1
|
Andronic O, Germann C, Jud L, Imhoff FB, Fröhlich S, Scherr J, Spörri J, Zingg PO. How useful are indirect radiographic measurements of hip instability in borderline hip dysplasia? An MRI-based comparison to a healthy cohort. INTERNATIONAL ORTHOPAEDICS 2024:10.1007/s00264-024-06202-8. [PMID: 38684549 DOI: 10.1007/s00264-024-06202-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/12/2024] [Accepted: 04/22/2024] [Indexed: 05/02/2024]
Abstract
PURPOSE Symptomatic hips with borderline hip dysplasia (BHD) morphology pose a challenge in differentiating stable from unstable hips. The current study aims to compare indirect radiographic signs of instability in a symptomatic BHD population to those in a healthy cohort. METHODS The study group consisted of patients with a lateral centre-edge angle (LCEA) with values 18° ≤ LCEA < 25° who underwent corrective periacetabular osteotomy (PAO) and reported an improvement in patient-reported outcome measures (PROMs). The comparison group consisted of a healthy cohort of athletes who did not complain of any hip-related symptoms and who had normal values of their hip morphological parameters (LCEA, acetabular index (AI°), alpha angle (α°), femoral version, acetabular version). Indirect signs of instability consisting of the femoro-epiphyseal acetabular roof index (FEAR), iliocapsularis-to-rectus-femoris (IC/RF) ratio and labral dimensions (height-to-length ratio) were assessed in both groups. Partial Pearson correlation, logistic multiple regression analysis and Receiver-Operating Characteristic (ROC) curve analysis were performed to determine correlations, as well as the sensitivity and specificity of these signs to differentiate between healthy hips and BHD. RESULTS On binary logistic multiple regression analysis, the FEAR Index was the only independent predictor to differentiate between BHD and healthy hips (p < 0.001). The IC/RF ratio did not achieve significance. The calculated area under the curve (AUC) was 0.93 (0.87 - 0.99, CI 95%, p < 0.001) for the FEAR Index and 0.81 (0.70 - 0.92, CI 95%, p < 0.001) for the height-length ratio. Using the predefined cut-off values (dysplastic-FEAR Index ≥ 5° or labral height-to-length ratio ≤ 0.5), 27% sensitivity/100% specificity and 20% sensitivity/ 100% specificity, were achieved. ROC analysis provided the following new thresholds: FEAR Index ≥ -5° (73% sensitivity/97% specificity); labral height-to-length ratio ≤ 0.8 (70% sensitivity, 79% specificity). CONCLUSION In our cohort, the FEAR index was an independent parameter that could differentiate between borderline dysplastic and asymptomatic hips. The previously published values for both the FEAR index and labral hypertrophy ratio had a poor sensitivity in differentiating symptomatic unstable BHD from healthy hips. The cut-off values of ≥ -5° (FEAR index) and ≤ 0.8 (labral height-to-length ratio) provided acceptable sensitivity and specificity when comparing to morphological healthy hips.
Collapse
Affiliation(s)
- Octavian Andronic
- Department of Orthopaedics, Balgrist University Hospital, University of Zurich, 8008, Zurich, Switzerland.
| | - Christoph Germann
- Department of Radiology, Balgrist University Hospital, University of Zurich, Zurich, Switzerland
| | - Lukas Jud
- Department of Orthopaedics, Balgrist University Hospital, University of Zurich, 8008, Zurich, Switzerland
| | - Florian B Imhoff
- Department of Orthopaedics, Balgrist University Hospital, University of Zurich, 8008, Zurich, Switzerland
| | - Stefan Fröhlich
- Sports Medical Research Group, Balgrist University Hospital, University of Zurich, Zurich, Switzerland
- University Centre for Prevention and Sports Medicine, Balgrist University Hospital, University of Zurich, Zurich, Switzerland
| | - Johannes Scherr
- Sports Medical Research Group, Balgrist University Hospital, University of Zurich, Zurich, Switzerland
- University Centre for Prevention and Sports Medicine, Balgrist University Hospital, University of Zurich, Zurich, Switzerland
| | - Jörg Spörri
- Sports Medical Research Group, Balgrist University Hospital, University of Zurich, Zurich, Switzerland
- University Centre for Prevention and Sports Medicine, Balgrist University Hospital, University of Zurich, Zurich, Switzerland
| | - Patrick O Zingg
- Department of Orthopaedics, Balgrist University Hospital, University of Zurich, 8008, Zurich, Switzerland
| |
Collapse
|
2
|
Kizawa F, Suzuki D, Nagoya S, Kanaizumi A, Shimizu T, Irie T, Takahashi D, Iwasaki N. Joint instability in patients with borderline developmental dysplasia of the hip. Clin Biomech (Bristol, Avon) 2024; 111:106136. [PMID: 38065038 DOI: 10.1016/j.clinbiomech.2023.106136] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/05/2022] [Revised: 10/08/2023] [Accepted: 10/27/2023] [Indexed: 01/16/2024]
Abstract
BACKGROUND The treatment strategy for developmental dysplasia of the hip is determined based on the lateral center-edge angle. Nonetheless, an evaluation of joint instability may be important in determining the treatment strategy. This study classified the displacement patterns of the femoral head center during hip abduction. METHODS Ten patients with borderline developmental dysplasia of the hip, 10 patients with developmental dysplasia of the hip, and 10 patients with normal hips were analyzed. Image matching was performed using X-ray images of hip abduction with a three-dimensional hip model. The displacement of the femoral head center and its trajectory length were measured. A cluster analysis was conducted to classify the displacement pattern of the femoral head center, and trajectory lengths were compared. FINDINGS Displacement was classified into three patterns: medialization, hinge abduction, and centering. Patients with borderline developmental hip dysplasia exhibited all three patterns. Almost all patients with developmental dysplasia of the hip showed medialization and hinge abduction, whereas all normal patients had the centering type. The mean trajectory length indices for the medialization and hinge abduction types were significantly longer than those for the centering type (P = 0.01 and P = 0.016, respectively). INTERPRETATION Borderline developmental dysplasia of the hip is a heterogeneous condition characterized by varying hip instability levels. Our findings suggest that uniform evaluation based on the lateral center-edge angle is inappropriate and that joint instability must be evaluated in each patient with borderline developmental dysplasia of the hip.
