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Kahana-Rojkind AH, Domb BG. Editorial Commentary: Concomitant Hip Arthroscopy and Periacetabular Osteotomy Treat Both the Cause and the Effects of Hip Dysplasia: The Best of Both Worlds. Arthroscopy 2024; 40:359-361. [PMID: 38296440 DOI: 10.1016/j.arthro.2023.07.046] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/24/2023] [Accepted: 07/26/2023] [Indexed: 02/08/2024]
Abstract
In the management of true hip dysplasia, the bony deformity is nearly always accompanied by, and often causal of, intra-articular pathology. It is strongly recommended to conduct a comprehensive preoperative evaluation as well as arthroscopic evaluation and treatment of coexisting hip joint conditions prior to performing an open Bernese periacetabular osteotomy. The osteotomy improves coverage of the femoral head and corrects the abnormal joint mechanics and loading patterns, which result in cartilage damage and subsequent osteoarthritis. Arthroscopy allows treatment of the intra-articular pathology. Combining the hip arthroscopy and periacetabular osteotomy procedures into a single surgical intervention, performed by either a single surgeon or a collaborative surgical team, allows us to address both the cause and the effects of dysplasia. This once-controversial combined technique has become a standard practice in the field with widespread adoption.
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Orner CA, Haws BE, Reuter J, Kenney R, Cook PC, Giordano BD. Patient-Reported Outcomes are Similar in the First Two Years after Staged versus Combined Hip Arthroscopy and Periacetabular Osteotomy for Hip Dysplasia. Arthroscopy 2023:S0749-8063(23)00197-4. [PMID: 36868528 DOI: 10.1016/j.arthro.2023.02.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/09/2022] [Revised: 01/31/2023] [Accepted: 02/15/2023] [Indexed: 03/05/2023]
Abstract
PURPOSE The purpose of this study was to compare early patient reported outcomes after staged versus combined hip arthroscopy and periacetabular osteotomy for hip dysplasia. METHODS A prospective database was retrospectively reviewed to identify patients that underwent combined or staged hip arthroscopy and PAO from 2012-2020. Patients were excluded if they were >40 years of age, had prior ipsilateral hip surgery, or did not have at least 12-24 month postoperative PRO data. PROs included the Hip Outcomes Score (HOS) Activities of Daily Living (ADL) and Sports Subscale (SS), Non-Arthritic Hip Score (NAHS), and the Modified Harris Hip Score (mHHS). Paired t-tests were used to compare preoperative to postoperative scores for both groups. Outcomes were compared using linear regression adjusted for baseline characteristics including age, obesity, cartilage damage, acetabular index, and procedure timing (early vs. late practice). RESULTS Sixty-two hips were included in this analysis (39 combined, 23 staged). The average length of follow up was similar between the combined and staged groups (20.8 vs. 19.6 months, p=0.192). Both groups reported significant improvements in PROs at final follow up compared to preoperative scores (p<0.05 for all). There were no significant differences in HOS-ADL, HOS-SS, NAHS, or mHHS scores between groups preoperatively or at 3, 6, or 12 months postoperatively (p>0.05 for all). There was no significant difference in PROs between the combined and staged groups at the final postoperative time point: HOS-ADL (84.5 vs. 84.3, p=0.77), HOS-SS (76.0 vs. 79.2, p=0.68), NAHS (82.2 vs. 84.5, p=0.79), mHHS (71.0 vs. 71.0, p=0.75) respectively. CONCLUSION Staged hip arthroscopy and PAO for hip dysplasia leads to similar PROs at 12-24 months compared to combined procedures. This suggests that with careful and informed patient selection, staging these procedures is an acceptable option for these patients and does not change early outcomes. LEVEL OF EVIDENCE Level III Retrospective Comparative.
