Short-term patient-reported outcomes following concomitant hip arthroscopy and the endoscopic modified shelf procedure for the treatment of acetabular dysplasia and intra-articular pathology

Arthroscopic labral repair combined with less invasive open-shelf acetabuloplasty for patients with developmental dysplasia of the hip

Hip arthroscopy has become widely used for intra-articular lesions, such as labral tears and femoral acetabular impingement. However, its use in patients with developmental dysplasia of the hip (DDH) has been controversial and has historically demonstrated mixed results, as acetabular dysplasia may cause instability due to insufficient bony coverage of the femoral head, thus causing excessive stress on the repaired labrum and cartilage. We devised a combined hip arthroscopic labral repair and a less invasive open-shelf procedure using a small skin incision as an anterolateral portal in hip arthroscopy. This novel procedure may improve the stability of the repaired labrum with a bony covering in a minimally invasive manner. Moreover, the shelf procedure can be performed under direct vision in a comparatively safe and precise manner. In total, 13 hips with DDH underwent the procedure for labral tears. All patients were females, with a mean age of 30 years. The mean follow-up period was 33 months. The mean Harris hip score improved from 74.2 to 93.6, and Oxford Hip score improved from 32.4 to 19.3. According to the Tönnis classification, the grade of arthritis preoperatively was grade 0 for nine hips and grade I for four hips. No radiographic progression of osteoarthritis was observed. It is possible that this novel procedure could be an effective treatment for labral tears with DDH and may prevent the early onset of secondary osteoarthritis. In this technical tip, we describe hip arthroscopic labral repair combined with a less invasive open-shelf acetabuloplasty in further detail.

Predictive radiological parameters of failure following surgical management of femoroacetabular impingement associated with borderline acetabular dysplasia

INTRODUCTION

The role of arthroscopic treatment of femoroacetabular impingement (FAI) in mild or borderline hip dysplasia (lateral center edge angle=18-25) is controversial. It is recommended to combine capsular plication with femoral neck osteoplasty and suture repair of the labrum. Few studies have investigated which radiological parameters are associated with failure of this procedure.

HYPOTHESIS

A larger number of radiological signs of mild or borderline hip dysplasia than radiological signs of FAI negatively influence the outcomes of arthroscopic treatment.

METHODS

This was a retrospective study done with data collected prospectively after a minimum of 2 years' follow-up in patients who underwent arthroscopic treatment of FAI due to cam impingement combined with mild to moderate hip dysplasia. Patients with hip osteoarthritis graded as ≥ Tönnis 2 were excluded. Functional outcome scores (mHHS and NAHS) were determined along with the need for reoperation. Three groups were defined based on the outcomes: success (mHHS ≥ Patient Acceptable Symptomatic State [PASS]); moderate improvement (improvement in mHHS + mHHS<PASS) and failure (worsening of the mHHS). Demographic data, radiographic parameters (LCEA, Tönnis angle, alpha angle, offset, FEAR index, Shenton's line, Cliff sign, anterior wall index [AWI], posterior wall index [PWI]) and intraoperative findings were compared between these three groups. The area under the curve (AUC) for the most relevant data identified during the univariate analysis were then modeled to define which factors were the best at predicting failed arthroscopic treatment a posteriori.

RESULTS

The study analyzed 39 patients. The mean mHHS was 76±15 [40-92]. The "success" group consisted of 21 patients (56%, 21/39), the "moderate improvement" group of 12 patients (31%, 12/39) and the failure group of 6 patients (13%, 6/39) (2 subsequently underwent total hip replacement, 4 underwent shelf acetabuloplasty). The FEAR index was significantly higher and the AWI and VCE were significantly lower in the "failure" group. The FEAR index was the best predictive factor; an index ≥ 4° detected 100% of failures with 96% specificity. The patients in the "moderate improvement" group were significantly older (37 years±8 [18-45]<p= 0.04) with a significantly higher offset (2mm±3 [-5-5]<p=0.004); an offset ≥ 2mm could detect 73% of them with a specificity of 72%.

CONCLUSION

A FEAR index ≥ 4° and offset ≥ 2mm is best able to detect patients at risk of failure and unsatisfactory results, respectively, in the mild clinical cam-type impingement in a population of FAI patients.

LEVEL OF EVIDENCE

IV, retrospective series.

Endoscopic Shelf Procedure and Ischiofemoral Decompression with Arthroscopic Acetabular Labral Reconstruction: A Case Report

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.