Collapse
Affiliation(s)
- Fumiya Kizawa
- Division of Rehabilitation, Hokkaido University Hospital, Kita-14, Nishi-5, Kita-ku, Sapporo 060-8648, Japan; Department of Musculoskeletal Biomechanics and Surgical Development, Sapporo Medical University, Minami-1, Nishi-17, Chuo-ku, Sapporo 060-8556, Japan.
| | - Daisuke Suzuki
- Department of Musculoskeletal Biomechanics and Surgical Development, Sapporo Medical University, Minami-1, Nishi-17, Chuo-ku, Sapporo 060-8556, Japan; Department of Health Sciences, Hokkaido Chitose College of Rehabilitation, Satomi 2-10, Chitose 066-0055, Japan.
| | - Satoshi Nagoya
- Department of Musculoskeletal Biomechanics and Surgical Development, Sapporo Medical University, Minami-1, Nishi-17, Chuo-ku, Sapporo 060-8556, Japan.
| | - Arata Kanaizumi
- Department of Orthopaedic Surgery, Sapporo Medical University School of Medicine, Minami-1, Nishi-17, Chuo-ku, Sapporo 060-8556, Japan
| | - Tomohiro Shimizu
- Department of Orthopaedic Surgery, Faculty of Medicine, Hokkaido University Graduate School of Medicine, Kita-15, Nishi-7, Kita-ku, Sapporo 060-8638, Japan.
| | - Tohru Irie
- Department of Orthopaedic Surgery, Faculty of Medicine, Hokkaido University Graduate School of Medicine, Kita-15, Nishi-7, Kita-ku, Sapporo 060-8638, Japan
| | - Daisuke Takahashi
- Department of Orthopaedic Surgery, Faculty of Medicine, Hokkaido University Graduate School of Medicine, Kita-15, Nishi-7, Kita-ku, Sapporo 060-8638, Japan.
| | - Norimasa Iwasaki
- Department of Orthopaedic Surgery, Faculty of Medicine, Hokkaido University Graduate School of Medicine, Kita-15, Nishi-7, Kita-ku, Sapporo 060-8638, Japan.
| |
Collapse
|
3
|
Kaplan DJ. Editorial Commentary: Diminished Hip Labral Width May Predict Inferior Outcome After Hip Femoroacetabular Impingement Surgery: Diminutive Labral Width Is a Relative Indication for Labral Reconstruction. Arthroscopy 2023; 39:1451-1453. [PMID: 36706967 DOI: 10.1016/j.arthro.2023.01.020] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/17/2023] [Accepted: 01/19/2023] [Indexed: 01/26/2023]
Abstract
Hip labral "width" should be defined as the distance from the chondrolabral junction to the tip of the labrum in triangular cross-section. "Height" should refer to the distance from the joint surface to the perilabral recess (perpendicular to the width). "Length" is the distance from the anterior end of the labrum, adjacent to the anterior transverse acetabular ligament (TAL), to the posterior end of the labrum, adjacent to the posterior TAL (as may be relevant in reconstructions). Most studies of labral size focus on width, as it is thought to most contribute to the suction seal effect and hip stability. Magnetic resonance imaging most accurately measures labral width. Labral width at the time of surgery should be considered its maximal size; the labrum is reduced in size after repair. Hypoplastic labrums may result in worse outcomes after hip arthroscopy, and hyperplastic labrums may result in higher scores than normoplastic labrums in patients with primary femoroacetabular impingement syndrome. Diminutive labral width is a relative indication for labral reconstruction.
Collapse
|
4
|
Liu R, Gao G, Wu R, Dong H, Zhang S, Xu Y. Changes in Hip Labral Size Two Years After Arthroscopic Repair Are Correlated With Preoperative Measurements on Magnetic Resonance Imaging. Arthroscopy 2023; 39:1440-1450. [PMID: 36621580 DOI: 10.1016/j.arthro.2022.12.021] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/16/2022] [Revised: 12/02/2022] [Accepted: 12/13/2022] [Indexed: 01/07/2023]
Abstract
PURPOSE The purposes of our study were 1) to investigate the potential change of labral size after arthroscopic repair and 2) to analyze the relationship between acetabular labral size and functional outcomes. METHODS In this retrospective study, patients diagnosed with labral tear and undergoing hip arthroscopic repair in our institution between September 2016 and December 2018 were included. Magnetic resonance imaging was obtained preoperatively and postoperatively, and the labral length and labral height were measured in three anatomic sites: 11:30, 1:30, and 3:00 positions. All patients completed at least 2-year follow-up. Patients whose preoperative labral size in any position wider than 2 standard deviation away from the mean were identified as the hypertrophic labrum group and were compared with the control in radiographic variables and patient-reported outcomes (PROs), including the visual analog scale (VAS), modified Harris Hip Score (mHHS), the International Hip Outcome Tool-12 (iHOT-12) and the Hip Outcome Score-Activities of Daily Living (HOS-ADL). RESULTS A total of 82 patients (82 hips) were included, and the mean follow-up period was 39.54 ± 8.48 months. Significant improvement in PROs was determined before and after surgeries. Twelve patients were identified with labral hypertrophy and had higher postoperative mHHS scores, higher postoperative iHOT-12 scores, and greater improvement in HOS-ADL compared with the control group. Patients with larger preoperative anterosuperior labral height exhibited more favorable clinical outcomes. Meanwhile, no significantly morphologic change in labral size was determined. CONCLUSION There is no significantly morphologic change in labral size of superior, anterosuperior, and anterior labrum after arthroscopic repair. Patients with hypertrophic labrum achieved more favorable clinical outcomes compared with those with normal-sized labrum. LEVEL OF EVIDENCE Level III, retrospective comparative prognostic trial.
