Predictors of Poor Clinical Outcome After Arthroscopic Labral Preservation, Capsular Plication, and Cam Osteoplasty in the Setting of Borderline Hip Dysplasia

Abstract

Preoperative predictors of poorer outcomes from hip arthroscopic labral preservation, capsular plication, and cam osteoplasty in the setting of BDDH are age ≥42 years old, broken Shenton line, osteoarthritis, Tönnis angle ≥15°, and VCA angle ≤17° on preoperative radiographs. Intraoperative predictors of poorer outcomes are severe acetabular chondral damage and even mild femoral chondral damage. Although the patients in the setting of BDDH may have good outcomes from isolated hip arthroscopy, caution is suggested for those with the aforementioned risk factors.

Clinical predictors of outcome following hip arthroscopy

“…As the average age of the participants in this study was younger than others referenced [23,77,184], clinicians should be aware of the high prevalence of severe femoral head chondropathy (21%) and The impact of femoral head chondropathy severity on pain and function has been reported in postoperative hip populations [117]. Severe chondropathy was associated with worse pain and function at 18 months post surgery [117] and had a negative effect on clinical outcome [83,211] with Grade IV changes on the femoral head deemed unlikely to respond to joint-preserving treatment attempts used in arthroscopy [95]. In this study, 10% -22% of the variability of the HOOS-Symptoms subscale (p=0.002), HOOS-Function subscale (p=0.01), and the POA (p=0.04) was associated with severe femoral head chondropathy.…”

“…It is also worth noting that potential participants with severe degenerative changes evident on imaging were not considered for arthroscopy. This suggests that the routinely used imaging techniques were ineffective at identifying all cases of severe chondropathy and indicates the importance of improved preoperative imaging assessment of cartilage status to help determine the best candidates for hip arthroscopy [83].…”

“…Typical procedures include osteoplasty of femoral and acetabular morphologies (cam and pincer, respectively), and repair of the acetabular labrum and adjacent cartilage [156]. Pathologies that exist in the advanced stages of osteoarthritis, such as cartilage defects on the femoral head or in the acetabular region, are considered to be poor prognostic indicators [26,83,152,199] and a limiting factor for clinical improvement [114,211]. When patients with advanced chondropathy or pre-existing osteoarthritis undergo hip arthroscopy, they report lower patient satisfaction and lower outcomes for function and pain [56,114] and tended to be unimproved or even deteriorated at follow-up [117,211] when compared to individuals with mild hip chondropathy.…”

“…Arthroscopy is utilized to treat patients in the early stages of hip pathology by osteoplasty of femoral and acetabular deformities (cam and pincer, respectively), and repair of injuries of the acetabular labrum and adjacent cartilage [156]. Pathologies that exist in the advanced stages of osteoarthritis, such as cartilage defects on the femoral head or in the acetabular region, are considered to be poor prognostic indicators [26,83,152,199] and a limiting factor for clinical improvement [114,211].…”

“…Pathology in the advanced stages of osteoarthritis, such as cartilage defects on the femoral head or in the acetabular region, is an indicator of poor prognosis [26,83,152,199]. Patients suffering advanced chondropathy who undergo hip arthroscopy report lower patient satisfaction and lower outcomes for function and pain [56,114,117,211] when compared to individuals with mild hip chondropathy.…”