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Affiliation(s)
- Caitlin A Orner
- Cedars Sinai Kerlan Jobe Institute, Department of Orthopaedics, 6801 Park Terrace, Suite 140, Los Angeles, CA 90045, U.S.A
| | - Brittany E Haws
- University of Rochester Medical Center, Department of Orthopaedics and Rehabilitation, 601 Elmwood Ave, Rochester, New York 14642, U.S.A
| | - John Reuter
- University of Rochester Medical Center, Department of Orthopaedics and Rehabilitation, 601 Elmwood Ave, Rochester, New York 14642, U.S.A
| | - Raymond Kenney
- University of Rochester Medical Center, Department of Orthopaedics and Rehabilitation, 601 Elmwood Ave, Rochester, New York 14642, U.S.A
| | - P Christopher Cook
- University of Rochester Medical Center, Department of Orthopaedics and Rehabilitation, 601 Elmwood Ave, Rochester, New York 14642, U.S.A
| | - Brian D Giordano
- University of Rochester Medical Center, Department of Orthopaedics and Rehabilitation, 601 Elmwood Ave, Rochester, New York 14642, U.S.A
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Atzmon R, Safran MR. Arthroscopic Treatment of Mild/Borderline Hip Dysplasia with Concomitant Femoroacetabular Impingement-Literature Review. Curr Rev Musculoskelet Med 2022; 15:300-310. [PMID: 35708882 PMCID: PMC9276885 DOI: 10.1007/s12178-022-09765-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 05/09/2022] [Indexed: 11/26/2022]
Abstract
Purpose of Review This literature review aims to survey the current knowledge about the management FAI in the setting of borderline hip dysplasia. Recent Findings With better understanding, hip arthroscopy has recently been advocated for treating mild or borderline hip dysplasia (BDH) with concomitant femoroacetabular impingement (FAI) despite early studies that condemned its use. Recent outcome data have demonstrated that hip arthroscopy is a viable option in BDH, with and without FAI, and has been gaining wider acceptance. Hip arthroscopy can address the concomitant soft tissue and bony intra-articular pathologies and obviate the necessity for other surgeries. Moreover, hip arthroscopy may be used as an adjuvant treatment to other procedures such as a periacetabular osteotomy (PAO). Summary Hip arthroscopy for BDH is an evolving procedure with promising short- and mid-term outcomes. The combination of BDH and FAI is becoming recognized as a problem in its own right, requiring dedicated treatment.
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Affiliation(s)
- Ran Atzmon
- Department of Orthopaedics Surgery, Stanford University, 450 Broadway, Redwood City, CA 94063 USA
| | - Marc R Safran
- Department of Orthopaedics Surgery, Stanford University, 450 Broadway, Redwood City, CA 94063 USA
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de Courtivron B, Brulefert K, Portet A, Odent T. Residual acetabular dysplasia in congenital hip dysplasia. Orthop Traumatol Surg Res 2022; 108:103172. [PMID: 34896582 DOI: 10.1016/j.otsr.2021.103172] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/09/2021] [Revised: 06/10/2021] [Accepted: 06/14/2021] [Indexed: 02/03/2023]
Abstract
Residual hip dysplasia may exist despite appropriate treatment of congenital hip dysplasia (CHD). The abnormalities chiefly affect the acetabulum and can lead to premature osteoarthritis. Although the main cause is delayed treatment of CHD, primary lesions are also possible and may be worsened by the initial treatment itself. Residual hip dysplasia must be detected during the follow-up of patients with CHD. The antero-posterior radiograph of the pelvis is the main diagnostic tool. However, the importance of non-ossified anatomical structures requires additional investigations such as arthrography and magnetic resonance imaging. The risk of premature osteoarthritis is difficult to predict based only on the imaging-study findings. Hip dysplasia is best treated before 5 years of age. The work-up at this age should allow determination of the best treatment. Surgery is required but should not be performed unnecessarily. The decision rests on the absence of improvement in the radiographic criteria and on the findings from additional imaging studies. The usual treatment is Salter's osteotomy, during which excessive anterior displacement should be avoided. At adolescence, the information provided by radiography in the coronal plane should be completed by a three-dimensional evaluation of the acetabulum and an assessment of the quality of the labrum. The shelf procedure has been proven to relieve pain and to significantly postpone the need for hip arthroplasty, when performed early, before the development of visible osteoarthritis, and on a congruent hip. Chiari's osteotomy has a role to play in complex dysplasia affecting both the acetabulum and the femur. Periacetabular osteotomy is getting more used thanks to cooperation between paediatric and adult orthopaedic surgeons. This osteotomy provides optimal correction in all three dimensions.
