic surgery

Lee

Wang

et al. 2016

J Hip Preserv Surg

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Acetabular dysplasia is one of the most common sources of hip arthritis. With the recent innovation in hip arthroscopy, the question has been raised whether arthroscopy can be used to treat dysplastic hip conditions. The purposes of this systematic review are (i) describe the prevalence of intra-articular pathologies and (ii) report the outcomes of dysplastic hip treatment with hip arthroscopy as a sole treatment. Medical databases were searched for articles including arthroscopic findings and treatment of dysplastic hip with predetermined criteria. PubMed, Ovid database and CINAHL (Cumulative Index to Nursing and Allied Health Literature) were searched up until 7 January 2015. Two reviewers independently assess the eligibility of retrieved studies using titles, abstracts and full-text articles. Thirteen studies were eligible to be included for the systematic review. Overall, labral tear was the most common pathology with a prevalence rate of 77.3%. All of the four studies describing arthroscopic treatment for only borderline dysplasia reported favorable outcome. With regard to more severely dysplastic hips, two out of three studies reported acceptable outcomes while one study reported negative results. This review indicates that intra-articular pathology is commonly observed in symptomatic dysplastic hips with a labral tear being the most common pathology. Arthroscopic treatment of borderline dysplasia could provide benefits whereas treatment of more dysplastic hips is controversial. Nevertheless, there is a lack of evidence for using arthroscopy alone in hips with a center edge angle <20°. Level IV, systematic review of Level IV studies.

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“…This approach has been associated with poor outcomes due to the failure to address the underlying abnormal pathomechanics present in acetabular dysplasia. [3,30,33] The management of patients with borderline acetabular dysplasia that present with labral pathology remains controversial; however, we have a low threshold to proceed with PAO in patients with any evidence of structural instability.…”

Section: Accepted Manuscriptmentioning

confidence: 98%