Collapse
Affiliation(s)
- Rongge Liu
- Department of Sports Medicine, Peking University Third Hospital, Haidian District, Beijing, China
| | - Guanying Gao
- Department of Sports Medicine, Peking University Third Hospital, Haidian District, Beijing, China
| | - Ruiqi Wu
- Department of Ultrasound, Peking University Third Hospital, Haidian District, Beijing, China
| | - Hanmei Dong
- Department of Sports Medicine, Peking University Third Hospital, Haidian District, Beijing, China
| | - Siqi Zhang
- Department of Sports Medicine, Peking University Third Hospital, Haidian District, Beijing, China
| | - Yan Xu
- Department of Sports Medicine, Peking University Third Hospital, Haidian District, Beijing, China.
| |
Collapse
|
5
|
Bai H, Fu YQ, Ayeni OR, Yin QF. The anterior hip capsule is thinner in dysplastic hips: a study comparing different young adult hip patients. Knee Surg Sports Traumatol Arthrosc 2023; 31:70-78. [PMID: 35687148 DOI: 10.1007/s00167-022-07022-2] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/14/2022] [Accepted: 05/17/2022] [Indexed: 01/25/2023]
Abstract
PURPOSE To investigate the thickness and intra-substance change of anterior capsule of the hip joint, and compare the difference of the capsular features in patients with different statuses of hip stability. METHODS A retrospective study was performed to review a hip preservation database. Using the lateral center edge angle(LCEA), patients with borderline dysplasia of the hip (BDH) of 20° ≤ LCEA ≤ 25°, femoracetabular impingement(FAI) with LCEA > 30° and dysplasia of the hip (DH) of LCEA < 20° were enrolled and stratified into different treatment groups. The patients' imaging was reviewed by two experienced musculoskeletal radiologists who were blinded to clinical outcomes. Thickness and intra-substance change of the anterior hip capsule was measured on the sagittal oblique sequences of MRI. A surgeon measured the thickness of the anterior hip capsule during arthroscopy. The capsular thickness and intra-substance change were compared among different groups. RESULTS Thirty patients (17 women and 13 men) enrolled in each group (FAI, BDH, and DH) matched by sex and ages were evaluated. There were no significant differences in terms of age, sex, BMI, Alpha angle, and Tönnis grade among all three groups. The mean thickness of the anterior capsule in the DH group was 3.2 ± 0.5 mm, which was significantly thinner than that in the BDH and FAI groups (4.5 ± 0.8 mm and 4.7 ± 0.6 mm), and there was no significant difference in capsular thickness between the BDH and FAI groups. The Median of anterior capsule thickness via arthroscopic measuring was 6 mm and 7 mm in the BDH and FAI groups respectively, which has no statistical difference. The intra-substance change of the anterior capsule shows a significant difference among the three groups, and a higher incidence of delamination of the capsule was found in DH groups (p < 0.001). CONCLUSIONS Patients with hip dysplasia have a significantly reduced capsular thickness on MRI and delaminated anterior joint capsule, which could be a sequence of instability. The clinical relevance of this study is that capsular thickness and intra-substance changes of the anterior capsule vary which could alter capsular management strategies. LEVEL OF EVIDENCE Level III of evidence, DIAGNOSTIC STUDIES, No consistently applied reference standard.
Collapse
Affiliation(s)
- Hui Bai
- Department of Radiology, The Second Hospital of Shandong University, Jinan, China
| | - Ying-Qiang Fu
- Department of Orthopedics, The Second Hospital of Shandong University, #247 Beiyuan Street, Jinan, 250033, China
- Cheeloo College of Medicine, Shandong University, Jinan, China
| | - Olufemi R Ayeni
- Division of Orthopaedic Surgery, Department of Surgery, McMaster University, Hamilton, ON, Canada
| | - Qing-Feng Yin
- Department of Orthopedics, The Second Hospital of Shandong University, #247 Beiyuan Street, Jinan, 250033, China.
| |
Collapse
|
6
|
Cho YJ, Rhyu KH, Chun YS, Kim MS. Patterns of labral tears and cartilage injury are different in femoroacetabular impingement and dysplasia. J Hip Preserv Surg 2022; 9:151-157. [PMID: 35992029 PMCID: PMC9389910 DOI: 10.1093/jhps/hnac026] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/15/2021] [Revised: 03/09/2022] [Accepted: 05/05/2022] [Indexed: 11/13/2022] Open
Abstract
The aim of this study was to assess injury patterns and risk factors of the acetabular labrum and associated cartilage in patients with femoroacetabular impingement (FAI) versus dysplasia. We retrospectively reviewed 137 patients diagnosed with labral tears and FAI or dysplasia (74 or 63 cases, respectively) through an arthroscopic procedure. Labral and concomitant cartilage injuries were evaluated. Demographics and radiological variables [lateral center-edge angle (LCEA), anterior center-edge angle, acetabular index (AI), acetabular version and alpha angle] were evaluated as risk factors for labral and cartilage injuries. Detachment of acetabular cartilage with intact labro-cartilaginous junction was the most common in dysplasia, whereas cartilage delamination from the labro-cartilaginous junction was more common in FAI (P < 0.001). A higher body mass index was significantly associated with delamination injury in FAI (odds ratio 1.226; 95% CI 1.043–1.441; P = 0.013). A significant correlation was evident between detachment injury and a larger AI in dysplasia (odds ratio 1.127; 95% CI 1.000–1.270; P = 0.049). In addition, symptom duration was positively correlated with the extent of labral tearing in FAI (P = 0.013), whereas the smaller LCEA was correlated with the larger extent of labral tearing in dysplasia (P = 0.044). FAI and dysplasia patients exhibited different labral and cartilage injury patterns. Increased body mass index was correlated with delamination injury in FAI, whereas an increased AI was associated with detachment injury in dysplasia. Greater tearing was associated with a longer symptom duration in FAI, and a decreased LCEA was a risk factor for the extent of tearing in dysplasia.