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Affiliation(s)
- Benoît de Courtivron
- Centre de pédiatrie Gatien de Clocheville, CHU Tours, 49, Boulevard Béranger, 37000 Tours, France.
| | - Kevin Brulefert
- Service d'orthopédie, CHU Nantes Hotel Dieu, 1, place Alexis-Ricordeau, 44093 Nantes Cedex 1, France
| | - Adrien Portet
- Centre de pédiatrie Gatien de Clocheville, CHU Tours, 49, Boulevard Béranger, 37000 Tours, France
| | - Thierry Odent
- Centre de pédiatrie Gatien de Clocheville, CHU Tours, 49, Boulevard Béranger, 37000 Tours, France; Université François Rabelais de Tours, PRES Centre-Val de Loire, 37000 Tours, France
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Maldonado DR, Owens JS, Jimenez AE, Saks BR, Lall AC, Domb BG. Endoscopic Shelf Procedure and Ischiofemoral Decompression with Arthroscopic Acetabular Labral Reconstruction: A Case Report. JBJS Case Connect 2021; 11:01709767-202112000-00048. [PMID: 34762605 DOI: 10.2106/jbjs.cc.21.00329] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
CASE A 43-year-old female patient complained of pain in the right hip. The diagnoses of hip dysplasia, ischiofemoral impingement (IFI), femoroacetabular (FAI) cam-type morphology, and labral tear were made. The patient underwent hip arthroscopy with labral reconstruction for an irreparable labral tear and cam-morphology correction, and hip endoscopy for shelf procedure and ischiofemoral decompression. Favorable outcomes were reported at 1-year follow-up. CONCLUSION Hip arthroscopy for FAI cam-type morphology with labral reconstruction and concomitant hip endoscopy for shelf and ischiofemoral decompression seem to be safe for the treatment of active young adult patients with FAI cam-type morphology, irreparable labral tear, dysplasia, and IFI diagnoses. Nevertheless, the results presented should not be extrapolated as this is a case report.
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Affiliation(s)
- David R Maldonado
- American Hip Institute Research Foundation, Chicago, Illinois.,Kerlan-Jobe Institute, Los Angeles, California
| | - Jade S Owens
- American Hip Institute Research Foundation, Chicago, Illinois
| | | | - Benjamin R Saks
- American Hip Institute Research Foundation, Chicago, Illinois.,AMITA Health St. Alexius Medical Center, Hoffman Estates, Illinois
| | - Ajay C Lall
- American Hip Institute Research Foundation, Chicago, Illinois.,AMITA Health St. Alexius Medical Center, Hoffman Estates, Illinois.,American Hip Institute, Chicago, Illinois
| | - Benjamin G Domb
- American Hip Institute Research Foundation, Chicago, Illinois.,AMITA Health St. Alexius Medical Center, Hoffman Estates, Illinois.,American Hip Institute, Chicago, Illinois
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Spiker AM, Turner EH, Gans I, Sisel HI, Wiseley BR, Goodspeed DC. Combined Hip Arthroscopy and Periacetabular Osteotomy (PAO): Technical Focus on Arthroscopically Elevating the Iliocapsularis and Performing the Open PAO. Arthrosc Tech 2021; 10:e2293-e2302. [PMID: 34754737 PMCID: PMC8556612 DOI: 10.1016/j.eats.2021.07.004] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/23/2021] [Accepted: 07/01/2021] [Indexed: 02/03/2023] Open
Abstract
In this Technical Note, we discuss the combined hip arthroscopy and periacetabular osteotomy (PAO) for the treatment of symptomatic hip dysplasia, with a focus on the technique we use for the PAO. We identify modifications that can be made during the arthroscopic portion of the procedure to assist in the PAO dissection, including arthroscopic capsular closure and arthroscopic elevation of the iliocapsularis muscle off the capsule, which allows for expedited open exposure during the PAO.
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Affiliation(s)
- Andrea M. Spiker
- Department of Orthopedic Surgery, University of Wisconsin – Madison, Madison, Wisconsin,Address correspondence to Andrea M. Spiker, M.D., Department of Orthopedic Surgery, University of Wisconsin – Madison, UW Health at The American Center, 4602 Eastpark Blvd., Madison, WI 53718.
