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

Abstract

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.

Trends of hip arthroscopy in the setting of acetabular dysplasia

“…The use of hip arthroscopy, as a stand-alone procedure, to address labral pathology in the setting of acetabular dysplasia remains controversial. A recent systematic review, reported on 13 studies on the role of arthroscopy in the dysplastic hip [ 18 ]. The authors concluded that arthroscopic treatment of mild dysplasia could yield satisfactory results whereas treatment of more dysplastic hips is controversial, with no evidence of optimal results for hips with a center edge angle <20°.…”

“…The authors concluded that arthroscopic treatment of mild dysplasia could yield satisfactory results whereas treatment of more dysplastic hips is controversial, with no evidence of optimal results for hips with a center edge angle <20°. [ 18 ] Parvizi et al reported on 34 patients with a diagnosis of acetabular dysplasia who had undergone isolated hip arthroscopy for labral injury. Seventy percent failed to obtain pain relief, 79% progressed to OA and 47% required an additional open surgical treatment [ 7 ].…”

Refractory pain following hip arthroscopy: evaluation and management

“…Though select exceptions (e.g. dynamic impingement, micro instability) [ 63 ], most hip arthroscopy experts caution against the use of arthroscopic surgery in setting of acetabular dysplasia, especially with center-edge angles less than 20 degrees [ 64 ], while borderline dysplasia is also cautioned [ 3 ]. In a study of 58 patients who failed hip arthroscopy and were treated with either arthroscopic or open revision procedure, 24% hips of the hips were determined to have dysplasia and were subsequently treated with acetabular reorientation via the Bernese periacetabular osteotomy (PAO) [ 65 ].…”

Editorial Commentary: 40 the New 30? Maybe Not for the Hip

“…From the literature, numerous studies have agreed that limited joint space and severe dysplasia are contraindications. 2,3 A study titled "Hip Arthroscopy in Patients Age 40 or Older: A Systematic Review" by Horner, Ekhtiari, Simunovic, Safran, Philippon, and Ayeni 4 looks at what the literature thinks about age and outcomes after hip arthroscopy.…”