Level of evidence
Level III. Case–control study.
Collapse
Affiliation(s)
- Yoon-Je Cho
- Department of Orthopaedic Surgery, College of Medicine , Kyung Hee University Hospital, 23 Kyung Hee Dae-ro, Dongdaemoon-ku, Seoul 02447, Republic of Korea
| | - Kee-Hyung Rhyu
- Department of Orthopaedic Surgery, College of Medicine , Kyung Hee University Hospital, 23 Kyung Hee Dae-ro, Dongdaemoon-ku, Seoul 02447, Republic of Korea
| | - Young-Soo Chun
- Department of Orthopaedic Surgery, College of Medicine , Kyung Hee University Hospital at Gangdong, 892 Dongnam-ro, Gangdong-ku, Seoul 05278, Republic of Korea
| | - Myung-Seo Kim
- Department of Orthopaedic Surgery, College of Medicine , Kyung Hee University Hospital at Gangdong, 892 Dongnam-ro, Gangdong-ku, Seoul 05278, Republic of Korea
| |
Collapse
|
7
|
Ruh E, Johnson C, Frankston N, Charles S, Anderst W, McClincy M. Does Femoral Head Translation Vary by Sex and Side in Asymptomatic Hips During a Weightbearing Apprehension Test? Clin Orthop Relat Res 2022; 480:1104-1111. [PMID: 35195575 PMCID: PMC9263503 DOI: 10.1097/corr.0000000000002144] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/24/2021] [Accepted: 01/27/2022] [Indexed: 01/31/2023]
Abstract
BACKGROUND Hip microinstability is an increasingly recognized source of pain and dysfunction but has no agreed upon diagnostic criteria and the pathophysiology remains unclear. It has been suggested that pain associated with microinstability is caused by excess translation of the femoral head. Recent research indicates that single-plane femoral head translation can be reliably measured using dynamic ultrasonography during a supine clinical examination; however, the overall accuracy of that technique has not been established, and the range of femoral head translation values that are found in individuals with no history of surgery or symptomatic pathology is unknown. QUESTIONS/PURPOSES (1) How much femoral head translation is present in native, uninjured hips during a weightbearing apprehension position for females and males? (2) How large is the side-to-side difference in hip translation and rotation within the same individual in females and males with no history of surgery or pain during the weightbearing apprehension position? (3) What differences exist in femoral head translation and rotation when comparing females to males? METHODS Twenty-two young adults (11 males, 11 females; mean age 22 ± 2 years; BMI 22 ± 5 kg/m2) with no history of hip pain, no known hip injury, and who never had hip surgery participated in this study. High-resolution CT images of the femur and pelvis were acquired for each participant, and the bone tissue was segmented from the CT volume. Synchronized biplane radiographs were collected during a neutral standing trial and during a static weightbearing apprehension position in which the participant extended, externally rotated, and abducted at their back hip while standing with their feet split in the AP direction. A validated volumetric model-based tracking technique was used to match the patient-specific bone models to the biplane radiographs with an accuracy of 0.3 mm for translation and 0.8° for rotation. Translation of the center of the femoral head relative to the center of the acetabulum and rotation of the femur relative to the pelvis from neutral to the weightbearing apprehension position were calculated. Sex-based differences in hip kinematics were assessed by bivariate linear regression. RESULTS The median (range) translation during the weightbearing apprehension position in females was 0.9 mm (0.2 to 2.7 mm), which was less than in the 1.3 mm (0.2 to 2.6 mm) translation found in males (median difference of 0.5 mm; p = 0.04). The median absolute side-to-side difference in translation during the pivot was 1.4 mm (0.1 to 3.8 mm) in females and 1.3 mm (0.1 to 4.4 mm) in males. CONCLUSION These findings demonstrate that the femoral head translates the same under bodyweight loading as previously observed during supine exam, showing the inherent stability of the hip with no history of surgery or symptomatic pathology. This study also provides normal values for comparison with individuals who have suspected microinstability. Future directions for research include directly comparing biplane radiography to alternative imaging techniques, such as dynamic ultrasound, for identifying hip microinstability and identifying threshold values for symptomatic hip microinstability. LEVEL OF EVIDENCE Level III, prognostic study.