| | - Elizabeth H.G. Turner
- Department of Orthopedic Surgery, University of Wisconsin – Madison, Madison, Wisconsin
| | - Itai Gans
- Premier Orthopaedics, Malvern, Pennsylvania
| | - Haley I. Sisel
- Department of Orthopedic Surgery, University of Wisconsin – Madison, Madison, Wisconsin
| | - Benjamin R. Wiseley
- Agnesian Healthcare, Fond du Lac Regional Clinic, Fond du Lac, Wisconsin, U.S.A
| | - David C. Goodspeed
- Department of Orthopedic Surgery, University of Wisconsin – Madison, Madison, Wisconsin
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Cho YJ, Kim KI, Kwak SJ, Ramteke A, Yoo MC. Long-Term Results of Periacetabular Rotational Osteotomy Concomitantly With Arthroscopy in Adult Acetabular Dysplasia. J Arthroplasty 2020; 35:2807-2812. [PMID: 32563590 DOI: 10.1016/j.arth.2020.05.045] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/08/2020] [Revised: 05/15/2020] [Accepted: 05/19/2020] [Indexed: 02/02/2023] Open
Abstract
BACKGROUND Although the long-term results of periacetabular osteotomy in acetabular dysplasia have been well documented, there is paucity in reports on the long-term outcomes of periacetabular osteotomy with simultaneous hip arthroscopy. This study aimed to assess the cumulative 10-year outcomes of periacetabular rotational osteotomy with concomitant hip arthroscopy. METHODS Through an arthroscopic procedure, the status of the labrum was assessed, and torn labrum was debrided. Evaluations on survival from conversion to total hip arthroplasty and success in radiographic and clinical long-term results were completed in 39 hips (36 patients). Acetabular parameters (center-edge angle, Sharp angle, acetabular-head index, and head lateralization index), Tönnis grades on radiograph, Harris Hip Score, and range of motion of the hip were evaluated. Survivorship analyses were evaluated with the Kaplan-Meier method. RESULTS Thirty-eight hips (97.4%, 95% confidence interval 0.832-0.996) were preserved for 12.8 ± 1.7 years on average, and only 1 hip was converted to total hip arthroplasty at 7.8 years. All the acetabular parameters were improved (P < .001). Twenty-eight hips (71.8%) showed unchanged or improved Tönnis grades at the latest follow-up. The average Harris Hip Score was significantly better than the preoperative value (P < .001), and range of motion was not significantly different until the latest follow-up. CONCLUSION Sufficient acetabular reorientation, such as periacetabular rotational osteotomy, with concomitant arthroscopic debridement showed successful long-term outcomes for acetabular dysplasia in adults.
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Affiliation(s)
- Yoon-Je Cho
- Department of Orthopaedic Surgery, Kyung Hee University School of Medicine, Seoul, Republic of Korea; Department of Orthopaedic Surgery, Kyung Hee University Hospital, Seoul, Republic of Korea
| | - Kang-Il Kim
- Department of Orthopaedic Surgery, Kyung Hee University School of Medicine, Seoul, Republic of Korea; Center for Joint Diseases and Rheumatism, Kyung Hee University Hospital at Gangdong, Seoul, Republic of Korea
| | - Sang-Joon Kwak
- Department of Orthopaedic Surgery, Kyung Hee University Hospital, Seoul, Republic of Korea
| | - Alankar Ramteke
- Center for Joint Diseases and Rheumatism, Kyung Hee University Hospital at Gangdong, Seoul, Republic of Korea
| | - Myung-Chul Yoo
- Center for Joint Diseases and Rheumatism, Kyung Hee University Hospital at Gangdong, Seoul, Republic of Korea
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8
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Maldonado DR, Chen SL, Walker-Santiago R, Shapira J, Rosinsky PJ, Lall AC, Domb BG. An Intact Ligamentum Teres Predicts a Superior Prognosis in Patients With Borderline Dysplasia: A Matched-Pair Controlled Study With Minimum 5-Year Outcomes After Hip Arthroscopic Surgery. Am J Sports Med 2020; 48:673-681. [PMID: 32017862 DOI: 10.1177/0363546519898716] [Citation(s) in RCA: 31] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND Hip arthroscopic surgery in patients with borderline dysplasia continues to be controversial. In addition, it has been suggested that ligamentum teres (LT) tears may lead to inferior short-term patient-reported outcomes (PROs) when compared with a match-controlled group. PURPOSES (1) To report minimum 5-year PROs in patients with borderline dysplasia and LT tears who underwent hip arthroscopic surgery and (2) to compare these PROs to those of a matched-pair control group of patients with borderline dysplastic hips without LT tears. STUDY DESIGN Cohort study; Level of evidence, 3. METHODS Data were prospectively collected for patients who underwent hip arthroscopic surgery between September 2008 and August 2013. Patients were included if they had a preoperative diagnosis of borderline dysplasia (lateral center-edge angle [LCEA], 18°-25°) and