Ten-Year Outcomes After Hip Arthroscopy in Patients With Femoroacetabular Impingement and Borderline Dysplasia

Abstract

Background: The role of hip arthroscopy in the treatment of patients with borderline hip dysplasia is controversial and evolving. Purpose: To evaluate outcomes at a minimum 10-year follow-up in patients who underwent hip arthroscopy for femoroacetabular impingement in a hip with borderline dysplasia. Study Design: Case series; Level of evidence, 4. Methods: All hips that underwent labral repair between June 2006 and March 2009 for femoroacetabular impingement with borderline dysplasia were included if they had a lateral center-edge angle of 20° to 25°, had primary hip arthroscopy for the diagnosis of femoroacetabular impingement, and were aged 18 to 70 years. Patients were excluded if they had previous hip surgery, avascular necrosis, or fracture. Kaplan-Meier survivorship was performed, with survivorship defined as avoidance of conversion to total hip arthroplasty (THA). Results: A total of 45 patients met the inclusion criteria, and 38 were contacted at a minimum 10 years postoperatively (84%; mean ± SD, 12 ± 1.3 years). There were 23 women and 15 men with an average age of 41 ± 9.6 years (range, 25-69). Twenty patients were ≥40 years of age. In this patient cohort, survivorship was 87% at 5 years and 79% at 10 years for conversion to THA. Of the 38 patients included, 9 were converted to THA (24%), and 3 required revision hip arthroscopy (7%). Patient age, Tönnis grade, microfracture of cartilage lesions, and Tönnis angle >15° were associated with conversion to THA. No statistically significant differences were found between those who underwent conversion to THA and those who did not regarding lateral center-edge angle, Sharp angle, or alpha angle. Significant improvements were seen at follow-up of 12 years (range, 10-13) for the modified Harris Hip Score (58 to 83; P = .002), Hip Outcome Score–Activities of Daily Living (70 to 87; P = .003), Hip Outcome Score–Sport (47 to 76; P = .004), and Western Ontario and McMaster Universities Osteoarthritis Index (31 to 10; P = .001). At follow-up, >80% maintained the minimal clinically important difference for the Hip Outcome Score (Activities of Daily Living and Sport) with no differences between patients aged <40 and ≥40 years. Conclusion: Risk factors for conversion to THA after hip arthroscopy in the borderline dysplastic hip included older age, higher Tönnis grades, grade 4 chondral lesions that were microfractures, and Tönnis angle >15°. In those patients who did not convert to THA, improvement in outcome measures was seen at 10 years. Careful patient selection is critical to the success of this procedure.

Long-term Outcomes After Arthroscopic Treatment of Femoroacetabular Impingement for Patients With Borderline Dysplasia

“…The authors noted that “being physically active” and female sex were independent predictors of achieving the MCID, while running, female sex, and a larger preoperative LCEA were predictors of achieving the PASS. Beals et al 1 reported a case series without a control group of 10-year data in patients with BD, with rates of achieving the MCID >80% for the HOS-ADL and HOS-SSS in those who did not convert to THA, indicating that a subset of patients fared well with isolated hip arthroscopic surgery, most likely those with a primary diagnosis of impingement without osteoarthritis. They noted rates of conversion to THA of 13% and 21% at 5 and 10 years, respectively.…”

“…For patients who did not convert to THA in that study, MCID rates of >80% for the Hip Outcome Score–Activities of Daily Living (HOS-ADL) and Hip Outcome Score–Sports-Specific Subscale (HOS-SSS) were achieved, and the authors indicated that patient selection is critical to success in the BD cohort. 1…”

“…For patients who did not convert to THA in that study, MCID rates of .80% for the Hip Outcome Score-Activities of Daily Living (HOS-ADL) and Hip Outcome Score-Sports-Specific Subscale (HOS-SSS) were achieved, and the authors indicated that patient selection is critical to success in the BD cohort. 1 Patients at our institution with a radiographic finding of BD are categorized into impinging ''stable'' or instability categories; they are then treated either with isolated hip arthroscopic surgery or PAO with or without arthroscopic surgery. The purpose of this study was to assess the long-term outcomes and durability of isolated hip arthroscopic surgery with labral repair and capsular closure for FAI in patients with BD.…”

High Survivorship and Comparable Patient-Reported Outcomes at a Minimum 5 Years After Hip Arthroscopic Surgery in Patients With Femoroacetabular Impingement, With and Without Lateral Rim Dysplasia

“…In a recent study examining 10-year outcomes in patients with borderline dysplasia, with survivorship defined as the avoidance of THR, Beals et al 1 reported a 5-year survival rate of 87% and 10-year survival rate of 79%. In the current study, a survival rate of 97% was observed at 5 years.…”

“…Longer term data for the MCID in dysplasia cohorts are lacking. While Beals and colleagues 1 reported MCID rates in patients with dysplasia, they did not include a control group, and thus, it was not possible to determine whether MCID achievement rates differ between dysplasia and FAI control groups with a longer follow-up. There was no difference observed in MCID achievement rates between borderline and severe dysplasia cases in this study, indicating similar clinically relevant improvements after corrective FAI surgery.…”