Collapse
Affiliation(s)
- Ethan Ruh
- Department of Orthopaedic Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
| | - Camille Johnson
- Biodynamics Laboratory, University of Pittsburgh, Pittsburgh, PA, USA
| | - Naomi Frankston
- Biodynamics Laboratory, University of Pittsburgh, Pittsburgh, PA, USA
| | | | - William Anderst
- Biodynamics Laboratory, University of Pittsburgh, Pittsburgh, PA, USA
| | - Michael McClincy
- Department of Orthopaedic Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
| |
Collapse
|
8
|
Wirries N, Dienst M. [Labral lesions in femoroacetabular impingement syndrome: evidence-based treatment]. ORTHOPADIE (HEIDELBERG, GERMANY) 2022; 51:450-457. [PMID: 35507061 DOI: 10.1007/s00132-022-04253-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 04/06/2022] [Indexed: 06/14/2023]
Abstract
BACKGROUND The acetabular labrum and the adjacent rim cartilage are the primary targets of primary or secondary degeneration processes in the hip joint. Currently, femoroacetabular impingement syndrome (FAIS) is considered the main mechanical pathology leading to chondrolabral damage. The treatment options for labrum tears range from a debridement/resection, repair to augmentation or transplantation. AIM Description of surgical treatment options for pathologic changes of the acetabulare labrum and their results with a focus on FAIS. MATERIALS AND METHODS A literature search was performed on https://pubmed.ncbi.nlm.nih.gov using the following key words: hip, labrum, therapy, resection, repair, augmentation, reconstruction. RESULTS The different surgical procedures as labrum therapy reduce pain and increase the joint function. Labral repair, augmentation, and reconstruction tend to have better results compared to resection but are associated with a higher rate of postoperative intraarticular adhesions. DISCUSSION In addition to reducing pain and improving function, the goal of surgical treatment of labrum lesions should be to maintain the functions of the labrum. The labrum should be preserved, in cases of adequate tissue quality and width. In the setting of resective procedures, the resection should be limited to the unstable parts of the labrum. The results of labral augmentation and reconstruction are promising, allowing these procedures to be considered for patients with ongoing symptoms in the revision situation with labral defects or an insufficient residual labrum.
Collapse
Affiliation(s)
- Nils Wirries
- Orthopädische Klinik, Medizinische Hochschule Hannover, DIAKOVERE Annastift, Anna-von Borries Str. 1-7, 30625, Hannover, Deutschland.
| | - Michael Dienst
- Orthopädische Chirurgie München (OCM), München, Deutschland
| |
Collapse
|
9
|
Physical Examination of the Hip: Assessment of Femoroacetabular Impingement, Labral Pathology, and Microinstability. Curr Rev Musculoskelet Med 2022; 15:38-52. [PMID: 35171468 PMCID: PMC9076795 DOI: 10.1007/s12178-022-09745-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 12/10/2021] [Indexed: 12/02/2022]
Abstract
Purpose of Review Determining the correct diagnosis can be challenging in patients presenting with hip pain. The physical examination is an essential tool that can aid in diagnosis of hip pathology. The purpose of this review is to provide an updated summary of recent literature on the physical exam of the hip, particularly as it relates to diagnosis of femoroacetabular impingement (FAI) syndrome, labral injury, and hip microinstability. Recent Findings Physical exam findings consistent with the diagnosis of FAI include reduced supine hip internal rotation and positive flexion-adduction-internal rotation maneuvers. Labral tears can be detected on exam with the Scour test. Studies demonstrate altered hip biomechanics in patients with FAI during activities such as walking and squatting. Those with FAI have slower squat velocities, slower sit-to-stand tests, and increased hip flexion moments during ambulation. Hip microinstability is a dynamic process, which can occur after prior hip arthroscopy. For hip microinstability, the combination of the three following positive tests (anterior apprehension, abduction-extension-external rotation, and prone external rotation) is associated with a 95% likelihood of microinstability as confirmed by examination under anesthesia at the time of surgery. Summary A comprehensive hip physical exam involves evaluation of the hip in multiple positions and assessing hip range of motion, strength, as well as performing provocative testing. A combination of physical exam maneuvers is necessary to accurately diagnose FAI syndrome and labral pathology as individual tests vary in their sensitivity and specificity. While an elevated level of suspicion is needed to diagnose hip microinstability, the provocative tests for microinstability are highly specific.
Collapse
|
10
|
Kuroda Y, Hashimoto S, Saito M, Matsumoto T, Nakano N, Kuroda R, Hayashi S. Femoro-Epiphyseal Acetabular Roof (FEAR) Index and Anterior Acetabular Coverage Correlate With Labral Length in Developmental Dysplasia of the Hip. Arthroscopy 2022; 38:374-381. [PMID: 33964382 DOI: 10.1016/j.arthro.2021.04.051] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/15/2020] [Revised: 04/15/2021] [Accepted: 04/23/2021] [Indexed: 02/02/2023]
Abstract
PURPOSE The aim of this study was to evaluate the association between labral length and radiographic parameters of lateral and anterior acetabular coverage and the femoro-epiphyseal acetabular roof (FEAR) index in patients with developmental dysplasia of the hip (DDH). METHODS We retrospectively analyzed data from patients with DDH who visited our hip joint clinic for the first time due to hip symptoms. DDH presence was defined as a lateral center-edge angle (LCEA) of ≤25°. The labral lengths on the anterior and lateral sides were measured on central axial and central coronal slices of T1-weighted magnetic resonance imaging, respectively. The Pearson correlation coefficients (r) and simple linear regression analyses were performed to determine the association of the lateral and anterior labral lengths with the radiographic parameters, including the LCEA, acetabular roof obliquity, FEAR index, anterior wall index, and vertical center anterior angle. RESULTS This study included 88 patients, with a mean age of 39.6 ± 11.8 years. There were 65 women and 23 men. The lateral and anterior labral lengths correlated with all parameters of dysplasia. Specifically, the lateral labral length had a strong positive correlation with the FEAR index (R = 0.65, P < .001). The anterior labral length had a strong negative correlation with the anterior wall index (R = -0.66, P < .001). CONCLUSIONS The lateral labral length had a strong positive correlation with the FEAR index. Furthermore, the anterior labral length had a correlation with the anterior dysplasia. LEVEL OF EVIDENCE Level III, retrospective cross-sectional study.
