Prevalence of High-Grade Cartilage Defects in Patients With Borderline Dysplasia With Femoroacetabular Impingement: A Comparative Cohort Study

Bolia, Ioanna K; Locks, Renato; Chahla, Jorge; Utsunomiya, Hidetsuna; Philippon, Marc J.

doi:10.1016/j.arthro.2018.03.012

Cited by 27 publications

(26 citation statements)

References 29 publications

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“…Surgical decision making is further complicated in patients with both borderline dysplasia and FAI, as they may have elements of both impingement and instability. 4,15 In a recent study of patients with borderline dysplasia (LCEA 18°-25°) receiving either PAO or hip arthroscopy, McClincy et al 29 reported a significantly increased AI (12.6° vs 4.0°; P < .001) and FEAR index with significantly decreased ACEA and anterior wall index measurements. 29 Further, the investigators identified multiple dysplastic features in the borderline dysplastic population and recommended a comprehensive approach as opposed to an isolated evaluation of the LCEA when assessing acetabular coverage.…”

Section: Discussionmentioning

confidence: 99%

Acetabular Morphologic Characteristics Predict Early Conversion to Arthroplasty After Isolated Hip Arthroscopy for Femoroacetabular Impingement

et al. 2019

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Background: Hip arthroscopy in the setting of dysplasia and borderline dysplasia is controversial. Dysplasia severity is most often defined by the lateral center edge angle (LCEA) but can also be evaluated radiographically by the acetabular inclination (AI). Purpose/Hypothesis: The purpose was to determine the effect of AI on outcomes after isolated hip arthroscopy for femoroacetabular impingement (FAI). We hypothesized that patients with dysplasia would have higher rates of arthroplasty as well as inferior clinical and functional outcomes compared with patients who did not have dysplasia. Study Design: Cohort study; Level of evidence, 3. Methods: A hip arthroscopy registry was reviewed for participants undergoing arthroscopic correction of FAI from February 28, 2008, to June 10, 2013. Participants required a clinical diagnosis and isolated arthroscopic correction of FAI with preoperative imaging and intraoperative cartilage status recorded. AI dysplasia was defined as an AI greater than 10°, LCEA dysplasia as LCEA less than 18°, and borderline LCEA dysplasia as LCEA 18° to 25°. Patients without an acetabular deformity (LCEA 25°-40°; AI <10°) served as a control population. Postoperative variables included patient-reported outcome surveys with conversion to arthroplasty as the primary endpoint. Minimum 5-year outcome scores were obtained for 337 of 419 patients (80.4%) with an average follow-up of 75.2 ± 12.7 months. Results: This study included 419 patients: 9 (2%) with LCEA dysplasia, 42 (10%) with AI dysplasia, and 51 (12%) with borderline dysplasia. The AI but not LCEA was significantly correlated with lower outcome scores on the modified Harris Hip Score ( r = 0.13; P = .01), Non-Arthritic Hip Score ( r = 0.10; P = .04), and Hip Outcome Score–Sports Subscale ( r = 0.11; P = .04). A total of 58 patients (14%) underwent arthroplasty at 31 ± 20 months postoperatively. Patients with LCEA dysplasia had an arthroplasty rate of 56% (odds ratio, 8.4), whereas patients with AI dysplasia had an arthroplasty rate of 31% (odds ratio, 3.3), which was significantly greater than the rate for the nondysplastic cohort (13.5%; P < .0001). Patients with borderline LCEA dysplasia did not have increased rates of arthroplasty. A multivariate analysis found increasing age, increasing AI, Tönnis grade higher than 1, and femoral Outerbridge grade higher than 2 to be most predictive of conversion to arthroplasty. Conclusion: We found that an elevated AI, along with increasing age, Tönnis grade, and femoral Outerbridge grade significantly predict early conversion to arthroplasty after isolated hip arthroscopy. We recommend using the AI, in addition to the LCEA, in evaluating hip dysplasia before hip arthroscopy.