had preoperative and minimum 5-year postoperative modified Harris Hip Score (mHHS), Nonarthritic Hip Score (NAHS), and visual analog scale (VAS) for pain scores. Exclusion criteria were osteoarthritis of Tönnis grade >1, previous hip conditions, any previous ipsilateral hip surgery, or workers' compensation status. There were 2 borderline dysplastic groups created. An LT tear group was matched 1:1 to a control group (no LT tear) with similar age, sex, body mass index (BMI), and laterality via propensity score matching. Significance was set at P < .05. RESULTS A total of 24 patients with an LT tear (24 hips) were matched to 24 patients without an LT tear (24 hips). There was no significant difference in age, sex, BMI, or laterality between groups. The mean age was 36.2 ± 17.2 and 34.9 ± 15.9 years for the control and LT tear groups, respectively (P = .783). There were 17 (70.8%) and 16 (66.7%) female patients in the control and LT tear groups, respectively, and the mean preoperative LCEA was 23.3° and 22.2° in the control and LT tear groups, respectively. No differences were observed between groups in baseline PROs, intraoperative findings, or surgical procedures. LT debridement was performed in 17 (70.8%) patients in the LT tear group compared with 0 (0.0%) in the control group. Also, 5-year postoperative PROs were comparable in both groups, with the control group exhibiting superior Veterans RAND 12-Item Health Survey (VR-12) mental (P = .041) and Short Form-12 (SF-12) mental (P = .042) scores. Finally, hips with an intact LT were significantly more likely (P = .022) to achieve the patient acceptable symptomatic state (PASS) for the mHHS (100.0% and 75.0%, respectively). No significant differences were present between the groups for the minimal clinically important difference (MCID) of the mHHS (P = .140), MCID of the Hip Outcome Score-Sport-Specific Subscale (HOS-SSS) (P = .550), or PASS of the HOS-SSS (P = .390). CONCLUSION After hip arthroscopic surgery, patients with borderline dysplasia and LT tears demonstrated favorable PROs at a minimum 5-year follow-up. Outcomes were similar to a matched-pair control group without LT tears, with the group with intact LTs showing higher VR-12 mental and SF-12 mental scores. Furthermore, patients with borderline dysplasia and intact LTs were significantly more likely to achieve the PASS for the mHHS.
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Affiliation(s)
- David R Maldonado
- American Hip Institute Research Foundation, Des Plaines, Illinois, USA
| | - Sarah L Chen
- Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | | | - Jacob Shapira
- American Hip Institute Research Foundation, Des Plaines, Illinois, USA
| | - Philip J Rosinsky
- American Hip Institute Research Foundation, Des Plaines, Illinois, USA
| | - Ajay C Lall
- American Hip Institute Research Foundation, Des Plaines, Illinois, USA.,American Hip Institute, Des Plaines, Illinois, USA
| | - Benjamin G Domb
- American Hip Institute Research Foundation, Des Plaines, Illinois, USA.,American Hip Institute, Des Plaines, Illinois, USA
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Achieving a Perfectly Spherical Femoroplasty: Pearls, Pitfalls, and Optimal Surgical Technique. Arthrosc Tech 2020; 9:e303-e313. [PMID: 32226736 PMCID: PMC7093702 DOI: 10.1016/j.eats.2019.10.011] [Citation(s) in RCA: 30] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/03/2019] [Accepted: 10/23/2019] [Indexed: 02/03/2023] Open
Abstract
Femoroacetabular impingement describes a pathologic interaction between the bony femoral head/neck junction and acetabulum. Cam-type femoroacetabular impingement results from an aspherical femoral head architecture, which increases early contact along the acetabular surface during hip range of motion. Errant arthroscopic femoroplasty recently has been discussed within the literature to describe a preventable etiology of failed hip arthroscopy, most notably cam over- and under-resection. We present an arthroscopic surgical technique for achieving the perfectly spherical femoroplasty, meant to minimize complications and improve postoperative outcomes.
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Abstract
Despite all the advances in hip arthroscopy, microfracture is still the workhorse for treating focal and full-thickness cartilage lesions. The success of this treatment is owed to its reliability and simplicity. Given the structure of the hip joint, however, there are challenges to this procedure using a conventional microfracture pick. This note presents our current and preferred microfracture technique using a curve drill guide and flexible drill. This method offers greater range of access to different regions of the joint with ease, thus ensuring a reproducible and quicker procedure with less risk.
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