Collapse
Affiliation(s)
- Yuichi Kuroda
- Department of Orthopaedic Surgery, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Shingo Hashimoto
- Department of Orthopaedic Surgery, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Masayoshi Saito
- Department of Orthopaedic Surgery, St. Luke's International Hospital, Tokyo, Japan
| | - Tomoyuki Matsumoto
- Department of Orthopaedic Surgery, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Naoki Nakano
- Department of Orthopaedic Surgery, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Ryosuke Kuroda
- Department of Orthopaedic Surgery, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Shinya Hayashi
- Department of Orthopaedic Surgery, Kobe University Graduate School of Medicine, Kobe, Japan.
| |
Collapse
|
11
|
Kawamura Y, Tetsunaga T, Yamada K, Sanki T, Sato Y, Yoshida A, Furumatsu T, Ozaki T. Mechanical stretching induces calcification and cartilage matrix metabolism, causing degeneration of the acetabular labrum. Hip Int 2021; 33:500-507. [PMID: 34538120 DOI: 10.1177/11207000211044675] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
PURPOSE The acetabular labrum plays an important role in joint lubrication, and damage to this structure leads to osteoarthritis. This study aimed to histologically classify the degree of degeneration of the acetabular labrum and to investigate the changes in gene expression induced by mechanical stretching. METHODS We obtained acetabular labrum cells from patients with hip osteoarthritis during total hip arthroplasty (n = 25). The labrum was stained with safranin O, and images were histologically evaluated using a new parameter, the red/blue (R/B) value. The samples were divided into the degenerated group (D group: n = 18) and the healthy group (H group: n = 7) in accordance with the Kellgren-Lawrence (KL) grade. The cultured acetabular labral cells were subjected to loaded uniaxial cyclic tensile strain (CTS). After CTS, changes in gene expression were examined in both groups. RESULTS Spearman's correlation analysis revealed that the R/B value was significantly correlated with the KL grade and the Krenn score. The expression levels of genes related to cartilage metabolism, osteogenesis and angiogenesis significantly increased after CTS in the H group, while gene expression in the D group showed weaker changes after CTS than that in the H group compared to the nonstretched control group. CONCLUSIONS The degree of labral degeneration could be classified histologically using the R/B value and the KL grade. Mechanical stretching caused changes in gene expression that support the pathological features of labral degeneration.
Collapse
Affiliation(s)
- Yoshi Kawamura
- Department of Orthopaedic Surgery, Okayama University Graduate School of Medicine, Dentistry, and Pharmaceutical Sciences, Okayama, Japan
| | - Tomonori Tetsunaga
- Department of Orthopaedic Surgery, Okayama University Graduate School of Medicine, Dentistry, and Pharmaceutical Sciences, Okayama, Japan
| | - Kazuki Yamada
- Department of Orthopaedic Surgery, Okayama University Graduate School of Medicine, Dentistry, and Pharmaceutical Sciences, Okayama, Japan
| | - Tomoaki Sanki
- Department of Orthopaedic Surgery, Okayama University Graduate School of Medicine, Dentistry, and Pharmaceutical Sciences, Okayama, Japan
| | - Yoshihiro Sato
- Department of Orthopaedic Surgery, Okayama University Graduate School of Medicine, Dentistry, and Pharmaceutical Sciences, Okayama, Japan
| | - Aki Yoshida
- Department of Orthopaedic Surgery, Okayama University Graduate School of Medicine, Dentistry, and Pharmaceutical Sciences, Okayama, Japan
| | - Takayuki Furumatsu
- Department of Orthopaedic Surgery, Okayama University Graduate School of Medicine, Dentistry, and Pharmaceutical Sciences, Okayama, Japan
| | - Toshifumi Ozaki
- Department of Orthopaedic Surgery, Okayama University Graduate School of Medicine, Dentistry, and Pharmaceutical Sciences, Okayama, Japan
| |
Collapse
|
12
|
Woodward RM, Vesey RM, Bacon CJ, White SG, Brick MJ, Blankenbaker DG. Microinstability of the hip: a systematic review of the imaging findings. Skeletal Radiol 2020; 49:1903-1919. [PMID: 32583134 DOI: 10.1007/s00256-020-03516-7] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/26/2020] [Revised: 05/31/2020] [Accepted: 06/10/2020] [Indexed: 02/02/2023]
Abstract
OBJECTIVES To undertake a systematic review of the morphologic features associated with hip microinstability and determine whether there are suggestive or diagnostic imaging findings. METHODS Four electronic databases were searched up to September 2019 to identify original research reporting morphologic features in individuals with either a clinical diagnosis of hip microinstability (instability without overt subluxation/dislocation) or those with symptomatic laxity demonstrated on imaging (increased femoral head translation/distraction or capsular volume). Studies focussing on individuals with pre-existing hip conditions (including definite dysplasia (lateral centre edge angle < 20°), significant trauma, previous dislocation or surgery were excluded. Methodological quality was assessed by the Quality Assessment of Diagnostic Accuracy Studies 2 tool. RESULTS Twenty-two studies met inclusion criteria (clinical diagnosis of microinstability n = 15 and demonstration of laxity n = 7). Imaging information gathered from the studies includes radiographs (n = 14), MRI (n = 6), MR arthrography (n = 4), CT (n = 1) and intraoperative examination. Most studies exhibited design features associated with an overall high or unclear risk of bias. Some dysplastic features are associated with microinstability or laxity reference measures; however, microinstability is frequently diagnosed in those with a lateral centre edge angle > 25°. Other associated imaging findings reported include impingement morphology, anterior labral tearing, femoral head chondral injury, ligamentum teres tears and capsular attenuation. CONCLUSIONS The current literature does not provide strong evidence for imaging features diagnostic of microinstability. In the appropriate clinical context, dysplastic morphology, anterior labral tears and ligamentum teres tears may be suggestive of this condition although further research is needed to confirm this. PROSPERO REGISTRATION CRD42019122406.