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Section: Discussionmentioning

confidence: 99%

Acetabular Morphologic Characteristics Predict Early Conversion to Arthroplasty After Isolated Hip Arthroscopy for Femoroacetabular Impingement

et al. 2019

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“…Adult hip dysplasia is most frequently diagnosed according to the LCEA, with most studies defining BHD by an LCEA between 5,23,30,49 20° and 25° or between 10,35,36 18° and 25°. However, the true assessment of hip instability goes beyond the measured LCEA, as some patients with a “borderline” LCEA may display dysplastic features during hip arthroscopy or per other imaging parameters.…”

Section: Discussionmentioning

confidence: 99%

“…Chondral defects of the femoral head or acetabular surface are also frequently identified in patients with hip dysplasia. In a retrospective comparative study of 2429 patients undergoing hip arthroscopy for treatment of FAI, Bolia et al 5 compared the prevalence of hip chondral defects between patients with BHD (LCEA = 20°-25°) and normal bony coverage (LCEA = 25°-40°). The authors found that patients with BHD were significantly more likely to have Outerbridge grade III or IV chondral lesions on the weightbearing surface of the femoral head than patients with normal acetabular bony coverage (39% vs 6%; P < .001).…”

Section: Hip Joint Morphologymentioning

confidence: 99%

A Contemporary Look at the Evaluation and Treatment of Adult Borderline and Frank Hip Dysplasia

et al. 2019

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Background: Adult hip dysplasia is often diagnosed according to the lateral center-edge angle (LCEA). Patients with frank hip dysplasia (LCEA <20°) traditionally require treatment with bony realignment through a periacetabular osteotomy (PAO) and/or derotational femoral osteotomy, while patients with borderline hip dysplasia (BHD) present a challenging treatment dilemma, as it remains unknown when they should be treated with hip arthroscopy and/or a PAO. Purpose: To perform a narrative review to report the differences in hip morphology and clinical outcomes between adult patients with frank hip dysplasia and BHD. Study Design: Narrative review. Methods: A systematic search of the literature was conducted through the Medline, EMBASE, and Cochrane databases with the search phrase borderline hip dysplasia. Results: The search identified 305 articles, of which 48 were considered relevant to this study after screening of titles and abstracts. Four articles discussed new radiographic means of evaluating adult hip dysplasia, 16 articles analyzed morphology of dysplastic hips, and 28 articles described the clinical outcomes of patients with frank hip dysplasia or BHD treated with hip arthroscopy and/or PAO. Because the level of evidence obtained from this search was not adequate for systematic review or meta-analysis, a current concepts review on the diagnosis, hip morphology, and clinical outcomes of patients with frank hip dysplasia or BHD is presented. Conclusion: Adult hip dysplasia is most commonly diagnosed based on the LCEA; however, the LCEA is an unreliable sole marker for dysplasia, and additional radiographic parameters should be utilized. Furthermore, specific pathology identified on imaging and/or during hip arthroscopy can provide clues to a surgeon when the diagnosis is inconclusive according to history and physical examination alone. While the data support that patients with frank dysplasia are best treated with PAO, there is no such preferred treatment for patients with BHD, who have a wide spectrum of instability. Selective use of arthroscopic labral and capsular treatment alone may provide good results in carefully chosen patients with BHD, while some may end up requiring a bony realignment procedure.

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“…First, patients with real BDDH should be distinguished and selected. Normally, BDDH is defined by a lateral center-edge angle (LCEA) between 20 and 25 1,2,[10][11][12][13]17,21,23,[29][30][31][32] or between 18 and 25 according to some modifications. [3][4][5][7][8][9]15,18,20,33 Because the diagnosis of BDDH relies primarily on a small range of LCEAs, even a minor offset can cause misdiagnosis, leading to the heterogeneity of the BDDH cohort.…”

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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Prevalence of High-Grade Cartilage Defects in Patients With Borderline Dysplasia With Femoroacetabular Impingement: A Comparative Cohort Study

Cited by 27 publications

References 29 publications

Acetabular Morphologic Characteristics Predict Early Conversion to Arthroplasty After Isolated Hip Arthroscopy for Femoroacetabular Impingement

Acetabular Morphologic Characteristics Predict Early Conversion to Arthroplasty After Isolated Hip Arthroscopy for Femoroacetabular Impingement

A Contemporary Look at the Evaluation and Treatment of Adult Borderline and Frank Hip Dysplasia

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

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