Parth Lodhia, M.D., F.R.C.S.C., Sivashankar Chandrasekaran, M.B.B.S., F.R.A.C.S., Chengcheng Gui, B.S.E., Nader Darwish, B.S., Carlos Suarez-Ahedo, M.D., and Benjamin G. Domb, M.D.
Purpose: To compare patient-reported outcome (PRO) and rates of conversion to total hip arthroplasty (THA) after hip arthroscopy, Bernese periacetabular osteotomy (PAO), and a combined approach for the management of patients with different grades of hip dysplasia.
Methods: We searched MEDLINE and PubMed databases for articles published since 2000 using the following terms: (((("hip dysplasia") or "dysplastic") and "arthroscopy")) or ((("hip dysplasia") or "dysplastic") and "osteotomy"). Two authors independently reviewed the literature. Inclusion criteria were English language, relevance to hip dysplasia, surgical outcomes, and sample size of 10 patients or more. We excluded articles that were reviews or techniques; articles that included overlapping populations, patients with a mean age less than 18 years, patients with other hip conditions, patients with genetic or neuromuscular causes of hip dysplasia, and patients with Tonnis grade 2 or greater arthritis; articles on femoral osteotomy, and articles on previous surgical intervention, except hip arthroscopy. Articles were analyzed for PRO scores and rates of conversion to THA
Results: Ten of 759 articles reviewed met the inclusion and exclusion criteria. Of 834 hips treated for dysplasia with a mean age of 31 years, 114 were treated with arthroscopy alone, 703 were treated with PAO alone, and 17 were treated with both procedures. Mean follow-up was 3.2 years, 6.5 years, and 5.6 years, respectively. Conversion rates to THA were 4.8%, 12.0%, and 17.7%, respectively. In studies reporting pre- and postoperative PRO scores, all but one reported improvement.
Conclusions: The management of hip dysplasia may entail hip arthroscopy, PAO, or a combined approach. Arthroscopy has resulted in improved outcomes in borderline dysplastic cases (lateral center edge angle between 18 and 25). PAO has primarily been used in true dysplasia with continued success. There were too few combined procedures of arthroscopy with PAO to reach a reliable conclusion in this subgroup.
Level of Evidence: Systematic review of Level III and Level IV studies.
Pathologic morphology of the hip exists on a spectrum from undercoverage or dysplasia to overcoverage or femoroacetabular impingement (FAI), both of which have been implicated as a cause of osteoarthritis (OA) in the hip.1-3 Dysplasia of the acetabulum, or insufficient coverage of the femoral head, has been defined as a lateral center edge angle (LCEA) of less than 25.4 The reduced area of the acetabular cartilage surface, hypertrophy of the acetabular labrum, and elongation of the ligamentum teres accompanying lateral subluxation of the femoral head are among the factors that can lead to tears of the labrum and ligamentum teres and articular cartilage injury.