Collapse
Affiliation(s)
- Rebecca M Woodward
- Faculty of Medical and Health Sciences, University of Auckland, 85 Park Road, Grafton, Auckland, 1023, New Zealand.,Auckland Radiology Group, Auckland, New Zealand
| | - Renuka M Vesey
- Faculty of Medical and Health Sciences, University of Auckland, 85 Park Road, Grafton, Auckland, 1023, New Zealand.
| | - Catherine J Bacon
- Faculty of Medical and Health Sciences, University of Auckland, 85 Park Road, Grafton, Auckland, 1023, New Zealand.,Orthosports North Harbour Ltd., Millennium Institute of Sport & Health, Auckland, New Zealand
| | - Steve G White
- Active Living and Rehabilitation: Aotearoa New Zealand, Health and Rehabilitation Research Institute, Faculty of Health and Environmental Sciences, Auckland University of Technology, Auckland, New Zealand.,Department of Physiotherapy, School of Clinical Sciences, Faculty of Health and Environmental Sciences, Auckland University of Technology, Auckland, New Zealand
| | - Matthew J Brick
- Orthosports North Harbour Ltd., Millennium Institute of Sport & Health, Auckland, New Zealand
| | | |
Collapse
|
13
|
Irie T, Espinoza Orías AA, Irie TY, Nho SJ, Takahashi D, Iwasaki N, Inoue N. Three-dimensional hip joint congruity evaluation of the borderline dysplasia: Zonal-acetabular radius of curvature. J Orthop Res 2020; 38:2197-2205. [PMID: 32073168 DOI: 10.1002/jor.24631] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/18/2019] [Revised: 01/14/2020] [Accepted: 02/11/2020] [Indexed: 02/04/2023]
Abstract
In theory, a hemispherical acetabulum provides the ideal hip congruity in any hip position. However, it remains unknown how the three-dimensional acetabular morphology of borderline dysplastic and frank dysplastic hips compare to normal hips. This study inquires if borderline dysplastic zonal-acetabular curvatures in the anterior, superior, and posterior zones are different from normal or dysplastic hips three-dimensionally. One-hundred and fifteen hips, grouped as control (25°≤ LCEA <40°), 36 hips; borderline (20°≤ LCEA <25°), 32 hips; dysplasia (LCEA ≤20°), 47 hips were analyzed. The radii of acetabular curvature for the anterior, superior, and posterior zones were calculated as the zonal-acetabular radius of curvature (ZARC). The mean acetabular roof obliquity of the borderline (10.6 ± 4.3 [SD]°) was significantly larger than the control (3.0° ± 5.4°; P < .001) and smaller than the dysplasia (19.3° ± 5.7°; P < .001). Although the mean acetabular anteversion angle of the borderline (21.3° ± 3.7°) was significantly larger than control (17.9 ± 3.5°; P = .001), that of the borderline was not different from the dysplasia (23.3° ± 4.0°; P = .053). The mean anterior ZARC in the borderline (29.8 ± 2.6 mm) was significantly larger than the control (28.0 ± 2.2 mm; P = .011) and smaller than the dysplasia (31.5 ± 2.7 mm; P = .009). The mean superior ZARC in the borderline (25.7 ± 3.0 mm) was not different from the control (25.9 ± 2.2 mm; P = .934) or the dysplasia (25.8 ± 2.5 mm; P = .991). Although the mean posterior ZARC in the borderline (27.2 ± 2.5 mm) was not different from the control (26.4 ± 1.9 mm; P = .455), that of the borderline group was significantly smaller than the dysplasia (30.4 ± 3.3 mm; P < .001); that is, the severity of lateral under-coverage affects the anterior and/or posterior zonal-acetabular curvature.
Collapse
Affiliation(s)
- Tohru Irie
- Department of Orthopedic Surgery, Rush University Medical Center, Chicago, Illinois.,Department of Orthopaedic Surgery, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, Sapporo, Japan
| | | | - Tomoyo Y Irie
- Department of Orthopedic Surgery, Rush University Medical Center, Chicago, Illinois.,Department of Orthopaedic Surgery, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, Sapporo, Japan
| | - Shane J Nho
- Department of Orthopedic Surgery, Rush University Medical Center, Chicago, Illinois
| | - Daisuke Takahashi
- Department of Orthopaedic Surgery, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, Sapporo, Japan
| | - Norimasa Iwasaki
- Department of Orthopaedic Surgery, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, Sapporo, Japan
| | - Nozomu Inoue
- Department of Orthopedic Surgery, Rush University Medical Center, Chicago, Illinois
| |
Collapse
|
14
|
Kamenaga T, Hashimoto S, Hayashi S, Takayama K, Niikura T, Kuroda R, Matsumoto T. Larger Acetabular Labrum Is Associated With Hip Dysplasia, Joint Incongruence, and Clinical Symptoms. Arthroscopy 2020; 36:2446-2453. [PMID: 32461021 DOI: 10.1016/j.arthro.2020.05.023] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/17/2019] [Revised: 05/13/2020] [Accepted: 05/13/2020] [Indexed: 02/02/2023]
Abstract
PURPOSE To evaluate the association of labral length with acetabular morphology and clinical symptoms. METHODS Patients treated at our hip joint clinic between January 2015 and December 2018 were retrospectively enrolled in the study. Our sample included patients who received a diagnosis of one or more of the following: hip labral tear, femoroacetabular impingement (FAI), and developmental dysplasia of the hip. Patients with osteoarthritis and/or osteonecrosis were excluded. Bilateral labral length was measured as the distance from the acetabular rim to the edge of the labrum at the level of the central coronal T1-weighted magnetic resonance imaging scan cross-referenced to the axial plane (3- to 9-o'clock position). The lateral center-edge angle (LCEA) and acetabular roof obliquity (ARO) were evaluated with plain radiographs. An LCEA of 25° or less was defined as developmental dysplasia of the hip, whereas a positive crossover sign in the presence of an LCEA of 30° or greater, an LCEA greater than 40°, or acetabular inclination lower 0° was defined as pincer FAI. An alpha angle greater than 50° or head-neck offset lower 8 mm was considered cam FAI. The severity of hip symptoms was evaluated bilaterally using the Japanese Orthopaedic Association pain scale, on which hips scoring full points (i.e., a perfect score) were defined as asymptomatic whereas hips with all other scores were considered symptomatic. We used simple linear regression to examine the correlations of labral length with the LCEA and ARO. Labral length was also compared according to patient hip symptom status using the Mann-Whitney U test. RESULTS The study included 102 patients (14 with bilateral symptoms and 88 with unilateral symptoms). Labral length was strongly correlated with the LCEA (r = -0.612, P < .001) and ARO (r = 0.635, P < .001). Additionally, patients with symptomatic hips had significantly larger labra (9.5 ± 3.0 mm) than those with asymptomatic hips (7.9 ± 2.1 mm, P = .004). CONCLUSIONS Acetabular labral length is significantly greater in dysplastic, irregularly congruent, symptomatic hips. LEVEL OF EVIDENCE Level Ⅳ, retrospective cross-sectional study.
Collapse
Affiliation(s)
- Tomoyuki Kamenaga
- Department of Orthopaedic Surgery, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Shingo Hashimoto
- Department of Orthopaedic Surgery, Kobe University Graduate School of Medicine, Kobe, Japan.
| | - Shinya Hayashi
- Department of Orthopaedic Surgery, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Koji Takayama
- Department of Orthopaedic Surgery, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Takahiro Niikura
- Department of Orthopaedic Surgery, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Ryosuke Kuroda
- Department of Orthopaedic Surgery, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Tomoyuki Matsumoto
- Department of Orthopaedic Surgery, Kobe University Graduate School of Medicine, Kobe, Japan
| |
Collapse
|
15
|
Brinkman JC, Domb BG, Krych AJ, Levy BA, Makovicka JL, Neville M, Hartigan DE. Is Labral Size Predictive of Failure With Repair in Hip Arthroscopy? Arthroscopy 2020; 36:2147-2157. [PMID: 32353623 DOI: 10.1016/j.arthro.2020.04.022] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/10/2019] [Revised: 04/09/2020] [Accepted: 04/10/2020] [Indexed: 02/02/2023]
Abstract
PURPOSE To assess whether labral size is predictive of labral repair failure or shows an association with patient outcomes after hip arthroscopy. METHODS We performed a retrospective chart review of patients who underwent arthroscopic hip labral repair. Labral size was measured in 4 quadrants with an arthroscopic probe. The average size across torn labral segments was assessed for failure as determined by the change in patient-reported outcomes, the rate at which subjects achieved the minimal clinically important difference and patient acceptable symptomatic state, and the need for additional surgery. Outcomes were evaluated for any continuous correlation as well as significant differences between the middle 50% of labral sizes and classes of labral sizes derived from upper and lower quartile and decile ranges. Included hips were those from patients aged between 18 and 55 years with 2-year postoperative follow-up and lateral center-edge angles between 25° and 40°. RESULTS The study included 571 hips. Labral width did not show a significant difference between hips requiring revision and those not requiring revision (P = .4054). No significant correlation was found between labral width and the change in the International Hip Outcome Tool 12 score (R2 = 0.05780), modified Harris Hip Score (R2 = 0.19826), or Nonarthritic Hip Score (R2 = 0.23543) from preoperatively to 2 years postoperatively. Hips with labral sizes in the upper decile of our cohort showed significantly decreased improvement in the International Hip Outcome Tool 12 score (P = .0287) and Nonarthritic Hip Score (P = .0490) compared with the middle 50% of labral sizes. No statistically significant difference was found in the rate at which the groups achieved the minimal clinically important difference or patient acceptable symptomatic state. CONCLUSIONS Hypertrophic labra in the largest 10th percentile showed lower postoperative outcome scores. However, no detectable clinical benefit was found in terms of patient-perceived clinical difference or acceptable symptomatic state. For most patients, labral size does not appear to significantly alter patient outcomes or the need for arthroplasty. LEVEL OF EVIDENCE Level IV, retrospective case series.
Collapse
Affiliation(s)
- Joseph C Brinkman
- Department of Orthopedic Surgery, Mayo Clinic in Arizona, Phoenix, Arizona, U.S.A
| | | | - Aaron J Krych
- Department of Orthopedic Surgery, Mayo Clinic in Rochester, Rochester, Minnesota, U.S.A
| | - Bruce A Levy
- Department of Orthopedic Surgery, Mayo Clinic in Rochester, Rochester, Minnesota, U.S.A
| | - Justin L Makovicka
- Department of Orthopedic Surgery, Mayo Clinic in Arizona, Phoenix, Arizona, U.S.A
| | - Matthew Neville
- Department of Orthopedic Surgery, Mayo Clinic in Arizona, Phoenix, Arizona, U.S.A
| | | |
Collapse
|
16
|
Kraeutler MJ, Safran MR, Scillia AJ, Ayeni OR, Garabekyan T, Mei-Dan O. A Contemporary Look at the Evaluation and Treatment of Adult Borderline and Frank Hip Dysplasia. Am J Sports Med 2020; 48:2314-2323. [PMID: 31725329 DOI: 10.1177/0363546519881411] [Citation(s) in RCA: 38] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
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.
Collapse
Affiliation(s)
| | - Marc R Safran
- Department of Orthopaedic Surgery, Stanford University Medical Center, Redwood City, California, USA
| | - Anthony J Scillia
- St Joseph's University Medical Center, Paterson, New Jersey, USA.,New Jersey Orthopaedic Institute, Wayne, New Jersey, USA
| | - Olufemi R Ayeni
- Division of Orthopaedic Surgery, McMaster University, Hamilton, Ontario, Canada
| | | | - Omer Mei-Dan
- Department of Orthopedics, School of Medicine, University of Colorado, Aurora, Colorado, USA
| |
Collapse
|